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

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

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. </table

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. </table

Effectiveness of exercise therapy for meniscal lesions in adults: A systematic review and meta-analysis

Optimising joint reconstruction management in arthritis and bone tumour patient