66 research outputs found
MR imaging of the knee in primary care
In this thesis we determined the added value of MR imaging
in primary care for patients with knee complaints. We conducted a randomised
controlled trial including patients with knee complaints after trauma, aged
18-45 year. Patients were randomised between usual care (no MR scan) or an MR
scan within 2 weeks. MR imaging was bot non-inferior but also not superior to
usual care. On the 1-year follow-up, patients in the MR group more often
perceived themselves to be recovered and more often reported to be satisfied
during the 1-year follow-up. However, the MR scan requested by the GP neither
improved health outcomes, nor saved costs. Furthermore, in the MR group there
was no reduction in the orthopaedic referral rate and a non-significantly
higher proportion of patients underwent an arthroscopy.
We also evaluated the added value of MR imaging for patients suspected to
develop knee osteoarthritis. We combined early MR osteoarthritis features
into a prediction model, resulting in moderate sensitivity and specificity
rates for the development of radiographic knee osteoarthritis.
We concluded that for the entire population seeking medical attention of the
GP for knee complains, MR imaging does not contribute to an improved clinical
outcome nor to cost containment.
ZonMW, study grant 171202005LUMC / Geneeskund
Photodynamic therapy of early stage oral cavity and oropharynx neoplasms: an outcome analysis of 170 patients
Inflammatory response to cardiopulmonary bypass in neonates and young children: endotoxin release, cytokine production, and gastrointestinal permeability
Efficacy of MRI in primary care for patients with knee complaints due to trauma: Protocol of a randomised controlled non-inferiority trial (TACKLE trial)
Background: Patients with traumatic knee complaints regularly consult their general practitioner (GP). MRI might be a valuable diagnostic tool to assist GPs in making appropriate treatment decisions and reducing costs. Therefore, this study will assess the cost-effectiveness of referral to MRI by GPs compared with usual care, in patients with persistent traumatic knee complaints. Design and methods. This is a multi-centre, open-labelled randomised controlled non-inferiority trial in combination with a concurrent observational cohort study. Eligible patients (aged 18-45 years) have knee complaints due to trauma (or sudden onset) occurring in the preceding 6 months and consulting their GP. Participants are randomised to: 1) an MRI group, i.e. GP referral to MRI, or 2) a usual care group, i.e. no MRI. Primary outcomes are knee-related daily function, medical costs (healthcare use and productivity loss), and quality of life. Secondary outcomes are disability due to knee complaints, severity of knee pain, and patients' perceived recovery and satisfaction. Outcomes are measured at baseline and at 1.5, 3, 6, 9 and 12 months follow-up. Also collected are data on patient demographics, GPs' initial working diagnosis, GPs' preferred management at baseline, and MRI findings. Discussion. In the Netherlands, the additional diagnostic value and cost-effectiveness of direct access to knee MRI for patients presenting with traumatic knee complaints in general practice is unknown. Although GPs increasingly refer patients to MRI, the Dutch clinical guideline 'Traumatic knee complaints' for GPs does not recommend referral to MRI, mainly because the cost-effectiveness is still unknown. Trial registration. Dutch Trial Registration: NTR3689
General Practitioners Referring Adults to MR Imaging for Knee Pain: A Randomized Controlled Trial to Assess Cost-effectiveness
Analysis and support of clinical decision makin
Texting with touchscreen and keypad phones - A comparison of thumb kinematics, upper limb muscle activity, exertion, discomfort, and performance
This study aimed to compare thumb kinematics and upper limb muscle activity, and the influence of hand size, when texting on a keypad smartphone and a touchscreen smartphone. Furthermore, the study compared exertion, discomfort, and performance when texting on the two phones. The thumb kinematics were tracked using a 3D motion analysis system and muscle activity was registered in six upper limb muscles using surface electromyography in 19 participants. When texting on the touchscreen phone compared to the keypad phone thumb flexion (p = 0.008) and flexion/extension range of motion were smaller (p = 0.02), the thumb was on average less internally rotated (p = 0.02), and activity (50th and 90th percentile) of the thumb and forearm muscles was lower (p = 0.05). The differences in thumb flexion were found only in the group with shorter hands and the differences in muscle activity was found only in the group with longer hands. These findings suggest there are differences in risks for developing musculoskeletal disorders during smartphone use with different key activation mechanisms and different hand sizes
Photodynamic therapy of early stage oral cavity and oropharynx neoplasms: an outcome analysis of 170 patients
The indications of photodynamic therapy (PDT) of oral cavity and oropharynx neoplasms are not well defined. The main reason is that the success rates are not well established. The current paper analyzes our institutional experience of early stage oral cavity and oropharynx neoplasms (Tis-T2) to identify the success rates for each subgroup according to T stage, primary or non-primary treatment and subsites. In total, 170 patients with 226 lesions are treated with PDT. From these lesions, 95 are primary neoplasms, 131 were non-primaries (recurrences and multiple primaries). The overall response rate is 90.7% with a complete response rate of 70.8%. Subgroup analysis identified oral tongue, floor of mouth sites with more favorable outcome. PDT has more favorable results with certain subsites and with previously untreated lesions. However, PDT can find its place for treating lesions in previously treated areas with acceptable results
MR imaging of the knee in primary care
In this thesis we determined the added value of MR imaging
in primary care for patients with knee complaints. We conducted a randomised
controlled trial including patients with knee complaints after trauma, aged
18-45 year. Patients were randomised between usual care (no MR scan) or an MR
scan within 2 weeks. MR imaging was bot non-inferior but also not superior to
usual care. On the 1-year follow-up, patients in the MR group more often
perceived themselves to be recovered and more often reported to be satisfied
during the 1-year follow-up. However, the MR scan requested by the GP neither
improved health outcomes, nor saved costs. Furthermore, in the MR group there
was no reduction in the orthopaedic referral rate and a non-significantly
higher proportion of patients underwent an arthroscopy.
We also evaluated the added value of MR imaging for patients suspected to
develop knee osteoarthritis. We combined early MR osteoarthritis features
into a prediction model, resulting in moderate sensitivity and specificity
rates for the development of radiographic knee osteoarthritis.
We concluded that for the entire population seeking medical attention of the
GP for knee complains, MR imaging does not contribute to an improved clinical
outcome nor to cost containment.
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