Medicine and Health Sciences Commons^™

Effect Of Hospital Volume On Outcomes Of Total Hip Arthroplasty: A Systematic Review And Meta-Analysis, Syed Hamza Mufarrih, Muhammad Owais Abdul Ghani, Russell S. Martins, Nada Qaisar Qureshi, Sayyeda Aleena Mufarrih, Azeem Tariq Malik, Shahryar Noordin

Department of Biological & Biomedical Sciences

Background: A shift in the healthcare system towards the centralization of common yet costly surgeries, such as total hip arthroplasty (THA), to high-volume centers of excellence, is an attempt to control the economic burden while simultaneously enhancing patient outcomes. The "volume-outcome" relationship suggests that hospitals performing more treatment of a given type exhibit better outcomes than hospitals performing fewer. This theory has surfaced as an important factor in determining patient outcomes following THA. We performed a systematic review with meta-analyses to review the available evidence on the impact of hospital volume on outcomes of THA.
Materials and methods: We conducted …

What Is Congenital Talipes Equinovarus?, Cornelia Lieb-Lundell

San Marcos, Fall 2019

An estimated 80% of clubfoot cases occur in low to middle-income countries. Incidence of clubfoot is estimated to be 1-1.5 per 1000 births, and male to female occurrence is 3:1. (1) Left untreated, this congenital anomaly becomes a “neglected clubfoot” and can result in lifelong hardships including limited ambulation related to gait deviations, pain, foot deformities and an inability to wear shoes. Without treatment, this health condition can lead to functional limitations with limited independence in activities of daily living and participation restrictions within the family and community related to decreased mobility. (2)

The intervention presented is the main components …

Biomechanics Analysis Of Anterior Cortical Perforation In Antegrade Femoral Nailing, Michael Ching

Electronic Thesis and Dissertation Repository

Hip and femur fractures are a common problem in an aging population. The number of hip and femur fractures are on the rise in Canada. Cephalomedullary fixation is a common method of treating hip and femur fractures, with a known complication of anterior cortical perforation of the distal femur. The literature describes risk factors, such as the influence of the start point at the greater trochanter, but there is no consensus on management. Some cases are treated with restricted weightbearing and other cases with revision surgery. Restricted weightbearing increases perioperative complications including mortality and decreases functional outcomes.

We analyze the …

Secukinumab Efficacy On Resolution Of Enthesitis In Psoriatic Arthritis: Pooled Analysis Of Two Phase 3 Studies., Laura C Coates, Johan K Wallman, Dennis Mcgonagle, Georg A Schett, Iain B Mcinnes, Philip Mease, Lawrence Rasouliyan, Erhard Quebe-Fehling, Darren L Asquith, Andreas E R Fasth, Luminita Pricop, Corine Gaillez

Articles, Abstracts, and Reports

BACKGROUND: Enthesitis is one of the psoriatic arthritis (PsA) domains. Patients with enthesitis are associated with worse outcomes than those without enthesitis. The effect of secukinumab on the resolution of enthesitis in patients with PsA was explored using pooled data from the FUTURE 2 and 3 studies.

METHOD: Assessments of enthesitis through week 104 used the Leeds Enthesitis Index. These post hoc analyses included resolution of enthesitis count (EC = 0), median time to first resolution of enthesitis (Kaplan-Meϊer estimate), and shift analysis (as observed) of baseline EC (1, 2, or 3-6) to full resolution (FR), stable (similar or reduction …

Secukinumab Efficacy On Resolution Of Enthesitis In Psoriatic Arthritis: Pooled Analysis Of Two Phase 3 Studies., Laura C Coates, Johan K Wallman, Dennis Mcgonagle, Georg A Schett, Iain B Mcinnes, Philip Mease, Lawrence Rasouliyan, Erhard Quebe-Fehling, Darren L Asquith, Andreas E R Fasth, Luminita Pricop, Corine Gaillez

Articles, Abstracts, and Reports

BACKGROUND: Enthesitis is one of the psoriatic arthritis (PsA) domains. Patients with enthesitis are associated with worse outcomes than those without enthesitis. The effect of secukinumab on the resolution of enthesitis in patients with PsA was explored using pooled data from the FUTURE 2 and 3 studies.

