Publication Type
February Total
Articles
124
Editorial Material
18
Reviews
10
Biographical Item
1
Total
153
Publications in Top Quartile Journals 106 out of 153 (69.3%)
Total Publications Fiscal Year to Date: 1,058
All rights reserved. Contents are the property of the authors and/or journals cited. Cover Image from “The Henle Fiber Layer in Albinism: Comparison to Normal and Relationship to Outer Nuclear Layer Thickness and Foveal Cone Density�
Marjorie C. Wang, MD, MPH Professor & Vice Chair of Clinical Operations Chief, Community Division of Neurosurgery Director, Spine Fellowship Program Medical College of Wisconsin
I am a professor of neurosurgery at MCW. I received a three-year Robert Wood Johnson Physician Faculty Scholars Award to study health outcomes after cervical spine surgery. My clinical practice and research focuses on spine, patient reported outcomes, quality of care, and health services. I am on the Editorial Board of the Journal of Neurosurgery and a Spine Section Editor for World Neurosurgery. I also serve as a Director on the American Board of Neurological Surgery.
“Variations in 30-day Readmissions and Length of Stay among Spine Surgeons: A National Study of Elective Spine Surgery among US Medicare Beneficiaries� Singh S, Sparapani R, Wang MC. Journal of Neurosurgery. Spine. 2018;29(3):286-291. Pay-for-performance programs target hospital readmissions with an assumption that readmissions are due to modifiable practice patterns. However, limited data supports this assumption. To study this, we examined variations in 30-day readmissions by spine surgeon among Medicare beneficiaries undergoing elective lumbar spine surgery for degenerative conditions. We used mixed models to estimate risk of readmission and length of stay (LOS) by surgeon. 39,884 beneficiaries were operated upon by 3,987 spine surgeons. After adjusting for patient characteristics and surgery type, we found no significant variations in readmission rates by surgeon. In contrast, we found significant variations in LOS by surgeon. Our findings suggest that surgeon practice patterns do not affect the risk of readmission but do influence LOS. Strategies to reduce readmissions would be better targeted at factors other than providers. Figure 1. Variation in risk of 30 day Readmission by spine surgeon.
The dotted line represents an odds ratio of 1. Each individual spine surgeons estimates of risk of readmission are presented as vertical bars (gray and black). The black line connects the mean estimated odds ratio for each spine surgeon and the height of the bars represents the upper and lower 95% confidence intervals. The black bars represent spine surgeons who have 95% confidence intervals for the odds of readmission with 30 days above or below 1.
Figure 2. Variation in length of stay by spine surgeon.
The dotted line represents the average length of stay normalized to a value of 1. Each individual spine surgeons estimates of length of stay in multiples of the mean are presented as vertical bars (gray and black). The black line connects the mean estimated length of stay for each spine surgeon and the height of the bars represents the upper and lower 95% confidence intervals. The black bars represent spine surgeons who have 95% confidence intervals for the length of stay above or below the normalized average of 1.
Julia Dickson-Gomez, PhD Professor Department of Psychiatry & Behavioral Medicine Deputy Director, Center for AIDS Intervention Research Medical College of Wisconsin
I study HIV prevention among drug users in the United States and El Salvador and am also interested in the influence of structural factors on HIV risk. My research explores the effects of housing policy on drug users' access to housing, variations in housing status and housing options of drug users, and levels of HIV risk related to these factors. My work also explores macro- and micro-social contexts of crack use and HIV risk in communities in El Salvador. Most recently, I have become interested in implementation science research, particularly the implementation of large-scale global health initiatives and ways of providing housing in low and middle-income countries.
“A Social Systems Analysis of Implementation of El Salvador’s National HIV Combination Prevention: A Research Agenda for Evaluating Global Health Initiatives” Dickson-Gomez J, Glasman LA, Bodnar G, Murphy M. BMC Health Services Research. 2018;18(1):848. Global Health Initiatives (GHIs) have been instrumental in the rapid acceleration of HIV prevention, treatment access, and availability of care and support services for people living with HIV (PLH) in low and middle-income countries (LMIC). These efforts have increasingly used combination prevention approaches that include biomedical, behavioral, social and structural interventions to reduce HIV incidence. However, little research has evaluated their implementation. We report results of qualitative research to examine the implementation of a national HIV combination prevention strategy in El Salvador funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Factors that negatively affected all intervention activities were an increase in violence in El Salvador during implementation of the strategy, resistance to decentralization, and budget constraints. Factors that affected peer outreach and sexual risk reduction were the human resource capacity of grassroots organizations and conflicts of the national HIV strategy with other organizational missions.
Ahmad Marashly, MD Assistant Professor Department of Neurology Medical College of Wisconsin Children’s Hospital of Wisconsin
I am a pediatric epileptologist and assistant professor of neurology at the Medical College of Wisconsin and Children’s Hospital of Wisconsin. I specialize in refractory epilepsy that does not respond to medical therapy, more specifically surgical treatment of refractory focal epilepsy. My research focuses on electrophysiologic and imaging methods to evaluate patients with refractory epilepsy, novel surgical therapies and outcomes of pediatric epilepsy surgery.
