News From ACFAS

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Attention ACFAS 2018 attendees! Don’t leave home without downloading the free ACFAS 2018 app first so you can access your personalized session schedule, the exhibitor directory, social media feeds, speakers list, convention center maps and more.

To download the app, search your app store for ACFAS 2018 or visit http://m.core-apps.com/acfas2018 or acfas.org/nashville and watch for an email the week of March 12 from ACFAS with your login details. Your login information will also be printed on the back of your ACFAS 2018 name badge, which you will receive in Nashville.

ACFAS 2018 will take place March 22–25 at the Gaylord Opryland Hotel in Nashville. See the newest products and services from more than 150 companies, meet up with your colleagues and friends for lunch, browse through hundreds of scientific posters, win prizes and update your headshot for free—all in the ACFAS 2018 Exhibit Hall, March 22–25 in Nashville.

The Exhibit Hall will also house the HUB and ACFAS Job Fair where you can either listen to 50-minute sessions on timely topics or search for your next job or new hire.

Be sure to stop by the Exhibit Hall during each morning and afternoon break to scan your badge at our new and improved scanning stations and earn credit for the sessions you attend.

Visit acfas.org/nashville for more on what you can expect at ACFAS 2018 and how to make the most of your conference experience! Want to find out about ACFAS activities close to home? Attend your ACFAS Region meeting during the Annual Scientific Conference March 22–24 at the Gaylord Opryland Hotel in Nashville!

The ACFAS Regions have recently been redistricted from 14 Divisions to nine Regions. Each of the nine new Regions will hold a meeting of its members in conjunction with the conference this month. Join your fellow local colleagues to meet and network with your Region officers and have a hand in your Region's plans for this coming year.

Region meetings are scheduled during conference lunch breaks at reserved tables in the Exhibit Hall. A complete schedule of meetings will be listed in your onsite conference brochure, on the conference mobile app and on signage at the conference.

All ACFAS members who attend their Region meetings will be placed in a drawing to win one of nine Amazon Echoes. Look for your raffle ticket in your registration packet. Come to the HUB, March 22–24 in the ACFAS 2018 Exhibit Hall, for practical, tried-and-tested guidance on job hunting, financial management and more and be sure to check out this year’s new sessions:

Promoting Yourself in the Digital Age
You need not have your own YouTube channel or 10,000 followers on Twitter to have a strong online presence. Listen to easy first steps you can take to promote your practice and expertise.

Journal of Foot & Ankle Surgery—How to Get Published: Authorship, Reporting Guidelines & Peer Review
Hear the JFAS editor, publisher and key section editor share their tips for preparing your manuscript and what to expect after you submit it to the Journal.

Preparing Your Office for Medical Emergencies
Are you and your staff prepared to handle the range of medical emergencies that can arise in your office at any time? Learn what protocols to put in place so you are never caught off guard.

Working with Industry
If you are thinking about consulting, serving on a speakers’ bureau or enrolling patients in clinical trials, this is the session for you.

Are You Tomorrow’s ACFAS Leadership?
Past ACFAS leaders discuss what is involved in helping to shape the College’s policies and how you can have a lasting impact on the profession’s future.

Download the ACFAS 2018 conference program at acfas.org/nashville to see the complete HUB schedule (pages 8–9). This month, ACFAS would like to know which social media platform you use most in your practice. Cast your vote in our new poll at right, then visit acfas.org throughout March to view real-time results.

Foot and Ankle Surgery

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A study was conducted in critical limb ischemia patients with thromboangiitis obliterans (TAO) to determine the long-term safety and effectiveness of treatment with autologous bone marrow-derived mononuclear cells (ABMMNCs). Patients were treated with smoking cessation and either aspirin alone or aspirin and ABMMNC injection based on patient preference. Groups were compared for demographics, clinical characteristics and short-term and long-term outcomes. Nineteen out of 59 patients with TAO who were treated opted for aspirin alone and 40 patients chose aspirin and ABMMNC injection. No patients had perioperative complications, and 49 patients remained smoke-free for a decade. The 10-year amputation-free survival was 85.3 percent in patients treated with ABMMNCs versus 40 percent in patients treated with aspirin alone. Ulcer area, toe-brachial index, transcutaneous oxygen pressure and pain score were also significantly improved with ABMMNC treatment, although no difference in mean ankle-brachial index was observed.


