Patient Oriented Research and Mentoring Program in Orthopedics

描述（由申请人提供）：肌肉骨骼（MSK）疾病代表了一组广泛的疾病，具有不同的病因，导致骨骼、关节、肌腱、韧带和/或肌肉的疼痛和功能损害。这些疾病是导致工作残疾的主要原因，也是老年人依赖他人的最常见原因。在美国，每年有超过300万人因MSK问题住院，主要是骨科手术干预。严格设计的以患者为导向的研究为循证实践奠定了基础，并作为连接患者期望、临床护理和共同决策的强大工具。目前，骨骼肌和骨科临床科学的证据基础还存在较大的空白。在过去的十年里，我一直致力于解决这些研究需求。通过K24中期职业研究者奖，我希望通过以患者为导向的研究继续这项工作，更重要的是，让下一代临床科学家参与MSK和骨科问题的严格研究。以患者为导向的研究（K24）中期职业奖将使我能够投入大量的时间来从事以患者为导向的骨科研究项目，并指导致力于骨科和肌肉骨骼患者为导向研究的年轻临床科学家。该奖项将支持我的指导和研究项目，目的如下：1)制定一个研究培训计划，为年轻的临床研究人员做好准备，对MSK疾病患者经常使用和/或最近开发的骨科干预措施进行严格评估。II)进一步发展以患者为导向的MSK疾病和骨科综合研究计划。我的指导项目的总体目标包括：1)为骨科患者导向研究提供培训，包括随机临床试验的设计和实施，观察性研究以及为MSK疾病患者制定新的诊断标准；2)增加在MSK疾病研究中受过严格训练的以患者为导向的研究人员数量；3)促进新的多学科合作；4)促进从实习生到教师的过渡。虽然该项目的目标涉及多个临床问题，但我在本提案中强调了两项研究：研究1：进行一项随机对照临床试验，以确定全膝关节置换术患者硬膜外麻醉的最佳退出时间。研究2：探讨临床病史对膝关节骨性关节炎（OA）症状性半月板撕裂的诊断价值。这些研究中的每一项，加上一个全面的结构化指导计划，将有助于解决MSK疾病患者管理中重要的未解问题。该项目还将帮助下一代临床科学家开发、评估和实施对MSK患者有效的治疗策略。

DESCRIPTION (provided by applicant): Musculoskeletal (MSK) disorders represent a broad group of conditions with diverse etiologies that result in pain and functional impairment of bones, joints, tendons, ligaments and/or muscles. These disorders are the leading cause of work disability and the most frequent source of dependency in the elderly. In the US, over 3 million hospitalizations for MSK problems occur annually, primarily for orthopaedic surgical interventions. Rigorously designed patient oriented research studies create the basis for evidence-based practice and serve as powerful tools to bridge patient expectations, clinical care and shared decision making. Presently, the evidence base in musculoskeletal and orthopedic clinical science has large gaps. I have dedicated much of my effort in the last decade to addressing these research needs. Through the K24 Mid Career Investigator Award, I hope to continue this work through patient oriented research and, importantly, to engage the next generation of clinical scientists in rigorous studies of MSK and orthopaedic problems. The Mid-career Award in patient oriented research (K24) will enable me to dedicate a substantial portion of my time to pursue a robust program in patient oriented research in orthopedics and to mentor young clinical scientists committed to orthopaedic and musculoskeletal patient oriented research. This Award will support my mentoring and research program with the following aims: I) To develop a research training program that will prepare young clinical investigators for rigorous evaluation of frequently utilized and/or recently developed orthopaedic interventions in patients with MSK disorders. II) To further develop a comprehensive patient oriented research program in MSK disorders and orthopaedics. The overarching goals of my mentoring program include: 1) providing training in patient oriented research in orthopedics, including design and conduct of randomized clinical trials, observational studies and developing new diagnostic criteria in patients with MSK disorders; 2) increasing the number of researchers focused on patient oriented research with rigorous training in the study of MSK disorders; 3) fostering new multidisciplinary collaborations; and 4) facilitating the transition from traineeship to faculty. While the goals of the program span multiple clinical problems, I highlight two research studies in this proposal: Study 1: To conduct a randomized controlled clinical trial to determine optimal timing for withdrawal of epidural anesthesia in patients undergoing total knee replacement. Study 2: To determine the diagnostic value of clinical history for the diagnosis of symptomatic meniscal tears in the presence of knee osteoarthritis (OA). Each of these studies, coupled with a comprehensive structured mentoring program, will help to address important unanswered questions in the management of patients with MSK disorders. The program will also help the next generation of clinical scientists to develop, evaluate and implement efficient and effective treatment strategies in patients with MSK conditions.