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R Brull

Publications and source records attributed to R Brull.

6 recordsLinked to original sources
PubMed2001

The role of anesthesiologists in Canadian undergraduate medical education.

PURPOSE: To examine the current role of anesthesiologists in Canadian undergraduate medical education (UME). METHODS: A 93-item questionnaire was mailed to the undergraduate course chairs/coordinators for anesthesia at the 16 medical schools in Canada. RESULTS: Of the faculty anesthesiologists in Canada, 1.7%, 4.9%, and 4.9% teach pre-clerkship lectures, seminars, and PBL tutorials, respectively. Annually, anesthesiologists teach an average of 3.3 hr (range: 0 to 15) of pre-clerkship lectures and 12.8 hr (range: 0 to 48) of pre-clerkship seminars at each medical school. The topics most commonly taught by anesthesiologists in pre-clerkship lectures and seminars are pharmacology and perioperative patient assessment, respectively. An anesthesia rotation during clerkship is mandatory at 13 schools, with an average duration of 9.6 dy (range: 5-20 dy). Clerkship teaching methods vary: ten schools provide seminars, eight use videos, six use computers, six use an airway skills laboratory, and four use an anesthesia simulator. The most common topics taught in clerkship anesthesia seminars are airway management and fluid therapy. CONCLUSION: A very small proportion of faculty anesthesiologists participate in Canadian UME at the pre-clerkship level. Considerable variation exists in the amount and format of teaching by anesthesiologists among the Canadian undergraduate curricula, particularly at the pre-clerkship level. However, our results indicate that anesthesiologists are assuming a more important teaching role during clerkship. Our findings may suggest that Canadian medical schools are overlooking the advantages that anesthesiologists offer to UME at the pre-clerkship level, or that many anesthesiologists are reluctant to assume pre-clerkship teaching responsibilities.

Anesthesiology↗
PubMed2000

[2-]

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Journal Article↗
PubMed1999

Missed opportunities for prevention in general internal medicine.

BACKGROUND: According to the Canadian Society of Internal Medicine, the Canadian general internist is in the ideal position to promote patient health through disease prevention. To explore the general internist's contribution to disease prevention, the authors quantified the extent to which opportunities for prevention were addressed by the general internal medicine (GIM) service in an acute care teaching hospital in Calgary. METHODS: The authors interviewed 100 adult patients before discharge from the hospital's GIM service between May 14, 1997, and Dec. 2, 1997. The number of potential opportunities for preventive intervention were identified for each patient from 10 possible interventions recommended by the Canadian Task Force on the Periodic Health Examination (now the Canadian Task Force on Preventive Health Care): breast cancer screening, Papanicolaou smear for cervical cancer, counselling on menopausal hormone replacement therapy, digital rectal examination for prostate cancer, smoking cessation counselling, cholesterol measurement, therapy or monitoring for hypertension, influenza vaccination, pneumococcal vaccination and colorectal cancer screening. The authors determined which interventions the patient had undergone before the current admission to hospital and, using patient recall and postdischarge medical chart review, which opportunities for intervention were addressed by the GIM service during the current admission. An opportunity for preventive intervention was considered as addressed by the GIM service if it was performed during the current admission or if the general internist informed the patient or the patient's family physician of the need for such intervention in the near future. RESULTS: Among the 10 preventive interventions considered, a mean of 3.8 potential opportunities for prevention were identified for each patient. Of these, 46.5% had been addressed before the current admission, and 8.7% were addressed by the GIM service during the admission. Therefore, at the time of discharge, a mean of 55.2% of opportunities had been addressed. Among the opportunities not previously addressed, the GIM service most frequently addressed digital rectal examination for prostate cancer and cholesterol measurement. INTERPRETATION: General internists are discharging patients without sufficiently addressing opportunities for disease prevention. Preventive care protocols may be needed to limit the frequency of missed opportunities for prevention in patients admitted to tertiary care GIM services.

Acute Disease↗
PubMed1998

Astrocyte mitochondria: a substrate for iron deposition in the aging rat substantia nigra.

Little is currently known concerning the cellular substrates for, and the mechanisms mediating the pathological deposition of, redox-active brain iron in Parkinson's disease. In various subcortical brain regions, populations of astroglia progressively accumulate peroxidase-positive cytoplasmic inclusions derived from effete, iron-laden mitochondria. In the present study, histochemical, ultrastructural, and elemental microanalytical techniques were used to demonstrate the existence of peroxidase-positive astroglia in the substantia nigra of adult rats. At 4 months of age and earlier, few GFAP-positive nigral astroglia contained small, electron-dense cytoplasmic inclusions which exhibited faint endogenous peroxidase activity (diaminobenzidine reaction product) and no detectable iron by microprobe analysis. In contrast, by 14-18 months of age, there was a significant, fourfold increase in numbers of peroxidase-positive astrocyte inclusions in the substantia nigra. The nigral gliosomes in the older animals were heterogeneously electron dense, immunoreactive for ubiquitin and a mitochondrial epitope, and often exhibited X-ray emission peaks for iron. Copper peaks were also detected in a minority of nigral gliosomes. Previous in vitro work indicated that the iron-mediated peroxidase activity in these cells promotes the bioactivation of dopamine and other catechols to neurotoxic free radical intermediates. Thus, mitochondrial sequestration of redox-active iron in aging nigral astroglia may be one factor predisposing the senescent nervous system to parkinsonism and other neurodegenerative disorders.

Aging↗