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Lie JJ, Huynh C, Li J, Mak N, Wiseman SM. Psychological Impact of the COVID-19 Pandemic on Canadian Surgical Residents: A Province-Wide Study. J Surg Educ 2024; 81:486-494. [PMID: 38388311 DOI: 10.1016/j.jsurg.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/22/2023] [Accepted: 12/22/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVES The objective of this study was to evaluate the psychological impact of the COVID-19 pandemic on surgical residents. DESIGN An online survey was distributed evaluating multiple domains: demographics, health and socioeconomic factors, clinical experience, educational experience, and psychological outcomes. The Mayo Clinic Resident Well-Being Index (RWBI) was used as a validated measure of resident mental health. SETTING AND PARTICIPANTS Surgical residents from University of British Columbia's surgical residency programs. RESULTS A total of 31/86 surgical residents responded to the survey. Of which, 57% and 46% reported feeling burned out or depressed, respectively. Residents who were concerned about personal protective equipment supply and who lived with family members with comorbidities had a higher risk of depression (p = 0.03, p = 0.04). The median Mayo Clinic Resident Well-Being Index was 2.5, higher than the median of 2 observed in the United States national survey of residents. CONCLUSIONS The pandemic had a considerable negative impact on the psychological well-being of surgical residents.
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Affiliation(s)
- Jessica J Lie
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline Huynh
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Li
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Mak
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada.
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Wells A, Lokanathan R, Webb M, Lie JJ. In situ open repair of renal artery aneurysm in 43-year-old with solitary kidney: a case report. J Surg Case Rep 2023; 2023:rjad702. [PMID: 38164214 PMCID: PMC10758240 DOI: 10.1093/jscr/rjad702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024] Open
Abstract
Renal artery aneurysms are rare. Indications for management include size > 3 cm, female gender within childbearing age, pain, hematuria, medically refractory hypertension, thromboembolism, dissection, and rupture. Management options include endovascular, open repair, and ex vivo approaches. A 43-year-old female with a history of polycystic kidney disease, solitary kidney, and uncontrolled hypertension was found to have a proximal large renal aneurysm on imaging. The patient underwent an in situ open aneurysm resection, temporary shunt insertion, and patch repair with good postoperative outcomes. Whereas previous studies showed the success of ex vivo repair and autotransplantation in large aneurysms with solitary kidneys, our case demonstrated that in situ open repair and patch with the use of a temporary shunt is a feasible and effective option. In a patient with a solitary kidney and large proximal renal artery aneurysm, an in situ open approach and patch repair with shunt insertion should be considered.
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Affiliation(s)
- Alix Wells
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Ramesh Lokanathan
- Department of Surgery, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Department of Surgery, University Hospital of Northern British Columbia, Prince George, BC V2M 1S2, Canada
| | - Mitchell Webb
- Department of Surgery, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Department of Surgery, University Hospital of Northern British Columbia, Prince George, BC V2M 1S2, Canada
| | - Jessica J Lie
- Department of Surgery, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Lie JJ, Nabata K, Zhang JW, Zhao D, Park CM, Hameed SM, Dawe P, Hamilton TD. Factors associated with recurrent appendicitis after nonoperative management. Am J Surg 2023; 225:915-920. [PMID: 36925417 DOI: 10.1016/j.amjsurg.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND The objective of this study is to identify predictors for recurrent appendicitis in patients with appendicitis previously treated nonoperatively. METHODS This is a prospective cohort study of all adult patients with appendicitis treated at a tertiary care hospital. Patient demographics, radiographic information, management, and clinical outcomes were recorded. The primary outcome was recurrent appendicitis within 6 months after discharge from the index admission. Given the competing risk of interval appendectomy, a time-to-event competing-risk analysis was performed. RESULTS Of the 699 patients presenting with appendicitis, 74 were treated nonoperatively (35 [47%] were women; median [IQR] age, 48 [33,64] years), and 21 patients (29%) had recurrent appendicitis. On univariate and multivariate analysis, presence of an appendicolith on imaging was the only factor associated with a higher risk of recurrent appendicitis (p = 0.02). CONCLUSIONS The presence of appendicolith was associated with an increased risk of developing recurrent appendicitis within 6 months.
