Martin Englund

Summary

Affiliation: Lund University
Country: Sweden

Publications

  1. doi request reprint Meniscus body position and its change over four years in asymptomatic adults: a cohort study using data from the Osteoarthritis Initiative (OAI)
    Katharina Bruns
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
    BMC Musculoskelet Disord 15:32. 2014
  2. doi request reprint Meniscus pathology, osteoarthritis and the treatment controversy
    Martin Englund
    Department of Orthopaedics, Clinical Sciences Lund, Lund University, Klinikgatan 22, SE 221 85 Lund, Sweden
    Nat Rev Rheumatol 8:412-9. 2012
  3. pmc Revision 1 size and position of the healthy meniscus, and its correlation with sex, height, weight, and bone area- a cross-sectional study
    Katja Bloecker
    Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University Salzburg, Austria
    BMC Musculoskelet Disord 12:248. 2011
  4. pmc The association between hip fracture and hip osteoarthritis: a case-control study
    Jonas Franklin
    University Hospital, Akureyri, Iceland
    BMC Musculoskelet Disord 11:274. 2010
  5. pmc Association between occupation and knee and hip replacement due to osteoarthritis: a case-control study
    Jonas Franklin
    Department of Orthopedics, University Hospital, Eyrarlandsvegi, Akureyri, IS 600, Iceland
    Arthritis Res Ther 12:R102. 2010
  6. doi request reprint Risk factors for medial meniscal pathology on knee MRI in older US adults: a multicentre prospective cohort study
    Martin Englund
    Lund University, Lund, Sweden
    Ann Rheum Dis 70:1733-9. 2011
  7. doi request reprint The role of the meniscus in osteoarthritis genesis
    Martin Englund
    Musculoskeletal Sciences, Department of Orthopaedics, Lund University Hospital, SE 221 85 Lund, Sweden
    Rheum Dis Clin North Am 34:573-9. 2008
  8. doi request reprint The meniscus in knee osteoarthritis
    Martin Englund
    Musculoskeletal Sciences, Department of Orthopedics, Klinikgatan 22, Lund University Hospital, SE 221 85 Lund, Sweden
    Rheum Dis Clin North Am 35:579-90. 2009
  9. doi request reprint The role of biomechanics in the initiation and progression of OA of the knee
    Martin Englund
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences Lund, Lund University, Sweden
    Best Pract Res Clin Rheumatol 24:39-46. 2010
  10. pmc Meniscal pathology on MRI increases the risk for both incident and enlarging subchondral bone marrow lesions of the knee: the MOST Study
    Martin Englund
    Lund University, Lund, Sweden
    Ann Rheum Dis 69:1796-802. 2010

Detail Information

Publications52

  1. doi request reprint Meniscus body position and its change over four years in asymptomatic adults: a cohort study using data from the Osteoarthritis Initiative (OAI)
    Katharina Bruns
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
    BMC Musculoskelet Disord 15:32. 2014
    ..However, very little is known about meniscal position in the asymptomatic knee and its natural history. Hence our objective was to study meniscal body position and its change over 4 years in asymptomatic adults...
  2. doi request reprint Meniscus pathology, osteoarthritis and the treatment controversy
    Martin Englund
    Department of Orthopaedics, Clinical Sciences Lund, Lund University, Klinikgatan 22, SE 221 85 Lund, Sweden
    Nat Rev Rheumatol 8:412-9. 2012
    ..However, the possibility of an increased risk of OA if functional meniscal tissue is removed cannot be overlooked...
  3. pmc Revision 1 size and position of the healthy meniscus, and its correlation with sex, height, weight, and bone area- a cross-sectional study
    Katja Bloecker
    Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University Salzburg, Austria
    BMC Musculoskelet Disord 12:248. 2011
    ..Meniscus extrusion or hypertrophy may occur in knee osteoarthritis (OA). However, currently no data are available on the position and size of the meniscus in asymptomatic men and women with normal meniscus integrity...
