Biomedical subjects
Hilary Sanfey
Publications and source records attributed to Hilary Sanfey.
The view of surgery department chairs on part time faculty in academic practice: results of a national survey.
BACKGROUND: Reduced resident work hours sparked debate regarding lifestyle of clinical faculty. We hypothesized surgery department chairs would not be supportive of part-time clinical faculty (PTF) and would be reluctant to grant requests to reduce total institutional commitment (TIC) or total professional effort. METHOD: A 16-question survey was mailed to 202 surgery chairs requesting department demographics, and perception of PTF. Chairs were given the option of identifying themselves. PTF referred to full-time equivalent clinicians who reduce their TIC for personal/family reasons and did not include clinicians with research or teaching commitments limiting clinical responsibilities. RESULTS: A total of 112 of 186 (61.2%) delivered surveys were returned. Of these, 48.2% of respondents indicated clinicians had requested reduced TIC and 40.2% of departments had PTF. Only 1 chair was unable to grant a request to reduce TIC. A total of 42.8% of respondents indicated that PTF receive reduced salary-linked benefits but (58.9%) no change in either academic status or (52.7%) eligibility for promotion/tenure. The percentage of women faculty was 12.0% in departments with PTF and 10.5% in departments without PTF. A total of 42.8% of chairs agreed facilitating PTF would improve faculty retention versus 24.1% who disagreed (P<.0001). When compared with departments without PTF, chairs with PTF were more supportive that facilitating PTF would improve faculty retention (53.3% vs 32.7%, P<.001) and would be beneficial to their departments (57.8% vs 22.4%, P<.001). Sixty-two percent of respondents volunteered their names and contact information for follow-up. CONCLUSIONS: Contrary to our hypothesis, surgery department chairs appear to be supportive of PTF and were interested in discussing this further.
Magnetic resonance urography for the assessment of potential renal donors: comparison of the RARE technique with a low-dose gadolinium-enhanced magnetic resonance urography technique in the absence of pharmacological and mechanical intervention.
The aim of this study was to determine whether magnetic resonance urography without pharmacological (diuretic) stimulation and mechanical compression allows conclusive evaluation of the urinary system in potential renal donors. In 28 consecutive patients magnetic resonance urography (MRU) was performed on a 1.5-T system. Two techniques, rapid acquisition with relaxation enhancement (RARE) and a gadolinium (Gd)-enhanced 3D fast low angle shot (FLASH) sequence were compared in the absence of adjunctive measures. Two reviewers assessed image quality, presence of artifacts and completeness of visualization of the collecting systems and ureters. Among the 53 MR urograms, there was no difference in image quality and presence of artifacts between RARE and Gd-MRU. Despite high image quality, visualization of the urinary collecting system was insufficient. Continuous visualization from the collecting system to the distal ureter was demonstrated bilaterally in only 14% of the RARE and 26% of Gd-enhanced MR urograms, respectively. Overall, Gd-enhanced MRU was superior to the RARE technique in displaying the segments of the urinary collecting system, but this difference was not found to be statistically significant. Neither the RARE technique nor the gadolinium-enhanced MRU technique is accurate enough to allow the evaluation of the collecting system and ureters in potential renal donors in the absence of pharmacological intervention and compression.
The night float system: ensuring educational benefit.
BACKGROUND: The ACGME mandated a change in resident work hours effective July 2003. We postulated that taking a block of night call would provide an opportunity for residents to improve clinical decision-making without detracting from operative experience. METHODS: The educational benefit of the Night Float model was evaluated weekly by anonymous questionnaires that assessed resident conference attendance, operative experience, attending teaching interactions, and consultations for the previous seven days. RESULTS: Preliminary results demonstrated that a higher percentage of Night Float residents reported less exposure to each educational opportunity than their colleagues. These data prompted several remedial interventions that resulted in significant improvement. Compliance with the 80-hour workweek was equal for both groups. CONCLUSIONS: The Night Float model has the advantage of fulfilling ACGME requirements, but it also has the potential to limit educational experience. Continued monitoring and faculty intervention are critical if we are to succeed in our goal to provide our residents with the best possible training.
Gender-specific issues in liver and kidney failure and transplantation: a review.
INTRODUCTION: Historically, research has been performed in male animals and extrapolated to the care of females regardless of biological differences. Men and women differ, however, with regard to severity and pathogenesis of disease and healthcare needs and this uniform approach, regardless of gender, is not always in the best interests of the patient. The relationship between sex hormones and immunological processes has been extensively documented but is not yet well understood and these differences will be discussed as they relate to liver and kidney failure and transplantation. DISCUSSION: Certain forms of organ failure are more common in either men or women and the physiological changes associated with pregnancy present unique challenges to the transplant physician since pregnancy may adversely affect graft function and immunosuppression presents a risk for opportunistic infection in the mother or fetal injury. Donor and recipient gender affect graft and patient survival after transplantation and there is clearly some gender bias in organ donation and transplantation. CONCLUSIONS: We need to be mindful of these differences in relation to gender-specific diseases, hormonal and immunological differences in designing clinical protocols and treatment pathways in order to improve outcomes in transplantation. Unfortunately, this is difficult in an environment where our practice is largely restricted by a shortage of donor organs and the need to decrease waiting list mortality.
Contrast-enhanced MR angiography after pancreas transplantation: normal appearance and vascular complications.
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Remediation of low ABSITE scores.
PURPOSE: In 2000, a program was initiated to improve American Board of Surgery In-Training Exam (ABSITE) scores below the 40th percentile (PGY-1 and -2) and the 30th percentile (PGY-3 and -5) for categorical residents. The goal of this program is to maintain scores above this standard. METHODS: One faculty member was designated to meet with each resident with ABSITE scores below the standard described above. In April, individual study plans were designed with each resident, which emphasized practice questions and strategic planning for study, and the ABSITE test structure and results were reviewed. Two subsequent meetings were held between November and December to monitor progress. Emphasis was placed on minimizing the stigma of poor scores and on maximizing the efficiency of study time. If the resident scored above-standard that year, further support was not required. RESULTS: From 2000 to 2004, 12 (9.5%) ABSITE scores were below-standard, which resulted in 8 (20.5%) residents receiving program support 9 times. All but 1 program encounter resulted in above-standard scores the following year (improvement range, 16 to 65 percentile points; average, 34 points). Two residents had recurrent below-standard scores in subsequent years despite above-standard scores immediately after the program. One resident did not participate in the program, despite it being designated as mandatory. During the same interval, the ABSITE scores of residents not involved in the program decreased by an average of 3.7 percentile points per examination (improved scores 31 times; 39.2%, range 1 to 46, average 13.5, worse scores 45 times; 57%, range 1 to 65, average 15.2, and no change 3 times, 3.8%). CONCLUSIONS: An individualized program that minimizes the stigma of poor test results, the time commitment required by the residents, and maximizes the benefits of a question-based study system and the knowledge of approach to the ABSITE resulted in significant improvements in scores the next year. However, maintenance of these results needs continued evaluation because 3 residents had recurrent poor scores in subsequent years.