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Affiliation(s)
- Jessica J Lie
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Kylie Nabata
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - Jenny W Zhang
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada.
| | - Darren Zhao
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada.
| | - Chan Mi Park
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA.
| | - S Morad Hameed
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - Philip Dawe
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - Trevor D Hamilton
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
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Lie JJ, Yoon HM, Karimuddin AA, Raval MJ, Phang PT, Ghuman A, Lee LH, Stuart H, Brown CJ. Management of rectal neuroendocrine tumours by transanal endoscopic microsurgery. Colorectal Dis 2023; 25:1026-1035. [PMID: 36747381 DOI: 10.1111/codi.16506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 02/08/2023]
Abstract
AIM The objective of this study was to evaluate the safety and effectiveness of transanal endoscopic microsurgery for rectal neuroendocrine tumours. METHOD A retrospective cohort study of all pathology-confirmed rectal neuroendocrine tumours treated by transanal endoscopic microsurgery from April 2007 to December 2020 at a tertiary care centre was performed. Demographic, clinical, radiographic and pathological data were collected. Characteristics of patients with recurrence were examined. Descriptive statistics were performed. RESULTS There were 58 patients treated by transanal endoscopic microsurgery excision. Referrals were for primary excision (15, 25.9%), completion re-excision after incomplete endoscopic removal (38, 65.5%) or locally recurrent rectal neuroendocrine tumours (5, 8.6%). The mean age of patients was 56.4 ± 11.9 years and 26 patients were women (44.8%). Mean tumour size was 7.4 ± 3.8 mm (range 1.0-15.0 mm). Most (86.4%) were Grade 1 tumours. Mean operative time was 37.2 ± 17.2 min and 56 patients (96.6%) were discharged on the same day. All patients had negative margins on final pathology. Of the 38 patients who were referred for completion re-excision after incomplete endoscopic removal, eight (21.1%) had residual tumour on final pathology. Three recurrences were diagnosed at 2.1, 4.5 and 12.5 years after excision. All recurrences were from Grade 1 or 2 primary tumours, less than 2 cm, and diagnosed radiographically. CONCLUSION To date, this is the largest North American study looking at transanal endoscopic microsurgery for rectal neuroendocrine tumours. This technique is effective in managing primary, incompletely excised and recurrent tumours with good clinical and oncological outcomes.
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Affiliation(s)
- Jessica J Lie
- Department of Surgery, University of British Columbia, British Columbia, Vancouver, Canada.,Harvard T.H. Chan School of Public Health, Massachusetts, Boston, USA
| | - Hyea Min Yoon
- Department of Surgery, St Paul's Hospital, British Columbia, Vancouver, Canada
| | - Ahmer A Karimuddin
- Department of Surgery, University of British Columbia, British Columbia, Vancouver, Canada.,Department of Surgery, St Paul's Hospital, British Columbia, Vancouver, Canada
| | - Manoj J Raval
- Department of Surgery, University of British Columbia, British Columbia, Vancouver, Canada.,Department of Surgery, St Paul's Hospital, British Columbia, Vancouver, Canada
| | - P Terry Phang
- Department of Surgery, University of British Columbia, British Columbia, Vancouver, Canada.,Department of Surgery, St Paul's Hospital, British Columbia, Vancouver, Canada
| | - Amandeep Ghuman
- Department of Surgery, University of British Columbia, British Columbia, Vancouver, Canada.,Department of Surgery, St Paul's Hospital, British Columbia, Vancouver, Canada
