Browsing by Author "Schneider, Prism"

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    Characterizing the structure-function relationship of hand osteoarthritis using dynamic and high resolution CT imaging
    (2024-03-27) Kuczynski, Michael Tadeusz; Manske, Sarah; Ronsky, Janet; Edwards, W. Brent; Schneider, Prism
    Osteoarthritis (OA) is the most common form of arthritis and affects the trapeziometacarpal (TMC) joint. While the etiology of OA is still not fully understood, it is a multifactorial disease with biomechanical factors associated in its development. The thumb is estimated to account for over 40% of the hand’s entire function, largely due to the TMC joint. A better understanding of structural and functional changes in TMC OA may improve our understanding of this degenerative joint disease. A recent advancement in computed tomography (CT) now allows for imaging moving joints in vivo. This technique, termed dynamic CT, provides a unique opportunity to quantify joint biomechanics in vivo. In this thesis, novel methodologies are presented that improve processing of dynamic and high-resolution peripheral quantitative CT (HR-pQCT) scans. These methodologies allow for semi-automated quantification of joint space and bone mineral density (BMD) in HR-pQCT scans and biomechanical outcomes from dynamic CT. The methodologies developed in this dissertation drastically reduce processing time for dynamic CT scans compared to previous literature. A cross-sectional study is presented that utilizes HR-pQCT to measure joint space (JS) changes in hand OA, the first of its kind. Maximum JS was significantly greater in OA than controls in the second and third distal interphalangeal (DIP2, DIP3) joints (DIP2: 2.07 mm vs. 1.88 mm; DIP3: 2.01 mm vs. 1.86 mm), and decreased hand function and increased hand disability were associated with increased radiographic TMC OA. A study was conducted to characterize normal TMC joint biomechanics in vivo using the presented methodologies. BMD was computed in anatomical quadrants of the TMC joint, and it was found that the radial-volar quadrant of the first metacarpal (426 mg HA/cm3) and ulnar-volar quadrant of the trapezium (373 mg HA/cm3) were significantly greater than other quadrants. When compared with proximity maps from dynamic CT, areas with high contact corresponded to quadrants with higher BMD. The results from this dissertation provide methodologies to analyze bone and joint changes with HR-pQCT and dynamic CT to better understand hand osteoarthritis.
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    Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study
    (2021-11-04) Harrison, Tyrone G.; Ronksley, Paul E.; James, Matthew T.; Ruzycki, Shannon M.; Tonelli, Marcello; Manns, Braden J.; Zarnke, Kelly B.; McCaughey, Deirdre; Schneider, Prism; Wick, James; Hemmelgarn, Brenda R.
    Abstract Background People with kidney failure have a high incidence of major surgery, though the risk of perioperative outcomes at a population-level is unknown. Our objective was to estimate the proportion of people with kidney failure that experience acute myocardial infarction (AMI) or death within 30 days of major non-cardiac surgery, based on surgery type. Methods In this retrospective population-based cohort study, we used administrative health data to identify adults from Alberta, Canada with major surgery between April 12,005 and February 282,017 that had preoperative estimated glomerular filtration rates (eGFRs) < 15 mL/min/1.73m2 or received chronic dialysis. The index surgical procedure for each participant was categorized within one of fourteen surgical groupings based on Canadian Classification of Health Interventions (CCI) codes applied to hospitalization administrative datasets. We estimated the proportion of people that had AMI or died within 30 days of the index surgical procedure (with 95% confidence intervals [CIs]) following logistic regression, stratified by surgery type. Results Overall, 3398 people had a major surgery (1905 hemodialysis; 590 peritoneal dialysis; 903 non-dialysis). Participants were more likely male (61.0%) with a median age of 61.5 years (IQR 50.0–72.7). Within 30 days of surgery, 272 people (8.0%) had an AMI or died. The probability was lowest following ophthalmologic surgery at 1.9% (95%CI: 0.5, 7.3) and kidney transplantation at 2.1% (95%CI: 1.3, 3.2). Several types of surgery were associated with greater than one in ten risk of AMI or death, including retroperitoneal (10.0% [95%CI: 2.5, 32.4]), intra-abdominal (11.7% [8.7, 15.5]), skin and soft tissue (12.1% [7.4, 19.1]), musculoskeletal (MSK) (12.3% [9.9, 15.5]), vascular (12.6% [10.2, 15.4]), anorectal (14.7% [6.3, 30.8]), and neurosurgical procedures (38.1% [20.3, 59.8]). Urgent or emergent procedures had the highest risk, with 12.1% experiencing AMI or death (95%CI: 10.7, 13.6) compared with 2.6% (1.9, 3.5) following elective surgery. Conclusions After major non-cardiac surgery, the risk of death or AMI for people with kidney failure varies significantly based on surgery type. This study informs our understanding of surgery type and risk for people with kidney failure. Future research should focus on identifying high risk patients and strategies to reduce these risks.