  4. pmc The association between hip fracture and hip osteoarthritis: a case-control study
    Jonas Franklin
    University Hospital, Akureyri, Iceland
    BMC Musculoskelet Disord 11:274. 2010
    ..There have been reports both supporting and refuting an inverse relationship between hip fracture and hip osteoarthritis (OA). We explore this relationship using a case-control study design...
  5. pmc Association between occupation and knee and hip replacement due to osteoarthritis: a case-control study
    Jonas Franklin
    Department of Orthopedics, University Hospital, Eyrarlandsvegi, Akureyri, IS 600, Iceland
    Arthritis Res Ther 12:R102. 2010
    ..The objective of this study was to examine the association between occupation and osteoarthritis (OA) leading to total knee (TKR) or hip (THR) joint replacement...
  6. doi request reprint Risk factors for medial meniscal pathology on knee MRI in older US adults: a multicentre prospective cohort study
    Martin Englund
    Lund University, Lund, Sweden
    Ann Rheum Dis 70:1733-9. 2011
    ..Meniscal pathology in which the aetiology is often unclear is a frequent finding on knee MRI. This study investigates potential risk factors for medial meniscal lesions or extrusion in middle-aged and elderly persons...
  7. doi request reprint The role of the meniscus in osteoarthritis genesis
    Martin Englund
    Musculoskeletal Sciences, Department of Orthopaedics, Lund University Hospital, SE 221 85 Lund, Sweden
    Rheum Dis Clin North Am 34:573-9. 2008
    ..Surgical resection of nonobstructive degenerate lesions may remove only the evidence of the disorder while the osteoarthritis degradation proceeds. Well-designed randomized, controlled clinical trials are needed...
  8. doi request reprint The meniscus in knee osteoarthritis
    Martin Englund
    Musculoskeletal Sciences, Department of Orthopedics, Klinikgatan 22, Lund University Hospital, SE 221 85 Lund, Sweden
    Rheum Dis Clin North Am 35:579-90. 2009
    ..A degenerative meniscal lesion often suggests early-stage knee OA. Surgical resection of nonobstructive degenerate lesions may merely remove evidence of the disorder while the OA and associated symptoms proceed...
  9. doi request reprint The role of biomechanics in the initiation and progression of OA of the knee
    Martin Englund
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences Lund, Lund University, Sweden
    Best Pract Res Clin Rheumatol 24:39-46. 2010
    ..Part of the problem is our current lack of understanding of early-stage OA, when it starts and how to define it...
  10. pmc Meniscal pathology on MRI increases the risk for both incident and enlarging subchondral bone marrow lesions of the knee: the MOST Study
    Martin Englund
    Lund University, Lund, Sweden
    Ann Rheum Dis 69:1796-802. 2010
    ..To investigate the association between meniscal pathology and incident or enlarging bone marrow lesions (BML) in knee osteoarthritis...
  11. doi request reprint Prevalence and incidence of rheumatoid arthritis in southern Sweden 2008 and their relation to prescribed biologics
    Martin Englund
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences Lund, Sweden
    Rheumatology (Oxford) 49:1563-9. 2010
    ..To gain updated estimates of prevalence and incidence of RA and proportion on biological treatment in southern Sweden...
  12. pmc Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: The Multicenter Osteoarthritis Study
    Martin Englund
    Boston University School of Medicine, Boston, Massachusetts, and Lund University Hospital, Lund, Sweden
    Arthritis Rheum 60:831-9. 2009
    ..Furthermore, meniscal damage is common. The aim of this study was to evaluate the association between meniscal damage in knees without surgery and the development of radiographic tibiofemoral OA...
  13. pmc Patellofemoral osteoarthritis coexistent with tibiofemoral osteoarthritis in a meniscectomy population
    M Englund
    Department of Orthopaedics, Lund University Hospital, SE 221 85 Lund, Sweden
    Ann Rheum Dis 64:1721-6. 2005
    ..To evaluate the frequency of patellofemoral osteoarthritis and its relevance to symptoms and function in a meniscectomy population...
