Canadian Task Force Research Articles

Unmasking Elder Abuse: Depression and Dependency in the Post-Pandemic Era.

A battery of questionnaires was administered to a sample of 167 participants electronically (M = 72.42; SD = 6.46), including the Abbreviated Yesavage Scale to assess depression, the Katz Index for Basic Activities of Daily Living to assess dependency, and the American Medical Association and the Canadian Task Force Questionnaire to assess suspicion of abuse. A prevalence of 40.72% of suspected abuse, of 5.99% of established depression, and of 1.20% of severe dependence was obtained. The prevalence of abuse was higher in the population with dependency (75%) than without dependency (37%). In the case of depression, the prevalence of abuse was 70% for people with established depression and 35.4% for people without depression. Women have higher rates of abuse than men, although this difference is not statistically significant. The same occurs with age. Nevertheless, having established depression and dependency are confirmed risk factors for suffering abuse.

Patient preferences for breast cancer screening: a systematic review update to inform recommendations by the Canadian Task Force on Preventive Health Care

Patient preferences for breast cancer screening: a systematic review update to inform recommendations by the Canadian Task Force on Preventive Health Care

Effect of Preoperative Bilateral Ultrasound-Guided Quadratus Lumborum Nerve Block on Quality of Recovery After Minimally Invasive Hysterectomy in an Enhanced Recovery After Surgery (ERAS) Setting

Study ObjectiveTo assess the effect of preoperative bilateral ultrasound-guided quadratus lumborum nerve block (QLB) on quality of recovery after minimally invasive hysterectomy, in an Enhanced Recovery After Surgery (ERAS) setting. DesignRandomized, controlled, double-blinded trial (Canadian Task Force level I) SettingUniversity affiliated tertiary medical center PatientsAll women undergoing an elective robotic or laparoscopic hysterectomy. Women with chronic pain, chronic anticoagulation, and body mass index (BMI) > 50 kg/m2 were excluded. InterventionPatients were randomized with a 1:1 allocation, to one of the following two arms, and stratified based on robotic versus laparoscopic approach.1. QLB: QLB (Bupivacaine) + Sham local trocar sites infiltration (normal saline). 2. Local Infiltration: Sham QLB (normal saline) + local infiltration (Bupivacaine) Measurements and Main ResultsThe primary outcome was defined as the quality of recovery score based on the validated questionnaire (QOR-40), completed 24-hours postoperatively. Secondary outcomes included: dynamic pain scores, accumulated opioid consumption up to 24-hours, post-operative nausea and vomiting, surgical complications, length of hospital stay, time to first pain medication administration in the post-anesthesia care unit (PACU) and adverse events. 76 women were included in the study. Demographic characteristics were similar in both groups. Median age was 44 (IQR 39-50) years, 47% of the participants were African American and mean BMI was 32.8 (SD 8.1) kg/m2. The mean QOR-40 score was 179.1 (+/- 10.3SD) in the QLB and 175.6 (+/- 9.7SD) for the local anesthesia group (p=0.072). All secondary outcomes were comparable between groups. ConclusionsQLBs do not significantly improve quality of recovery after elective robotic or laparoscopic hysterectomy compared to local anesthetic port site infiltration.

Impact of trainees involvement on surgical outcomes of abdominal and laparoscopic myomectomy

