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Vimr M.A.,St Josephs Health Center | Thompson G.G.,Independent Consultant
Healthcare Management Forum | Year: 2011

Hospital physicians often have little formal preparation for leadership roles. The St. Joseph's Health Centre program for physician leaders includes a competency profile, personal development plans, self-directed reflective learning, and action learning groups to work on current challenges. The program, developed with the participation of physicians, is intended to promote a culture that recognizes and supports physicians' contribution to hospital leadership and in which medical staff and hospital administrators work collaboratively and share accountability. © 2011 Canadian College of Health Leaders.

Vimr M.,St Josephs Health Center | Dickens P.,Iris Group
Healthcare Management Forum | Year: 2013

In 2001, St. Joseph's Health Centre reported on its efforts to design and deliver a physician leadership program. The program was launched in Fall 2010 and has just completed its second cohort with a total of 29 physicians participating. The results and associated learning have been very encouraging. © 2013 Canadian College of Health Leaders. Published by Elsevier Inc. All rights reserved.

Devereaux M.W.,Fluid Motion Physiotherapy 2012 Ltd | Elmaraghy A.W.,University of Toronto | Elmaraghy A.W.,St Josephs Health Center
American Journal of Sports Medicine | Year: 2013

Background: Diagnosis of complete distal biceps tendon rupture (DBTR) is frequently missed or delayed on clinical examination. No single clinical test, including MRI, has demonstrated 100% efficacy in assessing the integrity of the distal biceps tendon. Hypothesis: Combining 3 validated clinical tests for identifying complete rupture can maximize a true-positive diagnosis for complete DBTR without the need for confirmatory soft tissue imaging when performed in concert with other important factors from the history and clinical examination. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The hook test, the passive forearm pronation (PFP) test, and the biceps crease interval (BCI) test were applied in sequence in conjunction with a standard patient history and physical examination on 48 patients with suspected distal biceps tendon injuries. If results on all 3 special tests were positive for complete rupture, the patient was referred for surgical repair; diagnosis was confirmed intraoperatively. If results on all 3 special tests were negative, diagnosis was confirmed with soft tissue imaging and patients were managed nonoperatively. If results of the 3 tests were not in agreement, soft tissue imaging was used to clarify the disagreement and to confirm the diagnosis. Results: Thirty-five patients had unequivocal results based on history, physical examination, and special tests. Thirty-two tested in agreement positive for complete rupture, which were confirmed intraoperatively. Three tested in agreement negative, with subsequent imaging confirming partial rupture. Thirteen patients had equivocal special test results; soft tissue imaging suggested complete rupture in 10 and partial rupture in 3. Conclusion: Application in sequence of the hook test, the PFP test, and the BCI test results in 100% sensitivity and specificity when the outcomes on all 3 special tests are in agreement. © 2013 The Author(s).

ElMaraghy A.W.,St Josephs Health Center | ElMaraghy A.W.,University of Toronto | Devereaux M.W.,University of Toronto
Journal of Shoulder and Elbow Surgery | Year: 2012

Background: Reported descriptions of pectoralis major (PM) injury are often inconsistent with the actual musculotendinous morphology. The literature lacks an injury classification system that is consistently applied and accurately reflects surgically relevant anatomic injury patterns, making meaningful comparison of treatment techniques and outcomes difficult. Materials and methods: Published cases of PM injury between 1822 and 2010 were analyzed to identify incidence and injury patterns and the extent to which these injuries fit into a classification category. Recent work outlining the 3-dimensional anatomy of the PM muscle and tendon, as well as biomechanical studies of PM muscle segments, were reviewed to identify the aspects of musculotendinous anatomy that are clinically and surgically relevant to injury classification. Results: We identified 365 cases of PM injury, with 75% occurring in the last 20 years; of these, 83% were a result of indirect trauma, with 48% occurring during weight-training activities. Injury patterns were not classified in any consistent way in timing, location, or tear extent, particularly with regard to affected muscle segments contributing to the PM's bilaminar tendon. Conclusions: A contemporary injury classification system is proposed that includes (1) injury timing (acute vs chronic), (2) injury location (at the muscle origin or muscle belly, at or between the musculotendinous junction and the tendinous insertion, or bony avulsion), and (3) standardized terminology addressing tear extent (anterior-to-posterior thickness and complete vs incomplete width) to more accurately reflect the musculotendinous morphology of PM injuries and better inform surgical management, rehabilitation, and research. © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.

Coghlan J.G.,Royal Free Hospital | Pope J.,St Josephs Health Center | Denton C.P.,Royal Free Hospital
Current Opinion in Pulmonary Medicine | Year: 2010

Connective tissue disease-associated pulmonary arterial hypertension (PAH) is mostly related to systemic sclerosis, overlap syndromes with features of systemic sclerosis, mixed connective tissue disease, and systemic lupus erythematosus. It is an important cause of mortality in these conditions and represents up to one third of patients seen in most specialist pulmonary hypertension centers. Patients with PAH associated with connective tissue disease may have a worse outcome than those with other forms of PAH. Most randomized clinical trials of PAH therapies have included patients with connective tissue disease as part of a mixed population. Overall, analyses suggest that treatment responses parallel those seen in idiopathic PAH, though subgroup analyses must be interpreted with caution. There may also be significant comorbidity from other pulmonary complications such as interstitial fibrosis, aspiration, or chest wall restriction. In addition, the majority of clinical trials have used 6-minute walk distance as the primary endpoint; the clinical relevance of this is questionable in connective tissue disease patients, who often have multiple comorbidities, other than PAH, which adversely affect exercise tolerance. © 2010 Wolters Kluwer Health. Lippincott Williams & Wilkins.

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