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Biomedical subjects

W C Trier

Publications and source records attributed to W C Trier.

At least 19 recordsLinked to original sources
PubMed1991

Predictive validity of a house-officer selection process at one medical school.

This study explored the rank list generated by a process of evaluating applicants for a surgery residency; the process is a revision of an older process (pre-1982) used for that purpose. The study's aim was to learn whether the new process is more predictive of residents' performances in their first year than was the process it replaced and whether the rough rankings computed directly from ratings of applicants are more predictive than the final rankings determined in a meeting by the department faculty, who modify the rough rankings. The 1982-1986 rankings and performances of 32 first-year residents at the University of North Carolina at Chapel Hill School of Medicine were studied and compared with the rankings and performances of 77 applicants from 1976 and 1978-1979 under the previous system. Correlation analyses revealed that for the applicants studied, the rough rankings in the new and the previous systems were equally predictive of performances as measured by rating scales, but that the new system was more predictive of performances on the surgery in-training examination. However, all correlations were small. Finally, the rough rankings obtained under the new system were more predictive of the residents' later performances than were the faculty's final rankings.

Career Choice↗
PubMed1988

Complications of primary palatoplasty: a twenty-one-year review.

The complications of 196 patients who underwent primary palatoplasties at North Carolina Memorial Hospital between 1963 and 1983 were reviewed. The von Langenbeck technique was utilized in 50 percent of the patients, the Wardill-Kilner technique in 45 percent, and the Dorrance technique in 5 percent. Intravelar veloplasties were performed in 34 percent of the patients. The incidence of postoperative complications was: deaths, 0 percent; malignant hyperthermia, 0 percent; aborted procedures, 0.5 percent; feeding difficulties, 0.5 percent; aspiration, 0.5 percent; reexploration for bleeding, 0.5 percent; pneumonia, 1 percent; upper respiratory tract infections, 2 percent; postoperative airway difficulties, 3 percent; oropharyngeal infections, 4 percent; and otitis media, 10 percent. Later evaluations demonstrated problems with otitis media in 17 percent of the patients and fistulas in 6 percent. An additional palatal operation of some type was later required in 22 percent of the patients, with 18 percent of the patients requiring a pharyngeal flap. Intravelar veloplasties were associated with a decreased incidence of secondary pharyngeal flaps but also an increased transfusion requirement. The Wardill-Kilner technique was associated with a higher incidence of postoperative fistulas, and the use of perioperative antibiotics was associated with fewer postoperative fistulas.

Adolescent↗
PubMed1988

The effect of intravelar veloplasty on velopharyngeal competence following pharyngeal flap surgery.

Clinical experience from primary palatoplasty and studies of velopharyngeal valving suggest that intravelar veloplasty (IVVP) could increase the achievement of velopharyngeal competence in patients undergoing pharyngeal flap surgery. In order to test this hypothesis, a group of 91 patients undergoing superiorly based, high-attached, lined pharyngeal flaps along with intravelar veloplasty were compared retrospectively with 39 patients who underwent the same procedure without intravelar veloplasty. Comparison of speech evaluation and pressure-flow data demonstrated no difference in attainment of velopharyngeal competence between the two groups. Though theoretically sound, intravelar veloplasty did not appear to improve the results of pharyngeal flap surgery. The high incidence of postoperative hyponasality in both the study and control groups suggests a possible need for increased lateral port size in performing the procedure.

Adolescent↗
PubMed1987

Evaluation and redesign of a system to rank applicants for surgical residencies.

The present paper is a report of the evaluation and subsequent revision of a selection system for surgical house officers. The authors conducted a series of studies to determine the content validity, concurrent validity, and predictive validity of the system used by the surgery department prior to 1982. The results did not support the validity of that ranking system. In particular, the system was found not to evaluate candidates on criteria considered important by the faculty. Based on these findings, the department adopted a new ranking system organized around a multimethod-multitrait matrix (that is, using multiple methods to assess multiple traits) and based on a new set of traits that had been identified as important in the earlier validity studies. The new system has been used for five years, since 1982, with acceptance and favorable evaluation by the faculty. During that period, the median and mean rank of candidates who were matched to the residency program improved.

Educational Measurement↗
PubMed1987

Confirmatory factor analysis of house office candidate appraisals.

