Augmedix, one of several start-ups devising applications for Goggle Glass in health care, is developing a seamless way for Glass-wearing doctors to push information to and from electronic health records (EHRs). A recent study in the International Journal of Medical Informatics found that doctors who use EHRs in the exam room spend much of their time looking at the computer screen rather than at the patient. The Augmedix product would record information from the doctor-patient interaction automatically and potentially boost “face time.” Meanwhile, Austin, TX-based Pristine has developed an app that lets Glass-wearing physicians transmit HIPAA-compliant video and audio of patients to authorized computers. The idea is to enable real-time consults with specialists located remotely from the patient. (See related OrthoBuzz item from Jan. 30, 2014.)
The 2013 Boston Marathon was stolen from the athletes and the city by two terrorist bombs, which led to four deaths, hundreds of injuries, a city shuttered for long stretches, and a tense manhunt that concluded with one suspect dead and the other injured. But the 2013 Marathon wasn’t finished until the end of the day on April 21, 2014. Marathon Monday 2014 in Boston was a glorious day for more than 32,000 runners and more than a million spectators. It was a day throughout which the outcomes of orthopaedic, disaster preparedness, physical therapy, and emergency medicine teamwork were again on display.
From prosthetic limbs to fundraising groups paying it forward, the 2014 Boston Marathon was inspiring end-to-end. As thousands of runners observed a moment of silence in the chill morning at the Hopkinton start, the profound shared experience of the past year or years settled upon them. Urged to “Take back that finish line!” the runners ran through sun-filled streets to the finish line 26.2 miles away. Children, families, and strangers clapped, shouted, and urged them on every step of the way.
In March, in conjunction with our friends at the Journal of Orthopaedic and Sports Physical Therapy (JOSPT), we published a special report on the emergency preparedness, long-term care, and outcomes for many of those caught up in last year’s Marathon bombings. This report is available online for free at http://sites.jbjs.org/ittakesateam/2014/. I urge you to take a look.
If there was ever an event that showed how the skill, knowledge, and diligence of medical professionals benefited people with the resolve and strength to make the most of it, the 2014 Boston Marathon was that event. As families embraced at the finish line, as friends, heroes, and survivors shared in the accomplishment of completing not just one marathon but so much more, one theme stood out: the amazing strides made possible through teamwork in orthopaedic care, physical therapy, emergency medicine, trauma surgery, and system-wide planning.
Among 25 medical specialties, orthopaedic surgery ranked highest on payscale, according to Medscape’s 2014 Compensation Study (registration/login required). With an average annual salary of $413,000 in 2013, orthopaedists were followed by cardiologists with an average salary of $351,000 and urologists and gastroenterologists (tied at $348,000). The lowest-earning specialists were HIV/ID physicians, family- and internal-medicine doctors, and pediatricians, all making less than $200,000. Relative to 2012, orthopaedists experienced an increase of nearly 2%, while rheumatologists reaped the biggest year-to-year increase in pay, with a jump of 15%. A gender gap remained, with the average salary for male orthopaedic surgeons at $418,000, compared to female surgeons at $354,000. Geography also impacts salaries. The highest-paid orthopedists live in the Northwest and the Great Lakes regions. When asked whether they would choose the same specialty if given the chance to start over, 64% of orthopaedists said they would. However, despite the high salaries, Medscape’s study placed orthopaedists in the middle of the pack for overall career satisfaction.
Changes in and current “best practices” for anterior cruciate ligament (ACL) reconstruction were the subject of a recent JBJS webinar that is available for free viewing until March 5, 2015.
The webinar focused on the procedural and outcome differences between nonanatomic transtibial tunnel drilling and more anatomic anteromedial portal drilling. Drs. Freddie Fu and Christopher Kaeding summarized their recent JBJS papers on ACL tunnel drilling, and Drs. Brett Owens and Darren Johnson commented on the authors’ findings. Dr. Mark Miller moderated the webinar.
