ABSTRACT
ABSTRACT: The field of physical medicine and rehabilitation should strive for a physician workforce that is ethnically/racially, sex, and ability diverse. Considering the recent realities of disparities in health outcomes related to COVID-19 and in racial injustice in the United States, we are called to be champions for antiracism and equity. The specialty of physical medicine and rehabilitation should be the leaders in fostering a culture of inclusion and pay special attention to the population of applicants who are underrepresented in medicine. The specialty needs tools to start addressing these disparities. This article aims to provide strategic and intentional evidence-based recommendations for programs to follow. Holistic review, implicit bias training, structured interviews, and targeted outreach for those underrepresented in medicine are some of the tools that will help students enter and become successful in our specialty. Furthermore, this article provides novel guidance and considerations for virtual interviews during the COVID-19 pandemic.
Subject(s)
Cultural Diversity , Disabled Persons , Education, Medical, Graduate/standards , Physical and Rehabilitation Medicine , Prejudice/prevention & control , Workforce , Humans , Physical and Rehabilitation Medicine/education , Physical and Rehabilitation Medicine/organization & administration , Physical and Rehabilitation Medicine/standards , Prejudice/ethnology , Socioeconomic Factors , United States , Workforce/organization & administration , Workforce/standardsABSTRACT
BACKGROUND: Therapies that significantly improve the neurological and functional recovery of individuals with spinal cord injury (SCI) are still urgently needed. The ketogenic diet (KD) has been shown to improve forelimb motor function in an SCI rat model, likely by reducing inflammation and cell death in the spinal cord. Furthermore, our recent pilot study in patients with SCI showed that, compared with a standard hospital diet (SD), 5 weeks of KD started during acute care improved upper extremity motor function and reduced serum levels of a neuroinflammatory blood protein. The primary goals of the current study are to: 1) show the safety and feasibility of administering a KD during acute care for SCI; 2) determine if consuming 5 weeks of a KD significantly improves motor and sensory functions, functional independence and glycemic control; and 3) quantify serum biomarkers that are linked to improvements in neurological recovery and functional independence via targeted proteomics. METHODS/DESIGN: In a single-masked, longitudinal, randomized, parallel-controlled study, a total of 60 eligible, acutely traumatic spinal cord injured (cervical 5 to thoracic 12) participants ranging in age from 18 to 60 years with American Spinal Injury Association impairment scale (AIS) grades A-C (AIS-A, sensorimotor complete; AIS-B, sensory incomplete/motor complete; and AIS-C, nonfunctional motor incomplete) are being enrolled. Neurological and functional examinations, resting energy expenditure, blood, urine, and stool collections, and protein analyses related to neurological recovery will be performed within 72 h of injury (baseline measure) and repeated after 5 weeks of KD or SD (discharge measure). We anticipate a completion rate of 80% with a total of 48 participants. DISCUSSION: Intervention with a more neuroprotective diet during acute care of SCI can be implemented anywhere in the world at low cost and without major regulatory hurdles. Better functional recovery will lead to a better quality of life and long-term health outcomes in individuals with SCI. While this study targets SCI, if successful it has the potential to improve neurological outcomes for individuals with various traumatic injuries. TRIAL REGISTRATION: NCT03509571 Registered on April 28, 2018.
Subject(s)
Diet, Ketogenic/methods , Recovery of Function , Sensation , Spinal Cord Injuries/diet therapy , Acute Disease , Adolescent , Adult , Cervical Vertebrae/injuries , Energy Metabolism , Evaluation Studies as Topic , Female , Humans , Longitudinal Studies , Male , Middle Aged , Quality of Life , Randomized Controlled Trials as Topic , Single-Blind Method , Thoracic Vertebrae/injuries , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: The aim of this study was to determine the inter-rater reliability of the modified Medical Research Council (MRC) scale for grading motor function in patients with chronic incomplete spinal cord injury (SCI). METHODS: Two neurosurgical residents and 2 faculty members performed motor examinations in 6 chronic incomplete SCI patients for a total of 156 muscle groups. Examinations were performed using the modified MRC grading scale during routine clinic visits for each patient. Informed consent was obtained prior to enrollment. Patients with American Spinal Injury Association (ASIA) Impairment Scale grade A (ASIA A) injuries were excluded. Inter-rater reliability coefficients were calculated using Kendall's coefficient of concordance (W) and intraclass correlation coefficients (ICCs). RESULTS: Sixty-four percent of the tested variables demonstrated extremely strong (W 0.71-0.9) or strong (0.51-0.7) inter-rater reliability using Kendall's coefficient of concordance and an ICC corresponding to excellent (ICC > 0.75) or fair to good (ICC 0.4-0.75) inter-rater reliability. An additional 7% showed poor inter-rater reliability (ICC < 0.4). The remaining variables tested did not reach statistical significance. CONCLUSIONS: The inter-rater reliability of the modified MRC scale was found to be high in the majority of tested variables, but the results suggest that discrepancy among trained observers does exist. Reliability was greatest in the lower-extremity muscle groups and least in the upper-extremity muscle groups in patients with chronic incomplete SCI.
