Commentary on Nordenfelt's 'On Health, ability and activity: Comments on some basic notions in the ICF'.
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Persons with Disabilities↗
Biomedical subjects
T Stamm
Publications and source records attributed to T Stamm.
[Activity-score based therapy in rheumatoid arthritis].
Disease activity scores for rheumatoid arthritis have been developed and validated in recent years. They allow the longitudinal documentation of the effectiveness of treatment. Application of these scores in routine daily practice could significantly improve the effectiveness of therapy with relatively little effort. This review presents evidence for the benefits of the application disease activity scores in clinical routine.
Arthralgia↗
[Clinical outcome measures in hand- and finger joint osteoarthritis from the patient perspective].
Osteoarthritis (OA) is the most common joint disease. While research activities in OA have concentrated on the knee and hip in recent years, knowledge and research results in the field of hand OA are still limited. In order to measure the effects of treatment or to obtain information on the course of a disease and the health status of a patient, outcome measures are commonly used in rheumatology. Such measures are variables which can be quantified and which represent either the perspective of health professionals or the perspective of patients or both. The aim of this article is to evaluate clinical outcome measures and corresponding instruments which are currently used for patients with hand OA, and to examine whether these measures and instruments represent the perspective of patients. For hand OA, measurements of disease activity and inflammation, function and performance, pain, mobility and stiffness, deformity and aesthetic damage are recommended by experts. Corresponding instruments are available for most of these outcome measures, but these often do not sufficiently represent the perspective of the patients. Some instruments lack reliability because standardized protocols for measurement have not yet been developed.
Arthralgia↗
[Measuring disease activity for rheumatoid arthritis].
Rheumatoid arthritis (RA) is the most common systemic inflammatory joint disease. It can be treated effectively with disease modifying antirheumatic drugs, and the currently propagated treatment strategy is to treat RA consequently, and revise the therapeutic approach frequently on the basis of proper disease activity evaluation. In the current review, we focus on the instruments and measures used in the assessment of RA disease activity. We will first consider the so-called core set measures of activity, prividing comprehensive overviews on joint count scales, global scales, pain scales, biomarkers, and functional assessment instruments. The second part of the review focuses on the value of composite measures of disease activity; a term under which we subsume activity indices using various formulae, self-assessment tools of disease activity, and response criteria. Among the inflammatory rheumatic diseases, RA is the one for which the most intensive research is done, and usually instruments that work for RA are further tested for other joint diseases. However, there is still a research agenda for the assessment of disease activity, even for RA. One important aspect is to assess the reliability and utility of all available instruments, including the very low end of disease activity, since remission has become an achievable goal. Another focus of disease activity assessment is to derive measures that work in clinical trials and in daily practice, but are also well understood by patients and physicians. This will further improve our ability to care for patients with RA consequently.
Arthralgia↗
Ultrastructural characterization of the implant/bone interface of immediately loaded dental implants.
Primary stability and an optimized load transfer are assumed to account for an undisturbed osseointegration process of implants. Immediate loaded newly designed titanium dental implants inserted in the mandible of minipigs were used for the characterization of the interfacial area between the implant surface and the surrounding bone tissue during the early healing phase. Histological and electron microscopical studies were performed from implant containing bone specimens. Two different load regimens were applied to investigate the load related tissue reaction. Histological and electron microscopical analysis revealed a direct bone apposition on the implant surfaces, as well as the attachment of cells and matrix proteins in the early loading phase. A striking finding of the ultrastructural immunocytochemical investigations was the synthesis and deposition of bone related proteins (osteonectin, fibronectin, fibronectin receptor) by osteoblasts from day one of bone/biomaterial interaction. Calcium-phosphate needle-like crystallites were newly synthesized in a time-related manner directly at the titanium surface. No difference in the ultrastructural appearance of the interface was found between the two loading groups. Our experimental data suggest that loading of specially designed implants can be performed immediately after insertion without disturbing the biological osseointegration process.
Animals↗
Combined space management through Delaire/Joos osteotomy and postoperative orthodontic treatment. A retrospective longitudinal study.
The diagnostic records of all patients who had undergone Delaire/Joos osteotomy with mandibular setback at the Muenster University Hospital (period 1995-2000, n=22) were used for space management evaluation in the context of combined surgical-orthodontic treatment.Twenty-eight dental spaces were present prior to the start of treatment and 14 were created by extracting teeth as a pretreatment measure. In two patients, unilateral setback was performed according to Obwegeser/Dal Pont. Thus, 42 tooth-bounded spaces were present at the time of Delaire/Joos osteotomy with mandibular setback, most of them in the first molar region, followed by the second premolar region. A significant space reduction was achieved by the surgical intervention, but not by the subsequent orthodontic treatment. The best results with respect to complete space closure by orthognathic surgery/orthodontic treatment without the need for subsequent prosthetic rehabilitation were recorded in the second premolar region. In the absence of spaces and with a similar long-term prognosis for all potentially extractable teeth and adequate space for the necessary surgical repositioning, the second premolars should therefore be regarded as the 'extraction teeth of choice' for mandibular setback within the context of Delaire/Joos osteotomy.
