Correction Protocol Research Articles

MRI spine request form enhancement and auto protocoling using a secure institutional large language model

BACKGROUND CONTEXTSecure institutional large language models (LLM) could reduce the burden of non-interpretative tasks for radiologists. PURPOSEAssess the utility of a secure institutional LLM for MRI spine request form enhancement and auto-protocoling. STUDY DESIGN/SETTINGRetrospective study conducted from December 2023 to February 2024, including patients with clinical entries accessible on the electronic medical record (EMR). PATIENT SAMPLEOverall, 250 spine MRI request forms were analyzed from 218 patients (mean age = 55.9 years ± 18.9 [SD]; 108 women) across the cervical (n=56/250, 22.4%), thoracic (n=13/250, 5.2%), lumbar (n=166/250, 66.4%), and whole (n=15/250, 6.0%) spine. Of these, 60/250 (24.0%) required contrast and 41/250 (16.4%) had prior spine surgery/instrumentation. OUTCOME MEASURESPrimary–Adequacy of clinical information on clinician and LLM-augmented request forms were rated using a four-point scale. Secondary–Correct MRI protocol suggestion by LLM and first-year board-certified radiologists (Rad4 and Rad5) compared to a consensus reference standard. METHODSA secured institutional LLM (Claude 2.0) used a majority decision prompt (out of six runs) to enhance clinical information on clinician request forms using the EMR, and suggest the appropriate MRI protocol. The adequacy of clinical information on the clinician and LLM-augmented request forms was rated by three musculoskeletal radiologists independently (Rad1:10-years-experience; Rad2:12-years-experience; Rad3:10-years-experience). The same radiologists provided a consensus reference standard for the correct protocol, which was compared to the protocol suggested by the LLM and two first-year board-certified radiologists (Rad4 and Rad5). Overall agreement (Fleiss kappas for inter-rater agreement or % agreement with the reference standard and respective 95%CIs) were provided where appropriate. RESULTSLLM-augmented forms were rated by Rads 1–3 as having adequate clinical information in 93.6-96.0% of cases compared to 46.8-58.8% of the clinician request forms (p<0.01). Substantial interobserver agreement was observed with kappas of 0.71 (95%CI:0.67–0.76) for original forms and 0.66 (95%CI:0.61–0.72) for LLM-enhanced requests. Rads 1–3 showed almost perfect agreement on protocol decisions, with kappas of 0.99 (95%CI:0.94–1.0) for spine region selection, 0.93 (95%CI:0.86–1.0) for contrast necessity, and 0.93 (95%CI:0.86–0.99) for recognition of prior spine surgery. Compared to the consensus reference standard, the LLM suggested the correct protocol in 78.4% (196/250, p<0.01) of cases, albeit inferior to Rad4 (90.0%, p<0.01) and Rad5 (89.2%, p<0.01). The secure LLM did best in identifying spinal instrumentation in 39/41 (95.1%) cases, improved compared to Rad4 (61.0%) and Rad5 (41.5%) (both p<0.01). The secure LLM had high consistency with 227/250 cases (90.8%) having 100% (6/6 runs) agreement. CONCLUSIONSEnhancing spine MRI request forms with a secure institutional LLM improved the adequacy of clinical information. The LLM also accurately suggested the correct protocol in 78.4% of cases which could optimize the MRI workflow.

Seed ecology of the arid zone invasive thistle; Centaurea melitensis L.: A study of the effects of seasonal temperature, pH, salinity and moisture stress

