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PubMed2001

Effect of the inclusion of skimmed milk in freezing extenders on the viability of canine spermatozoa after thawing.

This study evaluated the effect of the inclusion of skimmed milk in freezing extenders on the motility, viability and acrosome morphology of canine spermatozoa after thawing. The Tris-glucose-citric acid buffer of a semen extender, which also included 20% egg yolk, 5% glycerol and 0.25% SDS, was replaced with 0, 50 or 100% skimmed milk. After thawing, the proportion of motile spermatozoa was not significantly different among semen extenders during incubation for 120 min at 37 degrees C. At 120 min after thawing sperm viability was significantly greater when an extender in which the buffer had been completely replaced by milk was used than in an extender in which the buffer had been partially replaced (P < 0.05). Acrosome morphology after thawing was similar for the three extenders tested. A considerable decrease in sperm motility and viability was observed during incubation, which may be due to concentrations of SDS that were not optimal. From these results it was concluded that the use of skimmed milk in extenders for freezing dog semen results in sperm motility and viability after thawing comparable to that obtained using a Tris-based buffer.

Animals↗

PubMedDate not supplied

Procedure of extended hilar bile duct resection and its application for hilar cholangiocarcinoma.

BACKGROUND/AIMS: Several surgical procedures from hilar bile duct resection to hepatectomy have been adopted for hilar cholangiocarcinoma. However the details of the surgical procedure and the indications for hilar bile duct resection have not been determined. METHODOLOGY: Pathohistological outcome of resected specimens in five patients undergoing extended hilar bile duct resection was reviewed and compared with 12 patients undergoing partial hepatectomy with caudate lobectomy. RESULTS: Extended hilar bile duct resection was used for older patients, cases of choledochal site and less invasive tumor. The mean lengths of the left hepatic duct (21.7 +/- 7.8 mm) and the anterior hepatic duct (18.0 +/- 3.2 mm) in the specimens resected by extended hilar bile duct resection did not differ from those seen in right and left hepatectomy, respectively. Furthermore, extended hilar bile duct resection removed partial caudal hepatic duct. However the length of the posterior hepatic duct removed by extended hilar bile duct resection (14.3 +/- 2.0 mm) was significantly less than that excised in left hepatectomy (19.3 +/- 6.6 mm) (P < 0.05). The histologic positive margin rate of the extended hilar bile duct resection group (40%) was the same as that of the hepatectomy group (50%). Papillary or nodular form tumor tended to have positive ductal margins in both surgical techniques. On the other hand, flat tumor tended to have high positive rates in both ductal and excisional margins even in hepatectomy. Two cases with positive surgical margin died of local recurrences, however another 3 cases with negative surgical margin are alive without recurrences from 8 to 20 months after surgery. CONCLUSIONS: The indication of extended hilar bile duct resection for hilar cholangiocarcinoma is limited to cases in which the infiltration is confined to the hepatic bifurcation, such as type I and type II of Bismuth classification with regard to papillary and nodular macroscopic appearance.

Aged↗

PubMed2002

Epidemiological and antibiotic resistant study on extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Zhejiang Province.

OBJECTIVE: To investigate the epidemiological status of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) and the drug resistance profiles of such organisms. METHODS: A total of 282 clinical isolates of E. coli and 180 of K. pneumoniae were collected from different districts of Zhejiang Province. Inhibitor potentiated broth dilution tests were performed for detecting extended-spectrum beta-lactamases. Etests were performed to detect the drug resistance of these strains against nine commonly used antibiotics. RESULTS: The prevalence of extended-spectrum beta-lactamases in E. coli and K. pneumoniae was 34.0% and 38.3%, respectively. The average prevalence of extended-spectrum beta-lactamases in E. coli and K. pneumoniae was 35.7%. The resistance prevalence of extended spectrum beta-lactamase producing strains to ceftazidime and cefotaxime was 40% and 26% respectively, so were those to cefepime, cefoxitin, piperacillin-tazobactam, cefoperazone-sulbactam, amikacin and ciprofloxacin. All these strains were sensitive to imipenem. CONCLUSION: The results in this study showed that the prevalence of extended-spectrum beta-lactamases was high, while extended-spectrum beta-lactamase producing strains were resistant to most antimicrobial agents except imipenem.