Adolescent↗
Are collimated low-dose digital radiographs valid for performing Delaire's architectural analysis?
Computed radiography (CR) provides the dynamic exposure range to reveal objects in film areas exposed by very low X-ray exposure. Conventional cephalometric radiographs are normally beam limited to the facial skeleton. The cranial vault and cervical vertebra are collimated and only exposed by extra-focal radiation and scatter. We hypothesize that, on conventional cephalometric radiographs obtained with CR, image data of collimated film areas can be enhanced for reliable performance of Delaire's cephalometric analysis of the entire skull. Therefore the aim of the present study was to compare the reproducibility of landmark placement on normal and underexposed film areas of CR images. Intra- and inter-observer reproducibility of landmark identification was evaluated on 200 randomly selected radiographs by calculating the error radius of repeated landmark placements. A paired-samples t-test revealed differences (P< 0.001) between intra- and inter-observer reproducibility. Intra-observer accuracy was influenced (P< 0.001) by variability of suture obliteration (bregma). Identification of landmarks in areas of extra-focal radiation showed no difference (P> 0.05) from that of landmarks inside the normally exposed area. CR offers the opportunity to perform of a full cranial analysis on a cephalometric radiograph collimated to the facial region.
Cephalometry↗
Survival and effectiveness of leflunomide compared with methotrexate and sulfasalazine in rheumatoid arthritis: a matched observational study.
OBJECTIVE: To determine the survival and clinical effectiveness of leflunomide (LEF) compared with methotrexate (MTX) and sulfasalazine (SSZ) for RA in an observational study. METHODS: An observational database of 1088 patients and 5141 patient years of DMARD treatment (2680 courses) from two academic hospitals was filtered for treatment with LEF, MTX, and SSZ. LEF treatment groups were matched for patients' age, baseline ESR, number of previous DMARDs, and hospital cohort with MTX and SSZ treatment groups. For these treatments, Kaplan-Meier analyses of time until the drug was discontinued (drug "survival"), and the effectiveness and safety of continuation of treatment, were performed. The change in disease activity markers (CRP, ESR) was compared between the groups. RESULTS: The median dose during the study increased from 10 to 15 mg MTX/week and from 1.5 to 2.0 g SSZ/day. Matched survival analysis showed better retention rates for MTX (mean (SEM) survival 28 (1) months) than for LEF (20 (1) months; p=0.001), whereas retention rates of SSZ (23 (1) months) were similar to those of LEF (p=NS). Treatments were stopped earlier because of adverse events (AEs, 3 months) than because of ineffectiveness (IE, 10 months; p<0.001). LEF and MTX were less likely to be stopped because of AEs than SSZ. LEF courses were stopped earlier for AEs (p<0.001) than MTX. CONCLUSIONS: Current dosing strategies should be re-evaluated, and coping strategies for common AEs should be investigated. This will be necessary to achieve better drug retention of LEF. At present, MTX continues to be the most effective drug in clinical practice.
Aged↗
First experience with a public domain computer-aided surgical system.
The outcome of complex craniofacial operations is critically dependent on careful and accurate preoperative planning. Recent advances in computer technology enable the surgeon to do surgical simulations directly on to a computer terminal. We describe the clinical application of a public domain-based computer-aided system in craniofacial surgery. Operation planning was based on clinical investigations and radiological images, with particular use of a virtual three-dimensional surgical simulation. Three patients with complex craniofacial malformations were admitted for orbital correction. Surgical simulation defined numerically the extent of bone movements and the extent of resection areas. Operations were guided by the virtual planning. The outcome was compared with the planning to assess the accuracy of the operative correction. Our first experience confirms that computer-assisted simulation is a reliable and useful tool that improves surgical planning and helps to evaluate the surgical outcome.
Adult↗
[Education, graduate and continuing education in geriatrics and geriatric rehabilitation].
