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Unmasked: Predatory Publishers in Orthopaedics

It’s been more than a year since OrthoBuzz revisited the topic of predatory publishing (see related OrthoBuzz articles), but the comprehensive “Orthopaedic Forum” about this unsavory subject in the November 7, 2018 issue of JBJS warrants our attention.

In a meticulous investigation focused just on orthopaedic literature, Yan et al. found 104 suspected predatory publishers, representing 225 possible predatory journals. That’s nearly 3 times as many bogus publications as the 82 legitimate orthopaedic journals that the authors also identified. Somewhat disturbingly, 20 of the presumably predatory journals were also found to be indexed in PubMed.

The median article processing charge (APC) among predatory journals was $420, compared with $2,900 for legitimate journals. (Lower APCs tend to lure more researchers—especially younger ones—into the scams.) The most prevalent countries of origin of the predatory journals were India, the US, and the UK, while most of the authors publishing in predatory journals were from India, the US, the UK, and Japan. Predatory publishers are clearly taking advantage of the widespread pressure on researchers to publish as an avenue for career advancement.

The authors reiterate previously cited “red flags” that can tip off researchers to possibly predatory journals:

    • Very low article processing fees
    • Spelling and grammatical errors on the journal’s website
    • Overly broad scope
    • Language that targets authors more than readers
    • Promises of rapid publication
    • Dearth of information about copyright, retraction policies, or digital preservation

Yan et al. conclude that “ the scientific community needs to increase awareness of how to identify and avoid predatory journals. This is especially important for junior researchers…”

If you want more information about specific predatory journals, see Table II of the article (“List of Suspected Predatory Journals in the Field of Orthopaedics”), which includes the criteria that prompted the authors to categorize them as predatory.

Jason Miller, JBJS Executive Publisher
Lloyd Resnick, JBJS Developmental Editor

Residents in the OR—What’s the Risk?

Orthopaedic educators have long confronted the subtle implication that resident participation in surgical care can contribute to patient harm or even death. While there have been numerous changes in residency education to improve the  supervision and training of residents, the reality is that surgical trainees have to learn how to operate. This fact can leave surgical patients understandably nervous, and many of them heave heard rumors of a “July effect”—a hypothetical increase in surgery-related complications attributed to resident education at the beginning of an academic year. To provide further clarity on this quandary, in the November 21, 2018 issue of The Journal, Casp et alexamine the relationship between complication rates after lower-extremity trauma surgery (for hip fractures, predominantly), the participation and seniority of residents, and when during the academic year the surgery occurred.

The authors used the NSQIP surgical database to examine >1,800 patient outcomes after lower-extremity surgery according to academic-year quarter and the postgraduate year of the most senior resident involved in the case. The analysis revealed two major findings:

  1. Overall, there was no “July effect” at the beginning of the academic year in terms of composite complication rates.
  2. Cases involving more senior residents were associated with an increased risk of superficial surgical site infection during the first academic quarter.

While the authors were unable to provide a precise reason for the second finding, they hypothesized that it could have been related to more stringent data collection early in the academic year, senior-resident inexperience with newly increased responsibilities, or the warm-temperature time of year in which the infections occurred. Casp et al. emphasize that the database used in the study was not robust in terms of documenting case details such as complexity and the degree of resident autonomy, which makes cause-and-effect conclusions impossible to pinpoint.

Although this large database study does not answer granular questions regarding the appropriate role of residents in orthopaedic surgery, it should stimulate further research in this area. Gradually increasing responsibility is necessary within residency programs so that residents develop the skills and decision-making prowess necessary for them to succeed as attending surgeons. Studies like this help guide future research into the important topic of graduate medical education, and they provide patients with some reassurance that the surgical care they receive is not affected by the time during the academic-calendar year in which they receive it.

Marc Swiontkowski, MD
JBJS Editor-in-Chief

Webinar–Diversity in Orthopaedics: Taking Action to Drive Change

November webinar speakers updated (002)

On Wednesday, November 14, 2018 at 8:00 PM EST, the American Orthopaedic Association (AOA) and The Journal of Bone & Joint Surgery (JBJS) will co-host a one-hour complimentary webinar that offers practical advice on how to achieve greater diversity in your orthopaedic workforce. The guidance comes from five orthopaedists with an impressive track record of success in meeting this challenge head-on:

  • Regis O’Keefe, MD, PhD, FAOA
  • Mary O’Connor, MD, FAOA
  • Julie Samora, MD, PhD, MPH
  • Kristy Weber, MD, FAOA
  • Lisa Lattanza, MD, FAOA

Recognizing the lack of diversity in the profession of orthopaedics as a critical issue, this webinar is one of many AOA initiatives supporting increased diversity within the profession.

