scholarly journals The Use of Routine Wrist Radiography is Not Useful in the Evaluation of Patients with a Ganglion Cyst of the Wrist

Hand ◽  
2007 ◽  
Vol 2 (3) ◽  
pp. 117-119 ◽  
Author(s):  
Andrew S. Wong ◽  
Peter J. L. Jebson ◽  
Peter M. Murray ◽  
Stephen D. Trigg
Keyword(s):  
Ganglion Cyst ◽  
Treatment Decision ◽  
Hand Surgery ◽  
Cost Effective ◽  
Metacarpophalangeal Joint ◽  
Distal Radioulnar Joint ◽  
Significant Finding ◽  
Thumb Carpometacarpal Joint ◽  
Treatment Decision Making ◽  
Thumb Carpometacarpal

The purpose of this study was to evaluate the cost-effectiveness of routine wrist radiography in the evaluation of patients with a wrist ganglion. In the setting of a University-based hand surgery practice, 103 consecutive patients with a dorsal or volar wrist ganglion underwent posteroanterior, lateral, and oblique radiographs of the involved wrist. There were 24 men and 79 women with an average age of 34 years (range 4–67 years). A retrospective review of the medical records was performed. Abnormalities on plain radiographs were noted in only 13 patients (13%). Findings included six cases of thumb carpometacarpal joint arthritis and one case each of an enchondroma, congenital distal radioulnar joint (DRUJ) anomaly, DRUJ degenerative changes, intraosseous ganglion, carpal boss, radiocarpal arthritis, and thumb metacarpophalangeal joint osteoarthritis. In only one case (1%) did the findings alter the management. At our institution, the professional and technical charge for three views of the wrist is $172. This confers a cost of $17,716 per therapeutically significant finding in our series. We conclude that routinely performing wrist radiography is not cost-effective in the evaluation and treatment decision-making process in patients with a wrist ganglion.

Arthroplasty in the hand: what works and what doesn’t?

2021 ◽  
pp. 175319342110177
Author(s):  
Daniel B. Herren ◽  
Hajime Ishikawa ◽  
Marco Rizzo ◽  
Mark Ross ◽  
Michael Solomons
Keyword(s):  
Surgical Technique ◽  
Metacarpophalangeal Joint ◽  
Distal Radioulnar Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Radioulnar Joint ◽  
What Works ◽  
Thumb Carpometacarpal

This review describes the different possibilities for arthroplasties at the proximal interphalangeal joint, thumb carpometacarpal joint, distal radioulnar joint, metacarpophalangeal joint and the wrist. For each joint, the indication for arthroplasty is explained, the surgical technique with the suitable implant is described and a brief summary of the outcomes reported in the literature is given.

Postoperative follow-up time and justification in prospective hand surgery research: a systematic review

2020 ◽  
Vol 45 (9) ◽  
pp. 899-903
Author(s):  
Rachel C. Hooper ◽  
Jacob S. Nasser ◽  
Helen E. Huetteman ◽  
Shale J. Mack ◽  
Kevin C. Chung
Keyword(s):  
Carpal Tunnel Release ◽  
Demographic Data ◽  
Tendon Repair ◽  
Hand Surgery ◽  
Level Of Evidence ◽  
Thumb Carpometacarpal Joint ◽  
Expected Time ◽  
Surgery Research ◽  
Thumb Carpometacarpal

We systematically reviewed prospective studies for five hand procedures to analyse postoperative follow-up time, clinical or radiographic plateau, and whether the authors provide justification for times used. Demographic data, outcomes and mean follow-up were analysed. A total of 188 articles met our inclusion criteria. The mean postoperative follow-up time among these studies were carpal tunnel release, 21 months (range 1.5–111); cubital tunnel release, 27 months (2.5–46); open reduction and internal fixation for the distal radius fracture, 24 months (3–120); thumb carpometacarpal joint arthroplasty, 64 months (8.5–228); and flexor tendon repair, 25 months (3–59). Authors provided justification for follow-up intervals in 10% of these reports. We conclude that most prospective clinical studies in hand surgery do not properly justify follow-up length. Clinically unnecessary follow-up is costly without much benefit. In prospective research, we believe justified postoperative follow-up is essential, based on expected time to detect clinical plateau, capture complications and determine the need for secondary surgery. Level of evidence: III

