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Biomedical subjects

D Witzke

Publications and source records attributed to D Witzke.

At least 19 recordsLinked to original sources
PubMed2001

The development and implementation of a computerized database for clinical research in minimal access surgery. An international pilot study.

BACKGROUND: The measurement of outcomes after minimal access surgery (MAS) relies on the maintenance of an accurate, prospective clinical database. The development of a system for data management often proves to be challenging, expensive, and extremely time-consuming. METHODS: We developed a computerized relational database for MAS using Microsoft Access 97 to reside on a hospital server, taking advantage of existing network connections, security, and backup systems. The design of the database includes a point-and-click approach with dropdown boxes for diagnoses, procedures, and complications (limited free-text entry). A fundamental feature of this database allows surgeons and surgical trainees to record clinical information at the point and time of data acquisition. RESULTS: A "beta version" or fully functional draft of the database was presented to a group of surgeons from a variety of specialties (n = 8), and a structured interview based on a questionnaire was used to elicit the surgeon's evaluations of the database. Using the information from the interviews, the database was extensively revised and restructured. CONCLUSIONS: We have developed a relational database that reflects the needs of surgeons interested in clinical research. This database may serve as a template for other centers. It can be expanded to adopt new procedures or modified for other surgical specialties.

Attitude of Health Personnel↗
PubMed1999

Laparoscopic vs open splenectomy.

HYPOTHESIS: Laparoscopic splenectomy (LS) provides health benefits to patients compared with open splenectomy (OS) in terms of perioperative morbidity, complications, and patient recuperation. DESIGN: Prospective operative and outcome data of LS patients were compared with those of OS patients (historical controls). SETTING: Data were gathered, and patients were evaluated and treated at 2 McMaster University teaching hospitals in Hamilton, Ontario, and at the University of Kentucky Chandler Medical Center, Lexington, also a teaching hospital. PATIENTS: From January 1, 1994, through October 31, 1998, a total of 210 patients were studied. Of them, 147 patients from 3 university teaching hospitals underwent LS. These patients were matched with 63 OS patients according to age, sex, spleen weight, indication for splenectomy, and preoperative morbidity score. INTERVENTIONS: A total of 147 patients evaluated for elective splenectomy underwent LS. MAIN OUTCOME MEASURES: Spleen weight, operative time, intraoperative blood loss, postoperative hospital stay, perioperative complications, and cost. RESULTS: No significant difference in mean spleen weight was found between groups. Mean operative time was significantly longer for LS, but intraoperative blood loss was significantly lower. Mean postoperative hospital stay was significantly lower and perioperative complications significantly fewer for LS patients. Mean cost for LS with no complications was slightly lower than for OS. CONCLUSIONS: Compared with OS, the lateral approach to LS takes longer to perform but results in reduced blood loss, shorter postoperative stay, and fewer complications. Mean weighted cost of LS is lower than OS at the study institutions. A prospective, randomized, controlled trial comparing these techniques is planned.

Adolescent↗
PubMed1999

Assessing the need for faculty development in women's health among internal medicine and family practice teaching faculty. The Women's Health Education Working Group (WHEWG).

Women's health education is an emerging interdisciplinary field that has recently received national attention. The American Board of Internal Medicine and the American Academy of Family Practice recently have published competencies in women's health for their residents, with increased attention to gynecological and mental health issues. Increasing women's health in the curricula of internal medicine (IM) and family practice (FP) residents will certainly require faculty development among IM and FP teaching faculty. We report a multiinstitution needs assessment among IM and FP teaching faculty for continuing medical education (CME) in multidisciplinary women's health topics. The survey (n = 100) asked whether faculty desired CME in 30 women's health topics. It also requested rates of referral to specialists for breast and menstrual problems and performance of tests commonly carried out in the care of women (e.g., endometrial biopsy, colposcopy, skin biopsy, and sigmoidoscopy) as measures of possible need for CME. Of the 69 respondents, 37% were IM physicians and 63% were FP physicians. Among the 30 women's health topics listed, breast cancer treatment alternatives, infertility for primary care providers, cervical dysplasia, medical treatment in pregnancy, vulvar disease, indications for pelvic ultrasound/endometrial biopsy, and menstrual disorders were of highest interest. The ranking of desirability of topics by IM and FP faculty correlated by .54 (Spearman rank, df = 28, p < 0.01). Analysis of variance revealed a significantly higher interest overall by IM than FP physicians, 58% vs. 42% (F = 4.1, df = 1, 50, p < 0.05). None of the IM teaching faculty performed endometrial biopsy or colposcopy compared with 57% of FP physicians, and only 12.5% of internists performed skin biopsy and sigmoidoscopy compared with 70% of FP physicians (F = 33, df = 1, 38, p < 0.001). We conclude that faculty development in women's health would benefit resident training in IM and FP, and topics of interest are identifiable. The correlation in interests between the IM and FP teaching faculty might make joint programs successful, although gynecological skills and knowledge clearly are needed more by IM teaching faculty. Obstetrics and gynecology (OB/GYN) faculty could be instrumental in improving women's health education among their IM and FP colleagues.

