Biomedical subjects

D M Marchiori

Publications and source records attributed to D M Marchiori.

10 recordsLinked to original sources

PubMed1999

Developing a clinical competency examination in radiology: part I--test structure.

BACKGROUND: There is a need for radiology educational outcome measures that evaluate clinical competency. This is the first of two articles introducing a clinical competency examination in radiology. This first article describes the evolution and structure of the examination. The second article presents the results of two administrations of the examination and evaluates possible outcome predictors. OBJECTIVE: To develop a measure of clinical competency in radiology. DESIGN: Descriptive. METHODS: A test was developed to simulate the radiologic interpretive skills needed in clinical chiropractic practice. Students were timed as they responded to questions regarding the localization, categorization, management, and identification of pathologic conditions presented on plain film images of the spine and chest. Twenty-five radiographic cases were displayed at individual viewbox stations, and student responses to the 4 questions were compared with the consensus responses of 2 radiology instructors. RESULTS: Two versions of the test, using different cases, were given to the same ninth trimester class of 210 chiropractic students in a 10-trimester program. Of the 210 students, 116 (55.2%; 86 men and 30 women) took version 1 of the examination, and 1 month later 181 (86.2%: 138 men and 43 women) took version 2 of the examination. Student comments after each examination were favorable. CONCLUSION: The test structure uniquely provides information related to the student's ability to localize, categorize, manage, and identify pathologic conditions on imaging studies. At present the examination is instructor time intensive; further refinement is needed before wide implementation can occur.

Chiropractic↗

PubMed1999

Developing a clinical competency examination in radiology: part II--test results.

BACKGROUND: This is the second of two articles introducing a clinical competency examination in radiology. The first article described the structure, administration, and postexamination student comments for two versions of the radiology competency examination. This article reports the results obtained from these two administrations of the examinations. OBJECTIVE: To measure and identify potential outcome predictors of student aptitude in clinical film interpretation. DESIGN: Experimental. METHODS: An examination was developed to simulate the radiologic interpretive skills needed in clinical chiropractic practice. Two versions of the examination were given to a class of 210 ninth trimester students in a 10-trimester chiropractic program. Linear regression and bivariate correlations were performed on possible predictors of student success and test scores on the version 2 examination. RESULTS: On version 1 of the examination, students were able to identify an average of 59.6% of the normal cases as normal and 51.6% of abnormal cases as abnormal. On version 2, 55.6% of the normal cases were recognized as normal and 58.2% of abnormal cases as abnormal. On both versions, students were less successful at correctly categorizing, managing, or naming pathologic conditions they found. Of the predictors evaluated, only the students' grades in the third radiology course (tumors, arthritides, and extremity trauma) and the scores on the diagnostic imaging section of National Boards part II were significant predictors. DISCUSSION: Our results should cause some concern for educators who use content-based radiology curricula. Students demonstrated poor abilities to recognize, categorize, manage, and identify common radiographic pathologic conditions. Educators cannot rely on National Board scores and course grades to determine student clinical competency. More radiology clinical competency exercises that emphasize film interpretation need to be incorporated into content-based curricula.

Aptitude↗

PubMed1998

Research productivity of chiropractic college faculty.

BACKGROUND: There is a growing need for research to further the goals of the chiropractic profession. Because of available resources, chiropractic faculty may be in the best position to accomplish much of the profession's research needs. A widely used method of assessing faculty research productivity is to count the number of peer-reviewed research publications over a selected time frame. OBJECTIVE: To investigate the research productivity of chiropractic college faculty and identify parameters associated with increased peer-reviewed publication. STUDY DESIGN: A survey was administered to collect data in a cross-sectional design. METHOD: Data were collected through a survey administered to all full-time chiropractic college faculty working in the United States. Although the survey addressed many scholarly activities, the criterion variable selected for this study is the number of peer-reviewed journal articles published over the past 3 yr. RESULTS: Three groups of faculty had more publications: those primarily assigned to research, those with either a D.C. degree or a D.C. and Ph.D. degree, and finally those with a rank of full professor. Faculty age and gender were not associated with the reported number of publications. The majority of faculty members (72.2%) have not published a single peer-reviewed article in the last 3 yr. Less than 2% of the faculty members has published 10 or more peer-reviewed articles in the last 3 yr. CONCLUSION: Many faculty are not involved in research activities. Faculty development and incentive programs need to be implemented to stimulate these individuals. Increasing faculty research activities benefits the faculty, their institutions and their profession.

Adult↗

PubMed1996

A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability.

