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1.
Arthroscopy ; 37(10): 3088-3089, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34602150

RESUMO

Analyzing patient-reported outcomes using the lens of the minimal clinical important difference (MCID) and patient acceptable symptomatic state allows surgeons to assess patient recovery at the individual level and make necessary changes to management if necessary. When patients with femoroacetabular impingement achieve MCID 6 months after arthroscopic treatment, they achieve patient acceptable symptomatic state 2 years postoperatively 88% of the time. The findings highlight the importance of the postoperative recovery trajectory and illustrate a quantitative way to study the progress of individual patients along their care journey.


Assuntos
Artroscopia , Diferença Mínima Clinicamente Importante , Atividades Cotidianas , Humanos , Satisfação do Paciente , Satisfação Pessoal , Resultado do Tratamento
2.
Arthrosc Sports Med Rehabil ; 3(5): e1431-e1440, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34712981

RESUMO

Purpose: To compare the efficacy of a single, intra-articular, nonconcentrated bone marrow aspirate (BMA) injection in comparison to cortisone for the treatment of glenohumeral joint osteoarthritis (GHJ OA). Methods: Inclusion criteria were patients between the ages of 18 and 75 with a diagnosis of GHJ OA on radiograph. Patients were randomized to receive an ultrasound-guided, intra-articular cortisone injection or BMA injection (without concentration). The primary outcome measure was the Western Ontario Osteoarthritis of the Shoulder (WOOS) index at 12 months. Secondary outcome measures were the QuickDASH, EuroQOL 5-dimensions 5-level questionnaire (EQ-5D-5L) and visual analogue scale. Results: The study included 25 shoulders of 22 patients who completed baseline and 12 months' patient-reported outcome measures (12 shoulders received cortisone, 13 shoulders received BMA) after the study was terminated early by changes in Health Canada regulations. Baseline characteristics demonstrated a significant difference in the ages of the 2 groups, with the BMA group being older (61.6 vs 53.8 mean years, P = 0.021). For the BMA group, a significant improvement was seen in the WOOS index (P = 0.002), the QuickDASH (P < 0.001), and the EQ-5D-5L pain dimension (P = 0.004) between baseline and 12 months. No significant difference was seen for any outcome in the cortisone group between baseline and 12 months. No significant difference was demonstrated between changes in the WOOS scores from baseline to 12 months when compared between groups (P = 0.07). However, a significant difference in changes in scores was seen in the QuickDASH (P = 0.006) and the EQ-5D-5L pain scores (P = 0.003) and the EQ-5D-5L health scores (P = 0.032) in favor of BMA. Conclusions: The results of this study demonstrate that patients with GHJ OA treated with BMA have superior changes in the QuickDASH and EQ-5D-5L pain and health scores but not in the WOOS outcomes measures at 12 months post injection when compared to patients treated with cortisone. However, because of the limited number of patients as a result of the early termination of the study, larger randomized studies are required to confirm these findings. Level of Evidence: Level II, randomized controlled trial.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34587014

RESUMO

In this paper, we report on a study of visual representations for cyclical data and the effect of interactively wrapping a bar chart `around its boundaries'. Compared to linear bar chart, polar (or radial) visualisations have the advantage that cyclical data can be presented continuously without mentally bridging the visual `cut' across the left-and-right boundaries. To investigate this hypothesis and to assess the effect the cut has on analysis performance, this paper presents results from a crowdsourced, controlled experiment with 72 participants comparing new continuous panning technique to linear bar charts (interactive wrapping). Our results show that bar charts with interactive wrapping lead to less errors compared to standard bar charts or polar charts. Inspired by these results, we generalise the concept of interactive wrapping to other visualisations for cyclical or relational data. We describe a design space based on the concept of one-dimensional wrapping and two-dimensional wrapping, linked to two common 3D topologies; cylinder and torus that can be used to metaphorically explain one- and two-dimensional wrapping. This design space suggests that interactive wrapping is widely applicable to many different data types.

4.
Reg Anesth Pain Med ; 46(12): 1091-1099, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34187911

RESUMO

Acute compartment syndrome (ACS) is a potentially reversible orthopedic surgical emergency leading to tissue ischemia and ultimately cell death. Diagnosis of ACS can be challenging, as neither clinical symptoms nor signs are sufficiently sensitive. The cardinal symptom associated with ACS is pain reported in excess of what would otherwise be expected for the underlying injury, and not reasonably managed by opioid-based analgesia. Regional anesthesia (RA) techniques are traditionally discouraged in clinical settings where the development of ACS is a concern as sensory and motor nerve blockade may mask symptoms and signs of ACS. This Education article addresses the most common trauma and elective orthopedic surgical procedures in adults with a view towards assessing their respective risk of ACS and offering suggestions regarding the suitability of RA for each type of surgery.

