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1.
Bone Joint J ; 101-B(8): 984-994, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362557

RESUMO

AIMS: The aim of the Scaphoid Magnetic Resonance Imaging in Trauma (SMaRT) trial was to evaluate the clinical and cost implications of using immediate MRI in the acute management of patients with a suspected fracture of the scaphoid with negative radiographs. PATIENTS AND METHODS: Patients who presented to the emergency department (ED) with a suspected fracture of the scaphoid and negative radiographs were randomized to a control group, who did not undergo further imaging in the ED, or an intervention group, who had an MRI of the wrist as an additional test during the initial ED attendance. Most participants were male (52% control, 61% intervention), with a mean age of 36.2 years (18 to 73) in the control group and 38.2 years (20 to 71) in the intervention group. The primary outcome was total cost impact at three months post-recruitment. Secondary outcomes included total costs at six months, the assessment of clinical findings, diagnostic accuracy, and the participants' self-reported level of satisfaction. Differences in cost were estimated using generalized linear models with gamma errors. RESULTS: The mean cost up to three months post-recruitment per participant was £542.40 (sd £855.20, n = 65) for the control group and £368.40 (sd £338.60, n = 67) for the intervention group, leading to an estimated cost difference of £174 (95% confidence interval (CI) -£30 to £378; p = 0.094). The cost difference per participant increased to £266 (95% CI £3.30 to £528; p = 0.047) at six months. Overall, 6.2% of participants (4/65, control group) and 10.4% of participants (7/67, intervention group) had sustained a fracture of the scaphoid (p = 0.37). In addition, 7.7% of participants (5/65, control group) and 22.4% of participants (15/67, intervention group) had other fractures diagnosed (p = 0.019). The use of MRI was associated with higher diagnostic accuracy both in the diagnosis of a fracture of the scaphoid (100.0% vs 93.8%) and of any other fracture (98.5% vs 84.6%). CONCLUSION: The use of immediate MRI in the management of participants with a suspected fracture of the scaphoid and negative radiographs led to cost savings while improving the pathway's diagnostic accuracy and patient satisfaction. Cite this article: Bone Joint J 2019;101-B:984-994.


Assuntos
Análise Custo-Benefício , Fraturas Ósseas/diagnóstico por imagem , Custos de Cuidados de Saúde/estatística & dados numéricos , Imageamento por Ressonância Magnética/economia , Osso Escafoide/lesões , Traumatismos do Punho/diagnóstico por imagem , Adolescente , Adulto , Idoso , Redução de Custos/estatística & dados numéricos , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Fraturas Ósseas/economia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Radiografia , Osso Escafoide/diagnóstico por imagem , Reino Unido , Traumatismos do Punho/economia , Adulto Jovem
2.
Br J Radiol ; 86(1031): 20120519, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24096590

RESUMO

This article reviews the technique, basic science principles and applications of integrated single photon emission CT (SPECT)-CT in musculoskeletal radiology. A review of the current evidence on the topic was undertaken, and selected clinical cases from the authors' institution have been used for illustration. SPECT-CT is a technology with emerging applications that offers technical advantages to image fusion of separately acquired SPECT and CT studies. The prevailing evidence indicates that there may be benefit in adding SPECT-CT to conventional imaging algorithms during the evaluation of some malignant and benign musculoskeletal conditions. SPECT-CT can improve both sensitivity and specificity by reducing equivocal interpretation in comparison to planar scintigraphy or SPECT alone. The evidence base for SPECT-CT in musculoskeletal radiology is still evolving. There is a lack of evidence comparing SPECT-CT with MRI in many key indications, and further research is required in these areas.


Assuntos
Doenças Musculoesqueléticas/diagnóstico , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Humanos , Imageamento por Ressonância Magnética , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade
3.
Diabet Med ; 27(8): 958-9, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20653755

RESUMO

BACKGROUND: Macro- and microvascular complications of diabetes are varied and can present with a range of clinical signs and symptoms. Diabetic muscle infarction is a rare vascular complication of diabetes that is often not recognized. CASE REPORT: We report a case of diabetic muscle infarction, where a 65-year-old woman with Type 2 diabetes presented with acute-onset severe pain in her right leg and foot drop. CONCLUSIONS: Her foot drop was a result of a concomitant compression nerve injury as a consequence of the muscle oedema following infarction. Our case highlights the importance of early recognition and investigation of atypical presentations of vascular complications of diabetes.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/complicações , Pé/irrigação sanguínea , Transtornos Neurológicos da Marcha/diagnóstico , Infarto/fisiopatologia , Idoso , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/fisiopatologia , Feminino , Humanos , Infarto/etiologia , Músculo Esquelético/irrigação sanguínea , Dor/etiologia , Dor/fisiopatologia
4.
Minerva Endocrinol ; 34(3): 237-54, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19859046

RESUMO

A common cause of morbidity and mortality in diabetic patients are foot infection/complications often leading to amputation of lower extremities. Various radiological and radionuclide techniques are available for the assessment of diabetic patients with bone or soft tissue infections. However, there are several advantages and limitations. The major limitation of all these techniques is their inability to accurately differentiate osteomyelitis from charcot's/neuropathic joints. Radiologically, magnetic resonance imaging (MRI) is the technique of choice and a radiolobeled white cell scan is a useful nuclear medicine technique in the evaluation of diabetic patients with suspected foot infection. In this review we discuss the efficacy of radiological and radionuclide techniques in the assessment of diabetic foot infection.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Complicações do Diabetes/diagnóstico por imagem , Pé Diabético/diagnóstico por imagem , Doenças Ósseas/etiologia , Osso e Ossos/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Radiografia , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único
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