METHOD: Assessments of enthesitis through week 104 used the Leeds Enthesitis Index. These post hoc analyses included resolution of enthesitis count (EC = 0), median time to first resolution of enthesitis (Kaplan-Meϊer estimate), and shift analysis (as observed) of baseline EC (1, 2, or 3-6) to full resolution (FR), stable (similar or reduction …

Fracture Repair Requires Trka Signaling By Skeletal Sensory Nerves., Zhu Li, Carolyn A Meyers, Leslie Chang, Seungyong Lee, Zhi Li, Ryan Tomlinson, Ahmet Hoke, Thomas L Clemens, Aaron W James

Department of Orthopaedic Surgery Faculty Papers

Bone is richly innervated by nerve growth factor-responsive (NGF-responsive) tropomyosin receptor kinase A-expressing (TrKa-expressing) sensory nerve fibers, which are required for osteochondral progenitor expansion during mammalian skeletal development. Aside from pain sensation, little is known regarding the role of sensory innervation in bone repair. Here, we characterized the reinnervation of tissue following experimental ulnar stress fracture and assessed the impact of loss of TrkA signaling in this process. Sequential histological data obtained in reporter mice subjected to fracture demonstrated a marked upregulation of NGF expression in periosteal stromal progenitors and fracture-associated macrophages. Sprouting and arborization of CGRP+TrkA+ sensory nerve fibers …

The Functional Outcome Of Direct Lateral Approach For Fixation Of Proximal Humeral Fractures: A Case Series From A Tertiary Care Hospital, Mujahid Jamil, Irfan Anwer, Muhammed Tabish Saleem, Ahmed Abdul Habib Khan, Mohammad Zohaib Nawaz Khan

Section of Orthopaedic Surgery

Displaced proximal humeral fractures warrant surgical fixation for early rehabilitation and better functional outcome. These fractures are traditionally fixed by delto pectoral surgical approach. Direct lateral approach has recently gained interest as it involves less soft tissue dissection and is particularly helpful in certain fracture patterns. However, there have been concerns of axillary nerve damage with this approach. We report a case series of proximal humerus fractures fixed by direct lateral approach from our institution. All displaced Type 2 and 3 fractures were included in our study. Pathological and comminuted Type 4 fractures and fractures with ipsilateral clavicle or elbow …

Assessing Physical Activity And Sleep In Axial Spondyloarthritis: Measuring The Gap., Atul Deodhar, Lianne S Gensler, Marina Magrey, Jessica A Walsh, Adam Winseck, Daniel Grant, Philip Mease

Articles, Abstracts, and Reports

Patients with axial spondyloarthritis (axSpA) frequently report pain, stiffness, fatigue, and sleep problems, which may lead to impaired physical activity. The majority of reported-on measures evaluating physical activity and sleep disturbance in axSpA are self-reported questionnaires, which can be impacted by patient recall (reporting bias). One objective measure, polysomnography, has been employed to evaluate sleep in patients with axSpA; however, it is an intrusive measure and cannot be used over the long term. More convenient objective measures are therefore needed to allow for the long-term assessment of both sleep and physical activity in patients' daily lives. Wearable technology that utilizes …

Elevated Glucose Acts Directly On Osteocytes To Increase Sclerostin Expression In Diabetes, Donna M. Pacicca, Tammy Brown, Dara Watkins, Karen Kover, Yun Yan, Matthew Prideaux, Lynda Bonewald

Manuscripts, Articles, Book Chapters and Other Papers

© 2019, The Author(s).

Bone quality in diabetic patients is compromised, leading to weaker bones and increased fracture risk. However, the mechanism by which this occurs in diabetic bone remains to be fully elucidated. We hypothesized that elevated glucose and glucose variation would affect the function of osteocytes, essential regulators of bone homeostasis and quality. To first test this hypothesis, we used the IDG-SW3 osteocyte-like cell line to examine the effects of glucose levels on osteocyte function and viability in vitro. We confirmed our in vitro findings using the in vivo streptozotocin-induced (STZ) diabetic rat model and ex-vivo cultured osteocytes …

Treatment And Outcome Improvement With Implementation Of A System-Wide Comprehensive Plan Of Care For Management Of Isolated Hip Fractures, C. Michael Lecroy, Adam Kaufman, Christina Mcquiston, Harold Michael Frisch, Martha Hoskyns, Sean Snyder, Terrie Smith, Jaclyn Gosnell, Michael J. Schurr, William Shillinglaw

Orthopedic Surgery

No abstract provided.

