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D J Effeney

Publications and source records attributed to D J Effeney.

12 recordsLinked to original sources
PubMed1991

Pre- and post-testing of students in surgery: do medical rotations help?

A prospective multiple choice question (MCQ) study developed to pre- and post-test fifth year medical students at the University of Queensland, was undertaken during 1990. We investigated whether there was a significant gain in their surgical knowledge base resulting from non-surgical rotations during the same year. We have previously reported a retrospective study suggesting that there was such a gain. Comparable clinical surgical pre- and post-tests were adapted from a fresh question bank, and were presented prospectively to four groups of fifth year medical students at the beginning and end of each 7 week General Surgical term. In contrast to our retrospective study, we found there was no significant increment in surgical knowledge using non-parametric Notched Box and Whisker Plot analysis of data. We conclude that this is either because students are compartmentalizing their factual knowledge base between one speciality and the next, or that indeed there is no benefit to Surgical knowledge base from prior non-surgical rotations. Assuming the former, a combined Medical and Surgical Objective Structured Clinical Examination (OSCE) at the end of the fourth year could serve to broaden the student's horizons and reduce factual dissociation during the fifth year.

Clinical Clerkship↗
PubMed1990

Surgical knowledge base augmentation by medical rotations: does it happen?

A study of 4 groups of fifth year medical students taking Surgery during the 4 terms of 1989 at the University of Queensland was undertaken to determine whether there was assimilation of factual material relevant to the surgical knowledge base from the other specialty rotations done during the same year of the course. The records of multiple choice question (MCQ) examination results for the 210 students were retrieved and reviewed. The performance of the same students during their fourth-year rotation in Surgery was checked to make sure that the 4 groups did not already display unusual surgical aptitude or incompetence. The questions were categorized in order to ascertain that the content of all the examinations was similar. The results of students doing Surgery during the first of the 4 terms in 1989 were compared with subsequent groups. The difference between the groups was that those in the first term had not had the benefit of fifth year rotations through Internal Medicine, Psychiatry, General Practice and electives. Subsequent groups had increasing experience in the other specialties. The fourth and final group in the year had undertaken all four of the other rotations before doing Surgery. Significant improvement was found in the performance of each of the subsequent groups of students compared with the first-term group. This implies that there is an escalating accural of factual knowledge related to surgery from the fifth-year courses in Internal Medicine, Child Health and Psychiatry.

Curriculum↗
PubMed1990

Efficacy of single or repeated hemoperfusion in a canine model of paraquat poisoning.

Although hemoperfusion has been used to treat paraquat poisoning, its efficacy has been widely debated. This study examines the kinetic and pathologic correlates of paraquat toxicity and hemoperfusion and the efficacy of hemoperfusion in four groups of four dogs. This species was chosen because the kinetics and toxicity of paraquat are similar to those in the human. All dogs given a lethal dose of paraquat dichloride producing 100% mortality as a 2-hr infusion (7.48 mg of paraquat ion per kg) developed the typical clinical, laboratory and pathologic features of paraquat toxicity and died within 5 to 7 days. All dogs given paraquat and hemoperfused for 8 hr daily, beginning at 12 hr, died within 3 to 6 days. Two of four dogs which were hemoperfused once, beginning at 2 hr, survived. One dog in the repeated hemoperfusion only group died from blood loss. Negligible amounts of paraquat (0.4-2.0% of the total dose) were adsorbed during repeated hemoperfusion because of extensive excretion of paraquat in urine and sequestration in peripheral tissues from which redistribution was slow. The efficacy in the single early hemoperfusion group can be attributed to removal of 25% of the dose by the procedure in the two survivors. We conclude that single hemoperfusion may have some clinical application in patients who present within a few hours of the ingestion and have not ingested a dose of paraquat that is multiples of the lethal dose producing 100% mortality. It is doubtful if there is any role for repeated hemoperfusion.

Absorption↗
PubMed1979

Surgery of the aortic arch branches and vertebral arteries.

