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Wang C, Ramasamy A, Verduzco-Gutierrez M, Brode WM, Melamed E. Acute and post-acute sequelae of SARS-CoV-2 infection: a review of risk factors and social determinants. Virol J 2023; 20:124. [PMID: 37328773 PMCID: PMC10276420 DOI: 10.1186/s12985-023-02061-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/02/2023] [Indexed: 06/18/2023] Open
Abstract
SARS-CoV-2 infection leading to Coronavirus Disease 2019 (COVID-19) has caused more than 762 million infections worldwide, with 10-30% of patients suffering from post-acute sequelae of SARS-CoV-2 infections (PASC). Initially thought to primarily affect the respiratory system, it is now known that SARS-CoV-2 infection and PASC can cause dysfunction in multiple organs, both during the acute and chronic stages of infection. There are also multiple risk factors that may predispose patients to worse outcomes from acute SARS-CoV-2 infection and contribute to PASC, including genetics, sex differences, age, reactivation of chronic viruses such as Epstein Barr Virus (EBV), gut microbiome dysbiosis, and behavioral and lifestyle factors, including patients' diet, alcohol use, smoking, exercise, and sleep patterns. In addition, there are important social determinants of health, such as race and ethnicity, barriers to health equity, differential cultural perspectives and biases that influence patients' access to health services and disease outcomes from acute COVID-19 and PASC. Here, we review risk factors in acute SARS-CoV-2 infection and PASC and highlight social determinants of health and their impact on patients affected with acute and chronic sequelae of COVID-19.
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Thaweethai T, Jolley SE, Karlson EW, Levitan EB, Levy B, McComsey GA, McCorkell L, Nadkarni GN, Parthasarathy S, Singh U, Walker TA, Selvaggi CA, Shinnick DJ, Schulte CCM, Atchley-Challenner R, Alba GA, Alicic R, Altman N, Anglin K, Argueta U, Ashktorab H, Baslet G, Bassett IV, Bateman L, Bedi B, Bhattacharyya S, Bind MA, Blomkalns AL, Bonilla H, Bush PA, Castro M, Chan J, Charney AW, Chen P, Chibnik LB, Chu HY, Clifton RG, Costantine MM, Cribbs SK, Davila Nieves SI, Deeks SG, Duven A, Emery IF, Erdmann N, Erlandson KM, Ernst KC, Farah-Abraham R, Farner CE, Feuerriegel EM, Fleurimont J, Fonseca V, Franko N, Gainer V, Gander JC, Gardner EM, Geng LN, Gibson KS, Go M, Goldman JD, Grebe H, Greenway FL, Habli M, Hafner J, Han JE, Hanson KA, Heath J, Hernandez C, Hess R, Hodder SL, Hoffman MK, Hoover SE, Huang B, Hughes BL, Jagannathan P, John J, Jordan MR, Katz SD, Kaufman ES, Kelly JD, Kelly SW, Kemp MM, Kirwan JP, Klein JD, Knox KS, Krishnan JA, Kumar A, Laiyemo AO, Lambert AA, Lanca M, Lee-Iannotti JK, Logarbo BP, Longo MT, Luciano CA, Lutrick K, Maley JH, Marathe JG, Marconi V, Marshall GD, Martin CF, Matusov Y, Mehari A, Mendez-Figueroa H, Mermelstein R, Metz TD, Morse R, Mosier J, Mouchati C, Mullington J, Murphy SN, Neuman RB, Nikolich JZ, Ofotokun I, Ojemakinde E, Palatnik A, Palomares K, Parimon T, Parry S, Patterson JE, Patterson TF, Patzer RE, Peluso MJ, Pemu P, Pettker CM, Plunkett BA, Pogreba-Brown K, Poppas A, Quigley JG, Reddy U, Reece R, Reeder H, Reeves WB, Reiman EM, Rischard F, Rosand J, Rouse DJ, Ruff A, Saade G, Sandoval GJ, Schlater SM, Shepherd F, Sherif ZA, Simhan H, Singer NG, Skupski DW, Sowles A, Sparks JA, Sukhera FI, Taylor BS, Teunis L, Thomas RJ, Thorp JM, Thuluvath P, Ticotsky A, Tita AT, Tuttle KR, Urdaneta AE, Valdivieso D, VanWagoner TM, Vasey A, Verduzco-Gutierrez M, Wallace ZS, Ward HD, Warren DE, Weiner SJ, Welch S, Whiteheart SW, Wiley Z, Wisnivesky JP, Yee LM, Zisis S, Horwitz LI, Foulkes AS. Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA 2023; 329:1934-1946. [PMID: 37278994 PMCID: PMC10214179 DOI: 10.1001/jama.2023.8823] [Citation(s) in RCA: 184] [Impact Index Per Article: 184.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
Importance SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. Objective To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. Design, Setting, and Participants Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. Exposure SARS-CoV-2 infection. Main Outcomes and Measures PASC and 44 participant-reported symptoms (with severity thresholds). Results A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months. Conclusions and Relevance A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.
