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Biomedical subjects

G Bernstein

Publications and source records attributed to G Bernstein.

At least 19 recordsLinked to original sources
PubMed1992

Utility of an oral examination in a surgical clerkship.

To evaluate the utility of the oral examination in a surgical clerkship, we designed a prospective and randomized study to relate the subjective impressions of experienced examiners with an objective measure of cognitive knowledge. The examiners were asked to score the student's performance as honors, high satisfactory, satisfactory, or unsatisfactory, according to their subjective impression of the student's ability. Student performance was grouped according to oral examination performance. The cognitive performance in the honors group was significantly better than that of the other groups (Student's t-test, p = 0.05). There was a significant difference in cognitive performance for oral examination groups throughout the rotations (analysis of variance, p = 0.000; Kruskal Wallis, p = 0.05). The oral examination is useful to identify a high level of cognitive achievement but cannot discriminate between groups of median to low competence. It should be used for educational feedback, career counseling, residency recommendations, and professional development.

Achievement↗
PubMed1992

Failure of gastric emptying and charcoal administration in fatal sustained-release theophylline overdose: pharmacobezoar formation.

We report the case of a fatal theophylline overdose from a sustained-release preparation in a 54-year-old woman. Initial serum theophylline concentration was 31.3 mg/L. Manifestations of mild toxicity cleared in the emergency department after treatment with gastric lavage, charcoal, and a cathartic. A life-threatening overdose was not suspected, and the patient arrested eight hours after discharge from the ED. At autopsy, her serum theophylline concentration was 190.1 mg/L. A white, waxy mass weighing 318.8 g and containing 29 g theophylline, representing the residue of many sustained-release tablets, was found in her stomach. This case reinforces the importance of obtaining repeat serum theophylline levels in patients with sustained-release theophylline overdose. Gastric pharmacobezoar formation should be considered in cases of sustained-release theophylline overdose with rising theophylline levels and patient deterioration, despite adequate gut decontamination.

Bezoars↗
PubMed1992

Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia.

The authors treated 17 patients with achalasia by a thoracoscopic (15 patients) or laparoscopic (2 patients) Heller myotomy. All patients had dysphagia and an upper gastrointestinal series demonstrating a dilated esophagus with a bird-beak deformity at the cardia. Manometry showed a mean lower esophageal sphincter (LES) pressure of 32 +/- 4 mmHg, incomplete sphincter relaxation on swallowing, and no primary esophageal peristalsis. After operation, mean LES pressure was 10 +/- 2 mmHg. Fifteen patients were fed on the second postoperative day. The average hospital stay was 3 days, and there were no deaths or major complications. In three early patients, the myotomy was not carried far enough onto the stomach, and dysphagia persisted until a second myotomy was performed (laparoscopically in two patients). The authors found that having an endoscope in the esophagus during the operation facilitated exposure and was vital to determine the appropriate length of the myotomy. With regard to dysphagia, final results were excellent in 12 patients (70%), good in two patients (12%), fair in two patients (12%), and poor in one patient (6%). Heller myotomy can be safely and reliably performed with minimally invasive techniques. Dysphagia is relieved, postoperative pain is minimal, hospital stay is short, and the patient can return quickly to normal activity.

Adult↗
PubMed1992

Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic-based trial of three intervention strategies.

In a large randomized trial involving over 2,000 women with abnormal cervical cytology (pap smear), three clinic-based interventions were tested as strategies to increase return rates for screening follow-up: 1) a personalized follow-up letter and pamphlet; 2) a slide-tape program on pap smears; and 3) transportation incentives (bus passes/parking permits). The three interventions were evaluated using a 2 x 2 x 2 factorial design. Results of this study confirm a high rate of loss to screening follow-up (i.e., no return visits) among women with abnormal pap smears (29% overall), with substantial variability among the 12 participating clinics (13% to 42/%). For the sample as a whole, both transportation incentives and the combined intervention condition of personalized follow-up and slide-tape program had a significant positive impact on screening follow-up. However, transportation incentives emerged as the dominant intervention condition among patient subgroups that can be characterized as more disadvantaged socioeconomically and at higher risk of developing cervical cancer, including patients receiving care from the county health department (odds ratio (OR) = 1.51; P less than .05); patients without health insurance (OR = 1.77; P less than .01); and patients with more severe pap smear results (OR = 1.71; P less than .05). In contrast, among patient subgroups that can be characterized as relatively more advantaged and at lower risk of developing cervical cancer, only the combined intervention condition of personalized follow-up and slide-tape program was associated with a higher patient return rate. Subgroups reflecting this pattern included patients seen in noncounty clinics (OR = 4.54; P less than .05) and patients with less severe pap smear results (OR = 5.16; P less than .01). The implications of these findings are discussed in terms of designing clinic-based interventions to improve screening follow-up.

Adolescent↗
PubMed1992

Experience as a surgeon determines resident knowledge.

BACKGROUND: This is a prospective study that compares operative experience with performance on the American Board of Surgery Inservice Training Examination (ABSITE) to establish the primacy of procedural experience in the graduate training environment. METHODS: Operative experience was determined from a computerized log of surgical procedures. The Report D of the 1991 ABSITE was used to assign each test item to specific operative procedures and to determine the frequency of the correct response (Fcr) for each item. The fraction of operative procedures (Fs) was determined for each category of surgical procedures (Fs = Number of procedures as surgeon/Total number of procedures). The Fcr was compared to the Fs by use of the Pearson correlation coefficient with significance at 95% confidence. RESULTS: Forty-two residents reported doing 8357 surgical procedures as surgeon in 12 months. Report D contained 209 test items. Of these, 162 items could be assigned to 26 categories of surgical procedures. The Fcr correlated directly with the Fs (p = 0.002, r = 0.605). CONCLUSIONS: A significant correlation exists between the experience of surgical residents as surgeon and their performance on the ABSITE:

Clinical Competence↗
PubMed1991

Human papillomavirus type 16 DNA in ocular and cervical swabs of women with genital tract condylomata.

