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G Stucki

Publications and source records attributed to G Stucki.

At least 127 records · Page 7Linked to original sources
PubMed1995

Comparison of the validity and reliability of self-reported articular indices.

Our objective was to compare the validity and reliability of three formats for self-administered articular indices assessing pain (PAI) or swelling (SAI). Fifty-five patients with rheumatoid arthritis were asked to mark the degree of pain on a list of 16 joints (PAI list), to mark 'painful joints' on a mannequin presenting 42 joints (PAI diagram), and to mark 'swollen or tender joints' on a mannequin presenting 38 joints (SAI diagram). The test--retest reliability (intraclass correlation coefficient) ranged from 0.63 (SAI diagram) to 0.67 (PAI diagram) and 0.85 (PAI list). The correlation with clinical parameters was strongest for the PAI list and the SAI diagram. The association of the SAI diagram with clinical parameters increased with omission of the less reliable toe joints and/or weighting for joint size according to Lansbury. As expected, the short and weighted SAI diagram correlated more strongly with the physician-derived swollen joint count (r = 0.49), C-reactive protein (r = 0.49) and erythrocyte sedimentation rate (r = 0.41) than did the PAI list whereas the PAI list correlated more strongly with physician-derived tender joint count (r = 0.43), global pain measured on a numerical rating scale (r = 0.57) and the Health Assessment Questionnaire (r = 0.49) than did the SAI diagram. We concluded that patients' rating of tender and swollen joints on a mannequin diagram and calculation of a 26-joint and weighted articular index produces an excellent estimate of total joint inflammation, which may be useful in clinical, health services and epidemiological research. An articular index calculated from ratings of pain degree of 16 joints or joint groups may provide complementary information.

Arthritis, Rheumatoid↗
PubMed1995

Ceiling effects of the Health Assessment Questionnaire and its modified version in some ambulatory rheumatoid arthritis patients.

OBJECTIVE: To examine if the reduced number of items in the modified version of the Health Assessment Questionnaire (MHAQ) concerning difficulty of performing activities of daily living may lead to a reduced ability to detect clinical changes compared with the original HAQ. METHODS: In 56 consecutive ambulatory patients with rheumatoid arthritis, we examined the mean change in clinical and laboratory parameters for those who recorded improved, unchanged, or worse MHAQ scores one year after a baseline assessment. RESULTS: At baseline, about 50% of the patients had an MHAQ score < 0.3 and clustered at the normal end of the scale. Because of a ceiling effect, the MHAQ failed to detect clinical improvement in 18% of the patients. Changes in clinical and laboratory parameters were associated with improved, unchanged, or worse scores with the HAQ but not the MHAQ. CONCLUSION: Although the format of the MHAQ has the advantage of eliciting a 'satisfaction' score, limitations in its sensitivity to detect clinical improvement in patients with relatively little difficulty in activities of daily living may not justify the use of this particular version of shorter questionnaire in certain clinical settings.

Activities of Daily Living↗
PubMed1995

Muscle strength assessment in polymyositis and dermatomyositis evaluation of the reliability and clinical use of a new, quantitative, easily applicable method.

OBJECTIVE: To evaluate the feasibility and the reliability of a quantitative method of maximal isometric strength measurement for the assessment of patients with myositis in clinical practice and research. METHODS: Three observers independently examined the strength of 13 muscle groups of 7 patients with stable polymyositis and dermatomyositis (PM/DM) using a handheld pull-gauge. Reliability was assessed following a balanced random 3-way cross classification with interactions and using the analysis of variance method. Serial followup strength data for 2 patients were compared to change in creatinine kinase (CK) levels. RESULTS: All measurements could be performed without causing pain to the patients. One single test including 13 muscle groups was done in 7 min or less. Both intra and interobserver correlations were strong and significant for all muscle groups. The intraobserver reliability ranged from 0.88 for elbow extensors to 0.98 for knee extensors and cervical spine flexors. The interobserver reliability ranged from 0.81 for elbow flexors to 0.98 for knee extensors and cervical spine flexors. The followup of 2 cases yielded moderate to strong correlations of serial strength measurements with CK levels. CONCLUSION: Serial measurement of isometric muscle strength with a handheld pull-gauge is a feasible, inexpensive, time efficient and reliable method and may provide additional quantitative information in the clinical assessment of patients with myositis.

