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R K Reznick

Publications and source records attributed to R K Reznick.

46 records · Page 3Linked to original sources
PubMed1987

Orthopaedic teaching: the practicing family doctor's perspective.

Two hundred and two family doctors in practice responded to a survey that identified orthopaedics as a surgical specialty in which they would have benefited from more training. Forty percent felt unprepared to apply casts or manage fractures. Learning objectives were either not used or used ineffectively, according to the majority of respondents. Fifty percent reported that indicating a career interest in family medicine resulted in a negative bias toward them during surgery clerkship. The results indicate the need for an increased allocation of curricular time to orthopaedics and an augmented emphasis on outpatient experiences.

Attitude of Health Personnel↗
PubMed1987

A rationale for the teaching of statistics to surgical residents.

The two aims of this study were to investigate the use of statistics in the surgical literature and to assess the degree of statistical comprehension possessed by graduating surgical residents. Two hundred journal articles were randomly selected from the 1984 issues of four surgical journals and were reviewed for statistical content. A classification of statistical techniques was created. A reader who has knowledge of descriptive statistics only has access to 44.5% of the articles. The addition of knowledge of t tests, contingency table analysis, other nonparametric techniques, and life table analysis to a reader's repertoire increases the access rate to 80.5%. The data indicate the specific statistical techniques that would best serve the surgeon who is attempting to increase access rate to the surgical literature. Ninety-one surgical residents in their fifth postgraduate year (PGY-5) responded to a questionnaire regarding their knowledge of statistics. While 90% of the respondents thought they would benefit from a course on statistics, 92% reported that they had received less than 5 hours of instruction in statistics during their residency. Both subjective self-ratings and objective testing revealed that the residents surveyed have a suboptimal knowledge of statistics. The results suggest the need for formal instruction in statistics during surgical residency.

Attitude of Health Personnel↗
PubMed1984

Results and hemodynamic changes after interposition mesocaval shunt.

Forty-seven patients have been treated by interposition mesocaval shunting for portal hypertension and variceal bleeding between December 1973 and March 1980. The average age was 55 years. The underlying diseases were alcoholic cirrhosis in 26 patients (56%), macronodular cirrhosis in 11 patients (23%), and other causes in 10 patients (21%). Thirty-five operations (75%) were performed on an emergency basis for patients who continued to bleed after failure of conservative management. In these patients, the early mortality rate was 43%. Overall survival, rebleeding, and postshunt encephalopathy rates are correlated with the preoperative Child's classification. These figures are similar to those reported for end-to-side portocaval shunts. The improvement in postshunt encephalopathy rates as reported by Drapanas is not borne out by our results. Postshunt angiography was performed in 31 patients and shunt patency was confirmed in 28 (90%). In 26 patients, selective studies to determine portal flow patterns were carried out, and in only three patients was there any evidence of hepatopedal flow. In each of these patients, some kinking of the shunt was noted. Mesocaval shunting is a reasonable alternative to end-to-side portocaval shunts and is associated with similar rates of patency, rebleeding, mortality, and late postoperative encephalopathy. A well-constructed, patent mesocaval shunt totally diverts portal flow.

Adult↗
PubMed1983

Small bowel transplantation in the dog using cyclosporine.

The effect of the new immunosuppressant cyclosporine on survival after total small intestinal allotransplantation (TSIA) was studied in a canine model. Successful TSIA was performed in 34 dogs. Eleven dogs were treated with cyclosporine, 25 mg/kg/day i.m., starting the day before the operation and continuing for four weeks. Thereafter the same dose was given orally. Thirteen dogs were given oral cyclosporine only, 25 mg/kg/day from the day after transplantation. Ten dogs served as controls. The dogs treated with intramuscular and oral cyclosporine survived a mean of 103.8 +/- 39.4 days (mean +/- S.E.M.). The longest survivor died after 432 days. Survival in this group was significantly longer than that of the control dogs, which survived 12.5 +/- 4.6 days. The orally treated dogs survived 30.4 +/- 7.6 days. All control dogs, and seven of the orally treated dogs, but only two of the intramuscularly treated dogs, died of acute rejection. It is concluded that cyclosporine is effective in prolonging survival after TSIA in the dog and reduces the incidence of acute rejection.

Animals↗
PubMed1983

Hyponatremia and arginine vasopressin secretion in patients with refractory hepatic ascites undergoing peritoneovenous shunting.

