Current News

 

 

March 1, 2010
Today's Top Story
1. Concerns rise with incidence of Gram-negative HAIs.
Other News
2. Earthquake strikes Chile; AAOS reaches out to Chilean Orthopaedic Society.
3. IOM meeting examines FDA 510(k) process.
4. Aging mechanism—not estrogen reduction—linked to osteoporosis.
5. AAOS seeks volunteers for knee brace work group.
6. Come to New Orleans early and help build a Family Fitness and Fun Park at AAOS 2010 Annual Meeting!
Today's Top Story
1. Concerns rise with incidence of Gram-negative HAIs.
An article in the New York Times looks at concerns over the rising incidence of Gram-negative bacteria in American hospitals. Although much research has been conducted on antibiotics to combat Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus, many Gram-negative bacteria strains are resistant to all modern antibiotics. Doctors treating resistant strains of Gram-negative bacteria may be forced to offer patients a choice between taking antibiotics such as colistin or polymyxin B—both of which were largely abandoned decades ago due to association with kidney and nerve damage—or no antibiotics at all. Health authorities in the United States lack good statistics regarding the number of infections linked to Gram-negative bacteria, but authorities in Europe estimate that Gram-negative infections account for two-thirds of the 25,000 deaths caused there each year by hospital-acquired infections (HAIs). HAIs from all types of bacteria combined cause or contribute to 99,000 deaths each year in the United States.  Read more...
Other News
2. Earthquake strikes Chile; AAOS reaches out to Chilean Orthopaedic Society.
On Saturday, Feb. 27, a magnitude 8.8 earthquake occurred off the coast of Chile. A much higher magnitude than the earthquake that struck Haiti on Jan. 12, the quake damaged communication, transportation, and power systems, and destroyed as much as 80 percent of some smaller towns in the region. The initial death toll is now at nearly 800 people and is expected to increase.
     AAOS is reaching out to the Chilean Orthopaedic Society and awaiting a response or request for aid before implementing any disaster assistance programs. The damage to life and property is considerably lower than in Haiti, and the government response and resources substantially greater, which may mitigate the need for outside assistance. According to the Washington Post, Chile was much better prepared for earthquakes and more able to respond internally to the disaster.  Read more...
Learn more about the AAOS Extremity War Injuries and Disaster Preparedness Project Team...
3. IOM meeting examines FDA 510(k) process.
As announced in the February 23 edition of AAOS Advocacy NOW, Randall J. Lewis, MD, AAOS fellow and former member of the Board of Councilors, spoke on behalf of AAOS before the Institute of Medicine (IOM) today regarding the U.S. Food and Drug Administration’s (FDA) 510(k) accelerated clearance process. Also known as premarket notification, section 510(k) of the Federal Food, Drug, and Cosmetic Act requires manufacturers of medical devices to notify FDA of their intent to market a medical device at least 90 days in advance. This window of time allows FDA to evaluate whether the device is "substantially equivalent" to a product already on the market, in which case the device does not need to go through the pre-market approval process. According to Dr. Lewis, the 510(k) process works well to ensure the safety and effectiveness of medical devices, with very few exceptions.  Read more...
Learn more about the IOM meeting…
Read comments from U.S. Senator Chuck Grassley (R-Iowa) to FDA regarding the 510(k) process (PDF)…4. Aging mechanism—not estrogen reduction—linked to osteoporosis.
According to research published in the February 3 issue of the journal Cell Metabolism and online in the journal Endocrine Reviews, it is an age-related mechanism and not a decrease of the hormone estrogen that reduces the ability of the body to defend against osteoporosis brought on through oxidative stress. The authors conditionally deleted forkhead box transcription factors FoxO1, FoxO3, and FoxO4 in 3-month-old mice, resulting in an increase in oxidative stress in bone and osteoblast apoptosis and a decrease in the number of osteoblasts, rate of bone formation, and bone mass at cancellous and cortical sites. Conversely, overexpression of a FoxO3 transgene in mature osteoblasts decreased oxidative stress and osteoblast apoptosis and increased osteoblast number, bone formation rate, and vertebral bone mass.  Read more...
Read the abstract in Cell Metabolism…
Read the abstract in Endocrine Reviews…
5. AAOS seeks volunteers for knee brace work group.
The Guidelines and Technology Oversight committee seeks AAOS fellows to participate on a work group assigned to develop an AAOS evidence-based technology overview on knee braces. AAOS technology overviews are developed using a rigorous systematic process to promote transparency and limit bias. Applicants must have a background in evidence-based medicine, no relevant financial conflicts of interest to this topic, be willing to sign an attestation form declaring they will maintain an absence of relevant conflicts for the duration of the technology overview process and one full year after Board of Directors’ approval. All work group members must be available for evening teleconference calls in May of 2010.
Learn more about technology overviews...
     To apply, please e-mail the evidence-based medicine coordinator, Fareeha Shuttari-Khan with your interest by March 15, 2010 and further information and instructions will be provided.  shuttari@aaos.org
6. Come to New Orleans early and help build a Family Fitness and Fun Park at AAOS 2010 Annual Meeting!
March 9, 2010 is the date for the first AAOS Family Fitness and Fun Park Build. The 2010 build will be in Jefferson Park, just outside of New Orleans. The build will take place over the course of one day, from 7 a.m. to 4 p.m.; shuttles will run between the build site and the Morial Convention Center. The ribbon-cutting will take place around 3:30 p.m. No experience is necessary to take part in this fun and rewarding activity! Please direct questions to Kayee Ip, public relations coordinator, at (847) 384-4035 or:  ip@aaos.org

