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This Week's Headlines

News From ACFAS
Foot and Ankle Surgery
Practice Management
Health Policy and Reimbursement
Technology and Device Trends

News From ACFAS

Joint Commission Seeks Feedback on Surgery Protocol

The Joint Commission invites practitioners in accredited organizations to complete an online survey on changes implemented in January to its universal protocol for preventing wrong site, procedure or person surgery. The commission wants feedback on whether organizations were able to implement the changes to the protocol, and the effect on patient care and internal processes. No additional changes to the protocol are planned in the near future. The survey is open through September 10 and takes an estimated 10 minutes to complete.
Focus Your Research Interest with Free Podcast

“How to Write a Grant Proposal” is the latest free podcast from ACFAS eLearning. If you’re interested in research, but have questions on how to proceed, this discussion by a panel of experienced educators and researchers will give you valuable advice on how to sort out the necessary elements of a research proposal.

“Writing a good research proposal is the first step in securing funding for a worthy project,” says podcast host Paul J. Kim, DPM, FACFAS. “Further, it focuses global ideas into specific, concrete objectives.”

Several of the panelists are also ACFAS Scientific and Clinical Research Grant awardees. Utilize their expertise for your own research project and submit a proposal for consideration for the 2010 grant! Applications and more information are available on the ACFAS website. The deadline for proposal submission is October 15.
Quick Reads on Current Research

Catch up on research in journals you may not usually read with ACFAS’ Scientific Literature Reviews. Article abstracts are prepared specifically for foot and ankle surgeons by podiatric residents. Some of the latest are:

Anterior Transplantation of the Posterior Tibial Tendon for Persistent Palsy of the Common Peroneal Nerve, from the Journal of Bone and Joint Surgery (American).
Reviewed by Evan Cichelli, DPM, Roxborough Memorial Hospital.

Long-Term Follow-up of Toenail Onychomycosis Caused by Dermatophytes After Successful Treatment With Systemic Antifungal Agents, from the American Academy of Dermatology, Inc.
Reviewed by Samuel Feinberg, DPM, OCPM/UHHS Richmond Medical Center.

Read these and many more reviews on the ACFAS website.

Foot and Ankle Surgery

Antibiotic-Resistant Bacteria Moving From South Asia to U.S.

A gene mutation that makes some bacteria resistant to almost all antibiotics is being found in patients in the United States who got medical care in India and Pakistan, where the mutation is more common. Experts are worried that the mutation, called NDM-1, could spread globally. However, they also note that there are numerous strains of antibiotic-resistant germs, and although they have killed many patients, none have yet lived up to the “superbug” hyperbole that greets the discovery of each new one.

From the article of the same title
New York Times (08/11/10) McNeil Jr., Donald G.

Researchers Study Incidence of MRSA in Patients Undergoing Elective Orthopaedic Surgery in MRSA Carrier vs. Non-carrier

Surgical site infection has been identified as one of the most important preventable sources of morbidity and mortality associated with medical treatment. Researchers evaluated the feasibility and efficacy of an institutional prescreening program for the preoperative detection and eradication of both methicillin-resistant and methicillin-sensitive Staphylococcus aureus in patients undergoing elective orthopaedic surgery. A universal prescreening program employing rapid polymerase chain reaction analysis of nasal swabs, followed by an eradication protocol of intranasal mupirocin and chlorhexidine showers for identified carriers, was implemented.

During the study period, 7019 of 7338 patients underwent preoperative screening before elective surgery; 22.6 percent of the patients were identified as Staphylococcus aureus carriers and 4.4 percent were identified as methicillin-resistant Staphylococcus aureus (MRSA) carriers. A significantly higher rate of surgical site infection was observed among methicillin-resistant Staphylococcus aureus carriers compared with noncarriers. Although a higher rate of surgical site infection was also observed among methicillin-sensitive Staphylococcus aureus carriers compared with noncarriers, the difference did not achieve significance. Overall, thirteen cases of surgical site infection were identified during the study period, for an institutional infection rate of 0.19 percent. This rate was significantly lower than that observed during the control period: 0.45 percent.

