Patricia Zheng

Learning Through Service: Student Perceptions on Volunteering at Interprofessional Hepatitis B Student-run Clinics

Student-run clinics (SRCs) are widespread, but studies on their educational impact are limited. We surveyed preclinical medical, nursing, and pharmacy students about their experiences in a hepatitis B elective which provided opportunities to they could volunteer at hepatitis B screening and vaccination SRCs. Student responses revealed positive perceptions of the volunteer experience. Benefits included interacting with patients, developing clinical skills, providing service to disadvantaged populations, and collaborating with health professional peers. Students who participated in clinic reported enhanced skills compared to those who did not attend. SRCs play a valuable role in instilling positive attitudes and improving skills.

Duration of Fluoroscopic-Guided Spine Interventions and Radiation Exposure Is Increased in Overweight Patients

The impact of patient body mass index (BMI) on image‐guided spine interventions remains unknown. Higher BMI is known to complicate the acquisition of radiographic images. Therefore it can be hypothesized that the patients body habitus can influence the delivery of a spinal injection.

Modulation of Acute Diarrheal Illness by Persistent Bacterial Infection

ABSTRACT Acute diarrheal illness is a global health problem that may be exacerbated by concurrent infection. Using Citrobacter rodentium, a murine model of attaching and effacing diarrheagenic Escherichia coli, we demonstrate that persistent Helicobacter hepaticus infection modulates host responses to diarrheal disease, resulting in delayed recovery from weight loss and from tissue damage. Chronic colitis in concurrently infected mice is characterized by macrophage and Foxp3+ regulatory T-cell accumulation. Prolonged disease is also associated with increased interleukin-17 expression, which may be due to suppression of gamma interferon during the acute phase of diarrheal infection. This new model of polymicrobial infection provides insight into the mechanism by which subclinical infection can exacerbate morbidity due to an unrelated self-limiting infection.

Impact of Student-Run Clinics on Preclinical Sociocultural and Interprofessional Attitudes: A Prospective Cohort Analysis

Introduction. Descriptive studies suggest student-run clinics (SRCs) positively affect preclinical students’ sociocultural and interprofessional attitudes, but few studies use validated measures. Methods. In a pre-post design, first-year medical, nursing, and pharmacy students who did and did not participate in SRCs completed demographic and open-ended questions, as well as two validated surveys, the Sociocultural Attitudes in Medicine Inventory (SAMI) and Readiness for Interprofessional Learning Scale (RIPLS), at the beginning and end of the year. Results. With 68% (n=182/267) matched surveys we found no significant differences between groups over time (SAMI p=.53, RIPLS p≥.28 for each subcategory). However, of SRC participants, 99% reported commitment to the underserved and 57% reported improved interprofessional attitudes. Discussion. Students participating in SRCs perceive positive benefits, but do not score differently from those who do not. The SRC experiences may not be frequent enough to affect these measures, particularly since our students were high-scoring upon entry.

Safety of epidural steroid injections

ABSTRACT Introduction: Epidural steroid injections (ESI) are a commonly utilized treatment for cervical and lumbar radicular pain. All medical procedures and medications carry an inherent level of risk, that must be balanced with the effectiveness of the treatment to determine the risk to benefit ratio for a patient. Areas covered: This article will outline the risks of ESIs and in doing so help shed light on the procedural risks versus the risks of the medication. Additionally, it will help differentiate minor adverse events from significant permanent complications. Expert Opinion: Catastrophic complications of ESI such as paralysis and stroke unquestionably warrant the recent increased attention given to the safety of these injections. While a single major complication is unacceptable, the relative rate of these major complications must be put in prospective. The true rate is small enough that it is impossible to calculate. All cases are limited to case reports and not detected in even the largest published cohorts of ESI. Moreover, recent advances in medication selection and technique have further reduced the incidence of these very rare complications. Conversely, the more common adverse events are rather minor, generally transient, and mostly occur at incidences of less than 1%.

