Expert clinical consensus in the delivery of hydrodilatation for the management of patients with a primary frozen shoulder : a modified Delphi study.

AIMS: To achieve expert clinical consensus in the delivery of hydrodilatation for the treatment of primary frozen shoulder to inform clinical practice and the design of an intervention for evaluation. METHODS: We conducted a two-stage, electronic questionnaire-based, modified Delphi survey of shoulder experts in the UK NHS. Round one required positive, negative, or neutral ratings about hydrodilatation. In round two, each participant was reminded of their round one responses and the modal (or 'group') response from all participants. This allowed participants to modify their responses in round two. We proposed respectively mandating or encouraging elements of hydrodilatation with 100% and 90% positive consensus, and respectively disallowing or discouraging with 90% and 80% negative consensus. Other elements would be optional. RESULTS: Between 4 August 2020 and 4 August 2021, shoulder experts from 47 hospitals in the UK completed the study. There were 106 participants (consultant upper limb orthopaedic surgeons, n = 50; consultant radiologists, n = 52; consultant physiotherapist, n = 1; extended scope physiotherapists, n = 3) who completed round one, of whom 97 (92%) completed round two. No elements of hydrodilatation were "mandated" (100% positive rating). Elements that were "encouraged" (≥ 80% positive rating) were the use of image guidance, local anaesthetic, normal saline, and steroids to deliver the injection. Injecting according to patient tolerance, physiotherapy, and home exercises were also "encouraged". No elements were "discouraged" (≥ 80% negative rating) although using hypertonic saline was rated as being "disallowed" (≥ 90% negative rating). CONCLUSION: In the absence of rigorous evidence, our Delphi study allowed us to achieve expert consensus about positive, negative, and neutral ratings of hydrodilatation in the management of frozen shoulder in a hospital setting. This should inform clinical practice and the design of an intervention for evaluation.Cite this article: Bone Jt Open 2022;3(9):701-709.

What is the relation between number of sessions worked and productivity of radiologists-a pilot study?

Increasing workloads and the current austerity measures are putting UK radiology departments under considerable stress. We need to look at the most efficient ways to manage radiology departments in order to cope with increasing demand. Consequently, a system is needed that can compare productivity between radiologists with different jobs. We measured workload in a UK radiology department and compared the productivities of consultants working different numbers of sessions, which are called programmed activities (PAs), to identify the optimal job plan structure for reporting productivity. Reporting data was gathered from electronic records for 14 consultants working different numbers of PA during the period April 2010-March 2011. These were converted into relative value unit (RVU) scores using a modified RCSI RVU system. Crude and net workloads were calculated for each consultant by dividing their total RVU score by the number of PAs they were contracted for and how many they spent reporting. The consultants reported 118,001 imaging studies. There was statistically significant variation in productivity between consultants working different numbers of PAs on χ (2) analysis (p < 0.05). Consultants working 12 PAs were more productive than consultants working 11 PAs, with net workloads of 7636 RVU/PA/year versus net 6146 RVU/PA/year, p < 0.05. Although UK consultants working 12 PAs per week are more productive than their colleagues, the reasons why are unclear. We have identified a method that can be developed further to identify efficient working practices in UK radiology departments. However, a UK-specific RVU system would make this productivity analysis more accurate.

Psychological blindness - a case report.

Rarely does malingering present in the form of complete blindness and that too of prolonged duration, in presence of possible organic corroboration and well supported by relatives. This case is reported to highlight the extremes of psychological production of symptoms and how it can be successfully dealt with.

A comparative, qualitative and quantitative antimicrobial efficacies of mouthrinses containing chlorhexidine gluconate and essential oils.

A project was launched to evaluate and compare antimicrobial efficacy of Hexidine and Listerine over placebo in 10 day human experimental gingivitis study. A rigid study schedule for subject compliance spanning well over 3 months was sorted out and volunteers recruited for study rinsed all the 3 assigned mouthrinses containing (a) chlorhexidine gluconate, (b) "essential oils" and (c) flavoured distilled water one after the other at certain prefixed intervals. After 10 days of assigned mouthrinse regimen, where the assigned mouthrinse was the only method practiced by the volunteers for oral hygiene, Supragingival Plaque was quantitatively and qualitatively assayed. Qualitatively supragingival plaque was assayed by Gram staining (Direct smear and Thioglycollate Broth) and growth characteristics i.e; Aerobic, Microaerophilic and Anaerobic growth was noted. Quantitatively plaque was assayed by calculating total microbial load per tooth by preparing Mafarland Nephelometer standard and Spectrophotometric analysis. It is concluded that Hexidine and Listerine exert similar antimicrobial efficacy in 10 days experimental gingivitis study. Hexidine and Listerine exert their antimicrobial influence through reduction of total Aerobes and Anaerobes reducing total microbial load per tooth by 58% and 53% respectively as compared to placebo.

Influence of diabetes mellitus on periodontal disease.

In the present study 62 uncontrolled diabetic and 60 non-diabetic patients between the age range of 35-66 years were examined and plaque, calculus, gingival and perio indices were studied. In this study correlation of salivary calcium and blood sugar with periodontal health and calculus deposition was also carried out. It shows that there was increase in RPI and OHI with duration in uncontrolled diabetic patients. We have also observed that salivary calcium level was significantly higher in uncontrolled diabetics which helps in calculus formation and hence increases severity of periodontal disease.

Rapid evolution of cardiac tamponade due to bacterial pericarditis in two patients with HIV-1 infection.

We describe two HIV-seropositive patients with acute pneumococcal empyema and pericarditis. Cardiac tamponade evolved rapidly in each patient and was reversed with prompt surgical intervention. In each case, immunologic abnormalities were detected which could have facilitated local spread of infection and progression to tamponade. Pericarditis, an otherwise rare manifestation of pneumococcal infection in the antibiotic era, should be anticipated in HIV-seropositive patients with pneumococcal empyema.