American Society For Surgery Of The Hand Research Articles

Frequency of Bone Health Presentations atNational Hand Meetings.

The purpose of this study was to determine the frequency with which osteoporosis topics (screening, medical treatment, and fracture prevention) are presented at national hand surgery meetings. This was compared with the frequency of the same topics presented at the Orthopaedic Trauma Association (OTA) annual meetings. The annual meeting programs for the American Society for Surgery of the Hand (ASSH), the American Association for Hand Surgery (AAHS), and the OTA from the previous 10 years (2007-2016) were searched for presentations that covered bone health at each of these meetings. We categorized the presentations as either instructional or research. There were 2 bone health instructional presentations at hand surgery meetings in contrast to 13 presentations at OTA meetings over the last 10 years. For the last 9 years, the OTA has featured at least 1 instructional presentation on bone health every year. We identified 11 research presentations at the hand surgery meetings compared with 16 at the OTA meetings. Osteoporosis and bone health are infrequently presented instructional topics at national hand meetings compared with OTA meetings. The cause of the difference is unclear and likely multifactorial, varying each year with different program chairs and committees. The level of involvement of hand surgeons in osteoporosis management is controversial; however, incorporation of this topic may stimulate discussion and help identify solutions for this controversy. It may benefit hand surgeons to place more importance on osteoporosis screening and treatment. We believe that there should be an annual instructional course on this topic at the ASSH and AAHS meetings.

Trends in the Surgical Treatment for Cubital Tunnel Syndrome: A Survey of Members of the American Society for Surgery of the Hand.

Cubital tunnel syndrome is the second most common compression neuropathy affecting the upper extremity. The aim of this study was to determine the preferred surgical treatment for cubital tunnel syndrome by members of the American Society for Surgery of the Hand (ASSH). We invited members of the ASSH research mailing list to complete our online survey. They were presented with 6 hypothetical cases and asked to choose their preferred treatment from the following options: open in situ decompression, endoscopic decompression, submuscular transposition, subcutaneous transposition, medial epicondylectomy, and conservative management. This was assessed independently and anonymously through an online survey (SurveyMonkey). 1069 responses were received. Seventy-three percent of the respondents preferred to continue conservative management when a patient presented with occasional paresthesias for greater than 6 months with a normal electromyogram (EMG) or nerve conduction velocity (NCV). Sixty-five percent picked open in situ decompression if paresthesias, weakness of intrinsics, and EMG/NCV reports of mild to moderate ulnar nerve entrapment was present. More than 50% of respondents picked open in situ decompression, as their preferred treatment when sensory loss of two-point discrimination of less than 5 or more than 10 was present in addition to the findings mentioned above. Seventy-nine percent of the respondents said their treatment algorithm would change if ulnar nerve subluxation was present. Our survey results indicate that open in situ decompression is the preferred operative procedure, if there is no ulnar nerve subluxation, among hand surgeons for cubital tunnel syndrome.

Inadvertent Harvest of the Median Nerve Instead of the Palmaris Longus Tendon.

The palmaris longus tendon is frequently used as a tendon graft or ligament replacement. In rare instances the median nerve has been inadvertently harvested instead of the palmaris longus for use as a tendon. Nineteen cases in which the median nerve had been mistakenly harvested instead of the palmaris longus tendon were collected from members of the American Society for Surgery of the Hand (ASSH) Listserve. Surgeons involved in the subsequent care of the subject who had had an inadvertent harvest were contacted or the chart was reviewed. The reason for the initial procedure, the skill level of the primary surgeon, and when the inadvertent harvest was recognized were documented. When possible, the method of harvest and subsequent treatment were also documented. The most common initial procedure was a reconstruction of the elbow ulnar collateral ligament, followed by basal joint arthroplasty, tendon reconstruction, and reconstruction of the ulnar collateral ligament of the thumb metacarpophalangeal joint. Only 7 of the inadvertent harvests were recognized intraoperatively; in the remaining 12 cases the nerve was used as a tendon graft. The sensory loss was not recognized as being due to the inadvertent harvest until the first postoperative visit (2 subjects), 3 to 4 weeks (2 subjects), 2 to 3 months (2 subjects), 5 to 7 months (2 subjects), 1 year (1 subject), 3 years (1 subject), or 10 years (1 subject). Preoperative clinical identification of the presence or absence of a palmaris longus did not necessarily prevent an inadvertent harvest. Knowledge of the relevant anatomy is crucial to avoiding inadvertent harvest of the median nerve instead of the palmaris longus tendon.

