BACKGROUND The number of patients receiving minimally and noninvasive cosmetic procedures is increasing. Often, patients turn to online review forums to gain and share advice regarding cosmetic procedures. Understanding and discussing patient-reported outcome data can help align physician and patient expectations and ultimately help improve the patient experience. OBJECTIVE To determine the most common reasons patients are dissatisfied with a selection of minimally and noninvasive cosmetic procedures. MATERIALS AND METHODS Negative patient reviews from the RealSelf.com website were analyzed, and the reason for patient discontent was recorded for the following treatments: tissue stabilized-guided subscision, cryolipolysis, electromagnetic therapy, deoxycholic acid injections, energy-induced thermolysis, radio thermoplasty, threadlifts, and ultrasound therapy. RESULTS One thousand two hundred four reviews were included in analysis. For all treatments analyzed, the most common reason for patient dissatisfaction was ineffectiveness (n = 782, 65.0%), followed by complications (n = 301, 25.0%). The most common complications were as follows: lumps for tissue stabilized-guided subscision (n = 6, 50.0%), treated area enlargement for cryolipolysis (n = 23, 22.1%), swelling for deoxycholic acid injections (n = 9, 47.4%), numbness for energy-induced thermolysis (n = 6, 35.3%), fat loss for radio thermoplasty (n = 26, 53.1%) and ultrasound therapy (n = 32, 48.5%), and indentations for threadlifts (n = 10, 30.3%). CONCLUSION Ineffectiveness and complications were the most common reasons for dissatisfaction among all treatments analyzed. Patient-reported outcome data may offer insight into how physicians can improve their patient's satisfaction with cosmetic procedures.
Asymptomatic individuals with significant coronary artery disease (CAD) are at risk for unanticipated cardiac events including myocardial infarction (MI). Laboratory studies, stress tests, and coronary artery imaging including coronary artery calcium (CAC) scoring evaluate at-risk individuals. Hand and wrist x-rays demonstrating significant arterial wall calcification may provide an additional means to identify asymptomatic individuals at risk for cardiac events. Here we report a case series of patients without known cardiac disease who demonstrated significant calcium deposits in the radial and/or ulnar arteries in radiographs performed for evaluation of their hand conditions. Each series patient was subsequently found to have calcification on coronary artery imaging and an elevated risk of future cardiac events. Our series suggests that peripheral arterial calcifications observed by radiologists and hand specialists may warrant systemic evaluation for atherosclerosis in other areas of the body.
This case emphasizes the importance of full access to patients' medical records for improving diagnostic accuracy. We believe that full-access systems will lower the risk of misdiagnosis and will help to maximize the potential of teledermatology.
Background: The Prone Apprehension Relocation Test (PART) augments existing radiographic measures and clinical provocative maneuvers in diagnosing hip instability. One measure of the potential clinical utility of the PART depends on the reproducibility of test results by evaluating providers including physicians, licensed athletic trainers, and physical therapists. Purpose: To determine the interrater reliability of the PART among health care providers. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We retrospectively identified patients in our institution’s hip preservation registry who presented between September 2017 and June 2019 for evaluation of hip pain. Patients included in the study had the PART performed by a single physician as well as 1 of 12 physician extenders (a licensed athletic trainer or a physical therapist). The providers were blinded to the findings of the other examining professional. Interrater reliability was assessed using the Cohen κ (≥0.75 was considered excellent; between 0.75 and 0.40, moderate; and ≤0.40, poor). Results: A total of 96 patients (190 hips) were included in this study (61 women and 35 men, average age 32 ± 12.1 years). A total of 23 hips had a positive PART from both examiners. Interrater reliability was excellent between health care professionals for the PART when evaluating the right hip (κ = 0.80), left hip (κ = 0.82), and when combining the results for left and right (κ = 0.81). A subanalysis of patients with a positive PART from both raters demonstrated that 19 of the 23 hips had a lateral center-edge angle >25°. Conclusion: Our study demonstrated excellent interrater reliability of the PART, supporting its use in the physical evaluation of painful hips.
Background: Hip dysplasia and related instability can cause pain, limit hip function, and ultimately result in osteoarthritis. The Prone Apprehension Relocation Test (PART) augments existing radiographic markers and clinical provocative maneuvers in diagnosing hip dysplasia. Reproducibility of the PART between examiners has not been previously studied. Hypothesis/Purpose: One measure of the potential clinical utility of the PART depends on the reproducibility of test results by evaluating providers including physicians, licensed athletic trainers, and physical therapists. The purpose of this study is to determine the inter-rater reliability of the PART between health care professionals. Methods: We retrospectively identified patients in our institution’s hip preservation registry who presented between September 2017 and June 2019 for evaluation of hip pain. Patients included in the study had the PART performed by two health care professionals who were blinded to the other’s results. Inter-rater reliability was assessed using the Cohen 𝜅, with a value of 𝜅 ≥ 0.75 considered excellent inter-rater reliability, between 0.75 and 0.40 moderate, and ≤ 0.40 poor. Results: 96 patients (190 hips) were included, with 63 females and 35 males, average age 32 ± 12.1 years. 23 hips had a positive PART from both examiners. Inter-rater reliability was excellent between health care professionals for the PART when evaluating the right hip (𝜅 = 0.80), left hip (𝜅 = 0.82), and when combining the results for left and right (𝜅 = 0.81). A sub-analysis of patients who had a positive PART from both raters demonstrated that 19 of the 23 hips had a lateral center edge angle > 25°. Conclusion: Our study demonstrates that the PART is a reliable physical exam maneuver in the evaluation of hip pain.
Background: Hip instability is a challenging clinical diagnosis, which often overlaps with the presentation of hip impingement and/or hip dysplasia. Many factors contribute to hip instability, including acetabular undercoverage, femoroacetabular-impingement-induced instability, and soft tissue laxity. It can cause significant pain and disability, either as a primary pathology or as a complication of surgery and if untreated can ultimately lead to early osteoarthritis. Indications: Hip dysplasia is often diagnosed with an anterior-posterior pelvic radiograph. The literature has supported a normal lateral center edge angle (LCEA) as ≥25°, borderline dysplasia an LCEA of 18° to 25°, and an LCEA <18° as true dysplasia, though some authors will diagnose borderline dysplasia as an LCEA of 20° to 25° and true dysplasia as an LCEA <20°. In addition, there are many radiographic measurements that have been described to aid in the diagnosis of hip instability beyond LCEA, including the acetabular inclination (or Tönnis angle), the femoro-epiphyseal acetabular roof (FEAR) index, and the cliff sign. Technique Description: Hip instability can be present even in the absence of radiographic findings, and many with insufficient coverage of the femoral head do not meet the radiographic definition of dysplasia. For this reason, it is important to have an understanding of the clinical assessment that may aid in the diagnosis of hip instability. Here, we present our preferred technique for clinical examination of the hip, focusing on the assessment of hip instability. Results: While no one maneuver is sufficient to diagnose hip instability, incorporation of multiple examinations in conjunction with radiographs can help to properly diagnose the presence of hip instability. Discussion/Conclusion: Hip instability is a challenging clinical diagnosis, and many examination maneuvers have been described to assess for hip instability. In this technical note, we describe our preferred technique for clinical examination of the hip, focusing on the assessment of hip instability.
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