ABSTRACT
Chronic hand and wrist pain is a common presenting complaint. The intricate anatomy results in a variety of pain generators-multiple bones, articular cartilage, intrinsic ligaments, triangular fibrocartilage complex, joint capsules and synovium, tendons and tendon sheaths, muscles, and nerves-in a compact space. The need for imaging and the choice of the appropriate imaging modality are best determined by the patient's presentation, physical examination, and the clinician's working differential diagnosis. Radiography is usually appropriate as the initial imaging study in the evaluation of chronic hand or wrist pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Subject(s)
Chronic Pain , Evidence-Based Medicine , Societies, Medical , Humans , Chronic Pain/diagnostic imaging , United States , Hand/diagnostic imaging , Diagnosis, Differential , Arthralgia/diagnostic imagingABSTRACT
According to JAMA's retraction statement, the first author of the article admitted to data fabrication following an internal investigation.² The source article does not provide subgroup analysis to determine how much of an effect the fabricated data may have had on the final reported outcome.
ABSTRACT
This ACE inhibitor can help patients with peripheral artery disease walk longer while remaining pain free.
Subject(s)
Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Intermittent Claudication/drug therapy , Peripheral Arterial Disease/drug therapy , Ramipril/therapeutic use , Walking , Female , Humans , MaleABSTRACT
For many smokers, the benefits of quitting will outweigh the risks associated with varenicline.
