[Transcranial magnetic stimulation in obsessive compulsive disorder: a systematic review]. / Systematische review: transcraniële magnetische stimulatie voor obsessieve-compulsieve stoornis.

BACKGROUND: Ten per cent of patients with obsessive-compulsive disorder (ocd) are resistant to treatment. For these patients, repetitive transcranial magnetic stimulation (rtms) may be an alternative form of treatment.
AIM: To clarify the effect and clinical application of rtms for treatment-resistant ocd.
METHOD: We searched the literature systematically and we discuss the relevant articles critically.
RESULTS: We included 17 randomised controlled trials (rcts) with 502 patients. The reported trials were small and heterogeneous. A small but consistent treatment effect was found for rtms (mean decrease y-bocs score 6.6 points) compared to placebo stimulation (mean decrease y-bocs score 2.4 points). However, the differences between the effects of rtms and the effects of placebo were often not statistically or clinically significant. The effect frequently disappeared within several weeks after ending rtms and the follow-up period was never longer than three months.
CONCLUSION: rtms is still not entirely suitable for inclusion in the regular treatment of resistant ocd. More information is needed about follow-up requirements and about the advisable length and intensity of the applied stimulation. Future developments may involve increasing the number of stimulation sessions, combining these with cognitive behavioral therapy and delivering a more personalised form of rtms.

Three-dimensional imaging: a novel, valid, and reliable technique for measuring wound surface area.

PURPOSE: The aim of this study was to investigate the validity and reliability of a novel three-dimensional imaging technique using Artec MHT™ 3D Scanner for measuring the wound surface area. METHODS: The validity was tested by measuring the surface area of 60 stickers (gold standard) on 20 volunteers. Stickers with standardized areas of 2590, 7875, and 15,540 mm2 were applied on the thorax, forearm, and thigh, respectively. For the reliability test, 58 burn wounds on 48 patients were assessed twice by two different observers with the Artec MHT™ 3D Scanner. Scanning, post-processing, and surface area measurements were performed by two clinicians. RESULTS: The results for the validity analysis showed an intraclass correlation coefficient of 0.99 and coefficient of variation of the thorax, forearm, and thigh were 1.1%, 0.9%, and 0.6%, respectively. The reliability analysis showed an intraclass correlation coefficient of 0.99, a coefficient of variation of 6.3%, and limits of agreement between measurements of two observers were calculated at 0 ± 0.17 × mean surface area. CONCLUSION: Three-dimensional imaging using the Artec MHT™ 3D Scanner is a valid and reliable method for measuring the wound surface area.

[The social dimension of quality of life within the care for adults with autism; two philosophical concepts that may provide practical tools to caregivers]. / De sociale dimensie van kwaliteit van leven binnen de zorg voor volwassenen met autisme.

BACKGROUND: The conceptualisation of quality of life of adults in treatment for autism has received very little attention in the medical literature. AIM: To clarify, from a philosophical perspective, two concepts, namely relational autonomy and coping, which contribute to quality of life and which, we believe, are easily applicable in the care for adults with autism. METHOD: We conducted a selective review of relevant medical and philosophical literature. We clarify the concepts of 'relational autonomy' and 'coping', present a case and discuss possible practical applications of the aforementioned concepts in clinical practice. RESULTS: We clarify from a philosophical point of view the concepts of relational autonomy and coping, how these concepts contribute to the quality of life and how they can be used in the daily provision of care. The care-givers should see a patient primarily as a person, and should be aware that the division of roles between patient and care-givers implies certain forms of communication. By utilising the relational aspects, the therapist and the care supervisor within the care relationship have the means, uniquely tailored to the person and the domain, to increase the patient's autonomy and consequently his/her quality of life. CONCLUSION: If the two concepts, relational autonomy and coping, are operationalised and applied in a straightforward manner in clinical practice, it should be possible to improve the quality of life of adults with autism.

Growth of preterm born children.

BACKGROUND: In this review, we describe the growth of (very) preterm infants or (very) low-birth-weight infants from birth until adulthood. METHODS: A systematic analysis of growth of these infants is thwarted by different definitions (classification by gestational age or birth weight) used in the literature. RESULTS: The early postnatal period of these individuals is almost invariably characterized by substantial growth failure. In the majority of preterm infants this is followed by a period of catch-up growth, which starts in early infancy and usually stops at 2-3 years of age, although in some cases it may continue into adolescence. Catch-up growth is usually incomplete, so that infants born preterm remain shorter and lighter than term-born peers during childhood, adolescence, and adulthood. Disproportionate catch-up growth in height and weight may lead to an altered body composition in adulthood, especially in females. CONCLUSION: Though early catch-up growth has shown to be beneficial for neurodevelopmental outcome, it is also associated with adverse metabolic consequences in adulthood. As the first generation of (very) preterm infants is now reaching young adulthood, future follow-up studies on these effects are warranted.

Three-dimensional imaging is a novel and reliable technique to measure total body surface area.

OBJECTIVE: The aim of this study was to explore the diverse clinimetric aspects of three-dimensional imaging measurements of TBSA in clinical practice compared with the methods currently used in clinical practice (i.e., the rule of nines and palm method) to measure TBSA in clinical practice. METHOD: To assess reliability, two independent researchers measured the TBSAs of 48 burn patients using Artec MHT™ Scanner and software. Subsequently, a resident and burn specialist estimated the TBSA of the same wounds using the rule of nines and palm method. RESULTS: Three-dimensional imaging showed excellent inter-observer reliability, with an intra-class correlation coefficient (ICC) of 0.99, standard error of measurement (SEM) of 0.054, and limits of agreement (LoA) of ±0.15×the mean TBSA (between the measurements of two researchers). The inter-observer reliability of the methods used in current clinical practice was less reliable, with an ICC of 0.91, SEM of 0.300 and LoA of ±0.78×the mean TBSA. The inter-observer reliability was least reliable between three-dimensional imaging and the residents compared with the burn specialists for the estimated TBSA, with an ICC of 0.68, SEM of 0.69 and LoA of ±1.49×the mean TBSA. CONCLUSION: The inter-observer reliability of three-dimensional imaging was superior compared with the rule of nines and palm method.