September 26, 2012

News From ACFAS

Register for the Diabetic Surgical Symposium
Don’t miss the opportunity to learn the latest cutting-edge approaches in the treatment of the diabetic patient’s foot and ankle at the Diabetic Foot and Ankle Surgical Symposium, October 26-28 in Miami. This program offers a vast array of topics to explore and debate; you will also learn core diabetic planning, approaches and procedures.

Plus, take advantage of the optional wet lab workshop for an additional fee. Learn from a faculty of dedicated physician experts who lead the discussions to enhance your knowledge on diabetic foot and ankle surgery. These experts will share first-hand their cases and experiences related to how they tackle diabetic controversies.

To view the full agenda, learn more about the symposium or register, visit the Diabetic Foot and Ankle Surgical Symposium page.
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Earn CME for New Clinical Session
Attend ACFAS’ online classroom at for the latest in our Scientific Session CME offerings, titled, “The Troublesome Achilles Tendon.” This dynamic online presentation from the educational selections features fellow foot and ankle surgeon speakers who take you inside the mechanics, treatments and solutions concerning the Achilles tendon. The video is available to members and non-members at no cost, and ACFAS members may earn up to 1.25 hours of continuing education credit.

Visit to take advantage of this program to enhance your knowledge on “The Troublesome Achilles Tendon.”
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Foot and Ankle Surgery

Comparison of Early Versus Delayed Weightbearing Outcomes after Microfracture for Small to Midsized Osteochondral Lesions of the Talus
A study was held to compare the clinical outcomes of early and delayed weightbearing following microfracture of small to midsized osteochondral lesions of the talus, using a cohort comprised of 81 ankles in 81 patients with a single osteochondral lesion of the talus treated by arthroscopic microfracture. Forty-one ankles were assigned to a delayed weightbearing (DWB) group while the other 40 ankles were allocated to an early weightbearing (EWB) group. Both groups were comparable with respect to preoperative data, while patients in the DWB group maintained nonweightbearing for six weeks and those in the EWB group were allowed early weightbearing at two weeks, postoperatively. Clinical results were assessed using the AOFAS ankle-hindfoot scale score, visual analog scale (VAS) score for pain and ankle activity score (AAS). The overall average follow-up duration was 37 months. Average AOFAS ankle-hindfoot scores were 64.9 points in the DWB group versus 66.5 points in the EWB group preoperatively, which improved to 89.5 and 89.3 at the final follow-up visits, respectively. Average preoperative VAS scores were 7.3 points in the DWB group and 7.4 points in the EWB group. Scores at final follow-up were 1.9 and 1.8, respectively. Mean AAS in the DWB and EWB groups climbed from three and three preoperatively to six and six at final follow-up, respectively. No significant differences were observed between both groups in terms of the AOFAS score, VAS score and AAS.

From the article of the same title
American Journal of Sports Medicine (09/01/12) Vol. 40, No. 9, P. 2023 Lee, Dong-Hyung; Lee, Keun-Bae; Jung, Sung-Taek; et al.
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Repair of Forefoot Skin and Soft Tissue Defects Using a Lateral Tarsal Flap with a Reverse Dorsalis Pedis Artery Pedicle
A study was held to assess surgical repair of forefoot skin and soft tissue defects through use of a lateral tarsal (LT) flap with a reverse dorsalis pedis artery (DPA) pedicle, focusing on traumatic defects with exposure of the tendon and/or bone involving 11 feet in 11 patients. Tendon grafts were employed to repair the injured tendons, while the free dorsalis pedis flap was outlined by centering it on the cutaneous branch of the LT artery and customizing it to the size of the injury, allowing 0.5 cm margins in length and width. The flap was rotated around the DPA's plantar perforating branch to cover the forefoot defect, and the lateral dorsalis pedis cutaneous nerve was anastomosed with the recipient plantar nerve stump. An inguinal, full-thickness skin graft was utilized to cover the donor site. Emergency repairs were administered to three patients with forefoot defects within eight hours of injury, while eight patients required delayed repair, and all patients were followed-up for a minimum of six months. All flaps survived without incident, with the exception of two that exhibited superficial marginal necrosis or severe venous insufficiency. All skin grafts covering the donor sites survived and all injuries healed. None of the patients showed restricted standing or walking at followups. The two-point discrimination was four mm to 10 mm at six months postoperative, and the average hallux-metatarsophalangeal-interphalangeal scale score was 93 points.

