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BACKGROUND: For several years, final-year students at McMaster University have been required to complete 10 mini-CEX type assessments per rotation. A similar system was being introduced at Ottawa. PURPOSE: To facilitate data capture, we decided to introduce a personal data assistant (PDA)-based system and evaluate its impact. METHOD: A randomized trial was designed to compare the acceptability of PDA and printed evaluation forms. The trial failed because of clerks' unwillingness to use PDAs. A focus group was held and user surveys were administered, chiefly by e-mail, to explore students' preference for printed forms. RESULTS: Thirty percent of invited clerks (52/176) agreed to use a PDA; 6% (11; 21% of those agreeing) recorded one or more encounters; 2% (4) recorded at least the minimum number of evaluations required by their program. Most survey respondents expressed concerns related primarily to the relative inconvenience of PDAs compared to paper, a judgment reflecting the time required both to install required software and to become familiar with the software and data entry form, and to record information via the form. A minority were also concerned about assessors' willingness or ability to use PDA forms. CONCLUSION: Before asking students and clinical supervisors to use a PDA-based encounter-evaluation form in clerkship, planners should conduct a careful assessment of the advantages and disadvantages for students of the system they hope to implement. The prima facie greater convenience and efficiency of the PDA may actually be offset by workplace disincentives and inefficiencies in data recording, relative to the incentives and efficiencies associated with a system based on printed (paper) forms. [ABSTRACT FROM AUTHOR]

PURPOSE: To quantify practice changes associated with implementing a clinical practice guideline for the second stage of labor in term nulliparous women with epidural anesthesia and to describe the lessons learned about knowledge translation. The main clinical practice guideline recommendation was waiting up to 2 hours before pushing after full dilatation. DESIGN AND METHODS: Pre- and post-evaluation of clinical outcomes and knowledge translation strategies associated with implementing the second stage of labor clinical practice guideline at two birthing units within a large teaching hospital. RESULTS: The implementation of the clinical practice guideline resulted in a significant increase in median waiting time before pushing of 33 minutes at Site 1. This change was also reflected in the twofold increase in the proportion of women waiting longer than 120 minutes before pushing at this site. There was no change in waiting time at Site 2. The duration of the second stage did not change significantly at either site. The median pushing time decreased at both sites but was only statistically significant at Site 1. CLINICAL IMPLICATIONS: Bringing about practice change in obstetrics is complex. The measured change in this study was less than we expected. Greater success might have been achieved by enhancing feedback to care providers and more frequent audits of practice. We need to better understand the subtle influences in attitude and culture that prevented successful implementation in one site. For units considering a similar process, we recommend a commensurately greater level of presence in the units to encourage compliance with the clinical practice guideline in order to achieve the desired level of practice change. [ABSTRACT FROM AUTHOR]

Substance use disorders (SUDs) in pregnancy are becoming increasingly prevalent. Our study aimed to measure the effect of a teaching module on alcohol, tobacco, and drug use on the attitude of second year medical students toward pregnant women with SUDs. A questionnaire was administered to 84 medical students before a 5-week systems block on human reproduction, which included specific learning events related to SUDs. The questionnaire was readministered at the completion of the block. Pre- and postintervention scores were compared. Students showed significant improvement (p < .05, reliability coefficient 0.90) in their level of comfort in dealing with womenwith SUD in pregnancy. Other positive trends relating to attitudes toward drug- and alcohol-dependent women during pregnancy were also identified. SUD teaching interventions among medical students can improve their comfort level and attitude toward pregnant women with SUDs. This supports the current initiative of Project CREATE (Curriculum Renewal and Evaluation of Addiction Training and Education) to implement a comprehensive undergraduate SUD teaching program in Canadian medical schools. [ABSTRACT FROM AUTHOR]

