Julia M. Reilly

Women Physicians Are Underrepresented in Recognition Awards From the Association of Academic Physiatrists

Objective Determine representation by gender for individual recognition awards presented to physicians by the Association of Academic Physiatrists (AAP). Design Cross-sectional survey was used. Lists of individual recognition award recipients for the 27-yr history of the AAP awards (1990–2016) were analyzed. The primary outcome measures were the total numbers of men versus women physician award recipients overall and for the past decade (2007–2016). Results No awards were given to women physicians for the past 4 yrs (2013–2016) or in half of the award categories for the past decade (2007–2016). No woman received the outstanding resident/fellow award since its inception (2010–2016). There was a decrease in the proportion of awards given to women in the past decade (2007–2016, 7 of 39 awards, 17.9%) as compared with the first 17 yrs (1990–2006, 10 of 46 awards, 21.7%). Furthermore, compared with their proportional membership within the specialty, women physicians were underrepresented for the entire 27-yr history of the AAP awards (1990–2016, 17 of 85 awards, 20%). According to the Association of American Medical Colleges, the proportion of full-time female physical medicine and rehabilitation faculty members was 38% in 1992 and 41% in 2013. Conclusions Women physicians have been underrepresented by the AAP in recognition awards. Although the reasons are not clear, these findings should be further investigated.

Women physicians underrepresented in American Academy of Neurology recognition awards

Objective To investigate representation by gender among recipients of physician recognition awards presented by the American Academy of Neurology (AAN). Methods We analyzed lists of individual recipients over the 63-year history of the AAN recognition awards. Included were awards intended primarily for physician recipients that recognized a body of work over the course of a career. The primary outcome measures were total numbers and proportions of men and women physician award recipients. Results During the period studied, the proportion of women increased from 18% (1996) to 31.5% (2016) among AAN US neurologist members and from 18.6% (1992) to 35% (2015) in academia, and the AAN presented 323 awards to physician recipients. Of these recipients, 264 (81.7%) were men and 59 (18.3%) were women. During the most recent 10-year period studied (2008–2017), the proportion of women increased from 24.7% (2008) to 31.5% (2016) among AAN US neurologist members and from 28% (2009) to 35% (2015) in academia, and the AAN presented 187 awards to physician recipients, comprising 146 men (78.1%) and 41 women (21.9%). Although it has been more than 2 decades since the proportion of women among US neurologist members of the AAN was lower than 18%, 1 in 4 AAN award categories demonstrated 0% to 18% representation of women among physician recipients during the most recent decade. Moreover, for highly prestigious awards, underrepresentation was more pronounced. Conclusion Although the reasons why are not clear, women were often underrepresented among individual physician recognition award recipient lists, particularly for highly prestigious awards.

Narrative Review on the Effect of Shockwave Treatment for Management of Upper and Lower Extremity Musculoskeletal Conditions

Extracorporeal shockwave therapy (ESWT) is a technology that was first introduced into clinical practice in 1982 for urologic conditions. Subsequent clinical applications in musculoskeletal conditions have been described in treatment of plantar fasciopathy, both upper and lower extremity tendinopathies, greater trochanteric pain syndrome, medial tibial stress syndrome, management of nonunion fractures, and joint disease including avascular necrosis. The aim of this review is to summarize the current understanding of treatment of musculoskeletal conditions with ESWT, accounting for differences in treatment protocol and energy levels. Complications from ESWT are rare but include 2 reported cases of injury to bone and Achilles tendon rupture in older adults using focused shockwave. Collectively, studies suggest ESWT is generally well‐tolerated treatment strategy for multiple musculoskeletal conditions commonly seen in clinical practice.

Nutrition Education Services Described on National Cancer Institute (NCI)-Designated Cancer Center Websites

For women diagnosed with breast cancer, healthy weight and enhanced nutrition may improve outcomes. The goal of this study is to examine the nutrition education services available on National Cancer Institute (NCI)-Designated Cancer Centers’ websites. In 2017, websites of all 61 NCI-Designated Cancer Centers that provide adult clinical care were reviewed at least twice. Websites were analyzed for the existence and type of expert-directed nutrition education services for breast cancer survivors. Of the 61 websites analyzed, 49 (80%) provided information about nutrition education. Twenty (33%) included only nutrition counseling, three (5%) only nutrition classes, and 26 (42%) both counseling and classes. Forty-six websites included information about nutrition counseling; of these, 39 had an easily identifiable description. Thirty-seven class options were offered, 22% were specific to breast cancer, 16% to subgroups such as young women, 41% were nutrition-only classes, and 24% included skills education. Nutrition services are an important part of breast cancer treatment. This study demonstrated that most NCI-designated cancer centers offered counseling. However, the type of information that was offered varied and services were not always specific to patients with breast cancer. Further research is needed to confirm the presence of services, assess patient access, and demonstrate their efficacy in promoting optimal survivor outcomes.

Poster 248: Dynamic Ultrasound in the Diagnosis of Retrocalcaneal Bursitis Causing Posterior Ankle Impingement with Dorsiflexion: A Case Report

Disclosures: Julia Reilly: I Have No Relevant Financial Relationships To Disclose Case/Program Description: This patient presented with persistent right posterior ankle pain for 6 weeks worsened with ankle dorsiflexion. She had increased her activity level in prior months by participating in Zumba exercises. One month prior to presentation, she was clinically diagnosed with Achilles tendinopathy by an orthopedist. Symptoms did not improve with Physical Therapy and anti-inflammatory medications. Examination was notable for pain with passive ankle dorsiflexion and tenderness to palpation along her posterior ankle at the level of the Achilles tendon insertion/retrocalcaneal bursa region without visible swelling. Diagnostic ultrasound revealed moderate retrocalcaneal bursitis without Achilles tendinopathy, enthesitis, or erosions. Dynamic view of posterior ankle in dorsiflexion showed bursal impingement on the Achilles tendon, reproducing patient’s symptoms. Due to persistent pain, an ultrasound-guided retrocalcaneal bursa corticosteroid injection was performed. Her ankle was immobilized in an aircast boot for 2 weeks and repetitive ankle activity was limited after immobilization. Setting: Tertiary Rheumatology Musculoskeletal Ultrasound Clinic. Results: At 8-weeks post-injection, the patient reported significant improvement in her ankle pain and tenderness. Follow-up ultrasound revealed reduction in bursal thickening with no further impingement. Discussion: Diagnostic ultrasound with dynamic maneuvers can accurately diagnose the etiology of posterior ankle pain. Ultrasound with clinical correlation identified the pain to arise from the retrocalcaneal bursa, and dynamic views confirmed impingement and reproduced pain with dorsiflexion. Retrocalcaneal bursitis is not often considered in the differential diagnoses of posterior ankle impingement symptoms. In this case, corticosteroid injection provided targeted therapy to the bursa. Injection to the tendon is contraindicated with her previous suspected diagnosis of Achilles Tendinopathy. Conclusions: Dynamic ultrasound can improve the diagnostic accuracy of posterior ankle pain. With clinical correlation, the pain generating structure can be visibly identified, and dynamic maneuvers can confirm impingement symptoms. This case highlights how point-ofcare ultrasound can expedite diagnostic accuracy and guided treatment in posterior ankle pain. Level of Evidence: Level V