 

March 3, 2010
Today's Top Story
1. SGR pay cut averted for another 30 days.
Other News
2. MedPAC releases recommendations for 2011 Medicare pay rates.
3. Mobile compression device prevents bleeding events after THA.
4. Bupivacaine anesthetic may be less toxic than monoiodoacetate.
5. AAOS seeks volunteers for antibiotic prophylaxis workgroup.
6. Call for volunteers: Instructional courses subcommittees.
Today's Top Story
1. SGR pay cut averted for another 30 days.
Modern Healthcare reports that President Obama has signed a bill to stave off Medicare pay cuts mandated under the Sustainable Growth Rate (SGR) formula for an additional 31 days. Late Tuesday night, the U.S. Senate voted to approve a bill to delay the reductions until April 1. The bill also extends COBRA health subsidies, insurance for the unemployed, and a number of rural Medicare provisions for the same length of time. The U.S. House of Representatives had earlier approved the legislation, but it had received resistance in the Senate. The U.S. Centers for Medicare & Medicaid Services has announced that effective immediately, claims with dates of service March 1 and later that were being held by Medicare contractors will be released for processing and payment  Read more...(registration required)
     In related news, the secretary of the U.S. Department of Health and Human Services has pledged to work with physicians to permanently repeal the SGR. Speaking at an American Medical Association conference, Sec. Kathleen Sebelius stated that temporary fixes to the SGR are inadequate, and that physicians should not have to repeatedly lobby for its repeal.  Read more...(registration required)
Read the AAOS position statement on principles of healthcare reform...
Other News
2. MedPAC releases recommendations for 2011 Medicare pay rates.
The U.S. Medicare Payment Advisory Commission (MedPAC) has released its March 2010 "Report to the Congress: Medicare Payment Policy." The principal focus of the report is the MedPAC’s recommendations for annual rate adjustments in fee-for-service Medicare. The recommendations are based on an assessment of payment adequacy, taking into account beneficiaries’ access to care, supply of providers, quality of care, and Medicare margins. Among other recommendations, the report states that Congress should:

  • Update payments for physician services in 2011 by 1 percent
  • Establish a budget-neutral payment adjustment for primary care services billed under the physician fee schedule and furnished by primary-care-focused practitioners
  • Increase payments for ambulatory surgical center services in 2011 by 0.6 percent, and require them to submit cost and quality data

