HCPC News Release

Wednesday 20 November 2013

New research commissioned by the HCPC shows that one in five 'doubted fitness to practise' of a health or care professional

The Health and Care Professions Council (HCPC) is launching new research today which finds that a fifth of UK adults have encountered behaviour from a health or care professional that made them doubt their fitness to practise.

More than a quarter said the health or care professional in question seriously or persistently failed to meet standards whilst 16 per cent said they felt the professional failed to respect the rights of a patient to make their own choices.  Thirteen per cent felt they were 'hiding mistakes' and a further nine per cent felt they were exploiting vulnerable patients.  One in twenty said they had experienced or witnessed reckless or deliberately harmful acts.

Despite these figures, just three out of ten reported their concerns, with a further 73 per cent of adults who would not know where to go to report concerning behaviour.

The data, released today supports research commissioned by the HCPC earlier in the year into what the general public feel they need protection from most.  Findings from this report show that Illegal drug taking and shoplifting were far more likely to concern members of the public than convictions for drink driving. Dishonesty and fraud were also key concerns for most.

Brian James, Head of Assurance and Development said:

"The vast majority of HCPC registrants practise safely and effectively and within nationally agreed standards for professional skills and behaviour. However, on the rare occasion that a registrant does not meet HCPC standards, action can be taken including imposing sanctions or stopping them from practising in the most serious of cases. After looking at the key findings in this research it is reassuring to know that we are dealing with the issues that the public feel they need protecting from the most."

The HCPC's 2013 annual fitness to practise report<http://www.hcpc-uk.org/publications/reports/index.asp?id=709>, which has just been published, shows the action the HCPC is taking to protect the public.

Anyone can contact the HCPC to raise a concern about a registrant. This includes members of the public, employers, the police and other professionals.

Save the Date

Save the Date for the BAPO conference 2014.

 

When: 14^th-16^th March
Where: The Point, Lancashire County Cricket Club, Old Trafford, Manchester.

Its set to be a Fantastic Weekend with some great speakers so don't miss out Save the Date now!

BAPO Conference & Exhibition 2014 Call for Papers

BAPO are seeking presentations both Prosthetic and Orthotic of 12 minutes duration with up to 3 minutes for questions and answers.

 

For more details download submission instructions here

Physiotherapy to Complement Orthotic Treatment

Physiotherapy to Complement Orthotic Treatment

Saturday 12th October 2013

**last chance to book on this course**

This course aims to:

Share how physiotherapists look at patients regarding an assessment and detail what elements of that assessment may lead to the involvement of orthotics.

 

Explore reasoning behind physiotherapy intervention, namely core stability, flexibility, strength, pathology, neurological involvement etc.

 

The event will be delivered by tutors who are also active clinicians using audio/visual aids as appropriate. We may call upon willing delegates to participate in the direct delivery of the syllabus. There will group discussions and case studies.

 

Contact hours: 6 hours plus 2 hours of independent reading

 

 

Physiotherapy to Complement Orthotic Treatment Short Course

LimbPower Holding Primary & Junior Games at Stoke Mandeville Stadium

Following the huge success of last year's inaugural Junior Games, LimbPower are proud to be holding this fantastic event once again at Stoke Mandeville Stadium, birthplace of the Paralympics. The weekend will introduce young amputees and the young ambulant disabled to a range of sporting activities in a safe, friendly and inclusive environment.

Saturday 5th October will see those aged 5-11 able to try out a variety of sports including athletics, cycling, football, tennis and basketball in 'Have a Go' sessions under the guidance of experienced mentors and instructors from each sport's governing body. The emphasis is on fun while encouraging the children to have a go at sports and socialise with their peers.

On Sunday 6th October the older children aged between 11-18 will be able to have a go at key Paralympic sports, with instruction from qualified coaches and experienced athletes. They will be able to try out a wide range of sports including; athletics, Powerlifting, basketball, sitting volleyball, archery, football, cycling, swimming and tennis. They will be able to have fun and also perhaps find some hidden talents. We may even discover the Paralympians of the future!

"We're thrilled to be able to run this event again and offer the same opportunities to children that we have been offering to adults at the Amputee Games" said Kiera Roche, LimbPower Chairman. "Last year was such a great success, and we're hoping to reach even more young people and give them the chance to challenge what they think they are capable of."

Juliette Woolf, mother of Rio Woolf who took part last year, commented; "The 2012 LimbPower Primary Games were life-changing for Rio - he absolutely loved trying all the different para-sports on offer and making friendships with other "children with special arms and legs" which will last a lifetime - they had an instant bond!"

