Canadian journal of surgery. Journal canadien de chirurgie
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The goal of the Maintenance of Competence (MOCOMP) Pilot Project is to develop a comprehensive CME strategy that will motivate specialists to continuously update their clinical practice. In its 1st year the pilot program has taken several significant steps. ⋯ A diary has been implemented for specialists to record CME activities and their potential impact on practice. The MOCOMP Program is the first attempt to motivate self-directed continuing medical education (CME) through the use of a diary and the first attempt to use this instrument to encourage critical appraisal of personal CME habits.
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The authors conducted the Advanced Trauma Life Support (ATLS) Course for 90 students who were in their 4th year of medicine at the University of Manitoba. The impact of the course was evaluated through questionnaires completed by students, instructors and emergency-room physicians. The students' performances were also compared with those of 96 practising physicians who took the ATLS course in Manitoba. ⋯ Ninety-five percent of the faculty and students suggested that this course should be mandatory in the 4th year curriculum of medicine and that the course improves trauma care provided by the students and interns by increasing their confidence and improving communication with specialist surgeons. However, 10% of the faculty suggested that more time should be allocated to the surgical-skills practicum. The authors' experience with this program suggests that the ATLS course should be uniformly incorporated in the Canadian undergraduate 4th year medical curriculum and that techniques used in this course should be considered in other areas of the undergraduate medical curriculum.
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Reconstruction of long-bone fractures with compression plates may give rise to stress shielding under the metal plate, which may be associated with late clinical problems due to insufficiency fractures around the implants. Therefore, it is common practice to remove forearm plates after fracture healing is completed. ⋯ A retrospective review of the management of 111 forearm diaphyseal fractures at a major Canadian centre confirmed a substantial complication rate in elective forearm-plate removal. Because the true incidence of late insufficiency fracture is not well defined, elective forearm-plate removal may be contraindicated in the asymptomatic patient.
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Review Case Reports
[Traumatic tricuspid insufficiency with a right-to-left shunt and heart luxation].
Traumatic tricuspid insufficiency (TTI) with a right-to-left shunt through a patent foramen ovale associated with a cardiac herniation was identified in a 39-year-old man with severe hypoxemia. All reported cases of TTI with a right-to-left shunt are reviewed, the technical aspects of repair described and the physiologic mechanisms discussed.