[Traction screw osteosynthesis after ramus osteotomy with resorbable osteosynthesis screws of polydioxanone (PDS)--initial results].
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Adult↗
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Polydioxanone (PDS), a novel monofilament synthetic absorbable suture.
The chemical and biologic properties of a unique, new monofilament suture, polydioxanone, have been described. The inherent flexibility of its polymer allows the polydioxanone suture to be fabricated into a monofilament fiber useful for all sizes of sutures. Polydioxanone suture has greater pliability than polypropylene suture and has greater strength than that of other monofilament sutures. In the body, polydioxanone suture retains its strength for longer periods than other synthetic absorbable sutures--58 per cent versus 1 to 5 per cent at four weeks and 14 per cent versus zero per cent at eight weeks, respectively. It elicits a low order of tissue response and is absorbed by simple hydrolysis.
Absorption↗
[PDS cord fixation of sternoclavicular dislocation and para-articular clavicular fractures].
Sternoclavicular joint dislocation and para-articular fractures of the clavicle are rare injuries. Because severe complications of dorsal dislocations have often been seen and because functional impairment has often followed ventral dislocations, we treat most patients with such injuries operatively. Internal fixation with K-wires frequently leads to severe complications. We present our operation techniques with a resorbable 2 mm polydioxanon cord. This pack up technique can be used in both dislocations and para-articular fractures with no risk of implant dislocation.
Clavicle↗
[Position of the PDS legislative group on cost saving measures by federal government in the area of rehabilitation].
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Cost Control↗
Evaluation of cervical lymph node vascularity: a comparison of colour Doppler, power Doppler and 3-D power Doppler sonography.
This study was undertaken to compare the performance of colour Doppler (CDS), power Doppler (PDS) and 3-D power Doppler sonography (3-D PDS) in the assessment of vascular pattern and vessel displacement of cervical lymph nodes. Colour Doppler (2-D CDS), power Doppler (2-D PDS) and 3-D power Doppler sonograms (3D PDS) of 145 cervical nodes were reviewed (metastases n=60, lymphoma n=30, tuberculosis n=23, reactive n=25, Kimura disease n=7). Sonograms of the three imaging modes were reviewed separately with an interval of 2 weeks. Lymph nodes were assessed for the vascular pattern (hilar, peripheral or mixed) and the presence or absence of displacement of hilar vascularity. For the assessment of displacement of hilar vascularity, only lymph nodes that showed hilar or mixed vascularity in the three imaging modes were included in the analysis. Results showed that there was a high level of agreement between CDS and PDS in assessment of vascular patterns (kappa=0.914), whereas the level of agreement between CDS and 3-D PDS (kappa=0.484) and between PDS and 3-D PDS (kappa=0.452) was low. There was a high level of agreement in the assessment of displacement of hilar vascularity among the three imaging modes (CDS and PDS, kappa=0.942; CDS and 3-D PDS, kappa=0.808; PDS and 3-D PDS, kappa=0.865). In the assessment of vascular patterns of cervical lymphadenopathy, CDS and PDS have a similar performance. However, accurate assessment of the vascular pattern of cervical nodes may be difficult using 3-D PDS. In the assessment of displacement of hilar vascularity, the performances of CDS, PDS and 3-D PDS are similar.
Adolescent↗
Effectiveness of a new perforated 0.15 mm poly-p-dioxanon-foil versus titanium-dynamic mesh in reconstruction of the orbital floor.
Introduction: In recent years a new perforated PDS (poly-p-dioxanon) foil (0.15 mm) has become available and has not yet been proven to be successful in reconstruction of the orbital floor after blow-out-fractures in randomized studies. The main aim of this clinical trial is to compare this new PDS foil with titanium dynamic mesh (0.3 mm) (TD), which is well established in reconstruction of the orbital floor. Patients and Methods: In a prospective multicentre randomized trial, conducted between 1997 and 1998, out of 42 patients with fractures of the orbital floor, 28 patients needing material for reconstruction were randomized to receive either PDS foil or TD. In a comprehensive preoperative and postoperative protocol patients were monitored by the surgeon, radiologist and ophthalmologist with a postoperative follow-up of least 6 months. Results: Maximum defects of the orbital floor were comparable in both groups (PDS group: 13.3 mm, TD group: 13.9 mm). In both groups the surgical procedure was well tolerated, and functional and cosmetic results were evaluated as satisfactory by all patients. Ophthalmological evaluation, performed up to 6 months postoperatively, revealed double vision or vertical strabismus in nine patients (five PDS group, four titanium group). This was not confirmed subjectively in each single patient. Also ex- or enophthalmos, registered in seven patients of the PDS and four of the TD group (mainly +/-1 mm) were not considered as relevant by the patients. Conclusion: The new 0.15 mm perforated PDS foil was comparable to 0.3 mm titanium mesh concerning functional and cosmetic outcome. Obviously, persisting ophthalmometric disorders were compensated very well in both groups. PDS foil is felt to be the preferred material since it is bioresorbable and more convenient to handle. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.