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    Novel Approaches to Breaking the Cycle of Intimate Partner Violence (IPV): Medical Trainee and Virtually-targeted Education to Increase Healthcare Provider Readiness to Manage IPV
    (2022-04) Dillabough, Kaitlyn; Schneider, Prism; Fiest, Kirsten; Temple-Oberle, Claire
    Intimate partner violence (IPV) is any violent or controlling behavior by a person in a dating, cohabitating or marital relationship to their partner in the form of psychological, physical, and/or sexual violence. Alas, global reports reveal one in three women experience IPV in their lifetime. To challenge the cycle of violence and mitigate associated morbidity and mortality, experts encourage an integrated, multi-faceted approach to IPV management in healthcare settings. The purpose of this thesis is to assess the mEDUCATE (Applying EDUCATE to Medical Student Intimate Partner Violence Training) program specifically, in the context of IPV education programs intended to prepare medical trainees for future practices that are conducive to meeting the societal need for healthcare provider IPV management. This manuscript-based thesis consists of two manuscripts in-progress. Both manuscripts focus on the mEDUCATE program, which was designed to educate medical trainees on IPV and current screening practices. Manuscript one is a qualitative evaluation of the mEDUCATE program using thematic analysis of semi-structured interviews. This study found value in the mEDUCATE program and established that medical trainees consider this training to be important and applicable to their future practice. Based on this research the mEDUCATE program is being modified for widespread, virtual implementation. The second manuscript presents the quantitative results of a pretest-posttest evaluation of the mEDUCATE program. The Physician Readiness to Manage IPV Survey (PREMIS) scores confirmed that medical trainees IPV knowledge and preparedness significantly increased post-training, The combined manuscripts demonstrate the value of implementing IPV training early in healthcare providers career to support consistent IPV screening practices and confidence in managing IPV; especially in critical circumstances like the COVID-19 pandemic that generate greater IPV frequency and severity.
