AO Dialogue 1|13 The newsletter for the AO community
AO and neurosurgery—transforming surgery; improving lives The history and future of neurosurgery within the AO Professors Paul Manson and Christian Matula “Today we classify injury to the most complex organ in the body as mild, moderate or severe. We use a decades old classification system which does not distinguish between pathology types. As a profession, we need many more tools to deliver effective therapies. We can do better.” Geoffrey T Manley, Neurosurgeon
The AO was founded by surgeons who knew that better treatments and tools were needed for their patients. They initiated challenging work in the laboratory, in the clinics and operating rooms, then classified and organized
their discoveries utilizing outcomes into a disciplined way to teach their peers the AO Principles. They developed the instruments to accomplish the surgery with a minimum of tissue injury, and continued to use the laboratory to improve clinical practice. In recent years the AO has welcomed the involvement of like-minded, impassioned, impatient, “triple threat” surgeons who have dedicated themselves to improving patient care for those who have suffered another devastating traumatic injury; a traumatic brain injury (TBI). TBI is an area of profound complexity, and one in desperate need of global health improvements. Literally millions suffer the injury annually. It is an injury that has the potential to [ continued on page 2 ]
Table of contents
AO and Neurosurgery
1
My view, James Kellam
4
AO Clinical Study Center program
6
New and future AO publications
8
AO Clinical Divisions updates 10 AO Institutes updates
14
AO President’s interview
19
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AO and neurosurgery continued… disable working individuals, and in doing so may devastate an entire family. Rapid interventions can dramatically change outcomes. Course program
1st AOCMF Neurotrauma Course December 9–10, 2010
Davos, Switzerland
Cranial neurosurgeons as a formal group within AO are relatively new. The core group was attracted by our known reputation for pursuing fact-based high standards and methodologies. This group understands that “Transforming Surgery—Changing Lives” and “Movement is Life and Life is Movement” are not mantras, but calls to action for patient welfare. Neuro Working Group within AO Technical Commission Initially formed as a Working Group to support the TK System in 2005 with the development of craniomaxillofacial (CMF) products for cranial neurosurgery, the group took on their charge with dedication and now functions as a highly productive team. This past year, the group was elevated from Working Group to Expert Group within the TK as the AO NTREG (Neuro Trauma and Reconstruction Expert Group). Professor Christian Matula, of the Medical University of Vienna was elected as the first Chairman. History of neurosurgeons within AOSpine and AOCMF Of course, neurosurgical members are not new to the AO Foundation. Many neurosurgeons have made profound contributions to AOSpine, and provide outstanding leadership in that part of the organization. Their passion, particularly in the area of spinal cord injury and tumor management, has helped to move AOSpine and spine patient care forward. For 20 years neurosurgeons have also made substantial contributions to the care of combined craniofacial injuries through their interaction with the AOCMF group, for example in the care of patients with congenital craniofacial deformities and complex skullbase injuries and deformities. Also AO’s industrial partners have run neuro-
surgical courses and educational programs in North America since 2004 in cooperation with members of AOSpine and AOCMF. All of these areas demonstrate the progress that is achieved with multidisciplinary cooperation. Having this in mind the first AO International Interdisciplinary Skull Base Course was initiated and successfully organized in Vienna in 2008. Neuro education program development efforts Aurelia Peraud of the University of Munich, Germany and Christian Matula of Vienna, Austria and several others initiated a European neurosurgical task force with the support of AOCMF to create a comprehensive curriculum for b these neurosurgery courses. Rigorous working sessions resulted in formulation of “key” areas, and a broader educational course structure was also created. Importantly, this group is also working to establish an appropriate avenue for new neurosurgical members to engage with b AO, and join its existing faculty as members. the First AO Neurotrauma Courses and upcoming education activities Together with AOCMF colleagues, the AO NTREG members organized a first Cranial Neurotrauma course in Davos in 2010. In just two short years, they have now held additional courses in Davos, the rest of Europe, Latin America, the Middle East and Asia, bringing this vital knowledge to a worldwide network. AOCMF has helped to introduce the AO community to neurosurgeons in these regions. They have developed other innovative courses, such as the Skull Base and Cranial Reconstruction programs, and participated in Distraction Osteogenesis and congenital Craniofacial programs. Our new colleagues are particularly engaging the AO network’s trauma tradition in their effort to advance TBI care. This past December in Davos the group held its third Davos Neu-
AO Dialogue 1|13
Faculty and participants at the first AO Neurotrauma course
rotrauma course led by preeminent surgeons in the field. A highlight was a discussion of a current New England Journal of Medicine article on the value of certain commonplace management techniques, such as intracranial pressure monitoring. The lead author of that article, Randy Chesnut of Harborview Medical Center and the University of Washington (USA) was on the 2012 Davos AO Neurotrauma Course faculty. He and others are planning to carry forward their experiences and other
Stephen Lewis, (left) works with Richard Hopper
ground-breaking work on how to best manage patients via the AO network. Typical of the AO effort, they are inspired to connect with global colleagues, and to move patient care forward. Near future In March of 2013, the AO Board of Directors approved the implementation of an AO Cranial Neuro “Pilot Project” for 2013-2014, which was fully funded by the AO’s industrial partner,
Christian Matula (Neurosurgery) and Rolf Evers (CMF)
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AO and neurosurgery continued…
The 1st International Interdisiplinary AO Course on Skull Base Surgery—Approaches to the Skull Base held in Vienna organized by Christian Matula and his team.
