The subspecialty training, practice type, and geographical distribution of recently trained ophthalmologists: a study of male and female physicians.

OBJECTIVE: To characterize the distribution of male and female ophthalmologists with regard to practice type, subspecialty training, rural-urban distribution, and regional distribution. METHODS: Ophthalmology Matching Program files containing the records of residents who began their second year at accredited programs between 1986 and 1990 (inclusive), were compared to membership files of the American Academy of Ophthalmology. Practice locations for each individual were classified according to region, stage, and Rural-Urban Continuum County Code, as defined by the US Department of Agriculture. RESULTS: This cohort comprised 2,494 individuals, 77.1% (1922) of whom were male and 22.9% (572) of whom were female. Group practice was most common (55.9% for women and 61.3% for men). More women were in salaried positions associated with health maintenance organizations (p = 0.006) and academic settings (p < 0.001) than were men. Notable differences in subspecialty choice were restricted to pediatric ophthalmology, chosen three times more frequently by women, and vitreoretinal diseases/surgery, chosen twice as often by men. Only 5.6% of women selected nonmetropolitan practice locales compared to approximately twice that percentage of men. The Middle Atlantic and New England regions attracted more women, while the South Atlantic attracted more men.

Local recurrence in patients with rectal cancer diagnosed between 1988 and 1992: a population-based study in the west Netherlands.

AIMS: We carried out a population-based study of local recurrence rates in curatively resected patients with rectal cancer, diagnosed between 1988 and 1992. The first objective was to make an inventory of the overall local recurrence rate after non-standardized conventional surgery, inter-institutional recurrence rate variability, and correlations between patient- and tumour-related factors and recurrence rate. A second objective was to investigate the compliance to guidelines for post-operative radiotherapy. METHODS: Data were obtained from the Comprehensive Cancer Centre West. The study comprised 1105 patients from 12 hospitals. Of these patients, 437 were ineligible because of missing medical records, no carcinoma, incorrect registration, no laparotomy, non-curative resection, or loss to follow-up. RESULTS: The overall local recurrence rate was 22.5% with a range of 9-36% between the hospitals. These differences were not significant. Dukes' Astler-Coller stage, tumour location, and residual tumour were significant independent prognostic factors for the risk of local recurrence. Indications for post-operative radiotherapy were Dukes' Astler-Coller B2 and C tumours, positive surgical margins, and tumour spill. Compliance to the guidelines for radiotherapy was only 50%. However, no significant difference in recurrence rate was found between patients treated according to the guidelines and those not treated according to the guidelines. CONCLUSION: This study shows a large variability in local recurrence rate between the participating hospitals and confirms that the risk of recurrence in primary rectal cancer is dependent on Dukes' Astler-Coller stage, tumour location and residual tumour. Furthermore, this study contributes to the discussion about the feasibility of guidelines for post-operative radiotherapy.

Basic concepts and terms for low vision rehabilitation.

As the involvement of occupational therapists in the rehabilitation of people with visual impairments increases, it is important for all professionals involved to communicate clearly by using the most accurate terminology. This article suggests the most appropriate use of terms and concepts. It recommends that the distinctions between the various aspects of vision loss be recognized and that the old dichotomy of legally blind versus legally sighted be replaced by the more detailed classification of the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), which recognizes multiple levels of visual performance.

The United States Neurological Surgery Residency Matching Program.

After 3 years of deliberations, The Society of Neurological Surgeons approved a national Neurological Surgery Matching Program in 1983 for residency positions beginning July 1, 1985. All directors of United States neurological surgery residency training programs agreed to participate and abide by the rules of the match. A review of 10 years' experience with 11 matches from 1983 to 1994 indicates full acceptance by both applicants and program directors and a highly successful process and outcome, satisfactory for everyone except for qualified applicants who failed to obtain a residency position. Since 1985, 1455 neurosurgical (Postgraduate Year 2) residency positions have been offered for match, and 2708 applicants have submitted a ranking list, filling 1434 positions with the initial computer run each year and leaving 1274 unmatched applicants. Thus, the ratio of applicants to available positions is almost 2:1. Various interesting details about multiple-year applications, International Medical Graduates, and nonstart, transfer, and dropout rates are presented, including the eventual practice activities of residents not completing neurosurgical training. A comparison of all United States medical schools, considering data on applications and matches for neurosurgical residency versus number of senior medical students, reveals wide differences. These differences are probably related to the availability of neurosurgical clerkships, faculty participation in the undergraduate curriculum, and the presence of a neurosurgical residency program.

Low vision rehabilitation: vision requirements for driving.

Driving requires several different sets of abilities, the interaction of which is complex. The combination of these factors, rather than any single factor alone, may make it inadvisable to issue a driver's license. Although vision is the predominant source of information for the driver, visual abilities are only one of the factors to be considered when judging the overall driving ability of an applicant. The final determination can only be made through on-the-road evaluation and cannot be based on the evaluation of vision alone. Individual evaluations should include a review of the past driving record and of nonvisual driving-related abilities, as well as observation of on-the-road performance by a qualified driving instructor or driving evaluator.

Low vision rehabilitation: visual acuity measurement in the low vision range.

1. To predict function and prescribe low vision aids, accurate measurements are needed. The routine measurement range can be extended by moving test charts normally used at 20 ft to a closer distance; 1 m is recommended, which gains a factor of 6. 2. Some practitioners recommend testing all reading at a standard distance, but they differ in the distances they recommend. Using a variable distance and recording the distance with every measurement allows for patients' preferred distances. 3. If the distance and letter size are properly recorded, the same visual acuity score should be calculated for all distances. Inches and J numbers, the most prevalent measurements, make visual acuity calculations impossible, but by adopting metric measurements, calculations are far easier.

Low vision rehabilitation: basic concepts and terms.

1. Ophthalmic professionals should avoid using the term "blindness' when referring to lesser levels of vision loss. Vision loss describes any type or degree of change in vision; blindness is total loss of sight. 2. Ophthalmologists deal with anatomy and organ function whereas rehabilitation counselors address the socioeconomic and skills aspects of vision loss. Successful visual rehabilitation must be a team effort with good communication between all professionals. 3. The replacement of the simple dichotomy between "legally sighted" and "legally blind" by normal vision, low vision, and blindness provides a more accurate and less stigmatizing classification.

Contribution of vision variables to mobility in age-related maculopathy patients.

Can mobility performance be predicted from measures of vision function? This study addressed this question by measuring a series of vision variables including visual acuity, visual fields, and differential motion sensitivity in a group of patients with age-related maculopathy (ARM) and a group of age-matched normals. Mobility performance at three adaptation levels was determined objectively on an indoor course. The results indicate that for the patients with ARM, mobility variables can be predicted from measures of vision function, including differential velocity sensitivity, and that simple variables such as time taken to complete the course and average speed are those which relate best to vision.

Effect of luminance, contrast, and eccentricity on visual acuity in senile macular degeneration.

We examined the effect of luminance on low contrast visual acuity in six patients with mild reductions in vision due to senile macular degeneration (SMD) and in six normals of approximately the same age. At the highest luminance tested the SMD patients showed a reduction in acuity compared to the controls, with eccentricity and contrast effects clearly shown. The SMD patients had difficulty performing the acuity task at the lower luminances (0.26 and 0.75 cd/m2); they showed little or no increase in visual acuity with increasing contrast levels at the lower luminances. Acuity was slightly influenced by target eccentricity at these luminances. These data suggest that the adaptation mechanisms allowing the normal visual system to operate efficiently over a wide range of luminances are affected in SMD, even when clinically measured acuity is only moderately depressed.