| | - Lik Hang Lee
- Department of Pathology and Laboratory Medicine, University of British Columbia, British Columbia, Vancouver, Canada
| | - Heather Stuart
- Department of Surgery, University of British Columbia, British Columbia, Vancouver, Canada
| | - Carl J Brown
- Department of Surgery, University of British Columbia, British Columbia, Vancouver, Canada.,Department of Surgery, St Paul's Hospital, British Columbia, Vancouver, Canada
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Park CM, Inouye SK, Marcantonio ER, Metzger E, Bateman BT, Lie JJ, Lee SB, Levin R, Kim DH. Perioperative Gabapentin Use and In-Hospital Adverse Clinical Events Among Older Adults After Major Surgery. JAMA Intern Med 2022; 182:1117-1127. [PMID: 36121671 PMCID: PMC9486639 DOI: 10.1001/jamainternmed.2022.3680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/03/2022] [Indexed: 12/14/2022]
Abstract
Importance Gabapentin has been increasingly used as part of a multimodal analgesia regimen to reduce opioid use in perioperative pain management. However, the safety of perioperative gabapentin use among older patients remains uncertain. Objective To examine in-hospital adverse clinical events associated with perioperative gabapentin use among older patients undergoing major surgery. Design, Setting, and Participants This retrospective cohort study using data from the Premier Healthcare Database included patients aged 65 years or older who underwent major surgery at US hospitals within 7 days of hospital admission from January 1, 2009, to March 31, 2018, and did not use gabapentin before surgery. Data were analyzed from June 14, 2021, to May 23, 2022. Exposures Gabapentin use within 2 days after surgery. Main Outcomes and Measures The primary outcome was delirium, identified using diagnosis codes, and secondary outcomes were new antipsychotic use, pneumonia, and in-hospital death between postoperative day 3 and hospital discharge. To reduce confounding, 1:1 propensity score matching was performed. Risk ratios (RRs) and risk differences (RDs) with 95% CIs were estimated. Results Among 967 547 patients before propensity score matching (mean [SD] age, 76.2 [7.4] years; 59.6% female), the rate of perioperative gabapentin use was 12.3% (119 087 patients). After propensity score matching, 237 872 (118 936 pairs) gabapentin users and nonusers (mean [SD] age, 74.5 [6.7] years; 62.7% female) were identified. Compared with nonusers, gabapentin users had increased risk of delirium (4040 [3.4%] vs 3148 [2.6%]; RR, 1.28 [95% CI, 1.23-1.34]; RD, 0.75 [95% CI, 0.75 [0.61-0.89] per 100 persons), new antipsychotic use (944 [0.8%] vs 805 [0.7%]; RR, 1.17 [95% CI, 1.07-1.29]; RD, 0.12 [95% CI, 0.05-0.19] per 100 persons), and pneumonia (1521 [1.3%] vs 1368 [1.2%]; RR, 1.11 [95% CI, 1.03-1.20]; RD, 0.13 [95% CI, 0.04-0.22] per 100 persons), but there was no difference in in-hospital death (362 [0.3%] vs 354 [0.2%]; RR, 1.02 [95% CI, 0.88-1.18]; RD, 0.00 [95% CI, -0.04 to 0.05] per 100 persons). Risk of delirium among gabapentin users was greater in subgroups with high comorbidity burden than in those with low comorbidity burden (combined comorbidity index <4 vs ≥4: RR, 1.20 [95% CI, 1.13-1.27] vs 1.40 [95% CI, 1.30-1.51]; RD, 0.41 [95% CI, 0.28-0.53] vs 2.66 [95% CI, 2.08-3.24] per 100 persons) and chronic kidney disease (absence vs presence: RR, 1.26 [95% CI, 1.19-1.33] vs 1.38 [95% CI, 1.27-1.49]; RD, 0.56 [95% CI, 0.42-0.69] vs 1.97 [95% CI, 1.49-2.46] per 100 persons). Conclusion and Relevance In this cohort study, perioperative gabapentin use was associated with increased risk of delirium, new antipsychotic use, and pneumonia among older patients after major surgery. These results suggest careful risk-benefit assessment before prescribing gabapentin for perioperative pain management.
