Prognosis of trochanteric pain in primary care

BACKGROUND: Trochanteric pain is the second most important diagnosis of hip problems presenting in primary care, but its incidence and prognosis in this context is largely unknown. AIM: To determine the 1- and 5-year prognoses of trochanteric pain and the predictive variables for consistent complaints. DESIGN OF THE STUDY: Retrospective cohort study. SETTING: One hundred and sixty-four patients (mean age = 55 years, 80% female) with incidental trochanteric pain in the years 1996 or 2000 were asked in 2001 for past and present symptoms of trochanteric pain. Therapeutic interventions, demographic factors and comorbidity were also investigated. METHOD: The databases of 39 GPs were screened in order to identify all incident cases with a suspicion of trochanteric pain in the years 1996 or 2000. These cases were sent a questionnaire. RESULTS: The incidence of trochanteric pain in primary care is 1.8 patients per 1000 per year. After 1 year at least 36% still suffered from trochanteric pain, and after 5 years this was 29%. Patients with osteoarthritis (OA) in the lower limbs had a 4.8-fold risk of persistent symptoms after 1 year, as compared to patients without OA. Patients who had received a corticosteroid injection had a 2.7-fold chance of recovery after 5 years, as compared with patients who had not received an injection. CONCLUSION: Trochanteric pain is shown to be a chronic disease in a substantial number of patients. The disorder is associated with much impairment when conducting daily activities.     

Waiting times for radiotherapy: consequences of volume increase for the TCP in oropharyngeal carcinoma.

BACKGROUND AND PURPOSE: Waiting lists for radiotherapy have become longer over the past years. Apart from the psychological distress for the patient we are concerned about tumour growth during this waiting time, which may worsen prognosis. The purpose of this pilot study was to investigate tumour growth in the waiting time and to obtain an indication of its clinical consequences for patients with oropharyngeal carcinoma. A tumour control probability (TCP) model was applied to evaluate consequences for outcome. METHODS AND MATERIALS: Increase in tumour volume was measured for 13 patients with oropharyngeal carcinoma by outlining the tumour on the diagnostic as well as on the treatment planning CT scan. Waiting time was defined as time between histopathological diagnosis and start of radiotherapy. For each tumour we calculated the increase in tumour volume and the tumour doubling time. The potential increase in TCP was calculated for each tumour for the situation without treatment delay. RESULTS: The mean increase in tumour volume was 70%. The mean waiting time was 56 days. Expected TCP with incorporation of delay was 47%, without delay it might have been 63-66%. CONCLUSION: This study shows tumour progression during the time between the diagnostic CT scan and the treatment planning CT scan in oropharyngeal cancer. As a consequence of waiting time, which allows tumour volume increase, there may be an average control loss of 16-19 % for these tumours during the total waiting time before radiotherapy.     

Sexual Expression and It’s Determinants,in People Diagnosed with Psychotic Disorders

This qualitative study aims to explore the difficulties people with a psychotic disorder have in sexual expression, and associated determinants. Twenty-eight semi-structured interviews were conducted and analyzed using the Grounded Theory method. Almost all participants experienced unfulfilled needs in sexual expression. These unfulfilled needs were associated with a range of factors, including antipsychotic medication, psychotic symptoms, sexual abuse, social skills and stigma, all of which may converge on a pathway involving (sexual) self-esteem. Further research is required to better understand the role of self-esteem in relation to sexual needs and expression in people with psychotic disorders.     

Knowing the Meaning of a Word by the Linguistic and Perceptual Company It Keeps

Debates on meaning and cognition suggest that an embodied cognition account is exclusive of a symbolic cognition account. Decades of research in the cognitive sciences have, however, shown that these accounts are not at all mutually exclusive. Acknowledging cognition is both symbolic and embodied generates more relevant questions that propel, rather than divide, the cognitive sciences: questions such as how computational symbolic findings map onto experimental embodied findings, and under what conditions cognition is relatively more symbolic or embodied in nature. The current paper revisits the Symbol Interdependency Hypothesis, which argues that language encodes perceptual information and that language users rely on these language statistics in cognitive processes. It argues that the claim that words are abstract, amodal, and arbitrary symbols and therefore must always be grounded to become meaningful is an oversimplification of the language system. Instead, language has evolved such that it maps onto the perceptual system, whereby language users rely on language statistics, which allow for bootstrapping meaning also when grounding is limited.     

Measuring wearing time of knee-ankle-foot orthoses in children with cerebral palsy: comparison of parent-report and objective measurement

Purpose state: Orthotic wearing time may be an important confounder in efficacy studies of treatment in children with spastic cerebral palsy (SCP). Most studies measure parent-reported wearing time (WT_parent) with questionnaires, but it is questionable whether this yields valid results. This study aims to compare WT_parent with objectively measured wearing time (WT_obj) in children with SCP receiving orthotic treatment.

Method: Eight children with SCP participated in this observational study. For one year, they received knee-ankle-foot orthosis (KAFO) treatment. WT_parent was measured using questionnaires. WT_obj was measured using temperature sensor-data-loggers that were attached to the KAFOs. The 2.5th and 97.5th percentiles and median of differences between methods (per participant) were used to calculate limits of agreement and systematic differences.

Results: There was no systematic difference between WT_parent and WT_obj (0.1?h per week), but high inter-individual variation of the difference was found, as reflected by large limits of agreement (lower limit/2.5th percentile: ?1.7?h/week; upper limit/97.5th percentile: 11.1?h/week).

Conclusions: Parent-reported wearing time (WTparent) of a KAFO differs largely from objectively measured wearing time (WT_obj) using temperature sensors. Therefore, parent-reported wearing time (WT_parent) of KAFOs should be interpreted with utmost care.

• Implications for Rehabilitation

• Low wearing time of orthoses may be a cause of inefficacy of orthotic treatment and incorrect reported wearing time may bias results of efficacy studies.

• Results of this study show that parent-reported wearing time is not in agreement with objectively measured wearing time.

• Parent-reported wearing time of KAFOs should be interpreted with utmost care.

• Objective methods are recommended for measuring orthotic wearing time.