Symptoms of Concussion and Comorbid Disorders.

Symptoms of concussion are divided into three major domains: physical, cognitive, and emotional. These symptoms including headache, neck pain, vision changes, cognitive deficits, and emotional changes can be seen immediately after the injury and usually resolve within the first 3 months. However, some of these symptoms may persist for several months afterward. Risk factors have been identified for prolonged symptoms. Certain early interventions may decrease persistent symptoms. In this chapter, we discuss common acute and persistent symptoms after concussion and provide an overview of assessment tools and management options.

Chronic Traumatic Encephalopathy.

This article focuses on neuropathologic diagnostic criteria for chronic traumatic encephalopathy (CTE) and consensus research diagnostic criteria for traumatic encephalopathy syndrome (TES). CTE as a tauopathy has a unique pattern for diagnosis and differs from other neurodegenerative diseases. We discuss the history, neuropathology, and mechanism of CTE as well as the preliminary reasearch diagnostic criteria for TES, which is the proposed clinical presentation of suspected CTE.

Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation.

OBJECTIVE: To determine rates of rehospitalization among discharged rehabilitation patients with traumatic spinal cord injury (SCI) in the first 12 months postinjury, and to identify factors associated with rehospitalization. DESIGN: Prospective observational cohort study. SETTING: Six geographically dispersed rehabilitation centers in the U.S. PARTICIPANTS: Consecutively enrolled individuals with new traumatic SCI (N=951), who were discharged from participating rehabilitation centers and participated in a 1-year follow-up survey. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Occurrence of postrehabilitation rehospitalization within 1 year of injury, length of rehospitalization stays, and causes of rehospitalizations. RESULTS: More than one third (36.2%) of participants were rehospitalized at least once in the 12-month follow-up period; 12.5% were rehospitalized at least twice. The average number of rehospitalizations among those rehospitalized at least once was 1.37 times, with an average length of stay (LOS) of 15.5 days across all rehospitalization episodes. The 3 most common health conditions associated with rehospitalization were those related to the genitourinary system (eg, urinary tract infection), respiratory system (eg, pneumonia), and skin and subcutaneous tissue (eg, pressure ulcer). Being a woman (95% confidence interval [CI], 1.034-2.279), having Medicaid as the main payer (95% CI, 1.303-2.936), and more severe case mix were associated with increased odds of rehospitalization. Those who had more intensive physical therapy (95% CI, .960-.981) had lower odds of rehospitalization. Some center-to-center variation in rehospitalization rates remained unexplained after case mix and practice differences were considered. The 6 SCI rehabilitation centers varied nearly 2-fold in rates at which their former SCI patients were rehospitalized--from 27.8% to 50%. Center-to-center variation diminished when patient case mix was considered. CONCLUSIONS: Compared with earlier studies, rehospitalization rates among individuals with SCI in the first postinjury year remain high and vary by level and completeness of injury. Rehospitalization risk was associated with younger age, being a woman, unemployment and retirement, and Medicaid coverage. Those who had more intensive physical therapy had lower odds of rehospitalization. Future studies should examine center-to-center variations in rehospitalization rates and availability of patient education and community resources.

Will ChatGPT Match to Your Program?

ABSTRACT: ChatGPT and other artificial intelligence word prediction large database models are now readily available to the public. Program directors should be aware of the general features of this technology and consider its effect in graduate medical education, including the preparation of materials such as personal statements. The authors provide a sample ChatGPT-generated personal statement and general considerations for program directors and other graduate medical education stakeholders. The authors advocate that programs and applicants will be best served by transparent expectations about how/if programs will accept application materials created using artificial intelligence, starting with this application cycle. Graduate medical education will have many additional factors to consider for the innovative use and safeguards for the ethical application of artificial intelligence in clinical care and educational processes. However, the exponential increase in the application of this technology requires an urgent review for appropriate management of program procedures, iteration of policies, and a meaningful national discussion.

Transmission of Bias in the Medical Record Among Physical Medicine and Rehabilitation Trainees.

ABSTRACT: Stigmatizing language can negatively influence providers' attitudes and care toward patients, but this has not been studied among physiatrists. An online survey was created to assess whether stigmatizing language can impact physical medicine and rehabilitation trainees' attitudes toward patients. We hypothesized stigmatizing language would negatively impact trainees' attitudes. Participants were randomized to a stigmatizing or neutral language vignette describing the same hypothetical spinal cord injury patient. Questions were asked about attitudes and assumptions toward the patient, pain management based on the vignette, and general views regarding individuals with disabilities. Between August 2021 and January 2022, 75 US physical medicine and rehabilitation residency trainees participated. Thirty-seven (49.3%) identified as women; 52 (69.3%) were White, and half (50.6%) received the stigmatized vignette. Participants exposed to stigmatizing language scored 4.8 points lower ( P < 0.01) on the provider attitude toward patient scale compared with those exposed to neutral language. There were no significant differences in the disability attitude scores between the two groups ( P = 0.81). These findings may indicate that stigmatizing language in the medical record may negatively affect physical medicine and rehabilitation trainees' attitudes toward patients. Further exploration is needed to identify the best way to educate trainees and reduce the propagation of bias in the medical record.