Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
Vertebral Fracture Identification presented by Dr Andrew Pearson, Consultant Radiologist, Borders Hospital, Melrose at the fracture liaison service champions' summit 2016. #flschampions
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
Vertebral Fracture Identification presented by Dr Andrew Pearson, Consultant Radiologist, Borders Hospital, Melrose at the fracture liaison service champions' summit 2016. #flschampions
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
Sarcoma is one of the leading cancer centers in Washington DC providing the best musculoskeletal cancer surgery. Dr. Martin Malawer is a highly specialized surgeon who had pioneered in the field of limb-sparing surgery.
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Precision and follow up scans in bone densitometryRamin Sadeghi
The current presentation is a brief overview of precision and follow up scans in BMD with especial attention to least significant change and Z-score changes in children
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
Sarcoma is one of the leading cancer centers in Washington DC providing the best musculoskeletal cancer surgery. Dr. Martin Malawer is a highly specialized surgeon who had pioneered in the field of limb-sparing surgery.
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Precision and follow up scans in bone densitometryRamin Sadeghi
The current presentation is a brief overview of precision and follow up scans in BMD with especial attention to least significant change and Z-score changes in children
The SlideShare 101 is a quick start guide if you want to walk through the main features that the platform offers. This will keep getting updated as new features are launched.
The SlideShare 101 replaces the earlier "SlideShare Quick Tour".
How to Make Awesome SlideShares: Tips & TricksSlideShare
Turbocharge your online presence with SlideShare. We provide the best tips and tricks for succeeding on SlideShare. Get ideas for what to upload, tips for designing your deck and more.
Poster: Audit of Appropriateness for Brain Scan Use for Paediatric Headache a...Lyndon Woytuck
The purpose is to evaluate practice variation at the emergency department in comparison with best practice for brain imaging in children presenting with headache. The results of the study might be used to inform a clinical prediction rule in order to better stratify risk according to the American College of Radiology Appropriateness Criteria.
I created a poster for presentation and am currently working on a paper for publication in a scholarly journal.
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Background: The transition from resident physician to independent practitioner is an important period for young physicians.Optimally, they would feel well prepared to independently care for all patients presenting to them for anesthesia, however, this is unlikely Methods: A survey was emailed to all accredited anesthesiology residency program coordinators in April 2018 for further distribution to their CA3 residents. The survey collected data on the resident’s perception of his or her preparedness to manage a variety of anesthesia cases, patients with comorbid conditions, and ethical issues as well as perform various procedures.
Robotic spine surgery is on the cutting edge of medicine, allowing our surgeons to exercise an incredible level of precision, well beyond standard capabilities.
Presentation on Spinal Metastases Scorng system and Decision making
By
Dr.SHASHIDHAR B K
Bangalore Spine Specialist Clinic
www.spinesurgeonbangalore.com
drshashidharbk@gmail.com
Anatomia y fisiopatologia de la injuria asociada con la anestesia regional y ...Silvestre Degreéf
Antecedentes y Objetivos: En marzo de 2012, la Sociedad Americana De Anestesia Regional y Medicina del Dolor convocó su segunda Consulta de Práctica sobre Complicaciones Neurológicas en Anestesia Regional y Medicina del Dolor. Esta actualización se basa en los trabajos de esa conferencia y en la información pertinente publicada desde su celebración. Este artículo actualiza la información previamente descrita sobre la fisiopatología de la lesión de la médula espinal y añade nuevo material sobre la estenosis espinal, el control de la presión durante el bloqueo neuraxial, lesión neuraxial posterior secundario a procedimientos transforaminales, síndrome de cauda equina , neurotoxicidad por anestésico local y aracnoiditis.