AbstractCentaurea melitensis L., known commonly as Malta thistle, is an aggressive and invasive weed species native to the Mediterranean region. This species now occupies a diverse range of ecosystems and climate types across the globe, including the semi‐arid zone of New South Wales, Australia. This semi‐arid climate differs dramatically from its native Mediterranean climate, therefore, we aimed to identify if local adaptations in the seed ecology for C. melitensis have developed. Seeds were collected from mature C. melitensis at Nanya Station, located within the Scotia region of NSW, and then transported to Federation University Australia, Mt. Helen, Victoria. Under laboratory conditions, mature seeds were tested for their germination responses to temperature (17/7, 25/15, 30/20, 35/25°C), photoperiod (12 h light and 12 h dark [L/D], 24 h dark [D]), salinity (0, 25, 50, 100, 150, 200, and 250 mM), osmotic potential (0, −0.1, −0.2, −0.4, −0.6, and −0.8 MPa), and pH (5, 6, 6.2, 7, 8, 9, and 10). The seeds achieved 100% germination in the 17/7°C treatment, with light not being a limiting factor. The seeds exposed to the 25/15°C (D) and 30/20°C (D) treatments also maintained high germination percentage, whilst germination was significantly reduced in the 35/25°C (D) treatment. The L/D photoperiod maintained a 77.5% germination rate at 35/25°C. Whilst increased salinity reduced seed germination from 97.5% in the control to 6% at 250 mM, this species nevertheless demonstrated resistance to osmotic stress with 23% germination observed at 0.8 MPa. Germination exceeded 90% at all of the soil pH treatments, although mean germination time was significantly reduced when seeds were treated with a solution of pH 10. Our results demonstrate that the C. melitensis seeds collected in Australia's semi‐arid zone demonstrated high germination plasticity and are capable of competitive germination in warmer and drier conditions compared to its native Mediterranean climate. Therefore, management efforts that prioritise restricting the spread of C. melitensis seeds into new environments, for example through practising correct sanitation protocols, coupled with the early detection and control of emerging populations will be critical for C. melitensis management in Australia.

Multifunctional GAN-based optimization for X-ray tomography under different conditions

Based on the generative adversarial network (GAN), we present a multifunctional X-ray tomographic protocol for artifact correction, noise suppression, and super-resolution of reconstruction. The protocol mainly consists of a data preprocessing module and multifunctional GAN-based loss function simultaneously dealing with ring artifacts and super-resolution. The experimental protocol removes ring artifacts and improves the contrast-to-noise ratio (CNR) and spatial resolution (SR) of reconstructed images successfully, which shows the capability to adaptively rectify ring artifacts with varying intensities and types while achieving super-resolution. Compared with the main existing deep learning models or conventional tomographic correction methods, it also enables higher processing speed and minimal information loss, especially for images of smaller dimensions. This study provides a robust optimization tool for the equivalent realization of large fields of view and high-resolution X-ray tomography. The experimental datasets were collected from a series of X-ray cone-beam computed tomography scans of biological samples.

Noise-adapted recovery circuits for quantum error correction

Implementing quantum error correction (QEC) protocols is a challenging task in today's era of noisy intermediate-scale quantum devices. We present quantum circuits for a universal, noise-adapted recovery map, often referred to as the Petz map, which is known to achieve close-to-optimal fidelity for arbitrary codes and noise channels. While two of our circuit constructions draw upon algebraic techniques such as isometric extension and block encoding, the third approach breaks down the recovery map into a sequence of two-outcome POVMs. In each of the three cases we improve upon the resource requirements that currently exist in the literature. Apart from Petz recovery circuits, we also present circuits that can directly estimate the fidelity between the encoded state and the recovered state. As a concrete example of our circuit constructions, we implement Petz recovery circuits corresponding to a four-qubit code that is tailor-made to correct for amplitude-damping noise. The efficacy of our noise-adapted recovery circuits is then demonstrated through ideal and noisy simulations on the IBM QasmSimulator. Published by the American Physical Society 2024

Monitoring the Energy of a Cavity by Observing the Emission of a Repeatedly Excited Qubit.

The number of excitations in a large quantum system (harmonic oscillator or qudit) can be measured in a quantum nondemolition manner using a dispersively coupled qubit. It typically requires a series of qubit pulses that encode various binary questions about the photon number. Recently, a method based on the fluorescence measurement of a qubit driven by a train of identical pulses was introduced to track the photon number in a cavity, hence simplifying its monitoring and raising interesting questions about the measurement backaction of this scheme. A first realization with superconducting circuits demonstrated how the average number of photons could be measured in this way. Here we present an experiment that reaches single-shot photocounting and number tracking owing to a cavity decay rate 4 orders of magnitude smaller than both the dispersive coupling rate and the qubit emission rate. An innovative notch filter and pogo-pin-based galvanic contact makes possible these seemingly incompatible features. The qubit dynamics under the pulse train is characterized. We observe quantum jumps by monitoring the photon number via the qubit fluorescence as photons leave the cavity one at a time. Additionally, we extract the measurement rate and induced dephasing rate and compare them to theoretical models. Our method could be applied to quantum error correction protocols on bosonic codes or qudits.