AOCMF Skull Base classification system
Members of the Neuro Program Development Group (L-R) Christian Matula, Jose Fernandez Alen, Francesco Biroli, Michael Bierschneider, Aurelia Peraud (Chair)
DePuy Synthes, with continued funding based upon mutual agreement and discussion of the results of the “Cranial Neuro Pilot”. This year, cranial neuro courses are planned for Europe, China and Toronto, and the course schedule for 2014 will be formulated in the summer of 2013. The North American Courses will be held in cooperation with AO Spine
North America, whose board approved the cooperative course project. The group has shared that current classification schemes in their profession do not adequately differentiate the many clinical situations requiring treatment. Christian Matula has actively engaged with AOCMF colleagues to help produce the recently launched AOCMF Skull Base
AO Dialogue 1|13
Rocco Armonda, National Capital Neurosurgery Consortium, Walter Reed National Military Medical Center, Washington DC, instructs participants at the Davos course on techniques for decompressive craniectomy. It is a technique on the forefront of TBI care to save patients. The subsequent careful cranioplasty and reconstruction helps a life to move forward.
classification system (photo-figure next page). The group has in mind other vital areas for research and development which can benefit patient care, utilizing the experience with the AO’s historic expertise in classification, analysis and treatment outcomes. TBI is one area which will benefit from AO capabilities, such as education delivery via Webinar discussions, to bring new treatment principles across the world in a rapid and economical format. “This is very exciting for all of us. The enthusiasm is palpable, and I must finally confess, I am a ‘closet neurosurgeon’! I feel very fortunate to have been able to have participated in the organization of the CMF group in North America and in the AO Foundation in the 1980’s, and now I see that it is possible for another group to possibly have the tremendous benefits and comradery of this unique AO Foundation membership as they share their knowledge and
experience to improve and coordinate patient care in this important discipline”, said Paul Manson, the AOVA appointed coordinator for the AO Cranial Neuro Pilot. It is our privilege to welcome and support our cranial neurosurgical colleagues as they open a new educational and development front for AO. Through our AO experiences and expertise we are eager to help our cranial neuro friends pursue answers and solutions to the hard problems they face. Importantly, the AO model allows them to do this while enjoying the collegiality of their educational partners, such as AO Spine and AOCMF. New and improved perspectives will be gained from international collaboration in patient care and education, as has been seen in the other disciplines of the AO. Together, we can make another impact in this area of cranial neurosurgery and TBI in order to advance world health.
