Springer has established a strategic partnership with the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) to publish their journal, a major reference work, and a book series as well as to develop an e-learning component for their portal. EFORT is the umbrella organization linking Europe’s national orthopaedic associations. Publication of these works will begin before the end of this year and will further strengthen and expand Springer’s orthopaedics portfolio.

European Orthopaedics and Traumatology will be the title of EFORT’s new official journal. Its mission is to connect member societies and encourage a strong link to their umbrella organization as well as to communicate the gold standard in the treatment of musculoskeletal diseases. Its aim is the harmonization of orthopaedic knowledge and training in Europe. A collection of papers in each issue, dealing with a specific topic and followed by a consensus discussion, will enhance a common understanding of the field within Europe and the member societies of EFORT. Original articles will complement each issue.

In addition to the journal, Springer will publish a major reference work for EFORT on surgical orthopaedics and traumatology. Furthermore, a book series (EFORT References in Orthopaedics and Traumatology) containing all topics relevant to EFORT will be produced. Springer will also develop an information and learning network for their portal.

William Curtis, Executive Vice President, Publishing, Clinical Medicine, at Springer, said, “This exciting new partnership between EFORT and Springer promises to greatly expand the amount of high-quality diagnostic, treatment, management and research information available to orthopaedic specialists in Europe and throughout the world. EFORT’s leadership and imprimatur insures that state-of-the-art knowledge will be available in each publication. Springer, through its dynamic online platform http://www.springerlink.com, will seamlessly distribute EFORT’s work to the widest possible audience of healthcare professionals.”

Professor Wolfhart Puhl, EFORT Past President, said, “Our aim and duty is to provide care to those suffering from musculoskeletal disorders and injuries throughout Europe, at a level of high quality reflecting the latest findings. A major pre-requisite for this are well-trained physicians with a high level of scientific knowledge. EFORT’s publishing program will contribute to this training and Springer, with over 165 years of publishing experience and expertise, will help us to accomplish our goal.”

EFORT President Karl-G?ran Thorngren said, “With the new ways of electronically distributing information that Springer uses, knowledge will become available for all EFORT members. Judging from the large number of abstracts submitted to the EFORT congresses, there will be substantial input from this discipline for the EFORT journal.”

EFORT is made up of 38 national societies in Europe with around 40,000 members. Its participating associations foster the exchange of scientific knowledge and experience in the prevention and treatment of diseases and injuries of the musculoskeletal system. Particular emphasis is placed on measures and projects focusing on education and research. EFORT organizes European conferences and instructional courses in conjunction with universities and other accredited institutions. It also initiates and supports basic and clinical research.

Springer is the second-largest publisher of journals in the science, technology, and medicine (STM) sector and the largest publisher of STM books. It publishes on behalf of more than 300 academic associations and professional societies. Springer is part of Springer Science+Business Media, one of the world’s leading suppliers of scientific and specialist literature. The group publishes over 1,700 journals and more than 5,500 new books a year, as well as the largest STM eBook Collection worldwide. Springer has operations in over 20 countries in Europe, the USA, and Asia, and some 5,000 employees.

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Published recently in The Journal of Bone and Joint Surgery - British Volume (JBJS-Br) is an annotation discussing the evidence for and against double-bundle arthroscopic reconstruction of the anterior cruciate ligament which will no doubt court controversy.

The researchers claim that ‘despite the enthusiasm of surgeons for the double-bundle technique, reconstruction with a single-bundle should remain the standard method for managing deficiency of the anterior cruciate ligament’. This is because the supposed advantages of double-bundle are yet to be confirmed.

The annotation weighed up the evidence for both methods and found that there is none ‘to show that fully anatomical double-bundle reconstruction of the ACL results in a better functional outcome’. The annotations authors therefore claim that single-bundle ’should not be abandoned until stronger scientific evidence in favour of double-bundle reconstruction can be produced’.

