The country’s cardiology centers have been producing subspecialists in the field of Invasive and Interventional Cardiology. To date, 11 hospitals and/or medical centers are involved in training these subspecialists in a 1 to 2-year program. And to this date, there have been no uniform standards and guidelines as to what comprises the basic and/or acceptable training outcomes for the interventionalist in training. This paper describes the development of the core curriculum for an interventional cardiovascular training program to prepare its trainees to be competent in performing invasive diagnostic and interventional cardiovascular procedures as part of comprehensive patient care. The task force for the core curriculum of the interventional training program gathered several officers and leaders of the PSCCI, the training heads of the various interventional programs in the country, as well as experts in the field of cardiology education. Through a series of meetings, consultations, and workshops, the task force laid out the template on which all the training programs would be based. Such a framework considered the international standards regarding minimum caseloads for interventional training and the peculiar situation of each training institution. International standards like the Core Cardiovascular Training Statement (COCATS 4) Task Force 10: Training in Cardiac Catheterizations and the 2020 EAPCI Core Curriculum for Percutaneous Cardiovascular Interventions served as the reference framework for key recommendations. A consensus was achieved that upheld the highest standards of competence without disenfranchising certain institutions due to intricacies and uniqueness of hospital set-up and training situation.

Minimally invasive colorectal surgery is currently well-accepted, with open techniques being reserved for very difficult cases. Laparoscopic colectomy has been proven to have lower mortality, complication, and ostomy rates; a shorter median length of stay; and lower overall costs when compared to its open counterpart. This trend is seen in both benign and malignant indications. Natural orifice specimen extraction surgery (NOSES) in colorectal surgery was first described in the early 1990s. Three recent meta-analyses comparing transabdominal extraction against NOSES concluded that NOSES was superior in terms of overall postoperative complications, recovery of gastrointestinal function, postoperative pain, aesthetics, and hospital stay. However, NOSES was associated with a longer operative time. Herein, we present our technique of robotic NOSES anterior resection using the da Vinci Xi platform in diverticular disease and sigmoid colon cancers.

Methods: LHTD were recruited across two Western Canadian provinces from seven different truck stops. The sample completed 207 surveys and 67 semi-structured interviews. Results: The average age of the participants was 52.5 ± 11.5 years (range 24–79); 96% were men. Approximately 33% of the LHTD had at least one crash. Those who did not receive formal driver training were significantly more likely to crash than those who had received training. Participants stated that current training standards are inadequate for the industry, particularly for new drivers. According to participants, entry-level curriculums should consist of both classroom and practical training, as well as on-road observation with a senior mentor. LHTD reported that many new drivers are not equipped to drive in various contexts and settings (e.g., mountains, slippery roads). Conclusions LHTD are not confident in the current training guidelines for novice truck drivers. Revisions to the training curriculum and standardization across Canada should be considered.Practical Application: A federal mandatory entry-level training program is needed in Canada to ensure that all new LHTD ascertain the necessary skills to drive safely. Such a program requires government involvement and input from LHTD to facilitate appropriate licensure and consistent training for all drivers.

Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction. This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection (ROSI), a technique which utilizes immature precursors of spermatozoa for fertilization. An electronic search was performed to identify relevant articles published through October 2018. Human cohort studies in English involving male patients who had round spermatids identified and used for fertilization with human oocytes were included. Fertilization rate, pregnancy rate, and resultant delivery rate were assessed following ROSI. Meta-analysis outcomes were analyzed using a random-effects model. Data were extracted from 22 studies involving 1099 couples and 4218 embryo transfers. The fertilization rate after ROSI was 38.7% (95% confidence interval [CI]: 31.5%-46.3%), while the pregnancy rate was 3.7% (95% CI: 3.2%-4.4%). The resultant delivery rate was low, with 4.3% of embryo transfers resulting in a delivery (95% CI: 2.3%-7.7%). The pregnancy rate per couple was 13.4% (95% CI: 6.8%-19.1%) and the resultant delivery rate per couple was 8.1% (95% CI: 6.1%-14.4%). ROSI has resulted in clinical pregnancies and live births, but success rates are considerably lower than those achieved with mature spermatozoa. While this technique may be a feasible alternative for men with azoospermia who decline other options, couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is relatively poor.

