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Biomedical subjects

W H Bunch

Publications and source records attributed to W H Bunch.

At least 19 recordsLinked to original sources
PubMed1992

The stresses of the surgical residency.

UNLABELLED: Concern over resident work hours prompted us to study the stress of surgical residencies and determine if the experience might be associated with an increased use of alcohol and drugs. Two hundred fifty-seven surgery residents were selected from a stratified, randomized sample of residents (n = 1728) from the AMA files and were given an eight-page self-administered questionnaire. RESULTS: Surgical residents reported very long hours and heavy duties and complained of loss of sleep and exhaustion, both of which correlated with nights on call. Despite the heavier work load, surgical residents showed no more emotional stress than other residents. Surgery residents were more likely to have used alcohol in the last month than other residents (P less than .05) but 70% had used it fewer than 10 times in the month. All surgical residents were less likely to have used marijuana, cocaine, or other drugs than were other residents. Surgical residents seem to cope well with the extreme stresses of surgery training programs; however, more research needs to be done if we are to fully understand the process for training surgeons.

Alcohol Drinking↗
PubMed1989

Factors influencing the penetration of wires into the neural canal during segmental wiring.

We evaluated the influence of the penetration of wires into the neural canal during segmental wiring in a three-part study. First we examined the anatomy of the thoracic spine, specifically the laminar and interlaminar dimensions, as well as the epidural space. In the second part, we evaluated the depth of penetration of wires into the spinal canal at the time of their passage during spinal segmental instrumentation, using direct laboratory measurements for three configurations of the wire: first with a straight wire, and then with two wires of varying curvature. The measurements were repeated after removal of a portion of the lamina. In the third and final part of the study, we assessed the relationship between the observed penetration of the wires and the depth of penetration as calculated using mathematical models for the three wire configurations. When a wire with the largest possible diameter of curvature was passed under the lamina, there was significantly less penetration using the curved-wire configuration. This was seen in calculated models, as well as in normal specimens of the thoracic spine that were obtained from cadavera. Little epidural space was found to be available for passage of the wire. In most instances, passage of the wire must result in contact with and displacement of the dural sac and its contents. To minimize the depth of penetration at any given spinal level, it is recommended that the wire be curved to the maximum degree that will allow it to pass under the lamina.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

The effect of immediate constrained digital motion on the strength of flexor tendon repairs in chickens.

Profundus tendon lacerations were repaired in the central toes of 216 chickens, and the digits were either immobilized in a cast or allowed immediate constrained motion in a tethering splint. The effect of digital motion on the early phases of tendon healing was investigated by comparing the rupture strengths of the two groups during the first 40 days after repair. The repairs in immobilized digits showed marked decreases in strength during the first 20 days, while the tendons in mobilized digits showed immediate and progressive gains in strength through the time intervals studied. By 5 days, the difference in strength between the two groups was significant (p less than 0.05), and the magnitude of this difference increased with time. The model developed in this study demonstrates that an initial loss of flexor tendon repair strength is not inevitable. Immediate constrained digital mobilization allows progressive tendon healing without an intervening phase of tendon softening.

Animals↗
PubMed1987

What faculty members value in practice plans.

Faculty practice plans are under scrutiny at many academic medical centers as teaching hospitals seek ways to encourage their physicians to increase their clinical activities. Discussions with physicians at two medical schools yielded insights into the faculty members' perspective on faculty practice plans. Interviews disclosed that the physicians were satisfied with a practice plan if they felt their professional goals were in balance with the institution's goals. Changes in the plan can either sustain institutional values or introduce new priorities. In view of physicians' loyalty to a particular plan and their anxiety in the face of change, the authors suggest that it may be better to modify an established plan than to impose a new system. The physicians interviewed agreed that strong chairmen can work within any plan to reward faculty members for research, clinical, or administrative contributions and thus to determine a department's directions and character. In considering changes in a practice plan, chairmen, deans, and administrators need to weigh the faculty's values and commitments.

Academic Medical Centers↗
PubMed1986

A biomechanical analog of curve progression and orthotic stabilization in idiopathic scoliosis.