Drug Resistance, Bacterial↗

PubMed1992

Conserved, extended MHC haplotypes.

Extended major histocompatibility complex (MHC) haplotypes are fixed conserved regions of the short arm of the sixth human chromosome defined by their HLA-B, complotype (BF, C2, C4A, C4B), HLA-DR alleles. The regions of conservation may extend further. At least a third of normal MHC haplotypes in Caucasians are extended, and they are largely responsible for previously observed linkage disequilibrium in the region. They are relatively population-specific. Their presence has major implications for tissue transplantation, and particularly for the identification of unrelated donor-recipient pairs, since matching for extended haplotypes probably optimizes engraftment in individuals who have them. Even for those who do not, extended haplotypes provide the means for identifying likely MLR-I-negative donor-recipients, and for identifying the genes involved in this function. Extended haplotypes provide most of the markers for HLA-associated autoimmune diseases; like the MHCs of inbred and inbred recombinant strains of mice, they have aided in the analysis of the contribution of specific genes in this region to disease susceptibility and immune functions, particularly the antibody response. Finally, extended haplotypes must be taken into account when considering population genetic questions and when using HLA markers to identify individuals in forensic applications.

Asthma↗

PubMed2004

Extended-spectrum beta-lactamases in clinical isolates of Escherichia coli and Klebsiella spp. in a Singapore hospital: clinical spectrum.

INTRODUCTION: The rising prevalence of extended-spectrum beta-lactamases in gram-negative bacillary pathogens is an important clinical problem resulting from the extensive use of broad-spectrum antibiotics. The emergence of the extended-spectrum beta-lactamases increases the possibility that traditional, empiric antimicrobial regimens may be ineffective. The aims of this study are: to determine the epidemiologic characteristics and clinical outcome of patients diagnosed with infection caused by Klebsiella spp. and Escherichia coli producing extended-spectrum beta-lactamases; to define a subgroup of patients who may benefit from early, empiric therapy; and to determine the local antibiotic sensitivity pattern in order to improve antibiotic utilisation in our hospital. MATERIALS AND METHODS: A 4-month retrospective review of patients hospitalised in Changi General Hospital between November 2000 and February 2001 who were diagnosed with infection caused by isolates of Klebsiella spp. or Escherichia coli producing extended-spectrum beta-lactamases. RESULTS: During the study period, 44 % of Klebsiella spp. and 16.1 % of Escherichia coli isolates were reported as producers of the extended-spectrum beta-lactamases. Sixty-eight patients were assessed to have clinically significant infection caused by 75 isolates. Most of them were elderly, had multiple medical problems and were recently treated with beta-lactam antibiotics. There was a trend toward better outcome in patients who received adequate initial, empiric therapy. CONCLUSION: Patients with infections caused by extended-spectrum beta-lactamase producing Enterobacteriaceae have certain identifiable, common clinical characteristics. In our institution, only carbapenems remain effective against all isolates of Klebsiella spp. or Escherichia coli producing extended-spectrum beta-lactamases. Further research is necessary to define a group of patients who can benefit from an early, broad-spectrum, empiric therapy.

Aged↗

PubMed2005

Low yield for extended reading of patch tests with topical corticosteroids.

