A Feasibility Pilot Study on the Use of Telemedicine for the Examination of the Knee Joint

Author(s):  
Sebastian Scheidt ◽  
Michael Kehrer ◽  
Max Jaenisch ◽  
Hans Goost ◽  
Dieter Christian Wirtz ◽  
...  

Abstract Background In times of a pandemic threat, such as COVID-19, and the need for reduced direct doctor-patient contact, internet-based telemedicine has attracted more and more attention as a surrogate service. Suspending the diagnosis and treatment of non-virus related diseases for longer periods of time is not a viable option since this would only exacerbate problems on the patient and national level. The need for alternative treatment modalities increased rather quickly. So far, telemedical applications have mainly focused on teleradiological diagnosis, follow-up and monitoring of psychiatric and internal diseases, as well as geriatric patient care. As far as these authors are aware, orthopaedic physical examination of the knee joint, including trauma work-up, has not been the subject of any studies to date. This feasibility study explores how video consultation can be designed and implemented in the context of history taking and physical examination in knee joint complaints. Material and Method 21 patient actors (PA) with simulated complaints of the knee joint were examined individually for each diagnosis, first via video consultation and then directly by a specialist (SP). One PA group has a medical background, the other was made up of laypersons. The time was measured for both types of consultation. The physician documented the detected symptoms, the quality of implementation of the self-examination steps, and the derived diagnosis on an assessment form. After completion of both consultation sessions, the PAs were handed a questionnaire on the respective examination modality. Results With the video consultation the examination lasted 8.63 (± 2.5) minutes on average and with the regular consultation in person 5.63 (± 1.7) minutes (p < 0.001). For the group with medical background the examination lasted 7.67 (± 1.4) minutes on average, while for the lay group the video consultation took 9.7 (± 3.1) minutes (p = 0.049). With increased age, the video consultation was prolonged (p = 0.032; r = 0.47). The mean value for self-examination of leg axis, gait pattern and degrees of freedom was 9.32 (± 0.4) of 10 points. The following functional tests resulted in lower mean values (points): Payr 7.2 (± 2.3), Merke 5.9 (± 2.8), no-touch Lachmann 6.4 (± 2.7), gravity sign-recurvatum 6.7 (± 2.4). The mean grade by the PAs for the feasibility of self-examination was 2.43 (± 0.98) out of 5 points. Conclusion The video consultation for musculoskeletal complaints of the knee joint allows exploratory remote examination and helps to minimise the number of patients in hospitals and practices. It takes longer for the physician to perform and does not permit functional testing for ligament injuries of the knee joint. In its present form, telemedical examination is not able to fully replace personal consultation.

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985377 ◽  
Author(s):  
Felix Kurt Massen ◽  
Cyril Raphael Inauen ◽  
Laurent Pascale Harder ◽  
Armin Runer ◽  
Stefan Preiss ◽  
...  

Background:Chondral and osteochondral lesions are being detected with increasing frequency. For large-diameter lesions, cell-based treatment modalities are speculated to result in the best possible outcome.Purpose:To prospectively evaluate the 2-year clinical and radiological results after the treatment of chondral and osteochondral knee joint lesions by a single-step autologous minced cartilage procedure.Study Design:Case series; Level of evidence, 4.Methods:From February 2015 to June 2016, a total of 27 consecutive patients suffering from chondral or osteochondral lesions of the knee joint were treated using a single-step autologous minced cartilage procedure. All patients underwent preoperative and postoperative magnetic resonance imaging for the collection of AMADEUS (Area Measurement and Depth and Underlying Structures) and MOCART (magnetic resonance observation of cartilage repair tissue) scores. Clinical analysis was conducted by a numeric analog scale (NAS) for pain and knee function before the intervention and at 12 and 24 months postoperatively.Results:A total of 12 female and 15 male patients (mean age, 28.7 years) were evaluated for a mean of 28.2 ± 3.8 months. The mean cartilage defect size encountered intraoperatively was 3.1 ± 1.6 cm2. There was a significant decrease in pain from 7.2 ± 1.9 preoperatively to 1.8 ± 1.6 ( P < .001) at 2-year follow-up. Knee function improved from a mean of 7.2 ± 2.0 preoperatively to 2.1 ± 2.3 ( P < .001) at 2 years after surgery. The mean preoperative AMADEUS score was 57.4 ± 21.4. Postoperatively, the mean MOCART score was 40.6 ± 21.1 at 6-month follow-up. No correlation was observed between the clinical data and the MOCART or AMADEUS scores.Conclusion:Overall, the findings of this study demonstrated that patients undergoing a single-step autologous minced cartilage procedure had a satisfactory outcome at 2-year follow-up. As a result, the single-step autologous minced cartilage procedure does represent a possible alternative to standard autologous chondrocyte implantation. Longer follow-up and larger cohorts are required to define the benefits of this procedure.


