Perceived Access to Healthcare of Indigenous Peoples in Canada With Rheumatoid Arthritis and Their First-Degree Relatives.

OBJECTIVE: There are complex and interrelated factors that lead to inequitable healthcare delivery in Canada. Many of the factors that underlie these inequities for Canada's geographically dispersed Indigenous peoples remain underexamined. METHODS: A cohort of 831 First Nations (FN) individuals from urban and remote communities were recruited into a longitudinal study of rheumatoid arthritis (RA) risk from 2005 to 2017. Data from each participant's initial enrollment visit were assessed using a survey that captured concerns with healthcare access. RESULTS: We found that remote participants with RA reported poor access compared to remote first-degree relatives (FDRs; P < 0.001); this difference was not observed for urban participants with RA. We observed substantial differences based on sex; female participants perceived access to care to be more difficult than male participants in both urban and remote cohorts (P < 0.001). We also observed that male participants with RA reported poor access to care compared to male FDRs. Importantly, access to care in remote communities appeared to improve over the duration of the study (P = 0.01). In a logistic regression analysis, female sex, remote location, and older age were independent predictors of poor access to care. Predictors of poor access in participants with RA also included female sex, remote location, and older age. CONCLUSION: FN peoples living in remote communities, particularly those with an established RA diagnosis, report more problems accessing health care. Sex-based inequities exist, with FN female individuals reporting greater difficulties in accessing appropriate health care, regardless of RA diagnosis. Addressing these sex-based inequities should be a high priority for improving healthcare delivery.

CanVasc consensus recommendations for the use of avacopan in antineutrophil cytoplasm antibody-associated vasculitis: 2022 addendum.

OBJECTIVE: In 2020, the Canadian Vasculitis Research Network (CanVasc) published their updated recommendations for the management of ANCA-associated vasculitides (AAV). The current addendum provides further recommendations regarding the use of avacopan in AAV based on a review of newly available evidence. METHODS: An updated systematic literature review on avacopan (formerly, CCX168) using Medline, Embase, and the Cochrane Library was performed for publications up to September 2022. New recommendations were developed and categorized according to the EULAR grading levels, as done for previous CanVasc recommendations. A modified Delphi procedure and videoconferences were used to reach ≥80% consensus on the inclusion, wording and grading of each recommendation. RESULTS: Three new recommendations were developed. They focus on avacopan therapy indication and duration, as well as timely glucocorticoid tapering. CONCLUSION: These 2022 addended recommendations provide rheumatologists, nephrologists and other specialists caring for patients with AAV with guidance for the use of avacopan, based on current evidence and consensus from Canadian experts.

Gongs galore: phaleristic study of the relative risk of a healing art related New Year Honour.

OBJECTIVES: To compare proportional representation of healthcare specialty workers, in receipt of New Year Honours (NYHs) and examine system bias. DESIGN: Observational study of UK honours system including comparative analysis of proportional representation of the UK medical workforce. PARTICIPANTS: Recipients of NYHs from 2010 to 2019. MAIN OUTCOME MEASURES: Absolute risk of receiving an NYH, related to medical specialty, gender and geographical region. Relative risk (RR) of receiving an NYH for services to healthcare related to specialty. RESULTS: 11 207 NYHs were bestowed, with 368 (3.3%) awarded to healthcare professionals: 212 (57.6%) women, 156 (42.4%) men. The RR of a healthcare professional receiving an NYH was 0.76 (95% CI 0.68 to 0.84, p<0.001) when compared with the remaining UK workforce. Doctors received most NYHs (n=181), with public health, clinical oncology and general medicine specialties most likely to be rewarded (RR 20.35 (95% CI 9.61 to 43.08, p<0.001), 8.43 (95% CI 2.70 to 26.30, p<0.001) and 8.22 (95% CI 6.22 to 10.86, p<0.001)), respectively; anaesthetists received fewest NYHs (RR 0.52 (95% CI 0.13 to 2.10), p=0.305). Men were more likely to receive NYHs than women (OR 0.44, 95% CI 0.36 to 0.54; p<0.001). Two hundred and fifty-four NYHs (69.0%) were bestowed on residents of England (60, 16.3% London), 49 (13.3%) Scotland (p=0.003), 39 (10.6%) Wales (p<0.001) and 26 (7.1%) Northern-Ireland (p<0.001). CONCLUSIONS: Relative risk of receiving an NYH varied over 150-fold by specialty, twofold by gender and threefold by geographical location. Public health physicians are perceived to be the pick of the parade.

