The University of Toronto Head Injury Treatment Study: A Prospective, Randomized Comparison of Pentobarbital and Mannitol

ABSTRACTFifty-nine patients were treated in a prospective, randomized comparison of pentobarbital and mannitol for the control of intracranial hypertension resulting from head injury. Patients with elevated intracranial pressure (ICP) after evacuation of intracranial hematomas were randomized to one of two treatment groups; mannitol initially or pentobarbital initially, followed by the second drug as required by further elevation of ICP. Similarly, patients with raised ICP but without hematomas requiring evacuation were randomly assigned to two treatment groups in an identical paradigm.Those with ICP elevation and no hematoma treated with pentobarbital as initial therapy had a 77% mortality compared to a 41% mortality for those with mannitol as initial treatment. Patients with evacuated hematomas had mortalities of 40% and 43% (no significant difference) for pentobarbital and mannitol respectively. In both no-hematoma and hematoma streams pentobarbital was less effective than mannitol for control of raised ICP.Multivariate statistical analysis indicates that pentobarbital coma is not better than mannitol for the treatment of intracranial hypertension and may be harmful in no-hematoma patients with intracranial hypertension after head injury.

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Passing a Technical Skills Examination in the First Year of Surgical Residency Can Predict Future Performance

Journal of Graduate Medical Education ◽

10.4300/jgme-d-16-00517.1 ◽

2017 ◽

Vol 9 (3) ◽

pp. 324-329 ◽

Cited By ~ 2

Author(s):

Sandra de Montbrun ◽

Marisa Louridas ◽

Teodor Grantcharov

Keyword(s):

Training Evaluation ◽

Technical Skills ◽

First Year ◽

Surgical Resident ◽

Training Performance ◽

University Of Toronto ◽

Future Performance ◽

Significant Difference ◽

Passing Scores ◽

The University

ABSTRACT Background The ability of an assessment to predict performance would be of major benefit to residency programs, allowing for early identification of residents at risk. Objective We sought to establish whether passing the Objective Structured Assessment of Technical Skills (OSATS) examination in postgraduate year 1 (PGY-1) predicts future performance. Methods Between 2002 and 2012, 133 PGY-1 surgery residents at the University of Toronto (Toronto, Ontario, Canada) completed an 8-station, simulated OSATS examination as a component of training. With recently set passing scores, residents were assigned a pass/fail status using 3 standards setting methods (contrasting groups, borderline group, and borderline regression). Future in-training performance was compared between residents who had passed and those who failed the OSATS, using in-training evaluation reports from resident files. A Mann-Whitney U test compared performance among groups at PGY-2 and PGY-4 levels. Results Residents who passed the OSATS examination outperformed those who failed, when compared during PGY-2 across all 3 standard setting methodologies (P < .05). During PGY-4, only the contrasting groups method showed a significant difference (P < .05). Conclusions We found that PGY-1 surgical resident pass/fail status on a technical skills examination was associated with future performance on in-training evaluation reports in later years. This provides validity evidence for the current PGY-1 pass/fail score, and suggests that this technical skills examination may be used to predict performance and to identify residents who require remediation.

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Simulation Technology

Anesthesiology ◽

10.1097/00000542-200201000-00008 ◽

2002 ◽

Vol 96 (1) ◽

pp. 10-16 ◽

Cited By ~ 94

Author(s):

Pamela J. Morgan ◽

Doreen Cleave-Hogg ◽

Jodi McIlroy ◽

James Hugh Devitt

Keyword(s):

Medical Students ◽

Learning Experience ◽

Critical Event ◽

Final Examination ◽

Long Term Effects ◽

Student Opinions ◽

University Of Toronto ◽

Significant Difference ◽

The University ◽

Future Work

Background The availability of simulator technology at the University of Toronto (Toronto, Ontario, Canada) provided the opportunity to compare the efficacy of video-assisted and simulator-assisted learning. Methods After ethics approval from the University of Toronto, all final-year medical students were invited to participate in the current randomized trial comparing video-based to simulator-based education using three scenarios. After an introduction to the simulator environment, a 5-min performance-based pretest was administered in the simulator operating room requiring management of a critical event. A posttest was administered after students had participated in either a faculty-facilitated video or simulator teaching session. Standardized 12-point checklist performance protocols were used for assessment purposes. As well, students answered focused questions related to the educational sessions on a final examination. Student opinions regarding the value of the teaching sessions were obtained. Results One hundred forty-four medical students participated in the study (scenario 1, n = 43; scenario 2, n = 48; scenario 3, n = 53). There was a significant improvement in posttest scores over pretest scores in all scenarios. There was no statistically significant difference in scores between simulator or video teaching methods. There were no differences in final examination marks when the two educational methods were compared. Student opinions indicated that the experiential simulator sessions were more enjoyable and valuable than the video teaching sessions. Conclusions Both simulator and video types of faculty-facilitated education offer a valuable learning experience. Future work is needed that addresses the long-term effects of experiential learning in the retention of knowledge and acquired skills.

