Towards a paradigm shift in chronic low back pain?:Identification of patient profiles to guide treatment

Kleuver, M. de [Promotor]Ostelo, R.W.J.G. [Promotor]Spruit, M. [Copromotor

Vascular compliance in sodium-sensitive and sodium-resistant borderline hypertensive patients

Vascular compliance in sodium-sensitive and sodium-resistant borderline hypertensive patients. Recently, we demonstrated a reduction in the compliance of the carotid, femoral and brachial arteries in sodiumsensitive subjects who had consumed a regular sodium intake of approximately 120 mmol per day, as compared to both sodium-resistant borderline hypertensive subjects and normotensive controls. Venous compliance was not different between the two borderline hypertensive groups and was only slightly lesser than in controls. Large artery compliance was studied using a non-invasive ultrasound vessel wall movement detector system, while venous compliance was determined by means of strain gauge plethysmography. The borderline hypertensive subjects were subsequently treated with enalapril 10 mg/day, felodipine 5 mg/day or placebo during six months. Despite similar reductions in blood pressure, enalapril induced a significant increase of the muscular femoral and brachial artery compliance, but not of the elastic carotid artery, while felodipine did not influence large artery compliance at all in the sodium-sensitive group. The effect of enalapril on muscular artery compliance was established through a dose-dependent increase in distension and not through a change in arterial diameter. Arterial compliance was not influenced by either of the drugs in the resistant group. Venous compliance was also not altered by the medication. In conclusion, femoral and brachial artery compliance in sodium-sensitive borderline hypertensive subjects, which was found to be lower than that of sodium-resistant subjects, improved with antihypertensive treatment with enalapril but not with felodipine, despite the similar reductions in blood pressure induced by both drugs. This finding implies that firstly, reduced arterial compliance is caused by more than just blood pressure elevation, and secondly, the renin-angiotensin system may play a role in the reduced arterial compliance of sodium-sensitive subjects

Using existing clinical information models for Dutch quality registries to reuse data and follow COUMT paradigm

Background Reuse of health care data for various purposes, such as the care process, for quality measurement, research, and finance, will become increasingly important in the future; therefore, "Collect Once Use Many Times" (COUMT). Clinical information models (CIMs) can be used for content standardization. Data collection for national quality registries (NQRs) often requires manual data entry or batch processing. Preferably, NQRs collect required data by extracting data recorded during the health care process and stored in the electronic health record.Objectives The first objective of this study was to analyze the level of coverage of data elements in NQRs with developed Dutch CIMs (DCIMs). The second objective was to analyze the most predominant DCIMs, both in terms of the coverage of data elements as well as in their prevalence across existing NQRs.Methods For the first objective, a mapping method was used which consisted of six steps, ranging from a description of the clinical pathway to a detailed mapping of data elements. For the second objective, the total number of data elements that matched with a specific DCIM was counted and divided by the total number of evaluated data elements.Results An average of 83.0% (standard deviation: 11.8%) of data elements in studied NQRs could be mapped to existing DCIMs . In total, 5 out of 100 DCIMs were needed to map 48.6% of the data elements.Conclusion This study substantiates the potential of using existing DCIMs for data collection in Dutch NQRs and gives direction to further implementation of DCIMs. The developed method is applicable to other domains. For NQRs, implementation should start with the five DCIMs that are most prevalently used in the NQRs. Furthermore, a national agreement on the leading principle of COUMT for the use and implementation for DCIMs and (inter)national code lists is needed.Neurological Motor Disorder

Endometrial scratching in women with one failed IVF/ICSI cycle-outcomes of a randomised controlled trial (SCRaTCH)

STUDY QUESTION: Does endometrial scratching in women with one failed IVF/ICSI treatment affect the chance of a live birth of the subsequent fresh IVF/ICSI cycle? SUMMARY ANSWER: In this study, 4.6% more live births were observed in the scratch group, with a likely certainty range between -0.7% and +9.9%. WHAT IS KNOWN ALREADY: Since the first suggestion that endometrial scratching might improve embryo implantation during IVF/ICSI, many clinical trials have been conducted. However, due to limitations in sample size and study quality, it remains unclear whether endometrial scratching improves IVF/ICSI outcomes. STUDY DESIGN, SIZE, DURATION: The SCRaTCH trial was a non-blinded randomised controlled trial in women with one unsuccessful IVF/ICSI cycle and assessed whether a single endometrial scratch using an endometrial biopsy catheter would lead to a higher live birth rate after the subsequent IVF/ICSI treatment compared to no scratch. The study took place in 8 academic and 24 general hospitals. Participants were randomised between January 2016 and July 2018 by a web-based randomisation programme. Secondary outcomes included cumulative 12-month ongoing pregnancy leading to live birth rate. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with one previous failed IVF/ICSI treatment and planning a second fresh IVF/ICSI treatment were eligible. In total, 933 participants out of 1065 eligibles were included (participation rate 88%). MAIN RESULTS AND THE ROLE OF CHANCE: After the fresh transfer, 4.6% more live births were observed in the scratch compared to control group (110/465 versus 88/461, respectively, risk ratio (RR) 1.24 [95% CI 0.96-1.59]). These data are consistent with a true difference of between -0.7% and +9.9% (95% CI), indicating that while the largest proportion of the 95% CI is positive, scratchin

