Wetenschappelijk overzicht
2012 - 2013
Wetenschappelijk overzicht 2012 - 2013
1
Deventer, maart 2014
Inhoud
Voorwoord
Voorwoord
3
Voor u ligt het wetenschappelijk jaaroverzicht 2012-2013 van het Deventer
Ziekenhuis en het Radiotherapeutisch Instituut Stedendriehoek en Omstreken
(RISO).
Het Deventer Ziekenhuis is onderdeel van de Samenwerkende Topklinische
OpleidingsZiekenhuizen (STZ). Naast opleiden en topklinische functies, is
wetenschappelijk onderzoek een belangrijk speerpunt van STZ-ziekenhuizen. Ook het RISO hecht waarde aan het opzetten van – en deelnemen aan
wetenschappelijk onderzoek. Om als zorginstelling mee te gaan in ontwikkelingen en om een aantrekkelijke werkomgeving te zijn voor professionals, is
het uitvoeren van klinisch wetenschappelijk onderzoek van wezenlijk belang.
De afgelopen jaren is er binnen het Deventer Ziekenhuis al geïnvesteerd
in het bevorderen van onderzoek, wat ertoe bijgedragen heeft dat er een
goede basis ligt voor het faciliteren van klinisch wetenschappelijk onderzoek.
Dit uit zich in verscheidene wetenschappelijk activiteiten: van het begeleiden
van co-assistenten bij hun wetenschappelijke stage, tot het deelnemen aan
grootschalige multicenter onderzoeken. Deze verschillende activiteiten zijn
weergegeven in dit boek, per vakgebied onderverdeeld in de onderdelen
publicaties (als co-auteur in PubMed geïndexeerd), collaborations (als collaborator in PubMed geïndexeerd), voordrachten, posters en promoties. Van
de ongeveer 30 specialismen in DZ, zijn er 22 specialismen waarbij in de
jaren 2012 en 2013 wetenschappelijk activiteiten hebben plaatsgevonden.
De top vier van specialismen met de meeste publicaties wordt gevormd door
heelkunde, gynaecologie, ziekenhuisfarmacie en cardiologie. Publicaties
geproduceerd vanuit de cardiologie, gynaecologie en MDL zijn gepubliceerd
in de bladen met de hoogste impact factor. Het wetenschappelijk werk in
het RISO in 2012 en 2013 vertaalt zich in 8 gepubliceerde artikelen met een
gemiddelde impact factor score van 3,6, een promotie en een groot aantal
posterpresentaties op internationale congressen.
Deventer Ziekenhuis
5
Anesthesiologie6
Cardiologie7
Dermatologie24
Gynaecologie29
Heelkunde50
Interne Geneeskunde
71
Kaakchirurgie86
Keel Neus Oorheelkunde
87
Kindergeneeskunde88
Klinische Chemie
91
Klinische Pathologie
94
Klinische Psychologie
96
Longziekten102
Maag Darm en Leverziekten
104
Microbiologie113
Neurologie120
Oogheelkunde122
Opleidingsinstituut125
Orthopedie126
Radiologie132
Spoedeisende Hulp
137
Ziekenhuisfarmacie138
Ziekenhuishygiëne154
Radiotherapeutisch Instituut
Stedendriehoek en Omstreken (RISO)
155
Wetenschapsprijzen 2012-2013
165
State of the Art Lectures 2012-2013
Impact Factors
167
Al met al prachtige resultaten op het gebied van klinisch wetenschappelijk
onderzoek in 2012 en 2013, die u nu niet had kunnen lezen als de inzet van
Marian Boerstoel, informatiespecialist in het Deventer Ziekenhuis, niet zo
tomeloos was geweest. Waarvoor onze grote dank!
Wij wensen u veel leesplezier en hopen dat ook 2014 maar een jaar mag
worden vol wetenschappelijke inspiratie!
169
Esther van ’t Riet, wetenschapscoördinator
Marjo van den Elsen, verplegingswetenschapper
Wetenschapsbureau, Teaching Hospital DZ
Auteurs index 171
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Deventer Ziekenhuis
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5
Anesthesiologie
Cardiologie
Posters
Publicaties
Single shot femoral nerve block offers superior postoperative mobilisation at an equal analgesia level after total.
Knee arthroplasty compared to continuous nerve block using a catheter.
Author(s): Heeremans E.H., Pape N., Koorevaar R.C.T., Cobben J.M.G.
European Society of Anesthesiology
Parijs 9-12 juni 2012
ECG changes after electroconvulsive therapy, cause or consequence?
Tuininga YS.
Neth Heart J. 2012 Mar;20(3):129-31.
Source
Department of Cardiology, Deventer Hospital, Nico Bolkesteinlaan 75, 7416
SE, Deventer, the Netherlands.
Low thoracic versus lumbar epidural anesthesia during the first
phase of labor.
Auteur:
J. Gutteling
Begeleider:
J.M.G. Cobben
Locatie:
Anesthesiologie, Deventer Ziekenhuis
Periode:
oktober 2012 – maart 2013
Anesthesiologie
Wetenschappelijk overzicht 2012 - 2013
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Wetenschappelijk overzicht 2012 - 2013
Cardiologie
Coronary artery assessment by multidetector computed tomography
in patients with prosthetic heart valves.
Habets J, van den Brink RB, Uijlings R, Spijkerboer AM, Mali WP, Chamuleau SA, Budde RP.
Eur Radiol. 2012 Jun;22(6):1278-86.
Abstract
OBJECTIVES: Patients with prosthetic heart valves may require assessment
for coronary artery disease. We assessed whether valve artefacts hamper
coronary artery assessment by multidetector CT.
METHODS: ECG-gated or -triggered CT angiograms were selected from
our PACS archive based on the presence of prosthetic heart valves. The
best systolic and diastolic axial reconstructions were selected for coronary
assessment. Each present coronary segment was scored for the presence of
valve-related artefacts prohibiting coronary artery assessment. Scoring was
performed in consensus by two observers.
RESULTS: Eighty-two CT angiograms were performed on a 64-slice (n = 27)
or 256-slice (n = 55) multidetector CT. Eighty-nine valves and five annuloplasty rings were present. Forty-three out of 1160 (3.7%) present coronary artery
segments were non-diagnostic due to valve artefacts (14/82 patients). Valve
artefacts were located in right coronary artery (15/43; 35%), left anterior
descending artery (2/43; 5%), circumflex artery (14/43; 32%) and marginal
obtuse (12/43; 28%) segments. All cobalt-chrome containing valves caused
artefacts prohibiting coronary assessment. Biological and titanium-containing
valves did not cause artefacts except for three specific valve types.
CONCLUSIONS: Most commonly implanted prosthetic heart valves do not
hamper coronary assessment on multidetector CT. Cobalt-chrome containing
prosthetic heart valves preclude complete coronary artery assessment because of severe valve artefacts. KEY POINTS : • Most commonly implanted
prosthetic heart valves do not hamper coronary artery assessment • Prosthetic heart valve composition determines the occurrence of prosthetic heart
Wetenschappelijke Stages
valve-related artefacts • Björk-Shiley and Sorin tilting disc valves preclude
diagnostic coronary artery segment assessment.
hemorrhage. The choice between warfarin and aspirin should be individualized. (Funded by the National Institute of Neurological Disorders and Stroke;
WARCEF ClinicalTrials.gov number, NCT00041938.).
Wetenschappelijk overzicht 2012 - 2013
Design and methodology of the COACH-2 (Comparative study on
guideline adherence and patient compliance in heart failure patients)
study: HF clinics versus primary care in stable patients on optimal
therapy.
Luttik ML, Brons M, Jaarsma T, Hillege HL, Hoes A, de Jong R, Linssen G,
Lok DJ, Berger M, van Veldhuisen DJ.
Neth Heart J. 2012 Aug;20(7-8):307-12.
Source
Department of Cardiology, University Medical Center Groningen, University
of Groningen, PO BOX 30.001, 9700, RB, Groningen, the Netherlands.
Abstract
BACKGROUND: Since the number of heart failure (HF) patients is still
growing and long-term treatment of HF patients is necessary, it is important
to initiate effective ways for structural involvement of primary care services
in HF management programs. However, evidence on whether and when
patients can be referred back to be managed in primary care is lacking.
AIM: To determine whether long-term patient management in primary care,
after initial optimisation of pharmacological and non-pharmacological treatment in a specialised HF clinic, is equally effective as long-term management in a specialised HF clinic in terms of guideline adherence and patient
compliance.
METHOD: The study is designed as a randomised, controlled, non-inferiority
trial. Two-hundred patients will be randomly assigned to be managed and
followed in primary care or in a HFclinic. Patients are eligible to participate if
they are (1) clinically stable, (2) optimally up-titrated on medication (according to ESC guidelines) and, (3) have received optimal education and counselling on pre-specified issues regarding HF and its treatment. Furthermore,
close cooperation between secondary and primary care in terms of back referral to or consultation of the HF clinic will be provided.The primary outcome
will be prescriber adherence and patient compliance with medication after 12
months. Secondary outcomes measures will be readmission rate, mortality,
quality of life and patient compliance with other lifestyle changes.
EXPECTED RESULTS: The results of the study will add to the understanding of the role of primary care and HF clinics in the long-term follow-up of
HF patients.
Social burden and lifestyle in adults with congenital heart disease.
Zomer AC, Vaartjes I, Uiterwaal CS, van der Velde ET, Sieswerda GJ, Wajon
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Wetenschappelijk overzicht 2012 - 2013
Cardiologie
Cardiologie
Warfarin and aspirin in patients with heart failure and sinus rhythm.
Homma S, Thompson JL, Pullicino PM, Levin B, Freudenberger RS, Teerlink
JR, Ammon SE, Graham S, Sacco RL, Mann DL, Mohr JP, Massie BM,
Labovitz AJ, Anker SD, Lok DJ, Ponikowski P, Estol CJ, Lip GY, Di Tullio
MR, Sanford AR, Mejia V, Gabriel AP, del Valle ML, Buchsbaum R; WARCEF
Investigators.
N Engl J Med. 2012 May 17;366(20):1859-69.
Collaborators (550)
Source
Columbia University Medical Center, New York, NY 10032, USA.
Abstract
BACKGROUND: It is unknown whether warfarin or aspirin therapy is superior for patients with heart failure who are in sinus rhythm.
METHODS: We designed this trial to determine whether warfarin (with a
target international normalized ratio of 2.0 to 3.5) or aspirin (at a dose of 325
mg per day) is a better treatment for patients in sinus rhythm who have a
reduced left ventricular ejection fraction (LVEF). We followed 2305 patients
for up to 6 years (mean [±SD], 3.5±1.8). The primary outcome was the time
to the first event in a composite end point of ischemic stroke, intracerebral
hemorrhage, or death from any cause.
RESULTS: The rates of the primary outcome were 7.47 events per 100
patient-years in the warfarin group and 7.93 in the aspirin group (hazard
ratio with warfarin, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P=0.40).
Thus, there was no significant overall difference between the two treatments.
In a time-varying analysis, the hazard ratio changed over time, slightly favoring warfarin over aspirin by the fourth year of follow-up, but this finding was
only marginally significant (P=0.046). Warfarin, as compared with aspirin,
was associated with a significant reduction in the rate of ischemic stroke
throughout the follow-up period (0.72 events per 100 patient-years vs. 1.36
per 100 patient-years; hazard ratio, 0.52; 95% CI, 0.33 to 0.82; P=0.005).
The rate of major hemorrhage was 1.78 events per 100 patient-years in the
warfarin group as compared with 0.87 in the aspirin group (P<0.001). The
rates of intracerebral and intracranial hemorrhage did not differ significantly
between the two treatment groups (0.27 events per 100 patient-years with
warfarin and 0.22 with aspirin, P=0.82).
CONCLUSIONS: Among patients with reduced LVEF who were in sinus
rhythm, there was no significant overall difference in the primary outcome
between treatment with warfarin and treatment with aspirin. A reduced risk
of ischemic stroke with warfarin was offset by an increased risk of major
EM, Plomp K, van Bergen PF, Verheugt CL, Krivka E, de Vries CJ, Lok DJ,
Grobbee DE, Mulder BJ.
Am J Cardiol. 2012 Jun 1;109(11):1657-63.
Source
Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
Abstract
We aimed to evaluate how the presence and severity of congenital heart
disease (CHD) influence social life and lifestyle in adult patients. A random
sample (n = 1,496) from the CONgenital CORvitia (n = 11,047), the Dutch
national registry of adult patients with CHD, completed a questionnaire on
educational attainment, employment and marital statuses, and lifestyle (response 76%). The Utrecht Health Project provided a large reference group
(n = 6,810) of unaffected subjects. Logistic regression models were used for
subgroup analyses and to adjust for age, gender, and socioeconomic status
where appropriate. Of all patients 51.5% were men (median age 39 years,
interquartile range 29 to 51) with mild (46%), moderate (44%), and severe
(10%) CHD. Young (<40-year-old) patients with CHD were more likely to
have achieved a lower education (adjusted odds ratios [ORs] 1.6 for men
and 1.9 for women, p <0.05 for the 2 comparisons), significantly more often
unemployed (adjusted ORs 5.9 and 2.0 for men and women, respectively),
and less likely to be in a relationship compared to the reference group
(adjusted ORs 8.5 for men and 4.5 for women). These poorer outcomes
were seen in all severity groups. Overall, the CHD population smoked less
(adjusted OR 0.5, p <0.05), had more sports participation (adjusted OR 1.2,
p <0.05), and had less obesity (adjusted OR 0.7, p <0.05) than the reference
group. In conclusion, there was a substantial social disadvantage in adult patients with CHD, which was seen in all severity groups and primarily in young
men. In contrast, adults with CHD had healthier lifestyles compared to the
reference group.
Cardiac sarcoidosis mimicking non-ST-elevation myocardial infarction.
Uijlings R, Balt JC, Boom P, Wever E.
J Cardiovasc Med (Hagerstown). 2012 Apr;13(4):277-80.
Author information
Department of Cardiology, University Medical Center, Utrecht,
The Netherlands.
Incremental prognostic power of novel biomarkers (growth-differentiation factor-15, high-sensitivity C-reactive protein, galectin-3, and highsensitivity troponin-T) in patients with advanced chronic heart failure.
Lok DJ, Klip IT, Lok SI, Bruggink-André de la Porte PW, Badings E, van
Wijngaarden J, Voors AA, de Boer RA, van Veldhuisen DJ, van der Meer P.
Am J Cardiol. 2013 Sep 15;112(6):831-7.
Wetenschappelijk overzicht 2012 - 2013
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Wetenschappelijk overzicht 2012 - 2013
Cardiologie
Cardiologie
Charcoal or chocolate: what captures the heart?
Bijvoet GP, Cramer MJ, Uijlings R, Kirkels JH, Schipper ME.
J Clin Pathol. 2012 Sep;65(9):859-61.
Iron deficiency in chronic heart failure: an international pooled analysis.
Klip IT, Comin-Colet J, Voors AA, Ponikowski P, Enjuanes C, Banasiak W,
Lok DJ, Rosentryt P, Torrens A, Polonski L, van Veldhuisen DJ, van der Meer
P, Jankowska EA.
Am Heart J. 2013 Apr;165(4):575-582.
Author information
Department of Cardiology, University Medical Center Groningen, University
of Groningen, Groningen, The Netherlands.
Abstract
BACKGROUND: Iron deficiency (ID) is an emerging problem in patients with
chronic heart failure (HF) and can be a potential therapeutic target. However,
not much is known about the prevalence, predictors, and prognosis of ID in
patients with chronic HF.
METHODS: In an international pooled cohort comprising 1,506 patients
with chronic HF, we studied the clinical associates of ID and its prognostic
consequences.
RESULTS: Iron deficiency (defined as a ferritin level <100 μg/L or ferritin
100-299 μg/L with a transferrin saturation <20%) was present in 753 patients
(50%). Anemic patients were more often iron deficient than nonanemic patients (61.2% vs 45.6%, P < .001). Other independent predictors of ID were
higher New York Heart Association class, higher N-terminal pro-brain-type
natriuretic peptide levels, lower mean corpuscular volume levels, and female
sex (all P < .05). During follow-up (median 1.92 years, interquartile range
1.18-3.26 years), 440 patients died (29.2%). Kaplan-Meier survival analysis
revealed ID as a strong predictor for mortality (log rank χ(2) 10.2, P = .001).
In multivariable hazard models, ID (but not anemia) remained a strong and
independent predictor of mortality (hazard ratio 1.42, 95% confidence interval 1.14-1.77, P = .002). Finally, the presence of ID significantly enhanced
risk classification and integrated discrimination improvement when added to
a prediction model with established risk factors.
CONCLUSIONS: Iron deficiency is common in patients with chronic HF,
relates to disease severity, and is a strong and independent predictor of
outcome. In this study, ID appears to have greater predictive power than
anemia.
Source
Deventer Hospital, Deventer, the Netherlands.
Abstract
Elevated natriuretic peptides provide strong prognostic information in patients with heart failure (HF). The role of novel biomarkers in HF needs to
be established. Our objective was to evaluate the prognostic power of novel
biomarkers, incremental to the N-terminal portion of the natriuretic peptide (NT-proBNP) in chronic HF. Concentrations of circulating NT-proBNP,
growth differentiation factor 15 (GDF-15), high-sensitivity C-reactive protein
(hs-CRP), galectin-3 (Gal-3), and high-sensitivity troponin T (hs-TnT) were
measured and related to all-cause long-term mortality. Of 209 patients (age
71 ± 10 years, 73% male patients, 97% New York Heart Association class
III), 151 (72%) died during a median follow-up of 8.7 ± 1 year. The calculated
area under the curve for NT-proBNP was 0.63, GDF-15 0.78, hs-CRP 0.66,
Gal-3 0.68, and hs-TnT 0.68 (all p <0.01). Each marker was predictive for
mortality in univariate analysis. In multivariate analysis, elevated concentrations of GDF-15 (hazard ratio [HR] 1.41, confidence interval [CI] 1.1 to 178,
p = 0.005), hs-CRP (HR 1.38, CI 1.15 to 1.67, p = 0.001), and hs-TnT (HR
1.27, CI 1.06 to 1.53, p = 0.008) were independently related to mortality. All
novel markers had an incremental value to NT-proBNP, using the integrated
discrimination improvement. In conclusion, in chronic HF, GDF-15, hs-CRP,
and hs-TnT are independent prognostic markers, incremental to NT-proBNP,
in predicting long-term mortality. In this study, GDF-15 is the most predictive
marker, even stronger than NT-proBNP.
with low ejection fraction in sinus rhythm for the primary outcome: first to occur of 84 incident ischemic strokes (IIS), 7 intracerebral hemorrhages or 531
deaths. Prespecified secondary analysis showed a 48% hazard ratio reduction (p = 0.005) for warfarin in IIS. Cardioembolism is likely the main pathogenesis of stroke in heart failure. We examined the IIS benefit for warfarin in
more detail in post hoc secondary analyses.
METHODS: We subtyped IIS into definite, possible and noncardioembolic
using the Stroke Prevention in Atrial Fibrillation method. Statistical tests,
stratified by prior ischemic stroke or transient ischemic attack, were the conditional binomial for independent Poisson variables for rates, the CochranMantel-Haenszel test for stroke subtype and the van Elteren test for modified
Rankin Score (mRS) and National Institute of Health Stroke Scale (NIHSS)
distributions, and an exact test for proportions.
RESULTS: Twenty-nine of 1,142 warfarin and 55 of 1,163 aspirin patients
had IIS. The warfarin IIS rate (0.727/100 patient-years, PY) was lower than
for aspirin (1.36/100 PY, p = 0.003). Definite cardioembolic IIS was less
frequent on warfarin than aspirin (0.22 vs. 0.55/100 PY, p = 0.012). Possible
cardioembolic IIS tended to be less frequent on warfarin than aspirin (0.37
vs. 0.67/100 PY, p = 0.063) but noncardioembolic IIS showed no difference:
5 (0.12/100 PY) versus 6 (0.15/100 PY, p = 0.768). Among patients experiencing IIS, there were no differences by treatment arm in fatal IIS, baseline
mRS, mRS 90 days after IIS, and change from baseline to post-IIS mRS.
The warfarin arm showed a trend to a lower proportion of severe nonfatal
IIS [mRS 3-5; 3/23 (13.0%) vs. 16/48 (33.3%), p = 0.086]. There was no
difference in NIHSS at the time of stroke (p = 0.825) or in post-IIS mRS (p =
0.948) between cardioembolic, possible cardioembolic and noncardioembolic stroke including both warfarin and aspirin groups.
CONCLUSIONS: The observed benefits in the reduction of IIS for warfarin
compared to aspirin are most significant for cardioembolic IIS among patients with low ejection fraction in sinus rhythm. This is supported by trends
to lower frequencies of severe IIS and possible cardioembolic IIS in patients
on warfarin compared to aspirin.
Optimale hartfalenzorg op lange termijn: vervolgonderzoek van het
Deventer-Alkmaar hartfalenproject
Pruijsers-Lamers PH
Cordiaal 2013;33(5):162-5.
Wetenschappelijk overzicht 2012 - 2013
Benefit of warfarin compared with aspirin in patients with heart
failure in sinus rhythm: a subgroup analysis of WARCEF, a randomized
controlled trial.
Homma S, Thompson JL, Sanford AR, Mann DL, Sacco RL, Levin B, Pullicino PM, Freudenberger RS, Teerlink JR, Graham S, Mohr JP, Massie BM,
Labovitz AJ, Di Tullio MR, Gabriel AP, Lip GY, Estol CJ, Lok DJ, Ponikowski
P, Anker SD; WARCEF Investigators.
Circ Heart Fail. 2013 Sep 1;6(5):988-97.
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Wetenschappelijk overzicht 2012 - 2013
Cardiologie
Cardiologie
Stroke in heart failure in sinus rhythm: the Warfarin versus Aspirin in
Reduced Cardiac Ejection Fraction trial.
Pullicino PM, Thompson JL, Sacco RL, Sanford AR, Qian M, Teerlink JR,
Haddad H, Diek M, Freudenberger RS, Labovitz AJ, Di Tullio MR, Lok DJ,
Ponikowski P, Anker SD, Graham S, Mann DL, Mohr JP, Homma S; WARCEF Investigators.
Cerebrovasc Dis. 2013;36(1):74-8.
Author information
University of Kent, Canterbury, UK.
Abstract
BACKGROUND: The Warfarin versus Aspirin in Reduced Cardiac Ejection
Fraction trial found no difference between warfarin and aspirin in patients
Author information
the Division of Cardiology, Department of Medicine.
Abstract
BACKGROUND: The Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial found no difference in the primary outcome
between warfarin and aspirin in 2305 patients with reduced left ventricular
ejection fraction in sinus rhythm. However, it is unknown whether any subgroups benefit from warfarin or aspirin.
METHODS AND RESULTS: We used a Cox model stepwise selection
procedure to identify subgroups that may benefit from warfarin or aspirin on
the WARCEF primary outcome. A secondary analysis added major hemorrhage to the outcome. The primary efficacy outcome was time to the first
to occur of ischemic stroke, intracerebral hemorrhage, or death. Only age
group was a significant treatment effect modifier (P for interaction, 0.003).
Younger patients benefited from warfarin over aspirin on the primary outcome (4.81 versus 6.76 events per 100 patient-years: hazard ratio, 0.63;
95% confidence interval, 0.48-0.84; P=0.001). In older patients, therapies did
not differ (9.91 versus 9.01 events per 100 patient-years: hazard ratio, 1.09;
95% confidence interval, 0.88-1.35; P=0.44). With major hemorrhage added,
in younger patients the event rate remained lower for warfarin than aspirin
(5.41 versus 7.25 per 100 patient-years: hazard ratio, 0.68; 95% confidence
interval, 0.52-0.89; P=0.005), but in older patients it became significantly
higher for warfarin (11.80 versus 9.35 per 100 patient-years: hazard ratio,
1.25; 95% confidence interval, 1.02-1.53; P=0.03).
CONCLUSIONS: In patients <60 years, warfarin improved outcomes over
aspirin with or without inclusion of major hemorrhage. In patients ≥60 years,
there was no treatment difference, but the aspirin group had significantly better outcomes when major hemorrhage was included.
the routine clinical care of patients discharged after an acute coronary syndrome, as compared with usual care only.
DESIGN: RESPONSE (Randomised Evaluation of Secondary Prevention by
Outpatient Nurse SpEcialists) was a randomised clinical trial.
SETTING: Multicentre trial in secondary and tertiary healthcare settings.
PARTICIPANTS: 754 patients admitted for acute coronary syndrome.
INTERVENTION: A nurse-coordinated prevention programme, consisting of
four outpatient nurse clinic visits, focusing on healthy lifestyles, biometric risk
factors and medication adherence, in addition to usual care.
MAIN OUTCOME MEASURES: The main outcome was 10-year cardiovascular mortality risk as estimated by Systematic Coronary Risk Evaluation at
12 months follow-up. Secondary outcomes included Framingham Coronary
Risk Score at 12 months, in addition to changes in individual risk factors.
Risk factor control was classified as ‘poor’ if 0 to 3 factors were on target,
‘fair’ if 4 to 6 factors were on target, and ‘good’ if 7 to 9 were on target.
RESULTS: The mean Systematic Coronary Risk Evaluation at 12 months
was 4.4 per cent (SD 4.5) in the intervention group and 5.4 per cent (SD 6.2)
in the control group (p=0.021), representing a 17.4% relative risk reduction.
At 12 months, risk factor control classified as ‘good’ was achieved in 35% of
patients in the intervention group compared with 25% in the control group
(p=0.003). Attendance to the nurse-coordinated prevention programme was
92%. In the intervention group, 86 rehospitalisations were observed against
132 in the control group (relative risk reduction 34.8%, p=0.023).
CONCLUSIONS: The nurse-coordinated hospital-based prevention programme in addition to usual care is a practical, yet effective method for reduction
of cardiovascular risk in patients with coronary disease. Our data suggest
that the counselling component of the programme may lead to a reduction in
hospital readmissions.
TRIAL REGISTRATION TRIALREGISTERNL IDENTIFIER: TC1290.
Wetenschappelijk overzicht 2012 - 2013
Early or late intervention in high-risk non-ST-elevation acute coronary
syndromes: results of the ELISA-3 trial.
Badings EA, The SH, Dambrink JH, van Wijngaarden J, Tjeerdsma G,
Rasoul S, Timmer JR, van der Wielen ML, Lok DJ, van ‘t Hof AW.
EuroIntervention. 2013 May 20;9(1):54-61.
Author information
Deventer Ziekenhuis, Deventer, The Netherlands.
Abstract
AIMS: To compare an early to a delayed invasive strategy in high-risk
patients with NSTE-ACS.
METHODS AND RESULTS: In this prospective multicentre trial, 542 patients
hospitalised with NSTE-ACS were randomised to either an immediate (an14
15
Wetenschappelijk overzicht 2012 - 2013
Cardiologie
Cardiologie
Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the
RESPONSE randomised trial.
