Benchmarking a Canadian Anesthesiology Resident Research Program against national norms using a logic model framework: a quality improvement study.

Background: Canadian specialty training programs are expected to deliver curriculum content and assess competencies related to the CanMEDS Scholar role. We evaluated our residency research program and benchmarked it against national norms for quality improvement purposes. Methods: In 2021 we reviewed departmental curriculum documents and surveyed current and recently graduated residents. We applied a logic model framework to assess if our program's inputs, activities, and outputs addressed the relevant CanMeds Scholar competencies. We then descriptively benchmarked our results against a 2021 environmental scan of Canadian anesthesiology resident research programs. Results: Local program content was successfully mapped to competencies. The local survey response rate was 40/55 (73%). In benchmarking, our program excelled in providing milestone-related assessments, research funding, administrative, supervisory, and methodologic support, and requiring a literature review, proposal presentation, and local abstract submission as output. Acceptable activities to meet research requirements vary greatly among programs. Balancing competing clinical and research responsibilities was a frequently reported challenge. Conclusions: The logic model framework was easily applied and demonstrated our program benchmarked well against national norms. National level dialogue is needed to develop specific, consistent scholar role activities and competency assessments to bridge the gap between expected outcome standards and education practice.

Contexte: Les programmes de spécialité canadiens doivent proposer un contenu de formation en lien avec le rôle CanMEDS d'érudit et évaluer les compétences qui s'y attachent. Nous avons évalué notre programme de résidence en recherche par rapport aux normes nationales en la matière à des fins d'amélioration de la qualité. Méthodes: En 2021, nous avons examiné les documents du programme d'études du département et interrogé des résidents et des médecins récemment diplômés. Nous avons utilisé un modèle logique pour déterminer si les intrants, les activités et les extrants de notre programme couvraient adéquatement les compétences pertinentes liées au rôle CanMeds d'érudit. Nous avons ensuite comparé de façon descriptive nos résultats à une analyse du milieu des programmes de résidence canadiens en recherche en anesthésiologie effectuée la même année. Résultats: Nous avons établi une correspondance entre le contenu du programme local et les compétences. Le taux de réponse à l'enquête était de 40/55 (73 %). D'après l'analyse comparative, notre programme se démarque par l'offre d'évaluations d'étape, de fonds de recherche, de soutien administratif, de supervision, d'orientation méthodologique, et, en ce qui concerne les extrants, par l'exigence d'une analyse documentaire, de la présentation d'une proposition et de la soumission d'un résumé à l'université. Les activités admissibles pour répondre aux exigences de la recherche varient considérablement d'un programme à l'autre. De nombreux répondants ont signalé la difficulté de concilier les responsabilités cliniques et de recherche. Conclusions: L'application du modèle logique a été aisée et elle a permis de montrer que notre programme respecte les normes nationales. Un dialogue au niveau national est nécessaire pour définir de manière précise et cohérente les activités et les évaluations des compétences en lien avec le rôle d'érudit afin de combler le fossé entre les normes quant aux résultats attendus et les pratiques des programmes.

Assessment of the reliability of virtual preanesthetic airway evaluation compared to traditional in-person airway evaluation: a prospective observational study.

PURPOSE: Airway evaluation is a fundamental component of the preanesthetic examination. Virtual care has increased during the COVID-19 pandemic. We aimed to assess the reliability of a virtual preanesthetic airway evaluation compared with a traditional in-person airway evaluation. METHODS: This prospective observational study compared the inter-rater agreement of an in-person airway evaluation performed by a consultant anesthesiologist with a virtual airway evaluation (VAE) performed by consultant anesthesiologists and medical students. The airway evaluation was completed using a comprehensive airway evaluation and scoring tool. The primary outcome was the inter-rater agreement of total scores between in-person anesthesiologist airway evaluations and the VAEs of both the anesthesiologists and medical students, assessed using Cohen's Kappa (CK). Secondary outcomes included the inter-rater agreement for each airway evaluation component between the in-person anesthesiologists and both the anesthesiologist and medical student VAEs, assessed using prevalence-adjusted and bias-adjusted Kappa. RESULTS: One hundred out of 111 participants completed all three evaluations. The in-person anesthesiologist airway evaluations had fair and good levels of agreement of total scores with the VAEs of the anesthesiologists (CK, 0.21; 97.5% confidence interval [CI], 0.07 to 0.34) and the medical students (CK, 0.74; 97.5% CI, 0.62 to 0.86), respectively. One participant was reported to have a difficult intubation. CONCLUSION: Virtual airway evaluations performed by anesthesiologists and medical students had fair and good inter-rater agreement, respectively, with in-person anesthesiologist airway evaluations. Further study with a focus on patients with difficult airways is required to define the predictive value of VAEs regarding difficult intubations.

