Deferring Routine Wrist Radiography Does Not Affect Management of de Quervain Tendinopathy Patients

Background Obtaining wrist radiographs prior to surgeon evaluation may be wasteful for patients ultimately diagnosed with de Quervain tendinopathy (DQT). Questions/Purpose Our primary question was whether radiographs directly influence treatment of patients presenting with DQT. A secondary question was whether radiographs influence the frequency of injection and surgical release between cohorts with and without radiographs evaluated within the same practice. Patients and Methods Patients diagnosed with DQT by fellowship-trained hand surgeons at an urban academic medical center were identified retrospectively. Basic demographics and radiographic findings were tabulated. Clinical records were studied to determine whether radiographic findings corroborated history or physical examination findings, and whether management was directly influenced by radiographic findings. Frequencies of treatment with injection and surgery were separately tabulated and compared between cohorts with and without radiographs. Results We included 181 patients (189 wrists), with no differences in demographics between the 58% (110 wrists) with and 42% (79 wrists) without radiographs. Fifty (45%) of imaged wrists demonstrated one or more abnormalities; however, even for the 13 (12%) with corroborating history and physical examination findings, wrist radiography did not directly influence a change in management for any patient in this series. No difference was observed in rates of injection or surgical release either upon initial presentation, or at most recent documented follow-up, between those with and without radiographs. No differences in frequency, types, or total number of additional simultaneous surgical procedures were observed for those treated surgically. Conclusion Wrist radiography does not influence management of patients presenting DQT. Level of Evidence This is a level III, diagnostic study.

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Physicians' Attitudes Toward Complementary and Alternative Medicine and Their Knowledge of Specific Therapies: A Survey at an Academic Medical Center

Evidence-based Complementary and Alternative Medicine ◽

10.1093/ecam/nel036 ◽

2006 ◽

Vol 3 (4) ◽

pp. 495-501 ◽

Cited By ~ 75

Author(s):

Dietlind L. Wahner-Roedler ◽

Ann Vincent ◽

Peter L. Elkin ◽

Laura L. Loehrer ◽

Stephen S. Cha ◽

...

Keyword(s):

Alternative Medicine ◽

Complementary And Alternative Medicine ◽

Medical Center ◽

Clinical Care ◽

Academic Medical Center ◽

Educational Interventions ◽

Level Of Evidence ◽

Web Based ◽

Academic Medical ◽

Complementary And Alternative

The purpose of this study was to evaluate the attitudes of physicians at an academic medical center toward complementary and alternative medicine (CAM) therapies and the physicians' knowledge base regarding common CAM therapies. A link to a Web-based survey was e-mailed to 660 internists at Mayo Clinic in Rochester, MN, USA. Physicians were asked about their attitudes toward CAM in general and their knowledge regarding specific CAM therapies. The level of evidence a physician would require before incorporating such therapies into clinical care was also assessed. Of the 233 physicians responding to the survey, 76% had never referred a patient to a CAM practitioner. However, 44% stated that they would refer a patient if a CAM practitioner were available at their institution. Fifty-seven percent of physicians thought that incorporating CAM therapies would have a positive effect on patient satisfaction, and 48% believed that offering CAM would attract more patients. Most physicians agreed that some CAM therapies hold promise for the treatment of symptoms or diseases, but most of them were not comfortable in counseling their patients about most CAM treatments. Prospective, randomized controlled trials were considered the level of evidence required for most physicians to consider incorporating a CAM therapy into their practice. The results of this survey provide insight into the attitudes of physicians toward CAM at an academic medical center. This study highlights the need for educational interventions and the importance of providing physicians ready access to evidence-based information regarding CAM.

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Implementing video visits into an orthopedic hip arthroscopy practice: a case study

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab042 ◽

2021 ◽

Author(s):

John Wickman ◽

Colleen Ferlotti ◽

Justin Ferrell ◽

Carolyn Hutyra ◽

Donna Phinney ◽

...