The Primary & Junior Games will help young amputees to learn new skills, have fun and importantly to discover their potential through sport. Anyone interested in taking part should contact Kiera Roche from LimbPower on: 07502 276858 or kiera@limbpower.com Alternatively registration forms can be downloaded from the website at www.limbpower.com/junior-games/

Surgical versus non‐surgical interventions in patients with adolescent idiopathic scoliosis

Surgical versus non‐surgical interventions in patients with adolescent idiopathic scoliosis

J Bettany‐Saltikov, HR Weiss, N Chockalingam… - The Cochrane Library, 2013

... Whilst scoliosis-specific exercises use internal corrective forces (ie muscles), braces use external
corrective forces ... However, some braces (called soft braces) are made of material similar to elas-
tic bands ... of the brace are used to straighten the spine and derotate the pelvis and ...

Retrospective Cohort Study ofthe Economic Value of Orthotic and Prosthetic Services

Medicare recipients given orthotic and prosthetic devices were more likely to remain active in the community and avoid facility-based care than similar Medicare patients who didn't receive such devices, a retrospective study found.

For example, patients receiving lower-extremity orthoses had fewer hospitalizations and emergency department (ED) admissions, and had about 10% lower Medicare costs after 18 months (P<0.05). Comparable Medicare savings were seen in patients with spinal orthoses and they also relied less on facility-based care (P<0.05).

The study results will be used to urge Medicare and other payers to make it easier for patients in need of prosthetics to receive them, the Amputee Coalition, a Manassas, Va.-based advocacy group that commissioned the study, said Tuesday.

The advocates said patients who receive orthoses and prosthetics will save Medicare money in the long run.

Although they relied less on facility-based care, patients receiving the orthotic and prosthetic devices did have more falls and fractures, and average Medicare episode payments weren't always lower. The increase in falls was most likely due to increased mobility because of the device, according to Allen Dobson, president of Dobson DaVanzo & Associates in Vienna, Va., the consulting firm that conducted the study.

"The increased physical therapy among O&P [orthoses and prosthetic] users allowed patients to become less bed-bound and more independent, which may be associated with higher rates of falls and fractures, but fewer emergency room admissions and acute care hospital admissions," the report concluded. "This reduction in health care utilization ultimately makes O&P services cost-effective for the Medicare program and increases the quality of life and independence of the patient."

Dobson, a former research director at the Centers for Medicare and Medicaid Services (CMS), and colleagues examined CMS data from 2007 to 2010 for patients who either had an amputation within the last year or who met predetermined etiological diagnoses. Patients who received a lower-extremity or spinal orthotic or prosthetic device were compared with those who hadn't received such devices.

The study compared healthcare utilization, Medicare payments, and negative outcomes such as fall and emergency department admissions for up to 18 months after receiving the device.

Generally, patients were found to be more mobile and therefore able to receive the physical therapy and rehabilitation required, and to avoid facility-based care.

With the data in hand, advocates hope it will be easier for patients to receive authorization for the devices.

"Insurers want to see the data that the healthcare system is better off if the service is provided," Susan Stout, interim president and chief executive of the Amputee Coalition, said in a call with reporters. "Now that the study is completed, we intend to use the information contained in the study to achieve fair insurance coverage for prosthetic devices."

Providers must prove the medical necessity of devices before insurers will pay for their use, a step which can be burdensome to patients and physicians. Insurers also have a tendency to provide the least expensive prostheses rather than one that maximizes a patient's mobility.

"For the first time, we can actually use the data ... that clearly demonstrates the efficiency and the efficacy of the services that we provide," Thomas Kirk, PhD, president of theAmerican Orthotic & Prosthetic Association, said in a call with reporters. "Not only are we providing services that can help out patients, we are also helping the American taxpayers save money."

While payers don't deny the devices, a number of patients are underserved by insurers, the advocates said on the call Tuesday. "Many payers have seen the cost of a prosthesis in a vacuum rather than seeing it as actually contributing to the overall improved health of the patient," Kirk said.

The authors hope to publish the results in a medical journal later.

Source: http://www.medpagetoday.com/PublicHealthPolicy/Medicare/41260

Link to report: http://www.amputee-coalition.org/content/documents/dobson-davanzo-report.pdf

Effect of rocker shoes on pain, disability and activity limitation in patients with rheumatoid arthritis

Masumeh Bagherzadeh Cham, Mohammad Sadegh Ghasemi, Bijan Forough, Mohammad Ali Sanjari, Mozdeh Zabihi Yeganeh, Arezoo Eshraghi

Abstract

Background: Rheumatoid arthritis is a chronic inflammatory joint disease which affects the joints and soft tissues of the foot and ankle. Rocker shoes may be prescribed for the symptomatic foot in rheumatoid arthritis; however, there is a limited evidence base to support the use of rocker shoes in these patients.

Objectives: The aim of this study was to evaluate the effectiveness of heel-to-toe rocker shoes on pain, disability, and activity limitation in patients with rheumatoid arthritis.

Study design: Clinical trial.

Methods: Seventeen female patients with rheumatoid arthritis of 1 year or more duration, disease activity score of less than 2.6, and foot and ankle pain were recruited. Heel-to-toe rocker shoe was made according to each patient's foot size. All the patients were evaluated immediately, 7 and 30 days after their first visit. Foot Function Index values were recorded at each appointment.

