What!? Congress Driving Physician Accreditation?…I Made a Bone: What Did You Do Today?…OREF Awards $200, 000 in Grants…Three Best Papers From AOFAS…77% of Patients Deficient in Vitamin D…and more.
What!? Congress Driving Physician Accreditation?
One year from now orthopedic residency programs will look very different. A consultant to the ACGME (Accreditation Council for Graduate Medical Education) tells OTW, “The ACGME is initiating a new approach to accreditation and orthopedic surgery is one of the seven specialties that will be the guinea pigs, as it were. While program directors will likely find the changes time consuming and burdensome while they learn the new system, the idea is that eventually the process of accreditation will take less time. The most significant shift will be away from the Program Information Form (PIF), an enormous document that includes detailed information on a program’s resources. In the past, some programs have had to submit faculty CV’s for 100 people!”
“We’ll be going toward an outcomes approach, i.e., monitoring what skills residents have mastered as they move through the program and what skills they have under their belts when they graduate. Part of the reason for the shift is that Congress and other groups are interested in making sure that the ACGME does a better job than we have been doing in certain areas. There is a new bill in the Senate that is reiterating Congress’ interest in ensuring that doctors graduating from our residency programs are well versed in all six general competency areas. Congress is saying, ‘Residents graduating from ACGME-approved programs are technically proficient and smart, but have some work to do in the other four domains…areas which are related to the affective domain (such as communication skills, systems based practice, etc.).’ This is not just in orthopedic surgery, mind you. But we do need to take charge of this issue as much as possible. If Congress starts appointing doctors to review panels, well, these are probably physicians who are being appointed for the wrong reasons (so-and-so is a big donor, etc.).”
Three Best Papers From AOFAS
David B. Thordarson, M.D. is professor of orthopaedic surgery at the University of Southern California and editor-in-chief of Foot & Ankle International. After attending the recent American Orthopaedic Foot and Ankle Society meeting, he shared his thoughts with OTW. “There was an impressive paper on synovial fluid markers for arthritis—lead author Kenneth J. Hunt, M.D. The researchers aspirated the joints at the time of surgery and showed that patients with arthritis in the ankle joint have inflammation biomarkers. Another novel paper was on the bioactivity of bone graft from various sites. The researchers, led by Christopher F. Hyer, D.P.M., M.S., saw that in bone from the iliac crest there were more osteoprogenitor cells and bioactive BMPs than from the distal tibia.”
“The research award went to Charles Saltzman, M.D., whose paper was on a new paradigm for patient reported outcomes assessment. The Patient Reported Outcome Measurement Information System (PROMIS) questionnaire is now being piloted at multiple centers. Outcome instruments are usually 100 questions—quite onerous—but this attempts to capture what we need in only 7 questions. It can be completed in five minutes or less, and can be done by patients, doctors, or research assistants. One of the reasons this is critical is for our maintenance of certification; to get recertified one of the things they will examine is your patient outcomes. If the pilot study is a success, we will have a tool that will increase the amount and quality of the research in the field.”
77% of Patients Deficient in Vitamin D…Raises Fracture Risk?
Brett Crist, M.D., co-chief of Orthopaedic Trauma at the University of Missouri is thinking about the vitamin D issue. He tells OTW, “As a field we are continuing to move toward larger studies that look prospectively at the issue of vitamin D deficiency. My team and I are applying for grants and will conduct a study on the best way to manage how people with this condition are treated. Years ago we minimized the risk of the role of vitamin D in fracture healing. Our goal is to determine whether vitamin D2 or D3 is more effective at elevating vitamin D levels to normal. Our first study included 880 patients—a whopping 77% of them were deficient in vitamin D. We are now trying to figure out what it means clinically. The general assumption is that most people are getting enough vitamin D from milk and multivitamins. So it’s either that we’re not getting enough or a lot of people need supplements when they fracture—or maybe the testing is overcalling it. We will be testing people at different timeframes in our prospective study. It could be that the testing methods are finding things in the bloodstream, i.e., someone is having a stress response, which drives certain things up or down and the vitamin D levels are falsely low because the patient is going through a traumatic event. This is really on the cutting edge in orthopedics, and we are pleased to be presenting our work at the upcoming Orthopaedic Trauma Association meeting.”