STUDY DESIGN: A cross-sectional design was used to correlate cervical radiographic findings of spinal degeneration to neck pain and disability. OBJECTIVES: The results were correlated to assess the clinical importance of radiographic spinal degeneration. SUMMARY OF BACKGROUND DATA: Past investigations suggest little association between clinical findings and radiographic evidence of spinal degeneration. However, changes in activities of daily living and chronicity of complaint have not been investigated. METHODS: Over a 5-month period, data were collected on 700 consecutive patients referred for cervical radiographic examination as part of their clinical evaluation. While in the radiology department, all subjects completed a visual analog pain scale, neck disability index, and short questionnaire, all of which quantified various aspects of any neck complaint. Relationships between indices of patient complaint and the number of cervical degenerative intervertebral discs were evluated using regression analysis. RESULTS: A significant relationship (P < 0.001) was noted between the number of levels of intervertebral disc degeneration and the chronicity of cervical complaint. No significant relationship was found between cervical degeneration and past trauma (P = 0.904) or gender (P = 0.213). Multiple-regression analysis of visual analog pain scale scores revealed a significant two-way interaction with chronicity and past trauma (P = 0.007) and a significant main effect with gender (P < 0.001). Cervical degeneration was not significant as a main effect or interaction with other factors. Multiple-regression analysis of neck disability index scores demonstrated a significant three-way interaction of chronicity, degeneration, and gender (P = 0.022) and a significant two-way interaction for chronicity and trauma (P = 0.025). No additional information was gathered by multivariate multiple-regression techniques. CONCLUSIONS: Increasing levels of spinal degeneration are related to increasing chronicity of patient complaints. Spinal degeneration is not related to past trauma or gender. Women, but not men, report higher disability with increasing levels of degeneration. Subjects with past trauma reported more intense pain and disability. Overall, men reported less neck pain and disability than women.

Activities of Daily Living↗

PubMed1996

Tethered cord syndrome.

OBJECTIVE: To briefly discuss a case of tethered spinal cord syndrome, and to acquaint the reader with one of many important differential considerations among patients presenting with low back and leg pain. FEATURES: A 32-yr-old woman sought treatment at a private chiropractic clinic for a 6-month history of low back pain with intermittent diffuse bilateral leg pain and numbness. Plain films of the lumbar spine revealed no abnormality. Magnetic resonance imaging demonstrated a tethered spinal cord. INTERVENTION: The abbreviated filum terminale was surgically corrected. CONCLUSIONS: Tethered cord syndrome, a significant finding, is likely to have been responsible for the patient's signs and symptoms. Magnetic resonance imaging is particularly helpful in evaluating spinal cord deformity, and may provide important information on patients not responding to chiropractic care.

Adult↗

PubMed1996

A survey of radiographic impressions on a selected chiropractic patient population.

INTRODUCTION: The chiropractic profession relies heavily on conventional radiography for patient clinical evaluation. Although the modality is widely used, there exists surprisingly little descriptive information about the common radiographic findings seen on chiropractic patients. The goal of this study is to provide descriptive data regarding the frequency and type of radiographic findings seen in a convenience sample of chiropractic outpatients. METHODS: A group of 300 patient radiographic reports were selected from a chiropractic teaching clinic. The group represented all those reports interpreted by the same chiropractic radiologist over the course of 3 months. Patient information, radiographic impressions and recommendations for further management were tabulated. RESULTS: In total, 300 reports (151 women and 149 men) were reviewed. Ages ranged from 6 to 82 yr (mean = 38.0, SD = 16.3). The majority of the patients had multiple skeletal areas examined. Most of the patients had X-rays of the spine (81.7%). Lytic bone changes, increased atlantodental intervals and fractures were among the more significant findings on the spinal films. A solitary pulmonary nodule and pneumonia was noted in the group of chest films. A vascular necrosis and fractures were important lesions found on the extremity films. CONCLUSIONS: Although degenerative disc and posterior joint changes were by far the most prevalent findings, more significant lesions were noted. Lesions such as lytic bone changes, increased atlantodental intervals and the solitary pulmonary nodule represented lesions that necessitated further evaluation. The findings emphasize a need for chiropractic training to address the early recognition and preliminary work-up of these relatively common lesions.

Adolescent↗

PubMed1994

A comparison of radiographic signs of degeneration to corresponding MRI signal intensities in the lumbar spine.

