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JOPA Writing Award Spotlight: Christy Rose

The JBJS Journal of Orthopaedics for Physician Assistants (JOPA) continues the tradition of recognizing outstanding review articles and case studies submitted during the previous year by practicing PAs, NPs, and PA students. OrthoBuzz is pleased to spotlight the winners of the 2020 JBJS JOPA Writing Awards. 

Name: Christy W. Rose, MSM, PA-C

Affiliations: University Orthopedic Surgeons, Division of Ortho Tennessee; University of Tennessee Medical Center, Knoxville

JOPA Article: “The Great Mimicker: Atypical Gout Presentations from an Orthopaedic Oncology Perspective

Tell us about your paper.

This paper presents 5 patients who were referred to our orthopaedic oncology clinic for atypical osseous and soft-tissue lesions or masses. Some of the lesions even appeared malignant on initial imaging, but once biopsy results were obtained, the pathology was consistent with gout. Gout is known as the “great mimicker” because it does a fantastic job of disguising itself as other disease processes. This paper highlights some of those atypical presentations with the hope that other providers will keep gout on their list of potential diagnoses when these patients present. We also cover some suggestions when working up osseous and soft-tissue masses and discuss when it is appropriate to refer to an orthopaedic oncologist.

How did you decide to write on this topic? What was the most interesting “take-away,” in your opinion?

At our institution, we treat everything from sarcomas to lipomas and everything in-between. These cases were particularly interesting to me because they were all referred to us for concerns of more nefarious diagnosis. When the patients present to our clinic, sometimes they are terrified because they were told that they had cancer even before a tissue diagnosis was obtained. These cases highlight that “nothing is certain until it is certain.” I know that this is not a profound statement, but I feel like we need to be up front with our patients and educate them on potential diagnosis, but at the same time, don’t crush their hope that something less threatening may be going on.

What do you enjoy most about your career?

My supervising physician, Dr. Anna Wallace, and I are honored and deeply humbled to have the privilege to walk with patients as they the go through their various oncologic treatments and pre- and postoperative process. These patients are so inspiring and encouraging to me because they are warriors, and they keep fighting. The outcomes aren’t always joyful (cancer stinks), but they can leave an impression on you that changes you.

How do you stay informed about new developments in orthopaedics?

I attend conferences, read journal articles, and listen to CME lectures through various apps.

What are you currently reading/listening to/watching?

My husband and I have 3 children, ages 7, 5, and 2. At home, we watch a lot of PAW Patrol, Bluey, and various Lego movies. When we are not watching something animated, we enjoy the Marvel spin-off series. When I can find time for pleasure reading, I enjoy devotionals targeted at working moms and historical fiction.

More details about the JBJS JOPA Writing Awards can be found here.

JOPA Writing Award Spotlight: Katherine Crandall 

 

The JBJS Journal of Orthopaedics for Physician Assistants (JOPA) continues the tradition of recognizing outstanding review articles and case studies submitted during the previous year by practicing PAs, NPs, and PA students. OrthoBuzz is pleased to spotlight the winners of the 2020 JBJS JOPA Writing Awards.

Name: Katherine Crandall, PA-S

Affiliation: Keck School of Medicine, University of Southern California

JOPA Article: “Physician Assistant Roles in Prevention and Management of Anterior Cruciate Ligament Injury

Tell us about your paper.

I chose to write a review article on the topic of physician assistant roles in the prevention and management of anterior cruciate ligament (ACL) injury. The roles and responsibilities of physician assistants — both in primary care and in orthopaedics — seamlessly translate to ACL care from primary prevention to long-term management.

PAs can help to prevent ACL rupture by screening for patients at risk for this injury, providing patient education on neuromuscular training techniques, and referring patients to available ACL rupture-prevention programs. Furthermore, I propose that the creation of a standardized screening tool assessing for ACL rupture risk may aid primary care PAs in screening patients for this injury.