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AO Clinical Study Center program Developed only three years ago, the program continues to gain momentum LIST OF CENTERS Kansas City University Medical Center
USA
John Hunter Hospital
Australia
Montreal General Hospital
Canada
University of Calgary
Canada
University of São Paulo - Ribeirão Preto
Brazil
Sykehuset i Vestfold
Norway
Mackay Base Hospital
Australia
Cornell University Medical College
USA
BG Unfallklinik Frankfurt am Main
Germany
Christian Medical College
India
All India Institute of Medical Science
India
University of Rochester
USA
Shanghai Sixth People’s Hospital
China
Stadtspital Triemli
Switzerland
Sint Maartenskliniek
Netherlands
Luzerner Kantonsspital
Switzerland
University of Campinas (UNICAMP)
Brazil
Medizinische Universität Innsbruck
Austria
BG Unfallklinik Ludwigshafen
Germany
Charité - Universitätsmedizin Berlin
Germany
BG Unfallklinik Tübingen
Germany
Spine Education and Research Institute
USA
Tan Tock Seng Hospital
Singapore
Queen Mary Hospital
China
Singapore General Hospital
Singapore
Universitätsklinikum Köln (AÖR)
Germany
Universitätsklinikum Regensburg
Germany
Universitätsklinikum des Saarlandes
Germany
Children’s University Hospital, Inselspital Bern
Switzerland
Universitätsklinikum Freiburg
Germany
Geisinger Health System
USA
Harvard Orthopaedic Trauma
USA
We hereby confirm that the has successfully passed the qualification process and is now a qualified
Clinical Study Center valid until
Davos,
Ivo Schauwecker AOCSC Project Leader
Dr. Beate P. Hanson Director AOCID
AOCSC site visit to the BG Unfallklinik in Ludwigshafen, DE
New clinics from around the world are entering the program at a steady pace. By the end of May 2013, there were 32 qualified and nearly qualified clinics from all corners of the globe. There are member clinics from North and South America, Europe, and Asia, a total of 12 different countries. In addition, more than 35 centers are at different stages of interaction with the AOCSC team and may well be qualified at a later date. This growing network of clinical research centers proudly boasting an AO qualification in standardized clinical research capabilities is enabling the program to meet its stated goals of: • Improving the efficacy and scientific validity of clinical trials • Ensuring the adequate training of clinical research personnel • Promoting collaboration between qualified AOCSC sites The internal processes which guide the AOCSC program have now been ISO-certified, further testimony to the program’s quality. A dedicated website is available at www.aocsc.org where you can find a wealth of information on the concept. A select number of regional representatives have been trained by the AOCSC team. These representatives can now qualify centers in order to extend the program’s reach and to reduce costs. Although the AOCSC core team is based in Switzerland, the program’s reach is global.
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My view Never heard of the AOCSC program before? Here’s an at-a glance-guide… The AOCSC program enables clinics to meet defined standards for clinical research and to receive an AO qualification valid for three years. The program arose from the clear need to have well organized and collaborative sites involved in AO clinical investigations. AO Clinical Investigation and Documentation (AOCID) developed the concept and the nine Standard Operating Procedures (SOPs) which candidate clinics have to adopt. These are easy to implement and improve the internal organization of clinical research operations. An initial site visit ensures that all local personnel are trained, and that the stringent requirements are met before a qualification can be awarded. Requalification happens every third year. Feedback Research conducted among qualified clinics has shown a high level of positive feedback. In particular, the centers highlight the improved research processes; better team organization; clearer definitions of responsibilities; useful reference guide, especially for study coordinators. Interested in having your clinic gain an AO qualification in clinical research? Email us at: aocid@aofoundation.org, phone +41 44 20 02 420 or visit our dedicated website: www.aocsc.org.
The team at Tübingen Trauma Clinic proudly displaying their AOCSC qualification
James F Kellam Editor-in-Chief james.kellam@aofoundation.org
AO Development? As AO grew, the development of new technology, instruments, implants and ideas was generated through its founders. Maurice Müller recognized the need to associate with industry in order to produce high quality implants and instrumentation. This relationship saw surgeons continue their development through the Technical Commission (TK). With the creation of the AO Foundation, an independent development program AO Development Institute [ADI] was established. However, times changed; implant and instrument development gradually moved away from the AO to the producers as most of development became modification of pre-existing implants. With the change in the AO’s financial arrangements with its industrial partners, development within the AO is not a priority and little new intellectual property is forthcoming. However, it is time for the AO to reconsider its position on development and the creation of intellectual property. Repair of musculoskeletal tissue is centered on the biological side of healing. Implant development now tends to comprise modification of existing implants through the manufacturers with major innovations and new ideas being of lesser interest. With potential changes in the AO’s relationships with producers, it is now time to consider the implementation of a new AO development focus. A new AO Development Program would emphasize the translational aspects of biological solutions to clinical problems as well as the application of information technology and computer navigation to musculoskeletal tissue repair. This would support the purpose of AO research in the development of clinically viable solutions to clinically relevant problems. The AO excels at basic research but its ability to translate these programs into viable products has not yet been solidified. An AO Development Program would facilitate this at the same time as creating more intellectual property thus allowing the AO improve its financial position and academic independence.