Diagnostic Testing Requested Before Surgical Evaluation for Carpal Tunnel Syndrome

We sought to evaluate how often physicians who perform carpal tunnel release in the state of Michigan routinely request electrodiagnostic studies (EDS) or other diagnostic tests prior to an initial consultation and whether provider or practice characteristics had an influence on requirements for preconsultation diagnostic tests. Through online data sources, we identified 356 providers in 261 practices throughout the state of Michigan with profiles confirming hand surgery practice or surgical treatment of carpal tunnel syndrome (CTS). We recorded American Society for Surgery of the Hand (ASSH) membership, teaching facility status, practice size, and primary specialty for each provider. Using a standardized telephone script, 219 providers were contacted by telephone to determine whether any diagnostic tests were needed before an appointment. Using multivariable logistic regression, we evaluated the relationship between the requirement for preconsultation testing and surgeon and practice characteristics. Among the 134 providers who were confirmed to perform carpal tunnel release, 57% (n= 76) required and 9% (n= 12) recommended a diagnostic test prior to the initial consultation. Of the 88 physicians who required/recommended testing, 85% (n= 75) requested EDS, 22% (n= 19) requested magnetic resonance imaging, 13% (n= 11) requested a computed tomography scan, and 9% (n= 8) requested an x-ray. Patients were asked to have multiple studies by 19 (22%) of the 88 surgeons who requested/recommended testing. In the multivariable analysis, ASSH membership, size of practice, and teaching facility status did not have a significant relationship with the requirement for preconsultation testing. Most surgeons who treat CTS in the state of Michigan routinely request EDS before evaluation, rather than reserving the test for cases in which the diagnosis is unclear. In the quest for high-value care, providers must consider whether the benefit of diagnostic tests for CTS likely outweighs the costs, inconvenience, and potential for treatment delay.

An Assessment of Online Reviews of Hand Surgeons.

The purpose of this study is to evaluate the number of reviews and scores for active members of the American Society for Surgery of the Hand (ASSH) in popular physician rating websites (Healthgrades.com and Vitals.com). A total of 433 ASSH active members were searched in two popular rating websites for a total of 866 web searches. Demographic data, overall and subcategory scores, number of reviews, and wait times were scored from each member's webpage. The average number of reviews per surgeon on Healthgrades.com and Vitals.com were 13.8 (range 1-108) and 9.4 (range 0-148), respectively. The average overall score for physicians was 8.1 out of 10 points. For both websites, the vast majority (80-90%) of active members of the ASSH had 20 or less reviews. Multivariate data analysis revealed no statistical differences in overall score by region (P=0.24) or gender (P=0.38). Increasing physician age negatively correlated with overall score (P=0.01). Wait time was not associated with a negative score (P=0.38). Active members of the ASSH received generally positive reviews. The average number of reviews for active members of the ASSH was exceedingly small, bringing into question the legitimacy and validity of these scores. This is especially important when taking into consideration the increasing popularity of these websites, and the reliance of patients on them to obtain physician information. The clinical implication of this study is that physicians have a vested interest in the legitimacy of the data provided by these websites and other physician rating outlets.