Background To determine the association of trainees involvement with surgical outcomes of abdominal and laparoscopic myomectomy including operative time, rate of transfusion, and complications. Methods A retrospective cohort study of 1145 patients who underwent an abdominal or laparoscopic myomectomy from 2008–2012 using the American College of Surgeons National Surgical Quality Improvement Program database (Canadian Task Force Classification II-2). Results Overall, 64% of myomectomies involved trainees. Trainees involvement was associated with a longer operative time for abdominal myomectomies (mean difference 20.17 minutes, 95% Confidence Interval (CI) [11.37,28.97], p < 0.01) overall and when stratified by fibroid burden. For laparoscopic myomectomy, there was no difference in operative time between trainees vs no trainees involvement (mean difference 4.64 minutes, 95% CI [−18.07,27.35], p = 0.67). There was a higher rate of transfusion with trainees involvement for abdominal myomectomies (10% vs 2%, p < 0.01; Odds Ratio (OR) 5.62, 95% CI [2.53,12.51], p < 0.01). Trainees involvement was not found to be associated with rate of transfusion for laparoscopic myomectomy (4% vs 5%, p = 0.86; OR 0.82, 95% CI [0.16,4.14], p = 0.81). For abdominal myomectomy, there was a higher rate of overall complications (15% vs 5%, p < 0.01; OR 2.96, 95% CI [1.77,4.93], p < 0.01) and minor complications (14% vs 4%, p < 0.01; OR 3.71, 95% CI [2.09,6.57], p < 0.01) with no difference in major complications (3% vs 2%, p = 0.23). For laparoscopic myomectomy, there was no difference in overall (6% vs 10% p = 0.41; OR 0.59, 95% CI [0.18,2.01], p = 0.40), major (2% vs 0%, p = 0.38), or minor (5% vs 10%, p = 0.32; OR 0.52, 95% CI [0.15,1.79], p = 0.30) complications. Conclusion Trainees involvement was associated with increased operative time, rate of transfusion, and complications for abdominal myomectomy, however, did not impact surgical outcomes for laparoscopic myomectomy.

Screening for lung cancer with computed tomography: protocol for systematic reviews for the Canadian Task Force on Preventive Health Care.

Lung cancer is the leading cause of cancer deaths in Canada, and because early cancers are often asymptomatic screening aims to prevent mortality by detecting cancer earlier when treatment is more likely to be curative. These reviews will inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening for lung cancer. We will update the review on the benefits and harms of screening with CT conducted for the task force in 2015 and perform de novo reviews on the comparative effects between (i) trial-based selection criteria and use of risk prediction models and (ii) trial-based nodule classification and different nodule classification systems and on patients' values and preferences. We will search Medline, Embase, and Cochrane Central (for questions on benefits and harms from 2015; comparative effects from 2012) and Medline, Scopus, and EconLit (for values and preferences from 2012) via peer-reviewed search strategies, clinical trial registries, and the reference lists of included studies and reviews. Two reviewers will screen all citations (including those in the previous review) and base inclusion decisions on consensus or arbitration by another reviewer. For benefits (i.e., all-cause and cancer-specific mortality and health-related quality of life) and harms (i.e., overdiagnosis, false positives, incidental findings, psychosocial harms from screening, and major complications and mortality from invasive procedures as a result of screening), we will include studies of adults in whom lung cancer is not suspected. We will include randomized controlled trials comparing CT screening with no screening or alternative screening modalities (e.g., chest radiography) or strategies (e.g., CT using different screening intervals, classification systems, and/or patient selection via risk models or biomarkers); non-randomized studies, including modeling studies, will be included for the comparative effects between trial-based and other selection criteria or nodule classification methods. For harms (except overdiagnosis) we will also include non-randomized and uncontrolled studies. For values and preferences, the study design may be any quantitative design that either directly or indirectly measures outcome preferences on outcomes pertaining to lung cancer screening. We will only include studies conducted in Very High Human Development Countries and having full texts in English or French. Data will be extracted by one reviewer with verification by another, with the exception of result data on mortality and cancer incidence (for calculating overdiagnosis) where duplicate extraction will occur. If two or more studies report on the same comparison and it is deemed suitable, we will pool continuous data using a mean difference or standardized mean difference, as applicable, and binary data using relative risks and a DerSimonian and Laird model unless events are rare (< 1%) where we will pool odds ratios using Peto's method or (if zero events) the reciprocal of the opposite treatment arm size correction. For pooling proportions, we will apply suitable transformation (logit or arcsine) depending on the proportions of events. If meta-analysis is not undertaken we will synthesize the data descriptively, considering clinical and methodological differences. For each outcome, two reviewers will independently assess within- and across-study risk of bias and rate the certainty of the evidence using GRADE (Grading of Recommendations Assessment, Development, and Evaluation), and reach consensus. Since 2015, additional trials and longer follow-ups or additional data (e.g., harms, specific patient populations) from previously published trials have been published that will improve our understanding of the benefits and harms of screening. The systematic review of values and preferences will allow fulsome insights that will inform the balance of benefits and harms. PROSPERO CRD42022378858.

