Telemedicine Orthopedic Consultations Duration and Timing in Outpatient Clinical Practice During the COVID-19 Pandemic.

Introduction: Orthopedic associations advocated telemedicine during the COVID-19 pandemic to prevent disease transmission without hindering providing services to orthopedic patients. The study aimed to evaluate outpatient orthopedic teleconsultations' timing, length, and organizational issues in the circumstances of the COVID-19 pandemic based on consecutive orthopedic teleconsultations during the period of the first lockdown. Methods: Orthopedic telemedical consultations (OTCs) were provided from March 23, 2020, to June 1, 2020, and analyzed retrospectively based on mobile smartphone billing and electronic health record. Teleconsultations were based on the legal regulations of telemedicine services in Poland. Results: One thousand seventy-one patients (514 women and 557 men) with a mean age of 41.7 were teleconsulted. The length of the OTC averagely lasted 13.36 min (standard deviation 8.63). Consulted patients suffered from orthopedic disorders 65.3%, musculoskeletal injuries 26.3%, and other diseases 8.4%. Most OTCs were delayed (74.22%) concerning the planned schedule, with a median delay time of 12 min. Only 7.3% of teleconsultations were held precisely on time. Conclusions: Televisit length may not be dependent on gender, older age, or more diagnoses. The services like e-prescriptions, e-Referrals, e-Orders for orthotics, and e-Sick-leaves influence OTC length. Any extension of the patient's OTC may create a "snowball effect" of further delay for each subsequent OTC. Orthopedic teleconsultation requires new understanding and skills by both the patient and specialist physicians. Future research directions should concern the practical aspects of orthopedic teleconsultations, like legal, organizational, and technological issues and their implementation.

The Influence of Lead and Acyrthosiphon pisum (Harris) on Generation of Pisum sativum Defense Signaling Molecules and Expression of Genes Involved in Their Biosynthesis.

The main aim of this study was to understand the regulation of the biosynthesis of phytohormones as signaling molecules in the defense mechanisms of pea seedlings during the application of abiotic and biotic stress factors. It was important to identify this regulation at the molecular level in Pisum sativum L. seedlings under the influence of various concentrations of lead-i.e., a low concentration increasing plant metabolism, causing a hormetic effect, and a high dose causing a sublethal effect-and during feeding of a phytophagous insect with a piercing-sucking mouthpart-i.e., pea aphid (Acyrthosiphon pisum (Harris)). The aim of the study was to determine the expression level of genes encoding enzymes of the biosynthesis of signaling molecules such as phytohormones-i.e., jasmonates (JA/MeJA), ethylene (ET) and abscisic acid (ABA). Real-time qPCR was applied to analyze the expression of genes encoding enzymes involved in the regulation of the biosynthesis of JA/MeJA (lipoxygenase 1 (LOX1), lipoxygenase 2 (LOX2), 12-oxophytodienoate reductase 1 (OPR1) and jasmonic acid-amido synthetase (JAR1)), ET (1-aminocyclopropane-1-carboxylate synthase 3 (ACS3)) and ABA (9-cis-epoxycarotenoid dioxygenase (NCED) and aldehyde oxidase 1 (AO1)). In response to the abovementioned stress factors-i.e., abiotic and biotic stressors acting independently or simultaneously-the expression of the LOX1, LOX2, OPR1, JAR1, ACS3, NCED and AO1 genes at both sublethal and hormetic doses increased. Particularly high levels of the relative expression of the tested genes in pea seedlings growing at sublethal doses of lead and colonized by A. pisum compared to the control were noticeable. A hormetic dose of lead induced high expression levels of the JAR1, OPR1 and ACS3 genes, especially in leaves. Moreover, an increase in the concentration of phytohormones such as jasmonates (JA and MeJA) and aminococyclopropane-1-carboxylic acid (ACC)-ethylene (ET) precursor was observed. The results of this study indicate that the response of pea seedlings to lead and A. pisum aphid infestation differed greatly at both the gene expression and metabolic levels. The intensity of these defense responses depended on the organ, the metal dose and direct contact of the stress factor with the organ.

