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Article ; Online: Arthroscopic synovectomy in rheumatoid arthritis of wrist.

Kim, Sung-Jae / Jung, Kwang-Am

2007 Volume 5, Issue 4, Page(s) 244–250

Abstract: The wrist is the most commonly involved region of the upper extremity in rheumatoid arthritis (RA ... such as wrist arthrodesis or total wrist arthroplasty in selective cases. Although arthroscopic synovectomy ... on radiological and clinical findings. Arthroscopic synovectomy is recommended for pain relief and ...

Abstract	The wrist is the most commonly involved region of the upper extremity in rheumatoid arthritis (RA). Because the wrist joint becomes involved early during the disease course and its involvement rapidly progresses, and because the disabilities associated with progressive RA are significant, early and adequate treatment must be introduced to prevent disease progression. Various treatment methods can be employed to treat RA wrists based on radiological and clinical findings. Arthroscopic synovectomy is recommended for pain relief and functional recovery in early stage RA, and is also helpful in advanced staged RA with Larsen stage III. However, arthroscopic synovectomy is not recommended as an effective method of treatment for all patients with advanced radiographic changes. Nevertheless, arthroscopic synovectomy may delay the need for complex surgery, such as wrist arthrodesis or total wrist arthroplasty in selective cases. Although arthroscopic synovectomy of the wrist cannot improve grip strength or range of motion, it can reduce wrist pain and improve function, and thus facilitate return to work.
MeSH term(s)	Arthritis, Rheumatoid/physiopathology ; Arthritis, Rheumatoid/surgery ; Arthroscopy/methods ; Humans ; Range of Motion, Articular ; Recovery of Function ; Synovectomy ; Wrist Joint/physiopathology ; Wrist Joint/surgery
Language	English
Publishing date	2007-12-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2303793-3
ISSN	1554-6179 ; 1539-4182
ISSN (online)	1554-6179
ISSN	1539-4182
DOI	10.3121/cmr.2007.768
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Article ; Online: Arthroscopic Synovectomy of the Wrist in Patients With Rheumatoid Arthritis: A Systematic Review of the Current Literature.

d'Ailly, Philip N / Mulders, Marjolein A M / Bisoendial, Radjesh J / Kuijper, T Martijn / Coert, J Henk / Schep, Niels W L

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

2021 Volume 28, Issue 2, Page(s) 77–83

Abstract: Background: Rheumatoid arthritis (RA) of the wrist can lead to loss of wrist function and ... progressive joint destruction if inadequately treated. Arthroscopic synovectomy of the wrist may prove ... review evaluating functional outcomes and pain following arthroscopic synovectomy of the wrist in RA ...

Abstract	Background: Rheumatoid arthritis (RA) of the wrist can lead to loss of wrist function and progressive joint destruction if inadequately treated. Arthroscopic synovectomy of the wrist may prove a valuable treatment for local inflammation. Objective: The aim of this study was to perform a systematic review evaluating functional outcomes and pain following arthroscopic synovectomy of the wrist in RA patients. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. MEDLINE, EMBASE, The Cochrane Library, Web of Science, and Google Scholar were searched for studies describing pain or functional outcomes following arthroscopic synovectomy of the wrist in RA patients (CRD42021270846). Risk of bias was assessed using the Methodological Index for Non-Randomized Studies. Data collection included patient characteristics, pain scores, wrist function questionnaires, secondary surgery, and complications. Results: Six noncomparative cohort studies were included, with a total of 153 arthroscopic synovectomies. Disease duration of RA ranged from 32 to 89 months, and radiographic progression was mild to moderate. The Methodological Index for Non-Randomized Studies scores ranged from 8 to 10 out of 16. Mean follow-up ranged from 21 to 95 months. Improvements were seen in pooled mean visual analog scale pain score (from 7.7 to 2.2, p < 0.05), pooled mean Modified Mayo Wrist Score (from 43.3 to 70.4, p < 0.05), and the Disability of the Arm, Shoulder, and Hand (from 67.5 to 36.5, p < 0.05). Two complications occurred, and 5 patients required secondary surgery. Conclusions: There is limited evidence suggesting that arthroscopic synovectomy of the wrist improves wrist function and pain in patients with RA, with few complications. In centers with arthroscopic expertise, it can be considered as a treatment option.
MeSH term(s)	Arthritis, Rheumatoid/complications ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/surgery ; Arthroscopy ; Humans ; Synovectomy ; Treatment Outcome ; Wrist ; Wrist Joint/surgery
Language	English
Publishing date	2021-10-19
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	1283266-2
ISSN	1536-7355 ; 1076-1608
ISSN (online)	1536-7355
ISSN	1076-1608
DOI	10.1097/RHU.0000000000001807
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Article ; Online: Arthroscopic Synovectomy of Wrist in Rheumatoid Arthritis.