5.
Arthroscopy ; 37(10): 3062-3069, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33940132

RESUMO

PURPOSE: To assess the accuracy and reliability of routine preoperative magnetic resonance imaging (MRI) in the detection of the comma sign compared with the gold standard of arthroscopic findings. METHODS AND MATERIALS: Preoperative MRI exams in consecutive patients undergoing arthroscopic subscapularis tendon repair, over a 5-year time frame, were retrospectively reviewed for full-thickness tears of the subscapularis and supraspinatus tendons, fatty atrophy of the subscapularis and supraspinatus muscles, and status of the long head of the biceps tendon. Each case was also evaluated for presence or absence of a comma sign on MRI. Surgical findings served as the diagnostic standard of reference in determination of a comma sign. RESULTS: The study cohort included 45 male and 10 female patients (mean age, 56; range, 32-80 years). A comma sign was present at arthroscopy in 19 patients (34.5%). Interclass and intrarater correlation showed 100% agreement in preoperative assessment of a comma sign on MRI. MRI showed an overall accuracy of 83.6% in diagnosis of a comma sign (sensitivity, 63.2%; specificity, 94.4%; positive predictive value, 85.7%; negative predictive value, 82.9%; positive likelihood ratio, 11.37; negative likelihood ratio, 0.39). No statistically significant association was observed between an arthroscopic comma sign and patient demographics or MRI findings of full-thickness rotator cuff tears, muscle fatty atrophy, or long head of the biceps tendon pathology. CONCLUSIONS: MR imaging illustrates excellent reliability and good specificity and accuracy in detection of the arthroscopic comma sign in the setting of subscapularis tendon tearing. Detection of a comma sign on MRI may be important preoperative planning information in the arthroscopic management of patients with subscapularis tendon tears. LEVEL OF EVIDENCE: Level IV, retrospective diagnostic study.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroscopia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Sensibilidade e Especificidade
6.
Artigo em Inglês | MEDLINE | ID: mdl-34056510

RESUMO

Background: An entrustable professional activity (EPA) is defined as a core task of a specialty that is entrusted to a trainee once sufficient competence has been reached. A group of EPAs reflects the activities that clinicians commonly do on a day-to-day basis. Lists of EPAs have been created for most medical subspecialties, but not orthopaedic surgery. The aim of this study was to create a peer-reviewed list of essential EPAs that a resident must perform independently before completing orthopaedic residency training. Methods: A focus group of 7 orthopaedic surgeons from the University of Toronto developed a comprehensive list of 285 EPAs. For each subspecialty group, the opinions of at least 15 academic and nonacademic surgeons, as well as subspecialty-trained and non-subspecialty-trained surgeons, were used. The modified Delphi method was used to rank EPAs on a five-point scale from not important to mandatory for a resident to competent before exiting training. Two Delphi rounds were used, using a threshold of >50% of surgeons considering the EPA as mandatory before being considered for the next round. A final list of EPAs was ratified using the focus group of academic surgeons involved in the study. Results: Seventy-five (75) of 107 (70%) surgeons invited responded to the survey. Nearly half (129) of the 285 EPAs were discarded after the first round of Delphi. A further 118 EPAs were discarded after the second Delphi round, leaving 49 final EPAs, across 9 subspecialties in orthopaedic surgery. Conclusions: Expert consensus was used to create a list of EPAs considered mandatory for completion of resident training in orthopaedics in our province. The final 49 peer-reviewed EPAs will be a valuable benchmark in curriculum design and assessment in orthopaedic surgery in the competency-based era for other programs.

7.
Arthroscopy ; 37(4): 1288-1289, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812528

RESUMO

Injections for the pain caused by knee osteoarthritis have been the focus of significant research for the last few decades. Systematic reviews and meta-analyses suggest that platelet-rich plasma (PRP) can provide up to 12 months of pain relief in these patients, superior to both cortisone and hyaluronic acid. There is also some evidence for a synergistic effect when combining both PRP and hyaluronic acid. Bone marrow aspirate concentrate (BMAC) has significantly greater levels of interleukin-1ra than PRP, as well as a small concentration of mesenchymal stromal cells. However, BMAC is yet unproven in its efficacy, and obtaining BMAC is not as simple as taking blood. Research into the use of expanded autologous and allogenic mesenchymal stem cells continues and shows future promise. For today, PRP remains the gold standard for the treatment of pain associated with knee osteoarthritis.


