Canada's slow adoption of new technologies adds burden to health care system

Ranking Decision-Making Criteria for Early Adoption of Innovative Surgical Technologies

Importance

There is no decision-making framework in the early-adoption stage of novel surgical technologies, putting the quality of health care and resource allocation of the health care system at risk.

Objective

To investigate relevant weighted criteria that decision-makers may use to make an informed decision for the early adoption of innovative surgical technologies.

Design, Setting, and Participants

This multi-institutional decision analytical modeling study used a mixed-methods multicriteria decision analysis (MCDA) and had 2 phases. First, a panel of 12 experts validated decision criteria in the literature and identified additional criteria. Second, 33 Canadian experts prioritized the main criteria (domains) using the composition pairwise-comparison weight-elicitation method (analytical hierarchy process model) and ranked their subcriteria using the direct-ranking elicitation method (Likert scale). Data were analyzed, and response consistency was estimated using the consistency ratio. Analysis of variance was used to assess for significant differences between expert responses. The MCDA was conducted at McGill University between 2021 and 2023. Data were collected nationally by inviting experts in Canada.

Main Outcome and Measure

Criteria domain weights and subcriteria rankings. Priority vectors, which are priority scores analyzed and prioritized from expert responses, were used to rank criteria domains and subcriteria for decision-making on adopting new innovative surgical technologies.

Results

A total of 45 experts (33 male [73.3%] and 12 female [26.7%]) were invited with different levels of education (22 experts with MD or equivalent, 13 experts with master's degree, and 12 experts with PhD degree) and years of experience (4 experts with <10, 12 experts with 11-20, 18 experts with 21-30, and 11 experts with >30 years). Surgeon experts (23 individuals) were from all surgical disciplines, and nonsurgeon experts (22 individuals) were administrative officers in surgical device procurement, health technology assessment experts, and hospital directors. A total of 7 domains and 44 subcriteria were identified. The MCDA model found that clinical outcomes had the highest priority vector, at 0.429, followed by patients and public relevance (0.135). Hospital-specific criteria (priority vector, 0.099), technology-specific criteria (priority vector, 0.092), and physician-specific criteria (priority vector, 0.087) were the next most highly ranked. The lowest priority vectors were for economic criteria, at 0.083, and finally policies and procedures, at 0.075. There was consensus in the responses (consistency ratio = 0.006), and there were no statistically significant differences between expert responses.

Conclusions and relevance

This study weighted priority criteria domains in importance and established ranked subcriteria for decision-making of early adoption of surgical technologies. Putting these criteria into a framework may help surgeons and decision-makers make informed decisions for the early adoption of new surgical technologies.

Awareness of Interventional Radiology Among Medical Students at a Saudi Medical School: Clerkship versus Pre-clerkship Years

Objectives

We sought to assess the awareness of interventional radiology (IR) as a specialty among medical students and determine any difference between the clerkship and pre-clerkship years.

Methods

We conducted a cross-sectional, survey-based study in February 2018 at King Abdulaziz University, Jeddah, Saudi Arabia. Five hundred and forty-two medical students were enrolled. The survey consisted of 17 items canvassing student awareness of and interest in IR. The data were compared using the chi-square test.

Results

A large proportion of the respondents (n = 199, 36.7%) rated their knowledge of IR as poor, and 85 (15.7%) reported that they knew nothing about IR. Only 87 students (16.1%) responded that they would consider a career in radiology. The most common reason for not considering IR was lack of knowledge (42.9%). Students in their clerkship years had more interest and exposure to IR than pre-clerkship students (73.0%, p < 0.001 and 55.7%, p = 0.030, respectively). Awareness of IR was significantly more common among those interested in diagnostic radiology and IR (65.5%, p < 0.001 and 61.5%, p = 0.010, respectively).

Conclusions

Awareness of and exposure to IR is poor among medical students, and can only be increased by a direct contribution from IR physicians to the undergraduate curriculum. Lack of a unified radiology curriculum in medical schools across the country should be addressed by the Council of Deans of Saudi Medical Schools. Involvement of the Saudi Interventional Radiology Society and Radiological Society of Saudi Arabia is essential.

Si vous pensez que c'est juste un mal de jambe… détrompez-vous: ce que les leaders en santé doivent savoir sur la maladie artérielle périphérique

Environ 800 000 Canadiens ont une maladie artérielle périphérique (MAP), une cause majeure d'amputation. Pourtant, le public et les cliniciens connaissent très peu cette maladie. Le présent article traite de la campagne de sensibilisation Si vous pensez que c'est juste un mal de jambe… détrompez-vous que l'Association canadienne du soin des plaies a lancée pour contrer cette tendance. Il porte également sur les facteurs de risque et le dépistage de la MAP, son lien avec le diabète, son traitement et ses soins, ses innovations en matière de soins de la MAP et la nécessité de faire preuve de leadership sur le plan des politiques.

Just leg pain? Think again: What health leaders must know about peripheral arterial disease

Approximately 800,000 Canadians have Peripheral Arterial Disease (PAD). Peripheral arterial disease is also a leading cause of limb amputation. Yet public and clinical awareness of PAD is very limited. This article discusses the "Just Leg Pain? Think Again" awareness campaign the Canadian Association of Wound Care has launched in response. This article also summarizes PAD risk factors, screening, linkage with diabetes, treatment and care interventions, PAD care innovations, and the need for policy leadership on this issue.

