Residency Program Directors' Interview Methods and Satisfaction With Resident Selection Across Multiple Specialties.

CONTEXT: Competition for postdoctoral training positions is at an all-time high, and residency program directors continue to have little direction when it comes to structuring an effective interview process. OBJECTIVES: To examine whether a relationship existed between interview methods used and program director satisfaction with resident selection decisions and whether programs that used methods designed to assess candidate personal characteristics were more satisfied with their decisions. METHODS: Residency directors from the Statewide Campus System at the Michigan State University College of Osteopathic Medicine were invited to complete a 20-item survey regarding their recent interview methods and proportion of resident selections later regretted. Data analyses examined relationships between interview methods used, frequency of personal characteristics evaluated, and subsequent satisfaction with selected residents. RESULTS: Of the 186 program director surveys distributed, 83 (44.6%) were returned, representing 11 clinical specialty areas. In total, 69 responses (83.1%) were from programs accredited by the American Osteopathic Association only, and 14 (16.9%) were from programs accredited dually by the American Osteopathic Association and Accreditation Council for Graduate Medical Education. The most frequent interview method reported was faculty or peer resident interview. No statistically significant correlational relationships were found between type of interview methods used and subsequent satisfaction with selected residents, either within or across clinical specialties. Although program directors rated ethical behavior/honesty as the most highly prioritized characteristic in residents, 27 (32.5%) reported using a specific interview method to assess this trait. Program directors reported later regrets concerning nearly 1 of every 12 resident selection decisions. CONCLUSION: The perceived success of an osteopathic residency program's interview process does not appear to be related to methods used and is not distinctively different from that of programs dually accredited. The findings suggest that it may not be realistic to aim for standardization of a common set of best interview methods or ideal personal characteristics for all programs. Each residency program's optimal interview process is likely unique, more dependent on analyzing why some resident selections are regretted and developing an interview process designed to assess for specific desirable and unwanted characteristics.

Comparison of four different nerve conduction techniques of the superficial fibular sensory nerve.

INTRODUCTION: There are many different nerve conduction study (NCS) techniques to study the superficial fibular sensory nerve (SFSN). We present reference distal latency values and comparative data regarding 4 different NCS for the SFSN. METHODS: Four different NCS techniques, Spartan technique, Izzo techniques (medial and intermediate dorsal cutaneous branches), and Daube technique, were performed on (114) healthy volunteers. A total of 108 subjects with 164 legs were included. RESULTS: The mean latency of the Spartan technique was longest (3.9 ± 0.3 ms) while the Daube technique was the shortest (3.6 ± 0.7 ms). The mean amplitude of the Daube technique displayed the highest (15.2 ± 8.2 µV) with the Spartan technique having the lowest (8.7 ± 4.2 µV). Among the absent sensory nerve action potentials (SNAPs), the Spartan technique was absent only twice (1.2%) and the Izzo Medial technique was absent more than the other techniques (2.9%). CONCLUSIONS: All 4 techniques were reliable methods for obtaining the superficial fibular nerve SNAP, present in 95% of individuals. Muscle Nerve 56: 458-462, 2017.

A quantitative study of intervertebral disc morphologic changes following plasma-mediated percutaneous discectomy.

OBJECTIVE: To quantitatively evaluate interval magnetic resonance imaging (MRI) changes in disc morphology following plasma-mediated percutaneous discectomy. DESIGN/SETTING: A retrospective comparison of pretreatment and posttreatment MRIs at a single university spine clinic. SUBJECTS: From a group of 60 consecutively treated patients, 15 met the study inclusion and exclusion criteria. All had either failed treatment or had other clinical reasons for a posttreatment MRI. METHODS: Two independent physicians electronically measured disc protrusion size and disc height at the treatment discs and adjacent discs on pre- and posttreatment MRI scans. Additionally, images were compared for gross anatomic changes including disc degeneration by Pfirrman classification, new disc herniations, high intensity zone (HIZ), vertebral endplate changes, post-contrast enhancement, and changes in segmental alignment. Pearson r correlation was used to determine interobserver reliability between the two physicians' MRI measurements. Paired t-tests were calculated for comparisons of pre- and posttreatment MRI measurements, and an ANOVA was performed for comparison of pre- to posttreatment changes in disc height measurements at treatment levels relative to adjacent levels. RESULTS: Correlation was high for measurement of disc height change (r = 0.89; P < 0.0001) and good for anteroposterior protrusion size change (r = 0.51; P = 0.0512). Disc height at treated discs demonstrated a small but statistically significant mean interval reduction of 0.48 mm (P = 0.0018). This remained significant when compared with the adjacent control discs (P < 0.0001). Pretreatment mean disc protrusion size (4.74 mm; range 3.75-6.55 mm) did not differ significantly (P = 0.1145) from posttreatment protrusion size (4.42 mm; range 2.55-7.95 mm). Gross anatomic changes at treatment levels included reduced disc protrusion size (N = 6), enlarged protrusion (N = 3), resolution of HIZ (N = 3), and improvement in endplate signal changes (N = 1). Also, 11/15 posttreatment MRIs included post-contrast images that showed epidural fibrosis (N = 1), rim enhancement (N = 2), and enhancement of the posterior annulus (N = 4). CONCLUSIONS: Based on MRI examinations, subtle anatomic changes may occur following plasma-mediated percutaneous discectomy. Further study is required to determine the clinical relevance of these changes.