Shim, Jae Woo / Park, Min Jong

Hand clinics

2017 Volume 33, Issue 4, Page(s) 779–785

Abstract: ... Synovectomy can provide pain relief and functional improvement for rheumatoid wrist. Arthroscopic synovectomy ... technique, and results of arthroscopic synovectomy in the rheumatoid wrist. ... Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist ...

Abstract	Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist involvement is common. Patients with persistent symptoms despite medical management are candidates for surgery. Synovectomy can provide pain relief and functional improvement for rheumatoid wrist. Arthroscopic synovectomy is a safe and reliable method, with minimal postoperative morbidity. This article reviews the role, technique, and results of arthroscopic synovectomy in the rheumatoid wrist.
Language	English
Publishing date	2017-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1315374-2
ISSN	1558-1969 ; 0749-0712
ISSN (online)	1558-1969
ISSN	0749-0712
DOI	10.1016/j.hcl.2017.07.005
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Article ; Online: Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist

P. N. d’Ailly / C. Deugd / N. W. L. Schep / T. M. Kuijper / M. R. Kok / A. Willemze / J. H. Coert / P. H. P. de Jong / W. K. Lam-Tse / A. H. M. van der Helm-van Mil / I. Tchetverikov / A. E. A. M. Weel-Koenders / R. J. Bisoendial

Trials, Vol 24, Iss 1, Pp 1-

study protocol for a randomized controlled trial (ARCTIC trial)

2023 Volume 13

Abstract: ... arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis ... Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and ... Abstract Background Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory ...

Abstract	Abstract Background Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care consists primarily of disease-modifying anti-rheumatic drugs (DMARDs), often supported by systemic corticosteroids or intra-articular corticosteroid injections (IACSI). IACSI, despite their use worldwide, show poor response in a substantial group of patients. Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and improve wrist function. The primary objective of this study is to evaluate wrist function following arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis. Secondary objectives include radiologic progress, disease activity, health-related quality of life, work participation and cost-effectiveness during a 1-year follow-up. Methods This protocol describes a prospective, randomized controlled trial. RA and PsA patients are eligible with prominent wrist synovitis objectified by a rheumatologist, not responding to at least 3 months of conventional DMARDs and naïve to biological DMARDs. For 90% power, an expected loss to follow-up of 5%, an expected difference in mean Patient-Rated Wrist Evaluation score (PRWE, range 0–100) of 11 and α = 0.05, a total sample size of 80 patients will be sufficient to detect an effect size. Patients are randomized in a 1:1 ratio for arthroscopic synovectomy with deposition of corticosteroids or for IACSI. Removed synovial tissue will be stored for an ancillary study on disease profiling. The primary outcome is wrist function, measured with the PRWE score after 3 months. Secondary outcomes include wrist mobility and grip strength, pain scores, DAS28, EQ-5D-5L, disease progression on ultrasound and radiographs, complications and secondary treatment. Additionally, a cost-effectiveness analysis will be performed, ...
Keywords	Rheumatoid arthritis ; Psoriatic arthritis ; Wrist arthroscopy ; Synovitis ; Synovectomy ; Surgery ; Medicine (General) ; R5-920
Subject code	616
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial).

d'Ailly, P N / Deugd, C / Schep, N W L / Kuijper, T M / Kok, M R / Willemze, A / Coert, J H / de Jong, P H P / Lam-Tse, W K / van der Helm-van Mil, A H M / Tchetverikov, I / Weel-Koenders, A E A M / Bisoendial, R J

Trials

2023 Volume 24, Issue 1, Page(s) 229

Abstract: ... arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis ... Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and ... synovectomy of the wrist in these patients compared to IACSI.: Trial registration: Dutch trial registry ...

