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M D Cusimano

Publications and source records attributed to M D Cusimano.

At least 19 recordsLinked to original sources
PubMed2004

Child safety education and the world wide web: an evaluation of the content and quality of online resources.

The purpose of this study was to assess the content, quality, and type of internet resources available for safety education. Using 19 search engines with search strings targeting major forms of injury, identified resources were classified by audience group, accessibility, and authorship. Two independent reviewers rated each resource on the basis of its content and a set of quality criteria using a three point scale. Overall, 10 (18.2%) resources were of highest quality, four (7.3%) were intermediate, and 41 (74.5%) were not recommended. Eighteen months after the original search, 67.3% of all resources and 90% of the highest quality resources were still on the internet. This study provides a methodology for evaluating child safety resources on the world wide web and demonstrates that most internet resources for safety education are of dubious quality. A rating system such as the one developed for this study may be used to identify valuable internet materials.

Accident Prevention↗
PubMed2003

Evaluation of the ThinkFirst Canada, Smart Hockey, brain and spinal cord injury prevention video.

OBJECTIVE: The ThinkFirst Canada Smart Hockey program is an educational injury prevention video that teaches the mechanisms, consequences, and prevention of brain and spinal cord injury in ice hockey. This study evaluates knowledge transfer and behavioural outcomes in 11-12 year old hockey players who viewed the video. DESIGN: Randomized controlled design. SETTING: Greater Toronto Minor Hockey League, Toronto Ontario. SUBJECTS: Minor, competitive 11-12 year old male ice hockey players and hockey team coaches. INTERVENTIONS: The Smart Hockey video was shown to experimental teams at mid-season. An interview was conducted with coaches to understand reasons to accept or refuse the injury prevention video. MAIN OUTCOME MEASURES: A test of concussion knowledge was administered before, immediately after, and three months after exposure to the video. The incidence of aggressive penalties was measured before and after viewing the video. RESULTS: The number of causes and mechanisms of concussion named by players increased from 1.13 to 2.47 and from 0.67 to 1.22 respectively. This effect was maintained at three months. There was no significant change in control teams. There was no significant change in total penalties after video exposure; however, specific body checking related penalties were significantly reduced in the experimental group. CONCLUSION: This study showed some improvements in knowledge and behaviours after a single viewing of a video; however, these findings require confirmation with a larger sample to understand the sociobehavioural aspects of sport that determine the effectiveness and acceptance of injury prevention interventions.

Attitude to Health↗
PubMed2001

Evaluating surgical resident selection procedures.

PURPOSE: The purposes of this study were to develop and assess a rating form for selection of surgical residents, determine the criteria most important in selection, determine the reliability of the assessment form and process both within and across sites, and document differences in procedure and structure of resident selection processes across Canada. METHODS: Twelve of 13 English-speaking orthopedic surgery training programs in Canada participated during the 1999 selection year. The critical incident technique was utilized to determine the criteria most important in selection. From these criteria a 10-item rating form was developed with each item on a 5-point scale. Sixty-six candidates were invited for interviews across the country. Each interviewer completed one assessment form for each candidate, and independently ranked all candidates at the conclusion of all interviews. Consensus final rank orders were then created for each residency program. Across all programs, pairwise program-by-program correlations for each assessment parameter were made. RESULTS: The internal consistency of assessment form ratings for each interviewer was moderately high (mean Cronbach's alpha = 0.71). A correlation between each item and the final rank order for each program revealed that the items work ethic, interpersonal qualities, orthopedic experience, and enthusiasm correlated most highly with final candidate rank orders (r = 0.5, 0.48, 0.48, 0.45, respectively). The interrater reliabilities (within panels) and interpanel reliabilities (within programs) for the rank orders were 0.67 and 0.63, respectively. Using the Spearman-Brown prophecy formula, it was found that two panels with two interviewers on each panel are required to obtain a stable measure of a given candidate (reliabilities of 0.80). The average pairwise program-by-program correlations were low for the final candidate rank orders (0.14). CONCLUSIONS: A method was introduced to develop a standard, reliable candidate assessment form to evaluate residency selection procedures. The assessment form ratings were found to be consistent within interviewers. Candidate assessments within programs (both between interviewers and between panels) were moderately reliable suggesting agreement within programs regarding the relative quality of candidates, but there was very little agreement across programs.

Canada↗
PubMed2001

A novel approach to endourological training: training at the Surgical Skills Center.

