Interrater reliability in myofascial trigger point examination

The myofascial trigger point (MTrP) is the hallmark physical finding of the myofascial pain syndrome (MPS). The MTrP itself is characterized by distinctive physical features that include a tender point in a taut band of muscle, a local twitch response (LTR) to mechanical stimulation, a pain referral pattern characteristic of trigger points of specific areas in each muscle, and the reproduction of the patient's usual pain. No prior study has demonstrated that these physical features are reproducible among different examiners, thereby establishing the reliability of the physical examination in the diagnosis of the MPS. This paper reports an initial attempt to establish the interrater reliability of the trigger point examination that failed, and a second study by the same examiners that included a training period and that successfully established interrater reliability in the diagnosis of the MTrP. The study also showed that the interrater reliability of different features varies, the LTR being the most difficult, and that the interrater reliability of the identification of MTrP features among different muscles also varies.

A Mutation in the Arabidopsis TFL1 Gene Affects Inflorescence Meristem Development

We present the initial phenotypic characterization of an Arabidopsis mutation, terminal flower 1-1 (tfl1-1), that identifies a new genetic locus, TFL1. The tfl1-1 mutation causes early flowering and limits the development of the normally indeterminate inflorescence by promoting the formation of a terminal floral meristem. Inflorescence development in mutant plants often terminates with a compound floral structure consisting of the terminal flower and one or two subtending lateral flowers. The distal-most flowers frequently contain chimeric floral organs. Light microscopic examination shows no structural aberrations in the vegetative meristem or in the inflorescence meristem before the formation of floral buttresses. The wild-type appearance of lateral flowers and observations of double mutant combinations of tfl1-1 with the floral morphogenesis mutations apetala 1-1 (ap1-1), ap2-1, and agamous (ag) suggest that the tfl1-1 mutation does not affect normal floral meristems. Secondary flower formation usually associated with the ap1-1 mutation is suppressed in the terminal flower, but not in the lateral flowers, of tfl1-1 ap1-1 double mutants. Our results suggest that tfl1-1 perturbs the establishment and maintenance of the inflorescence meristem. The mutation lies on the top arm of chromosome 5 approximately 2.8 centimorgans from the restriction fragment length polymorphism marker 217.

The type III histone deacetylase Sirt1 is essential for maintenance of T cell tolerance in mice

Although many self-reactive T cells are eliminated by negative selection in the thymus, some of these cells escape into the periphery, where they must be controlled by additional mechanisms. However, the molecular mechanisms underlying peripheral T cell tolerance and its maintenance remain largely undefined. In this study, we report that sirtuin 1 (Sirt1), a type III histone deacetylase, negatively regulates T cell activation and plays a major role in clonal T cell anergy in mice. In vivo, we found that loss of Sirt1 function resulted in abnormally increased T cell activation and a breakdown of CD4+ T cell tolerance. Conversely, upregulation of Sirt1 expression led to T cell anergy, in which the activity of the transcription factor AP-1 was substantially diminished.Furthermore, Sirt1 interacted with and deacetylated c-Jun, yielding an inactive AP-1 factor. In addition, Sirt1-deficient mice were unable to maintain T cell tolerance and developed severe experimental allergic encephalomyelitis as well as spontaneous autoimmunity. These findings provide insight into the molecular mechanisms of T cell activation and anergy, and we suggest that activators of Sirt1 may be useful as therapeutic agents for the treatment and/or prevention of autoimmune diseases.

