Congenital Upper-Extremity Differences: A Thematic Analysis of On-Line Discussion Boards.

PURPOSE: On-line discussion boards (DBs) are used by patients and family members to pose questions and share experiences with a broader community. Systematic analysis of the text posted to DBs about congenital upper-extremity (UE) differences may allow physicians to identify and address patients' questions and concerns better. METHODS: We used Google and Yahoo! Internet search engines to identify on-line DBs pertaining to congenital UE differences. Posts written between January 1, 2009 and January 1, 2019 were collected and analyzed. Each on-line post was coded by 2 researchers using 3 rounds of grounded theory: open coding, axial coding, and selective coding. This allowed comprehensive, central themes of the DBs to emerge. RESULTS: We collected 521 posts and analyzed 420 posts from 152 threads. A total of 163 unique users contributed to posts. Parents of a child with a congenital UE difference accounted for the majority of users (65%), most of which were postnatal (91%). Of posts written by patients, 48% expressed negative emotions pertaining to their difference, whereas 17% conveyed a positive experience. Five selective codes were identified from posts written by non-administrators: (1) Connecting With Others, (2) Emotional Aspects, (3) Treatment, (4) Diagnosis, and (5) Function. Connecting With Others was the most frequently assigned selective code; users were looking to establish a connection in 73% of posts. Posts seeking information (n = 106) were more often technical in nature than were posts providing information (54% vs 44%). Posts providing information (n = 206) were more often emotional (18% vs 13%). CONCLUSIONS: Individuals accessing on-line DBs are commonly searching for technical and emotional support from others. Through analysis and identification of the themes from these posts, we believe physicians should be proactive in addressing technical concerns through education and counseling, but should also validate emotional concerns and assist families and patients via support groups or connections to others. CLINICAL RELEVANCE: Treating surgeons can improve their care of patients with congenital UE differences by better understanding the needs of patients and their families that may not be elucidated in a traditional patient encounter.

Difficult conversations: Navigating intimate partner violence with standardized patients.

BACKGROUND: One in three women in the US experience intimate partner violence (IPV) in their lifetime. There are minimal opportunities for medical students to learn about responding to IPV. METHODS: Students participated in a learning intervention about recognizing and addressing IPV, followed by a standardized patient session. Students filled out a seven-question survey before and after the session, which assessed comfort addressing IPV, discussing resources, and practicing trauma-informed care. Responses were compared using the Mann-Whitney U test. RESULTS: Sixteen medical students participated, response rate of 100%. The median score for comfort recognizing signs of IPV increased from 2 to 3 (p < 0.01); for asking patients about IPV, from 1 to 3.5 (p < 0.01); in knowledge of IPV resources, from 1 to 3 (p < 0.01); in preparedness to practice trauma informed care, from 2 to 3.5 (ns). Comfort addressing IPV improved from 1 to 3 (p < 0.01). CONCLUSION: After the session, student preparedness and comfort addressing IPV increased. The learning intervention addressed information not in standard medical curricula. This module can be easily adapted to any medical school curricula.

Runx2 plays a central role in Osteoarthritis development.

Osteoarthritis (OA) is the most common form of arthritis, is the leading cause of impaired mobility in the elderly, and accounts for more than a third of chronic moderate to severe pain. As a degenerative joint disorder, OA affects the whole joint and results in synovial hyperplasia, degradation of articular cartilage, subchondral sclerosis, osteophyte formation, and chronic pain. Currently, there is no effective drug to decelerate OA progression and molecular targets for drug development have been insufficiently investigated. Anti-OA drug development can benefit from more and precise knowledge of molecular targets for drug development. Runt-related transcription factor 2 (Runx2) is a key transcription factor controlling osteoblast and chondrocyte differentiation and is among the most promising potential therapeutic targets. Notably, Runx2 expression is upregulated in several murine OA models, suggesting a role in disease pathogenesis. In this review article, we summarized recent findings on Runx2 related to OA development and evaluated its potential as a therapeutic target. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: A better understanding of the role of Runx2 in osteoarthritis pathogenesis will contribute to the development of novel intervention of osteoarthritis disease.

