Canadian Association Research Articles

Pan-Canadian survey on the impact of the COVID-19 pandemic on cervical cancer screening and management: cross-sectional survey of healthcare professionals.

The coronavirus disease 2019 (COVID-19) pandemic has caused disruptions to cancer care by delaying diagnoses and treatment, presenting challenges and uncertainties for both patients and physicians. We conducted a nationwide online survey to investigate the effects of the pandemic and capture modifications, prompted by pandemic-related control measures, on cervical cancer screening-related activities from mid-March to mid-August 2020, across Canada. The survey consisted of 61 questions related to the continuum of care in cervical cancer screening and treatment: appointment scheduling, tests, colposcopy, follow-up, treatment of pre-cancerous lesions/cancer, and telemedicine. We piloted the survey with 21 Canadian experts in cervical cancer prevention and care. We partnered with the Society of Canadian Colposcopists, Society of Gynecologic Oncology of Canada, Canadian Association of Pathologists, and Society of Obstetricians and Gynecologists of Canada, which distributed the survey to their members via email. We reached out to family physicians and nurse practitioners via MDBriefCase. The survey was also posted on McGill Channels (Department of Family Medicine News and Events) and social media platforms. The data were analyzed descriptively. Unique responses were collected from 510 participants (November 16, 2020, to February 28, 2021), representing 418 fully and 92 partially completed surveys. Responses were from Ontario (41.0%), British Columbia (21.0%), and Alberta (12.8%), and mostly comprised family physicians/general practitioners (43.7%), and gynecologist/obstetrician professionals (21.6%). Cancelled screening appointments were mainly reported by family physicians/general practitioners (28.3%), followed by gynecologist/obstetrician professionals (19.8%), and primarily occurred in private clinics (30.5%). Decreases in the number of screening Pap tests and colposcopy procedures were consistently observed across Canadian provinces. About 90% reported that their practice/institution adopted telemedicine to communicate with patients. The area most severely impacted by the pandemic was appointment scheduling, with an important level of cancellations reported. Survey results may inform resumptions of various fronts in cervical cancer screening and management. The present work was supported by the Canadian Institutes of Health Research (operating grant COVID-19 May 2020 Rapid Research Funding Opportunity VR5-172666 Rapid Research competition and foundation grant 143347 to Eduardo L Franco). Eliya Farah and Rami Ali each received an MSc stipend from the Department of Oncology, McGill University.

The Choosing Wisely Oncology Canada Cancer List: An Update

BackgroundChoosing Wisely (CW) Canada is a national campaign to identify unnecessary or harmful services that are frequently used in Canada. The original CW Oncology Canada Cancer list was developed in 2014. A CW Oncology Canada working group was established to review new evidence and guidelines and to update the current CW Oncology Canada Cancer List. MethodsBetween January and March 2022, we conducted a survey of members of the Canadian Association of Medical Oncology (CAMO), Canadian Association of Radiation Oncology (CARO) and the Canadian Society of Surgical Oncology (CSSO). We took the feedback from the survey, including potential new recommendations as well as those that were thought to be no longer relevant and up to date, and conducted a literature review with the assistance of the Canadian Agency for Drugs and Technology in Health (CADTH). The final updated list of recommendations was made by the CW Oncology Canada working group based on a consensus process. ResultsWe reviewed two potential recommendations to add and two potential recommendations to remove from the existing CW Oncology Canada Cancer List. The recommendation “Do not prescribe whole brain radiation over stereotactic radiosurgery for patient with limited brain metastases (≤4 lesions)” was supported by several evidence-based guidelines with the strength of recommendations ranging from strong to moderate and the quality of evidence ranging from level 1 to level 3. After reviewing the evidence, the working group felt that the other potential recommendation to add and the two potential recommendations to remove did not have sufficient strength and quality of evidence at this time to be added or removed from the list. ConclusionThe updated Choosing Wisely Oncology Canada Cancer List consists of 11 items that oncologists should question in the treatment of patients with cancer. This list can be used to design specific interventions to reduce low value care.

Call to action: equity, diversity, and inclusion in emergency medicine resident physician selection.