Keyword(s):

Patient Satisfaction ◽

Medical Center ◽

Quality Care ◽

Academic Medical Center ◽

Cost Effective ◽

Level Of Evidence ◽

Face To Face ◽

Academic Medical ◽

Clinic Visits

Abstract Telehealth videoconferencing has been shown to be feasible, cost-effective and safe in numerous fields of medicine. In an effort to increase access and improve the quality of care offered to patients we implemented a telehealth initiative allowing for remote orthopedic clinic visits at a major academic medical center. Here we report on our experience and early outcomes. A telehealth platform was launched for a single fellowship trained orthopedic surgeon at a major academic hospital in August 2018. New patients residing outside the metro area, all return patients and patients with an uncomplicated post-operative course were offered the option to complete patient encounters remotely via a telehealth platform. Each patient was offered a Patient Satisfaction Survey following video visit. Patient zip codes were used to estimate patient commutes. Ninety-six percent of patients agreed/strongly agreed with the statement ‘I was satisfied with my Telehealth experience’ while 51% agreed/strongly agreed with the statement ‘This visit was just as good as a face to face visit’. In all, 94% of patients agreed/strongly agreed with the statement ‘Having a telehealth visit made receiving care more accessible for me’. The median miles saved on commutes were 123.3 miles. The no show rate for telehealth visits was 8.2% versus 3.2% for in-person (P < 0.001). Telehealth video visits provided patients with a modality for completing orthopedic clinic visits while maintaining a high-quality care and patient satisfaction. Patient convenience was optimized with video visits with elimination of long commutes. Level of evidence: IV.

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Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center

Frontiers in Surgery ◽

10.3389/fsurg.2021.796876 ◽

2021 ◽

Vol 8 ◽

Author(s):

Matthew S. Lee ◽

Michael A. Fenstermaker ◽

Emily E. Naoum ◽

Suzanne Chong ◽

Cosmas J. Van de Ven ◽

...

Keyword(s):

Care Pathway ◽

Medical Center ◽

Evidence Synthesis ◽

Academic Medical Center ◽

Ease Of Use ◽

Diagnostic Study ◽

Team Members ◽

Diagnostic Uncertainty ◽

Academic Medical ◽

Pubmed Search

Introduction: The management of nephrolithiasis during pregnancy can be stressful for urologists due to concerns for investigations and treatments that may pose risk of fetal harm, and unfamiliarity with optimal management of these complex patients. In response, we created multi-disciplinary evidence-based guidelines to standardize the care for obstetric patients presenting with flank pain and suspicion for nephrolithiasis.Methods: A multi-disciplinary team involving Urology, Obstetric Anesthesiology, Obstetrics and Gynecology, Diagnostic Radiology, and Interventional Radiology from a single academic medical center was assembled. A PubMed search was performed using keywords of pregnancy/antepartum, nephrolithiasis/calculi/kidney stones, ureteroscopy, non-obstetric surgery, complications, preterm delivery, MRI, computerized tomography, renal bladder ultrasound (RBUS), and anesthesia to identify relevant articles. Team members reviewed their respective areas to create a comprehensive set of guidelines. One invited external expert reviewed the guidelines for validation purposes.Results: A total of 54 articles were reviewed for evidence synthesis. Four guideline statements were constructed to guide diagnosis and imaging, and seven statements to guide intervention. Guidelines were then used to create a diagnostic and intervention flowchart for ease of use. In summary, RBUS should be the initial diagnostic study. If diagnostic uncertainty still exists, a non-contrast CT scan should be obtained. For obstetric patients presenting with a septic obstructing stone, urgent decompression should be achieved. We recommend ureteral stent placement as the preferred intervention if local factors allow.Conclusions: We present a standardized care pathway for the management of nephrolithiasis during pregnancy. Our aim is to standardize and simplify the clinical management of these complex scenarios for urologists.