Screening for hypertension in adults: protocol for evidence reviews to inform a Canadian Task Force on Preventive Health Care guideline update

PurposeTo inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening in a primary care setting for hypertension in adults aged 18 years and older. This protocol outlines the scope and methods for a series of systematic reviews and one overview of reviews.MethodsTo evaluate the benefits and harms of screening for hypertension, the Task Force will rely on the relevant key questions from the 2021 United States Preventive Services Task Force systematic review. In addition, a series of reviews will be conducted to identify, appraise, and synthesize the evidence on (1) the association of blood pressure measurement methods and future cardiovascular (CVD)-related outcomes, (2) thresholds for discussions of treatment initiation, and (3) patient acceptability of hypertension screening methods. For the review of blood pressure measurement methods and future CVD-related outcomes, we will perform a de novo review and search MEDLINE, Embase, CENTRAL, and APA PsycInfo for randomized controlled trials, prospective or retrospective cohort studies, nested case–control studies, and within-arm analyses of intervention studies. For the thresholds for discussions of treatment initiation review, we will perform an overview of reviews and update results from a relevant 2019 UK NICE review. We will search MEDLINE, Embase, APA PsycInfo, and Epistemonikos for systematic reviews. For the acceptability review, we will perform a de novo systematic review and search MEDLINE, Embase, and APA PsycInfo for randomized controlled trials, controlled clinical trials, and observational studies with comparison groups. Websites of relevant organizations, gray literature sources, and the reference lists of included studies and reviews will be hand-searched. Title and abstract screening will be completed by two independent reviewers. Full-text screening, data extraction, risk-of-bias assessment, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) will be completed independently by two reviewers. Results from included studies will be synthesized narratively and pooled via meta-analysis when appropriate. The GRADE approach will be used to assess the certainty of evidence for outcomes.DiscussionThe results of the evidence reviews will be used to inform Canadian recommendations on screening for hypertension in adults aged 18 years and older.Systematic review registrationThis protocol is registered on PROSPERO and is available on the Open Science Framework (osf.io/8w4tz).

Closed system for the safe management of intravenous fluids and the reduction of healthcare-associated bloodstream infections

Introduction: the use of closed infusion systems for the administration of intravenous fluids has shown a notable impact on reducing Central Line-Associated Bloodstream Infections (CLABSI); however, their adoption in Chile remains limited. Objective: This study aimed to assess the role of closed infusion systems in preventing CLABSI. Methods: a rapid literature review was conducted, consulting databases such as Web of Science, SCOPUS, PubMed, SciELO, CINAHL, the Cochrane Library, and BVS. The searches were carried out in the Spanish, English, and Portuguese languages; only studies with a quantitative approach were included, with no time limit and that answered the research question. The Canadian Task Force on Preventive Health Care criteria were utilized to analyze the level of evidence and grade of recommendation. Results: out of the nine articles reviewed, 11 % presented Level IA evidence, and 88,9 % presented evidence and a recommendation grade of IIB, indicating that patients receiving intravenous fluids through open containers are at a two to five times higher risk of developing CLABSI compared to those using closed systems. Conclusion: the employment of closed systems for the administration of intravenous fluids via CVC is associated with a significantly lower risk of acquiring CLABSI compared to the use of open systems. This finding underscores the necessity of promoting the use of closed infusion technologies as a preventative measure in the clinical setting