This call to action seeks to improve emergency care in Canada for equity-deserving communities, enabled by equitable representation among emergency physicians nationally. Specifically, this work describes current resident selection processes and makes recommendations to enhance the equity, diversity, and inclusion (EDI) of resident physician selection in Canadian emergency medicine (EM) residency programs. A diverse panel of EM residency program directors, attending and resident physicians, medical students, and community representatives met monthly from September 2021 to May 2022 via videoconference to coordinate a scoping literature review, two surveys, and structured interviews. This work informed the development of recommendations for incorporating EDI into Canadian EM resident physician selection. At the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, these recommendations were presented to symposium attendees composed of national EM community leaders, members, and learners. Attendees were divided into small working groups to discuss the recommendations and address three conversation-facilitating questions. Symposium feedback informed a final set of eight recommendations to promote EDI practices during the resident selection process that address recruitment, retention, mitigating inequities and biases, and education. Each recommendation is accompanied by specific, actionable sub-items to guide programs toward a more equitable selection process. The small working groups also described perceived barriers to the implementation of these recommendations and outlined strategies for success that are incorporated into the recommendations. We call on Canadian EM training programs to implement these eight recommendations to strengthen EDI practices in EM resident physician selection and, in doing so, help to improve the care that patients from equity-deserving groups receive in Canada's emergency departments (EDs).

Current Practice Patterns, Challenges, and Need for Education in Performing and Reporting Advanced Pelvic US and MRI to Investigate Endometriosis: A Survey by the Canadian Association of Radiologists Endometriosis Working Group.

Purpose: The Canadian Association of Radiologists (CAR) Endometriosis Working Group developed a national survey to evaluate current practice patterns associated with imaging endometriosis using advanced pelvic ultrasound and MRI to inform forthcoming clinical practice guidelines for endometriosis imaging. Methods: The anonymous survey consisted of 36 questions and was distributed electronically to CAR members. The survey contained a mix of multiple choice, Likert scale and open-ended questions intended to collect information about training and certification, current practices and protocols associated with imaging endometriosis, opportunities for quality improvement and continuing professional development. Descriptive statistics were used to summarize the results. Results: Canadian radiologists were surveyed about their experience with imaging endometriosis. A total of 89 responses were obtained, mostly from Ontario and Quebec. Most respondents were community radiologists, and almost 33% were in their first five years of practice. Approximately 38% of respondents reported that they or their institution performed advanced pelvic ultrasound for endometriosis, with most having done so for less than 5years, and most having received training during residency or fellowship. 70% of respondents stated they currently interpret pelvic endometriosis MRI, with most having 1-5years of experience. Conclusion: Many radiologists in Canada do not perform dedicated imaging for endometriosis. This may be due to a lack of understanding of the benefits and limited access to training. However, dedicated imaging can improve patient outcomes and decrease repeated surgeries. The results highlight the importance of developing guidelines for these imaging techniques and promoting a multidisciplinary approach to endometriosis management.

Anticoagulation prescription among atrial fibrillation patients managed with and without an anticoagulant initiation pathway: a cohort study.

The Canadian Association of Emergency Physicians atrial fibrillation (AF) checklist advises that emergency physicians initiate anticoagulation therapy for patients with AF or flutter who are CHADS65 positive. The aim was to compare anticoagulation initiation rates between patients treated with and without an anticoagulation assessment pathway (the SAFE pathway). This was a retrospective cohort study. All emergency department patients were discharged home with a diagnosis of AF between June 2018 and May 2020 at two Canadian emergency departments. The SAFE pathway is a hard copy form which allows emergency physicians to document contraindications to anticoagulation, the positive components of the CHADS65 score, and details how to prescribe anticoagulation. Trained researchers abstracted data on the use of the SAFE pathway by the presence or absence of the completed, scanned pathway in the electronic medical chart. The exposure of interest was use of this pathway. Patients were followed forward in time for 90 days by electronic medical record review to document stroke, transient ischemic attack, arterial embolism and major bleeding events. All events were independently adjudicated. Adjusted odds ratios were calculated to compare outcomes between those managed with and without the SAFE pathway. In total, 766 patients were included, of whom 264 were already taking anticoagulation, 166 were CHADS65 negative and 65 had a contraindication to anticoagulation, leaving 271 patients eligible for anticoagulation prescription. Among the 271 eligible patients, 137/166 managed with the SAFE pathway were initiated on anticoagulation and 24/105 managed without the SAFE pathway started anticoagulation (adjusted odds ratio 25.9; 13.1-51.2). There was no statistically significant difference in the 90-day rate of stroke or bleeding. Use of the SAFE pathway was associated with a higher rate of anticoagulation prescription.

