BJJ Podcasts

BJJ's Festive Podcast 2020

December 07, 2020 The Bone & Joint Journal Episode 32
BJJ Podcasts
BJJ's Festive Podcast 2020
Show Notes Transcript

Listen to Mr Andrew Duckworth & Professor Fares Haddad discuss this year's challenges and accomplishments at The Bone & Joint Journal, including the achievements made by Bone & Joint Open in her first year of publication.

Discussed papers:
Click here to read 'Negative pressure wound therapy versus conventional dressing for open fractures in lower extremity trauma'
Click here to read 'Is the use of antibiotic-loaded bone cement associated with a lower risk of revision after primary total hip arthroplasty?'
Click here to read 'A prospective study of the role of bladder scanning and post-void residual volume measurement in improving diagnostic accuracy of cauda equina syndrome'

[00:00:00] Welcome everyone. I'm Andrew Duckworth and I'd like to thank you for joining us for our special festive edition podcast around a fire series for the year of 2020. And what a year it has been. The COVID-19 pandemic has without doubt being one of the most significant healthcare crisis of our generation to date and has led to severe global healthcare and economic disruption and uncertainty.

We've all faced huge challenges. And here at The Journal, we hope to provide support and information for both of you as our community, as well as the patients we care for, as we've all tried to navigate these difficult and strange times over the past year. 

So to finish the year off today, I'm delighted to be again joined by our Editor-in-Chief here  at The Journal, Professor Fares Haddad, who over the next 20 to 30 minutes will give us some insights into the past year, including the effects of the pandemic on us as a specialty and the research we do and what we can expect and hopefully look forward to in 202.

 Many thanks for joining us today, Prof, its great to have you back with us. 

Great to be with you, Andrew. And thanks again for doing such a phenomenal job with the podcast this year. We are very, very grateful at The Journal.

I enjoy it every time Prof.  It's great to have you here.

[00:01:00] So Prof, just looking at the year as a whole, as we said,  it's been a very difficult year for our healthcare system, for the world in general and our specialty, and also for our team here at The Journal. What do you feel have been the biggest challenges and how have we sort of faced those and adapted over the past year?

You know, I think staffing with The Journal, you know, we have an outstanding team at The Journal from, particularly the publishing and the management team, but also our editorial board and then, you know, a wider community. And, you know, it's been a huge stress for everybody at a personal level worrying about themselves, worrying about their families and adjusting to a different way of working and our team has been phenomenal in that you know, the process, the work at The Journal has gone on seamlessly, even though everyone has transitioned to working from home. There'd been no face-to-face meetings. We've created the virtual environment where we've worked extremely hard and the production team and, you know, Emma Vodden and Richard Hollingworth have [00:02:00] got everybody in a great cultural space. They're all working very hard and to compound all of that because of COVID and people perhaps not operating as much or not being in clinic as much, we've seen a huge increase in the number of papers. 

So, you know, this year with first time submissions and then resubmissions, we will have processed over 3000 papers. So  the core team has worked phenomenally hard and you know, I need to thank them. And I do regularly but I think at this time of year a huge thanks goes out to all of them and also to all our specialty editors and board members who've really carried the weight of the workload with The Journal. And in spite of everyone's uncertainty and you know, not knowing what's going to happen as we move forward.

Yeah, absolutely Prof. As you say its been a phenomenal amount of submissions. And would you say with that Prof, we've discussed  it before, but do you think the quality has gone up? Cause you know, we've had so much research come through, do you think we're [00:03:00] maybe rejecting things that we wouldn't have done in the past because we've had so many submissions?

So, you know, I think that's, that's a great question. We've tried not to change the level of the bar, but I think you're right.  We've accepted more than we would normally accept. So our acceptance percentage has stayed the same  so you'll find the issues in early 2021, slightly bigger than normal because we've had more good material. But a couple of other things have happened. I think one of the big drives during my time as editor has been to push towards more methodologically sound work. And nationally and internationally, we're seeing better quality research in Trauma & Orthopedics - be that RCTs or better looks at big data or more robust cohort studies. We are seeing better research coming through across the specialties, which is fantastic.

So I think that's raised the pressure to accept more. And we we've also had the bonus of the arrival and growth in [00:04:00] 2020 of Bone & Joint Open, our gold open access sister journal, which has really just only started in January yet now is well-established and has allowed us to find a home for those methodologically sound papers that are worthy of publication, but just don't fit in the BJJ. So it's been great to put those there, to put a whole load of protocols in there as well, some systematic reviews and also put a whole lot of COVID work there during the year. 