From the article of the same title
Clinical Orthopaedics and Related Research (09/13/12) Fu, Dehao; Zhou, Liyi; Yang, Shuhua; et al.
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The Volume of the Neovascularity and its Clinical Implications in Achilles Tendinopathy
A probe of 37 pathologic Achilles tendons from 27 patients by a three-dimensional power Doppler ultrasound system was conducted to investigate both the volume of the neovascularity (VON) and the volume of Achilles tendon (VOAT). VON-VOAT index (VVI), as the normalization of the neovascularization, was calculated. Relationship between the index, the visual analog scale for pain (VAS) and Victorian Institute of Sport Assessment Achilles (VISA-A) was then evaluated. Neovascularization was found to be present in 97.3 percent of the Achilles tendons. About 56 percent of these Achilles had neovascularity associated with the site of thickening. The VAS was determined to be positively correlated with the VON and the VVI, while the VON was found to be independent from the VOAT.

From the article of the same title
Ultrasound in Medicine and Biology (09/12) Yang, Xin; Coleman, Declan P.; Pugh, Neil D.; et al.
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Practice Management

Electronic Audits Can Prevent, Catch Data Breaches
Electronic health record (EHR) systems, under the security standard of the Health Insurance Portability and Accountability Act, are required to have role-based or context-based access controls, meaning the system will allow users to access only the data they need to perform their job duties. But when employees exploit that access to perform illegal activities, another function of the EHR system — the audit function — is designed to detect the bad behavior.

Audit reports of who looked at what information, when it was seen and for how long is one of the most important tools to help practices catch a data snoop in the act. Experts say every practice, no matter the size, should make auditing a regularly scheduled activity that is articulated clearly to employees and implemented.

From the article of the same title
American Medical News (09/17/12) Dolan, Pamela Lewis
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How to Reach Out to and Recruit Physicians
Recruitment methods for medical practices have changed in recent years, and experts recommend that practices use email to reach out to younger physicians. However, recruiters must ensure the message is specifically tailored to their practice and indicates the type of physician they are looking for so recipients do not flag it as spam or ignore it. Additionally, email recipient lists should be permission-based and acquired from a trusted source. Practices also should make sure their websites are mobile friendly so they can be easily viewed on such devices as iPhones, as would-be hires might lose interest if they cannot access the practice's site from their mobile device or if the practice is not technologically sophisticated. Experts say practices should still use traditional forms of networking -- conferences, career fairs, word of mouth, etc. -- as part of the recruitment process.

From the article of the same title
Physicians Practice (08/15/12) Westgate, Aubrey
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Keeping Medical Practice Staff on Task
Practice managers have a responsibility to help the staff balance their workload while adapting and evolving to technological and business model innovations by focusing on both their daily duties and their transitional responsibilities. Managers should clarify priorities and relay them to staff during times of transition. For instance, before scheduling a training session, the manager should confer with each employee to review their job responsibilities and identify those that take precedence when the office is being run by a skeleton crew. Employees' input should be solicited throughout the process. Setting long-term practice goals and sharing them with staff is also important.

When educating staff to operate new technology, managers should take every opportunity to lessen staff workload while they are training by asking coworkers to pitch in. Although some practices ask their staff to train outside of working hours, a more effective strategy is to set aside a few days or afternoons during the workweek for training. Teaching staff to budget their time is another approach for managers during transitional periods. With this in mind, it may pay to institute a practice-wide policy to keep digital distractions such as social networking sites and mobile devices to a minimum. To avoid distracted doctoring, it is recommended that physicians maintain a separate phone for professional use, deactivate pop-up alerts when they are in the office and exercise appropriate electronic etiquette. In addition, when using handheld devices during sessions with patients, physicians should explain to patients what they are doing and why.

Recognizing the staff's limitations is also critical as the practice undertakes technological upgrades and new projects. Before opting to hire more people, however, the manager should first determine whether job responsibilities can be redistributed among current employees. Managers also should exercise flexibility and not become overly focused on self-imposed deadlines. By exuding an aura of calm, the manager can help staff maintain productivity during the transition. Staff will be more amenable to changes if the manager emphasizes how they will work to the employees' advantage. Managers can help boost staffers' morale during long-term projects by posting a progress report in the break room. Managers also should be ready to address employee concerns quickly and honestly, particularly when they anticipate a worst-case scenario stemming from changes that could potentially threaten their job or income security.