Cross-clamping of the abdominal aorta can be associated with significant changes in haemodynamic variables. However, intraoperative changes in extravascular lung water (EVLW) have not been studied. Nine patients undergoing elective surgery, either aortic aneurysm repair or aorto-bifemoral grafting, were monitored invasively with arterial lines, pulmonary artery catheters and Edwards lung water catheters inserted in either the brachial or axillary artery. Determinations of EVLW were made prior to and five minutes after application of the aortic cross-clamp and at 30-minute intervals during the course of the operation. Baseline EVLW was found to be 7-9 ml.kg-1. There were no significant changes in haemodynamic variables and no changes in EVLW with cross-clamping of the aorta. The EVLW did not change during the course of surgery. The EVLW did not increase in the absence of sustained elevation of pulmonary capillary wedge pressure. One patient developed an axillary artery thrombosis which required thrombectomy at the site of lung water catheter insertion. Two other patients lost their distal pulses without overt ischaemic changes. It was felt that such relatively high incidence of complications precluded further use of the lung water catheter in the axillary or brachial artery. [ABSTRACT FROM AUTHOR]

An orifice equation is derived relating the effective aortic valve area, , the average aortic valve pressure gradient, dP, the stroke volume,, and the heart frequency, FH, through considerations of momentum conservation across the aortic valve. This leads to a formula consistent with Newton's second law of motion. The form of the new equation is A =(7.5 × 10) /, where , , and are expressed in cm, ml, s and mmHg, respectively. Aortic valve areas computed with the new orifice equation are found to correlate with those computed by the Gorlinformula in conditions of resting haemodynamic states at a level of = 0.86, =0.25 cm, = 120. The results suggest that the new formula may be considered as an independent orifice equation having a similar domain of validity as the Gorlinformula. The new equation offers the possibility of deriving additional useful haemodynamic relationships through combination with established cardiological formulas and applying it in a noninvasive Doppler ultrasonic or echocardiographic context. [ABSTRACT FROM PUBLISHER]

Objective: To evaluate the effect of treatment with alendronate sodium, a potent aminobisphosphonate, on the incidence of nonvertebral fractures in postmenopausal women with osteoporosis.Data Sources: Published data and data on file at Merck Research Laboratories.Study Selection: All completed prospective, randomized, placebo-controlled alendronate trials of at least 2 years' duration (5 studies).Data Extraction: All subjects were women with osteoporosis between the ages of 42 and 85 years, postmenopausal at least 4 years, with lumbar spine bone mineral density (measured using dual-energy x-ray absorptiometry) at least 2.0 SD below the mean for young adult women. All women randomized to treatment with placebo or alendronate at a dose higher than 1 mg per day for at least 2 years were included.Data Synthesis: In the placebo group (n=590), 60 women reported nonvertebral fractures during 1347 patient-years at risk (overall rate, 4.45 women with fractures per 100 patient-years at risk). In the alendronate group (n = 1012), 73 women reported nonvertebral fractures during 2240 patient-years-at risk (overall rate, 3.26 women with fractures per 100 patient-years at risk). The estimated cumulative incidence of nonvertebral fractures after 3 years was 12.6% in the placebo group and 9.0% in alendronate group. The relative risk for nonvertebral fracture estimated using the Cox proportional hazards model was 0.71 (95% confidence interval,0.502-0.997) (P=.048). A reduction in risk was consistent across each of the studies and at each major site of osteoporotic fracture, including the hip and wrist.Conclusion: In postmenopausal women with osteoporosis, treatment with alendronate reduces the risk of nonvertebral fractures over at least 3 years. [ABSTRACT FROM AUTHOR]

An abstract of the article "Ultrasound-guided selective termination in a dichorionic pregnancy following previable preterm premature rupture of membranes: A case report" by M. Roy-Lacroix and colleagues is presented.

An abstract of the conference paper "Successful fetal therapy for massive fetal sacrococcygeal teratoma (SCT) using radio frequency ablation (RFA)," by G. Ryan and colleagues, is presented.

An abstract of the conference paper "Diagnosis of placenta accreta in early pregnancy: Case report and review of literature," by K. Fung and colleagues is presented.