BACKGROUND: On the basis of reports that up to 30% of patch test reactions are missed if an extended reading is not performed, we required that patients who were being patch tested with the corticosteroid series return for a reading at least 1 week after placement of the allergens. OBJECTIVE: To report our institutional experience with extended readings (day 7 or beyond) of patch test reactions to the corticosteroid series. METHODS: We retrospectively reviewed patch test reactions to corticosteroids since extended readings were implemented (April 2001 to June 2004). RESULTS: A total of 135 patients were patch tested with 1,656 corticosteroid allergens. On day 5, five patients had five positive patch test reactions; by the time of the extended reading, no new reactions had developed in these patients. Of the patients with no reactions on day 5, two had a positive result at the extended reading: each had a relevant reaction to budesonide 0.1%, one on day 7 and the other on day 9. CONCLUSIONS: Only 2 reactions (to 1,656 corticosteroids) became apparent at the extended reading. Extended readings were of limited value in our experience.

Administration, Topical↗

PubMed1995

The effect of extended lymphadenectomy on survival in patients with gastric adenocarcinoma.

BACKGROUND: In the United States of America, the five-year survival rate among patients surviving curative resection for gastric carcinoma will range between 20 and 25 percent. In Japan, early diagnosis and an aggressive surgical approach including planned lymph node dissection has resulted in the five-year survival rate exceeding 50 percent for all patients with newly diagnosed gastric carcinoma. This report is a retrospective review evaluating the effect of extended lymph node dissection (D2) on overall survival in 101 patients with gastric adenocarcinoma who underwent a potentially curative gastric resection from 1975 to 1990 at Roswell Park Cancer Institute. STUDY DESIGN: Gastric carcinomas were staged according to the revised 1987 TNM classification. Lymph node dissections were defined according to the General Rules of the Japanese Research Society for Gastric Cancer. Gastric resections in this study were classified as D2.5, D2, D1.5, and D1 and divided into two groups, the extended resection group (D2, D2.5) and the limited resection group (D1, D1.5). RESULTS: The median follow-up period was 33 months. The entire group (n = 101) had an estimated five-year survival rate of 36 percent with a median survival rate of 33 months. The estimated five-year survival rate for the extended resection group (n = 46) was 49 percent with a median of 50 months compared with 27 percent and 25.7 months, respectively, for the limited resection group (n = 55, p = 0.01). Following extended resection, 74 percent of patients with stage I gastric carcinoma survived five years, 75 percent of patients with stage II carcinoma were alive at five years as were 13 percent with stage IIIA, and 30 percent with stage IIIB. Patients whose tumors fell into the classifications of T2-4, N0-1, M0 and required a total or proximal gastrectomy enjoyed a significant survival advantage undergoing an extended resection, with 44 percent surviving five years with a median of 43 months compared with 16 percent and 25 months, respectively, for patients undergoing a limited resection (p = 0.05). Of 13 patients treated with a D2 or greater resection whose gastric carcinomas metastasized to N2 lymph nodes, four patients (31 percent) survived at least five years. Only the extent of lymph node dissection and type of gastric resection proved to be significant independent predictors of overall survival. CONCLUSIONS: Patients treated by extended resection (D2, D2.5) were more likely to survive five years and had prolonged median survival times when compared with patients treated with limited resection (D1, D1.5). For patients with T2-4, N0-1, M0 gastric carcinomas treated with extended resection, their differences reached levels at or approaching statistical significance.

Adenocarcinoma↗

PubMed1994

[Surgical approach to petroclival meningioma. Value of translabyrinthine approach extended to the petrous apex].

Petro-clival meningiomas are rare tumors. Because of their deep location in the posterior fossa, many surgical approaches have been proposed, generally with severe post-operative morbidity and mortality. Thirty-six meningiomas of the petrous apex (34 posterior surface of petrous bone meningiomas, 2 clivus meningiomas) were operated, via a trans petrosal approach, from 1983 to 1993. In 14 cases, the trans-labyrinthine (TL) approach, extended by drilling the bone above the internal auditory canal (IAC) was performed (39%). In 18 cases the TL approach was extended in a subtemporal, transtentorial approach (50%). In one case (2.5%), after rerouting the facial nerve posteriorly, the TL approach was extended anteriorly in a transcochlear approach. The retro-sigmoïd approach was performed in one case (2.5%). The extended middle fossa approach was performed in two cases of clivus meningiomas (5%). Total excision was obtained in 27 cases (75%). By using the Laser, quality of resection is increased. Most complications and morbidity were encountered with tumors extending towards the cavernous sinus. Extended translabyrinthine approach allows total excision in most of cases of petro-clival meningiomas. For clivus tumors or tumors invading the cavernous sinus, the extended middle fossa approach and subtotal petrosectomy are proposed respectively.

