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K Reynard

Publications and source records attributed to K Reynard.

6 recordsLinked to original sources
PubMed2005

Core-peripheral temperature gradient as a diagnostic test in dyspnoea.

OBJECTIVES: To evaluate whether the core-peripheral temperature gradient could be used to distinguish between cardiac and respiratory causes of dyspnoea. METHODS: In total, 50 patients were enrolled in the study, based on the following inclusion criteria: (a) a primary presenting complaint of dyspnoea; (b) age > 40 years; (c) respiratory rate > 20 breaths/min; (d) hypoxia. The tympanic temperature and the temperature of the nasal tip were recorded, and the patient's discharge data and chest x ray results checked. Where there was discordance, arbitration was carried out by another researcher. RESULTS: Four patients were excluded, hence the final study sample was 46 patients. There was a statistically significant difference between the mean temperature gradients of the two study populations (p < 0.001). A gradient of > 8 degrees C was able to rule in a cardiovascular cause (92% specificity) whereas one of < 5 degrees C could rule it out (100% sensitivity). CONCLUSION: The test is safe, non-invasive and inexpensive. Although there were some limitations to the study, the test can still be commended as a useful adjunct to the emergency assessment of the acutely breathless patient.

Aged↗
PubMed1998

High-altitude cerebral edema evaluated with magnetic resonance imaging: clinical correlation and pathophysiology.

CONTEXT: Because of its onset in generally remote environments, high-altitude cerebral edema (HACE) has received little scientific attention. Understanding the pathophysiology might have implications for prevention and treatment of both this disorder and the much more common acute mountain sickness. OBJECTIVES: To identify a clinical imaging correlate for HACE and determine whether the edema is primarily vasogenic or cytotoxic. DESIGN: Case-comparison study. SETTING: Community hospitals accessed by helicopter from mountains in Colorado and Alaska. PATIENTS: A consecutive sample of 9 men with HACE, between 18 and 35 years old, 8 of whom also had pulmonary edema, were studied after evacuation from high-altitude locations; 5 were mountain climbers and 4 were skiers. The control group, matched for age, sex, and altitude exposure, consisted of 3 subjects with high-altitude pulmonary edema only and 3 who had been entirely well at altitude. Four patients with HACE were available for follow-up imaging after complete recovery. MAIN OUTCOME MEASURES: Magnetic resonance imaging (MRI) of the brain during acute, convalescent, and recovered phases of HACE, and once in controls, immediately after altitude exposure. RESULTS: Seven of the 9 patients with HACE showed intense T2 signal in white matter areas, especially the splenium of the corpus callosum, and no gray matter abnormalities. Control subjects demonstrated no such abnormalities. All patients completely recovered; in the 4 available for follow-up MRI, the changes had resolved entirely. CONCLUSIONS: We conclude that HACE is characterized on MRI by reversible white matter edema, with a predilection for the splenium of the corpus callosum. This finding provides a clinical imaging correlate useful for diagnosis. It also suggests that the predominant mechanism is vasogenic (movement of fluid and protein out of the vascular compartment) and, thus, that the blood-brain barrier may be important in HACE.

Adult↗
PubMed1994

Assessment of an objective structured clinical examination (OSCE) for undergraduate students in accident and emergency medicine.

Conventional techniques for assessing the knowledge and clinical competence of undergraduate medical students are widely acknowledged as being unsatisfactory. We introduced an objective structured clinical examination (OSCE) for our fourth year medical students at the end of their accident and emergency (A&E) medicine attachment. This paper outlines the organisation of the examination and the results of a comparison of marks obtained from the OSCE, from a multiple choice type examination and from a subjective rating of the students performance by their teachers. We found the OSCE to be an acceptable form of examination to both medical students and examiners. Our results show significant correlation between marks obtained on the OSCE exam and subjective rating of the students ability. There was no statistically significant relationship to marks obtained on a multiple choice questionnaire exam. The OSCE format is particularly appropriate to A&E medicine where the participation of patients in traditional clinical examinations is impractical.

Clinical Competence↗