Medical Specialties Commons^™

Family Physicians And Menstrual Care: An Analysis Of Cera 2023, Allison Casola, Olivia Rea, Tiffany Ho

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Menstrual health is an important indicator of overall health and has large impacts on quality of life. Despite number and impact, discussion of menstruation remains largely taboo within health care. Patients and physicians are not engaging in regular, meaningful discussions on menstruation. Family physicians, as primary care providers, can facilitate these important conversations.

OBJECTIVES: We sought to understand the profile of menstrual care providing family physicians and assessed physician comfort, knowledge, training, and perceived importance regarding menstrual care.

DESIGN/METHODS: This is a cross-sectional analysis of the 2022 Council of Academic Family Medicine Educational Research Alliance survey. The survey included …

Multi-Institution Single Geometry Plan Complexity Characteristics Based On Iroc Phantoms, Vimal Desai, Zacariah Labby, Wesley Culberson, Larry Dewerd, Stephen Kry

Department of Radiation Oncology Faculty Papers

BACKGROUND: Clinical intensity modulated radiation therapy plans have been described using various complexity metrics to help identify problematic radiotherapy plans. Most previous studies related to the quantification of plan complexity and their utility have relied on institution-specific plans which can be highly variable depending on the machines, planning techniques, delivery modalities, and measurement devices used. In this work, 1723 plans treating one of only four standardized geometries were simultaneously analyzed to investigate how radiation plan complexity metrics vary across four different sets of common objectives.

PURPOSE: To assess the treatment plan complexity characteristics of plans developed for Imaging and Radiation …

Full Issue: Volume 2, Issue 1 - April 2024

Bone Bulletin

i - Editors’ Note by Ari Clements & Amit Syal

ii - Foreword by Dr. Alan Hilibrand

7 - Exploring Approaches to Treatment of Musculoskeletal Injuries by Catherine Alvaro

9 - A Spotlight on the Various Subspecialties of Orthopedic Surgery by Ryan Garemani

14 - Exploring the Importance of Implant Selection in Total Hip Arthroplasty by John Czarnecki

16 - Revolutionizing Orthopaedics: Exploring the Therapeutic Potential of Stem Cells by Harrison Fellheimer

18 - Shoulder Arthroplasty in Patients with Inflammatory Arthritis: Preoperative and Perioperative Management of Disease Modifying Anti-Rheumatic Drug Therapy by Daniel Kwak

22 - The Role of Psychological …

Redefining Recovery: Multimodal Analgesics And Tranexamic Acid In Orthopedic Surgery, Elijah Hoffman

Bone Bulletin

Introduction As the demand for joint replacements continues to rise, optimizing patient outcomes and enhancing recovery have become paramount goals for orthopedic surgeons. Patients used to have minimal mobility following a Total Knee Arthroplasty (TKA) or Total Hip Arthroplasty (THA) due to pain or the effects of sedation from anesthesia. This would lead to longer hospital stays, more complications, and higher opioid use.¹ These surgeries also resulted in levels of blood loss that required transfusion therapy postoperatively.² In recent years, there has been a paradigm shift in postoperative care for total joint arthroplasty (TJA), marked by significant advancements …

A Review Of The Effects Of Early Sport Specialization On The Health Of Adolescent Baseball Players, Robert C. Juniewicz

Bone Bulletin

Introduction

Participation in sports during adolescence is beneficial for participants as it improves fitness, enhances psychosocial development, increases academic performance, and boosts self-esteem.¹ One of the most popular sports among adolescent athletes is baseball, with nearly 500,000 high school players in the United States in 2020.1 While participation in sports has been shown to have clear benefits and has been steadily increasing, recent decades have also seen a dramatic rise in the level of competition.² As a direct result, there has been an increase in the prevalence of early sports specialization (ESS) with an estimated 14-47% of adolescent …