Jorstad HT, von Birgelen C, Alings AM, Liem A, van Dantzig JM, Jaarsma W,
Lok DJ, Kragten HJ, de Vries K, de Milliano PA, Withagen AJ, Scholte Op
Reimer WJ, Tijssen JG, Peters RJ.
Heart. 2013 Oct;99(19):1421-30.
Author information
Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, Noord Holland, The Netherlands.
Abstract
OBJECTIVE: To quantify the impact of a practical, hospital-based nursecoordinated prevention programme on cardiovascular risk, integrated into
giography and revascularisation if appropriate <12 hr) or a delayed invasive
strategy (>48 hr after randomisation). Patients were eligible if they had two
of the following three high-risk characteristics: evidence of extensive myocardial ischaemia on ECG, elevated biomarkers for myocardial necrosis (TropT
>0.10 μg/L), and an age above 65 years. Primary endpoint of the study was
the combined incidence of death, reinfarction and/or recurrent ischaemia
at 30-day follow-up. Secondary endpoints were enzymatic infarct size as
assessed by a single cardiac troponin T, at 72-96 hours after admission or
at discharge, and the percentage of patients without a rise in CKMB during
admission. Median age was 71.9 (interquartile range [IQR] 64.5-78.4) years.
Median time between randomisation and start of angiography was 2.6 (IQR
1.2-6.2) hours in the immediate and 54.9 (44.2-74.5) hours in the delayed
intervention group. The composite of death, reinfarction and/or recurrent
ischaemia at 30 days occurred in 12% of patients and was not significantly
different between the two groups (9.9% and 14.2%, respectively, p=0.135).
All secondary endpoints and bleeding complications were comparable.
Hospital duration was two days shorter in the immediate intervention group
(4 days [IQR 2-10] vs. 6 days [IQR 4-12]).
CONCLUSIONS: Although no definitive conclusion can be drawn due to a
lower than expected prevalence of the primary endpoint, an immediate invasive strategy was safe and feasible but not superior to a delayed invasive
strategy in terms of the combined primary endpoint of death, reinfarction
and/or recurrent ischaemia at 30 days. These results are consistent with
previous randomised trials which studied the effect of timing of angiography
in patients with NSTE-ACS. Trial Registration: ISRCTN Register 9230163.
METHODS AND RESULTS: A total of 240 HF patients with New York Heart
Association (NYHA) Class III and IV were included. Patients were followed
for 8.7 ± 1 years, had a mean age of 71 ± 0.6 years and 73 % of the study
population was male. Circulating levels of NT-proBNP and Gal-3 were measured. Serial echocardiography was performed at baseline and at 3 months.
At baseline median left ventricular end-diastolic volume (LVEDV) was 267
mL [interquartile range 232-322]. Patients were divided into three groups
according to the change in LVEDV. Patients in whom the LVEDV decreased
over time had significant lower levels of Gal-3 at entry compared to patients
in whom the LVEDV was stable or increased (14.7 vs. 17.9 vs. 19.0 ng/mL; p
= 0.004 for trend), whereas no significant differences were seen in levels of
NT-proBNP (p = 0.33). Multivariate linear regression analyses revealed that
Gal-3 levels were positively correlated to change in LVEDV (p = 0.007). In
addition, Gal-3 was a significant predictor of mortality after long-term followup (p = 0.001).
CONCLUSION: Gal-3 is associated with left ventricular remodeling determined by serial echocardiography and predicts long-term mortality in
patients with severe chronic HF.
Rate control in atrial fibrillation, insight into the RACE II study.
Groenveld HF, Crijns HJ, Tijssen JG, Alings M, Hillege HL, Tuininga YS,
Van den Berg MP, Van Veldhuisen DJ, Van Gelder IC.
Neth Heart J. 2013 Apr;21(4):199-204.
Author information
Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the
Netherlands.
Wetenschappelijk overzicht 2012 - 2013
Collaborations
Basal insulin and cardiovascular and other outcomes in dysglycemia.
ORIGIN Trial Investigators, Gerstein HC, Bosch J, Dagenais GR, Díaz R,
Jung H, Maggioni AP, Pogue J, Probstfield J, Ramachandran A, Riddle MC,
Rydén LE, Yusuf S.
N Engl J Med. 2012 Jul 26;367(4):319-28.
Collaborators (2737)
Van der Sluis A, Lok D
Abstract
BACKGROUND: The provision of sufficient basal insulin to normalize fasting
plasma glucose levels may reduce cardiovascular events, but such a possibility has not been formally tested.
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Cardiologie
Cardiologie
Galectin-3 is an independent marker for ventricular remodeling and
mortality in patients with chronic heart failure.
Lok DJ, Lok SI, Bruggink-André de la Porte PW, Badings E, Lipsic E,
van Wijngaarden J, de Boer RA, van Veldhuisen DJ, van der Meer P.
Clin Res Cardiol. 2013 Feb;102(2):103-10.
Author information
Deventer Hospital, Nico Bolkesteinlaan 75, 7415 CM, Deventer,
The Netherlands.
Abstract
BACKGROUND: Galectin-3 (Gal-3) is a recently discovered marker for myocardial fibrosis and elevated levels are associated with an impaired outcome
after short-term follow-up in heart failure (HF) patients. However, whether
Gal-3 is related to cardiac remodeling and outcome after long-term follow-up
is unknown. Therefore, we determined the utility of Gal-3 as a novel biomarker for left ventricular remodeling and long-term outcome in patients with
severe chronic HF.
METHODS: We randomly assigned 12,537 people (mean age, 63.5 years)
with cardiovascular risk factors plus impaired fasting glucose, impaired
glucose tolerance, or type 2 diabetes to receive insulin glargine (with a
target fasting blood glucose level of ≤95 mg per deciliter [5.3 mmol per liter])
or standard care and to receive n-3 fatty acids or placebo with the use of
a 2-by-2 factorial design. The results of the comparison between insulin
glargine and standard care are reported here. The coprimary outcomes were
nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular
causes and these events plus revascularization or hospitalization for heart
failure. Microvascular outcomes, incident diabetes, hypoglycemia, weight,
and cancers were also compared between groups.
RESULTS: The median follow-up was 6.2 years (interquartile range, 5.8 to
6.7). Rates of incident cardiovascular outcomes were similar in the insulinglargine and standard-care groups: 2.94 and 2.85 per 100 person-years, respectively, for the first coprimary outcome (hazard ratio, 1.02; 95% confidence
interval [CI], 0.94 to 1.11; P=0.63) and 5.52 and 5.28 per 100 person-years,
respectively, for the second coprimary outcome (hazard ratio, 1.04; 95% CI,
0.97 to 1.11; P=0.27). New diabetes was diagnosed approximately 3 months
after therapy was stopped among 30% versus 35% of 1456 participants
without baseline diabetes (odds ratio, 0.80; 95% CI, 0.64 to 1.00; P=0.05).
Rates of severe hypoglycemia were 1.00 versus 0.31 per 100 person-years.
Median weight increased by 1.6 kg in the insulin-glargine group and fell by
0.5 kg in the standard-care group. There was no significant difference in
cancers (hazard ratio, 1.00; 95% CI, 0.88 to 1.13; P=0.97).
CONCLUSIONS: When used to target normal fasting plasma glucose levels
for more than 6 years, insulin glargine had a neutral effect on cardiovascular
outcomes and cancers. Although it reduced new-onset diabetes, insulin glargine also increased hypoglycemia and modestly increased weight. (Funded
by Sanofi; ORIGIN ClinicalTrials.gov number, NCT00069784.).
METHODS: In this double-blind study with a 2-by-2 factorial design, we
randomly assigned 12,536 patients who were at high risk for cardiovascular
events and had impaired fasting glucose, impaired glucose tolerance, or
diabetes to receive a 1-g capsule containing at least 900 mg (90% or more)
of ethyl esters of n-3 fatty acids or placebo daily and to receive either insulin
glargine or standard care. The primary outcome was death from cardiovascular causes. The results of the comparison between n-3 fatty acids and
placebo are reported here.
RESULTS: During a median follow up of 6.2 years, the incidence of the primary outcome was not significantly decreased among patients receiving n-3
fatty acids, as compared with those receiving placebo (574 patients [9.1%]
vs. 581 patients [9.3%]; hazard ratio, 0.98; 95% confidence interval [CI], 0.87
to 1.10; P=0.72). The use of n-3 fatty acids also had no significant effect on
the rates of major vascular events (1034 patients [16.5%] vs. 1017 patients
[16.3%]; hazard ratio, 1.01; 95% CI, 0.93 to 1.10; P=0.81), death from any
cause (951 [15.1%] vs. 964 [15.4%]; hazard ratio, 0.98; 95% CI, 0.89 to
1.07; P=0.63), or death from arrhythmia (288 [4.6%] vs. 259 [4.1%]; hazard
ratio, 1.10; 95% CI, 0.93 to 1.30; P=0.26). Triglyceride levels were reduced
by 14.5 mg per deciliter (0.16 mmol per liter) more among patients receiving
n-3 fatty acids than among those receiving placebo (P<0.001), without a significant effect on other lipids. Adverse effects were similar in the two groups.
CONCLUSIONS: Daily supplementation with 1 g of n-3 fatty acids did not
reduce the rate of cardiovascular events in patients at high risk for cardiovascular events. (Funded by Sanofi; ORIGIN ClinicalTrials.gov number,
NCT00069784.).
n-3 fatty acids and cardiovascular outcomes in patients with
dysglycemia.
ORIGIN Trial Investigators, Bosch J, Gerstein HC, Dagenais GR, Díaz R,
Dyal L, Jung H, Maggiono AP, Probstfield J, Ramachandran A, Riddle MC,
Rydén LE, Yusuf S.
N Engl J Med. 2012 Jul 26;367(4):309-18.
Collaborators (2737)
Van der Sluis A, Lok D
Abstract
BACKGROUND: The use of n-3 fatty acids may prevent cardiovascular
events in patients with recent myocardial infarction or heart failure. Their effects in patients with (or at risk for) type 2 diabetes mellitus are unknown.
Wetenschappelijk overzicht 2012 - 2013
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Cardiologie
Cardiologie
Effects of dalcetrapib in patients with a recent acute coronary syndrome.
Schwartz GG, Olsson AG, Abt M, Ballantyne CM, Barter PJ, Brumm J, Chaitman BR, Holme IM, Kallend D, Leiter LA, Leitersdorf E, McMurray JJ, Mundl
H, Nicholls SJ, Shah PK, Tardif JC, Wright RS; dal-OUTCOMES Investigators.
N Engl J Med. 2012 Nov 29;367(22):2089-99.
Collaborators (1041)
Lok DJ
Author information
Cardiology Section, Veterans Affairs Medical Center and University of Colorado School of Medicine, Denver, 80220, USA. gregory.schwartz@va.gov
Abstract
BACKGROUND: In observational analyses, higher levels of high-density
lipoprotein (HDL) cholesterol have been associated with a lower risk of coronary heart disease events. However, whether raising HDL cholesterol levels
therapeutically reduces cardiovascular risk remains uncertain. Inhibition of
cholesteryl ester transfer protein (CETP) raises HDL cholesterol levels and
might therefore improve cardiovascular outcomes.
METHODS: We randomly assigned 15,871 patients who had had a recent
acute coronary syndrome to receive the CETP inhibitor dalcetrapib, at a
dose of 600 mg daily, or placebo, in addition to the best available evidencebased care. The primary efficacy end point was a composite of death from
coronary heart disease, nonfatal myocardial infarction, ischemic stroke,
unstable angina, or cardiac arrest with resuscitation.
RESULTS: At the time of randomization, the mean HDL cholesterol level was
42 mg per deciliter (1.1 mmol per liter), and the mean low-density lipoprotein
(LDL) cholesterol level was 76 mg per deciliter (2.0 mmol per liter). Over
the course of the trial, HDL cholesterol levels increased from baseline by
4 to 11% in the placebo group and by 31 to 40% in the dalcetrapib group.
Dalcetrapib had a minimal effect on LDL cholesterol levels. Patients were
followed for a median of 31 months. At a prespecified interim analysis that
included 1135 primary end-point events (71% of the projected total number),
the independent data and safety monitoring board recommended termination
of the trial for futility. As compared with placebo, dalcetrapib did not alter the
risk of the primary end point (cumulative event rate, 8.0% and 8.3%, respectively; hazard ratio with dalcetrapib, 1.04; 95% confidence interval, 0.93 to
1.16; P=0.52) and did not have a significant effect on any component of the
primary end point or total mortality. The median C-reactive protein level was
0.2 mg per liter higher and the mean systolic blood pressure was 0.6 mm Hg
higher with dalcetrapib as compared with placebo (P<0.001 for both comparisons).
CONCLUSIONS: In patients who had had a recent acute coronary syndrome, dalcetrapib increased HDL cholesterol levels but did not reduce the
risk of recurrent cardiovascular events. (Funded by F. Hoffmann-La Roche;
dal-OUTCOMES ClinicalTrials.gov number, NCT00658515.).
Cardiorenal end points in a trial of aliskiren for type 2 diabetes.
Parving HH, Brenner BM, McMurray JJ, de Zeeuw D, Haffner SM, Solomon
SD, Chaturvedi N, Persson F, Desai AS, Nicolaides M, Richard A, Xiang Z,
Brunel P, Pfeffer MA; ALTITUDE Investigators.
N Engl J Med. 2012 Dec 6;367(23):2204-13.
Collaborators (817)
Lok D
Author information
Department of Medical Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. hhparving@dadlnet.dk
Abstract
BACKGROUND: This study was undertaken to determine whether use of the
direct renin inhibitor aliskiren would reduce cardiovascular and renal events
Wetenschappelijk overzicht 2012 - 2013
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Wetenschappelijk overzicht 2012 - 2013
Cardiologie
Cardiologie
in patients with type 2 diabetes and chronic kidney disease, cardiovascular
disease, or both.
METHODS: In a double-blind fashion, we randomly assigned 8561 patients
to aliskiren (300 mg daily) or placebo as an adjunct to an angiotensinconverting-enzyme inhibitor or an angiotensin-receptor blocker. The primary
end point was a composite of the time to cardiovascular death or a first
occurrence of cardiac arrest with resuscitation; nonfatal myocardial infarction; nonfatal stroke; unplanned hospitalization for heart failure; end-stage
renal disease, death attributable to kidney failure, or the need for renalreplacement therapy with no dialysis or transplantation available or initiated;
or doubling of the baseline serum creatinine level.
RESULTS: The trial was stopped prematurely after the second interim efficacy analysis. After a median follow-up of 32.9 months, the primary end point
had occurred in 783 patients (18.3%) assigned to aliskiren as compared
with 732 (17.1%) assigned to placebo (hazard ratio, 1.08; 95% confidence
interval [CI], 0.98 to 1.20; P=0.12). Effects on secondary renal end points
were similar. Systolic and diastolic blood pressures were lower with aliskiren
(between-group differences, 1.3 and 0.6 mm Hg, respectively) and the mean
reduction in the urinary albumin-to-creatinine ratio was greater (betweengroup difference, 14 percentage points; 95% CI, 11 to 17). The proportion of
patients with hyperkalemia (serum potassium level, ≥6 mmol per liter) was
significantly higher in the aliskiren group than in the placebo group (11.2%
vs. 7.2%), as was the proportion with reported hypotension (12.1% vs. 8.3%)
(P<0.001 for both comparisons).
CONCLUSIONS: The addition of aliskiren to standard therapy with reninangiotensin system blockade in patients with type 2 diabetes who are at high
risk for cardiovascular and renal events is not supported by these data and
may even be harmful. (Funded by Novartis; ALTITUDE ClinicalTrials.gov
number, NCT00549757.).
Subclinical atrial fibrillation and the risk of stroke.
Healey JS, Connolly SJ, Gold MR, Israel CW, Van Gelder IC, Capucci A, Lau
CP, Fain E, Yang S, Bailleul C, Morillo CA, Carlson M, Themeles E, Kaufman
ES, Hohnloser SH; ASSERT Investigators.
N Engl J Med. 2012 Jan 12;366(2):120-9.
Collaborators (328)
Tuininga YS
Author information
Population Health Research Institute, McMaster University, Hamilton, ON,
Canada.
Abstract
BACKGROUND: One quarter of strokes are of unknown cause, and subclinical atrial fibrillation may be a common etiologic factor. Pacemakers can
detect subclinical episodes of rapid atrial rate, which correlate with electrocardiographically documented atrial fibrillation. We evaluated whether
subclinical episodes of rapid atrial rate detected by implanted devices were
associated with an increased risk of ischemic stroke in patients who did not
have other evidence of atrial fibrillation.
METHODS: We enrolled 2580 patients, 65 years of age or older, with hypertension and no history of atrial fibrillation, in whom a pacemaker or defibrillator had recently been implanted. We monitored the patients for 3 months to
detect subclinical atrial tachyarrhythmias (episodes of atrial rate >190 beats
per minute for more than 6 minutes) and followed them for a mean of 2.5
years for the primary outcome of ischemic stroke or systemic embolism. Patients with pacemakers were randomly assigned to receive or not to receive
continuous atrial overdrive pacing.
RESULTS: By 3 months, subclinical atrial tachyarrhythmias detected by
implanted devices had occurred in 261 patients (10.1%). Subclinical atrial
tachyarrhythmias were associated with an increased risk of clinical atrial
fibrillation (hazard ratio, 5.56; 95% confidence interval [CI], 3.78 to 8.17;
P<0.001) and of ischemic stroke or systemic embolism (hazard ratio, 2.49;
95% CI, 1.28 to 4.85; P=0.007). Of 51 patients who had a primary outcome
event, 11 had had subclinical atrial tachyarrhythmias detected by 3 months,
and none had had clinical atrial fibrillation by 3 months. The population attributable risk of stroke or systemic embolism associated with subclinical atrial
tachyarrhythmias was 13%. Subclinical atrial tachyarrhythmias remained
predictive of the primary outcome after adjustment for predictors of stroke
(hazard ratio, 2.50; 95% CI, 1.28 to 4.89; P=0.008). Continuous atrial overdrive pacing did not prevent atrial fibrillation.
CONCLUSIONS: Subclinical atrial tachyarrhythmias, without clinical atrial
fibrillation, occurred frequently in patients with pacemakers and were associated with a significantly increased risk of ischemic stroke or systemic
embolism. (Funded by St. Jude Medical; ASSERT ClinicalTrials.gov number,
NCT00256152.).
Voordrachten
Resultaten van DEAL-HF studie op lange termijn.
Pruijsers-Lamers PH
Najaarscongres NVVC
Arnhem, 1 november 2013
Early or late intervention in high-risk NSTE-ACS patients: results of
the ELISA-3 trial.
Badings AE, The SH, Dambrink JH, Van Wijngaarden J, Tjeerdsma G,
Rasoul S, Timmer JR, Van der Wielen ML, Lok DJ, Van ’t Hof AW
Euro PCR
Parijs, 23 mei 2013
Posters
Delayed enhancement versus first-pass perfusion imaging at rest
Swart LE, Koster K, Jaspers MMJJR, Van Wijngaarden J, Uijlings R, Badings E, Martens FMAC
99th Scientific Assembly and Annual Meeting of the Radiological Society of North America
Chicago USA, 5 dec 2013
Long term results of the DEAL-HF (Deventer-Alkmaar Heart Failure
study) after 7-11 year.
Pruijsers-Lamers PH, Van Wijngaarden J, Badings E
Euro Heart Care 2013
Glasgow, 22 maart 2013
Promotie
Novel markers in chronic heart failure / Dirk Jan Arend Lok
Rijksuniversiteit Groningen, 22 mei 2013
Cardiologie
Cardiologie
Wetenschappelijk overzicht 2012 - 2013
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Dermatologie
[A contractor with damaged knees].
[Article in Dutch]
van Laarhoven S, Roerdink WH, van Ginkel CJ.
Ned Tijdschr Geneeskd. 2012;156(47):A4561.
Source
Deventer Ziekenhuis, Deventer, Afd. Heelkunde, the Netherlands.
Abstract
Zie Heelkunde
Publicaties
The first case record of a female patient with buboniclymphogranuloma venereum (LGV), serovariant L2b
Stephan P Verweij, Sander Ouburg, Harry de Vries, Servaas A Morre´,
Cees J W van Ginkel, Hanna Bos, Fré W Sebens
Sex Transm Infect 2012;88(5):346-7.
Abstract
Since 2003, a lymphogranuloma venereum epidemic has been reported in
The Netherlands and other European countries. This epidemic is caused
by Chlamydia trachomatis serovariant L2b and has only been seen in men
having sex with men. The authors investigated a woman presenting with
a bubo in her right groin. The authors showed by real-time PCR that the
woman was infected with C trachomatis, serovariant L2b. This is the first
reported case study of a female patient with bubonic lymphogranuloma
venereum caused by serovariant L2b, which was probably contracted via her
bisexual male partner.
A randomised trial of honey barrier cream versus zinc oxide ointment.
Nijhuis WA, Houwing RH, Van der Zwet WC, Jansman FG.
Br J Nurs. 2012 Nov 8-21;21(20):9-10, 12-3.
Author information
Ziekenhis Gelderse Vallei Ede, University Groningen, Department of
Pharmacotherapy and Pharmaceutical Care, Groningen, The Netherlands.
Abstract
In this single-blind multicentre, intervention study, 31 patients with symmetrical intertrigo in large skin folds were included to study the clinical effect of
two topical treatments, i.e. standard therapy with zinc oxide ointment versus
honey barrier cream. Patients were treated twice daily for 21 days, and the
severity of intertrigo was scored in an observation period of 21 days. Patients were used as their own controls by treating symmetrical skin folds, on
the left and right side. There was no significant difference in treatment effect
between intervention groups. For the majority of patients, both treatments
were effective. However, the use of honey barrier cream showed lower
pruritus complaints (12.9% versus 29.0%). Honey barrier cream is a suitable
alternative in the treatment of intertrigo, and promotes patient comfort.
A case of occupational airborne allergic contact dermatitis caused by
faveira amargosa, a tropical timber.
Kop EN, van Ginkel CJ, Röckmann H, van der Valk PG.
Contact Dermatitis. 2012 Jun;66(6):344-5.
Author information
Department of Dermatology, Radboud University Nijmegen Medical Centre,
Nijmegen, The Netherlands.
Opbrengst van een drempelloze “check-je-vlekje” dag.
Jongeneel E, Van Ginkel CJW
Ned T Derm Ven. 2012;22:414-7.
Wetenschappelijk overzicht 2012 - 2013
SCEN-arts en dermatoloog: Een verrijkende combinatie.
Houwing RH
Ned T Derm Ven. 2013;23(4):249-1.
Een acneiforme dermatitis door vitamine B12.
Van Jarwaarde JA, Houwing RH
Ned T Derm Ven. 2013;23(7):375-6.
Een peuter met één dik oor.
Mandigers LCJM, Bom SJH, Dassel ACM, Houwing RH, Van Ginkel CJW
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Dermatologie
Dermatologie
[A newborn with an acute itchy skin rash].
[Article in Dutch]
Hartmans E, Houwing RH.
Ned Tijdschr Geneeskd. 2012;156(48):A4519.
Source
Deventer Ziekenhuis, afd. Dermatologie, Deventer, the Netherlands.
Abstract
A 36-week-old girl presented with an itching papulous skin eruption symmetrically on her cheeks, buttocks and limbs. Based on the specific clinical
presentation she was diagnosed with Gianotti-Crosti-syndrome. This is a
self-limiting cutaneous response to a viral infection.
Ned Tijdschr KNO-heelkunde 2013;19:115-6
serve as an outcome measure in future studies and a relevant point of intervention for individual patients.
Myeloid marker S100A8/A9 and lymphocyte marker, soluble interleukin 2 receptor: biomarkers of hidradenitis suppurativa disease activity?
Wieland CW, Vogl T, Ordelman A, Vloedgraven HG, Verwoolde LH, Rensen
JM, Roth J, Boer J, Hessels J.
Br J Dermatol. 2013 Jun;168(6):1252-8.
Author information
Laboratory for Clinical Chemistry, Deventer Hospital, PO box 5001, 7400 GC
Deventer, The Netherlands.
Abstract : zie Klinische Chemie
Depression in patients with hidradenitis suppurativa.
Onderdijk AJ, van der Zee HH, Esmann S, Lophaven S, Dufour DN, Jemec
GB, Boer J.
J Eur Acad Dermatol Venereol. 2013 Apr;27(4):473-8.
Source
Department of Dermatology, Deventer Hospital, Rotterdam, Netherlands.
Abstract
BACKGROUND: Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in
the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL). It is hypothesized that depression is
more common in HS patients than among other dermatological patients.
OBJECTIVES: To evaluate the prevalence of depression in patients with HS.
METHODS: In total 211 HS patients were included in the study and 233
were dermatological control patients. Their QoL and depression scores were
assessed using the Dermatology Life Quality Index (DLQI) and the Major
Depression Inventory (MDI) questionnaires. HS severity was recorded with a
questionnaire and Hurley stages were extracted from the case records.
RESULTS: The DLQI was significantly higher for HS patients than for the
control patients, 8.4 ± 7.5 vs. 4.3 ± 5.6 (P < 0.0001) and correlated with
Hurley stage severity scores. Mean MDI scores were significantly higher for
HS patients, 11.0 vs. 7.2 (P < 0.0001). However, clinically defined depression rates according to the International Classification of Diseases, 10th edition (ICD-10) criteria were not significantly higher in HS patients compared to
controls (9% vs. 6%).
CONCLUSIONS: HS is a chronic skin disease with major impact on QoL
even when compared to other dermatological diseases. MDI scores in HS
patients correlate with disease severity. This correlation could indicate that
the MDI represents a valid measure of disease related morbidity that may
Results of a cosmetovigilance survey in The Netherlands.
Salverda JG, Bragt PJ, de Wit-Bos L, Rustemeyer T, Coenraads PJ, Tupker
RA, Kunkeler LC, Laheij-de Boer AM, Stenveld HJ, van Ginkel CJ, Kooi
MW, Bourgeois FC, van Gorcum TF, van Engelen JG, van Dijk R, de Graaf
J, Donker GA, de Heer C, Bruynzeel D.
Contact Dermatitis. 2013 Mar;68(3):139-48.
Author information
Centre for Substances and Integrated Risk Assessment (SIR), National
Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven,
The Netherlands.
Abstract
BACKGROUND: Cosmetic products contribute considerably to the incidence
of contact dermatitis. In response to a resolution of the Council of Europe,
the National Institute for Public Health and the Environment (RIVM) in The
Netherlands set up a pilot project to report undesirable effects attributed to
cosmetic products.
OBJECTIVES: To provide an overview of undesirable effects attributed to
cosmetic products and to identify the ingredients involved. The information
could contribute to the assessment of whether current EU legislation on
cosmetics provides adequate protection.