Volume Changes After Traumatic Spinal Cord Injury In Animal Studies - A Systematic Review, Mahdi Sharif-Alhoseini, Fariba Vahedi, Mahmoud Omidbeigi, Marzieh Sharifi, Zahra Hassannejad, Shayan Abdollah Zadegan, Motahareh Rezvan, Mona Mokhatab, Kiavash Sajadi, Aida Shakouri-Motlagh, Farhad Shokraneh, Alexander R. Vaccaro, Vafa Rahimi Movaghar

Department of Orthopaedic Surgery Faculty Papers

There are limited data on the lesion volume changes following spinal cord injury (SCI). In this study, a meta-analysis was performed to evaluate the volume size changes of the injured spinal cord over time among animal studies in traumatic SCI. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive electronic search of English literature of PubMed and EMBASE databases from 1946 to 2015 concerning the time-dependent changes in the volume of the spinal cord following mechanical traumatic SCI. A hand-search was also performed for non-interventional, non-molecular, and non-review studies. Quality appraisal, data extraction, …

Using Patient Experience In Optimizing The Total Knee Arthroplasty Patient Journey, Nienke Wolterbeek, Dieuwertje J. Hiemstra, Fiona A. Van Der Hoeven, Kiem G. Auw Yang

Patient Experience Journal

Information was used to improve the patient journey and to achieve patient-centered care. Patients (>18 years, purposive sampling) were interviewed once at one point of their total knee arthrosis journey within the hospital setting. Patients were accompanied and observed during their hospital visit by one of the 19 healthcare professionals which were trained as interviewers. A qualitative research approach with in-depth and semi-structured interviews using a standardized interview guide were used to gather an in-depth understanding of the perceptions of patients. Interviews were written out with the emphasis on positive and negative feedback, quotes and observations that were made. …

Test-Retest Reliability And Minimum Detectable Change For Various Frontal Plane Projection Angles During Dynamic Tasks, David M. Werner, Stephanie Di Stasi, Cara L. Lewis, Joaquin Alberto Barrios

Physical Therapy Faculty Publications

Objective: Establish between-day test-retest reliability metrics for 2-dimensional frontal plane projection angles (FPPAs) during the lateral step-down (LSD), single-limb squat (SLS), single-limb landing (SLL), and drop vertical jump (DVJ).

Design: Test-retest reliability study

Setting: University laboratory

Participants: 20 healthy adults (12 female, age = 23.60±1.93 years old, body mass index = 24.26±2.54 kg/m²) were tested on 2 separate occasions 7-14 days apart.

Main Outcome Measures: Intraclass correlation coefficients (ICC), standard errors of the measurement (SEM), and minimal detectable change (MDC) values across the LSD, SLS, SLL, and DVJ for the following body region variables: trunk, trunk on pelvis, …

Creating An Interprofessional Collaborative Research Opportunity For Physical And Occupational Therapy Students, Anne Fleischer, Mary Insana Fisher, Shirley P. O'Brien

Physical Therapy Faculty Publications

Physical therapy (PT) and occupational therapy (OT) professional associations assert the importance that entry-level therapists learn and apply the knowledge and skills necessary for interprofessional collaborative practice; however, the majority of PT and OT programs do not have the other discipline at their university. A challenge exists for the creation of a transparent active learning opportunity promoting interprofessional student engagement when the two professions do not reside in the same university. This case study provides a model for how to feasibly create an interprofessional experience for students in universities that do not include a complementary or collaborative allied health professional …

Preoperative Factors Related To Delayed Discharge After Total Knee Arthroplasty Removal From Inpatient-Only List, Juan Carlos Suarez, William Arguelles, Priscilla Rivera, Yvette Hernandez, Don Parris

All Publications

No abstract provided.

Nucleus Pulposus Primary Cilia Alter Their Length In Response To Changes In Extracellular Osmolarity But Do Not Control Tonebp-Mediated Osmoregulation., Hyowon Choi, Vedavathi Madhu, Irving M. Shapiro, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

The nucleus pulposus (NP) cells adapt to their physiologically hyperosmotic microenvironment through Tonicity-responsive enhancer binding protein (TonEBP/nuclear factor of activated T-cell5 [NFAT5])-mediated osmoregulation. Primary cilia in different organs serve diverse roles including osmosensing, but its contribution to NP cell osmoadaptive response is unknown. A high percentage of cultured primary NP cells possessed primary cilia that changed length in response to osmotic stimuli. Stable silencing of Intraflagellar Transport 88 (Ift88) or Kinesin Family Member 3 A (Kif3a) to inhibit the formation of primary cilia did not affect hyperosmotic upregulation of TonEBP. While ShKif3a blocked hyperosmotic increase of TonEBP-Transactivation Domain (TAD) activity, …

