Objectives: To compare the validity, responsiveness to change, and user friendliness of four self completed, shoulder-specific questionnaires in primary care. Methods: A cross sectional assessment of validity and a longitudinal assessment of responsiveness to change of four shoulder questionnaires was carried out: the Dutch Shoulder Disability Questionnaire (SDQ-NL); the United Kingdom Shoulder Disability Questionnaire (SDQ-UK); and two American instruments, the Shoulder Pain and Disability Index (SPADI) and the Shoulder Rating Questionnaire (SRQ). 180 primary care consulters with new shoulder region pain each completed two of the questionnaires, as well as EuroQoL and 10 cm visual analogue scales (VAS) for overall pain and difficulty due to the shoulder problem. Each participant was assessed by a standardised clinical schedule. Postal follow up at 6 weeks included baseline measures and self rated assessment of global change of the shoulder problem (seven point Likert scale). Results: Strongest correlations were found for SDQ-UK with EuroQoL 5 score, and for SPADI and SRQ with shoulder pain and difficulty VAS. All shoulder questionnaires correlated poorly with active movement at the painful shoulder. SPADI and SRQ performed better on ROC analysis than SDQ-NL and SDQ-UK (areas under the curve of 0.87, 0.85, 0.77, and 0.77, respectively). However, SRQ scores changed significantly over time in stable subjects. Conclusions: Cross sectional comparison of the four shoulder questionnaires showed they had similar overall validity and patient acceptability. SPADI and SRQ were most responsive to change. Additionally, SPADI was the quickest to complete and scores did not change significantly in stable subjects. M ost shoulder region pain is seen and managed in primary care.1 Our understanding about the natural history and optimal treatment for shoulder complaints has been hampered, however, by the use of different outcome measures, including a variety of shoulder-specific questionnaires.2-4 It is therefore important to identify a preferred shoulder questionnaire to facilitate the consistent use of outcome measures and meaningful comparison of results in primary care based cross sectional and longitudinal studies.Since 1990, a number of groups have developed self administered shoulder pain and disability questionnaires. 5-13Many were developed and tested in secondary orthopaedic care settings and were primarily intended for measuring outcomes after surgical procedures. To date, the validity and responsiveness of shoulder questionnaires has not been compared in primary care.We describe the results from a prospective study comparing the validity, responsiveness, and acceptability of four shoulder pain and disability questionnaires when used to assess primary care consulters with new onset shoulder region pain.

BACKGROUND AND PURPOSE: Multidetector CT has emerged as the standard of care imaging technique to evaluate cervical spine trauma. Our aim was to evaluate the performance of a convolutional neural network in the detection of cervical spine fractures on CT. MATERIALS AND METHODS:We evaluated C-spine, an FDA-approved convolutional neural network developed by Aidoc to detect cervical spine fractures on CT. A total of 665 examinations were included in our analysis. Ground truth was established by retrospective visualization of a fracture on CT by using all available CT, MR imaging, and convolutional neural network output information. The OE coefficients, sensitivity, specificity, and positive and negative predictive values were calculated with 95% CIs comparing diagnostic accuracy and agreement of the convolutional neural network and radiologist ratings, respectively, compared with ground truth. RESULTS:Convolutional neural network accuracy in cervical spine fracture detection was 92% (95% CI, 90%-94%), with 76% (95% CI, 68%-83%) sensitivity and 97% (95% CI, 95%-98%) specificity. The radiologist accuracy was 95% (95% CI, 94%-97%), with 93% (95% CI, 88%-97%) sensitivity and 96% (95% CI, 94%-98%) specificity. Fractures missed by the convolutional neural network and by radiologists were similar by level and location and included fractured anterior osteophytes, transverse processes, and spinous processes, as well as lower cervical spine fractures that are often obscured by CT beam attenuation. CONCLUSIONS:The convolutional neural network holds promise at both worklist prioritization and assisting radiologists in cervical spine fracture detection on CT. Understanding the strengths and weaknesses of the convolutional neural network is essential before its successful incorporation into clinical practice. Further refinements in sensitivity will improve convolutional neural network diagnostic utility.

The COQOL is the first otology-specific PROM. Initial studies demonstrate excellent reliability and encouraging preliminary criterion validity: further studies will allow a deeper validation of the instrument.

The COVID-19 pandemic has led to major changes in clinical practice on a global scale in order to protect patients. This includes the identification of vulnerable patients who should “shield” in order to reduce the likelihood of contracting SARS-CoV2. We used national specialty guidance and an adapted screening tool to risk stratify patients identified from our prescribing and monitoring databases, and identify those needing to shield (score ≥ 3) using information from departmental letters, online general practice records and recent laboratory investigations. We collated underlying rheumatological conditions and risk factors. Two months into the shielding process, we examined the COVID-19 status of these patients using hospital laboratory records and compared to population level data. Of 887 patients assessed, 248 (28%) scored ≥ 3 and were sent a standard shielding letter. The most common risk factor in the shielding letter group was age ≥ 70 years and/or presence of a listed co-morbidity (199 patients). The most common rheumatology conditions were rheumatoid arthritis (69.4%), polymyalgia rheumatica (8.5%) and giant cell arteritis (8.5%). Coronavirus incidence rates were similar in the shielding letter group (0.403%) and in the UK population (0.397%). However, we found a trend towards lower incidence (0.113%) in our whole cohort (RR 0.28, 95%CI 0.04–2.01 for the whole cohort compared to UK population). The trend towards lower incidence in this cohort could be because of prior education regarding general infection risk and response to public health messages. While risk stratification and shielding could be effective, prior education regarding general infection risk and public health messages to enhance health protection behaviours during a pandemic may have equal or more important roles. Key Points• Patients on treatment for rheumatic disorders showed a trend for lower incidence of COVID-19 transmission irrespective of shielding letter status• This could potentially be because of prior education regarding infection risk received when starting on disease-modifying medication• Health education influencing health protection behaviours may be of equal or more importance than shielding information in reducing transmission of SARS-CoV-2

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