Participatory evaluation of the process of co-producing resources for the public on data science and artificial intelligence.

BACKGROUND: The growth of data science and artificial intelligence offers novel healthcare applications and research possibilities. Patients should be able to make informed choices about using healthcare. Therefore, they must be provided with lay information about new technology. A team consisting of academic researchers, health professionals, and public contributors collaboratively co-designed and co-developed the new resource offering that information. In this paper, we evaluate this novel approach to co-production. METHODS: We used participatory evaluation to understand the co-production process. This consisted of creative approaches and reflexivity over three stages. Firstly, everyone had an opportunity to participate in three online training sessions. The first one focused on the aims of evaluation, the second on photovoice (that included practical training on using photos as metaphors), and the third on being reflective (recognising one's biases and perspectives during analysis). During the second stage, using photovoice, everyone took photos that symbolised their experiences of being involved in the project. This included a session with a professional photographer. At the last stage, we met in person and, using data collected from photovoice, built the mandala as a representation of a joint experience of the project. This stage was supported by professional artists who summarised the mandala in the illustration. RESULTS: The mandala is the artistic presentation of the findings from the evaluation. It is a shared journey between everyone involved. We divided it into six related layers. Starting from inside layers present the following experiences (1) public contributors had space to build confidence in a new topic, (2) relationships between individuals and within the project, (3) working remotely during the COVID-19 pandemic, (4) motivation that influenced people to become involved in this particular piece of work, (5) requirements that co-production needs to be inclusive and accessible to everyone, (6) expectations towards data science and artificial intelligence that researchers should follow to establish public support. CONCLUSIONS: The participatory evaluation suggests that co-production around data science and artificial intelligence can be a meaningful process that is co-owned by everyone involved.

Modern technology offers new treatment options for patients and novel avenues of research. However, there is limited available information in easily understandable language for the public explaining how technology relates to them and could influence their healthcare. The researchers, healthcare professionals and public members worked together collaboratively to address this problem by creating new materials for the public. Our paper explores that project through creative methods. Firstly, everyone involved was offered an opportunity to attend training sessions. Then, people took photos and described them to illustrate to others what is their experience of working together. Finally, we all met to use included photos as building blocks to present a shared experience in the project. Afterwards, the professional artist included it as one circular illustration with six interlinked layers. These layers present everyone's experiences (from inside) (1) is about the opportunity to build confidence in a new topic, (2) relationships with others, (3) working remotely during the pandemic, (4) motivation that influenced people to become involved in this particular piece of work, (5) expectation that the project needs be inclusive and accessible, (6) ethical principles that researchers using new technology should follow. We showed that it is possible for researchers, healthcare professionals and members of the public to feel joint ownership of the project and that working together can be meaningful to everyone.

A Daily Diagnostic Multidisciplinary Meeting to Reduce Time to Definitive Diagnosis in the Context of Primary Bone and Soft Tissue Sarcoma.

BACKGROUND AND OBJECTIVES: Cancer services are under increasing pressure to deliver waiting time targets. Our service has seen referral numbers increase to over 3000 per annum, with more than 80% coming from secondary care. In order to deliver a responsive service, the department has introduced a daily diagnostic multidisciplinary meeting (DMDT) with the aim being stratification of resources by directing rapid access to clinics and diagnostics to those felt to be at greatest risk of malignancy at the start of the pathway. It also aimed to improve communication with patients and referrers, consistency in decision making and deliver improved diagnostic turn-around times in a sustainable manner. An evaluation was undertaken to assess whether the introduction of the DMDT has improved the pathway, the primary endpoint being a reduction in time to definitive diagnosis (TTDD). Secondary endpoints included measurements of efficiency and whether there has been a reduction in variation in practice. METHODS: Retrospective access to a prospective database over a 1-month period before (2015) and after (2018) the intervention. RESULTS: The introduction of the DMDT has led to a reduction in TTDD (7 days). The service also has an added benefit in reducing average total patient miles travelled over the course of diagnosis by 22.68 miles. CONCLUSION: The introduction of a diagnostic MDT at the start of the pathway does lead to an improvement in service efficiency and a reduction in TTDD.

Secondary chondrosarcoma arising from osteochondroma: outcomes and prognostic factors.

