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B C Walters

Publications and source records attributed to B C Walters.

54 records · Page 3Linked to original sources
PubMed1995

Women surgeons: career and lifestyle comparisons among surgical subspecialties.

A national survey of 459 women surgeons yielded a 91.3 percent response rate. The largest subspecialties were obstetrics-gynecology (41 percent), ophthalmology (21 percent), and general surgery (12 percent). Representation in all "other" surgical specialties was small (26 percent). A comparison of career and lifestyle patterns among the four major subspecialties demonstrated no differences in marital status, although ophthalmologists were least likely to remain childless (32 percent) and general surgeons most likely (58 percent). Surgeons in obstetrics-gynecology worked the longest hours, and those in ophthalmology worked the shortest hours. No subspecialty differences were reported in quality-of-life parameters.

Career Choice↗
PubMed1994

Iatrogenic false aneurysm following repair of intracranial aneurysm.

False aneurysm of the intracranial arteries occurs infrequently as a complication of head injury and rarely as a consequence of other pathology. A case of false aneurysm of the supraclinoid internal carotid artery following minor intraoperative injury during clipping of a basilar-superior cerebellar aneurysm by the pterional approach is described. False aneurysm is a potential cause of recurrent intracranial hemorrhage after successful aneurysm clipping. Arterial bleeding which appears to come from the region of a branch origin should be viewed with concern even if it subsides spontaneously.

Adult↗
PubMed1994

Antibiotic prophylaxis for cerebrospinal fluid shunts: a metanalysis.

The value of antibiotic prophylaxis for clean neurosurgical procedures without the implantation of a foreign body has been conclusively demonstrated. Attempts to confirm its efficacy for cerebrospinal fluid shunt operations have produced confusing and inconclusive results. The objective of this study was to combine the results of high-quality controlled trials of antibiotic prophylaxis for cerebrospinal fluid shunt operations and to determine if there is evidence for the efficacy of this policy. Randomized clinical trials identified from presentations at national meetings and in the published literature were subjected to a metanalysis. The pooled data suggest a statistically significant effect favoring antibiotic prophylaxis (approximately a 50% reduction in infection risk when antibiotic prophylaxis is used). The effect is strongly related to the baseline infection rate when prophylaxis is not used and disappears when the baseline infection rate is at or below about 5%.

Adolescent↗
PubMed1993

Demand-side medical education: educating future physicians for Ontario.

Initiated by Associated Medical Services (AMS), Educating Future Physicians for Ontario is a 5-year collaborative project whose overall goal is to make medical education in Ontario more responsive to that province's evolving health needs. It is supported by AMS, the five universities with medical schools or academic health sciences centres and the Ontario Ministry of Health. The project's five objectives are to (a) define the health needs and expectations of the public as they relate to the training of physicians, (b) prepare the educators of future physicians, (c) assess medical students' competencies, (d) support related curricular innovations and (e) develop ongoing leadership in medical education. There are several distinctive features: a focus on "demand-side" considerations in the design of curricula, collaboration within a geopolitical jurisdiction (Ontario), implementation rather than recommendation, a systematic project-evaluation plan and agreement as to defined project outcomes, in particular the development of institutional mechanisms of curriculum renewal as health needs and expectations evolve.

Academic Medical Centers↗
PubMed1993

Women surgeons. Results of the Canadian Population Study.

OBJECTIVE: A national survey of women surgeons in Canada was undertaken to evaluate their ability to combine career with personal and family life. SUMMARY BACKGROUND DATA: Despite increasing numbers of women entering the medical profession, women continue to select nonsurgical careers. Although there are many reports regarding women in medical specialties there is little information available regarding women who choose surgical careers. Such data will be useful in increasing the enrollment of women in surgical training programs. METHODS: A 93-item questionnaire was mailed in July 1990 to the 459 eligible female surgeons. The survey was conducted using a modified Dillman 5-step computerized method. The study was closed in May 1991. RESULTS: Of the 459 surgeons who were located, 419 (91.3%) responded. Most surgeons (65.5%) were married. Only 6.5% were separated or divorced. The majority married another professional (91.4%). One quarter married another surgeon. Of all women who married at least once, 70.9% had at least one child. Most surgeons delayed child bearing until after they had completed their surgical training. The majority of respondents were in active surgical practice (82.3% full-time, 6.0% part-time). The most common surgical subspecialty was obstetrics and gynecology (40.9%), followed by ophthalmology (21.2%), and general surgery (12.1%). Surgeons were rarely dissatisfied (4-9%) with career, marriage, health, friendships, financial status, and hobbies. Overall, 88.3% were happy with their decision to pursue a career in surgery. CONCLUSIONS: Women surgeons practicing in Canada are able to combine productive careers with rewarding family lives and are satisfied with their decision to do so despite the compromises involved.