A Mutation in the Arabidopsis TFL1 Gene Affects Inflorescence Meristem Development

We present the initial phenotypic characterization of an Arabidopsis mutation, terminal flower 1-1 (tfl1-1), that identifies a new genetic locus, TFL1. The tfl1-1 mutation causes early flowering and limits the development of the normally indeterminate inflorescence by promoting the formation of a terminal floral meristem. Inflorescence development in mutant plants often terminates with a compound floral structure consisting of the terminal flower and one or two subtending lateral flowers. The distal-most flowers frequently contain chimeric floral organs. Light microscopic examination shows no structural aberrations in the vegetative meristem or in the inflorescence meristem before the formation of floral buttresses. The wild-type appearance of lateral flowers and observations of double mutant combinations of tfl1-1 with the floral morphogenesis mutations apetala 1-1 (ap1-1), ap2-1, and agamous (ag) suggest that the tfl1-1 mutation does not affect normal floral meristems. Secondary flower formation usually associated with the ap1-1 mutation is suppressed in the terminal flower, but not in the lateral flowers, of tfl1-1 ap1-1 double mutants. Our results suggest that tfl1-1 perturbs the establishment and maintenance of the inflorescence meristem. The mutation lies on the top arm of chromosome 5 approximately 2.8 centimorgans from the restriction fragment length polymorphism marker 217.

Burnout, depression, life and job satisfaction among Canadian emergency physicians

Our goal was to determine the level of burnout, depression, life and job satisfaction of Canadian emergency physicians. Six instruments were administered: the emotional exhaustion, depersonalization, and personal accomplishment intensity subscales of the Maslach Burnout Inventory (MBI); the Centre for Epidemiologic Research Self-Report Depression Scale (CES-D); the Satisfaction With Life Scale (SWLS); and the Emergency Physician Job Satisfaction Measurement Instrument (EPJS). Forty-six percent of the sample fell within the medium to high level of emotional exhaustion, 93% within the medium to high range for depersonalization, and 79% within the medium to low range for personal accomplishment. Sixty-one percent were satisfied with their lives, and 75.5% were satisfied with their jobs. Multiple regression analysis showed that increased age, being a department head, and increased weeks of holiday per year were positive contributors to EPJS scores (P < 0.05). Involvement in medical education, increased clinical hours worked per year, and region of residence-Quebec were negative contributors to EPJS scores (P < 0.05). Involvement in medical education is a significant factor among physicians experiencing depressive symptomatology. Time away from clinical practice is important to job satisfaction and emotional well-being.

Genetic Interactions That Regulate Inflorescence Development in Arabidopsis

In Arabidopsis, floral meristems arise in continuous succession directly on the flanks of the inflorescence meristem. Thus, the pathways that regulate inflorescence and floral meristem identity must operate both simultaneously and in close spatial proximity. The TERMINAL FLOWER 1 (TFL1) gene of Arabidopsis is required for normal inflorescence meristem function, and the LEAFY (LFY), APETALA 1 (AP1), and APETALA 2 (AP2) genes are required for normal floral meristem function. We present evidence that inflorescence meristem identity is promoted by TFL1 and that floral meristem identity is promoted by parallel developmental pathways, one defined by LFY and the other defined by AP1/AP2. Our analysis suggests that the acquisition of meristem identity during inflorescence development is mediated by antagonistic interactions between TFL1 and LFY and between TFL1 and AP1/AP2. Based on this study, we propose a simple model for the genetic regulation of inflorescence development in Arabidopsis. This model is discussed in relation to the proposed interactions between the inflorescence and the floral meristem identity genes and in regard to other genes that are likely to be part of the genetic hierarchy regulating the establishment and maintenance of inflorescence and floral meristems.

A systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches and officials

BACKGROUND

The aim of the current study was to conduct a systematic review determining the effect of sport-specific mental health awareness programs to improve mental health knowledge and help-seeking among sports coaches, athletes and officials. The second aim was to review the study quality and to report on the validity of measures that were used to determine the effectiveness of programs.

METHODS

Sport-specific mental health awareness programs adopting an experimental or quasi-experimental design were included for synthesis. Six electronic databases were searched: PsycINFO, MEDLINE (OVID interface), Scopus, Cochrane, CINAHL and SPORTDiscus. Each database was searched from its year of inception to October 2016. Risk of bias was assessed using the Cochrane and QATSQ tools.