Education, Medical, Continuing↗
PubMed1998

Kentucky physicians' perspectives and preparedness for computing in medical education and practice.

PURPOSE: To examine the University of Kentucky College of Medicine's community-based faculty's (CBF) perspective on computing skills that students should acquire for future medical practice, and if the CBF currently use these skills in their daily practice. METHODS: A survey was mailed to 281 of the institution's CBF in the spring of 1997. The survey listed eight basic computing skills derived from our computing curricular objectives for students and asked respondents (a) if they use the skill, and (b) if students should learn the skill. RESULTS: 200 respondents returned a completed survey. 14 CBF (7.2%) indicated that they have all eight computer skills while 91 CBF (46.4%) indicated that students should learn all eight computer skills. 25 CBF (13%) indicated that they have none of the computer skills, while none of the CBF indicated students need none of the skills. A significant difference between primary care CBF and other specialist CBF was found with respect to self-report of computer use, but not regarding their opinions about students' need to learn computer skills. CONCLUSION: The majority of our CBF report using at least one computer skill in their practices. Regardless of specialty, CBF report that students should possess more computer skills than they themselves have. Medical educators should incorporate computing applications into the curriculum to provide appropriate computer training for future physicians.

Adult↗
PubMed1994

Risk of nonshunt abdominal operation in the patient with cirrhosis.

BACKGROUND: The hazards of operative treatment for variceal hemorrhage and intractable ascites in patients with cirrhosis are well known. Much less information is available on the morbidity and mortality in these patients after abdominal operations not directly related to the sequelae of portal hypertension. STUDY DESIGN: We reviewed the records of 77 consecutive histologically proved cases of cirrhosis in patients undergoing 85 general surgical, abdominal procedures during a ten year period. Logistic regression analysis was done on 32 preoperative and intraoperative variables with relation to postoperative outcome. RESULTS: There were 47 men and 30 women, with a mean age of 61 years (range of 28 to 86 years). The 30-day mortality rate was 18 percent (15 of 77 patients). Emergent operation was associated with a mortality rate of 32 percent (11 of 35 patients) compared with 8 percent (four of 50 patients) after elective procedures (p < 0.05). Extensive complications occurred in 28 percent of patients (24 patients; 14 percent after elective operative treatment and 49 percent after emergent procedures). The mortality rate was greatest after gastric procedures (38 percent). Other factors of statistical significance (p < 0.05) associated with poor postoperative outcome included cachexia, preoperative transfusion of fresh frozen plasma, and intraoperative platelet transfusion. Surprisingly, operative blood loss, presence of ascites, and operative time were not associated with increased complications or death. CONCLUSIONS: We conclude that elective, nonshunt abdominal operations can be performed with acceptable morbidity and mortality rates in selected patients with cirrhosis.

Abdomen↗
PubMed1993

Education about death and dying during the clinical years of medical school.

BACKGROUND: Although there has been a dramatic increase in education about death and dying in medical school curricula, the physician's interaction with terminally ill patients and their families still causes concern. The purpose of our study was to determine the impact of the third-year clerkship on education of medical students about death and dying. METHODS: From August 1, 1988, to August 1, 1990, a questionnaire concerning the care of terminally ill patients was distributed to all students completing the third-year clinical clerkship at our medical school. RESULTS: One hundred and eighty questionnaires were distributed, of which 106 were returned, yielding a response rate of 59%. All students had cared for a terminally ill patient during their third year. Forty-four (41%) students responding had never been present when an attending physician talked with a dying patient, and 37 (35%) had never discussed with an attending physician how to deal with a terminally ill patient. During the surgical clerkship 77 (73%) students had never been present when a surgeon had to tell the family of a patient bad news after surgery, and 90 (85%) had never been present when an attending surgeon had informed a family that their relative had died. Despite the fact that the curriculum addresses the stages of death and dying, almost half of the students could not remember these. When they were discharging a terminally ill patient home, one third of students could not identify problems that would be encountered by the family in caring for the patient. CONCLUSIONS: Fifty-seven (54%) felt that they were poorly equipped to deal with terminally ill patients on graduation from medical school, and 91% welcomed the opportunity to be educated in this area during the clinical years.