Seats are limited, so REGISTER NOW.

Nov. 14 Webinar – Diversity in Orthopaedics: Taking Action to Drive Change

November webinar speakers updated (002)

On Wednesday, November 14, 2018 at 8:00 PM EST, the American Orthopaedic Association (AOA) and The Journal of Bone & Joint Surgery (JBJS) will co-host a one-hour complimentary webinar that offers practical advice on how to achieve greater diversity in your orthopaedic workforce. The guidance comes from five orthopaedists with an impressive track record of success in meeting this challenge head-on:

  • Regis O’Keefe, MD, PhD, FAOA
  • Mary O’Connor, MD, FAOA
  • Julie Samora, MD, PhD, MPH
  • Kristy Weber, MD, FAOA
  • Lisa Lattanza, MD, FAOA

Recognizing the lack of diversity in the profession of orthopaedics as a critical issue, this webinar is one of many AOA initiatives supporting increased diversity within the profession.

Seats are limited, so REGISTER NOW.

Diversity in Orthopaedics: Taking Action to Drive Change – Nov. 14 Webinar

November webinar speakers updated (002)On Wednesday, November 14, 2018 at 8:00 PM EST,the American Orthopaedic Association (AOA) and The Journal of Bone & Joint Surgery (JBJS) will co-host a one-hour complimentary webinar that offers practical advice on how to achieve greater diversity in your orthopaedic workforce. The guidance comes from five orthopaedists with an impressive track record of success in meeting this challenge head-on:

  • Regis O’Keefe, MD, PhD, FAOA
  • Mary O’Connor, MD, FAOA
  • Julie Samora, MD, PhD, MPH
  • Kristy Weber, MD, FAOA
  • Lisa Lattanza, MD, FAOA

For a very personal take on diversity in orthopaedics, read the “What’s Important” article by Joseph Zuckerman, MD from the August 1, 2018 issue of JBJS.

Seats are limited, so REGISTER NOW.

Nov. 14 Webinar – Diversity in Orthopaedics: Taking Action to Drive Change

November Webinar Presenters

In many areas of the US, the orthopaedic workforce does not mirror the patient population being treated. The need for workforce diversity is more than a social concern or a “good-business” practice. Diversity, or the lack of it, directly affects the quality of patient care as well as access to care.

On Wednesday, November 14, 2018 at 8:00 PM EST,the American Orthopaedic Association (AOA) and The Journal of Bone & Joint Surgery (JBJS) will co-host a one-hour complimentary webinar that offers practical advice on how to achieve greater diversity in your orthopaedic workforce. The guidance comes from four orthopaedists with an impressive track record of success in meeting this challenge head-on:

  • Regis O’Keefe, MD, PhD, FAOA
  • Mary O’Connor, MD, FAOA
  • Julie Samora, MD, PhD, MPH
  • Kristy Weber, MD, FAOA

Moderated by Lisa Lattanza, MD, Professor and Vice Chair of Diversity and Professionalism and Chief of Hand, Elbow, and Upper Extremity Surgery at UCSF, this webinar will conclude with a 15-minute Q&A session during which attendees can ask questions of the panelists.

Seats are limited, so REGISTER NOW.

Journal Club Grant Brings Bhandari to UChicago

Bhandari Head ShotEditor’s Note: The Journal of Bone and Joint Surgery’s Robert Bucholz Resident Journal Club Grant provides selected orthopaedic surgery residency programs with funds that facilitate career-long skills in evaluating orthopaedic literature and its impact on clinical decision-making. The Journal is always interested in hearing how those funds have been used to enhance orthopaedic education. Here, Michael Perrone, MD describes how the University of Chicago’s Department of Orthopaedic Surgery and Rehabilitation Medicine used its grant this past academic year.

Our residency hosted Dr. Mohit Bhandari for two days. Dr. Bhandari is widely recognized as the world’s foremost authority in the translation of orthopaedic research into clinical practice. On the first day, he joined us for dinner at a local Chicago pizzeria, where we had a “Deep Dish-cussion” about several landmark articles within the orthopaedic literature. He provided his insights on the design, merits, and limitations of each paper, while also discussing each study’s clinical impact. Both residents and faculty alike found the discussion enlightening and educational.

The following morning, Dr. Bhandari delivered Grand Rounds to the entire department. His talk, “Fear Less, Do More,” gave us an inside look at the trials and tribulations of conducting large, multicenter studies and bringing them to publication. Throughout the talk, he encouraged residents and faculty to be ambitious in their pursuit of research and evidence-based practice.