Journal Article↗
Procedure-specific surgical site infection rates and postdischarge surveillance in Scotland.
OBJECTIVE: To investigate the impact of postdischarge surveillance (PDS) on surgical-site infection (SSI) rates for selected surgical procedures in acute care hospitals in Scotland. DESIGN: Prospective surveillance of SSI after selected surgical procedures. SETTING: The Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP), which is based on the methodology of the Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance system (NNIS). Thirty-two of 46 acute care hospitals throughout Scotland contributed data to SSHAIP for this study. METHODS: Data were from 21,710 operations that took place between April 1, 2002, and June 30, 2004; nine categories of surgical procedures were analyzed. CDC NNIS system definitions and methods were used for SSI PDS. PDS is a voluntary component of the mandatory SSI surveillance program in Scotland. PDS was categorized as none, passive, active without direct observation, and active with direct observation. RESULTS: From our study information, PDS data were available for 12,885 operations (59%). A total of 2,793 procedures (13%) were associated with passive PDS and 10,092 (46%) with active PDS. The SSI rate among the 8,825 operations with no PDS was 2.61% (95% confidence interval [CI], 2.3%-3.0%), which was significantly lower than the SSI rate found among the 12,885 operations for which PDS was performed (6.34% [95% CI, 5.9%-6.8%]). For breast surgery, cesarean section, hip replacement, and abdominal hysterectomy, the rate of SSI when PDS was performed was significantly higher than that when PDS was not performed (P<.01 for each procedure). No differences in SSI rates were found for surgery to repair fractured neck of the femur or for knee replacement. SSI rates were examined according to procedure type, performance of PDS, and NNIS risk index; rates of SSI increased with NNIS risk index within procedure group and PDS group. Logistic regression analyses confirmed that procedure type, performance of PDS, and NNIS risk index were all statistically independent predictors of report of an SSI (P<.05). CONCLUSIONS: This Scottish national data set incorporates a substantial amount of PDS data. We recommend a procedure-specific approach to PDS, with direct observation of patients after breast surgery, cesarean section, and hysterectomy, for which the length of stay is typically short. Readmission surveillance may be adequate to detect most SSIs after orthopedic surgery or vascular surgery, for which the length of stay is typically longer.
Cohort Studies↗
Assessment of resectability of pancreatic head and periampullary tumors by color flow Doppler sonography.
OBJECTIVE: To examine the sensitivity of color flow Doppler ultrasonography in assessing resectability of pancreatic head and periampullary tumors. DESIGN: Validation cohort study. SETTING: Tertiary care public hospital. PATIENTS: Thirty-seven patients with pancreatic head or periampullary cancer were studied by color flow Doppler examination of the relevant blood vessels. MAIN OUTCOME MEASURE: A pancreatic Doppler score (PDS) was defined as the closest circumferential contact of the tumor to the superior mesenteric vein, superior mesenteric artery, or portal vein. A PDS of 1 indicated no contact (n = 9); PDS 2, less than 50% contact (n = 10); PDS 3, 50% to 99% contact (n = 7); and PDS 4, encasement (n = 11). The PDS was compared with operative and histologic resection margins. RESULTS: The lack of vascular invasion was confirmed operatively in 7 of 7 patients with a PDS of 1, and 6 patients who underwent resection had clear histologic margins. Nine (90%) of 10 patients with a PDS of 2 were confirmed to have no vascular invasion, and 3 (43%) of 7 patients who underwent resection had clear margins. Five (83%) of 6 patients with a PDS of 3 had correct operative findings, and both patients who underwent resection had positive margins. Operative confirmation of encasement was found in all 7 patients with a PDS of 4 who had operative exploration, and none underwent resection. CONCLUSIONS: Color flow Doppler sonography and PDS predicted resectability and the histologic margin status (positive predictive value, 97%). Patients with a PDS of 1 are predicted to have clear histologic margins after resection. Patients with a PDS of 4 have unresectable tumors, and nonoperative palliation should be considered. Patients with a PDS of 2 or 3 have a high likelihood of positive histologic margins after resection and may be candidates for neoadjuvant chemotherapy.