Isokinetic assessment of the female’s soccer player’s knee. A systematic review of outcomes measures

BackgroundIsokinetic normative data in females’ soccer players is scarce in comparison to males. Furthermore, evaluation protocols employed to obtain those data in female’s studies, strongly differ from each other, using different ranges of speeds and movement patterns, thus producing different output data. Thus, it is difficult for the researcher and the clinician to choose a correct protocol for knee isokinetic test in female soccer players. Aim of this paper is to review the literature to provide updated information on how to interpret a knee isokinetic testing in healthy females.MethodsGoogle Scholar, PubMed, Sport Discus, and Psych info databases were queried, and 17 papers were selected. Following PRISMA methodology and PEDro scale, we classified the retrieved papers and assessed the quality.ResultsIn this review some common features of isokinetic testing in female soccer players of various levels of qualification are highlighted. The isokinetic performance indexes widely accepted are the hamstring/quadriceps (H/Q) ratio and dominant/non-dominant (D/ND) ratio. It also emerges that, 3 reps at the speed of 60°/sec in knee flexion/extension are preferable due to the higher reliability and that the optimal H/Q ratio in healthy female soccer players of different level of qualification and age is 50%, while the interlimb differences (D/ND) should be below 10%.ConclusionsNormative data and methodologies reviewed can be useful for the isokinetic test of female soccer players. It emerges that simplifying test procedures limiting at few testing speed and considering selected H/Q and D/ND gives all the necessary relevant informations.

Excitonic properties and solar harvesting performance of Cs2ZnY2X2 as quasi-2D mixed-halide perovskites

Due to their low toxicity and high-temperature stability, lead-free quasi-2D metal halide perovskites (MHPs) are promising materials for optoelectronic applications. However, understanding their structural and optoelectronic properties, especially excitonic effects (electron-hole pair, e-h), is challenging due to their quantum well topology. We propose an efficient protocol for band gap correction of Cs2ZnX (X = Cl4, Br2Cl2, and I2Cl2) and Cs2PbI2Cl2 (used as a benchmark) quasi-2D MHPs. This protocol is based on a relativistic quasiparticle approach (DFT-1/2) using density functional theory (DFT). We first examined the hybrid contributions of the halide alloys, leading to excitonic characterization using the Bethe–Salpeter equation within the maximally localized Wannier functions tight-binding method. This method provides a cost-effective approach for describing e-h quasiparticle effects. Additionally, we analyzed the crystal structure, thermodynamic stability, and optoelectronic properties of the newly synthesized Zn-based systems, focusing on their structural stability mechanisms. We found a correlation between the allocation of Cs+ cations in the crystal structure and the formation of two distinct stabilization patterns, influenced by the radii of the metal (Zn or Pb) and halide components. The relativistic correction of the band gap energies yielded results within 10 % of the experimental values. Furthermore, incorporating e-h quasiparticle effects for Cs2PbI2Cl2 resulted in an exciton binding energy of 0.160 eV, in excellent agreement with experimental data. This work represents a significant advance in the optoelectronic characterization of Cs2ZnX systems, previously unexplored for their excitonic properties.

A Transcriptomic Analysis of Laryngeal Dysplasia.

This article describes how the transcriptional alterations of the innate immune system divide dysplasias into aggressive forms that, despite the treatment, relapse quickly and more easily, and others where the progression is slow and more treatable. It elaborates on how the immune system can change the extracellular matrix, favoring neoplastic progression, and how infections can enhance disease progression by increasing epithelial damage due to the loss of surface immunoglobulin and amplifying the inflammatory response. We investigated whether these dysregulated genes were linked to disease progression, delay, or recovery. These transcriptional alterations were observed using the RNA-based next-generation sequencing (NGS) panel Oncomine Immune Response Research Assay (OIRRA) to measure the expression of genes associated with lymphocyte regulation, cytokine signaling, lymphocyte markers, and checkpoint pathways. During the analysis, it became apparent that certain alterations divide dysplasia into two categories: progressive or not. In the future, these biological alterations are the first step to provide new treatment modalities with different classes of drugs currently in use in a systemic or local approach, including classical chemotherapy drugs such as cisplatin and fluorouracile, older drugs like fenretinide, and new checkpoint inhibitor drugs such as nivolumab and pembrolizumab, as well as newer options like T cell therapy (CAR-T). Following these observed alterations, it is possible to differentiate which dysplasias progress or not or relapse quickly. This information could, in the future, be the basis for determining a close follow-up, minimizing surgical interventions, planning a correct and personalized treatment protocol for each patient and, after specific clinical trials, tailoring new drug treatments.