Adult↗

PubMed1993

Comparison of outcome between extended and nonextended liver resections for neoplasms.

BACKGROUND: An aggressive approach to liver resection for neoplasms was adopted during a 5-year period. The results were evaluated by comparing the outcome between extended and nonextended liver resections. METHODS: Among 73 consecutive patients undergoing liver resections for neoplasm or suspicion of neoplasm, 33 underwent extended liver resections (26 extended right lobectomies and 7 extended left lobectomies) and 40 underwent resections of lesser extent. Mortality, morbidity, and survival between the two groups were compared. RESULTS: Overall morbidity was 21% and perioperative mortality was 5.4%. Morbidity and mortality were not significantly different between extended and nonextended liver resections (24% vs 18% and 6.1% vs 5.0%, respectively). Liver resections for extrahepatic cholangiocarcinomas were found to be associated with a higher morbidity (6 of 10) and mortality (2 of 10) when compared with liver resections for noncholangiocarcinomas. Bile leaks occurred mainly in patients with cholangiocarcinomas (4 of 6) and contributed to an increased overall morbidity in this series. After a median follow-up of 31 months, there was no difference in survival between extended and nonextended liver resections. CONCLUSIONS: Extensive liver resections for neoplasms can be carried out without significant increase in the operative risk. Short-term survival is comparable between patients undergoing extended and nonextended liver resections.

Adolescent↗

PubMed1992

Extended-wear of high oxygen-permeable quantum contact lenses.

This study was performed to investigate the effects of extended-wear of rigid aspherical high gas-permeable contact lenses on the cornea. In the study 32 subjects (62 eyes) were followed over a period of 3 to 24 months. A high gas-permeable contact lens (Dk 92), made of fluoro-silicone-acrylate copolymer, was used. Vision remained constant during the studied period. The corneal thickness decreased significantly (p less than 0.05) during the first six months. Significant changes (p less than 0.05) were found after three months in the corneal curvature, especially in the vertical meridian. No further topographical changes were noted in the period between three and six months of extended-wear. Complications, like acute red eye syndrome and bacterial infections, which may be encountered in soft lens extended-wear, were not noticed. At the end of the study 20 subjects (38 eyes, 61%) were still on extended-wear, 9 subjects (18 eyes, 29%) changed to daily wear and 3 subjects (six eyes, 10%) became unavailable for follow-up. Extended-wear of rigid aspherical high gas-permeable contact lenses may be considered as an acceptable alternative for soft lens extended-wear.

Adult↗

PubMed1991

A retrospective study of disposable extended-wear lenses in 100 patients.

A retrospective evaluation of 100 patients who wore disposable extended-wear contact lenses is presented. The patients were selected at random and were fitted with one of three lens brands approved for extended wear. There were 37 males and 63 females in the study. The mean age was 40.1 years (range, 14 to 76 years). Sixty-seven of the patients wore nondisposable extended-wear soft contact lenses before being fitted with disposable lenses. Complications were noted and included two instances of infectious ulcerative keratitis and six cases of peripheral corneal infiltrates. It is believed that the rate of complications is due to the ongoing hypoxic effect of prolonged use of extended-wear or other contact lenses and may be improved by providing a greater variety of lens fitting parameters. Disposable extended-wear lenses may be a reasonable means of vision correction in the appropriately selected patient and with proper follow-up. At the same time, caution should be exercised in the fitting and wear of disposable extended-wear lenses.