Adult↗
PubMed1992

Influence of spousal opinions on residency selection.

Fourth-year medical students face the difficult task of choosing a residency consistent with their career goals. Our study investigates the input of the spouse on the residency selection. From July 1, 1988, to July 1, 1990, questionnaires were sent to all 69 spouses of fourth-year medical students at the University of Arizona Medical Center. Fifty-six were returned for a response rate of 81%. Of the 16 women and 40 men who responded (mean age: 27 years), 55 (98%) spouse stated that there had been family discussions on the choice of a residency program, and 41 (73%) respondents thought that they had significant input. When asked to rank the items that most influenced their support for a particular training program, career goals of the medical student (68%) and lifestyle (21%) were most important, whereas prestige, earning capacity, and program length were ranked lowest. Specific concerns expressed by spouses on the selection of a surgical residency included time commitment as the most commonly cited (79%), followed by fatigue (48%). A statistically significant correlation existed between those spouses actively discouraging the choice of general surgery and those objecting to the time commitment during residency (p less than 0.05). We conclude that spouses have significant preferences regarding the choice of a training program following medical school. Career goals and lifestyle appear to be the most important factors; however, despite concern about the time commitment, the majority of spouses are supportive of the selection of a surgical residency.

Adult↗
PubMed1992

The role of early tracheostomy in blunt, multiple organ trauma.

During a 9-year period, 101 patients sustaining blunt, multiple organ injury underwent tracheostomy. Group I consisted of 32 patients who underwent tracheostomy within the first 4 days of injury (early tracheostomy) and Group II comprised 69 patients who underwent tracheostomy more than 4 days after surgery (late tracheostomy). There was no statistical difference between the two groups in terms of age, Injury Severity Score, Glasgow Coma Score, and associated injuries. The mean time of mechanical ventilatory support was 6.0 +/- 3.4 days in Group I as compared to 20.6 +/- 12.2 days in Group II (P less than 0.001). Early weaning from the ventilator was accomplished in 32 (100%) patients who underwent early tracheostomy versus 43 (62%) of those who underwent late tracheostomy (P less than 0.001). Finally, the incidence of nosocomial pneumonias was also significantly less in patients undergoing early tracheostomy. There were three nonlethal complications associated with tracheostomy. The authors conclude that early tracheostomy helps in early weaning from the ventilator and reduces the incidence of nosocomial pneumonias and time of mechanical ventilatory support in patients with blunt, multiple organ injury.

Academic Medical Centers↗
PubMed1991

A model for the assessment of students' physician-patient interaction skills on the surgical clerkship.

Physician-patient interaction skills are predominantly taught by successful role modeling but are rarely evaluated formally and systematically. This study describes a new model for the assessment of student physician-patient interaction skills and reports results of use in 78 third-year medical students on clerkships at two institutions. A single nurse instructor at each institution evaluated these skills using an 18-item checklist during student performance of wound care and dressing changes. Students were focused on the evaluation of their technical skills and were unaware of the evaluation of their interaction skills. Immediate feedback on performance was provided. The mean percentage score for the interaction skills was 35%, and no improvement was noted with greater clinical experience (later rotations). We conclude that there is a striking deficiency in physician-patient interaction skills among third-year students. The model described is effective for both evaluation and feedback.

Clinical Clerkship↗
PubMed1991

Value of lymph node biopsy in the treatment of patients with the human immunodeficiency virus.

The indications and value of lymph node biopsy in patients infected with the human immunodeficiency virus (HIV) are not clearly defined. We reviewed 29 consecutive lymph node biopsies performed on 24 patients with the HIV over a 4-year period. Indications for biopsy included: (1) new or worsening medical symptoms with no detectable etiology in patients with lymphadenopathy, (2) disproportionately larger or enlarging lymph node in patients with generalized adenopathy, and (3) exclusion of concomitant disease in patients with previously defined infectious or neoplastic processes. The biopsy samples exhibited a diversity of histologic appearances including atypical and reactive hyperplasia, malignancy, and infection. Nineteen biopsies (64%) resulted in the institution or alteration of treatment. The absolute number of T-helper cells prior to biopsy was significantly lower in patients with a diagnosis of malignancy or infection (p < 0.05), as well as in those who eventually died (p < 0.05). Four (14%) minor complications resulted from lymph node biopsy. Based on our results, we conclude that lymph node biopsy is indicated in the above three subsets of HIV-infected patients. Biopsy can be performed with minimal morbidity and significantly alters therapy in the majority of patients.

AIDS-Related Complex↗
PubMed1990

Structured single-observer methods of evaluation for the assessment of ward performance on the surgical clerkship.