Human papillomavirus type 16 is associated with dysplasias and carcinomas of the conjunctiva and of the uterine cervix. To explore the relationship between cervical and ocular human papillomavirus infection, we examined DNA from bilateral limbal swabs and cervical swabs from 17 women (age range, 17 to 46 years; median, 31.7 years) with biopsy-proven human papillomavirus-related cervical dysplasia who had a normal ocular surface. Using polymerase chain reaction, we identified human papillomavirus 16 DNA in one or both eyes of 13 (76.5%) patients, six (46.2%) of whom had demonstrable human papillomavirus 16 DNA in cervical swabs as well. It thus appears that human papillomavirus 16 is present in the conjunctivae of some patients with human papillomavirus-related genital warts who have no ocular manifestations of infection. Although autoinoculation of conjunctiva may be the source of some ocular human papillomavirus, data suggest that other modes of transmission to the eye also exist. Additional study of the epidemiologic characteristics of ocular human papillomavirus, a widely prevalent virus known to be associated with dysplasias/atypias and cancer, is warranted.

Adolescent↗
PubMed1991

Social competence and positive and negative symptoms: a longitudinal study of children and adolescents at risk for schizophrenia and affective disorder.

OBJECTIVE: The authors longitudinally examined social competence and positive and negative symptoms in children at risk for schizophrenia, children at risk for affective disorder, and matched normal subjects. METHOD: The subjects were offspring of parents with schizophrenia or affective disorder and normal comparison subjects matched on age, sex, and socioeconomic status. Ratings of social competence (Premorbid Adjustment Scale), affective flattening and poverty of speech (Scale for the Assessment of Negative Symptoms), and positive formal thought disorder (Scale for the Assessment of Positive Symptoms) were based on videotaped psychiatric interviews conducted in childhood (N = 144), early adolescence (N = 127), and adolescence (N = 106). RESULTS: In childhood, there were no significant group differences. In early adolescence, the subjects at risk for schizophrenia had poorer social competence than those at risk for affective disorder and the normal subjects. In early adolescence, the subjects at risk for schizophrenia also had greater positive thought disorder than those at risk for affective disorder but did not differ significantly from the normal subjects; there were no differences in negative symptoms. In adolescence, the subjects at risk for schizophrenia had poorer social competence and greater positive and negative symptoms than the adolescents at risk for affective disorder and the normal subjects. CONCLUSIONS: During early adolescence and adolescence, poor social competence may be more characteristic of children at risk for schizophrenia than those at risk for affective disorder. Higher levels of positive and negative symptoms may also be specific to subjects at risk for schizophrenia, but only during adolescence.

Adolescent↗
PubMed1990

The safety of dermatologic liposuction surgery.

The safety of liposuction surgery begins with appropriate preoperative evaluation and patient selection. Operative considerations include the type of anesthesia used, the volume of fat aspirated, and the liposuction technique utilized. Results from a recent survey revealed that liposuction surgery can be extremely safe when done under local anesthesia with conservative fat removal.

Accident Prevention↗
PubMed1989

Healing by secondary intention.

Healing of wounds by secondary intention is frequently an appropriate alternative to surgical closure of wounds. The determination of which wounds are to be allowed to heal secondarily requires knowledge of the biology of wound healing as well as the likely regional effects of wound contraction. The decision as to which wounds are allowed to heal secondarily versus those that require primary closure is based on location, confidence of completeness of tumor excision, depth of the wound, and characteristics of surrounding skin. Often it is appropriate to allow a wound to heal secondarily as an initial strategy and then to have it revised at a later date.

Facial Neoplasms↗
PubMed1988

Safety of liposuction: a review of 9478 cases performed by dermatologists.

Complications and methods of anesthesia were reviewed in 9478 patients who had undergone liposuction surgery often in several areas. Seventy-one percent of the patients were treated under local anesthesia and the overall level of complications was extremely low. The results of the survey reflect the large number of liposuction procedures that are being performed by dermatologists with a high degree of patient safety.

Adolescent↗
PubMed1988

Vaginal fluid zinc concentration as a marker for intercourse.

Zinc is present in high concentration in semen, but in low concentration in vaginal fluid. We evaluated vaginal zinc levels as a marker for intercourse by measuring precoital (greater than 11 h after intercourse) or postcoital (less than 5 h after intercourse) zinc and acid phosphatase levels in 26 specimens of vaginal fluid from 18 women. The approximate 95% reference range for zinc in precoital vaginal fluid was 1.2 to 15 micrograms/mL (mean 4.5), and in postcoital vaginal fluid 4.0 to 135 micrograms/mL (mean 24). There is an overlap between the precoital and postcoital reference ranges. Provided that the vaginal fluid zinc level is less than approximately 4.0 micrograms/mL or greater than approximately 15 micrograms/mL, vaginal fluid zinc concentration may be useful as an indicator of intercourse.

Acid Phosphatase↗
PubMed1987

Toxic shock syndrome.

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Contraceptive Devices, Female↗