bluuebunny/crossref_metadata_2025_split huggingface dataset:
9. Innovation in research instruction: Pilot testing of team learning to promote peer reviewed grantwriting by clinician trainees
Authors: Warnock F. , Sibley J. 
Published: May 2017

We piloted the combination of Team-Based Learning (TBL) with interactive in-class instruction in grantsmanship to test its effectiveness in preparing clinician trainees to produce a national (CIHR) peer reviewed operating grant in a small class setting. The approach was integrated into a university graduate quantitative method and design course delivered to five trainees in 12 weekly 4hr sessions. Outcomes to assess knowledge acquisition, retention and application included percentage scores in seven TBL individual and student team tests (each containing 15-20 multiple-choice items), student participation in a mock peer review and student own submission of an operating grant (using CIHR peer review evaluation criteria to assess methodological coherency and soundness of the research design and plan, feasibility, relevancy and innovativeness). Also assessed were student perception of the approach on their learning (7 item questionnaire) and two peer teaching evaluations.
In seven consecutive testing sessions, percentage scores for the individual tests were 80, 72, 76, 71, 83, 75 and 80 and corresponding team scores were 96, 96, 83, 100, 95, 97, and 97 suggesting an 18% increase in individual knowledge with team testing. Overall, student achievements were 93% for mock peer review and 78% for grant production. Trainees rated TBL and the interactive in-class activities as effective in consolidating knowledge and promoting complex research design decision making. Evaluations of the teaching were 4.7 and 4.8 out of 5. Findings suggest students mastered course content, that team learning increased individual knowledge and that trainees linked theory to successfully produce a CIHR operating grant. These pilot findings call for larger prospective studies to test the combined approach in larger classes and with other populations of clinician trainees.
The clinician scientist: yesterday, today and tomorrow. Canadian Institutes of Health Research. http://www.cihr-irsc.gc.ca/e/pdf_22084.htm. Accessed February 25, 2007.
Ringel SP. Steiner JF, Vickrey BG, Spencer SS. Training clinical researchers in neurology: We must do better. Neurology 2001; 57:388-392.
Haidet P, O’Malley KJ, Boyd R. An initial experience with “Team Learning’ in medical education. Academic Medicine 2002; 77: 40-41.
12. Disclosure of medical errors: A view through a global lens
Authors: Kalra J. , Neufeld H. , Mulla A. 
Published: May 2017

There are ongoing efforts worldwide to minimize the occurrence of medical errors. However, the issue of honest disclosure of a medical error to the patient or their family has been relatively unattended. We have previously reported the Canadian provincial initiatives encouraging open disclosure of a critical event and have suggested its integration into a ‘no-fault’ model. In the absence of uniform policies directing appropriate disclosure of a medical error, substantial scope exists for breaching the patient’s trust if errors during the process of care are not disclosed. We reviewed the various medical error disclosure initiatives across the globe to analyze the progress made in this key area. In 2001, the United States (US) Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandated an open disclosure of any critical event during care to the patient or their families. This was deemed as an essential accreditation standard for the institution. In Australia, the Australian Council for Safety and Quality in Health Care integrates the disclosure process with a risk management analysis towards investigating the critical event. In New Zealand, the patients suffering a medical error are rehabilitated and compensated through a no-fault, state-funded compensation scheme. The National Health Services (NHS) of the United Kingdom directs the doctors and managers to inform a patient of an act of negligence or omission that causes harm. The NHS scheme offers a remedial package to the patient including an apology and financial compensation in return for the patients waiving their right to litigate. The Canadian provincial initiatives, though similar in content, remain isolated because of their non-mandatory nature and absence of federal or provincial laws on disclosure. In Conclusion, we suggest that a uniform national policy centered on addressing errors in a non-punitive manner and respecting the patient’s right to an honest disclosure be implemented.
Kalra J, Massey KL, Mulla A. Disclosure of medical error: policies and practice. Journal of the Royal Society of Medicine 2005; 98(7): 307-09.
Hebert PC, Levin AV, Robertson G. Bioethics for clinicians: 23. Disclosure of medical error. CMAJ 2001; 164(4):509-13.
Mazor KM, Simon SR, Gurwitz JH. Communicating with patients about medical errors: a review of the literature. Arch Intern Med. 2004; 164(15):1690-7.
13. The impact of government regulation of ambulatory surgical facilities on access to elective surgical procedures
Authors: Fric-Shamji E. , Shamji M. 
Published: May 2017