The Ins And Outs Of Wide-Awake Hand Surgery, Molly Milano

Bone Bulletin

Introduction

As the name might imply, “wide awake local anesthesia no tourniquet” (WALANT) is a surgical method to perform hand surgery using only a local anesthetic without the use of a tourniquet or any sedation and general anesthetics. The WALANT technique takes advantage of the vasoconstrictive effects of epinephrine combined with the local anesthetic effects of lidocaine to create a surgical field that does not require a tourniquet or general anesthesia.¹ The main contributor is epinephrine, which decreases bleeding in the surgical field while also lengthening lidocaine’s absorption and effect.² When first introduced to the surgical world, the …

Examining The Role Of Augmented Reality In Total Hip Arthroplasty, Joseph Raphael

Bone Bulletin

Background

In 2023, it was reported that total hip arthroplasty (THA) was the main and effective surgical treatment for advanced hip osteoarthritis, osteonecrosis, and rheumatoid arthritis.¹ As the population ages, the number of annual THA procedures is projected to grow and reach 635,000 by the year 2030.² As such, further improving outcomes in THA will benefit this large population. On average age for individuals who sustain a hip fracture is 80 years old and the lifetime prevalence of hip fractures is 20% in women and 10% in men.³ Fracture reduction and internal fixation or arthroplasty are often …

The Role Of Psychological Readiness In Recovery From Acl Injury In Female Athletes, Samantha Meacock

Bone Bulletin

The Anterior Cruciate Ligament (ACL) injury is common in sports, with female athletes facing a disproportionately higher risk in comparison to male athletes.¹ This susceptibility is the result of a complex relationship between various factors including anatomical, biomechanical, hormonal, neuromuscular, and environmental influences.² In addition, the unique challenges that females face with respect to sports, violence, body image, and family planning create additional stressors that may further contribute to an increased risk for injury.^3,4 Following ACL Reconstruction (ACLR) surgery, these gender discrepancies carry over into recovery as female athletes exhibit decreased rates of return to sport (RTS) …

Shoulder Arthroplasty In Patients With Inflammatory Arthritis: Preoperative And Perioperative Management Of Disease Modifying Anti-Rheumatic Drug Therapy, Daniel Kwak

Bone Bulletin

Introduction

Inflammatory arthritis is a debilitating systemic autoimmune and inflammatory disease that leads to joint damage, resulting in significant pain and disability. Rheumatoid arthritis (RA) is the most common inflammatory arthritis typically associated with advanced arthritic changes of the glenohumeral joint as well as with rotator cuff tears.²⁰ Since the introduction of disease modifying anti-rheumatic drug (DMARD) therapy, patients diagnosed with inflammatory rheumatic diseases have observed improvements in pain management and functional outcomes, alongside a reduction in the occurrence of upper limb arthroplasties.¹⁶ Nonetheless, total joint arthroplasty still remains common in the treatment of RA.^8,14

One recognized …

Revolutionizing Orthopaedics: Exploring The Therapeutic Potential Of Stem Cells, Harrison Fellheimer

Bone Bulletin

The development of stem cells holds the key to a revolutionary era in medicine, unlocking multisystem processes that will help restore normal function in the human body. Stem cells are undifferentiated cells that have the capability to give rise to cells of the same type, and from which new cells can arise through the process of differentiation. Several sources of stem cells can be broadly categorized into three main types: embryonic stem cells (ESC), adult stem cells, and induced pluripotent stem cells (iPSCs).¹

Exploring The Importance Of Implant Selection In Total Hip Arthroplasty, John Czarnecki

Bone Bulletin

Introduction

Total Hip Arthroplasty (THA) is a rapidly growing field within the United States. In 2023 alone, 1,050,821 arthroplasties were performed, making it the second-most performed arthroplasty of the year.1 With over a million of these procedures completed each year, there are several medical device companies that create their own implants to be used in these procedures. Each company can patent their own device and go through a thorough process involving the FDA to receive approval provided there is evidence from clinical trials that demonstrates their device improves patient outcomes.2 With the many implant options available, one question to consider …

A Spotlight On The Various Subspecialties Of Orthopedic Surgery, Ryan Garemani

Bone Bulletin

Introduction

Currently, 60% of orthopedic surgeons are specialists, 25% have specialty interests, and the remaining 15% are generalists.¹ Given the numbers, most orthopedists focus on a specific anatomical area or patient demographic, from delicate nerve work to the larger surgical field encountered in adult reconstruction. This article embarks on a journey through the diverse and impactful world of orthopedic subspecialties, shedding light on the breadth of practice offered.

