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Biomedical subjects

J A DeLisa

Publications and source records attributed to J A DeLisa.

At least 37 records · Page 2Linked to original sources
PubMed1996

Physical medicine and rehabilitation workforce study: the supply of and demand for physiatrists.

OBJECTIVE: Analysis, results, and implications of a supply and demand workforce model for physical medicine and rehabilitation. Explicit issues addressed include: (1) the supply implications of maintaining current (1994-1995) output of physiatrists from residency programs; (2) the implications of continued growth in managed care on the demand for the services of physiatrists; (3) likely future supply and demand conditions; and (4) strategies to adapt to future conditions. DESIGN: A workforce model of the supply and demand for physiatrists was developed. Parameters of the model are estimated using econometric models and by applying the judgments of a consensus panel. The model evaluated several different scenarios regarding managed care growth, competition from other providers and other factors. RESULTS: Based on the analysis, physiatrists will continue to be in excess demand through the year 2000. More aggressive growth in managed care can affect this result. CONCLUSIONS: Based on an overall assessment of supply and demand conditions, and under the assumption that the supply of new entrants each year remains in the range of 1994-1995 levels, demand for physiatrists will continue to exceed supply, on average, through the year 2000. Excess supply has, and will, emerge in selected geographic areas. If the profession is successful in informing the market regarding the advantages of physiatry, the profession can continue to grow without experiencing excess supply, in the aggregate, for the foreseeable future.

Forecasting↗
PubMed1994

Factors used by physical medicine and rehabilitation residency training directors to select their residents.

A 17-item questionnaire was designed to assess the relative importance of various factors to physical medicine and rehabilitation (PM&R) training directors when ranking PM&R resident applicants during the National Resident Match. The questionnaire was sent to all PM&R residency training directors. The recipients were asked to grade most selection factors based on a numerical scale: 1, unimportant; 2, some importance; 3, important; 4, very important; 5, critical. The specific factors addressed in the questionnaire were: academic criteria, letters of recommendation, individual applicant characteristics and aspects of the interview process. Twelve yes-or-no questions were also designed to determine the weight that residency training directors place on certain academic criteria. A response rate of 88% (66/75) was obtained. The most important academic criteria were grades in a PM&R clerkship in their facility (4.1 +/- 0.8), followed by grades in a PM&R clerkship in another facility (3.6 +/- 0.9). The most important letters of recommendation were from a PM&R faculty member in the respondent's department (4.0 +/- 0.8), followed by the dean's letter (3.7 +/- 1.0) and the PM&R chairman's letter (3.7 +/- 1.0). The three most important applicant characteristics evaluated during the interview were compatibility with the program (4.4 +/- 0.8), the ability to articulate thoughts (4.2 +/- 0.8) and the ability to work with the team (4.2 +/- 0.8). Most program directors used multiple criteria to complete their rank list, but the most important were based upon the interview (4.5 +/- 0.9), letters of recommendation (3.7 +/- 0.9), medical school transcript (3.6 +/- 0.8) and the dean's letter (3.6 +/- 1.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Clerkship↗
PubMed1993

A method to assess the trainee profiles of medical students attracted to our physical medicine and rehabilitation residency training program.

A 35-item questionnaire was designed to assess the relative importance of various factors to medical students when ranking physical medicine and rehabilitation (PM&R) residency training programs. The questionnaire was used to assess the relative importance of the various factors to three groups of medical students: those who interviewed, those who matched and those who were listed on the match list of the UMDNJ-New Jersey Medical School (NJMS) Department of PM&R, as well as our current residents. Recipients were asked to grade selection factors based on a numerical scale: 1, extremely important; 2, very important; 3, important; 4, minimally important; 5, not important. A response rate of 100% (n = 72 medical students + 25 residents) was attained. The analysis indicates that, overall, there is no significant difference in ranking of the factors by each of the four groups. However, the medical students who recently matched with the UMDNJ-NJMS PM&R program rated the opportunity to conduct research significantly higher than the current house staff or the medical students on the entire match list. This is a desirable result, as the program strives to provide an environment that is conducive to the growth of research and academic physiatrists. This questionnaire could also be used by other residency training directors to guide the development of their program and to gain valuable information regarding the perception of their program among in-coming residents and the importance of various factors to the students interested in their program.

Career Choice↗
PubMed1993

Chief residents in physiatry. Expectations v training.