A Novel Approach of Intralesional Vasopressin using an Ovum Pick up Needle in Hysteroscopic Myomectomy

The aim was to evaluate the efficacy of vasopressin injected into the center of submucosal myomas using an ovum pick up needle during hysteroscopic myomectomy. Design: Canadian task force II-2 clinical study Setting: Urban clinical research center,38 patients were enrolled in the study Materials and Methods: A retrospective Canadian Task Force II-2 clinical study design conducted on women aged 22-55 years in an urban clinical research center. 38 symptomatic patients underwent hysteroscopic myomectomy after injection of dilute vasopressin (10U in 100mL Normal Saline). Around 5-8 mL was injected into the center of myomas using an ovum pick up needle, and the study was carried out between 2018-2021. Measured parameters were surgical operative time, and the secondary outcomes were related to fluid volume, visual clarity, and pregnancy outcome in patients with infertility. Results: The Wamsteker Grading System adopted by the European Society for Gynecological Endoscopy was used to classify the myomas. The mean time of myomectomy was 22 minutes (normal range: 15-40 minutes), with a median fluid deficit of 700 mL (normal range: 500- 900mL); one patient had more than 1000 mL fluid deficit which was detected immediately and managed efficiently. This patient had the longest surgical operative time of 40 minutes with 10 multiple myomas between 1 and 4 cm in size. The diagnosis of the size, number, and grade of submucosal myomas was made by transvaginal ultrasound. In our study it was observed that the use of vasopressin injection during hysteroscopic myomectomy resulted in significantly reduced surgical operative time, minimal fluid deficit, lesser bleeding with a clear surgical field, and improved pregnancy outcome in infertility patients. Conclusion: Injection of vasopressin during hysteroscopic myomectomy was found to be effective in decreasing surgical operative time, improvement of visual clarity, thereby improving pregnancy outcomes in patients presenting with infertility.

Venous Thromboembolism After Abdominal and Minimally Invasive Large Specimen Hysterectomy

To investigatethe incidence of venous thromboembolism (VTE) in patients undergoing large specimen hysterectomy for benign indications. To evaluate the impact of route of surgery and operative time in the development of VTE in this population. Retrospective cohort study (Canadian Task Force Classification II2) of targeted hysterectomy data prospectively collected from the American College of Surgeons National Surgical Quality Improvement Program involving over 500 hospitals across the United States SETTING: National Surgical Quality Improvement Program Database PATIENTS: Women aged 18 years or older undergoing hysterectomy for benign indications between 2014 and 2019. Patients were further classified into four groups according to uterine weight: <100g, 100-249g, 250g-499g, and specimens ≥500g. Current Procedural Terminology codes were used to identify cases. Variables including age, ethnicity, body mass index, smoking status, diabetes, hypertension, blood transfusion, and American Society of Anesthesiologists classification system scores were collected. Cases were stratified by route of surgery, operative time, and uterine weight. A total of 122,418 hysterectomies occurring between 2014-2019 were included in our study, of which 28,407 (23.2%) patients underwent abdominal, 75,490 (61.7%) laparoscopic, and 18,521 (15.1%) vaginal hysterectomy. The overall rate of VTE in patients with large specimen hysterectomies (≥500g) was 0.64%. After multivariable adjustment, there was no significant difference in the odds of VTE between uterine weight groups. Only 30% of the surgeries with uterine weight above 500g were performed with minimally invasive surgical routes. Patients who underwent minimally invasive hysterectomy had lower odds of VTE via laparoscopic (aOR 0.62; CI:0.48-0.81) and vaginal (aOR 0.46; CI:0.31-0.69) routes compared to laparotomy. Prolonged operative time (>120 min) was associated with an increased odds of VTE (aOR 1.86; CI:1.51-2.29). The occurrence of VTE after benign large specimen hysterectomy is rare. The odds of VTE is higher with longer operative times and lower with minimally invasive approaches even for markedly enlarged uteri.