Attitude of hand surgeons toward Affordable Care Act: A survey of members of American Society for Surgery of the Hand

The purpose of this study was to examine current attitude of hand surgeons toward the Affordable Care Act (ACA). An electronic survey was sent to members of American Society for Surgery of the Hand (ASSH) to examine their attitude toward the Affordable Care Act. 974 ASSH members responded to the survey (33% response rate). The majority of respondents were male (89%), trained in orthopedic surgery (81%), and in private practice (75%). 41% of respondents rated their knowledge of the ACA as average. Respondents disagreed that the ACA would improve healthcare in the United States (median 2, mean 2.06, scale 1–5), while agreeing that the ACA would decrease reimbursements specific to hand surgery (median 4, mean 4.11).

The American Academy of Orthopaedic Surgeons Evidence-Based Clinical Practice Guideline on: Management of Carpal Tunnel Syndrome.

Graham, Brent MD, MSc, FRCSC; Peljovich, Allan E. MD, MPH; Afra, Robert MD; Cho, Mickey S. MD; Gray, Rob MD; Stephenson, John MD; Gurman, Andrew MD; MacDermid, Joy PhD; Mlady, Gary MD; Patel, Atul T. MD; Rempel, David MD, MPH; Rozental, Tamara D. MD; Salajegheh, Mohammad Kian MD; Keith, Michael Warren MD; Jevsevar, David S. MD, MBA; Shea, Kevin G. MD; Bozic, Kevin J. MD, MBA; Adams, Julie MD; Evans, Jay Mark MD; Lubahn, John MD; Ray, Wilson Zachary MD; Spinner, Robert MD; Thomson, Grant MD, MSc; Shaffer, William O. MD; Cummins, Deborah S. PhD; Murray, Jayson N. MA; Mohiuddin, Mukarram MPH; Mullen, Kyle MPH; Shores, Peter MPH; Woznica, Anne MLS; Linskey, Erica; Martinez, Yasseline; Sevarino, Kaitlyn MBA

Abstract: Analysis of National Institutes of Health Funding in Hand Surgery

BACKGROUND: Research budgets of the National Institutes of Health (NIH) are decreasing, yet adequate funding is needed to advance biomedical research. Currently, the state of NIH funding in hand surgery is poorly understood. This study elucidates the portfolio of NIH grants to hand surgeons. METHODS: This was a cross-sectional study of NIH grants awarded to American Society for Surgery of the Hand (ASSH) members during 1992 - 2016. Funding totals, mechanisms, and institutes were obtained from the NIH RePORTER database. Abstracts were categorized by research type (clinical, translational, basic science, education/training) and area of interest. An Internet-based search was conducted to determine principal investigator characteristics. RESULTS: 2,316 ASSH members were queried and 19 had NIH funding (0.8%). NIH-funded hand surgeons were predominately male (17/19, 89%), full-professors (14/19, 74%), and orthopaedic trained (15/19, 79%). 39 unique grants were awarded for a total of $57,462,753. R01 grants accounted for most costs (84.2%) followed by ZIA intramural grants (6.4%), and K24 (2.1%) grants. The top NIH institutes were the National Institute for Arthritis and Musculoskeletal and Skin Diseases (63.2%) and the National Institute for Neurological Disorders and Stroke (34.1%). Costs supported translational (47.9%), basic science (32.5%), clinical (16.9%), and education/training (2.7%) research. Funded areas of research included peripheral nerve (29.6%), tendon (25.2%), nerve compression (11.4%), bone (18.4%), microvascular (7.8%), and joint (7.6%) diseases. The top funded institutions were Washington University (32.8%), Mayo Clinic (24.9%), and University of Michigan (14.7%). CONCLUSIONS: Few hand surgeons obtain NIH research grants suggesting a tenuous portfolio for possible budget cuts. Future research should elucidate barriers to NIH funding procurement among academic hand surgeons. DISCLOSURES:None

Inwieweit stimmt die Ergebnisbeurteilung nach Eingriffen bei Beugesehnenverletzungen bei Anwendung der Bewertungssysteme nach Buck-Gramcko, Strickland und der Amerikanischen Gesellschaft für Handchirurgie überein?

