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NICE guidance IPG0043
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08/04/04 02:44
Oliver O~sq~ Hare

not registered

08/04/04 02:44
Oliver O~sq~ Hare

not registered

NICE guidance IPG0043

Following NICE guidance on Needle fasciotomy for Dupuytren's contracture, is it now available anywhere in the UK?

The URL for this guidance is http://www.nice.org.uk/cms/ip/ipcat.aspx?o=71519

    08/05/04 02:09
    Sara

    not registered

    08/05/04 02:09
    Sara

    not registered

    Still waiting

    Oliver,

    I have been trying to find out if there is anyone doing this treatment in the UK for ages, and have explored several avenues, as yet to no avail. It is really as if the surgeons in this country are reluctant to offer the treatment. Not only are they charging exorbitant fees for standard fasciectomies done privately, this must be costing the NHS a fair amount too. After all, it is a fairly common condition. I can only suggest that the UK visitors to this site keep asking the appropriate bodies (PCTs, Department of Health and any other you can think of), when and where this will be available.

    If anyone does find out anything else, please let us know!

      10/25/05 02:20
      powell

      not registered

      10/25/05 02:20
      powell

      not registered

      needle fasciotomy.

      Can you please advise where in the uk this procedure is carried out.

      My preferred areas are London or Birmingham.

      John Powell.

        10/25/05 02:40
        marjorie 
        10/25/05 02:40
        marjorie 
        NA in UK

        Dear John,
        Oh dear, you are asking the impossible. So many of us have been trying to find someone who does NA in the UK. It is like trying to find a needle in a hatstack. Like living in a third world country.
        First, contact your local PCT and put your question.
        Second, do not be fooled by the Simple Fasciotomy that some will offer. This is not NA but a simpler option to full surgery. Small cuts are made and the cord is cut with a stitch cutter. Still causess problems, possibility of infection, need for physio etc.
        I have recently been to Paris for NA, no problem and faster than travelling from Manchester to London. Some people do the trip in a day but I made a holiday of it and stayed for four nights.
        If you need info on where to go for NA or any other details
        www.handcenter.org
        is excellent.
        Marjorie

          10/25/05 02:57
          John

          not registered

          10/25/05 02:57
          John

          not registered

          NA &DC

          To all,
          I think the real problem here is not the Dupuytren's or the NA ,but the lost revenue that the surgeon will not receive, I'm quite sure the good doctors don't want this NA to become the procedure of choice, not in any country.I have had the NA procedure here in the States and it has worked extremely well,Please go where ever you have to go to have this NA procedure done ,it takes only minutes to complete and the finshed product is more than you would or could hope for,So go to France or where ever, if thats what it will take ,and get on with your life.GOOD-LUCK
          Regards,
          John









            10/25/05 02:57
            John

            not registered

            10/25/05 02:57
            John

            not registered

            NA &DC

            To all,
            I think the real problem here is not the Dupuytren's or the NA ,but the lost revenue that the surgeon will not receive, I'm quite sure the good doctors don't want this NA to become the procedure of choice, not in any country.I have had the NA procedure here in the States and it has worked extremely well,Please go where ever you have to go to have this NA procedure done ,it takes only minutes to complete and the finshed product is more than you would or could hope for,So go to France or where ever, if thats what it will take ,and get on with your life.GOOD-LUCK
            Regards,
            John









              10/25/05 02:56
              John

              not registered

              10/25/05 02:56
              John

              not registered

              NA&DC

              Randy : Thank you, your points are well taken, and I will take them into consideration, However I don't think I have said anything out of turn, for this is only my opinion,and in the mean time I will stand by this,I do agree with some of your points however there are only Four Doctors in the U.S that I know of that will do NA, I was considering surgery, the cost would have been between six and seven thousand dollars the time spent in the operating room would have been no more then two hours[I would have thought more] according to my Surgeon,So faced with this and a little math I figure a surgeon doing this type of procedure twice or maybe three times per day that may come to $18,000 not to bad.My doctor [and your right] is six hundred per finger and will only do NA towards the end of the month and only books four or five procedures on that day and that is after twelve noon, you do the math ,so my piont to this whole matter is if half of all hand sergeons would do NA as their frist line of defence then I would call that a very big loss, wouldn't you think?,but then again this is just my opinion.
              Regards,
              John

                10/26/05 02:22
                Randy H.

                not registered

                10/26/05 02:22
                Randy H.

                not registered

                Counter Point

                John,

                You are quite correct that if in time NA does become the accepted first line of defense, and if Eaton is correct that "something well over 50%" of the newly diagnosed can avoid OS entirely, the total number of doctors needed to correct Dups will *decrease*. We just will not need as many.

                Given the laws of supply and demand this could eventually drive prices down. When and if that happens, yes, the argument could be made that the total revenue within the profession would be less. However, OS for Dups is not a huge portion of what they do.

                Do you really think CHS stay up late, do the math, and then purposefully impose on their patients unnecessary trauma and the dangers of OS so they can buy a new Mercedes very two years instead instead of every four? Personally I doubt it. And here are two reasons to support my conjecture:

                Indictable Collegenase does almost the same thing as NA, and yet *every* CHS you talk to knows about it and seems excited about the prospects of using it to avoid OS. The same financial dynamics should apply for this in-office procedure, and yet they support it. They all seem unified with one voice that a new noninvasive procedure would be a positive step in spite of the fact that less CHS would be needed for Dups treatment if it were a success.

                Second, Eaton is convinced that when this fellows finally see the benefits of NA they will get on board. That's what he has been working for the last 2 years. Is he naive to the overall greed of his fellows, or does he believe they actually want to give better care? I suspect he knows them better than we...

                Regardless of the validity of the above, it will not matter in the end. As new patients are educated, they will continue to get on airplanes until consumer demand forces change. At the current rate of change, CHS will simply not have a choice. We are in control, not them.

                As recent posts clearly show, NA is no cure all. OS will still be needed in many cases and is not going away any tine soon. Collegenase is no different. For now OS is here to stay

                  10/26/05 02:16
                  Frances

                  not registered

                  10/26/05 02:16
                  Frances

                  not registered

                  NA in the UK

                  Hi Guys,

                  The money thing is definately not an issue here in Ontario - there is no shortage of people needing surgery and the operating room line-ups are quite long - up to a year in some provinces, and certaily 4 months or longer in mine which is definately no fun if you have something like a gallbladder problem where you are in constant pain.

                  :-(

                  Our experience with our family doctor and surgeon is that they were unwilling to listen to anything coming from the mouth of a lay-person. I could go on and on but basically they were unwilling to stray from the beaten path unless told to do so from someone greater then them within the Canadian medical community.

                  Frances

                    10/27/05 02:07
                    C Baker

                    not registered

                    10/27/05 02:07
                    C Baker

                    not registered

                    NA in the UK

                    A friend has just told me about a TV programme 'City Hospital' on Fri 21st October from St Thomas' Hospital in London where 2 hands were treated with 'claw-like' fingers. She didn't know if it was Dups but it sounded like the needle procedure so I am ringing St Thomas'-0207-188-7188-(Topical TV Department) tomorrow to ask more questions. Might be hopeful.

                    Will keep everyone posted.

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