PATIENTS/METHODS: General practitioners, dermatologists and consumers in The Netherlands completed questionnaires on reported undesirable
effects of cosmetics. Dermatologists also carried out patch tests and, where
necessary, tests with specific batch ingredients of the associated cosmetic
product. A website and a public awareness campaign were launched to
encourage consumers to report undesirable effects.
RESULTS: Between July 2009 and May 2011, the RIVM received more than
1600 reports. Severe undesirable effects were claimed in 1-4% of the cases.
The most frequently reported cosmetic products were make-up and moisturi-
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Dermatologie
Dermatologie
Zout op je huid, ach wat zou ‘t!
Sillevis Smitt JH, Boer J, Van Everdingen JJE
Ned T Derm Ven. 2013;23(6):335.
Samenvatting
Zout is door de eeuwen heen een belangrijke stof geweest. De rol van zout
is voor de dermatoloog langzaam maar zeker van minder groot belang
geworden. Momenteel lijkt zout met name zinnig in de dermatologie door het
bescheiden additieve effect bij de behandeling van atopisch eczeem en psoriasis met UV-therapie. Ook kan intralesionale injectie met een zoutoplossing
mogelijk soelaas bieden bij de behandeling van corticosteroïdatrofie.
Gynaecologie
sers, and the most frequently identified allergens were isothiazolinones and
fragrance ingredients. Three patients tested positive for co-polymers/crosspolymers.
CONCLUSIONS: Further investigations are recommended on the prevalence of isothiazolinone-induced allergic contact dermatitis and the allergenic
potential of co-polymers/cross-polymers.
Publicaties
Voordrachten
Therapy for moderate hidradenitis suppurativa with deroofing and
topical resorcinol.
Boer J
Société Bruxelloise de Dermatologie
Brussel, België, 7 februari 2013
Boek(bijdrage)
Het Geriatrie Formularium 3e ed.
Redactie: P.A.F. Jansen, J. van der Laan, J. Schols
Hoofdstuk: Decubitus
R.H. Houwing
Bohn Stafleu Van Loghum, 2012
ISBN: 9789031392643
Wetenschappelijke stage
A retrospective study on the clinical course of hidradenitis suppurativa.
Auteur
: I. Deckers
Begeleider: J. Boer
E.P. Prens
Periode
: maart – augustus 2013
Dermatologie
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Gynaecologie
Prediction of recurrence of hypertensive disorders of pregnancy
between 34 and 37 weeks of gestation: a retrospective cohort study.
van Oostwaard M, Langenveld J, Bijloo R, Wong K, Scholten I, Loix S, Hukkelhoven C, Vergouwe Y, Papatsonis D, Mol B, Ganzevoort W.
BJOG. 2012 Jun;119(7):840-7.
Source
Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the Netherlands Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands Department
of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the
Netherlands Department of Obstetrics and Gynaecology Deventer Hospital,
Deventer, the Netherlands Department of Obstetrics and Gynaecology, Kennemer Gasthuis, Haarlem, the Netherlands Department of Obstetrics and
Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands The Netherlands Perinatal Registry, Utrecht, the Netherlands Department of Public
Health, Erasmus Medical Centre, Rotterdam, the Netherlands Department of
Obstetrics and Gynaecology, Amphia Hospital, Breda, the Netherlands.
Abstract
OBJECTIVE: To assess the recurrence risk of late-preterm hypertensive
disease of pregnancy, and to determine whether potential risk factors are
predictive. Design Retrospective cohort study. Setting Three secondary
and three tertiary care hospitals in the Netherlands. Population We identified women with a hypertensive disorder in the index pregnancy and delivery
at 34-37 weeks of gestation, between January 2000 and December 2002.
METHODS: Data were extracted from medical files and women were approached for additional information on subsequent pregnancies. An adverse
outcome was defined as the recurrence of a hypertensive disorder in the
next subsequent pregnancy. Main outcome measures Absolute risk of recurrence and a prediction model containing demographic and clinical factors
predictive for adverse outcome.
RESULTS: We identified 425 women who matched the criteria, of whom 351
could be contacted. Of these women, 189 (54%) had had a subsequent pregnancy. Hypertensive disorders recurred in 96 (51%, 95% CI 43-58%) women,
of whom 17 (9%, 95% CI 5-14%) delivered again before 37 weeks of gestation. Chronic hypertension and maternal age were the strongest predictors for
recurrence. Women undergoing recurrence had a nine-fold chance of developing chronic hypertension (37% versus 6%, OR 8.7, 95% CI 3.3-23).
CONCLUSIONS: Women with hypertensive disorders and late-preterm delivery have a 50% chance of recurrence, but only a 9% chance of recurrence
resulting in delivery before 37 weeks of gestation. Women with chronic
hypertension are prone to develop recurrence, and women with a recurrence
more often developed chronic hypertension.
Author information
Academic Medical Centre, Amsterdam, the Netherlands.
Abstract
OBJECTIVE: To examine whether cervical favourability (measured by
cervical length and the Bishop score) should inform obstetricians’ decision
regarding labour induction for women with gestational hypertension or mild
pre-eclampsia at term.
DESIGN: A post hoc analysis of the Hypertension and Pre-eclampsia Intervention Trial At Term (HYPITAT).
SETTING: Obstetric departments of six university and 32 teaching and district hospitals in the Netherlands.
POPULATION: A total of 756 women diagnosed with gestational hypertension or pre-eclampsia between 36 + 0 and 41 + 0 weeks of gestation randomly
allocated to induction of labour or expectant management.
METHODS: Data were analysed using logistic regression modelling.
MAIN OUTCOME MEASURES: The occurrence of a high-risk maternal
situation defined as either maternal complications or progression to severe
disease. Secondary outcomes were caesarean delivery and adverse neonatal outcomes.
RESULTS: The superiority of labour induction in preventing high-risk situations in women with gestational hypertension or mild pre-eclampsia at term
varied significantly according to cervical favourability. In women who were
managed expectantly, the longer the cervix the higher the risk of developing
maternal high-risk situations, whereas in women in whom labour was induced, cervical length was not associated with a higher probability of maternal
high-risk situations (test of interaction P = 0.03). Similarly, the beneficial effect of labour induction on reducing the caesarean section rate was stronger
in women with an unfavourable cervix.
CONCLUSION: Against widely held opinion, our exploratory analysis showed that women with gestational hypertension or mild pre-eclampsia at term
who have an unfavourable cervix benefited more from labour induction than
other women.
TRIAL REGISTRATION: The trial has been registered in the clinical trial
register as ISRCTN08132825.
Size and volume charts of fetal kidney, renal pelvis and adrenal gland.
van Vuuren SH, Damen-Elias HA, Stigter RH, van der Doef R, Goldschmeding R, de Jong TP, Westers P, Visser GH, Pistorius LR.
Ultrasound Obstet Gynecol. 2012 Dec;40(6):659-64.
Author information
Department of Pathology, University Medical Centre Utrecht, Utrecht,
The Netherlands.
Abstract
OBJECTIVE: To establish reference curves for size and volume of the fetal
kidney, renal pelvis and adrenal gland, as measured using ultrasound from
the 15(th) week of gestation.
METHODS: This was a prospective, longitudinal study of 96 fetuses in low-risk
singleton pregnancies, in which we performed serial ultrasound examinations
at 4-week intervals. The length and anteroposterior and transverse diameters
of both kidneys, the anteroposterior and transverse diameters of the renal
pelvises and the length of the adrenal glands were measured three times at
each examination, with the average being used for further analysis. Reference
charts were constructed using multilevel statistical analysis and comparisons
were made with previously published charts derived from cross-sectional data.
RESULTS: We present nomograms for fetal kidney dimensions and volume,
renal pelvis dimensions and adrenal gland length. The new charts show
differences in shape and have narrower percentile bands in comparison to
previously published reference ranges.
CONCLUSIONS: These new charts of measurements of the fetal kidney, renal
pelvis and adrenal gland, from a prospective, longitudinal study, may be useful
in the diagnosis and assessment of pathology of the kidney and adrenal gland.
Wetenschappelijk overzicht 2012 - 2013
Integration of patient characteristics and the results of Chlamydia
antibody testing and hysterosalpingography in the diagnosis of tubal
pathology: an individual patient data meta-analysis.
Broeze KA, Opmeer BC, Coppus SF, Van Geloven N, Den Hartog JE, Land
JA, Van der Linden PJ, Ng EH, Van der Steeg JW, Steures P, Van der Veen
F, Mol BW.
Hum Reprod. 2012 Oct;27(10):2979-90.
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Gynaecologie
Should cervical favourability play a role in the decision for labour
induction in gestational hypertension or mild pre-eclampsia at term?
An exploratory analysis of the HYPITAT trial.
Tajik P, van der Tuuk K, Koopmans CM, Groen H, van Pampus MG, van der
Berg PP, van der Post JA, van Loon AJ, de Groot CJ, Kwee A, Huisjes AJ,
van Beek E, Papatsonis DN, Bloemenkamp KW, van Unnik GA, Porath M,
Rijnders RJ, Stigter RH, de Boer K, Scheepers HC, Zwinderman AH,
Bossuyt PM, Mol BW.
BJOG. 2012 Aug;119(9):1123-30.
Author information
Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The
Netherlands.
Abstract
BACKGROUND: Tubal patency tests are routinely performed in the diagnostic work-up of subfertile patients, but it is unknown whether these diagnostic
tests add value beyond the information obtained by medical history taking
and findings at physical examination. We used individual patient data metaanalysis to assess this question.
METHODS: We approached authors of primary studies for data sets containing information on patient characteristics and results from tubal patency
tests, such as Chlamydia antibody test (CAT), hysterosalpingography (HSG)
and laparoscopy. We used logistic regression to create models that predict
tubal pathology from medical history and physical examination alone, as
well as models in which the results of tubal patency tests are integrated in
the patient characteristics model. Laparoscopy was considered to be the
reference test.
RESULTS: We obtained data from four studies reporting on 4883 women.
The duration of subfertility, number of previous pregnancies and a history
of previous pelvic inflammatory disease (PID), pelvic surgery or Chlamydia
infection qualified for the patient characteristics model. This model showed
an area under the receiver operating characteristic curve (AUC) of 0.63 [95%
confidence interval (CI) 0.61-0.65]. For any tubal pathology, the addition of
HSG significantly improved the predictive performance to an AUC of 0.74
(95% CI 0.73-0.76) (P < 0.001). For bilateral tubal pathology, the addition of
both CAT and HSG increased the predictive performance to an AUC of 0.76
(95% CI 0.74-0.79).
CONCLUSIONS: In the work-up for subfertile couples, the combination of
patient characteristics with CAT and HSG results gives the best diagnostic
performance for the diagnosis of bilateral tubal pathology.
to meningitis in the Netherlands, and to assess clinical features and risk
factors.
DESIGN: Confidential enquiry into the causes of maternal deaths.
SETTING: Nationwide in the Netherlands.
POPULATION: A total of 4 784 408 live births.
METHODS: Analysis of all maternal deaths due to meningitis in pregnancy
and puerperium from 1983 up to and including 2007 reported to the Maternal
Mortality Committee of the Dutch Society of Obstetrics and Gynaecology.
MAIN OUTCOME MEASURES: Incidence, clinical features and risk factors.
RESULTS: Fifteen maternal deaths occurred due to meningitis, representing
4.4% of all maternal deaths. Twelve women (80%) presented with meningitis during pregnancy, 8 (66%) of them in the third trimester. Presenting
symptoms were altered mental status (11; 73%), fever (9; 60%), nuchal
rigidity (5; 33%) and headache (13; 87%). Nine women (60%) had otolaryngological infection at presentation or in the previous days or weeks. Twelve
women (80%) underwent radiological examination, of which 5 (33%) showed
distinct abnormalities. Cerebrospinal fluid (CSF) examination showed infected CSF in 8 (53%) women. In ten women (67%) Streptococcus pneumoniae
was isolated. Substandard care was identified in 4 (27%) women.
CONCLUSION: Pregnant or puerperal women presenting with classical
symptoms of meningitis, particularly those with a history of otolaryngological
infection or headache, should undergo thorough investigation and radiological and CSF examinations. Early diagnosis and immediate antibiotic treatment are imperative because of rapid deterioration in pregnant women. In
case of doubt, the threshold for antibiotic treatment should be low and close
monitoring is warranted.
Fatal meningitis during pregnancy in the Netherlands: a nationwide
confidential enquiry.
Schaap TP, Schutte JM, Zwart JJ, Schuitemaker NW, van Roosmalen J;
Dutch Maternal Mortality Committee.
BJOG. 2012 Dec;119(13):1558-63.
Author information
Department of Obstetrics and Gynaecology, University Medical Centre
Utrecht, the Netherlands.
Abstract
OBJECTIVE: To determine the incidence of maternal deaths attributable
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Gynaecologie
Amniotic fluid embolism incidence, risk factors and outcomes: a
review and recommendations.
Knight M, Berg C, Brocklehurst P, Kramer M, Lewis G, Oats J, Roberts CL,
Spong C, Sullivan E, van Roosmalen J, Zwart J.
BMC Pregnancy Childbirth. 2012 Feb 10;12:7.
Author information
National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
Abstract
BACKGROUND: Amniotic fluid embolism (AFE) is a rare but severe complication of pregnancy. A recent systematic review highlighted apparent
differences in the incidence, with studies estimating the incidence of AFE to
be more than three times higher in North America than Europe. The aim of
this study was to examine population-based regional or national data from
five high-resource countries in order to investigate incidence, risk factors and
outcomes of AFE and to investigate whether any variation identified could be
ascribed to methodological differences between the studies.
METHODS: We reviewed available data sources on the incidence of AFE
in Australia, Canada, the Netherlands, the United Kingdom and the USA.
Where information was available, the risk factors and outcomes of AFE were
examined.
RESULTS: The reported incidence of AFE ranged from 1.9 cases per 100
000 maternities (UK) to 6.1 per 100 000 maternities (Australia). There was a
clear distinction between rates estimated using different methodologies. The
lowest estimated incidence rates were obtained through validated case identification (range 1.9-2.5 cases per 100 000 maternities); rates obtained from
retrospective analysis of population discharge databases were significantly
higher (range 5.5-6.1 per 100 000 admissions with delivery diagnosis). Older
maternal age and induction of labour were consistently associated with AFE.
CONCLUSIONS: Recommendation 1: Comparisons of AFE incidence
estimates should be restricted to studies using similar methodology. The
recommended approaches would be either population-based database
studies using additional criteria to exclude false positive cases, or tailored
data collection using existing specific population-based systems.Recommendation 2: Comparisons of AFE incidence between and within countries would
be facilitated by development of an agreed case definition and an agreed set
of criteria to minimise inclusion of false positive cases for database studies.
Recommendation 3: Groups conducting detailed population-based studies
on AFE should develop an agreed strategy to allow combined analysis of
data obtained using consistent methodologies in order to identify potentially
modifiable risk factors.Recommendation 4: Future specific studies on AFE
should aim to collect information on management and longer-term outcomes
for both mothers and infants in order to guide best practice, counselling and
service planning.
amniotic fluid embolism were dyspnea and massive obstetric hemorrhage. In
the majority of women, onset of symptoms was intrapartum or immediately
postpartum. Potential risk factors of developing amniotic fluid embolism were
maternal age >30, multiparity (OR 3.3, 95% CI 1.02-10.5), cesarean section
(OR 1.3, 95% CI 0.3-5.2) and induction of labor (OR 2.1, 95% CI 2.1-6.1).
Perinatal mortality was increased to 38.1% compared with 0.98% in the general pregnant population (p < 0.001) High maternal age and multiparity are
the most important risk factors for developing amniotic fluid embolism.
Severe maternal morbidity and mortality from amniotic fluid embolism in the Netherlands.
Stolk KH, Zwart JJ, Schutte J, VAN Roosmalen J.
Acta Obstet Gynecol Scand. 2012 Aug;91(8):991-5.
Author information
Leiden University Medical Centre, Department of Obstetrics, Leiden, the
Netherlands.
Abstract
We have assessed the incidence, symptoms and risk factors of amniotic
fluid embolism in the Netherlands. Data were retrieved from two nationwide
registration systems. From 1983 to 2005 the maternal mortality ratio of amniotic fluid embolism increased from 0.11 to 0.63 (odds ratio (OR) 5.8, 95%
confidence interval (CI) 1.3-25.3). The most common signs and symptoms of
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Severe maternal morbidity in ectopic pregnancy is not associated
with maternal factors but may be associated with quality of care.
van Mello NM, Zietse CS, Mol F, Zwart JJ, van Roosmalen J, Bloemenkamp
KW, Ankum WM, van der Veen F, Mol BW, Hajenius PJ.
Fertil Steril. 2012 Mar;97(3):623-9.
Author information
Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Abstract
OBJECTIVE: To study the association between patient-related risk factors
and severe maternal morbidity in women with tubal ectopic pregnancy (EP).
Furthermore, to identify substandard care factors in clinical care management of EP.
DESIGN: Case-control study.
SETTING: Not applicable.
PATIENT(S): Case subjects were from the LEMMoN study, a prospective
nationwide cohort study. Control subjects were from the ESEP study, an
international multicenter randomized controlled trial.
INTERVENTION(S): Case subjects were women with tubal EP complicated
by severe intra-abdominal hemorrhage necessitating blood transfusion of
≥4 units of packed red blood cells peri- or postoperatively. Control subjects
were women with tubal EP who were hemodynamically stable and surgically
treated.
MAIN OUTCOME MEASURE(S): Patient-related risk factors as: maternal
age, gestational age, previous EP, Chlamydia infection, pelvic inflammatory
disease, assisted reproductive techniques, and serum hCG level. Substandard care categories classified as unawareness of the clinician, misdiagnosis, and nonadherence to the guideline on EP.
RESULT(S): Twenty-nine case subjects and 99 control subjects were included. The mean serum hCG level was significantly higher in case subjects
compared with control subjects, but we found no reliable cutoff level of
serum hCG to rule out maternal morbidity. Other risk factors did not differ significantly. Substandard care was scored more often in case subjects
(43%) than in control subjects (14%), mainly concerning misdiagnosis.
CONCLUSION(S): No patient-related risk factors for severe intra-abdominal
hemorrhage in women with tubal EP were identified. Our findings underpin
the importance of awareness of EP among young fertile women and care
providers and clinical care management according to the guidelines to prevent severe maternal morbidity.
SETTING: The Netherlands, august 2004 to august 2006.
POPULATION: 1567 cases from initially primary care and 2994 women from
primary care practices as controls, out of 371 012 women delivering in the
Netherlands during the study period.
METHODS: Cases were women with SAMM obtained from a nationwide
prospective study. All women in this cohort who initially had low-risk pregnancies were compared with low-risk women without SAMM to calculate odd
ratios (ORs) to develop SAMM by body mass index (BMI) category. We divided body mass index in three overweight categories and calculated the ORs
(95% CI) of total SAMM and per specific endpoint by logistic regression, with
normal weight as reference. We adjusted for age, parity and socio-economic
status.
MAIN OUTCOME MEASURES: SAMM, defined as Intensive Care Unit
(ICU)-admission, Uterine Rupture, Eclampsia or Major Obstetric Haemorrhage (MOH).
RESULTS: SAMM was reported in 1567 cases which started as low-risk
pregnancies. BMI was available in 1097 (70.0%) cases and 2994 control
subjects were included. Analysis showed a dose response relation for
overweight (aOR, 1.3; 95% CI, 1.0-1.5), obese (aOR, 1.4; 95% CI, 1.1-1.9)
and morbidly obese (aOR, 2.1; 95% CI, 1.3-3.2) women to develop SAMM
compared to normal weight. Sub analysis showed the same dose response
relation for ICU-admission, Uterine Rupture and Eclampsia. We found no
association for MOH.
CONCLUSION: Overweight without pre-existent co-morbidity is an important
risk-indicator for developing SAMM. This risk increases with an increasing
body mass index.
Tissue composition of the vaginal wall in women with pelvic organ
prolapse.
Meijerink AM, van Rijssel RH, van der Linden PJ.
Gynecol Obstet Invest. 2013;75(1):21-7.
Source
Department of Gynecology and Obstetrics, Deventer Hospital, Deventer, The
Netherlands.
Abstract
BACKGROUND/AIMS: To determine the composition of the vaginal wall and
to explore the connective tissue layer, muscularis and basement membrane
in relation to the pathogenesis of pelvic organ prolapse (POP).
METHODS: We performed a histopathological study with respect to the
composition of the vaginal wall of 33 patients and 9 controls. Tissue samples
from the vaginal wall were analysed for collagens II and IV, desmin, elastin, fibronectin, smooth muscle actin (SMA) and transforming growth factor
(TGF)-β1 using (immuno)histochemistry. Morphometric analyses were also
performed.
RESULTS: Morphometric characteristics and expression of SMA, TGF-β1,
elastin and collagen II were significantly altered in women with POP.
CONCLUSION: Our results suggest that there could be an altered tissue
composition of the vaginal wall in women with POP. SMA expression could
play a role in the pathogenesis of POP. The alterations in elastin and TGF-β1
expression are likely a result of POP.
Overweight and severe acute maternal morbidity in a low-risk pregnant population in the Netherlands.
Witteveen T, Zwart JJ, Gast KB, Bloemenkamp KW, van Roosmalen J.
PLoS One. 2013 Sep 12;8(9):e74494.
Author information
Department of Obstetrics, Leiden University Medical Center, Leiden, The
Netherlands.
Abstract
OBJECTIVE: To investigate the association between overweight and severe
acute maternal morbidity (SAMM) in a low-risk pregnant population.
DESIGN: Nationwide case-control study.
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The clinical benefit of blood transfusion: a hypothetical experiment
based on a nationwide survey of severe maternal morbidity.
Hendriks J, Zwart JJ, Briët E, Brand A, van Roosmalen J.
Vox Sang. 2013 Apr;104(3):234-9.
Author information
Department of Obstetrics, Leiden University Medical Centre, Leiden, The
Netherlands.
Abstract
BACKGROUND: It is beyond doubt that blood transfusion services have
added to the decline in maternal mortality in high-resource countries. To
quantify the clinical benefit of red blood cell (RBC) transfusion in obstetric
care, we performed a hypothetical experimental study using data from a
prospective nationwide cohort of women giving birth in the Netherlands.
STUDY DESIGN AND METHODS: Data were abstracted from a nationwide
cohort study on severe maternal morbidity, including obstetric haemorrhage
requiring 4 or more units of RBC, to obtain an observed and a hypothetical
control group consisting of the same women. In the hypothetical control
group, we simulated a situation where RBC transfusion was unavailable
and estimated how many of these women would have died in that situation.
A questionnaire survey asked experts in major (obstetric) haemorrhage to
choose a critical minimal number of RBC transfusions at which a woman
with obstetric haemorrhage would have died if RBC transfusion was not
available. Maternal mortality rate per 100,000 maternities [maternal mortality
ratios (MMR)] and relative risk were calculated for the observed and hypothetical group. ReSULTS: The observed MMR was 13 per 100,000 maternities. According to 47 responding experts, the median number of RBC units
without which a woman would have most probably died was nine, resulting
in a hypothetical MMR of 87 per 100,000 maternities (relative risk 6·5; 95%
confidence interval 4·2-10·0).
CONCLUSIONS: It can be expected that unavailability of RBC transfusion in
obstetric care increases the risk of maternal death 6.5-fold. Blood transfusion
thus largely contributes to the decline of MMR and would also be an important pillar of improving quality of care in resource-poor settings.
METHODS: We performed a cross-sectional study. Three Dutch fertility
clinics (2 IVF-licensed) offered their patients a secure online clinical health
community through which clinicians can provide online information and
patients can ask questions to the medical team or share experiences and
find support from peers. We randomly selected and invited 278 men and
women suffering from infertility and attending 1 of the participating clinics.
Participants filled out a questionnaire about their background characteristics
and current use of the online community. Possible barriers and facilitators
were divided into 2 parts: (1) those for subscription to the community, and (2)
those for active participation in the community. We performed 2 multivariate
logistic regression analyses to calculate determinants for both subscription
and active participation.
RESULTS: Subscription appeared to be associated with patients’ background characteristics (eg, gender, treatment phase), intervention-related
facilitators (odds ratio [OR] 2.45, 95% CI 1.14-5.27), and patient-related
barriers (OR 0.20, 95% CI 0.08-0.54), such as not feeling the need for such
an online health community. After subscription, determinants for participation
consisted of aspects related to participant’s age (OR 0.86, 95% CI 0.760.97), length of infertility (OR 1.48, 05% CI 1.09-2.02), and to intervention-related facilitators (OR 5.79, 95% CI 2.40-13.98), such as its reliable character
and possibility to interact with the medical team and peers.
CONCLUSIONS: Implementing an online health community in addition to
usual fertility care should be performed stepwise. At least 2 strategies are
needed to increase the proportion of patient subscribers and consequently
make them active participants. First, the marketing strategy should contain
information tailored to different subgroups of the patient population. Second,
for a living online health community, incorporation of interactive elements,
as well as frequent news and updates are needed. These results imply that
involving patients and their needs into the promotion strategy, community’s
design, and implementation are crucial.
Wetenschappelijk overzicht 2012 - 2013
Postmenopausal bleeding and corticosteroids.
Klomp HA, van der Linden PJ.
Gynecol Obstet Invest. 2013;76(4):260.
Author information
Department of Gynecology and Obstetrics, Deventer Ziekenhuis, Deventer,
The Netherlands.
Perinatale sterftecijfers geven geen aanleiding tot onomkeerbare
organisatorische ingrepen in het verloskundig zorgsysteem.
Van der Leeuw-Harmsen L, Schaaf H
Medisch Contact 2013;68(5):252-4
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Barriers and facilitators for the implementation of an online clinical
health community in addition to usual fertility care: a cross-sectional
study.
Aarts JW, Faber MJ, den Boogert AG, Cohlen BJ, van der Linden PJ, Kremer JA, Nelen WL.
J Med Internet Res. 2013 Aug 30;15(8):e163.
Author information
Department of Obstetrics and Gynecology, Radboud University Nijmegen
Medical Center, Radboud University, Nijmegen, Netherlands.
Abstract
BACKGROUND: Online health communities are becoming more popular in
health care. Patients and professionals can communicate with one another
online, patients can find peer support, and professionals can use it as an
additional information channel to their patients. However, the implementation
of online health communities into daily practice is challenging. These challenges relate to the fact that patients need to be activated to (1) become a
member (ie, subscription) and (2) participate actively within the community
before any effect can be expected. Therefore, we aimed at answering 2
research questions: (1) what factors are associated with subscription to an
online health community, and (2) which are associated with becoming an
active participant within an online health community.
OBJECTIVE: To identify barriers and facilitators as perceived by patients for
the implementation of an online health community.
The prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: a systematic review.
Bij de Vaate AJ, van der Voet LF, Naji O, Witmer M, Veersema S, Brölmann
HA, Bourne T, Huirne JA.
Ultrasound Obstet Gynecol. 2013 Aug 30. [Epub ahead of print]
Author information
Department of Obstetrics and Gynaecology, VU University Medical Center,
Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Abstract
OBJECTIVE: To systematically review the medical literature reporting on the
prevalence of a niche using various diagnostic methods, on potential risk
factors for the development of a niche and on niche-related gynecological
symptoms in non-pregnant women.
