S179 S290
Poster 143:
Use of Clinical Practice Guidelines for Traumatic
Brain Injury to Identify Gaps in Research Evidence
Alan B. Tran, MD (Oklahoma State University, Tulsa, Oklahoma,
United States), Jared Scott, Medical Student, Anna Mazur-Mosiewicz,
PhD, HSP, Matthew Vassar, PhD, Julia H. Crawford, MLIS
Disclosures:
Alan B. Tran, MD: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
The objective of the study was to explore the integrity of
the research pipeline in traumatic brain injury research by evaluating
the extent to which research gaps (identified from low and very low
quality evidence during guideline development) are being addressed
by new and ongoing research cataloged in clinical trial registries.
Design:
Clinical practice guidelines were retrieved from the March
2013 Scottish Intercollegiate Guidelines Network on brain injury
rehabilitation in adults. Evidence underpinning recommendations
(graded low/very low quality or with a high risk of bias) were extracted
and screened. Next, we developed evidence-based research questions
using the PICO framework (Patient/Problem/Population, Intervention,
Comparator, Outcome). Search terms, based on these PICO questions,
were developed in consultation with medical research librarians using
a combination of Cochrane systematic reviews, Medline, and Embase.
Using these search terms, we searched ClinicalTrials.gov and the World
Health Organization’s International Clinical Trial Registry Platform to
identify new or ongoing studies in that area.
Setting:
N/A.
Participants:
N/A.
Interventions:
Not applicable.
Main Outcome Measures:
Frequency and percentage of new and
ongoing studies listed in clinical trial registries identified from practice
guidelines.
Results:
Clear deficits were noted across most domains. Of the 48
areas identified, little evidence was found of new studies being
informed by guideline development.
Conclusions:
Our findings suggest a potential inefficiency in resource
allocation for new and ongoing studies in traumatic brain injury
rehabilitation. Improved connectivity between the guideline devel-
opment process and study planning may improve the efficiency of the
research enterprise and result in more efficient practices.
Level of Evidence:
Level III
Poster 144:
The Institution of a Rehabilitation Transitional Care
Program Can Significantly Decrease Readmission
Rates to the Acute Care Hospital from The Acute
Inpatient Rehabilitation Unit
Annamaria L. Dunn, MD (JFK Med Cntr), Marianne Boylston,
Nurse Practitioner, Alessandra Dunn, N/A
Disclosures:
Annamaria Dunn: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
To test the hypothesis that establishing a rehabilitation
transitional care program in a 700 bed Level one Trauma/Compre-
hensive Stroke Center acute care hospital would significantly decrease
readmission rates.
Design:
A team of a Physiatrist, advanced practice nurse (APN), and
two admission screeners was developed to evaluate all patients who
were referred for admission to an acute inpatient rehabilitation hos-
pital from an acute care hospital. The patients who were being
referred to inpatient acute rehabilitation were first screened by one of
the two pre-admission screeners for financial clearance. The patient
names were then given to the rehabilitation APN who did a full eval-
uation: full review of chart (past and present), review of all labs and
imaging, review of pertinent medical information and current medical
status. The APN visited the patient, reviewed relevant medical/social
information, performed a physical exam, staged decubiti, examined
wounds and surgical incisions. This information was then presented to
the inhouse physiatrist who would determine if the patient was ready
for transfer to the acute inpatient rehabilitation hospital. If further
tests were needed or the patient was not ready due to medical issues,
the physiatrist would communicate this information to the medical
attending. In the case the patient was not transferred, the patient
would then be evaluated again the following day by the team.
Setting:
An acute care hospital: 700 bed Level 1 Trauma/Compre-
hensive Stroke Center.
Participants:
Physiatrist, APN, two pre-admission screeners.
Interventions:
Not Applicable.
Main Outcome Measures:
Percentage of patients readmitted back to
the acute hospital from the acute rehabilitation hospital.
Results:
The institution of the rehabilitation transitional care team
reduced the readmission rates from 13.8% to 1.3% over a two year
period. During the first year the rate decreased from 13.8% to 3.3%.
Conclusions:
The institution of a rehabilitation transitional care team
significantly decreases readmission rates and reduces cost to the acute
care hospital.
Level of Evidence:
Level V
Poster 145:
Level of Competitiveness of Physical Medicine and
Rehabilitation (PM&R) Residency Match based on the
National Resident Matching Program (NRMP ) data:
2007-2016.
Manoj K. Poudel, MBBS (Nepalese Academy of Physical Medicine and
Rehabilitation, Clovis, California, United States)
Disclosures:
Manoj Poudel: I Have No Relevant Financial Relationships
To Disclose
Objective:
Determine the recent trend of level of competitiveness of
PM&R residency match.
Design:
Descriptive epidemiological study.
Setting:
NRMP data.
Participants:
Residency applicants.
Interventions:
N/A
Main Outcome Measures:
Competitiveness of PM&R residency match.
Results:
PM&R residency training began in 1936. Historically, it used
to be reportedly less competitive. But, between 2007-2016, ratio of
number of PM&R residency applicant to number of PM&R residency
position offered has doubled. Percentage of US medical schools’
applicant and US-citizen international medical schools’ (US-IMG) ap-
plicants with successful PM&R residency matches are 82.0% (including
27.7% osteopaths) and 10.1% respectively in average with little fluc-
tuation. However, percentage of matched non-US-citizen IMG has been
decreasing (6.0% in 2007 to 3.1% in 2016). Mean USMLE Step-1 score of
allopathic US seniors who successfully matched into PM&R residency
has increased by 12 and 18 points in last five- and ten-year intervals
respectively. Similarly, mean USMLE Step-2-CK score has increased by
14 points in last five years. Last five-year interval increase of mean
USMLE Step-1 and Step-2-CK scores of applicants who matched into
PM&R residency are the highest among all other residencies offered in
The Match . Similarly, last ten-year interval increase of mean USMLE
Step-1 score is second highest increase after those of radiation
oncology (19) and plastic surgery (19) residencies. While ten-year in-
terval increase in median number of contiguous rank for successful
PM&R residency match is the highest (6), the 2016 value is second
highest (15) after neurological surgery (16). Allopathic US seniors who
successfully matched into PM&R residency have progressive increase in
average number of abstracts, publications, and presentations (from
1.3 to 3.9) and mean number of research experiences (by nearly six
times) in last decade.
Conclusions:
Matching into PM&R residency position has become more
competitive than ever before. It is trending to become even more
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Abstracts / PM R 9 (2017) S131-S290