Prognostic significance of competition ratios in surgical specialty training selection.

BACKGROUND: A competition ratio (CR) indicates the ratio of total applications for a training post when compared with numbers of specialty posts available. This study aimed to evaluate CRs' influence on National Training Number (NTN) selection in a single UK Statutory Education Body. METHODS: Consecutive core surgical trainees numbering 154 (105 men, 49 women; median years since graduation: four) were studied over a 6-year period. Annual specialty specific CRs were obtained from Health Education England's website, and primary outcome measure was UK NTN appointment. RESULTS: Overall NTN appointment was 45.5%. Median CR was 2.36; range Oral & Maxillofacial Surgery 0.70 (2020) to Neurosurgery 22.0 (2020). Multivariable analysis revealed that NTN success was associated with: CR (OR 0.46, p=0.003), a single scientific publication (OR 6.25, p=0.001), cohort year (2019, OR 12.65, p=0.003) and Universal Annual Review of Competence Progression Outcome 1 (OR 45.24, p<0.001). CRs predicted NTN appointment with a Youden index defined critical ratio of 4.42; 28.6% (n=8) versus 49.2% (n=62), p=0.018. CONCLUSION: CRs displayed 30-fold variation, with CRs below 4.42 associated with twofold better NTN promotion, but strong clinical competence and academic reach again emerged as the principal drivers of career advancement.

Relative Value of Adapted Novel Bibliometrics in Evaluating Surgical Academic Impact and Reach.

BACKGROUND: The Hirsch index, often used to assess research impact, suffers from questionable validity within the context of General Surgery, and consequently adapted bibliometrics and altmetrics have emerged, including the r-index, m-index, g-index and i10-index. This study aimed to assess the relative value of these novel bibliometrics in a single UK Deanery General Surgical Consultant cohort. METHOD: Five indices (h, r, m, g and i10) and altmetric scores (AS) were calculated for 151 general surgical consultants in a UK Deanery. Indices and AS were calculated from publication data via the Scopus search engine with assessment of construct validity and reliability. RESULTS: The median number of publications, h-index, r-index, m-index, g-index and i10-index were 13 (range 0-389), 5 (range 0-63), 5.2 (range 0-64.8), 0.33 (range 0-1.5), 10 (range 0-125) and 4 (range 0-245), respectively. Correlation coefficients of r-index, m-index, g-index and i10-index with h-index were 0.913 (p < 0.001), 0.716 (p < 0.001), 0.961 (p < 0.001) and 0.939 (p < 0.001), respectively. Significant variance was observed when the cohort was ranked by individual bibliometric measures; the median ranking shifts were: r-index - 2 (- 46 to + 23); m-index - 6.5 (- 53 to + 22); g-index - 0.5 (- 24 to + 13); and i10-index 0 (- 8 to + 11), respectively (p < 0.001). The median altmetric score and AS index were 0 (range 0-225.5) and 1 (range 0-10), respectively; AS index correlated strongly with h-index (correlation coefficient 0.390, p < 0.001). CONCLUSIONS: Adapted bibliometric indices appear to be equally valid measures of evaluating academic productivity, impact and reach.

Molecular basis for increased susceptibility of Indigenous North Americans to seropositive rheumatoid arthritis.