RESULTS

Ten studies were included from the 1216 studies retrieved: four comprising coaches or service providers, one with officials, four with athletes, and one involved a combination of coaches and athletes. A range of outcomes was used to assess indices of mental health awareness and well-being. Mental health referral efficacy was improved in six studies, while three reported an increase in knowledge about mental health disorders. However, seven studies did not report effect sizes for their outcomes, limiting clinically meaningful interpretations. Furthermore, there was substantial heterogeneity and limited validity in the outcome measures of mental health knowledge and referral efficacy. Seven studies demonstrated a high risk of bias.

CONCLUSIONS

Further, well-designed controlled intervention studies are required. Researchers, practitioners and policy makers should adhere to available methodological guidance and apply the psychological theory of behaviour change when developing and evaluating complex interventions.

TRIAL REGISTRATION

PROSPERO CRD42016040178.

Measurement of upper esophageal sphincter pressure. Effect of acute emotional stress

Recent studies suggest that resting upper esophageal sphincter pressure is more labile than previously thought, being augmented during rapid manometric pull-through and markedly decreased during sleep and anesthesia. The effect of acute emotional stress on resting upper esophageal sphincter pressure was evaluated in 13 normal subjects with a manometric sleeve assembly. Manometric sideholes were positioned in the pharynx and cervical and thoracic esophagus while the sleeve sensor straddled the upper esophageal sphincter. Subjects were stressed intermittently by 14-min periods of a dichotic listening task. As incentive, a financial reward was offered and made commensurate with performance. Alterations of heart rate, blood pressure, and skin conductance confirmed the effectiveness of the stressor. The overall mean upper esophageal sphincter pressure during control periods was 46.5 mmHg (SEM = 4.7). During stress there was a significant mean increase (11.8 +/- 2.9 mmHg; p = 0.002) in upper esophageal sphincter pressure from control levels, and the pressure increase during the first 2-min epoch of stress was 20.8 +/- 3.9 mmHg (p = 0.0003). Emotional stress causes significant elevation of upper esophageal pressure in normal subjects. This effect is likely to influence resting sphincter pressure measurements, particularly if measurement conditions are stressful to the subject.

Effect of dietary fiber on symptoms and rectosigmoid motility in patients with irritable bowel syndrome. A controlled, crossover study

The aims of this study were to determine (a) whether dietary fiber supplements modify symptoms in patients with irritable bowel syndrome, (b) the effect of fiber on rectosigmoid pressures, and (c) the relationship, if any, between rectosigmoid pressure and symptoms. Fourteen patients entered and 9 completed a double-blind, controlled, cross-over study of 7 mo duration. The mean age was 26 yr (range, 18-37). Patients received 4 cookies daily containing 20 mg corn fiber or placebo. Symptoms and compliance were evaluated monthly. Rectosigmoid pressures and dietary intake were evaluated at the outset and completion of each study arm. Symptoms improved during both fiber and placebo treatments. Those symptoms demonstrating significant improvement with time were pain severity, stool frequency, stool consistency (p = 0.001), number of additional gastrointestinal symptoms present (p = 0.02), and total symptom score (p less than 0.001). Rectosigmoid pressures were not significantly altered by fiber or placebo. Fasting pressures at the distal recording site tended to correlate with pain severity (r = 0.6; p = 0.06). It was concluded that (a) corn fiber and placebo were both effective in alleviating symptoms, (b) there was a correlation between symptom severity and fasting rectosigmoid pressure, and (c) there was a trend toward reduction in fasting and postprandial rectosigmoid pressures after fiber therapy.

Identifying lumbosacral radiculopathies: an optimal electromyographic screen

OBJECTIVE

The objective of this study was to determine prospectively the optimal electromyographic screening examination of the lower limb that ensures identification of those lumbosacral radiculopathies that can be electrodiagnostically confirmed, yet minimizes the number of muscles studied.

