Information For Identifying Patients Research Articles

Risks and benefits of sharing patient information on social media: a digital dilemma.

Social media (SoMe) has witnessed remarkable growth and emerged as a dominant method of communication worldwide. Platforms such as Facebook, X (formerly Twitter), LinkedIn, Instagram, TikTok, and YouTube have become important tools of the digital native generation. In the field of medicine, particularly, cardiology, attitudes towards SoMe have shifted, and professionals increasingly utilize it to share scientific findings, network with experts, and enhance teaching and learning. Notably, SoMe is being leveraged for teaching purposes, including the sharing of challenging and intriguing cases. However, sharing patient data, including photos or images, online carries significant implications and risks, potentially compromising individual privacy both online and offline. Privacy and data protection are fundamental rights within European Union treaties, and the General Data Protection Regulation (GDPR) serves as the cornerstone of data protection legislation. The GDPR outlines crucial requirements, such as obtaining 'consent' and implementing 'anonymization', that must be met before sharing sensitive and patient-identifiable information. Additionally, it is vital to consider the patient's perspective and prioritize ethical and social considerations when addressing challenges associated with sharing patient information on SoMe platforms. Given the absence of a peer-review process and clear guidelines, we present an initial approach, a code of conduct, and recommendations for the ethical use of SoMe. In conclusion, this comprehensive review underscores the importance of a balanced approach that ensures patient privacy and upholds ethical standards while harnessing the immense potential of SoMe to advance cardiology practice and facilitate knowledge dissemination.

Minimally Invasive L4-5 Oblique Lumbar Interbody Fusion With Robot-Assisted Single-Position Posterior Fixation: 2-Dimensional Operative Video.

We present here a 58-year-old female patient with L4-5 spondylolisthesis, who underwent a minimally invasive L4-5 oblique lumbar interbody fusion (OLIF) with robot-assisted bilateral posterior instrumented fixation in a single lateral position (Mazor X Stealth Edition, Medtronic). There has been interest in detailed video-based descriptions of single-position surgery with lateral approach interbody fusions, either in the prone or lateral decubitus position.1-6 Particularly, the addition of robotics has been shown to help increase overall operating efficiency in the lateral position with reduced case times even with the increased up-front robot setup time.7,8 The OLIF, also known as an anterior-to-psoas approach, allows for single-position posterior fixation and can be very effective at L4-5 where the anatomy of the iliac crest or lumbar plexus does not preclude this surgical corridor the way it could in the transpsoas lateral lumbar interbody fusion. Clinical outcomes between these 2 lateral approaches have been shown to be very good,9 and OLIF has reduced blood loss while still restoring alignment parameters compared with anterior lumbar interbody fusion, with better fusion and reduced subsidence compared with transforaminal lumbar interbody fusion.10,11 To our knowledge, this is the first video demonstrating a view of the OLIF approach through a high-definition retractor-based camera (MaxView Camera, Viseon Inc). There is no identifying patient information in this video. The participants and any identifiable individuals consented to publication of his/her image, and the patient consented to the procedure.

Primary CNS Lymphoma in Latin America: A Grupo De Estudio Latinoamericano De Linfoproliferativos (GELL) Survey in 80 Cancer Centers in Latin America