  14. doi request reprint The role of the meniscus in knee osteoarthritis: a cause or consequence?
    Martin Englund
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences Lund, Lund University Hospital, Klinikgatan 22, SE 221 85 Lund, Sweden
    Radiol Clin North Am 47:703-12. 2009
    ..Surgical resection of nonobstructive degenerate lesions may only remove evidence of the disorder while the OA and associated symptoms proceeds...
  15. doi request reprint The role of the meniscus in osteoarthritis genesis
    Martin Englund
    Musculoskeletal Sciences, Department of Orthopedics, Lund University, Hs 32, Box 117, SE 221 00 Lund, Sweden
    Med Clin North Am 93:37-43, x. 2009
    ..Surgical resection of nonobstructive degenerate lesions may only remove evidence of the disorder while the osteoarthritis degradation proceeds. Well-designed randomized, controlled clinical trials are needed...
  16. pmc Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study)
    Ali Guermazi
    Department of Radiology, Boston University School of Medicine, FGH Building, 820 Harrison Avenue, Boston, MA 02118, USA
    BMJ 345:e5339. 2012
    ..To examine use of magnetic resonance imaging (MRI) of knees with no radiographic evidence of osteoarthritis to determine the prevalence of structural lesions associated with osteoarthritis and their relation to age, sex, and obesity...
  17. doi request reprint Long-term work disability in patients with psoriatic arthritis treated with anti-tumour necrosis factor: a population-based regional Swedish cohort study
    Lars Erik Kristensen
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
    Ann Rheum Dis 72:1675-9. 2013
    ..To study long-term work disability before and after tumour necrosis factor (TNF)-antagonist therapy in patients with psoriatic arthritis (PsA)...
  18. pmc Medial posterior meniscal root tears are associated with development or worsening of medial tibiofemoral cartilage damage: the multicenter osteoarthritis study
    Ali Guermazi
    Quantitative Imaging Center, Department of Radiology, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 820 Harrison Ave, Boston, MA 02118, USA
    Radiology 268:814-21. 2013
    ..To assess the association of meniscal root tear with the development or worsening of tibiofemoral cartilage damage...
  19. doi request reprint Sickness absence among cancer patients in the pre-diagnostic and the post-diagnostic phases of five common forms of cancer
    Katarina Sjövall
    Department of Oncology, Clinical Sciences Lund, Lund University, Lund, Sweden
    Support Care Cancer 20:741-7. 2012
    ..The purpose of this study was to observe sickness absence before and after the cancer diagnosis among cancer patients with five common forms of cancer...
  20. ncbi request reprint Knee buckling: prevalence, risk factors, and associated limitations in function
    David T Felson
    Boston University School of Medicine, Hebrew SeniorLife, Brigham and Women s Hospital, and Boston Medical Center, Boston, Massachusetts 02118, USA
    Ann Intern Med 147:534-40. 2007
    ..Knee buckling is common in persons with advanced knee osteoarthritis and after orthopedic procedures. Its prevalence in the community is unknown...
  21. pmc Incidental meniscal findings on knee MRI in middle-aged and elderly persons
    Martin Englund
    Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA 02118, USA
    N Engl J Med 359:1108-15. 2008
    ..However, there is a paucity of data regarding the prevalence of meniscal damage in the general population and the association of meniscal tears with knee symptoms and with radiographic evidence of osteoarthritis...
  22. pmc The association between meniscal damage of the posterior horns and localized posterior synovitis detected on T1-weighted contrast-enhanced MRI--the MOST study
    Frank W Roemer
    Quantitative Imaging Center QIC, Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA
    Semin Arthritis Rheum 42:573-81. 2013
    ..The aim was to assess the cross-sectional associations of posterior horn meniscal damage with perimeniscal synovitis, and with synovitis posterior to the posterior cruciate ligament (PCL) using contrast enhanced (CE) MRI...