Dr Alison Young, Consultant Medical Oncology, Leeds Teaching Hospitals Trust
Dr Andrew Stewart, Haematologist and Lead for Acute Oncology, University Hospitals of the North Midlands
Ceri Stubbs, Clinical Lead, Velindre NHS Trust
Dr Sinead Clarke, Macmillan GP Advisor, Clinical Director for Performance, IT, Finance, Cancer and End of Life, South Cheshire and Vale Royal CCGs, Medical Lead for Cheshire end of Life Partnership
Dr Jackie Dominey, GP and Macmillan GP Advisor, Clinical Lead End of Life, Solihull CCG
Palliative Care and Acute Oncology IntegrationRecoveryPackage
Dr Catherine O'Doherty, Consultant in Palliative Medicine, Trust Acute Oncology Lead and Lead Cancer Clinician, Basildon and Thurrock University Hospitals NHS Foundation Trust
Karen Andrews, Head of Nursing for Macmillan/Acute Oncology and EOL services, Basildon and Thurrock University Hospitals NHS Foundation Trust
Dr Ricky Fraser, Acute Oncology Fellow, South West Wales Cancer Centre
Joanne Upton, Skin Cancer Advanced Nurse Practitioner, The Clatterbridge Cancer Centre
Dr Ashling Lillis, National Director's Clinical Fellow Macmillan Support, final year trainee in Acute Oncology
Dr Clare Philliskirk, Trainee in Acute Medicine, West Midlands
Dr Sarbit Clare, Acute Medical Consultant, Sandwell and West Birmingham Hospitals
Dr Ashling Lillis, National Director's Clinical Fellow Macmillan Support, final year trainee in Acute Oncology
Dr Clare Philliskirk, Trainee in Acute Medicine, West Midlands
Dr Sarbit Clare, Acute Medical Consultant, Sandwell and West Birmingham Hospitals
Dr Chris Jenkins, Consultant Haematologist, University Hospital of the North Midlands
Dr Andrew Stewart, Consultant Haematologist, The Royal Gwent Hospital
Dr Andrew Stewart, Consultant Haematologist, The Royal Gwent Hospital
Dr Chris Jenkins, Consultant Haematologist, University Hospital of the North Midlands
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
#27 A General Practice Based Audit on Speed of Referral for MRI Spine in Suspected Spinal Metastasis
1. 1 Introduction and Aim
This aim of this audit was to research our current practice in adhering to
guidance in accordance with the NICE guideline: Metastatic Spinal Cord
Compression in Adults (CG75 November 2008).
The audit standard was that all cases of suspected spinal metastasis (SM)
should be referred and have received an MRI whole spine within 7 days of
presentation (The other key recommendation of the guideline
recommends that in suspected spinal cord compression MSCC/cauda
equina syndrome the MRI should be arranged as an emergency within 24
hours. The assumption was made that most clinicians across all specialties
would recognise and act on these suspected cases in the time suggested,
so was this was not the standard I chose to investigate).
In England and Wales, it has been estimated that there are around 4000
cases of MSCC per year. By that rationale, the same group of patients, and
perhaps a much higher number, are at risk of spinal metastasis(SM)
without cord compression.
It has also been estimated that around 50% of these cases will have a
current or previous history of malignancy of the Breast, Lung, Prostate or
Myeloma.
This audit will focus on these main 4 primary malignancies, however it
should be noted that SM and MSCC should be considered in all patients
with a history of current or previous cancer with signs and symptoms that
are suggestive.
3 Results
83 patient contacts
77 patients fulfilled the criteria (6 excluded as sciatica, abdominal pain, SIJ pain).
35 of the 77 were examined
26 were referred for an MRI
i. 0 of these were for a whole spine MRI
ii. 16 had an MRI
iii. 11 had an XR
iv. 2 had a NMR Bone Scan
v. 2 had a DEXA
4 Discussion
The results show very poor awareness of the recommendation for whole spine MRI within 1 week for
suspected SM.
Not only does it appear that as GP’s we are not aware of the need for whole spine MRI and the necessary
speed for referral for this investigation, we are also referring inappropriately for other investigations.
The potential reasons for the delay in MRI could be:
1. Lack of awareness of the guideline recommendations i.e. Doctors educational need (DEN).
2. Lack of information on the referral for MRI, i.e. is previous cancer history documented on the referral
which could aid the radiologist to triage.
3. Accessibility and ease and (? cost) of other investigations may lead to inappropriate referral for XR,
Bone Scan.