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Allan JM, Brooks AK, Crusto C, Feld LD, Oxentenko AS, Spector ND, Verduzco-Gutierrez M, Silver JK. Five Strategies Leaders in Academic Medicine Can Implement Now to Enhance Gender Equity. J Med Internet Res 2023; 25:e47933. [PMID: 37310782 DOI: 10.2196/47933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023] Open
Abstract
Abundant disparities for women in medicine contribute to many women physicians considering leaving medicine. There is a strong financial and ethical case for leaders in academic medicine to focus on strategies to improve retention. This article focuses on five immediate actions that leaders can take to enhance gender equity and improve career satisfaction for all members of the workplace.
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Lugosi S, Sanchez S, Verduzco-Gutierrez M. Letter to the Editor on "Race, ethnicity, and utilization of outpatient rehabilitation for treatment of post COVID-19 condition". PM R 2023. [PMID: 37272721 DOI: 10.1002/pmrj.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/05/2023] [Indexed: 06/06/2023]
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DeMars J, Brown DA, Angelidis I, Jones F, McGuire F, O'Brien KK, Oller D, Pemberton S, Tarrant R, Verduzco-Gutierrez M, Gross DP. What is Safe Long COVID Rehabilitation? JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:227-230. [PMID: 36315323 PMCID: PMC9628454 DOI: 10.1007/s10926-022-10075-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Makowski MS, Trockel M, Paganoni S, Weinstein S, Verduzco-Gutierrez M, Kinney C, Kennedy DJ, Sliwa J, Wang H, Knowlton T, Stautzenbach T, Shanafelt TD. Occupational Characteristics Associated With Professional Fulfillment and Burnout Among US Physiatrists. Am J Phys Med Rehabil 2023; 102:379-388. [PMID: 37076955 DOI: 10.1097/phm.0000000000002216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Multiple national studies suggest that among physicians, physiatrists are at increased risk for occupational burnout. OBJECTIVE The aim of the study is to identify characteristics of the work environment associated with professional fulfillment and burnout among US physiatrists. DESIGN Between May and December 2021, a mixed qualitative and quantitative approach was used to identify factors contributing to professional fulfillment and burnout in physiatrists. SETTING Online interviews, focus groups, and survey were conducted. PARTICIPANTS The participants are physiatrists in the American Academy of Physical Medicine and Rehabilitation Membership Masterfile. MAIN OUTCOME MEASURES Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index. RESULTS Individual interviews with 21 physiatrists were conducted to identify domains that contributed to professional fulfillment followed by focus groups for further definition. Based on themes identified, scales were identified or developed to evaluate: control over schedule (6 items, Cronbach α = 0.86); integration of physiatry into patient care (3 items, Cronbach α = 0.71); personal-organizational values alignment (3 items, Cronbach α = 0.90); meaningfulness of physiatrist clinical work (6 items, Cronbach α = 0.90); teamwork and collaboration (3 items, Cronbach α = 0.89). Of 5760 physiatrists contacted in the subsequent national survey, 882 (15.4%) returned surveys (median age, 52 yrs; 46.1% women). Overall, 42.6% (336 of 788) experienced burnout and 30.6% (244 of 798) had high levels of professional fulfillment. In multivariable analysis, each one-point improvement in control over schedule (odds ratio = 1.96; 95% confidence interval = 1.45-2.69), integration of physiatry into patient care (odds ratio = 1.77; 95% confidence interval = 1.32-2.38), personal-organizational values alignment (odds ratio = 1.92; 95% confidence interval = 1.48-2.52), meaningfulness of physiatrist clinical work (odds ratio = 2.79; 95% confidence interval = 1.71-4.71), and teamwork and collaboration score (odds ratio = 2.11; 95% confidence interval = 1.48-3.03) was independently associated with higher likelihood of professional fulfillment. CONCLUSIONS Control over schedule, optimal integration of physiatry into clinical care, personal-organizational values alignment, teamwork, and meaningfulness of physiatrist clinical work are strong and independent drivers of occupational well-being in US physiatrists. Variation in these domains by practice setting and subspecialty suggests that tailored approaches are needed to promote professional fulfillment and reduce burnout among US physiatrists.