Experience with 192 operations of vascular reconstruction for atherosclerosis in the proximal brachiocephalic and vertebral arteries is reported. These procedures constitute only 10 per cent of operations for extracranial arterial occlusive cerebrovascular disease at the University of California, San Francisco, in the past 20 years. All patients were asymptomatic. Except for six patients with cerebral embolization from ulcerating lesions, symptoms resulted from cerebral hypoperfusion. Prevention of ultimate stroke was the primary objective of operation in patients with embolization and in patients with stenosis or occlusion of the common carotid arteries. Purely obstructive lesions in the subclavian and vertebral arteries were symptomatic only when there was bilateral involvement and the objective of operation was the relief of disabling symptoms of hypoperfusion for these otherwise essentially benign lesions. Prior correction of associated stenosis of the carotid artery often removed the need for a proximal operation. The majority of the operations were endarterectomy or transposition, or combinations of the two. Cervical bypass grafts, because of their less certain durability, were used only when a more direct operation was neither feasible nor safe.

Aorta, Thoracic↗
PubMed1978

The relationship between sepsis and disseminated intravascular coagulation.

As the initial problems of trauma have been resolved, patients may survive the immediate period following critical injury only to succumb later to the effects of sepsis. We previously noted a correlation between multiple organ failure and intravascular clotting. The present study evaluated the incidence of infection complications following proven disseminated intravascular coagulation. Detailed analysis of multiple clotting factor changes following critical surgical illness (Factors I, II, V, VIII, IX, X, XI, and platelets, fibrin degradation products and plasminogen) were carried out prospectively in 48 patients. Twenty-one of the 48 were classified as having a severe degree of intravascular coagulation on the basis of hematologic evidence. Only one survived without evidence of infection; 16 showed changes consistent with a moderate degree of intravascular coagulation, and ten subsequently developed evidence of infection. Of the 11 patients with minimal evidence of intravascular coagulation, infection developed in only one.

Adolescent↗
PubMed1977

Transmetatarsal amputation.

We have reviewed the records of 25 patients who underwent a transmetatarsal amputation at San Francisco General Hospital. The average patient age was 63 years old. Twelve of the patients were diabetic, while transmetatarsal amputations were performed in eleven with simple arteriosclerosis. Two patients underwent amputations for either trauma or nonhealing ulcer. Thirteen of the patients healed their amputation, and twelve of these became ambulatory. Eleven required higher amputation, because of nonhealing due to infection in seven and progressive ischemia in four. One patient died on the first postoperative day of pneumonia. The failure group was younger, contained more diabetics, and had a higher incidence of infection. The operative procedure of transmetatarsal amputation is described. We believe that patients with distal gangrene without spreading infection should be considered for transmetatarsal amputation, reserving initial below-knee amputation for those with greater involvement of the foot.

Adult↗
PubMed1977

In vivo assessment of anticoagulation.

All methods of assessing anticoagulation rely on in vitro techniques. Although these may reflect the clotting tendency in a specimen of blood accurately, they do not necessarily indicate the effectiveness of the anticoagulant in the body where stasis, acidosis, catecholamines, endotoxin, and exposed collagen may alter the coagulability of blood locally. We have utilized autologous 125I-labelled fibrinogen to assess fibrinogen half-life in normal subjects and in patients with clotting complications before and after the administration of anticoagulants. Fibrinogen half-life has varied from normal (104 hours) to markedly abbreviated (13 hours) in patients apparently fully anticoagulated, utilizing standard laboratory parameters. Although there are many potential causes of the shortening of fibrinogen half-life, including fibrinogenolysis and extravascular losses into the interstitial space and wounds, we have been able to establish whether the disappearance of the radioactive-labelled fibrinogen is due to these causes or to clotting by increasing the levels of anticoagulation. Plateauing of fibrinogen half-life values despite increased doses of heparin, or return of the half-life to normal, indicates full anticoagulation. This has permitted determination and administration of the theoretically optimal dose of heparin. In situations involving life-threatening clotting complications, such as massive pulmonary embolism, the use of 125I-labelled fibrinogen provides a means for controlling anticoagulant therapy in a rational fashion by this technique of assessing clotting.

Adult↗