Dissemination and implementation of clinical practice guidelines: a longitudinal, mixed-methods evaluation of the Canadian Task Force on Preventive Health Care's knowledge translation efforts.

The Canadian Task Force on Preventive Health Care (task force) develops evidence-based preventive health care guidelines and knowledge translation (KT) tools to facilitate guideline dissemination and implementation. We aimed to determine practitioners' awareness of task force guidelines and KT tools and explore barriers and facilitators to their use. The task force's KT team completed annual evaluations using surveys and interviews with primary care providers in Canada from 2014 to 2020, to assess practitioners' awareness and determinants of use of task force guidelines and tools. We transcribed interviews verbatim and double-coded them using a framework analysis approach. A total of 1284 primary care practitioners completed surveys and 183 participated in interviews. On average, 79.9% of participants were aware of the task force's 7 cancer screening guidelines, 36.2% were aware of the other 6 screening guidelines and 18.6% were aware of the 3 lifestyle or prevention guidelines. Participants identified 13 barriers and 7 facilitators to guideline and KT tool implementation; these were consistent over time. Participants identified strategies at the public and patient, provider and health systems levels to improve uptake of guidelines. Canadian primary care practitioners were more aware of task force cancer screening guidelines than its other preventive health guidelines. Over the 6-year period, participants consistently reported barriers to guideline uptake, including misalignment with patient preferences and other provincial or specialty guideline organizations. Further evaluations will assess tailored strategies to address the barriers identified.

Predictive Factors for Morcellation during Total Laparoscopic Hysterectomy: A Cohort Study

ObjectivesOur objective was to identify predictors of morcellation during a total laparoscopic hysterectomy (TLH). MethodsA retrospective cohort study (Canadian Task Force classification II-2) taking place in a university hospital center in Quebec, Canada. Participants were women undergoing a TLH for a benign gynaecologic pathology from January 1, 2017, to January 31, 2019. All women underwent a TLH. If the uterus was too voluminous to be removed vaginally, surgeons favoured in-bag morcellation by laparoscopy. Uterine weight and characteristics were assessed before surgery by ultrasound or magnetic resonance imaging to predict morcellation. ResultsA total of 252 women underwent a TLH and the mean age was 46 ± 7 (30–71) years old. The main indications for surgery were abnormal uterine bleeding (77%), chronic pelvic pain (36%) and bulk symptoms (25%). Mean uterine weight was 325 (17–1572) ± 272 grams, with 11/252 (4%) uterus being >1000 grams and 71% of women had at least 1 leiomyoma. Among women with a uterine weight <250 grams, 120 (95%) did not require morcellation. On the opposite, among women with a uterine weight >500 grams, 49 (100%) required morcellation. In addition to the estimated uterine weight (≥250 vs. <250 grams; OR 3.7 [CI 1.8 to 7.7, P < 0.01]), having ≥ 1 leiomyoma (OR 4.1, CI 1.0 to 16.0, P = 0.01) and leiomyoma of ≥5 cm (OR 8.6, CI 4.1 to 17.9, P < 0.01) were other significant predictors morcellation in multivariate logistic regression analysis. ConclusionsUterine weight estimated by preoperative imaging as well as the size and number of leiomyomas are useful predictors of the need for morcellation.

To screen or not to screen: Are we asking the right question? In response to considering de-implementation of universal perinatal depression screening

This Editorial is a response to the Canadian Task Force on Preventive Health Care's recent recommendation “against instrument-based depression screening using a questionnaire with cut-off score to distinguish ‘screen positive’ and ‘screen negative’ administered to all individuals during pregnancy and the postpartum period (up to 1 year after childbirth).” While we acknowledge the gaps and limitations in research on perinatal mental health screening, we have concerns regarding the potential impact of a recommendation against screening and for “de-implementation” of existing perinatal depression screening practices, particularly if there is not careful attention to the specificity as well as limitations of the recommendation, or if there are not clear alternative systems put in place to support the detection of perinatal depression. In this manuscript, we highlight some of our key concerns and suggest considerations for perinatal mental health practitioners and researchers.

