Sunnybrook Health Sciences Centre

About: Sunnybrook Health Sciences Centre is a healthcare organization based out in Toronto, Ontario, Canada. It is known for research contribution in the topics: Population & Medicine. The organization has 7689 authors who have published 15236 publications receiving 523019 citations. The organization is also known as: Sunnybrook.

Do Patient Expectations of Spinal Surgery Relate to Functional Outcome

Abstract: It is important for surgeons to understand patients’ expectations for surgery. We asked whether patient factors and preoperative functional outcome scores reflect the degree of expectations patients have for posterior spinal surgery. Second, we asked whether patients’ expectations for surgery predict improvements in functional outcome scores after surgery. We prospectively enrolled 155 consecutive surgical patients with greater than 90% followup. Patients’ expectations were evaluated preoperatively along with SF-36 and Oswestry disability questionnaires. Postoperatively (6 months for decompression; 1 year for fusions), we quantified patient-derived satisfaction regarding whether expectations were met and by patient-derived functional outcome scores. In patients undergoing decompression, gender, SF-36 general health domain, and SF-36 physical component score predicted patients with high expectations for surgery. Patients with high expectations also reported greater postoperative improvements in SF-36 role physical domain scores after surgery. Expectations for surgery were met in 81% of patients. In a subset of patients (21 of 143), expectations were not met. These patients reported lower mean preoperative SF-36 general health, vitality, and mean mental component scores. Level of Evidence: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Hospitalization for ambulatory care-sensitive conditions: a method for comparative access and quality studies using routinely collected statistics.

Abstract: Access to health care may be defined as the ability to obtain and benefit from care. Universal access to necessary care remains one of the chief goals of the health-care system in Canada. 1 Ambulatory care- sensitive conditions (ACSC) are a new neg- ative indicator of access. The rate of hospi- talization for ACSC is higher in communi- ties with poor access to ambulatory care. This paper describes the development, using consensus panels, of a Canadian set of ACSC and compares them to similar categories of care developed elsewhere. 2-4 ABSTRACT Background: Appropriate and timely provi- sion of ambulatory care is an important factor in maintaining population health and in avoid- ing unnecessary hospital use. This article describes conditions for which hospitalization rates have a strong and inverse relationship to access to high-quality ambulatory care. Methods: Three panels of Canadian physi- cians following different consensus techniques selected conditions for which the relative risk of hospitalization is inversely related to ambu- latory care access. Principal Findings: All panels identified asth- ma, angina pectoris, congestive heart failure, otitis media, gastric ulcer, pelvic inflammatory disease, malignant hypertension, and immunization- preventable infections as ambulatory care- sensitive admissions. These conditions strongly overlap with lists developed for similar purpos- es in the U.S. and England. Interpretation: Ambulatory care-sensitive conditions represent an intermediate health outcome. They are distinct from inappropriate hospitalizations. They may be useful for mea- suring the impact of health care policy, and for performance measurement or audit.

Nursing emotion work and interprofessional collaboration in general internal medicine wards: a qualitative study

Abstract: Title. Nursing emotion work and interprofessional collaboration in general internal medicine wards: a qualitative study Aim. This paper is a report of a study to examine nursing emotion work and interprofessional collaboration in order to understand and improve collaborative nursing practice. Background. Nursing standards identify collaborative practice as necessary for quality patient care yet many nurses are often reluctant to participate in interprofessional teams. Strategies intended to improve participation often fail which suggests that the factors underpinning nurses’ disinclination towards interprofessional collaboration have yet to be understood. The concept of emotion work has not been applied to nursing interprofessionalism, and holds the potential to improve collaborative practice. Nursing emotion work is defined as the management of the emotions of self and others in order to improve patient care. Methods. Qualitative data were collected in 2006 using non-participant observation, shadowing and semi-structured interviews with nursing, medical and allied professionals in the general internal medicine wards of three hospitals in urban Canada. Findings. Nurses’ collaborations with other professionals are influenced by emotion work considerations. The establishment and maintenance of a nursing esprit de corps, corridor conflicts with physicians, and the failure of the interdisciplinary team to acknowledge the importance of nursing’s core caring values are important factors underpinning nurses’ interprofessional disengagement. Conclusion. Longstanding emotion work issues must be addressed before nurses will engage collaboratively. We suggest improving nursing collaboration through the refining of holistic nursing information, and reflections on practice by all interprofessional team members.

CT texture features are associated with overall survival in pancreatic ductal adenocarcinoma – a quantitative analysis

Abstract: To assess whether CT-derived texture features predict survival in patients undergoing resection for pancreatic ductal adenocarcinoma (PDAC). Thirty patients with pre-operative CT from 2007 to 2012 for PDAC were included. Tumor size and five texture features namely uniformity, entropy, dissimilarity, correlation, and inverse difference normalized were calculated. Mann–Whitney rank sum test was used to compare tumor with normal pancreas. Receiver operating characteristics (ROC) analysis, Cox regression and Kaplan-Meier tests were used to assess association of texture features with overall survival (OS). Uniformity (p < 0.001), entropy (p = 0.009), correlation (p < 0.001), and mean intensity (p < 0.001) were significantly different in tumor regions compared to normal pancreas. Tumor dissimilarity (p = 0.045) and inverse difference normalized (p = 0.046) were associated with OS whereas tumor intensity (p = 0.366), tumor size (p = 0.611) and other textural features including uniformity (p = 0.334), entropy (p = 0.330) and correlation (p = 0.068) were not associated with OS. CT-derived PDAC texture features of dissimilarity and inverse difference normalized are promising prognostic imaging biomarkers of OS for patients undergoing curative intent surgical resection.

Sexual functioning in breast cancer survivors experiencing body image disturbance

Abstract: Background Breast cancer treatments and the traumatic nature of the cancer experience frequently elicit considerable sexual difficulties. Breast cancer survivors (BCS) experiencing body image (BI) issues may represent a vulnerable group for developing sexual dysfunction posttreatment. The current study explores sexual functioning (SF) in this unique clinical group. Methods A descriptive study assessed 127 BCS who were engaged in sexual activity. Standardized baseline measures included the following: BI Scale, BI after Breast Cancer Questionnaire, Female Sexual Function Index (FSFI), Kansas Marital Satisfaction Scale, and Functional Assessment of Cancer Therapy – Breast. Levels of SF were compared with BCS, heterogeneous cancer, and healthy female populations. Correlational analyses were conducted between SF, BI, relationship, and health-related quality of life variables. Guided by a conceptual framework, regression analyses were conducted to determine significant demographic, clinical, and psychosocial predictors of sexual desire, satisfaction, and overall SF. Results Eighty-three per cent of BCS met the FSFI clinical cutoff score for a sexual dysfunction. Participants exhibited poorer SF when compared with other female cancer and healthy groups. No significant correlations were found between BI questionnaire total scores and SF. BI after Breast Cancer Questionnaire – Body Stigma subscale showed significant associations with FSFI Arousal, Orgasm, Satisfaction (average r = −0.23), and overall SF (r = −0.25). Vaginal dryness (β = −0.50), body stigma (β = −0.24), and relationship satisfaction (β = 0.27) were significant predictors of overall SF. Conclusion Difficulties in SF appear to be highly prevalent in BCS experiencing BI disturbance posttreatment. Brief screening tools assessing SF should adopt a biopsychosocial model, which includes questions regarding vaginal dryness, relationship satisfaction, and body stigma issues. Copyright © 2015 John Wiley & Sons, Ltd.