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Within the field of global surgery, partnerships between low- and middle-income countries (LMICs) and high-income countries (HICs) are often used to improve surgical capacity and enhance surgical training. Similarly, medical rounds are common in postgraduate medical training, although joint rounds between LMICs and HICs have not been widely used. Over 1 year, 6 online joint education rounds were held for general surgery residents at the University of British Columbia and the University of Guyana. Rounds comprised resident-led case-based presentations on a surgical subspecialty topic. These rounds were evaluated by residents through an online survey and were found to be valuable and relevant to their training, with mutual and differential benefits to Canadian and Guyanese residents. This project demonstrated that joint rounds are a meaningful method to partner surgical residency programs and can provide another tool for implementation of global surgery.

Landmark trials established equivalent survival regardless of extent of breast surgery in early-stage breast cancer. However, recent studies suggest a survival advantage for breast conserving surgery (BCS) with radiotherapy (BCT). This study assesses the impact of type of surgery on overall survival (OS), breast cancer specific survival (BCSS) and local recurrence (LR) in a modern population-based cohort. Female patients aged ≥18, pT1-2pN0, who had surgery between 2006 and 2016 were identified from Breast Cancer Outcome Unit prospective database. Neoadjuvant chemotherapy patients were excluded. Multivariable Cox regression was used to assess the effect of surgical procedure on OS, BCSS, and LR on cohort with complete data. BCT was performed in 8422 patients and TM in 4034 patients. The baseline characteristics differed between the groups. Mean follow up was 8.3 years. BCT was associated with increased OS HR 1.37, p < 0.001, BCSS survival HR 1.49, p < 0.001, and similar LR HR 1.00, p > 0.90. This study supports that in early-stage breast cancer, BCT has improved BCSS compared to TM without an increased risk of LR. •In the modern era of systemic therapy, breast conserving therapy improves breast cancer specific survival over mastectomy alone in patents with early-stage node negative breast cancer.•Locoregional recurrence following breast conserving therapy is low, 3.2% at a mean follow up of 8 0.3 years, and not different for patients treated with mastectomy.•10-year breast cancer specific survival is excellent at 96.3% for women treated with breast conserving therapy, and 92.7% for patients who had mastectomy alone.

Objective This survey of Canadian general surgery residents was designed to determine their interest level, past experiences and awareness of opportunities in the field of international surgery. Methods A web-based national survey in both French and English was sent to all Canadian general surgery residents. This survey comprised 24 questions regarding demographics, education, previous international experience, interest level and perceived opportunities in international surgery. Results A 27% response rate revealed a high level of interest in international surgery among Canadian general surgery residents but a low level of awareness of the opportunities and relevant organizations. Conclusion Further initiatives are needed to increase international surgery awareness and opportunities among general surgery residents.