Adult↗
[Effect of various suture strength factors on behavior of meniscus sutures in cyclic loading conditions].
The aim of this study was to analyze meniscal sutures under cyclic loading conditions for different suture types (vertical and horizontal mattress sutures) and suture materials (absorbable monofilament sutures: PDS 2-0; PDS-0, and PDS-1 USP). Testing was performed on medial porcine menisci, using a well-established biomechanical testing model with a complete longitudinal tear 3 mm from the periphery of the meniscus. Sixty specimens were used. One suture was tested at a time. During cyclic testing 100 load cycles were applied with a crosshead speed of 50 mm/min. Three different maximum loads (10 N, 20 N, and 40 N) were used. The preload was set at 5 N. After cyclic loading, the specimens were loaded until failure. During cyclic loading, a gap appeared between the two parts of the meniscus, and partial tissue failures were observed at the surface of the meniscus. Gapping was more marked with higher loads and with the weaker suture material (p < 0.001). Using PDS 0 and PDS 1 sutures, less partial tissue failures were observed compared to PDS 2-0 (p < 0.001). The ultimate failure loads after cyclic loading were higher with PDS-0 and PDS-1 sutures. With these suture materials vertical sutures were stronger than horizontal sutures (p < 0.05). Using PDS 2-0 this difference could not be found. These results show that the primary strength of meniscal sutures depends on the suture material. The frequency and the amount of gapping and partial tissue failures, which can be observed under cyclic loading, are less distinct with PDS-0 and PDS-1 compared to PDS 2-0. From a biomechanical point of view, PDS 0 and PDS 1 sutures are recommended for meniscal sutures to guarantee a high primary stability, a small amount of gapping, and few partial tissue failures.
Animals↗
Assessing the needs of residency program directors to meet the ACGME general competencies.
OBJECTIVE: New accreditation requirements for residency training programs require residents to have educational experiences that allow them to demonstrate competency in the following areas: (1) patient care, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism, and (6) systems-based practice. Residents' competence must be assessed with dependable measures. Residency training program directors (PDs) need assistance in complying with these new requirements. DESCRIPTION: Using a survey modified from Michigan State University, we asked PDs to rate their current understanding of and preparation for the general competencies and to provide written comments. PDs of the 47 ACGME-accredited programs received e-mailed instructions to complete the Web-based survey. Twenty-four PDs (51%) complied by the deadline. The mean ratings were calculated from a five-point scale (1 = strongly disagree, major impediment or least useful, 5 = strongly agree, not an impediment, or most useful). PDs felt they were informed (3.45) and understood (3.67) the requirements, but they were not well prepared to meet them (2.95). The perceived impediments to implementation included amount of PD time (2.27), amount of residents' protected time for the curriculum (2.30), amount of residency support staff (2.73), lack of expertise in curriculum development (2.73) and evaluation (2.41), and lack of funding for resources other than personnel (2.91). PDs rated types of assistance that would be helpful: developing workshops or presentations on curriculum development and evaluation techniques (3.82), developing curricula (4.14), providing one-on-one consultation (4.23), receiving examples of materials, methods, and ideas from other programs (4.41), and describing evaluation methods/instruments (4.50). Written comments stated that time to concentrate on the topic, release time from clinical responsibilities, and technical computer support would be helpful. Of the six competency areas, PDs were most interested in receiving assistance in developing curricular materials for the competencies of systems-based practice (4.50), professionalism (4.36), and practice-based learning and improvement (4.27). PDs were most interested in receiving assistance in developing evaluations for practice-based learning and improvement (4.59), professionalism (4.59), interpersonal and communication skills (4.45), and systems-based practice (4.36). PDs responded that they currently use written faculty evaluations to assess all six general competency areas. DISCUSSION: Results of the survey indicate that PDs require assistance to comply with the new ACGME requirements. Curricular materials and valid and reliable evaluation methods need to be developed. In order to assist PDs, the following activities are under way: (1) PDs are members of a listserve for sharing ideas and examples of curricular and evaluation materials; (2) PDs attend a monthly seminar series that provides practical information for curricular material development and specific evaluation methods, including indications for use and feasibility; (3) educators from our Office of Educational Development provide individual consultations with each PD; (4) PDs participate in an eight hour workshop with practical sessions for developing curricular materials and evaluations; and (5) two institution-wide assessments are being developed: a patient-satisfaction survey and a 360-degree evaluation to assess communication skills and professionalism.
