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Mark O Baerlocher

Publications and source records attributed to Mark O Baerlocher.

At least 19 recordsLinked to original sources
PubMed2006

Does this patient with headache have a migraine or need neuroimaging?

CONTEXT: In assessing the patient with headache, clinicians are often faced with 2 important questions: Is this headache a migraine? Does this patient require neuroimaging? The diagnosis of migraine can direct therapy, and information obtained from the history and physical examination is used by physicians to determine which patients require neuroimaging. OBJECTIVE: To determine the usefulness of the history and physical examination that distinguish patients with migraine from those with other headache types and that identify those patients who should undergo neuroimaging. DATA SOURCES AND STUDY SELECTION: A systematic review was performed using articles from MEDLINE (1966-November 2005) that assessed the performance characteristics of screening questions in diagnosing migraine (with the International Headache Society diagnostic criteria as a gold standard) and addressed the accuracy of the clinical examination in predicting the presence of underlying intracranial pathology (with computed tomography/magnetic resonance imaging as the reference standard). DATA EXTRACTION: Two authors independently reviewed each study to determine eligibility, abstract data, and classify methodological quality using predetermined criteria. Disagreement was resolved by consensus with a third author. DATA SYNTHESIS: Four studies of screening questions for migraine (n = 1745 patients) and 11 neuroimaging studies (n = 3725 patients) met inclusion criteria. All 4 of the migraine studies illustrated high sensitivity and specificity if 3 or 4 criteria were met. The best predictors can be summarized by the mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling). If 4 of the 5 criteria are met, the likelihood ratio (LR) for definite or possible migraine is 24 (95% confidence interval [CI], 1.5-388); if 3 are met, the LR is 3.5 (95% CI, 1.3-9.2), and if 2 or fewer are met, the LR is 0.41 (95% CI, 0.32-0.52). For the neuroimaging question, several clinical features were found on pooled analysis to predict the presence of a serious intracranial abnormality: cluster-type headache (LR, 10.7; 95% CI, 2.2-52); abnormal findings on neurologic examination (LR, 5.3; 95% CI, 2.4-12); undefined headache (ie, not cluster-, migraine-, or tension-type) (LR, 3.8; 95% CI, 2.0-7.1); headache with aura (LR, 3.2; 95% CI, 1.6-6.6); headache aggravated by exertion or a valsalva-like maneuver (LR, 2.3; 95% CI, 1.4-3.8); and headache with vomiting (LR, 1.8; 95% CI, 1.2-2.6). No clinical features were useful in ruling out significant pathologic conditions. CONCLUSIONS: The presence of 4 simple historical features can accurately diagnose migraine. Several individual clinical features were found to be associated with a significant intracranial abnormality, and patients with these features should undergo neuroimaging.

Algorithms↗
PubMed2006

Successful recanalization of a longstanding complete left subclavian vein occlusion by radiofrequency perforation with use of a radiofrequency guide wire.

Treatment with radiofrequency (RF) energy can be used to ablate or perforate tissues. The latter involves lower power, higher voltage, and much shorter treatment time, and it is thought to induce much less collateral tissue damage. To date, RF perforation has been successfully used for various cardiac interventions; however, to our knowledge, there has not been a report of its use for peripheral vascular disease. This report describes the successful recanalization of a longstanding occlusion of a left subclavian vein in a 73-year-old woman with polycystic kidney disease and end-stage renal disease undergoing chronic hemodialysis treatment via an upper-extremity arteriovenous fistula. Multiple previous attempts at mechanical recanalization were unsuccessful. Recanalization was achieved by RF perforation with use of a PowerWire RF guide wire.

Aged↗
PubMed2006

Does sex affect the success rate of Canadian ophthalmology residency applicants?

BACKGROUND: Despite equalization of the ratio of men and women among matriculating medical students, it is possible that different rates of success for applicants at the level of resident selection in the annual residency match may occur on the basis of sex. As part of a larger project, we examined this issue across the medical specialties. In the current article, the effect of sex on resident selection within the specialty of ophthalmology is explored. METHODS: Data were obtained from the Canadian Medical Association, Canadian Institute for Health Information, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, and Canadian Residency Matching Service regarding sex- and age-specific demographics, as well as success rates for male and female applicants ranking an ophthalmology residency program as their top choice. The proportion of men who ranked ophthalmology as their top choice but did not match to any ophthalmology program was compared to the corresponding proportion of women. RESULTS: The female: male ratio of practicing ophthalmologists has slowly increased over the past decade and is highest (0.41:1) within the under-45 age group. By grouping data from 1993 to 2004, we found that men who ranked an ophthalmology program as their first choice had odds of not being accepted to an ophthalmology program that were 1.1 times (95% confidence interval 0.8-2.0; p=0.34) the corresponding odds for women. INTERPRETATION: Our data suggest that discrimination on the basis of sex does not occur at the level of residency selection. The lower level of female recruitment may be due to decreased interest in this specialty among women. Nonetheless, the proportion of female ophthalmologists within the Canadian workforce continues to increase.