  23. doi request reprint Sick leave in patients with ankylosing spondylitis before and after anti-TNF therapy: a population-based cohort study
    Lars E Kristensen
    Department of Orthopedics, Musculoskeletal Sciences, Clinical Sciences Lund, Lund University, Lund, Sweden
    Rheumatology (Oxford) 51:243-9. 2012
    ..To study levels of sick leave and disability pension before and after TNF-antagonist therapy in AS patients...
  24. pmc The effect of patient characteristics on variability in pain and function over two years in early knee osteoarthritis
    Przemyslaw T Paradowski
    Department of Orthopedics, Lund University, Lund University Hospital, SE 221 85 Lund, Sweden
    Health Qual Life Outcomes 3:59. 2005
    ..The objective of this study was to investigate the influence of age, gender, and body mass index (BMI) on clinically relevant change in pain and function over two years in subjects at high risk for or with knee OA...
  25. pmc Population-based consultation patterns in patients with shoulder pain diagnoses
    Eva Tekavec
    Occupational and Environmental Medicine, Laboratory Medicine Lund, Lund University, Lund SE 221 85, Sweden
    BMC Musculoskelet Disord 13:238. 2012
    ..To assess the annual consultation prevalence and new onset consultation rate for doctor-diagnosed shoulder pain conditions...
  26. pmc Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative
    David T Felson
    Boston University School of Medicine, Clinical Epidemiology Research and Training Unit, 650 Albany Street, Suite X200, Boston, MA 02118, USA
    Arthritis Rheum 65:355-62. 2013
    ..To study the effect of valgus malalignment on knee osteoarthritis (OA) incidence and progression...
  27. pmc Factors associated with meniscal extrusion in knees with or at risk for osteoarthritis: the Multicenter Osteoarthritis study
    Michel D Crema
    Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA
    Radiology 264:494-503. 2012
    ..To assess the associations of meniscal tears, knee mal-alignment, cartilage damage, knee effusion, and body mass index with meniscal extrusion...
  28. pmc Similar group mean scores, but large individual variations, in patient-relevant outcomes over 2 years in meniscectomized subjects with and without radiographic knee osteoarthritis
    Przemyslaw T Paradowski
    Department of Orthopedics, Lund University Hospital, SE 221 85 Lund, Sweden
    Health Qual Life Outcomes 2:38. 2004
    ..The aim of the study was, thus, to assess the variation in pain and function on group and individual level over 2 years in previously meniscectomized individuals with and without radiographic knee osteoarthritis (OA)...
  29. doi request reprint Decrease in sick leave among patients with rheumatoid arthritis in the first 12 months after start of treatment with tumour necrosis factor antagonists: a population-based controlled cohort study
    Tor Olofsson
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
    Ann Rheum Dis 69:2131-6. 2010
    ..To investigate the effect of tumour necrosis factor (TNF) antagonist treatment of patients with rheumatoid arthritis (RA) on sick leave (SL) and disability pension (DP) in a population-based setting in southern Sweden...
  30. pmc Patients with ankylosing spondylitis have increased sick leave--a registry-based case-control study over 7 yrs
    Britta Strömbeck
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden
    Rheumatology (Oxford) 48:289-92. 2009
    ....
  31. ncbi request reprint Meniscal tear--a feature of osteoarthritis
    Martin Englund
    Department of Orthopedics, Lund University, Sweden
    Acta Orthop Scand Suppl 75:1-45, backcover. 2004
    ..Meniscal resection may not benefit the patient with early-stage knee OA. The intervention merely removes evidence of the disorder, while the OA joint degradation proceeds...
