ABSTRACT
OBJECTIVE: To define if MRI scans can accurately be requested based on information provided in the primary care referral and, therefore, streamline the patient journey. The demand for outpatient spinal appointments significantly exceeds our services' ability to provide efficient, high-quality patient care. Currently, magnetic resonance imaging (MRI) of the spine is requested following first consultation. METHODS: During routine vetting of primary care referral letters, three consultant spinal surgeons recorded how likely they thought each patient would be to have an MRI scan. Following the first consultation with the spinal service, the notes of each patient were reviewed to see if an MRI was requested. We measured the positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of ordering MRI scans based on primary care referral letters. RESULTS: 149 patients were included [101 females, 48 males, mean age 49 (16-87)]. There were 125 routine, 21 urgent, and 3 'urgent-suspected cancer' referrals. The PPV of ordering MRIs before first consultation was 84%, NPV was 56% with the sensitivity and specificity being 82 and 59%, respectively. Ordering MRIs during initial vetting could shorten the patient journey with potential socioeconomic benefits. CONCLUSIONS: MRI scans can be effectively ordered based on the information provided by the primary care referral letter. Requesting MRI scans early in the patient journey can save considerable time, improve care, and deliver cost savings. These slides can be retrieved under Electronic Supplementary Material.
Subject(s)
Magnetic Resonance Imaging/statistics & numerical data , Primary Health Care/standards , Referral and Consultation/standards , Spine/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Correspondence as Topic , Early Diagnosis , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Primary Health Care/statistics & numerical data , Prospective Studies , Quality Improvement/organization & administration , Referral and Consultation/statistics & numerical data , Scotland , Sensitivity and Specificity , Young AdultABSTRACT
Computer-assisted navigation enables surgeons to measure and assess knee behavior during surgery, allowing real-time monitoring of the knee ranging from extension to flexion. Documenting passive motion before and after total knee arthroplasty (TKA) enabled the authors to analyze knee kinematics. Passive knee motion cannot predict full weight bearing knee behavior, the "crucial moment of truth" for TKA. This study supports individually adapting the femoral component rotation using the Whiteside line. Clinical follow-up alone will assess the possible benefits. In a study of 71 patients who underwent computer-assisted TKA, the authors assessed the actual rotational femoral alignment and dynamic long leg track hip-knee-ankle angle from 0 degrees, 30 degrees, 60 degrees, and 90 degrees of knee flexion before and after TKA.