Additionally, patients recovering from ACL ruptures can experience apprehension to return to sport, as the injury and the recovery process can be mentally traumatizing. As PAs frequently perform long-term care for patients during this process, they are well positioned to assess and intervene as needed for patients experiencing psychological obstacles throughout the process.

PAs embody the training, skills, and scope of practice to prevent and manage ACL injury; therefore, it becomes imperative to promote PA involvement in this injury.

How did you decide to write on this topic?

After working alongside physician assistants in orthopaedics both prior to PA school and throughout my clerkships, I witnessed firsthand the ability of PAs to help their orthopaedic teams meet goals in patient care. This stood true whether they were working on an orthopaedic team in the clinic, the OR, or other settings.

Additionally, while working in sports medicine and seeing patients recovering from ACL rupture, I noticed that there was overlap between the care required for this particular injury (i.e. prevention, acute care, long-term continuity of care) and the roles and responsibilities of PAs. I suspected that PAs could play a particularly instrumental role in preventing and managing this injury, and decided to investigate further.

What was the most interesting “take-away,” in your opinion?

The recovery period from an ACL rupture can be challenging both physically and psychologically. While there is ample focus placed on the physical recovery from this injury, patients frequently lack adequate psychological assessment and care during their recovery — an element of the healing process that is fundamental to an athlete’s safe return to activity.

Physician assistants are often involved in long-term care for patients recovering from ACL rupture. They have the opportunity to assess patient progression and recovery, both in the physical and psychological perspectives, and to act or intervene as needed. One way PAs can monitor their patients’ psychological progress is by using the ACL Return-to-Sport Index (ACL-RSI), which assesses a patient’s mental readiness to resume their activities. PAs regularly utilize clinical screening tools such as the PHQ-9 for depression or the CAGE questionnaire for alcohol abuse; therefore, PAs could utilize the ACL-RSI to monitor their patients’ readiness, and subsequently counsel or refer to psychological professionals as needed.

What do you enjoy most about your career?

Currently a PA student, I am scheduled to soon take (and hopefully pass!) my PA Boards. While I do not have a career yet, I can say that my greatest enjoyment as a student (outside of patient care) has been connecting with individuals and groups that are similarly passionate about the PA career, orthopaedics, and other similar health-care interests of mine such as advocacy, community involvement, and preventive medicine. I have been fortunate to participate in leadership and advocacy positions in my own USC program as well as with various PA organizations such as the Physician Assistant Education Association and the American Academy of PAs. In doing so, I have collaborated with numerous passionate and driven students, PAs, and others throughout the country, which has endured as a source of inspiration throughout my studies.

I would also like to thank Dr. Jennifer Beck for her assistance and continued support.

How do you stay informed about new developments in orthopaedics?

I keep up-to-date through JBJS, Physician Assistants in Orthopaedic Surgery, and other orthopaedic journals. I will now be sure to tune in to OrthoBuzz as well!

What are you currently reading/listening to/watching?

Listening to the Home Cooking podcast, reading The Body Keeps the Score, and watching The Crown.

More details about the JBJS JOPA Writing Awards can be found here.

 

A Thank You to JBJS Elite Reviewers

We would like to express our sincerest gratitude for all of our Elite Reviewers. These are a select group of individuals who go above and beyond the Reviewer duties and provide consistent, quality reviews for all submissions. We would not be able to uphold our high standards for peer-review without their contributions.