I mean, it has really been an amazing year for the BJO hasnt it? I mean, I think when we all started, we had high hopes for it, but I think it'd be fair to say, I'm sure you'd agree, it's surpassed our expectations really hasn't it in many ways?

Oh, without a doubt. So, we started in January, we will, by the end of this year, have published more than 107 papers, I think.  And these are all methodologically sound papers or papers that are very topical with good interest to our readership. It's  got really a rising interest on the web, good [00:05:00] Altmetric scores, and it's now on PubMed - it's indexed, which is great for our authors who've submitted, had them accepted, now they find that papers are on PubMed already within a few months. I think that's tremendous. So it's been a lot of hard work in the background from the editorial team. I should flag up that Alex Liddle has now joined me as Specialty Editor, helping out with BJO. So I'm grateful for his help but, again, the publishing team has supported us strongly, and I hope our readers are  enjoying reading BJO as well as BJJ. 

Absolutely Prof. I think like you say, I think particularly at the beginning of the year it was a really good outlet and a fast outlet to get some of our COVID-related research out that we're receiving. But if we go onto sort of the COVID research, from where we were back in maybe March, April time, how has that developed,  your role as editor? How have you seen that develop over the past year? And what do you feel like the key messages have been and  where do we need to go, if we need to go, next?

Yeah. I mean, it's like any journey that is [00:06:00] bumpy and unpredictable. It starts off with people wanting to describe what they're seeing and, you know, quick observational little things that came out and that really was everyone was seeking information, any tiny bits of information from countries that were exposed to it early or from early experiences. So whoever was able to collect quick data and quick observations. Those were the things we were seeing at the beginning. Then centres started coming together, research groups, starting to put some rigour around it. And we started to really understand,  what happens to the trauma patient in a COVID environment. And that, gave us some really good data and some really good insights. And then we really moved on after our specialty really came to a holt,  in terms of elective work during the height of the pandemic in the first lockdown. We suddenly started to look at, you know, what is it like to live with COVID? How are we going to reintroduce elective surgery? What is [00:07:00] safe? And what's isn't? And again, we moved through that. And then now we're on to really trying to understand what the impact is going to be, what the system change that will result from COVID will be. 

There'll be a whole load of health service-related research and one of my challenges for The Journal will be to pick the few things that really will make a difference to the thinking and the clinical practice of our orthopaedic community that are relevant from that point of view. 

So BJO has been a great rapid outlet for the COVID work. We haven't published that much in the main journal, but just some key messages and some highlight front matter, just to really keep people up to date with what we're thinking, what we're doing, what's going to pass and what's going to stay. 

Yeah, that's interesting Prof. I think so, you know, in terms of looking forward, do you think that the main thing will be, is as we do reintroduce more of our services particularly our elective services, it's knowing how those pathways and  the effectiveness of those pathways are going to be, do you think that's probably going to be the key in the [00:08:00] next year?

 I think that they will be part of it. I think there's a few things that COVID really flushed out. The first one is that there's very little data out there on the impact of prolonged waiting on our patients and on their outcomes. And so that's one fertile area of research that I know several groups have now started looking at. I think it's flushed out that as a community in Trauma & Orthopedics, we have to compete for space with other surgical specialties. And so getting our prioritization right, working out when we really do need to intervene early, even in things like arthroplasty cases. There were some parts of the country where arthoplasty is still defined as low priority worker and not making it in. And I know that's true worldwide as well. So it's really important that we make the case for our patients and collect the data around that.

And then as you suggested, very rightly, there are fundamental pathway changes that have occurred as a result of COVID and that we need to understand that those work for our patients, that they lead to good outcomes, [00:09:00] and make sure that we embed those that work well and go back from the ones that don't.

Yeah, no, absolutely Prof. Yeah, I totally agree. So,  if we are to sort of move on from COVID research, but  the other thing to highlight to our listeners, and I know a lot of them will be aware, but just maybe The Hip and Knee supplements from this year, you know, as many of our readers and listeners will know for the months of June and July, we published two supplements that contain some really great high quality papers from the American Hip and Knee closed meetings. So what do you feel have been the benefits, you know, so far to the readership of those supplements? I mean, there is some really great work in there isn't there?