Impact Of Best Practice Guideline Statement On Anesthesia Practice In Rural Mississippi Hospitals With Obese Patients Undergoing Total Knee Arthroplasty, Steven Hodnett

Doctoral Projects

The aim of this best practice guideline (BPG) was to be a resource for anesthesia providers practicing with obese patients undergoing total knee arthroplasty (TKA) and to measure the knowledge of these providers. After dissemination of an executive summary to anesthesia providers in two hospitals in rural Mississippi, an anonymous online survey was provided via Qualtrics software for voluntary participation. The survey consisted of 10 questions. The data collection period was five weeks. Respondents are noted at N=2, and the data was reviewed and categorized into one of three domains (i.e., knowledge, practice, and safety). In the domain of knowledge, …

Big Spine Data Put To Good Use: The Nhs Sets An Example., Jens R Chapman, Jeffrey C Wang, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Effects Of Accelerated Versus Standard Care Surgery On The Risk Of Acute Kidney Injury In Patients With A Hip Fracture: A Substudy Protocol Of The Hip Fracture Accelerated Surgical Treatment And Care Track (Hip Attack) International Randomised Controlled Trial, Flavia K. Borges, P J. Devereaux, Meaghan Cuerden, Mohit Bhandari, Ernesto Guerra-Farfán, Ameen Patel, Alben Sigamani, Masood Umer, John Neary, Maria Tiboni

Section of Orthopaedic Surgery

Introduction: Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI.
Methods and analysis: Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after …

Staged Bilateral Total Shoulder Arthroplasty With Non-Spherical Humeral Head Resurfacing And Inlay Glenoid Replacement, William Davis, Alex Rothfeld, Luis Vargas, John Zvijac, John Uribe

John Uribe

No abstract provided.

Neurological Conditions Associated With Spinal Cord Injury, Man Amanat, Alexander R. Vaccaro, Mona Salehi, Vafa Rahimi-Movaghar

Rothman Institute Faculty Papers

Background: Comorbid neurological conditions associated with spinal cord injury (SCI) significantly affect an individual’s quality of life, yet they are often under-rated. Recent reports suggest that SCI may predispose patients to develop other neurological disorders. We aim at providing an overview of the evidence of neurological conditions which are or seem resultant of SCI.

Methods: We conducted a literature review using PUBMED and GOOGLE SCHOLAR to evaluate the occurrence of different neurological disorders in people with SCI.

Results: Individuals with SCI seem at an increased risk of stroke, cognitive impairment, dementia, multiple sclerosis, Parkinson’s disease, restless leg syndrome, and seizures. …

The Effects Of Therapeutic Riding On Social Skills And Sensory Functioning In Children With Autism, Betsy Donahoe-Fillmore, Mary Insana Fisher, Christy Lee, Jordan Bevins, Cristin Carter, Stephanie Dailey, Kelsey Haynes, Allison Richard, Sarah Soboslay

Physical Therapy Faculty Publications

Purpose and Significance: Therapeutic riding (TR) is equine-assisted riding lessons that are adapted for people with a wide variety of impairments and is often used as an adjunct to traditional therapies. Previous research has shown that TR helped to improve sensory functioning, cognition and social skills in children with Autism Spectrum Disorder (ASD) but sessions have typically been for 10-12 weeks. The purpose of this study was to investigate if social skills and sensory functioning improved after only 8 weeks of TR.

Subjects: Children were recruited from a local TR center. Participants included seven children (5M, 2F) with a diagnosis …

Meta-Analysis A Myriad Of Data - Is It Helpful?, James Harrop

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Three Pillars Of Expectation Management In Spine Surgery: Trust, Communication, And Patient Education., Karsten Wiechert, Jeffrey C Wang, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

Outcomes Of Bilateral Shoulder Arthroplasties: A Comparison Of Bilateral Total Shoulder Arthroplasties And Bilateral Reverse Shoulder Arthroplasties., Ryan Matthew Cox, Tyler James Brolin, Eric Michael Padegimas, Mark D. Lazarus, Charles Lonnie Getz, Matthew Lee Ramsey, Gerald Ross Williams, Joseph Albert Abboud

Rothman Institute Faculty Papers

Background: The purpose of this study was to compare outcomes of patients who underwent bilateral total shoulder arthroplasties (TSAs) for osteoarthritis (OA) versus bilateral reverse shoulder arthroplasties (RSAs) for cuff tear arthropathy (CTA).