Results: With the use of rocker shoes, Foot Function Index values decreased in all subscales. This reduction was noted in the first visit and was maintained throughout the trials.

Conclusion: Rocker shoe can improve pain, disability, and activity limitation in patients with rheumatoid foot pain. All the subjects reported improved comfort levels.

Clinical relevance The results of this study showed that high-top, heel-to-toe rocker shoe with wide toe box was effective at reducing foot and ankle pain. It was also regarded as comfortable and acceptable footwear by the patients with rheumatoid foot problems.

Suspended without pay

HCPC REGISTRATION RENEWAL REMINDER
DEADLINE:  30 SEPTEMBER 2013

Can you afford to be suspended without pay?  46% of P&O registrants still have not re-registered with HCPC.  All registrants must re-register by 30th September 2013 or you will be unable to practice as a Prosthetist or Orthotist.  Re-registration only takes 5 minutes and can be done simply online on the HCPC website.
 
http://www.hpc-uk.org/aboutregistration/theregister/

Paediatric Gait Analysis and Orthotic Management - BAPO Run Short Course - 8th & 9th November 2013

This Course Aims to: 

Explore a fresh approach to the observation and analysis of normal gait and standing, and the classification and management of gait disorders. The biomechanics of normal gait and standing, and the pathological gaits of disabling conditions will be extensively reviewed, with particular reference to orthotic management. Pre-gait analysis and orthotic management assessment will be demonstrated. The emphasis of patient cases will focus on cerebral palsy, myelomeningocoele and other neurological conditions. Participants will gain a knowledge of the aims of orthotic management and how to achieve them through: the biomechanics of ankle-foot orthoses, the influence of footwear, varieties of ‘AFO Footwear Combination’ design, tuning ‘AFO Footwear Combinations’ to optimise gait and extensive video examples. In addition live patient demonstrations will help participants refine their clinical decision making skills involved in gait analysis and orthotic design.

                                                          Paediatric Gait Analysis and Orthotic Management

Register as a stakeholder for a Clinical Reference Group

Registration is now open for anyone with an interest in the work of the Specialised Services Clinical Reference Groups (CRGs).  To become a stakeholder in a particular CRG you will most likely be a patient, carer, a member of the public, a member of a voluntary organisation, or a clinical or non-clinical professional.

Physiotherapy to Complement Orthotic Treatment

This course aims to:

Share how physiotherapists look at patients regarding an assessment and detail what elements of that assessment may lead to the involvement of orthotics.

Explore reasoning behind physiotherapy intervention, namely core stability, flexibility, strength, pathology, neurological involvement etc.

The event will be delivered by tutors who are also active clinicians using audio/visual aids as appropriate. We may call upon willing delegates to participate in the direct delivery of the syllabus. There will group discussions and case studies.

Contact hours: 6 hours plus 2 hours of independent reading

Physiotherapy to Complement Orthotic Treatment Short Course

Does excessive flatfoot deformity affect function? A comparison between symptomatic and asymptomatic flatfeet using the Oxford Foot Model

Matthias Höslemail, Harald Böhm, Christel Multerer, Leonhard Döderlein

Treatment of asymptomatic flexible flatfeet is a subject of great controversy. The purpose of this study was to examine foot function during walking in symptomatic (SFF) and asymptomatic (ASFF) flexible flatfeet. Thirty-five paediatric and juvenile patients with idiopathic flexible flatfeet were recruited from an orthopaedic outpatient department (14 SFF and 21 ASFF). Eleven age-matched participants with typically developing feet served as controls (TDF). To study foot function, 3D multi-segment foot kinematics and ankle joint kinetics were captured during barefoot gait analysis. Overall, alterations in foot kinematics in flatfeet were pronounced but differences between SFF and ASFF were not observed. Largest discriminatory effects between flatfeet and TDF were noticed in reduced hindfoot dorsiflexion as well as in increased forefoot supination and abduction. Upon clinical examination, restrictions in passive dorsiflexion in ASFF and SFF were significant. During gait, the hindfoot in flatfeet (both ASFF and SFF) was more everted, but less flexible. In sagittal plane, limited hindfoot dorsiflexion of ASFF and SFF was compensated for by increased forefoot mobility and a hypermobile hallux. Concerning ankle kinetics, SFF lacked positive joint energy for propulsion while ASFF needed to absorb more negative ankle joint energy during loading response. This may risk fatigue and overuse syndrome of anterior shank muscles in ASFF. Hence, despite a lack of symptoms flatfoot deformity in ASFF affected function. Yet, contrary to what was expected, SFF did not show greater deviations in 3D foot kinematics than ASFF. Symptoms may rather depend on tissue wear and subjective pain thresholds.

http://www.gaitposture.com/article/S0966-6362(13)00251-8/abstract

--

Jonathan 

Prosthetic finger out of Bicle Parts

Colin MacDuff invents prosthetic finger out of BICYCLE partsDaily Mail

Mr Macduff constructed the prosthetic device using leftover bike parts, ... but doctors told him that there were no prosthetics for finger amputees available.