OREF Awards $200, 000
The Orthopaedic Research and Education Foundation (OREF) has just awarded a $200, 000 Prospective Clinical Research Grant to researchers at the Cleveland Clinic Foundation to study ways to reduce the risk of spine, neck and head injuries to adults and youth playing football. Edward C. Benzel, M.D., principal investigator for the project and chair, Department of Neurological Surgery at the Cleveland Clinic, indicated that the OREF-supported study will explore how the design of football helmets and other protective equipment, as well as the rules of play, might be modified to better shield young collision sport players from catastrophic trauma. Adam J. Bartsch, Ph.D., PE, a biomechanical engineer and director of Cleveland Clinic’s Head, Neck and Spine Research Laboratory, observed that similar logic has been applied to testing. This study was one of five projects selected for funding out of more than 75 applicants. The projects were chosen based on their potential to change clinical practice and provide better patient care. All five grants were made possible with support from Medtronic Sofamor Danek, USA.
I Made a Bone: What Did You Do Today?
Columbia University bioengineers have succeeded in growing bone from stem cells. In the mix? A cheek bone, bone plugs, and a complex temporomandibular joint (TMJ). Behind this brilliance is Gordana Vunjak-Novakovic, Mikati Foundation Professor of Biomedical Engineering and Medical Sciences. She told OTW, “I have been doing tissue engineering for 20 years and at that time science came to the point of developing technology that could instruct cells to go in a specific direction. Over the years my laboratory began working on developing systems that result in large of pieces of bone (a one-half inch bone defect will not heal properly). When I came to Columbia engineering in 2005 we started thinking about doing something real because the human body is not made of cubes and plugs (the shapes of the previously cultivated pieces of bone). We were able to grow a TMJ [temporomandibular joint] condyle, which is the top part of the lower jaw.”
“All we do is design the environment to please and direct the cells. We also provide them with a lot of oxygen; this is where control of the culture medium is important because if you have insufficient oxygen then the cells can’t survive and build bone. Mechanical conditioning by flow is also important; fluid flows over the surface of forming bone and the bone cells are very responsive to mechanical signals. One thing we are not using is growth factors because they may cause uncontrolled growth. Instead, we use scaffold materials with the capability to induce bone formation.”
“We recently completed a large animal study where we implanted up to two-inch large, anatomically shaped bone grafts; the initial data are encouraging. The imaging data also look promising. We are in the process of analyzing the data and are moving toward the next steps of more validation, talks with the FDA, companies, and surgeons.”
Christopher D. Harner, M.D. Named New President of AOSSM
Dr. Christopher Harner, Medical Director for the University of Pittsburgh Medicine Center Center for Sports Medicine, has been named the 41st president of the American Orthopaedic Society for Sports Medicine (AOSSM). Dr. Harner is the Blue Cross of Western Pennsylvania Professor of Orthopaedic Surgery at the University of Pittsburgh School of Medicine. He holds a secondary appointment as Professor of Physical Therapy, Health, and Physical Activity, and is dual certified in both orthopaedics and orthopaedic sports medicine. Since 1997, he has also been the Program Director for the Sports Medicine Fellowship Program and has trained more than 80 sports medicine physicians. In April of 2007, he was also appointed as the co-director of the UPMC Sports Medicine Biomechanics/Biodynamics laboratory. Dr. Harner earned his medical degree from the University of Michigan and went on to do his orthopedic residency at the University of Pittsburgh. He completed his sports medicine fellowship in Salt Lake City and then joined the faculty at the University of Pittsburgh. His accomplishments are many, including having been appointed to a ten year term on the Board of Directors of the American Board of Orthopaedic Surgery in 2000.