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Exciting new and future AO Publications Books from all the AO clinical divisions AOVET—The First 40 Years Jörg A Auer | Ortrun Pohler | Martina Schlünder | Ferenc Kása | Gerhilde Kása | Marvin Olmstead | Björn von Salis | Gustave E Fackelman The AO Foundation, Publishing and Faculty Support Media is proud to announce the launch in Lima, Peru on June 13, 2013 of “History of AOVET—The First 40 Years”, written and edited by exceptional AO veterinary, surgical professionals and founding members. The book traces the milestones, history, and key personalities responsible for the formation of AOVET and celebrates its 40 years of achievement. Despite being worshipped, domesticated, and loved, animals were for a long time mistreated and largely neglected medically. However, as scientific understanding of bone healing in humans grew, led by many of AO’s own founding fathers, the determination of a small group of veterinarians and others to transfer this knowledge to the animal world resulted in the formation of AOVET. With inspiration from childhood experiences of seeing a tragic horse racing accident, to a founding AO surgeon with a passion for dogs and a penchant for telling the local vet how to improve his fracture care technique, the History of AOVET is a fascinating story about the dedication and commitment shown by a small group of veterinary and human surgeons and scientists. It details their quest to find the right techniques, create the correct implants and instruments, and identify the best education and training methodologies, to ensure pain-free and successful surgical outcomes in small and large animals—including a polar bear.
History of AOVET—The First 40 Years
Under the editorship of Jörg A Auer and Ortrun Pohler we follow the journey of AOVET, from its origins in a small workshop of enthusiastic surgeons to today’s world-class international organization. We guarantee that this book will be of interest to all AO surgeons, regardless of their specialty. To obtain a free copy contact: patricia.codyre@aofoundation.org AOSPINE—The SMART Approach to Spine Clinical Research Michael J Lee | Daniel C Norvell | Joseph R Dettori | Andrea C Skelly | Jens R Chapman Following the highly acclaimed 2012 publication “Measurements in Spine Care”, AOSpine has released “The SMART Approach to Spine Clinical Research”, a must-have guide for spine care professionals seeking to make a meaningful contribution to the scientific literature. Guiding the reader step-by-step through the principles
The SMART Approach to Spine Clinical Research
AO Dialogue 1|13
and methods of planning and evaluating research, this new text now completes an unprecedented library of four reference and research books covering the outcomes and severity measures of spine disease and deformity, and measurements and research, ideal for both the student and practitioner alike. Superbly illustrated, and edited by Jens Chapman and an experienced team of authors and contributors, The SMART Approach to Spine Clinical Research and the additional AOSpine clinical management, classification and research collection is highly recommended to all AOSpine members. Soon-to-be-published AOTrauma manuals
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This new publication, under the editorship of Carsten Perka and Michael Schütz, brings together the latest global knowledge on periprosthetic fractures, including all relevant anatomical regions, surgical pitfalls, complex cases. It also includes a comprehensive new “Unified Classification System, UCS” on periprosthetic fractures, combining the original Vancouver classification with the AO-Müller classification. AOTrauma will also launch “Casts, Splints, and Support Bandages—Nonoperative Treatment and Perioperative Protection”, which promises to be a leading text of its kind, outlining the history, principles, guidelines for fracture treatment, and step-by-step instructions on performing more than 50 individual nonoperative and postoperative cast and splint techniques.
The Davos Courses 2013 will see the release of AOTrauma’s highlyanticipated “Manual of Periprosthetic Fracture Management”.
Recently released publications
Principles of Internal Fixation
Minimally Invasive Spine Surgery— Techniques, Evidence and Controversies
Minimally Invasive Plate Osteosynthesis —Second Expanded Edition
AOCMF released “Principles of Internal Fixation of the Craniomaxillofacial Skeleton—Trauma and Orthognathic Surgery”, which outlines the fundamentals of craniomaxillofacial surgery and reconstruction, and related soft tissues.
The most comprehensive book of its kind, this AOSpine text includes surgical techniques, illustrations, case images, and tips and tricks on minimally invasive surgery in the cervical, thoracic, and lumbar/ sacral spine.
In 2012, AOTrauma updated and expanded their classic textbook, covering the principles of MIPO surgery and filled with dozens of cases and case images.
