Publications by authors named "Stephen J Markwell"
Importance: Answering pages from nurses about patients in need of immediate attention is one of the most difficult challenges a resident faces during their first days as a physician. A Mock Page program has been developed and adopted into a national surgical resident preparatory curriculum to prepare senior medical students for this important skill.
Objective: The purpose of this study is to assess standardized mock page cases as a valid construct to assess clinical decision making and interprofessional communication skills.
Background: The study aim was to examine whether concomitant atrial fibrillation (AF) surgery at the time of mitral valve surgery in the elderly results in increased operative mortality (OM).
Methods: Medicare beneficiaries aged ≥65 years undergoing primary mitral valve repair or replacement between 2004 and 2006 were included. The cohort was divided into three groups: Group 1, AF- (n = 2,705); group 2, AF+AF surgery- (n = 2,119), and group 3, AF+AF surgery+ (n = 1,832).
Background: Optimizing pain control following total knee arthroplasty is of utmost importance to the immediate post-operative course. Various anesthesia modalities are available, but studies comparing multiple anesthesia modalities, patient age, and sex are limited.
Questions/purpose: The purpose of our study was to examine the impact of patient age, gender, and perioperative anesthesia modality on postoperative pain following primary total knee arthroplasty.
Background: The need for additional procedures during a segmental elective colectomy is considered to lead to increased postoperative morbidity, but there have been few data that have validated and quantified this risk.
Purpose: We hypothesized that patients having additional procedures performed during a segmental colectomy have worse outcomes compared to patients undergoing a colectomy alone.
Patients And Methods: All patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database who underwent an elective open or laparoscopic segmental colectomy during 2005-2009 and met the inclusion criteria were analyzed.
Purpose: Operative performance ratings (OPRs) need adequate clarity and detail to support self-directed learning and valid progress decisions. This study was designed to determine (1) the elapsed time between observing operative performances and completing performance ratings under field conditions and (2) the effect of increased elapsed time on rating clarity and detail.
Methods: Overall, 895 OPRs by 19 faculty members for 37 general surgery residents were the focus of this study.
Purpose: To determine the diagnostic justification proficiency of senior medical students across a broad spectrum of cases with common chief complaints and diagnoses.
Method: The authors gathered diagnostic justification exercise data from the Senior Clinical Comprehensive Examination taken by Southern Illinois University School of Medicine's students from the classes of 2011 (n = 67), 2012 (n = 66), and 2013 (n = 79). After interviewing and examining standardized patients, students listed their key findings and diagnostic possibilities considered, and provided a written explanation of how they used key findings to move from their initial differential diagnoses to their final diagnosis.
The literature on distal humeral supracondylar fractures does not systematically define relationships between patient characteristics and the severity or complications of these injuries. This study evaluated age, sex, height, and body mass index (BMI) in relation to fracture severity and posttreatment complications in a pediatric population. The medical records of 382 pediatric patients treated for distal humeral supracondylar fractures over a 5-year period at 1 institution were included.
View Article and Find Full Text PDFTo test the efficacy and safety of corticotropin-based immunotherapies in pediatric opsoclonus-myoclonus syndrome, 74 children received corticotropin alone or with intravenous immunoglobulin (groups 1 and 2, active controls); or both with rituximab (group 3) or cyclophosphamide (group 4); or with rituximab plus chemotherapy (group 5) or steroid sparers (group 6). There was 65% improvement in motor severity score across groups (P < .0001), but treatment combinations were more effective than corticotropin alone (P = .
View Article and Find Full Text PDFBackground: Cardiovascular disease is the main cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). SLE as a risk factor for adverse outcomes during mitral surgery has not been studied. The purpose of this investigation was to compare procedure selection and outcomes of patients with and without SLE.
View Article and Find Full Text PDFObjectives: Video-assisted thoracoscopic surgery (VATS) and median sternotomy (MS) are two approaches in lung-volume reduction surgery (LVRS). This study focused on the two surgical approaches with regard to postoperative pain.
Methods: In this prospective, non-randomized study, pain was measured preoperatively and postoperatively using the visual analog scale (VAS) and the brief pain inventory (BPI).
Objective: The literature is inconsistent regarding the role of chronic obstructive pulmonary disease (COPD) as a risk factor for blood product transfusion during coronary artery bypass graft (CABG). One reason may be lack of objective criteria to define COPD in previously published reports. We examined the role of COPD as a risk factor for transfusion using a strict definition based on objective pulmonary function test (PFT) data.
View Article and Find Full Text PDFObjective: The authors report on succession-planning for mid-level academic positions.
Method: The authors describe the process of succession-planning between clerkship directors and the smooth transition resulting in one case.
Results: Gradually transitioning allowed a new faculty person to assume the clerkship-director position with minimal disruption of the clerkship.
Introduction: Our study aims were to describe physical activity patterns and associations with fatigue and depressive symptoms among rural breast cancer survivors.