Introduction: Primary Central Nervous System Lymphoma (PCNSL) is a rare and aggressive subtype of lymphoma, representing 4-6% of extranodal lymphomas. Management of PCNSL involves a multidisciplinary approach which includes neurosurgery, ophthalmology, radiotherapy, autologous stem cell transplantation (ASCT) and the use of novel agents such as BTK-inhibitors, immunomodulatory agents and chimeric antigen receptor T-cell (CAR-T cell) therapy. These strategies can be costly and not readily available in developing countries. GELL, a multinational group for studying lymphoproliferative disorders, conducted a multicenter international survey to investigate the diagnosis, clinical staging and treatment patterns in Latin America (LATAM). Methods: We conducted an on-line survey consisting of 22 questions regarding diagnostic and treatment patterns of PCNSL in LATAM. All invited centers agreed to participate and contributed for the development of the survey. No identifiable patient information was abstracted at any time during the survey. Questions were structured based on 3 pillars: (1) diagnostic approach, including available biopsy procedures, immunohistochemistry markers, ophthalmology evaluation, flow cytometry and molecular testing; (2) first line therapy, including preferred regimens used for both transplant eligible and ineligible patients, and availability of novel agents, and (3) consolidation therapies including ASCT and whole brain radiation therapy (WBRT) Results: A total of 90 surveys were completed from 80 cancer centers in LATAM. Geographical distribution of the participating cancer centers are as followed: Argentina (n=11), Bolivia (n=2), Brazil (n=9), Chile (n=5), Colombia (n=17), Cuba (n=1), Ecuador (n=5), Mexico (n=10), Panama (n=1), Paraguay (n=4), Peru (n=5), Dominican Republic (n=1), Uruguay (n=5) and Venezuela (n=4). Most centers treat up to 5 new cases of PCNSL/year (84%), with only 3 centers treating more than 15 cases/year. Stereotaxic biopsy was the preferred diagnostic procedure in 78%, and complete resection was done in a minority of centers (3%). Cerebrospinal fluid studies were done in 82% and flow cytometry was available in 87% of the centers. Only 65% of centers had access to PET-CT at diagnosis. Interestingly, 80% of the physicians performed bone marrow biopsy at diagnosis, and ophthalmology evaluation was not available in 20% of the centers. Regarding IHC markers, EBV-LEMP was available in 55% and PDL-1 in only 38% of the centers. FISH for Myc/Bcl2 was performed in 32% and molecular testing in only 23% of the centers. The median time for treatment initiation was 0-10 days in 36%, 10-20 days in 37% and >30 days in 26% of the centers. Regarding first line therapy, MATRIX regimen was the preferred regimen for fit transplant eligible patients in 53% of the participants. However, thiotepa was not readily available as per 45% of the survey participants. Methotrexate (MTX) with Cytarabine was the preferred regimen for 36% of participants. Interestingly, serum monitoring of MTX was not available in 27% of the centers. ASCT was the preferred consolidation regimen for transplant eligible patients (78%), and the most used conditioning regimen was BEAM (49%), suggesting an impact of not availability of thiotepa in these centers. For transplant ineligible patients, MTR (27%), MATRIX (22%) and R-MVP (19%) were the preferred regimens, and 32% of survey participants considered WBRT as the preferred consolidation for these patients. Regarding relapsed/refractory (R/R) PCNSL, MTX-based salvage therapy was the preferred regimen in 38%, followed by cytarabine based in 23% and BTK-inhibitor based in 20% of the participants. CAR-T cell therapy was available in only 3 centers. Conclusion: Management of PCNSL is highly variable in LATAM. Access to targeted agents and novel therapies such as CAR-T cell therapy is limited. Moreover, most centers lack basic diagnostic approaches such as serum MTX level monitoring and ophthalmology evaluation. Lack of access to thiotepa was a common issue encountered by most cancer centers in LATAM. The use of thiotepa-containing regimens has demonstrated improved survivals both as consolidation and in the R/R setting. Thus, the absence of such agent in LATAM carries a profound impact on PCNSL outcomes in this area of the world. A retrospective evaluation on PNCSL outcomes is planned by the GELL group to better investigate our results.

Adherence of Radiological Investigation Requests from Medical Wards, to Royal College of Radiologists’ Guidelines

Background: Radiological investigation requests get rejected by vetting radiologists, if they do not adhere to Royal College of Radiologists (RCR) guidelines and Ionizing Radiation (Medical Exposure) Regulations - IR(ME)R 2017 guidelines. This leads to significant delays for all three parties involved: the requesting clinician, the radiologist who vets the investigation, and the patient whose management is affected. Hence radiological investigation requests, which are the main means of communication between the referring clinician and the radiologist, should be appropriately filled in to facilitate the justification process and to optimize patient management. Aims/purpose: To evaluate the adherence of radiological investigation requests of inpatients from medical wards at University Hospitals of Leicester, to RCR guidelines and identify improvement areas, thereby reducing preventable patient delays. Methods: Data from 500 investigation requests of adult inpatients for common modalities of imaging (CT, X-Ray, and MRI) from medical wards at University Hospitals of Leicester were collected across two audit cycles, omitting any patient-identifiable information, and were analyzed for their completeness and adherence to RCR protocols. Results: Based on the analysis, inadequacies of imaging requests were identified, both in completion and adherence to RCR guidelines. In the initial audit cycle, even though more than 90% of the 250 investigation requests analysed contained clinical history, the name of requesting clinician and the question to be answered, only 64% of the investigation requests contained clinical examination or relevant investigation findings. In comparison to more than 94% of MRI and X-Ray requests, only 68.6% of CT requests adhered to RCR and IR(ME)R 2017 guidelines. In order to raise awareness and educate, the audit findings and recommendations were presented in a local medical teaching session within the hospital, and the same was propagated among medical doctors, through an online flyer. During the re-audit, another 250 radiological investigation requests were evaluated, where 73.3% of the requests included relevant clinical examination and/or investigation results and 76% of the CT requests adhered to iRefer guidelines for indication. Conclusion: Radiological investigation requests get rejected if it does not adhere to RCR guidelines for completeness (1) or indication (in compliance with IR(ME)R 2017)(3). This in turn results in delays in patient management. This could be minimized by increasing awareness about the above guidelines and the need for adhering to the same, thereby making sure all the necessary details are filled in and the investigation being requested is appropriate for the clinical indication. Keywords: Radiology, Audit, Medicine.

