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J S Spratt

Publications and source records attributed to J S Spratt.

At least 37 records · Page 2Linked to original sources
PubMed1997

Practicing primary care physicians' perspectives on the junior surgical clerkship.

PURPOSE: Changing emphasis on educating generalist physicians prompted us to survey practicing primary care physicians to determine their perception of the lecture content and clinical skills required of students in our third-year surgical clerkship. METHODS: A 72-item questionnaire was developed. Respondents were asked to evaluate the relative importance of lecture topics and clinical skills on a 5-point Likert-type scale. Respondents were also asked about their medical practice and demographic information. Primary care physicians were randomly selected from among those registered in our state's medical association. RESULTS: Nearly 70% of physicians in the sample responded. Although there were significant differences in responses among the primary care physicians surveyed, virtually all indicated that faculty should teach pathways in surgical management with emphasis on when to refer the patient to a surgeon. CONCLUSIONS: The changing health care climate necessitates a closer examination of undergraduate surgical curricula with attention to the educational needs of the generalist physician.

Attitude of Health Personnel↗
PubMed1996

Rates of growth of human neoplasms: Part II.

Part I of this study [Spratt JS, Meyer JS, Spratt JA: J Surg Oncol 60:137-146, 1995] reviewed the early reports of investigators, predominantly mathematical biologists and statisticians considering the mathematical laws that would describe the growth of a neoplasm. Included were cytokinetic measurements of the mitotic index, thymidine labeling index, bromodeoxy-uridine labeling index, and the relation of these indices to the potential tumor volume doubling time. The actual doubling time of benign and malignant colonic neoplasms were reported. This second part provides the cumulative observations on the actual doubling times of pulmonary metastases, primary pulmonary cancers, skeletal sarcomas, melanomas, a chemodectoma, tumors of maxillary antrum, testicular cancers, prostate cancer, and the relation between the accumulation of multiple primary cancers and growth rates. The most complete data set is for breast cancer concluding that the cancer growth curve is a decelerating curve with great natural variance. Understanding of the rates of growth of human cancers is essential for understanding the spectrum of cancer behavior observed clinically.

Bone Neoplasms↗
PubMed1995

Rates of growth of human solid neoplasms: Part I.

The purpose of this article is to consolidate data collected from a variety of sources that have permitted calculations of the rates of growth of human neoplasms. These sources include Fischel State Cancer Hospital (Columbia, MO); Mallinckrodt Institute of Radiology, (St. Louis, MO); Roentgen Diagnostic Institute, Allmanna Sjukhuset (Malmo, Sweden); University of Louisville (Louisville, Kentucky); University of Heidelberg (Heidelberg, Germany); and St. Luke's Hospital (St. Louis, MO). Included in the data are laboratory measurements of cell replication rates. All gross measurements were made either on imaging studies or with a centimeter scale for surface or palpable neoplasms. Data have been reported for breast and pulmonary cancers and metastases of many types, melanomas, skeletal sarcomas, benign and malignant colonic neoplasms, and isolated cases of less frequent neoplasms. Related cytokinetic measurements by tritriated thymidine labelling, bromodeoxyuridine labelling, S-phase fraction from DNA flow cytometric analysis, and mitotic indices are discussed. The various mathematical formulae applicable to the analysis of the collected data and the determination of rates and patterns of growth are included. Also considered are the clinical implications of these data and the importance of ever better knowledge on the cytokinetics of human cancer. Prior studies on the evolution of insight into this field are cited and discussed. The authors conclude that a more accurate quantification of the growth rates of human cancer is essential for understanding the biological variance of human cancers seen clinically.

Breast Neoplasms↗
PubMed1995

Are learning objectives useful in evaluating medical school course and instructor performance?

We tested the hypothesis that learning objectives could be used to evaluate course and instructor effectiveness. Ninety-seven third-year medical students who had their surgical clerkship or their medical clerkship as their first clinical rotation were compared. The surgery clerks received 171 urologic learning objectives. Students taking the surgical clerkship had significantly higher postclerkship recognition of the learning objectives than did medical clerkship students. One year later, these students were again surveyed to determine whether they still knew the correct response to the learning objective. The follow-up survey showed that 50% of the students recognized objectives covered in five of the eight urology lectures, while the other lectures were not effective. Students who recognized the objective on the postclerkship evaluation were more likely to think the objective had been taught on this follow-up survey. These data suggest that learning objectives are useful for evaluating course and instructor effectiveness.

Adult↗
PubMed1994

[Growth rate of breast cancer, implication for early detection and therapeutic effects].