METHODS: The databases Medline and Embase were searched. All types
of clinical studies reporting on the prevalence, risk factors and/or symptoms
of a niche in non-pregnant women with a history of Cesarean section (CS)
were included. Case reports or case series were excluded.
RESULTS: We selected 21 papers. A wide range in the prevalence of a
niche was found. Using sonohysterography (SHG) in a random population of
women with a history of CS, the prevalence varied between 56% and 84%.
Nine studies reported on risk factors and each study evaluated different factors, which made it difficult to compare studies. Risk factors can be categorized into four categories: factors related to closure technique, development of
the lower uterine segment or localization of the incision, wound healing and
miscellaneous factors. Probable risk factors are single-layer myometrium
closure, multiple CSs and uterine retroflexion. Six out of eight studies described an association between the presence of a niche and postmenstrual
spotting.
CONCLUSIONS: The reported prevalence of a niche in non-pregnant women varies depending on the method of detection, the criteria used to define
a niche and the study population. Potential risk factors can be categorized in
four main categories, which may be useful for future research and meta-analyses. The predominant symptom associated with a niche is postmenstrual
spotting.
BS, van Kesteren PJ, Langenveld J, Smeets NA, van Vliet HA, van der
Steeg JW, Leeuwen YL, Dekker JH, Mol BW, Berger MY, Bongers MY.
BMC Womens Health. 2013 Aug 8;13(1):32.
Abstract
BACKGROUND: Heavy menstrual bleeding is an important health problem.
Two frequently used therapies are the levonorgestrel intra-uterine system
(LNG-IUS) and endometrial ablation. The LNG-IUS can be applied easily
by the general practitioner, which saves costs, but has considerable failure
rates. As an alternative, endometrial ablation is also very effective, but this
treatment has to be performed by a gynaecologist. Due to lack of direct
comparison of LNG-IUS with endometrial ablation, there is no evidence
based preferred advice for the use of one of these treatment possibilities.Method/designA multicenter randomised controlled trial, organized in a network
infrastructure in the Netherlands in which general practitioners and gynaecologists collaborate.Women >= 34 years with heavy menstrual bleeding,
a Pictorial Blood Assessment Chart (PBAC) score exceeding 150 points
and no future child wish can participate in the trial. After informed consent,
women will be randomised to a strategy starting with a levonorgestrel releasing intrauterine system or a strategy starting with endometrial ablation.The
primary outcome is the PBAC score at 24 months of follow-up. Secondary
outcomes are patient satisfaction, complications, number of re-interventions,
menstrual bleeding pattern, quality of life, sexual function, sick leave and
costs. As predictors of effect of intervention we also meaure level of coagulation factors.DiscussonThis study, considering both effectiveness and cost
effectiveness of LNG-IUS versus endometrial ablation may well improve
care for women with heavy menstrual bleeding.Trial registrationDutch trial
register, number NTR2984.
Levonorgestrel releasing intrauterine system (Mirena) versus endometrial ablation (Novasure) in women with heavy menstrual bleeding: a
multicentre randomised controlled trial.
Herman MC, van den Brink MJ, Geomini PM, van Meurs HS, Huirne JA,
Eising HP, Timmermans A, Pijnenborg J, Klinkert ER, Coppus SF, Nieboer T,
Catshoek R, van der Voet LF, van Eijndhoven HW, Graziosi G, Veersema
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Surgical versus expectant management in women with an incomplete evacuation of the uterus after treatment with misoprostol for
miscarriage: the MisoREST trial.
Verschoor MA, Lemmers M, Bossuyt PM, Graziosi GC, Hajenius PJ,
Hendriks DJ, van Hooff MA, van Meurs HS, Opmeer BC, van Tulder MW,
Bouwma L, Catshoek R, Geomini P, Klinkert ER, Langenveld J, Nieboer TE,
van der Ploeg JM, Radder CM, Spinder T, van der Voet LF, Mol BW, Huirne
JA, Ankum WM.
BMC Pregnancy Childbirth. 2013 May 2;13:102.
Author information
Department of Obstetrics and Gynaecology, Academic Medical Centre,
Amsterdam, The Netherlands.
Abstract
BACKGROUND: Medical treatment with misoprostol is a non-invasive and
inexpensive treatment option in first trimester miscarriage. However, about
30% of women treated with misoprostol have incomplete evacuation of the
uterus. Despite being relatively asymptomatic in most cases, this finding
often leads to additional surgical treatment (curettage). A comparison of effectiveness and cost-effectiveness of surgical management versus expectant
management is lacking in women with incomplete miscarriage after misoprostol.
METHODS/DESIGN: The proposed study is a multicentre randomized
controlled trial that assesses the costs and effects of curettage versus
expectant management in women with incomplete evacuation of the uterus
after misoprostol treatment for first trimester miscarriage.Eligible women will
be randomized, after informed consent, within 24 hours after identification
of incomplete evacuation of the uterus by ultrasound scanning. Women
are randomly allocated to surgical or expectant management. Curettage
is performed within three days after randomization.Primary outcome is the
sonographic finding of an empty uterus (maximal diameter of any contents
of the uterine cavity < 10 millimeters) six weeks after study entry. Secondary
outcomes are patients’ quality of life, surgical outcome parameters, the type
and number of re-interventions during the first three months and pregnancy
rates and outcome 12 months after study entry.
DISCUSSION: This trial will provide evidence for the (cost) effectiveness of
surgical versus expectant management in women with incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage.
TRIAL REGISTRATION: Dutch Trial Register: NTR3110.
followed by third stage manipulation. This study is the first population-based
study for uterine inversion. With the reported associated factors and occurrence in women with a low-risk profile, we show that every birth attendant
should be able to detect this rare but severe complication.
Puerperal uterine inversion in the Netherlands: a nationwide cohort
study.
Witteveen T, van Stralen G, Zwart J, van Roosmalen J.
Acta Obstet Gynecol Scand. 2013 Mar;92(3):334-7.
Author information
Department of Obstetrics, Leiden University Medical Center, Leiden, the
Netherlands.
Abstract
Puerperal uterine inversion is a severe but rare obstetric complication of yet
unknown origin. In this two-year study we determine the incidence of this
complication and we describe associated risk factors to expose its etiology.
All cases of uterine inversion were included from a nationwide cohort study
which contained all 98 hospitals with a maternity unit in the Netherlands.
We reviewed the medical records of 15 patients, resulting an incidence of
approximately 1 in 20 000 vaginal births. Fourteen cases (93.3%) were classified as low-risk pregnancies at booking. Nulliparous women were not overrepresented and the main associated factors were signs of prolonged labor
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Severe adverse maternal outcomes among low risk women with
planned home versus hospital births in the Netherlands: nationwide
cohort study.
de Jonge A, Mesman JA, Manniën J, Zwart JJ, van Dillen J, van Roosmalen J.
BMJ. 2013 Jun 13;346:f3263.
Author information
Department of Midwifery Science, AVAG and the EMGO Institute of Health and
Care Research, VU University Medical Center, Amsterdam, Netherlands.
Abstract
OBJECTIVES: To test the hypothesis that low risk women at the onset of
labour with planned home birth have a higher rate of severe acute maternal
morbidity than women with planned hospital birth, and to compare the rate of
postpartum haemorrhage and manual removal of placenta.
DESIGN: Cohort study using a linked dataset.
SETTING: Information on all cases of severe acute maternal morbidity in
the Netherlands collected by the national study into ethnic determinants of
maternal morbidity in the netherlands (LEMMoN study), 1 August 2004 to 1
August 2006, merged with data from the Netherlands perinatal register of all
births occurring during the same period.
PARTICIPANTS: 146 752 low risk women in primary care at the onset of
labour.
MAIN OUTCOME MEASURES: Severe acute maternal morbidity (admission
to an intensive care unit, eclampsia, blood transfusion of four or more packed cells, and other serious events), postpartum haemorrhage, and manual
removal of placenta.
RESULTS: Overall, 92 333 (62.9%) women had a planned home birth and
54 419 (37.1%) a planned hospital birth. The rate of severe acute maternal
morbidity among planned primary care births was 2.0 per 1000 births. For
nulliparous women the rate for planned home versus planned hospital birth
was 2.3 versus 3.1 per 1000 births (adjusted odds ratio 0.77, 95% confidence interval 0.56 to 1.06), relative risk reduction 25.7% (95% confidence
interval -0.1% to 53.5%), the rate of postpartum haemorrhage was 43.1
versus 43.3 (0.92, 0.85 to 1.00 and 0.5%, -6.8% to 7.9%), and the rate of
manual removal of placenta was 29.0 versus 29.8 (0.91, 0.83 to 1.00 and
2.8%, -6.1% to 11.8%). For parous women the rate of severe acute maternal
morbidity for planned home versus planned hospital birth was 1.0 versus
2.3 per 1000 births (0.43, 0.29 to 0.63 and 58.3%, 33.2% to 87.5%), the rate
of postpartum haemorrhage was 19.6 versus 37.6 (0.50, 0.46 to 0.55 and
47.9%, 41.2% to 54.7%), and the rate of manual removal of placenta was
8.5 versus 19.6 (0.41, 0.36 to 0.47 and 56.9%, 47.9% to 66.3%).
CONCLUSIONS: Low risk women in primary care at the onset of labour
with planned home birth had lower rates of severe acute maternal morbidity,
postpartum haemorrhage, and manual removal of placenta than those with
planned hospital birth. For parous women these differences were statistically
significant. Absolute risks were small in both groups. There was no evidence
that planned home birth among low risk women leads to an increased risk
of severe adverse maternal outcomes in a maternity care system with well
trained midwives and a good referral and transportation system.
Methotrexate or expectant management in women with an ectopic
pregnancy or pregnancy of unknown location and low serum hCG concentrations? A randomized comparison.
van Mello NM, Mol F, Verhoeve HR, van Wely M, Adriaanse AH, Boss
EA, Dijkman AB, Bayram N, Emanuel MH, Friederich J, van der LeeuwHarmsen L, Lips JP, Van Kessel MA, Ankum WM, van der Veen F, Mol BW,
Hajenius PJ.
Hum Reprod. 2013 Jan;28(1):60-7.
Author information
Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
Abstract
STUDY QUESTION: What is the treatment success rate of systemic methotrexate (MTX) compared with expectant management in women with an
ectopic pregnancy or a pregnancy of unknown location (PUL) with low and
plateauing serum hCG concentrations?
SUMMARY ANSWER: In women with an ectopic pregnancy or a PUL and
low and plateauing serum hCG concentrations, expectant management is an
alternative to medical treatment with single-dose systemic MTX.
WHAT IS KNOWN AND WHAT THIS PAPER ADDS: MTX is often used in
asymptomatic women with an ectopic pregnancy or a PUL with low and plateauing serum hCG concentrations. These pregnancies may be self-limiting
and watchful waiting is suggested as an alternative, but evidence from RCTs
is lacking. The results of this RCT show that expectant management is an
alternative to treatment with systemic MTX in a single-dose regimen in these
women.
STUDY DESIGN, SIZE, DURATION: A multicentre RCT women were assigned to systemic MTX (single dose) treatment or expectant management,
using a web-based randomization program, block randomization with stratification for hospital and serum hCG concentration (<1000 versus 1000-2000
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Gynaecologie
IU/l). The primary outcome measure was an uneventful decline of serum
hCG to an undetectable level (<2 IU/l) by the initial intervention strategy. Secondary outcome measures included additional treatment, side effects and
serum hCG clearance time.
PARTICIPANTS, SETTING, METHODS: From April 2007 to January 2012,
we performed a multicentre study in The Netherlands. All haemodynamically
stable women >18 years old with both an ectopic pregnancy visible on transvaginal sonography and a plateauing serum hCG concentration <1500 IU/l
or with a PUL and a plateauing serum hCG concentration <2000 IU/l were
eligible for the trial.
MAIN RESULTS: We included 73 women of whom 41 were allocated to
single-dose MTX and 32 to expectant management. There was no difference
in primary treatment success rate of single-dose MTX versus expectant management, 31/41 (76%) and 19/32 (59%), respectively [relative risk (RR) 1.3
95% confidence interval (CI) 0.9-1.8]. In nine women (22%), additional MTX
injections were needed, compared with nine women (28%) in whom systemic MTX was administered after initial expectant management (RR 0.8; 95%
CI 0.4-1.7). One woman (2%) from the MTX group underwent surgery compared with four women (13%) in the expectant management group (RR 0.2;
95% CI 0.02-1.7), all after experiencing abdominal pain within the first week
of follow-up. In the MTX group, nine women reported side effects versus
none in the expectant management group. No serious adverse events were
reported. Single-dose systemic MTX does not have a larger treatment effect
compared with expectant management in women with an ectopic pregnancy
or a PUL and low and plateauing serum hCG concentrations.
WIDER IMPLICATIONS OF THE FINDINGS: Sixty percent of women after
expectant management had an uneventful clinical course with steadily declining serum hCG levels without any intervention, which means that MTX, a
potentially harmful drug, can be withheld in these women. BIAS, LIMITATION
AND GENERALISABILITY: A limitation of this RCT is that it was an open
(not placebo controlled) trial. Nevertheless, introduction of bias was probably
limited by the strict criteria to be fulfilled for treatment with MTX.
STUDY FUNDING: This trial is supported by a grant of the Netherlands
Organization for Health Research and Development (ZonMw Clinical fellow
grant 90700154).
TRIAL REGISTRATION: ISRCTN 48210491.
Incidence and predictors of maternal cardiovascular mortality and
severe morbidity in The Netherlands: a prospective cohort study.
Huisman CM, Zwart JJ, Roos-Hesselink JW, Duvekot JJ, van Roosmalen J.
PLoS One. 2013;8(2):e56494.
Author information
Department of Obstetrics and Gynaecology, Bronovo Hospital, The Hague,
The Netherlands.
Abstract
OBJECTIVE: To assess incidence and possible risk factors of severe maternal morbidity and mortality from cardiovascular disease in The Netherlands.
DESIGN: A prospective population based cohort study.
SETTING: All 98 maternity units in The Netherlands.
POPULATION: All women delivering in The Netherlands between August
2004 and August 2006 (n = 371,021).
METHODS: Cases of severe maternal morbidity and mortality from cardiovascular disease were prospectively collected during a two-year period in
The Netherlands. Women with cardiovascular complications during pregnancy or postpartum who were admitted to the ward, intensive care or coronary
care unit were included. Cardiovascular morbidity was defined as cardiomyopathy, valvular disease, ischaemic heart disease, arrhythmias or aortic
dissection. All women delivering in the same period served as a reference
cohort.
MAIN OUTCOME MEASURES: Incidence, case fatality rates and possible
risk factors.
RESULTS: Incidence of severe maternal morbidity due to cardiovascular
disease was 2.3 per 10,000 deliveries (84/358,874). Maternal mortality rate
from cardiovascular disease was 3.0 per 100,000 deliveries (11/358,874).
Case fatality rate in women with severe maternal morbidity due to cardiovascular disease was 13% (11/84). Case fatality rate was highest in aortic
dissection (83%). Pre-existing acquired or congenital heart disease was
identified in 34% of women. Thirty-one percent of women were of advanced
maternal age (>35 years of age) and 5 percent above 40 years of age. Possible risk factors for cardiovascular morbidity were caesarean section (either
resulting in or as a result of cardiovascular disease), multiple pregnancy,
prior caesarean section, non-Western ethnicity and obesity.
CONCLUSIONS: In The Netherlands cardiovascular disease is a rare cause
of severe maternal morbidity with an incidence of 2.3 per 10,000 deliveries
and a high case fatality rate of 13%. Cardiovascular complications develop
mostly in women not known with cardiac disease pre-pregnancy.
lingslanden, en vergelijkbaar met de landen om ons heen.
De laatste jaren is er een daling zichtbaar in maternale sterfte in Nederland.
De meeste moedersterfte wordt veroorzaakt door cardiovasculaire oorzaken.
De belangrijkste directe oorzaken van moedersterfte blijven pre-eclampsie,
trombo-embolie en haemorrhagie postpartum. De auditcommissie maternale
sterfte geeft adviezen om de zorg voor zwangere vrouwen te optimaliseren.
Collaborations
Moedersterfte in Nederland op de ‘goede’ weg?
Schutte JM, Van den Akker T, Engel NMAA, De Groot CJM, Kuppens SMI,
Schuitemaker NWE, Vermeulen GM, Zwart JJ, Van Roosmalen JMM
Ned Tijdschr Obstet Gynaecol. 2013;126:286
Samenvatting
Gegevens over maternale sterfte in Nederland worden verzameld, geclassificeerd en beoordeeld op geleverde zorg door de auditcommissie maternale
sterfte. Maternale sterfte is in Nederland laag ten opzichte van ontwikkeWetenschappelijk overzicht 2012 - 2013
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Induction of labor versus expectant management in women with
preterm prelabor rupture of membranes between 34 and 37 weeks: a
randomized controlled trial.
van der Ham DP, Vijgen SM, Nijhuis JG, van Beek JJ, Opmeer BC, Mulder
AL, Moonen R, Groenewout M, van Pampus MG, Mantel GD, Bloemenkamp
KW, van Wijngaarden WJ, Sikkema M, Haak MC, Pernet PJ, Porath M,
Molkenboer JF, Kuppens S, Kwee A, Kars ME, Woiski M, Weinans MJ, Wildschut HI, Akerboom BM, Mol BW, Willekes C; PPROMEXIL trial group.
PLoS Med. 2012;9(4):e1001208.
Collaborators (39)
Stigter R
Author information
Department of Obstetrics and Gynecology, Maastricht University Medical
Center, GROW-School for Oncology and Developmental Biology, Maastricht,
The Netherlands.
Abstract
BACKGROUND: At present, there is insufficient evidence to guide appropriate management of women with preterm prelabor rupture of membranes
(PPROM) near term.
METHODS AND FINDINGS: We conducted an open-label randomized
controlled trial in 60 hospitals in The Netherlands, which included nonlaboring women with >24 h of PPROM between 34(+0) and 37(+0) wk of
gestation. Participants were randomly allocated in a 1:1 ratio to induction of
labor (IoL) or expectant management (EM) using block randomization. The
main outcome was neonatal sepsis. Secondary outcomes included mode of
delivery, respiratory distress syndrome (RDS), and chorioamnionitis. Patients
and caregivers were not blinded to randomization status. We updated a prior
meta-analysis on the effect of both interventions on neonatal sepsis, RDS,
and cesarean section rate. From 1 January 2007 to 9 September 2009, 776
patients in 60 hospitals were eligible for the study, of which 536 patients
were randomized. Four patients were excluded after randomization. We
allocated 266 women (268 neonates) to IoL and 266 women (270 neonates)
to EM. Neonatal sepsis occurred in seven (2.6%) newborns of women in the
IoL group and in 11 (4.1%) neonates in the EM group (relative risk [RR] 0.64;
95% confidence interval [CI] 0.25 to 1.6). RDS was seen in 21 (7.8%, IoL)
versus 17 neonates (6.3%, EM) (RR 1.3; 95% CI 0.67 to 2.3), and a cesarean section was performed in 36 (13%, IoL) versus 37 (14%, EM) women
(RR 0.98; 95% CI 0.64 to 1.50). The risk for chorioamnionitis was reduced in
the IoL group. No serious adverse events were reported. Updating an existing meta-analysis with our trial results (the only eligible trial for the update)
indicated RRs of 1.06 (95% CI 0.64 to 1.76) for neonatal sepsis (eight trials,
1,230 neonates) and 1.27 (95% CI 0.98 to 1.65) for cesarean section (eight
trials, 1,222 women) for IoL compared with EM.
CONCLUSIONS: In women whose pregnancy is complicated by late
PPROM, neither our trial nor the updated meta-analysis indicates that IoL
substantially improves pregnancy outcomes compared with EM.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN29313500
almost a similar accuracy was reached using AMH or AFC alone (AUC 0.78
and 0.76, respectively). Combining the two tests, however, did not improve
prediction (AUC 0.80, P = 0.19) of poor response. In predicting ongoing
pregnancy after IVF, age was the best single predictor (AUC 0.57), and none
of the ORTs added any value.
CONCLUSIONS: This IPD meta-analysis demonstrates that AFC and AMH
clearly add to age in predicting poor response. As single tests, AFC and
AMH both fully cover the prediction of poor ovarian response. In contrast,
none of the ORTs add any information to the limited capacity of female age
to predict ongoing pregnancy after IVF. The clinical usefulness of ORTs prior
to IVF will be limited to the prediction of ovarian response.
Boek(bijdrage)
Maternal Critial Care, a multidisciplinary approach.
Editors: M. van de Velde, H. Scholefeld, L.A. Plante.
Hoofdstuk : Sepsis.
J.J. Zwart
Uitgever: Cambridge University Press, New York.
ISBN: 9781107018495
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Gynaecologie
Added value of ovarian reserve testing on patient characteristics in
the prediction of ovarian response and ongoing pregnancy: an individual patient data approach.
Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt
P, Eijkemans MJ, Mol BW, Broekmans FJ; IMPORT study group.
Hum Reprod Update. 2013 Jan-Feb;19(1):26-36.
Collaborators (35)
Van der Linden PJ
Author information
Department of Reproductive Medicine, University Medical Center Utrecht,
Utrecht, The Netherlands. S.L.Broer-2umcutrecht.nl
Abstract
BACKGROUND: Although ovarian reserve tests (ORTs) are frequently used
prior to IVF treatment for outcome prediction, their added predictive value is
unclear. We assessed the added value of ORTs to patient characteristics in
the prediction of IVF outcome.
METHODS: An individual patient data (IPD) meta-analysis from published
studies was performed. Studies on FSH, anti-Müllerian hormone (AMH) or
antral follicle count (AFC) in women undergoing IVF were identified and
authors were contacted. Using random intercept logistic regression models,
we estimated the added predictive value of ORTs for poor response and
ongoing pregnancy after IVF, relative to patient characteristics.
RESULTS: We were able to collect 28 study databases, comprising 5705
women undergoing IVF. The area under the receiver-operating characteristic
curve (AUC) for female age in predicting poor response was 0.61. AFC and
AMH each significantly improved the model fit (P-value <0.001). Moreover,
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METHODS: Construction of the TiOS was based on a multidimensional theoretical framework. Cancer patients were surveyed within a week after their
consultation. Trust, satisfaction, trust in health care, self-reported health and
background variables were assessed. Dimensionality, internal consistency,
test-retest reliability and construct validity were investigated.
RESULTS: Data of 423 patients were included (response rate = 65%). After
item reduction, the TiOS included 18 items. Trust scores were high. Exploratory factor analysis suggested one-dimensionality.
Confirmatory factor analysis nevertheless indicated a reasonable fit of our
four-dimensional theoretical model, distinguishing competence, fidelity,
honesty and caring. Internal consistency and test-retest reliabilities were
high. Good construct validity was indicated by moderate correlations of trust
(TiOS) with satisfaction, trust in health care, willingness to recommend and
number of consultations with the oncologist. Exploratory analyses suggested
significant correlations of trust with ethnicity and age.
CONCLUSIONS: The TiOS reliably and validly assesses cancer patients’
trust in their oncologist. The questionnaire can be employed in both clinical
practice and future research of cancer patients’ trust.
Publicaties
Foot posture and patellar tendon pain among adult volleyball players.
de Groot R, Malliaras P, Munteanu S, Payne C, Morrissey D, Maffulli N.
Clin J Sport Med. 2012 Mar;22(2):157-9.
Abstract
OBJECTIVE: We hypothesized that individuals with a normal foot posture
would be less likely to experience patellar tendon pain and pathology than
those with a pronated or supinated foot.
DESIGN: Observational study.
SETTING: Field-based study among competing athletes.
PARTICIPANTS: Volleyball players competing in the Victorian State League,
Australia.
ASSESSMENT OF RISK FACTORS: Patellar tendinopathy (PT) is common
in sports involving running and jumping and can severely limit athletes’ ability
to compete. Several studies have investigated potential etiological factors for
the development of PT, but little is known about the association between PT
and foot posture.
MAIN OUTCOME MEASURES: Static foot posture index (FPI), patellar
tendon pain during single-leg decline squatting, and gray scale ultrasound
imaging were measured in 78 recreational to elite volleyball players (48 men
and 30 women).
RESULTS: Men with patellar tendon pain were more likely to have a normal
foot posture and men without pain were more likely to be pronated according
to the FPI (P < 0.05). Women showed no association between FPI and pain
or imaging (P > 0.05).
CONCLUSIONS: Men with a normal foot posture were more likely to have
PT compared to men with a pronated foot type.
The first case record of a female patient with buboniclymphogranuloma venereum (LGV), serovariant L2b
Stephan P Verweij, Sander Ouburg, Harry de Vries, Servaas A Morre´,
Cees J W van Ginkel, Hanna Bos, Fré W Sebens
Sex Transm Infect. 2012;88(5):346-7.
Abstract : zie Dermatologie
Assessing cancer patients’ trust in their oncologist: development
and validation of the Trust in Oncologist Scale (TiOS).
Hillen MA, Koning CC, Wilmink JW, Klinkenbijl JH, Eddes EH, KallimanisKing BL, de Haes JC, Smets EM.
Support Care Cancer. 2012;20(8):1787-95.
Abstract
PURPOSE: The aim of this study was to develop and validate the Trust in
Oncologist Scale (TiOS), which aims to measure cancer patients’ trust in
their oncologist. Structure, reliability and validity were examined.
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Heelkunde
[Acute obstructive colon carcinoma and liver metastases: how to treat?].
[Article in Dutch]
Buis CI, Bosker RJ, ter Borg F, de Noo ME, Liem MS.
Ned Tijdschr Geneeskd. 2012;156(43):A4817.
Source
Deventer Ziekenhuis, Afd. Chirurgie, Deventer, the Netherlands.
Abstract
BACKGROUND: The incidence of patients who present with acute obstructive colon carcinoma and synchronous liver metastases is increasing.
CASE DESCRIPTION: Two men aged 70 and 71 both had acute obstructive colon carcinoma with synchronous liver metastases. Both patients
underwent successful stent placement that solved the colonic obstruction.
Five weeks later the first patient underwent an elective surgical procedure at
which both the colon carcinoma and the liver metastases were resected. The
second patient had more widespread metastases and first received chemotherapy. After six courses of chemotherapy the liver metastases became
resectable and he underwent a two-stage liver resection with a left-sided
hemicolectomy.
CONCLUSION: These cases illustrate that placing a stent can be an alternative to an acute operation, and thus can save the patient from an emergency laparotomy with creation of a stoma that needs closure afterwards.
In addition stent placement is a good starting point for an intended curative
treatment trajectory, also in the setting of synchronous liver metastases accompanying the acute obstructive carcinoma.
left hemicolectomy or extended resection, postoperative mortality rate was
41% compared with 7% in patients without additional risk factors.
