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ABSTRACT Background: Despite female genital mutilation/cutting (FGM/C) practices being an illegal form of gender-based violence in Canada, this practice impacts many Canadians. Lack of education and training among Canadian health-care providers has resulted in systematic barriers to care. Awareness and FGM/C-related education among Canadian health-care providers must be urgently assessed. Methods: Canadian medical students were recruited to complete an anonymous survey via E-mails distributed through their schools' student organization between January and March 2021. We evaluated student understanding of FGM/C, attitudes toward medicalization and legislation, and prior clinical experience using multiple choice, Likert scale, and open-response questions. Results: Respondents (n = 135) performed poorly on knowledge assessment questions (mean percent correct <50%). Only 10.4% of respondents indicated knowing how to involve appropriate authorities when necessary, and most never evaluate FGM/C in patient history (86.7%) or clinical examination (57.1%). Subgroup analysis revealed that prior education significantly improved knowledge scores and influenced students' behaviors and attitudes. About 92.2% of respondents supported the integration of FGM/C curricula in undergraduate medical education. Discussion: This study reveals that Canadian medical students have a poor understanding of FGM/C and are not prepared to identify affected patients or intervene when necessary. These results provide rationale for the implementation of FGM/C-learning modules in undergraduate medicine.

Orofacial cleft (OFC) is one of the most common congenital malformations, with a wide variation in incidence worldwide. However, population-based studies on the incidence of OFC in North America are lacking. To examine the incidence of OFC in Ontario, Canada, and to compare risk factors and mortality associated with children with OFC vs children without OFC. This population-based retrospective cohort study used health administrative data from the province of Ontario, Canada. Children with OFC who were born from April 1, 1994, to March 31, 2017, in Ontario were each matched to 5 children without OFC based on sex, date of birth (±30 days), and mother's age (±5 years). Analyses were conducted from September 2018 to January 2019. Children born with OFC. Incidence of OFC over time and regional variation. Risk factors for OFC were assessed using 1-way analysis of variance for means, Kruskal-Wallis for medians, and χ2 tests for categorical variables. Adjusted Cox regression models were used to assess mortality. From 1994 to 2017, 3262 children were born with OFC in Ontario, Canada, and they were matched to 15 222 children born without OFC. Incidence of OFC in Ontario was 1.12 cases per 1000 live births, with wide geographic variation and a lower incidence from 2004 to 2017 compared with 1994 to 2003 (1.02 vs 1.13 cases per 1000 live births; P = .002), especially for the subgroup with cleft palate (0.52 vs 0.44 cases per 1000 live births; P = .006). Children with OFC, compared with children without OFC, were more likely to be born prematurely (406 children [13.3%] vs 1086 children [7.1%]; P < .001; standardized difference, 0.21) and had lower mean (SD) birth weight (3215.3 [687.6] g vs 3382.6 [580.0] g; P < .001; standardized difference, 0.26). The mortality rate among children with OFC was higher than among matched children without OFC (hazard ratio, 10.60; 95% CI, 7.79-14.44; P < .001). When mortality was adjusted for the presence of congenital or chromosomal anomalies, the risk of death was not significantly different between children with OFC and those without OFC (hazard ratio, 1.35; 95% CI, 0.73-2.72). These findings suggest that incidence of OFC In Ontario, Canada, decreased from 1994 to 2017. Mortality in children with OFC was high, especially in the first 2 years of life, and was predominantly associated with the presence of other congenital or chromosomal anomalies. Further research is required to better understand the causes of wide geographical variations of OFC incidence and improve the survival of these patients.

Background The use of virtual care has increased dramatically in response to the COVID-19 pandemic, yet evidence is lacking regarding the impact of virtual care on patient outcomes, particularly in pediatrics. A standardized evaluation approach is required to support the integration of virtual care into pediatric health care delivery programs. The objective of this work was to develop a comprehensive and structured framework for pediatric virtual care evaluation. This framework is intended to engage and guide care providers, health centres, and stakeholders towards the development of a standardized approach to the evaluation of pediatric virtual care. Methods We brought together a diverse multidisciplinary team, including pediatric clinicians, researchers, digital health leads and analysts, program leaders, a human factors engineer, a family advisor and our manager of health equity and diversity. The team reviewed the literature, including published evaluation frameworks, and used a consensus-based method to develop a virtual care evaluation framework applicable to a broad spectrum of pediatric virtual care programs. We used an iterative process to develop framework components, including domains and sub-domains, examples of evaluation questions, measures, and data sources. Team members met repeatedly over seven months to generate and provide feedback on all components of the framework, making revision as needed until consensus was reached. The framework was then applied to an existing virtual care program. Results The resulting framework includes four domains (health outcomes, health delivery, individual experience, and program implementation) and 19 sub-domains designed to support the development and evaluation of pediatric virtual care programs. We also developed guidance on how to use the framework and illustrate its utility by applying it to an existing pediatric virtual care program. Conclusions This virtual care evaluation framework expands on previously developed frameworks by providing additional detail and a structure that supports practical application. It can be used to evaluate a wide range of pediatric virtual care programs in a standardized manner. Use of this comprehensive yet easy to use evaluation framework will inform appropriate implementation and integration of virtual care into routine practice and support its sustainability and continuous improvement.