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Lercher K, Kumar RG, Hammond FM, Zafonte RD, Hoffman JM, Walker WC, Verduzco-Gutierrez M, Dams-O’Connor K. Distal and Proximal Predictors of Rehospitalization Over 10 Years Among Survivors of TBI: A National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2023; 38:203-213. [PMID: 36102607 PMCID: PMC9985661 DOI: 10.1097/htr.0000000000000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the rates and causes of rehospitalization over a 10-year period following a moderate-severe traumatic brain injury (TBI) utilizing the Healthcare Cost and Utilization Project (HCUP) diagnostic coding scheme. SETTING TBI Model Systems centers. PARTICIPANTS Individuals 16 years and older with a primary diagnosis of TBI. DESIGN Prospective cohort study. MAIN MEASURES Rehospitalization (and reason for rehospitalization) as reported by participants or their proxies during follow-up telephone interviews at 1, 2, 5, and 10 years postinjury. RESULTS The greatest number of rehospitalizations occurred in the first year postinjury (23.4% of the sample), and the rates of rehospitalization remained stable (21.1%-20.9%) at 2 and 5 years postinjury and then decreased slightly (18.6%) at 10 years postinjury. Reasons for rehospitalization varied over time, but seizure was the most common reason at 1, 2, and 5 years postinjury. Other common reasons were related to need for procedures (eg, craniotomy or craniectomy) or medical comorbid conditions (eg, diseases of the heart, bacterial infections, or fractures). Multivariable logistic regression models showed that Functional Independence Measure (FIM) Motor score at time of discharge from inpatient rehabilitation was consistently associated with rehospitalization at all time points. Other factors associated with future rehospitalization over time included a history of rehospitalization, presence of seizures, need for craniotomy/craniectomy during acute hospitalization, as well as older age and greater physical and mental health comorbidities. CONCLUSION Using diagnostic codes to characterize reasons for rehospitalization may facilitate identification of baseline (eg, FIM Motor score or craniotomy/craniectomy) and proximal (eg, seizures or prior rehospitalization) factors that are associated with rehospitalization. Information about reasons for rehospitalization can aid healthcare system planning. By identifying those recovering from TBI at a higher risk for rehospitalization, providing closer monitoring may help decrease the healthcare burden by preventing rehospitalization.