CONCLUSIONS: For elderly patients with two or more additional risk factors,
a nonelective resection should be considered a high-risk procedure with a
mortality risk of up to 41%. The results of this study could be used to adequately inform patient and family and should have consequences for composing an operative team.
Heelkunde
Nonelective colon cancer resections in elderly patients: results from
the dutch surgical colorectal audit.
Kolfschoten NE, Wouters MW, Gooiker GA, Eddes EH, Kievit J, Tollenaar
RA, Marang-van de Mheen PJ; Dutch Surgical Colorectal Audit group.
Dig Surg. 2012;29(5):412-9.
Collaborators (14)
Author information
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
AIMS: The aim of the study was to assess which factors contribute to postoperative mortality, especially in elderly patients who undergo emergency
colon cancer resections, using a nationwide population-based database.
METHODS: 6,161 patients (1,172 nonelective) who underwent a colon cancer resection in 2010 in the Netherlands were included. Risk factors for postoperative mortality were investigated using a multivariate logistic regression
model for different age groups, elective and nonelective patients separately.
RESULTS: For both elective and nonelective patients, mortality risk increased with increasing age. For nonelective elderly patients (80+ years), each
additional risk factor increased the mortality risk. For a nonelective patient of
80+ years with an American Society of Anesthesiologists score of III+ and a
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Combining process indicators to evaluate quality of care for surgical
patients with colorectal cancer: are scores consistent with short-term
outcome?
Kolfschoten NE, Gooiker GA, Bastiaannet E, van Leersum NJ, van de Velde
CJ, Eddes EH, Marang-van de Mheen PJ, Kievit J, van der Harst E, Wiggers
T, Wouters MW, Tollenaar RA; Dutch Surgical Colorectal Audit group.
BMJ Qual Saf. 2012 Jun;21(6):481-9.
Collaborators (11)
Author information
Department of Surgery, Leiden University Medical Center, PO Box 9600,
Leiden 2300 RC, The Netherlands.
Abstract
OBJECTIVE: To determine if composite measures based on process indicators are consistent with short-term outcome indicators in surgical colorectal
cancer care.
DESIGN: Longitudinal analysis of consistency between composite measures
based on process indicators and outcome indicators for 85 Dutch hospitals.
SETTING: The Dutch Surgical Colorectal Audit database, the Netherlands.
PARTICIPANTS: 4732 elective patients with colon carcinoma and 2239 with
rectum carcinoma treated in 85 hospitals were included in the analyses.
MAIN OUTCOME MEASURES: All available process indicators were aggregated into five different composite measures. The association of the different
composite measures with risk-adjusted postoperative mortality and morbidity
was analysed at the patient and hospital level.
RESULTS: At the patient level, only one of the composite measures was
negatively associated with morbidity for rectum carcinoma. At the hospital
level, a strong negative association was found between composite measures
and hospital mortality and morbidity rates for rectum carcinoma (p<0.05),
and hospital morbidity rates for colon carcinoma.
CONCLUSIONS: For individual patients, a high score on the composite
measures based on process indicators is not associated with better shortterm outcome. However, at the hospital level, a good score on the composite
measures based on process indicators was consistent with more favourable
risk-adjusted short-term outcome rates.
[A contractor with damaged knees].
[Article in Dutch]
van Laarhoven S, Roerdink WH, van Ginkel CJ.
Ned Tijdschr Geneeskd. 2012;156(47):A4561.
Source
Deventer Ziekenhuis, Deventer, Afd. Heelkunde, the Netherlands.
Abstract
A 51-year-old man developed burn wounds on both knees after finishing a cement floor. Cement burns are caused by wet cement, which is highly alkaline
Initial treatment consists of lavage. Further management can be conservative
but in full thickness injuries excision and grafting should be considered.
Acta Chir Belg. 2013 Jan-Feb;113(1):30-4.
Source
Department of Surgery, Deventer Hospital, the Netherlands.
Abstract
BACKGROUND: Diverticulitis can be complicated by a colovesical fistula
(CVF). This phenomenon is relatively uncommon in surgical practice. The
aim of this study was to evaluate diagnostic and surgical management of
CVF at our medical centre.
MATERIAL AND METHODS: In this retrospective study, details of 31 patients
undergoing surgery for CVF between January 1998 and March 2010 were
recorded. These patient records were analysed for presenting symptoms,
diagnostic investigations and surgical procedures.
RESULTS: The most common presenting symptoms were pneumaturia,
urinary tract infections, abdominal pain, and fecaluria. CT identified CVF in
28 patients (92.2%), cystoscopy in 4 patients (23.5%), and barium enema
in 3 patients (13.6%). Surgical management was resection of the diseased
colon segment with primary anastomosis in 29 of 31 patients. The bladder
fistulae were oversewn and an omental plasty was placed between bowel
anastomosis and bladder. There was only one postoperative leak and one
case of mortality (3.2%).
CONCLUSIONS: CT is the most sensitive test in identifying CVF. Resection
of the diseased colon segment and primary anastomosis seems to be an
effective and safe surgical method for treating CVF. This surgical treatment
has an acceptable risk for anastomotic leak and mortality.
Laparoscopic and Open Subtotal Colectomies Have Similar ShortTerm Results.
Hoogenboom FJ, Bosker RJ, Groen H, Meijerink WJ, Lamme B, Pierie JP.
Dig Surg. 2013 Aug 20;30(4-6):265-269.
Author information
Department of Surgery, Medical Centre Leeuwarden and the Leeuwarden
Institute of Minimally Invasive Surgery Leeuwarden, Groningen, The Netherlands.
Abstract
Background: Laparoscopic subtotal colectomy (STC) is a complex procedure. It is possible that short-term benefits for segmental resections cannot
be attributed to this complex procedure. This study aims to assess differences in short-term results for laparoscopic versus open STC during a 15-year
single-institute experience. Methods: We reviewed consecutive patients undergoing laparoscopic or open elective or subacute STC from January 1997
to December 2012. Results: Fifty-six laparoscopic and 50 open STCs were
performed. The operation time was significantly longer in the laparoscopic
Management of colovesical fistulae caused by diverticulitis: 12 years
of experience in one medical centre.
Niebling M, van Nunspeet L, Zwaving H, Eddes EH, Bosker R, Eeftinck
Schattenkerk M.
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Heelkunde
An association between chronic obstructive pulmonary disease
and abdominal aortic aneurysm beyond smoking: results from a casecontrol study.
Meijer CA, Kokje VB, van Tongeren RB, Hamming JF, van Bockel JH, Möller GM, Lindeman JH.
Eur J Vasc Endovasc Surg. 2012 Aug;44(2):153-7.
Author information
Department of Vascular Surgery, Leiden University Medical Center, Leiden,
The Netherlands.
Abstract
OBJECTIVES: It is currently unclear whether the parallels between abdominal aortic aneurysms (AAAs) and chronic obstructive pulmonary disease
(COPD) are explained by common risk factors alone, such as cigarette
smoking, or by a predetermined cause. Given the persistent controversy with
regard to the association between AAA and COPD, we studied this association in depth.
METHODS: We conducted a case-control study comparing patients with a
small AAA (maximum infrarenal diameter 35-50 mm, n = 221) with controls
diagnosed with peripheral artery disease (PAD, n = 87). The controls were
matched to the cases for lifetime cigarette smoking. Pulmonary function was
measured by spirometry, and all subjects completed a questionnaire on medical history and smoking habits (current, former and never smokers).
RESULTS: Aneurysm patients were similar to controls with respect to gender
(p = 0.71), lifetime cigarette smoking (39 vs. 34 pack years, p = 0.23) and
history of cardiovascular disease (45% vs. 55%, p = 0.12). Aneurysm patients had more airway obstruction (forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) (0.69 ± 0.12 vs. 0.78 ± 0.11, p < 0.001)), which was
most pronounced in never smokers (0.73 ± 0.07 vs. 0.86 ± 0.07, p < 0.001).
COPD was more prevalent in aneurysm patients (44%; 98/221) than in controls (20%; 17/87) (adjusted odds ratio (OR) 3.0; 95% confidence interval
(95%CI) 1.6-5.5, p < 0.001). In particular, a major proportion of AAA patients
was newly diagnosed with COPD; only 40 of 98 patients (41%) with COPD
(mild, moderate or severe/very severe) were known before with obstructive
pulmonary defects and received treatment.
CONCLUSIONS: This study confirms an association between AAA and
COPD and shows that this association is independent from smoking. Findings also demonstrate that COPD is under-diagnosed in AAA patients.
Uncommon cause of pneumoperitoneum.
van Nunspeet L, Eddes EH, de Noo ME.
World J Gastrointest Surg. 2013 Dec 27;5(12):329-31
Author information
Department of Surgery, Deventer Ziekenhuis, 7416 SE Deventer,
The Netherlands.
Abstract
Free intraperitoneal air is thought to be pathognomonic for perforation of
a hollow viscus. Here, we present a patient with pain in the upper left quadrant, a mild fever and leukocytosis. Free air was suggested under the left
diaphragm but during the explorative laparotomy no signs of gastric or diverticular perforation were seen. Further exploration and revision of the computed tomography revealed a perforated splenic abscess. Splenic abscesses
are a rare clinical entity. Presenting symptoms are often non-specific and
include upper abdominal pain, recurrent or persistent fever, nausea and
vomiting, splenomegaly, leukocytosis and left lower chest abnormalities.
Predisposing conditions can be very divergent and include depressed immunosuppressed state, metastatic or contiguous infection, splenic infarction
and trauma. Splenic abscess should therefore be considered in a patient
with fever, left upper abdominal pain and leukocytosis. Moreover, our case
shows that splenic abscess can present in an exceptional way without clear
underlying aetiology and should even be considered in the presence of free
abdominal air.
group, median 266 min (range 121-420 min), compared to 153 min (range
90-408 min) in the open group (p < 0.001). Median hospital stay showed no
statistical difference, 14 days (range 1-129 days) in the laparoscopic and
13 days (range 1-85 days) in the open group. Between-group postoperative
complications were not statistically different. Conclusions: Laparoscopic STC
has short-term results similar to the open procedure, except for a longer
operation time. The laparoscopic approach for STC is therefore only advisable in selected patients combined with extensive preoperative counseling.
Wetenschappelijk overzicht 2012 - 2013
[Nonelective colon cancer resections in elderly patients: results from
the Dutch Surgical Colorectal Audit].
[Article in Dutch]
Kolfschoten NE, Wouters MW, Gooiker GA, van Leersum NJ, Eddes EH,
Kievit J, Tollenaar RA, Marang-van de Mheen PJ.
Ned Tijdschr Geneeskd. 2013;157(30):A6426.
Author information
Leids Universitair Medisch Centrum, Leiden, Afd. Heelkunde, the Netherlands.
Abstract
OBJECTIVE: The aim of the study was to identify risk factors for postoperative mortality in patients undergoing surgery for colon cancer. We looked
specifically at patients ≥ 80 years of age in whom a nonelective colon cancer
resection was performed.
STUDY DESIGN: Observational study.
METHODS: We included data from 6,161 patients who underwent colon
cancer surgery in 2010 in a Dutch hospital; a nonelective colon cancer resection was performed in 1,172 of these patients. Risk factors for postoperative mortality were identified using a multivariate logistic regression analysis.
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Heelkunde
Evaluating the validity of quality indicators for colorectal cancer care.
Gooiker GA, Kolfschoten NE, Bastiaannet E, van de Velde CJ, Eddes EH,
van der Harst E, Wiggers T, Rosendaal FR, Tollenaar RA, Wouters MW;
Dutch Surgical Colorectal Audit group.
J Surg Oncol. 2013 Dec;108(7):465-71.
Author information
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
BACKGROUND: Quality indicators (QI) have been developed to measure
quality of colorectal cancer care in the Netherlands. The aim of this study is
to evaluate if these QI consistently assess the quality of colorectal cancer
care in a hospital (internal consistency) and if these QI correlate with each
other (construct validity).
METHODS: The performance of 85 hospitals participating in the Dutch Surgical Colorectal Audit between the 1st of January 2010 and 31st of December 2010, were evaluated on nine QI: three process indicators for colon cancer, three process indicators for rectal cancer and three outcome indicators.
Consistency between all process indicators was assessed, and correlations
between all process and outcome indicators were evaluated for colon and
rectal cancer care separately.
RESULTS: Hospital performance on the nine QI ranged widely. There was
little consistency between the process indicators in assessing hospital performance. Most evaluated process indicators for colorectal cancer care did
not correlate with each other, but were associated with better hospital specific patient outcomes.
CONCLUSION: QI on colorectal cancer care do provide complementary information. Individual QI are not suitable as a surrogate measure for the quality of colorectal cancer care. More comprehensive measures are needed for
true assessment of hospital performance.
We studied elective and nonelective intestinal resections separately in different age groups.
RESULTS: Mortality in the total study population was 4.9%. Mortality increased with age in patients who underwent either elective or nonelective
intestinal resection. For patients ≥ 80 years of age who underwent nonelective intestinal resection, each additional risk factor doubled the mortality risk.
In patients aged ≥ 80 years with an American Society of Anesthesiologists
classification of class ≥ 3 who underwent a left hemicolectomy or ‘other’ intestinal resection, the postoperative mortality rate was 41%; in patients of the
same age without additional risk factors this was 7%.
CONCLUSIONS: In patients ≥ 80 years of age with 2 or more additional risk
factors, nonelective intestinal resection should be considered a high-risk
procedure with a mortality risk of up to 41%. This result can be used in clinical decision making concerning treatment and in providing information for
patients and their families.
diagnostics, preoperative multidisciplinary meetings and standardised reporting increased; complication-, re-intervention and postoperative mortality
rates decreased significantly.
DISCUSSION: The success of the DSCA is the result of effective surgical
collaboration. The leading role of the ASN in conducting the audit resulted in
full participation of all colorectal surgeons in the Netherlands. By integrating
the audit into the ASNs’ quality assurance policy, it could be used to set national quality standards. Future challenges include reduction of administrative
burden; expansion to a multidisciplinary registration; and addition of financial
information and patient reported outcomes to the audit data.
[Improving healthcare and its manageability].
[Article in Dutch]
Eddes EH.
Ned Tijdschr Geneeskd. 2013;157(25):A6485.
Author information
Deventer Ziekenhuis, afd. Heelkunde, Deventer, the Netherlands.
Abstract
Healthcare in the Netherlands is facing serious challenges. With an ageing
population, the consumption of healthcare is on the rise. Quality needs to
go up while costs have to go down. The Netherlands Institute for Social
Research estimates that healthcare costs, as a percentage of the Gross
Domestic Product, will rise from 13% in 2011 (90 billion euros) up to 31%
in 2040. Clear choices need to be made in the near future; otherwise, the
cost of healthcare will become prohibitive. This commentary explains why
volume-directed healthcare alone is not the magic answer. Besides criteria
related to process and structure, we are also in need of robust and valid
data. Clinical auditing combined with patient-reported outcome measures
(PROMs) and financial data will give the additional tools needed to improve
and manage healthcare.
Wetenschappelijk overzicht 2012 - 2013
Focusing on desired outcomes of care after colon cancer resections;
hospital variations in ‘textbook outcome’.
Kolfschoten NE, Kievit J, Gooiker GA, van Leersum NJ, Snijders HS, Eddes
EH, Tollenaar RA, Wouters MW, Marang-van de Mheen PJ.
Eur J Surg Oncol. 2013 Feb;39(2):156-63.
Author information
Leiden University Medical Centre, Dept of Surgery K6-R, P.O. Box 9600,
2300 RC Leiden, The Netherlands.
Abstract
AIMS: We propose a summarizing measure for outcome indicators, representing the proportion of patients for whom all desired short-term outcomes
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Heelkunde
The Dutch surgical colorectal audit.
Van Leersum NJ, Snijders HS, Henneman D, Kolfschoten NE, Gooiker GA,
ten Berge MG, Eddes EH, Wouters MW, Tollenaar RA; Dutch Surgical Colorectal Cancer Audit Group, Bemelman WA, van Dam RM, Elferink MA, Karsten TM, van Krieken JH, Lemmens VE, Rutten HJ, Manusama ER, van de
Velde CJ, Meijerink WJ, Wiggers T, van der Harst E, Dekker JW, Boerma D.
Eur J Surg Oncol. 2013 Oct;39(10):1063-70.
Author information
Leiden University Medical Center, Leiden, Department of Surgery, The Netherlands.
Abstract
INTRODUCTION: In 2009, the nationwide Dutch Surgical Colorectal Audit
(DSCA) was initiated by the Association of Surgeons of the Netherlands
(ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is
currently widely used as a blueprint for the initiation of other audits, coordinated by the Dutch Institute for Clinical Auditing (DICA). This article illustrates
key elements of the DSCA and results of three years of auditing.
METHODS: Key elements include: a leading role of the professional association with integration of the audit in the national quality assurance policy;
web-based registration by medical specialists; weekly updated online feedback to participants; annual external data verification with other data sources; improvement projects.
RESULTS: In two years, all Dutch hospitals participated in the audit. Caseascertainment was 92% in 2010 and 95% in 2011. External data verification
by comparison with the Netherlands Cancer Registry (NCR) showed high
concordance of data items. Within three years, guideline compliance for
of care (a ‘textbook outcome’) is realized. The aim of this study was to investigate hospital variation in the proportion of patients with a ‘textbook outcome’ after colon cancer resections in the Netherlands.
METHODS: Patients who underwent a colon cancer resection in 2010 in the
Netherlands were included in the Dutch Surgical Colorectal Audit. A textbook
outcome was defined as hospital survival, radical resection, no reintervention, no ostomy, no adverse outcome and a hospital stay < 14 days. We
calculated the number of hospitals with a significantly higher (positive outlier)
or lower (negative outlier) Observed/Expected (O/E) textbook outcome than
average. As quality measures may be more discriminative in a low-risk population, analyses were repeated for low-risk patients only.
RESULTS: A total of 5582 patients, treated in 82 hospitals were included.
Average textbook outcome was 49% (range 26-71%). Eight hospitals were
identified as negative outliers. In these hospitals a ‘textbook outcome’ was
realized in 35% vs. 52% in average hospitals (p < 0.01). In a sub-analysis for
low-risk patients, only one additional negative outlier was identified.
CONCLUSIONS: The textbook outcome, representing the proportion of patients with a perfect hospitalization, gives a simple comprehensive summary
of hospital performance, while preventing indicator driven practice. Therewith
the ‘textbook outcome’ is meaningful for patients, providers, insurance companies and healthcare inspectorate.
further explored hospital differences in LR and conversion rates.
RESULTS: A total of 7350 patients, treated in 90 hospitals, were included.
LR rate was 41% with a conversion rate of 15%. After adjustment for differences in case-mix, LR was associated with a lower risk of mortality (odds
ratio 0.63, P < 0.01), major morbidity (odds ratio 0.72, P < 0.01), any complications (odds ratio 0.74, P < 0.01), hospital stay more than 14 days (odds
ratio 0.71, P < 0.01), and irradical resections (odds ratio 0.68, P < 0.01),
compared to OR. Outcome after conversion was similar to OR (P > 0.05). A
large variation in LR and conversion rates among hospitals was found; however, the difference in outcome associated with operative techniques was
not influenced by hospital of treatment.
CONCLUSIONS: Use of laparoscopic techniques in colorectal cancer surgery in the Netherlands is safe and results are better in short-term outcome
than open surgery, irrespective of the hospital of treatment. Outcome after
conversion was similar to OR.
Successful and safe introduction of laparoscopic colorectal cancer
surgery in Dutch hospitals.
Kolfschoten NE, van Leersum NJ, Gooiker GA, Marang van de Mheen PJ,
Eddes EH, Kievit J, Brand R, Tanis PJ, Bemelman WA, Tollenaar RA, Meijerink J, Wouters MW.
Ann Surg. 2013 May;257(5):916-21.
Author information
Department of Surgery †Medical Decision Making, Leiden University Medical
Center, The Netherlands.
Abstract
OBJECTIVE: To investigate the safety of laparoscopic colorectal cancer resections in a nationwide population-based study.
BACKGROUND: Although laparoscopic techniques are increasingly used
in colorectal cancer surgery, little is known on results outside trials. With the
fast introduction of laparoscopic resection (LR), questions were raised about
safety.
METHODS: Of all patients who underwent an elective colorectal cancer
resection in 2010 in the Netherlands, 93% were included in the Dutch Surgical Colorectal Audit. Short-term outcome after LR, open resection (OR),
and converted LR were compared in a generalized linear mixed model. We
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Heelkunde
Evaluation of the effect of a comprehensive multidisciplinary care
pathway for hip fractures: design of a controlled study.
Flikweert ER, Izaks GJ, Reininga IH, Wendt KW, Stevens M.
BMC Musculoskelet Disord. 2013 Oct 12;14:291.
Author information
Department of Surgery-Traumatology, University of Groningen, University
Medical Center Groningen, P,O, Box 30,001, 9700 RB, Groningen, The Netherlands.
Abstract
BACKGROUND: Hip fractures constitute an economic burden on healthcare
resources. Most persons with a hip fracture undergo surgery. As morbidity
and mortality rates are high, perioperative care leaves room for improvement. Improvement can be achieved if it is organized in comprehensive care
pathways, but the effectiveness of these pathways is not yet clear. Hence
the objective of this study is to compare the clinical effectiveness of a comprehensive care pathway with care as usual on self-reported limitations in
Activities of Daily Living.
METHODS/DESIGN: A controlled trial will be conducted in which the comprehensive care pathway of University Medical Center Groningen will be
compared with care as usual in two other, nonacademic, hospitals. In this
trial, propensity scores will be used to adjust for differences at baseline
between the intervention and control group. Propensity scores can be used
in intervention studies where a classical randomized controlled trial is not
feasible. Patients aged 60 years and older will be included. The hypothesis
is that 15% more patients at University Medical Center Groningen compared
with patients in the care-as-usual condition will have recovered at least as
well at 6 months follow-up to pre-fracture levels for Activities of Daily Living.
DISCUSSION: This study will yield new knowledge with respect to the clinical effectiveness of a comprehensive care pathway for the treatment of hip
fractures. This is relevant because of the growing incidence of hip fractures
and the consequent massive burden on the healthcare system. Additionally,
this study will contribute to the growing knowledge of the application of propensity scores, a relatively novel statistical technique to simulate a randomized controlled trial in studies where it is not possible or difficult to execute
this kind of design.
Box 9600, 2300 RC, Leiden, The Netherlands.
Abstract
PURPOSE: This paper reports the external validation of a recently developed instrument, the Discharge of Hip fracture Patients score (DHP) that
predicts discharge location on admission in patients living in their own home
prior to hip fracture surgery.
METHODS: The DHP (maximum score 100 points) was applied to 125 hip
fracture patients aged 50 or more years admitted to an academic centre in
the northern part of The Netherlands (Groningen cohort). The characteristics of this cohort, sensitivity, specificity and positive and negative predictive
value (PPV, NPV) of the DHP for discharge to an alternative location (DAL)
were calculated and compared with the original cohort of hip fracture patients from the western part of The Netherlands (Delft cohort). Scoring 30
points or higher indicated DAL.
RESULTS: The Groningen cohort was younger compared to the Delft cohort,
(mean age 75.4 vs. 78.5 years, P = 0.005) but was more often classified ASA
III/IV (46.4% vs. 25.2%, P < 0.001). Sensitivity of the DHP for DAL in the Groningen cohort was 75% (vs. 83.8%), specificity of 66.7% (vs. 64.7%) and a
PPV of 86.3% (vs. 79.2%), compared to the Delft cohort.
CONCLUSION: External validation of the DHP was successful; it predicted
discharge location of hip fracture patients accurately in another Dutch cohort,
the sensitivity for DAL was somewhat lower but the PPV higher. Therefore,
the DHP score is a useful valid and easily applied instrument for general hip
fracture populations.
The usefulness of lean six sigma to the development of a clinical
pathway for hip fractures.
Niemeijer GC, Flikweert E, Trip A, Does RJ, Ahaus KT, Boot AF, Wendt KW.
J Eval Clin Pract. 2013 Oct;19(5):909-14.
Author information
Department of Lean Six Sigma (5Q202), Martini Hospital Groningen, Groningen, The Netherlands.
Abstract
AIMS AND OBJECTIVES: The objective of this study was to show the usefulness of lean six sigma (LSS) for the development of a multidisciplinary
clinical pathway.
METHODS: A single centre, both retrospective and prospective, non-randomized controlled study design was used to identify the variables of a prolonged length of stay (LOS) for hip fractures in the elderly and to measure the
effect of the process improvements--with the aim of improving efficiency of
care and reducing the LOS.
RESULTS: The project identified several variables influencing LOS, and interventions were designed to improve the process of care. Significant results
were achieved by reducing both the average LOS by 4.2 days (-31%) and
the average duration of surgery by 57 minutes (-36%). The average LOS of
patients discharged to a nursing home reduced by 4.4 days.
CONCLUSION: The findings of this study show a successful application
of LSS methodology within the development of a clinical pathway. Further
research is needed to explore the effect of the use of LSS methodology at
clinical outcome and quality of life.
External validation of the discharge of hip fracture patients score.
Vochteloo AJ, Flikweert ER, Tuinebreijer WE, Maier AB, Bloem RM, Pilot P,
Nelissen RG.
Int Orthop. 2013 Mar;37(3):477-82.
Author information
Department of Orthopaedic Surgery, Leiden University Medical Center, P.O.
Wetenschappelijk overzicht 2012 - 2013
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Heelkunde
Complications following the extended lateral approach for calcaneal
fractures do not influence mid- to long-term outcome.
De Groot R, Frima AJ, Schepers T, Roerdink WH
Injury. 2013 Nov;44(11):1596-600.
Author information
Department of Surgery, Deventer Hospital, Deventer, The Netherlands.
Abstract
BACKGROUND AND AIM: Open reduction and internal fixation (ORIF) of
intra-articular calcaneal fractures through an extended lateral approach is
frequently accompanied by a high complication rate. However, ORIF currently provides the best long-term clinical results. The aim of this study was
twofold: (1) to evaluate both mid- to long-term clinical and radiological results
of a consecutive series treated by ORIF and (2) to determine the influence of
short-term complications on long-term clinical outcome.
METHODS: Patients with a displaced intra-articular calcaneal fracture, treated with ORIF, through an extended lateral approach, in a level-2 trauma
centre between 1995 and 2008 were evaluated for the study. The long-term
tients ≤70 years. Tumour specimens were analysed for microsatellite instability
(MSI), immunohistochemical mismatch-repair protein expression and MLH1promoter methylation. Tumours were classified as either: (a) likely caused by
LS; (b) sporadic microsatellite-unstable (MSI-H); or (c) microsatellite-stable
(MSS). Predictors of LS were determined by multivariable logistic regression. A
total of 1117 CRC patients (57% males, median age 61 years) were included.
