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David Swanson

Publications and source records attributed to David Swanson.

6 recordsLinked to original sources
PubMed2006

Partial cystectomy for muscle invasive urothelial carcinoma of the bladder: a contemporary review of the M. D. Anderson Cancer Center experience.

PURPOSE: Partial cystectomy is a surgical option for select patients diagnosed with urothelial carcinoma. We review our experience with partial cystectomy for muscle invasive urothelial carcinoma to assess local control and survival rates. MATERIAL AND METHODS: From 1982 to 2003 a total of 37 patients with muscle invasive urothelial carcinoma underwent partial cystectomy with curative intent. Reviewed data included history of superficial tumors, presence of variant histology, tumor location, clinical stage, pathological stage, presence of carcinoma in situ, adjuvant therapy and disease status. RESULTS: The 5-year overall, disease specific and recurrence-free survival rates were 67%, 87% and 39%, respectively. Mean followup was 72.6 months (range 6 to 217). Of the 37 patients 19 (51%) did not have tumor recurrence, 9 (24%) had superficial recurrence in the bladder that was treated successfully and 9 (24%) had recurrence with advanced disease. A total of 24 patients (65%) had an intact bladder with no evidence of disease after a median of 53 months. There were 6 patients (16%) who died of bladder cancer, 3 of whom died of late recurrence of muscle invasive cancer (41, 44 and 138 months after partial cystectomy). On multivariate analysis higher pathological stage (HR 3.4, p = 0.04) was associated with shorter recurrence-free survival. A history of superficial tumors (p <0.01) and clinical stage (p = 0.01) was associated with advanced recurrence-free survival. The use of adjuvant chemotherapy (HR 0.18, p = 0.03) was associated with prolonged advanced recurrence-free survival, however adjuvant chemotherapy did not impact overall survival. CONCLUSIONS: Partial cystectomy provides adequate local control of muscle invasive bladder cancer in select patients. Because late recurrence is not uncommon and is potentially life threatening, lifelong followup with cystoscopy is recommended.

Adult↗
PubMed2003

Assessing medical students' clinical sciences knowledge in France: a collaboration between the NBME and a consortium of French medical schools.

PURPOSE: The French government, as part of medical education reforms, has affirmed that an examination program for national residency selection will be implemented by 2004. The purpose of this study was to develop a French multiple-choice (MC) examination using the National Board of Medical Examiners' (NBME) expertise and materials. METHOD: The Evaluation Standardisée du Second Cycle (ESSC), a four-hour clinical sciences examination, was administered in January 2002 to 285 medical students at four university test sites in France. The ESSC had 200 translated and adapted MC items selected from the Comprehensive Clinical Sciences Examination (CCSE), an NBME subject test. RESULTS: Less than 10% of the ESSC items were rejected as inappropriate to French practice. Also, the distributions of ESSC item characteristics were similar to those reported with the CCSE. The ESSC also appeared to be very well targeted to examinees' proficiencies and yielded a reliability coefficient of.91. However, because of a higher word count, the ESSC did show evidence of speededness. Regarding overall performance, the mean proficiency estimate for French examinees was about 0.4 SD below that of a CCSE population. CONCLUSIONS: This study provides strong evidence for the usefulness of the model adopted in this first collaborative effort between the NBME and a consortium of French medical schools. Overall, the performance of French students was comparable to that of CCSE students, which was encouraging given the differences in motivation and the speeded nature of the French test. A second phase with the participation of larger numbers of French medical schools and students is being planned.

Clinical Medicine↗
PubMed2003

[Transposition of an American-designed comprehensive medical student examination within the framework of the forthcoming French nationwide comprehensive examination. A preliminary study].