NICE Stroke Rehabilitation Guideline

Stroke rehabilitation: long-term rehabilitation after stroke

Clinical guidelines, CG162 - Issued: June 2013

This guideline offers evidence-based advice on the care of adults and young people aged 16 years and older who have had a stroke with continuing impairment, activity limitation or participation restriction.

http://www.nice.org.uk/nicemedia/live/14182/64098/64098.pdf

NICE has published good practice guidance on patient group directions (PGDs)

The guidance has been developed to help individuals and organisations who are considering the need for, developing, authorising, using and/or updating PGDs to ensure they are appropriate, legal and that relevant governance arrangements are in place within commissioning and provider organisations.

The guidance underlines that supplying and/or administering medicines under PGD should be reserved for situations where this offers an advantage for patient care without compromising patient safety and where there are clear governance arrangements and accountability.

Physiotherapy to Complement Orthotic Treatment Saturday 12th October 2013

For further information on the 'Physiotherapy to Complement Orthotic Treatment' BAPO Short Course please follow the link below:

Further Information

Please note that the cancellation date of this course is 2 September 2013.  If you wish to book a place on the BAPO short course then please do so at your earliest convenience.

The clinical management of diabetic foot in the elderly and medico-legal implications

Claudio Terranova, Andrea Bruttocao

Abstract

Diabetic foot is a complex and challenging pathological state, characterized by high complexity of management, morbidity and mortality. The elderly present peculiar problems which interfere on one hand with the patient's compliance and on the other with their diagnostic-therapeutic management. Difficult clinical management may result in medico-legal problems, with criminal and civil consequences. In this context, the authors present a review of the literature, analysing aspects concerning the diagnosis and treatment of diabetic foot in the elderly which may turn out to be a source of professional responsibility. Analysis of these aspects provides an opportunity to discuss elements important not only for clinicians and medical workers but also experts (judges, lawyers, medico-legal experts) who must evaluate hypotheses of professional responsibility concerning diabetic foot in the elderly.

http://msl.sagepub.com/content/early/2013/08/06/0025802412473595.abstract

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy

TL Lin, HM Sheen, CT Chung, SW Yang, SY Lin… - … of Foot and Ankle Research, 2013

... However, what the four insole conditions will be, the configurations, and possible biomechanical
effects, were not told. ... 18. Menz HB: Two feet, or one person? Problems associated with statistical
analysis of paired data in foot and ankle medicine. Foot 2004, 14(1):2–5. 19. ...

How Effective Is Orthotic Treatment in Patients with Recurrent Diabetic Foot Ulcers?

Maria Luz Gonzalez Fernandez, PhD, Rosario Morales Lozano, PhD, Maria Ignacia Gonzalez-Quijano Diaz, PhD, Maximo Antonio Gonzalez Jurado, PhD, David Martinez Hernandez, MD and Juan Vicente Beneit Montesinos, MD

Abstract

Background: We assessed the efficacy of customized foot orthotic therapy by comparing reulceration rates, minor amputation rates, and work and daily living activities before and after therapy. Peak plantar pressures and peak plantar impulses were compared with the patients not wearing and wearing their prescribed footwear.

Methods: One hundred seventeen patients with diabetes were prescribed therapeutic insoles and footwear based on the results of a detailed biomechanical study and were followed for 2 years. All of the patients had a history of foot ulcers, but none had undergone previous orthotic therapy.

Results: Before treatment, the reulceration rate was 79% and the amputation rate was 54%. Two years after the start of orthotic therapy, the reulceration rate was 15% and the amputation rate was 6%. Orthotic therapy reduced peak plantar pressures in patients with reulcerations and in those without (P < .05), although a significant decrease in peak plantar impulses was achieved only in patients not experiencing reulceration. Sick leave was reduced from 100% to 26%.

Conclusions: Personalized orthotic therapy targeted at reducing plantar pressures by off-loading protects high-risk patients against reulceration. Treatment reduced the reulceration rate and peak plantar pressures, leading to patients' return to work or other activities. (J Am Podiatr Med Assoc 103(4): 281-290, 2013)

Source: http://www.japmaonline.org/content/103/4/281.short

THE MANIC MARAFUN!

The Manic Marafun is a 26 mile challenge, but with a difference.  Each participant only has to do one mile, or four laps of the track at the wonderful Stoke Mandeville Stadium, and to make it even more appealing, they can choose from a variety of wacky ways in which to complete it.  Whether it be running, walking backwards, cycling, scooting, pushing a day chair or even doing the wheelbarrow with a friend, there are plenty of options for completing your mile and having fun while you do it!

This is a family day, and there will be a delicious BBQ and children's entertainment to ensure that everyone has a great time, whether you are the finely honed athlete about to tackle a mile of skipping, or just there to watch the antics and socialise with friends.