One of several points the four ACL experts agreed upon during the webinar was the need for more objective outcome measures to help surgeons distinguish success from failure. For example, Dr. Fu argued for measuring outcomes with biomarkers and advanced imaging such as dynamic stereoradiography and 3-D computed tomography. As important as patient-centered outcomes are, Dr. Fu cited their subjectivity as a downside. “Getting back to sport in 6 months may not be so good if your ACL isn’t reconstructed anatomically,” he said.
Dr. Kaeding’s study found no KOOS-score differences between the two drilling techniques, but the transtibial group had a nearly 2.5-fold increased risk of subsequent ipsilateral knee surgery when compared to the anteromedial group. Commenting on that study, Dr. Johnson lauded the six-year follow-up and outcome metric of subsequent same-knee surgery. But he stressed that a combination of clinical outcomes–including patient satisfaction, knee stability, re-tear rates, and subsequent arthritis–would help surgeons make more informed decisions. He expressed hope that the patients in Dr. Kaeding’s study will continue to be followed so longer-term clinical data can been obtained.
To view the webinar in its entirety, free of charge, go to
You can also read a JBJS Reviews critical analysis of ACL tunnel placement here.
The article “Declining Rates of Osteoporosis Management Following Fragility Fractures in the U.S., 2000 through 2009” by Balasubramanian, et al. in the April 2, 2014 JBJS is a bit discouraging, but it will hopefully serve as a wake-up call for orthopaedic surgeons to re-engage with our patients to diagnose and treat previously undetected osteoporosis.
Fragility fractures–which primarily affect the vertebrae, hip, distal radius, or proximal humerus–are often the initial indication of osteoporosis in older individuals. For more than a decade, orthopaedic surgeons treating these fractures have been strongly encouraged to evaluate patients in this age group for the osteoporosis generally associated with these fractures. The American Orthopaedic Association (AOA) in 2005 began developing the Own the Bone program, specifically addressing the need to evaluate and treat osteoporosis, as well as the fracture, in these patients. The AOA has formed liaisons with several other national organizations to advance this program, and by late 2013, 44 states had hospitals implementing Own the Bone at their local institutions.
This article is sobering. Despite concerted efforts to link care of fragility fractures to evaluation and treatment of co-existing osteoporosis, these authors report an actual decrease in the rate of osteoporosis management for these patients. Only one-third of the women and one-sixth of the men in this retrospective cohort study were evaluated and treated according to current clinical guidelines.
This is an important public health issue. Despite the fact osteoporosis management involves non-operative treatment, it is essential that orthopaedic surgeons become more cognizant of the association between fragility fractures and osteoporosis treatment, and put in place a protocol to ensure that these patients are evaluated and treated for osteoporosis, as well as for the fracture. Osteoporosis may not be under the direct guidance of the orthopaedic surgeon, but the recognition of this potential problem is squarely within the practice scope of orthopaedists, who are well positioned to initiate secondary prevention measures for these older individuals.
Kent Anderson, CEO/Publisher of the JBJS Special Report: “It Takes a Team”, sits down and talks about the 2013 Boston Marathon Bombings. Some of the topics that Kent discusses in the interview are the emphasis on teamwork in healthcare, the importance of the first responders and orthopaedic surgeons who treated the survivors and lessons learned from this horrific tragedy. Listen now: http://bit.jbjs.org/1ph87Hu
Research reported at the 2014 AAOS Annual Meeting concluded that universal neuromuscular training for young athletes can be an effective and inexpensive way to avoid ACL sprains and tears. The research also found that screening tools, such as isokinetic tests to identify neuromuscular deficits, may reduce ACL injuries among high-risk athletes.
The modeling study evaluated a hypothetical cohort of 10,000 student athletes ages 14 to 22. Universal training reduced the incidence of ACL injury by 63%, while the screening program for at-risk athletes reduced the incidence rate by 40%. The study concluded that universal training would save an average of $275 per player per season when compared to estimated ACL reconstruction costs.