Adolescent↗

PubMed1995

Orphan prevalence and extended family care in a peri-urban community in Zimbabwe.

An orphan enumeration survey was conducted in 570 households in and around Mutare, Zimbabwe in 1992; 18.3% (95% CI 15.1-21.5%) of households included orphans. 12.8% (95% CI 11.2-14.3%) of children under 15 years old had a father or mother who had died; 5% of orphans had lost both parents. Orphan prevalence was highest in a peri-urban rural area (17.2%) and lowest in a middle income medium density urban suburb (4.3%). Recent increases in parental deaths were noted; 50% of parental deaths since 1987 could be ascribed to AIDS. Orphan household heads were likely to be older and less well-educated than non-orphan household heads. The majority of orphaned children were being cared for satisfactorily within extended families, often under difficult circumstances. Caregiving by maternal relatives represents a departure from the traditional practice of caring for orphans within the paternal extended family and an adaptation of community-coping mechanisms. There was little evidence of discrimination or exploitation of orphaned children by extended family caregivers. The fact that community coping mechanisms are changing does not imply that extended family methods of caring are about to break down. However, the emergence of orphan households headed by siblings is an indication that the extended family is under stress. Emphasis needs to be placed upon supporting extended families by utilizing existing community-based organizations. Orphan support programmes may need to be established initially in high risk communities such as low-income urban areas and peri-urban rural areas.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Rigid gas-permeable vs. hydrogel contact lenses for extended wear.

A clinical trial was conducted to compare the extended wear performance of rigid gas-permeable (RGP) contact lenses with that of soft lenses. Subjects were fitted with a RGP lens (Boston IV) in one eye and a soft lens (Bausch & Lomb "O" series) in the other eye, and wore them on an extended wear basis for up to 3 months. No subjects developed any acute adverse reactions in the RGP lens-wearing eye. After the initial adaptation period, subject acceptance of RGP extended wear in terms of vision and comfort was superior. The RGP lenses also induced less chronic hypoxic stress than hydrogel lenses of comparable Dk/L, as evidenced by the presence of epithelial microcysts. Several complications of RGP extended wear were observed including lens binding, blepharoptosis, transient pupil size increases, and corneal staining. As hypoxia-induced corneal changes, such as microcysts and striae, were observed in the RGP lens-wearing eyes, we consider that these particular RGP lenses do not have adequate oxygen transmissibility for successful long-term extended wear. However, if RGP lens materials of higher oxygen transmissibility and better designs can be attained, the potential of RGP extended wear would appear promising.

Adolescent↗

PubMed1995

Corneal epithelial permeability during extended wear of disposable contact lenses versus daily wear of soft contact lenses.

AIMS: The corneal epithelial permeability during extended wear of disposable contact lenses was compared with that during daily wear of soft contact lenses. The study was performed to verify whether the extended wear of disposable contact lenses would result in a higher permeability value than the daily wear of soft contact lenses. A higher permeability makes the cornea more vulnerable for bacterial infections and thus could explain the higher incidence of bacterial keratitis found in extended wear of disposable contact lenses in comparison with the daily wear of soft contact lenses. METHOD: The corneal epithelial permeability was determined by fluorophotometry in 33 healthy volunteers after the wear of soft, daily wear contact lenses for at least 6 months. Thereafter the determination was repeated in each volunteer after extended wear of disposable contact lenses for 1 month. The permeability in 34 healthy non-contact lens wearing volunteers was determined as a control. The permeability value was calculated from the amount of fluorescein that passed into the cornea after application by means of an eyebath. RESULTS: The mean permeability values after daily and extended wear were 0.032 nm/s and 0.031 nm/s, respectively. The values were not significantly different (Wilcoxon paired test p > 0.5). The mean permeability for the non-contact lens wearing controls was 0.042 nm/s. CONCLUSION: The results do not sustain the explanation that a difference in permeability value is the main cause of the increased incidence of keratitis during extended wear of disposable contact lenses in comparison with daily wear.