However, a further opinion on the article by a respected orthpaedic surgeon, published today, shows how controversial the annotation will be, especially among practitioners of double-bundle:

‘I am not sure that the conclusions they [the annotations authors] present can be supported. They rightly concluded that the literature shows that there has been no clinical advantage of the DB over the SB technique. They do no state, however, nor does the literature show that DB is any worse than SB’.

Read the annotation
Read the further opinion

The Journal of Bone and Joint Surgery - British Volume is a world leading orthopaedics journal with an Impact Factor of 1.868. JBJS-Br publishes twelve issues a year of high-quality, peer-reviewed research, overseen by an international editorial board led by Editor James Scott.

The Journal was first published in 1948 by The British Editorial Society of Bone and Joint Surgery, a registered charity (No. 209299), with the object of the advancement and improvement of education in orthopaedic surgery and allied branches of surgery and the diffusion of knowledge of new and improved methods of teaching and practicing orthopaedic surgery in all its branches.

The Journal of Bone and Joint Surgery - British Volume

August 2 — Most people love a dip in the pool to cool off during the summer swelter, but don’t let that refreshing feeling make you forgot basic safety rules.

According to the U.S. Consumer Product Safety Commission, medical professionals in 2007 treated almost 172,000 swimming-related injuries, including fractures, strains, sprains and contusions. With a bit of common sense, many of these injuries can be prevented.

“One must remember to exercise caution while swimming, especially before diving or jumping into unknown depths of water, where many head, neck and back injuries can occur,” orthopaedic surgeon Joseph Weistroffer, a member of the American Academy of Orthopaedic Surgeons Leadership Fellows Program, said in a news release issued by the organization.

The AAOS offers these other tips to increase swimming safety:

• Never swim alone or allow others to swim alone.
• Supervise children at all times. Anyone watching children near water should know CPR and be able to rescue a child.
• Swim only in supervised areas where lifeguards are present.
• Never swim if you feel tired, cold or overheated.
• Always inspect the depth of the water to make sure it is deep enough for diving. Never dive into shallow water.

When swimming in open water, such as the ocean or a lake:

• Carefully monitor the weather. Avoid being in the water during storms, fog or high winds.
• Do not swim after a storm, if the water seems to be rising or if there is flooding.
• Never enter waves head first.
• Avoid body surfing, as this activity results in many cervical spine injuries, shoulder dislocations and humeral fractures.

Safety rules for diving boards include:

• Only one person at a time on the board.
• Dive only off the end of the board.
• Walk, don’t run on the board.
• Do not try to dive far out or bounce more than once.
• Make room for the next diver by swimming away from the board immediately afterward hitting the water.

SOURCE: American Academy of Orthopaedic Surgeons, news release, July 22, 2008

Doctors often prescribe bisphosphonates for both osteoporosis as well as certain cancers. And usage has been increasing due to large-scale marketing and advertising to consumers.

Taken orally, these medications (such as Boniva® or Fosamax®) can help promote bone density in women with osteoporosis, and taken intravenously, can help stop the spread of cancer in chemotherapy patients. However, the use of bisphosphonates has also been linked to osteonecrosis of the jaw, more commonly known as “dead jaw.”

Osteonecrosis occurs when part of the jawbone essentially dies and becomes exposed. The disease is more prevalent among patients who receive bisphosphonates through an I.V., but Jon Suzuki, D.D.S, Ph.D., M.B.A., professor and director of the graduate program in periodontology at Temple University’s Maurice H. Kornberg School of Dentistry, says physicians and dental professionals should still keep a close eye on their patients who take the oral form.

“This is a very complex issue, and our understanding of it continues to grow,” said Suzuki. “Both dental and medical professionals need to maintain open lines of communication with each other to ensure the best care for their patients who are taking bisphosphonates.”

Previous studies have found between 1 and 10 patients out of 100 who receive bisphosphonates through an IV are at risk of the disease, while only about 1 in 100,000 patients taking the oral form are at risk.