Neuromuscular Load in Professional Women's Handball: Segmentation of the Player Load and the Impacts at Group and Individual Level.

Handball is a team sport characterised by physical interaction with other opponents. This interaction produces a high load on the players that can manifest itself in various ways, from discomfort to prolonged injuries due to tears caused by excessive load. In order to establish correct protocols for application in women's teams, context- and gender-specific reference data must be available. For this reason, the present research aims to find out how women's teams in European competitions prepare for decisive matches during the match week, analysing the load in a segmented way and the level of specificity that should be achieved in training. Ex post facto research was used in which a total of 17 players belonging to a women's first division handball team in Spain participated. The variables player load and impacts extracted from the use of Wimu ProTM inertial devices were analysed. The results showed a high neuromuscular load in players at this competitive level, especially in the variable impacts, reaching values per session of up to 1000 impacts. The individuality analyses show that the load varies significantly depending on the subject, which is why it is considered essential to establish protocols for strength work and load control in the most specific way possible.

Improved stability of open bite deformities: taking control of the transverse width using digital technology and robotic archwire bending

Many factors need to be considered when selecting the treatment protocol for the surgical correction of skeletal open bite deformities. In order to achieve stable long-term results, it is essential to explore the origin of the open bite, including any dysfunction of the temporomandibular joint or tongue and compromised nasal breathing, in addition to the skeletal deformity. Recurrence of a skeletal open bite is associated with relapse of the expanded transverse width. Three-dimensional virtual planning allows different treatment options to be explored and final decisions to be made together with the orthodontist who also designs the patient’s digital occlusion. This study presents a treatment protocol for predictable and stable widening of the maxillary transverse width over the long term, involving premolar extraction and rounding and shortening of the upper dental arch by advancing the molar segments. The stability of inter-canine, inter-premolar, and inter-molar distances, as well as overjet and overbite, were measured in 16 patients treated with this technique; measurements were obtained pre- and post-surgery, and the mean follow-up was 43 months. Orthodontic treatment was designed digitally and finished with robotically bent wires (SureSmile), which allowed exact planning of the overall treatment until debonding, thus making orthognathic surgery more predictable for the patient. The changes in transverse width were significant and stable over time.

Are zygomatic implants an alternative to orthognathic surgery in the treatment of a vertical discrepancy ? A case series to describe an open bite treatment protocol

IntroductionThis report aims to present case series to describe a treatment protocol for correction of severe open bite in non-growing patients MethodologyPatients diagnosed with skeletal open bite malocclusion (overbite range: -3 to -6 mm) were treated using a bonded appliance and skeletal anchorage. Intrusive force was applied between buccal bars of appliance and zygomatic multipurpose implants (MPI). Intrusion was continued until positive overbite occurred. Treatment progressed with conventional fixed orthodontic treatment for alignment and settling. MPIs were retained until the end of treatment for retention of intrusion ResultsClinically effective open bite correction was achieved by intrusion of maxillary buccal segment and mandibular counterclockwise autorotation ConclusionThis protocol includes zygomatic anchorage and an appliance that aims triple intrusion effect through combination of orthodontic and physiological forces. Achieving significant maxillary intrusion, controlling mandibular eruption and maximizing mandibular counterclockwise autorotation are the main outcomes of this protocol.

Q-value-guided femtosecond laser-assisted in situ keratomileusis for low-to-moderate myopia with age-related accommodation deficiency