Adult↗
PubMed1993

Cranial bone grafts for use in posterior fixation of the cervical spine. Technical note.

Bone grafts are usually an integral part of cervical spine fixation following spinal trauma. Unfortunately, many currently used bone graft donor sites (including the rib, iliac crest, and fibula) cause unacceptable patient morbidity, especially postoperative pain. A readily available source of autologous bone graft for posterior cervical fusion is the occipital bone. This membranous bone offers the advantage of strength and less bone resorption. It has been used at the Sunnybrook Health Science Centre for 4 years as a standard source of bone graft with no morbidity and excellent results for fusion.

Adult↗
PubMed1992

A randomized controlled trial of perioperative rifampin/trimethoprim in cerebrospinal fluid shunt surgery.

A randomized, double-blind, placebo-controlled trial of perioperative rifampin-trimethoprim was undertaken at the Hospital for Sick Children from March 1984 to October 1987, in which 243 patients undergoing 300 cerebrospinal fluid (CSF) shunting procedures were randomized into groups including treatment with rifampin/trimethoprim and placebo, and then followed for a minimum of 2 years. Patients were stratified prior to randomization into those with and those without meningo-myeloceles having first insertions of their shunts, and those having revisions. Patients could be entered into the study more than once, but always received the same treatment regimen once allocation had taken place. Among the patients receiving antibiotics there was an infection rate of 12%, versus 19% among patients receiving placebo. Among the surgical procedures, the rates were 9% and 15%, respectively. Because these rates of infection were a substantial increase over the rate of 7.5% overall for the few years prior to implementation of the study, and well over any acceptable rate of infection, the study was stopped before statistical significance was reached. However, had the study continued, and the proportions of patients becoming infected remained constant, we would have been able to achieve a statistically significant difference in rates of infection, and therefore demonstrate a benefit of rifampin/trimethoprim as prophylaxis against shunt infection. Methodological problems encountered in this and other studies of prevention of CSF shunt infection will be discussed.

Adolescent↗
PubMed1992

Cerebrospinal fluid shunt infection.

There are distinct clinical situations in which the various methods of treatment are generally used: 1. Medical therapy may be used in the circumstance of an infected, but functioning shunt. However, once a shunt is shown to be malfunctioning, it must be treated surgically to correct both the malfunction and the infection. 2. The one combination therapy that continues to treat the hydrocephalus while obeying surgical principles to remove an infected prosthesis is that of immediate shunt replacement. However, this mode of therapy has worked infrequently. 3. The form of combined surgical and medical therapy that allows time to sterilize the CSF in the absence of a foreign body in situ is that of delayed replacement following removal of the infected shunt. However, this method temporarily discontinues the treatment of hydrocephalus. 4. External ventricular drainage removes the foreign body and continues to treat the hydrocephalus; however, this therapy places the patient at increased risk for more virulent infection. With these points in mind, an algorithm for the treatment of shunt infection can be developed as depicted in Figure 8. Using this common sense approach, most circumstances commonly encountered in the practice of pediatric neurosurgery are dealt with, and the best hope of cure is obtained.

Anti-Bacterial Agents↗
PubMed1991

Venous thromboembolism after brain tumor surgery: a retrospective review.

We retrospectively reviewed the incidence rate of clinical postoperative deep vein thrombosis and/or pulmonary embolism in 1703 patients undergoing initial craniotomy for meningioma, glioma, or cerebral metastasis. The incidence rate of clinical thromboembolic complications was 1.59% for all tumor groups within the first 4 weeks of surgery. Patients undergoing surgery for meningiomas had a statistically significant increased risk of thromboembolism despite fewer overall perioperative risk factors, when compared with the other tumor groups. The tumor-specific incidence rates of deep vein thrombosis and/or pulmonary embolism for meningioma, glioma, and metastasis were 3.09%, 0.97%, and 1.03%, respectively. Whether this difference was a result of increased surgical time or an inherent property of meningiomas could not be ascertained.

Adult↗
PubMed1990

Unilateral megalencephaly associated with neonatal high output cardiac failure.