The Manic Marafun will be held on the 24^th August and is open to everyone.  To take part in the Marafun itself there is a registration fee of just £10 for adults and £1 for children, so now's the time to dream up a suitably 'Manic' way of completing your mile and sign up! 

To find out more and register for this event simply visit http://www.limbpower.com/events/

Interested in £4 million?

The Health Foundation wants to make care safer by closing the gap between best practice and current delivery of care. 

We have £4 million on offer to support up to nine project teams to implement and evaluate tested, evidence-based patient safety interventions at scale. 

Types of project could include (but are not limited to):

• approaches to build skills in improving patient safety
• interventions to improve reliability of clinical care
• creating the conditions for the delivery of safer care.

Applicants will need to demonstrate a strong track record in designing, delivering and evaluating improvement projects. 

Due to the range of skills and experience required, we anticipate applications will come from groups of organisations working together. The skills required include quality improvement, evaluation and clinical/service expertise. 

Projects will also need to include an organisation that can influence wider practice and opinion. 

Interested? 

Applications open on 3 June 2013 and close at 12 noon on 23 September 2013. 

Visit www.health.org.uk/ctgptsafety to find out more. 

An Introduction to Podiatric Medicine for Healthcare Professionals Saturday 21st September 2013

For further information on the 'An Introduction to Podiatric Medicine for Healthcare Professionals' BAPO Short Course please follow the link below: Further Information

AFOs Improve Balance Confidence in Poststroke Hemiplegia Patients

Researchers at Northwestern University Prosthetics-Orthotics Center (NUPOC), Chicago, Illinois, and the U.S. Department of Veterans Affairs (VA) have found that AFO use improves balance confidence in patients with chronic poststroke hemiplegia.

http://www.oandp.com/articles/NEWS_2013-06-28_02.asp

HCPC professional indemnity cover and registration

EU directive 2011/24/EU sets about member states being responsible for high quality care and as a result each state must have a mechanism to ensure that patients are protected from the event of harm.  In the UK this will mean that all healthcare professionals will have Professional Indemnity Insurance in place by Friday 25^th October 2013.   Cover via an employer's indemnity arrangements is sufficient to meet requirement.   NHS employees should be covered under the clinical negligence scheme (CNS).  Sub contracted companies should hold sufficient arrangements.  Likewise, individuals who practice independently must hold cover.  The regulated professional must ensure that their indemnity arrangements in place are appropriate for the nature of their work that they undertake.   Voluntary work and Good Samaritan acts are not covered by employer insurance.   Healthcare professionals do not need reciprocal individual insurance. Vicarious liability is sufficient under this indemnity arrangement. 

In situations were persons are seen to be working outside their perceived scope of practice, it is difficult to avoid vicarious liability unless practitioner steps outside scope in areas of clear cut situations where policies are in place. 

Consultation on HCPC guidance for registrants launched on 10th June and closes on 2 August 2013 and can be found on the HCPC website.   http://www.hpc-uk.org/aboutus/consultations/index.asp?id=158 Guidance will then be published in September and sets out the responsibilities of a registrant, information about professional indemnity cover, how registrants can meet the requirement and how the HCPC will check that the cover is in place.  The requirement will be introduced in October 2013 and will be of a self-declaration upon renewal.  The HCPC will start checking cover is in place from 1 April 2014.  Failure to ensure appropriate cover is in place may mean administrative removal from the registrar or referral to fitness to practice.  

If you use insurance provided through your BAPO membership, it is still up to the individual registrant to provide the HCPC with details of indemnity insurance.  If you require Policy details, please contact the Secretariat. High-risk practice such as private work with sports persons or models will bring about increased risk and must be disclosed as an area of work.  All disclosures must be disclosed to insurers.  Area of practice is important when considering insurance and not scope of practice. 

 

NICE has updated its guidelines on falls

Healthcare professionals should consider patients aged 65 or older, and those aged over 50 with underlying conditions such as stroke, at high risk of falling while in hospital care, according to updated guidelines from NICE.

Falling is the leading cause of injury-related admissions to hospital in those over 65, and costs the NHS an estimated £2.3 billion per year.

A number of falls occur in hospitals, with nearly 209,000 reported between 1 October and 30 September 2012.

While many who fall only experience minor cuts or bruises, over the past year 90 people died, and around 900 experienced hip fractures and head injuries as a result of falls.

NICE has updated its guidelines on falls, to help reduce the number of older people who are falling over in hospitals.

NICE says that certain groups of inpatients should be regarded as being at risk of falling in hospital. These include all patients aged 65 years or older, and those aged 50 to 64 years who are judged by a clinician to be at higher risk of falling because of an underlying condition such as dementia or stroke.

For these patients, aspects of the inpatient environment that could affect their risk of falling should be systematically identified and addressed. These include flooring, lighting, furniture and fittings such as hand holds.