Scores are essential for comparing function after flexor tendon reconstructions. The Buck-Gramcko Score, the Strickland Score and the ASSH (American Society for Surgery of the Hand) Score are the most commonly applied rating systems. The purpose of this study is to evaluate these systems and their interchangeability. Based on an unrestricted metacarpophalangeal (MCP) joint of 0-0-90° or limited range of motion of the MCP joint of 0-30-90°, the scores of the 3 rating systems were assessed and graphically displayed for each possible finger position regarding proximal (PIP) and distal (DIP) interphalangeal joints. Based on an unrestricted MCP joint, the scores of the 3 rating systems differed in 24-33% of the obtained values, depending on the sum of joint flexion and extension deficits of the aforementioned PIP and DIP joints. If the range of motion was restricted to 0-30-90° in the MCP joint, differing values were only observed in 16-19% of the obtained values. In extreme cases, scores for the same clinical presentation may thus be "excellent", "fair" or "poor", depending on which system has been used. The different rating systems for the evaluation of flexor tendon reconstruction are neither identical nor adjustable. Therefore, consensus or at least a recommendation is needed regarding the system to be used. It may even be necessary to develop a generally accepted rating system to compare studies. In the meantime, the readings of the active and passive range of motion of all joints of the affected finger/thumb ought to be published in studies to compare and validate the results.

Primary Residency Training Pre-determines Post-fellowship Clinical Practice in Board-certified Hand Surgeons: N/A - Not a clinical study

There is no financial information to disclose. This study seeks to identify the relationship between the type of residency training (general, plastic, or orthopaedic surgery) and the clinical practice profiles of hand surgeons in the United States. Membership applications to the American Society for Surgery of the Hand (ASSH) from 2011-2015 were obtained with permission. Data on type of residency training, practice type (private, private-university, hospital, or other), the percentage of hand surgery in practice, and the time to application from fellowship and CAQ completion were collected. The total number of cases as well as the number of cases in each key clinical category were collected from surgical case logs. Categorical variables were evaluated with chi-squared tests and continuous variable with Mood’s median tests and Kruskal-Wallis tests; the numbers of surgical cases were analyzed with Poisson regression. All statistical analysis were performed with STATA (v. 13.1, Mac). From 2011-2015, a total of 451 hand surgeons applied for ASSH membership. 73.8% were orthopaedic surgeons (16.0% plastic surgeons and 10.2% general surgeons). After excluding outliers, the median time to application after fellowship graduation and completion of the CAQ was 5 and 1 years, respectively, and was similar between groups. Plastic surgeons were more likely to be in an academic practice (48.3% versus 17.0% for orthopedics and 7.7% for general surgery, P < 0.0001). General surgeons were most likely to be in private practice (71.8% versus 59.2% for orthopedics and 39.7% for plastic surgery). Plastic surgeons had the smallest and most variable proportion of their practice dedicated to hand surgery (77.5%, SD 18.7%). Orthopaedic surgeons had the highest volume of cases (median 306, P < 0.0001). Out of all applicants, deficiencies in joint contracture (40.7%), congenital (80.5%), and microvascular surgery (47.6%) were the most common. Orthopaedic surgeons were most likely to perform bone and joint, nerve, tendon and muscle and tumor cases. Plastic surgeons were the most likely to perform skin and wound, congenital and microvascular cases. General surgeons did notably fewer bone and joint, tendon and muscle, and congenital cases relative to both plastic and orthopaedic surgeons. See Figure 1 for detailed results. •Orthopaedic, plastic, and general surgery-trained hand surgeons early in their career seek varied practice types and have different clinical case profiles.•Differences in case profiles may be due to surgeon interest and/or training experience.•Evaluation of training curriculums for hand fellows should ensure that graduates are adequately exposed to the full range of hand surgery.

Geographic and Age-Based Variations in Medicare Reimbursement Among ASSH Members.