Read more (PDF)…
Read the fact sheet (PDF)…
Read the complete report (PDF)…
3. Mobile compression device prevents bleeding events after THA.
A study published in the March issue of the Journal of Bone & Joint Surgery—American (JBJS-A) finds that use of a mobile compression device may be more effective than low-molecular-weight heparin for prophylaxis against venous thromboembolic (VTE) events following total hip arthroplasty (THA). The authors conducted a prospective study of 410 patients (414 hips) randomized to receive either a mobile compression device and up to 81 mg of aspirin daily or low-molecular-weight heparin after THA. At 12-weeks follow-up, zero percent of patients in the compression group and 6 percent of patients in the heparin group had had major bleeding events. Additionally, based on bilateral lower-extremity duplex ultrasonography, 3 percent of patients in the compression group were found to have distal DVT and 2 percent had proximal DVT, compared to 3 percent of the patients in the heparin group with distal DVT and 1 percent with proximal DVT. Within the 12-week follow-up period, one patient in the compression group had two events (one DVT and one pulmonary embolus), even though an ultrasonography on postoperative day 12 had negative findings. No difference between groups with regard to the prevalence of VTE was found.  Read the abstract…
4. Bupivacaine anesthetic may be less toxic than monoiodoacetate.
The potentially toxic effects on articular cartilage following a single injection of bupivacaine may be difficult to detect clinically, according to a rat study published in the March JBJS-A. The research team injected 48 Sprague-Dawley rats with 100-µL of sterile 0.9 percent saline solution (negative control) into one stifle joint and either 100 µL of preservative-free 0.5 percent bupivacaine (experimental group) or 0.6 mg/mL monoiodoacetate (positive control) into the contralateral joint. The rats were killed and examined at 1 week, 4 weeks, 12 weeks, or 6 months. In specimens injected with bupivacaine, the chondral surfaces remained intact as seen with gross and histological examination. The researchers found no differences in superficial chondrocyte viability or modified Mankin scores between the saline-solution and bupivacaine groups (p>0.05). A quantitative histological analysis of the bupivacaine-treated knees at six months revealed an up to 50 percent reduction in chondrocyte density compared with that of the saline-solution-treated knees (p=0.01). However, monoiodoacetate injection resulted in death of up to 87 percent of the superficial chondrocyte cells at one week and chondrolysis at 6 months.   Read the abstract…
5. AAOS seeks volunteers for antibiotic prophylaxis workgroup.
The Guidelines and Technology Oversight committee seeks AAOS fellows to participate in a collaborative effort by the AAOS and the American Dental Association to develop an evidence-based guideline on antibiotic prophylaxis for bacteremia in patients who have had an orthopaedic procedure. AAOS guidelines are developed using a rigorous systematic process to promote transparency and limit bias. Applicants must have no relevant financial conflicts of interest to this topic, be willing to sign an attestation form declaring they will maintain an absence of relevant conflicts for the duration of the guideline process and one full year after Board of Directors’ approval, and a background in evidence-based medicine. All work group members must be available to attend mandatory initial and final meetings in Rosemont, Ill.  Learn more about AAOS clinical practice guidelines…
     To apply, please e-mail the evidence-based medicine coordinator, Fareeha Shuttari-Khan with your interest by March 15, 2010 and further information and instructions will be provided.  shuttari@aaos.org
6. Call for volunteers: Instructional courses subcommittees.
March 24 is the last day to submit your application for open positions on several instructional courses subcommittees. Members of these subcommittees grade Instructional Course Lecture applications, provide input to the Instructional Courses Committee, and evaluate courses at the AAOS Annual Meeting. Instructional courses subcommittees with open positions include:

  • Adult Reconstruction Hip
  • Adult Reconstruction Knee
  • Foot and Ankle
  • Pediatrics
  • Practice Management
  • Shoulder and Elbow
  • Spine
  • Sports Medicine and Arthroscopy
  • Trauma
  • Tumor

Each subcommittee is seeking a chair and four members. Applicants for these positions should be active AAOS fellows with a practice specialty in the relevant area.
     Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program Web site regularly to view new openings and find one that interests you.  Learn more and submit your application…(member login required)

 

March 5, 2010
Today's Top Story
1. Public trust in physicians remains high both medically and politically.
Other News
2. Apixaban an effective alternative to enoxaparin for TKA patients.
3. Ethnic data on patients is helpful, but rarely collected.
4. Utah.
5. AAOS introduces new, improved AAOS Orthopaedic Disclosure Program.
6. New app makes AAOS Now content accessible via iPhone and Android.
7. AAOS requests participation in survey to determine how SGR cuts will affect physicians.
8. Call for volunteers: Program subcommittees.

