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The fourth-year courses selected by the classes of 1982 and 1986 in the Brown University Program in Medicine were compared. The data support the contention that medical students' perception that residency positions were more difficult to obtain led to changes in selecting courses in the fourth year of medical school. (Author/MLW)

A study of the predictive capacity of the medical school admission interview, based on first-year performance, suggests that elimination of the interview did not adverse the medical school's ability to recruit a diverse and academically successful student body. (MSE)

The effectiveness of a cost containment curriculum integrated into a required 6-week community health-primary care clerkship at Brown University is described. A computerized patient management problem was administered to half the students in order to assess its discrete effect on the students. (MLW)

A study compared the performance of 232 Brown University (Rhode Island) medical graduates on senior-year examinations in clinical skills examinations and during residencies, as evaluated by their residency directors. Results indicated a strong correlation between the two evaluations, suggesting that the performance-based undergraduate assessments, which use standardized patients, are good predictors of residency performance. (Author/MSE)

Background: Adequate post‐operative analgesia is essential for recovery following abdominal surgery. Abdominal wall nerve blocks have been shown to be beneficial in this respect following surgery. The purpose of this trial was to examine the efficacy of infusional versus intermittent bolus delivery of abdominal wall blocks in patients undergoing abdominal resectional gastrointestinal surgery. Methods: A prospective randomized clinical trial, involving 120 patients undergoing gastrointestinal surgery, was undertaken across three hospitals. Insertion of abdominal wall catheters was performed and patients were randomized to receive ropivacaine 0.2% by either continuous infusion or regular intermittent bolus. The primary outcome was respiratory function, as measured by spirometry on post‐operative days 1–3 and 30. Secondary outcomes were pain, mobility, return of gut function, length of hospital stay, complication rates and patient satisfaction with analgesia. Results: All 120 patients were followed up to trial completion. Patients were well matched with regards to demographics. There was no difference between groups with regards to the primary outcome of post‐operative respiratory function. The bolus group had improved mobility scores on post‐operative day 1 (P = 0.025). There were no complications associated with blockade, and no other differences were identified between assessed outcomes. Conclusions: Continuous infusion and intermittent bolus are both safe ways of delivering abdominal wall nerve blockade, with equivalent analgesic outcomes. Bolus delivery appears to provide superior early mobility in comparison with continuous infusion. [ABSTRACT FROM AUTHOR]

Background: Anastomotic leakage is a feared complication following colorectal surgery. Early prediction results in improved clinical outcome, but accurate predictive factors remain elusive. Many biomarkers have been studied with respect to diagnosis of anastomotic leakage but the concept of trajectory testing, using biomarkers, has not been assessed with regards to early diagnosis of anastomotic leak. Methods: C‐reactive protein (CRP), procalcitonin (PCT), white cell count (WCC) and gamma‐glutamyl transferase were assessed for predictive utility in diagnosing anastomotic leakage with emphasis on identifying an association with change in their levels or trajectory. Levels were collected preoperatively and daily for the first 5 post‐operative days on patients undergoing elective colorectal surgery, involving an anastomosis. Anastomotic leakage was defined clinically by operative or radiological intervention. Comparison was made between biomarkers and clinical anastomotic leakage, using receiver operator characteristic curves for logistic models, based on trajectory of the four biomarkers. Results: A total of 197 consecutive patients were analysed. Eleven patients developed clinical anastomotic leakage. An association of biomarker trajectory with anastomotic leakage was observed for WCC, PCT and CRP, but not for gamma‐glutamyl transferase. CRP was the superior biomarker based on trajectory, with area under the receiver operator curve of 0.961. Conclusion: This study identifies change in CRP, WCC and PCT as potential markers of anastomotic leakage following colorectal surgery and in particular highlights CRP trajectory as extremely accurate in diagnosing anastomotic leakage requiring intervention. External validation should be sought before incorporating this into routine clinical practice, given the numbers in this study. [ABSTRACT FROM AUTHOR]

Background: The presence of an indwelling urinary catheter (IDUC) is routine following colorectal resections. In Enhanced Recovery After Surgery programmes, excessive intravenous fluids (IVFs) are avoided. This study sought to determine whether the routine absence of an IDUC following colorectal surgery improved post‐operative outcomes and minimized fluid prescription. Methods: A retrospective comparative cohort study was performed on patients undergoing colorectal resection at a tertiary referral teaching hospital, over a 7‐year period. A policy of no routine IDUC was introduced over the last 3 years. Patients were divided into cohorts based on the presence or absence of an IDUC on leaving the operating theatre. The outcomes assessed were IVF prescription, length of stay, mortality and morbidity. Results: Of the 213 resections over the time period, 131 met the inclusion criteria (87 IDUC and 44 no IDUC). There was no difference between groups with respect to baseline demographics. Fluid administration was less in the group without routine IDUC (total fluid 6.16 L versus 10.89 L; P < 0.0001, fluid in the first 24 h 3.82 L versus 5.3 L; P < 0.0001 and fluid in the first 48 h 5.15 L versus 7.23 L; P < 0.0001). Length of stay was less in the ‘no IDUC’ group (5.9 days versus 10.1 days; P = 0.0009). There was no difference in morbidity and mortality. Conclusion: A policy of no IDUC following colectomy was associated with a reduction in IVF administration and length of stay. A randomized controlled trial is recommended in order to more accurately determine the degree of causal relationship. [ABSTRACT FROM AUTHOR]

Of 123 matriculants to the Brown University medical program in 1987-88 and 1988-89, more than one-third had taken traditional premedical course requirements after graduating from college. Academic performance, self-reports of preparation, or involvement in extracurricular activities in this group were comparable to that of traditional premedical students in the first two years. (Author/MSE)