  32. doi request reprint Cost of illness from the public payers' perspective in patients with ankylosing spondylitis in rheumatological care
    Britta Strömbeck
    Musculoskeletal Sciences Unit, Department of Orthopedics, Clinical Sciences Lund, Klinikgatan 22, Lund University Hospital, SE 221 85 Lund, Sweden
    J Rheumatol 37:2348-55. 2010
    ..To estimate the incremental costs to public payers for patients with ankylosing spondylitis (AS) of working age compared with reference subjects from the general population...
  33. doi request reprint Population-based estimates of common comorbidities and cardiovascular disease in ankylosing spondylitis
    Ann Bremander
    Lund University, Lund, Sweden
    Arthritis Care Res (Hoboken) 63:550-6. 2011
    ..To study the rate of common comorbidities and cardiovascular disease in patients with ankylosing spondylitis (AS) compared with the general population seeking health care...
  34. pmc Performance in physical education and health impairment 30 years later--a community based cohort study
    Simon Timpka
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
    PLoS ONE 7:e35718. 2012
    ..However, there is very limited evidence of the effects of PE on the adult health. We hypothesized that a low performance in PE was associated with an increased risk of health impairment by middle age...
  35. doi request reprint Prevalence of tibiofemoral osteoarthritis 15 years after nonoperative treatment of anterior cruciate ligament injury: a prospective cohort study
    Paul Neuman
    Department of Orthopedics, Malmo University Hospital, Lund University, Sweden
    Am J Sports Med 36:1717-25. 2008
    ....
  36. doi request reprint Risk of sick leave and disability pension in working-age women and men with knee osteoarthritis
    Jenny Hubertsson
    Department of Orthopedics, Clinical Sciences Lund, Sweden
    Ann Rheum Dis 72:401-5. 2013
    ..To investigate sick leave and disability pension in working-age subjects with knee osteoarthritis (OA) compared with the general population...
  37. doi request reprint Low back pain: epidemiology of consultations
    Anna Jöud
    Lund University and WHO Collaborating Centre for Evidence Based Healthcare in Musculoskeletal Disorders, Lund, Sweden
    Arthritis Care Res (Hoboken) 64:1084-8. 2012
    ....
  38. doi request reprint Natural history of radiographic hip osteoarthritis: A retrospective cohort study with 11-28 years of followup
    Jonas Franklin
    University Hospital, Akureyri, Iceland
    Arthritis Care Res (Hoboken) 63:689-95. 2011
    ..To evaluate the association between radiographic hip osteoarthritis (OA) and future total hip replacement (THR) due to OA or hip fracture...
  39. doi request reprint Sex differences in the association between body mass index and total hip or knee joint replacement resulting from osteoarthritis
    J Franklin
    Department of Orthopaedics, Clinical Sciences Lund, Lund University, Sweden
    Ann Rheum Dis 68:536-40. 2009
    ..To examine the association between body mass index (BMI) and osteoarthritis (OA) leading to total hip (THR) or knee (TKR) joint replacement...
  40. doi request reprint Trends in the first decade of 21st century healthcare utilisation in a rheumatoid arthritis cohort compared with the general population
    Sofia Hagel
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
    Ann Rheum Dis 72:1212-6. 2013
    ..To study 21st century trends in healthcare utilisation by patients with rheumatoid arthritis (RA) compared with the general population...
  41. doi request reprint The grade in physical education in adolescence as predictor for musculoskeletal pain diagnoses three decades later
    Simon Timpka
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
    Pain 150:414-9. 2010
    ..29 (95% CI=0.11-0.78). This study indicates that adolescent girls with a low PE grade could be an important group to target with early interventions to reduce future musculoskeletal illness...
  42. doi request reprint Patellofemoral osteoarthritis 15 years after anterior cruciate ligament injury--a prospective cohort study
    P Neuman
    Department of Orthopedics, Clinical Sciences, Lund University, Malmo, Sweden
    Osteoarthritis Cartilage 17:284-90. 2009
    ..Prevalence and clinical relevance of patellofemoral (PF) osteoarthritis (OA) after anterior cruciate ligament (ACL) injury...
