Medical Student Research Fellowship for Summer 2008
Mentor: Dr. Lawson A. B. Copley, MD
Department: Pediatric Orthopaedic Surgery
Room number: E2.300
Mail Code:
Phone number: 214 456 5614
E-mail: Lawson.Copley@Childrens.com
Project # 1 (Omar Gafur)
Project title: Clinical and Genetic Risk Factors of Musculoskeletal Infection in Children
Human subjects IRB approved project number (where applicable):
Genetics study: 052007-045
Prospective study: 032007-009.
Animal subjects IRB approved project number (where applicable):
Project Type:
Patient-based research
Brief Description of Project:
Prospective Study:
Description: A multi-disciplinary group was organized to develop evidence-based treatment guidelines to standardize treatment of children with musculoskeletal infection (Osteomyelitis, Septic Arthritis, Pyomyositis, and Abscess). This study aims to make a comparison between the cohort of children who were studied retrospectively and children who will be studied prospectively to determine if the appropriate use of standard treatment guidelines will result in better clinical outcomes. The appropriate use of treatment guidelines will result in greater compliance with recommended antibiotic therapy, fewer surgeries and shorter hospital stay. The use of MRI early in the diagnostic process will provide a more comprehensive diagnosis and facilitate the treatment process.
Responsibilities: The student will assist the research coordinator in the recruitment and enrollment of subjects. Other responsibilities (along with the research coordinator) include monitoring inpatient infection patient volume, track hospital course to ensure guidelines are properly implemented, meet with multi-disciplinary committee for guideline oversight, meet with clinic staff to ensure patient follow-up meets the guidelines, making sure that all pertinent data are accurately documented, enter data in database, participate in data analysis and review.
Literature Review:
Description: A database of over 2000 articles relevant to musculoskeletal infection (osteomyelitis, septic arthritis, pyomyositis, and abscess) have been identified to study the current state of the disease. A level of evidence review of these articles on musculoskeletal infection, published between 1970 and the present, will be performed by the key participants in a multi-disciplinary group composed of orthopaedic, infectious disease, general pediatrics, emergency medicine, radiology and laboratory department members as well as the research student.
Genetics Study:
Description: The pathogenetic mechanisms of severe, acute musculoskeletal infections in children are poorly understood. The purpose of this study is to evaluate human genetic factors that may either influence the clinical manifestations of musculoskeletal infection in children or facilitate the susceptibility to this disease. We will utilize a well-characterized patient population to achieve the following three specific aims: First, we will accumulate DNA and RNA repositories of children with musculoskeletal infection and their age matched controls. This portion of the study parallels an ongoing clinical prospective study (Evaluation and Management of Pediatric Musculoskeletal Infection According to Multi-Disciplinary Clinical Practice Guidelines, IRB#032007-009) in which clinical manifestations, severity of illness parameters and clinical outcomes measures are documented in a research database for future analysis. In our second aim, we will study the association of musculoskeletal infections in children with polymorphisms of selected candidate genes. An extensive list of genetic polymorphisms, various HLA alleles and other genes involved in innate immunity, have been associated with human infection. Third, we will study the distinct gene expression patterns of children with various forms of Staphylococcus aureus musculoskeletal infections to see if greater degrees of expressivity may be found with specific types of infection (osteomyelitis, septic arthritis, pyomyositis, and abscess).
Student's Role: On the prospective study Omar will assist with patient enrollment, data collection, database entry, and data analysis. For the literature review, Omar will review articles, assign level and grade to the articles, compile the feedback from other reviewers, perform data analysis with our statistician, and assist with manuscript preparation with the goal of peer review publication by the end of the summer. For the Genetics study, Omar will isolate DNA and RNA, perform PCR studies, record data, and help with data analysis.
Project # 2 (Yeonsoo Kim)
Project title: Retrospective Review of Pediatric Patients Diagnosed with Supracondylar Humerus Fractures
Human subjects IRB approved project number (where applicable):
032007-063
Project Type:
Patient-based research
Brief Description of Project:
Supracondylar humerus fractures are the most common pediatric elbow fracture.
There is a spectrum of injury patterns, surgical and non-surgical treatment
options, and sequelae from the injury. Numerous articles have been published
about issues raised in the treatment of these fractures, including vascular
injury, nerve injury, fracture pattern and stability, pinning techniques, timing
of operative intervention, infection after pinning, deformity, and correction
of deformity. To date, the largest report about supracondylar humerus fractures
comes from San Diego Children's which reviewed 1600 injuries over an 8 year
period. In our current practice at Children's Medical Center of Dallas, we surgically
treat over 400 of these fractures a year, and treat an additional 360 fractures
non-operatively.
We will perform a 3 year, retrospective review of the epidemiology and short
term treatment outcomes of supracondylar humerus fractures in children. We will
develop a database and record: age, sex, date of injury, zip code of patient
origin, insurance classification, mechanism of injury, method of transportation
to CMC, prior medical evaluation/treatment, time of arrival to CMC, fracture
pattern classification, time of treatment, method of treatment, length of surgery,
pin pattern, quality of reduction, associated injuries pre-operatively and post-operatively,
requirement for vascular intervention and method of treatment, timing of resolution
of any identified nerve injury, duration of follow-up, time until return to
full activities. There will also be a telephone interview to assess current
level of function.
This study will enabled a detailed portrayal of the epidemiology of pediatric
supracondylar humerus fractures at a level 1 pediatric trauma center. We anticipate
that the methodology which is adopted by a group of 10 pediatric orthopedic
surgeons, supported by 9 non-physician practitioners, to evaluate and treat
these fractures provides predictable and favorable outcomes in these children.
The findings of this study will be of interest to the pediatric orthopedic community
and will result in peer review publication and presentation at international
scientific meetings.
Student's Role: Yeonsoo will assist with database design, conduct data collection, enter data in the database, assist with data analysis and participate in the preparation of a manuscript for peer review publication. He will also develop an abstract for submission to scientific meetings for either oral or poster preparation.
Previous Research Activities or Publications with Medical Students:
Publications:
Hollmig ST, Copley LA, Browne RH, Grande LM, and Wilson, PL. Deep Venous Thrombosis
Associated with Osteomyelitis in Children. Journal of Bone and Joint Surgery.
Journal of Bone and Joint Surgery 89A (7): 1517-1523, 2007.
Omar A Gafur, BA; Lawson A Copley, MD; Tyler S Hollmig, BA; Richard H Browne,
PhD;
Lori A Thornton, RN, FNPC; Shellye E Crawford, RN, CPNP. The Impact of the Current
Epidemiology of Pediatric Musculoskeletal Infection on Evaluation and Treatment
Guidelines. Journal of Pediatric Orthopaedics. Publication Pending.
Lectures and Presentations:
Hollmig ST, Copley LA, Browne RH, Grande LM, and Wilson, PL. Deep Venous Thrombosis Associated with Osteomyelitis in Children. 29th annual Brandon Carrell Visiting Professorship of Texas Scottish Rite Hospital for Children. Dallas, Texas, 4/07.
Gafur O, Copley LA. The Changing Epidemiology of Musculoskeletal Infection in Children. 29th annual Brandon Carrell Visiting Professorship of Texas Scottish Rite Hospital for Children. Dallas, Texas, 4/07.
Gafur O, Copley LA. The Changing Epidemiology of Musculoskeletal Infection in Children. 6th annual Musculoskeletal Infection Society Meeting. San Diego, California, 8/07.