PURPOSE: We investigated the effects of didactic teaching and supervised hands-on practice on endourological skills using high fidelity genitourinary bench models at a surgical skills laboratory. We also validated a global rating scale and checklist designed specifically for endourological tasks. MATERIALS AND METHODS: We assessed 17 urology residents for the ability to remove a mid ureteral stone using a high fidelity genitourinary model on 3 occasions, including a pre-test at the beginning of the study to assess baseline skills, after a didactic teaching session and after a supervised practice session on high fidelity models. Performance was graded according to a global rating scale, checklist, pass rating and time needed to complete task. RESULTS: Senior residents achieved significantly higher pre-test global rating scores than junior residents (p <0.01). One-way repeated measures analysis of variance revealed a significant effect of training on the endoscopic global rating score (p <0.001). Post-hoc tests demonstrated significant improvement in the global rating scores from the pre-test to the post-didactic session (p <0.05) and from the post-didactic to the post-practice session (p <0.01). Interrater reliability using the global rating scale was high (Pearson's r = 0.82, p <0.01). Significant but less powerful results were observed in the checklist score, pass rating and time. CONCLUSIONS: There was a positive effect of training at the surgical skills laboratory on endourological skills. The global rating scale showed good construct validity and reliability for assessing endourological tasks, more so than the checklist, pass rating or time.

Adult↗
PubMed2001

Surgical exposure and resection of the vertical portion of the petrous internal carotid artery: anatomic study.

OBJECTIVE: The goals were to determine which surgical approaches, i.e., the preauricular subtemporal infratemporal fossa (PSI), postauricular transtemporal (PAT), and/or subtemporal middle fossa (SMF) approaches, provide optimal exposure of the anterior, posterior, medial, and lateral aspects of the vertical segment of the petrous internal carotid artery (VPCA) and to determine the length of the VPCA that can be resected before a vein graft is necessary. METHODS: Using 22 cadaveric specimens, we compared the length of exposure of the VPCA provided by the PSI, PAT, and SMF approaches. The segment of the VPCA that was exposed with each approach was measured in millimeters and expressed as a percentage of the total length of the VPCA. Resection of the VPCA in 1-mm increments was performed until a graft would be necessary; the total length of the resected segment was recorded in millimeters and was also expressed as a percentage of the total length of the VPCA. RESULTS: The PSI approach provided average exposures of 14.1 mm (95% of the total exposure possible) of the anterior aspect and 14.3 mm (96%) of the lateral aspect of the VPCA; resection of less than 2.3 mm (16%) of the VPCA could be repaired with an end-to-end anastomosis. The PAT approach provided average exposures of 10.5 mm (71 %) of the lateral aspect and 10.0 mm (76%) of the posterior aspect of the VPCA; resection of less than 2.8 mm of the VPCA could be repaired with an end-to-end anastomosis. The SMF approach provided average exposures of 6.1 mm (45%) of the anterior aspect and 5.4 mm (41 %) of the lateral aspect of the VPCA; resection of less than 2.4 mm (24%) of the VPCA could be repaired with an end-to-end anastomosis. CONCLUSION: Lesions on the anterior and lateral aspects of the VPCA can be fully exposed with the PSI approach or partially exposed with the less invasive SMF approach. Lesions on the posterior aspect of the artery are best exposed with the PAT approach. Lesions on the medial aspect of the VPCA cannot be exposed unless the VPCA is mobilized in the PSI approach. Resection of less than approximately 2.5 mm (20%) can be repaired with an end-to-end anastomosis, regardless of the approach used.

Carotid Artery, Internal↗
PubMed2001

Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome.

OBJECTIVE: Patient selection for cerebrospinal fluid diversion is difficult, because idiopathic normal pressure hydrocephalus (INPH) mimics other neurodegenerative disorders and no findings reliably predict outcome. The literature was reviewed to identify diagnostic criteria that predict shunt response and to formulate prognostic expectations. METHODS: MEDLINE was searched, and 44 articles meeting predetermined criteria were included. RESULTS: Clinical series were frequently retrospective with small patient numbers and unstandardized outcome evaluation. Clinical findings suggestive of shunt responsiveness were the complete triad (gait disturbance, urinary incontinence, and dementia) with early gait disturbance. Degree of hydrocephalus was not correlated with clinical improvement. Reduction of the subcortical low-blood flow area was correlated with improvement in three small studies. Clinical response to prolonged cerebrospinal fluid drainage predicted shunt outcome in all cases in two small series. Overall, 59% (range, 24-100%) of patients improved after shunting, and 29% (range, 10-100%) of patients experienced prolonged improvement. Complications occurred in 38% (range, 5-100%) of patients, additional surgery was required in 22% (range, 0-47%) of patients, and there was a 6% (range, 0-35%) combined rate of permanent neurological deficit and death. CONCLUSION: Shunting INPH is associated with an approximately 29% rate of significant improvement and a 6% significant complication rate. Enlargement of the subcortical low-flow area and clinical improvement secondary to prolonged lumbar drainage may provide additive predictive value above clinical and computed tomographic criteria. A multicenter clinical trial that focuses on the value of ancillary tests, defines the clinical course of a patient with a ventriculoperitoneal shunt, and evaluates the cost effectiveness of shunting INPH is needed to better describe outcome from shunting in INPH.

