Faculty Bibliography

OBJECTIVE:The aim of the study was to present: (1) physiatric care delivery amid the SARS-CoV-2 pandemic, (2) challenges, (3) data from the first cohort of post-COVID-19 inpatient rehabilitation facility patients, and (4) lessons learned by a research consortium of New York and New Jersey rehabilitation institutions. DESIGN:For this clinical descriptive retrospective study, data were extracted from post-COVID-19 patient records treated at a research consortium of New York and New Jersey rehabilitation inpatient rehabilitation facilities (May 1-June 30, 2020) to characterize admission criteria, physical space, precautions, bed numbers, staffing, employee wellness, leadership, and family communication. For comparison, data from the Uniform Data System and eRehabData databases were analyzed. The research consortium of New York and New Jersey rehabilitation members discussed experiences and lessons learned. RESULTS:The COVID-19 patients (N = 320) were treated during the study period. Most patients were male, average age of 61.9 yrs, and 40.9% were White. The average acute care length of stay before inpatient rehabilitation facility admission was 24.5 days; mean length of stay at inpatient rehabilitation facilities was 15.2 days. The rehabilitation research consortium of New York and New Jersey rehabilitation institutions reported a greater proportion of COVID-19 patients discharged to home compared with prepandemic data. Some institutions reported higher changes in functional scores during rehabilitation admission, compared with prepandemic data. CONCLUSIONS:The COVID-19 pandemic acutely affected patient care and overall institutional operations. The research consortium of New York and New Jersey rehabilitation institutions responded dynamically to bed expansions/contractions, staff deployment, and innovations that facilitated safe and effective patient care.

Introduction/UNASSIGNED:Providing feedback is a fundamental principle in medical education; however, as educators, our community lacks the necessary skills to give meaningful, impactful feedback to those under our supervision. By improving our feedback-giving skills, we provide concrete ways for trainees to optimize their performance, ultimately leading to better patient care. Methods/UNASSIGNED:In this faculty development workshop, faculty groups used six feedback video vignettes scripted, enacted, and produced by residents to arrive at a shared mental model of feedback. During workshop development, we used qualitative analysis for faculty narratives combined with the findings from a focused literature review to define dimensions of feedback. Results/UNASSIGNED:Twenty-three faculty (physical medicine and rehabilitation and neurology) participated in seven small-group workshops. Analysis of group discussion notes yielded 343 codes that were collapsed into 25 coding categories. After incorporating the results of a focused literature review, we identified 48 items grouped into 10 dimensions of feedback. Online session evaluation indicated that faculty members liked the workshop's format and thought they were better at providing feedback to residents as a result of the workshop. Discussion/UNASSIGNED:Small faculty groups were able to develop a shared mental model of dimensions of feedback that was also grounded in medical education literature. The theme of specificity of feedback was prominent and echoed recent medical education research findings. Defining performance expectations for feedback providers in the form of a practical and psychometrically sound rubric can enhance reliable scoring of feedback performance assessments and should be the next step in our work.

Description: The patient was a 65-year-old man with visual hallucinations after a right pontine infarct which improved without pharmacological intervention. He had dementia, hypertension, diabetes, and tobacco use. He was admitted to acute inpatient rehabilitation where he was noted to have visual hallucinations. He reported seeing furniture and objects that were not there. He had Lilliputian hallucinations which involved seeing objects smaller than they were in reality. The patient understood his hallucinations were not real and was not perturbed by them. Sleep disturbance was present. Prior electroencephalography was negative for seizures. Medications were reviewed for causes of hallucinations and ropinirole was stopped, but hallucinations persisted.
Setting(s): Academic Acute Inpatient Rehabilitation Hospital Results: The patient had peduncular hallucinosis and quetiapine was considered. However, due to his cardiovascular risk factors and dementia leading to increased risk of cardiovascular events with atypical antipsychotics, it was not given. As his hallucinations were not affecting his function and were non-threatening to the patient, the decision was made not to treat his hallucinations. His hallucinations became less frequent with time.
Discussion(s): Our case presents a patient who experienced peduncular hallucinosis after a pontine infarct, a rare neurologic disorder that can occur after a patient sustains damage to the midbrain, pons, or thalamus. Patients experience visual hallucinations that are often realistic. They can have Lilliputian hallucinations and sleep disturbances. The option to treat with atypical antipsychotics is available, however, given the risks associated with such medications and the self-resolving nature of the hallucinations in this case, their use was not necessary.
Conclusion(s): Our case is one of the few reported incidences of peduncular hallucinosis. Pharmacological intervention may not be required given its self-limited nature