  • Julie Agel
  • Robert Arciero
  • Jan Bartoníček
  • Ross A. Benthien
  • John G. Birch
  • R. Dale Blasier
  • Thomas J. Blumenfeld
  • Martin Boublik
  • Keith Bridwell
  • Chew Ee Ming Darryl
  • Charles N. Cornell
  • Roger Cornwall
  • Thomas A. DeCoster
  • Douglas R. Dirschl
  • Lori Ann Dolan
  • Lawrence D. Dorr
  • Shivi Duggal
  • Paul, J. Duwelius
  • Nicholas J. Giori
  • H. Kerr Graham
  • A. Seth Greenwald
  • Allan E. Gross
  • Christopher D. Harner
  • Iftach Hetsroni
  • Nitin Jain
  • David S. Jevsevar
  • Charles E. Johnston
  • Grant Lloyd Jones
  • Michael P. Kelly
  • Andrew P. Kurmis
  • Nicholas Kusnezov
  • William D. Lack
  • Simon M. Lambert
  • Mark Chong Lee
  • Paul E. Levin
  • Jonathan C. Levy
  • Morio Matsumoto
  • Terence E. McIff
  • Michael D. McKee
  • Harry A. McKellop
  • Dana C. Mears
  • Saeed Miramini
  • Fred R. Nelson
  • Peter O. Newton
  • Kanu Okike
  • Steven A. Olson
  • Terrance Peabody
  • Stephen Pinney
  • Kodali Siva Rama Krishna Prasad
  • Per-Henrik Randsborg
  • David Ring
  • Peter S. Rose
  • Robert C. Schenck, Jr.
  • Herbert S. Schwartz
  • Edward M. Schwarz
  • William F. Scully
  • Howard Seeherman
  • David A. Spiegel
  • Michael A. Stone
  • James B. Talmage
  • Lauren M. Tatman
  • James E. Tibone
  • Daniel G. Tobert
  • Thomas Parker Vail
  • Andre J. van Wijnen
  • Arvind G. von Keudell
  • Brian C. Werner
  • Carol A. Wise
  • David A. Wong
  • Jacques T. YaDeau
  • Adolph J. Yates, Jr.

Read more about our Elite Reviewers Program here.

Thank you, JBJS Reviewers

JBJS would like to thank and acknowledge all of the reviewer feedback received for Peer Review Week 2017. Below are the 2017 JBJS top reviewers who responded to the survey:

Robert J. Barth, PhD
Keith M. Baumgarten, MD
Timothy Bhattacharyya, MD
Eric M. Black, MD
Desmond Brown, MD
Pablo Castañeda, MD
Michael W. Chapman, MD
Antonia Chen, MD
Quanjun Cui, MD
Thomas DeCoster, MD
John R. Denton, MD
Sarah DeWitt, MD
Shivi Duggal, MD, MBA
Steve Elder, MD
Christopher Evans, MD
Mary Forte, PhD, DC
Joshua Gary, MD
Michelle Ghert, MD
Jessica Goetz, MD
James H. Herndon, MD
Carlos Higuera, MD
Nitin Jain, MD
Kelly Johnston, MD
Richard Kang, MD
Michael Kelly, MD
David H. Kim, MD
H. Mike Kim, MD
Michael Klassen, MD
William Lack, MD
Simon Lambert, MD
Loren Latta, MD
Gwo-Chin Lee, MD
Mengnai Li, MD
Guoan Li, MD
Luke McDonald, MD
Terence McIff, MD
Harry A. McKellop, PhD
Dana Mears, MD
James Michelson, MD
Peter M. Murray, MD
Dr. Jonathan Negus, MD
William Obremskey, MD
Javad Parvizi, MD
Benjamin Kyle Potter, MD
Hollis Potter, MD
William M. Ricci, MD
David Ring, MD
Raymond Robinson, MD
Joseph Schwab, MD
Brian J. Sennett, MD
James A. Shaw MD
Franklin H. Sim, MD
Marvin E. Steinberg, MD
James B Stiehl, MD, MBA
Kimberly Templeton, MD
Richard Terek, MD, FACS
Karen Troy, MD
Dionysios-Alexandros Verettas, MD
Scott Weiner, MD
Brian C. Werner, MD
John Wixted, MD
James Wright, MD
Alan Hargen, MD

We would like to thank these individuals as well as our entire pool of reviewers, whose ongoing contributions to JBJS enable us to continually work towards our mission of improving patient care around the world.