Accreditation↗
Evaluation of the personal dental services (wave 1) for Lambeth, Southwark and Lewisham primary care trusts--Part 2: Retrospective analyses of treatment and other dental record data.
AIM/OBJECTIVE: The purpose of the study was to undertake analyses of treatment data for the Personal Dental Services (PDS) of Lambeth, Southwark and Lewisham Primary Care Trusts and relate the analyses to the PDS goals of supporting practitioners deliver appropriate quality dental care and ensuring that appropriate quality safety net services are available for all residents. METHOD: Analyses of treatment data provided by the Dental Practice Board were undertaken for the post-PDS period (February 1999-March 2003, based on data availability). Analyses of the clinic notes for 1500 patients were also undertaken for the 1 year pre-PDS period (October 1997-September 1998) and post-introduction of the PDS (October 1998-June 2003). Two sets of analyses were undertaken to evaluate trends in treatment claims for the Dental Practice Board data, absolute numbers of each type of treatment claimed each month and change in numbers of types of treatments claimed over time. The clinic notes were used to undertake post-PDS, pre-PDS comparisons of the number of treatment items and grouped treatment item categories undertaken and the number of courses and percentages of private treatment items provided. The following sociodemographic characteristics of the patients were also analysed, age, gender, exemption status and attendance status. RESULTS: Overall it was identified that the percentage reduction in the number of treatment items undertaken was 13% (95% CI -19%, -7%), post- as compared to the pre-PDS introduction period. On an annual basis it was identified that the percentage reduction in the number of treatment items undertaken per year per patient post-PDS was 4% (95% CI -6%, -2%). There were significant variations in the impact of the PDS on the number of treatment items undertaken for different types of patients. A limited number of treatment types changed significantly post- as compared to pre-PDS. The proportion of exempt patients treated did not increase post-PDS. CONCLUSIONS: It is possible that a less invasive style of dental treatment was provided during the course of the PDS, however, there was only limited evidence to indicate that dentists practice style changed based on types of treatment categories provided. The PDS provided a limited safety net service for local residents. In setting program goals the nature of quality dental practice requires definition and evaluation should be undertaken on a prospective basis.
Adult↗
Factors affecting Staphylococcus epidermidis growth in peritoneal dialysis solutions.
Staphylococcus epidermidis is the most frequent cause of peritonitis complicating continuous ambulatory peritoneal dialysis. We studied factors that might influence the growth of S. epidermidis in commercially available peritoneal dialysis solution (PDS). Test strains were inoculated into PDS and incubated overnight at 37 degrees C. Samples were removed at appropriate intervals, bacterial counts were performed, and growth curves were constructed. We studied the effects of various osmolarities, the neutralization and acidification of fresh and spent PDS, and the effect of intraperitoneal dwell time on the ability PDS to support growth of S. epidermidis. In fresh PDS, numbers of bacteria remained constant after 24 h. No significant differences in growth were observed among PDS with 0.5, 1.5, 2.5, and 4.25% glucose. Neutralizing acidic fresh PDS had no effect on bacterial growth. However, growth did occur in spent PDS. PDS which was recovered after only 2 h in the peritoneal cavity supported growth to the same extent as did PDS recovered after 4 to 6 h. Mean log10 changes after 24 h of incubation were as follows: for fresh PDS, -1.3; after 2 h dwell time, 2.9; after 4 h dwell time, 1.9; and after 6 h dwell time, 1.3. Acidification of spent PDS to less than pH 6.35 produced less rapid growth; mean log10 increases after 24 h of incubation were 1.9 for pH 7.75, 1.6 for pH 6.35, 0.6 for pH 5.75, and 0.7 for pH 4.95. Fresh PDS of all available osmolarities neither supported the growth of S. epidermidis nor was bactericidal. Spent PDS supported bacterial growth, and this growth was partly independent of the neutralization which occurred during the dialysis.
