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D Scott Lind

Publications and source records attributed to D Scott Lind.

17 recordsLinked to original sources
PubMed2006

The use of virtual patients to teach medical students history taking and communication skills.

BACKGROUND: At most institutions, medical students learn communication skills through the use of standardized patients (SPs), but SPs are time and resource expensive. Virtual patients (VPs) may offer several advantages over SPs, but little data exist regarding the use of VPs in teaching communication skills. Therefore, we report our initial efforts to create an interactive virtual clinical scenario of a patient with acute abdominal pain to teach medical students history-taking and communication skills. METHODS: In the virtual scenario, a life-sized VP is projected on the wall of an examination room. Before the virtual encounter, the student reviews patient information on a handheld tablet personal computer, and they are directed to take a history and develop a differential diagnosis. The virtual system includes 2 networked personal computers (PCs), 1 data projector, 2 USB2 Web cameras to track the user's head and hand movement, a tablet PC, and a microphone. The VP is programmed with specific answers and gestures in response to questions asked by students. The VP responses to student questions were developed by reviewing videotapes of students' performances with real SPs. After obtaining informed consent, 20 students underwent voice recognition training followed by a videotaped VP encounter. Immediately after the virtual scenario, students completed a technology and SP questionnaire (Maastricht Simulated Patient Assessment). RESULTS: All participants had prior experience with real SPs. Initially, the VP correctly recognized approximately 60% of the student's questions, and improving the script depth and variability of the VP responses enhanced most incorrect voice recognition. Student comments were favorable particularly related to feedback provided by the virtual instructor. The overall student rating of the virtual experience was 6.47 +/- 1.63 (1 = lowest, 10 = highest) for version 1.0 and 7.22 +/- 1.76 for version 2.0 (4 months later) reflecting enhanced voice recognition and other technological improvements. These overall ratings compare favorably to a 7.47 +/- 1.16 student rating for real SPs. CONCLUSIONS: Despite current technological limitations, virtual clinical scenarios could provide students a controllable, secure, and safe learning environment with the opportunity for extensive repetitive practice with feedback without consequence to a real or SP.

Clinical Competence↗
PubMed2006

Virtual patients: assessment of synthesized versus recorded speech.

Virtual patients have great potential for training patient-doctor communication skills. There are two approaches to producing the virtual human speech: synthesized speech or recorded speech. The tradeoffs in flexibility, fidelity, and cost raise an interesting development decision: which speech approach is most appropriate for virtual patients? Two groups of medical students participated in a user study interviewing a virtual patient under each condition. We found no significant differences in the overall impression, speech intelligibility, and task performance. Our conclusion is that if the goal is to train students of which questions to ask, synthesized speech is just as effective as recorded speech. However, if the goal is to teach the student how to ask the correct questions, a high level of expressiveness in the virtual patient is needed. This in turn necessitates the higher cost - even with the lower flexibility - of recorded speech.

Communication↗
PubMed2005

Minimizing local recurrence after breast conserving therapy using intraoperative shaved margins to determine pathologic tumor clearance.

BACKGROUND: This study analyzed survival, locoregional recurrence, and reexcision rates after breast conserving therapy, based on the margin analysis technique used at the University of Florida, which incorporates frozen section analysis of shaved breast tissue from the lumpectomy cavity. STUDY DESIGN: A retrospective review was done of 257 patients who underwent 267 consecutive lumpectomy operations and completed radiation therapy at our institution. Margins in 189 patients were assessed using frozen section analysis of shaved margins from the lumpectomy cavity. RESULTS: Breast conserving therapy was performed for 220 (83%) patients with early breast cancer (T1 and T2 tumors) and 47 (17%) with ductal carcinoma in situ. With a median followup of 5.6 years, the crude locoregional recurrence rates for patients who had margins analyzed intraoperatively by frozen section analysis or margins analyzed by permanent analysis were 1.9% (3 of 157) and 3.1% (2 of 63), respectively, for early breast cancer and 15.6% (5 of 32) and 6.6% (1 of 15) for ductal carcinoma in situ (p=NS). Survival rates were 97% and 78%, at 5 and 10 years, respectively, for the early breast cancer patients, and 98% and 98%, respectively, for ductal carcinoma in situ patients. Permanent intraoperative frozen section analysis reexcision rates were 33.3% (26 of 78) and 5.8% (11 of 189). CONCLUSIONS: Regardless of the technique used for margin analysis, breast conserving therapy led to low locoregional recurrence relative to national figures, pointing to the importance of the technique of radiation therapy at our institution. Reexcision rate was reduced with the use of frozen section analysis.

