Dr. Sofiya Prilik and Dr. Greg Sweeney: Cardiac Rehabilitation: Strategies to Improve Access, Part 1

Dr. Sofiya Prilik is Clinical Director of Cardiopulmonary Rehabilitation and Transplant Rehabilitation and Clinical Assistant Professor of Physical Medicine and Rehabilitation at the NYU Rusk Rehabilitation department. Dr. Greg Sweeney is a Clinical Instructor in the Department of Rehabilitation Medicine at the NYU Grossman School of Medicine. Part 1 The discussion included the following topics: nature of a webinar to be offered on June 12  at NYU on the topic of cardiac rehabilitation; measuring whether the webinar achieves its objectives; outcomes or activities attendees can be expected to undertake afterward; kinds of health conditions and problems that qualify patients to be eligible to participate in cardiac rehabilitation; role played by disparities in obtaining health care; and kinds of patients that benefit most from cardiac rehabilitation.

Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at Rusk. He provides care for patients with physical and cognitive disabilities. He specializes in treating those who are recuperating from a stroke or brain injury. He is accompanied in this interview by Dr. Jonathan Whiteson who holds the rank of professor in both the Department of Medicine and the Department of Rehabilitation at Rusk Rehabilitation. Dr. Whiteson's skills and expertise focus on patients recovering from coronary and lung conditions. Part 3 The discussion included the following topics: measures used to monitor patient safety, quality of care, and patient satisfaction during the transition period; approaches to dealing with staff burnout; challenges that continue to exist after 18 years when positive outcomes proved highly difficult to achieve; and the likelihood that any new clinical divisions will be created at Rusk or the number of residency slots and accredited fellowships will be increased.

Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at Rusk. He provides care for patients with physical and cognitive disabilities. He specializes in treating those who are recuperating from a stroke or brain injury. He is accompanied in this interview by Dr. Jonathan Whiteson who holds the rank of professor in both the Department of Medicine and the Department of Rehabilitation at Rusk Rehabilitation. Dr. Whiteson's skills and expertise focus on patients recovering from coronary and lung conditions. Part 2 The discussion included the following topics: Dr. Whiteson was asked if there is any kind of new knowledge he may have to acquire to be successful in his upcoming role and how he is obtaining it; he also was asked how he intends to preserve Dr. Flanagan's  accomplishments while balancing them with the development of new priorities; and short-term and long-term challenges involved in incorporating AI in the work at Rusk.

Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at Rusk. He provides care for patients with physical and cognitive disabilities. He specializes in treating those who are recuperating from a stroke or brain injury. He is accompanied in this interview by Dr. Jonathan Whiteson who holds the rank of professor in both the Department of Medicine and the Department of Rehabilitation at Rusk Rehabilitation. Dr. Whiteson's skills and expertise focus on patients recovering from coronary and lung conditions. Part 1 The discussion included the following topics: when they both began working at Rusk; how Rusk looked 18 years ago (e.g., amount of external research funding); potential upsides and downsides of selecting an insider to take over leadership responsibilities versus bringing in an outsider; when planning for the transition was started; and the kinds of engagement with groups that could be affected by this transition, such as teaching faculty, clinicians, patients, and labor unions.

Ted Joyce is a Professor of Economics at Baruch College and the Graduate Center, the City University of New York and a Research Associate in the National Bureau of Economic Research's program in Health Economics. He has published extensively in the area economic demography and reproductive health policy.  His work on abortion policy has appeared in the Journal of Political Economy, New England Journal of Medicine, the Journal of the American Medical Association, the Journal of Human Resources and the Review of Economics and Statistics. His most recent work is on the evaluation of programs to improve the academic outcomes of low-income students in higher-education. Dr. Joyce is on the Editorial Board for the Journal of Policy Analysis and Management. Part 2 The discussion included the following topics: the speed at which change can occur; AI impact on higher education institutions and academic health science centers; trends regarding how AI and online learning might influence one another; and emerging ethical questions that must be addressed.    

Ted Joyce is a Professor of Economics at Baruch College and the Graduate Center, the City University of New York and a Research Associate in the National Bureau of Economic Research's program in Health Economics. He has published extensively in the area economic demography and reproductive health policy.  His work on abortion policy has appeared in the Journal of Political Economy, New England Journal of Medicine, the Journal of the American Medical Association, the Journal of Human Resources and the Review of Economics and Statistics. His most recent work is on the evaluation of programs to improve the academic outcomes of low-income students in higher-education. Dr. Joyce is on the Editorial Board for the Journal of Policy Analysis and Management. Part 1 The discussion included the following topics: does tension exist between AI and online learning; whether AI transforms online learning into something more effective; role played by AI in measuring student performance; and determining certainty that the work produced by a student is by that individual.      

Both corticosteroid injection and PRP demonstrate initial efficacy where steroid appears to provide superior pain relief, as you can see here going down within the first four weeks, whereas PRP demonstrated longer lasting effect, as you can see that the VAS score is actually going down all the way up to 24 weeks, where the corticosteroid injections kind of peak at four weeks, and then slowly the pain comes back to its original level by 24 weeks, maybe around, even like a 12 weeks' time mark. So, both steroid and PRP are considered safe and an effective treatment for the GTPS. But in more recently years, it seems like PRP has a better efficacious indication over CSI for the treatment of GTPS. In a recent system review, it was concluded that PRP seems to be safe and effective when treating degenerative meniscus tears. However, additional studies are warranted. It seems like I'm going to sound like a broken record here, but truly understanding clinical implications of PRP on meniscus treatment due to heterogeneity of the studies reviewed. Similarly, in a recent review, although PRP appears to yield improvements in clinical outcomes. its clinical significance remains uncertain given, again, heterogeneity of the studies. Regarding knee ligament injuries, injection treatment is typically not common for knee ligament related injuries, but injection therapies have a role in reflective cases or when there are significant functional limitations due to pain. Introduction by Dr. Francis Lopez.  Q&A followed Part 2. 

