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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

September JFAS: Read it Online Now

The September/October issue of the Journal of Foot & Ankle Surgery will be arriving in your mailbox next month. It is filled with must-read content, including:

• An illustrated technique guide: First Metatarsal-Cuneiform Arthrodesis for the Treatment of First Ray Pathology
• Six original research articles, including “The Laterality of the Surgical Correction of Forefoot Pathology”
• Seven case reports, including “Open Reduction-Internal Fixation of a Talar Body Fracture via Posterior Tibial Malleolar Osteotomy”
• And the ever-popular “Tips, Quips and Pearls.”

Read the new issue online now, using the web link below.

Got Research? Don't Miss These Deadlines!

2010 Annual Scientific Conference Posters: Applications and abstracts must be submitted by October 1.

2009 Clinical and Scientific Research Grant: Application deadline is October 15.

Applications and information are available via the web link, below.

Display Your Status with the ACFAS Member Logo

You've worked hard to achieve status as an ACFAS Fellow or Associate member. And patients want to know the qualifications of the doctor they choose.

Demonstrate your prestige by using the ACFAS member logo on your business card, practice stationery, web site, advertisements and brochures. Logos, available in a variety of formats for print and web use, can be downloaded via the web link, below.
ACFAS Is In the News…and You Can Be, Too!

"Five Signs Your Child May Have a Foot Problem," the latest ACFAS news release, advises parents not to ignore a child's irregular gait or inability to participate in physical activities. The release was distributed last week by the ACFAS PR department, and has been carried by over 100 print and internet news outlets.

You can put yourself in the news with this same story by using the pre-formatted ACFAS customizable news release and distributing it to your local news outlets. Download the fill-in-the-blanks release today using the web link below.

Foot and Ankle Surgery

Extensor Hallucis Longus Tendon Injury in Taekwondo Athletes

Extensor hallucis longus (EHL) tendon injuries can occur in taekwondo athletes when performing hyperplantarflexed barefoot kicking exercises. A state of full excursion of the extensor tendon is used to strike opponents in which the metatarsal bone and the proximal phalanx area is in contact with the opponent. Foot and ankle specialists from the Eulji Hospital in Seoul, Korea, examined the incidence of extensor hallucis longus tendon injury in taekwondo athletes. Fifty athletes from the Korean taekwondo national team and a control group of 50 healthy subjects took part in the study. Differences in the American Orthopaedic Foot and Ankle Society scores were noted with the control group at 92.95+/-9.18, and the experimental group score at 88.45+/-10.93 (p<0.01). Only one person (one tendon) from the control group demonstrated changes on sonography (2 percent), while 10 subjects from the taekwondo group displayed changes in 16 tendons (20 percent). EHL thickness of the experimental group (1.52+/-0.16 mm) was greater and the control group (1.46+/-0.11 mm) (p<0.01). The researchers concluded that Taekwondo athletes have a higher incidence of changes on sonographic imaging of the EHL compared to non-taekwando participating healthy subjects.

From the article of the same title
Physical Therapy in Sport (08/01/09) Lee, KT; Choi, YS; Lee, YK; et al.

Resurfacing Tophaceous Gout in the Foot With Anterolateral Thigh Flap

Researchers report the case of a 46-year-old patient who suffered from huge tophus masses involving the metatarsal joints of the big toes of both feet, with infection and skin necrosis secondary to chronic tophaceous gout. Following conventional curettage and debridement of each lesion, a free anterolateral thigh flap (ALTF) was used to resurface the circumferential wound, protect the underlying structures, and provide a gliding surface for the exposed tendons. The researchers concluded that ALTF was a viable option for the coverage of necrotic skin over tophi after adequate debridement.

From the article of the same title
Microsurgery (08/07/09)

Vacuum Assisted Closure (VAC) in the Treatment of Advanced Diabetic Foot

Deep diabetic foot lesions pose a large therapeutic problem. Researchers in this study presented their experience with the use of vacuum assisted closure (VAC) in the treatment of advanced and complicated diabetic foot lesions. Five cases of advanced diabetic foot that were treated with VAC. Foot salvage was achieved in all cases. The median number of changes of VAC was 16 within a median period of 8 weeks. Half of the changes were performed as an outpatient procedure.

From the article of the same title
Cirugia Espanola (08/13/09) Dzieciuchowicz, L.; Espinosa, G.; Grochowicz, L.

Practice Management

Doctors' Orders: Avoid Insurance

Many physicians, tired of patient overload and filing claims, are minimizing insurance-based coverage and offering round-the-clock service for a retainer. In a retainer practice, patients are charged an annual fee ranging from $1,500 to as high as over $10,000 for round-the-clock access to physicians, sometimes including house calls. Services included in the membership include annual physicals, preventive care programs, and hospital visits.

From the article of the same title
CNNMoney (08/17/09) Kavilanz, Parija B.

Physician Groups Earn Over $25 million for Quality Improvements

The Centers for Medicare & Medicaid Services (CMS) has announced that all 10 physician practice groups participating in the Physician Group Practice Demonstration accomplished benchmark performance on at least 28 of the 32 measures in the program’s third year. The program is designed to reduce growth in Medicare spending and includes quality measures for a number of chronic diseases. The groups earned over $25 million in incentive payments as a result of savings to the Medicare program. CMS noted that the groups had increased their quality scores since the program began. Several leaders of the groups noted that they have also developed new approaches to care as a result of participation, which has resulted in additional savings.

From "Medicare Demonstrations Show Paying for Quality Health Care Pays Off"
Centers for Medicare & Medicaid Services (08/17/09)

U.S. Grants $1.2 billion for Electronic Health Records

The U.S. government has released grants totaling nearly $1.2 billion to help hospitals and other healthcare providers implement and use electronic health records. The grants include $598 million to set up some 70 health information technology centers to help healthcare institutions acquire electronic health record systems and $564 million to develop a nationwide system of health information networks.