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Melamed E, Rydberg L, Ambrose AF, Bhavaraju-Sanka R, Fine JS, Fleming TK, Herman E, Phipps Johnson JL, Kucera JR, Longo M, Niehaus W, Oleson CV, Sampsel S, Silver JK, Smith MM, Verduzco-Gutierrez M. Multi-Disciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). PM R 2023; 15:640-662. [PMID: 36989078 DOI: 10.1002/pmrj.12976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
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Martinez CI, Sanchez AN, Frontera J, Lee MY, Escalon MX, Verduzco-Gutierrez M. Training Characteristics, Academic Accomplishments, and Motivation of Current Program Directors in Physical Medicine and Rehabilitation. Am J Phys Med Rehabil 2023; 102:254-260. [PMID: 36730836 DOI: 10.1097/phm.0000000000002139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT This study aimed to report the training characteristics, academic accomplishments, and motivation of current US academic physical medicine and rehabilitation program directors.A 22-question survey was developed and disseminated via email in May 2020 to 91 current residency program directors who are members of the Association of Academic Physiatrists Residency Fellowship Program Director Committee. Follow-up emails were sent 2 and 4 wks after initial distribution, and the survey was closed after 6 wks in June 2020. Data collected were deidentified. Descriptive analysis was performed.Response rate was 49.5% (45/91); 64.4% of program directors were men, and 35.6% were women. Of the respondents, 75.4% were White/Caucasian, 6.7% were Hispanic/Latinx, 15.6% were Asian, and 2.2% were Black/African American. Moreover, 56% (9/16) of female program directors vs. 0% (0/29) of male program directors reported experiencing sex discrimination in the workplace.Four percent of program directors were full professors in physical medicine and rehabilitation when first appointed, 17% were associate professors, and 72% were assistant professors. Thirty-four percent of program directors had at least six peer-reviewed publications when first appointed.This survey provides insight to the training characteristics, accomplishments, and motivation of current program directors for physiatrists aspiring to enter these ranks and highlights the underrepresentation of women/minorities among leadership positions in physical medicine and rehabilitation.
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Morgenroth DC, Knowlton T, Apkon S, Blauwet CA, Burns AS, Córdova Vallejos C, Frontera W, Hearn SL, Jayabalan P, Lim PA, Moroz A, Perret D, Powell D, Puderbaugh M, Rivers E, Sowa G, Verduzco-Gutierrez M, Celnik PA. Challenges and Opportunities in Academic Physiatry: An Environmental Scan. Am J Phys Med Rehabil 2023; 102:159-165. [PMID: 36634238 PMCID: PMC10233907 DOI: 10.1097/phm.0000000000002127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Environmental scans determine trends in an organization's or field's internal and external environment. The results can help shape goals, inform strategic decision making, and direct future actions. The Association of Academic Physiatrists convened a strategic planning group in 2020, composed of physiatrists representing a diversity of professional roles, career stages, race and ethnicity, gender, disability status, and geographic areas of practice. This strategic planning group performed an environmental scan to assess the forces, trends, challenges, and opportunities affecting both the Association of Academic Physiatrists and the entire field of academic physiatry (also known as physical medicine and rehabilitation, physical and rehabilitation medicine, and rehabilitation medicine). This article presents aspects of the environmental scan thought to be most pertinent to the field of academic physiatry organized within the following five themes: (1) Macro/Societal Trends, (2) Technological Advancements, (3) Diversity and Global Outreach, (4) Economy, and (5) Education/Learning Environment. The challenges and opportunities presented here can provide a roadmap for the field to thrive within the complex and evolving healthcare systems in the United States and globally.
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Siddiqui S, Farr E, Dusto N, Chen L, Kocherginsky M, Skelton F, Verduzco-Gutierrez M, Lee S. Telemedicine Use Among Physiatrists During the Early Phase of the COVID-19 Pandemic and Potential for Future Use. Telemed J E Health 2023; 29:242-252. [PMID: 35833791 PMCID: PMC10081713 DOI: 10.1089/tmj.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 03/20/2022] [Accepted: 03/28/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: With the coronavirus disease 2019 (COVID-19) pandemic causing the need for social distancing, telemedicine saw a significant increase in use to provide routine medical care. As a field, physiatry had already been implementing telemedicine prior to the pandemic. In this study, we characterized the use of telemedicine among physiatrists during the early phase of the COVID-19 pandemic to understand the barriers and facilitators to implementing telemedicine use in the field of physiatry in the future. Methods: Online survey of a cross-sectional sample of physiatrists. Analysis was conducted using logistic regression. Results: One hundred seventy one (n = 171) participants completed the survey. Before the pandemic, only 17.5% of respondents used telemedicine. In the logistic regression, physicians who used a hospital-provided platform were more likely to use telemedicine in the future compared with those who used their own secure platform, conducted a phone visit, and used a non-secure platform or other platforms. The three most popular barriers identified were "inability to complete the physical examination," "patients lack of access to technology," and "patients lack of familiarity with the technology." Discussion: Focus on education on telemedicine functional examination strategies and technology strategies for patients and providers (including addressing the digital divide and hospital-provided secure platforms) are potential targets of implementation strategies for greater telemedicine uptake for physiatrists in the future.