RéSUMé: OBJECTIF: L'évaluation des voies aériennes constitue un élément fondamental de l'examen préanesthésique. Les soins prodigués virtuellement ont augmenté pendant la pandémie de COVID-19. Nous avons tenté d'évaluer la fiabilité d'une évaluation préanesthésique virtuelle des voies aériennes par rapport à une évaluation traditionnelle en personne. MéTHODE: Cette étude observationnelle prospective a comparé la concordance inter-observateurs d'une évaluation des voies aériennes en personne effectuée par un anesthésiologiste avec une évaluation virtuelle des voies aériennes (EVVA) réalisée par des anesthésiologistes et des étudiants en médecine. L'évaluation des voies aériennes a été réalisée à l'aide d'un outil d'évaluation et de notation des voies aériennes. Le critère d'évaluation principal était la concordance inter-observateurs des scores totaux entre les évaluations des voies aériennes réalisées par des anesthésiologistes en personne et les EVVA effectuées par des anesthésiologistes et des étudiants en médecine, évaluée à l'aide du coefficient Kappa de Cohen (CK). Les critères d'évaluation secondaires comprenaient la concordance inter-observateurs pour chaque composante de l'évaluation des voies aériennes entre les anesthésiologistes en personne et les anesthésiologistes et étudiants en médecine ayant réalisé les EVVA, évaluée à l'aide d'un coefficient de Kappa ajusté pour la prévalence et les biais. RéSULTATS: Cent des 111 participants ont complété les trois évaluations. Les évaluations des voies aériennes par des anesthésiologistes en personne présentaient des niveaux de concordance des scores totaux fidèles et bons par rapport aux EVVA réalisées par les anesthésiologistes (CK, 0,21; intervalle de confiance [IC] à 97,5 %, 0,07 à 0,34) et les étudiants en médecine (CK, 0,74; IC 97,5 %, 0,62 à 0,86), respectivement. Une intubation difficile a été rapportée pour un participant. CONCLUSION: Les évaluations virtuelles des voies aériennes réalisées par des anesthésiologistes et des étudiants en médecine avaient une concordance inter-observateurs fidèle et bonne avec les évaluations des voies aériennes réalisées en personne par des anesthésiologistes. Des recherches plus approfondies axées sur les patients présentant une prise en charge difficile des voies aériennes sont nécessaires pour définir la valeur prédictive des EVVA dans un contexte d'intubations difficiles.

Neutral Effect of Increased Dairy Product Intake, as Part of a Lifestyle Modification Program, on Cardiometabolic Health in Adolescent Girls With Overweight/Obesity: A Secondary Analysis From a Randomized Controlled Trial.

Background: The presence of obesity and some cardiometabolic disease risk factors in childhood and adolescence track into adulthood. Intake of dairy products has been shown to be inversely related to adiposity and cardiometabolic variables in youth. However, limited research has examined cardiometabolic disease risk factors following increased dairy product consumption as part of a lifestyle modification intervention in youth with overweight/obesity. This secondary analysis aimed to determine whether 12 weeks of increased dairy consumption, as part of a lifestyle modification program, affects cardiometabolic variables in adolescent females (range: 10-18 years) with overweight/obesity (BMI > 85th centile). Methods: Participants were randomized into two groups: higher dairy intake (RDa; four servings/day [to reflect previous Canada's Food Guide recommendations]; n = 23) or low dairy intake (LDa; 0-2 servings/day; n = 23). Both RDa and LDa participated in a 12-week, eucaloric, lifestyle modification intervention consisting of exercise training, and nutritional counseling. Adiposity (percent body fat [%BF]), dietary intake, and measures of cardiometabolic health were measured pre- and post-intervention. Results: There were no significant changes over time within groups or differences over time between groups for triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), TC/HDL ratio, low-density lipoprotein cholesterol (LDL), glucose, insulin, homeostatic model assessment of insulin resistance, adiponectin, and tumor necrosis factor alpha (TNF-α) (main effects of time and interactions, p > 0.05). Leptin decreased over the 12-week lifestyle intervention in both groups (main effect of time, p = 0.02). After combining the groups (n = 46), significant correlations were found between change in %BF and change in some cardiometabolic variables (HDL [r = -0.40], TC/HDL ratio [r = 0.42], LDL [r = 0.36], and TNF-α [r = 0.35], p < 0.05). After controlling for change in dairy product intake, the correlations were unchanged. Conclusion: Our findings demonstrate that increased dairy product consumption, as part of a lifestyle modification, weight management intervention, had a neutral effect on cardiometabolic disease risk factors in adolescent females with overweight/obesity. Change in dairy product intake did not influence the relationships between change in adiposity and change in cardiometabolic variables. Future research designed to primarily assess the effect of increased dairy product consumption on cardiometabolic disease risk factors in this population is warranted. Clinical Trial Registration: Clinicaltrials.gov; NCT#02581813.