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AOTrauma’s global community of surgeons, researchers and ORPs Delivering high-quality educational activities With more than 7,100 members, AOTrauma enjoys an excellent reputation within the global trauma and orthopedic community. AOTrauma’s priority of providing value to its members directs all its achievements. To maintain its leading position, AOTrauma’s community development is exploring the evolving needs of surgeons from around the world in the different stages of their career. In response to the growing community’s demands, AOTrauma has enhanced its membership options, offering two- and three-year membership programs. Exclusive benefits—access to select journals, the global network directory, free e-books, AOTrauma webinars and webcasts—bring value to its members. Global Needs Analysis results Chairperson Kodi Kojima and the regional members of the AOTrauma Education Commission (AOTEC) are indebted to the 4,316 community members who provided valuable input to its educational planning by completing the 2012 Global Needs Analysis survey. This data has been analyzed and provides excellent guidance for strategic planning for all future Continuing Professional Development (CPD) activities. Many priorities were confirmed and several emerging trends and opportunities were identified for future development. More in-depth data analysis is being carried out by the Educational Taskforces in all subspecialties and by regional and national education committees. The resultant
Group picture during the AOTrauma Advances Course, Ribeirao Preto, BR
decisions will ensure that AOTrauma meets the future needs of the community using the most appropriate educational methods. Continued Education Transformation Continued Education Transformation, the initiative launched by AOTrauma Education in 2013, aims to transform AOTrauma’s course-focused education into comprehensive education portfolios relevant to the needs of surgeons and ORPs. AOTEC has launched a flexible framework for AOTrauma Basic Principles and Advanced Principles of Fracture Management courses in 2013. Its goal is to support chairpersons in providing high-quality educational activities with content relevant to the majority of course participants. AOTrauma World Café AOTrauma Trustees are invited to the AOTrauma World Café taking place during the 2013 Trustees Meeting in Lima, Peru on June 14, 2013 at 08:00. Built on the success of the World Café launched at the 2009 Trustees Meeting, it aims to continue discussions around key issues for AOTrauma. Trustees will embark on a sightseeing journey through three AOTrauma landmarks. The AO Trustees’ sense of adventure and participation will be put to good use during the event.
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AOSpine’s Global Spine Congress Record-breaking numbers of participants and abstract submissions at the congress Following successful conferences in the USA and Spain, the Global Spine Congress 2013 took place at the Hong Kong Convention and Exhibition Centre. More than 1,000 spine care professionals from 82 countries participated in the three-day event. As a meeting point for clinicians and researchers, the Global Spine Congress 2013 provided a full program of activities to allow interactive discussions on various topics of interest to the surgical community. Delegates shared their research output and clinical experience during the scientific sessions and e-poster presentations, whereas advanced issues and novel technologies were covered in the symposia moderated by the faculty and guest experts. In accordance with the AOSpine vision of promoting spine care and knowledge collaboration on a global scale, the 2013 event was the first Global Spine Congress to be held in the Asia Pacific region. The record-breaking numbers of participants and abstract submissions, the consistently high quality of research presentations and the dynamic AOSpine community all contributed to the great success of this event. AOSpine was honored to welcome guests from the US-based Lumbar Spine Research Society, the Chinese Orthopaedic Association and the Association of Spine Surgeons of India, as well as spine experts from Japan and Korea. Each group hosted a symposium
Germán Ochoa at the Global Spine Congress
in which spine-related issues relevant to their contexts were raised and discussed. LSRS, for example, hosted a symposium on degenerative spondylolisthesis that drew an impressive audience. “With this, our third Global Spine Congress, we’ve extended the international aspect of the event to reflect that AOSpine is the world’s largest organization of spine care professionals with a presence in more than 60 countries. We’ve come together to enjoy leading-edge presentations, discuss e-posters, attend lunchtime lectures and locallanguage sessions, and participate in symposia hosted by some very important societies from India, Korea, Japan, China, and the US.” Germán Ochoa, Co-Chairperson, Global Spine Congress 2013 “This Global Spine Congress has been very successful and the largest ever. But what has impressed me the most is that we have attracted both clinicians and researchers, achieving our aim of bringing people from different disciplines together. In terms of promoting spine care, this model presents the best opportunity for the future.” Kenneth Cheung, Local Host, Global Spine Congress 2013
We now look forward to the World Forum for Spine Research in Xi’an, China, in May 2014, as well as to the next Global Spine Congress in Santiago de Chile, in April 2015.
Kenneth Cheung at the Global Spine Congress
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AOCMF
AOVET
Focus on developing educational offerings
How best to provide more effective patient care
A major focus of recent AOCMF meetings has been the review, revision, and standardization of the course organization for the Principles course laboratory exercises. An integral part of these discussions has been about how to improve the quality of the AOCMF videos that are used in the laboratory exercises.