 These are two societies that really engender high quality research and high quality interactions. And,  we've entered into a three-year cycle with them so the publications that we'll see in 2021 will be the third of those three years to see whether those supplements really give us some high quality work and give us visibility for the [00:10:00] excellent other work that's in The Bone & Joint Journal in North America. And thus far it's been extremely successful.  So we've seen some really high quality research, some interesting thought provoking work, and we've developed a greater insight into what North America is doing, which inevitably has an impact on the rest of the world. So at the moment, we're all working very hard,  reviewing and editing all those submissions and the three award papers for Hip and the three award papers for Knee and the rest of the supplements, which are those papers that have passed the peer review bar should be with our readers in June and July respectively. We typically see a few more knee papers than hip papers. So that's been a very rewardin g partnership for us so far. It's something that we get to revisit after this three-year cycle. And, you know, we'll see if it's served its purpose, or if it's something we need to move forward with.

Absolutely. And do you feel when you look at the type of research and the topics that are covered, do you see that [00:11:00] mirrored in  the main journal as well, those sort of submissions we're seeing from maybe more UK or other parts of the world. 

I think that there is a parallel and  often we do follow those trends. So, there are problems that are picked up, there are questions that are asked where the North Americans lead the way. And yet, you know, in reality, there are lots of things where we lead the way be that in the UK or in Europe or elsewhere. So  it really is important to be global in our outlook. I think that's one of our strengths is we are really open to the whole breadth of Trauma & Orthopedics, and we truly want to be global because there are things to be learned from the current problem, the current research, the current thinking in every continent. 

Absolutely. I couldn't agree more Prof. So sort of moving on then  we've picked a few papers from the year that had been published over the past year that we just wanted to very briefly highlight and discuss, and we've sort of deliberately not picked some of the excellent COVID papers we published in both the BJJ and the BJO cause [00:12:00] obviously we've just discussed those, but the first paper we're just going to briefly mention was the paper by Tahir et al and their multicentre RCT, which compared clinical outcomes to patients with open tibial fractures and they compared standard versus negative pressure wound therapy. And it's interesting to me because it's very much consistent, very consistent with the results from the large multicentre UK trial WOLF, which was run by Matt Costa out of Oxford, which found no real benefit across the wide range of outcomes for negative pressure wound therapy. What made you pick that paper Prof and anything in particular you sort of wanted to highlight from it? 

Well,  I was really excited to see a paper from a less affluent country where we'd managed to embed an RCT across multiple centres that was methodologically done well. So that's something to be truly proud of.  Just to see that come out from those authors was wonderful in itself to then mirror the outcome of the WOLF study and Matt Costa's work [00:13:00] is important because I don't think one RCT is enough. For most things we really need to have credible evidence that follows that primary evidence that really will ultimately lead us to change practice. And here we are, we've got two RCTs that are going against what surgeons and industry are pushing for. So, I think this is really important to take seriously. And it's a good example that you can execute good quality RCTs, wherever you are in the world. You know, that's something as a journal that we are pushing for. And you know what I think we're pushing North America. We've raised the bar, North America is going to have to follow with good quality methodologically sound RCT. So I congratulate these authors. I think they've done a wonderful job. 

No, I couldn't agree more Prof. And I think, like you say, it's a very methodologically sound well-run trial. And I think it's interesting how much it does mirror WOLF, you know, from a different healthcare system, different, I would imagine, a different range of trauma they probably see than we do, but very similar findings. And I agree it's a real, [00:14:00] a really, really great paper. 

And if we sort of move on now, that was one of the RCTs, you know, the other paper we're going to just touch upon was the NJR study from the team in Wrightington. And obviously we get a lot of big, we're getting more and more big data studies data from the NJR and other alike, and this was sort of looking at the use of antibiotic loaded bone cement and the risk of revision after total hip replacement. And they found an association between the use of antibiotic loaded cement and reduced. PGI revision rates or infection revision rates. 

I think it's difficult with the big data sometimes Prof, they're not always designed to answer the question they asked, but  it was a great study this wasn't it?

This is a nice study. And, you know, as many of our listeners and readers are aware, I have been critical over the years of the misuse of big data. It was not designed necessarily to answer those questions, but there were times when the question needs to be addressed. And in this case, there's been a massive challenge about the use of antibiotic cement for a whole lot of reasons, [00:15:00] including cost and the fact that it hasn't been popular in certain parts of the world until recently.