A Quantitative Risk Assessment Framework for the Cybersecurity of Networked Medical Devices

Medical devices are increasingly the source of cybersecurity exposure in healthcare organizations. Research and media reports demonstrate that the exploitation of cybersecurity vulnerabilities can have significant adverse impacts ranging from the exposure of sensitive and personally identifiable patient information to compromising the integrity and availability of clinical care. The results can include identity theft and negative health consequences, including loss of life. Assessing the risk posed by medical devices can provide healthcare organizations with information to prioritize mitigation efforts. However, producing accurate risk assessments in environments with both sparse historical data and a lack of validation regarding the accuracy of forecasts is particularly challenging.
 We present a risk assessment framework for quantifying the risk posed by connected medical devices in trusted healthcare networks. Our framework is built upon prominent existing frameworks and guidance for general risk assessment and cybersecurity risk assessment. We add a method for quantifying risk, which to our knowledge is novel in the context of medical devices on trusted networks. The framework provides a structure for combining publicly available information along with expert elicitation about threats, vulnerabilities, and consequences. The goal is to provide healthcare organizations with actionable information for prioritizing and mitigating risks in medical devices.

Achieving proportionate governance review in Scotland: Threats and solutions.

The effectiveness of any healthcare-related research governance system is dependent on its ability to identify, challenge and change practices that compromise its ability to deliver timely, proportionate review. We present a case study outlining our experience of obtaining research ethics committee (REC) and Public Benefit and Privacy Panel (PBPP) for Health and Social Care approval to conduct a study which aimed to collect data on diagnostic and care pathways and determine the national prevalence of two rare diseases in Scotland. We discuss the threats posed to low-risk observational epidemiological research by disproportionate governance practices and propose practical solutions. In the context of increasing investment, the ever-increasing barriers to doing high-quality, low-risk epidemiological research using patient-identifiable information is concerning. Information governance committees, guided by clinical researchers, must step up as leaders in this area, making use of flexibilities and opportunities within the law.

Moving from development to implementation of digital innovations within the NHS: myHealthE, a remote monitoring system for tracking patient outcomes in child and adolescent mental health services.

This paper aims to report our experience of developing, implementing, and evaluating myHealthE (MHE), a digital innovation for Child and Adolescents Mental Health Services (CAMHS), which automates the remote collection and reporting of Patient-Reported Outcome Measures (PROMs) into National Health Services (NHS) electronic healthcare records. We describe the logistical and governance issues encountered in developing the MHE interface with patient-identifiable information, and the steps taken to overcome these development barriers. We describe the application's architecture and hosting environment to enable its operability within the NHS, as well as the capabilities needed within the technical team to bridge the gap between academic development and NHS operational teams. We present evidence on the feasibility and acceptability of this system within clinical services and the process of iterative development, highlighting additional functions that were incorporated to increase system utility. This article provides a framework with which to plan, develop, and implement automated PROM collection from remote devices back to NHS infrastructure. The challenges and solutions described in this paper will be pertinent to other digital health innovation researchers aspiring to deploy interoperable systems within NHS clinical systems.

Publication ethics: Patient consent for publishing case reports of adverse drug reactions is important yet absent from several recent manuscripts

Case reports of adverse drug reactions (ADRs) constitute an important source of medication safety information. Detailed description of patients in such reports could potentially make subjects identifiable, thereby emphasizing the importance of consent for publication. The Committee on Publication Ethics and the International Committee of Medical Journal Editors recommend obtaining patient consent prior to publishing potentially identifiable patient information. However, this report shows absence of information regarding patient consent for publication from several recently-published ADR case reports. A sample of 100 most-recent ADR case reports with free full-text indexed in PubMed was qualitatively reviewed for information regarding publication consent and other ethical disclosures. Of the 100 most-recently-published ADR case reports, only 52 (52%) manuscripts clearly described obtaining patient consent for publication. Thirty-seven (37%) manuscripts made no mention of such consent or approval from an ethics committee. Eleven (11%) manuscripts contained ethical disclosures such as patient consent to undergo treatment and study approval from an institutional ethics committee, but without a clear statement regarding patient consent for publication. A significant number of recently-published ADR case reports do not clearly describe if patient consent for publication was obtained. This could be attributable to various factors, including lack of clarity in journals’ guidelines regarding publication consent for case reports and dilemma regarding what constitutes identifiable patient information. This report calls for diligence of all stakeholders involved in medical manuscript publishing, viz. authors, manuscript reviewers, editors, and journal publishers to ensure that information regarding patient consent for publication is properly disclosed in ADR case reports.