Numerous trials have shown, that breast cancer have highly variable rates of growth. It is assumed, that the rates (relative growth rates) decelerate with increasing tumour size. The Universities of Heidelberg and Louisville carried out a retrospective statistical analysis of the mammographically measured growth rates of 448 screening patients until breast cancer diagnosis. The analysis did not include fast-growing carcinomas appearing between mammograms for which only one mammogram was available or some cancer, where growth was not detectable by mammography. Generalized logistic curves provided the best fit to the data on the increase in tumour size, as observed in mammograms. Large variations in individual tumour doubling times were found, from extremely fast-growing to extremely slow-growing tumours. The results are relevant for patient prognosis, for the evaluation of therapy, and for screening strategies.

Adolescent↗
PubMed1993

Decelerating growth and human breast cancer.

BACKGROUND: Improved understanding of human breast cancer growth rates may have many clinical applications. Previous reports have used small numbers of patients and assumed an exponential growth rate. METHODS: The exponential equation and the most commonly used decelerating growth equations, the Gompertz equation and seven generalized forms of the logistic equation, were fitted to mammographic measurements of primary breast cancer using the least squares method. An average of 3.4 observations was made in 113 patients, whereas two measurements were made in another 335 patients. Tumors were assumed to originate as a single cell with the lethal tumor volume assumed to be 2(40) cells. RESULTS: All decelerating equations tested provided a better fit than the exponential, whereas a form of the logistic equation provided the best fit to the data. Limitations in the number of tumor measurements, the assumption of maximal tumor size, and biases inherent in the method of data collection are reviewed. These observations suggest families of curves that characterize breast cancer growth during the early period of clinical observation. CONCLUSIONS: Breast cancer growth in the early clinical period was modeled by a form of the logistic equation. The exponential equation fit the data least well.

Breast Neoplasms↗
PubMed1993

Mammographic assessment of human breast cancer growth and duration.

BACKGROUND: Accumulating data from numerous sources have confirmed that breast cancers have highly variable rates of growth. Contemporary thought supports that collectively the gross rates should decelerate with increasing tumor mass. METHODS: Using composite data derived from mammographically measured growth of breast cancers observed at the Universities of Heidelberg and Louisville, the growth curve providing the best fit to the observed data, and the variance occurring around this curve has been calculated. RESULTS: A generalized logistic equation provided the best fit, with a natural variance ranging from extremely rapidly growing to slowly growing cancer. These data do not cover the entire range of growth rates because cancers appearing acutely between mammograms were observed only once, and some breast cancers never grew. CONCLUSIONS: The highly variable decelerating growth rates of breast cancers are better but incompletely defined, and these rates are of value in considering screening strategies and prognosis.

Adolescent↗
PubMed1993

Breast Cancer Detection Demonstration Project data can determine whether the prognosis of breast cancer is affected by the time of surgery during the menstrual cycle.

The purpose of this study was to determine the feasibility of using Breast Cancer Detection Demonstration Project (BCDDP) data to ascertain whether the prognosis of breast cancer in premenopausal women is affected when surgery is performed relative to the different phases of the menstrual cycle. In the Louisville BCDDP only 40 cases were available for study, but even with this small number, the data indicate that survivorship was superior when the surgery was performed between days 7-20 of the menstrual cycle (P < 0.06). One thousand eighty-seven premenopausal women underwent surgery for breast cancer during the first 5 years of the national BCDDP, beginning in 1972. This large number of cases, plus the long period of follow-up should provide sufficient statistical power for us to evaluate if there is any relationship between the day of the menstrual cycle, the day surgery was performed, and prognosis. This feasibility study indicates that these women should be followed up and the appropriate statistical studies should be done.

Adult↗
PubMed1992

An update on incision for ilioinguinal lymph node dissection.

The wound morbidity after ilioinguinal lymph node dissections can be significantly reduced by precise planning of both the incision and the extent of flap elevation. Flap elevation extends no farther than the edges of the quadrilateral block of Anson, and exposure is best obtained with a bipedicle incision with broad-based pedicles. The broad bases ensure the greatest possibility for the sustentation of the flaps by the remaining microcirculation. All suction drains are placed far laterally, not through the base of any flaps, to avoid the high bacterial count on the skin of the groin, genitals, perineum, and anus. Closure is undertaken with a running suture, which allows for a seal that will facilitate suction. Suction continues until drainage is less than 25 mL/d.

Groin↗
PubMed1991

The risky shift.

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Biometry↗