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Poster 291 Inpatient Rehabilitation Outcomes of End Stage Renal Disease Patients and Barriers to Rehabilitation
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Abstracts / PM R 7 (2015) S83-S222
infections with Epstein-Barr virus, cytomegalovirus, mycoplasma pneumoniae, and campylobacter jejuni have an association with Guillain-Barre syndrome. Possible theories include the notion that bypass surgery results in a decrease absorption of vital vitamins and nutrients that may weaken the immune system and make patients more vulnerable for infections that may lead to Guillain-Barre Syndrome. Furthermore, the surgery may alter the normal flora of our intestines in such a way that it promotes overgrowth of pathogenic organisms that were previously suppressed Conclusion: With the obesity epidemic and subsequent increase in the number of bariatric surgeries performed each year it is reasonable to predict that the number of Guillain-Barre Syndrome cases associated with this type of surgery will also be on the rise. Thus it is important to more clearly delinieate an etiology for this association in order to diagnosis and prevent such an occurrence. Poster 289 Utility of Sonography in Differentiating Neurofibromatosis from Familial Lipomatosis: A Case Report Lisa Williams, MD (Stanford University, Stanford, CA, United States), Min Kim, DO, Kamala Shankar, MD Disclosures: L. Williams: I Have No Relevant Financial Relationships To Disclose. Objective: Familial lipomatosis is a hereditary syndrome of unknown prevalence where multiple discrete, encapsulated tumors are found on the trunk and extremities. Neurofibromatosis is a neuroendocrine abnormality comprised of a set of clinical symptoms and soft tissue tumors known as neurofibromas. Although clinical appearance of these tumors may look similar, the ultrasonographic characteristics are distinct. Case Description: 55-year-old woman who presented with a ten year history of soft tissue lumps which began 10 years prior on her extremities and progressed to her torso. Her family history was significant for a father with multiple undiagnosed lumps. Physical examination revealed 20-30 subcutaneous, mobile, firm well demarcated nodules, 1-2 small areas of hyperpigmentation on the torso without skin tags or other signs of neurofibromatosis. She had associated pain and dysasthesias on several of the lumps. Further workup including MRI of the lumps on hip were unremarkable. Bedside ultrasound suggestive of lipoma without evidence of peripheral nerve involvement. Setting: Ambulatory tertiary care physical medicine and rehabilitation clinic. Results or Clinical Course: Her soft tissue swellings were later confirmed to be lipomas by biopsy. Discussion: The soft tissue tumors of neurofibromatosis and familial lipomatosis are clinically similar, however, distinct differences may be seen on ultrasound. Familial lipomatosis portends a much better prognosis then neurofibromatosis and ultrasonography may be a useful diagnostic modality in differentiating these lesions. Conclusion: Ultrasound may be a useful diagnostic modality for differentiating soft tissue lipomas from neurofibromatosis tumors. Poster 290 Evaluating Osteopathic Manipulative Therapy (OMT) as a Treatment Modality for the Reduction of Chronic Stress in Medical Students Trevor J. Tyner (Lake Erie College of Osteopathic Medicine, Bradenton, FL, United States), Chase Cavayero, OMS-II, Anthony Philips, OMS-II, Brooke Johnson, OMS-III, Thomas Quinn, DO, FAOCOPM Disclosures: T. J. Tyner: I Have No Relevant Financial Relationships To Disclose. Objective: To explore the impact of osteopathic manipulative therapy on surrogate markers of psychological distress and autonomic dysregulation. Design: The experimental treatment protocol consisted of seven minutes of lymphatic and autonomic focused treatments followed by a
brief rest period. The placebo group received only “light touch” treatments in the corresponding anatomical regions. Setting: Existing literature consistently demonstrates higher overall psychological distress amongst U.S. medical students relative to both the general public and demographic-matched peers. Having identified the prevalence of psychological distress among medical students, the next logical step is to investigate possible treatment options. Considering the accessibility of osteopathic manipulative therapy (OMT) in osteopathic colleges of medicine, there is a relative paucity of literature investigating the efficacy of psychobehavioral manipulation in distressed medical student populations. Participants: 37 (n¼37) students were randomly separated into experimental, placebo, and control groups. Interventions: A period of six weeks of OMT was initiated. Main Outcome Measures: Objective stress was measured using pre and post intervention samples of salivary alpha-amylase (sAA) and immunglobulin A (sIgA), while subjective values of stress were measured with surveys repeated at weekly intervals. Results or Clinical Course: Average change in perceived stress scale (PSS) in the Experimental group from survey 0 to survey 6 significantly differed (p¼.033), while