Development of JAK2 positive myelofibrosis on a background of chronic myeloid leukaemia.

A 50-year-old male patient was admitted with a history of constitutional symptoms and weight loss with a marked leucocytosis (WBC 270 × 109/L) and blood film appearances suggestive of chronic myeloid leukaemia (CML). Platelet count was normal at presentation (298 × 109/L). BCR-ABL1 was detected (b2a2) confirming CML. Bone marrow trephine sections revealed a markedly expanded myeloid series but no excess of blasts (Figure 1). Megakaryocytes were noted to be reduced in size with some bare nuclei seen. Cytogenetics confirmed 46,XY, t(9;22)(q34;q11) with no additional anomalies. He was commenced on imatinib but developed progressive full blood count abnormalities (WBC 9.6 × 109/L, Neutrophils 6.7 × 109/L, Hb 99 g/L, Platelets 650 × 109/L) with an increase in his BCR-ABL1 ratio 3 months following this. He was switched to nilotinib and had a further bone marrow evaluation, which revealed a marked increase in reticulin fibres (MF-2) but no evidence progression to accelerated or blast phase CML. Despite an excellent initial response to nilotinib (achieving molecular response (MR-2) after 7 weeks), he developed a persistent neutrophilia and thrombocytosis. Due to his blood count abnormalities and bone marrow fibrosis, JAK2 testing was performed and revealed the V617F mutation. A repeat bone marrow examination (to assess cytogenetic response) revealed increased megakaryopoiesis with dysplastic, spindle-shaped, and hyperlobulated nuclei, with clustering, with increased reticulin fibres (MF-2 with some focal areas of MF-3) noted again (Figures 2 and 3). No ABL kinase domain mutations were detected at time of JAK testing. He was diagnosed with JAK2 positive myelofibrosis (independent of his known CML) (DIPSS score 0, associated with medial survival of over 14 years). The patient began to experience headaches and was commenced on hydroxycarbamide 500 mg once daily in case these were vaso-occlusive in origin. He remains well and in a good molecular BCR-ABL1 response on both therapies over 2 years following the diagnosis. He achieved major molecular remission (MR4) at 26 months. Fibrosis within the bone marrow in CML patients is common. The presence of both BCR-ABL1 and JAK2 V617F mutations is highly unusual. It is unclear whether these mutations arose within the same clone or within differing clones. Previous cases have reported unmasking of Philadelphia negative myeloproliferative neoplasms during treatment for CML [1]. Of note, retrospective testing on the initial bone marrow samples from the CML was first diagnosed for JAK2 V617F was negative. None. The authors report no conflict of interest. Christopher Gerard Mullen wrote the clinical summary. Tamasin Doig provided images of bone marrow trephine sections. Victoria Louise Campbell and Alice Klauser made revisions and edits to the clinical summary. None. This article involved no human or animal research participants. No patient identifiable information was submitted. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Application of data mining algorithms to study data trends for corneal transplantation

To utilize data mining for analysis of corneal transplantations (CT) in Florida from 2005-2014, segmented by demographics, geography, and transplantation technique. A retrospective, database study was performed utilizing data queried from the Healthcare and Cost Utilization Project using Current Procedural Terminology codes for lamellar keratoplasty (ALK), endothelial keratoplasty (EK), and penetrating keratoplasty (PKP). Payer status, ethnic group, age, gender, and geography (urban versus rural) was extracted from each surgical encounter and reconfigured to provide a "clean", congruous dataset for statistical analysis. This Institutional Review Board-approved study did not utilize identifiable patient information; thus, individual informed consent was not required. From 2005-2014, CT (n=28,607) represented less than 1% of the total ambulatory surgeries (n=12,695,932) performed in Florida. EK volume increased while PKP and ALK volume decreased, year-over-year. Statistical significance was found between transplantation technique by sex (P<0.001) and ethnic group (P<0.001). The largest sex discrepancy was EK (59% female, 41% male). White patients underwent relatively fewer PKP than EK (71% vs. 83% of totals), while Black patients underwent relatively more PKP than EK (14% vs 6% of totals). Statistical significance was found between techniques by payer (P<0.001). Medicare was the most common payer for all techniques, but ALK and PKP had higher percentages of private insurance and self-pay. No statistical significance was found between techniques by geographic location. Corneal edema (22.4%), endothelial dystrophy (17.5%), and bullous keratopathy (10.9%) were erroneously coded as indications for ALK. Corneal scars (2.5%) and corneal opacity (1.7%) were erroneously coded as indications for EK. CT rates in Florida appear to overrepresent the female sex and underrepresent ethnic minorities, with propensities between PKP and African Americans, EK and female patients, and EK and Medicare reimbursement. Our study further confirms the utility of data mining for providing efficient, detailed, and practical insights into ophthalmology procedures, while highlighting the intrinsic challenges of large datasets.