Adult↗
PubMed2005

Adjuvant radiation therapy for resectable retroperitoneal soft tissue sarcoma: the University of Florida experience.

BACKGROUND: In the management of retroperitoneal sarcomas it is necessary to achieve local control to ensure survival. The role of adjuvant radiation therapy (RT), either pre- or postoperative, remains controversial. METHODS: Outcomes for 40 patients with retroperitoneal sarcoma treated with surgery and postoperative RT (n = 25) or preoperative RT (n = 15) were analyzed for variables prognostic for local control, survival, and associated complications. RESULTS: Patterns of failure for patients treated by resection and postoperative RT were local (n = 4), local and distant (n = 3), and distant (n = 3). The failure patterns for preoperative RT cases were local (n = 2), local and distant (n = 2); and distant (n = 4). Median time to local recurrence in the postoperative and preoperative RT series were 1 year and 2.5 years respectively. The margin status was predictive for local control (P = 0.0065) and survival (P = 0.0012), regardless of treatment sequence. Absolute 5-year survival was 12% with positive margins versus 69% if negative. Histologic grade was indicative of the risk for distant metastasis (low grade 8% vs high grade 64%; P = 0.1373), and significantly predicted 5-year absolute survival (low grade 77% vs high grade 34%; P = 0.0267). Postoperative RT was associated with significant complications (infection, hemorrhage, and bowel obstruction--2 cases each). CONCLUSION: Compared with the surgery-alone series, adjuvant RT appears to improve the probability of local control. Preoperative RT may be the preferred sequence potentially to improve tumor resectability and local-regional control with less risk of complications than with postoperative RT.

Adolescent↗
PubMed2004

Should decisions on internal mammary lymph node irradiation be based on current lymphoscintigraphy techniques for sentinel lymph node identification?

BACKGROUND: Treatment of internal mammary lymph node (IMN) metastases remains controversial because of the difficulty in predicting involvement, potential treatment-related morbidity, and questionable efficacy. Lymphoscintigraphy with sentinel lymph node biopsy offers a means to identify occult involvement of IMN, allowing appropriate patient selection for IMN treatment. METHODS: The authors retrospectively reviewed 262 lymphoscintigraphies (LS) of 248 patients treated at the University of Florida (Gainesville, FL) between 1998 and 2002. Tumor characteristics were assessed for their value in predicting IMN drainage and their association with IMN radiation. RESULTS: Lymph flow to the IMN was documented with LS in 23 of 262 tumor specimens (9%). Flow to the IMN was not correlated with any of the five factors: tumor location, tumor size, lymphovascular invasion, pathologic lymph node status, and laterality of the involved breast (right vs. left breast). Identification of IMN flow increased from 5.7% to 10.1% with the use of a deep injection technique. IMN radiotherapy was used more frequently in patients with larger tumors (15 of 188 in Tis/T1 vs. 31 of 70 in T2-T4; P<0.0001) and positive lymph nodes (17 of 91 in lymph node-negative patients vs. 28 of 66 in lymph node-positive patients; P<0.0001). In patients with T2N0 tumors (n=32), IMN radiotherapy was used more frequently with medial tumors (5 of 11 [45%]) than with lateral tumors (4 of 21 [19%]). CONCLUSIONS: The incidence of flow to the IMN documented with the current LS technique was low compared with other LS and extended radical mastectomy series. Histopathologic information was obtained for the sentinel IMN when IMN flow was identified on the LS. In the absence of histopathologic information, treatment decisions should continue to be based on clinical factors known to be correlated with occult IMN involvement.

Adult↗
PubMed2004

Breast-conserving therapy (BCT) for early-stage breast cancer.

Several patient and tumor factors go into the decision process to determine whether a breast cancer patient is a good candidate for breast-conserving therapy. The patient must be seen by all disciplines before any therapeutic intervention. When used appropriately, breast-conserving therapy produces maximal disease control and improves quality of life in patients with early-stage breast cancer.

Antineoplastic Agents, Hormonal↗
PubMed2004

Arginine and cancer.