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Wei C, Bernstein SA, Gu A, Mehta A, Sharma D, Mortman R, Verduzco-Gutierrez M, Chretien KC. Evaluating Diversity and Inclusion Content on Graduate Medical Education Websites. J Gen Intern Med 2023; 38:582-585. [PMID: 36443625 PMCID: PMC9707083 DOI: 10.1007/s11606-022-07973-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/17/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED Websites are important tools for programs to provide future residency applicants with freely accessible information regarding their program, including diversity, equity, and inclusion (DEI) initiatives. OBJECTIVE To describe the variability of DEI content in residency programs and compare DEI website content by specialty. METHODS Using the 2021 Accreditation Council for Graduate Medical Education (ACGME) list of residency programs, residency training websites were identified and evaluated. Information was extracted from program websites as indicators of DEI content. Chi-square analysis and one-way ANOVA were chosen to assess for statistical differences. RESULTS In total, 4644 program websites representing 26 specialties were assessed. Among all the programs, the average DEI completeness of a program website was 6.1±14.6% (range 0-100%). While 6.2% of all programs had a diversity webpage, only 13.3% included a commitment to DEI, and few programs (2.7%) provided information about underrepresented in medicine (URiM) faculty. CONCLUSIONS Graduate medical education programs can enhance information for current and prospective applicants about DEI initiatives on their websites. Including DEI initiatives on residency websites may improve diversity recruitment efforts.
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Ketchum EM, Downie SA, Esquenazi A, Francisco G, Verduzco-Gutierrez M, Ifantides K, Boroujerdi A, Buser A, Patel G, Ketchum N. A Virtual Reality Platform to Facilitate Training on Treatment of Lower Limb Spasticity With OnabotulinumtoxinA. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Verduzco-Gutierrez M, Wescott S, Amador J, Hayes AA, Owen M, Chatterjee A. Lasting Solutions for Advancement of Women of Color. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1587-1591. [PMID: 35731581 DOI: 10.1097/acm.0000000000004785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite efforts to improve parity in the biomedical workforce, gender bias persists related to equitable pay, promotion, speaking opportunities, journal editorial positions, research funding, and leadership positions. This bias becomes more prominent for women of color and women with other intersectional identities who come from underrepresented groups. It is critical to understand the barriers that women face and why the pathway is especially challenging for women of color. In this commentary, the authors cite research related to the effects of institutional gender bias in academic medicine, including research on bias against women of color. As academic leaders who come from underrepresented groups, the authors are aware that traditional approaches to reducing this bias have not worked well, and they instead highlight promising strategies aimed at filling the pathway to leadership with women of color who are qualified and ready to take the helm. They address solutions to ensure the academic pathway is supportive. They also provide several recommendations, including: offering more opportunities for mentorship and sponsorship, improving access to formal leadership programming, modeling successful upstander initiatives, recognizing the growing role of minority-based medical societies, implementing early-career education, increasing journal editorial board representation, and expanding promotion criteria. Appropriate training, education, and partnership with internal and external stakeholders are necessary to advance leadership equity for women of color in academic medicine.
