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Objective Cable closure has been introduced as a potential alternative to traditional wire cerclage (WC) for closure of median sternotomy. To evaluate whether cable closure improves patient outcomes, we conducted a systematic review and meta-analysis of the literature. Methods Ovid versions of Medline and Embase, and Google Scholar were used for the literature search. This yielded 7 studies ( n = 2,758), which compared traditional WC to cable closure systems. Outcomes included deep sternal wound infection, sternal dehiscence, postoperative pain score, and sternal wound infection. Results We found significantly lower incidence of sternal dehiscence for cable closure compared to WC (risk ratio [RR] 0.14, 95% confidence interval [CI]: 0.03 to 0.59 , P < 0.01 , I 2 = 0%) but no difference in DSWI (RR 0.97, 95% CI: 0.39 to 2.42, P = 0.95, I 2 = 33%). Cable closure was also associated with lower pain when compared with the WC group (mean difference −1.04 points, 95% CI: −1.89 to −0.19 , P = 0.02, I 2 = 87%). Conclusions This study suggests that cable closure results in less incidence of sternal dehiscence and pain compared to WC. Nonetheless, there remains a limited number of studies on this topic and further high-quality studies are required to confirm the results of this meta-analysis.

Background: Cost-related nonadherence to prescription medications affects many Canadians and is associated with negative self-perceptions of health. Biologic disease modifying anti-arthritic drugs (bDMARDs) are costly drugs recommended for certain patients with rheumatoid or psoriatic arthritis and ankylosing spondylitis. We investigated access and cost-related nonadherence (CRN) to bDMARDs compared to other therapies for such patients in Ontario. Methods: We conducted a cross-sectional telephone survey of adult patients recruited from two academic rheumatology practices in Hamilton, Ontario, asking demographic and socioeconomic characteristics, drug plan coverage, medication cost-related cutbacks, opinions on the value of bDMARDs, and assistance with costs from health professionals. CRN was defined by patient self-report of not using or using less than prescribed amount of medication, due to cost. Results: 104 patients (mean age (SD) 61(12) years) participated, including 77 (74%) women, 57 (54.8%) taking bDMARDs, and 27 (25.9%) with household income <$40,000 annually. CRN was reported by 19 (18.3%) participants with no significant difference between those taking versus not taking bDMARDs (risk difference (95% CI): -0.10 (-0.25, 0.04); p=0.19). 37 (64.9%) of those taking bDMARDs reported that they would not take them if they had to pay the full cost. Overall, few patients reported that they would ask their doctor (17.3%) or pharmacist (15.4%) for help with reducing prescription costs. Conclusion: CRN prevalence was relatively high amongst these rheumatology patients despite access to public and private funding mechanisms. Patients expressed a reluctance to ask their doctor or pharmacist for help in reducing their medication costs.

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In health care, negotiation is a crucial skill that physicians apply in many contexts, from delegating clinical duties to navigating work terms. Various strategies and approaches can improve the efficacy of these interactions, and it is increasingly important for medical curricula to be adapted in a way that fosters the development of certain skill sets centred around leadership. Negotiation falls into this category and is crucial in developing both management and clinical capacities. Although the literature identifies the relation between knowledge and skill in negotiating, there has been limited integration into curricular activities. This article provides an overview of negotiation strategies as examined in the literature. It includes the commonly used positional negotiation strategy as well as the more effective principled negotiation strategy developed by the Harvard Negotiation Project. We compare the usefulness of these two strategies using a real-world scenario and summarize the literature exploring the gap in the skill of negotiation among trainees. This can also serve to identify ways in which it can be incorporated as a standard in medical education. Overall, with the push for leadership development, we propose that negotiation should not be a skill that is expected to be gained through work experience, but as a formal part of the medical education curriculum.