2021 ◽  
pp. 12-15
Author(s):  
Puneet H Chamakeri ◽  
Shailesh V Udapudi ◽  
Sameer Haveri ◽  
Anmol Rs Mittal

Background: Dislocation of the knee joint is one of the most under-reported orthopaedic emergencies due to its ability to undergo spontaneous reduction. It carries a high risk of involving the popliteal artery and peroneal nerve both acutely, or in the long term. Due to this catastrophic potential of the condition, it has been well established that it warrants prompt diagnosis and management. It may be secondary to ultra-low, low or high velocity trauma which makes every dislocation case unique due to involvement of different joint structures, capsule or fractures of the articulating bones. A broad spectrum of treatment modalities (both conservative and surgical) has been documented for this condition, with the latter showing better results across most studies. In developing countries like India, the nancial chasm is relatively bigger with a major chunk of the population unable to bear the cost of complete surgical management. Objective: To assess the functional outcome in patients with frank knee dislocations with multiligamentous injuries and vascular decit treated by a middle path regimen of an extended period of external xator and immobilization. Method: A prospective study was undertaken from January 2018 to July 2020 involving 10 patients with knee joint dislocations with vascular decit and multiligamentous injury, treated by an extended period of external xator application and immobilization. Fasciotomy was done wherever needed, in association with split thickness skin grafting. The assessments were made using Lysholm knee scoring scale (LKSS), International Knee Documentation Committee Scores (IKDC), range of motion (ROM), antero- posterior tibial translation (AP translation) and overall patient satisfaction on every follow-up. Results: The mean LKSS score was 78.3±6.23, mean IKDC score was 68.17±5.34, mean ROM progressively increased to 135.8⁰ with a mean extension lag of 2.2⁰, while the mean AP tibial translation was noted to be 9.16 mm. No poor result or complication was reported. Conclusion: The middle path regimen provides an affordable alternative for providing a stable knee to patients who are ill-affording and are expected to have a sedentary lifestyle, without indulging into rigorous activities


2017 ◽  
Vol 78 (06) ◽  
pp. 529-534 ◽  
Author(s):  
Hyeun Kim ◽  
Sung Chung ◽  
Jee Jang ◽  
Seong Oh ◽  
Il Jang ◽  
...  

Background Diskogenic back pain is an unsolved mystery and accounts for a large number of patients with chronic low back pain. Various treatment modalities have been described, but treatment is still a matter of debate. We evaluated transforaminal epiduroscopic laser ablation (TELA) focusing on sinuvertebral nerve laser ablation for chronic diskogenic back pain. To our knowledge this is the first treatment described for diskogenic back pain that directly targets the sensitized sinuvertebral nerve extradiskally through a transforaminal approach. Methods A total of 52 patients with a diagnosis of chronic diskogenic back pain and treated with TELA between September 2015 and June 2016 were analyzed. Outcome was measured with the visual analog scale (VAS), Macnab criteria, and Oswestry Disability Index (ODI). Results Of the 52 patients, 55.8% were female, and the mean age was 42.40 ± 11.99 years. Pfirrmann disk degeneration grade was mostly grade IV (63.5%) and involved spinal levels L4–L5 and L5–S1. The average follow-up period was 15.88 ± 1.79 months. VAS decreased significantly after TELA (p < 0.001). Improvement in ODI was also significant (p < 0.001). Good to excellent outcome was 96.1% according to the Macnab criteria. Four patients had transient motor weakness. Conclusion TELA targeting to the sinuvertebral nerve was effective in 96.1% with good to excellent results and an immediate decrease in chronic diskogenic back pain. The sinuvertebral nerve may play an important role in chronic diskogenic back pain.


2011 ◽  
Vol 17 (6) ◽  
pp. E131-E137 ◽  
Author(s):  
Munira Borhany ◽  
Tahir Shamsi ◽  
Arshi Naz ◽  
Asif Khan ◽  
Kousar Parveen ◽  
...  