OBJECTIVE: The pathogenetic mechanisms by which HLA-DRB1 alleles are associated with anticitrullinated peptide antibody (ACPA)-positive rheumatoid arthritis (RA) are incompletely understood. RA high-risk HLA-DRB1 alleles are known to share a common motif, the 'shared susceptibility epitope (SE)'. Here, the electropositive P4 pocket of HLA-DRB1 accommodates self-peptide residues containing citrulline but not arginine. HLA-DRB1 His/Phe13ß stratifies with ACPA-positive RA, while His13ßSer polymorphisms stratify with ACPA-negative RA and RA protection. Indigenous North American (INA) populations have high risk of early-onset ACPA-positive RA, whereby HLA-DRB1*04:04 and HLA-DRB1*14:02 are implicated as risk factors for RA in INA. However, HLA-DRB1*14:02 has a His13ßSer polymorphism. Therefore, we aimed to verify this association and determine its molecular mechanism. METHODS: HLA genotype was compared in 344 INA patients with RA and 352 controls. Structures of HLA-DRB1*1402-class II loaded with vimentin-64Arg59-71, vimentin-64Cit59-71 and fibrinogen ß-74Cit69-81 were solved using X-ray crystallography. Vimentin-64Cit59-71-specific and vimentin59-71-specific CD4+ T cells were characterised by flow cytometry using peptide-histocompatibility leukocyte antigen (pHLA) tetramers. After sorting of antigen-specific T cells, TCRα and ß-chains were analysed using multiplex, nested PCR and sequencing. RESULTS: ACPA+ RA in INA was independently associated with HLA-DRB1*14:02. Consequent to the His13ßSer polymorphism and altered P4 pocket of HLA-DRB1*14:02, both citrulline and arginine were accommodated in opposite orientations. Oligoclonal autoreactive CD4+ effector T cells reactive with both citrulline and arginine forms of vimentin59-71 were observed in patients with HLA-DRB1*14:02+ RA and at-risk ACPA- first-degree relatives. HLA-DRB1*14:02-vimentin59-71-specific and HLA-DRB1*14:02-vimentin-64Cit59-71-specific CD4+ memory T cells were phenotypically distinct populations. CONCLUSION: HLA-DRB1*14:02 broadens the capacity for citrullinated and native self-peptide presentation and T cell expansion, increasing risk of ACPA+ RA.

Has the rescheduling of hydrocodone changed ED prescribing practices?

OBJECTIVE: The objective was to examine the effect of hydrocodone-containing product (HCP) rescheduling on the proportion of prescriptions for HCPs given to patients discharged from the emergency department (ED). METHODS: Electronic queries of ED records were used to identify patients aged 15 years and older discharged with a pain-related prescription in the 12 months before and after HCP rescheduling. Prescriptions were classified as HCPs; other Schedule II medications (eg, oxycodone products); other Schedule III medications (eg, codeine products); and non-Schedule II/III products (eg, nonsteroidal anti-inflammatory drugs). We compared the proportions of patients receiving each type of prescription before and after rescheduling using χ2 analysis and used logistic regression to explore the relationship between prescription type and time period while controlling for age, sex, race, and ethnicity. RESULTS: Before rescheduling, 58.1% (95% confidence interval [CI], 57.4-58.7) of patients receiving a pain-related prescription received an HCP; after rescheduling, 13.2% (95% CI, 12.7-13.7) received an HCP (P < .001). Concurrently, other Schedule III prescriptions increased (pre: 11.7% [CI, 11.3-12.2] vs post: 44.9% [CI, 44.2-45.6], P < .001)), as did non-Schedule II/III prescriptions (pre: 51.8% [CI, 51.2-52.5] vs post: 59.3% [CI, 58.6-60.0], P < .001). When controlling for demographic characteristics, patients remained less likely to receive an HCP after rescheduling (adjusted odds ratio [AOR], 0.11; CI, 0.10-0.11) and more likely to receive other Schedule III (AOR, 6.1; CI, 5.8-6.5) and non-Schedule II/III (AOR, 1.4; CI, 1.3-1.4) products. CONCLUSION: Rescheduling HCPs from Schedule III to Schedule II led to a substantial decrease in HCP prescriptions in our ED and an increase in prescriptions for other Schedule III and non-Schedule II/III products.

Atomic-layer electroless deposition: a scalable approach to surface-modified metal powders.

Palladium has a number of important applications in energy and catalysis in which there is evidence that surface modification leads to enhanced properties. A strategy for preparing such materials is needed that combines the properties of (i) scalability (especially on high-surface-area substrates, e.g. powders); (ii) uniform deposition, even on substrates with complex, three-dimensional features; and (iii) low-temperature processing conditions that preserve nanopores and other nanostructures. Presented herein is a method that exhibits these properties and makes use of benign reagents without the use of specialized equipment. By exposing Pd powder to dilute hydrogen in nitrogen gas, sacrificial surface PdH is formed along with a controlled amount of dilute interstitial hydride. The lattice expansion that occurs in Pd under higher H2 partial pressures is avoided. Once the flow of reagent gas is terminated, addition of metal salts facilitates controlled, electroless deposition of an overlayer of subnanometer thickness. This process can be cycled to create thicker layers. The approach is carried out under ambient processing conditions, which is an advantage over some forms of atomic layer deposition. The hydride-mediated reaction is electroless in that it has no need for connection to an external source of electrical current and is thus amenable to deposition on high-surface-area substrates having rich, nanoscale topography as well as on insulator-supported catalyst particles. STEM-EDS measurements show that conformal Rh and Pt surface layers can be formed on Pd powder with this method. A growth model based on energy-resolved XPS depth profiling of Rh-modified Pd powder is in general agreement. After two cycles, deposits are consistent with 70-80% coverage and a surface layer with a thickness from 4 to 8 Å.