Advances in medical technology have made free-standing ambulatory surgery centres a cost-effective method of delivering health care in the United States. One: Rapid expansion of such centres and duplication of services have raised concerns over rising health care costs, two: leading to government regulation of facilities via a Certificate of Need (CON) law in many states. Three: Such regulation may decrease access to elective procedures.
This study investigates access to elective surgical procedures in selected states with and without CON laws. Results of the Health Care Utilization Project were analyzed. Per capita rates of elective carpal tunnel release (CTR) and lumbar discectomy were evaluated in 16 states with CON laws and 5 states without CON laws over the years 2004-2005. Distribution of CTR and lumbar discectomy were analyzed by facility ownership and teaching status, using rates of emergent procedures as a control. Student’s t-tests compared rates of CTR and discectomy as a function of CON legislation. Two-factor ANOVA extended this analysis to account for teaching environment and facility ownership.
Fewer CTR cases were performed in states with CON laws (p=0.014), specifically in government-owned (p=0.012) and non-teaching facilities (p=0.01). No difference was observed in lumbar discectomy rates in states with respect to CON regulation. Distribution of both procedures among teaching and non-teaching centers was independent of CON laws. Facility ownership predicts fraction of these cases performed at an institution,(p < 0.01) and this distribution is influenced by CON regulation, increasing fractions of both types of procedures performed at private, not-for-profit centers (p=0.001, p=0.003 respectively).
We conclude that CON laws restrict access to certain procedures, specifically in government-owned and non-teaching facilities. These laws may limit the supply of surgical care, notably by redistributing away from government and for-profit centres. Potential solutions include reinvestigating the need for CON laws, or examining the CON methodology to accurately reflect need.
Small NC, Bert JM. Office Ambulatory Surgery Centers: Creation and Management. J Am Acad Orthop Surg 2003; 11:157-62.
Casalino LP, Devers KJ, Brewster LR. Focused Factories? Physician-Owned Specialty Facilities. Health Affairs 22(6):56-67.
Lanning JA, Morrisey MA, Ohsfeldt RL. “Endogenous hospital regulation and it’s effects on hospital and non-hospital expenditures” Journal of Regulatory Economics1991 (June); 3(2):137-54.
15. Meeting challenges in the delivery of surgical care
Authors: Sigurdson L. 
Published: May 2017