Multi-institutional distributed data networks for real-world evidence about medical devices: building unique device identifiers into longitudinal data (BUILD).

ObjectivesTo support development of a robust postmarket device evaluation system using real-world data (RWD) from electronic health records (EHRs) and other sources, employing unique device identifiers (UDIs) to link to device information.MethodsTo create consistent device-related EHR RWD across 3 institutions, we established a distributed data network and created UDI-enriched research databases (UDIRs) employing a common data model comprised of 24 tables and 472 fields. To test the system, patients receiving coronary stents between 2010 and 2019 were loaded into each institution’s UDIR to support distributed queries without sharing identifiable patient information. The ability of the system to execute queries was tested with 3 quality assurance checks. To demonstrate face validity of the data, a retrospective survival study of patients receiving zotarolimus or everolimus stents from 2012 to 2017 was performed using distributed analysis. Propensity score matching was used to compare risk of 6 cardiovascular outcomes within 12 months postimplantation.ResultsThe test queries established network functionality. In the analysis, we identified 9141 patients (Mercy = 4905, Geisinger = 4109, Intermountain = 127); mean age 65 ± 12 years, 69% males, 23% zotarolimus. Separate matched analyses at the 3 institutions showed hazard ratio estimates (zotarolimus vs everolimus) of 0.85–1.59 for subsequent percutaneous coronary intervention (P = .14–.52), 1.06–2.03 for death (P = .16–.78) and 0.94–1.40 for the composite endpoint (P = .16–.62).DiscussionThe analysis results are consistent with clinical studies comparing these devices.ConclusionThis project shows that multi-institutional data networks can provide clinically relevant real-world evidence via distributed analysis while maintaining data privacy.

A Rare Foreign Body: An Intracolonic Syringoperitoneal Shunt.

CASE REPORT A 55-year-old man with a history of C6 spinal cord injury, paraplegia, and syrinx, requiring a syringoperitoneal shunt 10 years earlier, was admitted to the intensive care unit with sepsis because of sacral osteomyelitis. An abdominal radiograph was obtained suggesting the tip of the syringoperitoneal shunt was within the colon. Subsequent computed tomography of the abdomen confirmed the syringoperitoneal shunt was terminating within the colon (a). A colonoscopy was performed, and the shunt, eroding through the wall of the descending colon, was visualized (b). After the shunt was disconnected by neurosurgery, a repeat colonoscopy was performed. The mucosa surrounding the shunt was tattooed to help with identification of the defect, followed by retrieval of the shunt with a cold snare. After the shunt was successfully retrieved, an over-the-scope clip (12/6 T, OTSC; Ovesco Endoscopy, Tuebingen, Germany) was deployed with adequate closure of the defect (c). Although the defect was apparent with the shunt in place, after removal, the area was difficult to identify with a capped device. In this case, the tattoo proved critical for identification of the defect for closure, and the use of tattoo can be considered for similar cases. Clinically, the patient did well after the procedure without any resultant sepsis and was treated with a 5-day course of oral antibiotics. In similar cases of ventriculoperitoneal shunt causing small intestine or colonic perforation, patients may present with meningitis, peritonitis, or abdominal pain. The standard of care has been surgical resection after disconnection of the catheter.1–3 Here, we presented a case showing the feasibility of endoscopic closure in cases of colonic perforation because of a syringoperitoneal shunt.Figure 1.: Abdominal computed tomography showing the syringoperitoneal shunt was terminating within the colon.Figure 2.: Colonoscopy showing the shunt eroding through the wall of the descending colon.Figure 3.: An over-the-scope clip closing the defect.DISCLOSURES Author contributions: NM McDonald wrote the manuscript and is the article guarantor. NM McDonald, JA Sloan, and S. Amateau performed the procedures. All authors performed critical review and editing of the manuscript. Financial disclosure: None to report. Informed consent for publication was obtained from the patient. All identifying patient information has been removed to protect patient privacy.

