News From ACFAS

Starting this week ACFAS will be conducting two crucial surveys…but you will receive just one. By random sample, half of ACFAS members will receive the Member Success and Challenges Survey…and half will receive the Practice Economics and Insights Survey. The survey will take only 15 minutes to complete.

You will receive the survey via e-mail in the next few days. Watch your inbox (or spam file) for e-mail from "Mary Crawford" or "ACFAS President." The link will take you to a confidential survey Web site. Your responses will be anonymous and only reported in the aggregate by a third-party survey consultant.

Respond by JUNE 8 to be eligible for the drawing for one of four new G4 iPhones, when it becomes available, or similar technology. Thank you!


The poster exhibit at the ACFAS Annual Scientific Conference, always located in the busy exhibit hall, is a lively spot for attendees to view and discuss the scientific studies and cases presented in the posters.

Over 180 posters were presented this year. You can apply to be a part of this valuable educational opportunity at the 2010 ASC by submitting your poster abstract for consideration before the October 1 deadline.

Full details and online submission instructions are now available via the web link below.

If the frantic pace of your practice has you frazzled, give yourself the gift of a few days spent with your fellow foot and ankle surgeons who want to provide the best surgical treatment for diabetic patients.

The three-day Diabetic Foot & Ankle Surgical Symposium, to be held July 9-11 in Santa Rosa, California, is structured to allow time to relax and enjoy the setting in the heart of the Sonoma wine region. The faculty, comprised of experienced, accomplished leaders in the field, will take you through the process of surgical decision-making and procedure selection. The optional skills wet lab provides an opportunity for hands-on application of techniques presented in the didactic sessions.

You’ll return to your practice energized and ready to implement new techniques and procedures that will solve your biggest limb salvage challenges.

Full details and online registration are available via the web link below.

Foot and Ankle Surgery

Fenofibrate Reduces Risk of Diabetes-related Amputation: Study

The anti-cholesterol drug Fenofibrate may cut the risk of amputation for patients with type 2 diabetes, according to a new study by the National Health and Medical Research Council Clinical Trials Center at the University of Sydney in Australia.

The five-year study involved 9,795 diabetics ages 50 to 75 who were given either 200 mg of fenofibrate a day or a placebo, along with optimal treatment. Risk of amputation was 36 percent lower in patients taking fenofibrate—attributable to a 47 percent reduction in the risk of amputations below the ankle. The study was published in a special edition on diabetes by The Lancet.



Proliferative Capacity of Vein Graft Smooth Muscle Cells and Fibroblasts In Vitro Correlates With Graft Stenosis

Approximately 25 percent of peripheral vein grafts fail due in part to intimal hyperplasia. The proliferative capacity and response to growth inhibitors of medial smooth muscle cells and adventitial fibroblasts in vitro were analyzed. The researchers concluded that the inherent differences in the proliferative response of vein graft cells to platelet-derived growth factor-BB (PDGF-BB) and heparin may partly explain the variability among patients regarding long term patency of vein grafts.



Risk Analysis for the Reverse Sural Fasciocutaneous Flap in Distal Leg Reconstruction

The reverse sural fasciocutaneous flap provides the potential for simple and efficient closure of distal leg, ankle, and foot defects. In young patients with traumatic injuries, low complication rates have been reported. Researchers demonstrated that its use is reliable in young healthy patients but has significant complication rates in patients with comorbidities, especially smokers. In these patients, the reverse sural fasciocutaneous flap requires multiple operative revisions. In such cases, a surgical delay should be considered.



Three-dimensional In Vivo Kinematics of the Subtalar Joint During Dorsi-Plantarflexion and Inversion-Eversion

Magnetic resonance imaging (MRI) sequences were acquired in seven positions during dorsi-plantarflexion (DPF) and in 10 positions during inversion-eversion (IE) at intervals of 10 degrees to determine the 3D kinematics of the subtalar joint in four healthy female volunteers. MRI data of the talus and calcaneus in the neutral position were superimposed on images of the other positions using voxel-based registration, and relative motions and axes of rotation were visualized and calculated quantitatively. The research demonstrated that the subtalar joint is essentially a uniaxial joint with a motion plane almost identical to that of IE of the entire foot, leading the researchers to conclude that knowledge of normal subtalar kinematics may be helpful when evaluating pathologic conditions.

Practice Management

2009 Federal Tax Breaks: How Your Practice Can Save

Physicians and practices stand to benefit from a reduced tax bill in 2009 and 2010 thanks to the American Recovery and Reinvestment Act (ARRA). Most relevant to physicians are extensions of the available tax write-offs for adding new equipment to a practice. ARRA extends so-called "bonus" depreciation, increases the Section 179 first-year write-off for newly acquired equipment, and adds two new "targeted" groups to those whose first-year wages are reduced via the work-opportunity tax credit.