Today's Top Story
1. Public trust in physicians remains high both medically and politically.
Two recent surveys offer evidence that public trust in physicians remains high, despite the wide availability of alternate sources of information. A survey published in the March 4 issue of the New England Journal of Medicine (NEJM) finds that the public's trust in physicians as their preferred source of health information increased from 2002 to 2008, while trust in health information from the Internet or from other sources decreased over the same period. The conclusions were drawn from the Health Information National Trends Survey, which gathers data every 2 years from a nationally representative sample of U.S. adults 18 years of age or older.  Read more...
     The second survey, conducted by Gallup, finds that the public places higher trust in physicians’ recommendations for healthcare reform than any other group in the survey. In June 2009, 73 percent of American respondents stated that they were confident in physicians’ recommendations. A similar survey conducted in March 2010 found that confidence had increased to 77 percent of Americans. Over the same time period, confidence in hospitals’ recommendations for healthcare reform also increased (from 61 percent to 64 percent). Confidence in healthcare reform recommendations made by politicians, however, fell—from 58 percent to 49 percent in President Obama’s recommendations; from 42 percent to 39 percent in Democratic congressional leaders; from 34 percent to 32 percent in Republican congressional leaders, and from 35 percent to 26 percent in health insurance company recommendations.  Read more...
Other News
2. Apixaban an effective alternative to enoxaparin for TKA patients.
Apixaban may be more effective than enoxaparin for prevention of venous thromboembolism following total knee arthroscopy (TKA), according to a study published in the March 6 issue of The Lancet. The authors conducted a multicenter, randomized, double-blind trial of 3,057 patients undergoing elective unilateral or bilateral TKA. Patients received either 2.5 mg oral apixaban twice daily (n=1,528) or 40 mg subcutaneous enoxaparin once daily (n=1,529). Overall, 1,973 patients were eligible for primary efficacy analysis. Of those, the primary outcome (composite of asymptomatic and symptomatic deep vein thrombosis, non-fatal pulmonary embolism, and all-cause death during treatment) was reported in 147 (15 percent) of 976 apixaban patients and 243 (24 percent) of 997 enoxaparin patients (relative risk 0.62 [95 percent confidence interval [CI] 0.51—0.74]; p<0.0001; absolute risk reduction 9.3 percent [5.8—12.7]). Major or clinically relevant non-major bleeding occurred in 53 (4 percent) of 1,501 patients receiving apixaban and 72 (5 percent) of 1,508 treated with enoxaparin (p=0.09).  Read more...
Read the abstract…
An audio discussion of this study is also available.   Listen to the podcast…
3. Ethnic data on patients is helpful, but rarely collected.
A commentary published in the March 4 issue of NEJM looks at issues surrounding the gathering of data on patients' race and ethnicity. The authors point out that such data can be useful in detecting disparities, optimizing quality-improvement interventions, generating more reliable quality metrics, and reaching out to patient communities. It may also have a direct medical benefit by providing probabilistic information about certain genetic conditions. However, physicians often avoid collecting this information in the belief that it would be expensive or time-consuming, intrusive, or even illegal. Some experts have argued that noting a patient’s race or ethnic group at the outset of clinical case presentations can carry a subtle social bias. The authors warn that a patient's race or ethnic group should not be used to infer information about the patient's health-related values or beliefs.   Read more...
4. Utah.
According to the Salt Lake Tribune, the Utah House of Representatives has approved a bill that, if enacted, would cap pain and suffering awards in medical liability cases at $450,000—a reduction from current limits of $480,000. The legislation would also protect hospitals when a physician commits an error. At least one critic argues that bill will reduce physician accountability, but supporters say that it will better balance accountability among physicians and trial lawyers. The state Senate must agree to a technical amendment added by the House before the bill goes to the governor for signature. Sources say the governor is likely to sign it into law.  Read more...
5. AAOS introduces new, improved AAOS Orthopaedic Disclosure Program.
Disclosing conflicts of interest has become an integral part of the practice of medicine. Under the AAOS mandatory disclosure policy, orthopaedic surgeons and others involved in AAOS organizational governance, educational materials and programming, clinical practice guidelines and technology overviews, and publications must disclose all orthopaedic-related commercial relationships occurring within the past 12 months. The new, improved AAOS Orthopaedic Disclosure Program makes it simple and easy to meet that requirement. The program debuts at the AAOS 2010 Annual Meeting next week...stop by the AAOS Orthopaedic Disclosure Assistance Booth in Lobby B of the Morial Convention Center, enter your disclosures, and pick up your special green "I Disclosed" ribbon.  Read more...
6. New app makes AAOS Now content accessible via iPhone and Android.
AAOS Now readers now have fingertip access to the publication’s top articles and podcasts via their Apple iPhones and Motorola Androids. Beginning today, the free AAOS Now app can be downloaded via users’ smartphones just like any other app. "This is a real step forward for us," says AAOS Now Editor-in-Chief Terry Canale, MD. "It enables us to put the most authoritative orthopaedic news and commentary in the hands of AAOS members and non-members alike in a matter of minutes rather than days."
7. AAOS requests participation in survey to determine how SGR cuts will affect physicians.
AAOS, along with the surgical community, continues to work with congressional leaders to address the issue of Medicare reimbursement, particularly regarding the Sustainable Growth Rate (SGR) formula, which is scheduled to result in a 21.2 percent reduction in Medicare reimbursement beginning April 1. On February 24, AAOS Council on Advocacy Chair, Peter J. Mandell, MD, sent a survey to AAOS fellows in a Call to Action. The deadline has been extended and AAOS fellows will be able to respond until early next week. The survey will take no more than a few minutes to complete and will help the AAOS and the broader surgical community in their efforts on Capitol Hill.
Take the survey…
8. Call for volunteers: Program subcommittees.
March 11 is the deadline for submitting your application for open positions on several program subcommittees. Members of program subcommittees grade abstracts, poster presentations, and symposia applications; provide input on hot topics; and may moderate sessions at the AAOS Annual Meeting. The following program subcommittees each have one member opening:

  • Adult Reconstruction Hip
  • Shoulder and Elbow
  • Trauma

Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program Web site regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

 

Note: AAOS Headline News Now will not be published during the week of March 8-12. Publication will resume on March 15. Please check AAOSNow.org for daily updates from the AAOS Annual Meeting.