Objective: To evaluate clinical outcomes and visual quality after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) performed with the Q-value-guided optimized monocular vision protocol (Custom-Q) for correction of low-to-moderate myopia and compensation for age-related accommodation deficiency. Methods: A prospective study was performed based on patients with myopia and age-related accommodation deficiency, who underwent Custom-Q FS-LASIK in the Peking University Third Hospital from October 2022 to October 2023. Monocular and binocular distance, intermediate, and near visual acuities, simulated whole-course visual acuity (binocular defocus curve), objective and subjective refractions, anterior corneal Q factor, anterior corneal higher-order aberrations and a subjective questionnaire assessing near visual acuity and visual quality were evaluated at 3 months postoperatively. Visual acuity was recorded using the logarithm of the minimum angle of resolution. The data were analyzed using the t-test and the Wilcoxon rank-sum test. Results: A total of 45 patients (90 eyes) who met the inclusion criteria and completed the 3-month follow-up were included in the study. The mean age of the 21 men (42 eyes) and 24 women (48 eyes) was (42.82±2.72) years. During the 3-month follow-up, all the patients achieved binocular uncorrected distance visual acuity not less than 0.00 and uncorrected near visual acuity not less than 0.20. Defocus curves revealed better results at 3 months postoperatively [0.00 (-0.08, 0.00), -0.08 (-0.08, 0.00)] at intermediate and near vergence (-1.50 to -1.00 D) compared to the preoperative values [0.00 (-0.08, 0.05), -0.08 (-0.08, 0.00)] (P<0.05). All the 45 patients maintained 0.10 or better vision at the defocus range from -2.50 to 0.00 D. The Q value in the dominant eyes was more positive postoperatively (0.01±0.26 vs.-0.15±0.14, P<0.05), while in the nondominant eyes, the Q value and corneal spherical aberration coefficient became more negative than those before surgery (-0.27±0.32 vs.-0.14±0.11, P<0.05; 0.08±0.05 vs. 0.12±0.03, P<0.05). The questionnaire demonstrated 42 (93.3%) patients were satisfied with near vision. The three most commonly reported visual discomforts after surgery were blurred vision, glare and halos. These symptoms were all mild to moderate in severity and did not interfere with daily life. Conclusion: For myopic patients with age-related accommodation deficiency, the Custom-Q algorithm proved to be a safe and effective way to achieve acceptable near vision and visual quality without compromising distance vision.

Comparing reach distance between the Y-Balance Test-Lower Quarter and Star Excursion Balance Test: Are practitioners using the correct protocol?

ObjectivesTo compare reach distances between the YBT-LQ and SEBT using the correct protocols as outlined by the developers. This will provide an accurate insight on the actual magnitude differences in reach distance between the movement screen tests and will safeguard practitioners on the subsequent use of these outcomes to inform clinical decision making. DesignObservational. SettingLaboratory. ParticipantsParticipants included sixteen healthy female subjects from the university and amateur sports teams. Main outcomeReach distances in the anterior direction (ANT), posterior medial (PM) and posterior lateral (PL) between participants on the YBT-LQ and SEBT. ResultsThe principal findings highlighted that a statistically significantly greater reach distance on the left and right side for the YBT-LQ compared to the SEBT in the ANT, PM, and PL directions (p < 0.0005). ConclusionThe results of this study suggest that the YBT-LQ and SEBT are not comparable tests due to the differences in reach distance and methodological differences. Therefore, previous, and future research using the YBT-LQ and SEBT cannot be used interchangeably. Not following developed guidelines questions the applicability of the findings of reach distance scores to infer on performance and assessment of injury risk.

Bayesian approach to coherent combination of single photon beams

We theoretically investigate the performance of a coherent beam combination of two light beams under relative phase fluctuations in the photon starved regime. We apply a first-principles approach using the optimal Bayesian phase correction protocol. We analyze the efficiency of beam combination as a function of the phase fluctuations strength.

Cross-detector scatter issues in dual synchronous tomography: An affine projection correction protocol

Dual-beam x-ray tomography systems are paving the way for new experimental procedures, such as multi-resolution and multi-energy imaging, where synchronous acquisitions are essential. However, in such systems, cross-detector scatter between the detecting devices can occur as the two beamlines operate simultaneously. This paper proposes a new affine image transformation model of each projection to correct for these cross-detector scatter issues. A toy tomography test case is presented to assess the feasibility and performance of the proposed correction method.