Abstract	Background: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care consists primarily of disease-modifying anti-rheumatic drugs (DMARDs), often supported by systemic corticosteroids or intra-articular corticosteroid injections (IACSI). IACSI, despite their use worldwide, show poor response in a substantial group of patients. Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and improve wrist function. The primary objective of this study is to evaluate wrist function following arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis. Secondary objectives include radiologic progress, disease activity, health-related quality of life, work participation and cost-effectiveness during a 1-year follow-up. Methods: This protocol describes a prospective, randomized controlled trial. RA and PsA patients are eligible with prominent wrist synovitis objectified by a rheumatologist, not responding to at least 3 months of conventional DMARDs and naïve to biological DMARDs. For 90% power, an expected loss to follow-up of 5%, an expected difference in mean Patient-Rated Wrist Evaluation score (PRWE, range 0-100) of 11 and α = 0.05, a total sample size of 80 patients will be sufficient to detect an effect size. Patients are randomized in a 1:1 ratio for arthroscopic synovectomy with deposition of corticosteroids or for IACSI. Removed synovial tissue will be stored for an ancillary study on disease profiling. The primary outcome is wrist function, measured with the PRWE score after 3 months. Secondary outcomes include wrist mobility and grip strength, pain scores, DAS28, EQ-5D-5L, disease progression on ultrasound and radiographs, complications and secondary treatment. Additionally, a cost-effectiveness analysis will be performed, based on healthcare costs (iMCQ questionnaire) and productivity loss (iPCQ questionnaire). Follow-up will be scheduled at 3, 6 and 12 months. Patient burden is minimized by combining study visits with regular follow-ups. Discussion: Persistent wrist arthritis continues to be a problem for patients with rheumatic joint disease leading to disability. This is the first randomized controlled trial to evaluate the effect, safety and feasibility of arthroscopic synovectomy of the wrist in these patients compared to IACSI. Trial registration: Dutch trial registry (CCMO), NL74744.100.20. Registered on 30 November 2020. Clinicaltrials: gov NCT04755127. Registered after the start of inclusion on 15 February 2021.
MeSH term(s)	Humans ; Wrist ; Synovectomy/adverse effects ; Prospective Studies ; Quality of Life ; Arthritis, Psoriatic/diagnosis ; Arthritis, Psoriatic/drug therapy ; Arthritis, Psoriatic/surgery ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/drug therapy ; Arthritis, Rheumatoid/complications ; Synovitis/drug therapy ; Antirheumatic Agents/adverse effects ; Injections, Intra-Articular/adverse effects ; Pain/drug therapy ; Treatment Outcome ; Arthroscopy/adverse effects ; Randomized Controlled Trials as Topic
Chemical Substances	Antirheumatic Agents
Language	English
Publishing date	2023-03-25
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-023-07129-y
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Article ; Online: Long-term results of arthroscopic wrist synovectomy in rheumatoid arthritis.

Lee, Hyun Il / Lee, Keun Ho / Koh, Kyoung Hwan / Park, Min Jong

The Journal of hand surgery

2014 Volume 39, Issue 7, Page(s) 1295–1300

Abstract: ... synovectomy on 56 wrists in 49 patients with rheumatoid arthritis. At a mean follow-up of 7.9 years (range, 5 ... Purpose: To investigate the effects of arthroscopic wrist synovectomy on the clinical course ... markers, or Larsen stage.: Conclusions: Arthroscopic synovectomy of the wrist can provide pain relief ...