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members' Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). "Hand-surgeons-per-capita" and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state's average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus number of hand surgeons per capita, and (3) total reimbursement from Medicare versus number of years in practice. Analysis of variance (ANOVA) was used to detect a difference in reimbursement based on categorical range of years as an ASSH member. Results: A total of 1667 ASSH members satisfied inclusion in this study. Although there was significant variation among states' average reimbursement, reimbursement was not significantly correlated with the state's hand surgeons per capita or total number of hand surgeons in that given state. Correlation between years as an ASSH member and average reimbursement was significant but non-linear; the highest reimbursements were seen in surgeons who had been ASSH members from 8 to 20 years. Conclusions: Peak reimbursement from Medicare for ASSH members appears to be related to the time of surgeons' peak operative volume, rather than any age-based bias for or against treating Medicare beneficiaries. In addition, though geographic variation in reimbursement does exist, this does not appear to correlate with density or availability of hand surgeons.

A Survey of the Use of Ultrasound by Upper Extremity Surgeons.

Background: Ultrasound is a versatile imaging modality that can be used by upper extremity surgeons for diagnostic purposes and guided injections. The perceptions of ultrasound for diagnosis and treatment among upper extremity surgeons and its barriers for adoption have not been formally surveyed. The purpose of this study is to determine the current usage of musculoskeletal ultrasound for diagnostic purposes and guided injections by upper extremity surgeons and their reasons for using it or not using it in practice. Methods: A 22-question survey was distributed to the American Society for Surgery of the Hand (ASSH). The survey questions consisted of respondent characteristic questions and questions pertaining to the use of ultrasound. Chi-square analysis was performed to assess for a difference in ultrasound usage across respondent characteristics. Results: Three hundred four (43%) answered that they have an ultrasound machine in their office; Fifty-one percent (362) of the respondents use ultrasound for diagnostic purposes. Fifty-five (8%) of the survey respondents use ultrasound to diagnose carpal tunnel syndrome; 168 (23.5%) respondents reported that they use ultrasound for guided injections. There was a statistically significant difference between access to an ultrasound machine in the office by practice setting and use of ultrasound for diagnostic purposes by practice setting. Conclusions: The use of ultrasound by upper extremity surgeons is split for diagnostic purposes, with fewer surgeons using ultrasound to diagnose carpal tunnel syndrome and guided injections. Ultrasound machine availability and the use of ultrasound for diagnosis appear to be influenced by practice setting.

Hand-e and Plastic Surgery Resident Training

Hand-e is the electronic online learning platform for the American Society for Surgery of the Hand (ASSH). It began as an idea from a group of young leaders in 2011, with the idea of creating a central repository for all ASSH educational material, including books, journals, videos, webinars and annual meeting content, and free-standing continuing medical education courses, to create a “go to” source for upper extremity education. This was initially known as the Surgery of the Hand and Upper Extremity Hand Online Resource Network. Through a series of meetings, ASSH merged the needed software programs to make this reality and went live in early 2014. Since inception, we have added content and as of the time of this meeting, have over 3500 videos, including surgical techniques/surgical skills videos, presentations from annual meetings, instructional courses, symposia, and more. We also have over 1200 images and 1300 text items, including meeting handouts, abstracts, and similar items. The content is organized and searchable under the Curriculum of Hand Surgery (educational content categorized by anatomical location and tissue type such as hand and wrist, forearm, nerve, and pediatrics) web collections including surgical skills, meeting content, webinars, and education resources. We also have content pertaining to practice management, including performance metrics, such as meaningful use, physician’s quality reporting system, and outcomes. There are several sections of specific interest to plastic surgery resident education, include a reading list as compiled by the resident education committee. This includes over 100 articles on various hand surgery conditions, including both “classic” articles and recent review articles. Those articles published in the Journal of Hand Surgery are available, and those published in other journals have a link to the abstract in PubMed. The comprehensive review of hand surgery (board review course) recorded, with presentations (audio and video) and power point handouts, gives an evidence-based review of topics covering the entire breadth of hand surgery. We also have surgical skills videos demonstrating multiple surgical techniques on live patients and cadavers. We are continuously adding content and are in the process of developing educational modules, including pre/post questions and important videos for the topic, such as review courses, selected review, and classic articles to provide a review of the topic, and anticipate having the first module available by late 2016. Hand-e access is an ASSH member benefit, and we have set it up to allow plastic surgery residents to have access to the content. This requires signing up through ASSH to create log-in information, providing residency program information and graduation date. We are also offering temporary access for plastic surgery residency program directors at no charge requiring similar registration through ASSH.