Formation of palladium nanofilms using electrochemical atomic layer deposition (E-ALD) with chloride complexation.

Pd thin films were formed by electrochemical atomic layer deposition (E-ALD) using surface-limited redox replacement (SLRR) of Cu underpotential deposits (UPD) on polycrystalline Au substrates. An automated electrochemical flow deposition system was used to deposit Pd atomic layers using a sequence of steps referred to as a cycle. The initial step was Cu UPD, followed by its exchange for Pd ions at open circuit, and finishing with a blank rinse to complete the cycle. Deposits were formed with up to 75 cycles and displayed proportional deposit thicknesses. Previous reports by this group indicated excess Pd deposition at the flow cell ingress, from electron probe microanalysis (EPMA). Those results suggested that the SLRR mechanism did not involve direct transfer between a Cu(UPD) atom and a Pd(2+) ion that would take its position. Instead, it was proposed that electrons are transferred through the metallic surface to reduce Pd(2+) ions near the surface where their activity is highest. It was proposed that if the cell was filled completely before a significant fraction of the Cu(UPD) atoms had been oxidized then the deposit would be homogeneous. Previous work with EDTA indicated that the hypothesis had merit, but it proved to be very sensitive to the EDTA concentration. In the present study, chloride was used to complex Pd(2+) ions, forming PdCl(4)(2-), to slow the exchange rate. Both complexing agents led to a decrease in the rate of replacement, producing more homogeneous films. Although the use of EDTA improved the homogeneity, it also decreased the deposit thickness by a factor of 3 compared to the thickness obtained via the use of chloride.

Familial clustering of the serum cytokine profile in the relatives of rheumatoid arthritis patients.

OBJECTIVE: Rheumatoid arthritis (RA) is prevalent in North American Native populations, with a high frequency of multicase families and seropositivity in first-degree relatives. This study was undertaken to determine whether the serum cytokine profile of first-degree relatives of North American Native patients with RA differed from that of individuals with no family history of autoimmunity and whether there was an association with RA autoantibodies. METHODS: North American Native patients with RA (n = 105), their first-degree relatives (n = 273), healthy North American Native controls (n = 200), and Caucasian controls (n = 150) were studied. Serum levels of 42 cytokines were tested using a multiplex laser bead assay. Rheumatoid factor (RF), anti-cyclic citrullinated peptide 2 (anti-CCP-2), monocyte chemotactic protein 1 (MCP-l), and high-sensitivity C-reactive protein (hsCRP) were tested by enzyme-linked immunosorbent assay, and HLA-DRB1 alleles by specific primers. Discriminant analysis and logistic regression classified individuals based on their cytokine profile. RESULTS: The prevalence of RF (cutoff level predetermined to include 5% of Caucasian controls) and anti-CCP (cutoff level of ≥40 units) was, respectively, 88% and 81% in the RA patients, 34% and 9% in first-degree relatives, and 9% and 4% in North American Native controls; the prevalence of anti-CCP was 0% in Caucasian controls. Levels of most cytokines were highest in RA patients; 17 of 40 cytokines (43%) were significantly higher in first-degree relatives than in controls, including multiple proinflammatory cytokines. Discriminant analysis showed a notable distinction between the groups, with 85% classification accuracy. First-degree relatives had markedly higher MCP-1 and hsCRP levels than North American Native controls, but there was no consistent association with RA autoantibodies. CONCLUSION: Our findings indicate that levels of multiple cytokines and hsCRP are higher in first-degree relatives of North American Native patients with RA compared to individuals from a nonautoimmune background. These data suggest that elevated baseline cytokine levels may be part of the risk profile for developing RA.