“Use of both preventative measures and screening tools sounds appealing, but often there are significant financial, administrative and social hurdles that have to be overcome before they can be implemented on a widespread level,” cautioned lead study author Eric F. Swart, MD, an orthopaedic resident at Columbia University Medical Center in New York.
For more information, read here: http://m.prnewswire.com/news-releases/universal-neuromuscular-training-reduces-acl-injury-risk-in-young-athletes-250280401.html
A recent study conducted at Emory University’s Center for Rehabilitation Medicine showed that short periods of breathing low oxygen levels can help patients with incomplete spinal-cord injuries walk better. The research included people with no joint shortening; some controlled ankle, knee and hip movements; and the ability to walk at least one step without human assistance.
Each of the participants was exposed to short periods of low-oxygen breathing (hypoxia). They breathed through a mask for about 40 minutes a day for 5 days, receiving 90-second periods of low oxygen levels followed by 60 seconds of normal oxygen levels. The participants were tested several times during the treatment and at one and two weeks post-treatment. Each participant improved their walking speed and endurance.
An editorial accompanying the study, published in Neurology, speculates that the low-oxygen treatment triggers spinal serotonin to induce protein changes that help restore spinal-cord connections.
For more information, read here: http://news.emory.edu/stories/2013/12/new_treatment_for_spine_injuries/
In a systematic review of 48 randomized controlled trials, European researchers found that a single type of exercise—either aerobic, resistance, or performance—was more effective for treating knee osteoarthritis than a mix of different exercise types. For pain reduction, quadriceps-specific resistance exercises were the most efficacious. The study, in the March 2014 Arthritis & Rheumatology, also concluded that the best results were achieved when the exercise program was supervised and engaged in thrice weekly for at least four weeks.
By a vote of 64 to 35, the US Senate approved a one-year “patch” of the current SGR-based Medicare payment formula, rather than entirely replacing the flawed system. President Obama signed the bill, which provides a 0.5% increase in physician Medicare reimbursements for the rest of 2014.
It’s the 17th such temporary stopgap Congress has passed over the last 11 years, and it came despite staunch opposition to another short-term “doc fix” by many physician groups, including the AMA and the AAOS. When the House passed the same measure a week earlier, AAOS president Frederick Azar, MD, said he was “profoundly disappointed.”
There was a last-ditch but unsuccessful effort by Senate Finance Committee chairman Ron Wyden (D-Oregon) to get his colleagues to vote on a permanent repeal of the SGR formula. Had Congress not acted at all, a 24% cut in Medicare reimbursements would have taken effect April 1, 2014. Previous patch votes have been accompanied by congressional promises to use the reprieve to hammer out a bipartisan deal to pay for a permanent SGR repeal. That has never happened, and few are optimistic that it will happen this year.
As physicians are swallowing the bitter pill of another SGR patch, some are relieved with another stipulation in the bill: a one-year delay in the implementation of the ICD-10 code set until at least Oct. 1, 2015. The AMA recently estimated that implementing the new, more complex code set could cost small practices up to $225,000, and last July the AAOS supported a bill to stop the transition to ICD-10 so physicians could develop an appropriate alternative. Another provision in the new bill gives the secretary of Health and Human Services permission to address “misvalued codes” used in the Medicare physician fee schedule.
According to Thomas Barber, MD, chair of the AAOS Council on Advocacy, “The delay in ICD-10 implementation may provide temporary relief for some, but the importance of a permanent SGR policy together with the harmful misvalued codes provision in this patch greatly outweigh any benefits.”
Read a summary of the bill’s provisions here: http://www.massmed.org/Advocacy/Key-Issues/Medicare/Summary–Protecting-Medicare-Access-Act-of-2014/#.UzrNkqJ0lyI