Epidemiology, Health Policy, Evidence-Based Medicine, Shared Decision-Making
Dr. Elliott Fisher directs The Dartmouth Institute of Health Policy and Clinical Practice (TDI), formerly the Center for the Evaluative Clinical Sciences, which was founded by a giant of health outcomes research, Dr. John Wennberg. Not only do our residents have the opportunity to complete an additional MS or MPH through TDI, we also have access to the United States Medicare databases. This database allows us access to over 50 million records related to the Medicare population. Using this database, Dr. Weinstein and colleagues at TDI published the first Dartmouth Atlas of Musculoskeletal Health Care. Dr. John-Erik Bell heads our Medicare Claims Unit, through which faculty and residents can continue to pursue research related to the entire U.S. population.
Multidisciplinary Clinical Research Center (MCRC)
The overall goal of the NIAMS-funded MCRC is to improve musculoskeletal outcomes for patients with musculoskeletal disease and injury. By taking advantage of cross-disciplinary collaborations, the MCRC is committed to improve the prevention, diagnosis, and treatment of musculoskeletal conditions that burden our aging population’s health and the economy. Through the Methodology Core, new educational opportunities and research support are provided for clinicians and researchers in training, thereby fostering new clinical research initiatives that will further improve the health of patients with musculoskeletal disease. Leaders of Dartmouth’s MCRC are Anna Tosteson, ScD (Center Director); Jon Lurie, MD, MS (Center Associate Director); and Tor Tosteson, ScD (Methodology Core Director).
Spine Patient Outcomes Research Trial
Dartmouth-Hitchcock's Department of Orthopaedics is fortunate to be coordinating the Spine Patient Outcomes Research Trial (SPORT), the largest clinical trial ever funded by NIH (NIAMS). SPORT comprises 13 sites spanning 11 states, now in its 12th year of follow-up. It is headed by Dr. Weinstein as Principal Investigator and asks the question whether surgical or non-surgical treatment is more effective for three different diagnoses for low back pain. SPORT affords residents many opportunities to do collaborative research and to publish in peer-reviewed journals.
Center for Shared Decision Making
Another resource is the Center for Shared Decision Making at DHMC, the founding director of which was Dr. Weinstein. This center now provides programs not just for orthopaedics but for many other disciplines and disease areas, and is a rich source of data on patient decision-making and interactions with the health care system.
Clinical Trials Office
The Clinical Trials Office at Dartmouth-Hitchcock is a collaborative endeavor meant to boost synergy amongst colleagues, residents included. It is a multidisciplinary collection of experienced researchers dedicated to the development and support of complex clinical research, especially clinical trials. It seeks to enrich the local research environment by providing essential expertise for the design, analysis, and administration of current and future trials.
Biomechanics / Bioengineering
Dartmouth Biomedical Engineering Center for Orthopaedics (DBEC). Housed at Dartmouth's Thayer School of Engineering, Dr. John Collier (Myron Tribus Professor of Engineering, Thayer School of Engineering) and Michael Mayor (William N. and Bessie Allyn Professor emeritus of Orthopaedics) run the world's foremost total joint implant retrieval lab. Over the last 30 years DBEC has examined over 7000 orthopaedic implants sent to them by more than 1000 surgeons, examining wear patterns of component materials and structures. Current projects are focused on oxidation differences between in vivo and shelf-aged components, and between component materials; the development of an accelerated aging environment; and modeling oxidative degradation of polyethylene. Research opportunities abound for our residents with new opportunities in prosthesis design methodology and biomaterials, as well as exposure to biomechanical testing of devices.
Musculoskeletal Biomechanical Laboratory (Department of Orthopaedic Surgery, DHMC)
The lab's primary purpose is to test newly developed orthopaedic devices for use in the human spine using both animal and human cadaver spines. The lab is headed by Dr. Dilip K. Sengupta and includes a freezer, cold storage and a state-of-art six-degree-of-freedom spine tester fabricated based upon a universal spine tester reported by H.J. Wilke in 1994. The system has three major characteristics: 1) Six degree-of-freedom which allows the spine specimen to move freely during testing, preventing non-physiological motion as observed in stiffness testing method. 2) Pure moment bending, which has been advocated in spine biomechanics research field as a preferred loading scheme to simplify spine specimen loading and make it possible to compare data produced from different laboratories and 3) Continuous cyclical loading on spine specimens, which is desirable for simulating in vivo spine motion conditions.
We also are fortunate to work closely with Dr. Joyce DeLeo, a world-class researcher on the neuroimmunology of pain and director of Dartmouth-Hitchcock's Neuroscience Center. We know musculoskeletal problems account for a significant portion of cases seen by physicians. At Dartmouth-Hitchcock we not only want to understand the burden of disease but also the reasons and pathomechanisms of the pain that is often the reason for which a patient seeks out an orthopaedic surgeon. Dr. DeLeo has joined our group in addition to her appointments in anesthesiology and pharmacology and has collaborated with us for over 10 years. The mission of Dr. DeLeo's laboratory is to create a better understanding of central nervous system mechanisms that lead to chronic pain including neuropathic and low back pain. This knowledge will translate into development of new, effective approaches for treatment and even prevention of these chronic pain syndromes. Central neuroimmune activation and neuroinflammation play a key role in generating chronic pain. Dr. DeLeo uses molecular, cellular, and in vivo behavioral pharmacological approaches with the ultimate goal to develop novel, non-addictive therapeutics for the prevention and treatment of chronic neuropathic and low back pain. Dr. DeLeo is a superb mentor for basic science research, and offers excellent prospects for our residents interested in the basic sciences.
Dr. Weinstein is editor-in-chief of Spine, the highest-ranking orthopaedics journal in the world (JCR, 2002). All of Dartmouth's residents (not just those with an interest in spine) have a unique opportunity to witness how important research information is reviewed, published, and disseminated to the research and greater community. Being exposed to the issues of conflict of interest, research biases and assumptions, legitimate authorship and the importance of peer review is imperative to the education of our future orthopaedic researchers if we are to refine and improve clinical research.
The Center for Surgical Innovation
Surgeons are too often limited by what they cannot see—anatomy that is difficult to reach or diseases that are not visible to the naked eye. While advances in imaging before and during surgery have revolutionized countless surgical procedures, tremendous opportunities for surgical innovation remain. A primary constraint is the lack of operating room time and space for research purposes. At Dartmouth, the Center for Surgical Innovation (CSI) removes that constraint. Dedicated to translational research, the CSI is equipped with MRI and CT machines that can move in and out of two spacious operating rooms. This allows surgeons and engineers to rapidly develop, test and validate new surgical tools and techniques, with the goal of advancing better, safer and, in some cases, less costly care for patients everywhere. Our Chairman, Dr. Sohail Mirza is the acting Medical Director for the Center for Surgical Innovation.
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