Disparities in rheumatoid arthritis outcomes for North American Indigenous populations.

Advances in rheumatoid arthritis (RA) management have significantly improved clinical outcomes of this disease; however, some Indigenous North Americans (INA) with RA have not achieved the high rates of treatment success observed in other populations. We review factors contributing to poor long-term outcomes for INA with RA. We conducted a narrative review of studies evaluating RA in INA supplemented with regional administrative health and clinical cohort data on clinical outcomes and health care utilisation. We discuss factors related to conducting research in INA populations including studies of RA prevention. NA with RA have a high burden of genetic and environmental predisposing risk factors that may impact disease phenotype, delayed or limited access to rheumatology care and advanced therapy. These factors may contribute to the observed increased rates of persistent synovitis, premature end-stage joint damage and mortality. Novel models of care delivery that are culturally sensitive and address challenges associated with providing speciality care to patients residing in remote communities with limited accessibility are needed. Progress in establishing respectful research partnerships with INA communities has created a foundation for ongoing initiatives to address care gaps including those aimed at RA prevention. This review highlights some of the challenges of diagnosing, treating, and ultimately perhaps preventing, RA in INA populations.

A retrospective cohort study of differential attainment, COVID and chaos: taking the difference out of a terrible trinity.

BACKGROUND: This study aimed to evaluate core surgical training (CST) differential attainment related to coronavirus disease 2019 (COVID-19), gender and ethnicity. The hypothesis was that COVID-19 adversely influenced CST outcomes. METHODS: A retrospective cohort study of 271 anonymised CST records was undertaken at a UK Statutory Education Body. Primary effect measures were Annual Review of Competency Progression Outcome (ARCPO), Membership of the Royal College of Surgeons (MRCS) examination pass and Higher Surgical Training National Training Number (NTN) appointment. Data were collected prospectively at ARCP and analysed with non-parametric statistical methods in SPSS. RESULTS: CSTs numbering 138 completed training pre-COVID and 133 peri-COVID. ARCPO 1, 2 and 6 were 71.9% pre-COVID versus 74.4% peri-COVID ( P =0.844). MRCS pass rates were 69.6% pre-COVID versus 71.1% peri-COVID ( P =0.968), but NTN appointment rates diminished (pre-COVID 47.4% vs. peri-COVID 36.9%, P =0.324); none of the above varied by gender or ethnicity. Multivariable analyses by three models revealed: ARCPO was associated with gender [m:f 1:0.87, odds ratio (OR) 0.53, P =0.043] and CST theme (Plastics vs. General OR 16.82, P =0.007); MRCS pass with theme (Plastics vs. General OR 8.97, P =0.004); NTN with the Improving Surgical Training run-through programme (OR 5.00, P <0.001). Programme retention improved peri-COVID (OR 0.20, P =0.014) with pan University Hospital rotations performing better than Mixed or District General-only rotations (OR 6.63, P =0.018). CONCLUSION: Differential attainment profiles varied 17-fold, yet COVID-19 did not influence ARCPO or MRCS pass rates. NTN appointment fell by one-fifth peri-COVID, but overall training outcome metrics remained robust despite the existential threat.

Enhanced Stress Resilience Training for UK Surgical Trainees; Effect and Evolution Evaluated.

INTRODUCTION: Core Surgical Training (CST) programs are associated with high burnout. This study aimed to assess the influence of Enhanced Stress Resilience Training (ESRT) over a 2-year period in a single UK Statutory Education Body. METHOD: CSTs participated in 5-weeks of formal ESRT to address work stressors. The primary outcome measure was career progression related to curriculum metrics and National Training Number (NTN) appointment. Secondary measures related to burnout using validated psychological inventories. RESULTS: Of 42 CSTs, 13 engaged fully with ESRT (31.0%; male 8, female 5, median age 28 year.), 11 engaged partially, and 18 did not. ESRT engagement was associated with better NTN appointment (ESRT 8/13 (61.5%) vs. not 1/18 (5.6%), p = 0.025), less burnout [aMBI; mean 5.14 (SD ± 2.35) vs. 3.14 (±2.25), F 6.637, p = 0.002, ηp2=0.167], less stress [PSS-10; 19.22 (±5.91) vs. 15.79 (±5.47), F 8.740, p < 0.001, ηp2=0.200], but more mindfulness [CAMS-R; 19.22 (±5.91) vs. 20.57 (±2.93), F 3.201, p = 0.047, ηp2=0.084]. On multivariable analysis, Improving Surgical Training (run-through CST) program (OR 5.2 (95% CI 1.42-28.41, p = 0.022), MRCS pass (OR 17.128 (95% CI 1.48-197.11, p = 0.023) and ESRT engagement (OR 13.249, 95% CI 2.08-84.58, p = 0.006) were independently associated with NTN success. DISCUSSION: ESRT was associated with less stress and burnout, better mindfulness, and most importantly 13-fold better career progression.