Existing research suggests that taking these medications orally for more than three years or intravenously for more than six months could disturb the balance between bone cells that produce calcium and those that remove calcium. This condition can lead to oral health problems including loose teeth, jaw and gum pain, swelling and infection, numbness and gum loss.

Patients who have existing dental problems or have just had dental work and are taking bisphosphonates are also at higher risk for osteonecrosis. Suzuki advises that these patients have a full dental exam to determine the health of their jaw and what level of bisphosphonates would be appropriate.

“If a patient needs dental surgery, the dentist and treating physicians need to decide whether other treatment options, including systemic antibiotics or antimicrobial mouth rinses, can help reduce the risk of osteonecrosis,” he said.

Temple University
301 University Services Bldg.1601 N Broad St.
Philadelphia, PA 19122
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http://www.temple.edu

View drug information on Boniva; Fosamax.

Slouching is bad for you, according to the August issue of Mayo Clinic Health Letter.

Poor posture, in combination with bone changes that sometimes come with aging, can result in the appearance of a hump on the back. The medical term for the rounding of the back is kyphosis(ki-FO-sis).

Fractures due to osteoporosis — thinning of the bones — are common in the vertebrae. Compression fractures can occur, and the bone can become weakened to the point of collapse within its own structure. Sometimes these compression fractures in the spine cause pain, stiffness and tenderness. However, they often are not detected until an X-ray is done for another reason.

In older adults, kyphosis associated with osteoporosis is typically found in the vertebrae of the thoracic spine, the portion that supports the shoulders, arms and trunk. Multiple compression fractures in the vertebrae can reduce a person’s height and also curve the spine. The result is what looks like a hump on the back. Stooped posture due to compression fractures adds to pressure along the spine, which creates the potential for more compression fractures.

Conversely, straight posture reduces excess pressure that can contribute to kyphosis curvature. Another way to prevent kyphosis is to do exercises that help strengthen the back muscles and improve posture. A care provider can recommend appropriate exercises. As a general rule, people with osteoporosis should avoid exercises that round the back and, instead, do exercises that gently straighten the trunk and back.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today’s health and medical news.

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When discussing surgery with their orthopaedic surgeons, older patients frequently do not raise all of their concerns about proposed procedures. A study published in the July 2008 issue of The Journal of Bone and Joint Surgery found that patients age 60 or older have many concerns and questions that they do not mention to their orthopaedic surgeons, which, in turn can become a barrier to obtaining optimal care.

Using audiotapes of visits between patients and their orthopaedic surgeons, as well as post-visit telephone interviews, researchers found:

— Patients raised only 53% of their concerns about surgery during office visits.

– Patients rarely raised concerns about their ability to meet the demands of surgery or about the orthopaedic surgeon’s communication and surgical experience.

– Patients did receive answers about the timing of surgery and about the care facility where the procedure would be performed.

“Unexpressed concerns can keep patients from accepting recommended surgeries that may be very beneficial for them,” says Pamela L. Hudak, B.Sc.P.T., Ph.D., primary author of the study and a research scientist at The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto. “If patients don’t bring up concerns with their orthopaedic surgeon, then the opportunity to help is missed. For example, if a patient’s unexpressed concern is based on incorrect information, a surgeon will be hard pressed to help”.

“Our study, also found that many patients do not mention worries about their capacity to meet the demands of surgery, especially in the post-operative period, likely thinking that the surgeon cannot help. But, orthopaedic surgeons may be able to direct patients to social workers and other professional staff who can,” Hudak says.

Orthopaedic surgeons and other physicians must be aware that patients will often have unexpressed concerns, and they must take steps to help bring those issues to the surface. To assist with that process, the American Academy of Orthopaedic Surgeons has developed the Communication Skills Mentoring Program (CSMP). This expanding program, now in its eighth year, uses more than 40 trained Academy fellows, who help facilitate highly rated interactive workshops with video vignettes. Participants learn specific techniques designed to help improve their communication with patients.