Fifty patients (4.5%, 95% CI 3.4-5.9) were likely to have LS, and 71 had a sporadic MSI-H tumour (6.4%, 95% CI 5.1-8.0). Thirty-five patients likely to have
LS (70%) were aged > 50 years. A molecular profile compatible with LS was
detected in 10% (15/144) of patients aged ≤50, in 4% (15/377) of those aged
51-60 and in 3% (20/596) of patients > 61 years. Compared to MSS cases,
patients likely to have LS were significantly younger (OR 3.9, 95% CI 1.7-8.7)
and more often had right-sided CRCs (OR 14, 95% CI 6.0-34). In conclusion,
molecular screening for LS in CRC patients ≤70 years leads to identification of
a molecular profile compatible with LS in 4.5% of patients, with most of them
not fulfilling the age criterion (≤50 years) routinely used for LS assessment.
Routine use of MSI testing may be considered in CRC patients up to the age
of 70 years, with a central role for the pathologist in the selection of patients.
Zwelling lies na operatief herstel van een pertrochantaire femurfractuur.
Dijkstra ML, Van Tongeren RB, Van der Hem LG
Ned Tijdschr Heelkd 2013;5:201.
Bias towards dementia: are hip fracture trials excluding too many
patients? A systematic review.
Hebert-Davies J, Laflamme GY, Rouleau D; HEALTH and FAITH investigators.
Injury. 2012 Dec;43(12):1978-84.
Collaborators (604)
Roerdink WH, Frima AH, Flikweert ER
Author information
University of Montréal, Hôpital du Sacré Cœur, 5400 Gouin Ouest, Local
J-3245, Montréal, Québec, Canada
Abstract
Patients with hip fractures are older and often present many co-morbidities,
including dementia. These patients cannot answer quality of life questionnaires and are generally excluded from trials. We hypothesized that a significant number of patients are being excluded from these studies and this may
impact outcomes. This was a two part study; the first analyzing databases
of two ongoing large-scale multi-centred hip fracture trials and the second
being a systematic review. The FAITH and HEALTH studies were analyzed
for exclusion incidence directly related to dementia. The second part consisted of a systematic search of all relevant studies within the last 20 years.
In the FAITH study, a total of 1690 subjects were excluded, 375 (22.2%) of
which were due to dementia or cognitive impairment. In the HEALTH study,
575 were excluded with dementia/cognitive impairment representing 207
patients (36%). Following the systematic review, 251 articles were identified
Collaborations
Heelkunde
Yield of routine molecular analyses in colorectal cancer patients ≤70
years to detect underlying Lynch syndrome.
van Lier MG, Leenen CH, Wagner A, Ramsoekh D, Dubbink HJ, van den
Ouweland AM, Westenend PJ, de Graaf EJ, Wolters LM, Vrijland WW, Kuipers EJ, van Leerdam ME, Steyerberg EW, Dinjens WN; LIMO Study Group.
J Pathol. 2012 Apr;226(5):764-74.
Collaborators (23)
Eddes EH.
Author information
Department of Gastroenterology and Hepatology, Erasmus MC, University
Medical Centre, Rotterdam, The Netherlands.
Abstract
Although early detection of Lynch syndrome (LS) is important, a considerable
proportion of patients with LS remains unrecognized. We aimed to study the
yield of LS detection by routine molecular analyses in colorectal cancer (CRC)
patients until 70 years of age. We prospectively included consecutive CRC paWetenschappelijk overzicht 2012 - 2013
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functional outcome (American Orthopaedic Foot & Ankle Society (AOFAS),
36-Item Short-Form Health Survey (SF-36) and Visual Analogue Scale
(VAS)) and radiographic results (e.g., Böhler and Gissane angle, height,
width and joint reduction) were determined. Short- and long-term complications were documented.
RESULTS: A total of 57 patients matched the inclusion criteria, from which 39
patients agreed to participate in this study (68%). The median follow-up was
6.5 years (range 2-16 years). Based on the AOFAS hindfoot score, 74% of the
patients had a good-to-excellent long-term clinical result. Radiological results
were satisfying with a median postoperative Böhler angle of 26° and 25° at
follow-up. Complications occurred in 32% of all patients; mainly wound-healing
problems were noted. Short-term complications did not influence mid- to longterm clinical results (p>0.05). Anatomic reconstruction of the calcaneus was
associated with improved long-term clinical results (p<0.05).
CONCLUSION: Despite the high complication rate following ORIF of a
calcaneal fracture, complications do not affect mid- to long-term clinical outcome. Surgical treatment should focus on restoring the anatomy. Level of
evidence: Therapeutic level IV.
17 of which were retained. The overall prevalence of dementia was 27.9%
(range 2-51%). Only two studies compared demented and non-demented
groups. In these studies significant increases in both mortality and complications were found. In summary, when investigating hip fractures, choosing
appropriate objective endpoints is essential to ensure results are also applicable to patients with dementia.
Voordrachten
Complicaties na open repositie en interne fixatie van gedisliceerde
intra-articulaire calcaneus fracturen hebben geen invloed op de langetermijn resultaten.
R de Groot, AJ Frima, T Schepers, WH Roerdink
Assistentensymposium traumachirurgie
Soestduinen, 29 januari 2012
Wetenschappelijk overzicht 2012 - 2013
A successfull integration.
Eddes EH
IHI
Orlando, USA, December 2012
Plug and Play registraties volgens een vast format.
Eddes EH
Hans Mak
Zeist, 2012
Predictions for succesfull auditing.
Eddes EH
IKNL
Utrecht, November 2012
De waarde van klinische kwaliteitsregistraties volgens een vast format.
Eddes EH
Delegatie Binnenlandse Zaken
Leiden, september 2012
Plug and Play registraties volgens een vast format.
Eddes EH
Dutch Spine Week
Amsterdam, juni 2012
Inzicht in kwaliteit door betrouwbare kwaliteitsregistraties.
Eddes EH
Nederlandse Vereniging voor Plastische Chirugie
Mei 2012
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Heelkunde
Heelkunde
Hepatic resection for metastatic melanoma in The Netherlands: survival and prognostic factors.
de Ridder J, van Walsum M, Verhoef C, Nagtegaal I, de Wilt J; Dutch Liver
Working Group.
Melanoma Res. 2013 Feb;23(1):27-32.
Collaborators (12)
Liem MS
Author information
Department of aSurgical Oncology, Radboud University Nijmegen Medical
Centre, Nijmegen, The Netherlands.
Abstract
Patients with hepatic metastases of melanoma have a very poor prognosis,
with a median overall survival of less than 6 months. There are several small
heterogeneous studies that have shown an association with prolonged survival in those patients treated with hepatic resection, but the role of surgery
remains unclear. We evaluated the safety and efficacy of hepatic resection
in a population-based study in the Netherlands for patients with metastatic
melanoma and assessed the factors that could affect disease-free and overall
survival. Patients with hepatic melanoma metastases who underwent potentially curative resection were identified between 1994 until 2010 using the PALGA database, a nation-wide network and registry of histopathology and cytopathology in the Netherlands. They were retrospectively evaluated for clinical
and pathological factors with respect to recurrence and survival using KaplanMeier curves to assess survival and univariate regression analysis for the
assessment of potential prognostic factors. A total of 32 patients were identified in 15 hospitals, 19 men and 13 women. The median age of the patients
at the time of hepatic resection was 52 years (range 27-69). Postoperative
complications occurred in five patients (15%), without postoperative mortality.
The median follow-up was 21 months (range 3-65). The median disease-free
survival was 11 months (range 0-57) and the median overall survival was
29 months (range 4-66). Significant prognostic factors for overall survival in
univariate analysis were the distribution and number of metastases, as well
as the type of hepatic resection (major or minor). Hepatic resection in patients
with resectable metastatic melanoma is safe and might be associated with a
prolonged survival in a highly selected group of patients.
Het starten van een registratie.
Eddes EH
DICA congres
Bussum, april 2012
De waarde van klinische kwaliteitsregistraties volgens een vast format.
Eddes EH
Congres bevolkingsonderzoek
Utrecht, februari 2013
Transparantie, keuzes en verbetering van zorg.
Eddes EH
DICA congres
Bussem, april 2012
De waarde van klinische kwaliteitsregistraties volgens een vast format.
Eddes EH
Gemeente Eindhoven
Eindhoven, maart 2013
Controversie in pancreascarcinoom.
Nunspeet van L, Reemst PHM
Post-SSO meeting van de NVCO
Zeist, 18 april 2013
Betere zorg door clinical auditing.
Eddes EH
Boer en Croon
Amsterdam, februari 2013
Kwaliteit van zorg en wetenschappelijk onderzoek.
Eddes EH
Nederlandse Vereniging voor Vaatchirurgie
November 2013
Extramurale veneuze invasie bij coloncarcinomen.
De Noo ME
Najaarsvergadering NVVH
Den Bosch, November 2013
Betere zorg door registraties?
Eddes EH
Nederlandse Vereniging voor Radiotherapeuten
Rotterdam, november 2013
Van biobank naar kliniek: de connectie bij colorectale tumoren.
De Noo ME
Regiodag Heelkunde
Zwolle, November 2013
DICA registraties en DICA knop, voer voor pathologen.
Eddes EH
Nederlandse Vereniging voor Pathologie
Utrecht, november 2013
Extramurale veneuze invasie bij coloncarcinomen.
De Noo ME
Sessie Pathologie DSCA, DICA congres
Amsterdam, juni 2013
Investeer in kwaliteit.
Eddes EH
DICA congres
Amsterdam, juni 2013
Hoofdstuk pathologie
De Noo ME, Van Krieken J
Jaarrapportage Dutch Surgical Clinical Audit, DICA rapportage 2013
Wetenschappelijk overzicht 2012 - 2013
Heelkunde
Heelkunde
De waarde van klinische kwaliteitsregistraties volgens een vast format.
Eddes EH
Nederlandse Traumadagen
Zwolle, juni 2013
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Interne Geneeskunde
Posters
Complications following the extended lateral approach for calcaneal
fractures do not influence long-term outcome
de Groot R, Frima AJ, Schepers T, Roerdink WH.
European Congress of Trauma & Emergency Surgery
Basel, Zwitserland, 12-15 mei 2012
Publicaties
[Differences in Dutch guidelines for chronic renal damage: no major
consequences for the practice].
[Article in Dutch]
Sluiter HE.
Ned Tijdschr Geneeskd. 2012;156(50):A5679.
Source
Deventer Ziekenhuis, afd. Interne Geneeskunde, Deventer, the Netherlands.
Abstract
The criteria in the 2009 Dutch National Transmural Agreement (LTA) for chronic renal damage are used in patient care. But in 2012, patient referral patterns have not fully adhered to this guideline. This commentary indicates that
the availability of a similar 2009 guideline used by nephrologists in in-hospital
care may cause confusion. As new evidence accumulates, it is reasonable to
expect a new 2014 guideline that will bring the two guidelines together. This
will lead to even greater adherence in referral patterns in the Netherlands.
De waarde van de STOPPA procedure in de hedendaagse praktijk.
Kortlandt F, de Noo ME, Frima AJ
Chirurgendagen, Veldhoven, mei 2012
Fifteen years of experience with anal fistula surgery.
Sprakel J, Eddes EH, de Noo ME
Proctology conference
St. Gallen, november 2012
Ultrasound imaging of colorectal liver metastases: still relevant or
already outdated?
Al Ali C, van Dijk RAJM, Bosker RJI, Klok CFM, Liem MSL
Essen, Duitsland, 2013
Boek(bijdrage)
Handboek colorectaal carcinoom / C.J.A. Punt
De Tijdstroom, mei 2012
ISBN 9789058981967
Hoofdstuk : Kwaliteit van (oncologische) zorg in Nederland
NE Kolfschoten, GA Gooiker, MW Wouters, RA Tollenaar, EH Eddes
Heelkunde
An unusual cause of hyperandrogenism.
Wendker-van Wattum M, Wouters RS, van der Wal JE, Glaudemans AW,
Wolffenbuttel BH.
Neth J Med. 2012 Jan;70(1):41, 45.
Wetenschappelijk overzicht 2012 - 2013
70
71
Wetenschappelijk overzicht 2012 - 2013
Interne Geneeskunde
Severe hepatitis with coagulopathy due to HSV-1 in an immunocompetent man.
Wind L, van Herwaarden M, Sebens F, Gerding M.
Neth J Med. 2012 Jun;70(5):227-9.
Source
Department of Internal Medicine, Deventer Hospital, the Netherlands.
Abstract
Severe hepatitis due to herpes simplex virus type 1 (HSV-1) in immunocompetent patients is a very rare event. The acute hepatitis may lead to fulminant deterioration of liver function and can be rapidly fatal. The diagnosis
should be considered in case of severe hepatitis of unknown cause. Early
consideration of HSV-1 hepatitis in the differential diagnosis in an adult patient, also with an apparently normal immune system, is important and early
initiation of antiviral treatment may be lifesaving in this situation.
The role of FDG PET-CT in the preoperative work up of colorectal
liver metastasis.
Al Ali C, Manders JMB, Smit FW, Bosker RJI, Liem MSL
Essen, Duitsland, 2013
Segmental and global subclasses of class IV lupus nephritis have
similar renal outcomes.
Haring CM, Rietveld A, van den Brand JA, Berden JH.
J Am Soc Nephrol. 2012 Jan;23(1):149-54.
Author information
Department of Nephrology, Radboud University, Nijmegen Medical Centre
Abstract
Whether renal outcomes differ between the segmental and global subclasses of diffuse proliferative (class IV) lupus nephritis is unknown. In this metaanalysis, we searched the literature in MEDLINE, EMBASE, five registries of
clinical trials, and selected cohort studies and randomized, controlled trials
that used the 2003 International Society of Nephrology and Renal Pathology
Society classification of lupus nephritis in adult patients. Our endpoint was the
composite of doubling of serum creatinine concentration or ESRD. In the eight
studies included in the final analysis, the incidence of this endpoint varied
between 0% and 67%. A funnel plot and Egger’s test did not suggest significant heterogeneity. The meta-analysis did not support a significant difference
in renal outcome between the segmental (IV-S) and global (IV-G) subclasses
(relative risk for class IV-G versus IV-S, 1.08; 95% confidence interval, 0.681.70). Meta-regression did not suggest that ethnicity or duration of follow-up
influenced the association between histologic class and renal risk. In conclusion, the rate of doubling of serum creatinine concentration or of ESRD did not
differ between patients with class IV-S and those with IV-G lupus nephritis.
Source
Department of Internal Medicine, Deventer Hospital, the Netherlands.
Inventarisatie van potentieel geneesmiddelgerelateerde problemen
bij oncologiepatiënten (ONCOMIND)
Bulsink A, Boor SD, Imholz ALT, Brouwers JRBJ, Jansman FGA
PW Wetenschappelijk Platform 2012;6:85-8.
Abstract
Zie Ziekenhuisfarmacie
Wetenschappelijk overzicht 2012 - 2013
Multifactorial intervention with nurse practitioners does not change
cardiovascular outcomes in patients with chronic kidney disease.
van Zuilen AD, Bots ML, Dulger A, van der Tweel I, van Buren M, Ten Dam
MA, Kaasjager KA, Ligtenberg G, Sijpkens YW, Sluiter HE, van de Ven PJ,
Vervoort G, Vleming LJ, Blankestijn PJ, Wetzels JF.
Kidney Int. 2012 Sep;82(6):710-7.
Author information
Department of Nephrology, University Medical Center Utrecht, Utrecht,
The Netherlands.
Abstract
Strict implementation of guidelines directed at multiple targets reduces
vascular risk in diabetic patients. Whether this also applies to patients with
chronic kidney disease (CKD) is uncertain. To evaluate this, the MASTERPLAN Study randomized 788 patients with CKD (estimated GFR 20-70 ml/
min) to receive additional intensive nurse practitioner support (the intervention group) or nephrologist care (the control group). The primary end point
was a composite of myocardial infarction, stroke, or cardiovascular death.
During a mean follow-up of 4.62 years, modest but significant decreases
72
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Interne Geneeskunde
Interne Geneeskunde
Clinical correlates of ‘BRCAness’ in triple-negative breast cancer of
patients receiving adjuvant chemotherapy.
Oonk AM, van Rijn C, Smits MM, Mulder L, Laddach N, Savola SP, Wesseling J, Rodenhuis S, Imholz AL, Lips EH.
Ann Oncol. 2012 Sep;23(9):2301-5.
Author information
Departments of Medical Oncology, The Netherlands Cancer Institute-Antoni
van Leeuwenhoek Hospital, Plesmanlaan 121,1066 CX Amsterdam, The
Netherlands.
Abstract
BACKGROUND: We have previously reported an array comparative genomic hybridization profile that identifies triple-negative breast cancers (TNBC),
with BRCA1 dysfunction and a high sensitivity to intensified dose bifunctional
alkylating agents. To determine the effect of conventional-dose chemotherapy in patients with this so-called BRCA1-like profile, clinical characteristics
and survival were studied in a large group of TNBC patients.
PATIENTS AND METHODS: DNA was isolated and BRCA1-like status was
assessed in 101 patients with early-stage TNBC receiving adjuvant cyclophosphamide-based chemotherapy. Clinical characteristics and survival were
compared between BRCA1-like and non-BRCA1-like groups. Results Sixtysix tumors (65%) had a BRCA1-like profile. Patients with BRCA1-like tumors
tended to be younger and had more often node-negative disease (P = 0.06
and P = 0.03, respectively). Five-year recurrence-free survival was 80% for
the BRCA1-like group and 75% for the non-BRCA1-like group (P = 0.35). T
stage was the only variable significantly associated with survival.
CONCLUSIONS: BRCA1-like tumors share clinical features, like young age
at diagnosis and similar nodal status, with breast cancers in BRCA1 mutation carriers. Their prognosis is similar to that of non-BRCA1-like tumors
when conventional-dose chemotherapy is administered. TNBCs that are
classified as BRCA1-like may contain a defect in homologous recombination
and could, in theory, benefit from the addition of poly ADP ribose polymerase
inhibitors.
were found for blood pressure, LDL cholesterol, anemia, proteinuria along
with the increased use of active vitamin D or analogs, aspirin and statins in the
intervention group compared to the controls. No differences were found in the
rate of smoking cessation, weight reduction, sodium excretion, physical activity, or glycemic control. Intensive control did not reduce the rate of the composite end point (21.3/1000 person-years in the intervention group compared
to 23.8/1000 person-years in the controls (hazard ratio 0.90)). No differences
were found in the secondary outcomes of vascular interventions, all-cause
mortality or end-stage renal disease. Thus, the addition of intensive support by
nurse practitioner care in patients with CKD improved some risk factor levels,
but did not significantly reduce the rate of the primary or secondary end points.
uiteen van 40 tot 80 mmHg en de gemiddelde TcpO2-waarden in de zes subgroepen verschilden niet significant van elkaar (chi-square = 3,18,9 = 0.673).
CONCLUSIES: Zowel de intraobserverovereenstemming als de interobserverovereenstemming is erg goed, hoewel er een aanzienlijke spreiding wordt
gezien (bij beperkt aantal referentiewaarden). Hier moet rekening mee worden gehouden bij het volgen van de NIV-richtlijk bij het opsporen van kritische ischemie. De TcpO2-waarde bij patiënten met diabetes mellitus zonder
een voetulcus neemt niet significant af met de leeftijd (in onze beperkte categorie referentiewaarden).
Characteristics of potential drug-related problems among oncology
patients.
Bulsink A, Imholz AL, Brouwers JR, Jansman FG
Int J Clin Pharm. 2013 Jun;35(3):401-7.
Samenvatting: zie Ziekenhuisfarmacie
Wetenschappelijk overzicht 2012 - 2013
VEGF levels in plasma in relation to platelet activation, glycemic control, and microvascular complications in type 1 diabetes.
Schlingemann RO, Van Noorden CJ, Diekman MJ, Tiller A, Meijers JC,
Koolwijk P, Wiersinga WM.
Diabetes Care. 2013 Jun;36(6):1629-34.
Author information
Ocular Angiogenesis Group, Departments of Ophthalmology and Cell Biology and Histology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Abstract
OBJECTIVE: Increased levels of vascular endothelial growth factor (VEGF)
in human plasma samples have suggested that circulating VEGF is a cause
of endothelial dysfunction in diabetes mellitus. However, artificial release of
VEGF from platelets as a source of VEGF in plasma samples, as also occurs in serum samples, has not been ruled out in these studies.
RESEARCH DESIGN AND METHODS: We determined VEGF levels in plasma collected in both citrate and PECT, a medium that inactivates platelets,
in a cross-sectional cohort of 21 healthy subjects and 64 patients with type
1 diabetes. In addition, we evaluated whether VEGF levels in both types of
plasma correlated with the presence of diabetes, glycemic control, markers
of in vivo or ex vivo platelet activation, and degree of diabetic retinopathy
and nephropathy.
RESULTS: VEGF levels were invariably low in PECT plasma of both nondiabetic and diabetic subjects and were unrelated to any other diabetes-related
variable studied. In contrast, VEGF levels in citrate plasma were 150%
higher in diabetic patients than in control subjects and correlated with diabe74
75
Wetenschappelijk overzicht 2012 - 2013
Interne Geneeskunde
Interne Geneeskunde
Transcutane zuurstofmeting is betrouwbaar toepasbaar bij patiënten
met diabetes gecompliceerd door een voetulcus.
Nederlands Tijdschrift voor Diabetologie 2013;11(2):60-64
Dijkstra-Bloemendal AH, Wind LJN, Gerding MN
Samenvatting
DOEL: Het meten van de intra- en interobservervariabiliteit van de transcutane zuurstofmeting (TcpO2) bij patiënten met een diabetisch voetulcus om
ischemie vroegtijdig op te sporen. Daarnaast het vaststellen van referentiewaarden in een groep patiënten met diabetes mellitus (DM) zonder een voetulcus naar leeftijd en geslacht.
METHODEN: Het onderzoek werd uitgevoerd in het Deventer Ziekenhuis
en in een podotherapiepraktijk. Bij 25 patiënten werd driemaal de TcpO2waarde gemeten; één meting werd uitgevoerd door een paramedicus en
twee metingen werden uitgevoerd door de onderzoeker. Intra- en interobservervariabiliteit werden onderzocht door het berekenen van de intraclass correlation coëfficiënt (ICC) en werden grafisch weergegeven met behulp van
Bland-Altman-plots. Voor het genereren van referentiewaarden werden 43
patiënten met diabetes mellitus onder behandeling van een podotherapeut
geïncludeerd en geclassificeerd in zes subgroepen, gestratificeerd naar geslacht en leeftijd per decade. De TcpO2-waarden in de subgroepen werden
met elkaar vergeleken met behulp van een Kruskal-Wallis-toets.
RESULTATEN: Analyses van de intraobservervariabiliteit lieten een Intraclass
correlation coëfficiënt van 0.90 (95%-betrouwbaarheidsinterval 0.79-0.95)
zien. Analyses van de interobservervariabiliteit werden twee keer uitgevoerd
en lieten een ICC van respectievelijk 0.81 (95%-betrouwbaarheidsinterval
0.62-0.91) en 0.88 (95%-betrouwbaarheidsinterval 0.74-0.94) zien. BlandAltman-plots lieten zien dat de observervariabiliteit gelijk verdeeld was. Echter,
het 95%-betrouwbaarheidsinterval van het intraobserververschil was -3,5-13,7
en het 95%-betrouwbaarheidsinterval van het interobserververschil was respectievelijk -4,6-19,1 en 2,3-15,3. Referentiewaarden in ons ziekenhuis liepen
tes-related variables. Multiple linear regression analysis showed that levels
of platelet factor 4, a marker for ex vivo platelet activation, and HbA1c were
the independent predictors of VEGF levels in citrate plasma. Platelet activation, in vivo and ex vivo, was similar in diabetic persons and control subjects.
CONCLUSIONS: Like serum, citrate plasma is not suitable for reliable measurements of circulating VEGF. The low levels of VEGF in vivo, as represented by measurements in PECT plasma in our study, do not support a role of
circulating VEGF in endothelial dysfunction in type 1 diabetes. Higher levels
of VEGF in citrate plasma samples of diabetic persons do not represent the
in vivo situation, but mainly originate from higher artificial ex vivo release
from platelets correlating with the degree of glycemic control.
RESULTS: Of the tumours, 66-69% had a BRCA1-like aCGH profile and 2737% showed BRCA1 promoter methylation. BRCA1-germline mutations and
BRCA1 promoter methylation were mutually exclusive events (P=1 × 10(-5)).
BRCAness was associated with younger age and grade 3 tumours. Chemotherapy response was significantly higher in BRCA1-mutated tumours, but
not in tumours with BRCAness (63% (12 out of 19) vs 35% (18 out of 52)
pathological complete remission rate, respectively).
CONCLUSION: The majority of the TNBCs show BRCAness, and those
tumours share clinicopathological characteristics with BRCA1-mutated tumours. A better characterisation of TNBC and the presence of BRCAness
could have consequences for both hereditary breast cancer screening and
the treatment of these tumours.
Treatment with lenalidomide in myelodysplastic syndromes with deletion 5q: results from the Dutch named patient program.
Abouyahya I, Alhan C, Westers TM, te Boekhorst PA, Kappers-Klunne MC,
Coenen JL, Heyning FH, Huls GA, de Wolf JT, Imholz AL, Koene HR, Veth
G, de Kruijf EJ, Muus P, Planken EV, Segeren CM, Vasmel WL, van der Velden AM, Velders GA, Koedam J, Ossenkoppele GJ, van de Loosdrecht AA.
Leuk Lymphoma. 2013 Apr;54(4):874-7.
No abstract available
Triple-negative breast cancer: BRCAness and concordance of clinical features with BRCA1-mutation carriers.
Lips EH, Mulder L, Oonk A, van der Kolk LE, Hogervorst FB, Imholz AL,
Wesseling J, Rodenhuis S, Nederlof PM.
Br J Cancer. 2013 May 28;108(10):2172-7.
Author information
Department of Molecular Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Abstract
BACKGROUND: BRCAness is defined as shared tumour characteristics
between sporadic and BRCA-mutated cancers. However, how to exactly
measure BRCAness and its frequency in breast cancer is not known. Assays
to establish BRCAness would be extremely valuable for the clinical management of these tumours. We assessed BRCAness characteristics frequencies
in a large cohort of triple-negative breast cancers (TNBCs).
METHODS: As a measure of BRCAness, we determined a specific BRCA1like pattern by array Comparative Genomic Hybridisation (aCGH), and
BRCA1 promoter methylation in 377 TNBCs, obtained from 3 different
patient cohorts. Clinicopathological data were available for all tumours,
BRCA1-germline mutation status and chemotherapy response data were
available for a subset.
Wetenschappelijk overzicht 2012 - 2013
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Interne Geneeskunde
Interne Geneeskunde
A core physical examination in internal medicine: what should students do and how about their supervisors?
Haring CM, van der Meer JW, Postma CT.
Med Teach. 2013 Sep;35(9):e1472-7.
Author information
Radboud University Nijmegen Medical Centre, The Netherlands.