Hand Society and Matching Program Web Sites Provide Poor Access to Information Regarding Hand Surgery Fellowship.

The Internet is a common resource for applicants of hand surgery fellowships, however, the quality and accessibility of fellowship online information is unknown. The objectives of this study were to evaluate the accessibility of hand surgery fellowship Web sites and to assess the quality of information provided via program Web sites. Hand fellowship Web site accessibility was evaluated by reviewing the American Society for Surgery of the Hand (ASSH) on November 16, 2014 and the National Resident Matching Program (NRMP) fellowship directories on February 12, 2015, and performing an independent Google search on November 25, 2014. Accessible Web sites were then assessed for quality of the presented information. A total of 81 programs were identified with the ASSH directory featuring direct links to 32% of program Web sites and the NRMP directory directly linking to 0%. A Google search yielded direct links to 86% of program Web sites. The quality of presented information varied greatly among the 72 accessible Web sites. Program description (100%), fellowship application requirements (97%), program contact email address (85%), and research requirements (75%) were the most commonly presented components of fellowship information. Hand fellowship program Web sites can be accessed from the ASSH directory and, to a lesser extent, the NRMP directory. However, a Google search is the most reliable method to access online fellowship information. Of assessable programs, all featured a program description though the quality of the remaining information was variable. Hand surgery fellowship applicants may face some difficulties when attempting to gather program information online. Future efforts should focus on improving the accessibility and content quality on hand surgery fellowship program Web sites.

What's New in Hand Surgery.

It is my privilege to provide an overview of some of the exciting developments that have taken place within the field of hand surgery in the past year. Before doing so, it would be remiss of me to not take this opportunity to sincerely thank Peter Amadio, MD, for his years of service in providing us with excellent “What’s New in Hand Surgery” Specialty Update articles. This review outlines some of the papers and publications that were presented at the annual meetings of the American Academy of Orthopaedic Surgeons (AAOS), the American Society for Surgery of the Hand (ASSH), and the American Association for Hand Surgery (AAHS) as well as scientific articles published within the literature. The management of distal radial fractures continues to be an area of much debate. In the past year, several prospective randomized studies were performed to determine the optimal treatment. Roh et al.1 conducted a prospective randomized study comparing volar-plate with external fixation in the management of seventy-four intra-articular AO type C2 and C3 distal radial fractures. Range of motion, grip strength, and Michigan Hand Questionnaire (MHQ) scores were greater in the volar-plate group at three months but were similar between both cohorts at twelve months. Radiographic parameters, including volar tilt and radial inclination, were similar between the treatment groups, with those treated with a volar plate having improved radial height. Costa et al.2 reported on 461 adult patients with acute dorsally displaced distal radial fractures that were amenable to closed reduction. Patients were prospectively randomized to either percutaneous Kirschner-wire fixation or locking-plate fixation performed by 244 surgeons within eighteen centers across the United Kingdom. The primary outcome measure was Patient-Rated Wrist Evaluation (PRWE) scores. At three, six, and twelve months of follow-up, there were no clinically significant differences in PRWE scores or …

The Attitude of Hand Surgeons toward the Affordable Care Act: A Survey of Members of the American Society for Surgery of the Hand