Arginine is a dibasic, cationic, semiessential amino acid with numerous roles in cellular metabolism. It serves as an intermediate in the urea cycle and as a precursor for protein, polyamine, creatine and nitric oxide (NO) biosynthesis. Arginine is conditionally essential since it becomes necessary under periods of growth and after recovery after injury. Arginine also promotes wound healing and functions as a secretagogue stimulating the release of growth hormone, insulin-like growth factor 1, insulin, and prolactin. Furthermore, arginine has several immunomodulatory effects such as stimulating T- and natural killer cell activity and influencing pro-inflammatory cytokine levels. The discover that l-arginine is the sole precursor for the multifunctional messenger molecule nitric oxide (NO) led to investigation into the role of arginine in numerous physiologic and pathophysiologic phenomena including cancer. Although NO was first identified in endothelial cells, it is now recognized to be generated by a variety of cell types, including several tumor cell lines and solid human tumors. Unfortunately, the precise role of NO in cancer is poorly understood but it may influence tumor initiation, promotion, and progression, tumor-cell adhesion, apoptosis angiogenesis, differentiation, chemosensitivity, radiosensitivity, and tumor-induced immunosuppression. The biological effects of NO are complex and dependent upon numerous regulatory factors. Further research is necessary to enhance our understanding of the complex mechanisms that regulate NO's role in tumor biology. A better understanding of the role of arginine-derived NO in cancer may lead to novel antineoplastic and chemopreventative strategies.

Animals↗
PubMed2003

An Internet-based tool for evaluating third-year medical student performance.

BACKGROUND: Shortened non-primary care medical school clerkships have increased time pressures for accurate assessment of student knowledge, skills, and attitudes. Paper-based student evaluations suffer from low response rates, inefficient data acquisition and analysis, and difficulty obtaining input from multiple evaluators. This project describes the development of a Web-based model for evaluating third-year medical student performance, improving evaluation response rates, and including multiple evaluators' input. METHODS: A secure Web-based system was designed to maintain evaluation data (11-item competency-based evaluations, oral examinations, National Board of Medical Examiners surgery test, and objective structured clinical examination) for the third-year surgery clerkship. Historical response rate, completion time, and administrative effort data were compared with data obtained using the Web-based model. RESULTS: Faculty response rates improved from 71.3% to 89.9%, with response times decreased from 28.0 +/- 3.0 to 9.0 +/- 0.7 days using the Web-based model. Administrative time requirements decreased from 5 days to 2 hours per rotation, and manual data entry, analysis, and reporting were eliminated through e-mail evaluator notification, direct data entry, and real-time analysis. Evaluator satisfaction was subjectively higher using the Web-based model. CONCLUSIONS: The Web-based 360-degree evaluation model improves third-year medical student assessment by including residents, reducing time and cost, and by providing a faster, more inclusive, and efficient evaluation.

Education, Medical, Undergraduate↗
PubMed2003

Antineoplastic therapy in colorectal cancer through proteasome inhibition.

Upregulation of nuclear factor (NF)-kappaB is found in many forms of cancer. Activation of NF-kappaB in cancer cells by chemotherapy or radiation can blunt the ability of this therapy to induce cell death. Proteasome inhibitors stimulate apoptosis in part via prevention of NF-kappaB activation. We sought to determine whether constitutive NF-kappaB activity is present in human colon cancer. In addition we studied whether alterations of NF-kappaB activity with a proteasome inhibitor would prevent colon cancer cell growth and induce apoptosis. We demonstrated constitutive transcriptional activation of NF-kappaB in SW48 and SW116 colon cancer cells by luciferase and electromobility shift assays. This was confirmed by p65 immunostaining. This activity was further induced in the presence of chemotherapy. In colon cancer specimens constitutive activation of NF-kappaB was observed in the majority of tumors. Treatment with the proteasome inhibitor (MG-132) inhibited growth and also stimulated apoptosis of colon cancer cells. We conclude that inhibition of NF-kappaB activation may be a logical therapy for certain cancers. This can be done via specific approaches on molecules necessary for keeping NF-kappaB inactivated in the cytoplasm. Other potentially useful ways to promote apoptosis in cancer cells include the utilization of proteasome inhibitors. Such inhibitors are currently being evaluated in clinical trials.

Animals↗
PubMed2003

Two decades of student career choice at the University of Florida: increasingly a lifestyle decision.

