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L Read

Publications and source records attributed to L Read.

24 records · Page 2Linked to original sources
PubMed1982

Non-union in a fracture of the shaft of the distal phalanx.

Fracture of the shaft of the distal phalanx is less common than more distal fractures involving the tuft: non-union in such a fracture is even more unusual. A case is described in which troublesome non-union of the shaft of the distal phalanx of the middle finger was successfully treated by open reduction and Kirschner wire fixation. The type of fracture and its treatment is discussed: it is emphasised that the principles applied to shaft fractures of the middle and proximal phalanges also apply to the distal phalanx.

Child↗
PubMed1982

Diagnosis and treatment of dyspepsia. A cost-effectiveness analysis.

Dyspepsia is a common problem in ambulatory care. While many authorities recommend ordering upper gastrointestinal x-ray series (UGI) before therapy, there is evidence that clinicians frequently treat dyspepsia without diagnostic procedures. Decision analysis was performed to select optimal management based on probabilities and outcome values from the published literature. The choices evaluated were Symptomatic Therapy (low dose antacids or anticholinergics), Ulcer Therapy (high dose antacids or cimetidine), or UGI followed by further tests or therapy. Our model indicates that mortality is minimized if UGI is performed prior to selection of therapy, and if endoscopy is performed when the x ray shows gastric ulcer. Weeks of pain are minimized if Ulcer Therapy is begun immediately, but direct health care costs are minimized by beginning with Symptomatic Therapy. The marginal cost per additional life saved by performing a UGI rather than beginning with Ulcer Therapy was +1.6 million to +2.3 million, depending on whether endoscopy followed the finding of gastric ulcer. Mortality advantages of the strategies beginning with UGI were sensitive to assumptions regarding the incidence of gastric cancer and the benefits of early diagnosis. With slight reductions in these base case values, the Ulcer Therapy strategy appeared to minimize all outcomes except dollar cost.

Cost-Benefit Analysis↗