Flexor digitorum profundus fractures are caused by forceful extension of the distal interphalangeal joint when in a flexed position, resulting in an avulsion fracture at the volar base of the distal phalanx, and usually require surgery. Uncomplicated middle and proximal phalanx fractures, typically caused by a direct blow, can be treated with buddy splinting if there is minimal angulation (less than 10 degrees); however, larger angulations, displacement, and malrotation often require reduction or surgery. Dorsal proximal interphalangeal joint dislocations require reduction and buddy splinting in slight flexion with an extension-block splint.

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Ryan Gorji MD
Dr Ryan Gorji
Ryan Gorji Chicago

#Ryan_Gorji_MD
#Dr_Ryan_Gorji
#Ryan_Gorji_Chicago

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Ryan Gorji MD
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Ryan Gorji Chicago

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Evidence Summary:

A 2000 systematic review assessed 32 studies[PS1]  with more than 2,300 patients from 1966 to 1998 that measured patient satisfaction after video telehealth consultations with healthcare providers.¹ The review included 1 RCT (N=104), 1 case control study (N=50), and 30 cross sectional studies with participant inclusion via random selection, referrals, convenience samples, volunteers, or unspecified techniques). Included studies ranged over varying healthcare provider settings from family medicine to a range of differing specialties. Studies were excluded if they used telecommunication technology for educational or administrative purposes not involving provision of care to patients. The primary outcome was overall participant satisfaction with telemedicine. There was no standardized outcome measure used; 26 studies used survey instruments, while 1 used qualitative analysis and 5 did not specify. Methodological heterogeneity therefore precluded formal statistical analysis and there were no numbers to report in this study. The authors conducted qualitative analysis of the data and findings with no standardized scoring method. The qualitative analysis revealed that video telemedicine was generally well-accepted in all studies; specific advantages were access to specialist care, less travel, and reduced wait times; disadvantages were video communication. Authors critically appraised each study using a checklist and found several conces related to validity and generalizability of individual studies. This study is limited by the subjective nature of qualitative analysis and unclear methodology of the analysis; the largest study in this review (N=585) was conducted in a prison setting, limiting generalizability of results to the general patient population.

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HDA Number: 87

Title: Patient Satisfaction with Video Telemedicine

Word Count: *

HDA Question: Is patient satisfaction with video telemedicine primary care visits comparable to face-to-face office visits?

Evidence-Based Answer[PS1] :

Yes. Patients rate video telemedicine visits comparably to face-to-face visits for satisfaction and quality of care. (SOR: B, systematic review and cross-sectional studies) Time saved is an advantage; video communication and technical conces are disadvantages. (SOR: B, systematic review and cross-sectional study) Predictors of higher satisfaction with telemedicine include patient understanding of telehealth, female gender, and uninsured status. (SOR: B, cross-sectional study) Cross-sectional studies included patients agreeable to telehealth visits and may be subject to selection bias. More studies are needed in primary care.

1. Generalized Anxiety Disorder
   1. Generalized anxiety disorder (GAD) is one of the most common mental disorder in the United States. GAD is defined by excessive, recurrent and persistent worry that is difficult to control. This condition routinely causes functional impairment, emotional distress and negatively impacts quality of life. Both pharmacologic and non pharmacologic options are available to alleviate the associated symptoms of GAD. Typically, non pharmacologic therapies such as Cognitive Behavioral Therapy are preferred starting technique for this condition.

1. Fibromyalgia
   1. Fibromyalgia is a complex, chronic, non inflammatory musculoskeletal nerve pain, often accompanied by multiple other symptoms including fatigue, cognitive disturbance, headache, and stiffness. The etiology of Fibromyalgia is unclear. This condition is often diagnosed by clinicians after ruling out other common musculoskeletal inflammatory causes. Treatment of Fibromyalgia is achieved through pharmacological and non pharmacological options.

Ryan Gorji MD
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Ryan Gorji Chicago

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After medical school, I trained in primary care. I wanted to become my patients’ “Go-To” doctor-  someone they can talk to about anything and everything. Whether that is to seek a 2^nd opinion or an advice in their family dynamic. Soon after during residency training I created a reputation for myself and a panel of patients who appreciated my approach. Patients were long treated differently and seeing a young enthusiastic face genuinely caring for them and leaing about their was noticeable to them.

While training in primary care, I got introduced to cosmetic/aesthetic medicine. It was clear to me from the beginning I could be treating someone’s diabetes or high blood pressure for years but the gratitude I am given by changing the same person’s appearance is much greater.

Ryan Gorji MD
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Ryan Gorji Chicago

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This question always brings tears to my eyes - it makes me appreciate the jouey and take a step back from everyday hustle and momentum. I was just 17 years old when I decided to move to the United States from Iran - to pursue my American dream.

Ryan Gorji MD
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Ryan Gorji Chicago

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