THREE DIMENSIONAL ARTHROKINEMATIC ANALYSIS OF THE LATE PREPARATORY PHASE OF HANDBALL THROWING

INTRODUCTION: At full cocking, functional instability of the glenohumeral (GH) joint is commonly found in handball players. In the past, 2D radiography was used to examine the in vivo translation of the humeral head (HH) on the glenoid cavity (GC). Considering the restraint validity of 2D methods to estimate 3D motion, 3D intra-articular GH kinematical data were obtained on the late cocking phase of handball throwing, using fast helical CT scanning. METHODS: Based on the CT data, 3D bone reconstructions of 3 asymptomatic and 3 functionally unstable GH joints (1 internal impingement, 2 with minor anterior GH instability) in handball players were acquired from a position with the shoulder in 90° abduction and 90° external rotation, and from a position of full cocking assessed on an individual basis. Kinematic analysis was based on a least squares method and linked to the finite helical axis (FHA) concept. After virtual disarticulation, a local frame was embedded on the GC. Subsequently, the GH FHA parameters of direction, rotation and shift were decomposed on this local frame. The displacement of the center of curvature of the HH was related to the GC. Based on an analytic error propagation model, the estimates of the rotation angle, the direction vector and the shift showed highly accurate results. The estimate of the position vector was insufficient for a mathematical analysis and therefore obtained graphically in the finite plane of motion, perpendicularly situated on the FHA. Subsequently, GH contact areal displacement of the mating articular surfaces was analyzed in this finite plane of motion. RESULTS: Towards full cocking, the HH of the asymptomatic shoulders practically did not externally/internally rotate on the local GC frame. The internal impingement demonstrated an accentuated GH external rotation, attended by a dysfunction in scapular setting, with a normal posterior translation of the HH on the GC. Minor anterior GH instability showed a diminished posterior translation of the center of the HH on the GC, as well as an accentuated external rotation. GH contact areal displacement in the normal throwing shoulders and the test case with internal impingement revealed roll behavior. The test cases with minor anterior GH instability featured a pivot. CONCLUSIONS: This research demonstrated the use of helical CT data reconstruction of joint structures with the implementation of an FHA approach to study the 6 degrees of freedom of intra-articular motion assessing a local articular embedded frame and contact areal displacements. The study provided insight in the arthrokinematics of functional instability of the GH joint at late cocking

Air pollution and childhood respiratory consultations in primary care:A systematic review

Background: Outdoor air pollution is a known risk factor for respiratory morbidity worldwide. Compared with the adult population, there are fewer studies that analyse the association between short-term exposure to air pollution and respiratory morbidity in children in primary care. Objective: To evaluate whether children in a primary care setting exposed to outdoor air pollutants during short-term intervals are at increased risk of respiratory diagnoses. Methods: A search in Medline, the Cochrane Library, Web of Science and Embase databases throughout March 2023. Percentage change or risk ratios with corresponding 95% CI for the association between air pollutants and respiratory diseases were retrieved from individual studies. Risk of bias assessment was conducted with the Newcastle-Ottawa Scale (NOS) for cohort or case-control studies and an adjusted NOS for time series studies. Results: From 1366 studies, 14 were identified as meeting the inclusion criteria. Most studies had intermediate or high quality. A meta-analysis was not conducted due to heterogeneity in exposure and health outcome. Overall, studies on short-term exposure to air pollutants (carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and particulate matter ≤10 μm (PM10)) were associated with increased childhood respiratory consultations in primary care. In general, exposure to ozone was associated with a reduction in respiratory consultations. Conclusions: The evidence suggests CO, SO2, NO2, PM10 and PM2.5 are risk factors for respiratory diseases in children in primary care in the short term. However, given the heterogeneity of the studies, interpretation of these findings must be done with caution. PROSPERO registration number: CRD42022259279.</p

How do referring clinicians want radiologists to report? Suggestions from the COVER survey

OBJECTIVE: To investigate what referring clinicians suggest when asked how the quality of radiology reports can be improved. METHODS: At the end of the questionnaire of the COVER survey, a bi-national quantitative survey on the radiology report among referring physicians, clinical specialists and general practitioners were able to freely enter suggestions with regard to improving the quality of the report. These suggestions were isolated from the quantitative results. Subjects and themes were identified, examined, ordered, counted, compared and analysed. RESULTS: Of a total of 3,884 invitations to participate, we received 735 response forms from clinicians (18.9%), 233 (31.7%) of which contained suggestions. Issues mentioned most frequently were the need for clinical information and a clinical question, for a conclusion, structuring, communicating directly with the clinician, completeness, integrating images or referring to images, mentioning relevant findings outside of the clinical question, mentioning a diagnosis or suitable differential diagnosis, and concise reporting. CONCLUSION: Although these spontaneous suggestions are erratic and sometimes contradictory, they summarise the ideas as well as the emotions of these clients of the radiology department. Therefore it is advisable to take them into account when developing new ways of reporting

