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News From ACFAS

Three Courses to Enhance Your Arthroscopy Skills
If you’ve taken a basic foot and ankle arthroscopy course, we have new courses for you to take the next step to sharpening your surgical skills!
Advanced Skills Courses
Advanced Arthroscopy and Cartilage Restoration
July 31-August 1 (Saturday/Sunday)

Orthopaedic Learning Center (OLC) | Rosemont, IL | CME: 16 hours
Learn the latest techniques as well as more recent cartilage restoration from leading surgeons—arthroscopic lateral ankle ligament repair, classic OATS resurfacing and particulate cartilage resurfacing techniques, en bloc resection and replacement techniques, subtalar joint arthroscopy and arthroscopic STJ fusion technique.

Total Ankle Arthroplasty
August 27-29 (Friday/Saturday)

Orthopaedic Learning Center (OLC) | Rosemont, IL | CME: 18.5 hours
Gain hands-on experience with the FDA-approved ankle replacement systems. You’ll perform implantation of all five, FDA-approved systems. This unique skills course is taught by faculty who specialize in total ankle replacement. They will discuss their experiences and surgical decision making and will offer proven tips to help improve your outcomes.

Surgical Management of the Active Patient
November 6-7 (Saturday/Sunday)

MERCI Lab | Chicago, IL | CME: 16 hours
This interactive, hands-on course led by skilled arthroscopy surgeons gives you the opportunity to learn and practice established and cutting-edge techniques in foot and ankle surgery. You'll come away with the latest techniques in management of the active patient. Highlights include Achilles tendon pathology, 1st MPJ pathology, jones fracture management and more.

To attend these courses, you must have previously taken a basic foot and ankle arthroscopy course. If it wasn’t an ACFAS program, fax your certificate and agenda from the program attended to ACFAS’ Education Department at (773) 693-9304. Visit for more information on these upcoming courses and to register now.
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FASTRAC is Live & Ready for Research
Submit your research now to Foot & Ankle Surgery: Techniques, Reports & Cases (FASTRAC) the ACFAS’ newly launched Open Access journal.

We are looking for the latest advances in cutting-edge surgical techniques for correction of foot and ankle disorders. The journal’s streamlined submission process allows ACFAS members and other foot and ankle surgeons around the world to stay up to date on the best clinical practices. Now you can submit your research your way, in any format, and once accepted your paper will be reformatted to fit the journal's template. ACFAS members will receive a 25 percent discount on the author fee charged upon acceptance of a paper.

For more information or to submit your research today, visit
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June Journal Club
Join us for another look at the latest in research with June’s ACFAS Virtual Journal Club coming up June 17, 7pm CT. This installment is hosted by the Kentucky Indiana Foot & Ankle Specialists Reconstructive Foot and Ankle Surgery Fellowship in Louisville and presented by Anna Meneely, DPM, Derrick Rowland, DPM and Paul Klutts, DPM, FACFAS.

Register now at
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Foot and Ankle Surgery

Conventional vs Accelerated Rehabilitation Protocol Following Reattachment of Achilles Tendon for Insertional Achilles Tendinopathy
A study sought to compare early versus conventional postoperative weightbearing following suture bridge Achilles tendon reattachment among 49 patients. The patients had insertional Achilles tendinopathy surgically treated via a central Achilles tendon-splitting approach and reattachment with suture bridge technique by a single surgeon. Eighteen and 31 patients received the conventional and accelerated protocols, respectively. The mean scores (conventional vs accelerated group) for the visual analog scale for pain, Foot and Ankle Ability Measure and Short Form Health Survey in the conventional group at three months postoperatively were 4 ± 1 vs 3 ± 1 points, 53 ± 8 vs 68 ± 3 points, and 57 ± 15 vs 67 ± 10 points (P < .05 for each comparison). There were no statistically significant differences between the groups at six and 12 months postoperatively. All patients could perform the single heel raise test at six months, with none experiencing complications.

From the article of the same title
Foot & Ankle International (05/24/2021) Arunakul, Marut; Pholsawatchai, Waroot; Arunakul, Preeyaphan; et al.
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Current Perception Threshold Testing in Chronic Ankle Instability
A study was conducted to quantitatively assess sensory nerve function in patients with chronic ankle instability (CAI) and healthy controls using current perception threshold (CPT) measurements, in addition to the influence of sex, age and body mass index (BMI) on CPT values and the relationship between CPT frequencies. The study featured 59 subjects with CAI and 30 healthy controls. Neither cohort exhibited significant differences in age, sex, height, weight or BMI and the CPT values did not have a significant difference by sex. These values had no significant correlation with age or BMI. Compared to the control group, the CAI cohort had significantly higher CPT values on the injured and uninjured sides under 250-Hz and five-Hz electrical stimuli, with a significant difference between the groups and effect size. No significant difference was seen under 2,000-Hz stimuli, while correlations were observed between CPT values at different frequencies, especially 250 Hz and five Hz.

