Boards approve position statement on children’s MS health, hear progress reports

AAOS President Stuart L. Weinstein, Md, thanked volunteers and staff, including CEO Karen L. Hackett, CAE, FACHE, for successfully relocating the Annual Meeting to Chicago after Hurricane Katrina devastated New Orleans.

By Susan A. Nowicki, APR

The Boards of Directors of the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS) met on Monday in Chicago. They approved a position statement on children’s musculoskeletal (MS) health, adopted a revised policy on Web site advertising and sponsorship and heard updates on trauma/on-call issues, the AAOS Patient-Centered Care Initiative and the Orthopaedic PAC.

In other actions, the Boards also recognized several members retiring from volunteer positions and heard progress reports on several key AAOS activities and projects.

Trauma care/on-call issues

Presenting what he called “food for thought” on the current crisis in the country’s ability to provide trauma care for patients, AAOS Second Vice President James H. Beaty, MD, provided an action plan for implementing the recommendations of the Academy’s Project Team on Trauma Care/On-Call Issues, which he chaired.

James H. Beaty, MD

Noting that the pressures of today’s practice environment have given rise to a growing realization among many orthopaedists that they are now being urged to provide emergency care with poor compensation, high liability and often less-than-adequate hospital and staff support, Dr. Beaty said that taking call and providing emergency care services have become points of contention. In response, the Board of Directors (Board) created the Project Team on Trauma Care/On-Call Issues in May 2005. Over the intervening months, the project team developed 10 recommendations for AAOS action. Dr. Beaty presented, and the Board approved the plan, which includes six primary steps:

Position statement on MS health in children approved

The Board approved a position statement developed by the Public Education and Media Relations (PEMR) Committee that focused on children and MS and referenced statistics about the prevalence of musculoskeletal conditions in children, recommendations for improving musculoskeletal health and a call for additional research in this area.

Presented by Stuart A. Hirsch, MD, chair of the Council on Communications, the position statement notes in part that, “As the musculoskeletal system matures and grows during childhood, the American Academy of Orthopaedic Surgeons (AAOS) stresses the importance of physical activity for children to maximize strong bone and muscle potential and combat obesity. The AAOS also believes additional research should be conducted to improve patient care and enhance the treatment and prevention of childhood musculoskeletal conditions, drawing from evidence-based medicine.”

Revised Web site advertising policy adopted
The AAOS Board of Directors first adopted a policy to govern advertising and sponsorship of the AAOS Web site in June 2000. At the time, it was envisioned that the Web site might break even financially or provide some revenue to the AAOS. However, very few companies have sought to advertise on or sponsor the site.

Recently, one company did contract with the AAOS to advertise on the site’s home page. Some concern was expressed about the placement of the message in such a prominent position. As a consequence, AAOS legal counsel suggested revising the policy to permit advertising on internal, or “landing pages,” but not on the home page. Following discussion, the Board approved the revised “Internet Web Site Advertising and Sponsorship Policy,” which does allow for placement of advertising on selected landing pages linked to the AAOS home page, but not directly on the home page.

Medical errors survey reported
David A. Wong, MD, chair of the Patient Safety Committee, reported on the results of a medical errors survey done with the AAOS membership on frequency, cause and outcomes of medical errors. Of the 917 members who responded to the survey, 510 reported an incident in the past 12 months.

David A. Wong, MD

Respondents noted that 78 percent of these incidents occurred in the hospital (52 percent in surgery, 10 percent in the patient’s room and 7 percent in the emergency room). In classifying the events, respondents indicated they would classify the 24.7 percent of the incidents as resulting from communication failure, 20 percent resulting from an equipment/instrument problem in the OR, 12.7 percent resulting from improper technique or physician impairment, 8.6 percent resulting from wrong site surgery and 8.2 percent resulting from medication errors.

Patient-centered care initiative well-underway
Frances A. Farley, MD, chair of the Patient-Centered Care Project Team, reported that the AAOS initiative is progressing smoothly, with most campaign projects already launched or well on their way to implementation. (See the in-depth article on the initiative in today’s Section B of Academy News.) She noted that the campaign, themed “Getting Better Together,” calls for a partnership between orthopaedic surgeons and patients to ensure patients and their families are informed, respected and involved in all care and treatment decisions.