According to Joseph A. Abboud, MD, a Rothman Orthopedics upper extremity surgeon, residents typically decide on a sub-specialty in their third or fourth year. For medical students, whether captivated by orthopedics …

Exploring Approaches To Treatment Of Musculoskeletal Injuries, Catherine Alvaro

Bone Bulletin

When approaching musculoskeletal injuries, there are many components of the patient assessment that contribute to different treatment options. Interviews with both an orthopedic surgeon and a sports medicine physician revealed similar yet different ways of diagnosing and treating orthopedic conditions.

Foreword, Alan S. Hilibrand

Bone Bulletin

As the Vice Chair of Academic Affairs and Faculty Development and as Director of Undergraduate Medical Education for the Department of Orthopaedic Surgery at the Sidney Kimmel Medical College, I am honored to once again have this opportunity to write a foreword for the second issue of the Bone Bulletin.

For many years, the DePalma Orthopaedic Society has provided medical students at SKMC with an excellent venue to learn about orthopaedic surgery, and its members continue to focus much time and energy on mentoring younger students interested in the field of orthopedic surgery. The DePalma leadership has worked hard …

Editors’ Note, Ari Clements, Amit Syal

Bone Bulletin

This year, we are very excited to announce the second issue of the Bone Bulletin, DePalma Orthopaedic Society’s student-run, non-peer reviewed journal for Sidney Kimmel Medical College (SKMC) students. The journal was initially started to provide another way to become involved with orthopaedics in medical school as well as providing a unique platform to report on diverse aspects of the field through editorial and opinion pieces.

By providing close 1-on-1 mentorship with a Rothman physician, the Bone Bulletin gives students a hands-on opportunity to engage with orthopaedic research and developments. Throughout this journal, you will find a variety of …

Modified Frailty Index Associates With Transoral Robotic Surgery Complications And Survival: A National Database Study, Amiti Jain, Zachary N. Goldberg, Erin Briggs, Dev R. Amin, Zachary D. Urdang, Richard A. Goldman, David M. Cognetti, Joseph M. Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: The modified frailty index (mFI-5) is a National Surgical Quality Improvement Program-derived 5-factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI-5 is a valid predictive measure in the transoral robotic surgery (TORS) population.

METHODS: Retrospective study utilizing the TriNetX US-collaborative health records network querying for TORS patients. Cohorts were stratified by mFI-5 score which uses five ICD-10 codes: nonindependent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Cohorts were matched by age using propensity score matching. Outcome measures included survival, infection, pneumonia, tracheostomy dependence, and percutaneous endoscopic …

Xpo1 Blockade With Kpt-330 Promotes Apoptosis In Cutaneous T-Cell Lymphoma By Activating The P53-P21 And P27 Pathways, Nitin Chakravarti, Amy Boles, Rachel Burzinski, Paola Sindaco, Colleen Isabelle, Kathleen Mcconnell, Anjali Mishra, Pierluigi Porcu

Kimmel Cancer Center Faculty Papers

Dysregulated nuclear-cytoplasmic trafficking has been shown to play a role in oncogenesis in several types of solid tumors and hematological malignancies. Exportin 1 (XPO1) is responsible for the nuclear export of several proteins and RNA species, mainly tumor suppressors. KPT-330, a small molecule inhibitor of XPO1, is approved for treating relapsed multiple myeloma and diffuse large B-cell lymphoma. Cutaneous T-cell lymphoma (CTCL) is an extranodal non-Hodgkin lymphoma with an adverse prognosis and limited treatment options in advanced stages. The effect of therapeutically targeting XPO1 with KPT-330 in CTCL has not been established. We report that XPO1 expression is upregulated in …