OBJECTIVES: To evaluate plain film radiographic findings of lumbar intervertebral disk degeneration. DESIGN: A cross-sectional observational design was employed. Contingency tables were constructed to evaluate the relationships between radiographic findings of degeneration and the corresponding MRI signal intensities of the inner intervertebral disk. SETTING: Twenty-four consecutive cases were retrospectively selected from an MRI imaging center. PATIENTS: No exclusion was made on the basis of age or sex. MAIN OUTCOME MEASURES: Radiographic findings of IVD degeneration include: Narrowed disk space, osteophyte formation, end-plate sclerosis, vacuum phenomenon, end-plate irregularity and Schmorl's node formation. The inner IVD signal intensity of the sagittal T2-weighted MRI image was visually categorized by three radiologists. The signal intensities were divided into low, medium and high categories. MAIN RESULTS: Visually reduced disk height, osteophytes and eburnation all demonstrate significant relationships with MRI signal intensity. Due to their infrequency, no significant relationships could be found with vacuum phenomena, end-plate irregularity, and Schmorl's nodes when compared to MRI signal intensity. CONCLUSIONS: In conclusion, visually reduced disk height is frequently associated with decreased signal intensity and, therefore, significantly indicates internal disk derangement. Osteophytes are more commonly present when the signal intensity is low. However, high signal intensity is associated with osteophytic change as well. Therefore, osteophytic change is less sensitive and accurate to early inner disk degenerative change. When osteophytes and reduced disk height are present together, a stronger prediction of degeneration is possible then when either finding is present alone. Due to their infrequency, eburnation, vacuum phenomena, end-plate irregularity and Schmorl's nodes are less helpful indicators of degeneration.

Adult↗

PubMedDate not supplied

Chiropractic student attitudes toward radiology.

INTRODUCTION: Diagnostic radiology is an important component of chiropractic education. Because ineffective teaching is costly in time and resources, educators need to continually evaluate both the content and design of their radiology curriculum. METHODS: A survey was administered to 121 senior students from one chiropractic institution immediately after completing presentation of the last of 11 radiology topics presented. Students reported their interest and perceived understanding of radiology topics and indicated which resources they thought were almost helpful during their training. RESULTS: Students ranked arthritides as the most interesting radiology subject and patient positioning as least interesting. They felt more time should be devoted to arthritides and case correlation/patient management issues, with less time devoted to radiology physics and patient positioning. Students felt that they best understood patient positioning, skeletal trauma, arthritides and bone tumors. They reported having less understanding of specialized imaging physics. Of those learning methods available, class lectures and film review sessions were the most helpful radiology resources; film teaching libraries and videodisc system were the least helpful. CONCLUSION: The results of this survey suggest more emphasis needs to be placed on radiology subjects that focus on the application of imaging studies in patient management and on correlating imaging findings to clinical circumstances. It seems that less time should be devoted to patient positioning and radiographic physics. Results of this survey need to be compared with goals of the radiology curriculum and objective testing before appropriate modifications are implemented.

Adult↗

PubMedDate not supplied

Chiropractic radiologists: a survey of demographics, abilities, educational attitudes and practice trends.

OBJECTIVE: To assess the education, abilities, practices and opinions of chiropractic radiologists. DESIGN: Eight-page survey with two mailings. PARTICIPANTS: One hundred seventy-five diplomates of the American Chiropractic Board of Radiology listed with the American Chiropractic College of Radiology office. RESULTS: Of the surveys mailed, 111 of the 175 were returned from the individuals listed with the American Chiropractic College of Radiology office. After excluding the deceased and those with a self-reported retired status, the response rate was calculated as 66%. Of those who responded, 81% were male; the mean age was 46.4 +/- 11.2 yr (mean +/- standard deviation). Most respondents were residents of California, followed by Canada and Illinois. Thirty-six percent taught at chiropractic colleges. They felt most confident in interpreting plain film studies of the musculoskeletal system. Many have undergone advanced training in specialized imaging. They felt topics related to patient positioning, plain film physics, arthritides, trauma, avascular necrosis and tumors are most important to a chiropractic curriculum. Most respondents felt the use of plain film radiology was most appropriate when the clinical presentation of the patient suggests the strong possibility of underlying disease. CONCLUSIONS: Radiology is an important topic to the education of students and the practice of chiropractic. The results of this survey will assist future decision-making regarding student education and clinical use of radiology.

Adult↗

PubMedDate not supplied

Spina bifida occulta mimicking a destructive lesion.

OBJECTIVE: To discuss an unusual presentation of spina bifida occulta (SBO) mimicking an aggressive bone lesion. CLINICAL FEATURES: A 59-yr-old man suffered from intermittent neck pain. The plain film radiographs revealed rarefaction of the C6 spinous process that mimicked an aggressive bone lesion. Computed tomography and previous radiographs of the region confirmed an SBO defect of the C6 level. INTERVENTION AND OUTCOME: Supportive therapy was applied to the patient for his presenting neck complaint. Chiropractic manipulative treatment was not applied to the lower cervical spine until the possibility of an aggressive bone lesion was excluded. CONCLUSION: An unusual presentation of SBO was presented. This case demonstrated the usefulness of specialized imaging to further delineate questionable anatomical presentations, which at times mimic destructive bone lesions.

Cervical Vertebrae↗