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Blitshteyn S, Whiteson J, Abramoff B, Azola A, Bartels MN, Bhavaraju-Sanka R, Chung T, Fleming TK, Henning E, Miglis MG, Sampsel S, Silver JK, Tosto J, Verduzco-Gutierrez M, Putrino D. Multi-Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Autonomic Dysfunction in Patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). PM R 2022; 14:1270-1291. [PMID: 36169154 PMCID: PMC9538426 DOI: 10.1002/pmrj.12894] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/11/2022]
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Silver JK, Booth GS, Chatterjee A, Crusto CA, El-Sayed N, Fleming TK, Gavini N, Golden SH, Jacobs JW, Jagsi R, Larson AR, Liu HY, Lorello GR, Muir R, Shim RS, Spector ND, Stanford FC, Verduzco-Gutierrez M, Zafonte RD. Organizations in science and medicine must hold each other accountable for discriminatory practices. Cell 2022; 185:3073-3078. [PMID: 35985283 PMCID: PMC9924297 DOI: 10.1016/j.cell.2022.06.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 01/24/2023]
Abstract
Many organizations persist in working with others that engage in known, remediable structural discrimination. We name this practice interorganizational structural discrimination (ISD) and argue it is a pivotal contributor to inequities in science and medicine. We urge organizations to leverage their relationships and demand progress from collaborators.
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Farr E, Lee S, Maltser S, Verduzco-Gutierrez M, Shapiro LT. A Rapid Response for Burnout Among Inpatient Physiatrists: A Survey of Leaders of Inpatient Rehabilitation Facilities. PM R 2022; 14:1080-1085. [PMID: 35789206 DOI: 10.1002/pmrj.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/30/2022] [Accepted: 06/20/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Symptoms of burnout are highly prevalent among physiatrists, and prior studies have helped identify key contributors to this epidemic of burnout. Little is known about the physician stressors unique to those providing care in inpatient rehabilitation facilities (IRFs) and what strategies such facilities have utilized to help mitigate burnout among inpatient physiatrists. OBJECTIVE To identify what IRF leaders perceive as stress points contributing to burnout among inpatient rehabilitation physicians and what, if any, interventions their programs have implemented to help mitigate physician burnout. DESIGN 10 item cross-sectional survey study of IRF physician and non-physician leaders in the United States. PARTICIPANTS 104 physicians serving in the roles of IRF Medical Director, Director of Rehabilitation, and/or Executive Leadership and 19 non-physician IRF leaders. RESULTS Regulatory demands, late admissions, understaffing, and on-call responsibilities were the major stress points most identified as contributing to physician burnout among both the physician and non-physician respondents. The utilization of advanced practice providers and hospitalists were the most common system changes reportedly used to help mitigate physician burnout. Although 57.8% of physician leaders felt late admissions were a major stress point for physicians, only 18.2% of those responding reported having implemented admission cut-off times. CONCLUSIONS There are stressors unique to the practice of inpatient rehabilitation that are likely contributing to physiatrist burnout, including late admissions and on-call responsibilities. Many IRFs have begun to implement system changes to help mitigate burnout among inpatient physiatrists. The utilization of non-physiatrist providers is a commonly reported strategy. Future studies are needed to determine the effectiveness of such a strategy on reducing symptoms of burnout among IRF physicians as well as its impact on IRF patient outcomes. This article is protected by copyright. All rights reserved.
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Kazerooni R, Healy S, Verduzco-Gutierrez M. Disparities in Access to Spasticity Chemodenervation Specialists in the United States: A National Analysis of Medicare Data. Toxicon 2022. [DOI: 10.1016/j.toxicon.2021.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Bean AC, Schroeder AN, McKernan GP, Mesoros M, Silver JK, Verduzco-Gutierrez M, Cuccurullo S, Franzese K. Factors Associated With Burnout in Physical Medicine and Rehabilitation Residents in the United States. Am J Phys Med Rehabil 2022; 101:674-684. [PMID: 35706120 DOI: 10.1097/phm.0000000000001886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aims of the study were to determine the prevalence of burnout in physical medicine and rehabilitation residents in the United States and to identify the personal- and program-specific characteristics most strongly associated with residents reporting burnout. DESIGN This was a cross-sectional survey of US physical medicine and rehabilitation residents. Emotional exhaustion, depersonalization, and burnout were assessed using two validated items from the Maslach Burnout Inventory. Associations of burnout with demographics and personal factors, residency program characteristics, perceived program support, and work/life balance were evaluated. RESULTS The survey was completed by 296 residents (22.8%), with 35.8% of residents meeting the criteria for burnout. Residents' perception of not having adequate time for personal/family life was the factor most strongly associated with burnout (χ2 = 93.769, P < 0.001). Residents who reported inappropriate clerical burden and working more than 50 hrs/wk on inpatient rotations were most likely to report that they did not have adequate time for personal/family life. Faculty support (χ2 = 41.599, P < 0.001) and performing activities that led residents to choose physical medicine and rehabilitation as a specialty (χ2 = 93.082, P < 0.001) were protective against burnout. CONCLUSIONS Residents reporting having inadequate time for their personal/family life was most strongly associated with physical medicine and rehabilitation resident burnout, although many personal and program characteristics were associated with burnout.