This study compares the traditional method (TM) of evaluating ward performance on the surgical clerkship with four structured, single-observer methods (SSOM) of evaluating the clinical skills demonstrated in patient workups, progress notes, physical examination, and technical performance. SSOM differed from TM in preciseness of evaluation criteria, training of evaluator, and amount of direct observation of clinical performance. SSOM appeared to be a more precise measurement instrument than TM and far more sensitive to the detection of clinical improvement. The study documents the significant contribution of a nurse-educator to the evaluation process, as this contribution correlates well with TM yet provides a unique and independent perspective. Finally, SSOM of evaluation correlated significantly with oral examination and the National Board of Medical Examiners (NBME) test results. Addition of SSOM to TM is recommended for clerkship evaluation of ward performance.

Clinical Clerkship↗
PubMed1990

The effect of alcohol in isolated blunt splenic trauma.

The effect of alcohol on trauma patients is controversial, with numerous authors citing no difference in mortality in acutely intoxicated patients. The purpose of our study was to retrospectively investigate the effect of alcohol in adult patients with isolated blunt splenic injury. From 1980 through 1989, 47 adult patients with splenic trauma as the only major injury were admitted to the Trauma Service. There were 37 males and ten females with a mean age of 29 years (range, 15 to 61). Motor vehicle accidents were responsible for 44 (94%) of the injuries. Group 1 consisted of 24 patients with a mean blood alcohol level of 185 mg/dl (range, 15 to 380). In Group 2 there were 23 patients without detectable blood alcohol. There were no statistically significant differences between the two groups in age, Abbreviated Injury Severity Score, initial hematocrit, and grade of splenic injury. Hypotension was present in 13 patients (55%) in Group 1 versus six patients (26%) in Group 2 (p less than 0.05). Significant abnormalities in clotting studies were present on admission in six patients (25%) in the alcohol-detected group versus one in the other group (p less than 0.05). Blood transfusion requirements in the first 24 hours were significantly greater in Group 1 (mean, 3.9 units) versus Group 2 (mean, 0.5 units) (p less than 0.001). If alcohol was present, there was much less chance for splenic conservation, as 18 patients (75%) underwent splenectomy versus seven patients (30%) in the nonalcohol group (p less than 0.05). There was one death and this occurred in a patient acutely intoxicated who suffered a cerebral infarct.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Test performance of a local examination at a nonlocal site for evaluation of surgical clerks.

Surgical clerkships frequently use locally prepared examinations or nationally available test item banks as an alternative to Surgery Shelf Examinations from the National Board of Medical Examiners (SSNBME) for student evaluation. This study examines performance of a well-designed, item-analyzed local examination (available nationally through the Association for Surgical Education) at a nonlocal site. A 100-item test with a stratified sample from a 442-item bank was administered to 72 third-year students in addition to the SSNBME. The Pearson product moment correlation coefficient between the two examinations was 0.61 (p less than 0.001). Test performance between the local site and nonlocal site was compared by the Kuder-Richardson formula 20 for subtest reliability (internal consistency) and difficulty index (percent correct responses) and the point biserial correlation coefficient (correlation of a student's performance on one item with performance on the rest of the items) for test item analysis. Data show that despite fair correlation with SSNBME, significant deteriorations in both test item performance and reliability occur with the use of a local examination at a nonlocal site. This likely results from problems with content validity at the nonlocal site. Clerkships that use local examinations or national test bank items are strongly advised to evaluate test performance and revise appropriately before using results for formal student evaluation.

Clinical Clerkship↗
PubMed1987

A comparison of the teaching effectiveness of the didactic lecture and the problem-oriented small group session: a prospective study.

A prospective study was designed to assess the teaching effectiveness of active learning in problem-oriented small group sessions (POSGS) compared with passive learning in didactic lectures (DL). Third-year medical students participated in a POSGS on breast disease and a standardized DL on thyroid disease (N = 23) or participated in a POSGS on thyroid disease and a DL on breast disease (N = 19). Students were tested with a multiple-choice examination (MCQ) and a highly structured oral examination (OE) administered by faculty members blinded about student group. Results of a between-within analysis of variance performed separately for breast and thyroid disease yielded significant group differences because of instructional method for thyroid disease (p = 0.003) and approached significance for breast disease (p = 0.095). Although no significant interactions were detected with percentage scores, a significant interaction between group membership and test type was noted for thyroid disease when the percentage scores were transformed to Z scores. We conclude that regardless of topic or testing method, students in POSGS tended to perform better than students in a DL and that the POSGS offers significant advantages over the DL in teaching surgery to third-year medical students.

Breast Diseases↗