From the article of the same title
BMC Musculoskeletal Disorders (05/18/21) Vol. 22, No. 453 Zhang, Ran; Zhang, Xi; Chen, Yaping; et al.
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Development of Multiple Epidermal Inclusion Cysts After Radiofrequency Microtenotomy for Plantar Fasciitis: A Case Report
Research reviewed a case of the development of multiple epidermal inclusion cysts of the plantar heel following radiofrequency microtenotomy for treatment of plantar fasciitis. Following radiofrequency coblation in November 2017, the patient developed multiple plantar heel cysts, then had them surgically excised in February 2018 and again in June 2018. By the time of presentation to the medical office in October 2018, multiple cysts were still present to her heel despite two surgical interventions. Seventeen months following surgical excision in February 2019, the patient remained cyst-free.

From the article of the same title
Journal of Foot & Ankle Surgery (05/20/21) Skolnik, Jennifer; Pontious, Jane; Hasenstein, Todd
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Practice Management

Connecting Positive Patient Experiences to a Physician Practice's 2021 Financial Health
The patient experience is a crucial factor in the success of any healthcare practice, one whose value is increasing with the emergence of healthcare consumerism. Studies have associated a positive patient experience with higher profitability and a negative patient experience with lower profitability. An Accenture survey estimated that 25 percent of patients who think their provider is handling COVID-19 poorly say they will not solicit further care from the practice or will wait at least 12 months until doing so; meanwhile, 64 percent say they will likely change providers if their expectations are not met. To avoid a decline in financial health going into 2021, practices must place a greater emphasis on patient satisfaction, and key to this is making a good first impression. Also critical is fostering greater patient engagement to determine the best course of treatment or care and enhancing access to care. Also recommended is the addition of omnichannel conveniences and the improvement of practice workflow.

From the article of the same title
Medical Economics (05/26/21) Blackman, Michael
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Doctors Harness the Power of Human Connections
Doctors are adopting social medicine programs to help patients with dementia, isolation and other problems. Saint Louis University's Aging and Memory Clinic hosts a cognitive stimulation therapy group, conducting weekly hourlong group sessions in which dementia patients listen to music and participate in group discussions led by a moderator. The object is to improve various aspects of cognition and memory in a stimulating, positive social setting where patients engage with one another. University of California, Los Angeles neurologist Indu Subramanian envisions such programs as the wave of the future, noting, "Social prescribing meets people in the community where they are and links them to social support structures." Britain's National Health Service aims to have roughly one million patients referred for social-prescription interventions by 2024. The US Department of Veterans Affairs in 2020 initiated the Compassionate Contact Corps, a social prescribing program for veterans, who take phone or video calls with trained volunteers. "I think this will definitely become more of a structured part of the practice of medicine," predicts Malissa J. Wood at the Massachusetts General Hospital Heart Center.

From the article of the same title
New York Times (04/28/21) Hanc, John
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Goodwill: How It Factors Into a Medical Practice Sale
Medical practices must make an effort to demonstrate goodwill in their sales pitch, and the strength of that goodwill is derived from practice brand, the reputation of the practice and its providers, its patient base, its loyal referring physicians and other intangible assets. In terms of financial worth, there is more variability in the calculation of goodwill, and practices needing guidance can consult their accountants on a variety of methods for calculating this value. These include average profit method, weighted average profit method, capitalization method and annuity method, to name a few. The interests of the buyer and seller clash with one another in terms of negotiating goodwill, due to tax implications. The parties must concur on the allocation of the components of the price of the practice, and this partially depends on the advice each party receives from their respective accountants. When finding a sales price acceptable to both buyer and seller, the former prefers to ask for as much as possible while the latter wants to pay as little as possible—and this is particularly relevant to the goodwill component. The goodwill value that a physician, especially a departing physician, brings to the table can intensify negotiations, but this is just one factor.

From the article of the same title
Physicians Practice (05/26/21) Hernandez, Nick
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How COVID-19 Is Helping to Change the Doctor's Waiting Room
Healthcare providers across the country aim to completely transform the waiting room experience and essentially eliminate the waiting room itself, in the wake of COVID-19 using technology and facility redesign. Chris Kean at The San Antonio Orthopaedic Group (TSAOG) Orthopaedics in Texas says she wants patients to feel more like they are checking in to a hotel, using a model location featuring a lobby with high ceilings, lounge chairs, an endless counter and the oversize feel of a hotel lobby. Kean adds that returning patients no longer need to arrive early, partly thanks to a software program called Clinic Q. Patients can use Clinic Q to schedule appointments and answer personalized pre-appointment questionnaires from home. The program also connects to the patient's insurer to provide an estimate of the cost of service. Kean says Clinic Q has let TSAOG add patients and providers without adding receptionists.