Seven patients with persistent hyponatremia but normal or elevated serum arginine vasopressin levels and refractory ascites undergoing peritoneovenous shunting were studied in a Metabolic Unit on a 20 mEq sodium 1200 ml fluid-restricted diet to elucidate the mechanism of this response. The intravascular volume expansion after shunt implantation resulted in improvements in cardiac output, renal plasma flow and creatinine clearance (70.7 +/- 9.5 to 140.1 +/- 18.5 ml/min, p less than 0.005). There was an immediate diuresis (632 +/- 135 to 2450 +/- 323 ml/day, p less than 0.005) and natriuresis (3 +/- 1 to 25.9 +/- 10.6 mEq/24 h, p less than 0.05), and urine osmolality decreased significantly (622 +/- 91 to 251 +/- 76 mosmol/L, p less than 0.05) with a significant rise in serum sodium concentration by 72 hr (131 +/- 2 to 135 +/- 1.6 mEq/L, p less than 0.05) and serum osmolality. Serum arginine vasopressin levels remained elevated at 3.85 +/- 0.94 microU/ml, however, although a transient depression cannot be excluded. Subsequently, a small but significant decrease in serum arginine vasopressin levels to 3.04 +/- 0.65 microU/ml (p less than 0.05) was associated with a further rise in serum sodium levels above baseline values (138 +/- 1.4 mEq/L, p less than 0.01) and in serum osmolality. In conclusion, these results indicate that in this group of cirrhotic patients with refractory ascites, intrarenal factors, such as decreased delivery of filtrate to the distal nephron as well as elevated inappropriate levels of arginine vasopressin, are important in the pathogenesis of hyponatremia.

Aldosterone↗
PubMed1982

Structure and function of small bowel allografts in the dog: immunosuppression with cyclosporin A.

Pairs of mongrel dogs received orthotopic total small bowel allografts. Half were treated with the immunosuppressive agent cyclosporin A and the other half were not. Ten untreated dogs survived a mean of 12.5 days (range from 7 to 25 days). They lost up to 30% of their initial body weight and rejection with hemorrhagic necrosis was usually the cause of graft failure. The mean survival of 11 dogs treated with cyclosporin A was 90.6 days (range 9 to 286 days) with early deaths being due to pneumonia or volvulus. Intestinal mucosa appeared normal, but there was some smooth muscle hypertrophy. Reconnection of lymph vessels was complete in all dogs examined more than 21 days after allografting. Two dogs survived for 203 and 221 days, respectively, and one dog remains alive and well 287 days after operation. The long-term survivors remained healthy, with steady body weights, formed stools, normal plasma protein values and xylose absorption curves that did not differ from those of autografted dogs. Roentgenography after a barium meal and follow-through study showed normal mucosa. The transit time was around 60 minutes (normal 150 minutes). Late, acute episodes of rejection occurred in two dogs, when blood levels of cyclosporin A were low (less than 400 ng/ml). Bowel mucosa showed ulceration and villous atrophy, with lymphoid infiltration, leading to malabsorption as a terminal event. Cyclosporin A is effective in increasing the duration of survival in dogs with small bowel allografts while maintaining essentially normal bowel structure and good function.

Animals↗
PubMedDate not supplied

Health care system and medical education in Canada. 1. Review of the health care context in a time of change.

Over the past three decades Canada has developed an exemplary system of universal health care. However, current financial constraints threaten to undermine the very foundation of the system that represents Canada's respect for social justice. The first of these two articles (Part 1) discusses the unique characteristics of the system, a comparative view of universal health care systems, the reaction of the medical profession to governmental control, and finally the funding and manpower shortages that are compelling a review of the values and organization that have sustained the system thus far. The second article (Part 2) reviews the organization and funding of medical education and the impact of some critical changes in the health care system on postgraduate medical education. Issues related to new licensure and certification requirements, changing population demographics and approaches to health care delivery, manpower needs, and the attitude and expectations of the public are discussed.

Canada↗
PubMedDate not supplied

Health care system and medical education in Canada. 2. Impact of changes in the health care system on medical education.

Over the past three decades Canada has developed an exemplary system of universal health care. However, current financial constraints threaten to undermine the very foundation of the system that represents Canada's respect for social justice. The first of these two articles (Part 1) discusses the unique characteristics of the system, a comparative view of universal health care systems, the reaction of the medical profession to governmental control, and finally the funding and manpower shortages that are compelling a review of the values and organization that have sustained the system thus far. The second article (Part 2) reviews the organization and funding of medical education and the impact of some critical changes in the health care system on postgraduate medical education. Issues related to new licensure and certification requirements, changing population demographics and approaches to health care delivery, manpower needs, and the attitude and expectations of the public are discussed.

Canada↗