Abstract Background: The purpose of this study was to examine the current attitude of hand surgeons toward the Act (ACA), assess their self-described knowledge of the law, and ascertain projected changes in practice plans. Methods: An electronic survey was sent to members of American Society for Surgery of the Hand (ASSH). Results: A total of 974 ASSH members responded to the survey (33% response rate). The majority of respondents were male (89%), trained in orthopaedic surgery (81%) and in private practice (75%). 41% of respondents rated their knowledge of the ACA as average. 84% reported receiving no education on the law. In general, respondents disagreed that the ACA would improve healthcare in the United States (median 2, mean 2.06, scale 1-5), while agreeing that the ACA would decrease reimbursements specific to hand surgery (median 4, mean 4.11). They also disagreed that the ACA would improve access to emergent (median 2, mean 2.10) and elective hand surgery (median 2, mean 2.30). 37% of respondents believed that implementation of the ACA would cause them to retire earlier than planned. Stratified analysis revealed that private-practice and male respondents had a more negative outlook on the ACA compared to academicpractice and female surgeons. Conclusion: The majority of responding hand surgeons have an unfavorable attitude toward the ACA, particularly private-practice and male members. Only a small percentage of respondents reported sufficient preparation for the coming changes related to the ACA. These findings suggest an opportunity for increased education and advocacy from professional organizations.

Physician-Rating Web Sites: Ethical Implications

To understand the ethical and professional implications of physician behavior changes secondary to online physician-rating Web sites (PRWs). The American Society for Surgery of the Hand (ASSH) Ethics and Professionalism Committee surveyed the ASSH membership regarding PRWs. We sent a 14-item questionnaire to 2,664 active ASSH members who practice in both private and academic settings in the United States. We received 312 responses, a 12% response incidence. More than 65% of the respondents had a slightly or highly unfavorable impression of these Web sites. Only 34% of respondents had ever updated or created a profile for PRWs, although 62% had observed inaccuracies in their profile. Almost 90% of respondents had not made any changes in their practice owing to comments or reviews. One-third of respondents had solicited favorable reviews from patients, and 3% of respondents have paid to improve their ratings. PRWs are going to become more prevalent, and more research is needed to fully understand the implications. There are several ethical implications that PRWs pose to practicing physicians. We contend that it is morally unsound to pay for good reviews. The recourse for physicians when an inaccurate and potentially libelous review has been written is unclear. Some physicians have required patients to sign a waiver preventing them from posting negative comments online. We propose the development of a task force to assess the professional, ethical, and legal implications of PRWs, including working with companies to improve accuracy of information, oversight, and feedback opportunities. It is expected that PRWs will play an increasing role in the future; it is unclear whether there will be a uniform reporting system, or whether these online ratings will influence referral patterns and/or quality improvement.

Does a Directive to an Internet Site Enhance the Doctor-Patient Interaction? A Prospective Randomized Study for Patients with Carpal Tunnel Syndrome.

Sixty-two percent of patients would like their doctor to recommend a specific web site to find health information, but only 3% of patients receive such recommendations. We investigated whether providing patients with an Internet web-site link recommended by their physician would improve patient knowledge and satisfaction. Our hypothesis was that directing patients to a reliable web site would improve both. Sixty patients with a new diagnosis of carpal tunnel syndrome were prospectively randomized into two groups. Twenty-three patients in the control group had a traditional physician office visit and received standard care for carpal tunnel syndrome. Thirty-seven patients in the treatment group received a handout that directed them to the American Society for Surgery of the Hand (ASSH) web page on carpal tunnel syndrome in addition to the standard care provided in the office visit. Patients later completed a ten-question true-or-false knowledge questionnaire and a six-item satisfaction survey. Differences in scores were analyzed using two-sample t tests. Less than half (48%) of the patients who were given the Internet directive reported that they had visited the recommended web site. The mean scores on the knowledge assessment (6.84 of 10 for the treatment group and 6.96 of 10 for the control group) and the satisfaction survey (4.49 of 5 for the treatment group and 4.43 of 5 for the control group) were similar for both groups. The mean score for knowledge was similar for the patients who had used the ASSH web site and for those who had not (6.89 and 6.97 respectively). Moreover, compared with patients who had not used the Internet at all to learn about carpal tunnel syndrome, patients who used the Internet scored 6.6% better (mean score, 7.14 for those who used the Internet compared with 6.70 for those who had not; p > 0.05). Regardless of Internet usage, most patients scored well on the knowledge assessment and reported a high level of satisfaction. Whether the patient was given a handout or had visited the ASSH or other Internet web sites, the knowledge and satisfaction scores for all patients were similar. Since the physician was the common denominator in both groups, the results indicate that the patient-physician relationship may be more valuable than the Internet in providing patient education. Effective communication between patients and practitioners is at the cornerstone of delivering excellent care and building trusting relationships. This study examines whether reliable Internet information should be embraced as a tool to enhance patient-surgeon communication in a clinical context.