A biomechanical analog of curve progression and orthotic stabilization in idiopathic scoliosis has been developed using the classical theory of curved beam-columns. The interaction of the spinal musculature and other supporting structures is incorporated in the model using an equivalent flexural rigidity. The stability of a given scoliotic curve relative to a normal spine is described in terms of the so-called critical load ratio (Pc/Pe). This dimensionless quantity appears in the exact solution of the governing differential equation and boundary conditions. It is defined as the ratio of the load bearing capacity of a scoliotic spine (Pc) to that of a normal spine where the load bearing capacity of a normal spine is defined as Euler's buckling load (Pe). The computation of Pc/Pe is based upon a maximum allowable moment criterion. This model is used to study the effect of the degree of initial curvature and curve pattern in the frontal plane on the stability of untreated idiopathic scoliosis. Although restricted to two-dimensions, the model appears to demonstrate the synergistic effects of end support, transverse loading, and curve correction on improvement in relative stability of an orthotically supported scoliotic curve. The results of this study are in qualitative agreement with clinical findings that are based on long-term studies of natural history of idiopathic scoliosis and of patients undergoing orthotic management for scoliosis.

Biomechanical Phenomena↗
PubMed1986

The candidate's view of the orthopaedic residency selection process.

Two hundred and seventy-nine applicants for an orthopaedic residency who participated in the 1985 match program returned a questionnaire that was designed to evaluate the candidate's impression of the process of selecting a residency. The respondents requested information from an average of thirty-three programs and applied to an average of twenty-two programs. The candidates who participated in the match each ranked an average of 7.5 orthopaedic residency programs. The candidates assigned a high ranking to programs in which the morale of the staff was high and the faculty was committed to teaching. Low morale, poor treatment by people at the institution, an inadequate commitment to teaching, a disorganized day of interviews, and a program in transition were the major reasons for not ranking a program. We concluded that the process is run for the convenience of the programs, with little regard to the problems that are faced by the applicants.

Choice Behavior↗
PubMed1985

Posterior fusion for idiopathic scoliosis.

A posterior fusion is the standard operative approach that will allow the orthopaedic surgeon to treat most scoliosis satisfactorily. The extent of fusion should be determined by the type and extent of the curve. All spines should not be fused from T4 to L4. The management of the blood loss has evolved to a very controlled situation, with the reasonable goal that no patient should be sensitized to homologous blood. Instrumentation systems provide good correction and stability to assist in providing a solid fusion. There are advantages and disadvantages to each instrumentation system, and the trade-offs should be considered for each patient. Finally, what our patients want more than anything else from these operations is safety, and we should strive to provide that for them.

Adolescent↗
PubMed1985

Patient preferences in surgery for scoliosis.

To assess individual preferences for a method of scoliosis surgery, we surveyed 224 teen-age patients, their parents, orthopaedic surgeons, and other health professionals. Rather than asking the respondents directly for the relative importance that they would assign to the four possible outcomes, we employed conjoint analysis, a preference measurement technique that is widely used in marketing and psychology. In conjoint analysis, respondents explicitly trade off the relative desirability of certain aspects of the outcome of scoliosis surgery--for example, between greater degree of curve correction or greater risk of reoperation. This study indicated that risk of nerve damage had the highest relative importance to the respondents, followed by risk of reoperation, curve correction, and aftercare, in that order. This ranking was found in all five groups of respondents.

Adolescent↗
PubMed1979

Dermatomal somatosensory evoked potentials in children with myelomeningocele.

Evoked responses were obtained from electrical stimulation of dermatomes representing individual lumbar and sacral roots. Normal ranges of latency have been established for adults, but have not been extended to children at this time. DSSEPs can be utilized, however, to sequentially follow lumbo-sacral cord function in individual children at risk of progressive myelopathy.

Adolescent↗
PubMed1978

Osteogenesis imperfecta in one of twins. Case report.

The is a report of a 5-year-old girl with osteogenesis imperfecta, an uncommon abnormality considered to encompass several distinct disorders and biochemically classified as a connective tissue disease. Affected individuals, in the more severe form of the disease, often die in utero or shortly thereafter secondary to birth trauma. The patient was one of dizygotic twins discordant for osteogenesis imperfecta tarda inherited as an autosomal dominant trait.

Adolescent↗
PubMed1978

Legg-Perthes disease in children less than four years old.

In children with Legg-Perthes disease who were less than four years old, better results were seen after treatment by recumbency and abduction bracing than with no treatment. All results were better in children having mild epiphyseal involvement (Catterall Groups I and II) than in those with more extensive disease.

Age Factors↗
PubMed1977

Kyphosis in the paralytic spine.

The paralytic spine without supplementary support is unstable and susceptible to axial collapse. The biomechanical factors responsible for spinal stability should be considered in any treatment regimen for paralytic spines. If posterior fusion is elected as the treatment, kyphosis must be corrected so that the eccentric loading and kyphotic bending moment is very small. When this is done, posterior fusion alone is adequate to give spinal stability and increased function to the individual.

Adolescent↗