1
|
Stone SN, Sheth M, Rydberg L. Creating and confirming observable professional activities (OPAs): A pilot study evaluating the feasibility of OPAs on a residency inpatient spinal cord injury rotation. PM R 2024. [PMID: 38700148 DOI: 10.1002/pmrj.13194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/28/2024] [Accepted: 03/21/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Shane N Stone
- Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Manasi Sheth
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Leslie Rydberg
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The Shirley Ryan AbilityLab, Chicago, Illinois, USA
| |
Collapse
|
2
|
Stone SN, Curley N, Sheth M, Butler C, Margolis S. Naloxone-Prescribing Practices in a Freestanding Rehabilitation Hospital. Am J Phys Med Rehabil 2024; 103:105-109. [PMID: 37339054 DOI: 10.1097/phm.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE The study aims to determine whether Physical Medicine & Rehabilitation physicians offer naloxone per the Centers for Disease Control and Prevention Guidelines to patients at the highest risk of complications from opioid treatment and whether there is a difference between inpatient and outpatient naloxone prescribing. DESIGN A retrospective chart review on 389 adults (outpatient n = 166; inpatient n = 223) from May 4 to May 31, 2022, at an academic rehabilitation hospital. Prescribed medications and comorbidities were evaluated to determine whether Centers for Disease Control and Prevention criteria for offering naloxone were met and whether naloxone was offered. RESULTS One hundred twenty-nine opioid prescriptions were written for 102 outpatients; 61 qualified for naloxone (morphine milliequivalent range = 10-1080, mean = 158.08). On inpatient, 68 patients received 86 opioid prescriptions; 35 qualified for naloxone (morphine milliequivalent range = 3.75-246, mean = 62.36). Overall, there was a significantly lower rate of opioid prescriptions for inpatients (30.49%) than outpatients (61.45%) ( P < 0.0001), a nonsignificant lower rate of inpatient (51.47%) than outpatient (59.80%) "at-risk" prescriptions ( P = 0.351), and a weakly significant lower rate of naloxone prescribing for inpatient (2.86%) than outpatient visits (8.20%) ( P < 0.0519). CONCLUSIONS At this rehabilitation hospital, there was a low rate of naloxone prescribing by inpatient and outpatient providers, with a higher rate occurring in the outpatient than inpatient setting. More research is needed to understand this prescribing trend to determine potential interventions.
Collapse
Affiliation(s)
- Shane N Stone
- From the Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois (SNS, SM); The Shirley Ryan AbilityLab, Chicago, Illinois (SNS, MS, CB, SM); and Creighton University Arizona Health Education Alliance, Phoenix, Arizona (NC)
| | | | | | | | | |
Collapse
|
3
|
Stone SN, Wei D, Reger C. Ultrasound guidance versus landmark guidance for intrathecal baclofen pump refill: A randomized pilot study. PM R 2023; 15:1425-1430. [PMID: 37029467 DOI: 10.1002/pmrj.12982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Refilling difficult-to-access intrathecal baclofen (ITB) pumps by a trainee can result in longer procedures, more needle punctures, and more frequent attending interventions. Though ultrasound guidance can be used, there has not been an investigation into the impact of ultrasound guidance on refill outcomes. OBJECTIVE To determine the feasibility of ultrasound guidance during difficult ITB refills to improve the experience of patients and providers. DESIGN Nonblinded, randomized controlled trial with crossover element. SETTING Outpatient clinic at a tertiary academic rehabilitation hospital. PARTICIPANTS Patients ≥18 years old with historically difficult refills who were scheduled for repeat refills. "Difficult" was defined as body mass index > 30.0, a deep/tilted pump, previously requiring >1 skin puncture, or previously needing special positioning to access. INTERVENTIONS Consented participants were randomized into a template-guided group (control) or an ultrasound-guided group (experimental) using a coin flip. Patients were crossed over if (1) a second refill occurred during the study period or (2) the randomized technique failed. MAIN OUTCOME MEASURES The primary measure was time spent with needle under skin (seconds). Number of needle punctures and needle passes, frequency of attending intervention, pain during and after the procedure, patient satisfaction, and practitioner perceived difficulty were investigated. RESULTS Seventeen patients underwent 21 refills (12 template guided and 9 ultrasound guided). No patients experienced adverse events. Although without statistically significant difference, the average time in the experimental group was shorter than the control (175 seconds vs 401 seconds), there were fewer episodes of multiple needle punctures (0 vs 2), multiple needle passes (2 vs 5), and attending interventions (0 vs 3) in the experimental group. No significant/clinical difference was found in pain during procedure, pain after procedure, patient satisfaction, or practitioner subjective difficulty. CONCLUSIONS This pilot study demonstrates that ultrasound-guided ITB refills may reduce time spent with the needle in the skin, number of needle punctures, number of needle passes, and frequency of attending intervention during trainee refilling of pumps that are difficult to access.