Assuntos
Osteoartrite do Joelho , Plasma Rico em Plaquetas , Humanos , Ácido Hialurônico , Injeções Intra-Articulares , Osteoartrite do Joelho/terapia , Dor , Resultado do Tratamento
8.
IEEE Comput Graph Appl ; 41(2): 8-16, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729921

RESUMO

We argue that visualization research has overwhelmingly focused on users from the economically developed world. However, billions of people around the world are rapidly emerging as new users of information technology. Most of the next billion users of visualization technologies will come from parts of the world that are extremely populous but historically ignored by the visualization research community. Their needs may be different to the types of users that researchers have targeted in the past, but, at the same time, they may have even more to gain in terms of access to data potentially affecting their quality of life. We propose a call to action for the visualization community to identify opportunities and use cases where users can benefit from visualization; develop universal design principles; extend evaluations by including the general population; and engage with a wider global population.

10.
IEEE Trans Vis Comput Graph ; 27(2): 1193-1203, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33074810

RESUMO

Collaborative visual analytics leverages social interaction to support data exploration and sensemaking. These processes are typically imagined as formalised, extended activities, between groups of dedicated experts, requiring expertise with sophisticated data analysis tools. However, there are many professional domains that benefit from support for short 'bursts' of data exploration between a subset of stakeholders with a diverse breadth of knowledge. Such 'casual collaborative' scenarios will require engaging features to draw users' attention, with intuitive, 'walk-up and use' interfaces. This paper presents Uplift, a novel prototype system to support 'casual collaborative visual analytics' for a campus microgrid, co-designed with local stakeholders. An elicitation workshop with key members of the building management team revealed relevant knowledge is distributed among multiple experts in their team, each using bespoke analysis tools. Uplift combines an engaging 3D model on a central tabletop display with intuitive tangible interaction, as well as augmented-reality, mid-air data visualisation, in order to support casual collaborative visual analytics for this complex domain. Evaluations with expert stakeholders from the building management and energy domains were conducted during and following our prototype development and indicate that Uplift is successful as an engaging backdrop for casual collaboration. Experts see high potential in such a system to bring together diverse knowledge holders and reveal complex interactions between structural, operational, and financial aspects of their domain. Such systems have further potential in other domains that require collaborative discussion or demonstration of models, forecasts, or cost-benefit analyses to high-level stakeholders.

11.
IEEE Trans Vis Comput Graph ; 27(2): 464-474, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33074819

RESUMO

We contribute MobileVisFixer, a new method to make visualizations more mobile-friendly. Although mobile devices have become the primary means of accessing information on the web, many existing visualizations are not optimized for small screens and can lead to a frustrating user experience. Currently, practitioners and researchers have to engage in a tedious and time-consuming process to ensure that their designs scale to screens of different sizes, and existing toolkits and libraries provide little support in diagnosing and repairing issues. To address this challenge, MobileVisFixer automates a mobile-friendly visualization re-design process with a novel reinforcement learning framework. To inform the design of MobileVisFixer, we first collected and analyzed SVG-based visualizations on the web, and identified five common mobile-friendly issues. MobileVisFixer addresses four of these issues on single-view Cartesian visualizations with linear or discrete scales by a Markov Decision Process model that is both generalizable across various visualizations and fully explainable. MobileVisFixer deconstructs charts into declarative formats, and uses a greedy heuristic based on Policy Gradient methods to find solutions to this difficult, multi-criteria optimization problem in reasonable time. In addition, MobileVisFixer can be easily extended with the incorporation of optimization algorithms for data visualizations. Quantitative evaluation on two real-world datasets demonstrates the effectiveness and generalizability of our method.

12.
IEEE Trans Vis Comput Graph ; 27(2): 1095-1105, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33074821

RESUMO

A fundamental part of data visualization is transforming data to map abstract information onto visual attributes. While this abstraction is a powerful basis for data visualization, the connection between the representation and the original underlying data (i.e., what the quantities and measurements actually correspond with in reality) can be lost. On the other hand, virtual reality (VR) is being increasingly used to represent real and abstract models as natural experiences to users. In this work, we explore the potential of using VR to help restore the basic understanding of units and measures that are often abstracted away in data visualization in an approach we call data visceralization. By building VR prototypes as design probes, we identify key themes and factors for data visceralization. We do this first through a critical reflection by the authors, then by involving external participants. We find that data visceralization is an engaging way of understanding the qualitative aspects of physical measures and their real-life form, which complements analytical and quantitative understanding commonly gained from data visualization. However, data visceralization is most effective when there is a one-to-one mapping between data and representation, with transformations such as scaling affecting this understanding. We conclude with a discussion of future directions for data visceralization.