Objective: To determine the frequency of inherited bleeding disorders, its complications, and treatment modalities available for its treatment. Design: Cross-sectional study. Patients and Methods: Patients with a history of bleeding tendency were tested for confirmation of the diagnosis. History and clinical findings were recorded. Laboratory analysis included prothrombin time (PT), activated partial thromboplastin time (APTT), bleeding time (BT), and fibrinogen assay. Patients with prolonged APTT were tested for factors VIII (FVIII) and IX (FIX). If FVIII was low, von Willebrand factor: antigen (vWF:Ag) and von Willebrand factor:ristocetin cofactor (vWF:RCo) were performed. When PT and APTT both were prolonged, FV, FX, and FII were tested. Platelet aggregation studies were done when there was isolated prolonged BT. Urea clot solubility test was done when all coagulation tests were normal. All patients with hemophilia A and B were evaluated for inhibitors. Results: Of the 376 patients, inherited bleeding disorder was diagnosed in 318 (85%) cases. Median age of patients was 16.4years. Hemophilia A was the commonest inherited bleeding disorder that was observed in 140 (37.2%) followed by vWD 68 (18.0%), platelet function disorders 48 (12.8%), and hemophilia B in 33 (8.8%) cases. We also found rare congenital factor deficiencies in 13 (3.4%), low VWF in 11 (3.0%) participants and 5 (1.3%) in female hemophilia carriers. Hemarthrosis was the most frequent symptom in hemophilia A and B (79.7%) involving knee joint. Inhibitor was detected in 21 (15%) cases. Fresh frozen plasma/cryoprecipitate were the most common modality of treatment. In 58 patients, no abnormality was detected in coagulation profile. Conclusion: Hemophilia A and vWD are the most common congenital bleeding disorders in this study. Hemarthrosis involving knee joint was the most common complication. Inhibitor was detected in a significant number of patients. Plasma is still the most common modality of treatment.


1981 ◽  
Vol 20 (03) ◽  
pp. 163-168 ◽  
Author(s):  
G. Llndberg

A system for probabilistic diagnosis of jaundice has been used for studying the effects of taking into account the unreliability of diagnostic data caused by observer variation. Fourteen features from history and physical examination were studied. Bayes’ theorem was used for calculating the probabilities of a patient’s belonging to each of four diagnostic categories.The construction sample consisted of 61 patients. An equal number of patients were tested in the evaluation sample. Observer variation on the fourteen features had been assessed in two previous studies. The use of kappa-statistics for measuring observer variation allowed the construction of a probability transition matrix for each feature. Diagnostic probabilities could then be calculated with and without the inclusion of weights for observer variation. Tests of system performance revealed that discriminatory power remained unchanged. However, the predictions rendered by the variation-weighted system were diffident. It is concluded that taking observer variation into account may weaken the sharpness of probabilistic diagnosis but it may also help to explain the value of probabilistic diagnosis in future applications.


2019 ◽  
Vol 11 (1) ◽  
pp. 9-18
Author(s):  
Abdul Wakhid ◽  
Ana Puji Astuti ◽  
Maya Kurnia Dewi