Cerebrospinal Fluid Shunts↗
PubMed2000

A computer-based trauma simulator for teaching trauma management skills.

BACKGROUND: The management of multiply injured trauma patients is a skill requiring broad knowledge, sound judgment, and leadership capabilities. The purpose of this study was to evaluate the effectiveness of a computer-based trauma simulator as a teaching tool for senior medical students. METHODS: All year-4 clinical clerks at the University of Toronto were approached to participate in a focused, 2-hour trauma management course. The volunteer rate for the course was 79%. Students were randomized to either computer-based simulator or seminar-based teaching groups. Outcome measures in this study were students' trauma objective structured clinical examination (OSCE) scores. RESULTS: Both the trauma simulator and seminar teaching groups performed significantly better than the comparison group (no additional teaching) on the trauma OSCE patient encounter component, but not the written component of the examination. There was no significant difference in the performances of the trauma simulator and seminar teaching groups. Students overwhelmingly felt the trauma simulator was effective for their trauma teaching, and improved their overall confidence in clinical trauma scenarios. CONCLUSIONS: There is a significant benefit associated with a focused, clinically based trauma management course for senior medical students. No additional improvement was noted with the use of a high fidelity computer-based trauma simulator.

Analysis of Variance↗
PubMed2000

Craniotomy revisited: techniques for improved access and reconstruction.

OBJECTIVE: To describe simple modifications of the technique of opening and closure of the craniotomy to improve basal exposure and reconstruction. METHODS: The modifications involve: a) additional soft-tissue dissection which is carried downward to the base of the ear and to the orbital rim, exposing the orbital rim and malar eminence without removing the bone; b) cutting the bone flap so that 'bridges' of bone remain that help to stabilize the flap when it is returned to the cranium at the end of the operation; c) the wedging of bone chips between the bone flap and native cranium at the time the bone is being reaffixed so as to provide firm stability by diminishing movement of the bone flap; d) the use of bone dust and bone chips mixed with the patient's blood to seal and bridge the gap between the bone flap and the native bone; e) reattachment of the temporalis muscle with the bone flap sutures. An 'inlay' technique of duraplasty is also described. RESULTS AND CONCLUSION: These simple modifications of craniotomy provide better basal exposure and reconstruction with little additional operating time at no additional cost.

Craniotomy↗
PubMed2000

Combined pleomorphic xanthoastrocytoma-ganglioglioma of the cerebellum.

Combined pleomorphic xanthoastrocytoma-ganglioma is a rare neoplasm, occurring in patients younger than 30 years. The clinical course of these tumors is difficult to predict because of their rarity. We report a case of combined pleomorphic xanthoastrocytoma-ganglioma that, in addition to the patient's age, is unusual in several respects. The lesion was located in the cerebellar vermis of a 60-year-old man and was radiographically solid. Histologically, there was an admixture of markedly pleomorphic astrocytic cells and neoplastic ganglion cells, with permeation of the overlying leptomeninges and surrounding cerebellum. In addition, there was focal capillary endothelial proliferation. There was no necrosis, and mitotic activity was rare at 1 mitotic figure per 40 high-power fields. The patient underwent a near gross total resection and postoperative radiotherapy and remains well through 16 months of follow-up.

Astrocytoma↗
PubMed1999

Quality-of-Life Assessment in Patients with Lesions of the Cranial Base.

Lesions of the cranial base have a propensity to affect physical, mental and social well-being of the patient. Cranial Base surgeons have a duty to go beyond the standard outcome measures of survival and morbidity in presenting the results of surgery for lessions of the cranial base. This paper reviews the fundamental features of quality of life outcome measures as applied to the field of skull base surgery.The author reviews the The Glasgow Outcome Scale, the Karnofsky Score, Spitzer Quality of Life Index, the Sickness Impact Profile, the Rand 36 (MOS-SF 36), the FACT G health-related quality of life scale and the University of Washington Quality of Life Scale for their use in the field cranial base surgery.Major advances in cranial base surgery will be facilitated by the use of scientifically sound and practical health-related quality of life outcome measures.

