Objective Smartphones have the ability to capture and send images, and their use has become common in the emergency setting for transmitting radiographic images with the intent to consult an off-site specialist. Our objective was to evaluate the reliability of smartphone-based instant messaging applications for the evaluation of various pediatric limb traumas, as compared with the standard method of viewing images of a workstation-based picture archiving and communication system (PACS). Methods X-ray images of 73 representative cases of pediatric limb trauma were captured and transmitted to 5 pediatric orthopedic surgeons by the Whatsapp instant messaging application on an iPhone 6 smartphone. Evaluators were asked to diagnose, classify, and determine the course of treatment for each case over their personal smartphones. Following a 4-week interval, revaluation was conducted using the PACS. Intraobserver agreement was calculated for overall agreement and per fracture site. Results The overall results indicate “near perfect agreement” between interpretations of the radiographs on smartphones compared with computer-based PACS, with κ of 0.84, 0.82, and 0.89 for diagnosis, classification, and treatment planning, respectively. Looking at the results per fracture site, we also found substantial to near perfect agreement. Conclusions Smartphone-based instant messaging applications are reliable for evaluation of a wide range of pediatric limb fractures. This method of obtaining an expert opinion from the off-site specialist is immediately accessible and inexpensive, making smartphones a powerful tool for doctors in the emergency department, primary care clinics, or remote medical centers, enabling timely and appropriate treatment for the injured child. This method is not a substitution for evaluation of the images in the standard method over computer-based PACS, which should be performed before final decision-making.
Study Design. A multicenter retrospective review of consecutive series of patients.Objective. Long-term experience with using the magnetically controlled growing rods (MCGR) to treat patients with deformity in the growing spine to the conclusion of treatment with posterior spine fusion. Summary of Background Data. MCGR treatment for growing spine gained popularity with paucity of long-term follow up data. We hypothesized that final fusion might be more effective in bringing additional correction of the spine deformity after treatment with MCGR than that reported after traditional growing rods (TGR) due to less scarring and auto-fusion. Methods. Retrospective review of 47 patients with varied etiology, treated between 2011 and 2017 which graduated treatment were followed in five academic medical centers for average of 50 months (range, 10-88).Results. The initial mean coronal deformity of 69.68 (95% CI 65-74) was corrected to 408 (95% CI 36-40) immediately after the MCGR implantation but progressed to 52.88 (95% CI 46-59) prior to the final surgery (P < 0.01). Nevertheless, thoracic spine growth (T1-T12 height) improved from 187.3 mm (95% CI [179][180][181][182][183][184][185][186][187][188][189][190][191][192][193][194][195] following index surgery to 208.9 mm (95% CI 199-218) prior to final fusion (P < 0.01). Significant correction and spinal length were obtained at final fusion, but metallosis was a frequent observation (47%, 22/47). The average growth rate was 0.5 mm/month (95% CI 0.3-0.6). The overall complication rate within our cohort was 66% (31/47) with 45% (21/47) of unplanned returns to the operating theater. 32% (15/47) of the patients had an implant related complication. Unplanned surgery was highly correlated with thoracic kyphosis greater than 408 . Conclusion. Treatment of growing spine deformities with MCGR provides adequate control of spine deformity it is comparable to previously published data about TGR. The overall high complications rate over time and specifically implant related complications.
Background: Previous studies provide increasing support for the impact of environmental factors on disease incidence and activity in multiple sclerosis (MS). Objectives: The purpose of this research was to assess the relationship between the incidence of MS relapses and weather conditions in Israel. Methods: Clinical data, including occurrence of relapses in 235 patients, during 3 consecutive years (2001–2003) were assessed against the general daily meteorological variables. Initially, the relationship between the relapses and their mode of distribution was evaluated. Second, the relationship between the number of relapses on a specific date and the meteorological variables was assessed. Third, the tendency to seasonality in the occurrence of relapses was examined. Results: No significant correlation was found between the number of relapses and a specific season, month or day. Moreover, no clear relationship was found between certain meteorological variables or a combination of variables and the frequency of the relapses. Conclusion: The meteorological parameters studied were not found to have a significant impact on the occurrence of relapses in this group of patients. These findings raise questions regarding the clinical significance of the impact of weather conditions, at least in the context of the Mediterranean climate, on the disease course of patients with MS.
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