Methods: Inclusion criteria were patients who underwent bilateral TSAs for OA or bilateral RSAs for CTA with at least 2 years of follow-up. Twenty-six TSA patients (52 shoulders) were matched 2 to 1 with 13 RSA patients (26 shoulders) by sex, age at first surgery, and time between surgeries. Outcomes measured were shoulder range of motion (ROM), complications, and patient-reported scores.

Results: Preoperatively, TSA patients had significantly …

Operative Versus Conservative Treatment Of Clavicular And Scapular Fractures, Chase Davis

Theses and Graduate Projects

Background: Clavicle fractures and scapula fractures represent up to 4% and 1% of all fractures, respectively.^1-4,9-11 Historically, both fracture types have been treated conservatively with acceptable outcomes. The surgical correction of these fractures is currently being investigated as a viable alternative to conservative management.

Method: A systematic search of PubMed was performed to identify articles comparing open reduction and internal fixation (ORIF) with conservative treatment for both clavicular and scapular fractures. Specific outcomes of interest were shoulder function, pain, strength, range of motion, and risk of nonunion.

Results: ORIF of midshaft clavicular fractures results in increased shoulder function within …

Effectiveness Of Mri To Assess The Integrity Of Distal Biceps Tendon Repair During The First Year Postoperatively, Keith Hecthman, Gary Kiebzak

Keith Hechtman

No abstract provided.

Equine Or Porcine Synovial Fluid As A Novel Ex Vivo Model For The Study Of Bacterial Free-Floating Biofilms That Form In Human Joint Infections, Jessica M. Gilbertie, Lauren V. Schnabel, Noreen J. Hickok, Megan E. Jacob, Brian P. Conlon, Irving Shapiro, Javad Parvizi, Thomas P. Schaer

Department of Orthopaedic Surgery Faculty Papers

Bacterial invasion of synovial joints, as in infectious or septic arthritis, can be difficult to treat in both veterinary and human clinical practice. Biofilms, in the form of free-floating clumps or aggregates, are involved with the pathogenesis of infectious arthritis and periprosthetic joint infection (PJI). Infection of a joint containing an orthopedic implant can additionally complicate these infections due to the presence of adherent biofilms. Because of these biofilm phenotypes, bacteria within these infected joints show increased antimicrobial tolerance even at high antibiotic concentrations. To date, animal models of PJI or infectious arthritis have been limited to small animals such …

Humeral Retroversion, Range Of Motion, And Strength Adaptations In Tennis Players, Daniel Hannah

Electronic Theses and Dissertations

Purpose: This study aimed to develop an understanding of humeral retroversion (HRV) asymmetries in tennis players and its impact on physical and performance characteristics of the shoulder.Participants: Healthy tennis players were categorized into 3 groups: younger juniors (n=11, age=14.5±0.5 years), older juniors (n=12, age=17.1±0.9 years), and collegiate (n=16, age=19.6±1.2 years). Methods: HRV, internal rotation (IR), and external rotation (ER), total arc of motion (TAM), HRV-corrected IR (HRVcIR), and HRV-corrected ER (HRVcER) were measured and calculated bilaterally using a digital inclinometer and ultrasonography. Bilateral differences (Δ) were calculated (dominant minus nondominant) for HRV and ROM variables. Isometric ER:IR strength ratios …

Vanadium Compounds Modulate Osteoblast Proliferation And Function, Bryan Sosa

Seton Hall University Dissertations and Theses (ETDs)

Osteoblastogenesis is an essential part of the bone healing process. Insulin has been shown to improve bone healing in both normal and diabetic bone healing models. In addition, insulin mimetic compounds such as Zinc chloride (ZnCl₂) and Vanadyl acetylacetonate (VAC) have also been shown to improve bone healing in these models as well. The purpose of this study was to determine the effects of vanadium compounds VAC and Vanadium (II) sulfate (VSO₄) in osteoblast proliferation and function. In addition the mechanisms by which growth and function are facilitated by these Vanadium compounds were also evaluated. In …