Formal mentorship in Canadian radiology residency programmes

To characterise formal mentorship programmes in Canadian radiology residency programmes, to evaluate residents' perspectives on formal mentorship, and to identify ways to optimise mentorship during radiology training. An anonymous survey was distributed to radiology resident representatives of the Canadian Association of Radiologists (CAR) Resident and Fellow Section (RFS). Questions pertained to the presence and structure of formal mentorship programmes at each participant's institution. The survey was distributed to 33 radiology residents, of which 30 responded. All 16 accredited radiology residency programmes in Canada were represented. Of these programmes, 12 (75%) had formal mentorship programmes and four (25%) did not. The structure of formal mentorship programmes varied among institutions including one-on-one and group mentoring. For 33% of residency programmes, the programme director assigned the mentor and mentee groups. Only 33% of respondents had the option of choosing their mentor. Lack of funding and lack of time were the two main perceived barriers by residents to maintaining mentorship relationships. Although not all radiology residency programmes in Canada have a formal mentorship programme, most have a form of structured mentorship in place. As formal mentorship programmes improve overall mentorship experience during residency, they can lead to improved research productivity, fellowship, and career preparation, as well as work-life balance for Canadian radiology residents.

Patterns and trends of equity, diversity and inclusion programs in academic libraries

Equity, diversity, and inclusion (EDI) have been core values and top priorities for academic institutions in recent decades. This paper presents a review on EDI and their manifestations in strategic planning of academic libraries. Advocating and advancing EDI have been broadly recognized as initiatives that create partnership opportunities and have been supported by various library associations, such as the Canadian Association of Research Libraries (CARL), the American Library Association (ALA), and the Association of College & Research Libraries (ACRL) and Association of Research Libraries (ARL). The first section of this paper presents the initiatives and resources created by these library associations that provide example frameworks, roadmap, and planning for individual libraries to customize. The second section presents cases of EDI programs in the institutions that the author visited or studied for a professional development program in 2021–2022. The conclusion discusses recurring themes and initiatives. The findings outlined in this paper provide references, resources, and contexts for library leaders and the EDI team leaders to embark and sustain the critical journey of incorporating EDI values in their work and culture.

Recommendations for Improvement of Equity, Diversity, and Inclusion in the CaRMs Selection Process.

Equity, diversity and inclusion (EDI) in the medical field is crucial for meeting the healthcare needs of a progressively diverse society. A diverse physician workforce enables culturally sensitive care, promotes health equity, and enhances the comprehension of the various needs and viewpoints of patients, ultimately resulting in more effective treatments and improved patient outcomes. However, despite the recognized benefits of diversity in the medical field, certain specialties, such as Radiology, have struggled to achieve adequate equity, diversity and inclusion, which results in a discrepancy in the demographics of Canadian radiologists and the patients we serve. In this review, we propose strategies from a committee within the Canadian Association of Radiologists (CAR) EDI working group to improve EDI in the CaRMS selection process. By adopting these strategies, residency programs can foster a more diverse and inclusive environment that is better positioned to address the health needs of a progressively diverse patient population, leading to improved patient outcomes, greater patient satisfaction, and advancements in medical innovation.

Call for Submissions for Special Issue focused on School Community Health and Wellness

The Canadian Journal of Action Research (CJAR) and the Canadian Association of Action Research in Education (CAARE) are inviting manuscripts for a special themed issue that will focus on school community health and wellness, and/or related disciplines such as physical education, health education, physical activity, sport, recreation, play, outdoor learning, social determinants of health, mental health literacy, and comprehensive school health/health promoting schools.
 Manuscript proposals are due June 15, 2023. Authors should send working title, abstract, and author bio to Managing Editor, Marianne Barker (Marianne.barker@mail.mcgill.ca) for editorial approval.
 Full final manuscripts are due December 15, 2023.

