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Biomedical subjects

R Reznick

Publications and source records attributed to R Reznick.

27 records · Page 2Linked to original sources
PubMed1995

Treatment of rectovaginal fistulas that has failed previous repair attempts.

PURPOSE: The purpose of this study was to assess results of treatment of rectovaginal fistulas (excluding pouch vaginal fistulas) that have failed previous attempts at repair. METHOD: A retrospective chart review of all patients presenting with nonhealing rectovaginal fistula was performed. RESULTS: Twenty eight patients with persistent fistulas were identified. In 18 patients the fistula was classified as simple, and in 10 the fistula was complex. Fourteen fistulas were secondary to obstetric injury, five were caused by Crohn's disease, and nine patients had miscellaneous etiologies for their fistulas. Of patients with persistent simple fistulas, 13 (72 percent) of the fistulas healed, 5 after advancement flaps, 5 following sphincteroplasty, and 3 after coloanal anastomoses. Of persistent complex fistulas, only four of ten (40 percent) healed, one following sphincteroplasty, one with coloanal anastomosis, and two after gracilis transposition. A total of 23 advancement flaps were done in 17 patients with five fistulas healing (29 percent). Sphincteroplasty and fistulectomy was successful in six of seven patients (86 percent). Coloanal anastomosis resulted in healing of four of six patients (67 percent) in whom it was attempted. Gracilis muscle transfer was successful in two of two patients (100 percent). CONCLUSION: Persistent rectovaginal fistula presents a difficult management problem. Choice of operation must be tailored to the underlying pathology and type of repair previously done. Advancement flap repair is generally not recommended for persistent complex fistulas or for simple fistulas that have failed a previous advancement flap repair.

Adult↗
PubMed1995

Description and results of a needs assessment in preparation for the "Surgeons as educators" course.

BACKGROUND: In August 1993 the American College of Surgeons sponsored a course entitled "Surgeons as Educators" (SAE) aimed at equipping academic surgeons with the knowledge and skills necessary to enhance surgical education administration, curriculum, teaching, and evaluation. METHODS: The instructional design model used to construct the course called for a formal needs assessment to determine the importance, current skill level, and priority of what needed to be learned to be an effective educator. The needs assessment was accomplished using a job analysis and questionnaire approach. The 68-item questionnaire was mailed to 320 academic surgeons representing eight medical schools. RESULTS: A 62% response rate was achieved. Results indicated the education-related tasks or activities that faculty felt were important to their careers, as well as their perceived level of development in each area. Descriptive statistics were used to summarize the responses that were critical to the SAE faculty in helping prioritize, sequence, and time ration course content. Collective results became the foundation for developing the SAE curriculum by the course's five faculty members. CONCLUSIONS: A well-done needs assessment does not necessarily guarantee course success; however, it is the first and critical step to planning an educationally sound faculty development course or program designed for adult learners.

Adult↗
PubMed1995

Demonstration of acquisition of trauma management skills by senior medical students completing the ATLS Program.

