Resources For Medical Education And Collaboration Inc

Programs: Bringing spine health care and on-site medical educationto the developing worldbelize spine programrmec established the goal to partner with communities and hospitals indeveloping countries to improve access to quality spine care by:1) promoting excellent clinic management from diagnosis to follow up;2) training orthopedic surgeons in diagnosing and treating spine pathology;3) developing educational programs to sustain community access to qualityspine care;4) establishing strong bilateral partnerships. Over the course of two years, a relationship with karl heusner memorial hospital in belize city was developed; khmh is the first location that rmec is supporting the development of a sustainable spine clinic pursuant to our mission stated above. Why khmh and belize? Karl heusner memorial hospital is the main referring center in belize. It is estimated that khmh has a draw of about one million people, which includes the belize populous of 350,000 and pull from surrounding countries. On average, khmh sees about 135 patients a day and most of these are trauma cases. With this large populous, the belize community is in need of a clinic well-trained in treating spinal pathologies and spine trauma. Orthopedic surgeons at khmh perform a limited number of spine surgeries, primarily focusing on basic cases and trauma cases. The orthopedic surgeons are very cautious about complex and instrumented cases, as they have limited access to the required instrument trays and devices, as well as lack the needed continuing education in diagnosing spinal pathology and surgical trainings in advanced techniques. To compound the delivery of care, approximately 50% of surgeons in belize are foreign-born; the surgeons at khmh operate under diverse educational and training backgrounds. This disparity in surgeon training poses challenges in establishing standards of care at khmh and results in disparate treatments and perspectives in providing spine care. To summarize, khmh is in need of continuing and specialized education programs in diagnosing and treating spinal pathologies, as well as in need of updated instrument trays, devices, and technology. Lastly, and importantly, khmh is open to a partnership that will improve access to quality spine care for their patient population. The belize spine program is a tailored, bilateral, clinical, and educational outreach program addressing the needs of patients seeking treatment for a spinal pathology. The program began small; in february, 2011, dr. Williams and ms. George traveled to belize and treated two adult patients, as well as holding clinic. In may 2011, dr. Williams, dr. Youssef, and dr. George returned for the 3-month follow up and clinic, as well as further relationship building. February 2012 marked the one-year anniversary of the bsp; dr. Williams and ms. George returned to perform four more life changing surgeries, alongside the belizean team, held clinic, and supported educational talks. In august 2012, a team of six (dr. Williams, dr. Moulton, ms. George (rn), an or specialist, a certified neurophysiologic intraoperative monitor (cnim), and an assistant) traveled to belize prepared to treat the 13 year old seen previously in clinic in february, as well as two adult patients. During the one-week trip in august 2012, fourteen patients were evaluated in clinic, three patients received life changing surgical treatment, critical educational opportunities for a number of physicians were supported, and steps toward greater collaboration were made. Numerous pathologies were seen in clinic including degenerative lumbar spondylolisthesis, lumbar spinal stenosis, lumbar arthodesis, adolescent idiopathic scoliosis, scheuermann's kyphosis, spina bifida/ mylomeningocele, dysphagia due to cervical spine procedures, and cases where additional tests were needed before a diagnosis could be made. Three patients seen in clinic were operated on throughout the week ahead. The cases included the following: (1) a 54 year old woman with lumbar spondylolisthesis treated with a plif at l4-l5, (2) a 13 year old girl with adolescent idiopathic scoliosis with a curve of 90 degrees treated with psf from t3 to l4 (including icbg harvest), and (3) a 72 year old male with degenerative scoliosis with rotatorylisthesis and lumbar spinal stenosis treated with l3-l4 plif, l2-l5 psf with decompression/laminectomies. All three cases were successfully completed. All patients have been discharged from the hospital at this time and are reported to be doing well. The first scoliosis correction surgery in belize was performed on this trip by dr. Andrew moulton and dr. Williams, with the help of numerous team members and with product support from the nuvasive spine foundation. This landmark event is a hallmark of the great collaboration between the north american and belizean teams to bring sustainable access to spine care for belize.