average change in placebo and control groups from survey 0 to survey 6 was not significantly different (p¼.353 and p¼.250 respectively). Independent laboratory analysis revealed a significant difference in average sIgA change between experimental and control groups (p¼.007) but not between experimental and placebo (p¼.28). The results for salivary alpha-amylase were not significant. Conclusion: The study findings suggest that brief, structured manipulative treatments may improve the health status of medical students. Further studies should be conducted to explore the role of OMT as an adjunct treatment for psychological distress. Poster 291 Inpatient Rehabilitation Outcomes of End Stage Renal Disease Patients and Barriers to Rehabilitation Shangming Zhang, MD (Penn State Hershey Medical Center, Hershey, PA, United States) Disclosures: S. Zhang: I Have No Relevant Financial Relationships To Disclose. Objective: 1. Assess rehabilitation outcomes of end stage renal disease (ESRD) patients on hemodialysis (HD) in acute rehabilitation. 2. Identify common barriers to favorable rehabilitation outcomes in this group. Design: This is a retrospective chart review of the selected patients at Penn State Hershey Rehabilitation Hospital (PSHRH). Setting: Inpatient rehabilitation facility (IRF). Participants: All patients with ESRD on hemodialysis admitted at PSHRH between 8/5/2010-2/27/2014 and debility patients as control group during the same period. Interventions: Not applicable. Main Outcome Measures: Functional independence measure (FIM), FIM gain, FIM efficiency, length of stay (LOS), unplanned transfers to acute care and discharge destination. Results or Clinical Course: There were 83 HD patients (F 26, M 57) with average age 66.1 year-old and 189 patients with average age of 70.1 year-old in control. FIM improved from 63.8 to 80.9 in HD patients and from 65.5 to 85.7 in control group. Approximately 80% of patients were discharged home for these two groups. LOS were 15.1 days in HD group and 13.3 days in control. FIM efficiency was 1.6 and 1.9 after missed therapy time adjustment. The most common barriers to participate in therapy are fatigue, pain, depression and orthostatic hypotension in HD patients. Conclusion: ESRD patients on HD show slower but steady improvement compared to the control group primarily secondary to fatigue especially post dialysis fatigue, pain, depression and orthostatic hypotension. Therefore early interventions of these limiting conditions are expected to improve overall inpatient rehabilitation outcomes for HD patients. In addition, all ESRD patients should receive 15-hour therapy over 7-day instead of over 5-day for better tolerance to therapy.
Abstracts / PM R 7 (2015) S83-S222
infections with Epstein-Barr virus, cytomegalovirus, mycoplasma pneumoniae, and campylobacter jejuni have an association with Guillain-Barre syndrome. Possible theories include the notion that bypass surgery results in a decrease absorption of vital vitamins and nutrients that may weaken the immune system and make patients more vulnerable for infections that may lead to Guillain-Barre Syndrome. Furthermore, the surgery may alter the normal flora of our intestines in such a way that it promotes overgrowth of pathogenic organisms that were previously suppressed Conclusion: With the obesity epidemic and subsequent increase in the number of bariatric surgeries performed each year it is reasonable to predict that the number of Guillain-Barre Syndrome cases associated with this type of surgery will also be on the rise. Thus it is important to more clearly delinieate an etiology for this association in order to diagnosis and prevent such an occurrence. Poster 289 Utility of Sonography in Differentiating Neurofibromatosis from Familial Lipomatosis: A Case Report Lisa Williams, MD (Stanford University, Stanford, CA, United States), Min Kim, DO, Kamala Shankar, MD Disclosures: L. Williams: I Have No Relevant Financial Relationships To Disclose. Objective: Familial lipomatosis is a hereditary syndrome of unknown prevalence where multiple discrete, encapsulated tumors are found on the trunk and extremities. Neurofibromatosis is a neuroendocrine abnormality comprised of a set of clinical symptoms and soft tissue tumors known as neurofibromas. Although clinical appearance of these tumors may look similar, the ultrasonographic characteristics are distinct. Case Description: 55-year-old woman who presented with a ten year history of soft tissue lumps which began 10 years prior on her extremities and progressed to her torso. Her family history was significant for a father with multiple undiagnosed lumps. Physical examination revealed 20-30 subcutaneous, mobile, firm well demarcated nodules, 1-2 small areas of hyperpigmentation on the torso without skin tags or other signs of neurofibromatosis. She had associated pain and dysasthesias on several of the lumps. Further workup including MRI of the lumps on hip were unremarkable. Bedside ultrasound suggestive of lipoma without evidence of peripheral nerve involvement. Setting: Ambulatory tertiary care physical medicine and rehabilitation clinic. Results or Clinical Course: Her soft tissue