The AO is currently engaged in redefining its research priorities. This should give us pause to consider how AOVET can best contribute to the Foundation’s goal of providing more effective patient care. Our unique expertise, not only as orthopedic specialists but also as veterinary care-providers for animals, many of which are employed in the orthopedic research process, should make us an indispensable and pivotal contributor. Realignment of the AO’s research strategy provides an opportunity for AOVET to fully integrate itself with other AO clinical divisions and institutes in the research process. AO research also offers an entry point for young researchers and clinicians to participate in the AO, teaches the scientific research methods, furthers development of AO technologies, and ultimately it helps advance academic careers.
There has been an increased emphasis on facilitating small group discussions to play a larger role at various courses, with a decreased amount of time devoted to traditional lectures. A pilot project will be launched at a Principles course in Minneapolis, USA in August, 2013, offering participants an alternative pedagogical experience comprising fewer lectures and a greater focus on small group discussions and laboratory exercises. There is a strategic plan to increase the number of Principles courses offered in countries that have been successful in recruiting good faculty, that represent the divergent specialties in those countries. The best example of this is in India, where the intention is to increase the number of Principles courses from two in 2013, to four in 2014, and six in 2015. AOLAT has just completed their Fifth Faculty Retreat where the focus was on emphasizing the importance of medical publications. The program taught faculty how to write a medical manuscript and get it accepted for publication.
July 2013 will be the third anniversary of AOVET’s membership launch. AOVET Active Members who joined the AOVET Membership in 2010, will become eligible to apply for the membership award level, AOVET Ambassador. AOVET has more than 600 Members worldwide with growing numbers in Latin American and Asia Pacific. In countries where professional opportunities for improvement are scarce, the AOVET Community Development Commission has been working together with the AOVET Education Commission in organizing courses, being present at main events with AOVET Days, and offering fellowships to its members.
From June 2013 the Journal of Craniomaxillofacial Trauma & Reconstruction (JCMTR) features newly-elected editorial board members under the leadership of Editor-in-Chief Paul Manson, and Associate Editor, Larry Hollier. This quarterly journal fills a gap in the current literature and will increase the number of articles it publishes. All manuscripts are peer-reviewed in an impartial and transparent process prior to publication. The AOCMF website will soon deliver a restructured submission process.
Last year, AOVET refreshed its member benefits by re-activating online access to VCOT. Plans for the future consist of improving the quality of member benefits, involving members more closely and increasing the number of fellowships. More courses will be offered in Asia Pacific and Latin America and in cooperation with the Education Commission, faculty training courses will be held in order to build up a regional faculty.
Practical exercise at AOCMF Principles Course in Kochi, IN
The first Principles in Small Animal Fracture Management Course in Cape Town, ZA
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TK System A unique value proposition for the AO In a healthcare environment which is globally becoming more and more complex, today’s approaches to medical device development demand incorporation of a growing number of requirements. A thorough review involving more than 200 surgeons and industry representatives from both inside and outside the AOTK network confirmed the added value provided by the AOTK System to the AO Foundation and its industrial partners. Spanning the overall scope of trauma and disorders of the musculoskeletal system care the AOTK System offers the industry an extra quality control process that is complementary (if not superior) to regulatory control, without delaying internal product development processes. It also helps to provide insights into the clinical needs of emerging markets. Evidence Based Development A key element of the AOTK System’s strategy is to obtain evidence for the improvement of medical innovations and procedures. Leveraging its long-standing cooperation with AO Institute Davos (ARI) and AO Clinical Investigation and Development (AOCID),
Meet the Experts session during the Davos Courses 2012
the AOTK System currently runs numerous pre-clinical and clinical studies. In addition, small “Focused Registries” are used on a regular basis by the various EGs to determine the benefits of a new technique in clinical experience. In practice any new project in the EGs needs to address the following key questions: • What is the benefit to the patient? • What is the benefit to the surgeon? • What is the value to the healthcare system?Furthermore Expert User Symposia are organized in all AO regions. Participants discuss their experiences with defined technology and fully assess their benefit. If applicable improvements can be initiated their improvement. Latest results can be seen in the next issue of the “AOTK Innovations” magazine which will be published later this year as well as the popular “Meet the Experts” Sessions at the Davos Courses. As always, please contact the publication’s editors for comments and feedback at AOTK@aofoundation.org.