Thank You, JBJS Elite Reviewers

The JBJS Elite Reviewers Program publicly recognizes our best reviewers for their outstanding efforts. Reviewers who review 4 or more manuscripts per year, rarely decline an invitation to review a manuscript (responding within 48 hours), and complete highly graded reviews within 1 week are eligible for the program. Elite Reviewers receive the following benefits in recognition of their exemplary performance:

  • No submission fees for papers of which the reviewer is the first author (for 12 months)
  • Free CME credits for all reviews
  • Free online access to all JBJS publications
  • A letter to the reviewer’s department head from JBJS Editor-in-Chief, Marc Swiontkowski, MD, recognizing and commending his/her good work
  • Name recognition on the JBJS Elite Reviewers Program Web page and on the masthead of The Journal

For JBJS Consultant Reviewer Guidelines, visit http://bit.ly/2cWvYvc.

To learn how you can be a better reviewer visit http://bit.ly/2cRt1hY.

Here is an updated list of JBJS Elite Reviewers:Elite_Reviewers

Peer Review Week Day 1-PM

JBJS is helping celebrate Peer Review Week 2017 by formally recognizing some of its top reviewers for their contributions. Each day during Peer Review Week 2017, JBJS will profile six different top reviewers on OrthoBuzz each morning and afternoon. This afternoon, let’s meet Simon Lambert, Dionysios-Alexandros Verettas, and Luke McDonald.

Simon_Lambert
Simon Lambert, MD
University College London Hospital

What do you like best about reviewing for JBJS?
I value the opportunity to learn new ideas and understand current concepts and clinical practice in my field of surgery while contributing to the endeavour to maintain the high quality of evidence and scientific argumentation that defines a high-level framework of thinking.

How do you find time to review for JBJS?
I always carry my laptop with me to read each paper a number of times during those gaps in the working day that inevitably open up. After evening family time, I review references for relevance and, in doing so, follow each reference’s trail to be clear how that reference has been used in the paper. I use the challenge of my own rudimentary knowledge of statistics to look up and understand the various tests to try to be clear they have been used appropriately. I will then formulate a list of impressions and comments on my note pad. I review this list after a week or so and then write my review having considered each paper a number of times.

What do you see as JBJS‘ role in shaping the future of orthopaedics?
I believe the JBJS has a number of important roles:
1. to maintain a high standard of scientific communication (a technical role);
2. to maintain and develop clinical practice commensurate with evolving scientific knowledge (an instructional and moderating role);
3. to promote research [into epidemiology, basic science (biological and mechanical), applied science, and audit of practice] which forms the foundation for novel interventions and future technologies (a forward-facing role).

dionysios_verettas
Dionysios-Alexandros Verettas, MD
Democritus University of Thrace, Greece

What do you like best about reviewing for JBJS?
Since the JBJS is the most prestigious journal of orthopaedics, the majority of the papers submitted are of high quality and thus give the oportunity to the reviewer to follow the most up-to-date research. I must add that the editorial office make the JBJS one of the most reviewer-friendly journals.

Q3  How do you find time to review for JBJS?
I find that the best time for reviewing is after office hours, when some relaxation is needed.

Q4  What do you see as JBJS‘ role in shaping the future of orthopaedics?
JBJS certainly plays a prime role in shaping the future of orthopaedics both in research and in education and training, at least in the USA. However, I would like the journal to include views and strategies that could apply to Europe as well.

ASSH
Luke McDonald, MD
Naval Medical Center San Diego

What do you like best about reviewing for JBJS?
I enjoy reviewing for JBJS as the manuscripts are well-written, allowing me to focus on the research rather than the writing style, and assigned topics fall within my areas of interest.

How do you find time to review for JBJS?
I am privileged to have the opportunity to review for JBJS, and build the time into my schedule, usually between cases or in the evenings.

What do you see as JBJS‘ role in shaping the future of orthopaedics?
Despite the rise of multiple subspecialty journals, JBJS remains the premier orthopaedic journal, disseminating quality literature to all subspecialty fields.