Radiomic Biomarkers Of Locoregional Recurrence: Prognostic Insights From Oral Cavity Squamous Cell Carcinoma Preoperative Ct Scans, Xiao Ling, Gregory S. Alexander, Jason Molitoris, Jinhyuk Choi, Lisa Schumaker, Phuoc Tran, Ranee Mehra, Daria Gaykalova, Lei Ren

Department of Radiation Oncology Faculty Papers

INTRODUCTION: This study aimed to identify CT-based imaging biomarkers for locoregional recurrence (LR) in Oral Cavity Squamous Cell Carcinoma (OSCC) patients.

METHODS: Computed tomography scans were collected from 78 patients with OSCC who underwent surgical treatment at a single medical center. We extracted 1,092 radiomic features from gross tumor volume in each patient's pre-treatment CT. Clinical characteristics were also obtained, including race, sex, age, tobacco and alcohol use, tumor staging, and treatment modality. A feature selection algorithm was used to eliminate the most redundant features, followed by a selection of the best subset of the Logistic regression model (LRM). The …

Endocarditis: A Review Of Recent Literature, Scott Dale, Zaid Tayyem, Steven Maceyko

Jefferson Hospital Staff Papers and Presentations

Purpose of Review

Endocarditis remains a challenging diagnosis, with significant implications for early identification and initiation of therapy. In this review, we examine the evolution in the epidemiology and presentation of infectious endocarditis (IE), the role of new diagnostic tools, and the approach to therapy.

Recent Findings

Staphylococcus and Streptococcus species remain the most common causative organisms, but the prevalence of IE caused by enterococcus and non-HACEK organisms is increasing. While newer antibiotics such as dalbavancin have shown promise, treatment must still be tailored on an individual basis. Evidence suggests that antibiotic prophylaxis to prevent IE be limited to high-risk …

Predictive And Prognostic Biomarkers And Tumor Antigens For Targeted Therapy In Urothelial Carcinoma, Aditya Eturi, Amman Bhasin, Kevin Zarrabi, William Tester

Department of Medical Oncology Faculty Papers

Urothelial carcinoma (UC) is the fourth most prevalent cancer amongst males worldwide. While patients with non-muscle-invasive disease have a favorable prognosis, 25% of UC patients present with locally advanced disease which is associated with a 10-15% 5-year survival rate and poor overall prognosis. Muscle-invasive bladder cancer (MIBC) is associated with about 50% 5 year survival when treated by radical cystectomy or trimodality therapy; stage IV disease is associated with 10-15% 5 year survival. Current therapeutic modalities for MIBC include neoadjuvant chemotherapy, surgery and/or chemoradiation, although patients with relapsed or refractory disease have a poor prognosis. However, the rapid success of …

Targeting Genomic Receptors In Voided Urine For Confirmation Of Benign Prostatic Hyperplasia, Mathew Thakur, Vivek S. Tomar, Emma Dale, Leonard G. Gomella, Charalambos Solomides, Oleksandr Kolesnikov, Scott W. Keith, Hector T. Navarro, Olivia Dahlgren, Michael Chaga, Edouard J. Trabulsi

Department of Radiology Faculty Papers

Objectives

The objective of this study is to validate a hypothesis that a non-invasive optical imaging assay targeting genomic VPAC receptors on malignant cells shed in voided urine will represent either benign prostatic hyperplasia (BPH) or prostatic cancer (PCa). Risk for BPH in men 50–70 years old is 50–70% and PCa is 17%. BPH and PCa can coexist in 20% of men with BPH. Most commonly practiced methods to diagnose BPH do not distinguish BPH from PCa.