From the article of the same title
Wall Street Journal (05/23/21) Kornelis, Chris
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Health Policy and Reimbursement

FDA Announces Draft Guidances to Help Increase Transparency, Assist Reporting and Timely Completion for Certain Medical Device Studies After FDA Approval or Clearance
Two new draft guidance documents from the Food and Drug Administration (FDA) address the continuous surveillance of certain approved and cleared medical devices. "When final, these guidance documents will help increase transparency and assist reporting and timely completion of studies on the safety and effectiveness of certain devices," said William Maisel, MD, chief medical officer and director of the Office of Product Evaluation and Quality in FDA's Center for Devices and Radiological Health, in a statement. The first guidance is for manufacturers of devices that are subject to an order under section 522 of the Federal Food, Drug and Cosmetic Act, which allows the FDA to mandate postmarket surveillance at any point for certain Class II and III devices. The guidance aims to help manufacturers complete their postmarket surveillance plan under the 522 order on time and discusses the agency's policy for posting relevant data in the 522 Postmarket Surveillance Program Database. The second guidance is intended to help stakeholders better understand post-approval study requirements for pre-market approval of a medical device and includes procedural information and recommendations about post-approval-related submissions.

From the article of the same title
FDA in Brief (05/26/21)
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Medicare Advantage Dual Eligibles Have Better Access to Care
A report from NORC at the University of Chicago found that Medicare Advantage dual eligibles reported having better access to care and access to telehealth during the coronavirus pandemic than traditional Medicare beneficiaries. Nearly six in 10 Medicare Advantage dual eligible individuals (56 percent) reported having four or more chronic conditions, compared to about five in 10 beneficiaries in traditional, fee-for-service Medicare (46 percent). However, traditional Medicare beneficiaries had a slightly higher rate of living with weakened immune systems and were more likely to be current smokers. Meanwhile, Medicare Advantage dual eligible enrollees reported lower barriers in access to care and higher access to telehealth. A little over half of traditional Medicare dual eligibles reported having access during the pandemic (52 percent), compared to nearly two-thirds of Medicare Advantage dual eligibles (63 percent).

From the article of the same title
HealthPayerIntelligence (05/25/21) Waddill, Kelsey
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Medicine, Drugs and Devices

Antibiotic Therapy for Six or 12 Weeks for Prosthetic Joint Infection
Prosthetic joint infection typically is resolved with surgery followed by antimicrobial therapy, but clinicians lack clear guidance on the optimal duration of antibiotic use in this setting. A study out of France investigated this unknown, with the participation of 410 patients in a randomized controlled trial. The sample population was divided into two treatment arms, with one-half undergoing antibiotic therapy for six weeks and the other one-half continuing for 12 weeks. The primary endpoint was persistent infection within two years of antibiotic discontinuation. After excluding patients who died, were lost to follow up or withdrew consent, the final analysis included 191 patients in the shorter-duration group and 193 patients in the extended-duration group. The main outcome of persistent infection occurred at a rate of 18.1 percent for those receiving treatment for six weeks but only 9.4 percent for those undergoing antibiotic therapy for 12 weeks. Thus, the researchers report, the shorter course of antibiotic treatment failed to demonstrate noninferiority to the longer course.

From the article of the same title
New England Journal of Medicine (05/27/21) Vol. 384, No. 21, P. 1991 Bernard, Louis; Arvieux, Cédric; Brunschweiler, Benoit; et al.
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Google, Hospital Chain Partner in Push to Boost Efficiency
Google Cloud and national hospital chain HCA Healthcare announced an alliance to upgrade medical care efficiency by producing "a secure and dynamic data analytics platform for HCA Healthcare and [enabling] the development of next-generation operational models focused on actionable insights and improved workflows." The partners said they will strive to store medical devices and digital health records with Google Data. The companies also said they aim to design more effective algorithms that will "empower physicians, nurses and others with workflow tools, analysis and alerts on their mobile devices to help clinicians respond quickly to changes in a patient's condition." Privacy and security will be prioritized, as HCA's Jonathan Perlin said identifying data on patient records would be removed before sharing with Google data scientists.

From the article of the same title
The Hill (05/26/21) Lonas, Lexi
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Time to Standardize Training on Blood Pressure Reading, AMA Says
The American Medical Association (AMA) unveiled an initiative to encourage the use of uniform techniques for taking blood pressure (BP) readings to ensure accuracy. The AMA developed three free learning modules on blood pressure measurement techniques intended for use at medical, nursing, physician assistant, medical assistant and pharmacy schools across the country. The association is collaborating with five medical schools to pilot the learning modules in the fall 2021 semester. AMA intends to extend the learning modules to schools nationally in 2022.

From the article of the same title
Becker's Hospital Review (05/26/21) Bean, Mackenzie
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, FACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

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