Perinatal Mental Health in Hamilton and Montreal

Mental health concerns experienced by individuals during or up to one year after pregnancy fall under the umbrella of perinatal mental health. Estimates suggest that one in five people will experience a perinatal mental illness at some point during their pregnancy or up to one year postpartum. Racialized individuals with low socioeconomic status are at an increased risk to perinatal mental health. Perinatal mental illness is becoming an incredibly relevant topic in the sphere of public health and policy. Recently, the Canadian Task Force on Preventive Health Care released a recommendation against screening individuals for depression during pregnancy and the postpartum period (up to 1 year after childbirth), stating that there is low certainty of evidence for such screening measures. This received backlash, with groups like the Canadian Perinatal Mental Health Collaborative (CPMHC) speaking out. Prime Minister Justin Trudeau and the Minister of Mental Health and Addictions aim to “ensure timely access to perinatal mental health services”, as identified in a recent mandate letter. Given its current salience, this piece seeks to explore perinatal mental health programs in Ontario and Quebec, critically analyze their effectiveness, and suggest future areas of improvement.

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

Perinatal Mental Health in Hamilton and Montreal

Mental health concerns experienced by individuals during or up to one year after pregnancy fall under the umbrella of perinatal mental health. Estimates suggest that one in five people will experience a perinatal mental illness at some point during their pregnancy or up to one year postpartum. Racialized individuals with low socioeconomic status are at an increased risk to perinatal mental health. Perinatal mental illness is becoming an incredibly relevant topic in the sphere of public health and policy. Recently, the Canadian Task Force on Preventive Health Care released a recommendation against screening individuals for depression during pregnancy and the postpartum period (up to 1 year after childbirth), stating that there is low certainty of evidence for such screening measures. This received backlash, with groups like the Canadian Perinatal Mental Health Collaborative (CPMHC) speaking out. Prime Minister Justin Trudeau and the Minister of Mental Health and Addictions aim to “ensure timely access to perinatal mental health services”, as identified in a recent mandate letter. Given its current salience, this piece seeks to explore perinatal mental health programs in Ontario and Quebec, critically analyze their effectiveness, and suggest future areas of improvement.

Spinal Anesthesia Prior to Laparoscopic Hysterectomy Resulted in Decreased Postoperative Pain and Opioid Use.

To determine if a pre-operative morphine/bupivacaine spinal injection prior to laparoscopic hysterectomy reduced postoperative pain and resulted in less opioid consumption during the hospital stay. A retrospective cohort study (Canadian Task Force Classification II-2) was conducted at a single institution regional referral center (community hospital) in North Carolina. Three hundred nineteen patients met criteria for inclusion: 192 received spinal anesthesia and 127 did not. Baseline demographics were similar between the two groups. Median pain scores were significantly lower in the treatment than the control group on day of surgery (DOS) (2 vs. 6; P < 0.001) and postoperative day 1 (POD1) (2 vs. 4; P < 0.001). Primary outcomes were pain scores on DOS and POD1 and inpatient opioid use. Pain scores were obtained using the 0 to 10 Numerical Rating Scale. Opioids were converted to oral morphine milliequivalents (OME). Median opioid use was also significantly lower in the treatment than the control group on DOS (0 vs. 15.00 OME; P < 0.001) and POD1 (0 vs. 7.5 OME; P < 0.001). Median length of stay between the groups was not significantly different. Pre-operative morphine spinal injection for laparoscopic hysterectomy led to significantly lower pain scores and inpatient opioid consumption. Pre-operative spinal anesthesia for benign laparoscopic hysterectomy appears helpful for enhancing the postoperative experience.