DESIGN

A prospective multicenter study was conducted from May 1996 to September 1997. Patients with suspected lumbosacral radiculopathy referred to participating electrodiagnostic laboratories were recruited and examined by needle electromyography using a standard set of muscles. Patients with electrodiagnostically confirmed lumbosacral radiculopathies were selected for analysis. Various muscle screens were tested against this group of patients with radiculopathies to determine the frequency with which each screen identified the patient with radiculopathy.

RESULTS

There were 102 patients identified. When paraspinal muscles were one of the screening muscles, four-muscle screens identified 88-97% of the radiculopathies, five-muscle screens identified 94-98%, and six-muscle screens 98-100%. When paraspinal muscles were not part of the screen, identification rates were lower for all screens, and eight distal muscles were necessary to identify about 90% of the radiculopathies.

CONCLUSIONS

Six-muscle screens with paraspinal muscles yielded consistently high identification rates. Studying additional muscles produced no improvements in identification.

Energy balance and nitrogen balance in growing low birthweight infants fed human milk or formula

Energy and nitrogen balances were measured in growing low birthweight infants fed either mother's expressed breast milk or a 20 kcal per ounce formula to determine whether or not there were differences between the two dietary groups in (1) the partition of energy among excretion, expenditure, and storage and (2) the relation of energy storage and nitrogen retention to weight gain. There were no significant differences between the human milk fed infants and formula fed infants in gross energy intake, metabolizable energy intake, nitrogen intake, or nitrogen retention. Energy expenditure was significantly lower in the human milk fed infants than in formula fed infants (221 kJ/(kg. day) and 244 kJ/(kg. day), respectively). There was no difference in mean energy storage between the two groups. Although weight gains were similar in both dietary groups, the ratio of energy storage to weight gain was significantly greater in infants fed with human milk (15.3 kJ/g, S.D. 2.0) than in infants fed formula (13.2 kJ/g S.D. 1.8). There was no significant difference between the two groups in the ratio of nitrogen stored to weight gain.

Perceived coercion in voluntary hospital admission

The legal status of service users admitted to psychiatric wards is not synonymous with the level of coercion that they can perceive during the admission. This study aimed to identify and describe the proportion of individuals who were admitted voluntarily but experienced levels of perceived coercion comparable to those admitted involuntarily. Individuals admitted voluntarily and involuntarily to three psychiatric hospitals were interviewed using the MacArthur Admission Experience Interview and the Structured Clinical Interview for DSM-IV diagnoses. One hundered sixty-one individuals were interviewed and 22% of the voluntarily admitted service users had levels of perceived coercion similar to that of the majority of involuntarily admitted service users. Voluntarily admitted service users who experienced high levels of perceived coercion were more likely to have more severe psychotic symptoms, have experienced more negative pressures and less procedural justices on admission. Individuals brought to hospital under mental health legislation but who subsequently agreed to be admitted voluntarily and those treated on a secure ward also reported higher levels of perceived coercion. It needs to be ensured that if any service user, whether voluntary or involuntary, experiences treatment pressures or coercion that there is sufficient oversight of the practice, to ensure that individual's rights are respected.

Effect of history and exam in predicting electrodiagnostic outcome among patients with suspected lumbosacral radiculopathy

OBJECTIVE

To determine the extent to which the history and physical examination predict the outcome of the electrodiagnostic (EDX) evaluation in patients with suspected lumbosacral radiculopathy.

DESIGN

Data for 170 subjects referred for low-back and lower limb symptoms were prospectively collected at five EDX laboratories. The sensitivity, specificity, positive and negative predictive values, and odds ratios were determined for symptoms and neurologic signs.

RESULTS

Symptoms were not significantly associated with an EDX study or a lumbosacral radiculopathy. The physical examination was better at predicting that an EDX study would be abnormal in general than it was at predicting a lumbosacral radiculopathy in particular. Of those subjects with normal physical examinations, 15%-18% still had abnormal EDX findings.

CONCLUSIONS

In a population of patients referred for an EDX study, the history and physical examination alone cannot reliably predict electrodiagnostic outcome.