swellings were later confirmed to be lipomas by biopsy. Discussion: The soft tissue tumors of neurofibromatosis and familial lipomatosis are clinically similar, however, distinct differences may be seen on ultrasound. Familial lipomatosis portends a much better prognosis then neurofibromatosis and ultrasonography may be a useful diagnostic modality in differentiating these lesions. Conclusion: Ultrasound may be a useful diagnostic modality for differentiating soft tissue lipomas from neurofibromatosis tumors. Poster 290 Evaluating Osteopathic Manipulative Therapy (OMT) as a Treatment Modality for the Reduction of Chronic Stress in Medical Students Trevor J. Tyner (Lake Erie College of Osteopathic Medicine, Bradenton, FL, United States), Chase Cavayero, OMS-II, Anthony Philips, OMS-II, Brooke Johnson, OMS-III, Thomas Quinn, DO, FAOCOPM Disclosures: T. J. Tyner: I Have No Relevant Financial Relationships To Disclose. Objective: To explore the impact of osteopathic manipulative therapy on surrogate markers of psychological distress and autonomic dysregulation. Design: The experimental treatment protocol consisted of seven minutes of lymphatic and autonomic focused treatments followed by a
brief rest period. The placebo group received only “light touch” treatments in the corresponding anatomical regions. Setting: Existing literature consistently demonstrates higher overall psychological distress amongst U.S. medical students relative to both the general public and demographic-matched peers. Having identified the prevalence of psychological distress among medical students, the next logical step is to investigate possible treatment options. Considering the accessibility of osteopathic manipulative therapy (OMT) in osteopathic colleges of medicine, there is a relative paucity of literature investigating the efficacy of psychobehavioral manipulation in distressed medical student populations. Participants: 37 (n¼37) students were randomly separated into experimental, placebo, and control groups. Interventions: A period of six weeks of OMT was initiated. Main Outcome Measures: Objective stress was measured using pre and post intervention samples of salivary alpha-amylase (sAA) and immunglobulin A (sIgA), while subjective values of stress were measured with surveys repeated at weekly intervals. Results or Clinical Course: Average change in perceived stress scale (PSS) in the Experimental group from survey 0 to survey 6 significantly differed (p¼.033), while average change in placebo and control groups from survey 0 to survey 6 was not significantly different (p¼.353 and p¼.250 respectively). Independent laboratory analysis revealed a significant difference in average sIgA change between experimental and control groups (p¼.007) but not between experimental and placebo (p¼.28). The results for salivary alpha-amylase were not significant. Conclusion: The study findings suggest that brief, structured manipulative treatments may improve the health status of medical students. Further studies should be conducted to explore the role of OMT as an adjunct treatment for psychological distress. Poster 291 Inpatient Rehabilitation Outcomes of End Stage Renal Disease Patients and Barriers to Rehabilitation Shangming Zhang, MD (Penn State Hershey Medical Center, Hershey, PA, United States) Disclosures: S. Zhang: I Have No Relevant Financial Relationships To Disclose. Objective: 1. Assess rehabilitation outcomes of end stage renal disease (ESRD) patients on hemodialysis (HD) in acute rehabilitation. 2. Identify common barriers to favorable rehabilitation outcomes in this group. Design: This is a retrospective chart review of the selected patients at Penn State Hershey Rehabilitation Hospital (PSHRH). Setting: Inpatient rehabilitation facility (IRF). Participants: All patients with ESRD on hemodialysis admitted at PSHRH between 8/5/2010-2/27/2014 and debility patients as control group during the same period. Interventions: Not applicable. Main Outcome Measures: Functional independence measure (FIM), FIM gain, FIM efficiency, length of stay (LOS), unplanned transfers to acute care and discharge destination. Results or Clinical Course: There were 83 HD patients (F 26, M 57) with average age 66.1 year-old and 189 patients with average age of 70.1 year-old in control. FIM improved from 63.8 to 80.9 in HD patients and from 65.5 to 85.7 in control group. Approximately 80% of patients were discharged home for these two groups. LOS were 15.1 days in HD group and 13.3 days in control. FIM efficiency was 1.6 and 1.9 after missed therapy time adjustment. The most common barriers to participate in therapy are fatigue, pain, depression and orthostatic hypotension in HD patients. Conclusion: ESRD patients on HD show slower but steady improvement compared to the control group primarily secondary to fatigue especially post dialysis fatigue, pain, depression and orthostatic hypotension. Therefore early interventions of these limiting conditions are expected to improve overall inpatient rehabilitation outcomes for HD patients. In addition, all ESRD patients should receive 15-hour therapy over 7-day instead of over 5-day for better tolerance to therapy.