Adolescent↗

PubMed2001

Bacterial populations on 30-night extended wear silicone hydrogel lenses.

PURPOSE: Ocular infection and inflammation during hydrogel lens extended wear is often associated with colonization of the lenses with bacteria. This study compares colonization of a high Dk silicone hydrogel contact lens (lotrafilcon A) worn on a 30-night extended wear basis to a low Dk HEMA-based lens (etafilcon A) worn on a 6-night extended wear schedule. METHODS: The group wearing the low Dk/t soft contact lens (n = 63) replaced their lenses weekly and the group wearing high Dk/t soft contact lenses replaced their lenses monthly (n = 64). Lens allocation was assigned randomly at enrollment. Worn lenses, from one eye only, were collected aseptically and placed in sterile vials. Microbial growth on various media was enumerated and the number of colony forming units (cfu) per lens was calculated in categories of normal ocular microbiota (such as coagulase-negative staphylococci and Propionibacterium spp.) and known ocular pathogens (such as Staphylococcus aureus and gram-negative bacteria). The proportion of samples colonized with these bacteria and the extent of colonization were compared between the two groups. The proportion of sterile lenses was calculated, and the types of bacteria on each lens group were compared. RESULTS: No differences between the low and high Dk/t Soft contact lens groups were observed in the proportion of lenses colonized by Propionibacterium spp. (48% vs 43%, P = 0.4) or coagulase-negative staphylococci (47% vs 54%, P = 0.2). Similarly, no differences were found for lenses colonized by S. aureus (0% vs 2%, P = 0.1) or gram-negative bacteria (3% vs 2%, P = 0.8). The types of bacteria isolated from the high and low Dk/t lenses were similar. There were no differences in the number of sterile samples (28% vs 27%, P = 0.8) from each group. CONCLUSIONS: These findings suggest that high Dk/t silicone hydrogel materials are colonized by similar numbers and types of microorganisms during extended wear compared to HEMA-based material. Most lenses were colonized by commensal bacteria during 30-night extended wear with high Dk/t lenses and during 6-night extended wear with low Dk/t lenses. The incidence of sterile samples was the same between the high and low Dk/t soft contact lens groups.

Adult↗

PubMed1993

Epithelial, stromal, and endothelial responses to hydrogel extended wear.

Corneal epithelial, stromal, and endothelial edema were assessed in 19 subjects before and after a 4-month period of hydrogel contact lens extended wear. A thick hydrogel lens was worn under closed-eye conditions for 3 hours to induce stromal edema and endothelial edema (blebs), and eye bathing with a hypotonic solution was used to induce epithelial edema. Initial central stromal edema (corneal thickness) was 14.4 +/- 0.6% in response to the stress lens compared with 2.1 +/- 0.4% in the control eye (mean +/- SE). After 4 months of lens extended wear, stromal edema was significantly reduced (P < 0.0001) to 12.3 +/- 0.6% and 0.5 +/- 0.2% in test and control eyes, respectively. Adjustment of the stromal edema response at the second visit for residual edema from the extended wear accounted for some of the reduction, but the edema response remained significantly decreased (stress lens: 13.6 +/- 0.7%; and control eye: 1.2 +/- 0.4%). Endothelial edema response to the stress lens, as measured on a scale of 1 to 7, decreased from 4.6 +/- 0.3 to 2.8 +/- 0.3 over the period of extended wear. The final level was indistinguishable from that of the eye not wearing the stress lens. The epithelial edema response to hypotonic exposure was not altered with extended wear. These findings indicate that the stromal and endothelial edema responses may be unreliable diagnostic signs of the physiologic impact of hydrogel extended wear.

Adult↗

PubMed2005

Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer.