High-level payment data provided by Doctors of BC showed a 19.7% pay disparity in annual payments between female and male general surgeons in fiscal year 2019/20, and this was previously as high as 30% in 2012/13. This study aimed to examine the impact of targeted fee increases on pay disparity by sex over time. The top 35 fees billed by female general surgeons, representing 76.3% of total payments, were retrospectively analyzed. The pay disparity by sex was calculated for each individual fee from 2000/01 to 2019/20. There were notable billing differences between female and male general surgeons. Female surgeons billed breast oncology procedures, malignancy consultations and visits, and peritoneal malignancy surgical procedures in greater proportions than did their male counterparts. Male surgeons billed hemorrhoid banding and rigid proctosigmoidoscopy in greater proportions than their female counterparts. With targeted fee increases, pay disparity by sex worsened for 17 of the top 35 fees but improved for the other 18 from 2010/11 to 2019/20, to varying degrees, resulting in an overall reduction in pay disparity by sex from 23% to 15%. If across-the-board fee increases had been implemented instead of targeted fee increases, the disparity in 2019/20 would have been 19% instead of 15%. Targeted fee increases reduced pay disparity between male and female general surgeons compared with theoretical across-the-board fee increases in British Columbia from 2010/11 to 2019/20, but not uniformly; some fee increases resulted in increased disparity. Other physician groups should conduct a similar analysis and allocate future fee changes with the aim of improving rather than worsening disparity. Les données sur les honoraires de haut niveau fournies par les médecins britanno-colombiens ont montré une disparité salariale annuelle de 19,7 % entre les chirurgiennes et les chirurgiens pour l’année fiscale 2019/20; cette disparité atteignait 30 % en 2012/13. La présente étude visait à mesurer l’impact des augmentations ciblées des honoraires sur la disparité salariale entre les sexes au fil du temps. Les 35 principaux honoraires facturés par les chirurgiennes générales, représentant 76,3 % des paiements totaux, ont été analysés rétrospectivement. La disparité salariale selon le sexe a été calculée pour chacun des honoraires entre 2000/01 et 2019/20. On a observé des différences de facturation notables entre les chirurgiennes et les chirurgiens de chirurgie générale. Comparativement à leurs homologues masculins, les chirurgiennes ont facturé davantage pour des interventions d’oncologie mammaire, des avis et consultations pour cancer et des interventions pour des cancers péritonéaux. De leur côté, les chirurgiens ont facturé pour des ligatures d’hémorroïdes et des proctosigmoïdoscopies rigides plus que leurs homologues féminines. Avec les augmentations d’honoraires ciblées, la disparité salariale selon le sexe s’est accentuée pour 17 des 35 principaux honoraires, mais elle s’est améliorée à divers degrés pour les 18 autres, entre 2010/11 et 2019/20, donnant lieu à une réduction globale de la disparité salariale selon le sexe de 23 % à 15 %. Si on avait appliqué des augmentations généralisées des honoraires plutôt que des augmentations ciblées, la disparité en 2019/20 aurait été de 19 % plutôt que de 15 %. En Colombie-Britannique, entre 2010/11 et 2019/20, les augmentations ciblées des honoraires ont réduit la disparité salariale entre les hommes et les femmes qui exercent en chirurgie générale comparativement à des augmentations généralisées théoriques, mais non de façon uniforme; certaines augmentations d’honoraires ont aggravé la disparité. D’autres groupes de médecins gagneraient à procéder à une analyse similaire et à appliquer d’éventuels changements d’honoraires de manière à atténuer et non pas aggraver la disparité.

Contexto : Les données sur les honoraires de haut niveau fournies par les médecins britanno-colombiens ont montré une disparité salaríale annuelle de 19,7% entre les chirurgiennes et les chirurgiens pour lannée fiscale 2019/20; cette disparité atteignait 30% en 2012/13. La présente étude visait a mesurer limpact des augmentations ciblées des honoraires sur la disparité salaríale entre les sexes au fil du temps. Methodes : Les 35 principaux honoraires facturés par les chirurgiennes générales, représentant 76,3 % des paiements totaux, ont été analysés rétrospectivement. La disparité salaríale selon le sexe a été calculée pour chacun des honoraires entre 2000/01 et 2019/20. Resultats : On a observé des differences de facturation notables entre les chirurgiennes et les chirurgiens de Chirurgie générale. Comparativement a leurs homologues masculins, les chirurgiennes ont facturé davantage pour des interventions doncologie mammaire, des avis et consultations pour cancer et des interventions pour des cancers péritonéaux. De leur coté, les chirurgiens ont facturé pour des ligatures dhémorroídes et des proctosigmoidoscopies rigides plus que leurs homologues feminines. Avec les augmentations dhonoraires ciblées, la disparité salaríale selon le sexe sest accentuée pour 17 des 35 principaux honoraires, mais elle sest améliorée a divers degrés pour les 18 autres, entre 2010/11 et 2019/20, donnant lieu a une réduction globale de la disparité salaríale selon le sexe de 23 % a 15 %. Si on avait appliqué des augmentations généralisées des honoraires plutöt que des augmentations ciblées, la disparité en 2019/20 aurait été de 19% plutöt que de 15 %. Conclusion : En Colombie-Britannique, entre 2010/11 et 2019/20, les augmentations ciblées des honoraires ont réduit la disparité salaríale entre les hommes et les femmes qui exercent en Chirurgie générale comparativement a des augmentations généralisées théoriques, mais non de faqon uniforme; certaines augmentations dhonoraires ont aggravé la disparité. Dautres groupes de médecins gagneraient a procéder a une analyse similaire et a appliquer déventuels changements dhonoraires de maniere a atténuer et non pas aggraver la disparité.