Patients (or Materials) and Methods

Males with BPH (N = 97, 60.8 ± 6.3 years, prostate-specific antigen 0.7 ± 0.4 ng/mL) and …

Comprehensive Guidance For The Prevention Of Periprosthetic Joint Infection After Total Joint Arthroplasty And Pitfalls In The Prevention, Javad Parvizi, Yonghan Cha, Emanuele Chisari, Kangbaek Kim, Kyung-Hoi Koo

Rothman Institute Papers

Total joint arthroplasty (TJA) is a surgical procedure, in which parts of damaged joints are removed and replaced with a prosthesis. The main indication of TJA is osteoarthritis, and the volume of TJA is rising annually along with the increase of aged population. Hip and knee are the most common joints, in which TJAs are performed. The TJA prosthesis is composed of metal, plastic, or ceramic device. Even though TJA is the most successful treatment for end-stage osteoarthritis, it is associated with various complications, and periprosthetic joint infection (PJI) is the most serious complication after TJA. With the increasing volume …

The Impact Of Outpatient Supportive Oncology On Cancer Care Cost And Utilization, Brooke Worster, Yifan Zhu, Gregory Garber, Sawyer Kieffer, Aaron Smith-Mclallen

Department of Medical Oncology Faculty Papers

BACKGROUND: Supportive oncology (SO) care reduces symptom severity, admissions, and costs in patients with advanced cancer. This study examines the impact of SO care on utilization and costs.

METHODS: Retrospective analysis of utilization and costs comparing patients enrolled in SO versus three comparison cohorts who did not receive SO. Using claims, the authors estimated differences in health care utilization and cost between the treatment group and comparison cohorts. The treatment group consisting of patients treated for cancer at an National Cancer Institute-designated cancer center who received SO between January 2018 and December 2019 were compared to an asynchronous cohort that …

Hippocampus Diffusivity Abnormalities In Classical Trigeminal Neuralgia, Shaun Andrew Hanycz, Alborz Noorani, Peter Shih-Ping Hung, Matthew R. Walker, Ashley B. Zhang, Timur H. Latypov, Mojgan Hodaie

Student Papers, Posters & Projects

INTRODUCTION: Patients with chronic pain frequently report cognitive symptoms that affect memory and attention, which are functions attributed to the hippocampus. Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder characterized by paroxysmal attacks of unilateral orofacial pain. Given the stereotypical nature of TN pain and lack of negative symptoms including sensory loss, TN provides a unique model to investigate the hippocampal implications of chronic pain. Recent evidence demonstrated that TN is associated with macrostructural hippocampal abnormalities indicated by reduced subfield volumes; however, there is a paucity in our understanding of hippocampal microstructural abnormalities associated with TN.

OBJECTIVES: To explore …

Perspectives From Patients With Chronic Lung Disease On A Telehealth-Facilitated Integrated Palliative Care Model: A Qualitative Content Analysis Study, Jeannette Kates, Carrie Tompkins Stricker, Kristin L. Rising, Alexzandra Gentsch, Ellen Solomon, Victoria Powers, Venise J. Salcedo, Brooke Worster

Department of Medicine Faculty Papers

BACKGROUND: Chronic lung disease affects nearly 37 million Americans and often results in significant quality of life impairment and healthcare burden. Despite guidelines calling for palliative care (PC) integration into pulmonary care as a vital part of chronic lung disease management, existing PC models have limited access and lack scalability. Use of telehealth to provide PC offers a potential solution to these barriers. This study explored perceptions of patients with chronic lung disease regarding a telehealth integrated palliative care (TIPC) model, with plans to use findings to inform development of an intervention protocol for future testing.