A study was conducted to assess clinical and magnetic resonance imaging (MRI) results following arthroscopic treatment of distal tibia osteochondral lesions and to report outcomes of treating them. A consecutive series of 27 patients were treated arthroscopically with the one-step BMDCT for OLTPs between October 2010 and November 2011. No complications were noted following surgery or during rehabilitation. The AOFAS score rose from 52.4 preoperatively to 80.6 at the final follow-up. All patients were satisfied with the procedure. In 14 cases, the MRI indicated a complete filling of the osteochondral defect; in three patients, hypertrophic tissue was seen; and in the other two patients, an incomplete repair of the lesion associated with a persistent slight subchondral edema was reported. A topographic study was also conducted.


A pilot study was conducted in which 36 patients, including 12 females, affected by disabling intermittent claudication or rest pain of the lower extremities, were exposed to daily 3-liter hydration for up to six weeks. Cutaneous foot temperature, ankle/brachial index, time and distance of claudication and pain intensity were recorded prior to and following the hydration period. Patients with an average age of 71 exhibited disabling claudication for more than five months while 11 percent noted pain at rest. A six-week water intake of more than 2,500 mL/24 hours was realized in 35 of the 36 patients. Greater water intake was associated with significant improvements in median ankle/brachial index and skin temperature. Supervised treadmill exercise based on time and distance to reported claudication improved from 100 meters to 535 meters and from 1.25 to 6.25 minutes.

Practice Management

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Executives planning to expand a medical practice must craft a plan that takes into account a number of factors. Timing, performance, strengths and weaknesses are all important issues to consider when planning an expansion. Other reasons to consider growth include increasing market share, diversification and new mergers or joint ventures. These goals require their own strategy, challenges and benefits.


Hospitals workers are at a higher risk for experiencing workplace violence than workers in other industries. However, many hospital employees accept it as part of the job and do not report incidents. Experts say this failure to report may be contributing to the overall problem. As a result, Lewis Kaplan, MD, says officials do not know the real figures on violent incidents in hospitals. He adds that underreporting also creates missed opportunities for mitigation and prevention efforts. Kaplan says staff needs more training on how to recognize potential violent incidents and how to de-escalate them.


Pamela Wible, MD, offers tips for physicians to fight the incidence of suicide among their numbers. Her first suggestion is to talk about the suicide issue and halt secrecy, while another recommendation is to eliminate mental health questions from licensing applications or to change wording from “Have you ever had a mental health condition?” to “Do you currently have a medical condition that would limit your ability to practice medicine safely?” Wible also urges providing on-the-job support, particularly for emergency department physicians and surgeons, who are in high-risk and high-mortality specialties. Also recommended is helping physicians open independent clinics where they can practice in alignment with their values and original goals when they entered medicine. In addition, Wible emphasizes supportive friendships between physicians, mentoring and spending time outside the office. Other suggestions include passing out thank-you cards and notes of appreciation, and transforming the office culture from isolating to communal.

Health Policy and Reimbursement

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Participating in Medicare wellness programs brought better outcomes to beneficiaries with chronic conditions, according to a new report from the Center for Medicare and Medicaid Innovation (CMMI). Medicare members who participated in wellness programs reported improved fitness levels, were less likely to be injured in a fall and were able to maintain their physical health better than nonparticipants. In addition, the researchers found that participation in chronic disease management, fall prevention and physical activity programs led to positive mental health effects, such as improved overall confidence.


By scaling back many of the requirements of the Affordable Care Act (ACA), the Trump administration and congressional Republicans effectively are turning over major components of health policy to the states, and Democratic and Republican states are moving in opposite directions on health policy. Republican states are taking steps to aggressively roll back the ACA, while Democratic states are rolling out efforts to bolster the law, which means a given state's healthcare options increasingly are determined by which party is in control. In Idaho, Gov. Butch Otter (R) is allowing insurers to sell plans that do not comply with the ACA, while Democratic-led states like California and Maryland are seeking to block or limit the expansion of cheaper and less-robust health plans that do not comply with the law. Furthermore, nearly a dozen states are considering measures that would require residents to have health coverage.