Peer Review Week Day 1-AM

JBJS is helping celebrate Peer Review Week 2017 by formally recognizing some of its top reviewers for their contributions. Each day during Peer Review Week 2017, JBJS will profile six different top reviewers on OrthoBuzz each morning and afternoon. This morning, let’s meet Benjamin “Kyle” Potter, Steve Elder, David H. Kim.

Benjamin_Potter
Benjamin “Kyle” Potter, MD
Walter Reed National Military Medical Center

What do you like best about reviewing for JBJS?
It gives me a sneak peek at some of what is coming in the Journal and forces me to really examine the article I am reviewing, and as a consequence other articles, with a more discerning and intellectually inquiring eye.

How do you find time to review for JBJS?
I have no idea – we’re surgeons, we make time.  Seriously, while the cumulative time to do a good review can be onerous, it is not that difficult to read an article in whole or part, take some notes, and then write/dictate/transcribe the longer review later when you have some more time.  So breaking it up helps, makes it more feasible and I think actually results in a better review than just cranking it out all at once, because you have some time to let the paper marinate.

What do you see as JBJS‘ role in shaping the future of orthopaedics?
I think the quality and focus of the content of our top journals like JBJS have a critical role in shaping how quickly and broadly new techniques or findings are adopted, and can further shape the emphasis of future research and practice changes in response to these same articles.

Steve_Elder
Steve Elder, MD
Mississippi State University

What do you like best about reviewing for JBJS?
I like the process.  Blinding the authors’ identity to reviewers is a practice that I wish other journals would adopt. I also appreciate being notified of the editor’s decision and then being granted access to the comments of the other reviewers.  I like to think reading their critiques helps me improve my own in the future.

How do you find time to review for JBJS?
I break it down into multiple short sessions.  A careful readthrough of the entire manuscript taking notes during as many short bursts as my schedule will allow, followed by several periods where I mull it over and crystallize my opinion (e.g. while walking to and from meetings across campus), and then a furious bout of writing.

What do you see as JBJS‘ role in shaping the future of orthopaedics?
I believe in evidence-based medicine, and I see JBJS as a major source of the evidence on which I hope clinicians are basing decisions about treatment.  I would also look to JBJS for the most promising experimental approaches.

 

David_Kim
David H. Kim, MD
New England Baptist Hospital

What do you like best about reviewing for JBJS?
Getting first access to the highest quality and most cutting edge orthopaedic research papers.

How do you find time to review for JBJS?
I dedicate every Wednesday afternoon to research and performing peer-review.

What do you see as JBJS‘ role in shaping the future of orthopaedics?
JBJS plays a critical role in screening and assessing all new scientific and technical developments in orthopaedics to make sure that its readership is exposed to only the highest-quality studies and most promising new advances.

 

JBJS: Mobile and Multimedia

15The Journal is one of the most valued sources of information for orthopaedists and orthopaedic researchers. Standards of excellence for the content we publish and the customer service that we provide are not going to change. However, the way in which people access content is changing rapidly. Today, content producers are faced with the challenge of providing their content through media that are accessible on-the-go.

Hence, the JBJSmedia YouTube channel. Here you’ll find information about JBJS products, procedure demonstrations, and webinars featuring top experts in the field— easily digestible and accessible on-the-go. You can easily find the videos you are looking for by going to the playlists tab.

The newest feature of our YouTube channel is the JBJS Podcast. These digital audio abstracts of specially selected JBJS articles are overlaid onto a video track and uploaded to the channel at the end of each month.

Please visit the JBJSmedia YouTube channel. If you have suggestions for better ways JBJS can deliver content, feel free to send an email to info@jbjs.org.

Subscribe to the JBJSmedia YouTube channel

Subscribe to the JBJS Podcast on iTunes

Contributed by

Nicholas Schepis

Social Media and Analytics Specialist, JBJS

 

What’s New in Musculoskeletal Infection: Update on Biofilms

Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries.