Postzygotic mosaicism of a novel PTPN11 mutation in monozygotic twins discordant for metachondromatosis.

Genetic mosaicism caused by postzygotic mutations is of a great interest due to its role in human disease. Monozygotic twins arising from a single zygote are considered as genetically identical, and any differences likely to be caused by postzygotic events. Thus, phenotypically discordant monozygotic twins offer a unique opportunity to study genotype-phenotype correlation. Here, we present a three-generation family starting from a pair of monozygotic twins discordant for metachondromatosis due to postzygotic p.(Gln175His) variant in the PTPN11 gene. Both phenotypically discordant monozygotic twins harbor p.(Gln175His), however significant differences in mosaic ratio is observed not only between twins, but also within different tissue types within one individual. Phenotypic manifestation of p.(Gln175His) in examined family clearly depends on allele variant fraction (VAF). Individuals harboring constitutional mutation (VAF 50%) present typical metachondromatosis. Milder phenotype is observed in twin harboring high-level mosaicism in the tissue of ectodermal origin (VAF 45%), but not in a blood (VAF 5%). Finally, her twin sister harboring low-level mosaicism in blood (VAF 2%) and nonblood (VAF 12%) tissues is phenotypically normal. Our results provide insights into biological role of mosaicism in disease and further support the usefulness of nonblood tissues as an optimal source of DNA for the identification of postzygotic mutations in phenotypically discordant monozygotic twins.

Bone Density at the Entry Point Correlates With the Trabecular Bone of the Thoracolumbar Vertebral Bodies - Quantitative Computed Tomography Study.

PURPOSE: To evaluate the relationship between cortical Bone Mineral Density (BMD) at pedicle entry points with trabecular BMD of the vertebral body in a spinal fracture. METHODS: Quantitative computed tomography of the thoracolumbar spine was analyzed using dedicated software - QCT Pro (Mindways, Austin, TX). RESULTS: Forty-six patients were evaluated. Among them 36 females were diagnosed with osteoporosis; the remaining 10 randomly selected from the database both males and females served as a control group. Overall measurements for 138 vertebrae were assessed. Cortical BMD of entry points for transpedicular screws was higher than trabecular vertebral BMD in osteoporotic (p < 0.001) and non-osteoporotic patients (p = 0.003). The difference was 3.6 times higher in low BMD cases (osteoporosis), compared to 2.3 times in normal subjects. Spearman's rank correlation coefficient showed the strongest correlation between patient's age and trabecular bone mineral density of L1 vertebral body (r = -0.94, p < 0.05), while cortical entry points were less correlated (r = -0.8, p < 0.05 and r = -0.65, p < 0.05 for left and right entry points, respectively). The strength of the correlations between BMD and age decreased gradually from L1 to L4, from r = -0.94 to r = -0.58 for the trabecular vertebral body; from r = -0.8 to r = -0.37 for entry points. Significant correlations were not found for BMD and the height or weight of the patients. CONCLUSIONS: Cortical BMD at pedicle entry points decreases with osteoporosis. The relative contribution of cortical vs trabecular BMD increases with osteoporosis. Vertebral trabecular BMD is highly correlated with the cortical BMD of the entry points and allows predicting the bone support in fracture cases.

Integrated Analysis of Small RNA, Transcriptome and Degradome Sequencing Provides New Insights into Floral Development and Abscission in Yellow Lupine (Lupinus luteus L.).