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Jumreornvong O, Haque A, Tabacof L, Bolds A, Sanchez A, Martinez CI, Verduzco-Gutierrez M, Escalon MX. Awareness of Physical Medicine and Rehabilitation as a Specialty Among US Medical Students. Am J Phys Med Rehabil 2022; 101:S45-S50. [PMID: 34121070 DOI: 10.1097/phm.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The objectives were to assess US medical students' awareness about physical medicine and rehabilitation, their career goals that may align with physical medicine and rehabilitation, and their exposure to physical medicine and rehabilitation and to compare the demographics of those applying to, interested, or not interested in physical medicine and rehabilitation residency. This was a descriptive cross-sectional study. An online survey was distributed to 76 medical schools, and 2067 students responded. First-generation and Hispanic/Latino students are less likely to know about physical medicine and rehabilitation. Medical students who heard about physical medicine and rehabilitation before or during college or who are first-generation students to attend medical school are more likely to be interested in physical medicine and rehabilitation. Medical students identified as female, Black or African American, and more advanced in medical training have lesser interest. Rotating in physical medicine and rehabilitation at their home institution and shadowing a physical medicine and rehabilitation physician also increase the likelihood of respondents to apply to physical medicine and rehabilitation residency. This study highlights that female students and underrepresented minorities in medicine are less likely to know about physical medicine and rehabilitation or be interested in physical medicine and rehabilitation. First-generation medical students know less about the field but the ones who do have increased interest in physical medicine and rehabilitation. These findings support the need for pipeline programs to improve exposure, recruitment, development, promotion, and retention of first-generation minorities and women into physical medicine and rehabilitation.
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Martinez CI, Sanchez AN, Knecht K, Frontera J, Escalon MX, Verduzco-Gutierrez M, Lee MY. Training Characteristics, Academic Accomplishments, and Motivation of Current Chairs in Physical Medicine and Rehabilitation. Am J Phys Med Rehabil 2022; 101:S62-S70. [PMID: 34347630 DOI: 10.1097/phm.0000000000001858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to report the training characteristics, academic accomplishments, and motivation of current United States academic physical medicine and rehabilitation chairs. DESIGN The authors developed a 23-question survey that was disseminated via e-mail to 86 current chairs who were members of the Chairs Council from the Association of Academic Physiatrists in May 2020. Follow-up e-mails were sent 2 and 4 wks after the initial distribution, and the survey closed after 6 wks in June 2020. The data collected were deidentified. Descriptive analysis was performed. RESULTS Forty-nine chair responses were received, which had a response rate of 60%. A total of 69.4% of the chairs (32 of 49) were men and 30.6% (17 of 49) were women. A total of 75.5% (37 of 49) were White/Caucasian, 12.2% (6 of 49) Hispanic/Latinx, 10.2% (5 of 49) Asian, and 2% (1 of 49) were Black/African American. A total of 8.2% of the chairs (4 of 49) reported having a disability. Sixty-seven percent of the female chairs (10 of 15) reported experiencing gender discrimination in the workplace versus 3% of male chairs (1 of 34). Twenty-nine percent of the chairs were full professors in physical medicine and rehabilitation when first appointed, 57.1% associate professors, and 6% assistant professors. A total of 73.5% of the chairs had served as a reviewer for a peer-reviewed publication. Fifty-two percent of the chairs had a leadership role in a national physical medicine and rehabilitation organization. Fifty-eight percent of the chairs had at least 16 peer-reviewed publications when first appointed. CONCLUSIONS This survey provides insight to the training characteristics, accomplishments, and motivation of current chairs for physiatrists aspiring to enter these ranks. It also highlights the underrepresentation of women and minorities among leadership positions in physical medicine and rehabilitation.