OBJECTIVE: To assess the teaching effectiveness of the Advanced Trauma Life Support (ATLS) Program among senior medical students. DESIGN, MATERIALS, AND METHODS: We used objective structured clinical examination (OSCE) and multiple choice question (MCQ) testing to assess 40 senior medical students (20 ATLS and 20 non-ATLS) at the University of Toronto. Pre- and post-ATLS, all students had four 15-minute OSCE stations and a 40-item MCQ test. The pre- and post-ATLS performance for the ATLS and non-ATLS group were compared. MEASUREMENTS AND MAIN RESULTS: Cronbach's reliability coefficients were 0.81 and 0.93 for the pre- and post-ATLS OSCEs. The mean (+/- SD) OSCE scores at the four pre-ATLS OSCE stations were 7.6 +/- 2.8, 7.4 +/- 2.3, 8.3 +/- 2.7, and 10.5 +/- 3.4 for the ATLS group and 6.5 +/- 2.1, 7.0 +/- 2.2, 7.6 +/- 2.5, and 9.6 +/- 3.1 for the non-ATLS group (p = NS). Post-ATLS scores for the four OSCE stations were: 15.5 +/- 1.6, 14.1 +/- 3.2, 12.3 +/- 2.9, and 18.3 +/- 1.0 (ATLS group) and 7.9 +/- 3.5, 6.3 +/- 2.8, 7.6 +/- 2.3, and 10.9 +/- 3.3 (non-ATLS group: p < 0.01). Pre-ATLS MCQ scores were 49 +/- 9 and 52 +/- 8% for the ATLS and non-ATLS groups respectively; the ATLS group increased MCQ scores to 83 +/- 5% and the non-ATLS group did not change (53 +/- 8%). Pre-ATLS scores for adherence to priorities were: 35 +/- 14% (ATLS) and 29 +/- 13% (non-ATLS: p = NS). Post-ATLS scores were 99 +/- 6% (ATLS) and 29 +/- 19% (non-ATLS; p < 0.01). The pre-ATLS organized approach to trauma ratings (range 1 to 5) were: 1.9 +/- 1.5 (ATLS) and 1.6 +/- 0.5 (non-ATLS; p = NS) compared to post-ATLS grades of 4.6 +/- 0.4 (ATLS) and 1.7 +/- 0.5 (non-ATLS: p < 0.01). All 20 students passed the ATLS course. CONCLUSION: Using highly reliable trauma OSCE stations we have demonstrated trauma management skills acquisition by senior medical students after the ATLS course.

Canada↗
PubMed1994

A comparative analysis of the costs of administration of an OSCE (objective structured clinical examination).

BACKGROUND: The objective structured clinical examination (OSCE) has become an accepted technique for the evaluation of clinical competence in medicine. Although advances have been made in our knowledge of the psychometric aspects of the OSCE, extremely little has been written about feasibility and cost issues. Given the current economic imperative to control costs and the extremely scant literature on the costs of developing and administering an examination in medicine, the authors felt it timely and relevant to explore issues related to the cost of the OSCE. METHOD: In 1991-92 and in 1992-93, costs and time requirements to implement and administer a structured oral (SO) examination and a six-station OSCE for a surgical clerkship at the University of Toronto Faculty of Medicine were gathered by review of invoices, interviews with those involved, and perusal of diaries kept by staff. RESULTS: To develop and administer the six-station OSCE, 327.5 hours of staff and faculty time were required for each rotation of surgical clerks (8.2 hours per student). The SO examination required 110 hours of staff and faculty time (2.75 hours per student). Direct expenses for the OSCE amounted to U.S. $6.90 per student per station, compared with no direct expense for the SO examination. CONCLUSION: The OSCE was more time-consuming and more expensive in human and material costs than the SO examination. However, costs of the OSCE can be substantially reduced from approximately U.S. $35 to U.S. ! per student per station if test developers, standardized patients, support staff, and examiners can donate their time. The authors compare the costs and time requirements of their OSCE with those of other OSCEs reported in the literature, and they provide guidelines to assist educators in deciding whether the costs of an OSCE are justifiable in the educators' individual settings.

Clinical Clerkship↗
PubMed1992

Continuing evolution of the pelvic pouch procedure.

