3 research outputs found
Management interventions for amputation stump neuromas : evidence based review and cost-benefit analysis
Amputation is a common military and civilian surgery with high morbidity. Patients without prostheses
due to neuroma pain lose productivity and lifelong contributions, which is often underestimated. The
surgical and non-surgical treatment of painful stump neuromas is controversial. An evidence-based assessment and cost-benefit analysis of painful stump neuroma management modalities emphasizes institutional awareness and disruptive technologies. An Oxford Centre for Evidence Based Methodology
critical appraisal and structured literature review were used in the research. We found 154 records using
a reproducible literature search strategy that included electronic databases and references. A full review
of 27 manuscripts after exclusion criteria yielded data for analysis. Surgical, injectable, and electromagnetic spectrum methods were used. Surgical interventions had longer follow-up times than injection and
radiofrequency treatments, which affected outcomes. CEBM level 4 evidence dominated primary literature, indicating low quality. No therapy was superior, but the risks varied. Injection therapies like sclerosing alcohol had limited success and side effects. Despite limited evidence, electromagnetic spectrum
modalities showed potential. Including direct and indirect costs, amputation stump refitting costs millions annually. Compared to outpatient non-surgical interventions, laser therapy could save a lot of
money. According to the study, surgical interventions are common but expensive and have limited functional success. Low-risk non-surgical methods like co-ablation, pulsed radiofrequency, and transcutaneous
laser therapy have mixed results. The short follow-up of all non-surgical studies seems to limit them.
Follow-up duration is crucial to outcome assessment. Long-term, low-risk laser-induced thermotherapy
is promising for future research. This study emphasizes the need for more research and the economic
benefits of disruptive technologies in treating painful stump neuromas.peer-reviewe
Learning from the handling of the referral of Dr Manjula Arora
The Singh and Forde review of the General Medical Council's handling of Dr Manjula Arora's referral made a number of recommendations for the General Medical Council, the wider NHS and other organisations. This article discusses how to move forward with the recommendations and deliver 21st-century regulation that is truly compassionate, fair and supportive