Collapse
Affiliation(s)
- Shane N Stone
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Daniel Wei
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Christopher Reger
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The Shirley Ryan AbilityLab, Chicago, Illinois, USA
| |
Collapse
|
4
|
Stone SN, Rydberg L. Creating and confirming observable professional activities (OPAs): A brief report on the practical approach for OPA design for resident education. J Spinal Cord Med 2023; 46:865-869. [PMID: 36972220 PMCID: PMC10446771 DOI: 10.1080/10790268.2023.2191100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
CONTEXT The transition of graduate medical education to competency-based education systems has resulted in exploration of the efficacy of Entrustable Professional Activities (EPAs) and related Observable Practice Activities (OPAs) as evaluation tools. EPAs were introduced to PM&R in 2017, but no OPAs have been reported for a non-procedurally based EPA. The primary aims of this study were to create and form consensus on OPAs for the Spinal Cord Injury EPA. METHODS A Modified Delphi panel of seven experts in the field was utilized to gain consensus on ten PM&R OPAs for the Spinal Cord Injury EPA. RESULTS After the first round of evaluations, most OPAs were evaluated by experts as requiring modifications (30/70 votes to keep, 34/70 votes to modify) with a majority of comments focusing on the specific content of the OPAs. Edits were made, and after the second round, the OPAs were evaluated and determined to be kept (62/70 votes to keep, 6/70 votes to modify) with most edits being about semantics of the OPAs. Ultimately, there was significant difference in all three categories between round 1 and round 2 (P < 0.0001) and 10 OPAs were finalized for use. CONCLUSIONS This study created 10 OPAs that can potentially help provide targeted feedback to residents on their competency in caring for patients with spinal cord injury. With regular usage, OPAs are designed to provide residents with insight into how they are progressing towards independent practice. In the future, studies should aim to assess the feasibility and utility of implementing the newly developed OPAs.
Collapse
Affiliation(s)
- Shane N. Stone
- Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Leslie Rydberg
- Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
5
|
Estave PM, Jacobs ML, Rukstalis M, Goforth J, Stone SN, Choi JA, Barrett J, Douglas HE, Oliver JB, Keating MK, Freischlag JA, O'Brien MC, McEwen S, Strowd RE. Opioid stewardship training during the transition to residency to prepare medical students to recognize and treat opioid use disorder. Subst Abus 2021; 42:1040-1048. [PMID: 34236292 DOI: 10.1080/08897077.2021.1915918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: With a drastic shortage of addiction medicine specialists-and an ever-growing number of patients with opioid use disorder (OUD)-there is a dire need for more clinicians to feel confident in prevention and management of OUD and obtain a DEA-X waiver to prescribe medications to treat OUD. Here we determine if it is feasible to certify 4th year medical students with DEA-X waiver training as a component of the PROUD (Prevent and Reduce Opioid Use Disorder) curriculum, and if PROUD enhanced preparedness for medical students to manage OUD as interns. Methods: We implemented a sequential mixed-methods IRB approved study to assess feasibility (completing all required components of DEA-X waiver training) and impact of PROUD (measured by knowledge growth, enhancement for residency, and utilization of training during internship). Students completed 11 hours of required OUD training. Quantitative data included pre-/post- knowledge and curriculum satisfaction assessments as well as long-term impact with follow up survey as interns. Qualitative data was collected by survey and semi-structured focus groups. Results: All 120 graduating medical students completed the required components of the curriculum. Knowledge improved on the Provider Clinical Support Services (12.9-17.3, p < 0.0001) and Brief Opioid Overdose Knowledge assessments (10.15-10.81, p < 0.0001). Course satisfaction was high: 90% recommended online modules; 85% recommended training overall. Six qualitative themes emerged: (1) curriculum content was practical, (2) online modules allowed flexibility, (3) in-person seminars ensured authenticity, (4) timing at the transition to residency was optimal, (5) curriculum enhanced awareness and confidence, and (6) training was applicable to future careers. At 3 months, 60% reported using their training during internship; 64% felt more prepared to treat OUD than peers. Conclusions: PROUD trained 4th year medical students in opioid stewardship. As interns, students felt ready to serve as change agents to prevent, diagnose, and treat OUD.