From the article of the same title
Reuters (08/20/09)

Health Policy and Reimbursement

Health Premiums Up 95% Since 2000; Income Up 17.5%

Families USA released a report last week which found that the average cost of a family health insurance policy provided by an employer rose 95% between 2000 and 2009. The employee’s share of the cost grew by 143.7, and workers typically paid higher co-pays and deductibles. During the same period, median income rose just 17.5%.

From the article of the same title
Philadelphia Inquirer (08/20/09) Burling, Stacey

Two House Democrats Seek Information from Insurers

Rep. Henry Waxman (D-CA) and Rep. Bart Stupak (D-MI) are asking executives from large health insurers, including Cigna, United and Aetna, to provide detailed information about executive and board compensation, and perks such as conferences and retreats. The two congressman wrote on behalf of the House Energy and Commerce Committee and did not mention the health reform debate in the request. However, many Democrats are referring to health reform as “health insurance” reform and the industry is clearly on the defensive.

From the article of the same title
Wall Street Journal (08/19/09) Bendavid, Naftali; Johnson, Avery

Grand Junction, Colo., Could Be a Model for Healthcare Reform

President Obama's visit to Grand Junction, Colo., for a town hall meeting signals the community's reputation for quality healthcare at a low cost, as indicated in a recent report by The Dartmouth Atlas of Health Care. According to the report, Grand Junction does not have an integrated system and most of its healthcare payers and providers are unaffiliated, just like the majority of the country, yet the community boasts "consistently excellent patient outcomes at relatively low cost." In 2006, average Medicare spending per capita in the city was $5,900, approximately 30 percent lower than the national average of $8,300.

The report highlights four lessons the community offers for national reform: 1) "aligned incentives help drive providers to work together" to better serve patients and the community, driven by the view held by local leaders that their interests and the community's are the same; 2) use of information systems and data sharing to enable evidence based collaboration on complex and high cost cases among institutions and clinicians; 3) collaboration among complementary institutions pursuing their comparative advantages rather than competition; and 4) the involvement of primary care physicians in all levels of treatment throughout a patient’s life.

From the article of the same title
Christian Science Monitor (08/15/09)

Technology and Device Trends

First Embryonic Stem-Cell Trial Placed on Hold by FDA

The FDA has put a clinical hold on Geron's prospective trial to treat spinal cord injury using embryonic stem cells. According to the company, the hold was placed after data was submitted to the FDA on preclinical animal studies to support delivery of increased doses of the cell product as well as the use of the product in the treatment of other neurodegenerative diseases. Neither the FDA nor Geron has released details regarding the reasons behind the hold, but Burnham Institute Prof. Evan Snyder offered several possible answers. According to Snyder, who was not privy to any unreleased information, the FDA may need more time to review the newly submitted data or the agency may have observed some indication of an adverse event in the preclinical testing. Snyder suggests that the most likely answer may be that, given the company is attempting to make larger doses of the cells, there may have been undifferentiated or non-neural cells observed in the cell product.

From the article of the same title
Nature (08/19/09) Baker, Monya

Medical Imaging Under the Gun in Health-Reform Push

Proposed by the White House and being pushed in the U.S. Congress are health-reform proposals that could significantly affect business for medical imaging equipment manufacturers by reducing Medicare payments to doctors and limiting the number of scans carried out. A June 2008 report from the Government Accountability Office (GAO) estimated that Medicare spending for physician imaging services more than doubled to $13.8 billion between 2000 and 2006. Health-reform bills in the House of Representatives would increase the assumed rate at which computed tomography scanners, magnetic resonance imaging scanners, and similar machines are used from 50 percent to 75 percent. The House plan also urges a contraction in government payments for additional scans performed on nearby body parts.

From the article of the same title
Dow Jones Newswires (08/14/09) Kamp, Jon

Near-Infrared Fluorescence Venography: A Navigation System for Varicose Surgery

Successful varicose vein surgery depends on accurate assessment and identification of veins. Researchers here report their clinical experiences with a simple, rapid method of detecting varicose veins using indocyanine green (ICG) fluorescence video venography, which was injected into the great saphenous vein at the ankle or into the ligated end of veins in 20 patients with varicose veins and used as the optical tracer agent. The researchers found that the method enabled easy, safe, and accurate diagnoses, simplified the search for veins during the operation, and minimized surgical invasiveness in varicose vein surgery.

From the article of the same title
Dermatologic Surgery (08/05/09) Kikuchi, M.; Hosokawa, K.

Secrets of the Sandcastle Worm could Yield a Powerful Medical Adhesive

Researchers have replicated the natural glue secreted by sandcastle worms when building their homes in intertidal surf in an effort to develop a long-sought medical adhesive needed to repair shattered bones. "This synthetic glue is based on complex coacervates, an ideal but so far unexploited platform for making injectable adhesives," says Russell Stewart, PhD, a bioengineer at the University of Utah in Salt Lake City. The traditional method of repairing shattered bones is to use mechanical connectors for support until they can bear weight. But achieving and maintaining alignment of small bone fragments using screws and wires is challenging, says Stewart. For precise reconstruction of small bones, health officials say that a biocompatible, biodegradable adhesive could be valuable because it would reduce metal hardware in the body while maintaining proper alignment of fractures. The new glue, according to Stewart, is at least as strong as Super Glue and twice as strong as the natural adhesive it mimics. Stewart's work is now focused on delivering bioactive molecules in the adhesive that could allow it to fix bone fragments and deliver treatments to the fracture site.

From the article of the same title
ScienceDaily (08/17/09)

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August 26, 2009