Accredited Hand Surgery Fellowship Web Sites: Analysis of Content and Accessibility

To assess the accessibility and content of accredited hand surgery fellowship Web sites. A list of all accredited hand surgery fellowships was obtained from the online database of the American Society for Surgery of the Hand (ASSH). Fellowship program information on the ASSH Web site was recorded. All fellowship program Web sites were located via Google search. Fellowship program Web sites were analyzed for accessibility and content in 3 domains: program overview, application information/recruitment, and education. At the time of this study, there were 81 accredited hand surgery fellowships with 169 available positions. Thirty of 81 programs (37%) had a functional link on the ASSH online hand surgery fellowship directory; however, Google search identified 78 Web sites. Three programs did not have a Web site. Analysis of content revealed that most Web sites contained contact information, whereas information regarding the anticipated clinical, research, and educational experiences during fellowship was less often present. Furthermore, information regarding past and present fellows, salary, application process/requirements, call responsibilities, and case volume was frequently lacking. Overall, 52 of 81 programs (64%) had the minimal online information required for residents to independently complete the fellowship application process. Hand fellowship program Web sites could be accessed either via the ASSH online directory or Google search, except for 3 programs that did not have Web sites. Although most fellowship program Web sites contained contact information, other content such as application information/recruitment and education, was less frequently present. This study provides comparative data regarding the clinical and educational experiences outlined on hand fellowship program Web sites that are of relevance to residents, fellows, and academic hand surgeons. This study also draws attention to various ways in which the hand surgery fellowship application process can be made more user-friendly and efficient.

The Management of Kienböck Disease: A Survey of the ASSH Membership.

Background The purpose of this study was to determine the current trends and common practices for the treatment of Kienböck disease at different stages. Question/Purpose To determine the current trends and common practices by hand surgeons for the treatment of Kienböck disease. Methods A survey with hypothetical Kienböck disease cases stratified by the Lichtman staging system was distributed to the American Society for Surgery of the Hand (ASSH) members. Questions and responses reflected common treatment strategies. Results Of a total of 375 worldwide respondents, preferred treatments of Kienböck disease were as follows: for Stage I disease, an initial trial of splinting was favored (74%), followed by radial shortening osteotomy for continued symptoms. For Stage II disease, 63% of surgeons preferred surgical intervention, particularly radial shortening osteotomy. For Stage IIIa with negative ulnar variance, 69% chose radial shortening osteotomy. Responses were heterogeneous for Stage IIIa Kienböck with positive variance, and capitate shortening osteotomy and vascularized bone grafting were preferred. Salvage procedures predominated for Stage IIIb disease, including proximal row carpectomy (PRC; 42%), intracarpal arthrodesis (21%), and total wrist fusion (10.7%). Similarly, Stage IV disease was treated by 87% of respondents by either PRC or wrist fusion. Without regard to stage of disease, 90% of participants reported using the same Lichtman staging to guide treatment and would also alter treatment strategy based upon ulnar variance. Conclusions Most respondents used Lichtman staging and ulnar variance to guide treatment decisions. Results indicate that the most common surgical treatments were radial shortening osteotomy for early disease and PRC in later stages. Level of Evidence Level IV, Economic/Decision Analysis.