Sequestration and turnover of guinea-pig milk proteins and chicken ovalbumin in Xenopus oocytes

The stability and distribution of proteins within the living cell can be studied using Xenopus laevis oocytes. Microinjection of messenger RNAs and secretory proteins, followed by cell fractionation, shows that transfer of ovalbumin and milk proteins across intracellular membranes of the oocyte only occurs during their synthesis. Thus milk protein primary translation products, made in the wheat germ cell-free system, when injected into oocytes remain in the cytosol and are not recovered within membrane vesicles. Such miscompartmentalized primary milk proteins are rapidly degraded (t 1/2 0.6 +/- 0.1 h). In contrast, processed milk proteins, extracted from oocytes injected with mammary gland RNA, are relatively stable when introduced into the cytosolic compartment (t 1/2 alpha-lactalbumin 20 +/- 8 h, casein A 6 h, casein B 4 h, casein C 8.3 h). The primary ovalbumin product is also stable (t 1/2 22 +/- 9 h). Indirect evidence that rapid degradation of miscompartmentalized milk protein primary translation products may occur in vivo was obtained by the injection of massive amounts of ovalbumin and milk protein mRNA. Under these conditions there is no accumulation of primary milk protein translation products, but a polypeptide resembling the unglycosylated ovalbium wheat germ primary product can be detected in the cytosol. Only the glyclosylated forms of ovalbumin are found in the oocyte membrane vesicle fraction. We discuss the roles played by the presence of detachable signal sequences and the absence of secondary modifications in determining the rate of degradation of primary translation products within the cytosol.

Development of the emergency physician job satisfaction measurement instrument

The objective of this study was to develop a valid and reliable instrument to measure the job satisfaction of physicians practicing emergency medicine. A prospective survey involving four separate stages (an item evaluation and reduction stage, a factor analysis stage, a construct validity stage, and a reliability stage) was distributed in Canada to full-time emergency physicians. Three separate survey instruments were administered (an initial draft instrument with 228 items, a pilot instrument with 142 items, and the final instrument with 79 items). Construct validity of the final instrument was tested by evaluating the correlation between physician scores on the instrument, and scores on two instruments measuring the same construct, and three measuring different but related constructs. A draft instrument with 228 items and six hypothetical domains was tested on 61 physicians. Evaluation for frequency endorsement, redundancy, and homogeneity reduced the item pool to 157. The remaining 157 items were used as a pilot instrument and tested on 223 physicians. Factor analysis eliminated 66 items from the pilot instrument, creating a final instrument with 79 items, 11 factors, and six domains. Cronbach's coefficient alpha for the final instrument domains is 0.81, and all domain-total correlations are greater than 0.4. All correlations between the final instrument and the construct validity instruments were statistically significant (P < .001), but not so high that they appeared to be measuring the same thing. Correlations between instruments measuring the same construct were higher than those measuring related but different constructs. Correlations between the final instrument and the CES-D scale, emotional exhaustion, and depersonalization subscales of the Maslach Burnout Inventory were negative. A test-retest reliability study on 42 physicians showed Pearson's correlation coefficients for individual domains were all greater than 0.7 and greater than 0.8 for the final instrument. This study has produced a valid and reliable instrument for measuring emergency physician job satisfaction, which is both internally consistent and stable.

Identification of cervical radiculopathies: optimizing the electromyographic screen

OBJECTIVE

To determine the optimal electromyography screening examination of the upper limb that ensures detection of those cervical radiculopathies, which can be electrodiagnostically confirmed, yet minimizes the number of muscles studied.

DESIGN

A prospective multicenter study was conducted from May 1996 to September 1997 at five institutions. Patients who were referred to participating electrodiagnostic laboratories with suspected cervical radiculopathy were recruited. A standard set of muscles were examined by needle electromyography. Patients with electrodiagnostically confirmed cervical radiculopathies, based on electromyography findings, were selected for analysis. Muscle screens were tested against this group to determine whether the screen identified the patients with radiculopathy.

