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This study investigated the association among isometric upper-limb strength of handcyclists and sport-specific performance outcomes. At two international events, 62 athletes were tested on upper-limb strength, measured with an isometric-strength setup and with Manual Muscle Test (MMT). Horizontal force (F-z), effectiveness, rate of development, variability, and asymmetries were calculated for upper-limb pull and push. Performance measures were mean (POmean) and peak (POpeak) 20-s sprint power output and average time-trial velocity (TTvelocity). Regression models were conducted to investigate which pull and push strength variables associated strongest with performance measures. Additional regression analyses were conducted with an MMT sum score as predictor. Push and pull F-z showed the strongest associations with all outcomes. Combined push and pull F-z explained (p < .001) 80-81% of variance of POmean and POpeak. For TTvelocity, only push F-z was included in the model explaining 29% of the variance (p < .001). MMT models revealed weaker associations with sprint PO (R-2 = .38-.40, p < .001) and TTvelocity (R-2 = .18, p = 0.001). The findings confirmed the relevance of upper-limb strength on handcycling performance and the significance of ratio-scaled strength measures. Isometric strength outcomes are adequate sport-specific indicators of impairment in handcycling classification, but future research should corroborate this notion and its potential to discriminate between sports classes.

Objectives: Data on national patterns of care for patients with superior sulcus tumors (SST) is currently lacking. We investigated the distribution of surgical care and outcome for patients with SST in the Netherlands. Material and methods: Data was retrieved from the Dutch Lung Cancer Audit for Surgery (DLCA-S) for all patients undergoing resection for clinical stage IIB-IV SST from 2012 to 2019. Because DLCA-S is not linked to survival data, survival for a separate cohort (2015–2017) was obtained from the Netherlands Cancer Registry (NCR). Results: In the study period, 181 patients had SST surgery, representing 1.03% (181/17488) of all lung cancer pulmonary resections. For 2015–2017, the SST resection rate was 14.4% (79/549), and patients with stage IIB/III SST treated with trimodality had a 3-year overall survival of 67.4%. 63.5% of patients were male, and median age was 60 years. Almost 3/4 of tumors were right sided. Surgery was performed in 20 hospitals, with average number of annual resections ranging from ≤ 1 (n = 17) to 9 (n = 1). 39.8% of resections were performed in 1 center and 63.5% in the 3 most active centers. 12.7% of resections were extended (e.g. vertebral resection). 85.1% of resections were complete (R0). Morbidity and 30-day mortality were 51.4% and 3.3% respectively. Despite treating patients with a higher ECOG performance score and more extended resections, the highest volume center had rates of morbidity/mortality, and length of hospital stay that were comparable to those of the medium volume (n = 2) and low-volume centers (n = 1). Conclusion: In the Netherlands, surgery for SST accounts for about 1% of all lung cancer pulmonary resections, the number of SST resections/hospital/year varies widely, with most centers performing an average of ≤ 1/year. Morbidity and mortality are acceptable and survival compares favourably with the literature. Although further centralisation is possible, it is unknown whether this will improve outcomes.

OBJECTIVE: The purpose of this study was to determine the effects of seat height, wheelchair mass and grip on mobility performance among wheelchair basketball players and to investigate whether these effects differ between classification levels. METHODS: Elite wheelchair basketball players with a low (n= 11, class 1 or 1.5) or high (n= 10, class 4 or 4.5) classification performed a field-based wheelchair mobility performance (WMP) test. Athletes performed the test six times in their own wheelchair, of which five times with different configurations, a higher or lower seat height, with additional distally or centrally located extra mass, and with gloves. The effects of these configurations on performance times and the interaction with classification were determined. RESULTS: Total performance time on the WMP test was significantly reduced when using a 7.5% lower seat height. Additional mass (7.5%) and glove use did not lead to changes in performance time. Effects were the same for the two classification levels. CONCLUSIONS: The methodology can be used in a wheelchair fitting process to search for the optimal individual configuration to enhance mobility performance. Out of all adjustments possible, this study focused on seat height, mass and grip only. Further research can focus on these possible adjustments to optimize mobility performance in wheelchair basketball.

Objective: An inadequate surgical informed consent process (SIC) may result in a medical malpractice claim or medical disciplinary board (MDB) complaint. Aim of this study was to analyse characteristics of a decade of malpractice claims and MDB decisions regarding SIC in the Netherlands.Methods: A retrospective analysis of malpractice claims and MDB decisions concerning SIC disputes in four major surgical specialties was conducted based on company data from the largest medical malpractice insurance company and two public available online MDB databases.Results: A total of 11376 malpractice claims and 661 MDB complaints were filed between 2004-2013 and 676(6%) of these claims and 69(10%) of these complaints involved an alleged deficient SIC process. A random sample of 245(37%) claims and all MDB decisions were analysed. Reasons for filing a claim or complaint were insufficient counselling or recording of SIC elements. In 20% of lawsuits and 25% of claims the case resulted in favour of the complainant.Conclusion: A substantial portion of malpractice claims and MDB decisions is related to a deficient SIC process.Practice implications: Focusing on crucial SIC elements for patients may improve satisfaction and expectations and result in a lower risk for malpractice claims and MDB complaints. (C) 2018 Elsevier B.V. All rights reserved.