Abstract	Purpose: To investigate the effects of arthroscopic wrist synovectomy on the clinical course of rheumatoid arthritis in a large series with long-term follow-up. Methods: We performed arthroscopic synovectomy on 56 wrists in 49 patients with rheumatoid arthritis. At a mean follow-up of 7.9 years (range, 5-12 y), we evaluated pain and patient satisfaction using a visual analog scale and assessed overall function using the Mayo wrist score. Radiographic stage was graded according to Larsen stage. We determined clinical outcomes on the recurrence of wrist synovitis, which we evaluated by symptoms of pain and swelling and physical examination. Preoperative variables were statistically analyzed to find factors that could influence the results. Results: The mean visual analog scale score for wrist pain decreased from 6.3 to 1.7, and the mean Mayo wrist score (evaluated in 39 wrists) improved from 48 (range, 5-70) to 76 (range, 55-100). The mean visual analog scale score for patient satisfaction was 7.9. At final follow-up, synovitis was controlled in 42 wrists (75%) and recurred in the others. The mean Larsen stage progressed from 2.2 to 3.3. Analysis of preoperative variables revealed no factors that significantly affected clinical outcomes in terms of sex, age, duration of wrist symptom, preoperative serologic inflammatory markers, or Larsen stage. Conclusions: Arthroscopic synovectomy of the wrist can provide pain relief and functional improvement with control of synovitis in 75% of rheumatoid wrists that have not responded to medication. Type of study/level of evidence: Therapeutic IV.
MeSH term(s)	Adult ; Aged ; Arthritis, Rheumatoid/diagnostic imaging ; Arthritis, Rheumatoid/physiopathology ; Arthritis, Rheumatoid/surgery ; Arthroscopy/adverse effects ; Arthroscopy/methods ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Pain Measurement ; Pain, Postoperative/physiopathology ; Radiography ; Range of Motion, Articular/physiology ; Retrospective Studies ; Severity of Illness Index ; Statistics, Nonparametric ; Synovectomy ; Synovitis/surgery ; Time Factors ; Treatment Outcome ; Wrist Joint/diagnostic imaging ; Wrist Joint/physiopathology ; Wrist Joint/surgery
Language	English
Publishing date	2014-07
Publishing country	United States
Document type	Evaluation Studies ; Journal Article
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2014.04.022
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Article: Arthroscopic synovectomy of the wrist in rheumatoid arthritis.

Park, M J / Ahn, J H / Kang, J S

The Journal of bone and joint surgery. British volume

2003 Volume 85, Issue 7, Page(s) 1011–1015

Abstract: ... which demonstrated the slow progression of degenerative changes. Arthroscopic synovectomy for rheumatoid arthritis ... We analysed the results of arthroscopic synovectomy of the wrist in 18 patients (19 wrists ... with rheumatoid arthritis who had not responded to conservative treatment. The patients' symptoms were assessed ...

Abstract	We analysed the results of arthroscopic synovectomy of the wrist in 18 patients (19 wrists) with rheumatoid arthritis who had not responded to conservative treatment. The patients' symptoms were assessed using visual analogue scales for pain and satisfaction. Standard posteroanterior radiographs which were taken pre-operatively and at final follow-up were analysed using a modified Larsen scoring system (normal, 0; total destruction, 40). The mean follow-up period was 29.2 months (24 to 45). The mean pre-operative pain score was 8.58 which decreased to 3.58 one year after surgery and increased again to 4.42 at final follow-up. This suggested a gradual increase in pain with time. The mean satisfaction score was 6.26. The mean modified Larsen's score was 9.8 pre-operatively and 13.9 at final follow-up, which demonstrated the slow progression of degenerative changes. Arthroscopic synovectomy for rheumatoid arthritis of the wrist allows effective pain relief and high patient satisfaction, although any prolonged benefits will require long-term follow-up.
MeSH term(s)	Adult ; Arthritis, Rheumatoid/surgery ; Arthroscopy/methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pain Measurement ; Patient Satisfaction ; Severity of Illness Index ; Synovectomy ; Treatment Outcome ; Wrist Joint/surgery
Language	English
Publishing date	2003-08-15
Publishing country	England
Document type	Evaluation Studies ; Journal Article
ZDB-ID	220626-2
ISSN	2044-5377 ; 0301-620X ; 0447-9076
ISSN (online)	2044-5377
ISSN	0301-620X ; 0447-9076
DOI	10.1302/0301-620x.85b7.14195
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Article: Arthroscopic synovectomy in wrists with advanced rheumatoid arthritis.

Kim, Sung-Jae / Jung, Kwang-Am / Kim, Jong-Min / Kwun, Jun-Dae / Kang, Ho-Jung

Clinical orthopaedics and related research

2006 Volume 449, Page(s) 262–266

Abstract: ... synovectomy is a useful treatment for modest and moderate stages of rheumatoid arthritis. It is especially ... Unlabelled: We evaluated the effects of arthroscopic wrist synovectomy for patients with advanced ... rheumatoid arthritis. We retrospectively reviewed data for 11 patients with moderately advanced arthritis and ...