RESULTS

There were 101 patients with cervical radiculopathies representing all cervical root levels. When paraspinal muscles were one of the screening muscles, five muscle screens identified 90% to 98% of radiculopathies, six muscle screens identified 94% to 99%, and seven muscle screens identified 96% to 100%. When paraspinal muscles were not part of the screen, eight distal limb muscles recognized 92% to 95% of radiculopathies.

CONCLUSION

This study demonstrated that six muscle screens including paraspinal muscles yielded consistently high identification rates. Studying additional muscles led to marginal increases in identification.

Predicting electrodiagnostic outcome in patients with upper limb symptoms: are the history and physical examination helpful?

OBJECTIVE

To determine the effectiveness of medical history and physical examination in predicting electrodiagnostic outcome in patients with suspected cervical radiculopathy.

METHODS

Data on 183 subjects prospectively collected at five different electrodiagnostic laboratories were analyzed (96 cervical radiculopathies, 45 normal studies, and 42 abnormal electrodiagnostic findings other than radiculopathy). The sensitivity, specificity, positive predictive value, negative predictive value, and odds ratios were determined for symptoms and neurologic signs.

RESULTS

Symptoms of numbness, weakness, and tingling were associated with twice the probability of having abnormal electrodiagnostic study results in general, yet were not helpful in identifying a cervical radiculopathy. All single and combined physical examination components had poor sensitivities, with the exception of weakness, but much higher specificities. Patients with either weakness or reduced reflexes on physical examination were up to five times more likely to have abnormal electrodiagnostic findings. In subjects with any abnormal neurologic sign, the sensitivity improved to 84%, the positive predictive value was 79%, but the specificity was low (44%). Of those subjects with normal physical examination results, almost one half had an abnormal electrodiagnostic study result (negative predictive value 52%).

CONCLUSIONS

In a population of patients with suspected cervical radiculopathy, medical history and physical examination are helpful yet not sufficient to predict the electrodiagnostic outcome.

International consensus statement on the psychosocial and policy-related approaches to mental health awareness programmes in sport

Background

Research focused on mental health in sport has revealed a need to develop evidence-supported mental health practices that are sensitive to sport culture, particularly for non-elite athletes. A consensus statement was produced to assist effective mental health awareness in sport and guide programme implementation in this rapidly emerging field.

Method

The AGREE Reporting Checklist 2016 was used in two international expert consultation meetings, followed by two online surveys. Experts from 10 countries and over 30 organisations contributed.

Results

Six objectives were agreed: (1) to define mental health awareness and service implementation constructs for inclusion in programmes delivered in sporting environments; (2) to identify the need to develop and use valid measures that are developmentally appropriate for use in intervention studies with sporting populations, including measures of mental health that quantify symptom severity but also consider causal and mediating factors that go beyond pathology (ie, well-being and optimisation); (3) to provide guidance on the selection of appropriate models to inform intervention design, implementation and evaluation; (4) to determine minimal competencies of training for those involved in sport to support mental health, those experiencing mental illness and when to refer to mental health professionals; (5) to provide evidence-based guidance for selecting mental health awareness and implementation programmes in sport that acknowledge diversity and are quality assured; and (6) to identify the need for administrators, parents, officials, coaches, athletes and workers to establish important roles in the promotion of mental health in various sports settings.

Conclusion

This article presents a consensus statement on recommended psychosocial and policy-related approaches to mental health awareness programmes in sport.

A controlled evaluation of a national continuing medical education programme designed to improve family physicians' implementation of diabetes-specific clinical practice guidelines

AIMS

New approaches to continuing medical education will facilitate the implementation of clinical practice guidelines. This study assessed the short and long-term impact of a 7-h, small group workshop on family physicians' attitude, knowledge and self-reported practice patterns regarding diabetes mellitus.