From "Institutional Prescreening for Detection and Eradication of Methicillin-Resistant Staphylococcus aureus in Patients Undergoing Elective Orthopaedic..."
Journal of Bone and Joint Surgery (American) (08/01/10) Vol. 92, No. 9, P. 1820; Kim, David H.; Spencer, Maureen; Davidson, Susan M.; et al.
Web Link - May Require Paid Subscription | Return to Headlines

Interposition Arthroplasty in the Treatment of Hallux Rigidus

Researchers evaluated the outcomes of interposition arthroplasty performed for the treatment of hallux rigidus. The study included 19 feet of 17 patients. According to the American Orthopaedic Foot and Ankle Society (AOFAS) scale, the results were excellent in seven feet (36.8 percent), good in nine feet (47.4 percent), and fair in three feet (15.8 percent). The mean total AOFAS score increased by 24.6 points postoperatively, while the mean range of motion of the first metatarsophalangeal (MTP) joint improved significantly from preoperative to postoperative degrees. The mean joint space width of the first MTP joint was 1.0+/-0.3 mm (range 1 to 2 mm) preoperatively, it increased to 3.0+/-1.1 mm (range 1 to 5 mm) on final radiographs. The mean hallux valgus angle decreased from preoperative 13.8 degrees (range 9 degrees to 17 degrees) to postoperative 10.2 degrees (range 4 degrees to 13 degrees), and the mean intermetatarsal angle increased from preoperative 10.5 degrees (range 8 degrees to 14 degrees) to postoperative 11.2 degrees (range 8 degrees to 15 degrees). Patient satisfaction levels were very good in nine feet (47.4%), good in seven feet (36.8%), moderate in one foot (5.3%), and poor in two feet (10.5%). Complications included metatarsalgia aggravated by long walks, hypoesthesia of the big toe, and loss of ground contact of the big toe. The push-off power of the big toes was measured as 3/5 in five cases, 4/5 in 11 cases, and 5/5 in three cases. None of the patients developed infection or osteonecrosis postoperatively.

From the article of the same title
Acta Orthopaedica et Traumatologica Turcica (08/01/10) Vol. 44, No. 2, P. 143; Ozan, F.; Bora, O. A.; Filiz, M. A.; et al.
Web Link - May Require Paid Subscription | Return to Headlines

Practice Management

Doctors and Hospitals Team Up for Payment Reform

Across Texas, hospital systems are scooping up physician groups and solo practitioners to create the kinds of coordinated medical teams that federal healthcare reform puts a premium on. But some healthcare providers say the push is too much, too soon. They say physician groups are cashing in their chips for fear of being left behind and that hospitals are going on doctor spending sprees without knowing if or how these new medical teams will work.

From the article of the same title
Texas Tribune (08/09/10) Ramshaw, Emily
Web Link - Publication Homepage: Link to Full Text Unavailable | Return to Headlines

Payers Pave Way to Provider EHRs

Physicians facing a 2015 federal deadline for upgrading to electronic health record (EHR) systems are finding that many insurers are eager to help with technology and financing. Next year, for example, some hospitals in California and Georgia may be eligible to borrow funds from WellPoint, while Humana recently announced that it would subsidize the implementation cost of athenahealth's EHR service for eligible physicians. UnitedHealthcare, meanwhile, has unveiled a program that will provide outcomes-based financial incentives to physicians who have successfully adopted EHR systems that meet meaningful use criteria.

From the article of the same title
HealthLeaders Media (08/11/10) Nucci, Cora

Managing EHR Privacy: Sensitivity Training

Information technology in current use is incapable of providing the level of privacy protection that some patients may desire, which is where the Tiger Team comes in. The team is a special work group of the Health IT Policy Committee, which was created under the American Recovery and Reinvestment Act of 2009 to advise HHS on healthcare policy matters. In an Aug. 3 meeting, the Tiger Team addressed the issue of the release of entire patient records in a directed exchange and considered whether the presence of particularly sensitive information in a patient's record should trigger a requirement that the patient's consent be obtained before the information is shared. The answer they came up with was no.