Imaging in the Age of Precision Medicine: Summary of the Proceedings of the 10th Biannual Symposium of the International Society for Strategic Studies in Radiology

During the past decade, with its breakthroughs in systems biology, precision medicine (PM) has emerged as a novel health-care paradigm. Challenging reductionism and broad-based approaches in medicine, PM is an approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle. It involves integrating information from multiple sources in a holistic manner to achieve a definitive diagnosis, focused treatment, and adequate response assessment. Biomedical imaging and imaging-guided interventions, which provide multiparametric morphologic and functional information and enable focused, minimally invasive treatments, are key elements in the infrastructure needed for PM. The emerging discipline of radiogenomics, which links genotypic information to phenotypic disease manifestations at imaging, should also greatly contribute to patient-tailored care. Because of the growing volume and complexity of imaging data, decision-support algorithms will be required to help physicians apply the most essential patient data for optimal management. These innovations will challenge traditional concepts of health care and business models. Reimbursement policies and quality assurance measures will have to be reconsidered and adapted. In their 10th biannual symposium, which was held in August 2013, the members of the International Society for Strategic Studies in Radiology discussed the opportunities and challenges arising for the imaging community with the transition to PM. This article summarizes the discussions and central messages of the symposium.

Awareness and level of knowledge of interventional radiology among medical students at a Canadian institution

PURPOSE

To assess the awareness and level of exposure of interventional radiology (IR) among medical students at a Canadian medical school. To understand how IR can be better described and introduced to medical students.

MATERIALS AND METHODS

Electronic anonymous surveys were sent to 542 medical students in their first, second, and third years at a Canadian 3-year medical school. A total of 103 students (19%) responded. Each survey contained 17 questions assessing knowledge, interest, and perception of IR.

RESULTS

Fifty-three percent (55/103) of respondents reported "poor" knowledge of IR and only 18% (19/103) said they would consider a career in IR. Respondents cited lack of knowledge (48%, 37/77) or lack of interest (43%, 33/77) as the main reasons why they would not consider IR as a career. Although 92% (95/103) of respondents could name at least one IR procedure, many (54%, 56/103) were unclear as to the duties of an interventional radiologist within the hospital. Seventy-four percent (76/103) of students stated that a mandatory 2-week rotation in radiology during clerkship would be beneficial, whereas 71% (73/103) stated that they would be interested in a 2-week IR selective during their mandatory core surgery rotation.

CONCLUSIONS

The knowledge and exposure to IR in medical school is limited. Students were eager to learn more about IR and expressed a desire for more exposure. Early exposure of medical students to IR should be introduced to attract future interventional radiologists as well as increase awareness among future referring physicians.

Shortcomings in interventional radiology in Canada and what is needed for change

PURPOSE

To describe the current and future financial needs of interventional radiology (IR) in Canada.

MATERIALS AND METHODS

The Millennium Research Group, an independent market research firm, was commissioned by the Canadian Interventional Radiology Association to create a report examining the current status and outlook of interventional radiology in Canada. This article presents some of the key findings.

RESULTS

The incidence of some of the major diseases relevant to interventional radiologists, as well as smoking and obesity, is predicted to increase over the next few years, leading to an expected increased demand for IR procedures. This will in turn further exacerbate a current shortage. To become a G7 leader in terms of number of IR procedures performed per population, Canada would need to increase its number of interventional radiologists by an additional 241% from 2005 levels. Canada must spend an additional Can$221.3 million annually to support IR in Canada, which would lead to estimated savings of at least Can$180.3 million in direct health care costs and Can$92.3 million in societal costs annually, as well as at least 402 lives and 98,010 hospital-bed days saved.

CONCLUSIONS

Canada, and more specifically hospital administrators, politicians, and medical policy-makers, must substantially increase funding, awareness, and support of interventional radiology in Canada to ensure first-world medical care to the Canadian population. By not doing so, dollars, lives, complications, and waiting times are being and will continue to be forfeited.

Awareness of Interventional Radiology among Patients Referred to the Interventional Radiology Department: A Survey of Patients in a Large Canadian Community Hospital

PURPOSE

To quantify the level of knowledge about interventional radiology (IR) among patients referred for an IR procedure and to develop recommendations on how to increase public awareness of IR.

MATERIALS AND METHODS

Paper surveys were prospectively administered to consecutive patients scheduled to undergo an IR procedure at a community hospital. The study was terminated at the accrual of 100 completed surveys.

RESULTS

Totals of 28% and 6% knew generally the job of a diagnostic radiologist and interventional radiologist, respectively, and 6% had heard of the field of IR before their referral (despite 21% having undergone a procedure previously). Before their arrival in the IR department, 87% had not received any information about IR. Three percent, 0%, 4%, 82%, and 82% had heard about uterine artery embolization, radiofrequency ablation, vertebroplasty, biopsy (any type), and angioplasty, respectively. After the procedures, 84% had a clearer view of what interventional radiologists do, but 98% believed that most others did not know what IR was. When asked how best to educate the public about IR, the responses were: unsure (39%), other (19%), pamphlets (12%), information from physicians (9%), television (8%), and Internet (7%). Overall, the mean satisfaction rate was 8.8 (with 0 representing the minimum and 10 representing the maximum), and 97% would choose IR over surgery for future treatments.

CONCLUSIONS

These data quantify and strongly support the views that (1) even among patients specifically referred to IR for a procedure, the majority of people are unaware of what the field is or may offer; and (2) most patients were satisfied with their IR experience. Six results-based recommendations are made to increase public awareness about IR.