Education and training in geriatric medicine for family doctors and medical specialists, nurses, physio- and ergotherapists, social workers becomes more important. A curriculum in high quality geriatric medicine can help solve the problems coming up with the increasing life-expectancy and with the increasing proportion of elderly depending on care and social services. The development of curricula and programs in high quality geriatric medicine demonstrates that the geriatrician has a special approach to the elderly patient different from traditional medicine. Describing and teaching this special approach to the elderly patient shows the special view of the geriatrician working with elderly patients. A number of barriers to program development must be considered. To successfully implement geriatrics training, geriatric faculties need to have adequate protected time to plan, administer and teach the curriculum. It is very important to implement geriatrics training in universities and medical institutes.
Aged↗
[Prospective cephalometric evaluation of a new 3-dimensional adjustable osteosynthesis system for sagittal ramus osteotomy].
The aim of the study was the prospective cephalometric analysis of 58 patients who underwent sagittal split ramus osteotomy (SSRO). Stabilisation of the fragments was achieved with an adjustable monocortical bone fixation system. Lateral cephalograms were taken preoperatively, postoperatively, 6 months postoperatively, and 12 months postoperatively. The radiographs were digitised, and a computerised analysis was performed. The mean mandibular advancement was 8.5 mm with a mean relapse of 0.8 mm after 12 months (P < 0.05). The mean mandibular setback was 7.8 mm with a mean relapse of 1.2 mm after 12 months (P < 0.05). The results of the present study show a minimal relapse after mandibular advancement and setback for the SSRO and the new adjustable fixation system. Postoperative analysis reveals a safe intraoperative positioning of the condyles with subsequent prevention of an immediate relapse. The results after 12 months indicate sufficient long-term stability, although additional evaluations with results after 5 and 10 years are necessary for a final report.
Adolescent↗
Three-dimensional magnetic resonance imaging of the orbit in craniofacial malformations and trauma.
Craniofacial malformations and trauma often lead to changes in orbital soft tissues, requiring surgical correction of both hard and soft tissues. Computed tomographic scans and 3-dimensional reconstructions are the optimal tools for evaluation of the bony structures. However, there is no equivalent method for the orbital soft tissues. The aim of this study was to establish a 3-dimensional magnetic resonance imaging (3-D MRI) technique that allows a differentiated visualization of the different types of soft tissue in the orbit. A total of 8 patients with different pathologic conditions of the orbit was examined. Five of these patients underwent secondary correction after trauma, and 3 had craniofacial malformations. The 3-D reconstruction was performed in the volume-rendering technique after acquisition of 3-mm axial slices. It was shown that a differentiated visualization of the orbital soft tissues is possible. Although the thin bony structures have a weak signal and, therefore, the imaging is poor, reliable reconstruction of the globe was achieved by different radiologists because of its circular delimitation from the bone. This technique is an additional support in the planning of orbital surgery.
Craniofacial Abnormalities↗
Computer-aided automated landmarking of cephalograms.
The computer-aided method presented is able to interpret and measure radiological structures automatically and reproducibly on a large number of randomly selected lateral head films of different film quality. For example the hard and soft tissue expression of the profile is used to discuss method, application and disadvantages. The performance of the system depends on image quality. The algorithm cannot be influenced by opacifications due to metal structure. In 90% of all cases the contours are identified correctly. Even if the image quality is poor, the recognition rate is about 84%. The selected cephalometric landmarks are placed in the right way in 85% of all cases. The constraint mathematical conditions and the high reproducibility improve the quality process of the cephalometric analysis. Recognition rates of 84% to 90% justify even nowadays the routine use of semi-automatic systems in PC-based analysis. With advancing digital radiography and improved computer performance, image interpreting systems will certainly become established.
Cephalometry↗
Computer-aided axiography of asymptomatic individuals with Class II/2.
UNLABELLED: The condylar axiographic tracings of 23 asymptomatic adult volunteers (Helkimo-index DiO) with Class II/2 axiography relationships were compared to tracings of an analogous group (DiO; n = 30) with normal occlusion. The obtained measurements were evaluated statistically and discussed with respect to possible recording errors. RESULTS: The open-close movement proceeded uncharacteristically, differences existed only in protrusion, mediotrusion and their combined rotation component. In Class II/2 cases an approximately 7 degrees higher angle of the condylar path inclination (CPI) was measured. The Class II/2 group rotated to a significantly higher angle in protrusive and mediotrusive movements and showed longer condylar path lengths than the control group. Another significant difference was found in the location of maximum CPI values and maximum rotation angles within the condylar path, because in no case was isolated rotation or translation of the hinge axis observed. CONCLUSION: The temporomandibular joint of Class II/2 individuals shows a wider range of motion than joints of subjects with normal occlusion. The reduced capacity of motion which was assumed to exist in a so-called hack-bite could not be backed up for Class II/2 deep bite cases. The investigated differences cannot be seen as pathomechanisms, because all participants were clinically free of dysfunction. The neuromuscular engram to overcome the overbite controls a complex spatial motion pattern which cannot be described by a simplified mechanical abstraction of motion in the sagittal plane. The temporomandibular joint with its complex pattern of movement is able to create physiological mechanisms of compensation to react to different dental and skeletal features.
