Survey of Techniques Utilized to Access Ventricular Shunts and Reservoirs.

AIMS: This study assessed variations in pediatric neurosurgical technique when accessing shunts and ventricular access devices (VADs). METHODS: A 12-question survey was developed and sent to members of the American Association of Neurological Surgeons (AANS) whose self-identified subspecialty was pediatric neurosurgery. RESULTS: Four hundred and twenty surveys were sent out, and 149 responses were received (35.5% response rate); 95.3% of respondents always use sterile gloves, 55.0% never use a sterile gown, and 69.8% always have a member of the neurosurgery team perform the procedure. The majority of respondents answered "sometimes" for use of a facemask (38.3%), sterile drapes (39.6%), site shaving (45.6%), having an attending present (68.5%), and having an assistant hold the patient's head (78.5%). The majority reported using a 23- or 25-gauge butterfly needle for site entry (96.6%), and betadine or ChloraPrep™ as the preferred antiseptic solution (64.4%). The frequency in which CSF is sent for analysis is not standardized in 31.5% of respondents, and wait time for the antiseptic solution to dry is not standardized in 62.4%. CONCLUSIONS: There is great variation in the technique for accessing shunts and VADs. Future studies are needed to assess whether these discrepancies affect infection rates.

Training Characteristics, Academic Accomplishments, and Motivation of Current Program Directors in Physical Medicine and Rehabilitation.

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.

Training Characteristics, Academic Accomplishments, and Motivation of Current Chairs in Physical Medicine and Rehabilitation.

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.

Awareness of Physical Medicine and Rehabilitation as a Specialty Among US Medical Students.

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.

Demographics and Durable Medical Equipment Needs of Persons With Disabilities in a Charitable Rehabilitation Clinic.

ABSTRACT: This study characterizes the demographics and durable medical equipment needs of persons with disabilities to improve utilization and management of resources at a philanthropic rehabilitation clinic. Paper charts from all encounters between 2013 and 2018 were reviewed. Data collected include sex, age, ethnicity, insurance status, diagnoses, and durable medical equipment requested/received. Paper charts that were incomplete or illegible were excluded. Among 763 individuals, there were 1157 encounters for durable medical equipment requests. Forty-six percent of individuals were uninsured. Thirty-seven percent had federal insurance such as Medicare or Medicaid, and 6% private insurance. Fifty-five percent of individuals were Hispanic, 28% African American, and 14% White. Fifty-six percent of encounters were with individuals with a neurological diagnosis, 18% medical diagnosis, 17% musculoskeletal/autoimmune diagnosis, 6% amputation diagnosis, and 3% cancer diagnosis. Of the 2680 items distributed, 34% were wheelchair parts and repair, 30% personal hygiene/incontinence supplies, 25% mobility equipment, and 11% bathroom equipment. Of the 513 unmet items requested, 49% were mobility equipment, 24% wheelchair parts and repair, 17% personal hygiene/incontinence supplies, and 11% bathroom equipment. More than a third (43%) of durable medical equipment requests were from individuals with either private insurance or federal payers, which implies lack of adequate coverage on durable medical equipment to maintain mobility and independence.

Ethnic and Racial Diversity in Academic Physical Medicine and Rehabilitation Compared with All Other Medical Specialties.

ABSTRACT: The primary aim of this study was to compare ethnic/racial diversity in academic physical medicine and rehabilitation (PM&R) with all other medical specialties in academia. The secondary aim was to characterize the ethnic/racial diversity of current PM&R program directors. Self-reported ethnicity/race information was collected from the Association of American Medical Colleges and Accreditation Council for Graduate Medical Education. Ethnicity/race was defined as white, Asian, African American, Hispanic, and other. Odds ratios (ORs) and Fisher's exact tests were used to compare ethnic/racial differences at each career level between each specialty. In 2017, in PM&R, compared with whites, there was decreased odds of African Americans by 89% (OR, 0.11), 90% for Hispanics (OR, 0.10), 62% for Asians (OR, 0.38), and 73% for other (OR, 0.27) (all P < 0.001). This disparity increased in full professors: 99% (OR, 0.01), 96% (OR, 0.04), 87% (OR, 0.13), and 90% (OR, 0.10), respectively (all P < 0.001). In 2019, most PM&R program directors identified as white (51%) compared with Hispanic (4%) and African American (2%). Overall, ethnic/racial underrepresented minorities in medicine decreased with increasing academic rank. Therefore, more robust initiatives must be implemented to improve the exposure, recruitment, and retention of ethnic/racial underrepresented minorities at all levels of PM&R academia.

Evaluation of Diversity and Inclusion Presence Among US Physical Medicine and Rehabilitation Residency Program Websites.

ABSTRACT: The primary aim of this study was to evaluate the presence of diversity and inclusion promotion among US physical medicine and rehabilitation residency program Websites. A list of physical medicine and rehabilitation residency programs was obtained from the Fellowship and Residency Electronic Interactive Database. The program Website links were obtained from the Fellowship and Residency Electronic Interactive Database or Google. Two reviewers evaluated the presence of 11 predetermined diversity and inclusion metrics. The presence of individual resident and faculty photos and biographies was also evaluated. Cross-sectional and descriptive analyses were performed. A total of 90 physical medicine and rehabilitation residency program Websites were reviewed. Only 15 (17%) Websites met at least 1 of the 11 predetermined criteria. Nine (10%) Websites mentioned diversity in their program mission statement, whereas 7 (8%) included a separate diversity statement. Eight (9%) Websites had a dedicated diversity page/section. Of Websites that included information on their residents and faculty, 62 (85%) had completed 100% of resident photos and 41 (47%) Websites had completed 100% of faculty photos. A total of 30 (41%) Websites had completed 100% of resident biographies, and 15 (17%) Websites had completed 100% of faculty biographies. Less than 20% of all residency program Websites promoted diversity and inclusion. Residency Websites lack key information that prospective applicants use to evaluate diversity.

Factors Affecting the Time and Process of CMC Drying Using Refractance Window or Conductive Hydro-Drying.

Intensive research on biodegradable films based on natural raw materials such as carboxymethyl cellulose (CMC) has been performed because it enables the production of transparent films with suitable barrier properties against oxygen and fats. Considering the importance of the production of this type of film at the industrial level, a scalable and continuous drying method is required. Refractance window-conductive hydro drying (RW-CHD) is a sustainable and energy-efficient method with high potential in drying this kind of compound. The objective of this study was to evaluate the factors (CMC thickness, heating water temperature, and film type) and radiation penetration depth that affect drying time and energy consumption. It was found that drying time decreased with increasing temperature and decreasing thickness. Similarly, energy consumption decreased with decreasing temperature and thickness. However, the drying time and energy consumed per unit weight of product obtained were equivalent when drying at any of the thicknesses evaluated. Film type had little effect on time and energy consumption compared to the effects of temperature and CMC thickness. The radiation penetration depth into the CMC was determined to be 1.20 ± 0.19 mm. When the thickness was close to this value, the radiation energy was better utilized, which was reflected in a higher heating rate at the beginning of drying.