METHODS: For this qualitative …

Parp-Ish: Gaps In Molecular Understanding And Clinical Trials Targeting Parp Exacerbate Racial Disparities In Prostate Cancer, Moriah L. Cunningham, Matthew J. Schiewer

Department of Urology Faculty Papers

PARP is a nuclear enzyme with a major function in the DNA damage response. PARP inhibitors (PARPi) have been developed for treating tumors harboring homologous recombination repair (HRR) defects that lead to a dependency on PARP. There are currently three PARPi approved for use in advanced prostate cancer (PCa), and several others are in clinical trials for this disease. Recent clinical trial results have reported differential efficacy based on the specific PARPi utilized as well as patient race. There is a racial disparity in PCa, where African American (AA) males are twice as likely to develop and die from the …

Relating Preoperative Mcs-12 To Microdiscectomy Outcomes, Jeremy C. Heard, Yunsoo Lee, Teeto Ezeonu, Mark J. Lambrechts, Rajkishen Narayanan, Caleb Yeung, Justin Wright, John Paulik, Caroline Purtill, John J. Mangan, Mark F. Kurd, Ian D. Kaye, Jose A. Canseco, Alan S. Hilibrand, Alex R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler

Rothman Institute Papers

PURPOSE: To determine the impact of poor mental health on patient-reported and surgical outcomes after microdiscectomy.

METHODS: Patients ≥ 18 years who underwent a single-level lumbar microdiscectomy from 2014 to 2021 at a single academic institution were retrospectively identified. Patient-reported outcomes (PROMs) were collected at preoperative, three-month, and one-year postoperative time points. PROMs included the Oswestry Disability Index (ODI), Visual Analog Scale Back and Leg (VAS Back and VAS Leg, respectively), and the mental and physical component of the short form-12 survey (MCS and PCS). The minimum clinically important differences (MCID) were employed to compare scores for each PROM. Patients …

Regimen For Accelerated Propranolol Initial Dosing (Rapid), Charles Y. Huang, Marissa J. Perman, Albert C. Yan

Student Papers, Posters & Projects

BACKGROUND: Infantile hemangiomas are common vascular tumors in children. Propranolol has proven effective in treating infantile hemangiomas and while generally safe, has potential risk for more serious side effects of hypoglycemia, hypotension, bradycardia, bronchospasm, and cardiovascular or respiratory compromise. Current prescribing guidelines recommend initiating propranolol doses at 1 mg/kg/day, with up-titration to 2 mg/kg/day. This study aims to compare the incidence of adverse events in infants and children treated with propranolol initiated at 1 mg/kg/day versus being initiated directly at 2 mg/kg/day.

METHODS: A retrospective cohort study was conducted using medical records of patients receiving propranolol therapy for infantile hemangiomas …

Evaluating Bone Fracture Healing Utilizing Doppler Imaging Modes, Shear Wave Elastography, X-Ray And Dual-Energy X-Ray Absorptiometry In A Rabbit Model, Priscilla Machado, Rachel Blackman, Ji-Bin Liu, Flemming Forsberg, Traci Fox

JCHP Collaborative Capstone and Research Exchange

Abstract

The healing of a bone fracture is a complex, multistage process consisting of inflammation in the local tissue, angiogenesis, callus formation, and eventually, remodeling and restoration of the bone to its original morphology. It is estimated that 5-10% of fractures do not heal properly and exhibit non-union of the fractured bone segments, with long-term complications compared to properly healed fractures. There is great clinical benefit in the ability to have early detection of impending non-union fractures, and diagnostic ultrasound can be used to image formation of the callus in a healing fracture through the use of different imaging modes. …

Design And Validation Of A Multiplex Qpcr Assay For The Diagnosis Of Bacterial Vaginosis, Morgan G. Shriver, Richard Sunday, Zi-Xuan Wang, Scott Gygax

JCHP Collaborative Capstone and Research Exchange

Abstract

Current diagnostic criteria and treatment options for bacterial vaginosis (BV) commonly result in the misdiagnosis and/or mistreatment of the active infection, as well as subsequent reinfection with BV. This project aims to design and validate a multiplex qPCR assay as a means to accurately detect and quantify populations of dysbiotic Gardnerella vaginalis, Atopobium vaginae, Megasphaera Type 1 & Type 2, Bacterial vaginosis-associated bacterium 2 (BVAB2), as well as the commensal Lactobacillus crispatus, Lactobacillus jensenii, and Lactobacillus gasseri in vaginal specimen for the accurate diagnosis of BV. As these bacterial species are generally unable to be …