AIMS: The aim of this study was to report the outcomes of patients who underwent definitive surgery for secondary chondrosarcomas arising from osteochondromas. PATIENTS AND METHODS: A total of 51 patients with secondary chondrosarcomas occurring from osteochondromas were reviewed. Median age was 36 years (interquartile range (IQR) 15 to 82). Median follow-up was 6.9 years (IQR 2.8 to 10.6). The pelvis was the most commonly affected site (59%). Histological grades were grade I in 35 (69%), grade II in 13 (25%), and grade III in three patients (6%). RESULTS: Preoperative biopsy histology correctly predicted the final histological grade in 27% of patients. The ten-year disease-specific survival (DSS) for all patients was 89.4%. Local recurrence occurred in 15 patients (29%), more commonly in pelvic tumours (37%) compared with limb tumours (19%). Four patients with pelvic tumours died from progression of local recurrence. No patient with limb tumours died of disease. Wide/radical margin was associated with improved local recurrence-free survival (p = 0.032) and local recurrence was associated with worse DSS (p = 0.005). CONCLUSION: We recommend that a secondary chondrosarcoma arising from osteochondroma of the pelvis is resected with wide/radical resection margins. The balance between the morbidity of surgery and risk of local recurrence needs to be considered in patients with limb secondary chondrosarcomas. Cite this article: Bone Joint J 2019;101-B:1313-1320.

Humeral Simple Bone Cysts: Observational Versus Interventional Management.

AIMS: Our study aims to review the outcomes of conservative and interventional management of simple bone cysts (SBC) in the humerus. METHODS: We retrospectively reviewed our center's prospectively collected database. All patients with a diagnosis of a humeral SBC and a minimum of 1-year follow-up or complete healing and discharge within the first year were included. Cyst radiographic measurements were collected for all patients with available radiographs. A successful outcome included fully or partially healed cysts with persistent and recurrent cysts marked as unsuccessful. RESULTS: In total, 91 patients were included in the study. Within the observational group, 44 patients (95.7%) achieved a successful outcome versus 38 patients (84.4%) in the interventional group. The 15/61 (25%) patients who were treated with observation at presentation required intervention at a later stage. The 9/30 (30%) of patients who had intervention at presentation required further additional intervention. Seven patients (11%) presenting with a fracture through a SBC went on to complete consolidation of the cystic lesion following the injury at a mean of 92.9 days (maximum, 176 d). CONCLUSIONS: We observed similar outcomes with conservative and interventional management in our retrospective series. We recommend observational management when a radiologic diagnosis is possible with intervention reserved for cases of diagnostic uncertainty and intrusive symptoms. LEVEL OF EVIDENCE: Level III-a retrospective case comparison study.

Patient factors affecting the Toronto extremity salvage score following limb salvage surgery for bone and soft tissue tumors.

BACKGROUND AND OBJECTIVES: The Toronto extremity salvage score (TESS) assesses physical function following limb salvage for bone and soft tissue sarcoma. In 2012, Clayer et al. showed increasing age affects the TESS score in normal individuals. The purpose of this study was to investigate what other patient factors affect outcome? METHODS: We reviewed the TESS scores, age, sex, BMI, diagnosis, smoking status, and social deprivation score of patients who have undergone limb salvage in our unit. Data were extracted from our tumor database and reviewed. Statistical analysis was performed using Wilcoxon pairwise test and linear regression analysis. RESULTS: Four hundred and ninety-eight TESS scores were found for 198 patients. Data were analyzed separating upper limb (UL) and lower limb (LL) tumors. In the UL group, being female (P = 0.01) and having a bone lesion (P < 0.001) were associated with a lower TESS score. In the LL group, being female (P = 0.04), increasing age (P = 0.002), having a bone lesion (P < 0.001), increasing BMI (P < 0.001), and smoking (P = 0.005) were associated with a lower TESS score. CONCLUSIONS: Analysis has shown that female sex, increasing age and BMI, smoking and having a bone lesion have an adverse effect on physical function following limb salvage, as indicated by the mean TESS score. J. Surg. Oncol. 2016;113:804-810. © 2016 Wiley Periodicals, Inc.

The treatment of periarticular soft tissue sarcoma following neo-adjuvant radiotherapy: a cohort study.