From the article of the same title
Physicians Practice (08/29/12) Schwartz, Shelly K.
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Health Policy and Reimbursement

Medicare Modifier Could Hit Unsuspecting Doctors with Pay Cuts
A proposal by the Centers for Medicare & Medicaid Services (CMS) calls for applying a value-based payment modifier to all physicians practicing in medical groups with 25 or more practitioners, adjusting 2015 Medicare rates through a scoring system that could elevate pay by up to 2 percent or slash it by as much as 1 percent. But the American Medical Association (AMA) and other organized medicine groups warn that many physicians will not have sufficient time to make the changes that might be required to excel under the new payment model before the official commencement of the reporting period on Jan. 1, 2013. In a recent comment letter, AMA CEO James L. Madara said value-based modifiers "are not ready for prime time, and we continue to believe that CMS could and should use the time between now and 2015 to do further testing and refinement of the modifier's components." The AMA urged CMS to apply the modifier only to multispecialty groups with at least 100 physicians in its initial year of implementation.

From the article of the same title
American Medical News (09/17/12) Fiegl, Charles
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PCORI Seeks New Comparative-Effectiveness Projects
A new cycle of funding for as much as $96 million in comparative-effectiveness research is now open, announced the Patient-Centered Outcomes Research Institute (PCORI). This announcement follows PCORI's first funding cycle announcement in May. Both address four of the five focus areas in the organization's National Priorities for Research and Research Agenda: assessment of prevention, diagnosis and treatment options; improving healthcare systems; communication and dissemination and addressing healthcare disparities. An additional PCORI funding announcement, expected this fall, will address the fifth priority: accelerating patient-centered and methodological research.

From the article of the same title
Modern Healthcare (09/17/12) Zigmond, Jessica
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Medicine, Drugs and Devices

Doctors Use EHRs to Do "Chart Biopsies"
A new study in the Journal of the American Medical Informatics Association found that inpatient physicians who get patients from the emergency department (ED) have started to conduct "chart biopsies" of electronic health records (EHRs) to prepare for the handoffs. The study notes that "chart biopsies appear to impact important clinical and organizational processes," including "the nature and quality of handoff interactions and the quality of care." The study focused on general internal medicine physicians and surgeons who received patients from the ED at the University of Michigan Health System over two years, and who had access to EHRs for inpatient and outpatient documentation as well as records used in the ED; when ED physicians and nurses inputted data into their EHR, the inpatient physicians could view that data immediately. Over time, they began reviewing the records prior to conversing with the ED physician who admitted the patient. Acquiring an overview of the patient, preparing for handoff and subsequent care and defending against potential biases were determined to be the three primary functions of chart biopsies.

From the article of the same title
InformationWeek (09/17/12) Terry, Ken
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Organs Tailor-Made with Body's Own Cells
Labs around the world are making progress in tissue engineering, where cells, blood vessels and nerves are harvested to manufacture functioning organs. Researchers are availing themselves of advances in the knowledge of stem cells, as well as gaining insights about scaffold compounds that act like glue to hold cells in their proper place and also play a key function in how cells are enlisted for the repair of tissues. Experimentation with scaffolds involves in some instances stripping the scaffolds of cells and planting the patient's own cells within them, all but eliminating the chance that foreign tissue will be rejected by the recipient. Using adult stem cells from the patient also circumvents the kind of ethical questions that have arisen over the use of embryonic stem cells.

From the article of the same title
New York Times (09/15/12) Fountain, Henry
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Researcher Develops New Coating to Help Bone Implants Last
Researchers at Colorado State University are using bone allografts to test a new nanostructured surface coating for bone that they developed. During the tests, researchers will compare the healing process seen in bones coated with the material--which is made up adult stem cells derived from bone marrow or fat and is designed to encourage the growth of healthy bone cells in place of dead cells in existing bone implants--with the healing of bones not coated with the substance. The researchers hope that their tests will show that they can cause stem cells to grow and that they can safely stabilize the proteins that encourage the creation of new bone. If successful, the research could help lengthen the lifespan of bone implants and provide a way to replace injured or diseased bone segments without having to amputate limbs.

From the article of the same title
Medicalxpress (09/20/2012)
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