Hi everyone,

So as I said last week, I have been having trouble going through patient charts, and finding all the information I need to gather. The problem was that I was given certain laboratory results, co-morbidities, hospital complications, and medications to find, but sometimes I couldn’t find them. For example, there are about 8 different laboratory tests I was told to look for, and I was told I wouldn't find every single test result for each patient because doctors usually don't have to order that many laboratory tests to make a diagnosis. But, for some patients I will be able to find four or five tests and others I wont be able to find a single one. I thought I wasn’t able to find any laboratory tests because I wasn’t looking in the right places. So I would keep searching, but with no luck. It turns out, there are patients that don’t need any laboratory test done to diagnose an infection. 

This week I had help from an orthopedic physician assistant, Neil, who also does research with the MORE Foundation. He showed me how he goes through the charts and all the different places you can look for certain information. Initially, I was only looking at the documents labeled laboratory test for the results, but sometimes doctors put the test values in hospital consults. He also told me some patients won’t have laboratory tests done and to explain why he shared a link with me. To summarize, the link explained that there is no single set of diagnostic criteria for a periprosthetic joint infection (PJI), but MSIS (Musculoskeletal Infection Society) proposed that a PJI exists when:

1) There is a sinus tract communicating with the prosthesis; or
2) A pathogen is isolated by culture from at least two separate tissue or fluid samples obtained from the affected prosthetic joint; or
3) Four of the following six criteria exist:

a) Elevated serum erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) concentration,

b) Elevated synovial leukocyte count,

c) Elevated synovial neutrophil percentage (PMN%),

d) Presence of purulence in the affected joint,

e) Isolation of a microorganism in one culture of periprosthetic tissue or fluid, or

f) Greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at ×400 magnification.

This link was helpful because now I can understand what a doctor is thinking when looking at a possible infected knee. For example, in the case that their is a sinus tract communicating with a prosthesis, then no laboratory tests was needed to be ordered, which means I probably won’t find any. 

Now that Neil helped understand the charts a bit better, I’ll be starting back at patient one to make sure I didn’t leave out any important information form when I initially reviewed the charts. 

Thats all I have for today, thanks for sticking around, and see you next week!

Hello everyone!

This week I was finally able to start working on my project. I was given 300 patients who have been diagnosed with an infection, and my job is to go through all of their charts. First, I am looking for co-morbidities that may have increased their chance of getting an infection, for example research shows that kidney disease increases a patient’s chance of getting an infection. But their is a lot of disagreement among researchers about which co-morbidities truly increase a patients chance of infection. For example, some doctors believe obesity is a co-morbidity while other doctors do not. I will be looking at the 300 patients that I received, and document any information that could be a co-morbidity for infection. Once doctors agree upon a list of co-morbidities, they will be able to inform their patients of their individual risk of getting an infection before getting surgery. This way a patient has a better understanding of their risk. The incidence of infection is between one to two percent, but if a patient has kidney disease, than their chance of infection is obviously going to be slightly higher. 

I will also be looking at complications the patients had after surgery, such as stiffness, pain, or wound drainage. From the patient charts that I have through so far it seems like a sudden increase of pain, wound drainage, and purulence are a few of the key indications of infection. 

The last thing I will be looking for are the lab results for each patient. The three main tests doctors will usually order when there are indications of infection are a white blood cell count, a erythrocyte sedimentation rate (ESR), and a C-reactive protein test (CRP).

Next week, I hope to be able to share some of the co-morbidities, complications, and lab result values that would be found with an infection. 

Until then,

Komal Majhail

Hey everyone, and welcome back to my blog! 

So I started my internship this week with the MORE Foundation, but, unfortunately I do not have a lot to say about my project this week. The MORE Foundation hasn’t started working on the project quite yet. They are still at the process of recruiting patients for the study. 

Since the MORE Foundation is constantly working on studies, I was able to help out with other studies until they started the one I will be sharing with you guys on my blog. While I was at my internship site, I went through patient charts looking for specific information that would be useful for the study, which is similar work to what I will be doing to help out for my project. But, I have to admit, it was much more difficult than I thought it would be. It is very tedious work. To hopefully speed up the process, I am also going to learning a lot more of the terminology than what I already have learned. This will allow me to comprehend the patient charts better and make myself more useful for the MORE Foundation. 

Since I don’t have much to say about the project, I figured I could tell you guys about the significance of the project. As a reminder, my project is developing a webpage that will calculate the chance a patient has an infection in their knee after a total knee arthroplasty (TKA) was performed on them. The key to treating a TKA infection is early diagnosis. Early diagnosis allows for a relatively straightforward treatment. Since inexperienced surgeons can sometimes have difficulty diagnosing a TKA infection due to mixed signals in a physical examination and in laboratory tests, the lack of conclusive evidence often leads to a delay in treatment. If the infection is present, the delay in treatment allows for the infection to grow, leading to a much more invasive and complicated infections. This causes multiple surgeries, rather than early detection and rapid aggressive treatment. Even if an infection is left untreated for a few weeks, the bacteria will adhere to the metal of the implant and form a biofilm. Once this biofilm has formed, the only good treatment option is the removal the implant, insertion of antibiotic materials into the joint area, and then after many weeks, insert a new implant. This requires at least two additional surgeries from the primary replacement surgery imposing heavy and emotional tolls on the patient. Because diagnosing an infected knee replacement is so difficult for inexperienced surgeons, the development of an algorithm to help detect TKA infections early on will lower the chances of patients having to deal with expensive follow-up surgeries.

Well thats about all I have for you guys today. See you next Friday!