Geometric 3D analyses of the foot and ankle using weight-bearing and non weight-bearing cone-beam CT images: The new standard?

OBJECTIVES: We hypothesize that three-dimensional (3D) geometric analyses in weight bearing CT-images of the foot and ankle are more reproducible compared to two-dimensional (2D) analyses. Therefore, we compared 2D and 3D analyses on bones of weight-bearing and non weight-bearing cone-beam CT images of healthy volunteers. METHODS: Twenty healthy volunteers (10 male, 10 female, mean age 37.5 years) underwent weight-bearing and non weight-bearing cone-beam CT imaging of both feet. Clinically relevant height and angle measurements were performed in 2D and 3D (for example: cuboid height, calcaneal pitch, talo-calcaneal angle, Meary's angle, intermetatarsal angle). Three-dimensional measurements were obtained using automated software. Intra-observer and inter-observer agreement were evaluated for all 2D measurements. RESULTS: Overall intraclass correlation coefficients (ICC's) were higher than 0.750 for most 2D measurements, ranging from 0.352 to 0.995. Calcaneal pitch, angle between the first metatarsal (MT1) and proximal phalange 1, between the fifth metatarsal (MT5) and the calcaneus and heights of the sesamoid bones, navicular, cuboid and talus decreased during weight-bearing in both 2D and 3D results (p < 0.01). Meary's angle was not statistically different in 2D (p = 0.627) and 3D (p = 0.765). Higher coefficients of variation in 2D geometric analysis parameters (0.27 versus 0.16) indicate that 3D analyses are more precise compared to 2D (p < 0.01). Results of left and right feet are comparable for 2D and 3D analyses. CONCLUSION: Although 2D and 3D geometrical analyses are fundamentally different, automated 3D analyses are more reproducible and precise compared to 2D analyses. In addition, 3D evaluation better demonstrates differences in bone configurations between weight-bearing and non weight-bearing conditions, which may be of value to demonstrate pathology.

[Dentists and peer review: results of a descriptive study on perceived effects of peer review]. / Tandartsen en het Alpha-model. Verslag van een onderzoek naar de door tandartsen ervaren effecten van het Alpha-model.

In the Netherlands over 20% of dentists participate in peer review groups. The peer review method is highly structured and consists of: setting standards for good dental care, measuring and evaluating performances against the standards and making improvements if necessary. An independent research institute (Nivel) investigated the perceived effects and advantages of and barriers to peer review. A postal questionnaire was sent tot 278 dentists who participate in peer review (response 60%). The results showed many effects of peer review. The most frequently reported effects were: more insight into the performances of colleagues, increased inter-professional contacts, a more critical attitude to performances, increased professional expertise and new inspiration and motivation. The respondents reported improvements in practice-organisation as well as in technical aspects of dental care. However, many dentists also mentioned some barriers to peer review. The method was evaluated as rather complex and it appeared to be difficult to reach consensus about standards for good dental care. In general, respondents perceived a positive balance between advantages and disadvantages of peer review, however many dentists were dissatisfied with the lack of financial compensation for participation in peer review.

[Dentists and mutual practice visitation. Results of a descriptive study on the effects on mutual visitation by dentists]. / Tandartsen en onderlinge visitatie. Verslag van een onderzoek naar de door tandartsen ervaren effecten van onderlinge visitatie.

In 1998 mutual practice visitation has been introduced in the Dutch dental practice as a method to improve quality of dental care. The method is called 'mutual visitation' because groups of three dentists visit and evaluate each others practices. An independent research institute (Nivel) investigated the perceived effects, advantages and barriers of visitation. A postal questionnaire was sent to all 235 dentists who, by that time, participated in visitation. The response was 57%. The results showed that the effects reported most frequently were: a more critical attitude to dental practice, more insight into practices of colleagues and actual improvements in dental care. The majority of the respondents considered visitation suitable to improve practice-organization. A minority considered visitation suitable to increase professional expertise. The mutuality of the visitation was highly valued by the participants. The main disadvantage of visitation appeared to be the time investment (a mean of three days per dentist). In general, the respondents held the view that the positive effects outweighed the time and efforts, however, many dentists regretted the lack of financial compensation for visitation.

[Decade of quality health care: dentists in comparison with other health professionals]. / Tien jaar kwaliteitszorg: tandartsen vergeleken met andere beroepsgroepen in de zorgsector.

In 1990 the Dutch organisations for health care providers, patients-organizations and insurance companies agreed on the implementation of quality systems in health care. Ever since, the health care professions--including dentists--are being involved in the development of quality systems to assure and improve the quality of care. In 2000 a national survey has been conducted to investigate which quality systems already were developed by Dutch health care professions and a comparison between the professions has been made. It appeared that the quality systems of the professions are characterised by four pillars. 1. professional expertise; 2. evidence based guidelines for good practice; 3. peer review directed at continuous improvement; and 4. re-licensing or certification to guarantee the quality. The study showed that the professions differ in the quality policies they pursue and in the progress which has been made. In dental practice an accent in the quality policy is on peer review (whereas in general practice the accent is on guidelines). Ranking the professions in the degree in which the quality system are developed, medical doctors and pharmacists are front-runners, dentist are in the middle rank whereas nurses and psychologists are lagging behind. For the years to come, a priority has been set on further implementation of the quality systems.

Social democratic government and spatial distribution of health care facilities. The case of hospital beds in Germany.

BACKGROUND: In this paper, the hypothesis that the spatial distribution of hospital beds is more even in countries with socialist or social democratic governments than in countries with conservative or Christian democratic governments was tested. To avoid the confounding influences of historical and institutional differences between countries, we used the Federal Republic of Germany as a case study. The German federal states have their own governments who play an important role in creating structures for the planning of hospital facilities. METHODS: The test of the hypothesis was largely quantitative. At the level of federal states the rank correlation was computed between the weighted number of years of left-wing government participation and the coefficient of variation in the number of hospital beds per 1000 inhabitants. In addition to this, the hospital plans of two federal states were studied. RESULTS: The hypothesis was supported by the data, showing a positive association between the number of years of left-wing government participation and regional variation in the number of hospital beds. A comparison of the hospital plans of two contrasting federal states showed less government interference in hospital planning in the state with a tradition of right-wing government. CONCLUSION: There seems to be a relation between left-wing government participation in West German states and a more equal distribution of the number of hospital beds per 1,000 inhabitants.