News From ACFAS

---

As part of ACFAS' live educational events designed to help teach the As to Zs of research, the College has kicked off two new research resources—a new virtual ACFAS Journal Club series and a webinar series.

With the ACFAS Journal Club, you can join us weekly for a 45-minute session hosted by Andrew Crisologo, DPM, AACFAS or Elizabeth Ansert, DPM and presented by various ACFAS research experts. The ACFAS Journal Club is open to all students and residents and will review noteworthy articles on pertinent topics in research. Join us for the next installment:

Forefoot Reconstruction
June 11, 7pm CT
Hosted by Unity Point Hospital
Presented by Sean Grambart, DPM, FACFAS and Ryan Prusa, DPM
Register

The ACFAS Research Webinar Series covers various areas of research from basic topics to formulating a topic and IRB submission to meeting and speaking with research experts to get all of your burning research questions answered.

Manuscript Preparation
Thursday, June 4, 8pm CT
Presented by Emily Zulauf, DPM and James Connors, DPM, FACFAS
Register

Check out all upcoming and past research learning opportunities. Visit acfas.org/journalclub for more information on the ACFAS Journal Club or acfas.org/researchwebinars for upcoming research webinars. The 2021 Call for Manuscripts is coming! The Annual Scientific Conference Program Committee will soon be accepting applications/papers for scientific manuscript presentations at the 79th Annual Scientific Conference, February 25-28, 2021 in Las Vegas. Deadline: Wednesday, September 23rd

Information on submission criteria and applications will be available on the Annual Scientific Conference web page at acfas.org/asc this month, so you have time to start gathering your research submissions. The College is lucky to have the tremendous, unwavering support from our sponsors. Their generosity makes it possible to provide numerous educational opportunities for foot and ankle surgeons—the Annual Scientific Conference activities, surgical skill courses, symposia and more!

Through these corporate grants and sponsorships, we continue to bring our members the very best in programs and services, cutting-edge education and new learning opportunities allowing you to advance in your career. Browse our Corporate Sponsorship Mall to learn more about our sponsors’ products and services and how they can assist you in your practice. The United States Bone and Joint Initiative (USBJI) Young Investigator Initiative (YII) is now accepting applications for the Fall Workshop October 23-25, 2020 in Toronto. The YII provides early-career investigators an opportunity to work with experienced researchers in our field to assist them in securing funding and other survival skills required for pursuing an academic career.

YII applications are open to promising junior faculty, senior fellows or post-doctoral researchers nominated by their department or division chairs seeking to pursue a career in clinical or basic research. It is also open to senior fellows or residents that are doing research and have a faculty appointment in place or confirmed. Basic and clinical investigators, without or with training awards, are invited to apply. Investigators selected to take part in the program attend two workshops, 12-18 months apart, and work with faculty between workshops to develop their grant applications. The program provides the unique opportunity for attendees to maintain a relationship with mentors until their application is funded.

The application deadline is July 15, 2020. Visit USBJI.org for more information or to apply now.

Foot and Ankle Surgery

---

The study evaluated the efficiency of Orthèse Diabète, a new customized removable knee-high offloading device immobilizing foot and ankle joints, in diabetic foot ulcer (DFU) healing. The study included 112 patients, who were randomly assigned to either Orthèse Diabète or any type of conventional removable offloading device. The primary outcome, which was the 3-month proportion of patients with fully healed DFU, occurred in 33 percent of participants using conventional device and in 35 percent of Orthèse Diabète users. Study groups were also comparable in terms of prespecified secondary end points including occurrence of new DFU, ipsilateral lower-limb amputation or infectious complications. Adverse events were comparable between groups, including 4 deaths unrelated to study allocation. Adverse events believed to be related to the device were higher in the Orthèse Diabète group than in the control group, and Orthèse Diabète was less frequently worn than conventional devices.


The retrospective case series reviewed 27 procedures in 25 patients who underwent minimally invasive nerve decompression as primary surgical management for Morton's neuroma. Postoperative patient satisfaction, complications, and the need for a follow-up neurectomy was ascertained from medical record review. Among the 22 procedures for which there was valid patient satisfaction data, patient satisfaction was excellent for 11, good for two and poor for nine. During the follow up period, five patients required an open neurectomy. Among the six patients who presented without a Mulder's sign on physical exam preoperatively, 83 percent reported excellent results.


The study assessed the diagnostic value of point-of-care bedside ultrasound (PoCUS) in suspected ankle and fifth metatarsal bone fractures, compared to the standard of radiographic imaging. The study included 242 patients presenting to the emergency department with ankle trauma and positive Ottawa Ankle Rules. All patients underwent PoCUS of the ankle by an emergency physician and resulting images were assessed by an ultrasound expert. The sensitivity of PoCUS in detecting clinically significant fractures by all sonographers was 80.0 percent, the specificity was 90.3 percent, the positive predictive value was 70 percent, and the negative predictive value was 94.1 percent. The sensitivity of PoCUS in detecting clinically significant fractures by the expert was 82.8 percent, the specificity was 99.2 percent, the positive predictive value was 96.7 percent, and the negative predictive value 95.3 percent.

Practice Management

---

Succession planning is a critical step for physician owners, but many hold on to false perceptions about the process, which the article aims to dispel. First, it is critical to start succession planning as soon as possible. It is also not necessarily easier to sell the practice than pass it on. Buyers are not necessarily prepared to wait for the right time in a business' life cycle to make an offer, and timing can influence how the practice will be valued. Practice owners should also come to terms with the fact that a successor will not necessarily be ready when they are, as taking on a practice will require a long apprenticeship that prepares them to manage business tasks and business relationships. Finally, it is entirely possible to transfer business ownership to an eventual successor without losing control or income or the continued opportunity to build a legacy.