Face validity of a virtual reality simulation platform to improve competency in endoscopy: a prospective observational cohort study.

Background and study aims Virtual reality endoscopic simulation training has the potential to expedite competency development in novice trainees. However, simulation platforms must be realistic and confer face validity. This study aimed to determine the face validity of high-fidelity virtual reality simulation (EndoSim, Surgical Science, Gothenburg), and establish benchmark metrics to guide the development of a Simulation Pathway to Improve Competency in Endoscopy (SPICE). Methods A pilot cohort of four experts rated simulated exercises (Likert scale score 1-5) and following iterative development, 10 experts completed 13 simulator-based endoscopy exercises amounting to 859 total metric values. Results Expert metric performance demonstrated equivalence ( P  = 0.992). In contrast, face validity of each exercise varied among experts (median 4 (interquartile range [IQR] 3-5), P  < 0.003) with Mucosal Examination receiving the highest scores (median 5 [IQR 4.5-5], P  = 1.000) and Loop Management and Intubation exercises receiving the lowest scores (median 3 [IQR 1-3], P  < 0.001, P  = 0.004), respectively. The provisional validated SPICE comprised 13 exercises with pass marks and allowance buffers defined by median and IQR expert performance. Conclusions EndoSim Face Validity was very good related to early scope handling skills, but more advanced competencies and translation of acquired clinical skills require further research within an established training program. The existing training deficit with superadded adverse effects of the COVID pandemic make this initiative an urgent priority.

Three-dimensional pore evolution of nanoporous metal particles for energy storage.

A well characterized and predictable aging pattern is necessary for practical energy storage applications of nanoporous particles that facilitate rapid transport of ions or redox species. Here we use STEM tomography with segmentation to show that surface diffusion and grain boundary diffusion are responsible for pore evolution at intermediate and higher temperatures, respectively. This unprecedented three dimensional understanding of pore behavior as a function of temperature suggests routes for optimizing pore stability in future energy storage materials.

Knee Osteoarthritis: An Investigation into the Clinical Practice of Physiotherapists in Canada.

Purpose: The purpose of this study was to establish the clinical practice of physiotherapists who treat people with knee osteoarthritis (OA) in Canada and examine their knowledge, awareness, use of, and attitudes toward clinical practice guidelines (CPGs). Method: We conducted a cross-sectional survey of physiotherapists who are licensed to practise in Canada and who treat people with knee OA. Results: A total of 388 physiotherapists completed our survey. Approximately two-thirds of them (271) were aware of CPGs. Out of all CPG recommendations, most respondents provided leg strengthening exercises (380) and education (364). More than 80% believed that CPGs improved patient care and enhanced decision making and were confident in their ability to interpret CPGs. More physiotherapists (204) identified barriers to the use of CPGs than facilitators of their use (117). Physiotherapists who were employed in private practice were substantially more likely to use interventions such as acupuncture (odds ratio [OR] 5.98; 95% CI: 2.92, 12.23; p < 0.01) and joint mobilization and manipulation (OR 6.58; 95% CI: 3.45, 12.55; p < 0.01) than were physiotherapists employed in hospital settings. Conclusions: Two-thirds of respondents were aware of CPGs. Physiotherapists provided education and leg strengthening exercises more often than aerobic exercise and weight management advice. Physiotherapists employed in private practice were more likely to use adjunct interventions.