Amino Acids↗
Personality disorders: model for conceptual approach and classification. Part I: General model.
In this article we present data suggesting that one core deficit in personality represents a common dimension extending across most categories of personality disorders (PDs), whereas clinically discrete syndromes classified as PDs in DSM IIIR are categorical maladaptive types related orthogonally to the common borderline dimension. In a sample of 121 subjects with PDs and 67 controls, persons with PDs and without PDs manifested similar profiles on the Millon Clinical Multiaxial Inventory (MCMI) scales for various behavior styles. Conversely, the two groups consistently differed with respect to the MCMI borderline scale: in contrast to non-PD persons, those with PDs were strikingly more borderline and typically scored above 75 points (the latter has been established as the cut off for the diagnosis of Borderline PD). Likewise, persons with PDs scored significantly higher on the Diagnostic Interview for Borderlines than the control group. These results suggest that: i) most symptoms usually considered typical of the borderline personality characterize other PDs as well; ii) borderline features seem to be characteristic of persons with PDs and can be used to distinguish PDs vs. non-PDs. Therefore, symptoms widely regarded as typical of the borderline personality characterize other PDs as well. This shared dimension may explain the overlap in categorical diagnoses of individual PDs. Moreover, this shared dimension may be efficiently used as the classificatory principle for PDs. In Part II of this article, we present a model that classifies deviant behaviors in a systematic way, i.e., combines three levels of functioning (normal, neurotic, and borderline) with a limited number of categories of (mal) adaptive behavior types.
Borderline Personality Disorder↗
Medical and psychiatric comorbidity and health care use among children 6 to 17 years old.
BACKGROUND: The association of psychiatric disorders (PDs) with other PDs and medical disorders (MDs) has been insufficiently explored in children and adolescents. OBJECTIVES: To estimate medical and psychiatric comorbidity present in children with PDs and to determine the medical service usage of children with PDs. DESIGN: We use administrative health care data to describe the health care provided for study children. Psychiatric disorders were classified into the following 3 categories: psychosis, emotion, and behavior. We used logistic regression to assess medical comorbidity for each category. Psychiatric comorbidity was determined using chi(2) test analysis. Health care use was determined by comparing the frequency of visits for MDs and PDs between children with PDs and children without PDs. SETTING: We studied 406,640 children (50.6% male) between 6 and 17 years old, living in Alberta, Canada, during the fiscal year April 1, 1995, through March 31, 1996. RESULTS: A PD was diagnosed in 32,214 (60.3% male) children. Psychiatric comorbidity was present in 13.6% of the children; comorbidity existed in all 3 psychiatric groups and peaked in postpubertal children. More girls than boys had significant medical comorbidity. Significant odds ratios (ORs) for girls varied from 1.2 (behavior and sinusitis, bronchitis, and chronic disorders; psychosis, and menstrual problems) to 15.3 (behavior and developmental delay). Among boys, the highest OR was seen with the combination of behavior and developmental delay (OR, 8.3) and psychosis and poisoning (OR, 8.2). With ORs ranging from 4.6 to 15.3, developmental delay consistently had high ORs for both sexes and all 3 types of PDs. Poisoning also had high ORs (3.3-14.1) with all 3 PDs and both sexes. Among girls, disorders associated with pregnancy and the genitourinary system had modest associations (OR, 1.9-2.2, for behavior) to moderate (OR, 2.5-4.0, for emotion). Children with PDs had significantly greater medical service usage than did children without PDs. Girls had greater medical health care usage than boys. Psychiatric service usage was similar for both sexes. CONCLUSIONS: Medical and psychiatric comorbidity exist in children with PDs. Girls are more commonly affected. Health care usage is higher in children with PDs.
Adolescent↗
Cloning and characterization of a maize cDNA encoding phytoene desaturase, an enzyme of the carotenoid biosynthetic pathway.