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Failure of the competitive N-methyl-d-aspartate antagonist Selfotel (CGS 19755) in the treatment of severe head injury: results of two Phase III clinical trials

Journal of Neurosurgery ◽

10.3171/jns.1999.91.5.0737 ◽

1999 ◽

Vol 91 (5) ◽

pp. 737-743 ◽

Cited By ~ 185

Author(s):

Gabrielle F. Morris ◽

Ross Bullock ◽

Sharon Bowers Marshall ◽

Anthony Marmarou ◽

Andrew Maas ◽

...

Keyword(s):

Head Injury ◽

Demographic Data ◽

Phase Iii ◽

Double Blind ◽

Content Type ◽

Treatment Groups ◽

Severity Of Injury ◽

Significant Difference ◽

Cgs 19755 ◽

Fine Print

Object. Excessive activity of excitatory amino acids released after head trauma has been demonstrated to contribute to progressive injury in animal models and human studies. Several pharmacological agents that act as antagonists to the glutamate receptor have shown promise in limiting this progression. The efficacy of the N-methyl-d-aspartate receptor antagonist Selfotel (CGS 19755) was evaluated in two parallel studies of severely head injured patients, defined as patients with postresuscitation Glasgow Coma Scale scores of 4 to 8.Methods. A total of 693 patients were prospectively enrolled in two multicenter double-blind studies. Comparison between the treatment groups showed no significant difference with regard to demographic data, previous incidence of hypotension, and severity of injury. As the study progressed, the Safety and Monitoring Committee became concerned about possible increased deaths and serious brain-related adverse events in the treatment arm of the two head injury trials, as well as deaths in the two stroke trials being monitored concurrently. The Selfotel trials were stopped prematurely because of this concern and because an interim efficacy analysis indicated that the likelihood of demonstrating success with the agent if the studies had been completed was almost nil.Conclusions. Subsequently, more complete data analysis revealed no statistically significant difference in mortality rates in all cases between the two treatment groups in the head injury trials. In this report the authors examine the studies in detail and discuss the potential application of the data to future trial designs.

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Bath Psoralen-ultraviolet A and Narrowband Ultraviolet B Phototherapy as Initial Therapy for Early-stage Mycosis Fungoides: A Retrospective Cohort of 267 Cases at the University of Toronto

Clinical Lymphoma Myeloma & Leukemia ◽

10.1016/j.clml.2017.06.015 ◽

2017 ◽

Vol 17 (9) ◽

pp. 604-612 ◽

Cited By ~ 4

Author(s):

Mohammad Almohideb ◽

Sandra Walsh ◽

Scott Walsh ◽

Neil Shear ◽

Raed Alhusayen

Keyword(s):

Mycosis Fungoides ◽

Retrospective Cohort ◽

Early Stage ◽

Initial Therapy ◽

Ultraviolet B ◽

Ultraviolet A ◽

University Of Toronto ◽

The University

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Postweaning Performance of the Agouti (Dasyprocta leporina): A Neotropical Rodent with Potential for Domestication

Veterinary Medicine International ◽

10.1155/2021/6664656 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Hannah-Marie Samantha Singh ◽

Kegan Romelle Jones

Keyword(s):

Weight Gain ◽

Average Daily Gain ◽

Live Weight ◽

The Other ◽

Field Station ◽

Treatment Groups ◽

Significant Difference ◽

Production Animals ◽

Neotropical Rodent ◽

The University

This project aimed to observe the effect of different weaning times on the weight gain in agouti (Dasyprocta leporina). The goal was to acquire an appropriate weaning time for offsprings. The experiment was performed at the University of the West Indies Field Station Farm (UFS) where animals were divided into four treatment groups, with each treatment group consisted of four animals. Treatment 1 offsprings were weaned at four weeks, treatment 2 offsprings were weaned at three weeks, treatment 3 offsprings were weaned at two weeks, and treatment 4 offsprings were weaned at one week. The offsprings were raised experimentally for their first seven weeks. There was no significant difference ( p > 0.05 ) recorded in offsprings live weight and average daily gain (ADG) for treatments 1, 2, and 3. However, offsprings reared in treatment 4 had significantly ( p < 0.05 ) less live weight and weight gain in comparison to the other groups at seven weeks. Offsprings in treatment 4 also experienced 50% mortality (2/4 animals died), one animal removed from the experiment due to progressive weight loss, and one offspring remained in the experiment for its duration. The other treatment experienced no loss (0% mortality). Based on the results of the experiment, agouti offsprings should not be weaned at one week due to high mortality and low live weight at the end of seven weeks. Animals can be weaned between 2 and 4 weeks of age with no detrimental effects. Dependent on the level of production, animals can be weaned at 2 or 4 weeks depending on the operators desired litters per year.