HYPOTHESIS: The required sample size of a prospective randomized trial comparing standard pancreaticoduodenectomy with pancreaticoduodenectomy plus extended lymphadenectomy for pancreatic adenocarcinoma is prohibitively large, making such a trial infeasible. DESIGN: Retrospective cohort study. SETTING: Comprehensive cancer center. PATIENTS: We identified 158 patients who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma with separate pathologic analysis of second-echelon lymph nodes, defined as lymph nodes along the proximal hepatic artery and/or the great vessels. MAIN OUTCOME MEASURES: To estimate the sample size required for a randomized trial, we devised a biostatistical model with the following assumptions: extended lymphadenectomy can benefit only patients who (1) actually have disease removed from second-echelon nodes, (2) have microscopically negative (R0) primary tumor resection margins, and (3) do not have visceral metastatic (M0) disease. RESULTS: Seventy-six patients (48.1%) had negative first- and second-echelon lymph nodes, 65 (41.1%) had positive first-echelon and negative second-echelon lymph nodes, and 17 (10.8%) had positive first- and second-echelon lymph nodes. Patients with positive second-echelon lymph nodes had an R0 resection rate of 47.1%. At a median follow-up of 65.1 months, 4 patients with positive second-echelon lymph nodes were alive, but 3 had recurrent disease. This implies that only 1 patient (5.9%) with positive second-echelon lymph nodes may have had true M0 disease. Therefore, only 0.3% of patients (10.8% with positive second-echelon lymph nodes x 47.1% with R0 resection x 5.9% with M0 disease) may achieve a survival benefit from extended lymphadenectomy. A randomized trial of standard pancreaticoduodenectomy vs pancreaticoduodenectomy with extended lymphadenectomy would require 202 000 patients in each study arm to detect such a small difference. CONCLUSIONS: Definitive evaluation of the potential benefits of extended lymphadenectomy would require a prohibitively large sample size. Adequately powered randomized trials to address the potential benefit of extended lymphadenectomy are infeasible.

Adenocarcinoma↗

PubMed2006

Extended work duration and the risk of self-reported percutaneous injuries in interns.

CONTEXT: In their first year of postgraduate training, interns commonly work shifts that are longer than 24 hours. Extended-duration work shifts are associated with increased risks of automobile crash, particularly during a commute from work. Interns may be at risk for other occupation-related injuries. OBJECTIVE: To assess the relationship between extended work duration and rates of percutaneous injuries in a diverse population of interns in the United States. DESIGN, SETTING, AND PARTICIPANTS: National prospective cohort study of 2737 of the estimated 18,447 interns in US postgraduate residency programs from July 2002 through May 2003. Each month, comprehensive Web-based surveys that asked about work schedules and the occurrence of percutaneous injuries in the previous month were sent to all participants. Case-crossover within-subjects analyses were performed. MAIN OUTCOME MEASURES: Comparisons of rates of percutaneous injuries during day work (6:30 am to 5:30 pm) after working overnight (extended work) vs day work that was not preceded by working overnight (nonextended work). We also compared injuries during the nighttime (11:30 pm to 7:30 am) vs the daytime (7:30 am to 3:30 pm). RESULTS: From a total of 17,003 monthly surveys, 498 percutaneous injuries were reported (0.029/intern-month). In 448 injuries, at least 1 contributing factor was reported. Lapse in concentration and fatigue were the 2 most commonly reported contributing factors (64% and 31% of injuries, respectively). Percutaneous injuries were more frequent during extended work compared with nonextended work (1.31/1000 opportunities vs 0.76/1000 opportunities, respectively; odds ratio [OR], 1.61; 95% confidence interval [CI], 1.46-1.78). Extended work injuries occurred after a mean of 29.1 consecutive work hours; nonextended work injuries occurred after a mean of 6.1 consecutive work hours. Injuries were more frequent during the nighttime than during the daytime (1.48/1000 opportunities vs 0.70/1000 opportunities, respectively; OR, 2.04; 95% CI, 1.98-2.11). CONCLUSION: Extended work duration and night work were associated with an increased risk of percutaneous injuries in this study population of physicians during their first year of clinical training.

Accidents, Occupational↗