JHS Journal Club

Created in 2018, the JHS Journal Club is a Twitter-based journal club that allows you to interact with other Journal of Hand Surgery readers and discuss interesting articles in JHS. You’ll participate in live meetings via Twitter, sharing thoughts with readers from around the world.

How to Participate

Step 1. Sign up for Twitter if you haven’t already. If you’re unfamiliar with Twitter, check out Twitter Guide: Getting Started.

Step 2. Join the conversation

Using the actual Twitter website or app is not the best option for participating, as you will be required to continually refresh your feed to follow the conversation. Try one of these easy alternatives:

  • Option 1 (highly recommended): Visit tchat.io and enter the hashtag #JHSJC to follow the conversation in real-time. The site will automatically add the #JHSJC hashtag to each of your tweets and make it easier for you to participate. An alternative to tchat.io is tweetchat.com. Be sure to allow access your Twitter account.
  • Option 2: Follow the #JHSJC hashtag as a saved search in a Twitter client such as Tweetbot (download for Mac, iPhone or iPad), which has the ability to continually stream when you are connected.

Step 3. Participate

Speak your mind!

  • If you’re following options 1 or 2 above, the #JHSJC hashtag will automatically be added to your tweets, so there’s nothing else you need to do.
  • If you’re using the Twitter website or app, be sure to include @JHandSurg and #JHSJC to your Tweets.

Questions? Contact us at jhs@assh.org.

December #JHSJC

December’s #JHSJC will take place on:

Date: December 10, 2019
Time: 9:00 p.m. EST

Article #1:
The Impact of Pre-Referral Advanced Diagnostic Testing on Wait Time to See a Hand Surgeon for Common Upper-Extremity Conditions
By Yu-Ting Lu, MPH, Steven C. Haase, MD, Ting-Ting Chung, MS, Kevin C. Chung, MD, MS, and Erika D. Sears, MD, MS

https://doi.org/10.1016/j.jhsa.2019.09.009
December 2019: Volume 44, Issue 12, Pages 1013-1020.e2
Full article: https://www.jhandsurg.org/article/S0363-5023(19)31393-0/fulltext
Free podcast: https://www.jhandsurg.org/pb/assets/raw/Health%20Advance/journals/yjhsu/December_2019.mp3

Summary

The authors reviewed their experience over a 10-year period between 2006 and 2015 and recorded the use and timing of advanced diagnostic testing (tests other than routine radiographs) as well as the time elapsed between referral to and being seen by a hand surgeon for one of 3 conditions, carpal tunnel syndrome (CTS), joint pain (JP) or soft tissue mass (STM).  Approximately 4,100 patient records were reviewed. CTS patients had the highest rate of receiving pre-referral advanced testing (53.4%), compared with 10.6% of JP patients and 5.8% of STM patients. Among the CTS patients, 19.5% received additional advanced testing after the hand surgeon assessment, almost all of which was repeat electrodiagnostic testing. Compared to patients who did not receive any pre-referral advanced testing, those who received pre-referral advanced testing, waited 19-94 days longer to be seen by a hand surgeon. The authors conclude that the pre-referral ordering of tests increases the wait time to be seen by the hand surgeon and they question the value of that testing.

Points for discussion

  • This was a single institution study. How likely is it that these findings are generalizable?
  • Presumably the basis for getting the pre-referral test is to expedite the care the patients require. That wasn’t studied in this investigation, but the authors have previously reported (https://www.jhandsurg.org/article/S0363-5023(16)30723-7/fulltext) that a large proportion of surgeons in their region request these tests prior to the patient being seen. Given the evidence around the role that electrodiagnostic tests should play in the diagnosis of CTS, is that justified?
  • What will the impact be of bundled fees or valued-based compensation on these practices? What is the best way of streamlining care in that context?