Abstract
BACKGROUND: Performance of a focused physical examination will induce
a high cognitive load for medical students in the early phase of the clinical
clerkships.
AIM: To come to a workable and clinically applicable standard physical examination for medical students to be used in every new patient in the daily
clinical practice of internal medicine.
METHOD: A questionnaire held among physicians that supervise students
during the clerkship of internal medicine in one Dutch training region.
RESULTS: Of the complete list of physical examination 55 items were
considered to be an integral part of the standard general physical examination for medical students. Most emphasized were elements of the physical
examination aimed at general parameters, thorax and abdomen, vascular
status, lymph nodes, spinal column, skin and some parts of the neurological
examination. The standard physical examinations performed by supervisors
themselves contain fewer items than they expected from the students. The
expectations a supervisor has towards the student correlates with the frequency with which they apply the various components in their own physical
examination.
CONCLUSION: This study provides us with a ‘core’ physical examination
for medical students that can be applied in the early phase of the clinical
clerkships.
Nurse Practitioner Care Improves Renal Outcome in Patients with
CKD.
Peeters MJ, van Zuilen AD, van den Brand JA, Bots ML, van Buren M, Ten
Dam MA, Kaasjager KA, Ligtenberg G, Sijpkens YW, Sluiter HE, van de Ven
PJ, Vervoort G, Vleming LJ, Blankestijn PJ, Wetzels JF.
J Am Soc Nephrol. 2013 Oct 24. [Epub ahead of print]
Author information
Department of Nephrology, Radboud University Medical Center, Nijmegen,
The Netherlands;
Abstract
Treatment goals for patients with CKD are often unrealized for many reasons,
but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and
Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study after extended follow-up to determine whether
strict implementation of current CKD guidelines through the aid of nurse
practitioners improves renal outcome. In total, 788 patients with moderate to
severe CKD were randomized to receive nurse practitioner support added to
physician care (intervention group) or physician care alone (control group).
Median follow-up was 5.7 years. Renal outcome was a secondary endpoint
of the MASTERPLAN study. We used a composite renal endpoint of death,
ESRD, and 50% increase in serum creatinine. Event rates were compared with
adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized phase, there were small but
significant differences between the groups in BP, proteinuria, LDL cholesterol,
and use of aspirin, statins, active vitamin D, and antihypertensive medications,
in favor of the intervention group. The intervention reduced the incidence of the
composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval,
0.66 to 0.98; P=0.03). In the intervention group, the decrease in estimated GFR
was 0.45 ml/min per 1.73 m2 per year less than in the control group (P=0.01). In
conclusion, additional support by nurse practitioners attenuated the decline of
kidney function and improved renal outcome in patients with CKD.
Abstract
OBJECTIVE: Most of the biomedical research is performed in University Medical Centers (UMC’s). Increasingly, however, biomedical research is also done in
non-academic large teaching hospitals, united in the Organization for Topclinical
Hospitals (STZ) in the Netherlands. The objective of this study was to compare
citation scores of biomedical publications from UMC’s and STZ hospitals.
DESIGN: Bibliometric analysis.
METHOD: The Center for Science and Technology Studies of the University of
Leiden, the Netherlands, annually analyzes the volume and quality (reflected
by normalized citation scores) of the publications of all UMC’s in the Netherland. Recently, also for STZ hospitals a similar analysis has been performed.
RESULTS: Research publications from UMC’s in the Netherland have normalized mean citation scores that are far above the mean world average.
The normalized mean citation score of publications from STZ hospitals is
lower when research is done independent of a UMC, whereas research that
is a combined effort of UMC’s and STZ hospitals has a very high mean normalized citation score.
CONCLUSION: The Netherlands produces a relatively large volume of biomedical research and publications. Based on citation analysis research done
in collaboration between UMC’s and STZ hospitals has a very high quality.
As most STZ hospitals mostly collaborate with a neighbouring UMC, the formation of research networks that overlap with existing teaching and training
networks, could provided the necessary infrastructure for further stimulating
this collaborative research.
Verschillen in richtlijnen chronische nierschade: geen grote consequenties voor de praktijk.
Commentaar.
Ned Tijdschr Geneesk. 2013;157:55-6
Sluiter HE
Collaborations
Wetenschappelijk overzicht 2012 - 2013
Fibroblast growth factor 23 is associated with proteinuria and
smoking in chronic kidney disease: an analysis of the MASTERPLAN
cohort.
Vervloet MG, van Zuilen AD, Heijboer AC, ter Wee PM, Bots ML, Blankestijn
PJ, Wetzels JF; MASTERPLAN group study.
BMC Nephrol. 2012 Apr 24;13:20.
Collaborators (21)
Sluiter H
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Interne Geneeskunde
Interne Geneeskunde
[Biomedical research in the Netherlands: high quality due to cooperation between University Medical Centers and non-academic large
teaching hospitals].
[Article in Dutch]
Levi M, Sluiter HE, van Leeuwen T, Rook M, Peeters G.
Ned Tijdschr Geneeskd. 2013;157(26):A6081.
Author information
Academisch Medisch Centrum/Universiteit van Amsterdam, Raad van Bestuur, Amsterdam, the Netherlands.
Author information
Department of Nephrology and ICaR-VU, VU university medical centre, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Fibroblast growth factor 23 (FGF23) has emerged as a
risk factor for cardiovascular disease and mortality throughout all stages of
chronic kidney disease (CKD), independent from established risk factors and
markers of mineral homeostasis. The relation of FGF23 with other renal and
non-renal cardiovascular risk factors is not well established.
METHODS: Using stored samples, plasma FGF23 was determined in 604 patients with moderate to severe kidney disease that participated in the MASTERPLAN study (ISRCTN73187232). The association of FGF23 with demographic
and clinical parameters was evaluated using multivariable regression models.
RESULTS: Mean age in the study population was 60 years and eGFR was
37 (± 14) ml/min/1.73 m(2). Median proteinuria was 0.3 g/24 hours [IQR
0.1-0.9]. FGF23 level was 116 RU/ml [67-203] median and IQR. Using multivariable analysis the natural logarithm of FGF23 was positively associated
with history of cardiovascular disease (B = 0.224 RU/ml; p = 0.002), presence of diabetes (B = 0.159 RU/ml; p = 0.035), smoking (B = 0.313 RU/ml;
p < 0.001), phosphate level (B = 0.297 per mmol/l; p = 0.0024), lnPTH (B =
0.244 per pmol/l; p < 0.001) and proteinuria (B = 0.064 per gram/24 hrs; p
= 0.002) and negatively associated with eGFR (B = -0.022 per ml/min/1.73
m(2); p < 0.001).
CONCLUSIONS: Our study demonstrates that in patients with CKD, FGF23
is related to proteinuria and smoking. We confirm the relation between
FGF23 and other cardiovascular risk factors.
METHODS: We selected non-transplanted patients with CKD stages 3-5
who participated in the MASTERPLAN study, a randomized controlled trial
in patients with CKD. Kidney failure was defined as the initiation of chronic
dialysis or kidney transplantation within 5 years. Patients who died before
kidney failure were censored. Patients followed for <5 years, who did not
develop kidney failure and did not die, were excluded. The 5-year kidney
failure risk was predicted using three different models developed by Tangri et
al. and compared with the actual kidney failure rate in MASTERPLAN. Model performance was evaluated using the area under the receiver operating
characteristic curve (ROC-AUC), the net reclassification index (NRI) and by
comparing the observed and predicted rates of kidney failure.
RESULTS: A total of 595 patients were included; 114 developed kidney failure.
(Overall observed kidney failure risk in our cohort was 5% lower than in the
Canadian validation cohort.) Discrimination of the eight-variable model [including age, sex, estimated glomerular filtration rate (eGFR), albuminuria, calcium,
phosphate, bicarbonate, albumin] was similar to that of the four-variable model
(including age, sex, eGFR, albuminuria) and the three-variable model (including age, sex, eGFR); ROC-AUCs were 0.89 [95% confidence interval (CI)
0.86-0.92], 0.88 (95% CI 0.85-0.91) and 0.88 (95% CI 0.85-0.92), respectively.
Using the NRI, the eight-variable model slightly outperformed the four-variable
model (NRI 6.5%) and the three-variable model (NRI 12.4%). The mean differences between the observed and predicted kidney failure risk were -4.0, -7.1
and -7.4% for the eight-, four-, and three-variable model, respectively.
CONCLUSIONS: The KFRE accurately predicted the progression to kidney
failure in European CKD patients. Discrimination of the three models was similar. Calibration of the eight-variable model was slightly better than that of the
simpler models. We question whether this outweighs its added complexity.
Wetenschappelijk overzicht 2012 - 2013
Posters
Metformin elimination by haemodialysis versus continuous
venovenous haemofiltration in renal failure patients with metformin associated lactic acidosis.
Bulsink A, Vermeij CG, Doorenbos CJ, van Berlo-van de Laar IRF
Nederlandse Ziekenhuisfarmaciedagen
Nunspeet, 11 mei 2012
Dragerschap van Extended-Spectrum Beta-Lactamases (ESBL’s) bij
hemodialysepatienten: retrospectief onderzoek naar het nut van routinematige screening naar ESBL-dragerschap en contactisolatie tijdens
dialyseren.
80
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Interne Geneeskunde
Interne Geneeskunde
Validation of the kidney failure risk equation in European CKD patients.
Peeters MJ, van Zuilen AD, van den Brand JA, Bots ML, Blankestijn PJ,
Wetzels JF; MASTERPLAN Study Group.
Nephrol Dial Transplant. 2013 Jul;28(7):1773-9.
Collaborators (13)
Sluiter HE
Author information
Department of Nephrology, Radboud University Nijmegen Medical Centre,
Nijmegen, The Netherlands.
Abstract
BACKGROUND: Patients with chronic kidney disease (CKD) are at risk for
progression to kidney failure. Using data of Canadian CKD patients, Tangri
et al. recently developed models to predict the progression of CKD stages
3-5 to kidney failure within 5 years. We validated this kidney failure risk
equation (KFRE) in European CKD patients.
Oosterwijk PR, Bergervoet PHM, Van der Zwet WC, Sluiter HE
Wetenschapsavond Deventer Ziekenhuis
Deventer, 1 november 2012
Wetenschappelijke Stages
NEO-ZOTAC: Efficacy of NEOadjuvant chemotherapy (TAC) with or
without ZOledronic acid for patients with HER2-negative large resectable or locally advanced breast cancer.
CharehbiliA, Van de Ven S, Liefers GJ, Smit VTHBM, Putter H, Heijns JB,
Van Warmerdam LJ, Kessels L, Dercksen M, Pepels MJ, Maartense E, Van
Laarhoven H, Vriens B, Wasser MN, Hamdy NAT, Meershoek-Klein Kranenbarg EM, Van Leeuwen-Stok AE, Van de Velde CJH, Nortier JWR, Kroep JR
ASCO 2013
Chicago, USA, 31 mei 2013
DIRECT: A phase II/III randomized trial with Dletary REstriction as an
adjunct to neoadjuvant ChemoTherapy for HER2-negative breast cancer.
De Groot S, Vreeswijk MPG, Smit VTHBM, Heijns JB, Imholz ALT, Kessels
LW, Dercksen MW, Jager A, Los M, Weijl NI, Smorenburg CH, Portielje JEA
SABCC
San Antonio, USA, 10 december 2013
Interne Geneeskunde
Boek(bijdrage)
Klinisch onderwijs en opleiden in de praktijk: Deel 2: organiseren, begeleiden, leiderschap.
Red. : T. de Vries, P. Brand, E. Heineman
Hoofdstuk 16: De visitatie
H.E. Sluiter
Prelum uitgevers, Houten, 2012
ISBN: 9789085621164
Wetenschappelijk overzicht 2012 - 2013
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Wetenschappelijk overzicht 2012 - 2013
Interne Geneeskunde
Dragerschap van Extended-Spectrum Beta-Lactamases (ESBL’s) bij
hemodialysepatiënten
Retrospectief onderzoek naar het nut van routinematige screening naar
ESBL-dragerschap en contactisolatie tijdens dialyseren.
Auteur: P.R.Oosterwijk Begeleider
H.E.Sluiter
Locatie:
Hemodialyse afdeling, Deventer Ziekenhuis
Periode: 21 november 2011 - 19 april 2012
Achtergrond: Antibiotica resistentie ten gevolge van Extended-Spectrum
Beta-Lactamase (ESBL) producerende bacteriën neemt toe. Wanneer deze
bacteriën infecties veroorzaken is er een beperkt aantal geschikte antibiotica
voorhanden. Hemodialysepatiënten worden gezien als risicogroep voor
dragerschap met ESBL-positieve bacteriën, maar de epidemiologische
gegevens hierover bij deze patiëntengroep zijn beperkt.
Methode: In een retrospectieve studie, over de periode maart 2009 tot
maart 2012, werd de prevalentie van ESBL-positieve patiënten binnen de
dialysepopulatie van het Deventer Ziekenhuis op 6 screeningsmomenten
bepaald. Bij patiënten die ESBL-positief kweekten tijdens de screeningen
werd vervolgens contactisolatie toegepast. Om de ESBL-positieve
dialysepatiënten te vergelijken met ESBL-negatieve dialysepatiënten, zijn
in totaal 120 dialysepatiënten uit de 6 screeningsmomenten geïncludeerd
in een case control onderzoek. Een risicofactor analyse voor dragerschap
met ESBL’s is gedaan. De overleving tussen beide groepen is met elkaar
vergeleken en met Amplified-Fragment Length Polymorphism (AFLP)typeringen werd nagegaan of er sprake was van mogelijke verspreiding van
identieke ESBL-positieve bacteriestammen.
Resultaten: Over de studieperiode varieerde de prevalentie van ESBL’s bij
dialysepatiënten van 5,8% tot 11,1%, maar veranderde niet significant. De
prevalentie van de dialysepopulatie kwam overeen met de puntprevalentie
(8,3%) van de algemene patiëntenpopulatie in het verzorgingsgebied van
het Deventer Ziekenhuis. In 3 gevallen zijn er identieke bacteriestammen
bij meerdere patiënten gevonden. Daadwerkelijke verspreiding werd niet
aangetoond. Uit een multivariate risicofactor analyse bleken voorafgaand
antibioticagebruik (OR: 6,167 95%CI: 2,288-16,624) en verblijf in een
verzorgings- of verpleeghuis (OR: 3,697 95%CI: 1,171-11,674) de enige
significante risicofactoren voor dragerschap met een ESBL. De overleving
verschilde niet.
Conclusies: De prevalentie van ESBL-positieve dialysepatiënten is niet
significant veranderd over de studieperiode en de prevalentie lijkt niet te
Changes in circulating vitamin D levels as a predictor for pathological response to neoadjuvant chemotherapy (NCT) in breast cancer
(BC): A Dutch Breast Cancer Trialists’ Group (BOOG) side-study.
Charehbili A, Hamdy NAT, Smit VTHBM, Liefers GJ, Putter H, MeershoekKlein Kranenbarg E, Heijns JB, Van Warmerdam LJ, Kessels L, Dercksen
M, Pepels MJ, Maartense E, Van Laarhoven H, Vriens B, Van Leeuwen-Stok
E, Van de Velde CJH, Nortier JWR, Kroep JR
San Antonio Breast Cancer Symposium
San Antonio, USA, 10 december 2013
verschillen met de algemene patiëntenpopulatie. ESBL-dragerschap is van
veel factoren afhankelijk, waarbij voorafgaand antibioticagebruik en verblijf in
een verzorgings- of verpleeghuis een belangrijke rol lijken te spelen. ESBLdragerschap heeft geen invloed op de uiteindelijke overlevingsduur van
dialysepatiënten.
Ccr-ur 43 ± 12 ml/min. De verdeling van de patiënten over de CKD stadia,
gebaseerd op de verschillende manieren van GFR bepaling, liet grote
verschillen zien tussen de methoden. In de hierop volgende analyses werd
duidelijk dat ook in dit cohort de Ccr de nierfunctie overschat en dat de Cur
de nierfunctie onderschat. Weergegeven in spreidingsdiagrammen leek de
Ccr-ur de GFR het beste weer te geven en de relatief hoge concordantie
correlatie coëfficiënt van de Ccr-ur en de Ciot leek dit te bevestigen.
‘Difference plots’ lieten zien dat de Ccr-ur de GFR (Ciot) goed benadert
als de GFR onder de 45 ml/min is, maar dat de Ccr-ur hierboven een
significante onderschatting (P < 0.005) geeft van de GFR.
CONCLUSIE: Deze studie toont aan dat de Ccr-ur een beter inzicht geeft in
de GFR dan de MDRD-formule of de Ccr, in niertransplantatiepatiënten met
chronische nierinsufficiëntie stadium 3B of stadium 4. Dus het is zonde om
de ureumklaring links te laten liggen; er is een rol weggelegd voor de Ccr-ur
als een specialist meer precisie wil dan de eGFR (MDRD) hem kan bieden.
Wetenschappelijk overzicht 2012 - 2013
Immunohistochemical biomarkers and their relation with (diseasefree) survival in BRCA1-like and non-BRCA1-like subgroups in triplenegative breast cancer
Auteur
: M. Maats
Begeleider: A.L.T. Imholz
M.M. Smits
Periode
: 3 oktober 2011 – 17 februari 2012
HER2 positivity in gastric and esophageal adenocarcinoma :
clinicopathological analysis and comparison
Auteur
: T. Koopman
Begeleider: A.L.T. Imholz
M.M. Smits
Periode
: 1 november 2012 – 24 maart 2013
Promoties
Non-alcoholic fatty liver disease: from patient to population.
E.M. Koehler
Erasmus Universiteit Rotterdam 2013
Chronic hepatitis C infection: clinical and societal evaluations.
D.M. Hotho
Erasmus Universiteit Rotterdam 2013
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Wetenschappelijk overzicht 2012 - 2013
Interne Geneeskunde
Interne Geneeskunde
Ureumklaring: Herleving van een oude analytische techniek?
Een retrospectieve pilotstudie over het gebruik van de gemiddelde
klaring van kreatinine en ureum voor het maken van een nauwkeurige
schatting van de nierfunctie, onderzocht bij niertransplantatiepatiënten
Auteur: S.C.C. Korste
Begeleider: H.E. Sluiter
Locatie: Nefrologie, Interne Geneeskunde, Deventer Ziekenhuis
Periode: oktober 2011 – februari 2012
Samenvatting
INLEIDING: Chronische nierinsufficiëntie (CKD) is een wereldwijd
gezondheidsprobleem met een toenemende incidentie. Voor een goede
behandeling van deze ziekte is het belangrijk om op de hoogte te zijn van
de nierfunctie, welke het beste beschreven wordt door de glomerulaire
filtratiesnelheid (GFR). De GFR kan worden gemeten met een ‘gouden
standaard’ methode (bv. de klaring van 125I-iothalamaat (Ciot)). Ook kan
de GFR worden geschat, bijvoorbeeld met de op serum kreatinine, geslacht
en leeftijd gebaseerde MDRD-formule (resulterend in een geschatte GFR
(eGFR)), of met de klassieke kreatinineklaring (Ccr) die gebruik maakt van
24 uurs urine verzameling. Helaas geven al deze methoden verschillende
GFR waarden. Omdat de Ccr de nierfunctie overschat en de ureumklaring
(Cur) de nierfunctie onderschat, is het aannemelijk dat het gemiddelde
van deze twee waarden de nierfunctie benadert. Dit gemiddelde wordt in
de praktijk soms gebruikt als maat voor de GFR bij CKD stadium 5. Wij
hebben de hypothese getoetst dat het gemiddelde van de kreatinine- en
ureumklaring (Ccr-ur) een nauwkeuriger weergave geeft van de GFR dan
de MDRD-formule of de Ccr, in patiënten met chronische nierinsufficiëntie
stadium 3 of 4.
METHODE: In deze retrospectieve pilotstudie werden 44 patiënten
geïncludeerd (55% man, gem. 54 ± 12 jaar). Allen hebben een
transplantatienier ontvangen in het Universitair Medisch Centrum Groningen,
worden vervolgd in het Deventer Ziekenhuis, hebben een Ciot ondergaan en
hebben CKD stadium 3 of 4. In dit cohort werd de Ccr-ur vergeleken met de
eGFR (MDRD) en de Ccr, wat betreft de mate van GFR (Ciot) benadering.
RESULTATEN: Gebaseerd op de eGFR (MDRD) hadden 39 patiënten CKD
stadium 3 en 5 patiënten CKD stadium 4. De Ciot was 50 ± 17 ml/min,
de eGFR (MDRD) 42 ± 10 ml/min/1,73m2, de Ccr 59 ± 16 ml/min en de
Kaakchirurgie
Keel Neus Oorheelkunde
Publicaties
Publicaties
Long-term results of maxillomandibular advancement surgery in
patients with obstructive sleep apnoea syndrome.
Jaspers GW, Booij A, de Graaf J, de Lange J.
Br J Oral Maxillofac Surg. 2013 Apr;51(3):e37-9.
Source
Department of Oral and Maxillofacial Surgery, Deventer Hospital, Deventer,
The Netherlands.
Abstract
This article describes the eight-year follow-up results of maxillomandibular
advancement (MMA) in a cohort of patients with obstructive sleep apnea
syndrome (OSAS). Results are promising by means of Apnoea Hypopnoea
Index (AHI) and Epworth Sleepiness Scale (ESS).
A possible case of complex regional pain syndrome of the nose?
Faraj-Hakim S, Bleys RL, Buwalda J, de Ru JA.
B-ENT. 2012;8(1):37-42.
Author information
Faculty of Medicine, University Medical Centre Utrecht, Utrecht,
the Netherlands.
Abstract
OBJECTIVE: We present a case report of a patient with a putative diagnosis
of complex regional pain syndrome of the nose. We would like to bring this
disorder to the attention of rhinologists.
CASE REPORT: A 53-year-old man presented with a history of extreme,
constant, debilitating pain in his nose that started after he underwent several
extensive nasal surgeries. Examination revealed atrophic nasal mucous
membranes at the nasal septum. No other abnormalities were found. The
pain did not diminish despite administration of analgesics and neuropathic
pain medications. We propose a diagnosis of complex regional pain syndrome of the nose.
CONCLUSION: The large number of nasal surgeries performed worldwide
and the far reaching consequences of this debilitating syndrome indicate that
it merits further investigation to determine whether it is a distinct disorder that
should be recognized as such.
Pathology quiz case 1. Allergic fungal rhinosinusitis (AFRS).
Lammers MJ, Lo Galbo AM, Buwalda J.
Arch Otolaryngol Head Neck Surg. 2012 Apr;138(4):426-8.
Author information
University Medical Center Utrecht, Utrecht, the Netherlands.
Kaakchirurgie
Een peuter met één dik oor.
Mandigers LCJM, Bom SJH, Dassel ACM, Houwing RH, Van Ginkel CJW
Ned Tijdschr KNO-heelkunde 2013;19:115-6
Wetenschappelijk overzicht 2012 - 2013
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Wetenschappelijk overzicht 2012 - 2013
Keel Neus Oorheelkunde
Ontoereikende diagnostiek bij een fractuur van het collum mandibulae.
Valstar MH, Jaspers GW, de Lange J.
Ned Tijdschr Tandheelkd. 2013;120:151-153.
Samenvatting
Een 13-jarige jongen presenteerde zich bij een mond-, kaak- en aangezichtschirurg na een val van zijn skateboard met pijn aan zijn kin en preauculaire
pijn. Er werden op een panoramische röntgenopname geen aanwijzingen
gevonden voor een fractuur van het collum mandibulae. Na 2 weken werd hij
door zijn orthodontist naar de afdeling Mond-, Kaak- en Aangezichtschirurgie
van een medisch centrum verwezen voor een teruggekeerde klasse IIImalocclusie na een kortgeleden afgeronde orthodontische behandeling van dit
probleem. Een computertomogram toonde een fractuur van het collum mandibulae. Bij verdenking op een dergelijke fractuur is altijd beeldvorming uit 2
richtingen noodzakelijk
Kindergeneeskunde
and long enough to prevent relapse. Further research should focus on the
optimal treatment protocol; the actual percentage of non-responders and
also the mechanism of resistance to propranolol is unknown and needs to be
illuminated.
Publicaties
Een peuter met één dik oor.
Mandigers LCJM, Bom SJH, Dassel ACM, Houwing RH, Van Ginkel CJW
Ned Tijdschr KNO-heelkunde 2013;19:115-6
Wetenschappelijk overzicht 2012 - 2013
Collaborations
The expert network and electronic portal for children with respiratory
and allergic symptoms: rationale and design.
Zomer-Kooijker K, van Erp FC, Balemans WA, van Ewijk BE, van der Ent
CK; Expert Network for Children with Respiratory and Allergic Symptoms.
BMC Pediatr. 2013 Jan 16;13:9.
Collaborators (10)
Gorissen DM
Author information
Department of Pediatric Pulmonology and Allergology, Wilhelmina Children’s
Hospital/University Medical Center Utrecht, PO Box 85090, 3508, Utrecht,
AB, The Netherlands.
Abstract
Data on baseline characteristics of children with asthma to predict individual
treatment responses are lacking. We aimed to set up a data-collection system which can easily fill this gap in clinical practice.A web-based application
was developed, named ‘Portal for children with respiratory and allergic
symptoms’, hereafter called Electronic Portal (EP). It contains health- and
disease-related questionnaires on respiratory- and allergic diseases. All
patients, 1-18 years of age, with respiratory- and/or allergic complaints are
invited to enter the EP before their first visit. By using the EP large amounts
of data, gathered during routine patient care can be used for research purposes. This may help to further investigate the different treatment related
asthma phenotypes and will be helpful to monitor risk factors for other atopic
diseases and respiratory infections.
88
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Wetenschappelijk overzicht 2012 - 2013
Kindergeneeskunde
Kindergeneeskunde
Propranolol treatment in life-threatening airway hemangiomas: a
case series and review of literature.
Broeks IJ, Hermans DJ, Dassel AC, van der Vleuten CJ, van Beynum IM.
Int J Pediatr Otorhinolaryngol. 2013 Nov;77(11):1791-800.
Author information
Department of Pediatrics, Deventer Hospital, Deventer, The Netherlands.
Abstract
OBJECTIVES: Infantile hemangiomas (IHs) in the airway may be potentially
life-threatening during the proliferative phase. Available treatments like oral
corticosteroids (OCS) and chemotherapeutic agents usually showed variable
responses and serious side effects. Propranolol is a new and promising treatment option.
METHODS: A case series of five IH patients with airway involvement is
presented, supplemented with a review of literature. Propranolol treatment
(2.0-3.0mg/kg/day) was initiated between 3 weeks and 6 months of age.
Three cases were treated with propranolol monotherapy, 2 cases with OCS
primarily and propranolol secondarily, in which treatment with OCS could be
reduced rapidly.
