Dear OTW Reader: “Will orthopedic training programs close?…Infectious complications and timing of anti TNF Meds…what’s going on with manual skills training for residents?…St. Vincent Team Wins Stinchfield Award…and more.
Training Programs to Close?
An observant consultant tells OTW, “Those of us who have been involved in accreditation and peer review of education are concerned about what’s going on in Washington, DC—regardless of who wins the next election. Graduate medical education (GME) is hanging by a thread, and whether the inevitable cuts are substantial or less so, the future of GME is just not clear. If ‘only’ 40% of the $14 billion that the government puts annually toward GME is cut, that will still leave programs scrambling for options. There is the possibility that residents could be charged tuition, something that could happen in orthopedic surgery because it is a highly competitive specialty. What is more likely is that institutions will begin getting out of fellowship subspecialty education. So instead of having a training program they would replace students with junior faculty so that they could bill for services all the while that these people are learning from the senior faculty people. Some private hospitals that weren’t designed to be educational institutions may get out of GME altogether. The institutions that are designed to be teaching hospitals will have it hardest as they will have to cut back, but will have more patients. This is all completely at odds with the fact that we are going to see more and more orthopedists retiring and the reality that we don’t have enough people to replace them.”
Daniel Garen New VP at Wright
Daniel Garen, an attorney, has been named Senior Vice President and Chief Compliance Officer. Garen has many years of experience with managing corporate compliance programs for public healthcare technology companies and has more than ten years of corporate legal experience. Garen, who earned his law degree—as well as a master of laws in health law—from the Loyola University Chicago School of Law, has held senior compliance officer positions with Siemens Corporation and Bayer Healthcare. He served as Chief Compliance Officer and Senior Counsel from October 2007 to August 2010 at Siemens Healthcare Sector US, and he most recently held the position of Vice President, Healthcare Policy and Clinical Affairs until January 2012 at Siemens Healthcare Sector US.
Infectious Complication? Look at the Timing of Anti TNF Meds
Dr. Beverly Johnson is a rheumatologist at Hospital for Special Surgery (HSS), and is lead author of the research on “Tweaking the Timing of Stopping Anti-TNF Medications Before Knee Replacement Surgery.” She told OTW, “I used HSS’ substantial joint replacement registry to examine the safety of taking anti TNF (tumor necrosis factor) medications around the time of surgery. Specifically, I looked at knee replacement patients who had rheumatoid arthritis (RA). There is not a lot of data about this, and thus far, every national rheumatological society has different recommendations. For example, the American College of Rheumatology recommends stopping anti-TNF meds for one week before surgery, then beginning again one week postop, while in Britain the recommendation is to stop 3-5 half lives preoperatively and to restart after wound healing. I wanted to see what we are doing here at HSS. I found that many physicians are actually stopping anti-TNF medications for several half lives, which is a more conservative approach and more similar to the British guidelines. They are holding these medications several half lives prior in an attempt to avoid infectious complications, but this may lead to postoperative RA flare. I found that there wasn’t a difference at six months in negative outcomes including infections, but the overall negative outcomes were low. I sent a survey to patients and found that a larger percentage of patients on preop anti-TNF had an RA flare. Basically, we may be holding these meds too long prior to surgery. We must weigh the risk of the possibility of having a negative outcome—an infection—six months out versus the risk of flare of RA as a result of holding the medications. More work is needed, however, as you would have to have two thousand surgeries in order to say that there is a statistically significant difference in the infection rate between the two groups.”
Kyle Mullens, Chris Scifert Join Orchid
Orchid Design has added Kyle Mullens to its team as Business Development Manager, while Chris Scifert, Ph.D., is the new Engineering Manager of the Memphis Design Center. Mullens’ was formerly Director of Business Development at Secant Medical, and Product Manager at K2M, Inc. At the latter company Mullens led product commercialization efforts for a portfolio of minimally invasive spinal implants and instruments. Mullens, who holds a B.S. in Plastics Engineering from Ferris State University in Michigan, has also executed Business Development and growth strategies for A.Schulman, Inc., an engineered polymer resin manufacturer. As for Dr. Scifert, his background includes serving as Senior Manager, Product Development at Medtronic Spinal and Biologics. He has also managed engineering projects as a Senior Engineer and Project Manager at Smith & Nephew focusing on early intervention knee and shoulder systems. Dr. Scifert received his B.S. in Engineering Sciences and Mechanics at the University of Tennessee and his Ph.D. in Biomedical Engineering at the University of Iowa with his Doctoral Dissertation entitled ‘A Finite Element Investigation into the Biomechanics of Total Artificial Hip Dislocation.’
Manual Skills Training for Residents!
Ann Van Heest, M.D. is a hand surgeon at the University of Minnesota, and has been the Residency Program Director for 13 years. She has worked steadily to incorporate technical skills as an area of resident evaluation. Dr. Van Heest tells OTW, “In November 2011 the American Academy of Orthopaedic Surgeons sponsored a surgical simulation summit, which included representatives from the major societies and the American Board of Orthopaedic Surgery (ABOS). The Council of Orthopaedic Residency Directors has been assessing surgical skills in residency training programs and at this summit we began exploring ways to incorporate this into programs in a standardized fashion. General surgeons are already required to undergo manual skills training, so we are hoping to learn from their experiences…and see if the ABOS will be open to a similar requirement/situation for our specialty. Part of the challenge is that such testing would have to be verified…and if it’s going to be done on a national level then it must be a standardized test that is reproducible and that measures these skills appropriately. This is really the long range goal. The importance of this to patient safety cannot be overemphasized. There are certain things that residents should really learn in a lab as opposed to on patients—such as knee arthroscopy. Doing so would lead to shorter operating room times because residents would have gained higher level skills in the lab.”
The Happy Orthopedic Surgeon?
Calling himself a “voice in the wilderness, ” Dr. Jesse Jupiter tells OTW, “I’m actually happier these days as an orthopedist. I find that my institution is making it easier at every point in the process to do surgery. I receive more support than ever before, and the technology is more advanced than ever…I’m doing more work and enjoying it more than ever. Also making things better is the abundance of ambulatory surgery centers whose quality is improving as people learn how to run them. This makes it easier to do many cases at a higher level of quality. I have always loved my work and now have more confidence in my surgery, better results, better decision making due to experience, and many patients returning after many years (like old friends). The main thing I see on the horizon that I am concerned about is a constant increase in regulations, some of which seem to have no relevance to what we do.”
St. Vincent Team Wins Stinchfield Award
Riding high in Los Angeles, a team of researchers at the Joint Replacement Institute (JRI) at St. Vincent Medical Center has won The Hip Society’s prestigious Frank Stinchfield Award. The scientists were acknowledged for their work on the age-related wear of total hip replacement implants. Thomas P. Schmalzried, M.D., Medical Director of the JRI, was the preceptor for the study, which was led by senior medical student Andrew Battenberg. The team used a microprocessor to measure leg motion in hip replacement patients. Patients in this JRI study were monitored for a minimum of ten years. The paper, “Decreasing Patient Activity with Aging: Implications for Cross-Linked Polyethylene Wear, ” will be presented during the American Academy of Orthopaedic Surgeons (AAOS) conference in San Francisco on February 11, 2012. The manuscript is set to be published in Clinical Orthopaedic and Related Research in approximately one year.