On consulting the Royal College of Radiologists web based guidelines ‘i-refer’, it was noted that MRI is the
only investigation that is sensitive and specific for a skeletal spinal metastasis.
The guidance states that XR is very non-specific and non-sensitive for skeletal metastasis, and NMR Bone
Scan is sensitive but not specific and will need further evaluation with and MRI id the results are
suggestive of skeletal metastasis.
2 Method
The audit was based on searches on EMIS, the practice records computer
system at Laurel House Surgery.
Laurel House Surgery is based in Tamworth, a large market town in
Staffordshire. The practice has around 13,000 registered patients with an
average age of 39.
Searches were initially based on the read codes ‘Metastatic Spinal Cord
Compression’ and ‘Spinal Metastasis’ and Cancer of the Lung, Breast,
Prostate or Myeloma from the present back to November 2008. This
revealed only 1 patient, so search terms were expanded to include ‘MRI
Spine’ and ‘Back Pain’ for the same time period in the same group of
patients .This revealed 20 and 56 patients respectively.
A potential total of 77 patient had been identified, although at the time
of the searches it was noted that some cases will be excluded based on
not fulfilling the criteria for the audit or having alternative
diagnosis/reasons for the MRI/back pain.
The individual patient records were then analysed for details in the
history and examination, reasoning and choice of investigation, and
positive findings were noted that would meet the criteria for Spinal
Metastasis (NICE2008), these criteria are:
a) Pain in the thoracic or cervical spine
b) Progressive Lumbar spinal pain
c) Severe or unremitting lumbar spinal pain
d) Spinal pain worsened by straining, coughing or sneezing
e) Localised spinal tenderness
f) Nocturnal spinal pain that interrupts sleep
Using anonymised data, the following results were compiled:
a) Total number of patient contacts
b) Total number of patient contacts that fulfilled criteria for SM (NICE
2008) within the history
c) How many of these patients were examined
d) Of those examined , how many fulfilled criteria (NICE 2008) for MRI
within 1 week
e) Of those that met this criteria , how many were referred for
I. Whole Spine MRI
II. MRI
III. Alternative investigation i.e. XR, CT, Bone Scan, DEXA)
f) How long did those that were referred for an MRI wait before scan
result was available.
5 Conclusion
We do not appear as a practice to follow NICE 2008-MSCC in cases of SM.
I suspect that as our practice comprises skilled and dedicated professionals, that we are not unique in these
findings. I aim to present this audit to the medical team at our next protected learning time.
This audit could then be redone in a designated future time period to reassess and complete the cycle of
change and hopefully to show quality improvement, and to promote good practice.
A General Practice Based Audit on Speed of Referral for MRI Spine in Suspected Spinal Metastasis
Dr Angela Timms MRCGP
6 Credits
Author: Dr. Angela Timms General Practitioner MBBS MRCGP Laurel House Surgery, Tamworth, Staffordshire. (No conflicts of interest or affiliations)
Contributors: Mrs W.Roe Practice Manager (data searches) Dr Glennie General Practitioner (data searches and discussion) Mr P.Bannister (technical support)
References: NICE Metastatic Spinal Cord Compression in Adults CG75 Nov.2008
i-refer guidelines RCR website.
0
10
20
30
40
50
60
70
80
No.PatientContacts
Fulfilled criteria in history for MRI
Received examination of spine
Fulfilled examination criteria an MRI whole spine
Triggered referral for investigation
Triggered referral MRI spine
Triggered referal for MRI whole spine
0 10 20 30 40 50 60 70 80 90 100 110 120
1 7 21 56 112
1 7 7 7 7 7 11 14 28 28 42 56 56 56 84 112
Q1 =7 Median = 21 Q3 = 56
Fig 2 – Distribution in days for speed of referral for MRI spine in presentation of suspected spinal
metastasis (SM)
Fig 3 – Data set (days)
Fig 1 – Adherence to NICE Metastasis Spinal Cord Compression with patients who present with
symptoms and/or signs of spiral metastasis (SM)