This article illustrates an application of confirmatory factor analysis, using the LISREL program, to retrospective analysis of rating data common in health professions education. We begin with specification of a causal model reflecting the multitrait-multimethod design of a surgical house-officer ranking system. The model is then tested using data provided by rating system functioning over two successive years. The results suggest that although most rating measures do cluster around latent traits as hypothesized, there is more method variance in the data set than trait variance. The trait and method factors are also found to be highly intercorrelated. Practical implications of these results include specific modifications in the rating system, potentially leading to improvement of the system.

Factor Analysis, Statistical↗
PubMed1985

Effectiveness of genetic counseling for families with craniofacial anomalies.

Questionnaire data about genetic counseling experiences are presented from 37 parents and 25 patients who were evaluated. The subjects' perceptions vary regarding the cause of cleft lip or palate or both. More positive feelings about the birth defect are expressed after the subjects receive counseling. However, 25 percent of the sample express negative feelings about the birth defect after counseling. Ninety percent of the subjects indicate that counseling should occur within the first 3 months of the birth of the infant with a cleft. The subjects agree significantly on the important components of genetic counseling. The authors conclude that effective counseling includes (1) providing facts, alleviating guilt, and dispelling misperceptions; (2) discussing decision making; and (3) facilitating the coping process. Implications for further research and a protocol for counseling are suggested.

Adolescent↗
PubMed1985

A pressure-flow technique for quantifying temporal patterns of palatopharyngeal closure.

The purpose of this study was to demonstrate a new application of the pressure-flow technique and to determine whether the temporal characteristics of aerodynamic data associated with single-word utterances could reliably differentiate speakers with adequate palatopharyngeal closure from those with inadequacy. The groups included 10 normals, 20 patients with cleft palate who had adequate closure (0.0-0.09 cm2), 20 patients who had borderline closure (0.10-0.19 cm2), and 20 patients who had inadequate closure (greater than 0.19 cm2). The test sound was the nasal-plosive blend /mp/ in the word hamper. The data were processed by a PDP 11/34 computer. The results demonstrate the utility of the pressure-flow technique for studying timing parameters associated with speech and reveal that patients with adequacy of closure can be differentiated from those with inadequacy using timing criteria. Additionally, the data suggest that the perception of nasal resonance in the group with borderline closure appears to be influenced by the timing of closure.

Cleft Palate↗
PubMed1985

Evaluation and treatment planning for patients with cleft lip and cleft palate.

The Oral-Facial and Communicative Disorders Program of the University of North Carolina has provided comprehensive diagnostic evaluation and inpatient and outpatient treatment for patients with cleft lip, cleft palate, and related problems for 22 years. A major aspect of the program is the initial diagnostic evaluation of patients and long-term follow-up evaluation of the results of treatment. The Oral-Facial and Communicative Disorders Program acts as both a consultant in providing requested information to referring professionals and agencies and also as a multi- and interdisciplinary treatment center. The nature of the evaluation process and the manner in which findings and recommendations are agreed upon in order that a comprehensive and coherent treatment plan can be established has been presented. It has been stressed that the needs of the patient can best be met by representatives from disciplines important to the diagnosis and management of patients with cleft lip and cleft palate who can meet together, and after discussion and negotiation arrive at a consensus for every aspect of treatment that is required, as well as a time that is most desirable for each patient.

Child↗
PubMed1985

Repair of unilateral cleft lip: the rotation-advancement operation.

The most obvious deformity in a unilateral cleft of the lip is asymmetry of the lip and nose. Operation must repair the cleft, lengthen the lip, restore muscle continuity, and create an adequate labial sulcus. Simultaneous correction of the nasal deformity should be carried out to the greatest extent possible at the same time. The rotation-advancement repair has advantages over other repairs in scar placement, correction of the nasal deformity, and conservation of lip and nose tissue. If revision of the lip or nose is required, it can be accomplished more easily following the rotation-advancement repair than other techniques.

Child↗
PubMed1985

Repair of bilateral cleft lip: Millard's technique.

The abnormal anatomy and principles of treatment of the bilateral cleft lip deformity have been presented. The Millard technique of bilateral cleft lip repair provides for a philtrum of proper width, a lip of proper height, a full-depth labial sulcus, and complete muscle continuity. Transposition of prolabium not required in the definitive lip repair into the floor of the nose permits subsequent columellar construction.

Child, Preschool↗
PubMed1985

Primary palatoplasty.

