August 22, 2012

News From ACFAS

Last Call for Research Grant Submissions
Submit now before it’s too late – the due date for applications is rapidly approaching! To earn support for your research with the 2012 ACFAS Clinical and Scientific Research Grant, you must apply by September 1, 2012. Educate your fellow ACFAS members through the implementation of evidence-based medicine in areas related to the betterment of foot and ankle surgery. Fellows and Associate Members can receive up to $20,000 for research in podiatric foot and ankle surgery that will be of interest to members of the College.

The ACFAS Research Committee is encouraging the use of a scoring scale, including the ACFAS Scoring Scale, which has been fully validated by a volunteer ACFAS task force. Find the Scoring Scale, its Validation, the application and more information at Your ACFAS member login is required.
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Ted Kennedy, Jr. to Headline ACFAS 2013
If there’s someone who understands the American healthcare system, as both a patient and from the political perspective, it’s Ted Kennedy, Jr. He’s a cancer survivor himself, while his father’s U.S. Senate career was devoted to healthcare access to all Americans. For those reasons, he will be the keynote speaker at the ACFAS 2013 Annual Scientific Conference on February 11-14 in Las Vegas, Nevada.

His topic, “Facing the Challenge,” will probe the issues that come into play when today’s physician strives to provide compassionate, optimal, patient-focused care.

The ACFAS 2013 program and hotel registration will be unveiled in early September. Hotel rates will be $139 at the Mandalay Bay Hotel or $169 for rooms at “The Hotel” at Mandalay Bay.
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Congratulations Class of 2012! Your First Year of Membership is on Us
The ACFAS Regional Divisions will continue to support first-year podiatric surgical residents by providing complimentary first-year membership in the College. This offer provides the benefits of membership with dues waived for one year. This is a direct value of $116, plus additional savings through member pricing on conferences, products and services.

Kick-start your career with ACFAS! We connect residents to a community of your peers — the best and brightest foot and ankle surgeons in the country. You will have access to the College’s premiere website, and a subscription to the prestigious online Journal of Foot and Ankle Surgery (JFAS) — a must-have to increase your knowledge of the latest surgical techniques and research.

Applications for membership are available through the ACFAS website. Apply now and get JFAS in your mailbox that much sooner!

Once again, congratulations to the Class of 2012. The ACFAS Regional Divisions look forward to welcoming you to the College.
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Save Time While Reading the Latest in Research
Your busy schedule may keep you from reading through multiple journals of research, but not to worry! In just a few minutes you can catch up with ACFAS’ Scientific Literature Reviews. These abstracts have been prepared for active foot and ankle surgeons by podiatric residents. Some of the latest are:Find a variety of abstracts to feed your interests at
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Foot and Ankle Surgery

Clinical Comparison of the Osteochondral Autograft Transfer System and Subchondral Drilling in Osteochondral Defects of the First Metatarsal Head
A study compared the osteochondral autograft transfer system (n = 10) with subchondral drilling (n = 14) for treatment of osteochondral defects of the first metatarsal head. Clinical results were assessed according to a visual analog scale (VAS) for pain, the AOFAS hallux metatarsophalangeal-interphalangeal scale and the Roles and Maudsley score. Significant improvement in the VAS was observed in both groups.

No difference was seen between the two groups at final follow-up. The first group's average AOFAS score improved from 62.9 ± 5.8 to 73.2 ± 8.2, while the second group's score improved from 65.0 ± 4.1 to 81.5 ± 5.8. A defect size larger than 50 square mm was associated with worse VAS and AOFAS scores in the first group while this association was not found in the second group. Neither group revealed an association between the site of the defect area and clinical outcome.

From the article of the same title
American Journal of Sports Medicine (08/01/12) Vol. 40, No. 8, P. 1824 Kim, Young Sang; Park, Eui Hyun; Lee, Ho Jin; et al.
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Functional Outcome After Air-Stirrup Ankle Brace or Fiberglass Backslab for Pediatric Low-Risk Ankle Fractures
A randomized, single-blinded, noninferiority controlled trial was held to assess the effectiveness of the below-knee fiberglass posterior splint compared to that of the Air-Stirrup ankle brace in returning children with a low-risk ankle fracture to their normal level of activity over a four-week period. The Activities Scale for Kids performance (ASKp) outcome tool was employed to quantify physical functioning over the four-week interim, and the primary outcome was ASKp scores at two and four weeks with secondary results including pain, weight-bearing ability and acceptability of device. Twenty-three patients were randomized to the posterior splint group and 22 to the Air-Stirrup ankle brace group. Ninety-six percent of the posterior splint group were non-weight bearing "at enrollment," versus 77 percent of the ankle brace group. At four weeks, the average ASKp score was 91.9 in the brace group and 84.2 in the posterior splint group. ASKp scores and disparities were favorable toward the brace in the 11- to 15-year age group at two weeks and four weeks but trended toward the posterior splint in the 5- to 10-year age group.

