Search

Objective & Methods: The VALIGA study investigated the utility of the Oxford Classification of IgA nephropathy (IgAN) in 1147 patients from 13 European countries. Biopsies were scored by local pathologists followed by central review in Oxford. We had two distinct objectives: to assess how closely pathology findings were associated with the decision to give corticosteroid/immunosuppressive treatments (CS/IS), and to determine the impact of differences in MEST-C scoring between central and local pathologists on the clinical value of the Oxford Classification. We tested for each lesion the associations between the type of agreement (local and central pathologists scoring absent, local present-central absent, local absent-central present, both scoring present) with the initial clinical assessment, as well as long-term outcomes in those patients who did not receive CS/IS. Results: All glomerular lesions (M, E, C and S) assessed by local pathologists were independently associated with the decision to administer CS/IS therapy whilst the severity of tubulointerstitial lesions was not. Reproducibility between local and central pathologists was moderate for S (segmental sclerosis) and T (tubular atrophy/interstitial fibrosis), and poor for M (mesangial hypercellularity), E (endocapillary hypercellularity), and C (crescents). Local pathologists found statistically more of each lesion, except for the S lesion, which was more frequent with central review. Disagreements were more likely to occur when the proportion of glomeruli affected was low. The M lesion, assessed by central pathologists, correlated better with the severity of the disease at presentation and discriminated better with outcomes. By contrast, the E lesion, evaluated by local pathologists, correlated better with the clinical presentation and outcomes compared to central review. Both C and S lesions, when discordant between local and central pathologists, had a clinical phenotype intermediate to double absent lesions (milder disease) and double present (more severe). Conclusion: We conclude that differences in the scoring of MEST-C criteria between local pathologists and central reviewer have a significant impact on the prognostic value of the Oxford Classification. Since the decision to offer immunosuppressive therapy in this cohort was intimately associated with the MEST-C score, this study indicates a need for a more detailed guidance for pathologists in the scoring of IgAN biopsies.

Verhagen AP, Damen L, Bruijn JKJ, Berger MY, Passchier J, Koes BW. Effectiviteit van interventies bij kinderen met migraine. Huisarts Wet 2005;49(3):123-9. Doelstelling Vaststellen van de effectiviteit en verdraagzaamheid van gangbare behandelingen van migraine bij kinderen. Methode Een systematische review. Wij zochten in PubMed, EMBASE, PsychInfo en de Cochrane Library (Issue 2, 2004) tot juni 2004 naar gecontroleerde onderzoeken over behandeling van kinderen (tot 18 jaar) met migraine. De methodologische kwaliteit is bepaald met behulp van de Delphi-lijst. De analyses zijn uitgevoerd binnen subgroepen op basis van het type interventie. We hebben drie subgroepen gedefinieerd: acute-pijnmedicatie, preventieve medicamenteuze en niet-medicamenteuze interventies. Resultaten In totaal hebben we 49 onderzoeken (3301 patiënten) geïncludeerd, waarvan er 16 (32,7%) van hoge kwaliteit waren. Bij 10 onderzoeken ging het om een vorm van medicatie bij acute pijn. De hoofdpijnklachten waren significant minder bij paracetamol, ibuprofen en sumatriptan neusspray vergeleken met placebo en voor prochloorperazine vergeleken met ketorolac. Alle middelen werden goed verdragen, maar sumatriptan neusspray gaf meer bijwerkingen dan placebo. Twintig onderzoeken gingen de effectiviteit na van preventieve medicatie. De hoofdpijnklachten waren significant minder na behandeling met flunarizine vergeleken met placebo. Twee RCT’s gaven strijdige resultaten over het effect van propranolol. Alle middelen werden goed verdragen en gaven verder geen significante verschillen. Negentien onderzoeken gingen de effectiviteit na van niet-medicamenteuze behandelingen. Ontspanningstherapie, ontspanningstherapie + biofeedback, ontspanningstherapie + biofeedback + cognitieve gedragstherapie bleken effectief vergeleken met wachtlijstconditie. Ontspanningtherapie in combinatie met gedragstherapie bleek effectief vergeleken met placebo. Er is tegenstrijdig bewijs voor het gebruik van speciale diëten. Conclusies Paracetamol, ibuprofen en sumatriptan neusspray blijken effectief bij de symptomatische behandeling van migraineaanvallen bij kinderen. Enkele behandelingen zoals ontspanningstherapie en flunarizine zijn effectief als preventieve behandeling. Gezien het kleine aantal onderzoeken en de methodologische tekortkomingen in veel onderzoeken moeten de conclusies met enige voorzichtigheid worden getrokken.

NRC

NRC Handelsblad

Paperbundel uitg. ENCIP

Purpose: In the tumor-node-metastasis (TNM) staging system, no recommendations are provided on what lymph node retrieval technique is to be used to determine lymph node status, which leads to variability in nodal status assessment and TNM staging. Patient and Methods: Lymph node retrieval was quantitated using data from 237 curatively resected gastric cancer patients, from a prospective, randomized trial that compared the Western resection with limited (D1) and the Japanese resection with extended lymphadenectomy (D2), and compared data from the literature, Moreover, the efficacy of different lymph node retrieval techniques was determined. Results: The mean yield of lymph nodes was 15 in D1 and 30 in D2, which is similar to results from German investigators, but substantially lower than results from Japanese investigators (60 in D2). Use of a fat-clearance technique significantly increased (P=.01) nodal yields compared with conventional retrieval. Significantly higher yields (P Conclusion: Despite some anatomical variability in the distribution of lymph nodes, advice on the number of nodes to examine per N level, feasible in all patients, should be incorporated into the TNM classification to standardize nodal status assessment, Based on our findings, we advocate retrieval of nodes immediately postoperatively by the surgeon. (C) by American Society of Clinical Oncology.

Gaming has played an important part in our daily lives for quite some time now. As a result, many researchers are interested in the various ways in which gaming has an impact beyond its own context. This dissertation explores one particular type of impact, i.e., the impact of gaming on organizations. It theorizes that gaming is a frame of mind that influences what we find important when it comes to communication and collaboration with our colleagues at work. To explore this further, this dissertation first develops the notion of ‘playful organization’. Using a framework of organizational culture and structure, the dissertation tries to find playful organizations where online gamers play and work. It re-evaluates previous empirical studies of online gaming communities and professional organizations. It also looks into the ‘corporations’ of the massively multiplayer online game EVE Online, based on an ethnographic study. Finally, it looks into the communities and work organizations of a panel of Dutch online gamers, listening to the panelists’ ideas about the extent of playful organization in both contexts and subsequent comparisons between the two. This dissertation is thus an interdisciplinary and in-depth organizational study of online gamers’ communities and work organizations, in an attempt to gain insights into gaming’s impact on organizations.