Can Sam's Club Bring Healthcare Tech to the Local Doctor?

Sam's Club has begun offering a bundled electronic medical records (EMR) service that includes software, hardware, and technical support in Illinois, Georgia, and Virginia as a pilot for offering the software as a service product throughout the United States. The offering could make the technology more affordable for practices, which could otherwise lose out on up to $44,000 in reimbursement funds from the federal government beginning in 2011. The Sam's Club offering is targeted at private practices with five doctors or less.



CMS: Same-day Scheduling Allowed

The Centers for Medicare & Medicaid Services (CMS) has announced two exceptions to new notification requirement for Ambulatory Surgery Center (ASCs) that were set to take effect on May 18. ASCs were to be required to provide notification of patients' rights and of the center's ownership before the day of surgery according to revisions to Medicare's ASC Conditions for Coverage. That requirement will be waived if the procedure is scheduled the day it is to be performed and the referring physician indicates in writing that it is medically necessary for the patient to have the surgery on the same day.

Health Policy and Reimbursement

Bill Expanding Health Plan Signed

Under a recently-enacted law, more Iowa children will be eligible to participate in the state’s children’s health insurance program (CHIP). Iowa Governor Chet Culver hopes that the new law will result in 12,000 of the state’s 30,000 uninsured children enrolling in the program in 2010. The law changes the income eligibility to 300% of the federal poverty level from 250% and requires parents to enroll children in the program.



Tax on Medical Benefits Gains Traction

There are indications that an expanding group of lawmakers is warming up to the idea of taxing employer-provided health insurance as one of a number of mechanisms to finance health system reform. The tax-exclusion cost the government about $133 in revenues in 2008. However, such a step faces strong opposition from organized labor and an uncertain reception by the Obama Administration.



California Seeks to Shorten Wait Time for a Doctor's Appointment

California could become the first state to impose timely access rules on healthcare providers. A key aspect of proposed regulations is a system requiring adequate telephone screening to determine the urgency of a patient's request for an appointment. Critics warn that the regulations could push physicians into a "stopwatch mentality," while supporters say it could improve the way physicians deliver customer service by bringing improvement to practice management, including greater use of electronic schedulers.

Technology and Device Trends

Autologous Peripheral Blood CD133+ Cell Implantation for Limb Salvage in Patients With Critical Limb Ischemia

Researchers from Northwestern University in Chicago, Ill., report the safety and feasibility of using autologous CD133+ cell implantation in the lower extremity muscles of patients with critical limb ischemia whose only other option was limb amputation. Nine patients participated in the study, and stem cell injection prevented leg amputation in seven of the nine.



Automated Tissue Engineering on Demand

A team of researchers from Germany's Fraunhofer-Gesellschaft is currently developing the first fully automatic production system for artificial skin that consists of two layers with different cell types, producing an almost perfect copy of human skin. The researchers are working on a full-skin model that will even include blood vessels. Once the research has been completed, fully automatic production of skin suitable for transplantation should be possible.



Motorized CPM/CAM Physiotherapy Device With Sliding-mode Fuzzy Neural Network Control Loop

Continuous passive motion (CPM) and controllable active motion (CAM) physiotherapy devices promote rehabilitation of damaged joints. Researchers from National Cheng Kung University in Tainan, Taiwan, presented a computerized CPM/CAM system controlled by a computer which performs sliding-mode Fuzzy Neural Network (FNN) calculations online, eliminating the need for mechanical resistance devices such as springs.

A force sensor under the patient's foot on the device pedal provides data for feedback in a sliding-mode FNN control loop built around the motor. The controller drives the motor to behave similarly to a damped spring by generating and controlling the amplitude and direction of the pedal force in relation to the patient's leg via an active impedance control feedback system.



Lawmakers Mull Medical Device Safety Act

Lawmakers discussed the merits of the Medical Device Safety Act of 2009 at a recent House Energy and Commerce Health Subcommittee hearing. The legislation would abolish the Supreme Court's ruling in 2008's Riegel vs. Medtronic case proscribing injured patients from suing device manufacturers over FDA-approved products, which Braley said was flawed because it shifts the cost of caring for those patients from manufacturers to taxpayers. Rep. Steve Buyer (R-Ind.) argued that permitting patients to sue device makers in state courts would ultimately hinder device innovation and "force manufacturers to refuse to market their product in states that support patients' rights to sue device makers with FDA-approved products."



Abstract News © Copyright 2009 INFORMATION, INC.

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