A lawsuit filed February 26 by a coalition of 20 states against the U.S. government claims that the Affordable Care Act (ACA) is no longer constitutional. Led by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel, the lawsuit said without the individual mandate, which was eliminated as part of the GOP tax law signed by President Donald Trump in December, the ACA is unlawful. The U.S. Justice Department did not immediately comment on whether the Trump administration would defend the law in court. The ACA requirement that people have health insurance or pay a fine was intended to ensure a viable health insurance market by requiring younger and healthier Americans to obtain coverage. Paxton asserted, "The U.S. Supreme Court already admitted that an individual mandate without a tax penalty is unconstitutional. With no remaining legitimate basis for the law, it is time that Americans are finally free from the stranglehold of the ACA, once and for all."

Medicine, Drugs and Devices

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Findings from two new studies comparing outcomes with two I.V. trauma therapies indicate that hospitalized patients who received I.V. balanced fluids instead of saline had about a 1 percent lower incidence of death and serious kidney injury. According to Matthew W. Semler, MD, of Vanderbilt University Medical Center in Nashville, the results—seen in critically ill and noncritically ill patients—suggest that largely replacing saline with balanced fluids in the hospital setting could lead to significant reductions in morbidity and mortality. The findings were reported at the Society of Critical Care Medicine annual meeting and published simultaneously in the New England Journal of Medicine. Replacing saline with balanced fluids, Semler estimated, could avoid up to 75,000 deaths, as well as 100,000 cases of renal failure leading to 40,000–50,000 individuals requiring dialysis. "There has not been evidence in favor of saline or balanced fluids," Semler said. "The choice about which one to use mostly comes down to how physicians are trained. Internal medicine physicians tend to use saline while anesthesiologists and surgeons tend to use balanced fluids more."


Attorney General Jeff Sessions announced that the Justice Department is throwing its weight behind plaintiffs in an opioids lawsuit in Ohio. The department plans to file a so-called statement of interest in the lawsuit, a technique that past administrations have typically reserved for cases that directly affect the federal government's interests, like diplomacy and national security. Sessions said the lawsuit targeted "opioid manufacturers and distributors for allegedly using false, deceptive and unfair marketing of opioid drugs." He also announced the creation of a task force to pursue the makers and distributors of prescription opioids and said it will "examine existing state and local government lawsuits against opioid manufacturers to determine if we can be of assistance." The lawsuit pending in Federal District Court in Cleveland consolidates more than 400 complaints by cities, counties and Native American tribes nationwide. Some of the high-profile defendants include pharmaceutical firms Johnson & Johnson, Purdue Pharma and Teva Pharmaceuticals, large distributors McKesson and Cardinal Health and community pharmacy chains, such as CVS Health, Rite Aid and Walgreens. U.S. Drug Enforcement Administration lawyers attended a hearing in the Ohio courtroom about how much data they would share about the national distribution of opioid analgesics. Richard Fields, a lawyer who represents state attorneys general and sovereign Native American nations in opioid litigation, predicted that the statement of interest "will help unlock this data so that we can hold manufacturers, distributors and pharmacies accountable."


Uber announced the public launch of Uber Health, a dashboard to let healthcare providers schedule rides for customers, while a study published in JAMA Internal Medicine found offering to schedule free Lyft rides to and from primary care appointments did not lower number of missed appointments compared to a cohort not offered the service. "I think we [as providers] tend to apply our choices of how we live our lives, and we kind of impose it on [care recipients'] lives," says the University of Pennsylvania's Krisda H. Chaiyachati. "We probably all use ride-sharing services — I used one this morning. We think the same thing will apply to a sick person or a poor person, and that might not be true." Chaiyachati noted the study might offer insights about what kinds of people could benefit from ride-sharing help. It could be possible that ride-sharing might be more beneficial in scenarios where adherence to appointments may be more critical, such as oncology. Lyft Business' Gyre Renwick says Lyft has been targeting groups of people, including seniors, in areas underserved by public transit and people for whom missing an appointment could have major health repercussions and could lead to costly hospitalizations. Among the lessons gained from Uber's health service pilot is that many customers have not used Uber before and may lack a smartphone.