Methods: Population-based, mailed survey of 483 rural breast cancer survivors including the International Physical Activity Questionnaire (IPAQ).
Results: With regard to type and intensity, domestic/gardening and moderate intensity accounted for the largest percentage of total energy expenditure (i.
Purpose: During the transition from medical school to internship, trainees experience high levels of stress related to pages on the inpatient wards. The steep learning curve during this period may also affect patient safety. The authors piloted the use of simulated pages to improve medical student preparedness, decrease stress related to pages, and familiarize medical students with common patient problems.
View Article and Find Full Text PDFAim: Oxidative stress and ischaemia are suggested as possible mechanisms of contrast-induced nephropathy (CIN). Statins may offer renoprotection in both acute and chronic kidney diseases because of their antioxidant and anti-inflammatory properties. We investigated whether use of statins before non-emergent percutaneous coronary intervention (PCI) reduces the incidence of CIN.
View Article and Find Full Text PDFObjectives: This study was designed to compare long-term clinical outcomes of drug-eluting stents (DES) versus bare metal stents (BMS) in patients with saphenous vein graft (SVG) disease in the "real world."
Background: The safety and efficacy of DES versus BMS in SVG remains uncertain due to contradictory reports of either lower revascularization rates with DES; or clinical equivalence to BMS; or even an excess of clinical events associated with DES use.
Methods: We identified consecutive patients who underwent stent placement within a de novo SVG lesion between May 1, 2003 and July 31, 2007.
Context: Rural breast cancer survivors may be at increased risk for inadequate exercise participation.
Purpose: To determine for rural breast cancer survivors: (1) exercise preference "patterns," (2) exercise resources and associated factors, and (3) exercise environment.
Methods: A mail survey was sent to rural breast cancer survivors identified through a state cancer registry, and 483 (30%) responded.
Purpose: The purpose of this study was to evaluate the influence of potential contributing factors to the incidence of seed slippage and quality of prostate brachytherapy dosimetry comparing "coated" vs. "bare" seeds with a Mick applicator.
Methods And Materials: Two consecutive groups of 89 patients were treated with (125)I prostate brachytherapy at a high treatment volume single institution.
Background: Identifying patients with head and neck cancer at greatest risk of poor health-related quality of life (HRQOL) will facilitate screening for such patients and targeted interventions.
Methods: This was a cross-sectional, self-administered survey with medical record review among 65 out-patients with head and neck cancer >6 months from diagnosis and off treatment.
Results: Most were men (80%) and white (95%), with a mean age of 60 +/- 13 years.
Background: Our aim was to determine exercise preferences among patients with head and neck cancer and their associations with quality of life, symptom severity, depression, and rural residence.
Methods: This study involved a cross-sectional chart review and self-administered survey, with 90 outpatients with head and neck cancer (response rate = 83%).
Results: The majority were <65 years old (65%), male (78%), and white (96%) with stage > or = III (81%).
Objective: As a first step in planning interventions to promote exercise in rural breast cancer survivors (BCS), we sought to determine the exercise preferences of rural BCS and to identify the major determinants of these preferences.
Methods: Self-administered mail survey to a population-based sample from a state cancer registry.
Results: Among the 483 respondents, 96% were White with mean education of 13+/-2.
Background: The objective of this study was to compare findings after a cytologic report of low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion (LSIL-H) with findings after a report of low-grade squamous intraepithelial lesion (LSIL).
Methods: A review of patient records revealed that 312 women had cytologic findings of LSIL-H, and 324 consecutive women in a comparison group had cytologic findings of LSIL during 2005. Findings over 6 months after diagnosis were retrieved and analyzed using chi-square tests, Fisher exact tests, and independent group t tests.
Objective: Our aim was to assess differences in exercise counseling preferences, program preferences, and telephone/Internet access among breast cancer survivors based on exercise behavior and demographic, medical, social cognitive, and environmental factors.
Methods: A self-administered survey was returned by 192 breast cancer survivors.
Results: Participants were Caucasian (98%), and the mean age was 64+/-11.
Background: Fatigue, sleep disturbances, and cognitive impairment are prevalent and clinically important problems among head and neck cancer patients. Our study aim was to determine the most important correlates of these problems among patients with head and neck cancer.
Methods: A cross-sectional, self-administered survey was completed by 58 (response rate 79%) patients with head and neck cancer in an academic oncology clinic.
Background: A better understanding of how prostate cancer survivors differ from men without prostate cancer and whether these potential differences vary across demographic subgroups will help to focus and prioritize future public health interventions for improving the health and well-being of prostate cancer survivors. Therefore, our study aims were to compare lifestyle behaviors, body mass index (BMI), and perceived health in men with and without a diagnosis of prostate cancer in a national, population-based sample and to explore whether these comparisons differ for demographic subgroups.
Methods: In a cross-sectional study, men aged > or = 40 were identified from the Behavioral Risk Factor Surveillance System (BRFSS) 2002 data (n = 63,662).