MR Imaging of Thumb Carpometacarpal Joint Ligament Injuries

2004 ◽  
Vol 29 (1) ◽  
pp. 46-54 ◽  
Author(s):  
D. A. CONNELL ◽  
J. PIKE ◽  
G. KOULOURIS ◽  
N. VAN WETTERING ◽  
G. HOY
Keyword(s):  
Mr Imaging ◽  
Ganglion Cyst ◽  
Cyst Formation ◽  
Ligament Injury ◽  
Carpometacarpal Joint ◽  
Chronic Injury ◽  
Joint Injury ◽  
Thumb Carpometacarpal Joint ◽  
Asymptomatic Volunteers ◽  
Thumb Carpometacarpal

This study describes the MR imaging appearances of the supporting ligaments of the thumb carpometacarpal joint in asymptomatic volunteers and in a group of patients following joint injury. Fourteen patients with 11 acute and three chronic injuries underwent MR imaging. The anterior oblique ligament was the most commonly injured ligament, usually on the metacarpal side where it was disrupted, or allowed dislocation because of subperiosted stripping from the base of the thumb metacarpal. The dorsal radial ligament was occasionally avulsed or partially torn from the trapezoid. Following chronic injury, MR imaging can evaluate ligamentous laxity, ganglion cyst formation or osteoarthritis. Accurate evaluation of ligament injury may identify patients who would benefit from surgery.

scholarly journals Multidimensional integrative medicine applied to outpatient cancer treatment in southern Brazil: Preliminary cost-effectiveness analysis.

2019 ◽  
Vol 5 (suppl) ◽  
pp. 5-5
Author(s):  
James Freitas Fleck ◽  
Ricardo Preger ◽  
Luis Fernando Venegas ◽  
Henrique de Araujo Vianna Trasel
Keyword(s):  
Decision Making ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Integrative Medicine ◽  
Metastatic Cancer ◽  
Clinical Stage ◽  
Treatment Decision ◽  
Cost Effective ◽  
Treatment Decision Making ◽  
Care Plans

5 Background: Cost-effective analysis as part of cancer treatment decision-making. Methods: We reviewed deaths of 52 metastatic cancer patients treated with multidimensional integrative medicine (MIM) approach. Patients received standard oncologic treatment plus a MIM predefined program of emotional, cognitive and social support. The method included empathy improvement, changes on physician attitude and office environment, modulation of staff behavior supporting patient’s needs and rights, promotion of belongingness, increasing on patient’s protagonism using multimedia interactive narrative and shared decision-making. Patients were categorised according to the tumor site, pathologic, molecular and IHC characteristics, clinical stage and treatment. Observed survival was defined as the time elapsed between the detection of first metastasis and death. The observed survival for each patient was compared with the median expected survival previously reported on prospective randomised trials which had accrued patients with similar prognostic factors based on a best fit model. Treatment monthly cost for each patient was converted in American dollars (USD) on a daily exchange basis. Cost of the treatment periods were compared with those analysed in four large USA commercial managed care plans. Results: Treatment of metastatic cancer patients using MIM showed a 44% increase in median survival and a 48% decrease in cost. The estimated ICER/QALY was of 32304 USD, which represented 2.0 of Brazilian PPP. Conclusions: Despite methodological limitations, this is the first study to indicate a cost-effective survival increase in metastatic cancer patients using a MIM-behavioral modulation model. [Table: see text]

EVALUATION OF THE FIRST METACARPAL PROXIMAL FACET INCLINATION AS A PROGNOSTIC PREDICTOR FOLLOWING ARTHROPLASTY FOR OSTEOARTHRITIS OF THE THUMB CARPOMETACARPAL JOINT

