In a prospective cohort study to propose a novel ultrasound scoring system for hand and wrist joints (US10) for evaluation of patients with early rheumatoid arthritis (RA), the researchers also investigated inter-observer reliability between two readers. Images from 20 randomly chosen patients (of the 48 patients included in the study) were evaluated for the inflammation and joint damage parameters of the joints included in the US10 score (second and third MCPs and PIPs and wrists), yielding a total of 200 images. A trained rheumatologist preformed the initial US examination, he had eight years of experience in US and was blinded to all other study findings. The 2nd evaluation of the ultrasound images was performed by a rheumatologist, with five years of experie
- Age: 19
- Gender: Male
- Medical history: None
- Initial presentation: Patient is a professional athlete (100 metres sprint) who has been intensively training for the last 6-8 weeks. Acute onset of pain in the medial part of the right foot.
A 9-year old boy with a long history of frequently relapsing nephrotic syndrome was reviewed at the pediatric outpatient clinic soon after recent immigration from another country. One striking feature on physical examination was excessive hair growth. The hair growth was restricted to his back and existed of long, dark hairs. Upon further examination, there were no signs of sexual development, such as testicular enlargement or pubic hair.
This 101 focusses on the topic of oxygenation and its distinction from ventilation. Furthermore, several types of oxygen delivery systems are discussed.
As of 2017 the fifth edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) will be the leading classification system for psychiatry in the Netherlands. It succeeds its predecessor DSM-IV, which has been around since the ‘90s and was known for adding the required ‘clinically significant impairment in functioning’ criterion to many disorders.
One of the biggest changes is the removal of the multiaxial system. Sixteen new classifications have been added and some disorder groups have changed radically. Most notably, the diagnosis ‘Autism Spectrum Disorder’ now encompasses autism, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified and it is categorized in severity. Another notable change is the reorganization of the former anxiety disorders into separate anxiety, obsessive-compulsive-related and trauma- and stressor-related disorders.
Not all changes have been met with enthusiasm. For example, there has been much debate about the removal of the bereavement exclusion in major depressive disorder. This criterion was used to exclude the possibility of diagnosing someone with a depression in the first two months of grief. Some fear that this removal may lead to unnecessarily medicalizing normal grief.
According to Edith Schippers, Minister of Health, Welfare and Sport, the change to DSM-5 will not have any noticeable effect, insurance-wise. It will be interesting to see how much impact this DSM update will have in the everyday clinical setting.
Area of expertise
Neuroendocrine diseases and diabetes mellitus.
Chairman, Board of Directors, AMC and dean of AMC.