Objective measurement of function following lumbar spinal stenosis decompression reveals improved functional capacity with stagnant real-life physical activity

BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) is a prevalent and costly condition associated with significant dysfunction. Alleviation of pain and improvement of function are the primary goals of surgical intervention. Although prior studies have measured subjective improvements in function after surgery, few have examined objective markers of functional improvement. PURPOSE We aimed to objectively measure and quantify changes in physical capacity and physical performance following surgical decompression of LSS. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE Thirty-eight patients with LSS determined by the treating surgeons clinical and imaging evaluation, and who were scheduled for surgical treatment, were consecutively recruited at two academic medical facilities, with 28 providing valid data for analysis at baseline and 6 months after surgery. OUTCOME MEASURES Before surgery and at 6 months after surgery, participants provided 7 days of real-life physical activity (performance) using ActiGraph accelerometers; completed two objective functional capacity measures, the Short Physical Performance Battery and Self-Paced Walking Test; and completed three subjective functional outcome questionnaires, Oswestry Disability Index, Spinal Stenosis Symptom Questionnaire, and Short-Form 36. METHODS Physical activity, as measured by continuous activity monitoring, was analyzed as previously described according to the 2008 American Physical Activity Guidelines. Paired t tests were performed to assess for postsurgical changes in all questionnaire outcomes and all objective functional capacity measures. Chi-square analysis was used to categorically assess whether patients were more likely to meet these physical activity recommendations after surgery. RESULTS Participants were 70.1 years old (±8.9) with 17 females (60.7%) and an average body mass index of 28.4 (±6.2). All subjective measures (Oswestry Disability Index, Spinal Stenosis Symptom Questionnaire, and Short-Form 36) improved significantly at 6 months after surgery, as did objective functional measures of capacity including balance, gait speed, and ambulation distance (Short Physical Performance Battery, Self-Paced Walking Test). However, objectively measured performance (real-life physical activity) did not change following surgery. Although fewer participants qualified as inactive (54% vs. 71%), and more (11% vs. 4%) met the physical activity guideline recommendations at the 6-month follow-up, these differences were not statistically significant (p=.22) CONCLUSIONS: This is the first study, of which we are aware, to objectively evaluate changes in postsurgical performance (real-life physical activity) in people with LSS. We found that at 6 months after surgery for LSS, participants demonstrated significant improvements in self-reported function and objectively measured physical capacity, but not physical performance as measured by continuous activity monitoring. This lack of improvement in performance, despite improvements in self-reported function and objective capacity, suggests a role for postoperative rehabilitation focused specifically on increasing performance after surgery in the LSS population.

Seated Tai Chi to alleviate pain and improve quality of life in individuals with spinal cord disorder

Context: Previous research studies have confirmed therapeutic physical and psychological benefits of Tai Chi for both the able-bodied and disabled populations. However, given the limited availability of seated Tai Chi, there have not been any studies to date that have examined the effectiveness of seated Tai Chi in individuals with spinal cord disorder (SCD). We designed a customized seated Tai Chi program to meet the need for improved exercise options for individuals with SCD. Findings: Twenty-six participants were enrolled in a 12-week seated Tai Chi course consisting of weekly sessions. After each Tai Chi session, patients reported improved visual analog scale (VAS) monitoring pain (P) (3.18 v 2.93; P 1.63E-03), emotional sense of well-being (EWB) (2.61 vs 2.04; P 2.86E-07), mental distraction (MD) (3.13 v 2.29; P 9.36E-08), physical sense of well-being (PWB) (2.84 v 2.25; p 7.38E-08), and sense of spiritual connection (SC) (3.28 v 2.50; P 6.46E-08). In our limited follow-up of 9 participants who completed half of the sessions and the long term surveys after the 12-week course, there were no detectable differences in weekly P, EWB, MD, PWB, and SC before each session. Conclusion and Clinical Relevance: Individuals with SCD demonstrated benefits in pain, emotional sense of well-being, mental distraction, physical sense of well-being, and sense of spiritual connection immediately after seated Tai Chi exercise sessions in our pilot study. More research in a larger population would be needed to study the long-term impact of seated Tai Chi.