From the article of the same title
Modern Healthcare (08/12/10) Conn, Joseph

Health Policy and Reimbursement

21 Senators Ask CMS to Fix ASC Update

A bipartisan group of 21 senators has asked CMS to fix the ambulatory surgery center payment update. In a letter submitted to CMS Administrator Don Berwick, the lawmakers asked CMS to use the hospital market basket, the index used for payment updates to hospital outpatient departments, instead of the Consumer Price Index for all Urban Consumers (CPI-U) to update ASC payments in 2011.

From the article of the same title
Outpatient Surgery (08/07/10) O'Connor, Dan

Healthcare Reform to Extend Medicare's Life by 12 Years

With the passage of the healthcare reform law, the financial future of Medicare has improved, according to the White House. Projections estimate Medicare will remain solvent through 2029, 12 years longer than expected. Medicare Chief Actuary Richard Foster said previously that the healthcare reform law could save the program $575 billion over 10 years. Moreover, Medicare Part B payments for outpatient services will now account for 2.5 percent of the nation's economy in 75 years, down from the earlier projection of 4.5 percent. However, much of the savings depend on a 21 percent decrease in Medicare reimbursements for doctors beginning in December.

From "Report Finds Healthcare Reform to Extend Medicare's Life by 12 Years"
The Hill (08/05/10) Lillis, Mike

Study: Medical Errors Cost Nation Almost $20B Each Year

Preventable medical errors cost the United States at least $19.5 billion in 2008, according to a report published by the Society of Actuaries. More than half of the costs were associated with just five avoidable medical injuries: pressure ulcers; post-op infections; mechanical troubles with devices, implants or grafts; post-laminectomy syndrome; and hemorrhages. The report was released as lawmakers are hoping to rein in the skyrocketing cost of healthcare by reducing waste and linking provider payments more closely to the quality of care delivered.

From the article of the same title
The Hill (08/09/10) Lillis, Mike

Technology and Device Trends

Crucial Milestone in Quest for Lifelong Joint Replacement Devices

Joint replacement devices that last a lifetime are closer to reality thanks to recent breakthroughs involving specialized nanodiamonds. Researchers at the University of Alabama at Birmingham, armed with funding from the National Institutes of Health, have worked to refine a process to adhere a self-designed coating consisting of nanodiamonds to cobalt chromium, the metal most commonly used in joint replacement devices. The nanodiamond coating is tough, yet smooth. Once adhered to the metals of a joint implant device, it is intended to last for the life of the device while reducing friction and saving wear and tear on the joint replacement’s moving parts.

From the article of the same title
Newswise (08/09/10)

MIT Diabetes Device Monitors Glucose With Light

A team of Massachusetts Institute of Technology (MIT) researchers are working to develop a glucose monitor for diabetes patients that would eliminate the need for finger pricks. The laptop-size device scans the user's arm or finger with near-infrared light through the use of Raman spectroscopy, which determines chemical compounds based on molecular vibration. The light is fired into the skin, penetrating only about half a millimeter to reach the interstitial fluid around the skin cells without reaching the blood itself. Glucose is represented in the interstitial fluid, but there is a delay of up to 10 minutes between the time glucose spikes in the bloodstream and when it surges in the fluid. The MIT researchers also developed an algorithm and a calibration method to predict blood glucose based on measurements of the interstitial fluid. The team described their device in a paper published in Analytical Chemistry.

From the article of the same title
CNet (08/10/10) Hornyak, Tim

Molecular Bandit Keeps Pain at Bay

The Aug. 4, 2010, issue of the Journal of Neuroscience details the discovery of an enzyme that blocks chronic pain by researchers at the University of North Carolina (UNC) at Chapel Hill. The enduring suppression of pain by proprostatic acid phosphatase (PAP) is facilitated when the enzyme siphons off the PIP2 molecule, which plays a key role in the chemical cascade underlying chronic pain. "Essentially PAP robs the cell of PIP2 so pro-pain pathways can't signal as effectively," says Mark J. Zylka, PhD, with the UNC Neuroscience Center. PAP could potentially deliver prolonged pain relief when administered before nerve injury or inflammation, such as prior to surgery, according to Zylka. The study suggests that the injection of PAP in addition to other pain relievers might reduce post-surgical patients' need for analgesics such as opiates.

From the article of the same title
Newswise (08/02/10)

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August 18, 2010