Meet the Experts session during the Davos Courses 2012
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AO Clinical Investigation and Documentation (AOCID) ISO Certification and audits
AO Outcome Center
AOCID’s ISO recertification visit was held in April 2013 and after a thorough audit, certification was awarded for the next three years without any non-conformities requiring immediate action. As the audit proved, AOCID’s recent successful ventures have all been achieved with an eye on quality.
This is an online tool to enable a clinician to administer computeradaptive testing (CAT) of outcome measurements to patients. Pilot data collection is planned for centers in Chicago and Boston, USA. Once the pilot study is has been evaluated and adjusted, the first version will be released to AO members in North America. AO Trustees will be given an exclusive peek at the tool at the Trustees Meeting in Lima in June 2013.
Recertification was quickly followed by an audit by the AO’s industrial partner, DePuy Synthes. AOCID’s two Swiss locations were visited and no major concerns were reported. AOCID is currently implementing several recommendations and is well poised to conduct clinical research for DePuy Synthes. Educational courses In recent years, AOCID has added accredited courses in Good Clinical Practice (GCP) and one for study coordinators to its long list of services. A sold out GCP course took place in Hong Kong in April around the Global Spine Congress. The next AO Study Coordinator Course will take place in Boston from 26-28 September 2013. More information is available at www.aofoundation.org/ studycoordinator.
filling in outcome measurement
Fellowships There have been two clinical research fellowships in 2013 already. Jose Alfredo Corredor Santos from Colombia learned about elements of clinical research and worked on his project dealing with arthroscopic therapy of discoid menisci. The second-ever Audi Accident Research Unit (AARU) fellow, Antonio Ernstberger, also came to the AOCID offices for three months to further analyze data collected from a large database of car collisions across a variety of parameters. Social Media AOCID is now active on Twitter: www.twitter.com/ao_cid
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AO Research Institute (ARI) Fellows Report The Research Fellowship program—funded by AO Clinical Division Boards and AO Exploratory Research Board—attracts resident and senior surgeons from around the world. The ARI Fellowships are advantageous for both the surgeon and the research team. While the scientists appreciate the clinical input from the fellow, the surgeon benefits from the membership of a multidisciplinary research and development team. The main
goals of a six to twelve month fellowship are learning how to approach translational research questions, creating tangible research results, and co-authoring publications in scientific journals. Fellows of all research groups/programs furthermore acknowledge the invaluable extension of their personal networks for future R&D activities.
Rukmanikanthan Shanmugam, Malaysia “To work with a multidisciplinary team where each member is an expert is a golden opportunity to learn from the best and establish links with good mentors for future projects.”
Joseph George, India “Working alongside software engineers and coffee breaks with molecular biologists, polymer chemists and engineers encourages and inspires everyone.” Tomas I Nicolino, Argentina “As a surgeon this experience gives me the opportunity to understand medical problems from different points of view.” Fabian Duttenhoefer, Germany “Working at the ARI provides me with an excellent research platform owing to its implementation of multiple scientific fields and its very friendly and helpful environment.”
Daniel Wagner, Germany “This helps me to think in different ways, to work scientifically and hopefully to find new clinical solutions. I would recommend a medical fellowship in the ARI to every surgeon with an interest in science.”
Ahmad F Seifeldin, Egypt “As an orthopedic surgeon, it is a perfect opportunity to align my practical experience with high quality research, attaining methodologies of data acquisition and interpretation and conducting evidence based investigations.”
Abhay Gahukamble, India “The expertise in the various interconnected fields dealing with the musculoskeletal system which is found under the same roof is a testimony to the excellent research. The knowledge and experience gained here will be an asset in the future.”
Tatiana Nataly Pirvu, Germany “In addition to practical skills in working with cell and tissue cultures, I have learned different viewpoints and approaches regarding exploratory research, which clearly differ from medical opinions and clinical research.”
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AO Education Institute In the delivery of education the AO is addressing the shift towards continued medical education by a strong increase in online delivery of content through webinars and webcasts. The AOTrauma online education platform “STaRT” will be launched in 2013.
AOTrauma’s web-based offerings for resident will offer three distinct learning strategies:
STaRT—an online learning resource for residents
As surgeon presenters discuss a case, the video pauses and questions pop up to engage the learner. Tips and tricks and direct links to further learning material help residents to deepen their knowledge of the topic. There is a strong focus in these modules on decision-making skills and the discussion of typical patient situations on three levels: basic, intermediate, and complex cases.