Logoterapi merupakan terapi untuk menemukan makna positif dibalik sebuah kejadian yang tidak diharapkan. Logoterapi dilaksanakan secara individu maupun berkelompok dalam bentuk konseling dan berorientasi pada pencarian makna hidup individu. Tujuan logoterapi meningkatkan makna pengalaman hidup individu yang diarahkan kepada pengambilan keputusan yang bertanggung jawab. Penelitian ini dilakukan dengan menggunakan rancangan pre-experiment dengan metode pre and post test group, artinya pengumpulan data dilakukan terhadap responden untuk membandingkan kualitas hidup sebelum dan sesudah dilakukan intervensi. Teknik pengambilan sampel dilakukan dengan metode total sampling yaitu pengambilan seluruh sampel dengan tetap memperhatikan kriteria yang telah ditetapkan. Jumlah pasien yang menjalani hemodialisis di RSUD Ungaran sebanyak 21 orang dan di RSUD Ambarawa sebanyak 25 pasien. Analisis data dilakukan dengan menggunakan uji t test dependent. Hasil penelitian didapatkan bahwa dari 46 responden didapatkan rata-rata skor kualitas hidup pasien yang mejalani hemodialisis sebesar 60.22 dengan skor terrendah 55 dan skor tertinggi 69. Bahwa dari 46 responden didapatkan rata-rata skor kualitas hidup pasien yang mejalani hemodialisis sebesar 88.72 dengan skor terrendah 79 dan skor tertinggi 103. Hasil uji statistik dengan uji t test dependent diketahui ada pengaruh logoterapi terhadap kemampuan memaknai hidup pada klien yang menjalani hemodialisis di RSUD Kabupaten Semarang (p value: 0,0001). Saran perlunya peningkatan kemampuan perawat dalam memberikan layanan kesehatan termasuk pemberian atau pemanduan penemuan makna hidup bagi pasien hemodialysis, agar selain dengan hemodialysis, ada faktor internal dari pasien yang dapat dijadikan sebagai motivasi untuk sembuh dari penyakit.   Kata Kunci: Logoterapi, kualitas hidup   IMPROVE THE QUALITY OF LIFE OF PATIENTS WITH RENAL FAILURE WHO UNDERWENT HEMODIALYSIS   ABSTRACT Logotherapy is a therapy to discover the positive meaning behind an unexpected event. Logotherapy is carried out individually or in groups in the form of counseling and oriented to the search for the meaning of individual life. This study aims to improve the quality of life of patients with renal failure who underwent hemodialysis. This research was conducted by using pre-experiment with pre-post test study. The sampling technique was done by the convenience sampling. The number of patients undergoing hemodialysis as many as 46 respondents. Data analysis was done by using test t test dependent. The result showed that from 46 respondents got the mean of quality of life of patients who had hemodialysis 60.22 with lowest score 55 and highest score 69. Whereas from 46 respondents got the mean score of life quality of patients who had hemodialysis 88.72 with score the lowest score 79 and the highest score 103. The result of statistical test with t test dependent is known there is influence of logoterapi to the ability of meaningful life on client who undergo hemodialysis at Semarang Regency hospitals (p value: 0.0001). Advice on the need to improve the nurse's ability to provide health services, including the provision or guidance of the discovery of the meaning of life for hemodialysis patients, in addition to hemodialysis, there are internal factors of the patient that can be used as a motivation to recover from illness.   Keywords: Logotherapy, quality of life, kidney failure.  


2009 ◽  
Vol 5 (2) ◽  
pp. 81 ◽  
Author(s):  
Martijn WA van Geldorp ◽  
Johanna JM Takkenberg ◽  
Ad JJC Bogers ◽  
A Pieter Kappetein ◽  
◽  
...  

Over the next few decades the number of patients diagnosed with aortic stenosis is expected to rise as the population ages and the use of several diagnostic tools expands. This will result in a growing need for both medical and surgical treatment and stimulate the development of new diagnostic and surgical techniques. This article briefly describes the prevalence, pathogenesis and clinical presentation of patients with aortic stenosis and focuses on developments in diagnostic tools, treatment strategies and treatment modalities: the use of echocardiography, tissue Doppler imaging, stress testing and biomarkers is discussed, as well as timing of surgery and the role microsimulation can play in prosthesis selection. Furthermore, newly developed transcatheter valve implantation techniques and their possible role in treating ‘inoperable’ or ‘elderly’ patients are discussed.


2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 9-20 ◽  
Author(s):  
Hung-Chuan Pan ◽  
Ming-Hsi Sun ◽  
Jason Sheehan ◽  
Meei-Ling Sheu ◽  
Clayton Chi-Chang Chen ◽  
...  

