Current concepts in the management of the rheumatoid hand.

Hand surgeons are an integral part of the management team for patients with rheumatoid arthritis. There is now a greater understanding of the national use of rheumatoid hand surgery, which highlights the differences between hand surgeons and rheumatologists regarding the treatment of the rheumatoid hand. Advances in medical treatments have also decreased the prevalence of hand deformities caused by this disease. Hand surgeons today have less exposure to treating rheumatoid hand, but despite more effective medical options, surgery may still offer patients hope for improvement of hand function and appearance. This article summarizes the current state of rheumatoid hand surgery and discuss the surgical treatment strategies for optimizing outcomes for patients with rheumatoid arthritis.

Treatment of common congenital hand conditions.

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Recognize the clinical features associated with five common congenital hand conditions. 2. Describe the indications and appropriate timing for various surgical procedures used to treat congenital hand anomalies. 3. Identify the pearls and pitfalls of these surgical treatments to avoid complications. 4. Understand the expected postoperative outcomes associated with these surgical procedures. SUMMARY: This article provides an introduction to congenital hand differences by focusing on practical surgical strategies for treating five commonly encountered conditions, including syndactyly, constriction ring syndrome, duplicated thumb, hypoplastic thumb, and trigger thumb. The accompanying videos demonstrate common and reliable surgical techniques for syndactyly release, duplicated thumb reconstruction, and pollicization for hypoplastic thumb.

A systematic review of applying patient satisfaction outcomes in plastic surgery.

BACKGROUND: The authors performed a systematic review of patient satisfaction studies in the plastic surgery literature. The specific aim was to evaluate the status of satisfaction research that has been undertaken to date and to identify areas for improvement. METHODS: Four medical databases were searched using satisfaction and plastic surgery-related search terms. Quality of selected articles was assessed by two trained reviewers. RESULTS: Of the total of 2936 articles gleaned by the search, 178 were included in the final review. The majority of the articles (58 percent) in our review examined patient satisfaction in breast surgery populations. In addition, 53 percent of the articles were limited in scope and only measured features of care in one or two domains of satisfaction. Finally, the majority of the studies (68 percent) were based solely on the use of ad hoc satisfaction measurement instruments that did not undergo formal development. CONCLUSIONS: Given the important policy implications of patient satisfaction data within plastic surgery, we found a need to further refine research in this area. The scarcity of satisfaction research in the craniofacial, hand, and other reconstructive specialties, the narrow scope of satisfaction measurement, and the use of unvalidated instruments are current barriers preventing plastic surgery patient satisfaction studies from producing meaningful results.

A systematic review of ethical principles in the plastic surgery literature.

BACKGROUND: This purpose of this study was to perform a systematic review to identify articles that discuss ethical issues relating to the field of plastic and reconstructive surgery and to evaluate whether ethical issues are underrepresented in the plastic surgery literature. METHODS: Four medical databases were selected to search through the medical literature with specific inclusion criteria to disqualify irrelevant articles from the study. Appropriate articles were extracted, and their quality and validity were assessed by multiple investigators to maximize reproducibility. The data were then synthesized and analyzed for associations among the ethical principles. RESULTS: Of a total library search of more than 100,000 plastic surgery-oriented articles, only 110 clearly focused on ethical principles. Autonomy (53 percent) was the most common major theme, whereas distributive justice (15 percent) represented the least frequently emphasized ethical principle. The proportions of each ethical principle were tested against each other for equality using Cochran's Q test; the Q test reached statistical significance (Q = 67.04, df = 3, p < 0.0001), indicating that the ethical principles were not discussed equally in plastic surgery literature, which was expected because autonomy represented 53 percent of the articles, whereas distributive justice represented only 15 percent of articles. When examining both major and minor themes, more than half of the articles (61 percent) addressed two or more ethical principles. Beneficence and nonmaleficence were strongly associated (Pearson's chi = 55.38, df = 1,p < 0.0001). CONCLUSION: Despite the extensive number of ethical issues that plastic surgeons face, a relatively small proportion of plastic surgery literature was dedicated to discussing ethical principles.

Future of the US healthcare system and the effects on the practice of hand surgery.

The multitier healthcare system of the USA has several major flaws. High costs and uncertain quality of care indicate that this system is no longer practical. Several improvement initiatives, such as the Oregon Health Plan, Leapfrog, Lean Manufacturing, and Pay-for-Performance have been implemented into the current system. All of these quality improvement models are being experimented in a limited fashion and do not address the biggest problem in the US healthcare, inequality of care. There is now increasing support for a universal health coverage model as an ethically sound and just way to decrease health disparities in the USA. The current quality initiatives as well as an adoption of universal coverage appear to be the best way to improve quality of care, reduce cost, and increase equality in healthcare. These initiatives may have considerable effects on the practice of hand surgery in the near future, and thus, it is important for the field of hand surgery to become more engaged in advocacy and public policy arena. The purpose of this paper is to examine the current problems in the US healthcare system and to evaluate potential solutions that will enhance quality while simultaneously curbing the unchecked increase in healthcare expenditure.