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Biomedical subjects

J A DeLisa

Publications and source records attributed to J A DeLisa.

At least 19 recordsLinked to original sources
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↗
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↗
PubMed1990

Needle electrode insertion into tibialis posterior. A new approach.

The tibialis posterior can be a valuable muscle in the electrodiagnostic evaluation of the sacral plexus, lumbosacral roots, lower extremity neuropathies and tibial nerve lesions. It may be under utilized, however, because it is generally considered to be inaccessible to needle examination. The purpose of this study was to compare the widely recommended posterior approach to this muscle to an anterior approach that we define. In six cadaver legs, the safe access to this muscle via the anterior approach was 16.8 +/- 5 mm by contrast to 9.5 +/- 2 mm by the posterior approach. We conclude that the anterior approach to needle electromyography of the tibialis posterior muscle is easier, safer and deserves more widespread practice.

Cadaver↗
PubMed1990

Deep peroneal sensory nerve. Standardization in nerve conduction study.

Ankle or foot pain may be due to various clinical conditions. Injury or entrapment of the deep peroneal sensory nerve is part of the differential diagnosis; however, no technique studying the deep peroneal sensory conduction velocity has been described. We describe a technique that is simple and reproducible with averaging. We electrophysiologically studied the deep peroneal sensory nerve in 40 neurologically healthy adult subjects. The latency to onset of the sensory action potential was 2.9 +/- 0.4 ms (range = 2.1-3.6 ms). The latency to the peak of the sensory action potential was 3.6 +/- 0.4 ms (range = 2.7-4.2 ms). The conduction velocity was 42 +/- 5 m/s (range = 33-53 m/s). The amplitude was 3.4 +/- 1.2 microV (range = 1.6-6.6 microV). We conclude that the deep peroneal sensory nerve is readily accessible for electrophysiologic evaluation. It may be of value in diagnosing deep peroneal nerve pathology.

Action Potentials↗
PubMed1990

Research in physical medicine and rehabilitation. XI. Research training: setting the stage for lifelong learning.

This is the summary article in our research series. We have attempted to provide useful information for persons at all levels of research training, from the student to the clinician with a collaborative but not active role, to the new clinical researcher, to the experienced faculty member. But there is much more to be learned than can be presented in a short series of articles. From this series, you should be able to make a reasoned choice about what role in research you would like to take, and seek to maintain or upgrade your research skills to accomplish that. The previous articles, exercises and references presented will guide you in independent study. The focus of this article is to help you choose an environment in which you can continue to learn and develop. Although the "ideal" place as described here may never exist, no institution is totally devoid of research possibilities and you can use this article to help seek or develop local resources you may not have considered. By extracting questions and clues from people around you, you stimulate them to "think research" even if a formal program is absent; at the least, you can ally yourself with a nearby institution which has researchers in other clinical specialties or areas of basic science. Each organization is obviously different, having different strengths and resources. It is up to each chairperson to decide what proportion of limited resources should be invested in research. Once this decision is made, it is the initiative of the individual faculty members that will make a productive department.

Education, Medical, Continuing↗
PubMed1989

Evoked potential assessment: utility in prognosis of chronic head injury.

Brainstem auditory evoked potentials (BAEP) and somatosensory evoked potentials (SSEP) were performed on 29 patients an average of 12.4 months after traumatic brain injury (TBI). The study purpose was to predict long-term outcome in chronic TBI patients by using multimodality evoked potentials (MEP), the Rancho Los Amigos Scale (RLAS), and other clinical parameters. Neither the BAEP nor SSEP correlated significantly with the cognitive level on the RLAS at the MEP study approximately one year after TBI (RLAS1). Only 11.7% of RLAS1 could be predicted by the combined study of BAEP and SSEP. BAEP and SSEP obtained about one year after TBI jointly had a 15% predictive power of the long-term follow-up RLAS score obtained 18 months after performance of the MEP (RLAS2). Stepwise regression analysis showed that the best predictive indicator of the status of long-term outcome was RLAS1 which alone can predict 60% of long-term outcome. The predictive value of combinations of RLAS1 and age improved prediction of long-term outcome to 66.8%, and the combination of RLAS1, age, and SSEP further increased the value to 72%. Perhaps the MEPs were relatively insensitive in reflecting the patient's adaptation to fixed neuronal damage since patients can perform higher cognitive function by adaptation through behavioral modification and cognitive retraining despite little structural improvement. This adaptation would result in a discrepancy between MEP and RLAS scores in the late chronic phase.

Adolescent↗
PubMed1988

Electrodiagnosis and recovery of function.

The study of electrodiagnosis with respect to recovery of function is in its infancy. There is a need for better understanding of the mechanisms of recovery and for better techniques to monitor recovery. This paper reviews the potential uses and limitations of current electrodiagnostic tests to predict and monitor neuromuscular recovery. It illustrates the use of these techniques in patients with spinal cord injury.

Adult↗