http://repub.eur.nl/res/aut/4194/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/30970/ 2011-09-16T00:00:00Z Purpose: In about 5% of all cases LBP is associated with serious underlying pathology requiring diagnostic confirmation and directed treatment. Magnetic resonance imaging (MRI) is often used for this diagnostic purpose yet its role remains controversial. Consequently, this review aimed to summarize the available evidence on the diagnostic accuracy of MRI for identifying lumbar spinal pathology in adult low back pain (LPB) or sciatica patients. Methods: MEDLINE, EMBASE and CINAHL were searched (until December 2009) for observational studies assessing the diagnostic accuracy of MRI compared to a reference test for the identification of lumbar spinal pathology. Two reviewers independently selected studies for inclusion, extracted data and assessed methodological quality. Pooled summary estimates of sensitivity and specificity with 95% confidence intervals were calculated for homogenous subsets of studies. Results: Eight studies were included in this review. Strata were defined for separate pathologies i.e. lumbar disc herniation (HNP) and spinal stenosis. Five studies comparing MRI to findings at the surgery for identifying HNP were included in a meta-analysis. Pooled analysis resulted in a summary estimate of sensitivity of 75% (95% CI 65-83%) and specificity of 77% (95% CI 61-88%). For spinal stenosis pooling was not possible. Conclusions: The results suggest that a considerable proportion of patients may be classified incorrectly by MRI for HNP and spinal stenosis. However, the evidence for the diagnostic accuracy of MRI found by this review is not conclusive, since the results could be distorted due to the limited number of studies and large heterogeneity. http://repub.eur.nl/res/pub/30977/ 2011-09-14T00:00:00Z Aim: In low back pain if serious pathology is suspected diagnostic imaging could be performed. One of the imaging techniques available for this purpose is computed tomography (CT), however, insight in the diagnostic performance of CT is unclear. Method: Diagnostic systematic review. Studies assessing the diagnostic accuracy of CT in adult patients suggested having low back pain caused by specific pathology were selected. Two review authors independently selected studies for inclusion, extracted data and assessed risk of bias. Pooled summary estimates of sensitivity and specificity with 95% CI were calculated. Results: Seven studies were included, all describing the diagnostic accuracy of CT in identifying lumbar disc herniation. Six studies used surgical findings as the reference standard and were considered sufficiently homogenous to carry out a meta-analysis. The pooled summary estimate of sensitivity was 77.4% and specificity was 73.7%. Conclusions: We found no studies evaluating the accuracy of CT for pathologies such as vertebral cancer, infection and fractures and this remains unclear. Our results should be interpreted with some caution. Sensitivity and specificity, regarding the detection of lumbar disc herniation, showed that a substantial part of the patients is still classified as false-negative and false-positive. In future, the diagnostic performance of CT must be assessed in high quality prospective cohort studies with an unselected population of patients with low back pain. http://repub.eur.nl/res/pub/11264/ 2006-01-01T00:00:00Z Om gemeenten in staat te stellen te profiteren van de efficiencyvoordelen van het uitbesteden van taken is in 2003 het BTW-compensatiefonds ingevoerd. De meeste gemeenten vinden het fonds overbodig, ze zijn niet meer gaan uitbesteden. http://repub.eur.nl/res/pub/818/ 2003-09-03T00:00:00Z The levying of VAT in countries of the European Union creates significant distortions for local authorities in their decision-making on public provision and contracting out of public services. In several EU-countries, a refund of VAT to local governments eliminates this effect. Therefore, these schemes facilitate contracting out by local governments. In European countries with a refund scheme for the VAT costs of local governments or other ways to solve this distortion, contracting out refuse collection is relatively high compared to countries without. Moreover, the design of the scheme may have an effect on the tax rates of the included government sectors. A closed system financed by local governments only will lead to an increase of local tax rates.