Abstract	Unlabelled: We evaluated the effects of arthroscopic wrist synovectomy for patients with advanced rheumatoid arthritis. We retrospectively reviewed data for 11 patients with moderately advanced arthritis and joint space narrowing of 25% to 50% (Group A) treated from May 1993 to March 2000. We compared effects of these patients with effects of six patients with earlier disease and joint space narrowing of 0% to 25% (Group B). For Group A, the total modified Mayo wrist scores increased from an average of 26.36 points preoperatively to an average of 56.36 points postoperatively. Postoperative scores for pain and return to work status, and two components of the modified Mayo wrist score also showed differences compared with the respective preoperative scores. There was an increase in final followup scores in return to work status and total modified Mayo wrist scores. Group A showed larger differences than Group B. Our data suggest that arthroscopic synovectomy is a useful treatment for modest and moderate stages of rheumatoid arthritis. It is especially effective for decreasing pain and improving function, allowing patients to return to work. Level of evidence: Therapeutic study, Level III. See the Guidelines for Authors for a complete description of levels of evidence.
MeSH term(s)	Adolescent ; Adult ; Aged ; Arthritis, Rheumatoid/diagnostic imaging ; Arthritis, Rheumatoid/surgery ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiography ; Recovery of Function ; Retrospective Studies ; Synovectomy ; Treatment Outcome ; Wrist Joint
Language	English
Publishing date	2006-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	80301-7
ISSN	1528-1132 ; 0009-921X
ISSN (online)	1528-1132
ISSN	0009-921X
DOI	10.1097/01.blo.0000218732.44591.c9
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Article ; Online: Office-based arthroscopic synovectomy of the wrist in rheumatoid arthritis.

Wei, N / Delauter, S K / Beard, S / Erlichman, M S / Henry, D

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

2000 Volume 17, Issue 8, Page(s) 884–887

Abstract: ... arthroscopic synovectomy of the wrist in patients with refractory rheumatoid arthritis can be performed safety ... We present an office-based technique for performing arthroscopic synovectomy of the wrist ... in patients with rheumatoid arthritis. Intra-articular anesthesia as well as subcutaneous portal anesthesia ...

Abstract	We present an office-based technique for performing arthroscopic synovectomy of the wrist in patients with rheumatoid arthritis. Intra-articular anesthesia as well as subcutaneous portal anesthesia are used. Standard portals are used in the radial carpal and midcarpal joints. Standard instrumentation is used and the synovectomy is accomplished using a motorized shaver. We performed 30 procedures in 21 patients: 15 complete synovectomies, 3 radioulnar carpal synovectomies because of only limited disease, and 12 limited synovectomies because these patients were participants in a clinical trial and required only limited synovectomy for investigational purposes. There were no complications. Office-based arthroscopic synovectomy of the wrist in patients with refractory rheumatoid arthritis can be performed safety and effectively. This technique is useful in both a clinical as well as a research setting.
MeSH term(s)	Ambulatory Surgical Procedures/methods ; Anesthesia/methods ; Arthritis, Rheumatoid/surgery ; Arthroscopy/methods ; Humans ; Postoperative Care ; Supine Position ; Synovectomy ; Wrist Joint/surgery
Language	English
Publishing date	2000-11-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/s0749-8063(01)90014-3
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Article ; Online: Arthroscopic synovectomy of the wrist.

Adolfsson, Lars

Hand clinics

2011 Volume 27, Issue 3, Page(s) 395–399

Abstract: ... The technique has also been used for other diagnoses causing wrist arthritis, but very few results have been ... reported and the indications remain to be defined. In rheumatoid arthritis (RA), juvenile chronic arthritis ... Arthroscopic synovectomy is safe and reliable, with mild postoperative morbidity. The rationale ...

Abstract	Arthroscopic synovectomy is safe and reliable, with mild postoperative morbidity. The rationale of a surgical synovectomy is to excise inflamed synovium and thereby, remove as much effusion and inflammatory substrate as possible. In most cases, arthroscopic synovectomy is performed as an outpatient procedure. The technique has also been used for other diagnoses causing wrist arthritis, but very few results have been reported and the indications remain to be defined. In rheumatoid arthritis (RA), juvenile chronic arthritis (JCA), systemic lupus erythematosus (SLE), and postinfectious monoarthritis, a long period of increased comfort and improved function can be anticipated.
MeSH term(s)	Arthralgia/surgery ; Arthritis, Rheumatoid/surgery ; Arthroscopy/methods ; Contraindications ; Hand Strength ; Humans ; Range of Motion, Articular ; Synovectomy ; Synovitis/surgery ; Wrist Joint/surgery
Language	English
Publishing date	2011-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1315374-2
ISSN	1558-1969 ; 0749-0712
ISSN (online)	1558-1969
ISSN	0749-0712
DOI	10.1016/j.hcl.2011.06.001
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