Publications from Dr. Dy
Evaluation of the patient experience following brachial plexus injuries
The complexity and heterogeneity of brachial plexus injuries (BPI) create a challenge when reporting clinical outcomes of treatment. In the systematic review, we demonstrated that the vast majority of papers reporting outcomes after BPI do not include patient-centered outcomes measures. To help address this deficit, I worked with Dr. Carol Mancuso (an expert in qualitative research and design of clinical measurement tools) to conduct in-depth semi-structured interviews with patients who had BPI. This provided an improved understanding of the expectations of treatment that are held by patients, as well as important insight into how to best frame patient-reported outcomes after BPI. More recently, we conducted a thematic analysis of online discussion boards to ascertain what types of information patients are seeking regarding BPI on the internet. This will guide the development of patient education materials for BPI. Lastly, I led a pair of administrative data studies that demonstrated (1) the suboptimal delivery of care for BPI patients, as approximately one-third of BPI patients undergo surgery beyond the recommended time window and (2) the frequency of depression and anxiety in patients with brachial plexus injuries.
- Dy CJ, Garg R, Lee SK, Tow P, Mancuso CA, et al. A systematic review of outcomes reporting for brachial plexus reconstruction. J Hand Surg Am. 2015 Feb;40(2):308-13. PubMed PMID: 25510158.
- Mancuso CA, Lee SK, Dy CJ, Landers ZA, Model Z, Wolfe SW. Expectations and limitations due to brachial plexus injury: a qualitative study. Hand (N Y). 2015 Dec;10(4):741-9. doi: 10.1007/s11552-015-9761-z. Epub 2015 May 1. PubMed PMID: 26568734; PubMed Central PMCID: PMC4641103.
- Mancuso CA, Lee SK, Dy CJ, Landers ZA, Model Z, Wolfe SW. Compensation by the Uninjured Arm after Brachial Plexus Injury. Hand (N Y). 2016 Oct; 11(4): 410-415. PMID: 28149206.
- Mancuso CA, Lee SK, Saltzman EB, Model Z, Landers ZA, Dy CJ, Wolfe SW. Development of a questionnaire to measure impact and outcomes of brachial plexus injury. J Bone Joint Surg Am, in press.
- Morris M, Daluiski A, Dy CJ. A Thematic Analysis of Online Discussion Boards for Brachial Plexus Injury. J Hand Surg Am. Aug 2016; 41(8):813-818. PMID: 27311862
- Dy CJ, Baty J, Saeed MJ, Olsen MA, Osei DA. A Population-Based Analysis of Time to Surgery and Travel Distances for Brachial Plexus Surgery. J Hand Surg Am. 2016 Sep;41(9):903-909.e3. PMID: 27570225
- Yannascoli S, Stwalley D, Saeed MJ, Olsen MA, Dy CJ. A Population-based Assessment of Depression and Anxiety in Patients Undergoing Surgery of Brachial Plexus Injuries. Submitted to Journal of Hand Surgery on 08/10/17 (under review). Presented at the American Society for Surgery of the Hand’s Annual Meeting 9/6/17.
Socioeconomic disparities in the delivery of orthopaedic surgery care
Increasing attention has been drawn the presence of disparities in the delivery of healthcare and, specifically, in orthopaedic surgery care. In this series of papers, we used administrative data to investigate whether socioeconomic disparities exist in delivery of care for both traumatic and elective orthopaedic conditions. There are race- and insurance-based disparities in outcomes for fractures in both pediatric and elderly patients. There are similar disparities following total hip and knee arthroplasty, with patients from lower socioeconomic backgrounds more likely to undergo early revision surgery. To further investigate potential surgeon bias in indications for surgery, we conducted a video-based survey using case vignettes. This demonstrated that orthopaedic surgeons were not biased against performing total joint arthroplasty in black or female patients, provided that the clinical criteria were clearly in favor of surgery.
- Dy CJ, Lane JM, Pan TJ, Parks ML, Lyman S. Racial and Socioeconomic Disparities in Hip Fracture Care. J Bone Joint Surg (Am). 2016 May 18;98(10):858-65. PMID: 27194496
- Dy CJ, Lyman S, Do HT, Fabricant PD, Marx RG, et al. Socioeconomic factors are associated with frequency of repeat emergency department visits for pediatric closed fractures. J Pediatr Orthop. 2014 Jul-Aug;34(5):548-51. PubMed PMID: 24590328; PubMed Central PMCID: PMC4051828.
- Dy CJ, Marx RG, Bozic KJ, Pan TJ, Padgett DE, et al. Risk factors for revision within 10 years of total knee arthroplasty. Clin Orthop Relat Res. 2014 Apr;472(4):1198-207. PubMed PMID: 24347046; PubMed Central PMCID: PMC3940740.
- Dy CJ, Lyman S, Boutin-Foster C, Felix K, Kang Y, et al. Do patient race and sex change surgeon recommendations for TKA?. Clin Orthop Relat Res. 2015 Feb;473(2):410-7. PubMed PMID: 25337976; PubMed Central PMCID: PMC4294909.
