Operative Versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Pilot Economic Decision Analysis

Background: The operative treatment of Achilles tendon ruptures has been associated with lower rerupture rates and better function but also a risk of surgery-related complications compared with nonoperative treatment, which may provide improved outcomes with accelerated rehabilitation protocols. However, economic decision analyses integrating the updated costs of both treatment options are limited in the literature. Purpose: To compare the cost-effectiveness of operative and nonoperative treatment of acute Achilles tendon tears. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: An economic decision model was built to assess the cost-utility ratio (CUR) of open primary repair versus nonoperative treatment for acute Achilles tendon ruptures, based on direct costs from the practices of sports medicine and foot and ankle surgeons at a single tertiary academic center, with published outcome probabilities and patient utility data. Multiway sensitivity analyses were performed to reflect the range of data. Results: Nonoperative treatment was more cost-effective in the average scenario (nonoperative CUR, US$520; operative CUR, US$1995), but crossover occurred during the sensitivity analysis (nonoperative CUR range, US$224-US$2079; operative CUR range, US$789-US$8380). Operative treatment cost an extra average marginal CUR of US$1475 compared with nonoperative treatment, assuming uneventful healing in both treatment arms. The sensitivity analysis demonstrated a decreased marginal CUR of operative treatment when the outcome utility was maximized, and rerupture rates were minimized compared with nonoperative treatment. Conclusion: Nonoperative treatment was more cost-effective in average scenarios. Crossover indicated that open primary repair would be favorable for maximized outcome utility, such as that for young athletes or heavy laborers. The treatment decision for acute Achilles tendon ruptures should be individualized. These pilot results provide inferences for further longitudinal analyses incorporating future clinical evidence.

Qualitative Assessment of Research done at Two Premier Medical Institutes in India: Some Data for Introspection

ABSTRACT Aim To perform a qualitative assessment of research publications coming from two premier medical institutes in India. Materials and methods Research publications from AIIMS and PGIMER published during 2004 to 2008 were analyzed. The publications were categorized into five types. A year-wise analysis was done for both the institutes. Data was obtained from Scopus. The collected data included the number of papers published in a category, total citations received by a type of publication in a year, number of publications which have no citations, number of publications with only one citation, h-index, number of zero and only one citation were added to get publications with negligible citations. Results A total number of 4,828 and 2,882 research publications were analyzed from AIIMS and PGIMER respectively. The original articles attracted highest no of citations that is 64 and 66% of the total citations in a year for AIIMS and PGIMER respectively. Approximately 37 to 42% of the original articles get negligible citations. The h-index for various categories of article was higher for the original articles (18/13), whereas it was very low for other category of research publications. Conclusion The original articles fetch more citations in long run. Close to 40% of the original research done in the studied institutes get negligible citations pointing toward their outcome utility and quality. More than 60% of the minor category publications remain uncited. This sort of data if periodically obtained should serve as a benchmark for quality analysis of scientific research. How to cite this article Kanojia RP, Rathod KK, Rao KLN. Qualitative Assessment of Research done at Two Premier Medical Institutes in India: Some Data for Introspection. J Postgrad Med Edu Res 2012;46(1):24-33.

Motivational Factors Influencing Return to Work

Data on the return-ta-work rates of people who experience mid-career disabilities indicate an increase in the rate of early retirement. Motivation to resume work or to retire due to disability is directly influenced by the person's careful consideration of three factors-probability of a successful outcome, utility of the outcome, and costs associated with certain actions. Findings from the return-ta-work literature are summarized via the three motivational concepts; implications for return-ta-work interventions are stressed.