This month, Arvind Nana, MD, co-author of the July 20, 2016 Specialty Update on musculoskeletal infection, selected the three most compelling discoveries from among the more than 100 studies cited in the Specialty Update, which focused on biofilms.

Dr. Nana and his co-authors provide a concise primer on the biology of biofilms, the network of microorganisms that adhere to implant surfaces and form a complex structure surrounded by a self-generated extracellular polymeric matrix. This matrix not only anchors bacteria to orthopaedic implants, but also provides a nearly impenetrable defense mechanism against the host immune system. Staphylococci are the most common biofilm-forming bacteria found in orthopaedics.

Persister Cells in Biofilms

So-called persister cells have an inherent tolerance to antimicrobial agents. Misconceptions about persisters have permeated the literature. The authors provide clarification about persisters:

  • Persister cells CAN be reliably killed when the antimicrobial concentration is high enough. The minimum biofilm eradication concentration (MBEC) is lower when antimicrobial exposure is continuous and prolonged.1
  • Decreasing the number of microorganisms with antimicrobial intervention is NOT good enough. Cure requires the total elimination of all viable microbes.

Biofilm in Orthopaedic Trauma

Biofilm formation in the setting of open fractures is concerning because biofilm can develop on bone and in soft tissues in a matter of hours. The assumption is that appropriate surgical techniques for open fractures, including therapeutic antibiotic administration, can decrease bioburden and provide fracture stability, thus modulating the acute, local inflammatory response and minimizing biofilm formation.2 However, current technology does not enable noninvasive quantification of biofilm activity and presence in a stable open fracture following wound closure.

Biofilm in Total Joint Arthroplasty

Traditionally, prosthesis-related biofilm infections in the US have been treated by a 2-stage exchange arthroplasty. Although biofilm from the implant is removed by extraction of the components, the potential exists for persistence of biofilm in the surrounding soft tissues. Most patients treated for periprosthetic joint infections also receive intravenous antibiotics, but a recent in vitro study demonstrated that administering cefazolin even at increased concentrations still resulted in persistent Staphylococcus biofilm on cobalt-chromium, polymethylmethacrylate, and polyethylene,3 which supports the need for explantation.

There is still room to develop novel treatment methods for eradicating biofilm in periprosthetic joint infections. Future novel treatment methods for eradicating implant biofilm will help minimize the morbidity associated with current accepted periprosthetic joint infection treatment options.

References

  1. Castaneda P, McLaren A, Tavaziva G, Overstreet D. Biofilm antimicrobial susceptibility increases with antimicrobial exposure time. Clin Orthop Relat Res. 2016 Jan 21.
  1. Pfeifer R, Darwiche S, Kohut L, Billiar TR, Pape HC. Cumulative effects of bone and soft tissue injury on systemic inflammation: a pilot study. Clin Orthop Relat Res. 2013 Sep;471(9):2815-21.
  2. Urish KL, DeMuth PW, Kwan BW, Craft DW, Ma D, Haider H, Tuan RS, Wood TK, Davis CM 3rd..Antibiotic-tolerant Staphylococcus aureus biofilm persists on arthroplasty materials. Clin Orthop Relat Res.2016 Feb 1.

A Reminder about What Orthopaedic Surgeons Should Not Do

OrthoBuzz

The Choosing Wisely campaign seeks to bring more awareness to tests and procedures that should be discussed between physicians and patients. The campaign was spearheaded by the ABIM Foundation, and the American Academy of Orthopaedic Surgeons (AAOS) partnered with the campaign to develop a list of the five things physicians and patients should question.

  1. Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty.
  2. Don’t use needle lavage to treat patients with symptomatic osteoarthritis of the knee for long-term relief.
  3. Don’t use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.
  4. Don’t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.
  5. Don’t use post-operative splinting of the wrist after carpal tunnel release for long-term relief.

The list was developed after review of approved clinical practice guidelines and included input from specialty society leaders.

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