A Review of Anonymization for Healthcare Data.

Mining health data can lead to faster medical decisions, improvement in the quality of treatment, disease prevention, and reduced cost, and it drives innovative solutions within the healthcare sector. However, health data are highly sensitive and subject to regulations such as the General Data Protection Regulation, which aims to ensure patient's privacy. Anonymization or removal of patient identifiable information, although the most conventional way, is the first important step to adhere to the regulations and incorporate privacy concerns. In this article, we review the existing anonymization techniques and their applicability to various types (relational and graph based) of health data. Besides, we provide an overview of possible attacks on anonymized data. We illustrate via a reconstruction attack that anonymization, although necessary, is not sufficient to address patient privacy and discuss methods for protecting against such attacks. Finally, we discuss tools that can be used to achieve anonymization.

Blinded intraoperative skill evaluations avoid gender-based bias.

Gender bias has been identified consistently in written performance evaluations. Qualitative tools may provide a standardized way to evaluate surgical skill and minimize gender bias. We hypothesized that there is no difference in operative time or GEARS scores in robotic hysterectomy for men vs women surgeons. Patients undergoing robotic hysterectomies performed between June 2019 and March 2020 at 8 hospitals within the same hospital system were captured into a prospective database. GEARS scores were assigned by crowd-sourced evaluators by a third party blinded to any surgeon- or patient-identifying information. One-way ANOVA was used to compare the mean operative time and GEARS scores for each group, and significant variables were included in a one-way ANCOVA to control for confounders. Two-tailed p-value < 0.05 was considered significant. Seventeen women and 13 men performed a total of 188 hysterectomies; women performed 34 (18%) and men performed 153 (81%). Women surgeons had a higher mean operative time (133 ± 58 vs 86.3 ± 46min, p = 0.024); after adjustment, there were no significant differences in operative time (p = 0.607). There was no significant difference between the genders in total GEARS score (20.0 ± 0.77 vs 20.2 ± 0.70, p = 0.415) or GEARS subcomponent scores: bimanual dexterity (3.98 ± 0.03 vs 4.00 ± 0.03, p = 0.705); depth perception (4.04 ± 0.04 vs 4.05 ± 0.02, p = 0.799); efficiency (3.79 ± 0.02 vs 3.82 ± 0.02, p = 0.437); force sensitivity (4.01 ± 0.04 vs 4.05 ± 0.05, p = 0.533); or robotic control (4.16 ± 0.03 vs 4.26 ± 0.01, p = 0.079). There was no difference in GEARS score between men vs womensurgeons performing robotic hysterectomies. Video-based blinded assessment of skills may minimize gender biases when evaluating surgical skill for competency evaluation and credentialing.

Inter Spinal Fixation and Stabilization Device for Lumbar Radiculopathy and Back Pain.

Introduction: Generally, interspinal distractor fixation devices are used for severe low back pain associated with neurogenic claudication, and radiculopathy with central or lateral recess stenosis and/or foraminal narrowing. In this paper, the authors result in cases of severe low back pain and lumbar radiculopathy in whom this device was used with excellent results.Method: This is a retrospective study. Patients were contacted via phone call and their pain score and other data were recorded at different timelines. The final data presented in this paper are the data collected at the final follow-up that ranges from 14 months to 24 months. Surgeries were performed in the outpatient setting and although no identifiable patient information is included in this paper, yet, patients were asked for their verbal consent. The patient data are only included if verbal consent was obtained.Results: Over the past 24 months, 13 patients with disc protrusion and/or central and/or foraminal spinal stenosis were treated with this procedure. Follow-up ranges from 14 months to 24 months with a median of 19 months, male/female ratio of 6/7, and a median age of 68 years. There were no complications or reoperation. Statistical analysis showed significant improvement in the Numeric Pain Rating Scale (NPRS) for back and radicular leg pain (p-value = 0.000552 for back pain and p-value = 0.000291 for radicular leg pain).Conclusion: The system reported in this paper is a solid fixation system that works both as a distractor and internal decompressor of the spinal canal. It is simple to use and safe. Though the number of patients is small, statistically significant improvement was reported at a median follow-up of 19 months.

Robotic transthoracic diaphragmatic hernia repair.

Robotic transthoracic diaphragmatic hernia repair.