The floral development in an important legume crop yellow lupine (Lupinus luteus L., Taper cv.) is often affected by the abscission of flowers leading to significant economic losses. Small non-coding RNAs (sncRNAs), which have a proven effect on almost all developmental processes in other plants, might be of key players in a complex net of molecular interactions regulating flower development and abscission. This study represents the first comprehensive sncRNA identification and analysis of small RNA, transcriptome and degradome sequencing data in lupine flowers to elucidate their role in the regulation of lupine generative development. As shedding in lupine primarily concerns flowers formed at the upper part of the inflorescence, we analyzed samples from extreme parts of raceme separately and conducted an additional analysis of pedicels from abscising and non-abscising flowers where abscission zone forms. A total of 394 known and 28 novel miRNAs and 316 phased siRNAs were identified. In flowers at different stages of development 59 miRNAs displayed differential expression (DE) and 46 DE miRNAs were found while comparing the upper and lower flowers. Identified tasiR-ARFs were DE in developing flowers and were strongly expressed in flower pedicels. The DEmiR-targeted genes were preferentially enriched in the functional categories related to carbohydrate metabolism and plant hormone transduction pathways. This study not only contributes to the current understanding of how lupine flowers develop or undergo abscission but also holds potential for research aimed at crop improvement.

Translation, Cross-Cultural Adaptation, and Psychometric Properties of the Polish Version of the Hip Disability and Osteoarthritis Outcome Score (HOOS).

Background and Objectives: This study aimed to translate the Hip disability and Osteoarthritis Outcome Score (HOOS) into the Polish language, to determine its validity and reliability, and to assess its main psychometric properties. Materials and Methods: A total of 332 hip osteoarthritis (OA) subjects were recruited to the study group and 90 healthy subjects to the control group. The study consisted of the HOOS translation and the assessment of the discriminative power, internal consistency, and the potential floor and ceiling effects followed by the determination of the construct validity and test-retest reliability. The analysis was performed using Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and SF-36 questionnaires. Results: The translation process consisted of forward translation, reconciliation, backward translation, review, harmonization, and proofreading. The hip OA patients reported a reduced HOOS score when compared to the control subjects. The discriminant validity of the questionnaire was confirmed. A Cronbach's alpha of 0.97 was found, indicating a high internal consistency. The HOOS showed a significant correlation with the SF-36 and WOMAC, which ranged from r = -0.93, p-value < 0.05 for WOMAC total score to r = 0.92, and p-value < 0.05 for WOMAC daily living. No floor or ceiling effects were found. A very high intraclass correlation coefficient (ICC) was found (0.93-0.97) for the total score and the individual domains of the HOOS. Conclusions: The Polish HOOS is valid and reliable for evaluating the outcomes of hip OA patients in Poland. This questionnaire may be used with confidence for clinical and research purposes.

The role of physical activity in early adulthood and middle-age on bone health after menopause in epidemiological population from Silesia Osteo Active Study.

BACKGROUND: Osteoporosis is a growing problem in women after menopause. Among factors protecting from this disease is a physical activity (PA). AIM: The objective of the study was to evaluate the influence of PA in early adulthood and at middle-age on bone health after menopause. MATERIAL AND METHODS: The study group consisted of 362 randomly recruited postmenopausal women after menopause. Mean age was 65.2±6.9 years. Medical history was collected from all participants, and they completed questionnaires assessing PA in early adulthood and at middle-age. Physical capacity was estimated using the Duke scale. Bone status was measured with use of densitometry (DXA) for lumbar spine and hip and calcaneus quantitative ultrasound (QUS) measurements. RESULTS: Physical activity and healthy lifestyle activity in early adulthood did not correlate with bone health, but current PA did (for QUS parameters r=.11; P<.05). Physical capacity correlated with all QUS parameters (r=.2 to .22; P<.05) and femoral neck (FN) BMD and T-score (for both r=.16; P<.05). Current PA frequency at the level of several times a week has the highest positive impact on FN DXA results (P=.01). Bone mass in DXA and QUS variables is related to the type of exercises (P<.05). CONCLUSION: Physical activity, especially several times a week, at middle-age is a major factor influencing bone health in women after menopause. Further studies concerning the type of exercises are needed.

Software-assisted morphometry and volumetry of the lumbar spine.