To study regulation of the plastid-localized maize carotenoid biosynthetic pathway, a cDNA encoding phytoene desaturase (PDS) was isolated and characterized. The DNA sequence of the maize Pds cDNA was determined and compared with available dicot Pds genes. The deduced PDS protein, estimated at 64.1 kDa (unprocessed), had a dinucleotide binding domain and conserved regions characteristic of other carotene desaturases. Alignment of available PDS sequences from distantly related organisms suggests that Pds has potential as a phylogenetic tool. By use of heterologous complementation in Escherichia coli, maize PDS was shown to catalyze two desaturation steps converting phytoene to zeta-carotene. RFLP (restriction fragment length polymorphism) mapping was used to place Pds on chromosome 1S near viviparous5 (vp5), and RT-PCR (reverse-transcriptase polymerase chain reaction) analysis indicated reduced Pds transcript in vp5 mutant relative to normal endosperm. Other phytoene-accumulating mutant endosperms, vp2 and white3 (w3), showed no difference in Pds transcript accumulation as compared with normal endosperm counterparts. RT-PCR analysis of Pds transcript accumulation in developing endosperm showed Pds was constitutively expressed. Therefore, endosperm carotenogensis is not regulated by increasing the level of Pds transcripts.
Amino Acid Sequence↗
Inter-ictal- and ictal-like epileptic discharges in the dendritic tree of neocortical pyramidal neurons.
Dendritic mechanisms have been implied to play a key role in the formation of epileptic discharges. However, presently only a handful of direct dendritic recordings have been reported during epileptic discharges. In this study, I performed simultaneous voltage recordings from the soma and apical dendrite of the same neuron combined with calcium-imaging measurements to investigate inter-ictal- and ictal-like epileptic discharges in dendrites of layer 5 pyramidal neurons. Neocortical brain slices treated with bicuculline (BCC) produced both isolated "inter-ictal" paroxysymal depolarization shift (PDS) responses and electrographic seizures. Concomitant voltage recordings from the soma and apical dendrite revealed that PDS responses developed in both the apical dendrites and soma. However, the two responses differed from one another. In apical dendrites, the PDS was significantly higher in amplitude and shorter in duration compared with the somatic PDS. The PDS response in dendrites had a peak amplitude of 68.9 +/- 2.2 (SD) mV, peak voltage value of 9.3 +/- 2.7 mV, and half-width of 203.8 +/- 38.4 ms. In contrast, the somatic PDS had a peak amplitude of 48.7 +/- 2.7 mV, peak voltage value of -11.9 +/- 3.1 mV, and half-width of 247.8 +/- 57.3 ms (P < 0.01, n = 18). In addition the apical dendritic PDS always preceded the somatic counterpart in all 18 neurons examined. Concomitant calcium-imaging measurements showed the PDS evoked large calcium influx into the entire dendritic tree including the apical tuft, basal, and oblique dendrites. The PDS evoked [Ca(2+)](i) were not uniform along the dendritic tree, being highest in the oblique dendrites (71.3 +/- 14.5 microM) and lowest at the distal tuft branches (9.3 +/- 0.7 microM). The PDS responses persisted after blockade of voltage-gated sodium channels by intracellular QX-314 but became narrower (by 69.6 +/- 9.7%) following intracellular administration of the voltage-gated calcium channel blocker D600. Electrographic seizures recorded in the soma and apical dendrites were composed of recurrent bursts. The initial bursts represented PDS responses. During the seizure the amplitude of bursts gradually attenuated and reached an average value of 26 +/- 13% of the initial ictal PDS burst. Double recordings during electrographic seizures revealed the initial one to four ictal bursts appeared first at the apical dendrite while later ictal bursts were always observed first at the soma. In conclusion, the results of this study show "inter-ictal" PDS responses originated in the apical dendritic tree, were partially mediated by voltage-gated calcium channels and spread throughout the dendritic tree including the fine tuft, basal, and oblique dendrites. During electrographic seizures the origin of epileptic bursts shifted from the apical dendritic tree to the soma-basal region.
Animals↗
Characteristics of emergency medicine program directors.
