Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991-2001

Bland, Jeremy D.P.

doi:10.1136/jnnp.74.12.1674

Cited by 222 publications

(222 citation statements)

References 21 publications

Supporting

Mentioning

189

Contrasting

Unclassified

Order By: Relevance

“…95 Incidence peaks in the late fifties for women and the late seventies for both men and women. 96 Although most people present with CTS in one hand, more than 50% subsequently develop bilateral CTS. 96 Compression of the median nerve produces pain, paraesthesia (pins and needles) and numbness in the hand.…”

Section: Overview Of Carpal Tunnel Syndromementioning

confidence: 99%

“…96 Although most people present with CTS in one hand, more than 50% subsequently develop bilateral CTS. 96 Compression of the median nerve produces pain, paraesthesia (pins and needles) and numbness in the hand. Mild CTS presents with intermittent symptoms often at night.…”

Section: Overview Of Carpal Tunnel Syndromementioning

confidence: 99%

“…96 HES data document a 41% increase in NHS CTR surgery in England in the decade between 2001/2 (n = 39,724 procedures) and 2010/11 (n = 55,957). CTR surgery is usually preformed as a day case procedure under local anaesthesia.…”

Section: Overview Of Surgical Interventions and Guidelines For Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Hollingworth

Rooshenas

Busby

et al. 2015

Health Services and Delivery Research

View full text Add to dashboard Cite

BackgroundNHS expenditure has stagnated since the economic crisis of 2007, resulting in financial pressures. One response is for policy-makers to regulate use of existing health-care technologies and disinvest from inefficiently used health technologies. A key challenge to disinvestment is to identify existing health technologies with uncertain cost-effectiveness.ObjectivesWe aimed to explore if geographical variation in procedure rates is a marker of clinical uncertainty and might be used by local commissioners to identify procedures that are potential candidates for disinvestment. We also explore obstacles and solutions to local commissioners achieving disinvestment, and patient and clinician perspectives on regulating access to procedures.MethodsWe used Hospital Episode Statistics to measure geographical variation in procedure rates from 2007/8 to 2011/12. Expected procedure numbers for each primary care trust (PCT) were calculated adjusting for proxies of need. Random effects Poisson regression quantified the residual inter-PCT procedure rate variability. We benchmarked local procedure rates in two PCTs against national rates. We conducted rapid systematic reviews of two high-use procedures selected by the PCTs [carpal tunnel release (CTR) and laser capsulotomy], searching bibliographical databases to identify systematic reviews and randomised controlled trials (RCTs). We conducted non-participant overt observations of commissioning meetings and semistructured interviews with stakeholders about disinvestment in general and with clinicians and patients about one disinvestment case study. Transcripts were analysed thematically using constant comparison methods derived from grounded theory.ResultsThere was large inter-PCT variability in procedure rates for many common NHS procedures. Variation in procedure rates was highest where the diffusion or discontinuance was rapidly evolving and where substitute procedures were available, suggesting that variation is a proxy for clinical uncertainty about appropriate use. In both PCTs we identified procedures where high local use might represent an opportunity for disinvestment. However, there were barriers to achieving disinvestment in both procedure case studies. RCTs comparing CTR with conservative care indicated that surgery was clinically effective and cost-effective on average but provided limited evidence on patient subgroups to inform commissioning criteria and achieve savings. We found no RCTs of laser capsulotomy. The apparently high rate of capsulotomy was probably due to the coding inaccuracy; some savings might be achieved by greater use of outpatient procedures. Commissioning meetings were dominated by new funding requests. Benchmarking did not appear to be routinely carried out because of capacity issues and concerns about data reliability. Perceived barriers to disinvestment included lack of collaboration, central support and tools for disinvestment. Clinicians felt threshold criteria had little impact on their practice and that prior approval systems would not be cost-effective. Most patients were unaware of rationing.ConclusionsPolicy-makers could use geographical variation as a starting point to identify procedures where health technology reassessment or RCTs might be needed to inform policy. Commissioners can use benchmarking to identify procedures with high local use, possibly indicating overtreatment. However, coding inconsistency and limited evidence are major barriers to achieving disinvestment through benchmarking. Increased central support for commissioners to tackle disinvestment is needed, including tools, accurate data and relevant evidence. Early engagement with patients and clinicians is essential for successful local disinvestment.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

Section: Overview Of Carpal Tunnel Syndromementioning

confidence: 99%

Section: Overview Of Carpal Tunnel Syndromementioning

confidence: 99%

See 1 more Smart Citation

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Hollingworth

Rooshenas

Busby

et al. 2015

Health Services and Delivery Research

View full text Add to dashboard Cite

show abstract

“…Bland and Rudolfer noted a bimodal age distribution with peaks in the groups of 50-54 and 75-84 years [3]. There have been few studies of CTS in younger populations.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Carpal Tunnel Syndrome in the US Military Population

Wolf

Mountcastle

Owens

2009

Hand (New York, N,Y.)