Closed-suction drainage to reduce seromas is standard after mastectomy. This study evaluates the safety of early drain removal. Women undergoing mastectomy were randomized to early removal on postoperative day 2 or standard removal (<30 mL drainage in 24 hours or postoperative day 14). Primary endpoints were time to drain removal and physician visits. Secondary endpoints were number of seroma aspirations, drain reinsertions, and infections. Twenty-seven patients were recruited before an interim analysis was performed to address safety concerns. Three patients withdrew before trial completion, leaving 14 patients in the standard group and 10 in the early group. Patients in the standard group had significantly fewer seroma aspirations, fewer drain reinsertions, and fewer physician visits. The trial was halted because of the higher rate of events in the early group. Surgical drains cannot be safely removed on postoperative day 2 after mastectomy. Early removal significantly increases the occurrence of seromas requiring treatment.

This survey of Canadian general surgery residents was designed to determine their interest level, past experiences and awareness of opportunities in the field of international surgery. A web-based national survey in both French and English was sent to all Canadian general surgery residents. This survey comprised 24 questions regarding demographics, education, previous international experience, interest level and perceived opportunities in international surgery. A 27% response rate revealed a high level of interest in international surgery among Canadian general surgery residents but a low level of awareness of the opportunities and relevant organizations. Further initiatives are needed to increase international surgery awareness and opportunities among general surgery residents. Ce sondage réalisé auprès de résidents en chirurgie générale du Canada visait à connaître leur degré d’intérêt, leurs expériences et leur connaissance des possibilités en chirurgie à l’étranger. On a envoyé un questionnaire national web, en français et en anglais, à tous les résidents canadiens en chirurgie générale. Le questionnaire comportait 24 questions portant sur les caractéristiques démographiques, les études, l’expérience antérieure à l’étranger, le degré d’intérêt et les possibilités perçues en chirurgie à l’étranger. Le taux de réponse de 27 % a révélé un intérêt important à l’égard de la chirurgie à l’étranger chez les résidents canadiens en chirurgie générale, mais une faible connaissance des possibilités et des organisations pertinentes. D’autres initiatives s’imposent pour faire mieux connaître aux résidents en chirurgie générale la situation de la chirurgie à l’étranger et les possibilités qu’elle offre.

The surprising incidence of nonlethal skeletal fractures implies that many organisms operate near their upper performance limits, yet we know little about the loads at which biological structures break or about the material properties of those structures. In addition, biologically realistic estimates of how closely normal maximal loads approach breaking strengths (i.e., safety factors) remain elusive. We measured cuticular breaking strength (a material property) and safety factors (breaking force/maximum biting force) for intact claws of six species of predatory Cancer crabs (Crustacea, Brachyura). Cuticular breaking stresses in Cancer claws (40-120 MN m-2) exceeded those reported for the carapace of shore crabs (Carcinus) and swimming crabs (Scylla), but were similar to published values for the claws of stone crabs (Menippe). Cuticular breaking strength increased towards the tip of the pollex (fixed finger), correlated with visible changes in the claw cuticle, but decreased with increasing claw size. Safety factors of the pollex varied within and among Cancer species and ranged from 2 to 7. Safety factors increased with increasing claw size (∞manus length0.6), due to proportionally thicker cuticle (∞manus length1.31± 0.078) and proportionally lower maximum biting forces (∞manus length1.49± 0.082). Why larger crabs have proportionally lower biting forces remains an important unsolved problem. The higher safety factors of larger claws appear adaptive, however, since costs of failure and unpredictability of cuticle strength increase with increasing size. Patterns of intraspecific size-dependence offer an attractive test of whether safety factors vary adaptively. A brief review of the literature suggests that positive size-dependence often signals adaptive variation in safety factors, whereas negative size-dependence may signal the action of constraints on growth or form.