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Joseph Bernstein

Publications and source records attributed to Joseph Bernstein.

At least 19 recordsLinked to original sources
PubMed2006

The required research rotation in residency: the University of Pennsylvania experience, 1978-1993.

The University of Pennsylvania orthopaedic surgery residency program under the direction of Dr. Carl T. Brighton was uniquely structured to require a year of research as part of a 5-year program. This requirement was instituted to foster critical thinking, and not necessarily to produce academic orthopaedic surgeons. Nonetheless, measures of academic productivity of the 127 residents who trained under Dr. Brighton's leadership may be instructive. The purpose of this study was to assess metrics of academic productivity. In addition, the six current and former chairmen of orthopaedic surgery programs who performed research while residents at the University of Pennsylvania were surveyed for their impressions regarding required research rotations. Fifty-nine percent of the University of Pennsylvania residents took faculty positions after training; 75% published a peer-reviewed paper after residency; and 17% are current members of the American Orthopaedic Association. Overall, the chairmen surveyed found great value in their own resident research experience, but none have replicated the Brighton model of residency organization. Only two of the six programs have a research year: at both, this research rotation is in addition to the standard 5 years of clinical education and only at one are all residents required to participate.

Authorship↗
PubMed2004

Normative ethics in sports medicine.

The relationship between a team physician and an athlete differs significantly from the traditional doctor-patient relationship. To better define the ethical norms and ideals in sports medicine, we surveyed the views of practicing team physicians in the Ivy, National Football, and National Hockey Leagues and compared them with responses offered by professional ethicists. Six hypothetical cases were presented, each representing a distinct area of ethical conflict: advertising, conflicting healthcare goals, confidentiality, innovative treatments, enabling dangerous behavior, and treating children. Thirty-one ethicists and 131 team physicians responded to the surveys. Subjects were asked to rate agreement or disagreement with statements that followed the case description. Responses were converted to scores ranging from 0 to 100. A priori, a difference greater than 20 points was set to represent significant disagreement. By that standard, there was agreement between the physicians and ethicists for 18 of 23 statements. We concluded that team physicians and ethicists share many of the same ethical views on common ethical issues in sports medicine. The high degree of variance in the responses in both groups, however, suggests that many unresolved areas remain in the field of ethics in sports medicine.

Advertising↗
PubMed2004

MD-PhD students in a major training program show strong interest in becoming surgeon-scientists.

A wide spectrum of individuals have discussed the importance of promoting research in orthopaedics and of developing clinician-scientists (physicians who also do significant research) in the field. Although orthopaedic research may benefit from recruitment of MD-PhD students as clinician-scientists, it is unclear to what extent MD-PhD students are interested in pursuing research and surgical specialties concurrently. To better understand their professional goals, all MD-PhD students enrolled in our institution's training program were invited to complete an online questionnaire concerning training satisfaction and future career goals. Twenty-four percent of respondents (57.5% response rate of 167 recruits) reported a primary clinical interest in a surgical field (3% interest in orthopaedics); interest was strongest late in training. The majority of surgical MD-PhD students, like nonsurgical students, were planning to make research a significant part of their careers. In addition, students identified the importance of factors such as family issues and faculty role models in determining their clinical interests. The study data indicate that MD-PhD students have strong interests in becoming surgical clinician-scientists. They also suggested that active recruitment (especially early in training) that is responsive to the personal and professional needs of students has the potential to increase the number of clinician-scientists in orthopaedics.

Adult↗
PubMed2004

The 2004 Marshall Urist award: delays until surgery after hip fracture increases mortality.

The objective of this study was to analyze whether a delay in time from admission until surgical treatment increased the mortality rate for patients with a closed hip fracture. We used the day of the week of admission as an instrumental variable to pseudorandomize patients. We analyzed 18,209 Medicare recipients who were 65 years of age or older and had surgical treatment for a closed hip fracture. Patients for whom the delay between admission and surgery was 2 days or more had a 17% higher chance of dying by Day 30. Using instrumental variables analysis, we found a similar 15% increased risk of mortality in patients with delays until surgery of 2 or more days. Based on these results, we found that a delay of 2 or more days significantly increased the mortality rate. This suggests that delay to surgery independently affects mortality, therefore additional study on the effect of smaller delays on outcome is needed.