Abdominal aortic aneurysm screening in an academic family practice: Short-term impact of guideline changes.

To investigate abdominal aortic aneurysm (AAA) screening rates in the 6 months before and after the introduction of updated Canadian Task Force on Preventive Health Care (CTFPHC) guidelines to determine effects on practice patterns, as well as to determine whether certain patient characteristics impact AAA screening rates. Retrospective chart review. Academic family health centre in London, Ont. Male patients between the ages of 65 and 80. Screening rates for AAA before and after the guideline update were compared using the normal approximation of the binomial distribution. Analysis of demographic characteristic effects on screening rates was completed with the Fisher exact test. Number of visits to the clinic with a primary care provider within the study period and imaging type were collected. Of the 266 patients included in the study, 160 patients were eligible for screening at the start of the study period, 6 months before publication of the CTFPHC AAA guideline. Individuals eligible for screening visited the clinic an average (SD) of 2.44 (1.82) times in the 6 months before and 2.66 (1.99) times in the 6 months after. Overall, 69 individuals had AAA screening completed and 9 had a discussion of AAA screening without any imaging, for a total uptake rate of 88.5% for those who had screening recommended. The overall imaging rate was 48.9%. There was no statistically significant difference in screening rates between the time periods (P=.337) among those eligible for screening. For demographic characteristics for risk stratification, 7 individuals had a documented family history, of whom 5 had imaging of their abdominal aorta performed, plus 1 additional individual who had screening recommended but not completed. This was not statistically significant relative to the total population (P=.0598). Positive smoking status (active or ex-smoker) was more common, with 135 individuals having a relevant smoking history. Approximately half of these current and former smokers (68 individuals [50.4%]) had any sort of abdominal aortic imaging performed or recommended, which was not statistically significantly different compared with non-smokers (62 of 126 imaging performed or recommended, 49.2%; P=.9016). Screening practices did not change appreciably with the introduction of the CTFPHC AAA screening guidelines. Further research is needed to improve AAA screening rates. It is worth exploring electronic medical record-based reminders, nursing staff involvement in screening, screening programs via public health, and point-of-care ultrasound screening in a primary care setting.

Changes in mammography screening in Ontario and Alberta following national guideline dissemination: an interrupted time series analysis.

Background:In November 2011, the Canadian Task Force on Preventive Health Care released guidelines for screening women at average breast cancer risk. Weak recommendations (framed using GRADE methodology) were made for screening women aged 50 to 74 years every two to three years, and for not screening women aged 40 to 49 years. Methods:We conducted an interrupted time series analysis using administrative data to examine bilateral mammography use before and after a release of a national breast screening guideline. Women aged 40 to 74 years living in Ontario or Alberta from 30th November 2008 to 30th November 2014 were included. Strata included age, region of residence, neighbourhood income quintile, immigration status, and education level. Results:In both provinces, mammography use rates were lower in the post-intervention period (527 vs. 556 and 428 vs. 465/1000 women in Ontario and Alberta, respectively). In Ontario, mammography trends decreased following guideline release to align with recommendations for women aged 40 to 74 (decrease of 2.21/1000 women, SE 0.26/1000, p<0.0001). In Alberta, mammography trends decreased for women aged 40 to 49 years (3/1000 women, SE 0.32, p<0.001) and 50 to 69 (2.9/1000 women, SE 0.79, p<0.001), but did not change for women aged 70 to 74 (0.7/1000 women, SE 1.23, p=0.553). In both provinces, trends in mammography use rates were sustained for up to three years after guideline release. Conclusions:We observed a decrease in screening for women aged 40-49. Additional research to explore whether shared decision making was used to optimize guideline-concordant screening for women aged 50-74 is needed.

Academic productivity in pediatric neurosurgery in relation to elective surgery slowdown during the COVID-19 pandemic.