Dr. Farley noted that, as part of the campaign, a significant expansion of Your Orthopaedic Connection (YOC), the Academy’s patient education Web site, is planned. Recruitment is now underway for a YOC editor who will oversee a new editorial board. Enhancements to site graphics are in development and new interactive features are planned. A new “Patient-Centered Care” section has already been added to the site.

An array of 30- and 60-second radio public service announcements as well as print ads, posters, postcards, a new DVD called “Getting Better Together” for use in orthopaedists’ reception rooms and a community awareness PowerPoint presentation on CD have been produced and will be going into circulation next month. The print and radio ads focus on doctor-patient communication and the importance of joint collaboration on health care decisions. The overall 2006 PSA campaign has a decided patient-centered care focus, highlighting the campaign theme “Getting Better Together.”

The Communications Skills Mentoring Program, which is a central element of the member communications aspect of the campaign, continues to expand with 10 more mentors completing their training.

“We are also asking our members to sign an affirmation statement pledging to provide patient-centered care as part of their practice,” Dr. Farley said. “It is important that patients know that their orthopaedic surgeons support patient-centered care and we hope AAOS members will join in this effort. We are asking members to go to the Academy’s Web site ( and record their participation by signing the pledge.” To help orthopaedists spread the word about patient-centered care, AAOS has also created a free patient-centered care kit. (For more information about the pledge and information kits, see the related articles in Section B of this issue of Academy News.)

PAC had record year
The Political Action Committee (PAC) of the American Association of Orthopaedic Surgeons reached an important milestone in 2005, reported PAC Treasurer William J. Robb III, MD. By the end of last year, the Orthopaedic PAC became the top fundraising physician specialty PAC, displacing the anesthesiologists’ PAC. As of December 31, 2005, the PAC had received $1,246,292 from a total of 2,811 contributors. This bested 2004 fundraising levels, when the PAC received $961,584 in receipts.

During 2005, the Orthopaedic PAC made more than $443,000 in contributions to individuals, leadership and party political action committees, with $100,500 going to the Democrats and $242,500 going to Republicans. Dr. Robb pointed out this should not be perceived as a partisan effort; it just means that more Republicans are in key government leadership positions at present.

Conflict of interest data base
Alan M. Levine, MD, chair of the Council on Education, sought input from the Board on a new form of disclosure to be used in education programs – a database open to view by all members. The council previously approved the use of a mandated disclosure database for all educational speakers, a central repository that faculty, authors and others would update at least yearly.

Dr. Levine offered that it might be appropriate to expand this database to include disclosure for volunteers serving at all levels within AAOS. It would be accessible to all members for review and available for use by the AAOS and subspecialty societies. He noted that this represented an initial step in managing, rather than just reporting on, conflicts of interest. It is proactive rather than reactive in approach.

Members would make complete disclosure of all relevant relationships and this information would be included in numerous publications – the Annual Meeting Final Program, individual books, course syllabi, electronic media programs, etc.

After discussion, the Board decided that, while the conflict of interest database could be expanded in the future, for now it should remain a tool of the Council on Education.

JAAOS Report
William P. Cooney III, MD, editor of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), reported that 2005 was a time of dramatic transition for JAAOS. Dr. Cooney took over as editor and JAAOS moved from bimonthly to monthly publication beginning with its September issue, the anniversary of its first publication in 1993.

JAAOS was also redesigned and several new features, including “Surgical Techniques,” “From the AAOS Leadership” and “On the Horizon” were added. Online manuscript review was instituted and notation of levels of evidence was introduced in the reference section of each article.

Dr. Cooney noted that the international circulation of the English-language edition increased from 17,604 in 1993 to almost 30,000 in 2005. JAAOS is now published in four languages in 10 countries. International readership – including the foreign-language translations brings total readership to nearly 40,000.

Beginning with the March/April 2005 issue, the number of standard articles published per issue was reduced from eight to six in anticipation of the faster production schedule dictated by the move to monthly publication. This strategy was successful; each of the monthly issues that appeared during the last four months of the year was published and distributed on time. The average length of each issue is now 60 pages compared with the previous average of 75 pages.