Clefts of the secondary palate, either isolated or accompanying a cleft lip, are characterized by a defect in the palate of varying extent and by abnormal insertion of the levator veli palatini muscles. Repair of the palate should be carried out in one stage, shortly before or after 1 year of age, and should include intravelar veloplasty. The technique of von Langenbeck palatoplasty with intravelar veloplasty has been described. This technique should provide velopharyngeal competency in 80 to 90 per cent of patients with clefts of the secondary palate.

Airway Obstruction↗
PubMed1985

The pharyngeal flap operation.

Patients with velopharyngeal inadequacy require structural modification of the velopharyngeal area by a prosthesis or by surgery in order to provide a mechanism for intelligible speech. The superiorly based, high-attached, lined pharyngeal flap was chosen for the treatment of velopharyngeal incompetency and the operative technique was described. Results showed that 90 per cent of the patients demonstrated significantly improved or normal velopharyngeal adequacy for speech following surgery, and 92 per cent of the patients demonstrated adequate closure of the velopharyngeal orifice as determined by aerodynamic studies.

Child↗
PubMed1984

A comparison of palatoplasty techniques.

The efficacy of palate lengthening procedures and intravelar veloplasty performed at the time of primary cleft palate repair was studied in a series of eighty patients by comparing speech results, pressure flow studies, and the ultimate need for pharyngeal flaps. The results indicate that intravelar veloplasty yields better speech through better velopharyngeal function and less frequent pharyngeal flap procedures.

Adolescent↗
PubMed1984

Primary von Langenbeck palatoplasty with levator reconstruction: rationale and technique.

In the preceding article, patients undergoing von Langenbeck palatoplasty without reconstruction of the levator veli palatini muscles were compared to patients undergoing the identical procedure, but with intravelar veloplasty. Palatoplasty included repair of both hard and soft palate, tension-free approximation of mucoperiosteal and soft palate flaps, and everting suture of nasal mucous membrane and oral mucous membrane from the anterior extent of the palate cleft to the tip of the uvula. No attempt was made to repair an alveolar cleft, if present. The authors concluded that intravelar veloplasty was of significant value in providing velopharyngeal competency, and in this companion article the rationale and technical details are presented.

Cleft Palate↗
PubMed1983

Cerebrospinal fluid rhinorrhea following rhinoplasty.

Cerebrospinal fluid rhinorrhea, whatever the etiology, is a serious and life-threatening problem. We present a case following rhinoplasty. To our knowledge, this specific complication has not been reported, most likely because it has gone unrecognized, since most cerebrospinal fluid leaks cease spontaneously. Surgeons performing rhinoplasty should be aware of this potential complication, how to confirm the diagnosis, and methods for its treatment.

Adult↗
PubMed1983

Velopharyngeal incompetency in the absence of overt cleft palate: anatomic and surgical considerations.

Fifty-two patients with velopharyngeal incompetency without overt cleft palate underwent pharyngeal flap surgery. Surgery included exploration of the soft palate and reconstruction of the levator muscles. Four patients had a completely normal hard and soft palate. In two patients, the palatal musculature was normal but a U-shaped defect of the posterior hard palate was palpable. Seventeen patients had a diagnosis of submucous cleft palate made preoperatively and of these thirteen presented with the classic triad of a bifid uvula, a palpable abnormality of the hard palate and diastasis of the soft palate musculature. In thirteen patients a notch was found in the hard palate and in one patient a U-shaped defect was palpable at the posterior edge of the hard palate. Three patients presented no abnormality of the hard palate. One patient's uvula was normal. In the remaining twenty-nine patients, all demonstrated abnormal insertion of the palate muscles into the hard palate. In fifteen of these patients the hard palate was normal. In nine of the patients a U-shaped defect was palpable at the posterior hard palate and in three patients a notch was palpable. Thus, forty-eight of fifty-two patients (92%) demonstrated abnormal anatomy of the palate responsible for their velopharyngeal incompetency.

Humans↗
PubMed1979

Considerations in the choice of surgical needles.

Bodily tissues of varying consistency, thickness, penetrability, location and weave are encountered by the surgeon. Correspondingly, he should choose surgical needles that will introduce sutures through these tissues in the most precise and rapid manner, ideally creating a wound just large enough to draw the suture material into and through the tissue. Manipulation of the needle is aided by selecting one appropriate to the specific wound site and by the choice of a needle holder that is most ideally suited to the particular needle. Although the primary reason for appropriate choice of needle and needle holder is better patient care, an extremely important secondary reason is greater comfort and satisfaction for the surgeon in using ideal instruments.

Humans↗