The aim of the study was to measure volumes of the lumbar vertebral bodies with use dedicated Computed Tomography (CT) workstation software to predict expected volume of PMMA for vertebroplasty and supplement calculations using computed tomography scanogram. Quantitative CT scans of 87 women's (mean age 69.4 years; SD 10.9) and 15 men's (mean age 64.3 years; SD 11.8) lumbar spines were analyzed; this made a total of 379 vertebrae. The population of patients was divided into three groups depending on measured BMD value, in accordance with American College of Radiology Practice Parameter for the Performance of Quantitative Computed Tomography (QCT) Bone Densitometry. With the use of the general linear model and least squares means groups were compared regarding vertebral volume, anterior, middle, and posterior vertebral heights. Morphometric parameters tended to be greater in males than in females, in a population of diversified bone mineral density. BMD result should be considered as the modifying factor for preoperative planning of the bone cement volume to be deposited inside the vertebra. Vertebral body volumetry might prove to be a useful tool in pre-operative planning as well as an alternative for treatment monitoring after minimally invasive spinal procedures.

Posture and low back pain during pregnancy - 3D study.

OBJECTIVES: Back pain is a common complaint of pregnant women. The posture, curvatures of the spine and the center of gravity changes are considered as the mechanisms leading to pain. The study aimed to assess spinal curvatures and static postural characteristics with three-dimensional surface topography and search for relationships with the occurrence of back pain complaints among pregnant women. MATERIAL AND METHODS: The study was conducted from December 2012 to February 2014. Patients referred from University Clinic of Gynecology and Obstetrics were examined outpatient at the Posture Study Unit of Department of Orthopaedics and Traumatology. Sixty-five women at 4-39 weeks of pregnancy were assessed and surveyed with Oswestry Disability Index; posture was evaluated using surface topography. RESULTS: The study confirmed that difficulties in sitting and standing are significant in the third trimester of the pregnancy. The overall tendency for significant lumbar curvature changes in pregnant women was not confirmed. Major changes in sagittal trunk inclination in relation to the plumb line were not observed in the study group. CONCLUSIONS: The issue regarding how the pregnancy causes changes in spinal curvature and posture remains open for further studies. Presented method of 3D surface topography can reveal postural changes, but that requires several exams of each subject and strict follow-up of the series of cases.

The time effectiveness of three-dimensional telediagnostic postural screening of back curvatures and scoliosis.

BACKGROUND: Postural screening remains a powerful tool that can be used to identify children and adolescents with scoliosis or sagittal plane deformities. The aim of this study was to assess the time effectiveness of implemented telediagnostic screening procedures. MATERIALS AND METHODS: Medical images (virtual objects) of acquired clouds of points of 100 subjects of both sexes were chosen at random from the database and used for parametric evaluation for this study. This study was performed using a newly developed three-dimensional (3D) back surface topography measurement system for posture and scoliosis using a structured light method. The duration of each step of therapist/nurse/physician-assisted 3D assessment was measured independently with a stopwatch. Two configurations of PC computers and Internet connections were used to test the time effectiveness. Scoliotic postures were detected using cutoff values of angle of trunk rotation, Posterior Trunk Symmetry Index, and Deformity in the Axial Plane Index indices. RESULTS: The overall assessment of all subjects consumed from 2 h 55 min 55 s to 3 h 18 min 59 s dependent on PC and Internet connection configuration. Average examination time per subject ranged from 2 min 43 s to 4 min 51 s, respectively. The virtual landmarking and report generation times were dependent on the PC configuration (p<0.001). Our study confirmed satisfactory time effectiveness of the implemented telediagnostic postural screening procedure. We assume that it may influence the cost-effectiveness of the screening, which is usually mentioned as an important factor for recommendations against postural school screening. Relatively fast Internet connection and a medium-level PC configuration are sufficient for achieving a reasonably short time of 3D posture assessment of a virtual object representing a real subject's back surface. CONCLUSIONS: The efficiency of remote assessment of exact 3D surface topography can be used in large-scale studies for posture and scoliosis epidemiology.

