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JBJS Webinar-Sept. 23: Opioid Use Challenges and Solutions

Amid the current backdrop of opioid misuse, overdose, and addiction, conducting robust studies to investigate management of musculoskeletal pain is uniquely challenging. Last November, a JBJS-convened symposium, supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, explored those challenges. From that meeting came a 12-article JBJS Supplement published in May 2020.

On Wednesday, September 23, 2020 at 8 PM EDT, a one-hour live JBJS webinar will focus on 2 of the most salient solutions arising from the symposium.

Jeffrey Katz, MD, MSc will examine how to overcome study-design challenges such as quantifying opioid use, confounding by indication, and distinguishing between nationwide “secular changes” in opioid prescribing and the true effects from studied interventions.

Seoyoung Kim, MD, ScD, MSCE will emphasize that careful attention to methods is crucial when designing and conducting observational studies based on claims databases and patient registries. Widely accepted definitions of many common terms, such as “persistent opioid use,” do not exist.

Moderated by James Heckman, MD, Editor Emeritus of JBJS, the webinar will feature additional expert commentaries on the two author-led presentations. Andrew Schoenfeld, MD will weigh in on Dr. Katz’s paper and Nicholas Bedard, MD will comment on Dr. Kim’s paper.

The webinar will conclude with a 15-minute live Q&A session during which attendees can ask questions of all the panelists.

Seats are limited–so Register Today!

Thieme to Market JBJS Clinical Classroom in South Asia

The Journal of Bone and Joint Surgery, Inc. and Thieme Medical and Scientific Publishers have joined forces in a 5-year agreement that grants Thieme exclusive rights to market and license JBJS Clinical Classroom on NEJM Knowledge+ in South Asia, including India, Pakistan, Bangladesh, Sri Lanka, and Nepal. JBJS Clinical Classroom is an adaptive system for orthopaedic learning that individualizes learners’ experiences as their knowledge, skill, and confidence develops.

Throughout the Indian subcontinent, Thieme representatives will demonstrate and promote the many unique features of JBJS Clinical Classroom to orthopaedic residency programs, hospitals, medical schools, and pharmaceutical companies. Those features include:

  • Regularly updated, evidence-based content that is peer-reviewed by subspecialty content experts and approved by Clinical Classroom Editor Christopher Chiodo, MD
  • Custom algorithms that direct learners away from subjects in which they are proficient and toward weaker areas until all content is mastered
  • An automated “recharge” function to help learners retain previously learned content and to relearn things they may have forgotten

Thieme is an award-winning international medical and science publisher serving health professionals and students for more than 125 years. A similarly venerable organization, The Journal of Bone and Joint Surgery, Inc. is the publisher of JBJS, the most valued source of information for orthopaedic surgeons and researchers for over 125 years and the gold standard in peer-reviewed scientific information in the field.

Click here for more information about JBJS Clinical Classroom.

For more information about the JBJS-Thieme alliance, please contact Betsy Bellar at bbellar@jbjs.org.

Opioid Use Challenges and Solutions: JBJS Webinar-Sept. 23

Amid the current backdrop of opioid misuse, overdose, and addiction, conducting robust studies to investigate management of musculoskeletal pain is uniquely challenging. Last November, a JBJS-convened symposium, supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, explored those challenges, and from that meeting came a 12-article JBJS Supplement published in May 2020.

On Wednesday, September 23, 2020 at 8 PM EDT, a one-hour live JBJS webinar will focus on 2 of the most salient solutions arising from the symposium.

Jeffrey Katz, MD, MSc will examine how to overcome study-design challenges such as quantifying opioid use, confounding by indication, and distinguishing between nationwide “secular changes” in opioid prescribing and the true effects from studied interventions.

Seoyoung Kim, MD, ScD, MSCE will emphasize that careful attention to methods is crucial when designing and conducting observational studies based on claims databases and patient registries, because widely accepted definitions of many common terms, such as “persistent opioid use,” do not exist.

Moderated by James Heckman, MD, Editor Emeritus of JBJS, the webinar will feature additional expert commentaries on the two author-led presentations. Andrew Schoenfeld, MD will weigh in on Dr. Katz’s paper and Nicholas Bedard, MD will comment on Dr. Kim’s paper.

The webinar will conclude with a 15-minute live Q&A session during which attendees can ask questions of all the panelists.

Seats are limited–so Register Today!

Pledge from JBJS Regarding Race-Based Inequalities

The JBJS Board of Trustees published a statement today that addresses the global COVID pandemic and the worldwide demonstrations against systematic racism. As an organization, JBJS has pledged to take the following actions to promote racial equality in health care and in other aspects of human affairs that we influence:

  • In addition to the >100 articles already published in JBJS that explore health care disparities, The Journal will now prioritize manuscripts that delineate solutions to these widespread inequities.
  • JBJS will continue to support initiatives that increase minority representation in orthopaedic surgery programs throughout the US—including minority members of academic faculties. We will also publish data on the results of those efforts.
  • JBJS will look inward to promote greater diversity within our own organization.