Framework for large-scale automatic curation of heterogeneous cardiac MRI (ACUR MRI)

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UKRI CDT in AI for Healthcare http://ai4health.io and British Heart Foundation Background Data curation is an important process that structures and organises data, supporting research and the development of artificial intelligence models. However, manually curating a large volume of medical data is a time-consuming, repetitive and costly process that puts additional strain on clinical experts. The curation becomes more complex and demanding as more data sources are used. This leads to an introduction of disparity in the data structure and protocols. Purpose Here, we propose an automatic framework to curate large volumes of heterogenous cardiac MRI scans acquired across different sites and scanner vendors. Our framework requires minimal expert involvement throughout and works directly on DICOM images from the scanner or PACS. The resulting structured standardised data allow for straightforward image analysis, hypothesis testing and the training and application of artificial intelligence models. Methods It is broken down into three main components anonymisation, cataloguing and outlier detection (see Figure 1). Anonymisation automatically removes any identifiable patient information from the DICOM image attributes. These data are replaced with anonymised labels, whilst maintaining relevant longitudinal information from each patient. DICOM attributes are also used to automatically group the different images according to imaging sequence (e.g. CINE, Delayed-Enhancement, T1 maps), acquisition geometry (e.g. short-axis, 2-chamber, 4-chamber) and imaging attributes (e.g. slice thickness, TE, TR), for easier querying. The sorting characteristics are flexible and can easily be defined by the user. Finally, we detect and flag, for subsequent manual inspection, any outliers within those groups, based on the similarity levels of chosen DICOM attributes. This framework additionally offers interactive image visualisation to allow users to assess its performance in real time. Results We tested the performance of ACUR CMRI on 26,668 CMR image series (723,531 images) from 858 patient examinations, which took place across two sites in four different scanners. With an average execution time per patient of 100 seconds, ACUR was able to sort imaging data with 1191 different sequence names into 43 categories. The framework can be freely downloaded from https://bitbucket.org/cmr-ai-working-group/acur/. Conclusions We present ACUR, an automatic framework to curate large volumes of heterogeneous cardiac MRI data. We show how it can quickly and automatically curate data, grouping it according to desired imaging characteristics defined in DICOM attributes. The proposed framework is flexible and ideally suited as a pre-processing tool for large biomedical imaging data studies.

Preliminary case report study of training and support needed to conduct bowtie analysis in healthcare

BackgroundThere is limited engagement in healthcare with the kinds of proactive approaches to risk assessment used in other industries. Bowtie analysis (BTA) has previously been shown to have potential as...

Reconstructing the Symptomatic-Case Epidemic from COVID-19-Related Deaths in England: A Spatiotemporal Modelling Study