Stagnant Physical Therapy Referral Rates Alongside Rising Opioid Prescription Rates in Patients with Low Back Pain in the United States 1997–2010

Study Design. A cross-sectional observational study utilizing the National Ambulatory and National Hospital Ambulatory Medical Care Surveys between 1997 and 2010. Objective. The aim of this study was to characterize national physical therapy (PT) referral trends during primary care provider (PCP) visits in the United States. Summary of Background Data. Despite guidelines recommending PT for the initial management of low back pain (LBP), national PT referral rates remain low. Methods. Race, ethnicity, age, payer type, and PT referral rates were collected for patients aged 16 to 90 years who were visiting their PCPs. Associations among demographic variables and PT referral were determined using logistic regression. Results. Between 1997 and 2010, we estimated 170 million visits for LBP leading to 17.1 million PT referrals. Average proportion of PCP visits associated with PT referrals remained stable at about 10.1% [odds ratio (OR) 1.00, 95% confidence interval (95% CI) 0.96–1.04)], despite our prior finding of increasing number of visits associated with opioid prescriptions in the same timeframe. Lower PT referral rates were observed among visits by patients who were insured by Medicaid (OR 0.48, 95% CI 0.33–0.69) and Medicare (OR 0.50, 95% CI 0.35–0.72). Furthermore, visits not associated with PT referrals were more likely to be associated with opioid prescriptions (OR 1.69, 95% CI 1.22–2.35). Conclusion. Although therapies delivered by PTs are promoted as a first-line treatment for LBP, PT referral rates remain low. There also exist disparately lower referral rates in populations with more restrictive health plans and simultaneous opioid prescription. Our findings provide a broad overview to PT prescription trend and isolate concerning associations requiring further explorations. Level of Evidence: 3

Poster 26: Trends in Physical Activity Research With and Without Accelerometers

Participants: n/a Interventions: n/a Main Outcome Measures: n/a Results: Grey-scale ultrasound is consistently reported as an effective and user-friendly imaging modality for the patellar tendon, with specificity and sensitivity equivalent to or greater than MRI in the diagnosis of patellar tendinopathy. The ultrasound exam may gain accuracy when supplemented with color Doppler imaging, but at this time no evidence exists to indicate the use of elastographic imaging for patellar tendinopathy. Also, findings are mixed concerning the accuracy of ultrasonographic measurement of the patellar tendon. Conclusions: Given the high and growing costs of musculoskeletal MRI imaging in the United States and promising preliminary findings in MSK ultrasound, we recommend that ultrasound may be selectively substituted for MRI in cases of patellar tendinopathy. Barriers to the implementation of MSK ultrasound revolve mainly around education and competence. To the experienced operator, MSK ultrasound may represent a powerful, cost-efficient bedside diagnostic tool. Level of Evidence: Level IV

The Potential of Digital Technology to Improve Self-Care for Musculoskeletal Conditions

Purpose of ReviewDigital technology offers a broad range of tools that can be used to enhance health care. We aim to summarize for the physiatrist use-cases of these tools in musculoskeletal self-care.Recent FindingRecent advances in and increasing prevalence of wearable sensors and mobile phones make these digital technologies ideal tools to help patients become active participants in their own healthcare. However, given digital health technologies’ fast-paced growth and turnover, implementation and research challenges remain.SummaryDigital technology provides novel methods to objectively evaluate patients and to engage them in active rehabilitation. Further research is needed to guide the adaptation of these emerging tools to enhance self-care of musculoskeletal conditions. Physiatrists, who have extensive experience in non-surgical management of mobility-limiting conditions, are particularly equipped to lead the efforts in the design and validation of these technologies.