Synchronous videoconferencing: impact on achievement of medical students.

BACKGROUND: Medical schools are expanding their enrollment, and synchronous lecture broadcast is being used more frequently to deliver instruction across multiple sites. PURPOSE: To assess whether the videoconferencing lecture-delivery method is associated with differences in medical student performance on national licensing examinations at lecture site-of-origin versus lecture receiving sites. METHODS: The academic preparedness of medical students at the time of admission and performance on a national licensing examination were compared for students predominantly receiving live lectures and those receiving synchronous videoconferencing lectures. External metrics were analyzed to establish baseline preparedness (Medical College Admission Test scores) and to determine academic achievement (national licensing examination scores). RESULTS: The authors found no statistically significant differences between site-of-origin and receiving sites in medical student preparedness or academic achievement. CONCLUSIONS: Medical students that receive the majority of their lectures through synchronous videoconferencing perform no differently on national licensing examinations than students that attend live lectures at the site-of-origin.

Relationship of spasticity to soft tissue body composition and the metabolic profile in persons with chronic motor complete spinal cord injury.

BACKGROUND/OBJECTIVE: To determine the effects of spasticity on anthropometrics, body composition (fat mass [FM] and fat-free mass [FFM]), and metabolic profile (energy expenditure, plasma glucose, insulin concentration, and lipid panel) in individuals with motor complete spinal cord injury (SCI). METHODS: Ten individuals with chronic motor complete SCI (age, 33 +/- 7 years; BMI, 24 +/- 4 kg/m2; level of injury, C6-T11; American Spinal Injury Association A and B) underwent waist and abdominal circumferences to measure trunk adiposity. After the first visit, the participants were admitted to the general clinical research center for body composition (FFM and FM) assessment using dual energy x-ray absorptiometry. After overnight fasting, resting metabolic rate (RMR) and metabolic profile (plasma glucose, insulin, and lipid profile) were measured. Spasticity of the hip, knee, and ankle flexors and extensors was measured at 6 time points over 24 hours using the Modified Ashworth Scale. RESULTS: Knee extensor spasticity was negatively correlated to abdominal circumferences (r = -0.66, P = 0.038). After accounting for leg or total FFM, spasticity was negatively related to abdominal circumference (r = -0.67, P = 0.03). Knee extensor spasticity was associated with greater total %FFM (r = 0.64; P = 0.048), lower % FM (r = -0.66; P = 0.03), and lower FM to FFM ratio. Increased FFM (kg) was associated with higher RMR (r = 0.89; P = 0.0001). Finally, spasticity may indirectly influence glucose homeostasis and lipid profile by maintaining FFM (r = -0.5 to -0.8, P < 0.001). CONCLUSION: Significant relationships were noted between spasticity and variables of body composition and metabolic profile in persons with chronic motor complete SCI, suggesting that spasticity may play a role in the defense against deterioration in these variables years after injury. The exact mechanism is yet to be determined.

Influence of needle type on the incidence of intravascular injection during transforaminal epidural injections: a comparison of short-bevel and long-bevel needles.