Are Women Proportionately Represented as Speakers at Orthopaedic Surgery Annual Meetings? A Cross-Sectional Analysis.

BACKGROUND: In spite of efforts to improve gender diversity in orthopaedic surgery, women remain underrepresented, particularly with increasing academic rank. Opportunities to speak at society meetings are an important component of building a national reputation and achieving academic promotions. However, little is known about the gender diversity of orthopaedic society annual meeting speakers. Data on this topic are needed to determine whether these speaking roles are equitably distributed between men and women, which is fundamental to equalizing professional opportunity in academic orthopaedic surgery. QUESTION/PURPOSES: (1) Is the gender diversity of invited speakers at annual orthopaedic subspecialty society meetings proportional to society membership? (2) Are there differences in the proportion of women invited to speak in technical sessions (defined as sessions on surgical outcomes, surgical technique, nonsurgical musculoskeletal care, or basic science) versus nontechnical sessions (such as sessions on diversity, work-life balance, work environment, social media, education, or peer relationships)? (3) Does the presence of women on the society executive committee and annual meeting program committee correlate with the gender diversity of invited speakers? (4) Do societies with explicit diversity efforts (the presence of a committee, task force, award, or grant designed to promote diversity, or mention of diversity as part of the organization's mission statement) have greater gender diversity in their invited speakers? METHODS: Seventeen national orthopaedic societies in the United States were included in this cross-sectional study of speakership in 2018. Each society provided the number of men and women members for their society in 2018. The genders of all invited speakers were tabulated using each society's 2018 annual meeting program. Speakers of all credentials and degrees were included. All manuscript/abstract presenters were excluded from all analyses because these sessions are selected by blinded scientific review. A Fisher's exact test was used to compare the proportion of women versus men in nontechnical speaking roles. The relationship between women in society leadership roles and women in all speaking roles was investigated using a linear regression analysis. A chi square test was used to compare the proportion of women in all speaking roles between societies with stated diversity efforts with societies without such initiatives. RESULTS: Overall, women society members were proportionately represented as annual meeting speakers, comprising 13% (4389 of 33,051) of all society members and 14% (535 of 3928) of all annual meeting speakers (% difference 0.6% [95% CI -0.8 to 1.5]; p = 0.60); however, representation of women speakers ranged from 0% to 33% across societies. Women were more likely than men to have nontechnical speaking roles, with 6% (32 of 535) of women's speaking roles being nontechnical, compared with 2% (51 of 3393) of men's speaking roles being nontechnical (OR 4.2 [95% CI 2.7 to 6.5]; p < 0.001). There was a positive correlation between the proportion of women in society leadership roles and the proportion of women in speaking roles (r = 0.73; p < 0.001). Societies with a stated diversity effort had more women as conference speakers; with 19% (375 of 1997) women speakers for societies with a diversity effort compared with 8% (160 of 1931) women speakers in societies without a diversity effort (OR 2.6 [95% CI 2.1 to 3.1]; p < 0.001). CONCLUSIONS: Although the percentage of women in speaking roles was proportional to society membership overall, our study identified opportunities to improve gender representation in several societies and in technical versus nontechnical sessions. Positioning more women in leadership roles and developing stated diversity efforts are two interventions that may help societies improve proportional representation; we recommend that all societies monitor the gender representation of speakers at their annual meetings and direct conference organizing committees to create programs with gender equity. CLINICAL RELEVANCE: Society leadership, national oversight committees, invited speakers, and conference attendees all contribute to the layers of accountability for equitable speakership at annual meetings. National steering committees such as the American Academy of Orthopaedic Surgeons Diversity Advisory Board should monitor and report conference speaker diversity data to create systemwide accountability. Conference attendees and speakers should critically examine conference programs and raise concerns if they notice inequities. With these additional layers of accountability, orthopaedic surgery annual meetings may become more representative of their society members.