Recently, there has been a decrease in the number of graduating U.S. medical students entering surgical residency. Therefore the purpose of this study was to examine student career choice over the last two decades (1982-2002) at the University of Florida. Residency match and academic performance data for the University of Florida medical school graduates from 1982 through 2002 were obtained from the College of Medicine's Offices of Student Affairs and Education. The percentage of medical students pursuing a career in surgery rose slightly in the 1980s to peak at 22 per cent of the graduating class in 1991 and then steadily declined in the 1990s to 15 per cent in the graduating class of 2002. The percentage of women entering surgical residency has remained relatively constant (20-year mean = 6.41 +/- 0.77) despite a significant increase percentage of women in the graduating class (Class of 1983, 24%; Class of 2002, 55%). The percentage of graduating students entering a primary care residency has remained relatively constant (54.4 +/- 1.24), whereas the number of students pursuing a "lifestyle-friendly" specialty has increased substantially over the last two decades (Class of 1983, 9%; Class of 2002, 22%). In addition the mean overall grade point average of female students entering 'lifestyle-friendly' specialty residencies is significantly higher than the mean overall grade point average of all students entering a surgical residency (3.61 +/- 0.38 versus 3.48 +/- 0.35; P < 0.05). Similar to national trends the percentage of senior medical students entering surgical residency at the University of Florida is gradually declining. Although the percentage of graduating medical students entering primary care has remained relatively constant the number of students following a lifestyle-friendly specialty has steadily increased. A disproportionately low number of graduating female medical students are entering surgical residency. By one measure of academic performance the quality of female graduates entering lifestyle-friendly specialty residencies is superior to that of students entering surgical residency. Lifestyle issues are increasingly important in student career choice decisions.

Career Choice↗
PubMed2002

External beam radiotherapy for primary and adjuvant management of aggressive fibromatosis.

PURPOSE: To review a large single-institution experience in the management of aggressive fibromatosis to determine the effectiveness of external beam radiotherapy (EBRT) and identify the presentation and treatment variables predictive of locoregional control. METHODS AND MATERIALS: Between 1975 and 2000, 72 patients were treated with EBRT for a pathologically confirmed diagnosis of aggressive fibromatosis. Thirty patients were treated at the primary presentation and 42 at the time of a locoregional recurrence. Minimal 2-year follow-up data were available for 65 patients (median 6 years). Megavoltage irradiation with 60Co to 20 MV photons or electron therapy was used for all patients. Most patients were treated after attempted complete surgical resection; 16 patients underwent pretreatment biopsy alone. The prescribed treatment was standard (1.8 Gy) daily fractions in 42 cases and 1.2 Gy fractions b.i.d. in 23 cases. The median prescribed dose was 54 Gy. The prognostic variables and treatment results were evaluated by Kaplan-Meier actuarial analysis. RESULTS: Locoregional control was achieved in 52 of 65 patients. The 5-year actuarial locoregional control was 83%. Locoregional failure occurred in 13 patients (11 in patients with recurrent tumors). Only two failures occurred within the irradiation fields; nine failures occurred at the field margins. Eleven patients were salvaged by surgery: wide excision in nine and amputation in two. The only prognostic factor significant for locoregional control was primary vs. recurrent presentation (p = 0.0193). The 5-year locoregional control rates for irradiation at initial presentation and at recurrence were 96% and 75%, respectively. The variables without significance for locoregional control included primary tumor location, surgical procedures performed, resection margins, and gross vs. microscopic residual tumor at irradiation. Lymphedema was the most common late effect, occurring in 7 patients, 5 with prior treatment. Bone fracture occurred in 3 patients; all 3 had fibromatosis involving the bone at presentation but without recurrence at the time of fracture. CONCLUSION: EBRT is effective treatment for aggressive fibromatosis. The probability of locoregional control decreases with multiple prior recurrences.

Adolescent↗
PubMed2002

Competency-based student self-assessment on a surgery rotation.