Canada↗
PubMed2006

Factors leading to radiology career selection: results of the 2004 National Physician Survey.

Data from the 2004 National Physician Survey were used to determine when current Canadian radiologists made their decision to pursue a radiology career and to determine which factors were most influential in their decision. Most respondents reported having made this decision during their clerkship years of medical school (32.7%) or after a period of time in practice (25.4%). The most influential factors involved in this decision were perceived intellectual stimulation and workload flexibility or predictability. These results provide insight into the trainee's decision to pursue radiology and may be useful to those recruiting for radiology as well to medical students considering the field.

Canada↗
PubMed2006

Uterine artery embolization--inpatient and outpatient therapy: a comparison of cost, safety, and patient satisfaction.

OBJECTIVES: To determine whether uterine artery embolization (UAE) can be safely performed as an outpatient procedure without increased complications and readmission rates or decreased patient satisfaction rates and to determine the Canadian cost difference between performing UAE as an outpatient, compared with inpatient, procedure. METHODS: We performed a retrospective chart review and patient survey of 2 groups of patients, 132 patients who underwent inpatient UAE and 20 patients who underwent outpatient UAE. Of these, 82 and 18, respectively, were successfully surveyed by telephone. Variables examined included presenting complaints, postprocedural symptoms, patient satisfaction, and readmission or complication rates. We also performed a detailed Canadian cost analysis comparing inpatient with outpatient UAE. RESULTS: We did not find any statistically significant difference between inpatient and outpatient UAE on any of the patient variables measured, including presenting complaints, postprocedural symptoms, patient satisfaction, and readmission or complication rates. We also found that outpatient UAE costs significantly less than inpatient UAE, primarily owing to decreased hospital overhead costs for overnight admission. In Ontario, inpatient UAE costs per patient totalled dollars 3216.22, whereas outpatient costs totalled dollars 2194.53--a saving of dollars 1021.69, which represents a 31.8% cost reduction. CONCLUSION: Given these results, we recommend that centres consider performing UAE as an outpatient procedure. A key enabling factor is the ability to have several hours of close nursing supervision of the patient postprocedure, prior to discharge.

Adult↗
PubMed2006

The importance of foreign-trained physicians to Canada.

PURPOSE: To examine the proportion of Canada's physicians who are foreign-trained (non-Canada, non-US), and to determine if there was a relationship between this number and the net change in physicians of each province as affected by inter-provincial migration. METHODS: Data were obtained from the Canadian Medical Association, based on information contained within the Southam Medical Database of the Canadian Institute for Health Information (1987-2003). Information on the net change in the number of physicians lost or gained due to inter-provincial migration was obtained for each province, as well as the percentage of physicians that are foreign-trained (non-Canada, non-US). A correlation between the net change in physician supply and the proportion of foreign-trained physicians was explored. RESULTS: Foreign-trained physicians comprised from 19% (Prince Edward Island) to 55% (Saskatchewan) of the provincial physician supply. There was a strong linear correlation between the net change in physician supply due to inter-provincial migration and the proportion of foreign-trained physicians (r2 0.546; P=0.0146). DISCUSSION: Canada continued to rely heavily on foreign-trained physicians. This was particularly true for provinces which lost the greatest number of physicians to inter-provincial migration. Such 'poaching' of physicians may have important ramifications for the source countries.

Canada↗
PubMed2005

Improving the quality of coronary bypass surgery with intraoperative angiography: validation of a new technique.