We hope the readers of JBJS and OrthoBuzz are also taking action in their homes, workplaces, and communities to ensure that all people are treated fairly and equally.

High-Level Clinical Research in Developing Countries? Yes!

Generally speaking, orthopaedic surgeons in low-resourced environments deliver the best care for their patients with skill, creativity, and passion. These surgeons are accustomed to scrambling for implants and other tools and to working around limited access to operating theaters and anesthesia services. Their everyday struggles usually leave little energy or time to even think about clinical research.

However, in the May 20, 2020 issue of The Journal, Haonga and colleagues prove that, with a “little help from their friends,” it is possible to conduct Level I research while treating patients in a resource-limited setting. They enrolled and followed 221 patients with open tibial fractures (mostly males in their 30s injured in a road-traffic collision) and randomized them to treatment with either uniplanar external fixation or intramedullary (IM) nailing. The nails were supplied by SIGN Fracture Care International, a not-for-profit humanitarian organization that provides specially designed IM nails that can be used without image intensification to hospitals in developing countries around the world. (See related OrthoBuzz post.)

The research was done in Dar es Salaam, Tanzania, in collaboration with trauma surgeons and epidemiologists from the University of California San Francisco, which has a long-standing relationship with Tanzania’s Muhimbili National Hospital. At the 1-year follow-up, there were no significant between-group differences in primary-outcome events—death or reoperation due to deep infection, nonunion, or malalignment. IM nailing was associated with a lower risk of coronal or sagittal malalignment, and quality-of-life (QoL) scores favored IM nailing at 6 weeks, but QoL differences dissipated by 1 year.

Just as important as the clinical findings, these investigators proved that it is possible to do high-level research in centers with high patient volume and limited resources. Future patients will benefit because the clinicians now have better information to share regarding expectations for functional recovery and risk of infection. Physicians and other healthcare professionals benefit because data like this help improve their analytical skills and become more discerning appraisers of the published literature. With strong internal physician leadership and a little outside support, Haonga et al. have convinced us that prospective—and even randomized—research is possible in these special places.

Finally, SIGN deserves our support as a true champion of orthopaedic surgeons working in under-resourced environments. In addition to providing education and implants, SIGN surgeons are required to report their cases through the SIGN Surgical Database—which encourages the research mindset and helps SIGN surgeons improve tools and techniques for better patient outcomes.

Marc Swiontkowski, MD
JBJS Editor-in-Chief

Virtual-Meeting Best Practices from OrthoEvidence

In addition to medical appointments between physicians and patients, many medical meetings and conferences have moved to online platforms due to the COVID-19 pandemic. That prompted the OrthoEvidence team, led by renowned orthopaedic surgeon and researcher Mohit Bhandari, MD, to publish a 32-page, downloadable resource titled “Best Practice Recommendations for Virtual Meetings.”

The document—developed from extensive reviews of the literature and private and public-sector documents, consultation with experts, and stakeholder surveys—is designed to help guide healthcare and academic groups as well as policymakers and funders.

The guidelines are organized into 5 sections:

  • Preplanning Considerations
  • Planning
  • Accomplishing goals
  • Response
  • Engaging the audience for future activities

A virtual-meeting planning checklist, a helpful table of virtual-meeting platform vendors, and many other practical resources are included in the document’s 6 Appendices.

Platooning Orthopaedic Residents Amid COVID-19

Under the best of circumstances, an orthopaedic residency requires trainees and trainers to balance clinical work, surgical skills, didactics, and academic investigations. The global COVID-19 crisis is certainly not the best of circumstances. A fast-track article just published in JBJS explains how the urban, high-volume orthopaedic department at Emory University School of Medicine in Atlanta created a two-team system that helps residents keep learning, helps maintain a healthy workforce, and addresses the needs of orthopedic patients amid this unprecedented situation.

Emory is now dividing its orthopaedic residents into “active duty” and “working remotely” teams. In observation of the presumed incubation period of COVID-19 symptoms, transitions between active and remote activities occur every two weeks. A similar “platooning” system is in place for both faculty and administrators to safeguard a healthy network of leaders and command-and-control decision makers.

Active duty residents participate in in-person surgical encounters and virtual ambulatory encounters. Orthopaedic surgical cases deemed essential present an ideal opportunity for active-duty education, the authors observe, and there is also a role for supplementation of surgical education in the form of virtual reality or simulation training. Faculty members cover their in-person clinics without resident assistance when possible, but most musculoskeletal subspecialty visits can be performed with video-enabled telemedicine, and active-duty residents are part of these virtual clinic visits in real time.

Remotely working residents participate by videoconference in daily faculty-led, case-based didactics. The authors recommend virtually conducted one-and-a-half-hour collaborative, interactive learning sessions on predetermined schedules and topics. Each session includes question-based learning, facilitated with the use of an audience-response system. Remotely working residents also study for their boards and work on clinical research projects, grant writing, and quality improvement projects.