Article #2:
Reduction of Opioid Use After Upper-Extremity Surgery through a Predictive Pain Calculator and Comprehensive Pain Plan
By Marissa D. Jamieson, MD, Joshua S. Everhart, MD, MPH, James S. Lin, MD, Sonu A. Jain, MD, Hisham M. Awan, MD, and Kanu S. Goyal, MD

https://doi.org/10.1016/j.jhsa.2019.10.002
December 2019: Volume 44, Issue 12, Pages 1050–1059.e4
Full article: https://www.jhandsurg.org/article/S0363-5023(19)31389-9/fulltext

Summary

The authors developed an app-based opioid calculator (see the calculator here) by first making observations regarding opioid usage in approximately 300 patients undergoing routine hand surgery procedures. This information was used to create regression models to predict the number of opioid pills that should be prescribed, taking into account factors of patient age, baseline opioid use, use of regional block, employment status, nature of the operative procedure and procedure time. This model was then used to direct prescribing in 221 patients. The authors noted decreases in pills prescribed, pills wasted and overall consumption in the post-intervention group. There were no differences between the pre- and post-intervention groups with respect to patient-reported pain control or the need for prescription refills.

Points for discussion

  • Clearly, we have moved on from identifying the scope of the opioid problem in hand surgery and on to strategies for better prescribing (some examples of some of those strategies can be found here, here, here and here). How practical is the use of an app of this nature?
  • The patients also received pre-operative counselling regarding post-operative analgesic use. That probably represents a confounder here because there is evidence to show that that also reduces opioid use in the post-operative period. What was the likely role of these two factors in the observations? In other words, could the same effects have been observed without the calculator?
  • The investigators found that the use of regional anesthesia increased the opioid consumption in the development group and so the use of that anesthesia modality was a factor increasing the amount of opioid the calculator predicted would be necessary. That is a somewhat counter-intuitive result but, more importantly, how might that have an impact on prescribing in an era where an increasing proportion of hand surgery procedures are done under minimal anesthetic coverage like WALANT?

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Previous #JHSJC Discussion Articles

November 2019
Article 1: Complications of Corrective Osteotomies for Extra-Articular Distal Radius Malunion (https://www.jhandsurg.org/article/S0363-5023(17)31618-0/fulltext)
Article 2: Outcomes and Direct Costs of Needle Aponeurotomy, Collagenase Injection, and Fasciectomy in the Treatment of Dupuytren Contracture (https://www.jhandsurg.org/article/S0363-5023(18)31491-6/fulltext)
Read the Transcript!

October 2019
Article 1: The Effect of Intraoperative Corticosteroid Injections on the Risk of Surgical Site Infections for Hand Procedures (https://www.jhandsurg.org/article/S0363-5023(18)31764-7/fulltext)

Article 2: Early Practice Patterns of Hand Surgeons: An American Board of Orthopaedic Surgery Database Study (https://www.jhandsurg.org/article/S0363-5023(18)31684-8/fulltext)
Read the Transcript!

September 2019
Article 1: The Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma (https://www.jhandsurg.org/article/S0363-5023(18)31262-0/fulltext)

Article 2: Failure Rates of Base of Thumb Arthritis Surgery: A Systematic Review (https://www.jhandsurg.org/article/S0363-5023(18)30698-1/fulltext)
Read the transcript!

July 2019
Article 1: The Relationship Between Pain-Related Psychological Factors and Postoperative Opioid Use After Ambulatory Hand Surgery (https://www.jhandsurg.org/article/S0363-5023(18)30805-0/fulltext)
Article 2: Patient Satisfaction in the Hand Surgery Clinic: An Analysis of Factors That Impact the Press Ganey Survey (https://www.jhandsurg.org/article/S0363-5023(18)30659-2/fulltext)
Read the transcript!

June 2019
Article 1: An In-Depth Review of Physician Reimbursement for Digit and Thumb Replantation (https://www.jhandsurg.org/article/S0363-5023(18)30858-X/fulltext)
Article 2: Feasibility and Usability of a Ranking Tool to Elicit Patient Preferences for the Treatment of Trigger Finger (https://www.jhandsurg.org/article/S0363-5023(18)30534-3/fulltext)
Read the transcript!

