Sunitha Malay

Economic analysis of screening strategies for rupture of silicone gel breast implants

Background: In 2006, the U.S. Food and Drug Administration recommended screening of all women with silicone gel breast implants with magnetic resonance imaging 3 years after implantation and every 2 years thereafter to assess their integrity. The cost for these serial examinations over the lifetime of the breast implants is an added burden to insurance payers and to women. The authors performed an economic analysis to determine optimal screening strategies by considering the diagnostic accuracy of the screening tests, costs of the tests, and subsequent implant removal. Methods: The authors determined aggregate/pooled values for sensitivity and specificity of the screening tests of ultrasound and magnetic resonance imaging in detecting silicone breast implant ruptures from the data obtained from published literature. They compiled costs, based on Medicare reimbursements for 2011, for the following elements: imaging modalities, anesthesia, and three surgical treatment options for detected ruptures. A decision tree was used to compare three alternate screening strategies of ultrasound only, magnetic resonance imaging only, and ultrasound followed by magnetic resonance in asymptomatic and symptomatic women. Results: The cost per rupture of screening and management of rupture with ultrasound in asymptomatic women was

Minimal clinically important difference of carpal tunnel release in diabetic and nondiabetic patients

1090; in symptomatic women, it was

Applicability of large databases in outcomes research.

1622. A similar cost for magnetic resonance imaging in asymptomatic women was

Is Double-Blinded Peer Review Necessary? The Effect of Blinding on Review Quality.

2067; in symptomatic women it was

Testing the Validity of Preventing Complex Regional Pain Syndrome With Vitamin C After Distal Radius Fracture

2143. A similar cost for ultrasound followed by imaging in asymptomatic women was

Comprehensive breast reconstruction in an academic surgical practice: an evaluation of the financial impact.

637; in symptomatic women, it was

A systematic review of the management of acute pyogenic flexor tenosynovitis

2908. Conclusion: Screening with ultrasound followed by magnetic resonance imaging was optimal for asymptomatic women, and screening with ultrasound was optimal for symptomatic women.

Analysis of Publication Bias in the Literature for Distal Radius Fracture

Background: Establishing the minimal clinically important difference for patient-reported outcomes questionnaires is essential in outcomes research to evaluate the patient’s perspective of treatment effectiveness. The authors aim to determine the minimal clinically important difference after carpal tunnel release in diabetic and nondiabetic patients using the Boston Carpal Tunnel Questionnaire. Methods: The authors prospectively evaluated 114 patients (87 nondiabetic and 27 diabetic patients) undergoing carpal tunnel release. In addition to standard history and physical examination, the authors obtained preoperative electrodiagnostic studies to confirm carpal tunnel syndrome. The Boston Carpal Tunnel Questionnaire was administered before and after surgery at 3 and 6 months. Patients were asked about their level of satisfaction at the final follow-up visit. The authors applied the receiver operating characteristic curve approach to determine the minimal clinically important difference of symptom and function severity scales of the questionnaire. The authors used patient satisfaction as the reference standard to compare against the standardized change in scores after surgery for the two groups. Results: For both diabetic and nondiabetic patients, symptom and function severity scales showed large effect sizes of greater than 0.8 at 3 and 6 months after surgery. At 6 months after surgery, to be satisfied, diabetic patients required a minimal clinically important difference of 1.55 and 2.05 for symptom and function scales, respectively, whereas nondiabetic patients required 1.45 and 1.6, respectively. Conclusions: Diabetic patients needed a greater improvement in Boston Carpal Tunnel Questionnaire score to be satisfied on functional and symptom severity scales than nondiabetic patients. Overall, diabetic patients had less improvement in Boston Carpal Tunnel Questionnaire final scores compared with nondiabetics. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis

Outcomes research serves as a mechanism to assess the quality of care, cost effectiveness of treatment, and other aspects of health care. The use of administrative databases in outcomes research is increasing in all medical specialties, including hand surgery. However, the real value of databases can be maximized with a thorough understanding of their contents, advantages, and limitations. We performed a literature review pertaining to databases in medical, surgical, and epidemiologic research, with special emphasis on orthopedic and hand surgery. This article provides an overview of the available database resources for outcomes research, their potential value to hand surgeons, and suggestions to improve their effective use.

Sharps injuries: the risks and relevance to plastic surgeons.

Background: The review process can be completely open, double-blinded, or somewhere in between. Double-blinded peer review, where neither the authors’ nor peer reviewers’ identities are shared with each other, is thought to be the fairest system, but there is evidence that it does not affect reviewer behavior or influence decisions. Furthermore, even without presenting author names, authorship is often apparent to reviewers, especially in small specialties. In conjunction with Plastic and Reconstructive Surgery (PRS), the authors examined the effect of double-blinded review on review quality, reviewer publishing recommendation, and reviewer manuscript rating. The authors hypothesized that double-blinded review will not improve review quality and will not affect recommendation or rating. Methods: Traditionally, PRS peer review has been conducted in a single-blinded fashion. During a 3-month period of standard operation of the Journal, the authors examined reviews, recommendations, and manuscript ratings. Beginning October 1, 2014, PRS started conducting reviews in a double-blinded manner. The authors examined the additional reviews submitted during a 3-month period after the change. Review quality was assessed using the validated Review Quality Instrument. Results: Double-blinding had no effect on reviewer publishing recommendation or manuscript ranking. Review quality did not improve after the implementation of double-blinded review. Blinding was successful 66 percent of the time. The most common reasons for blinding failure were reviewer familiarity with authors’ work and author self-citation. Conclusions: Double-blinding adds considerable work for authors and editorial staff and has no positive effect on review quality. Furthermore, the authors’ results revealed no publication bias based on author identity at PRS.