Changes in Body Composition, Energy Expenditure, and Energy Intake during Four Years of University-A Follow-Up Study.

Purpose: The transition to university is often accompanied by the adoption of negative lifestyle habits, which may result in weight and fat gain. While this has been demonstrated during 1st year, little is known about subsequent years. We investigated changes in body composition, energy expenditure, and dietary/energy intake from 1st to 4th year university. Methods: Thirty-eight students (14 males, 24 females) completed a lifestyle questionnaire and had their body mass, fat mass, lean body mass (LBM), and body fat percentage (%BF) measured three times: at the beginning and end of 1st year, and end of 4th year. Results: During 1st year, body mass, fat mass, LBM, and %BF increased (+3.2 ± 3.8 kg, +2.5 ± 3.0 kg, +0.7 ± 2.1 kg, +2.3 ± 4.9%, respectively; p < 0.01), while daily energy intake and expenditure decreased (-359 ± 1019 kcal·d-1 and -434 ± 786 kcal·d-1, respectively; p < 0.01). Between the end of 1st year and end of 4th year, body mass, LBM, and energy expenditure increased (+3.2 ± 3.8 kg, +1.3 ± 2.9 kg, +209 ± 703 kcal·d-1, respectively; p ≤ 0.05), while %BF, fat mass, and energy intake did not change. Conclusions: Although %BF and fat mass remained stable from the end of 1st year to the end of 4th year in this group of university students, the positive increase in energy expenditure was not enough to reverse the weight and fat gained during 1st year.

A cardiovascular disease risk factor in children with congenital heart disease: unmasking elevated waist circumference - a CHAMPS* study *CHAMPS: Children's Healthy-Heart Activity Monitoring Program in Saskatchewan.

BACKGROUND: Children with congenital heart disease (CHD) have an elevated risk of future cardiovascular disease but the underlying mechanisms are unclear. Abdominal obesity (measured as waist circumference) is a risk factor for adult onset of cardiovascular diseases and is correlated with low physical activity levels, commonly found in children with congenital heart disease. Elevated waist circumference may be a mechanism by which cardiovascular disease risk is elevated in children with CHD. The purpose of this study was to compare waist circumference between children with and without CHD, while considering potential confounders. We hypothesized that children with CHD would have higher measures of waist circumference when controlling for differences in birthweight, lean mass, and physical activity. METHODS: Thirty-two children with CHD (10.9 ± 2.6 years; 12 female) from the Children's Healthy-Heart Activity Monitoring Program in Saskatchewan, and 23 healthy controls (11.7 ± 2.5 years; 10 female) were studied. Waist circumference, physical activity (physical activity questionnaire), body composition (lean mass; dual x-ray absorptiometry), and birthweight were assessed. Analysis of covariance, Mann-Whitney U, and independent sample t-tests were used to assess group differences (p < 0.05). RESULTS: Children with CHD had greater waist circumference than controls, controlling for lean mass, physical activity, birthweight, and sex (F (1, 49) = 4.488, p = 0.039). Physical activity, lean mass, and birthweight were not significantly different between groups (p > 0.05). CONCLUSION: Our findings generate a novel hypothesis-higher waist circumferences in children with CHD compared to age-matched controls, may contribute to an elevated risk of cardiovascular disease.

The role of growth and maturation during adolescence on team-selection and short-term sports participation.

BACKGROUND: During adolescence, deselection from sport occurs during team try-outs when month of birth, stage of growth and maturation may influence selection. AIM: The purpose of this study was to identify differences in growth and maturity related factors between those selected and deselected in youth sports teams and identify short-term associations with continued participation. SUBJECTS AND METHODS: Eight hundred and seventy participants, aged 11-17 years, were recruited from six sports try-outs in Saskatchewan, Canada: baseball, basketball, football, hockey, soccer and volleyball. Two hundred and forty-four of the initial 870 (28%) returned for follow-up at 36 months. Chronological (years from birth), biological (years from age at peak height velocity (APHV)) and relative (month of birth as it relates to the selection band) ages were calculated from measures of date of birth, date of test, height, sitting height and weight. Parental heights were measured or recalled and participant's adult height predicted. Reference standards were used to calculate z-scores. Sports participation was self-reported at try-outs and at 36-month follow-up. RESULTS: There was an over-representation of players across all sports born in the first and second quartiles of the selection bands (p < 0.05), whether they were selected or deselected. z-scores for predicted adult height ranged from 0.1 (1.1) to 1.8 (1.2) and were significantly different between sports (p < 0.05). Height and APHV differences (p < 0.05) were found between selected and deselected male participants. In females only weight differed between selected and deselected female hockey players (p < 0.05); no further differences were found between selected and deselected female participants. Four per cent of deselected athletes exited sports participation and 68% of deselected athletes remained in the same sport at 36 months, compared with 84% of selected athletes who remained in the same sport. CONCLUSIONS: It was found that youth who attended sports team's try-outs were more likely to be born early in the selection year, be tall for their age, and in some sports early maturers. The majority of both the selected and deselected participants continued to participate in sport 36 months after try-outs, with the majority continuing to participate in their try-out sport.