Adult↗
PubMed1994

Is misoprostol cost-effective in the prevention of nonsteroidal anti-inflammatory drug-induced gastropathy in patients with chronic arthritis? A review of conflicting economic evaluations.

Whether misoprostol, a synthetic prostaglandin E1 analogue, should be routinely prescribed along with nonsteroidal anti-inflammatory drugs (NSAIDS) to prevent gastric damage is of great clinical importance and has profound cost implications. No consensus exists on whether misoprostol cotherapy results in a cost-saving, is cost-effective, or is costly. The different conclusions reached by five economic evaluations of misoprostol can be explained solely by the assumed absolute risk reduction of symptomatic ulcer, which was more than seven times greater in the studies that concluded that misoprostol was cost-effective than in a study that concluded misoprostol to be costly. Since no study has directly shown the effectiveness of misoprostol cotherapy in preventing clinically significant ulcer disease (ie, hemorrhage and perforation), it is impossible to judge which assumptions are most appropriate. The absence of firm data on the rate of NSAID-induced gastric ulcers reduced by misoprostol makes it impossible to conclude whether it is cost-effective in patients with chronic arthritis who use NSAIDS.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

Increased removal capacity for 1,2-dichloroethane by biological modification of the granular activated carbon process.

The removal of 5 mg l-1 1,2-dichloroethane [(CH2Cl)2] was studied in two granular activated carbon (GAC) reactors run with hydraulic retention times of below 1 h. One reactor was operated abiotically. The other one was inoculated with microorganisms able to degrade (CH2Cl)2. While the (CH2Cl)2-adsorption capacity of the non-inoculated GAC reactor was exhausted after 20 days, it apparently did not exhaust for at least 170 experimental days in the biologically activated system because (CH2Cl)2 was removed to over 95% as a result of the microbial degradation. The biodegradation was quantified: during the passage through the biologically activated GAC reactor, (CH2Cl)2 (5 +/- 1 mg l-1) disappeared, chloride ions (3.3 +/- 0.2 mg l-1) were produced, and oxygen (4 to 6 mg l-1) was consumed. Removal of 30% of GAC at the entrance of the reactor, which visibly carried most of the biomass, and its replacement by virgin GAC at the end of the column did not change the apparent (CH2Cl)2 removal capacity of the GAC column, indicating that still enough biomass was available to degrade most of the chemical fed. After the addition of the virgin carbon, the effluent concentration fell for a short period of time from about 200 micrograms l-1 to below 100 micrograms l-1, indicating partial adsorption of the non-degraded (CH2Cl)2 at the end of the reactor by the virgin carbon. Thus, the modification of the adsorption process by inoculation and maintenance of bacteria with special degradation capabilities resulted in a lower consumption of GAC and thus led to an extended service life of the GAC columns.

Adsorption↗
PubMed1994

Efficacy of rehabilitation interventions in rheumatic conditions.

All industrialized nations are facing a crisis in health care financing. Rising expectations coupled with increasing specialization and technologic capacities have forced health care payers to examine their assumptions and to seek data on the outcomes of medical interventions. Clinical investigators who have been taught to use randomized controlled trials that evaluate efficacy under experimental conditions have been redirected toward studies that can help answer health policy questions. Such studies examine the effectiveness of interventions in more realistic settings on a richer array of patient-centered outcomes such as function and consider cost effectiveness and relative cost effectiveness. Rehabilitation interventions, which are by and large pragmatic, have never had a strong scientific basis grounded in controlled trials, and this lack of evidence has put tremendous pressure on clinicians to justify their practices. In this article, we review the recent literature on effectiveness of rehabilitation interventions in rheumatic disorders.

Cost-Benefit Analysis↗
PubMed1994

Does a muscle strength index provide complementary information to traditional disease activity variables in patients with rheumatoid arthritis?