Residents have unique learning needs. The AO STaRT (Surgical Training and Assessment for Residents) Program is committed to determining the best strategies for residents to benefit from the wealth of knowledge and resources available within the AO. A detailed needs analysis led to the development of a concept for web-based learning tools for orthopedic trauma and spine residents. The first offerings with interactive videos, options for self-assessment in four different knowledge areas, and an overview of available AO learning material for residents are scheduled to go online in December 2013. Structured interviews with resident supervisors and directors of residency programs in three countries (Germany, Saudi Arabia, Brazil) helped to identify the needs of residents with regard to learning resources. One of the main challenges that residents face nowadays is a lack of time for learning and skills development. To address these and other challenges residents are facing the AO STaRT program aims to: • • •
Support self-directed learning Enhance effectiveness of adopting basic principles and clinical reasoning skills Complement the formal educational offerings by the certifying bodies (ie, curricula, catalogues, et al) and the teaching hospitals
Interactive eLearning
Self-assessment To help identify knowledge gaps, learners can test themselves with multiple choice questions (basic, intermediate, or complex questions), receiving feedback when the short test is completed. The training mode allows for focused learning through immediate feedback. For each topic, further learning material is suggested. Online collection of AO resources targeted at residents Structured access to existing learning material allows residents to quickly identify the available learning resources. All learning material is labeled as basic, intermediate, or complex content and includes videos, webinars, recorded lectures, eLearning modules, readings, mobile Apps, access to AO Surgery Reference and Traumaline etc.
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From the President Jaime Quintero talks to AO Dialogue Jaime Quintero, this is your first Trustees Meeting as AO President, what are your aspirations for the meeting?
The Annual Board of Trustees Meeting is where the General Assembly takes places. Important decisions regarding the scientific and clinical mission of the AO Foundation, as well as reports, elections, presentations of financial reports and from time to time modifications to the Charter and Bylaws are integral to this. We live in times of change and my aspiration is to receive the support of our esteemed Trustees for the amendments to the Bylaws that are needed to improve our research and development activities and become more efficient and more focused in our research strategy. Another aspiration is that the Trustees take this opportunity to learn more about our host country, Peru and host region of Latin America, where the enthusiasm for AO activities is truly contagious. During the opening ceremony a video and lecture will highlight the history and culture of Peru and an AO Trustee, Peter Cole, will talk about his experience of a health mission in the Peruvian Amazon. Our guest speaker Alvaro González–Alorda will address the Trustees on collaboration and the keys to leading people in a fast-evolving environment. Some other meeting program highlights include presentations from our clinical divisions on provocative topics and our institutes on their activities in innovation and scientific production. The final session, “A conversation with our Past Presidents”, comprises a tribute to their wisdom, experience and insights. What should have been achieved by the end of the Trustees Meeting 2013?
One crucial session during this Trustees Meeting addresses current initiatives and discussions with our new industrial partner. There are preliminary projects that may provide us with tools to consider new collaborations in other fields such as joint arthroplasty, neurotrauma and sports medicine. It is important to clarify the role of education and the relationship between academia and industry will be part of this discussion. Elements such as compliance and regulations need to be clarified and explained in detail to the Trustees. By the end of the meeting the AO Foundation should see that its values and principles are maintained and continue to be a powerful tool to gain reputation and respect. Our surgeons, represented by the clinical divisions and its members, our collaborators and employees should look optimistically to the future and its challenges. As long as there are patients, we will be there providing what it is best for their health. What is the future of the relationship between the AO and DePuy Synthes?
The future of the relationship between AO and DePuy Synthes will be based on mutual trust, collaboration, transparency, ethics and respect. It is clear that the process of integration of both companies will take some time still and there are regional and even national differences that must be addressed. We have now a new and challenging opportunity for both organizations, let us aim high.
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Impressum AO Dialogue 1|13 Editor-in-Chief: James F Kellam Managing Editor: Olga Harrington Publisher: AO Foundation Design and typesetting: Manuel Kurth Editorial contact address: AO Foundation, Clavadelerstrasse 8, CH-7270 Davos Platz, Phone: +41 81 414 28 14 Fax: +41 81 414 22 97 E-mail: dialogue@aofoundation.org www.aofoundation.org Copyright © 2013, AO Foundation, Switzerland
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AO Dialogue 1|13