“Patients are individuals, not ‘the left shoulder in room 2,’ but sometimes, orthopaedic surgeons become so technically focused that we forget to develop that necessary personal relationship,” says John R Tongue, MD, Chair of the AAOS CSMP Project Team. “About 20 to 30 percent of patients who undergo a knee or hip replacement end up having someone else do the surgery because they didn’t feel a personal connection was established in that first meeting with the orthopaedic surgeon.”

“Improved communication skills can be learned, and even small changes can make a big difference,” Tongue says. “This research strongly supports our program’s emphasis on specific techniques that allow us to be more empathetic with our patients. Since the average orthopaedic surgeon sees 160,000 patients during his or her career, AAOS Communicaton Skills Workshops can have a significant impact on patient care.”

Researchers suggest that when soliciting questions from patients, surgeons should be aware of and pay particular attention to:

— Their body language

Orthopaedic surgeons should stop competing activities (like writing in a medical chart) and always direct their body and gaze toward the patient.

– The particular wording of their inquires about concerns

Orthopaedic Surgeons should ask: “Is there something else you want to talk about today”.

What questions do you have?

The study also notes that it can be valuable for surgeons to be aware of all patient concerns, even those that they cannot help or change. “There are potential therapeutic benefits associated with simply allowing for the expression of these concerns” Hudak says. “Listening to our patients demonstrates a willingness on the part of the surgeon to engage in a dialogue with patients that supports their decision making. “Simply offering some empathy and reassurance can go a long way in easing a patient’s concerns about surgery.”

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institute on Aging (RO1 AGO18781). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Co-authors of the study are Wendy Levinson, M.D. and Pamela L Hudak, Ph.D. of St. Michael’s Hospital and the University of Toronto; Kristy Armstrong, M.Sc. of the University of Ottawa; and Clarence Braddock III, M.D., MPH of Stanford University.

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July 31 — High levels of alkaline phosphatase — a routinely measured marker of bone disease — may signal an increased risk of death among patients receiving dialysis for chronic kidney disease, say U.S. researchers.

The study analyzed data on almost 74,000 hemodialysis patients during a three-year period. It found that patients with alkaline phosphatase levels above the upper limit of normal had a 25 percent higher death rate. This association was significant across various subgroups of patients.

The study also found that patients whose alkaline phosphatase level increased during the first six months of the study were at higher risk over the subsequent two-and-one-half years.

The findings were expected to be published in the November issue of the Journal of the American Society of Nephrology.

“This large epidemiological study shows, for the first time, a consistent and robust association between a high blood level of alkaline phosphatase and cardiovascular death in thousands of dialysis patients across the United States,” researcher Dr. Kamyar Kalantar-Zadeh, of the University of California, Los Angeles, said in an American Society of Nephrology news release.

“If the association between alkaline phosphatase and mortality has a causal link, treatment strategies that reduce alkaline phosphatase levels may improve survival in patients with CKD [chronic kidney disease] and probably in many other patients with chronic diseases and active bone disorders,” Kalantar-Zadeh said.

Alkaline phosphatase levels are routinely measured in dialysis patients to monitor for metabolic bone disease, a common complication of CKD. However, current guidelines don’t include specific recommendations or targets for alkaline phosphatase levels in patients.

“In dialysis patients, increased levels of alkaline phosphatase in the blood indicate a so-called high-turnover bone disease, which can happen due to hormonal imbalance in CKD,” said Kalantar-Zadeh, who added that previous studies have identified a possible link between bone disease and cardiovascular health in CKD patients.

“Alkaline phosphatase has recently been shown to be associated with increased vascular calcification in experimental studies. Our study shows the clinical manifestation of this association in real-world patients,” he said.

SOURCE: American Society of Nephrology, news release, July 30, 2008

A study published looking at US soldiers injured in Iraq shows the need for investment in emerging treatment technologies for serious injuries both by the UK military and the NHS.

