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Neill T, Millar J, O'Connor P, Glover P. Specialist nurse for organ donation in an emergency department will increase organ donation. Crit Care 2013. [PMCID: PMC3642874 DOI: 10.1186/cc12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Millar J, Adamson F, O'Connor P, Wilson R, Ferrie E, McLaughlin R. Use of propofol for procedural sedation reduces length of stay in the emergency department. Crit Care 2013. [PMCID: PMC3642759 DOI: 10.1186/cc12328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Francis PL, Jakubovic R, O'Connor P, Zhang L, Eilaghi A, Lee L, Carroll TJ, Mouannes-Srour J, Feinstein A, Aviv RI. Robust perfusion deficits in cognitively impaired patients with secondary-progressive multiple sclerosis. AJNR Am J Neuroradiol 2013; 34:62-7. [PMID: 22700746 DOI: 10.3174/ajnr.a3148] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive impairment is a common, disabling symptom of MS. We investigated the impact of cerebral perfusion and brain and lesion volumetry on cognitive performance in 45 patients with SPMS by using MR imaging. MATERIALS AND METHODS Cognition was assessed by using a standard battery, the Minimal Assessment of Cognitive Function in Multiple Sclerosis. qCBF and qCBV maps were analyzed by using SPM and PLS. SPM was also used to conduct the GM, WM, and WML volumetric analyses. RESULTS Both SPM and PLS demonstrated significantly reduced qCBV in the superior medial frontal cortex of impaired patients. PLS also revealed significantly lower qCBV in the bilateral thalami and caudate nuclei of impaired patients and identified a pattern of significantly attenuated qCBF similar to that of qCBV. Performance on the Symbol Digit Modalities Test, which assesses information-processing speed, correlated most strongly overall with cerebral perfusion. Focal (ie, voxelwise) analyses of GM, WM, and WML volume revealed no significant differences between patients with and without cognitive impairment, though global GM volume was significantly decreased and global WML volume was significantly increased in impaired patients. CONCLUSIONS These results suggest that cognitively impaired patients with SPMS exhibit robust perfusion deficits in cortical and subcortical GM and impaired processing speed.
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Byrne D, O'Connor P, Lydon S, Kerin MJ. Preparing new doctors for clinical practice: an evaluation of pre-internship training. IRISH MEDICAL JOURNAL 2012; 105:328-330. [PMID: 23495542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A consistent finding in the literature is that newly graduated medical students often do not prossess the basic skills required to perform their jobs. Training designed to prepare newly graduated medical students for intermship was developed and delivered to 106 newly graduated medical students. Feedback on the course was obtained using anonymous pre-and post-course questionaires. A total of 32 students (52.5% of the recourse respondents) felt that they were prepared prior to the training, compared wit 51students (79.7% of the post-course respondents) who felt prepared for intership after the training. The largest effect size of the training was for the administration of medication (Cohen's d = 0.93). Futher development to the training programme is required. Nevertheless, it is suggested that this course serve as a model to address the unsatisfactory levels of preparedness for the work of a junior reported by medical students from many countries.
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O'Connor P. HEALTH BENEFITS OF WORK. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580f.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hutchinson CE, O'Connor P. Olympic special feature editorial. Br J Radiol 2012; 85:1146-7. [DOI: 10.1259/bjr/93053062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Aviv RI, Francis PL, Tenenbein R, O'Connor P, Zhang L, Eilaghi A, Lee L, Carroll TJ, Mouannes-Srour J, Feinstein A. Decreased frontal lobe gray matter perfusion in cognitively impaired patients with secondary-progressive multiple sclerosis detected by the bookend technique. AJNR Am J Neuroradiol 2012; 33:1779-85. [PMID: 22538071 DOI: 10.3174/ajnr.a3060] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is increasing evidence implicating microvascular impairment in MS pathogenesis. Perfusion imaging offers a unique opportunity to investigate the functional impact of GM pathology. We sought to quantify differences in MR imaging-based bookend-derived cerebral perfusion between cognitively impaired and nonimpaired patients with SPMS. MATERIALS AND METHODS Patients were prospectively recruited and assessed using MR imaging and the standard cognitive battery called the Minimal Assessment of Cognitive Function in MS. Patients exhibiting impairment on ≥ 2 individual tests were classified as cognitively impaired. Healthy controls were prospectively recruited and assessed using MR imaging to validate bookend assumptions. Structural and perfusion scans were coregistered and partitioned into anatomic brain regions and tissue compartments. Clinical and radiologic characteristics were compared between patients with and without impairment to identify potential confounders. A Bonferroni adjusted P value threshold (P < .005) was used for lobar and sublobar level analyses to correct for multiple comparisons. RESULTS Thirty-seven patients with SPMS (age 56 ± 9 years; 23 women, 14 men) and 10 age- and sex-matched healthy controls were recruited. Bookend assumptions were found to be valid in MS. GM and WM qCBV were all globally reduced in impaired patients. After adjusting for potential confounders while examining sublobar level perfusion, only GM qCBV was significantly different between cognitive groups, and this hypoperfusion localized to the bilateral medial superior frontal regions and left inferior, middle, and superior frontal regions (P < .005) of impaired patients compared with nonimpaired patients. GM qCBV accounted for 22.5% of the model variance compared with a model including only confounders (P = .0007). CONCLUSIONS Bookend-derived GM qCBV was significantly reduced in cognitively impaired patients with SPMS in functionally relevant brain regions.