Healthcare professionals should also consider a multifactorial assessment and multifactorial intervention for patients at risk of falling in hospital.

These assessments should identify a patient's individual risk factors for falling in hospital that can be treated, improved or managed during their expected stay.

Such risk factors may include cognitive impairment, continence problems, a history of falls, postural instability and visual impairment.

Healthcare professionals should ensure that any multifactorial intervention carried out should promptly address the patient's identified individual risk factors for falling in hospital, and take into account whether the risk factors can be improved managed or treated during the patient's expected stay.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: "Falling over is a serious problem in hospitals, and unfortunately their likelihood increases with age as people become frailer. They can cause distress, pain, injury, a loss of confidence and independence, and in some cases, death."

He added: "While it would be virtually impossible to prevent all hospital falls from happening, our guideline calls for doctors and nurses to address the issues that will reduce the risk of their patients suffering avoidable harm. No two patients are the same and so a "one size fits all" approach will not work."

Michelle Mitchell, Director General of Age UK said: "The consequences of a fall in later life can be physically and emotionally devastating, potentially resulting in loss of mobility, independence and confidence.

"In addition to the pain caused to the individual, falls cost around £6 million a day in hospital and social care costs to treat."

He added: "Implementing these new guidelines to reduce falls in hospitals must be a priority for our health service, not only to improve patient safety, but to help save precious NHS resources."

A kinematic description of dynamic midfoot break in children using a multi-segment foot model

Jessica D. Maurer, Valerie Ward, Tanja A. Mayson, Karen R. Davies, Christine M. Alvarez, Richard D. Beauchamp, Alec H. Black

Gait & Posture, Volume 38, Issue 2 , Pages 287-292, June 2013

Abstract 

Midfoot break (MFB) is a foot deformity that occurs most commonly in children with cerebral palsy (CP), but may also affect children with other developmental disorders. Dynamic MFB develops because the muscles that cross the ankle joint are hypertonic, resulting in a breakdown and dysfunction of the bones within the foot. In turn, this creates excessive motion at the midfoot. With the resulting inefficient lever arm, the foot is then unable to push off the ground effectively, resulting in an inadequate and painful gait pattern. Currently, there is no standard quantitative method for detecting early stages of MFB, which would allow early intervention before further breakdown occurs. The first step in developing an objective tool for early MFB diagnosis is to examine the difference in dynamic function between a foot with MFB and a typical foot. Therefore, the main purpose of this study was to compare the differences in foot motion between children with MFB and children with typical feet (Controls) using a multi-segment kinematic foot model. We found that children with MFB had a significant decrease in peak ankle dorsiflexion compared to Controls (1.3±6.4° versus 8.6±3.4°) and a significant increase in peak midfoot dorsiflexion compared to Controls (15.2±4.9° versus 6.4±1.9°). This study may help clinicians track the progression of MFB and help standardize treatment recommendations for children with this type of foot deformity.

http://www.gaitposture.com/article/S0966-6362(12)00457-2/abstract?elsca1=etoc&elsca2=email&elsca3=0966-6362_201306_38_2&elsca4=elsevier

Conference 2013 Photographs

BAPO have a collection of around 500 photographs taken at this years conference.  We have now placed these in an online Gallery for you to see.  Please click the link to view the photographs.

http://files.bapo-online.com/gallery/?Conference

Short Course: Paediatric Gait Analysis and Orthotic Management: A Segmental Kinematic Approach

Paediatric Gait Analysis and Orthotic Management:
A Segmental Kinematic Approach
8th & 9th November 2013
SALTS Healthcare, Birmingham

For further information on the 'Paediatric Gait Analysis and Orthotic Managemnet: A Segmental Kinematic Approach' BAPO Short Course please follow the link below:

Further Information

Please note that the cancellation date of this course is 25th October 2013.  If you wish to book a place on the BAPO short course then please do so at your earliest convenience.

How is the new NHS structured?

The Kings Fund have released a simplified flow diagram of the new NHS structure which can be found here

http://www.slideshare.net/kingsfund/nhs-structures

Prosthetics service for veterans launched

A NATIONAL prosthetics service has been launched for veteran military amputees.

The service will provide amputees with advanced prosthetics designed to function as much like a natural limb as possible. It will also act as a dedicated point of access to services including limb fitting and rehabilitation.

It is estimated there are about 66 military amputees in Scotland, and ministers yesterday met one of them, Steven Richardson from East Lothian.

He lost both legs and some fingers on both hands after he stood on an explosive device during a tour in the Nad-e-Ali district of Afghanistan in 2010.

Health secretary Alex Neil said: "It is only right our veterans, who have risked their lives for this country, receive world-class services through our NHS.

"Scotland is already leading the way in prosthetic care and this new specialist service is a fantastic example of the NHS using innovative technologies to deliver 21st-century healthcare."