A large majority of physical medicine and rehabilitation residencies have chief resident positions, but little has been written about the expectations of the program directors and the training of the chief resident to fulfill those expectations. A 20-item questionnaire was mailed to 73 program directors in physical medicine and rehabilitation in May 1992. The participants were asked about selection methods, their perception of the duties of the chief resident(s), their concerns about the chief resident(s) position, the training and the evaluation of the chief resident(s). An 85% (62/73) response rate was achieved. There was a chief resident position(s) in 98% of the programs responding. Chief resident selection was made mostly by appointment of the chairman and/or program director and/or the vote of the faculty. The program directors perceived the most important duties of the chief resident to be: act as a liaison between faculty and the residents, act as a role model, do scheduling, build teamwork and give constructive feedback. The most important skills were considered to be leadership and stress management. Causes of concern were time pressure, abuse of power, stress and work overload. Opportunities to develop leadership and administrative/management skills were considered the most exciting aspects of the position. It was surprising, however, that only 15 of 61 (25%) provided some formal training. Only 28 of 61 (46%) had a position description.

Humans↗
PubMed1993

The effect of temperature on antidromic median sensory conduction.

It has been well documented that sensory nerve conduction studies are influenced by many factors. Twenty-two healthy subjects were electrophysiologically evaluated to measure the onset latency, peak latency and amplitude (baseline to negative peak) after cooling the non-dominant hand. The distal onset latency was prolonged by 0.06 msec/degrees C, peak latency by 0.1 msec/degrees C and the amplitude was increased by 1.8 microV/degrees C by cooling hand skin temperature from 34 to 26 degrees C. These results can be used to extrapolate the value at normal physiologic skin temperature for the subject whose temperature is lower than normal. The results were compared with previous reports.

Adult↗
PubMed1992

Selecting a physical medicine and rehabilitation residency.

A 35-item questionnaire, designed to assess the relative importance of various factors to medical students when ranking physical medicine and rehabilitation (PM&R) residency training programs during the Match, was sent to all members of the 1991 senior class after Match Day. This mailing was coordinated with the National Resident Matching Program. The questionnaire was also sent to all PM&R residency training program directors and all physiatrist faculty members at the University of Medicine and Dentistry of New Jersey--New Jersey Medical School (UMDNJ-NJMS). Recipients were asked to grade selection factors based on a numerical scale: 1, extremely important; 2, very important; 3, important; 4, minimally important; 5, not important. A response rate of 41% (73/179) for medical students, 87% (62/71) for residency training directors and 71% (22/31) for UMDNJ-NJMS faculty members was attained. Analysis of the results indicates that, overall, there is no significant difference in ranking of the factors by each of the three groups surveyed. The intergroup responses for one-third of the factors were significantly different. Diversity of the training experience, current house officer satisfaction, it "feels" right and house officer quality were the four most important selection factors to the medical students.

Career Choice↗
PubMed1992

Current status of chairpersons in physical medicine and rehabilitation.

There are currently 77 academic departments, divisions or units of physical medicine and rehabilitation (PM&R) in the United States. The authors conducted a survey to develop a profile of the current chairpersons of PM&R, as well as to assess the short- and long-term needs of the field. The survey addressed basic demographic information as well as the level of formal training and/or experience in various management, patient care and academic areas. The level of satisfaction with various aspects of the position such as workload, relationship with the university and role as a researcher were also measured. The chairpersons were asked when they plan to vacate their position and if they felt there were any members of their faculty who are qualified and ready to assume a chairperson position. Those that identified a qualified individual were then asked whether the person had formal training and/or experience in the various management, patient care and academic areas. The results indicate that, although the chairpersons have a high level of job satisfaction with respect to the challenge of the position and their administrative and supervisory roles, they are least satisfied with their role as a researcher. The field must be concerned with this finding, because academic PM&R units in the United States will experience a substantial change in leadership by the end of the 20th century. Approximately 39% of the current chairpersons who returned the questionnaire are planning to step down by 1999, with an additional 37% unsure when they will vacate the position.(ABSTRACT TRUNCATED AT 250 WORDS)

Administrative Personnel↗
PubMed1992

Lateral dorsal cutaneous branch of the sural nerve. Standardization in nerve conduction study.

Lateral ankle or foot pain may have various etiologies including entrapment of or injury to the distal sural nerve or early peripheral neuropathy. Antidromic distal sural conduction studies have not been used in clinical neurophysiologic evaluation, however, for technical reasons. The purpose of this study was to determine if by modifying recording parameters and using electronic averaging adequate responses could be obtained to permit standardization of distal sural conduction. Standard surface recording electrodes with an inter-electrode separation of 37 mm were used. The distal sural nerve conduction of 40 healthy adult subjects (mean age = 33 +/- 9 yr, range = 23 to 52) was measured. The latency to the onset was 3.2 +/- 0.4 ms (range = 2.5 to 4.0 ms) and to the negative peak was 3.9 +/- 0.5 ms (range = 3.0 to 4.9 ms). The conduction velocity was 38 +/- 5 m/s (range = 30 to 48 m/s). The amplitude measured from baseline to negative peak was 5.8 +/- 2.1 microV (range = 3.0 to 11.0 microV). The results indicated that electrodiagnostic evaluation of the distal sural nerve could be readily achieved and that this might be useful in differential diagnosis.