Mechanical Stability of the Prodisc-C Vivo Cervical Disc Arthroplasty: A Preliminary, Observational Study Using Radiostereometric Analysis

Contains fulltext : 220943.pdf (publisher's version ) (Open Access)STUDY DESIGN: Prospective cohort study. OBJECTIVE: To investigate the primary stability of the Prodisc-C Vivo cervical disc arthroplasty with regard to the adjacent cervical vertebrae using radiostereometric analysis (RSA), and to monitor its clinical performance. METHODS: Sixteen patients with degenerative cervical disc disease were included. RSA radiographs were obtained at the first postoperative day, at 6 weeks, 3 months, and 6 months postoperatively. Migration (translation [mm]) of the superior and inferior implant components were measured with model-based RSA, expressed along the 3 orthogonal axes, and calculated as total translation. Clinical outcomes were Neck Disability Index, numeric rating scales for neck and arm pain, Likert-type scales for satisfaction, and adverse events. Range of motion was reported as C2-C7 flexion-extension mobility (ROM). RESULTS: At final follow-up, no significant increase over time in median total translation was found. One inferior and 3 superior components subsided but were asymptomatic. ROM remained stable and clinical outcomes improved over time. Although 3 patients were unsatisfied and 3 adverse events occurred, this was not related to translation of the components. CONCLUSIONS: On a group level, both components of the Prodisc-C Vivo cervical disc arthroplasty remained stable over time and below the clinical threshold of 1 mm. Individual outliers for translation were not clinically relevant and probably related to settling of the components into the vertebral endplates. RSA allowed us to perform a preliminary but accurate study on the micromotion of a new cervical disc replacement in a small sample size, without putting large numbers of patients at risk

Pulmonary function in patients with spinal deformity: have we been ignorant?

Contains fulltext : 229925.pdf (publisher's version ) (Open Access

Long-term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: a concise report of an extended cohort with a minimum of 5-year follow-up

Contains fulltext : 206215.pdf (publisher's version ) (Open Access

Low sensitivity of implant sonication when screening for infection in revision surgery

Background and purpose - Prosthetic-joint infection (PJI) is the most serious complication of arthroplasty, and accurate identification of a potentially responsible microorganism is essential for successful antibiotic treatment. We therefore determined the diagnostic accuracy of sonication and compared it with tissue culture as a screening tool in detecting prosthetic joint infection in revision arthroplasty. Patients and methods - 252 consecutive revision arthroplasty cases were enrolled. These cases were determined as being suspected or unsuspected of having infection according to standard criteria. Perioperatively, 6 periprosthetic interface tissue biopsies were obtained from each patient and the implants removed were sonicated. The sensitivity and specificity of periprosthetic tissue culture and sonication fluid cultures were determined. Results - Preoperatively, 75 revision cases were classified as having PJI (33 early and 42 late) and 177 were unsuspected of having infection. Compared with tissue culture, the sensitivity of the sonication fluid analysis was low: 0.47 (95% CI: 0.35-0.59) for sonication as compared to 0.68 (95% CI: 0.56-0.78) for tissue culture. The specificity of the sonication fluid analysis was higher than that for tissue culture: 0.99 (95% CI: 0.96-1.0) as compared to 0.80 (95% CI: 0.74-0.86). Interpretation - Sonication is a highly specific test for diagnosis of PJI. However, due to the low sensitivity, a negative sonication result does not rule out the presence of PJI. Thus, sonication is not of value for screening of microorganisms during revision surgery

The Oswestry Disability Index (Version 2.1a)

Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

MRI image features with an evident relation to low back pain: a narrative review.

PURPOSE: Low back pain (LBP) is one of the most prevalent health condition worldwide and responsible for the most years lived with disability, yet the etiology is often unknown. Magnetic resonance imaging (MRI) is frequently used for treatment decision even though it is often inconclusive. There are many different image features that could relate to low back pain. Conversely, multiple etiologies do relate to spinal degeneration but do not actually cause the perceived pain. This narrative review provides an overview of all possible relevant features visible on MRI images and determines their relation to LBP. METHODS: We conducted a separate literature search per image feature. All included studies were scored using the GRADE guidelines. Based on the reported results per feature an evidence agreement (EA) score was provided, enabling us to compare the collected evidence of separate image features. The various relations between MRI features and their associated pain mechanisms were evaluated to provide a list of features that are related to LBP. RESULTS: All searches combined generated a total of 4472 hits of which 31 articles were included. Features were divided into five different categories:'discogenic', 'neuropathic','osseous', 'facetogenic', and'paraspinal', and discussed separately. CONCLUSION: Our research suggests that type I Modic changes, disc degeneration, endplate defects, disc herniation, spinal canal stenosis, nerve compression, and muscle fat infiltration have the highest probability to be related to LBP. These can be used to improve clinical decision-making for patients with LBP based on MRI