Journal Article↗
PubMed1999

An analysis of attrition from Canadian neurosurgery residency programs.

PURPOSE: To determine the magnitude of and reasons for attrition from neurosurgical residency programs in Canada. METHOD: Directors of the 13 Canadian neurosurgery residency programs were asked to complete questionnaires on their programs, magnitude of attrition, reasons for attrition, and selection criteria. Open-ended questions were assessed with content analysis and quantified with dual-scaling techniques. Similar questionnaires were sent to 30 residents who had completed training; six residents who had voluntarily withdrawn were interviewed. RESULTS: Twelve of the 13 directors (92%) responded. Forty-two residents voluntarily withdrew from residency training between 1980 and 1992; withdrawal rates grew during that period. The number of dismissals--approximately 1.8 per year--remained constant. Reasons for voluntary withdrawal focused on excessive workloads and unexpected residency demands, whereas reasons for dismissal related primarily to deficits in professional attitudes and behaviors such as interpersonal skills and ethics. In selecting residents, programs with low attrition rates gave more importance to a candidate's work ethic than did programs with high attrition rates. The low-attrition programs also gave more importance to the relationship developed with residents during training. CONCLUSION: These results suggest that voluntary attrition from neurosurgical residency is significant and is related to issues of lifestyle control. Dismissal is rarely related to cognitive or psychomotor deficits, but usually occurs for concerns about professionalism such as ethics and interpersonal skills and behaviors. Further studies are necessary to confirm these findings across specialties and countries.

Canada↗
PubMed1998

Surgery in stereo.

Explore the source record for details and available documents.

Brain Neoplasms↗
PubMed1998

A compendium of higher education opportunities in health professions education.

The authors assembled a compendium of programs world-wide that are dedicated to teaching individuals how to direct, research, or improve the education of health professionals. To accomplish this task, in 1996 and 1997 they interviewed and corresponded with researchers in the health professions and with staffs of faculty development fellowship programs listed in the 1966 Fellowship Directory for Family Physicians, and consulted several postings on the DR-ED listserv. To be included in the compendium, the program had to be specifically focused on health professions education. Out of 51 possible programs, 17 were identified. The authors then sent a questionnaire to the staffs of these 17 programs, asking for program descriptions and information about curricula, students, graduates, costs, and financial aid. Detailed data were received from 15 programs from three continents. Eleven programs offered master's-level degrees and five offered PhD degrees. The majority had flexible study-time arrangements. Graduates of such courses have already assumed leadership position in health professions education and research around the world. The authors hope that their compendium of programs will help guide health professionals who seek to improve their skills in health professions education.

Data Collection↗
PubMed1998

Serial magnetic resonance imaging findings for a spontaneously resolving spinal subdural hematoma: case report.

OBJECTIVE AND IMPORTANCE: Spinal subdural hematoma (SSDH) is a rare entity, and cases are usually managed as surgical emergencies. We describe a patient with a SSDH who demonstrated incomplete clinical resolution with nonsurgical management, despite continued anticoagulation treatment. We provide the most complete demonstration of the magnetic resonance imaging (MRI) characteristics of a large SSDH from its initiation to its radiological resolution. CLINICAL PRESENTATION: A 61-year-old woman developed a large SSDH as a complication of a lumbar puncture. Her only neurological deficit was urinary retention. INTERVENTION: Because of the extensiveness of the hematoma and the relative neurological preservation of the patient, she was treated conservatively. Serial MRI scans were obtained at 4, 7, 13, and 25 days. The evolution of deoxyhemoglobin in the hematoma to methemoglobin was observed. By 25 days, MRI scans showed virtual resolution. CONCLUSION: SSDHs undergo MRI signal changes that are similar to those of brain hematomas. In certain cases, even large SSDHs demonstrate swift and dramatic spontaneous resolution, despite continued anticoagulation treatment. This report suggests that there is a role for conservative management for selected cases of SSDHs.

Female↗
PubMed1998

Malignant transformation of ganglioneuroma into spinal neuroblastoma in an adult. Case report.

Ganglioneuroma is generally considered to be a benign tumor and potentially surgically curable. The authors present a case of a 21-year-old woman who underwent resection of a retroperitoneal ganglioneuroma and developed spinal neuroblastoma 11 years later. She has survived 10 more years with only recent development of metastases. To the authors' knowledge, this is the first report of malignant transformation of a ganglioneuroma into a neuroblastoma. Also, such long-term survival in an adult with spinal neuroblastoma has not been reported previously. This case raises the possibility of a dedifferentiating potential for ganglion cells in a ganglioneuroma or the presence of a long-term, quiescent form of neuroblastoma.

Adult↗