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 69-72 ◽  
Author(s):  
Ichiro Tonogai ◽  
Yoshitaka Hamada ◽  
Naohito Hibino
Keyword(s):  
Radiological Finding ◽  
Metacarpophalangeal Joint ◽  
Carpometacarpal Joint ◽  
Prognostic Predictor ◽  
Thumb Carpometacarpal Joint ◽  
Carpometacarpal Joints ◽  
Radiographic Measurements ◽  
Poor Outcomes ◽  
Thumb Carpometacarpal

We have retrospectively reviewed 17 thumbs in 16 patients with osteoarthritis of the thumb carpometacarpal joints, for which arthroplasty was performed using Kaarela's method. Postoperatively, three thumbs in two patients had poor outcomes; both patients had a sharp slope of the base of the first metacarpal. Serial radiographic measurements suggested that this sharp slope affected the adducted position of the first metacarpal, and led to the appearance of a metacarpophalangeal joint hyperextension deformity of the thumb. This radiological finding could be a prognostic predictor after surgery for osteoarthritis of the thumb carpometacarpal joint.

scholarly journals Cost-effectiveness analysis of proton beam therapy for treatment decision making in paranasal sinus and nasal cavity cancers in China

2020 ◽  
Author(s):  
Guo Li ◽  
Bo Qiu ◽  
Yi-Xiang Huang ◽  
Jerome Doyen ◽  
Pierre-Yves Bondiau ◽  
...  
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Nasal Cavity ◽  
Paranasal Sinus ◽  
Treatment Decision ◽  
Cost Effective ◽  
Proton Beam Therapy ◽  
Clinical Decision ◽  
Base Case ◽  
Treatment Decision Making

Abstract Background: Cost-effectiveness is a pivotal consideration for clinical decision making of high-tech cancer treatment in developing countries. Intensity-modulated proton radiation therapy (IMPT, the advanced form of proton beam therapy) has been found to improve the prognosis of the patients with paranasal sinus and nasal cavity cancers compared with intensity-modulated photon-radiation therapy (IMRT). However, the cost-effectiveness of IMPT has not yet been fully evaluated. This study aimed at evaluating the cost-effectiveness of IMPT versus IMRT for treatment decision making of paranasal sinus and nasal cavity cancers in Chinese settings.Methods: A 3-state Markov model was designed for cost-effectiveness analysis. A base case evaluation was performed on a patient of 47-year-old (median age of patients with paranasal sinus and nasal cavity cancers in China). Model robustness was examined by probabilistic sensitivity analysis, Markov cohort analysis and Tornado diagram. Cost-effective scenarios of IMPT were further identified by one-way sensitivity analyses and stratified analyses were performed for different age levels. The outcome measure of the model was the incremental cost-effectiveness ratio (ICER). A strategy was defined as cost-effective if the ICER was below the societal willingness-to-pay (WTP) threshold of China (30,828 US dollars ($) / quality-adjusted life year (QALY)).Results: IMPT was identified as being cost-effective for the base case at the WTP of China, providing an extra 1.65 QALYs at an additional cost of $38,928.7 compared with IMRT, and had an ICER of $23,611.2 / QALY. Of note, cost-effective scenarios of IMPT only existed in the following independent conditions: probability of IMPT eradicating cancer ≥ 0.867; probability of IMRT eradicating cancer ≤ 0.764; or cost of IMPT ≤ $52,163.9. Stratified analyses for different age levels demonstrated that IMPT was more cost-effective in younger patients than older patients, and was cost-effective only in patients ≤ 56-year-old.Conclusions: Despite initially regarded as bearing high treatment cost, IMPT could still be cost-effective for patients with paranasal sinus and nasal cavity cancers in China. The tumor control superiority of IMPT over IMRT and the patient’s age should be the principal considerations for clinical decision of prescribing this new irradiation technique.

scholarly journals Cost-Effectiveness Analysis of Proton Beam Therapy for Treatment Decision Making in Paranasal Sinus and Nasal Cavity Cancers in China