Prevalence of mental health disorders in knee osteoarthritis patients: a systematic review and meta-analysis.

Background: Knee osteoarthritis (OA) is a prevalent degenerative disease affecting synovial joints, predominantly the knee, leading to various complications, including mental health conditions like depression and anxiety. This systematic review aimed to determine the prevalence of depression and anxiety in knee OA patients. Methods: A comprehensive literature search was conducted in various databases till September 15, 2023. Studies focusing on the prevalence of mental health issues in patients with knee OA were included, excluding narrative reviews, protocols, unpublished reports, editorials, case reports, abstracts, and commentaries. All statistical analyses were performed in R version 4.2.3. Results: This review included a total of 14 studies involving middle-aged to elderly adult patients with knee OA, with ages ranging from 45 to 75 years. Among these, 13 studies involving 3390 adult patients with an average age of 59.75 years reported a pooled prevalence of depression of 30% (95% confidence interval: 18-43), demonstrating a substantial heterogeneity (I 2=98%). Additionally, anxiety was identified with a combined prevalence of 27% (95% confidence interval: 24-30) based on three studies that included 1407 older adult patients with an average age of 62.1 years. These studies displayed minimal heterogeneity (I 2=7%). Conclusion: The findings show a significant prevalence of depression among adult patients with knee OA and anxiety among older adults with knee OA, emphasizing the need for integrated healthcare approaches that address both orthopedic and mental health conditions. More comprehensive research is essential to deepen our understanding of the connection between mental illnesses and knee OA and to develop effective preventive and treatment strategies.

Telehealth and telenursing perception and knowledge among university students of nursing in poland.

OBJECTIVE: Telehealth and telenursing are becoming the new reality in studying nursing. Little is known whether undergraduate nursing students receive adequate education on telenursing for patient care. The aim for this study was to evaluate the knowledge and attitude of nursing students toward telenursing. SUBJECTS AND METHODS: Students of nursing faculties from medical universities in Poland were invited to complete a survey about telehealth and telenursing. The survey was conducted utilizing a Web-based surveying platform ( www.mini-ankiety.pl ). RESULTS: We surveyed 308 undergraduate students of nursing faculty-291 females (94%) and 17 males (6%)-from medical universities in Poland. There were 116 students in their first year (course) (38%) and 96 students each in the second and third years (31%). Most of the students (220 [71%]) in the study group were in the age range from 20 to 23 years. The accurate definition of telemedicine was identified by 251 (82%) respondents. The definition of telenursing was recognized properly by 230 (75%) respondents. Of the students, 207 (67%) would anticipate telenursing service implementation into the national healthcare system, and 214 (69.49%) would appreciate the addition of telenursing classes to the curriculum. Students from a few universities showed significantly higher willingness to introduce telenursing classes into nursing curriculum and the intention to use telenursing services in their future nursing practice. The difference among universities could be influenced by regional e-health initiatives. This study has shown the rise of trust in technology along with the increase in the year of nursing study. CONCLUSIONS: The current generation of university students of nursing seems to be well educated in medical informatics and technology use. They are better prepared for and open to information society membership, including the practice of telehealth. The advancement in university education has an influence on positive attitudes toward telenursing and may become a milestone in the development of e-health in Poland.

Quantitative Ultrasound Examination (QUS) of the Calcaneus in Long-Term Martial Arts Training on the Example of Long-Time Practitioners of Okinawa Kobudo/Karate Shorin-Ryu.