biologics collaborative programssummary: the biologics collaborative includes jeffrey c. Wang, md, howard s an, md, wellington k hsu, md, jay r lieberman, md, and s tim yoon, md. The collaborative is currently supported by resources for medical education and collaboration (rmec) and rmec board members, jim a. Youssef, md and darrel s. Brodke, serve as liaisons to the collaborative. The group first met in may 2011 to chart out the development of a biologics registry. In the last year and a half, we have been successful in raising awareness around the need for data and supporting greater education surrounding biologics use in spine surgery by: hosting a new annual meeting in our second year this year (2nd annual biologics collaborative, october 6, 2012 santa monica ca), publishing a paper in the global spine journal, applying to two oref grants with a 50% success rate, critically evaluating the prospects of a biologics registry, and taking a strong step towards improving data available on biologics. In our work, we have recognized that the registry space is increasingly competing for resources and there is a strong need for collaboration in order for data collection to be efficient and meaningful. As such, in september of this year we began reaching out to fellow organizations that have established registries or study groups with data platforms; these groups include the association for collaborative spine research (acsr), north american spine society (nass), society of lateral access surgery (solas), the spine research foundation (srf), and the society for minimally invasive spine surgery (smiss). Other groups that were not contacted and are also pursuing databases in this area include the association of american neurological surgeons (aans), which has developed a comprehensive quality improvement effort. Data points of interest that were sought to be included in partnering registries have been determined and our outlined in the program files. The biologics collaborative has developed a generous donor base for its annual meeting and was in the process of developing strong relationships with key donors in developing a database. Amid concerns around the funding model, bias, and a starting point that would enable a sustainable project, we began to focus on supporting key studies that would serve as pillars in the area of biologics, given the paucity of data. These studies are currently being defined by the group.

supporting research activities in clinical medicinethe osteobiologics registryevidence-based medicine is at the forefront of healthcare reform. The need for evidence is preceded by the need for data. Specifically, rmec has identified a need to gather data surrounding the use of osteobiologics in various surgical spine procedures. To address this need, we are developing the osteobiologics registry, a platform designed to collect multisite data surrounding the application of osteobiologics in spine surgery. This project has been on the rmec radar since 2009, and in 2011 we made substantial progress on the establishment of the osteobiologics registry. Background on osteobiologicsosteobiologics are classified as autogenous bone graft substitutes, extenders, or enhancers; types of osteobiologics include demineralized bone matrices (dbm), allografts and allograft formulations, synthetic bone grafts, bone morphogenic proteins, bone marrow aspirate systems, and platelet-rich plasma systems. New types of osteobiologics, such as stem cell therapies, are continually being developed and introduced to the market. Given the number and range of biologics on the market in the united states, comparative clinical effectiveness research is important to improve treatments and outcomes for patients electing for spine surgery. Evidence across the diverse classifications of osteobiologics is notoriously lacking; many products pass through the fda as "minimally manipulated human allograft" and/or are used off-label. To this end, an effective means of collecting standard of care data, encouraging research, and disseminating evidence is required; the osteobiologics registry will address this void by assembling uniquely qualified clinicians, including novices and leaders in the research realm to participate in registry data collection and enable tools and resources to promote the dissemination of findings through publications and presentations. Accomplishments towards the goal of establishing the osteobiologics registry:the development and oversight of the osteobiologics registry is helmed by five clinicians, each with a unique ability to provide insight and direction to the project. Jeffrey c wang, md presides over the advisory board. This study is a prospective, multi-center, longitudinal, observational study designed to collect data surrounding the application of osteobiologics in spinal fusion surgery. Institutional review board (irb) approval will be pursued for the prospective database with the intent to perform retrospective studies. Data will include demographics, surgical details including osteobiologic product use, clinical and radiographic follow up, and patient reported odi, vas, and eq-5d. The osteobiologics meeting was an important accomplishment towards establishing the registry and educating surgeons in this area.

providing internship opportunitiesstudents interested in pursuing a career in medicine are curious about the real-world setting and have a desire to see first-hand the doctor-patient relationship, the dynamics between physicians, and staff, the inner workings of a private practice, and to contribute to clinical research projects. The rmec internship program gives local students (durango, co) interested in medicine these experiences and furthers their ambitions for careers in medicine. Hearing interns recount their experiences with passion and intrigue reveals the value and need for a program to support medical internships. The primary goals of rmec' s internship program are to foster an interest in medicine as a career, improve the students understanding of the practice of medicine in a rural setting, and to increase the opportunities for local students of achieving admittance to medical school. Over the past 8 years, more than 22 interns have gone through our doors. Of those students we have been able to track, 5 have gone on to medical school, 4 have attended physicians assistant school, and one has completed a ph. D. Program in chemistry, one completed an mba program, one is in clinical research, one is a physical therapist, and seven are in the process of application to medical and pa schools. The success of our internship program is attributable to the quality of our applicants and the generosity of our mentors. A practitioner's time represents extraordinary value; the gift they give in sharing expertise with a student at the sacrifice of other endeavors is immeasurable and speaks volumes of their priorities. We select our interns based on their capability and their passion, and their respect for the contribution and the opportunity afforded them. Rmec facilitates internships by advertising physician/practitioner opportunities through our partners; supporting physician sponsorship of interns; interviewing applicants and screening for placement; establishing the expectations for the students to ensure a beneficial experience; providing mediums for interns to network with each other and practitioners/healthcare professionals; following up with intern alumni to provide a measure of success towards our goals.