BACKGROUND CONTEXT: Vascular penetration and injection of corticosteroids into a vessel during lumbosacral transforaminal epidural injection is a suspected cause of myelopathy. Blunt needles have been suggested to avoid vascular penetration, but they are difficult to navigate. Another alternative to the standard long-bevel sharp needles is the short-bevel needles. Some have postulated that short-bevel needles are the best option for high-risk spine injections because they maintain navigation characteristics while potentially reducing the risk of complications. To date, no studies have been performed to either confirm or refute this. PURPOSE: The purpose of this study was to determine if there is a difference in the incidence of vascular penetration during lumbosacral transforaminal epidural injections between short-bevel and long-bevel needles. STUDY DESIGN/SETTING: This is a prospective, observational, in vivo study. PATIENT SAMPLE: The sample comprises patients receiving lumbosacral transforaminal epidural injections at a university-based outpatient spine center. OUTCOME MEASURE: The outcome measure was the incidence of vascular contrast patterns observed under live fluoroscopy. METHODS: One interventional spine physician recorded contrast patterns observed during 158 fluoroscopically guided lumbosacral transforaminal epidural injections under live fluoroscopy using two different types of needle tips. RESULTS: Vascular injections were observed in 22 of the 158 injections, for an overall incidence of 13.9%. The incidence of vascular injections in the short-bevel group was 15.6% (10/64) and in the long-bevel group was 12.8% (12/94). This difference was not statistically significant (p=.6447). A secondary analysis was performed to determine if the needle gauge influenced the incidence of vascular injections, and again, there were no statistical differences in the overall rates of vascular injection. CONCLUSIONS: In comparison with long-bevel needles, short-bevel needles do not reduce the risk of inadvertent vascular injection in lumbosacral transforaminal epidural injections.

Respiratory measurement utilizing a novel laser displacement technique: normal tidal breathing.

UNLABELLED: A novel technique for achieving plethysmography measurements utilizing noncontact laser displacement sensors is described. This method may have utility in measuring respiratory and pulmonary function similar to that of respiratory inductive plethysmography. The authors describe the apparatus and method and provide results of a validation study comparing respiratory excursion data obtained by (1) the laser sensor technique, (2) standard respiratory inductive plethysmography (RIP), and (3) lung volume measurements determined by pressure variations in a control volume. Six healthy volunteers (five female, one male, ages ranging from 19 to 23 years) were measured for tidal breathing excursions simultaneously via all three measurement techniques. RESULTS: Excellent correlation between the techniques was shown. Pairwise comparisons among all three measurement techniques across all subjects showed intraclass correlation coefficients of 0.995 in each case. These results indicate the laser plethysmograph (LP) system provides results that are, at a minimum, equivalent to those of the RIP at the two sites commonly measured by RIP. Use of the LP system has the potential to provide much more extensive and precise measurements of chest wall function and the respiratory musculature.

Interpretation of contrast dispersal patterns by experienced and inexperienced interventionalists.

OBJECTIVE: Determine how accurately inexperienced interventionalists interpret epidural contrast dispersal patterns compared with experienced interventionalists. DESIGN: Prospective comparative study. SETTING: University spine center. PARTICIPANTS: Two experienced interventionalists and 3 pain fellows in training. METHODS: Each participant independently interpreted 100 images showing contrast dispersal patterns from transforaminal epidural injections. All images were obtained by another physician after 0.5 mL of contrast material was injected. The true contrast dispersal pattern was determined under live fluoroscopy during the injection and classified as follows: epidural only, vascular only, or simultaneous epidural and vascular. Participants were told to assume that 0.5 mL of contrast had been injected before each image and were asked to describe the contrast patterns as epidural, vascular, both, or neither. MAIN OUTCOME MEASURE: Variance in agreement with the true contrast patterns between experienced and inexperienced participants. RESULTS: Overall, the inexperienced participants were in exact agreement with the true pattern in 52% of the images versus 70% for experienced participants (P=.03). Experienced participants correctly identified epidural contrast patterns with greater accuracy than inexperienced participants (94% and 76%, respectively; P=.01). Not surprisingly, the accuracy for all participants was low in the identification of vascular patterns on these static images, with 73% accuracy for the experienced and 68% for the inexperienced (P=.18). CONCLUSION: Even with 6 months of intensive experience, trainees are significantly less accurate than experienced physicians in the interpretation of contrast dispersal patterns from transforaminal epidural injections. The competency of interventional trainees and the amount of experience necessary to safely perform epidural injections deserve further examination.

Health behavior change models and theories: contributions to rehabilitation.

PURPOSE: This article highlights the importance of health behavior change (HBC) theory, and its relevance to rehabilitation research and practice. METHOD: An extensive review of HBC-related literature pertinent to rehabilitation was conducted, focusing on the potential impact of these theories and models in enhancing long-term results of rehabilitation with regard to lifestyle change and health promotion, and outlining the benefits of incorporating HBC themes into rehabilitation practice. For our purposes, the HBC concept is based on initiation and maintenance of health behaviors, functioning, wellness, and self-management of chronic conditions or disabilities within an environmental context. While comparing and contrasting three widely known theories of HBC, the contributions of these theories to rehabilitation research and practice are discussed. RESULTS: Three propositions are put forward: (1) HBC variables should regularly be used as outcome measures in evidence-based rehabilitation research; (2) there should be a better understanding of the role of the rehabilitation provider as a facilitator in eliciting healthy behaviors; and (3) there is a need to expand the HBC concept into a more comprehensive view encompassing a person's functioning within the environmental context. CONCLUSIONS: A conceptual merger between HBC theories and rehabilitation practice can have major implications for individuals with disabilities, their functioning, health, and well-being.