Canadian surgeons are faced with looming demographic challenges. Shortages in surgical manpower cannot be addressed expediently due to 14-year university requirements. A potential solution is to increase the efficiency of surgeons already in practice. Physician assistants (PA’s), may play a role in this regard by allowing surgeons to concentrate on their core competency, namely operating. The purposes of this investigation are to explore the inefficiencies in a current Canadian surgeon’s practice, examine the feasibility of PA employment and evaluate the financial impacts.
The study was performed in 3 parts. In part 1, operating room plastic surgery Surgiserver® data for 10 years leading up to 2005 were analyzed to determine daily operating time actually used. In part 2, 4 months of detailed time series data were captured prospectively for every patient care event. The data was analyzed using SPSS (ver. 11.5) to determine the percentage and types of events that could be delegated to a PA. In part 3, PA hiring scenarios were developed using formal business case analyses.
Over 3,635 days, mean operating time used in a 10-hour surgical day was 5.93 hours. Of the 806 patients seen in 13 clinics, 53.5% could have been cared for by a PA. In the minor procedure area, 48.8 % of surgical time was spent performing non-essential, PA compatible work. In the main OR, 25.9% of surgical time was PA compatible. Considering the weekly mix of activities, a PA could increase surgical productivity by 36.7%. Hiring a PA was neutrally cost effective at the 37% productivity increase level. However, much greater discounted incremental cash flows, internal rates of return (IRR) and return on investments (ROI) were achieved when PA hiring allowed one surgeon to run 2 OR’s simultaneously.
Employing PA’s, in conjunction with increasing OR capacity, have the potential to markedly increase the capability of surgeons to deal with lengthy wait lists in a cost effective manner.
McKibbin RC. Cost-effectiveness of physician assistants: A review of recent evidence. Pa J 1978; 8(2):110-115.
Maxfield RG. Use of physician's assistants in a general surgical practice. Am J Surg 1978; 131(4):504-508.
Kaissi A, Kralewski J, Dowd B. Financial and organizational factors affecting the employment of nurse practitioners and physician assistants in medical group practices. J Ambul Care Manage 2003; 26(3):209-216.
16. Postgraduate training and its effect on practice location, career choice and practice profile: Tracking 10 years of output from the University of Toronto
Authors: Abrahams C. , Verma S. , Glazier R. , Jaakkimainen L. , Shultz S. 
Published: May 2017

The purpose of this study is to investigate the relationship between location and specialty of training and practice characteristics such as type of practice (i.e. community versus academic), socio-demographic profile of patients and their complexity, hospital/health facility affiliations and workload/productivity.
The analysis required an extraction of registrant data from the University of Toronto Postgraduate Web Evaluation and Registration (POWER) system for a cohort of exiting residents and fellows from 1993 to 2003. The data extract was linked to several administrative databases held by ICES, including physician practice and billing information from the Ontario Health Insurance Plan (OHIP) and anonymized patient demographic data from the Registered Persons Database (RPDB).
Results of this study will inform workforce policy issues such as the overall contribution made by Toronto graduates to Ontario, other Canadian provinces and international practice pool of physicians, trends regarding medical career choice, similarities and differences between career choices of International Medical Graduates versus Canadian Medical Graduates, impact of location/program of training, impact of length of training and profile/geography of patients served by graduates of Toronto. The study will aim to create a methodology/template for analysis that can be applied to other medical schools and catchment areas in human health resource planning.
Chan B, Willett J. Factors Influencing Participation in Obstetrics by Obstetrician-Gynecologists. 2004; 103(3):493-498.
Noble J, Baerlocher MO. Future Practice Profiles of Canadian Medical Trainees. Clinical and Investigative Medicine 2006; 29(4):288-289.
Watson DE, Katz A, Reid RJ, Bogdanovic B, Roos N. Family Physician Workloads and Access to Care in Winnipeg: 1991 to 2001. Canadian Family Physician 2004; 171(4):339-342.
27. Immigration and other evils: A profile of Dr. C. K. Clarke and the eugenics movement in Canada
Authors: Lee L. 
Published: May 2017

