Rita G. Hamilton D.O.

Roberson, D., D. K. Newman, J. B. Ziemba, A. Wein, H. Stambakio, R. G. Hamilton, L. Callender, L. Holderbaum, T. King, A. Jackson, T. Tran, G. Lin and A. L. Smith (2021). “Results of the patient report of intermittent catheterization experience (PRICE) study.” Neurourol Urodyn 40(8): 2008-2019.

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AIMS: Patient satisfaction is paramount to health-related quality of life (HR-QoL) outcomes. High quality, quantitative data from the US describing patients’ actual experiences, difficulties, and HR-QoL while on an intermittent self-catheterization (ISC) regimen is very scarce. Our objective was to better understand patient practices with and attitudes towards ISC. METHODS: This is a cross-sectional, multi-centered, clinical study of adult men and women performing ISC in the United States. Data collected included demographics, medical history, catheter characteristics, specific self-catheterization habits and two validated HR-QoL questionnaires: The Intermittent Self-Catheterization Questionnaire (ISC-Q) and the Intermittent Catheterization Difficulty Questionnaire (ICDQ). RESULTS: Two hundred participants were recruited from six sites; 70.0% were male, 73.5% were Caucasian with a median age was 51.0 years (range 19-90 years). The ISC-Q showed that the vast majority of participants reported ease with ISC (82.0% satisfaction score) had confidence in their ability to perform ISC (91.9% satisfaction score); yet, many felt self-conscious about doing so (58.3% satisfaction score) and had concerns about long-term adverse effects (58.1% satisfaction score). The ICDQ indicated little to no difficulty for most participants with all routine ISC practices. A small minority of participants reported some difficulty with a “blocking sensation” during initiation of catheterization, leg spasticity, and painful catheterization. Multivariate linear regression results are also reported. DISCUSSION/CONCLUSION: Participants are confident with ISC and have little overall difficulty, which may be a product of successful education and/or catheter design. urinary tract infections (UTIs) were common (yet variable) and may contribute to the noted long-term ISC concerns. Limitations exist including various selection biases leading to concerns of external validity. Future educational interventions in this population may further improve HR-QoL, optimize UTIs prevention, and diminish concerns with long-term ISC.

Taylor, C.M., 2nd, Baer, H., Edgar, L., Jenkins, J.G., Harada, N., Helkowski, W.M., Zumsteg, J.M., Francisco, G.E., Sabharwal, S., Hamilton, R.G. and Mallow, M. (2021). “Improving the Assessment of Resident Competency: Physical Medicine and Rehabilitation Milestones 2.0.” Am J Phys Med Rehabil 100(2S Suppl 1): S45-s50.

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In 2015, the Accreditation Council for Graduate Medical Education published the Physical Medicine and Rehabilitation Milestones 1.0 as part of the Next Accreditation System. This was the culmination of more than 20 yrs of work on the part of the Accreditation Council for Graduate Medical Education to improve graduate medical education competency assessments. The six core competencies were patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills. While providing a good foundation for resident assessment, the Physical Medicine and Rehabilitation Milestones 1.0 was not without faults. With input from program directors, national organizations, and the public, the Physical Medicine and Rehabilitation Milestones 2.0 strives to further advance resident assessment, providing improvements through the integration of the harmonized Milestones and the addition of a supplemental guide.

Taylor, C.M., 2nd, Baer, H., Edgar, L., Jenkins, J.G., Harada, N., Helkowski, W.M., Zumsteg, J.M., Francisco, G.E., Sabharwal, S., Hamilton, R.G. and Mallow, M. (2020). “Improving the Assessment of Resident Competency: Physical Medicine and Rehabilitation Milestones 2.0.” Am J Phys Med Rehabil.

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In 2015, the Accreditation Council for Graduate Medical Education (ACGME) published the Physical Medicine and Rehabilitation (PM&R) Milestones 1.0 as part of the Next Accreditation System (NAS). This was the culmination of over 20 years of work on the part of the ACGME to improve graduate medical education competency assessments. The six core competencies were patient care (PC), medical knowledge (MK), systems-based practice (SBP), practice-based learning and improvement (PBLI), professionalism (PROF), and interpersonal and communication skills (ICS). While providing a good foundation for resident assessment, the PM&R Milestones 1.0 wasn’t without faults. With input from program directors, national organizations, and the public, the PM&R Milestones 2.0 strives to further advance resident assessment, providing improvements through the integration of the harmonized Milestones and the addition of a Supplemental Guide.

Pollifrone, M., S. Sikka and R. Hamilton (2020). “Takotsubo cardiomyopathy in a chronic spinal cord injury patient with autonomic dysreflexia: A case report.” J Spinal Cord Med Feb 11:1-4. [Epub ahead of print].

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Context: Takotsubo cardiomyopathy (TC) is a transient stress-induced cardiomyopathy with left ventricular dysfunction of unknown etiology. A well accepted theory for the pathophysiology of TC is attributed to a massive catecholamine release [1]. This case report will review a chronic tetraplegia patient who was diagnosed with TC after a severe episode of autonomic dysreflexia (AD). He experiences mild episodes of AD several times a day; however, he had never experienced the severity of symptoms that was associated with this episode which led to his hospitalization. Autonomic dysreflexia is a syndrome of imbalanced sympathetic input secondary to loss of descending central sympathetic control in spinal cord injury due to noxious stimuli below the level of the injury, which occurs when the injury level is at thoracic level 6 (T6) or above [2].Findings: In this specific case, it is presumed that the massive catecholamine release associated with this severe AD episode resulted in TC. Although TC has been diagnosed after other instances of acute stress, it is unknown for it to be diagnosed after AD in a chronic setting.Clinical Relevance: The long-term effects of AD have not been well studied, and this case illustrates the importance of education to recognize and manage AD in the spinal cord patient who frequently has episodes of AD.

Sikka, S., A. Vrooman, L. Callender, D. Salisbury, M. Bennett, R. Hamilton and S. Driver (2019). “Inconsistencies with screening for traumatic brain injury in spinal cord injury across the continuum of care.” J Spinal Cord Med 42(1): 51-56.

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OBJECTIVE: Explore how traumatic brain injury (TBI) is screened among spinal cord injury (SCI) patients across the continuum of care. DESIGN: Retrospective chart review Setting: Emergency department, trauma, inpatient rehabilitation Participants: 325 patients with SCI from inpatient rehabilitation facility (IRF) between March 1, 2011 and December 31, 2014 were screened. 49 eligible subjects had traumatic SCI and received care in adjoining acute care (AC) hospital. OUTCOME MEASURES: Demographic characteristics and variables that capture diagnosis of TBI/SCI included documentation from ambulance, emergency department, AC, and IRF including ICD-9 codes, altered mental status, loss of consciousness (LOC), Glasgow Coma Score, Post Traumatic Amnesia (PTA), neuroimaging, and cognitive assessments. RESULTS: Participants were male (81%), white (55%), privately insured (49%), and aged 39.3+/-18.0 years with 51% paraplegic and 49% tetraplegic. Mechanisms of injury were gunshot wound (31%), fall (29%), and motor vehicle accident (20%). TBI occurred in 65% of SCI individuals, however documentation of identification of TBI, LOC, and CT imaging results varied in H&P, discharge notes, and ICD-9 codes across the continuum. Cognitive assessments were performed on 16% of subjects. CONCLUSIONS: Documentation showed variability between AC and IRF and among disciplines. Imaging and GCS were more consistently documented than LOC and PTA. It is necessary to standardize screening processes between AC and IRF to identify dual diagnosis.