Adult↗
[MRI 3D imaging of the orbits in craniofacial abnormalities and injuries].
Craniofacial malformations and trauma often lead to changes in orbital soft tissues that require operative correction of both hard and soft tissues. CT scan and 3D reconstructions are optimal tools for the evaluation of the bony structures but there is no equivalent for the orbital soft tissues. The aim of this study was to establish a 3D-MRI technique that allows differentiated visualization of the different soft-tissue types of the orbit. A total of eight patients with different pathologic conditions of the orbit were examined. Five of these patients came for secondary correction after trauma and three showed a craniofacial malformation. 3D reconstruction was performed in volume-rendering technique after acquisition of 3 mm axial slices. It was shown that differentiated visualization of the orbital soft tissues is possible. Even though the thin bony structures have a weak signal and therefore the imaging is poor, the globe could be reconstructed reliably by different radiologists because of its circular delimitation from the bone. This technique provides additional support in the planning of orbital operations.
Craniofacial Abnormalities↗
A fish oil-derived concentrate enriched in eicosapentaenoic and docosahexaenoic acid as ethyl esters inhibits the formation and growth of aberrant crypt foci in rat colon.
It was examined whether the fish oil derived n-3 fatty acid concentrate K85 (51.0% of eicosapentaenoic acid, 35.3% of docosahexaenoic acid and 7.7% of other n-3 fatty acids, all as ethyl esters) could inhibit the initial formation of aberrant crypt foci and the later growth of pre-existing aberrant crypt foci in the colon of male F344 rats treated with the carcinogens dimethylhydrazine or azoxymethane, the proximate metabolite of dimethylhydrazine. Given intragastrically 5 times a week, K85 caused a dose-dependent reduction of the initial (week 0-6) formation of aberrant crypt foci induced by azoxymethane (2 x 15 mg/kg body weight/injection the first two weeks). The number of aberrant crypt foci was reduced by 36% (P < 0.001) with 3.0 g K85/kg body weight/dose, the largest dose tested. The reduction was most pronounced (46%, P = 0.009) among the fastest growing aberrant crypt foci (foci with 3 or more aberrant crypts). When given in a later phase of the carcinogenesis (week 17-23) a similar intragastric treatment with K85 caused a dose-dependent reduction of the growth of pre-existing aberrant crypt foci induced by dimethylhydrazine (3 x 20 mg/kg body weight/injection the first week). The crypt multiplicity (aberrant crypt/focus) was reduced by 22% (P = 0.016) with 2.24 g K85/kg body weight/dose, the largest dose tested. This was sufficient to completely block the growth of the pre-existing aberrant crypt foci in the treatment period. The arrest of crypt multiplication was further documented by the 63% reduction (P = 0.03) of the large aberrant crypt foci (foci with 9 or more aberrant crypts). The total number of aberrant crypt foci was not affected.
Animals↗
[Ambulatory geriatric rehabilitation--concepts, chances and responsibilities of participating physicians].
The third stage of the bill of the health structure (GSG) still focuses on the tremendous increase of costs in hospitals. Hospitals are accused that the care of the older patients involves too much money and staff. Experts complain that geriatric-rehabilitative thinking and acting does hardly influence the daily work on the wards. Competent geriatric rehabilitation should diminish or prevent the need for nursing, should support the patients ability for self-sufficiency, and decrease hospitalization time. Since the expenses for the hospital care of older patients have increased during the last couple of years and show the greatest dynamic of increase together with the supply of aids, health politicians and health economists, physicians, health insurances, and social insurances set more and more medical and economic hope on the geriatric rehabilitation. Especially models of out of hospital programs in connection with panel doctors are discussed to relieve the hospitals and are favoured by legal institutions and health politicians. Despite the documented success of geriatric rehabilitation, it is surprising the only a few areas realize differentiated out of hospital concepts. This article summarizes the most important models of out of hospital geriatric rehabilitation as they are tested in different areas in Germany. Advantages and disadvantages are discussed and the demands of the participating physicians are demonstrated. The goal of this paper is to describe the medical role in these models to win more physicians for this task. The urgently necessary development of a country-wide out of hospital rehabilitation, introduces new important medical fields of activity.
Activities of Daily Living↗
Generalized racemose livedo and neurological lesions.
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Female↗