Track and field injuries.

OBJECTIVE: A review of the existing literature on injuries to youth (< or =18 years old) in track and field or athletics. DATA SOURCES: Searches of the Medline and SPORT Discus databases for English language articles through the end of 2003, using the search terms (adolescent or youth) and (track or field or running) and injuries. MAIN RESULTS: Only nine prospective or retrospective studies were found dealing with track and field injuries in children and that stated injury rates or provided enough information to allow the estimation of injury rates. Differences in study design and inconsistencies in the definition of a reportable injury provided major hindrances to making comparisons or combining data across studies. Among the few conclusions that can be drawn are that the lower extremities account for the majority of injuries, and muscle strains and ligament sprains are the predominant types of injury. While a majority of injuries may occur during training, since there is much more exposure during training than during competitions, the risk of injury is about four times higher during competitions. CONCLUSIONS: Informed decisions with regard to preventing injuries in youth track and field are dependent upon the quality of the basic epidemiological data available, and at this time such data are, for the most part, nonexistent. Because of the large numbers of participants and the large number and variety of activities involved in track and field, adequately designed epidemiological research is difficult, but opportunities for research in this sport are available for anyone willing to take on the challenge.

Perceived barriers to exercise in people with spinal cord injury.

OBJECTIVE: To identify barriers to physical fitness faced by individuals with spinal cord injury preventing them from participating in a physical fitness program. DESIGN: In this cross-sectional study, a survey of barriers to exercise was administered to 72 individuals with spinal cord injury. RESULTS: Although 73.6% of the participants expressed an interest in an exercise program, less than half (45.8%) were currently active in an exercise program. Less than half (47.2%) reported that their physician had recommended an exercise program for them. The most frequently cited concerns about barriers to exercise fell into three areas: (1) intrapersonal or intrinsic (e.g., lack of motivation, lack of energy, lack of interest), (2) resources (e.g., cost of an exercise program, not knowing where to exercise), and (3) structural or architectural (e.g., accessibility of facilities and knowledgeable instructors). More individuals with tetraplegia reported concerns over exercise being too difficult and that health concerns kept them from exercising. Greater number of concerns was significantly related to higher levels of perceived stress. CONCLUSIONS: People with spinal cord injury face multiple barriers to physical fitness in functional, psychological, and architectural domains. Identification of these barriers can facilitate the participation of individuals with spinal cord injury in an exercise program, improving long-term health and wellness.

Assessment of a holistic wellness program for persons with spinal cord injury.

OBJECTIVE: To test the effectiveness of a holistic (comprehensive and integrated) wellness program for adults with spinal cord injury. DESIGN: A total of 43 adults with spinal cord injury were randomly assigned to intervention or control groups. The intervention group attended six half-day wellness workshops during 3 mos, covering physical activity, nutrition, lifestyle management, and prevention of secondary conditions. Outcome measures included several physical measures and standard psychosocial measures. Statistical analyses included paired t tests, used to determine within-group differences, and multiple regression conducted to assess between-group differences. RESULTS: When comparing within-group baseline and final results, the intervention group reported fewer and less severe secondary conditions by the end of the study. Similarly, significant improvements were found in health-related self-efficacy and health behaviors. No significant changes in physiologic variables were observed. Although no significant between-group differences were observed, regression analyses suggested participation in the wellness program may be associated with improved health behaviors. CONCLUSION: Within-group comparisons suggest improvements in several areas of the participants' overall health behaviors. These findings, although preliminary, emphasize the potential role of health behaviors in positively influencing long-term health outcomes and quality of life.

Two-year prospective study of relative risk of a second cerebral concussion.

OBJECTIVE: To prospectively measure the relative risk of cerebral concussion among those with a history of concussion compared with those having no previous concussions by using a population of high school and college football players. DESIGN: A representative national sample of high school and college football players was followed for two football seasons over a 2-yr period (1997-1998) as part of a national football injury surveillance project. There were a total of 15,304 player-seasons and over 1 million athlete-exposures to the possibility of injury in practices and games; 975 of the player-seasons (6.4%) had a history of concussion in the previous 5 yr. RESULTS: There were 572 concussions recorded, 161 among those with a history (16.5%) and 411 among those with no history (2.9%). Relative risk for individuals with a history of concussion is 5.8 times greater than for individuals with no history (95% confidence interval, 4.8-6.8). CONCLUSION: This large prospective cohort study indicates the risk of sustaining a cerebral concussion is nearly six times greater for individuals with a history of concussion than for individuals with no such history.