Collapse
Affiliation(s)
| | | | - Margaret Rukstalis
- University of South Carolina School of Medicine and VAMC, Columbia, SC, USA
| | - Jon Goforth
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Shane N Stone
- Department of Physician Medicine and Rehabilitation, McGaw Medical Center, Northwestern University, Chicago, IL, USA
| | | | | | - Heather E Douglas
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Jennifer B Oliver
- Department of Anesthesia, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Michelle K Keating
- Department of Family Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Julie A Freischlag
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Mary Claire O'Brien
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Sara McEwen
- Governor's Institute on Substance Abuse, Raleigh, NC, USA
| | - Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC, USA
| |
Collapse
|
6
|
Laurence CE, Jones JR, Stone SN, Moses-Hampton M, Yates SJ, Khalil ME, Callese TE, Kaye SP, Wirth SH, Keskinyan VS, Bentley PG, Reynolds PS, Strowd RE. Feasibility and Impact of a Student-Led, Semi-Structured, Near-Peer Student Guides Program on Navigating Through Medical School. Med Sci Educ 2020; 30:457-466. [PMID: 34457689 PMCID: PMC8368906 DOI: 10.1007/s40670-020-00929-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Mentorship is critical to developing health professionals. Near-peer mentorship pairs senior mentors with junior peers to help navigate academic, professional, and social aspects of training. METHODS In this convergent parallel mixed methods study, we assessed the feasibility, usability, professional and social impact, and barriers to implementation of a 16-week semi-structured, near-peer, student guides program involving 39 first year medical students (MS1s) and 41 fourth year medical students (MS4s). Student enrollment was quantified, guide-guidee meetings tracked, and > 2 meetings defined as feasible. Meeting topics, impact on student advising, and barriers to sustainability were contextualized qualitatively. RESULTS Twenty-two percent of all MS4s and 46% of MS1s enrolled in the program; 67% of guides facilitated the requisite two meetings with their group, which was less than our predetermined feasibility criteria of 75%. Most guide-guidee interactions occurred in person (91%), but text messages (82%) and video/mobile messaging apps (78%) were also used. Ninety-two percent of guidees recommended the program, and 85% were satisfied with guidance received. Barriers included meeting coordination, infrequent meetings, and informal meeting structure. CONCLUSIONS While the program was infeasible by predefined frequency criteria, participant satisfaction was high and academic, professional, and social benefits of near-peers were reported. In response, programmatic revisions now incorporate centralized support for meetings, e-mentorship, and guide training.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Paige G. Bentley
- Counselling & Well-Being Services, Wake Forest School of Medicine, Winston-Salem, NC USA
- Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Patrick S. Reynolds
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Roy E. Strowd
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| |
Collapse
|
7
|
Abstract
CONTEXT Glucose-6-phosphate dehydrogenase (G6PD) deficiency is likely the most prevalent enzyme deficiency on the planet, with an estimated 4.9% of people, or approximately 330 million individuals, across the globe affected by the disease. In the United States, 4% to 7% of the population is likely affected, but each year our nation's major sport leagues become more international. It is important for medical professionals who treat athletes to understand how this genetic condition can affect the athletes we are working with, especially because exercise in itself results in oxidative stress. EVIDENCE ACQUISITION PubMed was searched for relevant articles published from 1980 to 2018. The search terms G6PD, athletes, military, and sports were used. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Though some case reports suggest a potential impact on athlete safety and performance, controlled studies demonstrate limited impact of exercise on oxidative stress in G6PD-deficient individuals. The care of athletes with G6PD deficiency does not drastically differ from the care of athletes without this condition. Most of the medications and supplements that are regularly given to athletes should not negatively affect their health. CONCLUSION Although the care of athletes with G6PD deficiency is for the most part no different from the care of other athletes, there are certain situations (visiting areas where malaria is endemic) and medications for which it is important to recognize how your management should change. G6PD deficiency is not regularly screened for but could be considered if an athlete has known sickle cell disease or when traveling to areas where malaria is prevalent. Expanding our knowledge of G6PD deficiency will allow for better care of athletes.