Dr. C.K. Clarke (1857-1924) was one of Canada’s most prominent psychiatrists. He sought to improve the conditions of asylums, helped to legitimize psychiatry and established formal training for nurses.
At the beginning of the 20th Century, Canada experienced a surge of immigration. Yet – as many historians have shown – a widespread anti-foreigner sentiment within the public remained. Along with many other members of the fledgling eugenics movement, Clarke believed that the proportion of “mental defectives” was higher in the immigrant population than in the Canadian population and campaigned to restrict immigration. He appealed to the government to track immigrants and deport them once they showed signs of mental illness. Clarke’s efforts lead to amendments to the Immigration Act in 1919, which authorized deportation of people who were not Canadian-born, regardless of how many years that had been in Canada. This change applied not only to the mentally ill but also to those who could no longer work due to injury and to those who did not follow social norms.
Clarke is a fascinating example of how we judge historical figures. He lived in a time where what we now think of as xenophobia was a socially acceptable, even worthy attitude. As a leader in eugenics, therefore, he was a progressive. Other biographers have recognized Clarke’s racist opinions, some of whom justify them as keeping with the social values of his era. In further exploring Clarke’s interest in these issues, this paper relies on his personal scrapbooks held in the CAMH archives. These documents contain personal papers, poems and stories that proclaim his anti-Semitic and anti-foreigner views. Whether we allow his involvement in the eugenics movement to overshadow his accomplishments or ignore his racist leanings to celebrate his memory is the subject of ongoing debate.
Dowbiggin IR. Keeping America Sane: Psychiatry and Eugenics in the United States and Canada 1880-1940. Ithaca and London: Cornell University Press, 1997.
McLaren A. Our Own Master Race: Eugenics in Canada 1885-1945. Toronto: McClelland and Stewart, 1990.
Roberts B. Whence They Came: Deportation from Canada 1900-1935. Ottawa: University of Ottawa Press, 1988.
33. How to steal a body
Authors: Turner C. 
Published: May 2017

You are a medical student in 1820, training in anatomy has now become a prerequisite to graduation but there are limited cadavers available for dissection. Could you be a body snatcher? What about if you only took unclaimed bodies? What if you didn’t actually excavate, just helped drive the wagon? What would be your conditions before you would turn to a life of crime? Keep in mind that just by “borrowing” the occasional body you would provide yourself with ample opportunities to learn anatomy and also easily afford your tuition.
If you do decide to go ahead and become a body snatcher you’re going to have to learn the classic modus operandi employed by the best in the business.
First of all you want to do some daytime reconnaissance by attending the burial to see if any booby traps are being set for potential body snatchers. Next, you return at night with a wagon and drop two men off at the burial site. They then start digging a 3’X3’ hole until they hit the coffin. The body is carefully extracted and any identifying clothing or jewelry is removed and put back in the coffin before being reburied.
Now you might be worried about retribution but you really don’t have much to fear. Townsfolk have been known to protest in front of medical schools but you’d have to deal with this even if you weren’t a body snatcher. If you end up going to court the worst that would happen is a fine that you could easily pay off by stealing another body or two.
Highet MJ. 2005. Body snatching and grave robbing: bodies for science. History and Anthropology 2005; 16(4):415-440.
MacGillivray R. Body snatching in Ontario. CBMH/BCHM 1988; 5:51-60.
Ross I, Ross CU. Body snatching in 19th Century Britain: from exhumation to murder. British Journal of Law and Society 1979; 6(1):108-118.
34. A brief history of cardiac arrhythmia
Authors: Ducas R. 
Published: May 2017

Throughout the ages there has been little else as impressive to both the patient and physician as abnormalities and aberrancy in the heartbeat. It was through careful observation and characterization of physiology that the tactile measurement of the pulse translated and evolved in to the vast field of cardiology we know today. For thousands of years the only window physicians had into the hearts of their patients was through palpation of a pulse. The ancient Egyptians, Chinese and Greeks are credited with measurement and characterization of peripheral pulses and their association with illness. The work of Claudius Galen (129-199) furthered the association of pulse to cardiac function. Galen’s work set the stage for William Harvey’s (1578-1657) first description of the circulatory system and thereafter the function of the heart. However, it was not until the advent of electrocardiography that modern, efficient studies of cardiac rhythm began. The work of August Desir Waller (1856-1922) and Willem Einthoven (1860-1927) revolutionized the study of arrhythmia with the advent of the electrocardiogram (ECG). This instrument transformed the diagnosis of heart disease and catalyzed the creation of cardiology as a subspecialty. It was through the use of the ECG that cardiac rhythm disorders were first characterized. James Mackenzie and Arthur Cushny first recognized atrial fibrillation and the work of Drs. Wolf, Parkinson and White theorized the neuro-cardiac function of the heart. Further study led to the discovery of the Purkinje system and the mechanics of cardiac electrical conduction. Medicine has thus used many approaches in the treatment of arrhythmias, employing pharmacology, electricity and surgery, with an ever-evolving spectrum of treatment. It was through observation, innovation and determination that diseases of the heart are understood and treated today.
Hanon S, Shapiro M, Schweitzer P. A troubled beginning: Evolving concepts of an old arrhythmia. J. Electrocardiol. 2005 (July); 38(3):213-7.
Fye,W. Tracing atrial fibrillation - 100 years. N Engl J Med. 2006 (Oct); 5;355(14):1412-4.
Lüderitz B. History of the disorders of cardiac rhythm. 3rd Ed. Armonk, NY: Futura Pub. Co., 2002.
35. Models that change: The study of gay identity development
Authors: Heng K. 
Published: May 2017