Optimizing opioid prescribing practices after minimally invasive lung resection through a quality-improvement intervention.

In their 2019 guideline on the prescribing and management of opioids after elective ambulatory thoracic surgery, the Canadian Association of Thoracic Surgeons (CATS) recommended 120 morphine milligram equivalents (MME) after minimally invasive (video-assisted thoracoscopic surgery [VATS]) lung resection. We conducted a quality-improvement project to optimize opioid prescribing after VATS lung resection. We assessed baseline prescribing practices for opioid-naive patients. Using a mixed-methods approach, we selected 2 quality-improvement interventions: formal incorporation of the CATS guideline into our postoperative care pathway, and development of a patient information handout regarding opioids. The intervention was initiated on Oct. 1, 2020, and was formally implemented on Dec. 1, 2020. The outcome measure was average MME of discharge opioid prescriptions, the process measure was proportion of discharge prescriptions exceeding the recommended dosage, and the balancing measure was opioid prescription refills. We analyzed the data using control charts, and compared all measures between the pre-intervention (12 mo before) and postintervention (12 mo after) groups. A total of 348 patients who underwent VATS lung resection were identified, 173 before the intervention and 175 after the intervention. Significantly less MME was prescribed after the intervention (100 v. 158, p < 0.001), and a lower proportion of prescriptions were nonadherent to the guideline (18.9% v. 50.9%, p < 0.001). Control charts showed special cause variation corresponding with the intervention, and system stability existed after the intervention. There was no statistically significant difference in the proportion or dosage of opioid prescription refills after the intervention. After implementation of the CATS opioid guideline, there was a significant reduction in opioids prescribed at discharge and no increase in opioid prescription refills. Control charts are a valuable resource for monitoring outcomes on an ongoing basis and for assessing the effects of an intervention.

A call for nurse practitioner-led cancer survivorship clinics: The need for development and adoption within Ontario, Canada.

The growing prevalence of cancer survivors requiring comprehensive follow-up care after the completion of treatment is placing a significant strain on the Canadian healthcare system (Moura et al., 2022). Given the current landscape and the higher workload demands that are further exacerbated by shortages in healthcare staffing, the oncology specialist-led care, as the standard model for survivorship care is unsustainable and suboptimal in addressing a broad range of physical, psychosocial, supportive, informational, and rehabilitative needs of cancer survivors (Brennan et al., 2010; Canadian Partnership Against Cancer & Canadian Association of Provincial Cancer Agencies, 2010). Nurse-led models of survivorship care provided by oncology nurse practitioners (NPs) have been shown to be safe, effective, feasible, and appropriate for follow-up care (Chan et al., 2018). In the province of Ontario, survivorship care is provided mostly by physicians. Specialized NP-led survivorship clinics or programs are currently lacking based on a recent environmental scan. This paper outlines current barriers and opportunities in NP-led survivorship care. This is a call to action and for advocacy regarding the examination of oncology services and outlines the need for the development and implementation of NP-led survivorship clinics in Ontario, Canada.

CAR Practice Statement on Advanced Pelvic Ultrasound for Endometriosis.

The Canadian Association of Radiologists (CAR) Endometriosis Working Group was tasked with providing guidance and benchmarks to ensure the quality of technique and interpretation for advanced imaging modalities associated with diagnosing endometriosis. This practice statement provides an overview of the state of the art of advanced pelvic ultrasound in the diagnosis and mapping of pelvic endometriosis. While acknowledging that advanced pelvic ultrasound in some practices falls within the scope of clinical colleagues rather than imaging departments, the statement seeks to guide radiologists interested in implementing these techniques into their practice for patients referred for evaluation and diagnosis of endometriosis. The statement covers indications, some components of the ultrasound assessment and technique, reporting, and recommendations for starting an ultrasound endometriosis evaluation program.

Point-of-Care Ultrasound (POCUS) Literature Primer: Key Papers on Renal and Biliary POCUS.