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Barriers to and facilitators of a screening procedure for PTSD risk in a level I trauma center

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000345 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000345 ◽

Cited By ~ 1

Author(s):

Sacha A McBain ◽

Kevin W Sexton ◽

Brooke E Palmer ◽

Sara J Landes

Keyword(s):

Trauma Center ◽

Medical Center ◽

Academic Medical Center ◽

Screening Tools ◽

Screening Procedure ◽

Acute Care Surgery ◽

Level Of Evidence ◽

Academic Medical ◽

Level I ◽

Care Surgery

BackgroundPatients admitted to the hospital after an injury are at a greater risk for developing post-traumatic stress disorder (PTSD) due to the nature of the injury and the traumatic nature of necessary medical interventions. Many level I trauma centers have yet to implement screening protocols for PTSD risk. The goal of the study was to characterize the barriers to and facilitators of implementation of a screening procedure for PTSD risk in a level I trauma center.MethodsWe conducted semistructured qualitative interviews with multidisciplinary academic medical center stakeholders (N=8) including those with clinical, research, teaching, and administrative roles within an urban academic medical center’s Department of Surgery, Division of Acute Care Surgery. We analyzed the qualitative data using summative template analysis to abstract data related to participants’ opinions about implementation of a screener for PTSD.ResultsParticipants’ general perception of screening for PTSD risk after injury was positive. Identified challenges to implementation included timing of screening, time burden, care coordination, addressing patients with traumatic brain injury or an altered mental status, and ensuring appropriate care after screening. Reported facilitators included existing psychosocial screening tools and protocols that would support inclusion of a PTSD screener, a patient-centered culture that would facilitate buy-in from providers, a guideline-driven culture, and a commitment to continuity of care.ConclusionsThis study offers concrete preliminary information on barriers to and facilitators of PTSD screening that can be used to inform planning of implementation efforts within a trauma center.Level of evidenceLevel V, qualitative.

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Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

Journal of Wrist Surgery ◽

10.1055/s-0040-1708863 ◽

2020 ◽

Vol 09 (04) ◽

pp. 289-297 ◽

Cited By ~ 2

Author(s):

Andrew R. Stephens ◽

Ziji Yu ◽

Angela P. Presson ◽

Andrew R. Tyser ◽

Nikolas H. Kazmers

Keyword(s):

Medical Center ◽

Financial Burden ◽

Academic Medical Center ◽

Consumer Price Index ◽

Level Of Evidence ◽

Surgical Costs ◽

Patient Reported ◽

De Quervain ◽

Surgical Setting

Abstract Background First extensor compartment release is a common surgical procedure that represents a financial burden to the health care system. Questions/Purposes Study questions included (1) whether surgical encounter costs differ based upon surgical setting (operating room [OR] vs. procedure room [PR]) or (2) based upon anesthesia choice (local only, Bier's block [BB], monitored anesthesia care [MAC], or general [GA]) for De Quervain release (DQR). Patients and Methods Consecutive adult patients undergoing isolated unilateral DQR at a single academic medical center were identified retrospectively by Current Procedural Terminology code (25000). Using our institution's information technology value tools, we calculated total direct costs for each surgical encounter. Costs were adjusted to January 2016 dollars using the Consumer Price Index, normalized using each participant's surgical encounter cost divided by the median cost in the PR group, then compared across each group using Kruskal–Wallis and Nemenyi's post hoc pair-wise tests. Multivariable gamma regression analysis with a log link was performed to identify factors associated with surgical costs. QuickDASH (disabilities of the arm, shoulder, and the hand) scores were compared using a t-test at final follow-up. Results Among 58 included patients, 29% (17/58) were treated in the PR and 71% (41/58) in the OR. Compared with local only in the PR, all other groups were significantly more costly. Multivariable gamma regression indicated that use of OR/BB, OR/MAC, or OR/GA independently led to 211, 222, and 357% greater surgical costs as compared with the PR with local only while controlling for provider and patient age. Furthermore, QuickDASH scores were similar between PR and OR groups at final follow-up. Conclusion Performing DQR in the PR setting under local only anesthesia yields greater value than the OR, as patient-reported outcomes are similar despite significantly lower surgical costs. Level of Evidence This is a Level III, cost analysis study.

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