OBJECTIVE: To develop a muscle strength index (MSI) and determine whether it provides complementary information to traditional disease activity variables in patients with rheumatoid arthritis (RA). METHODS: The MSI was developed on the basis of practical and empirical aspects and statistical considerations. Intra and interobserver reliability was assessed on the data from 3 observers on 2 strength measurements in each of 10 patients. The association of the MSI with variables of disease activity and severity was assessed in univariate analysis. The contribution of the MSI in the explanation of physician's global disease activity after accounting for the effect of traditional measures of disease activity was assessed in multiple linear regression models. RESULTS: Eight strength measurements (extension and flexion of knee and elbow joints) obtained with a hand held pull gauge were aggregated into the MSI as the mean of the standardized scores. In 65 patients with RA, the MSI had a high internal consistency (Cronbach's alpha 0.95) and intra and interobserver reliability (Pearson correlation coefficient 0.94 each). The MSI correlated moderately with traditional measures of disease activity and strongly with physical functional disability and radiological damage. In contrast to grip strength, the MSI explained additional variation of physician's global assessment of disease activity if added to variables of pooled activity indices. CONCLUSION: The MSI is a reliable and valid measure of disease activity and severity and may improve the content validity of pooled disease activity indices.

Adult↗
PubMed1994

Evaluation of a German version of the physical dimensions of the Health Assessment Questionnaire in patients with rheumatoid arthritis.

OBJECTIVE: Our objective was to translate and adapt the disability section of the health assessment questionnaire (HAQ) into German (HAQ-G) to suit Swiss-German conditions and to test its metric properties, reliability, and validity. METHODS: We tested 62 consecutive patients with rheumatoid arthritis (RA) attending the outpatient Clinic of the Department of Rheumatology, University Hospital Zurich. All patients fulfilled the American Rheumatism Association 1987 revised criteria for RA. The translation was done by 2 translators aware of the objective of the questionnaire and some questionable items were discussed and resolved in a panel by 4 rheumatologists including one bilingual clinical researcher. Test-retest reliability was assessed with Pearson's correlation coefficient on the scores of 2 questionnaire mailed in a 10-day interval. The internal consistency was assessed with Cronbach's coefficient alpha. To assess the construct validity, we compared the HAQ scores to clinical, laboratory, and radiological variables of disease activity and outcome. To assess criterion validity, we compared physicians' assessment of functional class (observed disability) to the HAQ (referred disability). The content validity was assessed in a multivariate model explaining HAQ scores with a variety of other measurements of disease activity and outcome. RESULTS: The test-retest reliability was 0.94; the internal consistency was 0.92; the criterion validity was 0.76; and correlations with other disease variables ranged from 0.39 (Larsen radiological score) to 0.66 (grip strength). CONCLUSION: The HAQ-G is a reliable and valid instrument for measuring functional disability in a German speaking population with RA.

Aged↗
PubMed1994

Contribution of neuromuscular impairment to physical functional status in patients with lumbar spinal stenosis.

OBJECTIVE: To evaluate the relationship between neuromuscular impairment and physical functional status in patients with lumbar spinal stenosis. METHODS: Cross sectional analysis of 217 consecutive patients with lumbar spinal stenosis referred to 3 teaching hospitals. Physical functional status was measured with the physical dimension of the Sickness Impact Profile (P-SIP). Physical and radiological findings were abstracted from clinical records. The neuromuscular findings included pin sensation, strength, deep tendon reflexes and vibration. They were aggregated in a neuromuscular impairment index (NMI). Univariate relationships of the P-SIP and the NMI were analyzed with nonparametric methods. The determinants of physical functional status were evaluated using multiple linear regression models. RESULTS: In 148 patients with complete clinical data, objective weakness of the lower extremity as measured at rest was not related to physical functional status in univariate analyses. Decreased vibration was common and was associated with balance disturbance and reduced physical functional status, reflecting the importance of proprioception loss. In the multivariate regression analysis, neuromuscular deficit explained only 2.5% of the variance in physical functional status. The primary determinants of physical functional status were pain, depression, comorbid conditions and work status. CONCLUSION: While neuromuscular impairment is an indispensable feature of the diagnostic evaluation, its value in assessing outcome is limited. The decision whether to intervene surgically in patients without cauda equina syndrome or rapidly progressive neurological deficits should therefore be driven by pain and physical disability rather than the degree of neuromuscular impairment.