Objective The objective of this study is to identify the top five influential papers published on renal point-of-care ultrasound (POCUS) and the top five influential papers on biliary POCUS in adult patients. Methods A 14-member expert panel was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. All panel members have had ultrasound fellowship training or equivalent, are actively engaged in POCUS scholarship, and are involved with POCUS at their local site and nationally in Canada. We used a modified Delphi process consisting of three rounds of sequential surveys and discussion to achieve consensus on the top five influential papers for renal POCUS and biliary POCUS. Results The panel identified 27 relevant papers on renal POCUS and 30 relevant papers on biliary POCUS. All panel members participated in all three rounds of the modified Delphi process, and after completing this process, we identified the five most influential papers on renal POCUS and the five most influential papers on biliary POCUS. Conclusion We have developed a list, based on expert opinion, of the top five influential papers on renal and biliary POCUS to better inform all trainees and clinicians on how to use these applications in a more evidence-based manner. This list will also be of interest to clinicians and researchers who strive to further advance the field of POCUS.

A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline

This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential. This Guideline is endorsed by the Canadian Critical Care Society, the Canadian Medical Association, the Canadian Association of Critical Care Nurses, Canadian Anesthesiologists’ Society, the Canadian Neurological Sciences Federation (representing the Canadian Neurological Society, Canadian Neurosurgical Society, Canadian Society of Clinical Neurophysiologists, Canadian Association of Child Neurology, Canadian Society of Neuroradiology, and Canadian Stroke Consortium), Canadian Blood Services, the Canadian Donation and Transplantation Research Program, the Canadian Association of Emergency Physicians, the Nurse Practitioners Association of Canada, and the Canadian Cardiovascular Critical Care Society.

Forum: Interpretation of the Canadian Association of Social Workers’ Code of Ethics as Penguin Comic

Forum: Interpretation of the Canadian Association of Social Workers’ Code of Ethics as Penguin Comic

Screening for the primary prevention of fragility fractures among adults aged 40 years and older in primary care: systematic reviews of the effects and acceptability of screening and treatment, and the accuracy of risk prediction tools

Screening for the primary prevention of fragility fractures among adults aged 40 years and older in primary care: systematic reviews of the effects and acceptability of screening and treatment, and the accuracy of risk prediction tools

Intra-Specialty Citation Pattern in Radiology and Gastroenterology/Hepatology Journals: A Cross-Specialty Comparison.

Objectives: To investigate intra-specialty citation patterns of radiology articles, compared with another medical specialty: gastroenterology/hepatology. Methods: Four radiology journals (Radiology, European Radiology, Diagnostic and Interventional Imaging, Canadian Association of Radiologists Journal) and four gastroenterology/hepatology journals (Journal of Hepatology, Journal of Gastroenterology, World Journal of Gastroenterology, Journal of Clinical Gastroenterology) with similar Web of Science in-category 2020 IF ranking were selected. The original research, review, letter, and editorial articles published in these journals in 2021 were identified. The average number of intra-specialty citations per article (intra-specialty citation count) and percentage of intra-specialty citations out of total citations per article (intra-specialty citation rate) were compared between radiology and gastroenterology/hepatology articles using Student's t-test. Results: The radiology articles demonstrated a lower total citation count per article (radiology: 29.7 ± .4 (mean ± SEM), n = 2063; gastroenterology/hepatology: 50.1 ± 1.4, n = 1335). The intra-specialty citation count was also lower in radiology articles than gastroenterology/hepatology articles (radiology: 12.9 ± .2, gastroenterology/hepatology: 19.6 ± .7; P < .001), both overall and in all article types. Additionally, the overall intra-specialty citation rate was not significantly different between the two specialties (radiology: 48.8% ± .5%; gastroenterology/hepatology: 47.1 ± .8%; P = .057), although the intra-specialty citation rates were higher in radiology original research and editorial article types. Conclusions: The significantly lower per-article intra-specialty citation counts in all radiology article types, a measurement that directly links to specialty IFs, may contribute to the lower impact factors of radiology journals compared with gastroenterology/hepatology ones.

ERAS guidelines for esophagectomy: adherence patterns among Canadian thoracic surgeons.