  43. ncbi request reprint Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy
    M Englund
    Lund University, Lund, Sweden
    Arthritis Rheum 50:2811-9. 2004
    ....
  44. pmc Association between synovial fluid levels of aggrecan ARGS fragments and radiographic progression in knee osteoarthritis
    Staffan Larsson
    Department of Orthopedics, Clinical Sciences Lund, Lund University, BMC C12, Klinikgatan 28, SE 221 84 Lund, Sweden
    Arthritis Res Ther 12:R230. 2010
    ..We determined whether synovial fluid (SF) levels of ARGS-aggrecan distinguish subjects with progressive radiographic knee osteoarthritis (ROA) from those with stable or no ROA...
  45. doi request reprint Sick leave of spouses to cancer patients before and after diagnosis
    Katarina Sjövall
    Department of Oncology, Clinical Sciences Lund, Lund University, Lund, Sweden
    Acta Oncol 49:467-73. 2010
    ..The impact of cancer on spouses of cancer patients may be considerable in many aspects. Our objective was to evaluate sick leave in spouses of cancer patients before and after the diagnosis...
  46. ncbi request reprint Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls
    M Englund
    Department of Orthopedics, Lund University Hospital, SE 221 85 Lund, Sweden
    Arthritis Rheum 48:2178-87. 2003
    ..To investigate long-term radiographic and patient-relevant outcome of isolated limited meniscectomy with regard to type of meniscal tear and extent of surgical resection...
  47. ncbi request reprint Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness
    M Englund
    Clinical Epidemiology Branch and Training Unit, Boston University School of Medicine, 650 Albany Street, Boston, MA 02118, USA
    Arthritis Rheum 56:4048-54. 2007
    ..To evaluate the effect of meniscal damage on the development of frequent knee pain, aching, or stiffness in middle-aged and older adults...
  48. ncbi request reprint Change in self-reported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee osteoarthritis
    E M Roos
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Sweden
    Ann Rheum Dis 67:505-10. 2008
    ..In the present work, we describe the clinical course and predictors of change in self-reported outcomes and objectively assessed physical function over time in middle-aged subjects at high risk of, or with knee osteoarthritis (OA)...
  49. ncbi request reprint Association of radiographic hand osteoarthritis with radiographic knee osteoarthritis after meniscectomy
    M Englund
    Lund University Hospital, Lund, Sweden
    Arthritis Rheum 50:469-75. 2004
    ..To evaluate the association between radiographic hand osteoarthritis (OA), a disease with marked heredity, and radiographic knee OA in patients treated with meniscectomy...
  50. ncbi request reprint High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury
    L S Lohmander
    Lund University, Lund, Sweden
    Arthritis Rheum 50:3145-52. 2004
    ..To determine the prevalence of radiographic knee osteoarthritis (OA) as well as knee-related symptoms and functional limitations in female soccer players 12 years after an anterior cruciate ligament (ACL) injury...
  51. ncbi request reprint Patient-relevant outcomes fourteen years after meniscectomy: influence of type of meniscal tear and size of resection
    M Englund
    Department of Orthopedics, Lund University Hospital, S-221 85, Sweden
    Rheumatology (Oxford) 40:631-9. 2001
    ....
  52. doi request reprint Presence of peripheral arthritis and male sex predicting continuation of anti-tumor necrosis factor therapy in ankylosing spondylitis: an observational prospective cohort study from the South Swedish Arthritis Treatment Group Register
    L E Kristensen
    South Sweden Musculoskeletal Research Centre, Lund University Hospital, Lund University, Sweden
    Arthritis Care Res (Hoboken) 62:1362-9. 2010
    ..To examine clinical characteristics as possible predictors of long-term treatment continuation with adalimumab, etanercept, and infliximab in ankylosing spondylitis (AS) patients who had never taken biologics treated in clinical practice...