All of the patients included in the study were suffering from combat injuries classed as grade III tibial fractures, 68% of which were from blasts such as road side bombs.

The soldiers, split retrospectively into two groups and those receiving the rhBMP-2 protein had remarkable results; a strikingly improved rate of union, a reduced rate of infection and a much lower rate of reoperation. These results display a ‘compelling argument for the continued use of such technologies’ in treatment of soldiers returning from combat zones and other patients, showing that the research is the most significant trauma contribution arising from the Iraq war.

A Freedom of Information Request was lodged with the Ministry of Defense for information on whether this treatment has been used on British Soldiers, but so far no answer has been forthcoming. Discussion has been ongoing about the variance in treatments between UK and US soldiers injured in combat and most likely the study will add to debates about the availability for emerging treatments and current climate cost-benefits analyses.

Read the article

The Journal of Bone and Joint Surgery - British Volume is a world leading orthopaedics journal with an Impact Factor of 1.868

JBJS-Br publishes twelve issues a year of high-quality, peer-reviewed research, overseen by an international editorial board led by Editor James Scott

The Journal was first published in 1948 by The British Editorial Society of Bone and Joint Surgery, a registered charity (No. 209299), with the object of the advancement and improvement of education in orthopaedic surgery and allied branches of surgery and the diffusion of knowledge of new and improved methods of teaching and practicing orthopaedic surgery in all its branches

You can find out more about The Journal at http://www.jbjs.org.uk

Journal of Bone and Joint Surgery

The decision to undergo surgery can be particularly difficult and confusing for older adults. In a study published in the July 2008 issue of the Journal of Bone and Joint Surgery, Richard M. Frankel, Ph.D., of the Indiana University School of Medicine, and colleagues report that older patients and their surgeons do not communicate effectively when exploring surgical treatment options.

The researchers audiotaped patient-surgeon consultations and later interviewed the patients regarding their concerns about surgery to find out what, if anything, they had not discussed with their surgeons. The researchers found that the older adults had raised only about half of the concerns mentioned in the subsequent interview.

“Unexpressed concerns are challenging because they can lead to different expectations and understanding of the problems patients are concerned about and treatment recommendations that are poorly tailored to patient needs,” said Dr. Frankel, a professor of medicine at the IU School of Medicine and a Regenstrief research scientist. He is also is a member of the Center for Health Services Outcomes Research at the Regenstrief Institute and the Center for Implementing Evidence-Based Practice at the Richard L. Roudebush Veteran’s Administration Medical Center in Indianapolis.

Dr. Frankel and his colleagues noted that if concerns are unexpressed, “physicians will have little chance to correct or modify them. Unfortunately unexpressed concerns may contribute to breakdowns in communication which are frustrating for both physicians and patients.”

The overwhelming majority (84 percent) of older adult concerns related to the surgery itself. Concerns about anticipated quality of life after surgery, the post-surgery care facility and timing of surgery were among those most frequently voiced by older adults.

A mere 16 percent of older patient concerns were related to the surgeons including doubts about competency of the surgeon and the perceived tendency of surgeons to promote surgery as the only real treatment option.

The researchers found that surgeons generally do a good job of responding to patient concerns when they are raised. However they found that patients appear highly selective about what concerns they mention.

“Knowing that older adults frequently don’t voice all their concerns should help surgeons create opportunities for patients who are reluctant to bring them up,” said Dr. Frankel. The researchers found that patients most often raised concerns when the surgeon was describing treatment recommendations and possible options. Surprisingly, few responses were elicited when surgeons asked, “Do you have any questions or concerns?”

The authors report only one statistically significant finding when comparing concerns by race. White patients were about four times more likely to express concern about their physical well-being and “going under the knife” than African-American patients.

The authors focused on orthopedic surgery because the aging U.S. population will be increasingly faced with decisions about major orthopedic procedures like joint replacement.