Aged↗
PubMed2004

The relationship between required medical school instruction in musculoskeletal medicine and application rates to orthopaedic surgery residency programs.

BACKGROUND: Orthopaedic residency programs lack gender and race diversity. This study examines the hypothesis that exposure to a required course in musculoskeletal medicine in medical school is associated with a higher rate of application to orthopaedic surgery residency programs by underrepresented groups. METHODS: All 122 medical schools in the United States were surveyed in 2001 to determine whether they required dedicated course work in musculoskeletal medicine, defined as a preclinical module or clinical clerkship in orthopaedic surgery, rheumatology, or physiatry. Data from the Electronic Residency Application Service were obtained for the class of 2002. From these two sources, the rate of applications from students to orthopaedic surgery residency programs was calculated as a function of exposure to a required course in musculoskeletal medicine. Subgroup analysis was further carried out for women and for African Americans, Latinos, and Native Americans. RESULTS: In 2002, there were 16,294 graduates of American medical schools, of whom approximately 55% had mandatory instruction in musculoskeletal medicine. The rate of application to orthopaedic surgery residency programs was 5.7% among the students with required instruction compared with a rate of 5.1% for students without such required instruction. The rate of application for female students was 2.0% for those who had required courses and 1.1% for the female students who had not had the required courses. The rate of application for minority students in schools with required courses was 8.2% compared with a rate of 6.1% for those students without such exposure. CONCLUSIONS: Required instruction in musculoskeletal medicine was associated with a 12% higher rate of application to orthopaedic surgery residency programs among all students (5.7% of those who received required instruction compared with 5.1% of those who did not). The relative difference was more pronounced among women (a 75% difference in the rate of application) and minorities (a 35% difference in the rate of application). This study suggests that required instruction in musculoskeletal medicine can help to promote diversity in orthopaedic surgery residency programs.

Cultural Diversity↗
PubMed2003

Statistical sampling and hypothesis testing in orthopaedic research.

The purpose of the current article was to review the process of hypothesis testing and statistical sampling and empower readers to critically appraise the literature. When the p value of a study lies above the alpha threshold, the results are said to be not statistically significant. It is possible, however, that real differences do exist, but the study was insufficiently powerful to detect them. In that case, the conclusion that two groups are equivalent is wrong. The probability of this mistake, the Type II error, is given by the beta statistic. The complement of beta, or 1-beta, representing the chance of avoiding a Type II error, is termed the statistical power of the study. We previously examined the statistical power and sample size in all of the studies published in 1997 in the American and British volumes of the Journal of Bone and Joint Surgery, and in Clinical Orthopaedics and Related Research. In the journals examined, only 3% of studies had adequate statistical power to detect a small effect size in this sample. In addition, a study examining only randomized control trials in these journals showed that none of 25 randomized control trials had adequate statistical power to detect a small effect size. However, beta, or power, is less well understood. Because of this, researchers and readers should be aware of the need to address issues of statistical power before a study begins and be cautious of studies that conclude that no difference exists between groups.

Epidemiologic Research Design↗
PubMed2003

Curricular reform in musculoskeletal medicine: needs, opportunities, and solutions.

Musculoskeletal medicine is not taught adequately in American medical schools and the predictable consequences are seen. Students cannot show cognitive mastery of the subject and lack confidence in this topic. To address this, the Academic Orthopaedic Society held a symposium on medical school education at its annual meeting in 2001. There, the panelists presented an analysis of the problem and proposed solutions. Specifically, it was noted that because of the autonomy of the various schools and their varied approaches to teaching, it would be unlikely that one monolithic and mandated plan could be effective on a national basis. Rather, successful reform would comprise a coalition-based effort to define learning objectives, to provide teaching materials, and to create forums for sharing resources. Recruitment of national organizations was thought to be essential. Finally, it was felt that although inadequate education is neither new nor necessarily unique among disciplines, the coming year or two, the beginning of the Bone and Joint decade, was seen to be a particularly auspicious time for attempting curricular reform.