Relationship Between Trajectories of Trunk Fat Development in Emerging Adulthood and Cardiometabolic Risk at 36 Years of Age.

OBJECTIVE: This study examined trajectories of trunk fat mass (FM) accrual during emerging adulthood of individuals categorized, at 36 years of age, as having higher compared with lower scores of (1) metabolic risk and (2) blood pressure risk. METHODS: Fifty-five individuals from the Saskatchewan Pediatric Bone Mineral Accrual Study (1991-2017) were assessed from adolescence (mean [SD], 11.5 [1.8] years) through emerging adulthood (26.2 [2.2] years) and into early adulthood (35.6 [2.2] years) (median 11 visits per individual). Sex-specific median splits of continuous standardized risk scores at 36 years of age were created. Dual-energy x-ray absorptiometry-assessed trunk FM trajectories were analyzed using multilevel random effects models. RESULTS: Higher risk scores of blood pressure risk and metabolic risk had significantly steeper trajectories of fat development (0.45 [0.11] and 0.44 [0.11] log g, respectively) than the lower risk scores. Dietary fat was not related (P > 0.05). Physical activity was negatively related (-0.04 [0.02] physical activity score) to trunk FM development during emerging adulthood. CONCLUSIONS: Young adults with higher metabolic risk at 36 years of age had greater trunk FM development during both adolescence and emerging adulthood, supporting the need for intervention at both these critical periods of fat accrual.

Influence of Childhood and Adolescent Fat Development on Fat Mass Accrual During Emerging Adulthood: A 20-Year Longitudinal Study.

OBJECTIVE: Fat mass and the prevalence of overweight/obesity (OWO) increase during emerging adulthood (EA; 18-25 years). The factors that contribute to the transition from having healthy weight to having OWO during EA are understudied. This study aimed to identify the independent effect of concurrent physical activity (PA) and energy intake (EI) and childhood/adolescent fat accrual, PA, and EI on EA fat accrual. METHODS: One hundred twenty-six participants (59 male) were measured serially between 1991 and 2011. Measures included age, height, weight, total body and trunk fat mass (TBF and TrF, in grams) derived from dual-energy x-ray absorptiometry, and PA and EI. Composite childhood/adolescent z scores were calculated for each participant (average mean z score) for TBF, TrF, PA, and EI. Multilevel random-effects models were developed. RESULTS: EA fat accrual was predicted by childhood and adolescent TBF and TrF z score (0.30 ± 0.05, P < 0.05), respectively, in both sexes. Concurrent PA (-0.06 ± 0.02, P < 0.05) was significant in males only. CONCLUSIONS: These results underscore the importance of maintaining a lower TBF and TrF during childhood and adolescence, and a higher level of PA in order to mitigate TBF and TrF accrual and prevent the transition from having healthy weight to having OWO during EA.

Longitudinal patterns in BMI and percent total body fat from peak height velocity through emerging adulthood into young adulthood.

OBJECTIVES: Emerging adulthood, a potential critical period, is an understudied period of fat mass accrual. The aim of this study was to describe patterns of fat mass accrual, and weight status, from adolescence, through emerging adulthood, into young adulthood. METHODS: One-hundred-eighteen participants (59 male) were measured repeatedly for 20 years. Annual measures of height, weight, and body composition (DXA) were taken. Calculated measures included: peak height velocity (PHV), biological age (BA; years from PHV), body mass index (BMI), and percent total body fat (%TBF). Weight status groupings (normal NW, and overweight/obese OWO) were created using age and sex specific BMI and %TBF cut-offs. Analysis included t-tests and logistic regression. RESULTS: BMI and %TBF increased significantly until 8 years post PHV (P < .05), plateaued for 7 years (P > .05), and then began increasing again (P < .05). At PHV, 9% of males and 14% of females were OWO rising to 65% and 32% respectively 15 years post PHV. OWO status at PHV did not predict OWO status in early adulthood (P > .05). CONCLUSIONS: During emerging adulthood, the prevalence of OWO increased. Being NW at PHV was not protective against being overweight in young adulthood. Emerging adulthood appears to be a potential critical period for fat accrual and warrants further attention.