13.
IEEE Trans Vis Comput Graph ; 27(2): 1214-1224, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33048730

RESUMO

data has no natural scale and so interactive data visualizations must provide techniques to allow the user to choose their viewpoint and scale. Such techniques are well established in desktop visualization tools. The two most common techniques are zoom+pan and overview+detail. However, how best to enable the analyst to navigate and view abstract data at different levels of scale in immersive environments has not previously been studied. We report the findings of the first systematic study of immersive navigation techniques for 3D scatterplots. We tested four conditions that represent our best attempt to adapt standard 2D navigation techniques to data visualization in an immersive environment while still providing standard immersive navigation techniques through physical movement and teleportation. We compared room-sized visualization versus a zooming interface, each with and without an overview. We find significant differences in participants' response times and accuracy for a number of standard visual analysis tasks. Both zoom and overview provide benefits over standard locomotion support alone (i.e., physical movement and pointer teleportation). However, which variation is superior, depends on the task. We obtain a more nuanced understanding of the results by analyzing them in terms of a time-cost model for the different components of navigation: way-finding, travel, number of travel steps, and context switching.

14.
IEEE Trans Vis Comput Graph ; 27(2): 1171-1181, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33048740

RESUMO

Immersive technologies offer new opportunities to support collaborative visual data analysis by providing each collaborator a personal, high-resolution view of a flexible shared visualisation space through a head mounted display. However, most prior studies of collaborative immersive analytics have focused on how groups interact with surface interfaces such as tabletops and wall displays. This paper reports on a study in which teams of three co-located participants are given flexible visualisation authoring tools to allow a great deal of control in how they structure their shared workspace. They do so using a prototype system we call FIESTA: the Free-roaming Immersive Environment to Support Team-based Analysis. Unlike traditional visualisation tools, FIESTA allows users to freely position authoring interfaces and visualisation artefacts anywhere in the virtual environment, either on virtual surfaces or suspended within the interaction space. Our participants solved visual analytics tasks on a multivariate data set, doing so individually and collaboratively by creating a large number of 2D and 3D visualisations. Their behaviours suggest that the usage of surfaces is coupled with the type of visualisation used, often using walls to organise 2D visualisations, but positioning 3D visualisations in the space around them. Outside of tightly-coupled collaboration, participants followed social protocols and did not interact with visualisations that did not belong to them even if outside of its owner's personal workspace.

15.
IEEE Trans Vis Comput Graph ; 27(2): 1764-1774, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33112748

RESUMO

Efficient optimisation algorithms have become important tools for finding high-quality solutions to hard, real-world problems such as production scheduling, timetabling, or vehicle routing. These algorithms are typically "black boxes" that work on mathematical models of the problem to solve. However, many problems are difficult to fully specify, and require a "human in the loop" who collaborates with the algorithm by refining the model and guiding the search to produce acceptable solutions. Recently, the Problem-Solving Loop was introduced as a high-level model of such interactive optimisation. Here, we present and evaluate nine recommendations for the design of interactive visualisation tools supporting the Problem-Solving Loop. They range from the choice of visual representation for solutions and constraints to the use of a solution gallery to support exploration of alternate solutions. We first examined the applicability of the recommendations by investigating how well they had been supported in previous interactive optimisation tools. We then evaluated the recommendations in the context of the vehicle routing problem with time windows (VRPTW). To do so we built a sophisticated interactive visual system for solving VRPTW that was informed by the recommendations. Ten participants then used this system to solve a variety of routing problems. We report on participant comments and interaction patterns with the tool. These showed the tool was regarded as highly usable and the results generally supported the usefulness of the underlying recommendations.