There are few people with more experience or expertise within orthopaedic research than Dr. Bhandari, and his visit to our residency program was inspirational and enlightening. Such an experience would not have been possible without the generous support from JBJS.

Michael Perrone, MD
PGY-5
University of Chicago

New Frontiers in Journal Clubs

Journal Club for OBuzzDepending on which historical account you read, journal clubs have been a staple of medical education since around 1875.  Still ubiquitous within medical education today, journal clubs help educators and students alike stay current on medical literature, provide a vehicle for teaching how to critically appraise medical studies, and convene a forum in which respectful debate can occur among colleagues.  Journal clubs constitute a medical-education practice that almost no one questions, probably because they are so effective.

But that doesn’t mean journal clubs can’t be improved. As the September 30, 2018 deadline approaches to submit applications for the JBJS Robert Bucholz Journal Club Grant Program (click here for the application form), I encourage medical-education leaders to envision new ways in which journal clubs could further orthopaedic education. That might include various iterations of “virtual” journal clubs over the internet. For example, the Journal of Hand Surgery recently hosted a journal club on Twitter.  Another intriguing possibility would be to invite authors of journal articles with conflicting conclusions about the same research question to discuss their findings in a point/counterpoint format over teleconference. (Today’s teleconferencing platforms are not hard to set up, are relatively low-cost, and could broaden journal-club participation to anyone with a suitable device and a high-speed internet connection.)

The traditional face-to-face journal club provides many unique benefits, but creating new, innovative platforms for using departmental or grant-based journal-club funds could increase their impact and help ensure the sustainability of these educational programs. It will also be important for everyone to share their experiences with alternative journal-club formats. It behooves the orthopaedic community to continually envision how to integrate the journal-club component of medical education into new technologies as they evolve.

Chad A. Krueger, MD
JBJS Deputy Editor for Social Media

Sept. 11 Webinar – Assessment of Bone Health for the Orthopaedic Surgeon

Sept Webinar Speakers

Orthopaedic care teams can play an active role in evaluating and optimizing their patients’ bone health to help prevent primary and secondary fragility fractures and to improve postsurgical outcomes. In just about any orthopaedic scenario, helping patients optimize their bone health is an imperative for the delivery of quality care.

On Tuesday, September 11, 2018 at 8 pm EDTthe American Orthopaedic Association (AOA) and The Journal of Bone & Joint Surgery (JBJS) will host a complimentary one-hour webinar that will cover the basics of a bone-health assessment by orthopaedists.

  • Christopher Shuhart, MD will discuss the fundamentals of bone-related laboratory workups and bone densitometry studies.
  • Joe Lane, MD, FAOA will identify bone-health “red flags” in orthopaedic patients, including common nutritional deficiencies.
  • Paul Anderson, MD, FAOA will cover recent advances in bone-density measurements.

Moderated by Douglas Lundy, MD, MBA, FAOA, orthopaedic trauma surgeon at Resurgens Orthopaedics, this webinar will include a 15-minute live Q&A session during which attendees can ask questions of the panelists.

Seats are limited so REGISTER NOW.

Clinical Conversations: Beyond the Article

Article Title for OBuzz

Words are powerful. That is why it is so important for consumers of medical research to completely and thoughtfully read and evaluate the literature. Without a thorough understanding of methods, statistics, and clinical context, it is easy for a casual reader (e.g., one who scans abstracts) to make misguided conclusions based on an article’s findings—or even its title.

That concern is a large part of what Hensley et al. state in their September 21, 2017 eLetter in response to the Austin et al. study that appeared in the April 19, 2017 edition of JBJS. While many of the points made in the eLetter are valid, they itemize limitations that most readers should be able to identify during a careful reading of the article. Could the wording of the original article by Austin et al.—especially the title—have been adjusted? Sure, but all orthopaedic researchers want their results to be as impactful as possible, and they therefore will occasionally title their article to highlight the point they find most important. Sometimes (but not always) reviewers and/or editors will ask that certain phrasing be modified to avoid possible misinterpretation by readers.

The bottom line is that it is up to individual readers to critically evaluate the methods, data, and statistics to form their own conclusions from the articles they read. Hensley et al. wanted more data to review and clearly felt more context could have been placed in the paper. They read the article, looked at the data, and developed their own conclusions. I am thankful that they took the time to let the orthopaedic community be privy to their thoughts.

I am equally grateful that Austin et al. took the time to comprehensively address the eLetter by Hensley et al. Taken together, these thoughtful responses to well-conducted original research represent the best in respectful “clinical conversations” that help ensure optimal orthopaedic care for our patients.

Chad A. Krueger, MD
JBJS Deputy Editor for Social Media