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    Quantifying Hypercoagulability in Patients with Pelvic and Acetabular Fractures, as Determined by Thrombelastography
    (2023-04-18) Clarke, Ashley Nicole; Schneider, Prism; Korley, Robert; Skeith, Leslie
    Background: Pelvic and acetabular fractures are major orthopaedic injuries, which are known to have high rates of life-threatening venous thromboembolism (VTE) following surgery. Current guidelines recommend that thromboprophylaxis be prescribed for patients requiring major orthopaedic surgery for up to 35 days; however, the duration of hypercoagulability and increased VTE risk for pelvic and acetabular fractures is unknown. This population continues to have high rates of VTE, with a 12% incidence despite thromboprophylaxis. Thrombelastography (TEG) is a whole-blood viscoelastic point-of-care assay which provides an overview of the entire clotting process, from clot formation to clot breakdown. The maximal amplitude (MA) parameter from TEG analysis is a measure of clot strength, and values ≥ 65 mm can be used to quantify hypercoagulability and increased VTE risk in patients after major orthopaedic injuries. Purpose: The purpose of this study was to use serial TEG analysis to quantify the duration of post-operative hypercoagulability and increased VTE risk for patients with pelvic and acetabular fractures. Methods: Serial TEG analysis was performed in a cohort of adult patients with surgically managed pelvic and acetabular fractures, beginning upon hospital admission until three months post-operatively, at timepoints determined a priori. Hypercoagulability was defined as MA ≥ 65 mm. Patient characteristics, including demographics and medical comorbidities, injury and surgical characteristics including fracture type, surgical treatment type, resuscitation strategies, and complications such as VTE events were captured. Patient mobility was measured using the Timed-Up-and-Go test, which was assessed by the research team. Patient-reported adherence to thromboprophylaxis was recorded by survey questions. All patients received standardized thromboprophylaxis using low molecular weight heparin (LMWH) for a minimum of 28 days. A study related compression ultrasound (CUS) was performed on POD3 as well as at 2-, 4-, and 6-week timepoints if individuals were still admitted in hospital, to capture asymptomatic proximal DVT. One- and two-sided t-tests were used to compare individual, and group mean MA values to each other as well as to the hypercoagulable threshold (MA ≥ 65 mm). Exploratory analysis with additional t-tests was used to identify risk factors for hypercoagulability over time in this population. An exploratory multivariate logistic regression model was created to predict VTE events. Results: In total, 30 patients (22 males) with a median age of 52.5 years old (IQR = 33 – 60.8) were enrolled in this study. Serial TEG analysis demonstrated a hypercoagulable state (MA ≥ 65 mm) by post-operative day three, suggesting early increased VTE risk. Hypercoagulability peaked for patients on post-operative day seven, followed by prolonged hypercoagulability, with the majority of patients (68.8%) remaining hypercoagulable four weeks post-operatively when thromboprophylaxis was discontinued. At six weeks post-operatively, 28.6% of participants were hypercoagulable, and 22.7% remained hypercoagulable three months post-operatively, demonstrating the prolonged hypercoagulability and increased VTE risk that occurs in this high-risk population. There were seven patients (23.3%) from the cohort who developed VTE, with five events being symptomatic pulmonary embolism (PE) and two being proximal deep vein thrombosis (DVT). Every VTE event that occurred in patients with acetabular fractures were PE, whereas two of the three patients with pelvic fractures (66.7%) had DVT only. At every timepoint, patients with acetabular fractures had higher mean MA values compared to pelvic fractures, although the difference between these groups were only statistically significant at POD5 (p = 0.044). Additionally, follow-up mobility assessments demonstrated that less mobile patients at four and six weeks post-operatively were more likely to be hypercoagulable. The additional exploratory t-test analysis highlighted that the need for a blood transfusion, more complex acetabular fracture type, increased duration of surgery, and longer time between injury and surgery, were potential predictors for elevated MA. The exploratory logistic regression model indicated that as time between injury and surgery increased as well as increasing age, so did the likelihood of a VTE event. Additionally, male sex, the need for a blood transfusion, an anterior approach for surgical fixation, a longer time to surgery, increased use of fluids and greater age also increased the likelihood of VTE in this cohort. Conclusion: The high VTE rate of 23.3% in this study, despite thromboprophylaxis with LMWH, highlights that prolonged hypercoagulability and increased VTE risk remains a clinical concern for patients with pelvic and acetabular fractures. Therefore, this data supports that a minimum of 35 days of post- operative thromboprophylaxis is recommended for pelvic and acetabular fractures. This duration may need to be further extended for acetabular fractures as their VTE event rate appears to be higher. Additionally, the use of pre-operative thromboprophylaxis, screening CUS, and further investigation into alternative thromboprophylaxis agents may improve outcomes for some patients. The increased VTE risk, especially with complex acetabular fractures and reduced post-operative mobility, is critical to be aware of, in order to mitigate complications for these patients. These results support continued research to inform optimal type and duration of thromboprophylaxis for this high-risk trauma population.
