127 research outputs found

    MR imaging in early rheumatoid arthritis : techniques and applications

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    The main aim of this thesis is to determine the role of magnetic resonance imaging (MRI) in early rheumatoid arthritis (RA). We set out to improve the MRI protocol and sequences used in arthritis patients, to detect subclinical inflammation in various patient groups and to describe the clinical implications of MRI. Chapter 1 provides a general introduction to this thesis, in chapter 2 the earliest disease stages of rheumatoid arthritis and the concept of pre-rheumatoid arthritis are further explored. In chapters 3-5 various ways are described to optimize the scanning protocol for arthritis patients. In chapters 6-8 we looked at the presence of inflammation on MRI when no inflammation can be detected at physical examination, i.e. subclinical inflammation. In chapters 9 and 10 we explore some of the clinical implications of the MRI findings. Chapter 11 provides a summary of the thesis and a discussion of the main findings.Center for Translational Molecular Medicine and Dutch Arthritis Foundation, project TRACER (grant 04I-202)LUMC / Geneeskund

    Extending the theory of Owicki and Gries with a logic of progress

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    This paper describes a logic of progress for concurrent programs. The logic is based on that of UNITY, molded to fit a sequential programming model. Integration of the two is achieved by using auxiliary variables in a systematic way that incorporates program counters into the program text. The rules for progress in UNITY are then modified to suit this new system. This modification is however subtle enough to allow the theory of Owicki and Gries to be used without change

    The value of computed tomography in detecting distal radioulnar joint instability after a distal radius fracture

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    This study evaluated the value of computed tomography scans for the diagnosis of distal radioulnar joint instability. A total of 46 patients, conservatively treated for a unilateral distal radius fracture, were evaluated. Clinical instability was tested using the stress test and clunk test. A computed tomography scan of both wrists was performed in pronation and supination. Two independent observers reviewed the computed tomography scans using: the radioulnar line, subluxation ratio, epicentre and radioulnar ratio methods. Radiological distal radioulnar joint instability was assessed by comparing the measurements of the injured wrist with those of the contralateral uninjured wrists. A

    Cost-utility analysis of a one-time supervisor telephone contact at 6-weeks post-partum to prevent extended sick leave following maternity leave in The Netherlands: results of an economic evaluation alongside a randomized controlled trial

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    <p>Abstract</p> <p>Background</p> <p>Working women of childbearing age are a vital part of the population. Following childbirth, this group of women can experience a myriad of physical and mental health problems that can interfere with their ability to work. Currently, there is little known about cost-effective post-partum interventions to prevent work disability. The purpose of the study was to evaluate whether supervisor telephone contact (STC) during maternity leave is cost-effective from a societal perspective in reducing sick leave and improving quality-adjusted life years (QALYs) compared to common practice (CP).</p> <p>Methods</p> <p>We conducted an economic evaluation alongside a randomized controlled trial. QALYs were measured by the EuroQol 5-D, and sick leave and presenteeism by the Health and work Performance Questionnaire. Resource use was collected by questionnaires. Data were analysed according to intention-to-treat. Missing data were imputed via multiple imputation. Uncertainty was estimated by 95% confidence intervals, cost-utility planes and curves, and sensitivity analyses.</p> <p>Results</p> <p>541 working women from 15 companies participated. Response rates were above 85% at each measurement moment. At the end of the follow-up, no statistically significant between-group differences in QALYs, mean hours of sick leave or presenteeism or costs were observed. STC was found to be less effective and more costly. For willingness-to-pay levels from €0 through €50,000, the probability that STC was cost-effective compared to CP was 0.2. Overall resource use was low. Mean total costs were €3678 (95% CI: 3386; 3951). Productivity loss costs represented 37% of the total costs and of these costs, 48% was attributable to sick leave and 52% to work presenteeism. The cost analysis from a company's perspective indicated that there was a net cost associated with the STC intervention.</p> <p>Conclusions</p> <p>STC was not cost-effective compared to common practice for a healthy population of working mothers; therefore, implementation is not indicated. The cost-utility of STC for working mothers with more severe post-partum health problems, however, needs to be investigated. Work presenteeism accounted for half of the total productivity loss and warrants attention in future studies.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN73119486">ISRCTN73119486</a></p

    Comparison of anthropometric body features of highclass volleyball players

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    One of the factors determining skills of athletes in certain sport is body build features. Sport result depends a lot on morphologic features of the sportsman, that is one of the selective factors determining the sportsman's perspective. Purpose of research is studying of peculiarities anthropomentric and somatometric indices of super league, premier league and first league teams

    Interobserver reliability of diagnosis in patients with complex regional pain syndrome

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    Abstract Complex regional pain syndrome type I (CRPS-I), formerly reflex sympathetic dystrophy (RSD), is a chronic pain syndrome of unknown aetiology. Its diagnosis is a clinical one, for which several criteria systems have been defined. Despite their widespread use, the reliability of these criteria has never been studied. In this interobserver study 25 chronic CRPS patients were interviewed and examined by six physicians. Through structured questionnaires signs, symptoms, and diagnosis were recorded, after which observer agreement for these was calculated with j statistics. PhysiciansÕ agreement in assessment of signs and symptoms in CRPS patients varied greatly. More importantly, final diagnosis of CRPS showed poor observer agreement (j: 0.20). The j values were higher, had physicians applied IASP criteria, but still insufficient. The application of BruehlÕs criteria results in a fair j of 0.38, but then frequency of CRPS diagnosis in our study population decreased from 73% to 43% in comparison with physiciansÕ own diagnosis. We conclude that, using current criteria systems, the diagnosis of CRPS is not reliable

    Interobserver reliability of diagnosis in patients with complex regional pain syndrome

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    Abstract Complex regional pain syndrome type I (CRPS-I), formerly reflex sympathetic dystrophy (RSD), is a chronic pain syndrome of unknown aetiology. Its diagnosis is a clinical one, for which several criteria systems have been defined. Despite their widespread use, the reliability of these criteria has never been studied. In this interobserver study 25 chronic CRPS patients were interviewed and examined by six physicians. Through structured questionnaires signs, symptoms, and diagnosis were recorded, after which observer agreement for these was calculated with j statistics. PhysiciansÕ agreement in assessment of signs and symptoms in CRPS patients varied greatly. More importantly, final diagnosis of CRPS showed poor observer agreement (j: 0.20). The j values were higher, had physicians applied IASP criteria, but still insufficient. The application of BruehlÕs criteria results in a fair j of 0.38, but then frequency of CRPS diagnosis in our study population decreased from 73% to 43% in comparison with physiciansÕ own diagnosis. We conclude that, using current criteria systems, the diagnosis of CRPS is not reliable
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