2020 ◽  
Author(s):  
Guo Li ◽  
Bo Qiu ◽  
Yi-Xiang Huang ◽  
Jerome Doyen ◽  
Pierre-Yves Bondiau ◽  
...  
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Nasal Cavity ◽  
Paranasal Sinus ◽  
Treatment Decision ◽  
Cost Effective ◽  
Clinical Decision ◽  
Base Case ◽  
Treatment Decision Making ◽  
The Cost

Abstract Background: Cost-effectiveness is a pivotal consideration for clinical decision making of advanced cancer treatment in developing countries. Intensity-modulated proton radiation therapy (IMPT) has been found to improve the prognosis of the patients with paranasal sinus and nasal cavity cancers compared with intensity-modulated photon-radiation therapy (IMRT). However, the cost-effectiveness of IMPT has not yet been fully evaluated. This study aimed at evaluating the cost-effectiveness of IMPT versus IMRT for treatment decision making of paranasal sinus and nasal cavity cancers in Chinese settings.Methods:A 3-state Markov modelwas designed for cost-effectiveness analysis. A base case evaluation was performed on a patient of 47-year-old (median age of patients with paranasal sinus and nasal cavity cancers in China). Model robustness was examined by probabilistic sensitivity analysis, Markov cohort analysis and Tornado diagram. Cost-effective scenarios of IMPT were further identified by one-way sensitivity analyses and stratified analyses were performed for different age levels. The outcome measure of the model was the incremental cost-effectiveness ratio (ICER). A strategy was defined as cost-effective if the ICER was below the societal willingness-to-pay (WTP) threshold of China (30,828 US dollars ($) / quality-adjusted life year (QALY)).Results: IMPT was identified as being cost-effective for the base case at the WTP of China, providing an extra 1.65 QALYs at an additional cost of $38,928.7 compared with IMRT, and had an ICER of $23,611.2 / QALY. Of note, cost-effective scenarios of IMPT only existed in the following independent conditions: probability of IMPT eradicating cancer ≥ 0.867; probability of IMRT eradicating cancer ≤ 0.764; or cost of IMPT ≤ $52,163.9. Stratified analyses for different age levels demonstrated that IMPT was more cost-effective in younger patients than older patients, and was cost-effective only in patients ≤ 56-year-old.Conclusions: Despite initially regarded as bearing high treatment cost, IMPT could still be cost-effective for patients with paranasal sinus and nasal cavity cancers in China. The tumor control superiority of IMPT over IMRT and the patient’s age should be the principal considerations for clinical decision of prescribing this new irradiation technique.

Patient Involvement in Treatment Decision Making Can Help or Hinder Placebo Analgesia

2014 ◽  
Vol 222 (3) ◽  
pp. 165-170 ◽  
Author(s):  
Andrew L. Geers ◽  
Jason P. Rose ◽  
Stephanie L. Fowler ◽  
Jill A. Brown
Keyword(s):  
Patient Involvement ◽  
Cold Water ◽  
Prior Experience ◽  
Water Immersion ◽  
Treatment Decision ◽  
Cold Water Immersion ◽  
Not Given ◽  
Placebo Analgesia ◽  
Treatment Decision Making ◽  
Immersion Experience

Experiments have found that choosing between placebo analgesics can reduce pain more than being assigned a placebo analgesic. Because earlier research has shown prior experience moderates choice effects in other contexts, we tested whether prior experience with a pain stimulus moderates this placebo-choice association. Before a cold water pain task, participants were either told that an inert cream would reduce their pain or they were not told this information. Additionally, participants chose between one of two inert creams for the task or they were not given choice. Importantly, we also measured prior experience with cold water immersion. Individuals with prior cold water immersion experience tended to display greater placebo analgesia when given choice, whereas participants without this experience tended to display greater placebo analgesia without choice. Prior stimulus experience appears to moderate the effect of choice on placebo analgesia.

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