Background: The COVID-19 epidemic has differentially impacted communities across England, with regional variation in rates of confirmed cases, hospitalisations and deaths. Measurement of this burden changed substantially over the first months, as surveillance was expanded to accommodate the escalating epidemic. Laboratory confirmation was initially restricted to clinical need (“pillar 1”) before expanding to community-wide symptomatics (“pillar 2”). This study aimed to ascertain whether biases in case data resulting from varying testing coverage could be addressed by drawing inference from COVID-19-related deaths. Methods: We fit a Bayesian spatio-temporal model to weekly COVID-19-related deaths per local authority (LTLA) throughout the first wave (1 January - 30 June 2020), with respect to the local epidemic timing and the age, deprivation and ethnic composition of its population. We drew predictions averaging these sources of case-fatality variation, and back-translated according to a population case fatality ratio estimated under community-wide testing. Results: A model including temporally- and spatially-correlated random effects best accommodated the observed variation in mortality, after accounting for local population characteristics. Final predictions suggest a total of 276,219-420,491 cases over the first wave - an increase of 19-81% from the reported. Conclusions: Limitations in testing capacity biased the observed trajectory of COVID-19 cases throughout the first wave. Basing inference on COVID-19-related mortality and higher-coverage testing later in the time period, we could explore the extent of this bias more explicitly. Evidence points towards substantial under-representation of initial growth and peak magnitude of symptomatic infections nationally, to which different parts of the country contribute unequally.Funding Information: The following funding sources are acknowledged as providing funding for the named authors:This research was partly funded by the Bill & Melinda Gates Foundation (NTD Modelling Consortium OPP1184344: GFM; OPP1183986: ESN). Royal Society (Dorothy Hodgkin Fellowship: RL). Wellcome Trust (206250/Z/17/Z: TWR; 206471/Z/17/Z: OJB; 210758/Z/18/Z: SA). The following funding sources are acknowledged as providing funding for the working groupauthors:This research was partly funded by the Bill & Melinda Gates Foundation (INV-001754: MQ; INV-003174: JYL, KP, MJ, YL; INV-016832: SRP; NTD Modelling Consortium OPP1184344: CABP; OPP1139859: BJQ; OPP1191821: KO'R). BMGF (INV-016832; OPP1157270: KA). CADDE MR/S0195/1 & FAPESP 18/14389-0 (PM). EDCTP2 (RIA2020EF-2983-CSIGN: HPG). Elrha R2HC/UK FCDO/Wellcome Trust/This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (KvZ). ERC Starting Grant (#757699: MQ). ERC (SG 757688: CJVA, KEA). This project has received funding from the European Union's Horizon 2020 research and innovation programme - project EpiPose (101003688: AG, KP, MJ, RCB, WJE, YL). FCDO/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: CABP, KvZ). This research was partly funded by the Global Challenges Research Fund (GCRF) project 'RECAP' managed through RCUK and ESRC (ES/P010873/1: CIJ, TJ). HDR UK (MR/S003975/1: RME). HPRU (NIHR200908: NIB). Innovation Fund (01VSF18015: FK). MRC (MR/N013638/1: EF, NRW; MR/V027956/1: WW). Nakajima Foundation (AE). NIHR (16/136/46: BJQ; 16/137/109: BJQ, FYS, MJ, YL; 1R01AI141534-01A1: DH; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: TJ; NIHR200908: AJK, RME; NIHR200929: CVM, FGS, MJ, NGD; PR-OD-1017-20002: AR, WJE). Singapore Ministry of Health (RP). UK DHSC/UK Aid/NIHR (PR-OD-1017-20001: HPG). UK MRC (MC_PC_19065 - Covid 19: Understanding the dynamics and drivers of the COVID-19 epidemic using real-time outbreak analytics: NGD, RME, SC, TJ, WJE, YL; MR/P014658/1: GMK). Authors of this research receive funding from UK Public Health Rapid Support Team funded by the United Kingdom Department of Health and Social Care (TJ). UKRI Research England (NGD). UKRI (MR/V028456/1: YJ). Wellcome Trust (206250/Z/17/Z: AJK; 208812/Z/17/Z: SC, SFlasche; 210758/Z/18/Z: JDM, JH, SFunk, SRM; 221303/Z/20/Z: MK; UNS110424: FK). No funding (AMF, DCT, YWDC).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: Approval for the use of anonymised linelist data was granted by Public Health England and the Department for Health and Social Care. Consent of individuals was not required as no patient identifiable information was used.

PerFECT 2.0: A Web-Based Platform Designed to Facilitate and Support the Diagnosis of Patients with Idiopathic Pulmonary Fibrosis in Italy.

IntroductionTimely and accurate diagnosis of idiopathic pulmonary fibrosis (IPF) is challenging, requiring specific tests including chest high-resolution computed tomography (HRCT), and limited by access to specialist centres with a multidisciplinary team (MDT). Here we describe PerFECT 2.0, an Italian web-based platform designed to create a network between tertiary centres with an MDT (hubs) and secondary centres (spokes), aiming to facilitate the diagnosis of IPF.MethodsPerFECT 2.0 went live on 1 November 2016. Spoke centres submit anonymised documentation (HRCT images, pathological samples, clinical data) for a second opinion on the potential diagnosis of IPF from a hub centre. HRCT images are quickly uploaded, with patient-identifying information automatically removed. The hub centre views documentation online (no downloads allowed), makes any further information requests, then returns their second opinion as free text. An e-learning area contains educational material and simulated training clinical cases. Metrics were collected for 2017–2019; a user survey was conducted from 30 June–31 July 2020.ResultsTen hub centres and 137 spoke centres have registered. The requests for a second opinion numbered 251 in 2017, 270 in 2018 and 265 in 2019 (overall mean 19.9 requests per month). The proportion of requests answered was 100.0% (251) in 2017, 100.0% (270) in 2018 and 97.7% (259) in 2019. The mean response time was 15.7 days. In the user survey, of nine hub responders and 19 spoke responders, 78% and 74%, respectively, reported that the platform is easy to use, and 100% and 89%, respectively, would recommend the platform to colleagues.ConclusionThe PerFECT 2.0 web-based platform has created a network that enables secondary centres to gain quick and easy access to a second opinion from a tertiary centre with an MDT through online evaluation of anonymised documentation, thereby facilitating and supporting the timely and accurate diagnosis of IPF.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41030-021-00155-8.