Adult↗
PubMed1991

AAEM Minimonograph #10: volume conduction.

A volume conductor is any medium with the capability of passively conducting a current between regions of potential difference. The monophasic positive intracellular action potential produces a monophasic negative extracellular waveform and a triphasic extracellular waveform in a poor and good volume conductor, respectively. The observed waveform characteristics are dependent upon both the recording electrode montage and the type of volume conductor surrounding the excitable tissue. The extracellular current flow associated with an action potential can be divided into two current sources flanking a central current sink. If a recording electrode is located over the negative current sink, a negative potential is observed. When the two current sources approach a recording electrode, a positive potential is recorded. If a positive deflection of the baseline is observed, one may conclude that the wave of depolarization under investigation did not originate under, but traveled toward, the recording location. Electric currents from external sources are free to propagate extraneurally as the body is a good volume conductor. Care must be taken to not activate nearby nerves and, subsequently, obtain a waveform contaminated with potentials from undesired sources. Additionally, electrical activity from neighboring muscles and nerves can summate in the volume conductor and yield responses capable of masking pathology. An understanding of the principles of volume conduction theory can help the electrodiagnostician avoid artifactual errors and erroneous conclusions.

Electric Conductivity↗
PubMed1991

Nerve conduction studies and vibration perception thresholds in diabetic and uremic neuropathy.

Two parameters of nerve conduction studies (nerve conduction velocities and amplitudes of the evoked sensory and motor responses) were compared with quantitative vibration perception thresholds (VPT) in patients with peripheral neuropathy (diabetes mellitus and/or end-stage renal disease). VPT measurements were made using a "two-alternative, forced-choice" method in which the patient is required to identify which of the two rods is vibrating at progressively decreasing vibration intensities. VPTs correlated significantly with nerve conduction velocities in all upper and lower extremity sensory and motor nerves tested, and with the amplitudes of the evoked motor responses in three motor nerves: median and ulnar (motor components) and tibial. For the median and ulnar nerves (motor components) the amplitudes of the evoked motor responses were more sensitive than nerve conduction velocities in correlation with VPTs. Comparison of VPT values, based upon whether or not evoked sensory and motor responses were obtained, indicated that mean VPTs were consistently higher among subjects in whom these evoked responses were not elicited. VPT measurements is thus shown to be a valid and valuable method for evaluation of severity in peripheral neuropathy. It has the advantages of being simple, quick and painless. Patient cooperation and compliance with this form of testing are excellent.

Adult↗
PubMed1991

Resident interest in physical medicine and rehabilitation fellowships. Results of a survey.

Physiatry, one of the six medical specialties that does not currently offer added or special qualification certification examinations, does not have accredited fellowships in potential subspecialty areas. These issues are currently being debated by the leadership organizations within physical medicine and rehabilitation such as the Association of Academic Physiatrists, the American Academy of Physical Medicine and Rehabilitation, the Physical Medicine and Rehabilitation Residency Review Committee and the American Board of Physical Medicine and Rehabilitation. Recent events, such as the establishment of funding agencies with an interest in medical rehabilitation research training, suggest that physiatric fellowships may become more available. A survey was conducted to determine whether physiatric residents desire postresidency training and, if interested, what type of additional training they would seek. This information could be used in formulating policies regarding the establishment, accreditation and certification of subspecialty fellowships within physical medicine and rehabilitation. Of 968 physiatric residents currently in training, 525 (54%) responded to a 22-question survey assessing resident interest regarding fellowship training, the different subspecialty areas, salary expectations, fellowship duration, preferred amount of time devoted to clinical v research work, mentorship, double boarding, accreditation, certification and a section for general comments. The results of the survey indicate considerable interest in fellowship training, which diminishes as residents approach graduation. Residents favored clinically oriented fellowships of 1-yr duration, which should be accredited and certified. Sports medicine was identified as the area of greatest subspecialty interest.

Attitude of Health Personnel↗
PubMed1991

Rehabilitation of patients with spinal cord disease.

Spinal cord injury and disease have multisystem consequences and many potential medical complications. This article addresses the various medical, psychosocial, and vocational issues associated with spinal cord injury and describes how the patient's lifestyle may be affected. The role of the physician and other rehabilitation professionals in the rehabilitation process is described. In addition, various medical concerns, complications, and available treatment modalities are discussed.

Humans↗