COVID-19 has not only impacted healthcare systems directly via hospitalizations and resource utilization, but also indirectly via adaptations in healthcare practice, such as the evolution of the academic environment and the rise of telemedicine and virtual education. This void in clinical responsibilities has been filled with academic productivity in various fields. In this study the authors investigate the influence of COVID-19 on the academic focus within pediatric neurosurgery. All data were obtained from the Journal of Neurosurgery: Pediatrics (JNS Peds). The number of submissions for each month from January 2017 to December 2021 was collected. Data including number of publications, publication level of evidence (LOE), and COVID-19-related articles were collected and verified. Each publication was categorized by manuscript and LOE according to adaptations from the Canadian Task Force on Periodic Health Examination. Publication groups were categorized as pre-COVID-19 (January 2017-February 2020), peri-COVID-19 (March 2020-July 2020), and post-COVID-19 (August 2020-December 2021). Statistical analysis was performed to compare pre-COVID-19, peri-COVID-19, and post-COVID-19 academic volume and quality. During the study time period, a total of 3116 submissions and 997 publications were identified for JNS Peds. Only 2 articles specifically related to COVID-19 and its impact on pediatric neurosurgery were identified, both published in 2021. When analyzing submission volume, a statistically significant increase was seen during the shutdown relative to pre-COVID-19 and post-shutdown time periods, and a significant decrease was seen post-shutdown relative to pre-COVID-19. LOE changed significantly as well. When comparing pre-COVID-19 versus post-COVID-19 articles, a statistically significant increase was identified only in level 4 publications. When analyzing pre-COVID-19 versus post-COVID-19 (2020) and post-COVID-19 (2021), a statistically significant decrease in level 3 and increases in levels 4 and 5 were identified during post-COVID-19 (2020), with a rebound increase in level 3 and a decrease in level 5 during post-COVID-19 (2021). There was a significant increase in manuscript submission during the initial pandemic period. However, there was no change during subsequent spikes in COVID-19-related hospitalizations. Coincident with the initial surge in academic productivity, despite steady publication volume, was an inverse decline in quality as assessed by LOE.

The Role of Minimally Invasive Intrauterine Surgery in Improving the Results of IVF Programs

<h3>Study Objective</h3> to determine the intrauterine pathology in women preparing for IVF and to evaluate the impact of minimally invasive intrauterine interventions on the success of subsequent IVF programs. <h3>Design</h3> prospective observational study, Level II, Canadian Task Force. <h3>Setting</h3> Department of Operative Gynecology, National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Moscow, Russia. <h3>Patients or Participants</h3> 600 patients preparing for IVF program underwent diagnostic hysteroscopy. <h3>Interventions</h3> All patients underwent diagnostic or operative hysteroscopy on the 5th-8th day of the menstrual cycle. The patients included in the study received infertility treatment following the IVF protocol with controlled ovarian stimulation. <h3>Measurements and Main Results</h3> 36% of the examined patients had normal endometrial morphology, 42.7% had benign endometrial pathology (23.3% had chronic endometritis, 18.3% had endometrial hyperplastic processes), 5.5% of women had atypical hyperplasia and endometrial cancer. 15.9% had other intrauterine pathology. The average duration of infertility was 5.8±0.6 years, 42% of women could not achieve reproduction for more than 5 years, 59.8% had a history of ineffective IVF programs. Based on analysis of data 1 year after embryo transfer, pregnancy occurred in 62% of women. 51% of pregnancies ended in successful childbirth. <h3>Conclusion</h3> Intrauterine pathology that required hysteroscopic evaluation and treatment was observed in 58.5% of women with infertility. Surgical and subsequent conservative treatment of intrauterine pathology contributed to a reduction of the frequency of pregnancy losses (OR 1.4, 95%CI 1,0-2,0), as well as an increase in the frequency of pregnancies that ended in childbirth <b>(</b>OR 1.7, 95% CI 1,2-2,6), on average 1.5 times.