The service has been launched by the Scottish Government following recommendations in a report by Dr Andrew Murrison on NHS prosthetics for veterans, particularly those from recent conflicts in Iraq and Afghanistan.

The UK government asked Dr Murrison, a Tory MP, to review prosthetic services after concerns were raised by some charities the NHS may not provide services to the same standard as the Defence Medical Service provided by the Ministry of Defence.

Ian Waller, of the British Limbless Ex-Service Men's Association, said: "We are encouraged by the clear message this sends to our members in Scotland; that their needs have been recognised, considered and are being addressed."

Source: http://www.scotsman.com/news/health/prosthetics-service-for-veterans-launched-1-2976943

Cost Benefit Analysis of Knee Prostheses

A study is being conducted at Imperial College Business School. The purpose of this study is to analyse the costs and benefits of different types of leg prostheses used by clients in the UK.

The survey is directed to patients who have undergone UNILATERAL ABOVE-KNEE AMPUTATION (only in one leg).

The RESULTS of this study will help provide evidence-based research to support the campaign for more funding to be made available for microprocessor knees in the UK.

The survey can be completed in 10-15 minutes and can be found on the following link https://iclbusiness.eu.qualtrics.com/SE/?SID=SV_7QdSoPKMkQkHqhD

Your response will be confidential. You will be assigned a participant number and only these numbers will appear in subsequent analyses of the data.

If you do not wish to answer a particular question please leave it blank and you can withdraw from the study at anytime.

By completing the survey, you acknowledge that you have read this information and agree to participate in this research.

An Introduction to Podiatric Medicine for Healthcare Professionals Saturday 21st September 2013

For further information on the 'An Introduction to Podiatric Medicine for Healthcare Professionals' BAPO Short Course please follow the link below:

Further Information

Please note that the cancellation date of this course is 24th August 2013.  If you wish to book a place on the BAPO short course then please do so at your earliest convenience.

NHS e-Referral Service vision - making paperless referrals a reality

What might an NHS e-Referral Service look like in the future?

The needs of patients and professionals will be foremost in designing the new service, which will include support for enhanced functionality and usability for delivering some or all of the following:

Improved integration and usability

Referral management support

Any to any referrals

Linked appointments

Follow-up appointments

Self referrals

Enhanced reporting capability

Electronic communications

http://systems.hscic.gov.uk/ers

Effect of rocker shoe design features on forefoot plantar pressures in people with and without diabetes

J.D. Chapman, S. Preece, B. Braunstein, A. Höhne, C.J. Nester, P. Brueggemann, S. Hutchins

Abstract 
Background

There is no consensus on the precise rocker shoe outsole design that will optimally reduce plantar pressure in people with diabetes. This study aimed to understand how peak plantar pressure is influenced by systematically varying three design features which characterise a curved rocker shoe: apex angle, apex position and rocker angle.

Methods

A total of 12 different rocker shoe designs, spanning a range of each of the three design features, were tested in 24 people with diabetes and 24 healthy participants. Each subject also wore a flexible control shoe. Peak plantar pressure, in four anatomical regions, was recorded for each of the 13 shoes during walking at a controlled speed.

Findings

There were a number of significant main effects for each of the three design features, however, the precise effect of each feature varied between the different regions. The results demonstrated maximum pressure reduction in the 2nd–4th metatarsal regions (39%) but that lower rocker angles (<20°) and anterior apex positions (>60% shoe length) should be avoided for this region. The effect of apex angle was most pronounced in the 1st metatarsophalangeal region with a clear decrease in pressure as the apex angle was increased to 100°.

Interpretation

We suggest that an outsole design with a 95° apex angle, apex position at 60% of shoe length and 20° rocker angle may achieve an optimal balance for offloading different regions of the forefoot. However, future studies incorporating additional design feature combinations, on high risk patients, are required to make definitive recommendations.

http://www.clinbiomech.com/article/S0268-0033(13)00114-9/abstract

Physiotherapy to Complement Orthotic Treatment Saturday 12th October 2013 Staffordshire University

Please click for Further Information on the 'Pysiotherapy to Complement Orthotic Treatment' BAPO Short Course.

HCPC launches consultation on guidance for professional indemnity cover and registration

News release 

The Health and Care Professions Council (HCPC) has today launched an eight week consultation to seek the views of stakeholders on guidance for registrants in relation to professional indemnity cover and registration. 

The Government are proposing that all health professionals must hold professional indemnity cover as a condition of registration. This is subject to parliamentary approval and will apply to all of the professions regulated by the HCPC with the exception of social workers in England*. This is because these 15 professions are considered to be 'healthcare professions' under the terms of the European Directive 2011/24/EU on cross-border healthcare. 

We anticipate that the majority of our registrants will already be able to meet these requirements as they will be indemnified either through their employer, a professional body, directly with an insurer or a combination of these. However, it is important that registrants ensure that they have cover in place that is appropriate for their practice. 

