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Biomedical subjects

D J Curtis

Publications and source records attributed to D J Curtis.

At least 19 recordsLinked to original sources
PubMed1991

Radiologic recommendation for breast biopsy on screening mammography reports.

Radiologic reports on screening mammography findings often obligate breast biopsy. Ready recommendation for biopsy of nonpalpable lesions imaged by x ray is a conservative radiologic policy but is unsettling for patients and creates an imperative bind for surgeons. Like the decision to send the patient with right lower quadrant abdominal pain home rather than to the operating room, the diagnosis that requires clinical confidence and precision is nonappendicitis. Noncancer of the breast is a similar diagnosis that can usually be made on clinical and mammographic findings rather than passing such patients through to invasive diagnosis. A series of 84 patients was referred for needle localization of nonpalpable mammographically detected lesions called suspicious on screening examination. Of these 84 patients, new radiographic reports reinterpreting the findings without biopsy were written on the original mammogram in 15 patients. This is a cancellation rate of 21 per cent. In 69 patients needle localization was carried out with the finding of cancer in 28 per cent, compared with the national average of 15 per cent. This higher than average yield caused concern whether any unbiopsied cancers had been followed, and a review of these patients was undertaken. In the log of patients referred for needle localization, the prereading by the mammographer performing the needle localization was recorded in advance of biopsy confirmation, and specificity proved to be 94 per cent and sensitivity 96 per cent. Of the cancers that were detected, 39 per cent were proven in patients older than 50 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy, Needle↗
PubMed1989

Selecting radiology resident candidates.

Radiology resident candidate selection has become a burdensome, subjective, and somewhat arbitrary process. Because the luxury of many well-qualified candidates exists, there is an obligation to select them as honestly, equitably, and objectively as possible. Two years were spent in revising and modifying the resident selection process to make it more uniform and more efficacious. An application scoring form was devised to extract uniform pertinent information from the original application form. Candidates could then be ranked according to a numerical score derived from the form. This allowed easy selection of top candidates to be interviewed. A new interviewing scoring form was developed to include desirable characteristics of resident candidate performance. This form was also devised in such a way as to be easily scored and to allow selection of the top 20 to 25 candidates. These candidates were then ranked by participating faculty members while reviewing their application score forms and their interview forms. Positions for the residency training program were offered according to the ranking. The usefulness of both new forms was evaluated and confirmed by correlating form scores with faculty ranking of academic performance of current residents in the training program.

District of Columbia↗
PubMed1988

Physician assessments of practice patterns in emergency department radiograph interpretation.

Emergency and radiology department directors at 517 acute-care US teaching hospitals were sent identical questionnaires surveying practice patterns of ED plain film radiograph interpretation. Fifty-seven percent of ED directors and 51% of radiology department (RD) directors responded. Both groups reported that the most common practice pattern (60%) was alternating responsibility for immediate interpretation between emergency physicians and radiologists during a 168-hour week. Remaining hospitals were nearly equally divided between systems in which radiologists always provided immediate interpretation and those in which the emergency physicians always provided the initial interpretation. In all systems in which emergency physicians provided some immediate radiograph interpretation, radiologists provided subsequent review. Institutions varied as to the level of training of the physician in both the ED and RD who provided immediate radiograph interpretation; at least 30% of the institutions responding were reported to have either emergency physicians or radiologists of resident level providing immediate interpretation at least part of the 24-hour day. Interpretation discrepancy rates between emergency physicians and radiologists were estimated to be 4% to 6%. The large amount of variation among hospitals in ED radiograph interpretation systems suggests that these systems were not designed with quality of care concerns as their primary criterion. As a consequence, objective patient outcome and process measures need to be developed and measured to ensure that a particular internal system for ED radiograph interpretation is providing an acceptably high standard of patient care.

Emergency Service, Hospital↗
PubMed1988

Testing as a teaching tool.

More than four years ago, the authors initiated testing as a means of obtaining data for evaluating residents. The testing process has evolved now and is used for its teaching value and as a means of objective resident self-evaluation. Testing is designed to provide 10 cases an hour, with characteristics allowing a single diagnosis as a unique answer. No history is provided because a common topic and anatomic area provide a context for each examination. Answers are given during the examination after each question, and discussion follows. All answers are written, and answer sheets are collected. Attendance is high. Test scores are routinely lower than in other forms of evaluation. Testing integrates all aspects of radiology training from cognitive through deductive, simulates written consultations, and provides a means of self-evaluation through rapid feedback. Testing is a viable form of teaching that blends self-evaluation with faculty and peer feedback.

Educational Measurement↗
PubMed1988

Ranking: a year three follow-up in a different institution.

Ranking residents as a means of semiobjective evaluation of their overall performance was described in 1985. The predictive nature of pooled faculty ranking of residents was stressed. Ranking of resident total scores on The American College In-training Examination and American Board of Radiology written examination was noted to be statistically related to the pooled faculty ranking. Similarly, the faculty ranking was predictive of itself in subsequent rankings. A cohesiveness of faculty consensus was present such that small numbers (five minimum) were predictive of larger groups of participating faculty. All reported observations persist in the new institution. Exceptions to expected residency level of training stratification (eg, third-year residents ranking in the midst of first-year residents, second-year residents ranking above many third-year residents) continue to be the most useful observation in counseling residents. Additional information reported includes sensitivity of the ranking to improvement or nonimprovement of probated residents.