Blood pressure measurements for diagnosing hypertension in primary care:room for improvement

Background: In the adult population, about 50% have hypertension, a risk factor for cardiovascular disease and subsequent premature death. Little is known about the quality of the methods used to diagnose hypertension in primary care. Objectives: The objective was to assess the frequency of use of recognized methods to establish a diagnosis of hypertension, and specifically for OBPM, whether three distinct measurements were taken, and how correctly the blood pressure levels were interpreted. Methods: A retrospective population-based cohort study using electronic medical records of patients aged between 40 and 70 years, who visited their general practitioner (GP) with a new-onset of hypertension in the years 2012, 2016, 2019, and 2020. A visual chart review of the electronic medical records was used to assess the methods employed to diagnose hypertension in a random sample of 500 patients. The blood pressure measurement method was considered complete if three or more valid office blood pressure measurements (OBPM) were performed, or home-based blood pressure measurements (HBPM), the office- based 30-minute method (OBP30), or 24-hour ambulatory blood pressure measurements (24 H-ABPM) were used. Results: In all study years, OBPM was the most frequently used method to diagnose new-onset hypertension in patients. The OBP-30 method was used in 0.4% (2012), 4.2% (2016), 10.6% (2019), and 9.8% (2020) of patients respectively, 24 H-ABPM in 16.0%, 22.2%, 17.2%, and 19.0% of patients and HBPM measurements in 5.4%, 8.4%, 7.6%, and 7.8% of patients, respectively. A diagnosis of hypertension based on only one or two office measurements occurred in 85.2% (2012), 87.9% (2016), 94.4% (2019), and 96.8% (2020) of all patients with OBPM. In cases of incomplete measurement and incorrect interpretation, medication was still started in 64% of cases in 2012, 56% (2016), 60% (2019), and 73% (2020). Conclusion: OBPM is still the most often used method to diagnose hypertension in primary care. The diagnosis was often incomplete or misinterpreted using incorrect cut-off levels. A small improvement occurred between 2012 and 2016 but no further progress was seen in 2019 or 2020. If hypertension is inappropriately diagnosed, it may result in under treatment or in prolonged, unnecessary treatment of patients. There is room for improvement in the general practice setting.</p

Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients

OBJECTIVE: There has been an increase in testing of vitamins in patients in general practice, often based on irrational indications or for non-specific symptoms, causing increasing healthcare expenditures and medicalisation of patients. So far, there is little evidence of effective strategies to reduce this overtesting in general practice. Therefore, the aim of this qualitative study was to explore the barriers and facilitators for reducing the number of (unnecessary) vitamin D and B12 laboratory tests ordered. DESIGN AND SETTING: This qualitative study, based on a grounded theory design, used semistructured interviews among general practitioners (GPs) and patients from two primary care networks (147 GPs, 195 000 patients). These networks participated in the Reducing Vitamin Testing in Primary Care Practice (REVERT) study, a clustered randomized trial comparing two de-implementation strategies to reduce test ordering in primary care in the Netherlands. PARTICIPANTS: Twenty-one GPs, with a maximum of 1 GP per practice who took part in the REVERT study, and 22 patients (who were invited by their GP during vitamin-related consultations) were recruited, from which 20 GPs and 19 patients agreed to participate in this study. RESULTS: The most important factor hampering vitamin-test reduction programmes is the mismatch between patients and medical professionals regarding the presumed appropriate indications for testing for vitamin D and B12. In contrast, the most important facilitator for vitamin-test reduction may be updating GPs' knowledge about test indications and their awareness of their own testing behaviour. CONCLUSION: To achieve a sustainable reduction in vitamin testing, guidelines with clear and uniform recommendations on evidence-based indications for vitamin testing, combined with regular (individual) feedback on test-ordering behaviour, are needed. Moreover, the general public needs access to clear and reliable information on vitamin testing. Further research is required to measure the effect of these strategies on the number of vitamin test requests. TRIAL REGISTRATION NUMBER: WAG/mb/16/039555

Back Complaints in the Elders (BACE); design of cohort studies in primary care: an international consortium

Background: Although back complaints are common among older people, limited information is available in the literature about the clinical course of back pain in older people and the identification of older persons at risk for the transition from acute back complaints to chronic back pain. The aim of this study is to assess the course of back complaints and identify prognostic factors for the transition from acute back complaints to chronic back complaints in older people who visit a primary health care physician. Methods/design. The design is a prospective cohort study with one-year follow-up. There will be no interference with usual care. Patients older than 55 years who consult a primary health care physician with a new episode of back complaints will be included in this study. Data will be collected using a questionnaire, physical examination and X-ray at baseline, and follow-up questionnaires afte