Subject to the legislative timetable, cover must be in place by Friday 25 October 2013. From 1 April 2014 new applicants to the Register and those renewing their registration will be required to complete a professional declaration. Failure to hold appropriate cover will mean an individual will not have their registration renewed or, in the case of new applicants, will not be registered by us.

Louise Hart, Director of Council and Committee Services commented;

"It is important that professionals are aware of their responsibilities to have appropriate indemnity cover and to take steps to ensure they meet this new requirement of registration.

"The draft guidance we have produced outlines what professionals need to know about their responsibilities and provides detailed information about professional indemnity, how they can meet this requirement and how the HCPC will check that cover is in place.

"We are now seeking views on this draft guidance and would welcome feedback from professionals on our Register as well as employers and other stakeholders who may be affected by this new requirement."

The consultation will run from 10 June 2013 until 2 August 2013 and can be found on the following link https://www.research.net/s/consultationonguidanceforPIIrequirement

Gene Associated With Adolescent-Onset Scoliosis Identified

Researchers at the RIKEN Center for Integrative Medical Sciences in Japan have identified a gene associated with adolescent idiopathic scoliosis (AIS). This is the first time that any gene or specific cause has been linked to this form of scoliosis which affects adolescents. Scoliosis is a skeletal disease that causes the spine to become deformed: the spine of an individual suffering from scoliosis may look like the shape of an "S" or a "C" when viewed on an X-ray. AIS, as the name suggests, is a form of scoliosis that has its onset in adolescence, usually during the puberty growth period. Although the condition is called idiopathic because its cause is unknown, scientists have suspected that genetics may play a part in causing AIS. In their study, published in Nature Genetics, the team from RIKEN sought to uncover genetic risk factors for AIS by studying the genomes over 1,800 patients who suffer from AIS and almost 26,000 unaffected individuals in the Japanese population.

From their genome-wide analysis, the researchers identified variants of a gene, GPR126, that were

significantly associated with a higher risk for developing AIS. The team subsequently confirmed

that GPR126 is also linked to AIS susceptibility in the Han Chinese and Caucasian populations.

Experiments further showed that the GPR126 gene product, which is known to play a role in human

height and trunk length, promotes growth and bone tissue formation in spine development. These findings suggest that genetic alterations in GPR126 may affect both AIS susceptibility and height by causing abnormal spinal development and growth. 

The article can be found at: Kou et al. (2013) Genetic Variants In GPR126 Are Associated With Adolescent Idiopathic Scoliosis.

http://www.asianscientist.com/health-medicine/gene-adolescent-onset-scoliosis-identified-2013/

The Department of Health has announced a £4m fund to improve the way diseases are diagnosed.

This money will fund research that looks at the way a number of different diseases are diagnosed, so patients can access the best available treatments more quickly.

The National Institute for Health Research (NIHR) will share the funding across four NHS organisations in London, Leeds, Newcastle and Oxford. These places will become national centres of expertise called NIHR diagnostic evidence co-operatives.

These centres will promote research into medical tests used to diagnose things like cancer, liver and respiratory diseases, so patients across the NHS can benefit from advances in technology. More .....

Specialised health services clinical reference groups: Patient and carer member recruitment – second wave

Specialised health services clinical reference groups: Patient and carer member recruitment – second wave NHS England has opened the second wave of recruitment for patient and carer members of its Clinical Reference Groups for 2013/14. For a full list of CRGs who are still recruiting members please follow the link below. CRGs are responsible for providing NHS England with clinical advice regarding specialised services, and for promoting equity of access to high quality services for all patients, regardless of where they live. CRGs are also at the forefront of the drive to spearhead innovation, working with clinical leaders, patients and suppliers to identify and promote best practice; scanning the horizon for new treatment approaches; and taking action to improve patient experience and outcomes in the NHS. This is an exciting time to join a CRG, as they take their place within the new commissioning structures of the NHS. The accompanying Guide to CRGs and Information Pack for Patients and Carers will provide you with more, detailed information about their work; where they sit within NHS England, and what it means to be a patient and carer member of a CRG. If you are interested in applying to be a patient or carer member, you will also find an application form which you can complete online. The closing date for applications for membership is midnight 13 June 2013. To find out more about becoming a patient or carer member of one of these groups, where you will find the list of CRGs we are still recruiting to,  a Guide to CRGs, an Information Pack and application form. This opportunity is open to people 18 years and over. We are committed to ensuring that the work of CRGs is informed by the voice of children and young people; however, we are also aware that there are extra support needs for this group and that membership of the CRGs may not be the most appropriate approach to engaging with this section of the population. They are recruiting for the following CRG's INTERNAL MEDICINE A5 Morbid Obesity Surgery A13 Specialised Rheumatology TRAUMA D10 Specialised Orthopaedic Services D14 Complex Spinal Surgery D15  Major Trauma WOMEN AND CHILDREN E4 Paediatric Cancer Services E12 Fetal Medicine E7 Paediatric Intensive Care E13  Multi System Disorder