Quantitative research of bone tissue related to physical activity (PA) and sport has a preventive dimension. Increasing the parameters of bone tissue strength, especially reaching the maximum value of peak bone strength in childhood, adolescence, and early adulthood due to practicing sports can contribute to maintaining bone health throughout life. Practicing martial arts (tai chi, traditional karate, judo, and boxing) can effectively improve the quality of bone and reduce the risk of falls and fractures. The study aimed to evaluate the calcaneus bones among Okinawa Kobudo/Karate Shorin-Ryu practitioners using the quantitative ultrasound method as an indicator for assessing bone fracture risk. Forty-four adult martial arts practitioners with a mean age of 36.4 participated in this study. Quantitative ultrasound (QUS) with a portable Bone Ultrasonometer was used in this study. Speed of sound (SOS), broadband ultrasound attenuation (BUA), and the stiffness index (SI) were measured. Subjects were assigned to two groups of black and color belts, according to the advancement in Kobudo/karate practice. The measurements of the SI, BUA, SOS, T-score, and Z-score were significantly higher in subjects from the advanced, long-term practice (black belts) (p < 0.05). The long-term martial arts training in traditional karate and Kobudo significantly impacts the parameters of the calcaneus quantitative ultrasound measurements. Significantly higher bone density was observed among the black belt holders. Long-term practice subjects achieved results far beyond the norm for their age groups. Further studies using non-invasive methods of bone quantification are needed to determine the specific conditions for preventing osteoporosis through physical activity, sports, and martial arts, particularly the duration of the activity, the magnitude of loads, and other related factors.

Telediagnostic 3D school screening of back curvatures and posture using structured light method - pilot study.

BACKGROUND: Several studies consider the school scoliosis screening as controversial. Many authors postulate to improve its clinical effectiveness. AIM: Authors assumed that three dimensional telediagnostic surface topography measurements allowing measuring several postural deformity indexes and angles of curvatures in sagittal plane may enhance current practice. The study was designed to determine usefulness of school screening back evaluation performed utilizing the three dimensional telediagnostic measurement system. METHODS: The measurement module is based on structured light method using "3D Orthoscreen" system. The technique for 3D image acquisition of back shape is based on temporal phase shifting and Gray codes. Measurement data was securely archived for remote access by investigator over the secure Internet connection. Acquired "images" were transferred to Telediagnostic Center for clinical evaluation. Spine parameters and deformation indexes like Posterior Trunk Symmetry Index (POTSI), Deformity in the Axial Plane Index (DAPI), kyphosis and lordosis angle were measured. The preliminary study was performed in 2 selected schools (basic and middle schools). The study was approved by Bioethical Committee. Clouds of points representing back topography of assessed subjects were acquired at schools in March and May 2011 and stored for remote evaluation and analysis. RESULTS: 758 children averagely aged 11.1 years (from 5 to 16), 387 females and 371 males, were examined. Their average body mass was 45.13 kg [16-105; STD 16.4] and average height was 151.43 cm, [110-192; STD 18.3]. The average values of back assessment parameters were as follows: POTSI 15.97% [0-73.4; STD 10.3]; DAPI 0.88% [0-5.9; STD 0.76]; kyphosis angle 10.19° [0-32; STD 5.82]; and lordosis angle 32,82° [0-56; STD 9.86]. CONCLUSION: Technical and clinical issues of the practical implementation allowed to elaborate preliminary protocol for cohort studies addressed to subject (i.e. parents acceptance of examination of undressed back) and technical issues (i.e. upload data and retrieval, network transfer velocity). Postural telediagnostics was found sufficiently feasible for further implementation of remote, cohort 3D back shape evaluations including school screening. Permanently saved 3D data allow monitoring back surface of the individual subjects.

Orthopedic Telemedicine Outpatient Practice Diagnoses Set during the First COVID-19 Pandemic Lockdown-Individual Observation.