May 2019
Article 1: Sonographic Findings Associated With Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(17)31113-9/fulltext)
Article 2: Correlations Among Objectively Measured Impairment, Outcome Classification Systems, and Subjectively Perceived Disability After Flexor Tendon Repair (https://www.jhandsurg.org/article/S0363-5023(18)30794-9/fulltext)

April 2019
Article 1: Evaluation of Version 2.0 of the PROMIS Upper Extremity Computer Adaptive Test in Nonshoulder Upper Extremity Patients (https://www.jhandsurg.org/article/S0363-5023(18)30376-9/fulltext)
Article 2: Defining Quality in Hand Surgery From the Patient’s Perspective: A Qualitative Analysis (https://www.jhandsurg.org/article/S0363-5023(18)30789-5/fulltext)

March 2019
Article 1: False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(18)30599-9/fulltext)
Article 2: Effect of Radial Nerve Release on Lateral Epicondylitis Outcomes: A Prospective, Randomized Double-Blinded Trial (https://www.jhandsurg.org/article/S0363-5023(18)30793-7/fulltext)

February 2019
Article 1: Opioid Prescriber Education and Guidelines for Ambulatory Upper-Extremity Surgery: Evaluation of an Institutional Protocol (https://www.jhandsurg.org/article/S0363-5023(17)31857-9/fulltext)
Article 2: Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System (https://www.jhandsurg.org/article/S0363-5023(17)32092-0/fulltext)

January 2019
Article 1: Intermediate-Term Outcome After Distal Radius Fracture in Patients With Poor Outcome at 1 Year: A Register Study With a 2- to 12-Year Follow-Up (https://www.jhandsurg.org/article/S0363-5023(18)30248-X/fulltext)
Article 2: External Fixation Versus Volar Locking Plate for Unstable Dorsally Displaced Distal Radius Fractures—A 3-Year Follow-Up of a Randomized Controlled Study (https://www.jhandsurg.org/article/S0363-5023(18)30023-6/fulltext)

December 2018
Article 1: Predicting Clinical Outcome After Surgical Treatment in Patients With Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(18)30650-6/fulltext)
Article 2: Cost-Effective Management of Stenosing Tenosynovitis (https://www.jhandsurg.org/article/S0363-5023(17)30874-2/fulltext)

November 2018
Article 1: Outcome of a Hand Orthosis and Hand Therapy for Carpometacarpal Osteoarthritis in Daily Practice: A Prospective Cohort Study (https://www.jhandsurg.org/article/S0363-5023(17)30684-6/fulltext)
Article 2: Cost Implications of Varying the Surgical Technique, Surgical Setting, and Anesthesia Type for Carpal Tunnel Release Surgery (https://www.jhandsurg.org/article/S0363-5023(17)31145-0/fulltext)

October 2018
Article 1: The Effectiveness of Mini–C-Arm Fluoroscopy for the Closed Reduction of Distal Radius Fractures in Adults: A Randomized Controlled Trial (https://www.jhandsurg.org/article/S0363-5023(17)30746-3/fulltext)
Article 2: Pain Management After Carpal Tunnel Release Surgery: A Prospective Randomized Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone (https://www.jhandsurg.org/article/S0363-5023(18)30652-X/fulltext)

September 2018
Article 1: A Prospective Comparison of Diagnostic Tools for the Diagnosis of Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(17)31445-4/fulltext)
Article 2: Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties (https://www.jhandsurg.org/article/S0363-5023(16)30694-3/fulltext)

August 2018
Article 1: Association Between Radiological and Patient-Reported Outcome in Adults With a Displaced Distal Radius Fracture: A Systematic Review and Meta-Analysis (https://www.jhandsurg.org/article/S0363-5023(18)30613-0/fulltext)
Article 2: Cost of Surgical Treatment for Distal Radius Fractures and the Implications of Episode-Based Bundled Payments (https://www.jhandsurg.org/article/S0363-5023(18)30629-4/fulltext)

July 2018
Article 1: Immediate Versus Overnight-Delayed Digital Replantation: A Comparative Retrospective Cohort Study of Survival Outcomes (https://www.jhandsurg.org/article/S0363-5023(18)30459-3/fulltext)
Article 2: Arthroscopic Diagnosis of the Triangular Fibrocartilage Complex Foveal Tear: A Cadaver Assessment (https://www.jhandsurg.org/article/S0363-5023(17)30956-5/fulltext)