Biomedical subjects

Randall S Burd

Publications and source records attributed to Randall S Burd.

6 recordsLinked to original sources

PubMed2002

Intraoperative communication of residents with faculty: perception versus reality.

INTRODUCTION: During a surgical procedure, an attending may propose a surgical treatment that a resident believes is not the standard of care based on previous readings, discussions with other faculty, or experience. We hypothesized that resident disagreements over intraoperative management are common and are handled differently by residents than faculty members perceive. METHODS: Surveys were sent to 68 residents (82% response) and 45 faculty (91% response) in general surgery and seven subspecialties. Questions were asked to determine the frequency of disagreements and the differences in perceptions of how residents should act when they have disagreements over the intraoperative decisions of attendings. Significance was defined using Fisher's exact test at P < 0.05. RESULTS: Residents reported having major disagreements with faculty over intraoperative decisions as often as monthly (41%) or two to three times per year (37%). Estimates of the frequency of major resident disagreements did not differ between attendings and residents. Fewer residents felt comfortable asking the faculty to discuss their intraoperative decisions than was perceived by faculty members (41% vs 78%, P < 0.001). Residents at all levels are less comfortable than perceived by their mentors in discussing intraoperative decisions even when residents believe that patient injury may result. Residents felt that most of their disagreements occurred because of attending knowledge deficit, while most attendings attributed these differences to resident knowledge deficits. CONCLUSION: Residents frequently have disagreements with faculty over intraoperative management. Education to improve preoperative and intraoperative communication between surgical residents and faculty is needed.

Communication↗

PubMed2002

The role of protective antireflux procedures in neurologically impaired children: a decision analysis.

BACKGROUND/PURPOSE: Despite normal clinical history and preoperative radiologic and pH studies, gastroesophageal reflux (GER) can become apparent in neurologically impaired (NI) children after gastrostomy tube placement. An antireflux procedure performed at the time of gastrostomy tube placement may prevent postoperative GER and help avoid the need for a subsequent surgical procedure but is associated with a high morbidity and mortality rate in NI children. The purpose of this study was to determine the role of protective antireflux procedures in NI children undergoing gastrostomy tube placement. METHODS: Decision analysis was used to evaluate the effect of a protective antireflux procedure on morbidity and mortality in NI children. The rate of postoperative GER, need for secondary antireflux procedures, and morbidity and mortality rates after gastrostomy tube placement with or without an antireflux procedure in NI children were estimated from the literature and expert opinion and used to construct decision trees. RESULTS: At baseline values, gastrostomy tube placement resulted in a lower morbidity (11% v 13%) than gastrostomy tube placement with a protective antireflux procedure. One-way sensitivity analysis showed that gastrostomy tube placement was the favored approach when the morbidity of gastrostomy tube placement was less than 11% or the morbidity of antireflux surgery was greater than 10%. At baseline values, gastrostomy tube placement resulted in a lower mortality rate (0.3% v 0.8%) than gastrostomy tube placement with a protective antireflux procedure. Using 1-way sensitivity analysis, no threshold value of any variable was found that favored the use of a protective antireflux procedure with respect to mortality. CONCLUSIONS: Although a protective antireflux procedure may reduce the need for additional surgery, inclusion of this procedure is associated with a higher morbidity and mortality rate. Initial placement of a gastrostomy tube without a protective antireflux procedure is the favored approach for NI children without preoperative evidence of GER.

Decision Trees↗

PubMed2002

Decision analysis: a basic overview for the pediatric surgeon.

Decision making in medicine requires choosing the option that best maximizes benefit while minimizing risk and cost. Even though uncertainty is an inherent feature of any clinical issue, clinicians and policy makers frequently are required to evaluate the best evidence and make therapeutic or policy decisions based on that evidence. Decision analysis is a quantitative approach to decision making under conditions of uncertainty that can be applied to specific types of clinical problems. This method disaggregates a complex clinical problem into its most important components that then can be understood more easily and analyzed quantitatively. Decision analysis has many potential applications in medicine and can be applied to solve specific clinical problems, analyze health care costs, or develop health care policies. In this review, the basic methods for constructing and analyzing decision analyses will be presented, and specific applications of this method to pediatric surgery will be discussed.

Decision Support Techniques↗

PubMed2002

Murine beta-defensin-3 is an inducible peptide with limited tissue expression and broad-spectrum antimicrobial activity.

Beta-defensins are cationic peptides produced by epithelial cells that have been proposed to be an important component of immune function at mucosal surfaces. Similarities between mammalian beta-defensins may permit the use of murine models to further define the role of these peptides in innate host defense. Murine beta-defensin-3 (mBD-3) is a peptide that exhibits homology at the gene level to human beta-defensin-2 (hBD-2), one of four beta-defensins identified in man. The purpose of this study was to determine the antimicrobial activity of mBD-3, the tissue distribution of mBD-3 expression, and the effect of gram-negative bacterial infection on mBD-3 expression. Based on the sequence deduced from mBD-3 cDNA, a 40-amino acid peptide was assembled using automated [n-(9-fluorenyl)methoxycarbonyl] solid-phase synthesis. The antimicrobial activity of synthetic mBD-3 was evaluated in microdilution broth assays using bacterial and fungal organisms. mBD-3 mRNA expression was assayed by polymerase chain reaction (PCR) using cDNA derived from a panel of tissues. Expression of mBD-3 was also evaluated in tissues obtained from mice 24 h after intraperitoneal infection with Escherichia coli using reverse transcriptase (RT)-PCR. Synthetic mBD-3 inhibited the growth of E. coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans at concentrations from 25 to 50 microg/mL. Constitutive expression of mBD-3 mRNA was not consistently found in any organ using RT-PCR. In an E. coli peritonitis model, expression of mBD-3 mRNA was upregulated only in the esophagus and tongue. We conclude that mBD-3 is an inducible peptide with limited tissue expression during E. coli peritonitis. Because it exhibits broad-spectrum antimicrobial activity, this peptide may serve as an innate defense against microbial invasion at specific mucosal surfaces in the mouse.

Amino Acid Sequence↗

PubMed2002

Ketorolac for pain management after abdominal surgical procedures in infants.

BACKGROUND: While the use of intravenous ketorolac in infants less than 6 months old has not been previously reported, ketorolac may reduce opioid use and prevent opioid-associated side effects that are frequent in this age group. We reviewed our experience with ketorolac in infants to develop recommendations for using it after abdominal surgery. METHODS: We reviewed the records of 10 infants less than 6 months old who received ketorolac supplemented with morphine and 8 infants who received morphine alone for pain after abdominal surgery. RESULTS: Infants receiving ketorolac required less morphine than infants receiving morphine alone in the first 48 hours after surgery. Four patients receiving ketorolac did not require any supplemental morphine. CONCLUSIONS: Ketorolac reduces the amount of morphine required after abdominal surgery in infants less than 6 months old. The use of ketorolac deserves further study as a method of reducing opioid-associated adverse effects in this patient group.

Abdomen↗

PubMedDate not supplied

Inguinal hernia in the premature infant: management of a common problem.

Inguinal hernia repair is one of the most common surgical procedures performed on premature infants. Improved survival rates in the NICU have led to an increase in the incidence of premature infants with inguinal hernias. The NICU nurse, often the first to notice an inguinal hernia in a premature infant, should understand the etiology, basic pathophysiology, and nursing care for this condition.

Diagnosis, Differential↗