The COVID-19 pandemic has caused a substantial intensification of the telemedicine transformation process in orthopedics since 2020. In the light of the legal regulations introduced in Poland, from the beginning of the SARS-CoV-2 pandemic, physicians, including orthopedic surgeons, have had the opportunity to conduct specialist teleconsultations. Teleconsultations increase epidemiological safety and significantly reduce the exposure of patients and medical staff to direct transmission of the viral vector and the spread of infections. The study aimed to describe diagnoses and clinical aspects of consecutive orthopedic teleconsultations (TC) during the pandemic lockdown. The diagnoses were set according to the International Classification of Diseases (ICD-10). Hybrid teleconsultations used smartphones and obligatory Electronic Health Record (EHR) with supplemental voice, SMS, MMS, Medical images, documents, and video conferencing if necessary. One hundred ninety-eight consecutive orthopedic teleconsultations were served for 615 women and 683 men (mean age 41.82 years ± 11.47 years). The most frequently diagnosed diseases were non-acute orthopedic disorders "M" (65.3%) and injuries "S" (26.3%). Back pain (M54) was the most frequent diagnosis (25.5%). Although virtual orthopedic consultation cannot replace an entire personal visit to a specialist orthopedic surgeon, in many cases, teleconsultation enables medical staff to continue to participate in providing medical services at a sufficiently high medical level to ensure patient and physician. The unified approach to TC diagnoses using ICD-10 or ICD-11 may improve further research on telemedicine-related orthopedics repeatability. Future research directions should address orthopedic teleconsultations' practical aspects and highlight legal, organizational, and technological issues with their implementations.

Associations between Patient Report of Pain and Intervertebral Foramina Changes Visible on Axial-Loaded Lumbar Magnetic Resonance Imaging.

The intervertebral foramen may influence spinal nerve roots and, therefore, be related to the corresponding dermatomal pain. In vivo evaluation of the intervertebral foramen-dermatome relationship is essential for understanding low back pain (LBP) pathophysiology. The study aimed to correlate the lumbar MRI unloaded-loaded foraminal area changes with dermatomal pain in the patient's pain drawings. Dynamic changes of the dermatomal pain distribution related to the intervertebral foramen area changes between quantitative conventional supine MRI (unloaded MRI) and axial-loading MRI (alMRI) were analyzed. The MRI axial-loading intervertebral foramen area changes were observed, and the most significant effect of reducing the foraminal area (-6.9%) was reported at levels of L2-L3. The incidence of pain in the dermatomes increases linearly with the spine level, from 15.6% at L1 to 63.3% at L5 on the right and from 18.9% at L1 to 76.7% at L5 on the left. No statistically significant effect of changes in the intervertebral foramen area on the odds of pain along the respective dermatomes was confirmed. Changes in the foraminal area were observed between the unloaded and loaded phases, but differences in area changes between foramen assigned to painful dermatomes and foramen assigned to non-painful dermatomes were not significant.

High-resolution, three-dimensional magnetic resonance imaging axial load dynamic study improves diagnostics of the lumbar spine in clinical practice.

BACKGROUND: The response to axial physiological pressure due to load transfer to the lumbar spine structures is among the various back pain mechanisms. Understanding the spine adaptation to cumulative compressive forces can influence the choice of personalized treatment strategies. AIM: To analyze the impact of axial load on the spinal canal's size, intervertebral foramina, ligamenta flava and lumbosacral alignment. METHODS: We assessed 90 patients using three-dimensional isotropic magnetic resonance imaging acquisition in a supine position with or without applying an axial compression load. Anatomical structures were measured in the lumbosacral region from L1 to S1 in lying and axially-loaded magnetic resonance images. A paired t test at α = 0.05 was used to calculate the observed differences. RESULTS: After axial loading, the dural sac area decreased significantly, by 5.2% on average (4.1%, 6.2%, P < 0.001). The intervertebral foramina decreased by 3.4% (2.7%, 4.1%, P < 0.001), except for L5-S1. Ligamenta flava increased by 3.8% (2.5%, 5.2%, P < 0.001), and the lumbosacral angle increased. CONCLUSION: Axial load exacerbates the narrowing of the spinal canal and intervertebral foramina from L1-L2 to L4-L5. Cumulative compressive forces thicken ligamenta flava and exaggerate lumbar lordosis.

Evaluating Patients' Experiences with Healthcare Services: Extracting Domain and Language-Specific Information from Free-Text Narratives.