Object In the modern era, stereotactic radiosurgery is an important part of the multidisciplinary and multimodality approach used to treat dural carotid-cavernous fistulas (DCCFs). Based on the ease of performance of techniques to fuse cerebral angiography studies with MR images or CT scans during the radiosurgical procedure, the Gamma Knife and XKnife are 2 of the most popular radiosurgical instruments for patients with DCCF. In this study, the authors compared the efficacy, neurological results, and complications associated with these 2 radiosurgical devices when used for DCCF. Methods Records for 41 patients with DCCF (15 treated using the XKnife and 26 with Gamma Knife surgery [GKS]) were retrieved from a radiosurgical database encompassing the period of September 2000 to August 2008. Among these patients, at least 2 consecutive MR imaging or MR angiography studies obtained after radiosurgery were available for determining radiological outcome of the fistula. All patients received regular follow-up to evaluate the neurological and ophthalmological function at an interval of 1–3 months. The symptomatology, obliteration rate, radiation dose, instrument accuracy, and adverse effects were determined for each group and compared between 2 groups. The data were analyzed using the Student t-test. Results The mean age of the patients was 63 ± 2.6 years, and the mean follow-up period was 63.1 ± 4.4 months (mean ± SD). Thirty-seven patients (90%) achieved an obliteration of the DCCF (93% in the XKnife cohort and 88% for the GKS cohort). In 34 of 40 patients (85%) with chemosis and proptosis of the eyes, these symptoms were resolved after treatment (4 had residual fistula and 2 had arterializations of sclera). All 5 patients with high intraocular pressure demonstrated clinical improvement. Ten (71%) of 14 patients with cranial nerve palsy demonstrated improvement following radiosurgery. Significant discrepancies of treatment modalities existed between the XKnife and GKS groups, such as radiation volume, conformity index, number of isocenters, instrument accuracy, peripheral isodose line, and maximum dosage. The XKnife delivered significantly higher radiation dosage to the lens, optic nerve, optic chiasm, bilateral temporal lobe, and brainstem. Few adverse events occurred, but included 1 patient with optic neuritis (GKS group), 1 intracranial hemorrhage (XKnife group), 1 brainstem edema (XKnife), and 3 temporal lobe radiation edemas (XKnife). Conclusions Radiosurgery affords a substantial chance of radiological and clinical improvement in patients with DCCFs. The Gamma Knife and XKnife demonstrated similar efficacy in the obliteration of DCCFs. However, a slightly higher incidence of complications occurred in the XKnife group.


2021 ◽  
pp. 112067212110237
Author(s):  
Ilkay Kilic Muftuoglu ◽  
Ecem Onder Tokuc ◽  
V Levent Karabas

Purpose: To report outcomes of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) stuffing technique in patients with optic disc pit associated maculopathy (ODP-M). Methods: Data including best-corrected visual acuity (BCVA), central macular thickness (CMT), foveal center point thickness (FCP), and maximum height of fluid (max_fluid) (intraretinal or subretinal) were collected from the medical records of the patients. Results: Six eyes of six patients with a mean age of 28.0 ± 17.68 years (range: 9–53 year) underwent PPV + ILM plug surgery. The mean follow-up duration was 25.62 ± 26.11 months (range: 11.80–78.00 month) duration. The mean BCVA increased from 1.25 ± 1.04 logMAR (20/355, Snellen equivalent) to 0.86 ± 1.09 logMAR (20/144, Snellen equivalent) at last follow-up ( p = 0.043). Compared to baseline, CMT, FCP, and max_fluid significantly decreased at all visits after the surgery ( p < 0.05 for all visits). At last follow-up, 66.6% of the eyes (four eyes) showed complete resolution of fluid at a mean of 5.25 ± 4.99 months (range: 1–12 months) after the surgery. Conclusion: PPV with ILM plug seemed to be an effective surgical technique in ODP-M. Studies with longer follow-up and higher number of patients are needed to confirm our results.


Biology ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 239
Author(s):  
Tomasz Milecki ◽  
Natalia Majchrzak ◽  
Adam Balcerek ◽  
Maciej Rembisz ◽  
Michał Kasperczak ◽  
...  

Introduction: Epidemiological data indicate an increased incidence of testicular cancer (TC), making it the most common malignant tumor in men from aged 15–45. Oncological and urological associations recommend that men with specific TC risk factors should regularly perform a testicular self-exam (TSE). The aim of the study was to discover the attitudes among Polish males regarding TSE and factors (environmental, social, educational) that affect intention to perform TSE. Methods: An original survey containing 21 questions was used to conduct a study among the Polish branch of VW (Volkswagen Poland) employees. Results: A total of 522 fully completed questionnaires were collected. The mean age of the surveyed respondents was 32 years. Information about TC and how to perform TSE was obtained by 34.4% (n = 185) of the men. It was shown that the following factors increase men’s intention to perform TSE: TC in their family member (p < 0.05; HR = 5.9; 95% Cl: 1.5–23.0), GP’s(General Practitioner) recommendations (p < 0.001; HR = 6.8; 95% Cl: 3.2–14.3), concern expressed by their partner (p < 0.001; HR = 3.3; 95% Cl: 2.1–5.3), and social campaigns (p < 0.001; HR = 2.6; 95% Cl: 1.5–4.6). Conclusions: Approximately half of young polish males do not perform TSE. Access to information on TC prevention is limited. Further action is needed to improve men’s awareness of TC and TSE.


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