Enhanced recovery after surgery (ERAS) guidelines have been incorporated across surgical specialties supported by the publication of evidence-based guidelines. The purpose of this research was to explore adherence to such guidelines among Canadian thoracic surgeons with respect to esophagectomy. A standardized questionnaire was developed comprising 43 validated ERAS recommendations. Additional questions such as the number of annual esophagectomies per institution, the clinical practice environment of the survey responder, preferred operative approach, and responder demographics were included. The survey was circulated to all Canadian Association of Thoracic Surgery (CATS) members and remained open for a four month period. Of the 136 CATS members, 74 (54.4%) completed the survey. Among responders, 29 (40.3%) did have a standard ERAS protocol at their institution. The majority of the responders practiced at an academic center (50, 88.3%). A self-reported adherence rate greater than 80% was observed in six out of 12 of the pre-operative ERAS recommendations, two out of eight of the intraoperative, and seven out of 23 of the post-operative ERAS recommendations. Among the five recommendations associated with high levels of evidence, two had been incorporated into practice by the majority of responders. Out of the 29 strong recommendations, 24 were incorporated into practice by the majority of responders. Canadian thoracic surgeons' express practices that are largely consistent with strongly recommended ERAS guidelines in patients undergoing esophagectomy. ERAS guidelines continue to be instrumental in the improvement of perioperative care; however, high adherence is ultimately necessary for optimal patient outcomes.

Investigating the Persistence of Federal Government Publications in Academic Former Full Depository Libraries in Canada

Objective – The Depository Services Program (DSP) provided printed Government of Canada publications to libraries until the termination of its distribution program in 2013. Full Depository Libraries (FDLs) received all eligible publications distributed by the DSP automatically. This study endeavours to determine whether academic library members of the Canadian Association of Research Libraries (CARL) that were formerly FDLs have maintained their print, federal government holdings since 2013; and what the results of the data collected in this study reveal about access to government information in Canada more broadly. Methods – The study identified a sample of 100 monographs distributed to FDLs via the DSP between 1979 and 2009. Each monograph was then searched for in the public catalogues of former FDL CARL member libraries to determine current holdings. Results – Most libraries included in the sample did not have records of all 100 publications, but every publication was located in at least 5 libraries and 12 publications were found in all libraries included in the study. Of the libraries in our sample, 1/3 had retained more than 90 of 100 publications, and 3/4 had retained at least 80. Conclusion – The redundancy that was a cornerstone of the DSP network still exists to a certain extent and should be leveraged to ensure retention and access to these essential materials for years to come. Existing collaborations and partnerships are well positioned to support a pan-Canadian discussion about preservation of and access to historical federal government information in Canadian libraries and library networks.

Confronting Anti-Black, Anti-Indigenous, and Anti-Asian Racisms in Food Systems in Canada

The impetus for this themed section came out of the broader reckoning that touched off in the summer of 2020 in the wake of the murder of Geroge Floyd. The Canadian Association for Food Studies board, like so many organizations struggling to respond to such brazen violence, released a statement on racialized police violence and systemic racism. In the statement the CAFS board commits to more deliberately centering the work of anti-racism in our association̶­ —and this included two shorter-term projects. Curating and publishing an open access resource list on food and racism in so-called Canada, and publishing a themed section on racism in the food system. The CFP for the special issue was released the following May, 2021, and read in part “As we reckon with the ways white supremacy, capitalism, patriarchy and colonization has shaped food systems, we must also reflect on and redress dominant modes of thought and approaches that reproduce inequity within the academy (e.g., research and teaching) and society at large. As such, we welcome submissions that centre diverse ways of knowing and methods of knowledge production.” Over the past nearly two years, we (the special issue guest editor, Ama, and collaboration assistant, Michael) have met virtually many times to discuss the CFP, the process, the articles, and the broader backdrop of white supremacy, colonialism, and capitalism. And as we reflected on how we wanted to write this editorial, it occurred to us that our own approach to collaboration on this project has been relational, conversational. So, rather than writing a conventional editorial, we once again met virtually to reflect on some key themes that (re)emerged over the past couple of years. What follows is part of that conversation, edited for clarity and brevity. We hope this special issue contributes to keeping the conversations (and action) focused on structural change going.