Since the declassification of homosexuality as a mental disorder by the American Psychiatric Association in 1974, a large number of models of gay identity development have been proposed in the literature. This is unique because for the first time, more attention was paid to the process of developing a gay identity rather than theorizing about the etiologies of homosexuality. This paper reviews the changes in thought found in the literature describing how one comes to develop a gay identity.
For the marginalized, identity development is generally described against a backdrop of stigma. Fortunately, our current society is very different from the hostile world that surrounded the APA in 1974: homosexuality is more tolerated and accepted, laws are less discriminatory, and gay role models are more abundant and accessible. As society has evolved, so too have its descriptive models. Shame and reluctance are found in Plumer’s (1975) and Lee’s (1977) models. Pride and activism appear in Hencken and O’Dowd’s (1977) and Cass’ (1979) models. Troiden (1989) mentions the fear of AIDS in his writings. Alderson’s (1998) model reflects a climate where religion, friends, and society can be catalysts in developing a positive identity. Taken together, these models are like time capsules containing clues as to the social conditions of the time.
As the rate of social evolution accelerates, it is doubtful that any model regarding marginalized individuals will ever become definitive. For the case of homosexuality, if and when its stigma is removed, then the defining feature of gay identity development is also removed. It is possible that in its place will be a general model of sexual identity development, where homosexual and heterosexual paths diverge innocently and quietly in a society that does not value one over the other.
Alderson K. The ecological model of gay male identity. The Canadian Journal of Human Sexuality 2003; 12(2):75-85.
Cass V. Homosexual identity formation: A theoretical model. Journal of Homosexuality 1979; 4(3):219-35.
Troiden R. The formation of homosexual identities. Journal of Homosexuality 1989; 17(1/2):43-73.
40. The evolution of prosthetics
Authors: Kam A. 
Published: May 2017

Throughout history, prosthetic limbs have undergone significant changes in design and function. For example, an ancient bronze and iron prosthesis with a wooden core, discovered in Italy and dated back to 300 BC, has evolved into a modern shock-absorbing multi-axis prosthetic foot for walking on uneven ground. Recent advances in “neuro-controlled” prosthetics with microprocessor controllers further allow their users to produce smooth, multi-joint movements, simulating “real limbs”. With an increase in government funding focusing on researches in independent mobility, it is expected that new designs will improve immensely the quality of life of amputees. Are we approaching closer to the “ideal prosthetic limb”? The objective of this paper is to examine the evolution of various prosthetic designs and to re-apply some of the old concepts into new designs. The method used is mainly literature review. Results/conclusion: N/A.
Wetz H, Gisbertz D. History of artificial limbs for the leg. Orthopade 2000; 29(12):1018-32.
Pascual G. Amputations, walking and prosthesis development. An R Acad Nac Med (Madr) 2003; 120(3):593-607.
Cottrell-Ikerd V, Ikerd F, Jenkins DW. The Syme’s amputation: a correlation of surgical technique and prosthetic management with an historical perspective 1994; 33(4):355-64.