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Co-authors of the study are Wendy Levinson, M.D. and Pamela L Hudak, Ph.D. of St. Michael’s Hospital and the University of Toronto; Kristy Armstrong, M.Sc. of the University of Ottawa; and Clarence Braddock III, M.D., MPH of Stanford University.

Source: Cindy Fox Aisen
Indiana University

CompuMed, Inc. (OTCBB:CMPD) — a medical informatics company serving the healthcare community with diagnostic software solutions — announced it has received approval from the State Food and Drug Administration (SFDA) of the People’s Republic of China to market the OsteoGram system for screening, diagnosing and monitoring osteoporosis.

The approval (Reg. # SFDA(I) 20083701577) enables CompuMed to sell the OsteoGram product as an approved clinical device in China and will allow CompuMed to work with its Chinese OEMs to target a market with substantial strategic importance.

“With this approval, we have passed all of the regulatory hurdles necessary to support our effort in the Chinese market where the demographics are very favorable and the incidence of bone disease is very high,” said CompuMed CEO Maurizio Vecchione.

Osteoporosis affects more than 200 million people worldwide and is especially prevalent in China, where the traditional diet lacks calcium. According to China’s most recent national census, about 100 million Chinese citizens suffer from the disease in various stages.

The OsteoGram is a software-based bone density measurement system that can be used with digital (i.e., filmless) x-ray equipment, as well as with older film-based machines. It provides an accurate, low-cost alternative to DXA bone mineral density (BMD) screening systems, which require dedicated and costly equipment, office space and staff. The OsteoGram’s benefits in terms of cost and efficiency can help facilitate more widespread osteoporosis screening and treatment of at-risk patients.

About CompuMed

CompuMed, Inc. (OTCBB:CMPD) develops and markets products and services that combine advanced imaging with medical informatics. Its focus is on analysis and remote monitoring for patients with cardiovascular and musculoskeletal diseases. The Company has specialized expertise and intellectual property in telemonitoring imaging and analysis designed to improve healthcare provider workflow and patient care while reducing costs. CompuMed’s core products, the OsteoGram(R) and CardioGram(TM), are cleared by the FDA and reimbursable by Medicare. The OsteoGram is a non-invasive diagnostic system that has been proven by many clinical studies to provide effective and accurate bone density measurement for screening osteoporosis and assessing hip fracture risk. The OsteoGram has significant cost advantages over other technologies in the marketplace. The CardioGram system is one of the first telecommunication networks designed to remotely interpret electrocardiograms and is used by private practice, as well as government and corporate healthcare providers nationwide. The CardioGram delivers online electrocardiogram interpretations within minutes of receipt and has the additional capability of automatically providing an over-read (i.e., follow-up review) by a cardiologist. CompuMed is headquartered in Los Angeles and distributes its products worldwide both directly and through OEM partners. Visit CompuMed on-line at http://www.compumed.net.

Statements contained in this press release that are not historical facts, such as statements about prospective earnings, savings, revenue, operations, revenue and earnings growth, results of contracts and other financial results, are forward-looking statements pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. All such forward-looking statements including statements concerning the Company’s plans, objectives, expectations and intentions are based largely on management’s expectations and are subject to and qualified by risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. These statements are subject to uncertainties and risks including, without limitation, competitive factors, outsourcing trends in the pharmaceutical industry, product and service demand and acceptance, changes in technology, ability to raise capital, the availability of appropriate acquisition candidates and/or business partnerships, economic conditions, the impact of competition and pricing, capacity and supply constraints or difficulties, government regulation and other risks identified in the Company’s filings with the Securities and Exchange Commission including its Annual Report on Form 10-KSB and Quarterly Reports on Form 10-QSB. All such forward-looking statements are expressly qualified by these cautionary statements. The Company expressly disclaims any obligation or undertaking to release publicly any updates or revisions to any forward-looking statements to reflect events, conditions or circumstances on which any such statement is based after the date hereof, except as required by law.

CompuMed