The US Centers for Disease Control and Prevention (CDC) has updated its COVID-19 guidance. The updated version removes the prior recommendation that all elective procedures be postponed. However, it emphasizes the importance of reducing facility risk by cancelling elective procedures, using telemedicine when possible and managing and screening everyone entering the facility. Symptomatic patients should be isolated as soon as possible, and healthcare personnel should be protected with barriers to limit patient contact at triage and other measures. The guidance notes that person-to-person transmission most commonly happens during close exposure to a person infected with the virus that causes COVID-19, primarily via respiratory droplets produced by speech, coughing and sneezing. In times of equipment shortages, alternatives to N95s should be considered, including powered air-purifying respirators (PAPRs), other classes of disposable FFRs, elastomeric half-mask and full facepiece air-purifying respirators where feasible.


The number of states that require e-prescribing of controlled substances passed the halfway mark in 2019, reaching 26. Electronic prescribing has the potential to make prescriptions much more accurate and curb the misuse of legal controlled substances, but they are also prone to hacking attempts. Regulations are becoming commonplace, but some efforts may be misguided, with regulations outpacing the ability of providers to follow them. This is why e-prescribing systems should be accredited by a third party to ensure compliance with industry standards and government regulations.

Health Policy and Reimbursement

---

Many laid-off workers who lost health insurance in the coronavirus shutdown soon face the first deadlines to qualify for fallback coverage under the Affordable Care Act (ACA). Taxpayer-subsidized health insurance is available for a modest cost or free across the country. For those who lost their health insurance as layoffs mounted in late March, a 60-day "special enrollment" period for individual coverage under the ACA closed at the end of May in most states. The Kaiser Family Foundation estimates that nearly 8 in 10 of the newly uninsured would likely qualify for some sort of coverage under the ACA or Medicaid. People can find those plans on the federal HealthCare.gov or their state's health insurance website. Laid-off workers should be able to get their children covered even if the adults in the family cannot help. The federal-state Children’s Health Insurance Program and Medicaid cover kids in families with incomes well above the poverty level. People can continue their employer coverage under a federal law known as COBRA, but they have to pay 102% of the premium.


A Kaiser Family Foundation poll released on May 27 found that 48 percent of Americans said they or a family member has skipped or delayed medical care because of the pandemic, and 11 percent of those respondents said the person's condition worsened as a result of the delayed care. Since March, hospitals, health systems and private practices dramatically reduced inpatient, nonemergency services to prepare for an influx of COVID-19 patients. According to the poll, nearly 7 in 10 of those who had skipped seeing a medical professional expect to get care in the next three months.


The US Department of Health and Human Services (HHS) has disbursed $72 billion since April to support providers during the COVID-19 pandemic. So far, most of the funds are going to larger, wealthier hospitals. Twenty large recipients have received a total of more than $5 billion in recent weeks, according to an analysis of federal data by Good Jobs First. Those hospital chains were already sitting on more than $108 billion in cash, according to regulatory filings and bond-rating firms. In dispensing funds to hospitals, the HHS devised formulas that favored large, wealthy institutions. While HHS also set aside funding for rural hospitals, the department did not take into account each hospital's existing financial resources. Hospitals that serve a greater proportion of wealthier patients got twice as much relief as those focused on low-income patients with Medicaid or no coverage at all, according to a study this month by the Kaiser Family Foundation.

Medicine, Drugs and Devices

---

The COVID-19 pandemic has put a spotlight on pharmaceutical companies' drug pricing decisions. Gilead Sciences has promised to give away its first production run of the antiviral therapy remdesivir and allow poor countries to make generics. Johnson & Johnson said it would sell its vaccine, now in trials, on a not-for-profit basis. Moderna’s chief executive said "we don't want to maximize profit" on its vaccine. Industry analysts say such efforts do not constitute a sustainable business model: In the long run the companies have to charge prices commensurate with the cost of developing drugs, including those that fail. The question is whether the pandemic proves to the public and politicians the merits of the current pricing system.


Many Medicare recipients could pay less for insulin next year under a deal President Donald Trump announced Tuesday. Medicare recipients who pick a drug plan offering the new insulin benefit would pay a maximum of $35 a month starting next year, a savings estimated at $446 annually. The insulin benefit will be voluntary, so during open enrollment this fall Medicare enrollees who are interested must make sure to pick an insurance plan that provides it. The benefit also offers stable copays for insulin, which come from an agreement shepherded by the administration between insulin manufacturers and major insurers. Medicare estimates that about 60 percent of beneficiaries are already in prescription drug plans that will offer the new insulin benefit.


As COVID-19 induces unprecedented shortages of N95 masks, some are turning to reusable silicone masks called elastomeric respirators, which are just as effective and can be cleaned and reused for years. Studies have found that healthcare workers could be rapidly fitted and trained to use the masks during a pandemic, and last month the US Centers for Disease Control and Prevention published guidance on deploying them in response to the coronavirus. However, only a handful of US hospitals are using the masks widely, and the federal government has made no effort to boost production or facilitate their distribution. Idled industrial facilities likely have elastomerics sitting unused, and more could be produced relatively quickly by repurposing manufacturing lines, according to occupational health experts and industry officials. Elastomerics pose practical challenges, including fitting and cleaning, as well as concerns about the masks' appearance and reluctance to consider alternatives when N95s were cheap and abundant.