16.
Clin J Sport Med ; 31(4): 392-399, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31233432

RESUMO

OBJECTIVE: There is growing enthusiasm for the increased use of quadriceps tendon (QT) autograft for primary anterior cruciate ligament reconstruction (ACLR). The purpose of this analysis was to synthesize and quantitatively assess the available evidence comparing QT autograft with hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts, regarding functional outcomes, knee stability, anterior knee pain, and revision rates. DATA SOURCES: A search in MEDLINE, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials for eligible studies up to May 2018 was conducted. Two reviewers selected studies based on inclusion criteria and assessed methodological quality. Outcomes analyzed were anterior knee pain, graft failure rates, knee stability, functional outcomes, and adverse events. Pooled analyses were performed for continuous and dichotomous variables where appropriate. MAIN RESULTS: Ten studies (1 randomized trial and 9 nonrandomized cohorts) met our inclusion criteria, which included 1398 patients. The analysis showed no statistical difference in anterior knee pain when comparing QT and HT autografts, but a significant difference between QT and BPTB autografts [odds ratio, 0.15 (95% confidence interval, 0.08-0.27); P < 0.001]. There were no differences between all 3 autografts in revision rates, knee stability, and patient-reported functional outcomes. CONCLUSIONS: Quadriceps tendon autograft is a suitable graft alternative for primary ACLR, as it achieves good clinical outcomes with a low incidence of anterior knee pain. Given the limited quality of the included studies, there is a need for a well-designed multicenter randomized control trial comparing QT autograft with other primary ACL autografts to confirm our findings. LEVEL OF EVIDENCE: Level IV systematic review.

17.
IEEE Trans Vis Comput Graph ; 27(2): 1677-1687, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33301404

RESUMO

Node-link diagrams are widely used to visualise networks. However, even the best network layout algorithms ultimately result in 'hairball' visualisations when the graph reaches a certain degree of complexity, requiring simplification through aggregation or interaction (such as filtering) to remain usable. Until now, there has been little data to indicate at what level of complexity node-link diagrams become ineffective or how visual complexity affects cognitive load. To this end, we conducted a controlled study to understand workload limits for a task that requires a detailed understanding of the network topology-finding the shortest path between two nodes. We tested performance on graphs with 25 to 175 nodes with varying density. We collected performance measures (accuracy and response time), subjective feedback, and physiological measures (EEG, pupil dilation, and heart rate variability). To the best of our knowledge this is the first network visualisation study to include physiological measures. Our results show that people have significant difficulty finding the shortest path in high density node-link diagrams with more than 50 nodes and even low density graphs with more than 100 nodes. From our collected EEG data we observe functional differences in brain activity between hard and easy tasks. We found that cognitive load increased up to certain level of difficulty after which it decreased, likely because participants had given up. We also explored the effects of global network layout features such as size or number of crossings, and features of the shortest path such as length or straightness on task difficulty. We found that global features generally had a greater impact than those of the shortest path.

19.
Artigo em Inglês | MEDLINE | ID: mdl-32937005

RESUMO

OBJECTIVE: To understand what sports orthopedic surgeons (OS), primary care physicians (PCPs) with sports medicine training and physiotherapists (PTs) managing non-elite athletes with anterior cruciate ligament (ACL) injury tell their patients about their osteoarthritis (OA) risk. METHODS: An electronic survey was distributed by the Canadian Academy of Sport and Exercise Medicine (PCPs, OS), the Sports and Orthopedic Divisions of the Canadian Physiotherapy Association (PTs), and to OS identified through the Royal College of Physicians and Surgeons and the Canadian Orthopaedic Association. The survey included four sections: demographics; factors discussed; timing of discussions; and, discussion of risk factors and their management. Proportions or means with 95% confidence intervals (CI) were calculated. RESULTS: 501 (98 PCP, 263 PT, and 140 OS) responded. Seventy to 77% of physicians reported always discussing OA risk but only 35% of PTs did. All reported that patient activities perceived as detrimental to knee health, ACL re-injury and simultaneous injury to other structures in the knee were most often the reason for discussing OA risk. OA risk was discussed at initial management post-injury (65 to 94%) with few discussing risk subsequently. Eighty percent of physicians and 99% of PTs indicated that PTs were suited to provide OA risk and management information. CONCLUSION: Health care professionals (HCPs) routinely managing people with ACL injury do not consistently discuss OA risk post injury with them. Educational strategies for HCPs are urgently needed to develop care pathways inclusive of support for OA risk management post ACL injury.

20.
Artigo em Inglês | MEDLINE | ID: mdl-32746267

RESUMO

We introduce Tilt Map, a novel interaction technique for intuitively transitioning between 2D and 3D map visualisations in immersive environments. Our focus is visualising data associated with areal features on maps, for example, population density by state. Tilt Map transitions from 2D choropleth maps to 3D prism maps to 2D bar charts to overcome the limitations of each. Our paper includes two user studies. The first study compares subjects' task performance interpreting population density data using 2D choropleth maps and 3D prism maps in virtual reality (VR). We observed greater task accuracy with prism maps, but faster response times with choropleth maps. The complementarity of these views inspired our hybrid Tilt Map design. Our second study compares Tilt Map to: a side-by-side arrangement of the various views; and interactive toggling between views. The results indicate benefits for Tilt Map in user preference; and accuracy (versus side-by-side) and time (versus toggle).

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