OBJECTIVES: We report a comprehensive assessment and validation of a new intraoperative angiography technique. BACKGROUND: Technical problems at the site of the distal anastomosis compromise an underappreciated proportion of coronary bypass grafts. The absence of a systematic, validated technique to verify graft patency in the operating room represents a significant breach in quality assurance. METHODS: Fluorescent indocyanine green (ICG) dye is excited with dispersed laser light to create an angiographic depiction of the graft, native vessel, and anastomosis. One-hundred twenty patients underwent ICG angiography. Angiograms were reviewed for reliability and validity studies. RESULTS: A total of 348 coronary bypass grafts were studied. Each ICG angiogram took 2.2 +/- 1.1 min to perform. The ICG angiography found 4.2% of patients had significant graft problems requiring major revision. Quality of visualization was rated according to a seven-point Likert scale (1 = worst, 7 = best). Among conduits, saphenous veins were best visualized (mean score +/- standard deviation), 6.4 +/- 1.5 versus 5.5 +/- 1.9 for internal mammary arteries and 4.4 +/- 2.3 for radial arteries (p = 0.02). Location of distal anastomosis did not influence quality of visualization. There was high inter-rater reliability for graft revision (kappa = 1.0) and graft patency (kappa = 0.97) between surgeons. Sensitivity and specificity of the ICG angiograms for graft stenosis >50% was 100% among 22 grafts also studied with X-ray angiography. CONCLUSIONS: Information from ICG angiograms led to graft revisions for technical problems in 4.2% of patients that would have otherwise gone unrecognized. Intraoperative angiography is an emerging tool for improving the quality of coronary bypass surgery.

Aged↗
PubMed2005

Attitudes of and influences on residents in English Canadian radiology programs regarding interventional radiology: results of a national survey by the Canadian Interventional Radiology Association (CIRA).

PURPOSE: There has been a North American trend toward reduced application to the subspecialty of Interventional Radiology (IR). Out of fear of a looming manpower shortage, this survey was conducted to better understand awareness and attitudes toward IR by radiology residents-in-training. MATERIALS AND METHODS: An anonymous online survey was emailed to the Diagnostic Radiology Residency Program Director/Department Chairperson of each of the 13 English medical schools in Canada, to be forwarded to each respective Radiology Residency Program's radiology residents. The survey was open for a period of 1 month. The survey consisted of 29 questions, which could be answered online using a web-based program. Responses to questions were tabulated and comments recorded. RESULTS: A total of 84 survey responses were received of a possible 333 (25%), including responses from each of the 13 English Programs. Responses regarding demographics, training, careers aspirations and motivations, and influences were collected. Fifty-one percent of respondents reported being either "moderately" or "very" interested in the field of IR; however, only 13% reported intention to perform an IR fellowship. A number of issues were identified as dissuading current radiology residents from pursuing IR, including income, work hours and hours of on-call, and turf issues. CONCLUSION: A number of issues were identified as factors which prevented residents with an interest in IR from applying to IR fellowships. These must be addressed to increase IR recruitment rates of radiology residents.

Adult↗
PubMed2005

Management of type 2 diabetes mellitus. Role of thiazolidinediones.

OBJECTIVE: To review evidence supporting use of thiazolidinediones (TZDs) in management of type 2 diabetes mellitus (DM2). QUALITY OF EVIDENCE: A MEDLINE search found several randomized controlled trials (level I evidence). No systematic reviews of these trials were found in the Cochrane Library. MAIN MESSAGE: Thiazolidinediones lower hemoglobin AIc levels by as much as 1.0% to 1.5%. Effects can be seen in as little as 4 weeks, but full lowering takes 6 to 12 weeks. When used in combination with other diabetic agents, such as sulfonylureas and biguanides, TZDs' hypoglycemic effects appear to be complementary. Thiazolidinediones directly improve insulin sensitivity and recovery of pancreatic beta cell function. Nevertheless, there is no evidence indicating that TZDs are superior to other antidiabetic agents currently available or that TZDs reduce the long-term complications of DM2. CONCLUSION: Ongoing trials will further define the role of TZDs in management of diabetic patients. In current practice, cost is often a factor in the decision to prescribe TZDs.

Diabetes Mellitus, Type 2↗
PubMed2005

Current issues of interventional radiology in Canada: a national survey by the Canadian Interventional Radiology Association.

OBJECTIVE: To determine current issues facing the field of interventional radiology (IR) in Canada. METHODS: An anonymous online survey was emailed to all members of the Canadian Interventional Radiology Association. The survey was open for 1 month. RESULTS: A total of 83 survey responses were received (of an estimated possible 233). Responses regarding demographics, aspects of practice, research, and IR trainee education were collected. CONCLUSIONS: Several issues were identified as pertinent to Canadian interventional radiologists, including a current and future drought of interventional radiologists, a lack of women in the profession, inadequate protected research time for those in academic practice, a lack of protected clinical time, concern regarding turf issues with other specialties, division between interventional and diagnostic radiology, and the ideal profile of the future interventional radiologist. The field of interventional radiology (IR) continues to develop, expand, and mature at a rapid pace. As the field is still relatively young, several issues are bound to arise. It is important therefore to stay abreast of the current trends and opinions of practitioners within the field.

Canada↗