Collapse
Affiliation(s)
- Shane N Stone
- Primary Care Sports Medicine Fellowship, Department of Family & Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Karl V Reisig
- Bozeman Health Family Medicine at Belgrade Clinic, Belgrade, Montana
| | - Heather L Saffel
- Primary Care Sports Medicine Fellowship, Department of Family & Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Christopher M Miles
- Primary Care Sports Medicine Fellowship, Department of Family & Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| |
Collapse
|
8
|
McClain CR, Balk MA, Benfield MC, Branch TA, Chen C, Cosgrove J, Dove ADM, Gaskins L, Helm RR, Hochberg FG, Lee FB, Marshall A, McMurray SE, Schanche C, Stone SN, Thaler AD. Sizing ocean giants: patterns of intraspecific size variation in marine megafauna. PeerJ 2015; 3:e715. [PMID: 25649000 PMCID: PMC4304853 DOI: 10.7717/peerj.715] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/10/2014] [Indexed: 11/20/2022] Open
Abstract
What are the greatest sizes that the largest marine megafauna obtain? This is a simple question with a difficult and complex answer. Many of the largest-sized species occur in the world’s oceans. For many of these, rarity, remoteness, and quite simply the logistics of measuring these giants has made obtaining accurate size measurements difficult. Inaccurate reports of maximum sizes run rampant through the scientific literature and popular media. Moreover, how intraspecific variation in the body sizes of these animals relates to sex, population structure, the environment, and interactions with humans remains underappreciated. Here, we review and analyze body size for 25 ocean giants ranging across the animal kingdom. For each taxon we document body size for the largest known marine species of several clades. We also analyze intraspecific variation and identify the largest known individuals for each species. Where data allows, we analyze spatial and temporal intraspecific size variation. We also provide allometric scaling equations between different size measurements as resources to other researchers. In some cases, the lack of data prevents us from fully examining these topics and instead we specifically highlight these deficiencies and the barriers that exist for data collection. Overall, we found considerable variability in intraspecific size distributions from strongly left- to strongly right-skewed. We provide several allometric equations that allow for estimation of total lengths and weights from more easily obtained measurements. In several cases, we also quantify considerable geographic variation and decreases in size likely attributed to humans.
Collapse
Affiliation(s)
- Craig R McClain
- National Evolutionary Synthesis Center , Durham, NC , USA ; Department of Biology, Duke University , Durham, NC , USA
| | - Meghan A Balk
- Department of Biology, University of New Mexico , Albuquerque, NM , USA
| | - Mark C Benfield
- Department of Oceanography and Coastal Sciences, Louisiana State University , Baton Rouge, LA , USA
| | - Trevor A Branch
- School of Aquatic & Fishery Sciences, University of Washington , Seattle, WA , USA
| | - Catherine Chen
- Department of Biology, Duke University , Durham, NC , USA
| | - James Cosgrove
- Natural History Section, Royal British Columbia Museum , Victoria, BC , Canada
| | | | - Leo Gaskins
- Department of Biology, Duke University , Durham, NC , USA
| | - Rebecca R Helm
- Department of Ecology and Evolutionary Biology, Brown University , Providence, RI , USA
| | - Frederick G Hochberg
- Department of Invertebrate Zoology, Santa Barbara Museum of Natural History , Santa Barbara, CA , USA
| | - Frank B Lee
- Department of Biology, Duke University , Durham, NC , USA
| | | | - Steven E McMurray
- Department of Biology and Marine Biology, University of North Carolina Wilmington , Wilmington, NC , USA
| | | | - Shane N Stone
- Department of Biology, Duke University , Durham, NC , USA
| | - Andrew D Thaler
- Blackbeard Biologic: Science and Environmental Advisors , Vallejo, CA , USA
| |
Collapse
|
9
|
|