BACKGROUND: Although self-assessment is an essential component of self-directed adult learning, few data exist regarding the ability of medical students to perform this important task. Therefore, the purpose of this study was to evaluate the ability of medical students to perform self-assessment during a third-year surgery clerkship. METHODS: Sixty-eight (34 male, 34 female) third-year medical students assessed their progress at the midpoint of an 8-week surgery clerkship using an 11-item, competency-based evaluation. Students compared perceptions of their performance with a faculty member's assessment using the identical evaluation form. RESULTS: Male students tended to overestimate their midclerkship performance compared with faculty formative and summative evaluations (3.31 +/- 0.03 vs 3.23 +/- 0.03 and 3.28 +/- 0.03) although this did not reach statistical significance. Female students significantly underestimated their midclerkship performance compared with faculty formative and summative evaluations (3.06 +/- 0.03 vs 3.40 +/- 0.03 and 3.45 +/- 0.03, P < 0.05 vs faculty evaluations). Preclerkship academic performance (first- and second-year grade point averages and NBME Part 1 scores) was not predictive of student self-assessment. Finally, women statistically outperformed men on the surgery clerkship (86.6% +/- 0.75 vs 83.2% +/- 1.20, P < 0.05 vs male students). CONCLUSIONS: Female students tend to underestimate their midclerkship performance compared with male students on a surgery rotation. Despite lower self-assessment, female students actually outperform male students. Women may underreport their capabilities when compared with men as a result of gender differences in socialization. These gender differences in self-assessment may be important to recognize when faculty provide feedback to students.

Adult↗
PubMed2002

Combined liver and pancreas resection with biochemotherapy for metastatic ocular melanoma.

Systemic therapy alone for metastatic melanoma is relatively ineffective, and surgical resection of metastases to a solitary site remains the best single treatment to improve survival. While cytoreductive surgery plus chemotherapy play a significant role in the management of advanced ovarian cancer, the precise role of surgery as an adjunct to systemic therapy for melanoma metastatic to multiple sites is not well defined. We report a patient with ocular melanoma metastatic to liver and pancreas treated by cytoreductive surgery consisting of mesohepatic resection, distal pancreatectomy, and portal node dissection, followed by biochemotherapy with dacarbazine and interferon alpha. The concept of cytoreductive surgery is reviewed, with particular attention to its use in the management of metastatic melanoma. The patient's postoperative course was unremarkable and she remains alive and asymptomatic with no detectable disease at 20 months' follow-up. Cytoreductive surgery as a part of an aggressive multidisciplinary approach may play a role in the treatment of cutaneous and ocular melanoma metastatic to multiple visceral sites. Data from well-designed, innovative clinical trials of cytoreductive surgery and biochemotherapy are required to determine the effectiveness of this multidisciplinary approach.

Antineoplastic Agents, Alkylating↗
PubMed2002

Carcinoid heart disease: a case report and literature review.

We report a patient who presented for elective exploratory laparotomy, and resection of a pelvic mass, which was thought to be ovarian carcinoma. Intraoperative transesophageal echocardiography demonstrated right-sided valvular heart lesions, which suggested the diagnosis of carcinoid syndrome before a pathologic confirmation was obtained. This article discusses the classical presentation and anesthetic management of patients with carcinoid syndrome and emphasizes the importance of proper preoperative diagnosis and careful planning if the incidence and severity of the symptoms that this condition can provoke are to be reduced.

Anesthesia↗
PubMed2002

Sequential dermal-peritumoral radiocolloid injection for sentinel node biopsy for breast cancer: the University of Florida experience.

Although sentinel lymph node (SLN) biopsy is rapidly becoming the standard of care for small breast cancers the optimal radiocolloid injection technique remains controversial. We report our experience with sequential dermal-peritumoral radiocolloid injection that takes advantage of both techniques. One hundred eighteen patients with clinical stage T(is), T1, T2 and N0 breast cancer underwent SLN biopsy at the University of Florida. Twelve to 18 hours before surgery patients received either an injection of 0.5 to 1.0 mCi 50:50 filtered:unfiltered technetium sulfur colloid into the dermis overlying the tumor and/or a peritumoral injection of a 3 to 4-mCi of radiocolloid 30 minutes later. Dynamic lymphoscintigraphy was performed and the topographical location of all imaged lymph nodes was marked on the skin. The next morning the surgeon utilized a hand-held gamma probe to remove all SLN(s) defined as any lymph node with radioactive counts 10 per cent or more of the ex vivo counts of the most radioactive SLN [internal mammary (IM) nodes were not removed]. The SLN identification rate was 98.5 per cent (3 IM nodes) for dermal injection (d.), 83.3 per cent (1 IM node) for peritumoral injection (p.), and 100 per cent (14 IM nodes) for sequential dermal-peritumoral injection (d.p.) (p < 0.05 DP versus D). Sequential d.p. 50:50 filtered:unfiltered technetium sulfur colloid injection results in a rapid, high SLN identification rate that persists until surgery the next morning. Delineation of nonaxillary SLNs may lead to more accurate breast cancer staging and may also influence the delivery of IM node radiation.

Aged↗