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The origins of Electron Microscopy in North America at the University of Toronto

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100120412 ◽

1992 ◽

Vol 50 (1) ◽

pp. 2-3

Author(s):

John H. L. Watson

Keyword(s):

Electron Microscopy ◽

North America ◽

University Of Toronto ◽

The University

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The Organization of the University of Toronto

PsycEXTRA Dataset ◽

10.1037/e597372010-087 ◽

1895 ◽

Author(s):

W. H. Fraser

Keyword(s):

University Of Toronto ◽

The University

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Relevance Predictability in Information Retrieval Systems

Methods of Information in Medicine ◽

10.1055/s-0038-1636254 ◽

1967 ◽

Vol 06 (02) ◽

pp. 45-51 ◽

Cited By ~ 6

Author(s):

A. Kent ◽

J. Belzer ◽

M. Kuhfeerst ◽

E. D. Dym ◽

D. L. Shirey ◽

...

Keyword(s):

Information Retrieval ◽

Experimental Conditions ◽

Treatment Groups ◽

Retrieval Systems ◽

Significant Difference ◽

Information Retrieval Systems ◽

High Predictability ◽

Intermediate Response ◽

Quantitative Indicators ◽

Level Of Processing

An experiment is described which attempts to derive quantitative indicators regarding the potential relevance predictability of the intermediate stimuli used to represent documents in information retrieval systems. In effect, since the decision to peruse an entire document is often predicated upon the examination of one »level of processing« of the document (e.g., the citation and/or abstract), it became interesting to analyze the properties of what constitutes »relevance«. However, prior to such an analysis, an even more elementary step had to be made, namely, to determine what portions of a document should be examined.An evaluation of the ability of intermediate response products (IRPs), functioning as cues to the information content of full documents, to predict the relevance determination that would be subsequently made on these documents by motivated users of information retrieval systems, was made under controlled experimental conditions. The hypothesis that there might be other intermediate response products (selected extracts from the document, i.e., first paragraph, last paragraph, and the combination of first and last paragraph), that would be as representative of the full document as the traditional IRPs (citation and abstract) was tested systematically. The results showed that:1. there is no significant difference among the several IRP treatment groups on the number of cue evaluations of relevancy which match the subsequent user relevancy decision on the document;2. first and last paragraph combinations have consistently predicted relevancy to a higher degree than the other IRPs;3. abstracts were undistinguished as predictors; and4. the apparent high predictability rating for citations was not substantive.Some of these results are quite different than would be expected from previous work with unmotivated subjects.

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Effect of Fixed Minidose Warfarin, Conventional Dose Warfarin and Aspirin on INR and Prothrombin Fragment 1 + 2 in Patients with Atrial Fibrillation

Thrombosis and Haemostasis ◽

10.1055/s-0038-1656065 ◽

1997 ◽

Vol 77 (05) ◽

pp. 0845-0848 ◽

Cited By ~ 23

Author(s):

B G Koefoed ◽

C Feddersen ◽

A L Gulløv ◽

P Petersen

Keyword(s):

Atrial Fibrillation ◽

International Normalized Ratio ◽

Coagulation System ◽

Nonvalvular Atrial Fibrillation ◽

Treatment Groups ◽

Prothrombin Fragment ◽

Conventional Dose ◽

Dose Warfarin ◽

Significant Difference ◽

Changes Over Time

SummaryThe efficacy of conventional dose adjusted oral anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation is well- documented but not considered ideal as primary antithrombotic treatment in elderly patients. The antithrombotic effect of fixed minidose warfarin 1.25 mg/day alone or in combination with aspirin 300 mg/day, of conventional dose adjusted warfarin (INR 2.0-3.0), and of aspirin 300 mg/day have been investigated in outpatients with chronic nonvalvular atrial fibrillation in the second Copenhagen Atrial Fibrillation, Aspirin and Anticoagulant Therapy Study (AFASAK 2). In order to investigate the effect on the coagulation system of the treatments, the International Normalized Ratio of the prothrombin time (INR) and prothrombin fragment 1 + 2 (F1 +2) were monitored at baseline and after three months of treatment in 100 patients consecutively included in the trial. At baseline no differences in INR and F1+2 between the four treatment groups were present. After three months of therapy the level of INR increased significantly from baseline in patients receiving warfarin in any dose and the level of F1+2 decreased significantly by combined minidose warfarin-aspirin and by dose adjusted warfarin. When comparing the changes over time in FI +2 (three-month value minus baseline value) during therapy with fixed minidose warfarin, combined minidose warfarin-aspirin and aspirin alone no significant difference between the groups was found. In conclusion, INR was changed by all three warfarin regimens but only dose adjusted warfarin (INR 2.0-3.0) had a marked effect on F1+2.

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