BACKGROUND: Optimising post-operative joint function is challenging when treating periarticular soft tissue sarcoma (STS). Radiotherapy reduces local recurrence rates but periarticular fibrosis may adversely affect joint function. Neo-adjuvant radiotherapy requires lower doses and smaller treatment volumes and therefore has potential benefits for the management of periarticular STS, but has previously been shown to be associated with an increased risk of post-operative wound complications. This study assesses initial outcome and complications after treatment with neo-adjuvant radiotherapy and surgery for patients with periarticular STS. METHODS: Seventeen patients (mean age 52.5 years) were treated using a standard protocol between January 2009 and June 2012 with three-dimensional conformal neo-adjuvant radiotherapy to a dose of 50 Gy in 25 fractions at a single centre, followed by limb salvage surgery. Patients were assessed weekly for adverse effects during radiotherapy. Surgery was planned for 6 weeks following completion of radiotherapy. Patients remain under follow-up with regular Toronto Extremity Salvage Scores (TESS) performed. RESULTS: No patients had a significant adverse effect during radiotherapy. Three patients (17.6%) suffered a wound complication following surgery, all treated conservatively. Magnetic resonance imaging (MRI) demonstrated a reduction in mean maximal tumour diameter from 7.56 to 5.24 cm (p = 0.017, 11 of 17 patients). Tumour necrosis was measured between 50% and 100% in 10 of 11 resections where accurate assessment was possible. One patient had further surgery due to incomplete margins. No patients required post-operative radiotherapy. No local recurrences have occurred after a mean follow-up of 32 months (range 19 to 59 months). Two patients have developed metastatic disease. Mean TESS scores for upper and lower limb patients were 98.5 and 85.5, respectively, at latest follow-up. CONCLUSIONS: We have demonstrated improved wound complication rates compared to the existing literature on the use of neo-adjuvant radiotherapy. This may relate to modification of the technique and patient selection compared to previous series. Excellent functional outcomes can be obtained with this treatment strategy.

Anatomic description of the distal tibia: implications for internal fixation.

Fracture fixation using minimally invasive plating techniques around the distal tibia are well described, although there are a number of potential hazards and complications. Our study provides an anatomical description of the distal tibia and its relations to surrounding structures. Twenty magnetic resonance imaging scans of the distal tibia were analyzed in the coronal, sagittal, and axial planes. Measurements were taken by 2 observers on 2 occasions of the distance of anterior structures from the tibial cortex as well as dimensional parameters. The mean dimensions of the distal tibia at the level of the plafond were 39 mm medial-lateral and 36 mm anteroposterior. The anterior neurovascular bundle was found to be a mean of 3 mm from the anterior tibial cortex with the anterior tendinous structures located <6 mm. The intraclass correlation coefficient for the first observer was 0.8 and for the second observer was 0.78 with an interclass correlation coefficient of 0.8. This demonstrated excellent interobserver and intraobserver reliability. This study presents the first magnetic resonance imaging-based anatomical description of the distal tibia. It showed that key anatomical structures are in very close proximity to the distal tibia, and this is important to consider when treating fractures in this region with internal fixation.

Osteoid osteoma: can impedance levels in radiofrequency thermocoagulation predict recurrence?

Objective. To evaluate rise in impedance during percutaneous radiofrequency thermocoagulation (PRFTC) of osteoid osteomas as a predictor of local recurrence. Design and Patients. A prospective study of 23 patients (24 PRFTC procedures) with minimum of 2.25-year followup (average 3.3 years). Average age 19.6 years (range 4-44), sex ratio 15 : 8 (male : female), 16 nondiaphyseal, 7 diaphyseal. Results. In 19 procedures, an increase in impedance was measured-no recurrences have occurred in this group to date. In 5 procedures, no increase in impedance was seen (3 non-diaphyseal, 2 diaphyseal), and 1 recurrence has been seen in this group to date. This difference is statistically significant with a P value of .05.

The outcome of locking plate fixation for the treatment of periarticular metastases.

Periarticular bone metastasis may be treated with endoprosthetic reconstruction. The extensive surgery required may not, however, be appropriate for all patients. Our aim was to establish whether locking plates provide good functional outcomes and a durable construct when used in the management of metastatic disease. Prospective data collection was performed. Twenty one patients underwent surgery for periarticular metastatic tumours. The median duration of followup for surviving patients is one year. There have been no cases of implant failure and no requirement for revision surgery. Pain relief was excellent or good in the majority of patients. Patients who had sustained a fracture prior to fixation had restoration of their WHO performance status. All patients had a dramatic improvement in their MSTS scores. The median pre-operative score was 15% (0%-37%) improving to a median score of 80% (75%-96%) post operatively. Locking plates were found to provide reliable fixation and excellent functional restoration in selected patients suffering from periarticular metastatic bone disease.

Comparison of Herbert and Acutrak screws in the treatment of scaphoid non-union and delayed union.

A retrospective analysis was performed on patients who had undergone surgery for delayed union or non-union of a scaphoid fracture. This was conducted to investigate if there was a difference in outcome between patients treated with the Acutrak screw or the Herbert screw. Twenty two cases were treated with a Herbert screw and 23 with an Acutrak screw. The patient demographics, aetiology of injury and fracture types were similar between the two groups. There was no significant difference in union rate or time to union for fractures treated with the Herbert screw or the Acutrak screw. There appears to be no difference in outcome for cases of scaphoid fracture delayed union and non-union treated with either the Herbert screw or the Acutrak screw.