View full text Add to dashboard Cite

Carpal tunnel syndrome (CTS) is a common disease. Its epidemiology has been evaluated previously, mostly in regional populations or in working groups, with an incidence between 1.5 and 3.5 per 1,000 person-years. We studied this diagnosis in the US military population, with the hypothesis that this young population would have a lower incidence of CTS than previously reported in general populations. The Defense Medical Epidemiology Database notes all medical encounters for all US military personnel and maintains the number of all personnel on active duty each year. We queried the database using the International Classification of Diseases, ninth revision, code 354.0 (CTS) and analyzed the personnel presenting for initial visits for the years 1998-2006. Multivariate Poisson analysis was performed, controlling for rank, gender, age, and race. The raw incidence of CTS in the US military was 3.98 per 1,000 person-years, in a population of 12,298,088 person-years. Females had a significantly higher incidence of CTS than males, with an adjusted incidence rate ratio of 3.29. CTS incidence increased by age, with the age group ≥40 years having a significantly higher incidence. Additionally, military rank was found to be an independent risk factor for CTS, with rates higher in senior officer and enlisted groups. This suggests that occupational requirements have an effect on CTS within the military. We showed a comparable incidence of CTS between the US military and general population, with a significantly higher female cohort with a diagnosis of CTS. Increased age and advanced rank were risk factors for CTS.

show abstract

“…Una de las ventajas del proyecto fue la relación estadís-ticamente significativa que se pudo establecer entre los síntomas reportados por los odontólogos y el diagnóstico del evento que fue realizado por una profesional especializada; lo que podría indicar que las ARP podrían implementar estrategias de tamizaje en los odontólogos, 9 fundamentados en el autoreporte de síntomas relacionados con dolor, entumecimiento y debilidad a nivel de la mano así como dejar caer objetos en forma involuntaria.…”

Section: -25unclassified

Prevalencia Del Sindrome De Túnel Carpiano Y Sus Factores Asociados en Odontólogos De La Ciudad De Bucaramanga Y Su Área Metropolitana

et al. 2018

View full text Add to dashboard Cite

RESUMENObjetivo: Determinar la prevalencia del Síndrome del Túnel Carpiano (STC) y sus factores asociados en odontólogos de la ciudad de Bucaramanga y su área metropolitana. Materiales y métodos: Se realizó un estudio observacional analítico de corte transversal. El universo se constituyó por 250 y la muestra por 156 seleccionados mediante muestreo aleatorio simple. Se analizó la relación de presencia de STC con cada variable, mediante test de chi2 y test exacto de Fischer. El análisis multivariado mediante un modelo de regresión binomial, considerado como variable de salida la presencia de STC y como variable explicatoria las relacionadas con factores de riesgo. Resultados: La prevalencia de STC en odontólogos de Bucaramanga fue de 15.8%. El 40% de los endodoncistas registraron STC; se observó que el 33% de los odontólogos que registraban compromiso sistémico presentaban la condición de interés y que el 25% de las personas que usaban instrumental manual durante tiempos menores de 240 min/día registraban STC. Hubo una asociación seis veces mayor de tener STC en personas con compromiso sistémico y 0.13 de no tenerlo en personas que trabajan instrumental manual tiempos superiores a 240 min/día. Conclusión: Se estableció que el compromiso sistémico fue un factor determinante en la aparición de STC y el uso de instrumental rotario por tiempos prolongados, fue un factor relacionado con el ejercicio profesional, asociado con el fenómeno. CARPAL TUNNEL SYNDROME PREVALENCE AND ITS ASSOCIATED FACTORS IN DENTISTSFROM THE CITY BUCARAMANGA AND IT´S METROPOLITAN AREA. ABSTRACTObjective: To determine the prevalence of Carpal Tunnel Syndrome (CTS) and its associated factors in dentists of Bucaramanga and its metropolitan area. Materials and methods:An analytical cross section observational study was made. The universe were 250 dentists and the sample 156 dentists that were chosen by a simple random sampling. The relationship between the presence of CTS with each variable was analyzed by means of test of chi2 and Fisher´s exact test. The multivaried analysis included binomial regression model that considered as an exit variable the presence of CTS and like explicatory variables those related risk factors. Results:The prevalence of CTS in dentists who work in Bucaramanga was 15.8%. After analyzing the results according to each specialty, 40% of the endodontists had CTS, 30% of the dentists who had systemic compromise had CTS and 25% of the dentists who used manual instruments during time periods less than 240 min/day had CTS. There was an association six times greater of having CTS in people with systemic compromise and 0.13 of not having CTS in persons who work with manual instruments during time periods greater than 240 min/day. Conclusion: It was established that systemic compromise is determining factor in the appearance of CTS, the use of rotatory instruments for long time periods was a factor related to the professional exercise, associated to the phenomena.

show abstract

Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991-2001

Cited by 222 publications

References 21 publications

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Incidence of Carpal Tunnel Syndrome in the US Military Population

Prevalencia Del Sindrome De Túnel Carpiano Y Sus Factores Asociados en Odontólogos De La Ciudad De Bucaramanga Y Su Área Metropolitana

Contact Info

Product

Resources

About