OBJECTIVES: To characterize emergency medicine (EM) program directors (PDs) and compare the data, where possible, with those from other related published studies. METHODS: An online survey was e-mailed in 2002 to all EM PDs of programs that were approved by the Accreditation Council of Graduate Medical Education. The survey included questions concerning demographics, work hours, support staff, potential problems and solutions, salary and expenses, and satisfaction. RESULTS: One hundred nine of 124 (88%) PDs (69.7% university, 27.5% community, and 2.8% military) completed the survey; 85.3% were male. Mean age was 43.6 years (95% confidence interval [CI] = 42.6 to 44.7 yr). The mean time as a PD was 5.7 years (95% CI = 4.9 to 6.5 yr), with 56% serving five years or less. The mean time expected to remain as PD is an additional 6.0 years (95% CI = 5.2 to 6.8). A 1995 study noted that 50% of EM PDs had been in the position for less than three years, and 68% anticipated continuing in their position for less than five years. On a scale of 1 to 10 (with 10 as highest), the mean satisfaction with the position of PD was 8.0 (95% CI = 7.2 to 8.3). Those PDs who stated that the previous PD had mentored them planned to stay a mean of 2.0 years longer than did those who were not mentored (95% CI of difference of means = 0.53 to 3.53). Sixty-five percent of PDs had served previously as an associate PD. Most PDs (92%) have an associate or assistant PD, with 54% reporting one; 25%, two; and 9%, three associate or assistant PDs. A 1995 study noted that 62% had an associate PD. Ninety-two percent have a program coordinator, and 35% stated that they have both a residency secretary and a program coordinator. Program directors worked a median of 195 hours per month: clinical, 75 hours; scholarly activity, 20 hours; administrative, 80 hours; and teaching and residency conferences, 20 hours; compared with a median total hours of 220 previously reported. Lack of adequate time to do the job required, career needs interfering with family needs, and lack of adequate faculty help with residency matters were identified as the most important problems (means of 3.5 [95% CI = 3.2 to 3.7], 3.4 [95% CI = 3.2 to 3.6], and 3.1 [95% CI = 2.9 to 3.3], respectively, on a scale of 1 to 5, with 5 as maximum). This study identified multiple resources that were found to be useful by >50% of PDs, including national meetings, lectures, advice from others, and self-study. CONCLUSIONS: Emergency medicine PDs generally are very satisfied with the position of PD, perhaps because of increased support and resources. Although PD turnover remains an issue, PDs intend to remain in the position for a longer period of time than noted before this study. This may reflect the overall satisfaction with the position as well as the increased resources and support now available to the PD. PDs have greater satisfaction if they have been mentored for the position.
Adult↗
Influence of red light and pattern on photic driving.
The photic drivings (PDs) in response to the following visual stimuli were studied in 108 cases, of which 84 (78%) were epileptics; ages ranged from 5 to 57 years old. An intermittent photic stimulation (IPS) of 5 cycles/sec by a stroboscopic light was given to the subjects with eyes closed and open. Following these stimuli, red-flicker and flickering-pattern of 5 cycles/sec and 20 cd/m2 were given successively to the subjects with eyes open using a "visual stimulator". The PDs evoked by IPS to the eyes closed and those by red-flicker were similar in the wave form and amplitude. In most of the cases, however, both stimuli failed to evoke apparent PDs (over 25 muV in amplitude), i.e., in 81% and 72%, respectively. IPS to the eyes open and flickering-pattern showed comparable effects in evoking PDs; they evoked high amplitude PDs (over 50 muV in amplitude) with a frequency of 19% by the former and 28% by the latter. In 95 out of 108 cases, both IPS to the eyes closed and red-flicker failed to evoke apparent PDs. In rare cases, IPS to eyes closed evoked high amplitude PDs; in 7 out of these 8 cases, red-flicker also evoked high amplitude PDs. In 18 out of 20 cases in which high amplitude PDs were evoked by IPS to the eyes open, flickering-pattern was also effective in evoking high amplitude PDs. Based on these findings, similarities between IPS to the eyes closed and red-flicker, and similarities between IPS to the eyes open and flickering-pattern in evoking PDs are discussed. It is concluded that flickering-pattern and red-flicker are superior to IPS to the eyes open and closed, respectively, for examining the low frequency PDs.
Adolescent↗