Aged↗
PubMed1994

Diagnosis of lumbar spinal stenosis.

Lumbar spinal stenosis is a clinical-anatomic syndrome. Radiographic evidence of cauda equina compression is necessary but not sufficient to establish the diagnosis. Patients must have a clinical syndrome consisting of back and lower extremity discomfort exacerbated by lumbar extension or relieved by flexion, or evidence of lower extremity neurologic deficits. Symptomatic lumbar spinal stenosis may arise from a variety of specific etiologies and frequently coexists with other pain syndromes.

Diagnosis, Differential↗
PubMed1993

Efficacy and safety of radiation synovectomy with Yttrium-90: a retrospective long-term analysis of 164 applications in 82 patients.

In this long term retrospective study of radiation synovectomy with Yttrium-90 (Y90), we evaluated the results of 164 applications in 82 patients with RA, OA with synovitis, ankylosing spondylitis and psoriatic arthritis. Radiation synovectomy with Y90 has an overall success rate of approximately 50% and is therefore an effective alternative to surgical synovectomy in chronic synovitis which fails to respond to conservative treatment. Elbow and knee responded significantly better than shoulder and ankle joints. Patients with radiological stages from 0 to 2 showed a significantly better success rate than those with stage 3 changes. In responders, repeat therapy for recurrence of symptoms or treatment of a symptomatic corresponding symmetrical joint is advisable. Repeat therapy in a previous non-responder is associated with an unacceptably high failure rate. Therefore, when a joint fails to respond after 6 months, arthroscopy should be performed to evaluate further treatment procedures. A successful result was found in only 11 of 25 joints treated with arthroscopic synovectomy followed by radiation synovectomy within 2 weeks, indicating no benefit of this combination.

Adult↗
PubMed1992

Ankylosing spondylitis and sarcoidosis--coincidence or association? Case report and review of the literature.

We report a 25-year-old woman presenting with sarcoidosis and bilateral sacroiliitis. Her sarcoidosis related symptoms (malaise, cough and dyspnoea) improved dramatically under treatment with steroids but severe back pain persisted. Only seven similar cases have been described over the last 40 years and the question of a possible association between the two diseases has been raised. However, prevalence data from the literature and the apparent lack of genetic links are better arguments for coincidence than for association.

Adult↗
PubMed1990

Biological decomposition of dichloromethane from a chemical process effluent.

The application of specialized microorganisms to treat dichloromethane (DM) containing process effluents was studied. An aerobic fluidized bed reactor with a working volume of 801 filled with sand particles as carriers for the bacteria was used. Oxygen was introduced into the recycle stream by an injector device. DM was monitored semi-continuously. A processor controlled the feed volume according to the DM effluent concentration. Mineralization rates of 12 kg DM/m3bioreactor.d were reached within about three weeks using synthetic wastewater containing 2000 mg/l DM as single carbon compound. DM from process water of a pharmaceutical plant was reduced from about 2000 mg/l in the feed to below 1 mg/l in the effluent at volumetric loading rates of 3 to 4 kg DM/m3bioreactor.d. Degradation of wastewater components like acetone and isopropanol were favoured, thus making the process less attractive for waste streams containing high amounts of DOC other than of DM. DM concentrations of up to 1000 mg/l were tolerated by the immobilized microorganisms and did not influence their DM degradation capacity. The ability to mineralize DM was lost when no DM was fed to the reactor for 10 days.

Aerobiosis↗
PubMed1987

Role of dissolution rate and solubility in biodegradation of aromatic compounds.