“Stereotactic Laser Ablation for Nonlesional Cingulate Epilepsy: Case Report” Marashly A, Loman MM, Lew SM. Journal of Neurosurgery. Pediatrics. 2018;22(5):481-488. A 17-year-old male presented with refractory nocturnal seizures characterized by bilateral arms stiffening lasting several seconds. Semiology suggested an epileptogenic zone close to one of the supplementary sensory-motor areas. Electroencephalography showed seizures from the central region without lateralization. Brain imaging was normal. An invasive evaluation using bilateral stereo-electroencephalography (SEEG) showed seizures from the middle portion of the right cingulate gyrus. SLA targeting the right mid-cingulate gyrus was performed. The patient has remained seizure-free since immediately after the procedure with no post-operative deficits (follow up of 16 months). This case highlights the utility of SEEG in evaluating difficult to localize, focal epilepsy. It also demonstrates the use of SLA can be extended to non-lesional, extra-temporal epilepsies.
Figure 4.
TOP: Sagittal postcontrast T1-weighted & axial T2-weighted MR images showing the laser cannula prior to ablation. This trajectory is chosen to avoid passing through the primary motor cortex or corticospinal tracts.
LEFT: Sagittal and coronal postcontrast T1-weighted MR images obtained immediately after the treatment showing the created ring-enhancing ablation lesion in the right middle portion of the cingulate gyrus.
Sabrina Hofmeister, DO Associate Program Director Assistant Professor Department of Family & Community Medicine Medical College of Wisconsin
I am a family physician practicing full spectrum family medicine at a residency training clinic in Milwaukee. I provide education to family medicine residents and patient care services to disadvantaged populations. My patient care and research interests include underserved medicine, women’s health, and osteopathic and allopathic medical education.
“Comparative Analysis of the American Board of Family Medicine and American College of Osteopathic Family Physicians In-Training Examinations” Hofmeister S, O’Neill TR, Butler DJ. Family Medicine. 2018;50(10):746-750. Family Medicine residency programs will all be accredited by the ACGME in 2020 as the American Osteopathic Association ceases accreditation services. This study assessed whether the degree of similarity for the construct of family medicine knowledge and clinical decision making as measured by the ABFM’s In-Training Examination was similar enough to be considered to the equivalent to the ACOFP’s In-Service Examination. A repeated measures design was used to correlate the rankings of 18 PGY-3 residents who took both exams and a Wilcoxon signed rank test indicated the median scores between both exams were not statistically significantly different. The lack of a difference on statistical analysis of exam scores suggests that the cohorts of residents in both types of residency programs are of similar ability and therefore there is no clear justification for administering both examinations. Figure 1. Scatterplot of PGY3 ITE and ISE Scores from 2013-2016
Michelle Pickett, MD, MS Assistant Professor Department of Pediatrics Section of Emergency Medicine Medical College of Wisconsin
I am a Pediatric Emergency Medicine physician with a Master’s degree in Clinical and Translational Science. I have always enjoyed working with adolescents so it not surprising my research has focused on adolescent sexual healthcare. Specifically, my research focuses on the management of sexually transmitted infections in this population. Adolescents (especially Milwaukee teens) have very high rates of chlamydia and gonorrhea. It is my goal to use my research to improve the clinical care of these patients to ultimately decrease rates of chlamydia and gonorrhea in adolescents.
“Physician Adherence to Centers for Disease Control and Prevention Guidelines for Sexually Active Adolescents in the Pediatric Emergency Setting” Pickett ML, Melzer-Lange MD, Miller MK, Menon S, Vistocky AM, Drendel AL. Pediatric Emergency Care. 2018;34(11):767-773. In this national survey of providers who work in pediatric emergency settings, we asked about clinical management in different hypothetical scenarios. We found poor adherence to the Centers for Disease Control and Prevention guidelines for the management of chlamydia and gonorrhea. In adolescent females with vaginal discharge, only 37.4% selected the CDC recommended specimen type and test. The CDC recommends vaginal swabs as the optimal specimen, however many providers chose to use more invasive cervical swabs. We also inquired about providers’ knowledge of expedited partner therapy (EPT). EPT is recommended by the CDC and allows providers to treat partners of patients with certain sexually transmitted infections if it is unlikely they will seek treatment themselves, however laws vary by state. Only 17.7% of participants knew their state’s EPT laws. Overall rates of physician adherence to CDC guidelines and expedited partner therapy prescription by scenario (N=231)^ Scenario 14 year old asymptomatic patient Adhered to CDC guidelines (% yes) Prescribed EPT (% yes)
18 years old asymptomatic patient
18 years old asymptomatic patient with partner with penile discharge
18 years old symptomatic patient with vaginal discharge only
201 (87.4)
196 (85.6)
162 (70.4)*
86 (37.4)*
20 (8.8)
25 (10.9)
28 (12.3)
35 (15.4)
^Missing data is ≤5%. Percentages based on number of responses for each category. *p<0.001when compared to the 18 year old asymptomatic patient scenario
Joseph Zenga, MD Assistant Professor Division of Head and Neck Surgical Oncology & Reconstruction Department of Otolaryngology and Communication Sciences Medical College of Wisconsin
I am a faculty member in the Department of Otolaryngology with a focus on both ablative head and neck cancer surgery and microvascular reconstruction of head and neck defects. My research includes clinical outcomes for head and neck cancer patients regarding both oncologic control as well as functional and quality of life outcomes. I have an interest in both multi-institutional trials as well as large database research.