From the article of the same title
Pediatric Emergency Care (08/12) Vol. 28, No. 8, P. 745 Barnett, Peter Leslie John; Lee, Melissa H.; Oh, Luke; et al.
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The Lateral Dorsal Cutaneous Branch of the Sural Nerve: Clinical Importance of the Surgical Approach to Proximal Fifth Metatarsal Fracture Fixation
A study was held to bring attention to the percutaneous surgical approach to Jones fracture fixation and corresponding anatomy by characterizing the site of the lateral dorsal cutaneous nerve (LDCN) and its branches relative to the base of the fifth metatarsal and to the standard lateral approach. The study involved 10 cadaveric foot specimens dissected at the lateral aspect of the foot over the proximal fifth metatarsal, followed by identification of the LDCN and its branches. The distance between the LDCN and the superior border of the peroneus brevis tendon was measured relative to standard reference points in all specimens, and the presence of an anastomotic branch was observed. A set of vertical and horizontal reference lines also were constructed to ascertain whether a standard lateral approach would compromise the LDCN or its branches. The LDCN was lateral and inferior to the superior border of the PBT in all specimens and at all reference points. The researchers identified a bifurcation of the LDCN in eight specimens, and located a median of 18 mm posterior and 11 mm dorsal to the base of the fifth metatarsal. The dorsolateral branch and dorsomedial branch of the LDCN each intersected with the base of the fifth metatarsal horizontal line and vertical line, respectively, demonstrating potential compromise of the nerve with a standard lateral surgical approach.

From the article of the same title
American Journal of Sports Medicine (08/01/12) Vol. 40, No. 8, P. 1895 Fansa, Ashraf M.; Smyth, Niall A.; Murawski, Christopher D.; et al.
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Practice Management

5 Keys to Bridging the Mobile-Desktop Divide
Physicians continue to rely primarily on desktops for practice management, despite the ever-increasing availability and popularity of mobile devices and apps. A recent survey showed that 75 percent of physicians use desktops for practice management, while only 6 percent use smart phones and 10 percent use tablets. Five critical issues should be addressed in the mobile market to help bring physicians into the fold. These five keys include making relevant healthcare apps available on mobile devices, offering speech recognition technology, using a hybrid strategy that allows a gradual transition from desktops to mobile devices, demonstrating a value-add and educating physicians on state-of-the art apps.

Many apps that physicians use on a desktop are not readily available on iPhones or iPads. While some workarounds exist, the process is awkward and frustrating to many physicians. Speech technology, especially dictation and speech-based documentation, would encourage physicians to embrace mobile devices. Physicians have traditionally used cell phones for documentation, so moving this functionality to a mobile device and then gradually adding more functionality is a logical evolution. Another important step is using a hybrid strategy that allows physicians to continue using desktops for editing and reviewing material and mobile devices for capturing information on the go. Requiring physicians to transition entirely to mobile devices all at once is not likely to be successful.

Physicians must also understand the value of using the mobile device instead of the desktop for work purposes. While physicians widely use and appreciate mobile devices in their private lives, many do not see the advantage of using them over the desktop in a hospital or office setting. Mobile apps are not filling a need that physicians are aware of, or the apps are too awkward to use. Finally, education on current mobile apps is essential, because many physicians had negative experiences with mobile technology when it was first introduced and are not aware of the usability and usefulness of today’s improved applications.

From the article of the same title
Healthcare IT News (08/01/12) McNickle, Michelle
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Having a Trainee Surgeon in Operations Is Safe: Study
A new U.S. study detailed in the Annals of Surgery found that a patient's risk of serious complications during surgery appears to be no greater than normal with the participation of a trainee surgeon in the operation, based on data from over 60,000 surgeries performed between 2005 and 2007. Slightly less than 6 percent of patients were determined to have suffered a major complication such as severe bleeding or a serious infection when a resident was involved in surgery, and the rate was identical for procedures without resident participation. "This shows that resident participation is safe," says lead study author Ravi Kiran at Ohio's Cleveland Clinic.

From the article of the same title
Reuters (08/15/12) Norton, Amy
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Suspect Embezzlement? Here's What to Do
When a medical practice suspects the perpetration of embezzlement by employees, the suspicion should first be confirmed before contacting law enforcement. Accusing an employee of a crime before evidence has been amassed could potentially hurt workplace morale, as well as give an embezzler an opening to destroy proof. Medical practice consultants say the first step in proving embezzlement is to back up any relevant electronic data and make photocopies of crucial paperwork. This may prevent evidence from disappearing before an investigation can be completed, if embezzlement is an ongoing issue. The next step is to discreetly get in touch with a lawyer, certified fraud examiner, or forensic accountant to discuss any suspicions. These experts can be contacted via their relevant professional associations. The idea is to have some kind of probe to determine where money is going. The investigation may yield evidence that an employee is not necessarily stealing from the practice, but simply failing to fulfill their responsibilities.