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    SAVE (Screening tool to identify Abusive and Violent Efforts): A Novel Tool for Identifying Perpetrators of Intimate Partner Violence
    (2024-04-24) Cherppukaran, Tanya Joju; Schneider, Prism; Temple-Oberle, Claire; McLane, Brienne
    Intimate partner violence (IPV) remains a pervasive global issue as the leading cause of nonfatal injury among women. Historically, efforts to address IPV have primarily centred on supporting survivors, often neglecting the identification of and assistance for perpetrators, which may more effectively interrupt the cycle of violence. Existing screening tools used to identify perpetrators of IPV are limited by excessive length and accusatory language, underscoring the need for a tool characterized by brevity and neutrality to effectively provide assistance for this population. This study aimed to assess the acceptability of a series of questions, that were informed by patient perspectives, in order to develop a screening tool for identifying IPV perpetrators within fracture and hand clinics. Employing a convergent mixed-methods approach, this study integrated focus group discussions, semi-structured interviews, and cross-sectional surveys. Orthopaedic patients, healthcare providers, and male clients participating in a men’s counselling program were recruited to provide their unique insights into the developed screening tool. Thematic analysis was used to analyse the qualitative component of the study, while proportion test, Wilcoxon signed rank test, receiver operating characteristic curve and descriptive statistics were used to analyse the quantitative data. A total of 224 orthopaedic patients, 151 healthcare providers, and four male clients participated in the study. The five most acceptable questions were identified from both patient and healthcare provider groups, with three questions demonstrating consistency across both cohorts. Thematic analysis revealed the following five key themes in the development of a screening tool to identify perpetrators of violence: Immersing, Non-blaming, Recognizing, Distinguishing, and Emphasizing. The final SAVE screening tool was developed by integrating both qualitative and quantitative findings. These findings support the implementation and further validation of the novel SAVE screening tool for IPV perpetrators across various healthcare settings. Identifying perpetrators is paramount in guiding educational initiatives and interventions aimed at addressing violent behaviour, with the ultimate goal of disrupting the cycle of IPV.
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    Studying the Effects of Bone Morphogenetic Protein-2 on Osteosarcoma Tumour Biology
    (2019-01-04) Kendal, Joseph; Monument, Michael; Jirik, Frank; Mahoney, Douglas; Schneider, Prism
    Impaired bone healing biology in osteosarcoma patients contributes to significant local complications following limb salvage surgery. Recombinant human bone morphogenetic protein-2 (rhBMP-2) has potential to mitigate these complications; however, its use is limited due to concerns of pro-oncogenic signalling. Conversely, recent pre-clinical studies suggest BMP-2 may induce osteosarcoma differentiation. We assessed the oncologic consequences of BMP-2 signalling on osteosarcoma in vitro and in vivo. Two human (143b and SaOS-2) and one syngeneic mouse (DLM8-M1) osteosarcoma cell lines were engineered to up-regulate BMP-2. Xenograft orthotopic murine models were used to assess the effects of exogenous and endogenous elevations in BMP-2 signaling on tumour growth and metastasis. Tumour burden was quantified using tumour volume measurements, bioluminescence and micro-CT. In the 143b cell line there was no differentiation response, however cellular proliferation, motility and tumour growth were enhanced with BMP-2. The SaOS-2 cell line was found to be more differentiated than the 143b cell line and responded to BMP-2 signalling with partial osteoblastic differentiation, and a reduction in in vivo local tumour burden. Rates of lung metastasis were unchanged in both 143b and SaOS-2. BMP-2 upregulation in the DLM8-M1 cell line induced a partial differentiation response; in vivo studies are ongoing. The observed divergent effects of BMP-2 on osteosarcoma tumour growth may be due to the variation in intrinsic differentiation abilities of different cell lines. Importantly, these results do not support the clinical application of BMP-2 in osteosarcoma limb salvage surgery due to the potential for stimulating growth of any microscopic tumour burden.