Capillary malformation-arteriovenous malformation (CM-AVM) is a clinical entity newly identified in 2003 that is caused by mutation of the RASA-1 gene, which encodes the protein p120-RasGAP. To date, most of the clinical reports on CM-AVM in the literature involve samples entirely consisting of Caucasians of European and North American descent, while reports from China or East Asia are few. Here, we describe a genetic clinical report of CM-AVM. Sequencing revealed a novel stop mutation in the RASA-1 gene causing loss of function (LOF) of the RasGAP domain. To our knowledge, this is the first genetic clinical report of a CM-AVM patient in East Asia. This report may extend our understanding and support further studies of CM-AVM in East Asia.

Background Spitz nevi are uncommon melanocytic neoplasms found in children. Historically, the diagnosis and management of these tumors has lacked consensus among oncologists, pathologists, plastic surgeons, and dermatologists. Once interpreted and treated as a “juvenile melanoma”, many have argued for the benignancy of such tumors in certain patient age groups, encouraging a conservative approach. The lack of consensus surrounding the diagnosis and perceived malignant potential of these tumors has led physicians to approach them on a case-by-case basis and institutional protocols. To date, no evidence-based management guideline exists. The objective of this systematic review is to both collect and appraise the evidence on the diagnosis and management of these tumors. Methods A comprehensive electronic literature search will be conducted in PubMed, MEDLINE, Embase, and the Cochrane Library from inception to December 2016. Our search involved collaborating with a healthcare librarian to create a strategy for the OVID/MEDLINE databases. A search of electronic databases for oncology, pathology, plastic surgery, and dermatology abstracts will be performed. Key search terms will include, among several others, “Spitz nevi,” “Spitzoid melanoma,” “juvenile tumor,” and “pediatric”. The language of publication will be restricted to English and French. Wherever data allows, meta-analyses will be used to assess differences between Spitz nevi and the tumor of comparison. Additionally, data extraction and summarization using tables will be performed. This review has been registered with PROSPERO (CRD42016034045). Conclusions This review will systematically and comprehensively review diagnostic and management practices associated with the Spitz nevus. This overview of current literature will hopefully provide the foundation for future standardization of clinical practice. Systematic review registration PROSPERO CRD42016034045

Background: Pierre Robin sequence (PRS) is a triad of micrognathia, glossoptosis, and respiratory distress. There is no standard clinical classification used in the management of neonatal airway in patients with PRS. The goal of our study was to review the presentation and management of patients with PRS and formulate a clinical grading system and treatment algorithm. Methods: A 10-year retrospective review of all neonates diagnosed with PRS was performed after obtaining institutional ethics approval. Patients were identified using our cleft lip and palate program database. Inclusion criteria were 2 of the following 3 clinical features—glossoptosis, retrognathia, or airway obstruction. We collected demographic data, clinical information (coexisting airway morbidity, maxillary-mandibular discrepancy, type of intervention used, complications, and outcomes (feeding, length of stay, and airway status) during the first year of life. Results: Sixty-three patients met our inclusion criteria. Of these, 55 (87%) had cleft palate and 17 (27%) were syndromic. Forty-eight (76%) patients were managed by prone positioning. Of the 15 surgically managed patients, the initial procedure was floor of mouth release in 7, mandibular distraction osteogenesis (MDO) in 4, and tongue-lip adhesion in 4. Five patients with coexisting airway morbidity needed a second surgery; 2 had MDO and 3 tracheostomies (one patient was later decannulated). Seven (47%) of the surgically managed patients required a gastrostomy tube. Conclusion: At present, there is no consensus on neonatal airway management in infants with PRS. From our review of 63 patients with PRS, we hereby propose a simple 4-point classification system and treatment algorithm, based on clinical features.

Surgery has become increasingly recognized as an important component of health care in low and middle income countries (LMICs). Many surgeons from high income countries (HICs) are interested in working on improving access to surgery in LMICs. We sought to evaluate the involvement and potential barriers of Canadian plastic surgeons and plastic surgery residents in international work with an online survey. The survey indicated that plastic surgery residents have a high interest and involvement in international electives, with 45% of graduating residents previously involved. About 40% of respondents were involved in international projects, and academic plastic surgeons were more frequently involved than community surgeons. Taking time off work and personal/family commitments were cited as the greatest obstacles for those who are currently involved, whereas finding opportunities was the biggest challenge for those who would like to participate in the future.

