Processes of Governing in European Networks

This thesis examines processes of governing in European co-operation networks, critiquing the argument that co-operation networks provide a depoliticized space for exchange and learning by demonstrating that hierarchies, struggles and contestation are inherent features of European network processes.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Recurrence of Dupuytren’s contracture: A consensus-based definition

Purpose: One of the major determinants of Dupyutren disease (DD) treatment efficacy is recurrence of the contracture. Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available today. The aim of this study is to bring an unbiased pool of experts to agree upon what would be considered a recurrence of DD after treatment; and from that consensus establish a much-needed definition for DD recurrence. Methods: To reach an expert consensus on the definition of recurrence we used the Delphi method and invited 43 Dupuytren’s research and treatment experts from 10 countries to participate by answering a series of questionnaire rounds. After each round the answers were analyzed and the experts received a feedback report with another questionnaire round to further hone in of the definition. We defined consensus when at least 70% of the experts agreed on a topic. Results: Twenty-one experts agreed to participate in this study. After four consensus rounds, we agreed that DD recurrence should be defined as “more than 20 degrees of contracture recurrence in any treated joint at one year post-treatment compared to six weeks post-treatment”. In addition, “recurrence should be reported individually for every treated joint” and afterwards measurements should be repeated and reported yearly. Conclusion: This study provides the most comprehensive to date definition of what should be considered recurrence of DD. These standardized criteria should allow us to better evaluate the many treatment alternatives

Long-term follow-up of flaps for extensive Dupuytren's and Ledderhose disease in one family

Dupuytren's and Ledderhose disease can be a cumbersome condition in patients with a severe diathesis with a very early onset. Two brothers are described with a reversed radial forearm flap on both hands and two upper lateral arm flaps on both feet with a long-term follow-up ranging from 14 to 25 years. They had multiple procedures of both hands before the flaps were considered. No recurrence occurred under the flap. In very severe diathesis flaps should be considered in an earlier phase to prevent multiple procedures and early recurrence. (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved

Percutaneous Aponeurotomy and Lipofilling (PALF) A Regenerative Approach to Dupuytren Contracture

Dupuytren disease is a progressive fibroproliferative disorder, which leads to flexion contractures of the digits. A minimally invasive technique consisting of an extensive percutaneous aponeurotomy of the cord with a needle combined with lipofilling is presented. The selective cutting of the cords under continuous tension disintegrates the cords while sparing the looser neurovascular bundles. Subsequently, lipoaspirate is injected subcutaneously. The authors' prospective results show a significantly shorter recovery time and less overall complications in this technique when compared with open surgery, while no significant difference was observed in the extent of immediate contracture correction and in the recurrence rate at 1 year follow-up