â&#x20AC;&#x153;State of the Art: Rehabilitation of Speech and Swallowing after Total Laryngectomyâ&#x20AC;? Zenga J, Goldsmith T, Bunting G, Deschler DG. Oral Oncology. 2018;86:38-47. Despite the development and expansion of non-surgical organ preservation therapy, total laryngectomy continues to be the optimal therapy for far-advanced local disease and the only curative option for radiotherapy failures not amenable to partial laryngeal procedures. Laryngectomy, however, remains a life-altering operation with profound effects on swallowing and speech. In the nearly 150 years since the first total laryngectomy was performed, few ablative aspects have changed, but reconstructive techniques have undergone radical evolution. This review will trace the origins of laryngeal rehabilitation for voice and swallowing, the current state of the art with attention to pre-treatment considerations and post-operative management, current surgical management techniques, and the future of functional laryngeal reconstruction.
Laryngectomy Diagram
Image Copyright: Atos Medical
“Exosomes Exert Cardioprotection in Dystrophin-Deficient Cardiomyocytes via ERK1/2-p38/MAPK Signaling” Gartz M, Darlington A, Afzal MZ, Strande JL. Scientific Reports. 2018;8(1):16519. Exosomes are secreted vesicles that contain molecular cargo, mediate intercellular communication and influence cellular phenotypes. Recently, our lab investigated the shortterm effects of exosomes in dystrophin-deficient (Dys) induced pluripotent stem cellderived cardiomyocytes (iCMs). Exosomes secreted from wild type (WT) or Dys-iCMs were found to protect Dys-iCMs from stress-induced injury and death by decreasing reactive oxygen species and maintaining mitochondrial membrane potential. Protection was dependent on the presence of exosomal surface proteins and activation of ERK1/2 and p38 MAPK. In summary, the acute effects of exosomes on recipient cells can be initiated from exosome membrane proteins and not necessarily their cargo.
Melanie Gartz, MS, MHS Graduate Student Department of Cell Biology, Neurobiology and Anatomy
Daniel J. Lee, BA Medical Student Class of 2019 Department of Ophthalmology
“The Henle Fiber Layer in Albinism: Comparison to Normal and Relationship to Outer Nuclear Layer Thickness and Foveal Cone Density” Lee DJ, Woertz EN, Visotcky A, et al. Investigative Ophthalmology & Visual Science. 2018;59(13):5336-5348. Directional optical coherence tomography (D-OCT) allows the visualization of the Henle fiber layer (HFL) in vivo. We used D-OCT to characterize the HFL and outer nuclear layer (ONL) in albinism and examine the relationship between foveal ONL and peak cone density. We found that foveal HFL thickness was thicker in albinism than in normal controls, whereas foveal ONL thickness was thinner in albinism than in normal controls. Foveal ONL thickness was positively correlated with peak cone density in subjects with albinism. Our data suggest that increased foveal cone packing drives the formation of Henle fibers, more so than the lateral displacement of inner retinal neurons.
“Cutaneous Squamous Cell Carcinoma With Sclerosing Features: An Uncommon and Potentially Aggressive Variant” Ronen S, Gru AA, Noland MM, Rowe DM, Wick MR. American Journal of Dermatopathology. 2018;40(8):575-579. Sclerosing squamous cell carcinoma (sSCC) is a rare subtype of cutaneous malignancy. This variant is clinically significant because it is associated with an increased risk of local recurrence and metastasis. We presented 16 examples of sSCC of the skin in 8 men and 3 women. The most common site of origin for this tumor is the skin of the head and neck. Microscopically, sSCCs are characterized by cellular cords, nests, and islands, as well as scattered single cells in filtrating densely desmoplastic and collagenized connective tissue. The differential diagnosis principally includes sclerosing basal cell carcinoma, microcystic adnexal carcinoma,and desmoplastic trichoepithelioma.
Shira Ronen, MD Anatomic & Clinical Pathology Residency, PGY-IV Department of Pathology
Lindsey N. Clark, MD General Surgery Resident Department of Surgery
“The Impact of Preoperative Anemia and Malnutrition on Outcomes in Paraesophageal Hernia Repair” Clark LN, Helm MC, Higgins R, et al. Surgical Endoscopy. 2018;32(11):4666-4672. Patients with a paraesophageal hernia may experience a variety of symptoms that can lead to anemia, weight loss, and subsequent malnutrition. Using the American College of Surgeons National Surgical Quality Improvement Program datasets we found that both anemia and malnutrition were associated with higher rates of complications, readmissions, reoperations, and mortality as well as a longer length of stay. Medical providers can use this information for risk assessment, patient counseling, and preoperative optimization of these risk factors when clinically appropriate.