Curriculum↗
PubMed2003

The incidence of pathology detected by magnetic resonance imaging of the knee: differences based on the specialty of the requesting physician.

The usage patterns of magnetic resonance imaging (MRI) by orthopedic and nonorthopedic surgeons were studied. A sample consisting of the radiologist reports from all knee MRIs in a single year at our institution were reviewed. Studies to evaluate tumors or infections were excluded. Reports were classified as normal or demonstrating degenerative joint disease, meniscal tears, cruciate ligament pathology, collateral ligament pathology, focal chondral defects, chondromalacia patella, cysts, extensor mechanism dysfunction, intraosseous edema, or fractures. Six hundred eighteen reports were reviewed. The combined incidence of a normal study or one that found only degenerative joint disease was 45% for nonorthopedic surgeons and 27.6% for orthopedic surgeons (P<.00001). Given the higher incidence of normal findings in studies ordered by nonorthopedic surgeons, these physicians probably use MRI more for screening whereas orthopedic surgeons are more apt to use it for confirmation. Therefore, if clinical guidelines for using MRI are to be established, differences in use as a function of specialty must be acknowledged.

Hospitals, University↗
PubMed2003

A perspective on the study of Moseley et al: questioning the value of arthroscopic knee surgery for osteoarthritis.

Arthroscopy for degenerative conditions of the knee is among the most commonly employed orthopedic procedures, but its effectiveness (like the effectiveness of many surgical operations) has never been proven in prospective trials. Moreover, the precise mechanism by which arthroscopy improves the course of degenerative conditions of the knee has not been established conclusively. Moseley et al performed a double-blinded, randomized, placebo-controlled trial to compare the effectiveness of arthroscopic lavage and arthroscopic debridement vs a sham procedure. Data regarding pain and function were obtained at multiple time points over a 2-year period. The authors found that all three treatment groups fared equally: each reported subjective symptomatic relief, but no objective improvement in function was noted in any of the groups. These data suggest that the benefits of arthroscopy for the treatment of osteoarthritis of the knee is to provide subjective pain relief, and that the means by which arthroscopy provides this benefit is via a placebo effect.

Arthroscopy↗
PubMed2002

Preoperative sedation in pediatric patients with sleep-disordered breathing.

OBJECTIVE: Based on a few reports that describe obstructive sleep apnea (OSA) patients as having an increased risk of acute upper airway obstruction (UAO) after pharmacological sedation, this population is less likely to receive sedation prior to surgery. Our objective was to evaluate pediatric patients with sleep-disordered breathing who received preoperative sedation to determine if there was an increase in preoperative airway obstruction. DESIGN: Retrospective chart review from 1995 to 2000. SETTING: Two tertiary care academic medical centers. PATIENTS: Sixty-five children (mean age=4.7+/-2.3 years; 49 boys, 16 girls) diagnosed with sleep-disordered breathing by sleep study or clinical evaluation that received preoperative midazolam hydrochloride. OUTCOME MEASURE: The occurrence of preoperative adverse events defined as UAO, hypoventilation, desaturation, bradycardia, or sustained lethargy that required active intervention after the administration of midazolam hydrochloride within 24 h of surgery. RESULTS: None of the 65 children evaluated in this study experienced respiratory compromise requiring intervention after the administration of preoperative sedation. Potential risk factors such as patients' age, sex, weight, comorbidities, midazolam hydrochloride dose, and severity of sleep apnea did not appear to affect outcome. CONCLUSION: The preliminary data suggested that preoperative sedation might be safely administered to children with mild or moderate sleep-disordered breathing, and possibly to children with severe OSA, if children are closely observed prior to surgery. Further prospective studies are needed to confirm these results.

Academic Medical Centers↗