And there's a message here that we've known from the Swedish Registry and elsewhere for years, but that needed restudying, reinforcing a new look with modern data. And, you know, this group has to their credit done a great job of looking at our registry and trying to unpick that they've recognized the strength and the limitations. They've pretty much followed the advice we gave in The Journal with the search guidelines that we put out in February this year with the help of Ben Ollivere and Dan Perry to really try and get some methodological rigour into studies. So I think it's important that for any question that we're trying to answer, we use the best data. And I think to answer this question, the registries are a great repository and resource and they've done a great job and we should encourage people to continue using antibiotic loaded cement in hip arthroplasty. 

Yeah. I think that's an interesting point Prof, isn't it? As we've said you know [00:16:00] RCTs,  they're definitely a gold standard in many ways and not to give the game away for our listeners, but next month we'll be  talking to Mike Whitehouse about a paper that he's got coming out in January, which looks at a very similar question, but in hip and knee replacement and the big metanalysis there.

And, in some ways, you know,  an RCT in this area would be great, but it would require a huge amount of patients and it would be very costly, and even though it'd be great to run it is whether you'd have the echo points from the surgeons, because like we've said before, you know, how many patients would you be willing to give antibiotics meant to, to prevent one infection? That number would be pretty big in most of our eyes. It's interesting as this, well, like you say, it's the question we're asking and the method by which we can strip best, isn't it? 

Absolutely. I think  this is a good example of. Where we are, seems to work, let's not change practice in this case.

Absolutely. And finally Prof. So moving on to the last paper. Slightly different paper to the first two. This was from Nottingham, which is a really interesting perspective study looking at 260 patients with suspected cauda equina syndrome . And they looked at the sort of [00:17:00] diagnostic performance characteristics of the various clinical signs and, highlighting the value in particular of using post voiding, residual vala volume of greater and equal to 200 mls, they found  as the most accurate predictor in determining patients with Cauda Equina syndrome. Quite interesting to see very much different methodology to the first two, but a really interesting message in many ways. 

I think this is a valuable message for the practicing clinician. It is something that will help with evaluation of patients. It uses simple metrics and yet gives us a way of predicting. It will save money to a certain extent. And it's something that makes sense to most orthopedic surgeons seeing patients acutely. And it also illustrates that members in this group have set out, they thought about what they were going to look at and they've looked at it and it is a great credit to them. And when we move in a world of multicentre, randomized studies and big data it is still possible from a well-organized unit to produce some good research that will change thinking and [00:18:00] change practice. And I like that sort of thing. And I also like to highlight the fact that we do publish some very good spine papers and very good paediatric papers, some good upper limb papers and we get a lot of good trauma and hip and knee work, but actually we cover the full spectrum. 

Absolutely Prof. No, I couldn't agree more. So moving on Prof and maybe just to finish up, looking ahead to the new year,  and looking at the future  what'd you feel are the sort of positives we can take forward as we head into next year? And hopefully with some hope on the horizon, vaccine is coming in, we're told. And what do you think are going to be, the positives ahead and maybe the challenges ahead over the next year?

You know, everyone's been through a tough, whichever way you look at it it's been tough. None of us expected this year to be as it has been. But in reality, we have learned a lot from it. I think our community has been phenomenal both in terms of its resilience and in how it's served our patients. And we're going to have a massive workload to deal with. We're going to [00:19:00] have to get back on with our teaching and training and get back on with our research and we're going to have to learn from this. And I think it will change. We will have better communication virtually. We're going to have to look at new ways of educating. And I think we will refocus our research to things that really matter in this brave new world we're going into. It's still going to be a bumpy year next year, whilst we get people vaccinated. Whilst we see if that works, whilst get back on with our surgery and get our hospitals working, get our efficiency levels back up. So I think we need to be mindful of the fact that there were still some challenges ahead, but there's at least there's optimism in the air and compared to the darkness of the first half of the year, I think we should be looking forward to 2021. And from a journal perspective, we're immensely grateful to our entire team at The Journal, but actually our entire community, our reviewers, our readers, our authors. All of whom [00:20:00] are contributing and continue to contribute and, we hope that everybody will be able to celebrate the holidays in some way or other, and they will look forward positively to 2021, and that we will all be able to communicate together and help each other through 2021.

Absolutely Prof. I think that's a really nice note to finish on . Thank you so much Prof,  an excellent overview as ever,  and it's really been informative and always great to talk to you. So thanks very much for joining us. 

Thank you, Andrew. 

And finally, as ever, we would like to wish all of our listeners and the wider community, a very happy festive period and all the very best for 2021.

We at The Journal thank you so much for your ongoing support. Stay safe and well and thanks for listening.