Clinton E. Faulk

Critical Gastrointestinal Bleeding at an Inpatient Rehabilitation Center: Incidence, Risk Factors, and the Role of Gastrointestinal Prophylaxis

To determine the incidence of critical gastrointestinal bleeding at an inpatient rehabilitation center, the risk factors associated with said bleeding, and the role of gastrointestinal prophylaxis.

Impact of a required fourth-year medical student rotation in physical medicine and rehabilitation.

ABSTRACTThis study evaluated the impact of a 2-wk required rotation in Physical Medicine and Rehabilitation (PM&R) on fourth-year medical students’ knowledge of PM&R and attitude toward teamwork in patient care. Survey results on attitudes toward a team approach to patient care and knowledge in PM&R were compared prerotation and postrotation. One hundred thirty-eight fourth-year medical students participated in this 2-yr study. The combined response rates for the attitude and knowledge surveys were 62% and 56%, respectively. As measured by a pretest and posttest self-reported knowledge assessment, the rotation increased knowledge of PM&R (P ⩽ 0.05). Four aspects of the rotation that were rated higher by students from the second year of the rotation were role and responsibility definition, incorporation of current literature, enhancement of clinical skills, and general rotation satisfaction. The rotation provides an experience for medical students to increase their knowledge of PM&R.

The Impact of a “Search and Destroy” Strategy for the Prevention of Methicillin-Resistant Staphylococcus aureus Infections in an Inpatient Rehabilitation Facility

To determine how the implementation of a methicillin‐resistant Staphylococcus aureus (MRSA) control program in an inpatient rehabilitation facility (IRF) affects MRSA health care−associated infections (MRSA‐HAIs).

Poster 93 The Impact of Lower Extremity Dysvascular Amputation on Hypertension

Disclosures: E. Ballestas, No Disclosures. Objective: The objectives of this study were: a) establish the prevalence of diabetes in a population of patients admitted to an acute inpatient rehabilitation unit; b) establish the incidence of poorly controlled and well controlled diabetes in this population; c) evaluate for differences in function at admission, discharge and in gains made during rehabilitation between non-diabetics and diabetics (well controlled and poorly controlled). Design: Retrospective chart review of 150 charts-80 non-diabetic and 70 diabetic patients. The chart review consisted of: a) review of daily glucose levels; b) FIM levels at admission, discharge and gains made during rehabilitation. Setting: Inpatient rehabilitation unit. Interventions: N/A. Main Outcome Measures: FIM scores glucose levels. Results: 70/150 (46%) patients had diabetes and 24/70 (34%) of diabetic patients had poorly controlled diabetes (greater than 25% of daily finger sticks 200 mm/dL throughout admission). Mean FIM scores for non-diabetics: admission, 73; Discharge, 94; FIM change, 21. Mean FIM scores for diabetics: admission, 54; Discharge, 76; FIM change, 22. Mean FIM scores for well-controlled diabetics: admission, 54; discharge, 75; FIM change, 21. Mean FIM scores for poorly controlled diabetics: admission, 59; discharge, 81; FIM change, 22. Conclusions: Non-diabetics have higher levels of function at admission and discharge compared to well-controlled and poorly controlled diabetics; however, they have similar functional gains in their rehabilitation.

Poster 132 Electrodiagnostic and Functional Changes Observed in a Patient with Charcot-Marie-Tooth Type 2 Over a Decade: A Case Report

CRDs is of uncertain significance. Also unclear is the significance of dementia in this case. The association of ALS and dementia is well documented in the literature (e.g., ALS with frontotemporal dementia and Western Pacific ALS-parkinsonism-dementia complex). Current understanding of the pathophysiology implicate ubiquitinpositive inclusions, which are found in motor neurons as well as the frontal and temporal lobes in patients with both ALS and dementia. Conclusions: This case describes a unique presentation of widespread CRDs on electromyography in a patient presenting with both dementia and slowly progressive motor neuron disease.

Poster 414 The Impact of an Acute Care Hospital's Active Surveillance Program for Methicillin-resistant Staphylococcus aureus (MRSA) on Clinical Infections With MRSA in an Associated Inpatient Rehabilitation Facility

hilar lymph node that was too small to biopsy. Recommended follow-up imaging 3 months later demonstrated a significant increase in the size of the lesion. He was found to have poorly differentiated squamous cell lung carcinoma and subsequently underwent radiation therapy. A follow-up positron emission tomography suggested resolution of the tumor. He is currently able to ambulate well with a walker and is independent with all activities of daily living. Discussion: This is a case of a patient with chronic symptomatic alcoholic neuropathy who presented with acute worsening of neuropathic symptoms secondary to a paraneoplastic syndrome from an occult cancer. A diagnosis of paraneoplastic syndrome facilitated the early treatment of the tumor and resulted in resolution of the paraneoplastic symptoms. Conclusions: This case demonstrates the importance of considering alternate diagnoses when a patient with a preexisting neuropathic condition presents with changes not consistent with the underlying neuropathy.

Poster 48: Developing Clinical Predictors for Admission to Inpatient Rehabilitation to Improve Outcomes

Disclosures: H. K. Vincent, None. Objective: This study examined the effects of anemia on functional and clinical inpatient rehabilitation outcomes after unilateral and bilateral total knee arthroplasty (TKA). Design: This was a multicenter, retrospective study. Setting: 15 inpatient rehabilitation facilities. Participants: A total of 5421 patients with very low hematocrit (Hct)( 30%), low Hct (30%-36% women, 30%41% men), or normal Hct ( 36% women, 41% men) were included. Inpatient rehabilitation occurred after TKA. Interventions: Interdisciplinary inpatient rehabilitation. Main Outcome Measures: Physical function and mobility were assessed using functional independence measure (FIM) scores at admission and discharge. The rehabilitation length of stay (LOS), itemized hospital charges, discharge destination were additional main outcomes. Results: Rehabilitation LOS was 13% longer and hospital charges were 12.5-18.0% higher in the very low Hct group than remaining groups (P .0001). The total FIM scores by discharge and FIM subscores for walking, stair climbing, bathing, transfers, and dressing changes were comparable for all Hct groups for the overall score. Hct 30% did not correspond to worse outcomes in patients with bilateral surgeries compared with unilateral surgeries; total FIM scores improved 47%-53% across all Hct groups, regardless of bilateral surgical status. The prevalence of discharge to home ranged 92.6%-94.7% across all Hct groups (P .05). Conclusions: Rehabilitation teams can expect comparable functional improvements and discharge to home in anemic and nonanemic patients with either unilateral or bilateral surgeries without hematologic correction in the rehabilitation setting, but might need an additional day to accomplish these outcomes.