Introduction: Lymphatic malformations are benign, low-flow vascular malformations that typically present at or near birth. Due to morbidity associated with operative treatment, nonoperative treatment with injection of sclerosant has become the mainstay of therapy. Over the past 15 years, several patients at our centre with macrocystic (>2 cm cyst size) lymphatic malformations have seen their lesions resolve spontaneously while awaiting treatment. In this study, we review features of these patients that may contribute to spontaneous resolution. Method: A retrospective chart review was conducted from our Vascular Anomalies Clinic database (1999-2014) of all macrocystic lymphatic malformations; characteristics of patients with spontaneous resolution were reviewed. Results: Of 61 patients with macrocystic lymphatic malformations, 7 cases (11.5%; 4 females, 3 males) resolved spontaneously. Median age at malformation appearance was 2 years (range: 0-6.5 years), with median age at resolution of 4 years (range: 10 months-7 years). Median time from appearance to resolution was 24 months (range: 3-43 months), with a median follow-up time of 4 years (range: 1-15 years). All but 1 case was associated with local or upper respiratory tract infection antecedent to resolution. Six of the 7 lesions were located in the neck. Conclusion: Among the cases reviewed, there was a common theme of upper respiratory tract or local infection antecedent to spontaneous lesion resolution. Compared to the literature, our proportion of malformations presenting after birth and the proportion of malformations presenting in the neck region were higher than those of other series. Although side effects associated with treatment are generally mild and/or rare, risks related to sclerotherapy and the accompanying requirement for general anesthesia in pediatric populations nevertheless exist. As the median time from lesion appearance to resolution was 24 months, it may be reasonable to observe these malformations for up to 24 months before proceeding with treatment if the lesion does not impair function and disfigurement is not considerable, particularly if the lesion presents after birth and/or is located in the neck region.

IntroductionViolence against women and girls (VAW) is a global public health problem. Burn-related violence against women and girls (BVAW) has been reported in many countries regardless of national income. The international burns community has unique insights into BVAW and play a major role in BVAW secondary prevention. In 2018, the International Society of Burn Injuries (ISBI) Prevention Committee’s (ISBIPC) began the ‘Burn-related violence against women and girls initiative’.MethodsA BVAW integrative review was published by ISBIPC members and colleagues in 2021. In 2022, ISBIPC members and Australian colleagues have begun an Australian BVAW research study involving analysis of BVAW data within the Burn Registry of Australia and New Zealand (BRANZ). BRANZ collects data on people with burn injuries admitted to Australian and New Zealand burn centres for 24 hours or more. A BVAW secondary prevention project is occurring concurrently involving:benchmarking current BVAW identification and intervention practices in Australian burn centres,a literature review to summarise evidence regarding the efficacy of BVAW secondary prevention programs,engagement with national family/interpersonal violence stakeholders to develop standardised Australian burn centre guidelines for BVAW identification and intervention.ResultsKornhaber et al’s integrative review, which included 15 studies, identified that the social determinants of health risk factors for BVAW were similar to risk factors for broader VAW. These included low socioeconomic status, unemployment, illiteracy, lack of financial independence, and living in cultures more tolerant of gender inequality. Perpetrators of BVAW were mostly spouses of injured women in context of marital, family or financial issues. Injuries were mostly caused by flames or acid, and were associated with high mortality. Overall limited BVAW evidence exists. Results from the registry study and advocacy plan will be presented at the congress.Learning OutcomesBVAW like VAW is socially complex and multicausal. The burns community has an opportunity and responsibility to optimise interventions in burn centres for BVAW secondary prevention. Effective sustainable solutions require collaboration across organisational and professional boundaries. Following the initial Australian trial, the ISBIPC plans to replicate the BVAW secondary prevention project in other countries.

The aim of this study was investigating the characteristic and outcome of self-immolation cases admitted to the Burn Centre of Birjand, Iran over an eight year period. This study is a retrospective review of case notes for patients with self-Immolation and admitted to our referral burn centre in the last 8 years (January 2003-January 2011). A performa was designed to collect the data such as: demographic information, length of hospital stay, extent of the burn injuries as %TBSA (Total Body Surface Area) and final outcome. Data was analyzed by SPSS software. Between 2003 and 2011, 188 self-immolation cases admitted. The mean age was 26.97 ±12.6 years. Female to male ratio was 1.7:1. Housewives represented the largest group (43.1%) and kerosene was the most frequent agent used (74.6%). There was significant different between mortality and TBSA and low educational level (P=0.0001). There was a significant fluctuation time trend in the incidence (per 100,000 population) of self-immolation from 2003 (4.64, CI 95%: 4.62-4.65) to 2008 (5.2, CI 95%: 5.19-5.21). Mortality rate was 64%. The survival rates at three weeks survival for patients who self-immolated was 24 percent (CI 95%: 17-31). The mean and median survival times were 6 days (CI 95%: 4.8-7.2) and 17.5 days (CI 95%: 13.3-21.6), respectively. Our study has shown a lower incidence of self-immolation (5.3%) in the South Khorasan region, when compared with other parts of Iran, as well as a relatively low mortality rate. We have also reported self-immolation in pregnant women which has rarely been reported in medical literature.