Implementation of perioperative blood glucose monitoring and insulin infusion protocol can decrease postoperative infection rate in diabetic patients undergoing elective craniotomy: An observational study

BackgroundSevere perioperative hyperglycemia (SH) is a proven risk factor for postoperative complications after craniotomy. To reduce this risk, it has been proposed to implement the standardized clinical protocol for scheduled perioperative blood glucose concentration (BGC) monitoring. This would be followed by intravenous (IV) insulin infusion to keep BGC below 180 mg/dl in the perioperative period. The aim of this prospective observational study was to assess the impact of this type of protocol on the postoperative infection rate in patients undergoing elective craniotomy. MethodsA total of 42 patients were prospectively enrolled in the study. Protocol included scheduled BGC monitoring in the perioperative period and rapid-acting insulin IV infusion when intraoperative SH was detected. The diagnosis of infection (wound, pulmonary, blood stream, urinary tract infection or central nervous system infection) was established according to CDC criteria within the first postoperative week. A previously enrolled group of patients with sporadic BGC monitoring and subcutaneous insulin injections for SH management was used as a control group. ResultsAn infectious complication (i.e., pneumonia) was diagnosed only in one patient (2 %) in the prospective group. In comparison with the control group, a decrease in the risk of postoperative infection was statistically significant with OR = 0.08 [0.009 – 0.72] (p = 0.02). Implementation of the perioperative BGC monitoring and the correction protocol prevented both severe hyperglycemia and hypoglycemia with BGC < 70 mg/dl. ConclusionScheduled BGC monitoring and the use of low-dose insulin infusion protocol can decrease the postoperative infection rate in patients undergoing elective craniotomy. Future studies are needed to prove the causality of the implementation of such a protocol with an improved outcome.

DONOR-SPECIFIC ANTIBODIES AS A PREDICTOR OF GRAFT REJECTION AFTER LIVER TRANSPLANTATION

The main reason for graft loss is the rejection of the donor organ, which may occur at different time after transplantation and may be caused by the recipient’s organism reaction against donor’s human leukocyte antigen (HLA) proteins. Donor-specific antibodies (DSA) are produced in patient’s organism as a response to foreign HLA antigens. Aim. The purpose of our study was to evaluate the effects of already existed and/or de novo generated DSAs in liver transplantation as predictors of graft rejection and to establish an interconnection between blood biochemical parameters (Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin level) with the level of DSA in patients with liver transplant. Methods. xMAP-Luminex next generation flow cytometry technology and LABScreen Single antigen beads reagent (Onelambda, USA) were used for antiHLA determination. Total bilirubin level was detected photometrically. The activity of ALT and AST was determined spectrophotometrically on the automatic analyzer COBAS C 111 (Roche, Switzerland) in accordance with the manufacture’s instruction. Results. Detection of DSA and PRA was important at the same level as measurement of classical biochemical parameters of liver function (ALT, AST etc.) for monitoring of graft status and prevention of acute or chronical rejection and choosing correct immunosuppression protocol. Conclusions. The DSA and PRA levels as well as total bilirubin and ALT and AST activity corresponded to each other and could be used for comprehensive both pre- and post-transplantation screening of patients requiring liver transplantation or re-transplantation. Detection of DSA and PRA was important at the same level as measurement of classical biochemical parameters of liver function (ALT, AST etc.) for monitoring of graft status and prevention of acute or chronical rejection and choosing correct immunosuppression protocol.

Gottesman-Kitaev-Preskill Encoding in Continuous Modal Variables of Single Photons.

GKP states, introduced by Gottesman, Kitaev, and Preskill, are continuous variable logical qubits that can be corrected for errors caused by phase space displacements. Their experimental realization is challenging, in particular, using propagating fields, where quantum information is encoded in the quadratures of the electromagnetic field. However, traveling photons are essential in many applications of GKP codes involving the long-distance transmission of quantum information. We introduce a new method for encoding GKP states in propagating fields using single photons, each occupying a distinct auxiliary mode given by the propagation direction. The GKP states are defined as highly correlated states described by collective continuous modes, as time and frequency. We analyze how the error detection and correction protocol scales with the total photon number and the spectral width. We show that the obtained code can be corrected for displacements in time-frequency phase space, which correspond to dephasing, or rotations, in the quadrature phase space and to photon losses. Most importantly, we show that generating two-photon GKP states is relatively simple, and that such states are currently produced and manipulated in several photonic platforms where frequency and time-bin biphoton entangled states can be engineered.

E042 Referrals for back pain to rheumatology outpatients: time to rethink service delivery?

