Investigating Canadian Radiology Residents' Personal Financial Literacy: A Nation-Wide Assessment.

Purpose: Canadian resident physicians carry large debt to finance their education, which impacts their wellness and their future decision making. The objective of this observational study is to assess the financial literacy of Canadian radiology residents through testing their financial knowledge and examining their current financial status. Methods: A survey was designed to assess the financial literacy and current financial status of radiology residents, which was distributed to Canadian radiology residents via Google Forms. Descriptive analyses on preliminary data and the association between level of training and financial quiz scores were obtained. Results: 104 valid responses from 16 universities were received. The majority (53%) of residents indicated that their debt was greater than $150 000. Residents on average scored 71% on the financial quiz and the scores were not associated with training level (P = .71). The majority (89%) of residents indicated a strong interest in a formal financial literacy curriculum, with 80% preferring a physician-led curriculum. Conclusion: Overall, residents face a high debt burden. Current resident physicians value a formal financial literacy curriculum as a part of their residency program despite existing financial knowledge. Most importantly, residents feel that a curriculum created with involvement of other physicians would be optimal.

Using Nutraceuticals to Help Manage Traumatic Spinal Cord Injury.

Traumatic spinal cord injury (TSCI) is a significant public health challenge that has an adverse impact on functional independence, quality of life, and life expectancy. Management of people's chronic conditions is a key aspect of contemporary medical practice. Our study was an open label, single arm, prospective pilot study to evaluate the feasibility of treating people with TSCI. The study intervention was treatment with oral selenium and vitamin E. Participants were 18 years or older and experienced a TSCI at least one year prior to enrollment. Daily doses of 50 mcg of selenium and 400 IU of vitamin E were administered. Participants had radiologic (MRI tractography) and clinical (ASIA) assessments prior to initiating treatment, and these assessments were repeated after one year of treatment. Four subjects completed the full twelve-month study. Adherence, based on pill counts, was approximately 75% in all subjects. There were no adverse events related to study medications. During the treatment period, subjects reported improvement in certain symptoms. There was no significant difference in ASIA scores before and after the intervention. Combination treatment with vitamin E and selenium has been demonstrated as safe for TSCI patients. It is possible to use DTI values to locate the epicenter of a lesion as well as gauge the extent of injury. MRI tractography may serve as a meaningful surrogate endpoint. The results of this study suggest that it is feasible to conduct a larger long-term clinical trial to evaluate the efficacy of combination treatment of TSCI.

Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: a prospective international cohort study.

OBJECTIVES: Covert stroke after non-cardiac surgery may have substantial impact on duration and quality of life. In non-surgical patients, covert stroke is more common than overt stroke and is associated with an increased risk of cognitive decline and dementia. Little is known about covert stroke after non-cardiac surgery.NeuroVISION is a multicentre, international, prospective cohort study that will characterise the association between perioperative acute covert stroke and postoperative cognitive function. SETTING AND PARTICIPANTS: We are recruiting study participants from 12 tertiary care hospitals in 10 countries on 5 continents. PARTICIPANTS: We are enrolling patients ≥65 years of age, requiring hospital admission after non-cardiac surgery, who have an anticipated length of hospital stay of at least 2 days after elective non-cardiac surgery that occurs under general or neuraxial anaesthesia. PRIMARY AND SECONDARY OUTCOME MEASURES: Patients are recruited before elective non-cardiac surgery, and their cognitive function is measured using the Montreal Cognitive Assessment (MoCA) instrument. After surgery, a brain MRI study is performed between postoperative days 2 and 9 to determine the presence of acute brain infarction. One year after surgery, the MoCA is used to assess postoperative cognitive function. Physicians and patients are blinded to the MRI study results until after the last patient follow-up visit to reduce outcome ascertainment bias.We will undertake a multivariable logistic regression analysis in which the dependent variable is the change in cognitive function 1 year after surgery, and the independent variables are acute perioperative covert stroke as well as other clinical variables that are associated with cognitive dysfunction. CONCLUSIONS: The NeuroVISION study will characterise the epidemiology of covert stroke and its clinical consequences. This will be the largest and the most comprehensive study of perioperative stroke after non-cardiac surgery. TRIAL REGISTRATION NUMBER: NCT01980511; Pre-results.

Sublaminar wire migration into the medulla oblongata: a case report.

Atlantoaxial procedures have been developed in an effort to ensure solid C1-C2 fusion. However, techniques that involve sublaminar wiring have the potential for neural structure injury. We present the management of a patient who previously underwent Gallie fusion 10 years ago and is presenting with a dislodged titanium wire that has migrated into the medulla oblongata. A 52-year-old female patient known with rheumatoid arthritis presented with truncal ataxia and food regurgitation 10 years after undergoing a C1-C2 Gallie fusion. A computerized tomography (CT) scan revealed that a wire from her Gallie fusion procedure migrated into the medulla oblongata. The patient underwent foramen magnum decompression with C1 bilateral laminectomy, instrumentation, and removal of a migrated wire. Six months later, a CT scan showed that all occipital screws were pulled out. In the revision surgery, new occipital screws were placed with a resultant significant improvement in patient's gait postoperatively. Wire migration as a differential diagnosis should be considered in patients presenting with neurological dysfunction who underwent surgical treatment with sublaminar wire fusion techniques.