Finally, this team system, championed by strong departmental leadership, allows for isolation of any resident who acquires COVID-19, allowing them time to recover, while diminishing the risk of rapid, residency-wide disease transmission.

Rotator Cuff Conundrums: JBJS Webinar-Feb. 24

Rotator cuff tears account for an estimated 4.5 million patient visits per year in the US, which translates into a $3 to $5 billion annual economic burden. Add to that the pain and disability associated with rotator cuff tears, and it’s understandable that many clinical questions arise regarding how best to help patients manage this common condition.

On February 24, 2020 at 8 pm EST, JBJS will host a complimentary 60-minute webinar focused on 2 frequently encountered rotator cuff dilemmas: surgical versus nonsurgical management, and surgical alternatives for irreparable cuff tears that don’t involve joint replacement.

Bruce S. Miller, MD, MS unpacks the findings from his team’s matched-pair analysis in JBJS, which revealed that patients receiving both surgical and nonsurgical management of full-thickness tears experienced pain and functional improvements—but that surgical repair was the “better of two goods.”

Some patients who opt for nonoperative management end up with a chronic, irreparable rotator cuff tear. Teruhisa Mihata, MD, PhD will present findings from his team’s JBJS study, which showed that, after 5 years, healed arthroscopic superior capsule reconstruction in such patients restored function and resulted in high rates of return to recreational sport and work.

Moderated by Andrew Green, MD of Brown University’s Warren Alpert Medical School, the webinar will feature additional expert commentaries. Grant L. Jones, MD will comment on Dr. Miller’s paper, and Robert Tashjian, MD will weigh in on Dr. Mihata’s paper.

The webinar will conclude with a 15-minute live Q&A session during which attendees can ask questions of all the panelists.

Seats are limited, so Register Today!

JBJS Webinar on Feb. 24: Rotator Cuff Conundrums

Rotator cuff tears account for an estimated 4.5 million patient visits per year in the US, which translates into a $3 to $5 billion annual economic burden. Add to that the pain and disability associated with rotator cuff tears, and it’s understandable that many clinical questions arise regarding how best to help patients manage this common condition.

On February 24, 2020 at 8 pm EST, JBJS will host a complimentary 60-minute webinar focused on 2 frequently encountered rotator cuff dilemmas: surgical versus nonsurgical management, and surgical alternatives for irreparable cuff tears that don’t involve joint replacement.

Bruce S. Miller, MD, MS unpacks the findings from his team’s matched-pair analysis in JBJS, which revealed that patients receiving both surgical and nonsurgical management of full-thickness tears experienced pain and functional improvements—but that surgical repair was the “better of two goods.”

Some patients who opt for nonoperative management end up with a chronic, irreparable rotator cuff tear. Teruhisa Mihata, MD, PhD will present findings from his team’s JBJS study, which showed that, after 5 years, healed arthroscopic superior capsule reconstruction in such patients restored function and resulted in high rates of return to recreational sport and work.

Moderated by Andrew Green, MD of Brown University’s Warren Alpert Medical School, the webinar will feature additional expert commentaries. Grant L. Jones, MD will comment on Dr. Miller’s paper, and Robert Tashjian, MD will weigh in on Dr. Mihata’s paper.

The webinar will conclude with a 15-minute live Q&A session during which attendees can ask questions of all the panelists.

Seats are limited, so Register Today!

The Evolution of Orthopaedic Surgical Skills Simulation

Surgical skills education in orthopaedics has changed dramatically from the “see one, do one, teach one” process of 30 years ago. These changes have come with a greater degree of supervision and formal skills assessments, and they have been aided by the visionary leadership at the Accreditation Council for Graduate Medical Education (ACGME) and our own orthopaedic Residency Review Committee. These skill-acquisition enhancements have benefited both our trainees and the patients we collectively care for.

A decade ago, we entered a new phase of skill development and enhancement with computer-based surgical simulators. With advances in software and widespread interest across North America in goal-driven learning through simulation, great progress has been made. In the November 20, 2019 issue of JBJS, Weber et al. report on the further validation of a surgical simulator focused specifically on percutaneous, fluoroscopically guided pin placement for femoral neck fractures. The simulator was developed in partnership between the AAOS and OTA.

This study sought to determine whether novice practitioners (medical students, in this case) who completed 9 training modules before using the simulator (the “trained” group) would perform the simulated pinning task better than peers who did not complete the presimulation training (the “untrained” group). It was no surprise to me that the trained group had a significantly higher overall performance score on the simulator. In addition, relative to the untrained group, the trained students also showed improved performance on 4 specific measures—3 of which were related to the angle between the placed pins.

These findings are clearly supportive of continued development of this and additional simulation environments. But at the same time, we need to move forward with improved documentation of surgical skill acquisition among orthopaedic residents and fellows. As simulator technology continues to improve, the next decade should yield even more positive results in skills acquisition than we saw in the last decade. We are clearly on the right path with the use of advanced technology for surgical skill development among orthopaedic trainees.

Marc Swiontkowski, MD
JBJS Editor-in-Chief