Abstract. Objective: Although interruptions have been shown in aviation and other work settings to result in error with serious and sometimes fatal consequences, little is known about interruptions in the emergency department (ED). The authors conducted an observational, time-motion task-analysis study to determine the number and types of interruptions in the ED. Methods: Emergency physicians were observed in three EDs located in an urban teaching hospital, a suburban private teaching hospital, and a rural community hospital. A single investigator followed emergency staff physicians for 180-minute periods and recorded tasks, interruptions, and breaks-intask. An ''interruption'' was defined as any event that briefly required the attention of the subject but did not result in switching to a new task. A ''break-intask'' was defined as an event that required the attention of the physician for more than 10 seconds and subsequently resulted in changing tasks. Results:The mean (ϮSD) total number of patients seen at all three sites during the 180-minute study period was 12.1 Ϯ 3.7 patients (range 5-20). Physicians performed a mean of 67.6 Ϯ 15.7 tasks per study period. The mean number of interruptions per 180-minute study period was 30.9 Ϯ 9.7 and the mean number of breaks-in-task was 20.7 Ϯ 6.3. Both the number of interruptions (r = 0.63; p < 0.001) and the number of breaks-in-task (r = 0.56; p < 0.001) per observation period were positively correlated with the average number of patients simultaneously managed. Conclusions: Emergency physicians are ''interruptdriven.'' Emergency physicians are frequently interrupted and many interruptions result in breaks-intask. Key words: attention; emergency medicine; human engineering; medical errors; task performance and analysis. ACADEMIC EMERGENCY MEDICINE 2000; 7:1239-1243 A S ANY parent knows, task interruption has a marked influence on human efficiency.

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OBJECTIVE To provide an update on the efficacy and safety of tadalafil, a phosphodiesterase‐5 inhibitor, in the treatment of erectile dysfunction (ED). PATIENTS AND METHODS In all, 2102 men (mean age 56 years) with mild‐to‐severe ED of various causes were randomized to placebo or tadalafil, taken as needed with no food restrictions, at fixed ‘on‐demand’ doses of 10 or 20 mg in 11 randomized, double‐blind, placebo‐controlled trials lasting 12 weeks. The three co‐primary outcomes were changes from baseline in the erectile function domain of the International Index of Erectile Function (IIEF) and the proportion of ‘yes’ responses to questions 2 and 3 of the Sexual Encounter Profile (SEP). Additional efficacy instruments included a Global Assessment Question (GAQ). RESULTS Compared with placebo, tadalafil gave significantly better outcomes. Patients receiving either dose of tadalafil had a significant mean improvement of 6.5 and 8.6, respectively, in the IIEF erectile function domain score from baseline (P < 0.001 vs placebo). At both doses the mean success rate for intercourse attempts (SEP‐Q3) was 58% and 68%, respectively, compared with 31% in the placebo group (P < 0.001), and 71% and 84% reported improved erections at the endpoint (GAQ), vs 33% on placebo (P < 0.001). Tadalafil was effective up to 36 h after dosing and was effective regardless of disease severity and causes, and in patients of all ages. The most frequent adverse events were headache, dyspepsia, back pain and myalgia. CONCLUSION Tadalafil was an effective and well‐tolerated treatment for ED.

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ABSTRACT:The most widely used reference values for human semen and sperm variables were developed by the World Health Organization (WHO) to help assess the fertility status of men interested in reproduction (typically a younger population). In this retrospective analysis, data from a large population of men aged 45 years or older were analyzed to derive semen and sperm reference ranges for an older population. Baseline semen samples were obtained from 1174 men with no or mild erectile dysfunction (ED) during the screening phase of two clinical trials evaluating the effects of a drug on human spermatogenesis. The median values and 95% reference ranges for 4 measured semen and sperm parameters (semen volume, sperm concentration, sperm motility, and sperm morphology) and 1 derived parameter (total sperm count) were calculated for the population and by age quartile. These references ranges were compared to established WHO reference values. Associations between the semen and sperm parameters and smoking status, alcohol use, and serum hormone concentrations were also analyzed. The mean age was 52.9 years (range: 45-80). Median semen volume, sperm motility, and sperm morphology parameters declined significantly with age. Only 46% of study subjects had baseline values for semen and sperm parameters that met or surpassed all the WHO reference values. This is the first study to statistically derive semen reference ranges from a large population of men aged 45 years or older. The observation that less than half the men in this study met all 4 WHO reference values for measured semen and sperm parameters underscores the need for age-specific reference ranges.