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Miller A, Lublin F, O'Connor P, Taniou C, Dive-Pouletty C. Impact of Relapses with Sequelae on Disability, Health-Related Quality of Life, and Fatigue in a Population with Relapsing Forms of Multiple Sclerosis Using Data from TEMSO, a Pivotal Phase III Teriflunomide Trial (P07.082). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hauser S, Kappos L, Li D, Calabresi P, O'Connor P, Bar-Or A, Barkhof F, Wells C, Leppert D, Glanzman R, Tinbergen J. Long-Term Efficacy and Safety of Ocrelizumab in Patients with Relapsing-Remitting Multiple Sclerosis (RRMS): Week 96 Results of a Phase II, Randomized, Multicenter Trial (S30.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s30.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Miller A, Lublin F, O'Connor P, Wolinsky J, Comi G, Kappos L, Freedman M, Olsson T, Dive-Pouletty C, Bego-Le-Bagousse G, Confavreux C. Effect of Teriflunomide on Relapses with Sequelae and Relapse Leading to Hospitalization in a Population with Relapsing Forms of Multiple Sclerosis: Results from the TEMSO Study (S30.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s30.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hartung H, Kappos L, Goodin D, O'Connor P, Filippi M, Arnason B, Comi G, Cook S, Jeffery D, Petkau J, Bogumil T, Knappertz V, Beckmann K, Stemper B, Pohl C, Sandbrink R. Predictors of Disease Activity in 857 MS Patients Treated with IFNB-1b (PD5.009). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd5.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rotstein D, Evans M, Hohol M, O'Connor P. A Randomized, Controlled Trial of an Educational Intervention for MS Patients Concerning CCSVI (P05.128). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Freedman M, O'Connor P, Wolinsky J, Confavreux C, Comi G, Kappos L, Olsson T, Truffinet P, Dukovic D, Miller A. Teriflunomide Increases the Proportion of Patients Free from Disease Activity in the TEMSO Phase III Study (PD5.007). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd5.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kappos L, Radue EW, O'Connor P, Polman C, Hohlfeld R, Calabresi P, Selmaj K, Agoropoulou C, Jin J, Zhang-Auberson L, Francis G. Long-Term Efficacy and Safety of Fingolimod (FTY720) in Relapsing-Remitting Multiple Sclerosis (RRMS): Results from the Extension of the Phase III FREEDOMS Study (S41.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s41.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Antel J, Montalban X, O'Connor P, de Vera A, Cremer M, Sfikas N, Comi G, Kappos L. Long-Term (7-Year) Data from a Phase 2 Extension Study of Fingolimod in Relapsing Multiple Sclerosis (P01.129). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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O'Connor P, Ritchie J, Drouin S, Covell CL. Redesigning the workplace for 21st century healthcare. Healthc Q 2012; 15 Spec No:30-35. [PMID: 22874444 DOI: 10.12927/hcq.2012.22844] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Walker PB, O'Connor P, Phillips HL, Hahn RG, Dalitsch WW. Evaluating The Utility of DoD Hfacs Using Lifted Probabilities. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/1071181311551372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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O'Connor P, Reader T, Salas E, Yule S, Sundt T, Musson D, Wiegmann D. Techniques for Improving the Performance of Healthcare Teams: Learning from Aviation and Other HROs. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/1071181311551139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Montalban X, Comi G, O'Connor P, Gold S, de Vera A, Eckert B, Kappos L. Oral fingolimod (FTY720) in relapsing multiple sclerosis: impact on health-related quality of life in a phase II study. Mult Scler 2011; 17:1341-50. [PMID: 21727148 DOI: 10.1177/1352458511411061] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) worsens with multiple sclerosis (MS) relapses and disease progression. Common symptoms including depression and fatigue may contribute to poor HRQoL. OBJECTIVES To report exploratory analyses assessing the impact of fingolimod (FTY720) on HRQoL and depression in a phase II study of relapsing MS. METHODS The Hamburg Quality of Life Questionnaire in MS (HAQUAMS) and Beck Depression Inventory second edition (BDI-II) scores were assessed during a 6-month, placebo-controlled study and optional extension. RESULTS HAQUAMS total score improved with fingolimod and worsened with placebo. Mean score change from baseline to month 6 was -0.02 with fingolimod 1.25 mg (p < 0.05 versus placebo), -0.01 with fingolimod 5.0 mg and + 0.12 with placebo. Categorical data supported a clinically important effect of fingolimod on HRQoL. Fingolimod 1.25 mg was also beneficial over placebo in the fatigue/thinking HAQUAMS sub-domain (p < 0.05 versus placebo). Change in mean BDI-II scores from baseline to month 6 and the proportion of patients with BDI-II scores indicative of clinical depression favored fingolimod 1.25 mg over placebo (p < 0.05 for both). At month 4, mean BDI-II and HAQUAMS total scores appeared to be maintained in fingolimod-treated patients. CONCLUSION Fingolimod 1.25 mg may improve HRQoL and depression at 6 months compared with placebo in patients with relapsing MS.
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Filippi M, Rocca MA, Camesasca F, Cook S, O'Connor P, Arnason BGW, Kappos L, Goodin D, Jeffery D, Hartung HP, Comi G, Wolinsky JS, Bogumil T, Pohl C, Beckmann K, Sandbrink R, Croze E, Brown C, Desimone TM, Arnold DL, Cutter G, Knappertz V. Interferon β-1b and glatiramer acetate effects on permanent black hole evolution. Neurology 2011; 76:1222-8. [PMID: 21464426 DOI: 10.1212/wnl.0b013e3182143577] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare interferon β-1b (IFNβ-1b) and glatiramer acetate (GA) on new lesion (NL) (gadolinium-enhancing, new T2) evolution into permanent black holes (PBH)--a marker of irreversible tissue damage--in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS BEYOND was a large, phase III, clinical trial comparing IFNβ-1b 250 μg, IFNβ-1b 500 μg, and GA (2:2:1). Patient scans were reexamined post hoc for PBH in a rater-blinded manner. Two predefined coprimary endpoints compared IFNβ-1b 250 μg with GA: first, number of PBH per patient at year 2 evolving from year 1 NL, then proportion of year 1 NL evolving into PBH at year 2. IFNβ-1b 500 μg and GA were compared in an exploratory fashion. RESULTS Approximately 90% (1,957/2,244) of patients had NL at year 1 with follow-up at year 2. Mean numbers of PBH per patient at year 2 evolving from year 1 NL were lower for IFNβ-1b 250 μg than GA (0.30 vs 0.43; p = 0.0451). The proportion of NL evolving into PBH was similar (IFNβ-1b 250 μg vs GA: 21.6% vs 23.5%; p > 0.20). For IFNβ-1b 500 μg, both the mean PBH number per patient at year 2 evolving from year 1 NL (0.26 vs 0.43; p = 0.0037) and proportion of NL evolving into PBH (16.3% vs 23.5%; p = 0.0409) were lower relative to GA. CONCLUSION IFNβ-1b affected PBH development to a similar or better extent than GA. IFNβ-1b favorably influences an MRI outcome indicative of permanent tissue destruction in the brains of patients with multiple sclerosis. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that IFNβ-1b is associated with a reduction in MRI PBH formation and evolution compared with GA between years 1 and 2 of treatment.