The results of the pelvic pouch procedure were reviewed to assess the surgical complication rate and outcome of patients who had had the procedure performed with a stapled ileo-anal anastomosis with and without a defunctioning ileostomy. Between December 1982 and March 1992, 483 patients underwent a pelvic pouch (PP) procedure. Patients were divided into three groups: group I consisted of 325 patients (178 men and boys and 147 women and girls) who underwent a PP procedure with a handsewn ileoanal anastomosis (IAA) with a defunctioning loop ileostomy. In group II, there were 87 patients (47 men and boys and 40 women and girls) who had a stapled IAA with a defunctioning ileostomy. Group III patients consisted of 71 patients (43 men and boys and 28 women and girls) who had a stapled IAA with no covering ileostomy. Assessment was made of the IAA leak rate, the surgical complications, the reoperation rate, and functional outcome. Early surgical complications included 40 (12%) IAA leaks in group I patients compared with only six (7%) leaks in group II patients who had a stapled IAA (p < 0.05). In group III patients, who had a stapled IAA but no covering ileostomy, there were 13 leaks (18%). Eleven of these 13 leaks healed spontaneously with tube drainage; one patient remains with a rectal tube in place 6 weeks after operation, and only one patient has required a reoperation (defunctioning ileostomy). Functionally, all patients with a healed IAA after a leak have had an excellent result comparable to those without a leak. Patients who were male, older than age 40, on steroids, and had had a true one-stage PP procedure, had a greater risk of developing an IAA leak. In two patients, there was intraoperative difficulty, and one of these patients had an IAA leak after operation. Disease activity at the resection margin and patient weight did not affect the leak rate. Our results suggest that the IAA leak rate is significantly reduced in patients with a stapled IAA with an ileostomy compared with those with a handsewn IAA. Omission of the defunctioning ileostomy is associated with a higher IAA leak rate, but spontaneous healing occurs in almost all patients without impairment of functional results. In patients in whom the ileostomy is omitted, the IAA leak rate is greatest in male patients who have undergone a true one-stage PP procedure, are on steroids, and are older than age 40.

Adenomatous Polyposis Coli↗
PubMed1992

An objective structured clinical examination for the licentiate: report of the pilot project of the Medical Council of Canada.

The Medical Council of Canada (MCC) administers a qualifying examination for the issuance of a license to practice medicine. To date, this examination does not test the clinical skills of history taking, physical examination, and communication. The MCC is implementing an objective structured clinical examination (OSCE) to test these skills in October 1992. A pilot examination was developed to test the feasibility, reliability, and validity of running a multisite, two-form, four-hour, 20-station OSCE for national licensure. In February 1991, 240 volunteer first- and second-year residents were tested at four sites. The candidates were randomly assigned to one of two forms of the test and one of two sites for two of the four sites. Generalizability analysis revealed that the variance due to form was 0.0 and that due to site was .16 compared with a total variance of 280.86. The reliabilities (inter-station) were .56 and .60 for the two forms. Station total-test score correlations, used to measure station validity, were significant for 38 of the 40 stations used (range .14-.60). The results of the OSCE correlated moderately with the MCC qualifying examination; these correlations were .32 and .35 for the two test forms. Content validity was assessed by postexamination questionnaires given to the physician examiners using a scale of 0 (low) to 10 (high). The physicians' mean ratings were: importance of the stations, 8.1 (SD, 1.8); success of the examination in testing core skills, 8.1 (SD, 1.6); and degree of challenge, 7.8 (SD, 2.1). The results indicate that a full-scale national administration of an OSCE for licensure is feasible using the model developed. Aspects of validity have been established and strategies to augment reliability have been developed.

Canada↗
PubMed1978

Radionuclide test for gastric bile reflux.

The authors conducted a study using radioactive endogenous bile to detect gastric bile reflux in healthy volunteers and patients suspected of having bile gastritis. When 7 muCi of pyridoxylideneglutamate of hydroxyiminodiacetic acid labelled with technetium-99m is injected intravenously it is excreted by hepatocytes, and sequential gamma camera images visualize the bile ducts and show subsequent activity in the gut. Following such an injection, the authors determined the presence of isotope-labelled bile in the stomach in fasting subjects by assaying count rates in serial gastric aspirates obtained by means of a nasogastric tube positioned in the antrum. The results were related to the clinical history and gastroscopic findings. In normal persons only extremely low counts were detected, possibly due to free activity; high counts (in excess of 50 000/min) indicated abnormal reflux. It is suggested that this test is a useful adjunct, and is more physiologic than endoscopy, in the assessment of bile reflux.

Bile↗