If there is indeed theft transpiring at the practice, then the probe will most likely shed light on processes that permit the commission of embezzlement. Issues that may surface include whether appropriate checks and balances for handling cash require deployment at the practice, the processes for reconciling accounts and how the practice should augment money-handling protocols. If following these steps fails to get the practice back on financial track, then notifying law enforcement or the economic crime division of your attorney general's office may be appropriate. However, this step should mainly be followed if there are significant sums of embezzled money involved, and the practice also should be prepared to present any collected evidence. One consultant says it may not be worth the practice's while to press charges to recover, say, a few hundred dollars in embezzled money, but the practice may want to take steps to protect itself and other practices that may hire the embezzler in the future. Any dialogue with the alleged embezzler should occur with several persons present to lower the risk of provoking a charge of unfair dismissal or physical violence.

Practices may be able to recover some of the embezzled money following settlement of criminal prosecution issues, as criminal courts may mandate that the perpetrator pay back money as restitution. Numerous practices have insurance policies that shield against worker dishonesty, and insurers are the most probable sources for any retrieved funds.

From the article of the same title
American Medical News (08/13/12) Elliott, Victoria Stagg
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Health Policy and Reimbursement

CMS Asks for ICD-10 Readiness Comments
The Center for Medicare and Medicaid Services (CMS) is seeking comments on ICD-10 readiness, according to a notice published in the Federal Register. The ICD-10 readiness assessment will look to understand the progress of the different sectors impacted by ICD-10 such as providers and payers. Additionally, it will “determine what communication and educational efforts can best help affected entities obtain the tools and resources they need to achieve timely compliance with ICD-10.” The agency says this is only for educational purposes, not for making policy decisions.

From the article of the same title
Healthcare Informatics (08/12)
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New Mass. Law Changes Malpractice Procedures
A new Massachusetts law revamps the state's approach to cases of medical malpractice by requiring doctors who commit errors during treatment to disclose their mistakes and permitting them to apologize to patients without facing litigation. The revisions include the establishment of a 182-day "cooling-off" period as both sides try to arrive at a settlement, requiring the plaintiff and defendant to share information and letting healthcare providers acknowledge making an error without it being used as an admission of liability. Furthermore, patients who are legitimately injured by a nonprofit hospital and not a doctor or nurse will be entitled to maximum compensation of $100,000, up from $20,000.

From the article of the same title
Associated Press (08/14/12) Young, Shannon
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Medicine, Drugs and Devices

Foot, Ankle 3-D Imager Faces Hurdles
Curve Beam's pedCAT is a weight-bearing computed tomography (CT) scanning device designed to better diagnose foot and ankle problems. It was granted 510(k) clearance from the U.S. Food and Drug Administration earlier this year. The device employs cone beam CT to produce three-dimensional images. As with many new technologies, reimbursement has become a vexing problem, and it is CurveBeam's biggest challenge for getting pedCAT into the offices of orthopaedic surgeons and podiatrists. It has hired a CT reimbursement expert to assemble tip sheets for medical professionals to help guide them on the best ways to submit a claim. But Medicare reimbursement poses an even bigger challenge. As of the start of the year, Medicare requires a device to be "accredited before it will reimburse scans." United Healthcare has also adopted this guideline. As part of the accreditation guidelines, physicians are required to interpret the scans, and a radiology technician is required to act as the operator of the device. Although that is not a problem in hospitals and large medical centers, CurveBeam's target market includes podiatrists, who do not have medical degrees.

From the article of the same title
MedPage Today (08/08/12) Baum, Stephanie
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Medicare to Require Prior Authorization for Power Wheelchairs
The Centers for Medicare & Medicaid Services (CMS) has launched a three-year Medicare demonstration project that will require doctors in seven states to receive prior authorization before they prescribe power wheelchairs and scooters to their patients. Under the program, physicians in California, Florida, Illinois, Michigan, New York, North Carolina and Texas who want to prescribe power mobility devices to their patients would have to send authorization requests and supporting documentation to a Medicare contractor, which will check to see if the request complies with national and local coverage requirements. If the request is approved, an authorization number will be given to the power mobility device supplier to complete the order, but if the request is denied, the contractor will ask the physician for more information and will perform an additional review within 20 days. The introduction of the demonstration project, which has been criticized by the American Medical Association and others, comes amid high rates of Medicare fraud involving power wheelchairs.

From the article of the same title
American Medical News (08/13/12) Fiegl, Charles
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No More Skipping Your Medicine -- FDA Approves First Digital Pill
The U.S. Food and Drug Administration has approved a first-of-its-kind silicon chip that is designed to be implanted in placebo pills and ingested by patients so that physicians can tell if they are taking their medications. The chip, which is made by Proteus Digital Health, produces a voltage after it interacts with the patient's digestive juices. The voltage produced by the chip can be read from the surface of the patient's skin through a detector patch, which in turn uses a mobile phone to send a signal to the physician to inform him whether the patient has taken his medication or not. The sensor is also capable of reading the patient's heart rate and estimating his level of physical activity, which can help doctors determine whether or not they need to alter the dosage of the drug being taken by the patient.

From the article of the same title
Forbes (08/09/12) Murray, Peter
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