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O'Connor P. View from Scottish pilot site of Safer Patients Initiative. BMJ 2011; 342:d1314. [PMID: 21363852 DOI: 10.1136/bmj.d1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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72
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O'Connor P, Keogh IJ. Addressing human error within the Irish healthcare system. IRISH MEDICAL JOURNAL 2011; 104:5-6. [PMID: 21387875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Din OS, Dodwell D, Wakefield RJ, Bradburn M, Emery P, Wilson G, Tan AL, O'Connor P, Highland A, Horgan K, Coleman RE. Abstract P5-11-18: Investigating Early Features of Aromatase Inhibitor-Induced Arthralgia. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-11-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Aromatase inhibitors (AI) are well known to be associated with troublesome musculoskeletal side effects but the underlying mechanisms are poorly understood and methods of objective assessment poorly defined. We have performed a prospective detailed evaluation of grip strength (primary endpoint), symptoms, imaging and biomarkers in patients receiving either an AI, tamoxifen or no endocrine therapy. Methods: 77 patients with early breast cancer from two specialist Breast Units were recruited prior to starting one of 4 treatment arms: upfront AI (A), switch from tamoxifen to AI (B), tamoxifen (C) and no treatment (D). Arthralgia was defined as worsening of joint pain score at 3 months and a positive Tinel's or Phalen's test was taken as evidence of carpal tunnel syndrome. Grip strength was measured (average of three readings from each hand) using a Jamar Dynamometer at baseline, 1, 2, 3, 6 and 12 months. In addition, biochemical (endocrine and collagen markers), rheumatological (inflammatory and cytokine markers) and radiological assessments of the hands (diagnostic ultrasound, bone density using DXA and plain radiograph) were performed at protocol-specified intervals. A subset of patients also underwent hand MRI at baseline, 3 and 12 months. Detailed rheumatological examination and questionnaire (DAS-28, SF-36, HAQ-DI and BPI-SF) assessment were performed at each visit. Grip strength was analysed using analysis of covariance with age, prior chemotherapy and baseline grip as covariates. The Kruskal-Wallis test was used for questionnaire data. The 3 month data on grip strength, questionnaire, clinical assessment and hand ultrasound are presented here. Results: 47 patients received an AI (34 upfront, 13 switch), 22 tamoxifen and 8 no endocrine treatment (controls). Median age (yearrs) for each group was: 62.1 (A), 51.0 (B), 65.2 (C) and 61.2 (D). The incidence of arthralgia at 3 months was 38% (A), 17% (B), 38% (C) and 14% (D). Mean baseline grip strength was similar in each arm: 22.5kg (A), 23.1kg (B), 20.2kg (C) and 23.2kg (D) (p=0.342 ANOVA). At 3 months, the mean percentage change in grip strength was +0.2% (A), +2.2% (B), +4.5% (C),+1.2% (D) (p=ns ANCOVA). In those on AI, the development of arthralgia was not shown to be associated with change in grip strength (p=0.82). Morning stiffness was also no different at 3 months. Clinical signs of carpal tunnel syndrome were evident in 10/45 (22%) of patients receiving AI therapy compared to 4/28 (14%) on tamoxifen/control. There were 4 cases of trigger thumb or finger, all in patients receiving AI treatment. Changes in HAQ-DI and pain (VAS) at 3 months were no different between groups (p=0.27, p=0.1 respectively). Ultrasound assessment of the flexor tendons at 3 month identified an increase in median score for tendon sheath fluid in those in the AI groups (3 (AI) v 1 (No AI) p=0.07, Mann-Whitney U test). There was no significant change in average median nerve cross-sectional area at 3 month.
Conclusion: This study suggests that patient reported arthalgia does not correlate with early changes in and mean grip strength. However, there may be early signs of carpal tunnel syndrome, trigger finger and fluid in the flexor tendon sheaths detectable by ultrasound.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-11-18.
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Degutis C, Busch S, Pantalon M, Fiellin D, O'Connor P, D'Onofrio G. Health risk behaviors and injured patients: an exploratory study. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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75
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Chitale S, Ciapetti A, Hodgson R, Grainger A, O'Connor P, Goodson NJ, Thompson RN, Estrach C, Moots RJ, Grassi W, Anderson ME. Magnetic resonance imaging and musculoskeletal ultrasonography detect and characterize covert inflammatory arthropathy in systemic sclerosis patients with arthralgia. Rheumatology (Oxford) 2010; 49:2357-61. [DOI: 10.1093/rheumatology/keq268] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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