METHODS

One hundred and seventy-seven of 1807 family physicians who participated in this nationwide workshop, and 113 non-participant controls completed two validated questionnaires. Participants completed one questionnaire before the workshop and a second equivalent questionnaire 1 month later. Non-participant controls also completed the two questionnaires 1 month apart. Between 8 and 24 months later, these individuals were mailed the same questionnaire they completed on the first occasion; 143 participants and 50 controls returned this third questionnaire.

RESULTS

Participants were more likely to be female (P = 0.03), not certified in family practice (P = 0.02), in a smaller centre (P = 0.0005), recent medical graduates (P = 0.001) and seeing fewer patients per month (P = 0.01) than controls. Compared to controls, participants had improved their attitude (P<0.0001), knowledge (P = 0.04) and self-reported practice patterns (P<0.002) regarding diabetes after 1 month but not after 1 year.

CONCLUSIONS

An interactive, small group, diabetes continuing education programme effectively disseminates practice guidelines to family physicians. The impact of such a programme declines after 1 year.

Morphactin-Induced Parthenocarpy in the Cucumber

Parthenocarpy was induced in cucumber Cucumis sativus L. by foliar application of morphactin. Morphactin (chlorfluorenol) was most effective in inducing parthenocarpy when applied in the flowering stage, and the response was enhanced by prior treatment with Ethrel (2-chloroethylphosphonic acid). Morphactin stimulated pistillate flower development in a monoecious cultivar but did not modify sex expression of a gynoecious line.

Predictive validity of the emergency physician and global job satisfaction instruments

OBJECTIVE

To evaluate the predictive validity of the Emergency Physician Job Satisfaction (EPJS) and Global Job Satisfaction (GJS) instruments.

METHODS

Prospective mail survey of 223 Canadian emergency physicians (EPs) using a 42-item questionnaire, including 14 items evaluating their reasons for leaving emergency medicine (EM). Original (1990) EPJS and GJS scores were analyzed using 1-way ANOVA and Scheffe's test comparing the physicians who left EM with those still in their original jobs, and those who had left their original jobs but who stayed in EM. Mean scores on the 14 "reason for leaving" items were compared with scores from an earlier sample of U.S. physicians using a t-test for independent means. Criteria for statistical significance were set at alpha = 0.05 for all analyses.

RESULTS

The response rate for the primary study questions was 99.1%. Of the respondents, 29.4% had left their original jobs, and 10.4% had left EM altogether. The GJS scores for the physicians who left EM were significantly different from those for the physicians who stayed (p = 0.004). The EPJS scores for the physicians who left EM were not significantly different from those for the physicians who stayed (p = 0.56). There was no significant difference in scores between the Canadian and U.S. physicians' reasons for leaving EM (all p-values > 0.05). Shiftwork scored the highest as a reason to leave EM.

CONCLUSIONS

A low GJS score is associated with physicians' leaving EM, but not with changing jobs. The EPJS instrument was not associated with either outcome. Canadian and U.S. EPs place similar levels of importance on potential reasons for leaving EM.

Symptom duration and spontaneous activity in lumbosacral radiculopathy

OBJECTIVES

A long-held notion in the electrodiagnostic literature is that paraspinal muscles tend to show spontaneous activity (fibrillations and positive sharp waves) on needle electromyography, early on in a lumbosacral radiculopathy, and that more distal muscles become abnormal later in the disease process. The purpose of this study was to determine whether paraspinal muscle and other major proximal and distal muscle spontaneous activity is related to a lumbosacral radiculopathy symptom duration.

METHODS

A multicenter, prospective study that collected standard information on history, physical examination, and electrodiagnostic findings in patients with electrodiagnostically confirmed lumbosacral radiculopathies was undertaken.

RESULTS

Multivariate probit analyses of 96 patients identified with a lumbosacral radiculopathy showed no evidence of correlation between spontaneous activity in the paraspinal muscles and symptom duration. Symptom duration was also nonsignificant in nine of the remaining ten lower limb muscles analyzed.

CONCLUSION

These findings emphasize the limitations of using symptom duration when interpreting electrodiagnostic findings in lumbosacral radiculopathy.