Objective: The addition of maintenance olaparib to bevacizumab demonstrated a significant progression-free survival (PFS) benefit in patients with newly diagnosed, advanced ovarian cancer in the PAOLA-1/ENGOT-ov25 trial (NCT02477644). We evaluated maintenance olaparib plus bevacizumab in the Japan subset of PAOLA-1. Methods: PAOLA-1 was a randomized, double-blind, phase III trial. Patients received maintenance olaparib tablets 300 mg twice daily or placebo twice daily for up to 24 months, plus bevacizumab 15 mg/kg every 3 weeks for up to 15 months in total. This prespecified subgroup analysis evaluated investigator-assessed PFS (primary endpoint). Results: Of 24 randomized Japanese patients, 15 were assigned to olaparib and 9 to placebo. After a median follow-up for PFS of 27.7 months for olaparib plus bevacizumab and 24.0 months for placebo plus bevacizumab, median PFS was 27.4 versus 19.4 months, respectively (hazard ratio [HR]=0.34; 95% confidence interval [CI]=0.11–1.00). In patients with tumors positive for homologous recombination deficiency, the HR for PFS was 0.57 (95% CI=0.16–2.09). Adverse events in the Japan subset were generally consistent with those of the PAOLA-1 overall population and with the established safety and tolerability profiles of olaparib and bevacizumab. Conclusion: Results in the Japan subset of PAOLA-1 support the overall conclusion of the PAOLA-1 trial demonstrating that the addition of maintenance olaparib to bevacizumab provides a PFS benefit in patients with newly diagnosed, advanced ovarian cancer.

Methods: LHTD were recruited across two Western Canadian provinces from seven different truck stops. The sample completed 207 surveys and 67 semi-structured interviews. Results: The average age of the participants was 52.5 ± 11.5 years (range 24–79); 96% were men. Approximately 33% of the LHTD had at least one crash. Those who did not receive formal driver training were significantly more likely to crash than those who had received training. Participants stated that current training standards are inadequate for the industry, particularly for new drivers. According to participants, entry-level curriculums should consist of both classroom and practical training, as well as on-road observation with a senior mentor. LHTD reported that many new drivers are not equipped to drive in various contexts and settings (e.g., mountains, slippery roads). Conclusions LHTD are not confident in the current training guidelines for novice truck drivers. Revisions to the training curriculum and standardization across Canada should be considered.Practical Application: A federal mandatory entry-level training program is needed in Canada to ensure that all new LHTD ascertain the necessary skills to drive safely. Such a program requires government involvement and input from LHTD to facilitate appropriate licensure and consistent training for all drivers.

No abstract available.
Arthroplasty ; Bradycardia ; Cough ; Hip

Introduction: Chronic hepatitis C (CHC) infection is an important cause of chronic and end stage liver disease. Treatment response has improved with combination therapy. We review our experience with combination therapy in CHC patients. Materials and Methods: All patients who had completed at least one course of combination therapy (> 6 months) and had longer than 6 months of follow-up were retrospectively reviewed. Results: There were 28 (22 males, mean age 40.7 ± 9.9 years old) patients who completed one course of treatment. Intravenous drug use (IDU) accounted for 61% of the aetiology. The end of treatment biochemical response was 92.6%. The overall sustained viral response (SVR) was 64.3%. Comparing IDU to the others (non-IDU), there was no difference in treatment SVR (64.7% vs. 63.6%, p = 0.954). Responders had significantly higher pretreatment serum alanine aminotransferase (p = 0.018). Overall treatment side effects were observed in 64% (flu-like symptoms 58.3%, haematological 50% and depressive mood 8%). Conclusions: Our response rates are comparable to published data. There was no difference in treatment response rate between the IDU and non-IDU. CHC infected IDU should be offered treatment.