High-flow cerebral arteriovenous fistulae are well known to present in the neonatal period with macrocephaly, cranial bruits and high-output cardiac failure. This report describes a newborn infant with such a clinical presentation, who had unilateral megalencephaly without macroscopic arteriovenous shunts. Ultrasound Doppler examination of the carotid and cerebral vessels showed diastolic flow, or a decreased pulsatility index, consistent with decreased intracranial vascular resistance. The ipsilateral cerebral arteries and veins were markedly enlarged at angiography and at post-mortem examination, but there was no arteriovenous malformation. The infant expired from high-output cardiac failure and hypoglycemia. It is postulated that the high-output cardiac failure was due to increased blood flow through the enlarged, dysplastic cerebral hemisphere.

Brain↗
PubMed1990

Improving the record of patient assessment in the trauma room.

To facilitate clinical research at the Regional Trauma Unit at Sunnybrook Medical Centre in Toronto, it was decided to attempt to improve the quality and quantity of clinical patient information obtained at initial assessment in the Trauma Room. Standardized patient forms were introduced to replace the narrative record, including forms for the Trauma Team Leader, Anesthesia, General Surgery, Neurosurgery, Orthopedic Surgery, and Plastic Surgery. These forms were evaluated in this study which compared 100 charts generated before introduction of the forms to 100 charts generated following the implementation of the forms, with respect to certain items of patient demography and clinical condition. There was a statistically significant improvement in amount of information collected and in a format which facilitates data storage and retrieval. This, in turn, establishes an excellent standardized database for clinical trials in trauma care.

Emergency Medical Service Communication Systems↗
PubMed1989

The Sunnybrook Neurotrauma Assessment Record: improving trauma data collection.

A neurotrauma assessment record has been designed to aid in data collection and clinical documentation of patients with multiple injuries. The record collects data concerning patient demography, trauma and medical history, neurological and systemic examinations, investigations, and treatment planning. It consists of two pages and the clinician need only circle listed choices, write focused comments, or draw on provided diagrams. It obviates the narrative record of the history and physical examination. We reviewed the written records of 100 consecutive polytraumatized patients seen in the Trauma Room before institution of the form, transcribing their information onto the form. These were compared to a second series of 100 consecutive patients who were evaluated following the introduction of the neurotrauma form as the initial assessment record. Seventy-seven of these patients were evaluated by the Neurosurgical service. Overall, the quality and completeness of recording improved dramatically. The neurotrauma assessment record ensures more complete recording of information during initial patient assessment, allows easy transfer to computerized databases, and may assist academic centres in performing clinical research.

Humans↗
PubMed1985

Dermoid cysts.

Explore the source record for details and available documents.

Child↗
PubMed1985

Decreased risk of infection in cerebrospinal fluid shunt surgery using prophylactic antibiotics: a case-control study.

Four randomised controlled trials have focussed on the use of prophylactic antibiotics in the prevention of cerebrospinal fluid (CSF) shunt infection. None of these studies has been able to demonstrate a statistically significant difference in rate of infection. This may be due to the inadequate power of the studies to detect a clinically significant difference, as a result of small sample size. This retrospective case control study was designed using the same basic principles of avoidance of bias which make randomised controlled trials the model studies for generation of scientific evidence. It has found a highly statistically significant difference in the use of antibiotics among infected compared to non-infected patients, suggesting a three times greater risk of infection among patients who did not receive antibiotics. This study provides the strongest evidence to date regarding the usefulness of perioperative antibiotics in CSF shunt surgery.

Adolescent↗
PubMed1984

Cerebrospinal fluid shunt infection. Influences on initial management and subsequent outcome.

A retrospective study of the management of patients with infected cerebrospinal fluid (CSF) shunts was undertaken, covering the 20 years from 1960 to 1979, inclusive, and involving 222 patients with 267 infections. The data were analyzed with emphasis on influences surrounding treatment choice and subsequent outcome. Treatment was classified into three major categories: medical management (antibiotics alone), surgical management (antibiotics plus operative removal of the infected shunt), and no treatment (ranging from admission and observation only to shunt revision), the diagnosis of shunt infection having been missed. Results showed surgical treatment to be more efficacious than medical or no treatment, with a higher rate of initial cure, and lower morbidity and mortality rates. Also examined were the relationships among clinical presentation, infection rate, and results of specimens sent for culture, and initial treatment. The definitive nature of initial treatment was revealed to be directly proportional to the aggressiveness of microbiological investigation. This latter aspect was related to clinical presentation, with shunt malfunction being the least recognized symptom of shunt infection. Patients presenting with blocked shunts were less likely to receive therapy appropriate for infection than any other group, leading to the conclusion that shunt malfunction may be more specific to infection than heretofore believed.

Anti-Bacterial Agents↗