CORRELATION BETWEEN THROWING MOTION AND MAXIMUM ELBOW VARUS TORQUE IN FEMALE PROFESSIONAL BASEBALL PITCHERS

The purpose of this study was to identify the correlation between throwing motion and maximum elbow varus torque (MEV) in female professional baseball pitchers. Twelve pitchers without pre-existing pain were recruited. Ball velocity and pitching motion were measured. Ball velocity and, kinematic and kinetic data from each joint during the pitch were extracted to evaluate the correlation with MEV. There was no correlation between the fastest ball velocity and MEV. Sixteen kinematic and kinetic parameters were found to have significant correlations with MEV. Particularly, as trunk rotation angle to the non-throwing direction before lead foot contact (FC) increased, the MEV decreased. Rotating the trunk in the non-throwing direction before FC and immediately in the throwing direction after FC could be a key component of the throwing motion

混合病棟におけるインシデントノートを使用したコミュニケーションエラー減少の取り組み

　2011年４月より合計12科の混合病棟となったことで，看護業務が煩雑化し，医療事故・過誤の高リスクとなっていた．その改善の目的で，当該病棟の看護師22名が，コミュニケーションエラーの回避・減少を目的としたインシデントノート（【ノート】と表記）を2011年7月10日から2011年12月31日まで使用し，記入されたデータから意図の共通性を分類した．さらに【ノート】使用の前後で実施した意識調査の結果を合わせて内容分析を行った．【ノート】の内容は，３つのコアカテゴリー（『コア』と表記），その下層に計9つのカテゴリー（≪カテゴリー≫と表記）に分類された．『意識付けによる安全行動への期待』では，≪発生したインシデントの状況の記述≫および≪確認不足による間違い≫から，具体的な事実を確認でき，病棟にある潜在的リスクが情報として表在化された．そして≪厳守規則≫として，情報発信，ルールづくり，遵守徹底が図られた．【ノート】の使用によって，それらの情報をタイムリーに，アサーティブな方法でエラーを指摘することができ，意識付け，チーム間で話し合うという安全風土の形成に有効であった．『潜在リスクの表在化』では，意識調査において，経験年数９年以下では10年以上のスタッフに比べ危険を察知する割合が低いという結果が得られた．≪不慣れ・知識不足からのインシデント情報≫から，知識・経験の豊富なスタッフやリスク感性の高いスタッフが情報を提供することが，相互サポートとして活用できたことが判明した．『医師からの知識情報』では，12科32名の医師の指示に対応する必要性があり，この項目もノートに記述されエラーの低減に有効であった．当該病棟では，混合病棟による環境に影響を受けた個人要因を一番高いリスク因子と捉えており，【ノート】の使用はリスク因子を表在化し，改善策に結びつけることができた．また，【ノート】をツールとした情報共有によるコミュニケーションが，患者安全を意識した風土作りに有効と考えられた．今後は必要に応じ【ノート】を使用することにより，更なる看護業務の改善を図りたい．　In April of 2011, Kawasaki Medical School General Medical Center created a mixed ward consisted of twelve different departments. This mixed-department ward initially resulted in more complex nursing duties and a higher risk of medical incidents. We analyzed descriptions written by 22 nurses in incident notebooks shared among the mixed-department ward nurses between July and December of 2011, and an awareness survey performed six months after the mixed ward was created. The contents of the notebooks were classified into three core categories with nine sub-categories. In the core category [safe behavior through awareness], incident data from the sub-categories “incident descriptions” and “errors due to a lack of communication” was presented to the ward nurses and “rules to be sure to follow”were decided and implemented. The notebooks were helpful for finding problems in a clear and timely fashion and helped create a culture of safety by raising awareness and communication among the various teams in the ward. The second core category [awareness of hidden risks] was especially noticed by nurses with over ten years of experience, according to the awareness survey. Nurses with vast knowledge and experience along with nurses with an above average risk sensitivity were able to mutually support less experienced nurses with information in the sub-category classified as“ incidents occurring from inexperience or a lack of knowledge.” The final core category [information from doctors] were notes written in response to information from one or more of the 32 doctors working in the ward. Knowledge from the physicians was recorded and shared among the nursing staff through the notebooks. In the mixed ward, the environmental factors considered to be the highest risk factors were recorded in the notebooks and led directly to improved measures. In addition, the communication fostered by sharing information in the notebooks contributed towards a conscious culture of medical safety management

Spine Alignment in Standing and Maximal Upper Limb Elevation in Baseball Players with Lumbar Spondylolysis and Those without Low Back Pain

The changes in lumbar lordosis angle (LL) and sacral slope angle (SS) related to upper limb elevation and thoracic kyphosis angle (TK) in baseball players with spondylolysis remain unclear. Herein, we investigated baseball players with spondylolysis and those without low back pain, comparing LL and SS with upper limb elevation within and between groups and TK between groups. Baseball players with spondylolysis were enrolled as subjects, and baseball players without low back pain were enrolled as controls (n = 8 each). X-rays were obtained in the standing position and with maximal elevation position of the upper limb (elevation position). LL and SS were measured in the standing and elevated positions, and TK was measured in the standing position. LL was significantly larger in individuals with spondylolysis than controls. The SS of the control group was significantly larger in the elevated position than in the standing position, while the SS of the spondylolysis group was not significantly different between positions. SS was significantly larger in the spondylolysis group than in the control group, only in the standing position. Physical therapy for spondylolysis should focus on hyperlordosis alignment in the standing and maximal elevation positions of both upper limbs, sacral hyper-slope alignment in the standing position, and decreased sacral slope motion

Range of motion patterning in trunk and upper and lower extremities of high school baseball pitchers

Evaluating range of motion (ROM) using several joints is essential for rehabilitating throwing injuries. We used multivariate analysis to elucidate the ROM patterns in baseball pitchers. This cross-sectional study measured the variable ROM in the upper extremities, trunk, and lower extremities. High school baseball pitchers participated (N = 121). Factor analysis of ROM was performed using the maximum likelihood method. We analyzed the characteristics of pitchers with positive findings by classifying all players using cluster analysis (Ward’s method). Factor analysis showed a seven-factor solution was shown to be appropriate. Cluster analysis indicated that we could divide the players into three clusters that we named according to their characteristics and ROM: Cluster A: “Low flexibility” type, Cluster B: “High rotation” type, and Cluster C: “Poor rotation” type. The results indicated that most positive players were in Cluster A (46.4%). Players in Cluster A had lower ROM in the trunk, hip rotation, and SLR (straight leg raise) test than the other groups. This is the first study to identify the patterns of ROM in high school baseball pitchers with positive findings. These results are useful for conditioning baseball players