Strains of Moraxella sp., Pseudomonas sp., and Flavobacterium sp. able to grow on biphenyl were isolated from sewage. The bacteria produced 2.3 to 4.5 g of protein per mol of biphenyl carbon, and similar protein yields were obtained when the isolates were grown on succinate. Mineralization of biphenyl was exponential during the phase of exponential growth of Moraxella sp. and Pseudomonas sp. In biphenyl-supplemented media, Flavobacterium sp. had one exponential phase of growth apparently at the expense of contaminating dissolved carbon in the solution and a second exponential phase during which it mineralized the hydrocarbon. Phase-contrast microscopy did not show significant numbers of cells of these three species on the surface of the solid substrate as it underwent decomposition. Pseudomonas sp. did not form products that affected the solubility of biphenyl, although its excretions did increase the dissolution rate. It was calculated that Pseudomonas sp. consumed 29 nmol of biphenyl per ml in the 1 h after the end of the exponential phase of growth, but 32 nmol of substrate per ml went into solution in that period when the growth rate had declined. In a medium with anthracene as the sole added carbon source, Flavobacterium sp. converted 90% of the substrate to water-soluble products, and a slow mineralization was detected when the cell numbers were not increasing. Flavobacterium sp. and Beijerinckia sp. initially grew exponentially and then arithmetically in media with phenanthrene as the sole carbon source. Calculations based on the growth rates of these bacteria and the rates of dissolution of phenanthrene suggest that the dissolution rate of the hydrocarbon may limit the rate of its biodegradation.

Biodegradation, Environmental↗
PubMed1983

Bacterial growth on 1,2-dichloroethane.

1,2-Dichloroethane (5 mM) served as the only carbon and energy source for bacterium DE2, a gram-negative, oxidase-positive, motile rod. The specific growth rate mu of strain DE2 on 1,2-dichloroethane was 0.08 h-1. A NAD-dependent 2-chloroacetaldehyde dehydrogenase activity and a 2-chloroacetate halidohydrolase activity were detected in extracts of cells grown on 1,2-dichloroethane.

Aldehyde Oxidoreductases↗
PubMedDate not supplied

Identification of health problems in patients with acute inflammatory arthritis, using the International Classification of Functioning, Disability and Health (ICF).

OBJECTIVES: To identify the most common health problems experienced by patients with acute inflammatory arthritis using the International Classification of Functioning, Disability and Health (ICF), and to provide empirical data for the development of an ICF Core Set for acute inflammatory arthritis. METHODS: Cross-sectional survey of patients with acute inflammatory arthritis of two or more joints requiring admission to an acute hospital. The second level categories of the ICF were used to collect information on patients' health problems. Relative frequencies of impairments, limitations and restrictions in the study population were reported for the ICF components Body Functions, Body Structures, and Activities and Participations. For the component Environmental Factors absolute and relative frequencies of perceived barriers or facilitators were reported. RESULTS: In total, 130 patients were included in the survey. The mean age of the population was 59.9 years (median age 63.0 years), 75% of the patients were female. Most had rheumatoid arthritis (57%) or early inflammatory polyarthritis (22%). Fifty-four second-level ICF categories had a prevalence of 30% or more: 3 (8%) belonged to the component Body Structures and 10 (13%) to the component Body Functions. Most categories were identified in the components Activities and Participation (19; 23%) and Environmental Factors (22; 56%). CONCLUSION: Patients with acute inflammatory arthritis can be well described by ICF categories and components. This study is the first step towards the development of an ICF Core Set for patients with acute inflammatory arthritis.

Activities of Daily Living↗
PubMedDate not supplied

Construct validation of the ACR 1991 revised criteria for global functional status in rheumatoid arthritis.

In order to assess the construct and discriminatory validity of the 1991 ACR functional status criteria for rheumatoid arthritis (RA), a cross-sectional analysis of 62 consecutive patients with RA (according to the American Rheumatism Association 1987 revised criteria) who were attending the outpatient clinic of rheumatology, University Hospital Zürich, was carried out. A moderate-to-strong association of the ACR criteria with pain (r = 0.54), the tender (r = 0.54) and swollen joint count (r = 0.31), grip strength (r = -0.49), C-reactive protein (r = 0.35), the HAQ disability index (r = 0.76), self-perceived global health (r = 0.58), and the Larsen radiological score (r = 0.32) was found. The mean scores of most disease parameters and all 8 domains of the health assessment questionnaire were significantly different between, and increased regularly across, the 4 classes. We conclude that the ACR 1991 functional status criteria for RA are a valid measure of the consequences of impairment and discriminate well the physical functional status.

Aged↗