Current available literature supports the use of exercise programs and rehabilitation interventions to improve fatigue, mood, functional independence, breathlessness, and pain. Rehabilitation and palliative care practitioners share many goals in their approach to patient care and augment one another well. Palliative care providers should consider referral to physiatry (physical medicine and rehabilitation) to help optimize patients' quality of life.

6MWT and GMFM-E have the strongest associations with level, amount and intensity of walking in daily life. Results suggest that the 6MWT and GMFM-E can be employed to estimate community walking activity in ambulatory children with CP. Future studies should focus on environmental and personal factors that influence community walking performance.

Background Cancer rehabilitation is an integral part of the continuum of care for survivors. Due to the increasing number of survivors, physiatrists commonly see cancer patients in their general practices. Essential to guiding the field is to understand the current training and practice patterns of cancer rehabilitation physicians. Objectives To assess current trends in training and practice for cancer rehabilitation physicians, including the level of burnout among providers in this field. Design Cross‐sectional descriptive survey study. Setting Online survey. Participants American physicians who are affiliated with the Cancer Rehabilitation Physician Consortium (CRPC) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R). The CRPC is a group of cancer rehabilitation providers (both fellowship‐trained and not fellowship‐trained) with the mission of furthering cancer rehabilitation medicine through education, research, and networking. Methods All CRPC physicians were invited to complete a voluntary and anonymous 43‐question online survey. The survey was conceived by a group of eight experts interested in providing additional information to the current literature regarding the training and practice in the cancer rehabilitation field. Main Outcome Measurements Training, practice, opioid prescribing, and professional support. Results Thirty‐seven of 50 physicians participated (response rate = 74%). Respondents were from various states, the three most common being New York (16%, n = 6), Texas (16%, n = 6), and Massachusetts (11%, n = 4). About 57% (n = 21) of the respondents were employed in an academic medical center and 73% (n = 27) reported their primary departmental affiliation was Physical Medicine and Rehabilitation (PM&R). Approximately 78% (n = 29) credited mentorship early in training for their interest in the field. More than half (54%, n = 20) either strongly agreed or agreed that cancer rehabilitation fellowship training is necessary for graduating physiatrists who plan to treat oncology patients/survivors. National PM&R meetings were the primary source of continuing education for 86% (n = 31). Sixty‐five percent (n = 24), strongly agreed or agreed that cancer rehabilitation physiatrists should know how to prescribe opioids, and 35% (n = 13) reported prescribing them when appropriate. About 54% (n = 20) rated their level of burnout as low or very low, and more than half (51%, n = 19) believed their burnout level was lower than physiatrists treating other rehabilitation populations. Conclusions Cancer rehabilitation is a growing subspecialty in PM&R, and most physiatrists in general practice will treat many survivors—often for neurologic or musculoskeletal impairments related to cancer or its treatment. Cancer rehabilitation physicians perceive that they have relatively low levels of burnout, and early mentorship and fellowship training is beneficial. Professional conferences and mentorship are a primary source for continuing education. Level of Evidence IV.

A case report D iabetic retinopathy is one of the major complications of diabetes, and it is the most common cause of blindness. Following the recommendation of the management guidelines for type 2 diabetes, we have established a routine screening for diabetic complications in our clinics (1). Although nonmydriatic fundus photography was widely used for screening of diabetic retinopathy, less attention has been directed toward the correlation between asymmetric retinopathy (i.e., more advanced retinopathy in one eye and no retinopathy in the other) and carotid artery disease. Here, we are reporting on a diabetic patient with asymptomatic internal carotid artery (ICA) occlusion who presented with significantly asymmetric retinopathy found by nonmydriatic fundus photography in our routine screening clinic.A 59-year-old man with a known history of hypertension, type 2 diabetes, and dyslipidemia for ϳ10 years was regularly followed up in our hospital. Routine screening with nonmydriatic fundus photography found asymmetric retinopathy with hemorrhagic and cotton wool spots in the left eye and no retinopathy in the right eye ground. (Fig. 1). After noting this finding, we asked the patient about possible neurological symptoms. Only mild vision deterioration in the left eye was noted in the past 10 days. Because it did not hinder his daily life, he had not paid attention to the condition. He denied any other motor, sensory, or visual disturbances. There was no history of cigarette smoking, alcohol consumption, or previous surgical operation. On physical examination, his height and weight were 170 cm and 69 kg, respectively. His blood pressure was 138/90 mmHg, with a regular pulse and no carotid bruit or heart murmur. Examinations of the chest and abdomen produced normal results. No pitting edema was found in the extremities, the distal circulation was intact, and the bilateral ankle/brachial index was 1.06/1.06. No remaining evidence of any other neurological deficits was noted during normal sensory examinations and measurements of deep tendon reflexes and muscle power.The laboratory studies revealed a hemoglobin level of 13.4 g/dl, a platelet count of 258 ϫ 10 9 /l, fasting plasma glucose level of 175 mg/dl, a postprandial plasma glucose level of 153 mg/dl, HbA 1c value of 6.9%, a creatinine level of 0.8 mg/dl, total cholesterol level of 275 mg/dl, triglyceride 690 mg/dl, and urinary albumin excretion count of 30-300 mg/g creatinine. We further performed a carotid ultrasound examination, and found total occlusion of the left ICA and mild plaque in the right ICA (Fig. 2). After weighing the risk of stroke during medical management versus the risks of surgery, the patient was prescribed aspirin 650 mg/day for antiplatelet L E T T E R S , normal in the right eye, (A) and preproliferative retinopathy with cotton wools and hemorrhagic spots in the left eye fundus (B). 1430DIABETES CARE, VOLUME 23, NUMBER 9, SEPTEMBER 2000 Letters therapy, buflomedil 150 mg 3 times a day for reducing risks of myocardial infarction, stroke...

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