Abstract Background/Aims Diagnostic delay in inflammatory and mechanical back pain (IBP and MBP) is a challenge, leading to time-off-work, mental health deterioration and chronicity of pain. Here we describe referral and follow-up characteristics in patients referred to a rheumatology service with back pain. By identifying these patients earlier and having a more proactive approach we may be able to reduce diagnostic delay and prevent some of this burden. Methods All new patients attending rheumatology outpatients at Guys and St Thomas’ Trust in London, UK are routinely sent a digital pre-appointment questionnaire to complete prior to initial visit. Between 21/06/2021 and 20/10/2022, 137 patients referred with back pain completed this questionnaire, which included the Assessment of SpondyloArthritis International Society (ASAS) IBP criteria. Clinical records were reviewed until June 2023. Results Our cohort had a mean (SD) age of 40.5(13.5) years, 50% were female and 66% were referred from primary care. Average symptom duration was 5.2(6.1) years. A primary diagnosis of axial spondyloarthritis was made in 41%, 53% were diagnosed with MBP and 6% had MBP on a background of other inflammatory disease. Incomplete data was an issue, with only 54% of the referrals having a CRP result, 50% having an ESR result and 22% with HLAB27 done and result available at referral. Rheumatology requested an MRI spine in 61% of back pain referrals. Of the 38% with a prior MRI, 15% did not have the result available at first rheumatology visit, 21% did not have the correct MRI protocol done and 17% had a further MRI spine done through rheumatology clinic. Overall, 92% of patients had at least one MRI spine done. The referral to new appointment wait time in this cohort was 19.4 (41.4) weeks and new visit to first follow-up visit duration of 18.2(13.0) weeks. Only 18% of patients were referred for back pain physiotherapy prior to being seen in rheumatology, with 20% referred at first rheumatology visit and 38% referred after this time. Of those with MBP, 96% were discharged with 82% being discharged after one follow-up i.e. after reviewing new investigation results. Conclusion Delay in time to diagnosis and management of back pain is considerable, with long referral to review and follow-up times and less than 1/5 patients referred for physiotherapy prior to being seen in secondary care. With 92% of patients having at least one MRI spine done, there is a call for front-loading new back pain referrals with appropriate MRI spine imaging at point of vetting along with appropriate blood tests, which we feel would help reduce diagnostic delay and be in line with the UK Getting It Right First Time (GIRFT) programme which advocates that quality care is given first time, every time. Disclosure N. Arumalla: None. E. Okoye: None. R. Jones: None. F. Humby: None. S. Subesinghe: None. T. Golding: None. T. Garrood: Shareholder/stock ownership; Serac Healthcare. Honoraria; UCB, Abbvie. Grants/research support; Versus Arthritis, Pfizer, Gilead, Guy’s and St Thomas’ Charity, NHSX. Other; Fresnius-Kabi. R. Byng-Maddick: None.

Complications of Surgically Assisted Rapid Maxillary/Palatal Expansion (SARME/SARPE)-A Retrospective Analysis of 185 Cases Treated at a Single Center.

Objectives: The study aims to assess and classify complications in patients treated for maxillary transverse deficiency using surgically assisted rapid maxillary/palatal expansion (SARME/SARPE) under general anesthesia. The classification of the complications aimed to assess the difficulty of their treatment as well as estimate its real cost. Methods: The retrospective study covered 185 patients who underwent surgery for a skeletal deformity in the form of maxillary constriction or in which maxillary constriction was one of its components treated by a team of maxillofacial surgeons at one center (97 females and 88 males, aged 15 to 47 years, mean age 26.1 years). Complications were divided into two groups: early complications (up to 3 weeks after surgery) and late complications (>3 weeks after surgery). In relation to the occurrence of complications, we analyzed the demographic characteristics of the group, type of skeletal deformity (class I, II, III), presence of open bite and asymmetry, surgical technique, type and size of appliance used for maxillary expansion, as well as the duration of surgery. Results: In the study group, complications were found in 18 patients (9.73%). Early complications were found in nine patients, while late complications were also found in nine patients. Early complications include no possibility of distraction, palatal mucosa necrosis, perforation of the maxillary alveolar process caused by the distractor and asymmetric distraction. Late complications include maxillary incisor root resorption, no bone formation in the distraction gap, and maxillary incisor necrosis. None of the patients required prolonged hospitalization and only one required reoperation. Conclusions: Complications were found in 18 patients (9.73%). All challenges were classified as minor difficulties since they did not suppress the final outcome of the treatment of skeletal malocclusion. However, the complications that did occur required additional corrective measures. Surgically assisted rapid maxillary expansion, when performed properly and in correlation with the correct orthodontic treatment protocol, is an effective and predictable technique for treating maxillary constriction.