Medical training is undergoing extensive revision in France. A nationwide comprehensive clinical competency examination will be administered for the first time in 2004, relying exclusively on essay-questions. Unfortunately, these questions have psychometric shortcomings, particularly their typically low reliability. High score reliability is mandatory in a high-stakes context. The National Board of Medical Examiners-designed multiple choice-questions (MCQ) are well adapted to assess clinical competency with a high reliability score. The purpose of this study was to test the hypothesis that French medical students could take an American-designed and French-adapted comprehensive clinical knowledge examination with this MCQ format. Two hundred and eighty five French students, from four Medical Schools across France, took an examination composed of 200 MCQs under standardized conditions. Their scores were compared with those of American students. This examination was found assess French students' clinical knowledge with a high level of reliability. French students' scores were slightly lower than those of American students, mostly due to a lack of familiarity with this particular item format, and a lower motivational level. Another study is being designed, with a larger group, to address some of the shortcomings of the initial study. If these preliminary results are replicated, the MCQ format might be a more defendable and sensible alternative to the proposed essay questions.

Adult↗
PubMed2002

The quality of in-house medical school examinations.

PURPOSE: Most medical schools test their students throughout the curriculum using in-house examinations written by the faculty who teach the courses. The authors assessed the quality of in-house examinations used in three U.S. medical schools. METHOD: In 1998, nine basic science examinations from the three schools were gathered and each question was subjected to quality assessment by three expert biomedical test developers, each of whom has had extensive experience in reviewing and evaluating questions for the United States Medical Licensing Examination (USMLE) Steps 1 and 2. Questions were rated on a five-point scale: 1 = tested recall only and was technically flawed to 5 = used a clinical or laboratory vignette, required reasoning to answer, and was free of technical flaws. Each rater made independent assessments, and the mean score for each question was calculated. Mean quality scores for National Board of Medical Examiners (NBME) who were trained question writers were compared with the mean scores for question writers without NBME training. The raters' quality assessments were made without knowledge of the test writers' training background or the study's hypothesis. RESULTS: A total of 555 questions were analyzed. The mean score for all questions was 2.39 +/- 1.21. The 92 questions written by NBME-trained question writers had a mean score of 4.24 +/- 0.85, and the 463 questions written by faculty without formal NBME training had a mean score of 2.03 +/- 0.90 (p <.01). CONCLUSIONS: The in-house examinations were of relatively low quality. The quality of examination questions can be significantly improved by providing question writers with formal training.

Education, Medical, Undergraduate↗
PubMedDate not supplied

Surgical management of renal cell carcinoma associated with complex inferior vena caval thrombi.

The operative morbidity and mortality of radical nephrectomy are considerably higher when the vena cava is involved by the tumor. The prognostic significance of vena caval extension in this setting remains controversial. We reviewed our experience of vena caval thrombectomy specifically addressing prognostic factors. We retrospectively studied 96 patients treated at our institution between 1985 and 2001. The study population included 28 women and 68 men; (37 left- and 59 right-sided tumors). Twenty-seven patients had metastatic disease at presentation. Prognostic features (age, sex, race, side of tumor, embolization, tumor grade, tumor confinement by renal capsule, cephalic extent of thrombus, nodal status, and presence of distant metastasis) were evaluated using a Cox proportional hazards model (univariate and multivariate). These prognostic features were analyzed in the group as a whole and in the subgroup of patients who did not have metastatic disease at presentation and did not die perioperatively. There were 5 perioperative deaths. Extracapsular tumor extension and regional node involvement were present in 64% and 17% of the patients, respectively. Level of tumor thrombus were as follows: level I (41%), II (29%), III (7%), IV (15%). Fuhrman's grade was 2 in 17%, 3 in 45%, and 4 in 30% of the patients. For all 96 patients, median overall survival (OS) was 35 months. Five-year OS was 35%. The presence of distant metastasis at presentation did not significantly alter median OS (20 months with metastasis vs. 38 months without, P = 0.3), although this finding may have been confounded by selection. The presence of nodal metastasis was associated with decreased OS by multivariate analysis (P < 0.01). After exclusion of patients dying perioperatively and patients with metastasis at presentation, median OS and progression-free survival were 40 and 18 months, respectively (5-year OS was 40%). In the multivariate model, none of the factors examined were associated with OS, but age <58 years, and the presence of extracapsular tumor extension were associated with an increased risk of recurrence. In patients with renal tumors and extension of tumor thrombus into the vena cava, the level of propagation of the thrombus does not predict for OS. Selected patients with metastatic renal cancer may benefit from aggressive surgical resection of the primary tumor and associated tumor thrombus.

Adult↗