Dr. Haruki Ishii discussed a review paper on the risks and benefits of corticosteroid injections versus plasma injections in patients. The aim of this review was to compare the evidence for clinical applications of these injectates as a treatment for a variety of musculoskeletal conditions in patients. Platelet-Rich Plasma (PRP) injections for clinical use as discussed here, is defined as autologous  plasma, extracted from minimally processed blood, and then containing activated platelets. So PRP delivers concentrated growth factors and cytokines acting as extra cell signaling molecules at the side of the injection. Key clinical applications of PRP include tendinopathies, osteoarthritis, muscle injuries, and then post -surgical healing treatment. The first study looked at is one published in 2021, a systemic review article. What it showed was that the corticosteroid injection yielded significant superior functional recovery and in pain compared with the PRP injections for rotator cuff lesions during the short -term follow-up period. He referred to an article that looked at the difference between a corticosteroid injection and a PRP injection for frozen shoulder patients, involving the functional outcome between those two injectates. Introduction by Dr. Francis Lopez. 

Dr. Kathleen Martin Ginis is a Distinguished University Scholar and a Professor in the Department of Medicine (Division of Physical Medicine and Rehabilitation) and in the School of Health and Exercise Sciences at The University of British Columbia. She holds the Reichwald Family Chair in Preventive Medicine and is a Fellow of the Royal Society of Canada, the Canadian Academy of Health Sciences, the Canadian Society for Psychomotor Learning and Sport Psychology, and as is an International Fellow of the National Academy of Kinesiology. The focus of Dr. Martin Ginis's research is placed on understanding and changing physical activity behaviour, particularly among people living with spinal cord injury. She is deeply committed to knowledge translation; specifically, the development and implementation of evidence-based best-practices to improve health and well-being among people with disabilities. By example, Dr. Martin Ginis spearheaded the formulation and knowledge translation of scientific exercise guidelines for adults with spinal cord injury. These guidelines have been translated into nearly 20 languages and are used worldwide in clinical and community settings. Part 2 Eighty percent admittedly is an arbitrary number, but it's one that most exercise scientists use as a sort of the minimum threshold for deeming someone adherent to the protocol. There were no differences in pain reduction between those with neuropathic versus musculoskeletal pain, but the small ends, small sample sizes for those two groups, make it difficult to really confirm that there is no difference in exercise outcomes for those two groups. She thinks we need to look at that further with bigger samples for each type of pain. Given the pragmatic nature of the trial that we let people exercise on their own in the community, she thinks this speaks to the feasibility of using exercise as a pain self-management strategy, but with the caveat that it's likely not going to be effective for everyone. Fifty percent of people with spinal cord injury report no leisure time physical activity whatsoever. In other words, no activity that could potentially improve cardiorespiratory fitness or muscle strength. And that's not the fault of people with spinal cord injury. Factors that influence physical activity don't just rest within the person, but they rest within society.

Dr. Kathleen Martin Ginis is a Distinguished University Scholar and a Professor in the Department of Medicine (Division of Physical Medicine and Rehabilitation) and in the School of Health and Exercise Sciences at The University of British Columbia. She holds the Reichwald Family Chair in Preventive Medicine and is a Fellow of the Royal Society of Canada, the Canadian Academy of Health Sciences, the Canadian Society for Psychomotor Learning and Sport Psychology, and as is an International Fellow of the National Academy of Kinesiology. The focus of Dr. Martin Ginis's research is placed on understanding and changing physical activity behaviour, particularly among people living with spinal cord injury. She is deeply committed to knowledge translation; specifically, the development and implementation of evidence-based best-practices to improve health and well-being among people with disabilities. By example, Dr. Martin Ginis spearheaded the formulation and knowledge translation of scientific exercise guidelines for adults with spinal cord injury. These guidelines have been translated into nearly 20 languages and are used worldwide in clinical and community settings. Part 1 One of her objectives is to present recent data showing the physical and mental health benefits of exercise for adults with spinal cord injury. She wants to introduce exercise guidelines for adults with SCI. Starting with the benefits of exercise from a mental and physical health perspective, probably the best two areas, best two outcomes for which there is evidence are improving insulin sensitivity and cardiovascular disease risk in this population. The fitness guideline stipulates that to improve cardiorespiratory fitness and muscle strength, adults with SCI should do at least 20 minutes of moderate to vigorous intensity, aerobic activity twice per week, and strength training exercises twice per week. The guideline for cardiometabolic health stipulates that a minimum of 30 minutes of moderate to vigorous intensity physical activity is required three times per week. She discussed how exercise improves well-being. She also talked about exercise in chronic pain. She described the Epic SCI trial, a pragmatic, randomized controlled trial, testing the effects of exercising according to the scientific SCI exercise guidelines on SCI chronic pain.