Rehabilitation of a Patient with Diabetic Myonecrosis: A Case Report

Setting: Inpatient rehabilitation unit at a university hospital Patient: 37-year-old male with diabetic myonecrosis. Case Description: The patient had a long-standing history of uncontrolled diabetes mellitus with multiple comorbidities, including end-stage renal disease on dialysis and diabetic myonecrosis of the left biceps femoris diagnosed by biopsy and magnetic resonance imaging (MRI.) On this admission, he presented with right leg pain and swelling, found to be a reoccurrence of diabetic myonecrosis in the vastus lateralis, medialis, and intermedius, diagnosed by MRI only. Prior to admission, he lived alone in a wheelchair inaccessible duplex and required minimal assistance with housekeeping. Assessment/Results: Upon initial consultation, he ambulated 25-50 feet at a minimum assistance level with a single point cane. As he was unsafe to return home alone, he was transferred to inpatient rehabilitation after a two week acute hospitalization. During his rehabilitation stay, he increasingly was unable to tolerate standing secondary to pain, and at discharge, he was non-ambulatory despite many attempts at pain control and assistive devices for ambulation. His right leg swelling persisted throughout his stay. After five weeks on our unit, he was discharged to a long-term care facility at a wheelchair independent level. One year later he still was not ambulating, and still lived in the long-term care facility. Discussion: Diabetic myonecrosis is an uncommon complication of both insulin-dependent and non-insulin dependent diabetics. Symptoms usually resolve on their own with rest and analgesics within weeks to several months. There are reports of physical therapy prolonging the recovery period and exacerbating symptoms, which may have happened with our patient. Conclusions: Download poster

Provider Perspectives on Language Barriers in MyChart Enrollment for Patients with Limited English Proficiency

Background: There are 25 million people in the United States with limited English proficiency (LEP). Patients with LEP are a vulnerable population who may have worse health outcomes compared to English-proficient patients, as they face barriers to safe, effective, and high-quality care. Previous studies show this population is likely to benefit from utilization of patient portals, which allow users to access personal health information and communicate with healthcare providers. Current literature reports that patients with LEP and their families have a strong interest in using the patient portal as it can help them understand their providers and health, remember their care plan, and have more control over their health. However, there is less portal access and utilization among patients with LEP. This study was conducted to obtain provider perspectives surrounding MyChart engagement of patients with LEP to identify potential barriers to MyChart enrollment at the University of Vermont Health Network (UVMHN). Methods: EPIC’s Slicer Dicer tool was utilized to obtain UVMHN patient counts organized by reported language and MyChart activation. Data was collected from an anonymous REDCap survey sent to 211 providers within UVMHN Departments of General Internal Medicine, Family Medicine, and Pediatrics, and analyzed utilizing Excel. Results: 67.9% of UVMHN Primary Care English speakers have MyChart activated compared to 46.9% of patients with LEP. Providers strongly believe that MyChart is beneficial to patients and families with 72.1% of providers agreeing that it improves the patient-provider relationship. When asked specifically about patients with LEP, 36% of providers agree that MyChart access is beneficial to care. 49% report they are likely to encourage MyChart enrollment to their patients with LEP; however, only 14% know how to assist in enrollment. Differences in knowledge of language services are seen in different visit modalities: 78.1% of providers report ability to provide language services during in-person visits compared to 48.8% for video visits and 46.3% for telephone visits. Once made aware of the differences in MyChart activation status between English proficient patients and patients with LEP, providers frequently requested more education around language assistance, MyChart activation instructions to provide patients in their dominant language, translation tools within EPIC, and training for support staff to also encourage patients with LEP to enroll in MyChart. Conclusions: While providers overwhelmingly believe MyChart is useful to patient care and are likely to recommend it to their patients with LEP, they lack the tools and education necessary to aid in equitable enrollment. Educational materials and translated resources should be created for providers to utilize in assisting their patients with LEP. A follow-up study with patients would provide an opportunity to compare patient and provider responses and gain additional perspectives on MyChart access and utilization

Recurrent Concussion, How Many is Too Many? Sport- Football

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Time-dependence of SrVO3_3 thermionic electron emission properties

Thermionic electron emission cathodes are critical components of various high power and high frequency vacuum electronic devices, electron microscopes, e-beam lithographic devices, and thermionic energy converters, which all demand an efficient and long-lasting low work function cathode. Single phase, polycrystalline perovskite oxide SrVO$_3$, with its intrinsic low effective work function and facile synthesis process, is a promising cathode candidate, where previous works have shown evidence of an effective work function as low as 2.3 eV. However, assessment of the stability over time under conditions relevant for operation and the related interplay of evolving surface chemistry with emission performance are still missing, and necessary for understanding how to best prepare, process and operate SrVO$_3$ cathodes. In this work, we study the vacuum activation process of SrVO$_3$ and find it has promising emission stability over 15 days of continuous high temperature operation. We find that SrVO$_3$ shows surface Sr and O segregation during operation, which we hypothesize is needed to create a positive surface dipole, leading to low effective work function. Emission repeatability from cyclic heating and cooling suggests the promising stability of the low effective work function surface, and additional observations of drift-free emission during one hour of continuous emission testing at high temperature further demonstrates its excellent performance stability