Standards for acceptance of a manuscript have been tightened, and the number of unsolicited manuscripts has been minimized. With that step, the number of invited manuscripts on specialty topics will increase, including the anticipated publication of AAOS Annual Meeting symposia.

Average time from acceptance of a manuscript to its publication is now 10 months. The goal is to get manuscripts into print within six to eight months.

Plans are to publish all 12 of the lead Annual Meeting symposiums in a future issue. In addition, two supplements are scheduled – one will cover the recent war wounds symposium and another will be done in partnership with the J. Robert Gladden Society.

Intellectual property rights and responsibilities
The Council on Education sought approval of a new requirement that would alert educational program volunteers to relevant intellectual property issues for their own edification and help protect the AAOS publishing and CME efforts from copyright infringement suits.

The comprehensive education plan would be aimed at helping all authors and presenters to understand their intellectual property rights and responsibilities. It would ask volunteers to review a learning guide on intellectual property rights, and then take a 10 question test. There would be no passing grade; the experience would be to review the material, take the exam and review the correct answers and the rationale for those answers. Volunteers would be asked to take the exam every three years.

Upon the recommendation of Dr. Levine, council chair, the Board approved the request.

New Communications Cabinet chair, vice chair affirmed
Under the new volunteer governance structure, the Council on Communications will be expanded to become the Communications Cabinet. Following an extensive recruitment process, the Committee on Committees nominated Frank B. Kelly, MD, as chair and Alan S. Hilibrand, MD, as vice chairman. Richard F. Kyle, MD, first vice president, who chairs the Committee on Committees, presented the nominations and the Board approved them. Dr. Kyle noted that this was the first time a vice chairman was being appointed to co-lead an AAOS program and reflected the Academy’s desire to help build a cadre of experienced leaders for the future.

JBJS Update
James D. Heckman, MD, editor-in-chief of The Journal of Bone and Joint Surgery (JBJS), provided an update on JBJS activities, describing the content aspects of the publication during 2005.

Dr. Heckman noted that 1,278 manuscripts were received during 2005, 129 more than were received during 2004. In addition, 39 solicited manuscripts were submitted for publication in two supplements published during the year.

The overall acceptance rate upon first submission was 17 percent. The acceptance rate was 19 percent for clinical manuscripts, 11 percent for case reports and 19 percent for basic science manuscripts. The articles that appear in the “Orthopaedic Forum,” “Ethics in Practice,” “Topics in Training,” “What’s New,” and “Evidence-Based Orthopaedics” have an overall acceptance rate of 80 percent.

The 12 issues during 2005 contained a total of 2,889 text pages and 306 original articles were published. The average time from submission to publication was 11.8 months for clinical manuscripts, 11.3 months for basic science manuscripts and 11.6 months for case reports. Two supplements (Surgical Techniques Part I and II and the AAOS Selected Scientific Exhibits) totaling 423 pages were published. In addition, 12 AAOS Annual Meeting Instructional Course Lectures, totaling 128 pages, were published during 2005.

Dr. Heckman further pointed out that JBJS continues to provide an opportunity to AAOS members to obtain continuing medical education credit for reading JBJS through both a “paper and pencil” quarterly examination and an electronic version. Last year, more than 1,000 orthopaedic surgeons participated.

Finally, Dr. Heckman said that the JBJS online version contains several features not available in the print version. The Web site contains transactions of selected orthopaedic society meetings, a monthly “Image Quiz,” “Letters to the Editor” and electronic supplements to and commentary upon articles appearing in JBJS.

Retiring board members recognized
Eight individuals retiring from the Boards of Directors or Councils were recognized for their service, including Dr. Farley and Oheneba Boachie-Adjei, MD, who served as members-at-large; Robert W. Bucholz, MD − first past president; James H. Herndon, MD − second past president; Edward R. Toriello − treasurer; Frank B. Kelly, MD − BOC chair; and Mark C. Gebhardt, MD, chair of the Board of Specialty Societies (BOS)(COMSS). In addition, Stuart A Hirsch, MD was recognized for his service as chair of the Council on Communications.

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