Evaluating patients' experience and satisfaction often calls for analyses of free-text data. Language and domain-specific information extraction can reduce costly manual preprocessing and enable the analysis of extensive collections of experience-based narratives. The research aims were to (1) elicit free-text narratives about experiences with health services of international students in Poland, (2) develop domain- and language-specific algorithms for the extraction of information relevant for the evaluation of quality and safety of health services, and (3) test the performance of information extraction algorithms' on questions about the patients' experiences with health services. The materials were free-text narratives about health clinic encounters produced by English-speaking foreigners recalling their experiences (n = 104) in healthcare facilities in Poland. A linguistic analysis of the text collection led to constructing a semantic−syntactic lexicon and a set of lexical-syntactic frames. These were further used to develop rule-based information extraction algorithms in the form of Python scripts. The extraction algorithms generated text classifications according to predefined queries. In addition, the narratives were classified by human readers. The algorithm-based and the human readers' classifications were highly correlated and significant (p < 0.01), indicating an excellent performance of the automatic query algorithms. The study results demonstrate that domain-specific and language-specific information extraction from free-text narratives can be used as an efficient and low-cost method for evaluating patient experiences and satisfaction with health services and built into software solutions for the quality evaluation in health care.

The COVID-19 Pandemic as an Impulse for the Development of Telemedicine in Primary Care in Poland.

Telemedicine gives a safe and effective way of providing healthcare. During the COVID-19 pandemic, it was possible to offer teleconsultations in primary care (Primary Care Teleconsultation-PCT). The study aimed to present an analysis of the PCTs served in the years 2020-2021 in the field of primary care in Poland to determine how the COVID-19 pandemic contributed to the development of telemedicine in primary care in Poland. The database, containing a list of medical services provided remotely obtained from the National Health Fund, was analyzed. Economic and tax indicators obtained from the Ministry of Finance were also analyzed. Personal Income Tax (PIT) value was used as an indicator of household wealth, and the Corporate Income Tax (CIT) was used as an indicator of economic activity in individual counties for 2019. Along with the COVID-19 pandemic, patients as healthcare beneficiaries can take advantage of previously unserved telemedicine services as part of primary care. The data analysis showed that, along with the introduced recommendations and restrictions in connection with the pandemic, the number of teleconsultations in 2021 increased compared to 2020. In response to the pandemic, an educational campaign targeted older patients. These indicate the most significant percentage of PCTs among patients aged 70 and older. The study shows that the awareness barrier in implementing services for the elderly population decreased significantly. There was a clear correlation between the increase in PCTs and patient age.

Web-based support for fracture healing evaluation and monitoring.

BACKGROUND: The lack of a universal system for fracture healing progress evaluation recommended by evidence-based orthopedics is mentioned in current literature. Radiographs and the observation of clinical signs and symptoms remain standard practice for the assessment of fracture healing progress. OBJECTIVES: The general aim of this study was to show the main functionalities of the Web-based telediagnostic tools designed to improve fracture healing assessment follow-up and to present a study of fracture healing assessment based on collected study group of long bone fracture cases. METHODS: The originally designed Web-based system was used to assess remotely fracture healing in 40 complete radiographic sets (211 radiographs) randomly selected from a database. Digital radiographic images and clinical data were stored in the database and then subjected to detailed analysis. Descriptive classifications, scorings, and radiographic image optical density analysis measurements were used for a series of cases. RESULTS: Curves on the graph, drawn from the consecutive follow-up measurements of fracture gap optical density, can slope down regularly in normal healing cases or remain irregular and disorganized in delayed unions. An association between optical density values, callus index, and descriptive scoring variables was found for normal healing based on results received from Web-based telediagnostic system. CONCLUSIONS: The development of Web-based telediagnostic applications have the potential to improve fracture qualitative and quantitative evaluation and monitoring for the improvement of the quality of fracture care. The results imply the feasibility of Web-based fracture healing assessment telediagnostic applications over the Internet.