Objectif : déterminer la pratique clinique des physiothérapeutes qui traitent des personnes atteintes d'arthrose du genou au Canada et examiner leurs connaissances, leur sensibilisation, leur utilisation et leurs attitudes envers les directives cliniques (DC). Méthodologie : sondage transversal auprès des physiothérapeutes autorisés à exercer au Canada et qui traitent des personnes atteintes d'arthrose du genou. Résultats : au total, 388 physiothérapeutes ont rempli le sondage. Environ les deux tiers (271) connaissaient l'existence des DC. Parmi toutes les recommandations des DC, la plupart des répondants donnaient des exercices de renforcement des jambes (380) et de l'information (364). Plus de 80 % étaient d'avis que les DC amélioraient les soins aux patients et la prise de décision et avaient confiance en leur capacité d'interpréter les DC. Un plus grand nombre de physiothérapeutes (204) constatait plus d'obstacles que d'incitations à utiliser les DC (117). Les physiothérapeutes en pratique privée étaient considérablement plus susceptibles de recourir à des interventions comme l'acupuncture (rapport de cotes [RC] 5,98; IC à 95 % : 2,92, 12,23; p < 0,01), les mobilisations et les manipulations articulaires (RC 6,58; IC à 95 % : 3,45, 12,55; p < 0,01) que les physiothérapeutes en milieu hospitalier. Conclusions : les deux tiers des répondants connaissaient l'existence des DC. Les physiothérapeutes fournissaient de l'information et des exercices de renforcement des jambes plus souvent que des exercices aérobiques et des conseils sur la gestion du poids. Ceux qui travaillaient en pratique privée étaient plus susceptibles de recourir à des interventions complémentaires.

Biosensors, Biomarkers and Biometrics: a Bootcamp Perspective.

Introduction: Competitive physical performance is routinely monitored by wearable technology (biosensors), yet professional healthcare is not, despite high prevalence of trainee stress and burnout, notwithstanding the corresponding risk to patient safety. This study aimed to document the physiological stress response of UK Core Surgical Trainees (CSTs) during simulation training. Methods: CSTs (n=20, 10 male) were fitted with Vital Scout Wellness Monitors (VivaLNK, Campbell, California, USA) for an intensive 3-day training bootcamp. In addition to physiological parameters, CST demographics, event diaries and Maslach Burnout Inventory scores were recorded prospectively during exposure to three scenarios: interactive lectures, clinical skills simulation and non-technical (communication) training. Results: Baseline heart rate (BHR, 60 bpm (range 39-81 bpm)) and baseline respiratory rate (14/min (11-18/min)) varied considerably and did not correlate (rho 0.076, p=0.772). BHR was associated with weekly exercise performed (66 bpm (<1 hour) vs 43 bpm (>5 hour), rho -0.663, p=0.004). Trainee response (standardised median heart rate vs BHR) revealed heart rate was related proportionately to lectures (71 bpm, p<0.001), non-technical skills training (79 bpm, p<0.001) and clinical skills simulation (88 bpm, p<0.001). Respiratory rate responded similarly (p<0.001 in each case). Heart rate during clinical skills simulation was associated with emotional exhaustion (rho 0.493, p=0.044), but maximum heart rate was unrelated to CSTs' perceived peak stressors. Discussion: Stress response, as derived from positive sympathetic heart rate drive varied over two-fold, with a direct implication on oxygen uptake and energy expenditure, and highlighting the daily physical demands placed upon clinicians.

CanVasc Consensus Recommendations for the Management of Antineutrophil Cytoplasm Antibody-associated Vasculitis: 2020 Update.

OBJECTIVE: In 2015, the Canadian Vasculitis Research Network (CanVasc) created recommendations for the management of antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) in Canada. The current update aims to revise existing recommendations and create additional recommendations, as needed, based on a review of new available evidence. METHODS: A needs assessment survey of CanVasc members informed questions for an updated systematic literature review (publications spanning May 2014 to September 2019) using Medline, Embase, and Cochrane. New and revised recommendations were developed and categorized according to the level of evidence and strength of each recommendation. The CanVasc working group used a 2-step modified Delphi procedure to reach > 80% consensus on the inclusion, wording, and grading of each new and revised recommendation. RESULTS: Eleven new and 16 revised recommendations were created and 12 original (2015) recommendations were retained. New and revised recommendations are discussed in detail within this document. Five original recommendations were removed, of which 4 were incorporated into the explanatory text. The supplementary material for practical use was revised to reflect the updated recommendations. CONCLUSION: The 2020 updated recommendations provide rheumatologists, nephrologists, and other specialists caring for patients with AAV in Canada with new management guidance, based on current evidence and consensus from Canadian experts.