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Affiliation(s)
- Chan Mi Park
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Sharon K. Inouye
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Edward R. Marcantonio
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Eran Metzger
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Jessica J. Lie
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Park CM, Dhawan R, Lie JJ, Sison SM, Kim W, Lee ES, Kim JH, Kim DH. Functional status recovery trajectories in hospitalised older adults with pneumonia. BMJ Open Respir Res 2022; 9:9/1/e001233. [PMID: 35545298 PMCID: PMC9096550 DOI: 10.1136/bmjresp-2022-001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background and objectives Pneumonia is associated with significant mortality and morbidity in older adults. We investigated changes in functional status over 6 months after pneumonia hospitalisation by frailty status. Methods and measurements This single-centre prospective cohort study enrolled 201 patients (mean age 79.4, 37.3% women) who were hospitalised with pneumonia. A deficit-accumulation frailty index (range: 0–1; robust <0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, severely frail ≥0.45) was calculated on admission. Functional status, defined as self-reported ability to perform 21 activities and physical tasks independently, was measured by telephone at 1, 3 and 6 months after discharge. Group-based trajectory model was used to identify functional trajectories. We examined the probability of each trajectory based on frailty levels. Results On admission, 51 (25.4%) were robust, 43 (21.4%) pre-frail, 40 (20.0%) mild-to-moderately frail and 67 (33.3%) severely frail patients. Four trajectories were identified: excellent (14.4%), good (25.4%), poor (28.9%) and very poor (31.3%). The trajectory was more strongly correlated with frailty level on admission than pneumonia severity. The most common trajectory was excellent trajectory (59.9%) in robust patients, good trajectory (74.4%) in pre-frail patients, poor trajectory (85.0%) in mild-to-moderately frail patients and very poor trajectory (89.6%) in severely frail patients. The risk of poor or very poor trajectory from robust to severely frail patients was 11.8%, 25.6%, 92.5% and 100%, respectively. Conclusions Frailty was a strong determinant of lack of functional recovery over 6 months after pneumonia hospitalisation in older adults. Our results call for hospital-based and post-acute care interventions for frail patients.
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Affiliation(s)
- Chan Mi Park
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.,Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, USA
| | - Ravi Dhawan
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessica J Lie
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.,Division of General Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie M Sison
- VA New England Geriatric Research Education and Clinical Center, Bedford, Massachusetts, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Wonsock Kim
- Department of Family Medicine, Eulji University College of Medicine, Gyeonggi-do, Republic of Korea .,Korea University School of Medicine, Seoul, Republic of Korea
| | - Eun Sik Lee
- Department of Family Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Bundang CHA Medical Center, Seongnam, Republic of Korea
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Lie JJ, Huynh C, Scott TM, Karimuddin AA. Optimizing Resident Wellness During a Pandemic: University of British Columbia's General Surgery Program's COVID-19 Experience. J Surg Educ 2021; 78:366-369. [PMID: 32747316 PMCID: PMC7368914 DOI: 10.1016/j.jsurg.2020.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/21/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The University of British Columbia's General Surgery Program delineates a unique and systematic approach to wellness for surgical residents during a pandemic. SUMMARY BACKGROUND DATA During the COVID-19 pandemic, health care workers are suffering from increased rates of mental health disturbances. Residents' duty obligations put them at increased physical and mental health risk. It is only by prioritizing their well-being that we can better serve the patients and prepare for a surge. Therefore, it is imperative that measures are put in place to protect them. METHODS Resident wellness was optimized by targeting 3 domains: efficiency of practice, culture of wellness and personal resilience. RESULTS Efficiency in delivering information and patient care minimizes additional stress to residents that is caused by the pandemic. By having a reserve team, prioritizing the safety of residents and taking burnout seriously, the culture of wellness and sense of community in our program are emphasized. All of the residents' personal resilience was further optimized by the regular and mandatory measures put in place by the program. CONCLUSIONS The new challenges brought on by a pandemic puts increased pressure on residents. Measures must be put in place to protect resident from the increased physical and mental health stress in order to best serve patients during this difficult time.
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Affiliation(s)
- Jessica J Lie
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline Huynh
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tracy M Scott
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; General Surgery, St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada
| | - Ahmer A Karimuddin
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; General Surgery, St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada.
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