This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City.
Questions from around the country are answered in this exciting and extremely important episode!
Please excuse any issues with sound.
Dr. Jeffrey Fine serves as Vice Chairman of NYU Langone Health Brooklyn Rehabilitation & Rusk Rehabilitation Network Development. He is a clinician educator and administrator who has been practicing in academic medicine at Level I Trauma Center teaching hospitals for over 20 years. Dr. Fine is chairperson of the VBM ICU early mobilization program at NYU Langone Hospital Brooklyn and also chairperson of the Brooklyn brain injury outpatient care planning team. He holds four certifications from the American Board of Medical Specialties in the following areas: Physical Medicine & Rehabilitation; Spinal Cord Injury; Brain Injury Medicine; and Pain Medicine. He also has published several articles regarding patient safety during transitions of care including communication during handoffs, and identification/reconciliation of barriers to safe community discharge with resultant enhanced patient satisfaction. His medical degree is from New York Medical College and he completed his residency at Mount Sinai School of Medicine in New York City. Among his many prestigious awards, on more than one occasion he was honored as Best Teacher Of The Year in the Department of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai.
In this interview, Dr. Fine discusses the following: kinds of patients he is treating for COVID-19; patient pathways to arrive for treatment; differential susceptibility of patients entering the health care setting on the basis of age, gender, socioeconomic factors, genetic variations and other characteristics, such as preexisting conditions like diabetes; whether accurate predictors are being employed, along with any kinds of measures or rating scales to help distinguish patients who can expect to be discharged to their homes compared to individuals with more life-limiting medical conditions; access to all necessary therapies, including those considered still at an experimental stage of effectiveness; role of telehealth in treating COVID-19; possible impact on daily activities of wearing full-body PPE by clinicians in the hospital; and how as a health professional life may have changed since the appearance of COVID-19.
Dr. Brian Im serves as director of brain injury rehabilitation at the Rusk Rehabilitation Institute at NYU Langone Health. He is heavily involved in program development and academic medicine. He has an active role in TBI research with a focus on studying health care disparities and differences that exist in traumatic brain injury care for different populations. After completing medical school at SUNY, Syracuse, a rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and a fellowship in brain injury medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent tenure at Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations.
In this episode, Dr Im discusses the kinds of patients he has been treating for COVID-19, after-effects that are caused or associated with the onset of coronavirus that might not have occurred in the absence of a COVID-19 infection; patterns that characterize these patients; when triage becomes necessary; whether any kinds of measures or rating scales are being used at Rusk as a means of helping to distinguish patients who can expect to be discharged to their homes compared to individuals with more life-limiting medical conditions; whether accurate predictors exist to help determine whether a patient’s condition may be prone to deteriorate rapidly as opposed to achieving recovery eventually from what ails them; if Rusk has access to all necessary therapies, including those considered still at an experimental stage of effectiveness; if wearing full-body PPE in the hospital results in physical barriers that hinder personal activities; ways is which his life has changed since the appearance of COVID-19; and whether telehealth plays a role in treating either patients who have been discharged after being treated for COVID-19 or patients who already were being treated by Rusk clinicians prior to the outbreak of that disease.
Dr. Naomi Gerber serves as the Director of Research for the Department of Medicine at Inova Fairfax Hospital in Virginia and the Outcomes Program at the Beatty Center for Integrated Research. After graduating from Tufts University School of Medicine, Dr. Gerber completed two residencies in internal medicine and rehabilitation medicine and a fellowship in rheumatology. She served as the Chief of the Rehabilitation Medicine Department at the Clinical Center, National Institutes of Health in Bethesda, Maryland and was instrumental in helping to develop the sub-specialty of rehabilitative rheumatology. In 2006, Dr. Gerber joined the faculty of George Mason University in the Health Administration and Policy Department and is co-director of the Laboratory for the Study and Simulation of Human Movement.
Listeners to Part 1 of Dr. Gerber’s presentation will recall that she talked about fatigue in the context of proteomics, performance, and perception. In Part 2, she began by asking how do we separate central fatigue from depression? It is a difficult question and may be why the biosignatures are so important. From a clinical perspective, sad and despairing feelings, anhedonia, really is the hallmark of depression. It’s not the hallmark of central fatigue, which is a different pathway. Many important factors here originate in the liver. We need to be attentive to the way we measure the specifics of both peripheral and central fatigue. We have objective measures that are quantitative and we have self-reports. Both are needed, along with observer-recorded reports to obtain a full picture of what we mean by fatigue. A perfect fatigue instrument has not been found yet. She described the fatigue severity scale and indicated some of its deficiencies. She also described the kinds of procedures undertaken in her laboratory to obtain a fuller understanding of fatigue. She indicated who can be considered fatigued. It’s usually women, individuals who are less active, who are obese or overweight, who are smokers with more than moderate alcohol intake, often complaining of depressed symptomology, and they are anxious. In her view, metabolic issues are under appreciated by our specialty.