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Rolin S, Chakales A, Verduzco-Gutierrez M. Rehabilitation Strategies for Cognitive and Neuropsychiatric Manifestations of COVID-19. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022; 10:182-187. [PMID: 35602927 PMCID: PMC9107067 DOI: 10.1007/s40141-022-00352-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 01/08/2023]
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Verduzco-Gutierrez M, Katz NB, Fleming TK, Silver EM, Hunter TL, El Sayed N, Escalon MX, Lorello GR, Silver JK. Author Diversity on Clinical Practice Guideline Committees. Am J Phys Med Rehabil 2022; 101:493-503. [PMID: 34775456 DOI: 10.1097/phm.0000000000001932] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Reports have demonstrated that women overall and women physicians, in particular, are underrepresented as authors of clinical practice guidelines. This analysis used publicly available information to explore the diversity of rehabilitation-related clinical practice guideline authors by gender, race, and ethnicity. Primary analysis identified authors' gender, race, ethnicity, and visible minority status. Two sets were analyzed: (1) clinical practice guidelines by Department of Veterans Affairs (VA) categorized as "Rehabilitation" or "Pain" (n = 7; VA clinical practice guidelines) and (2) a set (n = 10) published in the United States (US) from 2019 to 2021 that were selected because of low numbers of inclusion at less than 20% women authors. Key findings include that among physician authors, both the VA and US clinical practice guidelines underrepresented women (15 [24.2%] and 27 [16.7%], respectively) and those coded as a racial or ethnic minority were particularly underrepresented. Notably, women authors overall were equally represented (92 [50.0%]) in the VA clinical practice guidelines. The US clinical practice guidelines had women authors who were underrepresented (36 [19.0%]). Secondary analysis of the entire set of VA clinical practice guidelines (n = 21) found gaps in diversity-related content. Clinical practice guidelines have far-reaching health and economic impacts, and addressing disparities in the diversity of author teams and/or gaps in diversity-related content is of paramount importance.
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Haloot J, Kabbani M, Verduzco-Gutierrez M, Bhavaraju-Sanka R, Pillarisetti J. CE-541-02 POST-COVID AND POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME. Heart Rhythm 2022. [PMCID: PMC9049668 DOI: 10.1016/j.hrthm.2022.03.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Dragojlovic N, Romanoski NL, Verduzco-Gutierrez M, Francisco GE. Prevalence and Treatment Characteristics of Spastic Hypertonia on First-Time Admission to Acute Inpatient Rehabilitation. Am J Phys Med Rehabil 2022; 101:348-352. [PMID: 34121067 DOI: 10.1097/phm.0000000000001823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to report the prevalence of spasticity and treatment patterns during first-time admission to inpatient rehabilitation after acute stroke, traumatic brain injury, and spinal cord injury. DESIGN This is a retrospective cohort study. METHODS A review of 285 adult patients consecutively admitted to inpatient rehabilitation was conducted. Patients with a history of spasticity and inpatient rehabilitation course and those younger than 18 yrs were excluded. Main outcome measures are as follows: admitting diagnosis, length of stay, time from injury to admission, acute transfer rate, prevalence and severity of spasticity using Modified Ashworth Scale at admission and discharge, Functional Independence Measure scores at admission and discharge, Functional Independence Measure efficiency, and treatments for spasticity. RESULTS Stroke patients had the highest prevalence of spasticity: 68% on admission and 50% at discharge. In traumatic brain injury, spasticity prevalence was 55% on admission and 30% at discharge. In spinal cord injury, spasticity prevalence was 48% on admission and 46% at discharge. Patients with spinal cord injury received the most medications to control spasticity, whereas those with traumatic brain injury and stroke received the most procedural interventions. CONCLUSIONS Spasticity is a common sequela of upper motor neuron injury for patients admitted to inpatient rehabilitation. Early recognition and management are essential to prevent contractures, minimize pain, and maximize functional recovery.
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