Patient Oriented Research and Mentoring Program in Orthopedics

描述(由申请人提供)：肌肉骨骼(MSK)疾病是一组具有不同病因的疾病，会导致骨骼、关节、肌腱、韧带和/或肌肉的疼痛和功能障碍。这些障碍是老年人丧失工作能力的主要原因，也是最常见的依赖来源。在美国，每年有300多万人因MSK问题住院，主要是因为骨科手术干预。严谨设计的以患者为中心的研究为循证实践奠定了基础，并成为沟通患者期望、临床护理和共同决策的强大工具。目前，肌肉骨骼和骨科临床科学的证据基础还存在很大差距。在过去的十年里，我投入了大量的精力来满足这些研究需求。通过K24中期职业研究人员奖，我希望通过以患者为中心的研究来继续这项工作，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。以患者为中心的职业生涯中期奖(K24)将使我能够将大量时间投入到骨科以患者为中心的研究中，并指导致力于骨科和肌肉骨骼以患者为中心的研究的年轻临床科学家。该奖项将支持我的指导和研究计划，目标如下：i)开发一个研究培训计划，为年轻的临床研究人员做好准备，以便对MSK疾病患者常用和/或最近开发的矫形外科干预措施进行严格评估。Ii)进一步发展以病人为中心的MSK障碍和骨科综合研究计划。我的指导计划的总体目标包括：1)在骨科以患者为导向的研究方面提供培训，包括设计和实施随机临床试验、观察性研究，并为MSK障碍患者制定新的诊断标准；2)通过严格的MSK障碍研究培训，增加专注于以患者为导向的研究的研究人员的数量；3)促进新的多学科合作；以及4)促进从实习生到教员的过渡。虽然该计划的目标跨越了多个临床问题，但我在此建议中重点介绍了两项研究：研究1：进行随机对照临床试验，以确定全膝关节置换患者退出硬膜外麻醉的最佳时机。研究2：确定临床病史对膝关节骨关节炎(OA)症状性半月板撕裂的诊断价值。这些研究中的每一项，再加上一个全面的结构化指导计划，都将有助于解决MSK障碍患者管理中尚未回答的重要问题。该计划还将帮助下一代临床科学家开发、评估和实施有效的MSK患者治疗策略。

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.