Regionalization of orthopaedic surgery care
The transition of American healthcare from “volume to value” has prompted calls for regionalization of orthopaedic care to specialized centers of excellence. In doing so, access to high quality orthopaedic care may not be readily available to all patients, particularly those from lower socioeconomic standing. In this series of papers, we leveraged the strengths of administrative databases to evaluate whether regionalization of care (and associated patient travel) would have undesired consequences. We demonstrated that traveling for care to a regional center of excellence is safe, but patients from lower socioeconomic standing were more likely to utilize hospitals with lower procedure volumes for total joint arthroplasty. These patients were at increased risk for postoperative complications.
- Dy CJ, Marx RG, Ghomrawi HM, Pan TJ, Westrich GH, et al. The potential influence of regionalization strategies on delivery of care for elective total joint arthroplasty. J Arthroplasty. 2015 Jan;30(1):1-6. PubMed PMID: 25282073.
- Dy CJ, Bozic KJ, Padgett DE, Pan TJ, Marx RG, et al. Is changing hospitals for revision total joint arthroplasty associated with more complications?. Clin Orthop Relat Res. 2014 Jul;472(7):2006-15. PubMed PMID: 24615420; PubMed Central PMCID: PMC4048404.
- Nwachukwu BU, Dy CJ, Burket JC, Padgett DE, Lyman S. Risk for Complication after Total Joint Arthroplasty at a Center of Excellence: The Impact of Patient Travel Distance. J Arthroplasty. 2015 Jan 19;PubMed PMID: 25639857.
Publications from Dr. Brogan
Brachial Plexus and peripheral nerve injuries comprise a complex constellation of diagnoses and pathologies. However, understanding the etiology of this difficult problem, as well as effective treatment options can help to restore function and relieve pain. Our clinical reviews help to direct the translational research in the lab.
- Brogan DM, Carofino BC, Kircher MF, Spinner RJ, Elhassan BT, Bishop AT, Shin AY. “Prevalence of Rotator Cuff Tears in Adults with Traumatic Brachial Plexus Injuries” Journal of Bone and Joint Surgery 2014 96(16):e139.
- Carofino B, Brogan D, Kircher M, El Hassan B, Spinner R, Bishop A, Shin A. “Iatrogenic Nerve Injuries During Shoulder Surgery” Journal of Bone and Joint Surgery 95(18):1667-74, 2013.
- Brogan D, Kakar S. “Management of Neuromas of the Upper Extremity” Hand Clinics 29(3):409-420, 2013.
- Brogan D, Bishop AT, Shin AY, Spinner RJ. “Lateral Antebrachial Cutaneous Neuropathy Following Long Head of the Biceps Rupture” Journal of Hand Surgery 37(4):673-6, 2012.
Ulnar sided wrist pain has been referred to as the black box of the wrist. Injuries of the triangular fibrocartilage complex can be a source of persistent pain, and at times instability of the DRUJ. We have conducted several biomechanical studies to evaluate the effectiveness of new repair techniques in restoring stability of the DRUJ.
- Johnson J, Pfeiffer F, Jouret J, Brogan D. “Biomechanical Analysis of Capsular Repair versus Arthrex TFCC Ulnar Tunnel Repair for Triangular Fibrocartilage Complex Tears” Hand, In press
- Brogan D, Kakar S. “Ulnar Sided Wrist Pain” JBJS Reviews, Submitted
The marketplace does a poor job of stimulating development of antibiotics and neglected vaccines as these often provide insufficient profit to justify the necessary expenses to bring a promising compound through the pre-clinical and clinical development phase. Estimates of the cost of new drug development are well over $1 billion. Therefore, new mechanisms are necessary to stimulate antibiotic development by both small and large corporations. As a graduate student I developed the concept of a funding mechanism modeled after financial call options, in which public payers or private philanthropists could help to stimulate new drug development by purchasing options on the drug itself. This method has since been included in a report to the Swedish government during its Presidency of the European Union as well as a report to the British government to inform a working panel on antibiotic resistance. Multiple manuscripts have been published detailing it, including a model of the potential savings such a scheme could produce. I continue to be active in this academic arena, even as a surgeon, as I believe that antibiotic resistance will play an increasingly large role in the health and outcomes of my own patients.
- Brogan DM, Mossialos E. “A critical analysis of the review on antimicrobial resistance report and the infectious disease financing facility.” Global Health 12,8 (2016)
- Renwick MJ, Brogan DM, Mossialos E. A systematic review and critical assessment of incentive strategies for discovery and development of novel antibiotics. J Antibiot (Tokyo). 2015 Oct 14. doi: 10.1038/ja.2015.98. [Epub ahead of print] Review. PubMed PMID: 26464014.
- Brogan DM, Mossialos E. Incentives for new antibiotics: the Options Market for Antibiotics (OMA) model. Global Health. 2013 Nov 7;9:58. doi: 10.1186/1744-8603-9-58. PubMed PMID: 24199835; PubMed Central PMCID: PMC4226193.
- Brogan D, Mossialos E. Applying the concepts of financial options to stimulate vaccine development. Nat Rev Drug Discov. 2006 Aug;5(8):641-7. Epub 2006 Jul 14. PubMed PMID: 16883302.
- Mossialos E, Morel, Edwards, Berenson, Gemmill-Toyama, Brogan (2010). Policies and incentives for promoting innovation in antibiotic research, European Observatory on Health Systems and Policies.