Achievement↗
PubMed1987

An isodicentric X chromosome with short arm fusion in a woman without somatic features of Turner's syndrome.

A 25 year old woman with gonadal dysgenesis but no other somatic features of Turner's syndrome was found to have a 45,X/46,XidicX(p22.3) karyotype. It is postulated that because her stature is within the normal range there has been no loss of genetic material in the fusion of the two Xs. Her mother, who also had a history of menstrual problems, was found to be a 46,XX/47,XXX mosaic.

Adult↗
PubMed1987

Barrett's esophagus. A prevalent, occult complication of gastroesophageal reflux disease.

A prospective study of patients with symptoms of gastroesophageal reflux was undertaken to determine the prevalence of Barrett's esophagus and reevaluate the diagnostic approach necessary to detect this complication. Endoscopy with mucosal biopsy was performed in 97 subjects. Twelve (12.4%) were found to have Barrett's esophagus. The sensitivity and specificity of the endoscopic and radiologic examinations for Barrett's esophagus were prospectively evaluated. Endoscopy (92%) was significantly more sensitive than radiology (24%) in detecting Barrett's esophagus (p less than 0.001). The frequency and severity of reflux symptoms among patients determined to have Barrett's esophagus, reflux esophagitis, or normal esophageal biopsies were quantitatively similar in all three groups, except for significantly greater daytime heartburn in those with reflux esophagitis (p less than 0.01). These data indicate that Barrett's esophagus complicates gastroesophageal reflux more often than previously believed.

Barrett Esophagus↗
PubMed1986

Radiology of the nutcracker esophagus.

We prospectively evaluated 22 patients with manometrically proven "nutcracker esophagus" (high amplitude peristaltic contractions). All patients were symptomatic with angina-like chest pain, dysphagia, or both. Patients underwent barium esophagram with video-recording of the images. Video tapes were reviewed independently by a gastrointestinal radiologist who was unaware of the patients' manometric diagnoses. The video-esophagram was normal in 12 of 22 (55%) patients. Eight of 22 (36%) had dysmotility: either diffuse spasm (9%) or tertiary contractions (27%) (Fig. 2). A hiatal hernia was the only abnormality in two patients. Although the presence of diffuse spasm or tertiary contractions may suggest the presence of the underlying motor disorder in patients with nutcracker esophagus, we conclude that the "barium swallow" lacks sufficient sensitivity to screen adequately for this disorder in patients with atypical angina or dysphagia.

Adult↗
PubMed1986

Patient-induced stress test of the first metacarpophalangeal joint: a radiographic assessment of collateral ligament injuries.

The metacarpophalangeal (MCP) joint of the thumb is frequently injured, and the extent of soft-tissue injury is sometimes difficult to determine clinically. Routine radiographs are often normal, without evidence of a fracture. Radiographs obtained during patient-induced stress of the first MCP joint can show significant collateral ligament injury. It is important to make an early diagnosis of collateral ligament rupture.

Adolescent↗
PubMed1986

Rumination, heartburn, and daytime gastroesophageal reflux. A case study with mechanisms defined and successfully treated with biofeedback therapy.

A 31-year-old man with a 19-year history of rumination developed frequent episodes of heartburn and regurgitation associated with acid gastroesophageal reflux that occurred predominantly during the day. This reflux and its attendant symptoms resulted from abdominal muscle contractions at the time of gastroesophageal pressure equilibration (i.e., common cavity phenomena) consistent with the egress of air from the stomach to the esophagus. A voluntary pharyngeal maneuver unassociated with swallowing but simultaneous with the abdominal contraction resulted in a decrease in upper esophageal sphincter pressure. This lowered pressure facilitated acid esophagopharyngeal regurgitation at a velocity of 100 cm/s. Biofeedback therapy directed at relaxing the abdominal muscles during eating and avoiding the pharyngeal maneuver resulted in a decrease in reflux and marked improvement in symptoms.

Adult↗
PubMed1986

Systematic esophageal evaluation of patients with noncardiac chest pain.

We prospectively studied 73 patients with angina-like chest pain severe enough to warrant admission to a coronary care unit over a five-month period. Thirty-four patients (47%) were found to have coronary artery disease as the cause of their symptoms, based on exercise testing, stress radionuclide imaging, or cardiac catheterization. The remaining 39 patients had normal cardiac findings and then underwent videoesophagography, radionuclide esophageal transit study, and esophageal manometry. Thirty-three of the 39 underwent acid perfusion testing (modified Bernstein's test). The findings at esophageal manometry were abnormal in 29 (74%) of 39. Manometric diagnoses were "nutcracker esophagus" in 17 (59%), nonspecific esophageal motility disorders in nine (31%), diffuse esophageal spasm in two (7%), and achalasia in one (3%). Bernstein's test reproduced symptoms in only 12%. The sensitivity of videoesophagography in detecting esophageal motility disorders was 66%, and that of radionuclide esophageal transit was 79%. The positive predictive values were 86% and 85%, respectively.

Adult↗