RESULTS: In our case series a dramatic, fast response was observed in all
cases, with a permanent effect after discontinuation in four cases. In one
patient a relapse of airway problems occurred two months after discontinuation of propranolol at 16 months of age; this resolved after re-start of propranolol. Review of literature together with these five cases showed 81 patients
with airway IHs treated with propranolol. Propranolol was effective in 90%
of the cases and seven patients were classified as non-responders. Eight
IHs relapsed while weaning of propranolol or after discontinuation; dose
adjustment or restart was effective in most cases but one patient appeared
resistant to therapy.
CONCLUSIONS: Propranolol seems to be a rapidly effective and safe treatment strategy for most IHs obstructing the airway. Because of the fast
and important effects of propranolol, randomized controlled trials are hardly
justifiable for this specific, relatively rare but, acute treatment indication.
Despite the efficacy of propranolol, close monitoring of the patients with an
airway IH is required, considering the risk of relapse of symptoms during
or after treatment and the reported resistance to propranolol in at least 9%
of the published cases. The dose and duration of treatment should be high
Klinische Chemie
Posters
Urinary incontinence at young age: evaluation of diagnosis and treatment of children aged 3-6 years.
Sytema N, Dellink-Vlietstra R, Kreileman J, Van der Deure J
ICCS
Londen, oktober 2012
Publicaties
The use of EMDR in the treatment of therapy resistant enuresis: a
pilot study.
Van der Deure J
ICCS
Londen, oktober 2012
The effect of a continuous glucose monitoring sensor as a diagnostic tool on HBA1C levels in children with type 1 diabetes mellitus.
Meendering AL, Dassel ACM, Spaans-Hummelink EAJM
ESPR
Porto, oktober 2012
Kindergeneeskunde
Wetenschappelijk overzicht 2012 - 2013
90
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Wetenschappelijk overzicht 2012 - 2013
Klinische Chemie
Evaluation of Prevent ID and Quantum Blue rapid tests for fecal
calprotectin.
Hessels J, Douw G, Yildirim DD, Meerman G, van Herwaarden MA,
van den Bergh FA.
Clin Chem Lab Med. 2012 Jan 13;50(6):1079-82.
Source
Laboratory for Clinical Chemistry, Deventer Ziekenhuis, Deventer,
The Netherlands.
Abstract
BACKGROUND: Tests for fecal calprotectin are usually either enzyme-linked
immunosorbent assays (ELISA) or a time-resolved fluorimetric immunoassay
(TRFIA). These time-consuming tests are performed only once every 1 or 2
weeks. Before the results of the tests are known most patients have already
undergone colonoscopy. A rapid test, performed on outpatients, could minimize the number of necessary colonoscopies. To establish optimal cut-off
values minimizing the necessity for colonoscopies, we compared two commercially available rapid tests with a quantitative TRFIA.
METHODS: Fecal samples were collected from 85 patients with lower gastrointestinal complaints. Calprotectin was measured using quantitative TRFIA
as well as using two rapid tests: Prevent ID CalDetect and Quantum Blue
calprotectin. We used the TRFIA method as the golden standard with a cutoff value of 50 μg/g. The percentage correct classification, sensitivity, specificity and positive and negative predictive value were calculated for both rapid
tests at various cut-off levels.
RESULTS: Correlation between both of the rapid tests with TRFIA was significant. Quantum Blue calprotectin (κ 0.77) correlated better than Prevent ID
CalDetect (κ 0.46). Optimal cut-off levels for Prevent ID CalDetect and Quantum Blue calprotectin rapid tests were 15 μg/g and 40 μg/g with a reduction
in the number of necessary colonoscopies of 39% and 62%, respectively.
CONCLUSIONS: The Quantum Blue calprotectin rapid test demonstrated
better analytical performance than the Prevent ID CalDetect in reducing the
number of colonoscopies. Furthermore, the former test has the advantage
of using a point of care reader for quantitative measurement and for establishing an optimal cut-off level.
Wetenschappelijk overzicht 2012 - 2013
Collaborations
Yield of routine molecular analyses in colorectal cancer patients ≤70
years to detect underlying Lynch syndrome.
van Lier MG, Leenen CH, Wagner A, Ramsoekh D, Dubbink HJ, van den
Ouweland AM, Westenend PJ, de Graaf EJ, Wolters LM, Vrijland WW, Kuipers EJ, van Leerdam ME, Steyerberg EW, Dinjens WN; LIMO Study Group.
J Pathol. 2012 Apr;226(5):764-74.
Collaborators (23)
van Rijssel RH, Eddes EH, ter Borg F.
Author information
Department of Gastroenterology and Hepatology, Erasmus MC, University
Medical Centre, Rotterdam, The Netherlands.
Abstract : Zie Heelkunde
Klinische Chemie
Klinische Chemie
Myeloid marker S100A8/A9 and lymphocyte marker, soluble interleukin 2 receptor: biomarkers of hidradenitis suppurativa disease activity?
Wieland CW, Vogl T, Ordelman A, Vloedgraven HG, Verwoolde LH, Rensen JM, Roth J, Boer J, Hessels J
Br J Dermatol. 2013 Jun;168(6):1252-8.
Author information
Laboratory for Clinical Chemistry, Deventer Hospital, PO box 5001, 7400 GC
Deventer, The Netherlands.
Abstract
BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory
and debilitating disease of the skin. No biomarkers for this disease exist.
OBJECTIVES: We set out to test whether angiotensin-converting enzyme
(ACE), lysozyme, soluble interleukin 2 receptor (sIL-2R) and S100A8/A9
(calprotectin) are elevated in patients with HS.
METHODS: Serum was collected from 29 patients with HS at different
stages of the disease, and from 51 controls. ACE, lysozyme, sIL-2R and
S100A8/A9 levels were measured. Clinical observation of disease activity
was scored according to the Hurley grading system and by a physician global score (PGS) of disease severity.
RESULTS: Serum levels of lysozyme and ACE were not increased above
the normal reference values in controls or patients with HS. Levels of sIL-2R
and S100A8/A9 were significantly higher in patients with HS than in controls
(P<0·001 for both sIL-2R and S100A8/A9). Based on the receiver operating
characteristic curves, the optimum sIL-2R and S100A8/A9 cut-off values
were 375 U mL(-1) and 680 ng mL(-1), respectively, with a sensitivity of
0·79 and specificity of 0·78 for sIL-2R, and 0·86 and 0·88, respectively, for
S100A8/A9. No correlations with Hurley classification scores were found.
However, when using PGS of disease activity to categorize patients, levels
of S100A8/A9, but not sIL-2R, tended to be higher in patients with more active disease.
CONCLUSIONS: Levels of S100A8/A9 and sIL-2R, but not ACE or lysozyme, are elevated in the serum of patients with HS. However, there is no correlation between S100A8/A9 or sIL-2R levels and disease stage according
to the Hurley classification system. Further research is needed to study the
potential of S100A8/A9 to score disease activity in larger cohorts of patients
and to predict disease flares.
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Klinische Pathologie
Wetenschappelijke Stages
Immunohistochemical biomarkers and their relation with (diseasefree) survival in BRCA1-like and non-BRCA1-like subgroups in triplenegative breast cancer
Auteur
: M. Maats
Begeleider
: A.L.T. Imholz
M.M. Smits
Periode
: 3 oktober 2011 – 17 februari 2012
Publicaties
AIRP best cases in radiologic-pathologic correlation: Brunner gland
hamartoma.
Houwers JB, de Bie SH, Hofstee N.
Radiographics. 2012 Jan-Feb;32(1):213-8.
Source
Department of Radiology and Pathology, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE Deventer, the Netherlands.
Prevalence and prognostic relevance of immunohistochemical biomarkers related with trastuzumab resistance in HER2 positive breast
cancer
Auteur
: G.M. Teeuwen
Begeleider: M.M. Smits
Periode
: 1 mei 2012 – 18 oktober 2012
Wetenschappelijk overzicht 2012 - 2013
HER2 positivity in gastric and esophageal adenocarcinoma : clinicopathological analysis and comparison
Auteur
: T. Koopman
Begeleider
: A.L.T. Imholz
M.M. Smits
Periode
: 1 november 2012 – 24 maart 2013
Klinische Pathologie
Klinische Pathologie
Tissue composition of the vaginal wall in women with pelvic organ
prolapse.
Meijerink AM, van Rijssel RH, van der Linden PJ.
Gynecol Obstet Invest. 2013;75(1):21-7.
Source
Department of Gynecology and Obstetrics, Deventer Hospital, Deventer, The
Netherlands.
Abstract
BACKGROUND/AIMS: To determine the composition of the vaginal wall and
to explore the connective tissue layer, muscularis and basement membrane
in relation to the pathogenesis of pelvic organ prolapse (POP).
METHODS: We performed a histopathological study with respect to the
composition of the vaginal wall of 33 patients and 9 controls. Tissue samples
from the vaginal wall were analysed for collagens II and IV, desmin, elastin, fibronectin, smooth muscle actin (SMA) and transforming growth factor
(TGF)-β1 using (immuno)histochemistry. Morphometric analyses were also
performed.
RESULTS: Morphometric characteristics and expression of SMA, TGF-β1,
elastin and collagen II were significantly altered in women with POP.
CONCLUSION: Our results suggest that there could be an altered tissue
composition of the vaginal wall in women with POP. SMA expression could
play a role in the pathogenesis of POP. The alterations in elastin and TGF-β1
expression are likely a result of POP.
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Klinische Psychologie
sterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Abstract
BACKGROUND: The Infant Behavioral Assessment and Intervention Program
(IBAIP©) improved motor function at 24 months, and mental and behavioural
development in high risk subgroups of very low birth weight (VLBW) infants.
AIM: To determine IBAIP’s effects on executive functioning, behaviour and
cognition at preschool age.
STUDY DESIGN: Follow-up of a randomised controlled trial (RCT).
SUBJECTS: At 44 months corrected age, all 176 VLBW infants were invited for
follow-up. Forty-one term born children were assessed for comparison.
OUTCOME MEASURES: Visual Attention Task (VAT), Gift delay, Peabody
Picture Vocabulary Test III-NL (PPVT), Visual motor integration tests and Miller
assessment for preschoolers. Parents completed Behavior Rating Inventory of
Executive Function-Preschool (BRIEF-P) and Child Behavior Checklist (CBCL).
RESULTS: At preschool age, 76 (88%) children of the intervention group and
75 (83%) children of the control group participated. There were no significant differences between the intervention and the control group. However,
positive interaction effects between intervention and infants with bronchopulmonary dysplasia, infants born at gestational age<28 weeks, and infants of
low educated mothers were found on CBCL, CBCL and BRIEF-P, and PPVT
respectively. Most interaction effects exceeded 1 standard deviation in favour
of the intervention children. The 151 VLBW children performed significantly
worse than the term born children on the VAT, BRIEF-P and CBCL.
CONCLUSION: IBAIP effects in VLBW children did not sustain until preschool
age on executive functioning, behaviour and cognition. However, the most
vulnerable children had a clinical relevant profit from IBAIP. VLBW children
performed worse than the term born children. This study is a follow-up at
preschool age of the multi-centre RCT of IBAIP versus usual care in VLBW
infants. The RCT was performed in Amsterdam, The Netherlands (IBAIP).
Artikelen
Difference in mother-child interaction between preterm- and
term-born preschoolers with and without disabilities.
Potharst ES, Schuengel C, Last BF, van Wassenaer AG, Kok JH, Houtzager BA.
Acta Paediatr. 2012 Jun;101(6):597-603.
Author information
Psychosocial Department of the Emma’s Children’s Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
Abstract
AIM: To investigate differences in the quality of mother-child interaction between
preterm- and term-born children at age 5, and to study the association of mother-child interaction with sociodemographic characteristics and child disability.
METHODS: Preterm children (n = 94), born at <30 weeks’ gestation and/or
birth weight <1000 g, and term children (n = 84) were assessed at corrected
age of 5 using a mother-child interaction observation. Disabilities were assessed using an intelligence test, behaviour questionnaires for parents and
teachers, and motor and neurological examinations.
RESULTS: Mothers of preterm-born children were less supportive of and
more interfering with their children’s autonomy than mothers of term-born
children. This difference was only partly explained by sociodemographic factors. Dyads showed a lower quality of mother-child interaction if children had
a severe disability, especially when mothers had a lower level of education.
CONCLUSION: Five years after birth, mother-child interaction of very premature children and their mothers compared unfavourably with term children
and their mothers. Mothers with sociodemographic disadvantages, raising
a preterm child with severe disabilities, struggle most with giving adequate
sensitive support for the autonomy development of their child. Focused specialized support for these at risk groups is warranted.
The infant behavioral assessment and intervention program in very
low birth weight infants; outcome on executive functioning, behaviour
and cognition at preschool age.
Verkerk G, Jeukens-Visser M, Houtzager B, Koldewijn K, van Wassenaer A,
Nollet F, Kok J.
Early Hum Dev. 2012 Aug;88(8):699-705.
Author information
Department of Rehabilitation, Academic Medical Centre, University of AmWetenschappelijk overzicht 2012 - 2013
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Klinische Psychologie
Development and validation of the distress thermometer for parents
of a chronically ill child.
Haverman L, van Oers HA, Limperg PF, Houtzager BA, Huisman J,
Darlington AS, Maurice-Stam H, Grootenhuis MA.
J Pediatr. 2013 Oct;163(4):1140-6
Author information
Psychosocial Department, Academic Medical Center/Emma Children’s
Hospital, Amsterdam, The Netherlands.
Abstract
OBJECTIVE: To develop and validate a Distress Thermometer for Parents (DTP) for chronically ill children and to determine a cutoff score for clinical distress.
STUDY DESIGN: Parents of a chronically ill child (0-18 years) were recruited
via announcements or were actively approached at the outpatient clinics
of the Emma Children’s Hospital/Academic Medical Center and Vrije Universiteit Medical Center. We modeled the development of the DT-P on the
Distress Thermometer used in oncology medical care. The DT-P consists
of a thermometer score from 0 (no distress) to 10 (extreme distress) and a
problem list (practical, social, emotional, physical, cognitive, and parenting
domains). The DT-P was validated with the Hospital Anxiety and Depression
Scale (HADS) and the Parenting Stress Index.
RESULTS: The mean thermometer score of the 706 participating parents
was 3.7 (SD 3.0). The thermometer score and the scores in the practical,
emotional, physical, and cognitive problem domains were strongly related
to anxiety, depression, and the total score of the HADS (0.55 ≤ r ≤ 0.72).
The thermometer score and all problem domain scores were moderately-tostrongly related to the Parenting Stress Index (0.38 ≤ r ≤ 0.63). A cutoff-score
of 4 correctly identified 86% of “clinical HADS cases” (sensitivity) and 67% of
“nonclinical HADS cases” (specificity).
CONCLUSIONS: We developed the DT-P and examined its diagnostic
utility in a large sample. The DT-P appeared to be a valid and useful short
screening-tool for identifying parental distress.
for which results were inconclusive. Effect sizes for group effects were small to
medium (r(2) varying between 0.02 and 0.07). Principal component isolated four
factors: visual-motor coordination, face/emotion recognition, reaction time/attention, and accuracy/attention. When sociodemographic and child characteristics
at birth were accounted for, bronchopulmonary dysplasia was significantly negatively associated with all four components and also with working memory.
INTERPRETATION: Very preterm children are at risk for problems on a
broad array of neurocognitive functions. Bronchopulmonary dysplasia is an
independent risk factor for impaired neurocognitive functioning.
Collaborations
Perinatal risk factors for neurocognitive impairments in preschool
children born very preterm.
Potharst ES, van Wassenaer-Leemhuis AG, Houtzager BA, Livesey D, Kok
JH, Last BF, Oosterlaan J.
Dev Med Child Neurol. 2013 Feb;55(2):178-84.
Author information
Psychosocial Department, Emma’s Children’s Hospital Academic Medical
Centre, Amsterdam, The Netherlands.
Abstract
AIM: This study aimed to compare a broad array of neurocognitive functions
(processing speed, aspects of attention, executive functioning, visual-motor
coordination, and both face and emotion recognition) in very preterm and termborn children and to identify perinatal risk factors for neurocognitive dysfunctions.
METHOD: Children who were born very preterm (n=102; 46 males, 56 females), defined as a gestational age of less than 30 weeks and/or birthweight
under 1000 g, and a comparison group of term-born children (n=95; 40 males, 55 females) were assessed at age 5 with the Wechsler Preschool and
Primary Scale of Intelligence, Stop Signal Task, several tasks of the Amsterdam Neuropsychological Tasks, and a Digit Span task.
RESULTS: When sociodemographic characteristics were taken into account,
very preterm children scored worse than term-born children on all neurocognitive functions, except on tasks measuring inhibition and sustained attention,
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Klinische Psychologie
Parental psychological distress and anxiety after a successful IVF/
ICSI procedure with and without preimplantation genetic screening:
follow-up of a randomised controlled trial.
Beukers F, Houtzager BA, Paap MC, Middelburg KJ, Hadders-Algra M, Bos
AF, Kok JH; PGS study group.
Early Hum Dev. 2012 Sep;88(9):725-30.
Collaborators (20)
Houtzager BA
Author information
Department of Neonatology, Academic Medical Center Amsterdam, 1105 AZ
Amsterdam, The Netherlands.
Abstract
BACKGROUND: Infertility treatment has an acknowledged psychological
impact on women and their partners; however, information about the development of parental well-being after child birth is inconclusive. Preimplantation
genetic screening (PGS) has been suggested to increase the efficacy of infertility treatments, but the effect it may have on parental well-being is unknown.
AIM: To evaluate parental distress and anxiety at one and two years after
successful infertility treatment and to explore variables that might affect parental outcome, including PGS and child behaviour.
STUDY DESIGN: Follow-up of a randomised controlled trial (RCT) on the
efficacy of PGS.
SUBJECTS: Parents (n=101) that successfully underwent IVF/ICSI with or
without PGS.
OUTCOME MEASURES: At one and two years, parental distress and anxiety were assessed with the General Health Questionnaire 30 and State Trait
Anxiety Inventory, respectively. At two years, child development and behaviour were assessed with the Dutch Bayley Scales of Infant Development-II
and the Child Behaviour Checklist 1½-5, respectively.
RESULTS: PGS had no effect on parental distress or anxiety. Child behaviour
problems were associated with parental distress and anxiety. There was a main
effect of time on parental distress, with distress levels decreasing over time.
CONCLUSIONS: We found no objection to PGS related to parental psychological distress and anxiety. When parental psychological problems are
present after infertility treatment, the results of this study could be useful to
support counselling.
5.1%; odds ratio adjusted for center, 0.97; 95% CI, 0.61-1.55; P = .89).
CONCLUSION: Neonatal caffeine therapy was no longer associated with a
significantly improved rate of survival without disability in children with very
low birth weights who were assessed at 5 years.
Survival without disability to age 5 years after neonatal caffeine therapy for apnea of prematurity.
Schmidt B, Anderson PJ, Doyle LW, Dewey D, Grunau RE, Asztalos EV,
Davis PG, Tin W, Moddemann D, Solimano A, Ohlsson A, Barrington KJ,
Roberts RS; Caffeine for Apnea of Prematurity (CAP) Trial Investigators.
JAMA. 2012 Jan 18;307(3):275-82.
Collaborators (165)
Houtzager B
Author information
Department of Clinical Epidemiology and Biostatistics, McMaster University,
Hamilton, Canada.
Abstract
CONTEXT: Very preterm infants are prone to apnea and have an increased
risk of death or disability. Caffeine therapy for apnea of prematurity reduces
the rates of cerebral palsy and cognitive delay at 18 months of age.
OBJECTIVE: To determine whether neonatal caffeine therapy has lasting
benefits or newly apparent risks at early school age.
DESIGN, SETTING, AND PARTICIPANTS: Five-year follow-up from 2005 to
2011 in 31 of 35 academic hospitals in Canada, Australia, Europe, and Israel, where 1932 of 2006 participants (96.3%) had been enrolled in the randomized, placebo-controlled Caffeine for Apnea of Prematurity trial between
1999 and 2004. A total of 1640 children (84.9%) with birth weights of 500 to
1250 g had adequate data for the main outcome at 5 years.
MAIN OUTCOME MEASURES: Combined outcome of death or survival to 5
years with 1 or more of motor impairment (defined as a Gross Motor Function
Classification System level of 3 to 5), cognitive impairment (defined as a Full
Scale IQ<70), behavior problems, poor general health, deafness, and blindness.
RESULTS: The combined outcome of death or disability was not significantly
different for the 833 children assigned to caffeine from that for the 807 children assigned to placebo (21.1% vs 24.8%; odds ratio adjusted for center,
0.82; 95% CI, 0.65-1.03; P = .09). The rates of death, motor impairment,
behavior problems, poor general health, deafness, and blindness did not differ significantly between the 2 groups. The incidence of cognitive impairment
was lower at 5 years than at 18 months and similar in the 2 groups (4.9% vs
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Klinische Psychologie
Morphologic abnormalities in 2-year-old children born after in vitro
fertilization/intracytoplasmic sperm injection with preimplantation
genetic screening: follow-up of a randomized controlled trial.
Beukers F, van der Heide M, Middelburg KJ, Cobben JM, Mastenbroek S, Breur
R, van der Lee JH, Hadders-Algra M, Bos AF, Kok JH; PGS Study Group.
Fertil Steril. 2013 Feb;99(2):408-13.
Collaborators (17)
Houtzager BA
Author information
Department of Neonatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Abstract
OBJECTIVE: To evaluate the effect of preimplantation genetic screening
(PGS) on morphologic outcome in children.
DESIGN: Follow-up of a randomized controlled trial (RCT).
SETTING: University hospital.
PATIENT(S): Two-year-old children born to mothers who participated in an
RCT on the efficacy of PGS: 50 children born after in vitro fertilization (IVF)/
intracytoplasmic sperm injection (ICSI) with PGS (intervention group; PGS+)
and 72 children born after IVF/ICSI only (control group; PGS-). Sixty-six agematched children conceived without any form of assisted reproduction were
recruited separately in a local public health service center (reference group).
INTERVENTION(S): PGS.
MAIN OUTCOME MEASURE(S): Body surface examination and anthropometry. The evaluation of morphologic abnormalities allowed assessment of
children’s phenotype in detail. Morphologic abnormalities were classified as
major abnormalities (abnormal development in organogenesis, deformations,
disruptions, or dysplasia) and minor anomalies (deviations in phenogenesis).
RESULT(S): The percentage of children with ≥ 1 major abnormality was 28%
in the PGS+ and 35% in the PGS- group [difference -7%, 95% CI -23% to
10%]. The percentage of children with ≥ 1 minor anomaly was 64% in the
PGS+ and 67% in the PGS- group [difference -3%, 95% CI -15% to 20%]. In
the reference group 30% of the children had ≥ 1 major abnormality [95% CI
20% to 43%] and 74% had ≥ 1 minor anomaly [95% CI 62% to 84%].
CONCLUSION(S): No statistically significant differences were found in minor
anomalies between children conceived after IVF/ICSI with or without PGS. There
is < 2.5% chance of ≥ 10% more major abnormalities in children born after PGS.
Longziekten
Abstract
BACKGROUND: Metal fume fever is an occupational disease caused by
inhalation of volatile metal oxides. Clinically there is a strong resemblance
to influenza. It is thought that metal fume fever occurs much more frequently
than it is reported. The symptoms are self-limiting without treatment, disappearing within 24-48 hours without residual symptoms.
CASE DESCRIPTION: A male 35-year-old construction worker had cut galvanized steel plates in a closed environment. He had a flu-like illness with
fever, leucocytosis and hypoxemia. The symptoms resolved completely without treatment within 18 hours.
CONCLUSION: Metal fume fever is a frequently occurring disease but is
often overlooked. It is important to ask about exposure to metal fumes in certain occupational groups in order to make the correct diagnosis. In this way
measures can be taken to avoid exposure to metal oxides and to prevent
recurrence of the disease.
Artikelen
Circulating tumor cells in small-cell lung cancer: a predictive and
prognostic factor.
Hiltermann TJ, Pore MM, van den Berg A, Timens W, Boezen HM, Liesker
JJ, Schouwink JH, Wijnands WJ, Kerner GS, Kruyt FA, Tissing H, Tibbe AG,
Terstappen LW, Groen HJ.
Ann Oncol. 2012 Nov;23(11):2937-42.
Author information
Department of Pulmonary Diseases, m University Medical Center
Groningen, Groningen, The Netherlands.
Abstract
BACKGROUND: Initial response of small-cell lung cancer (SCLC) to chemotherapy is high, and recurrences occur frequently, leading to early death.
This study investigated the prognostic value of circulating tumor cells (CTCs)
in patients with SCLC and whether changes in CTCs can predict response to
chemotherapy. Patients and methods In this multicenter prospective study,
blood samples for CTC analysis were obtained from 59 patients with SCLC
before, after one cycle, and at the end of chemotherapy. CTCs were measured using CellSearch systems.
RESULTS: At baseline, lower numbers of CTCs were observed for 21 patients with limited SCLC (median = 6, range 0-220) compared with 38 patients with extensive stage (median = 63, range 0-14,040). Lack of measurable CTCs (27% of patients) was associated with prolonged survival (HR 3.4;
P ≤ 0.001). CTCs decreased after one cycle of chemotherapy; this decrease
was not associated with tumor response after four cycles of chemotherapy.
CTC count after the first cycle of chemotherapy was the strongest predictor
for overall survival (HR 5.7; 95% CI 1.7-18.9; P = 0.004).
CONCLUSION: Absolute CTCs after one cycle of chemotherapy in patients with
SCLC is the strongest predictor for response on chemotherapy and survival.
Patients with low initial CTC numbers lived longer than those with higher CTCs.
[Metal fume fever, often unrecognized].
[Article in Dutch]
Kooistra J, de Hosson SM.
Ned Tijdschr Geneeskd. 2012;156(32):A4171.
Source
Deventer Ziekenhuis, afd. Longziekten, Deventer, the Netherlands.
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Longziekten
Geriatric rehabilitation for patients with advanced COPD: programme
characteristics and case studies.
van Dam van Isselt EF, Groenewegen-Sipkema KH, Spruit-van Eijk M,
Chavannes NH, Achterberg WP.
Int J Palliat Nurs. 2013 Mar;19(3):141-6.
Author information
Institute of Psychiatry, King’s College, London, UK.
Abstract
Considering the worldwide ageing of populations, there is a growing need
for rehabilitation programmes specifically designed for geriatric patients.
The authors developed and implemented a post-acute geriatric rehabilitation
programme in a skilled nursing facility for patients with advanced chronic
obstructive pulmonary disease (COPD)-the GR-COPD programme. This paper describes the characteristics of the programme and presents three case
studies to illustrate its possible benefits for individual patients. The case studies show that integration of rehabilitation and palliative care components is
essential, as patients with advanced COPD admitted to hospital for an acute
exacerbation often suffer from high symptom burden, deteriorating quality of
life, and poor prognosis. Development and implementation of a post-acute
GR-COPD programme is feasible and can offer substantial benefits for patients with advanced COPD admitted to hospital for an acute exacerbation.
Maag, Darm en Leverziekten
Abstract
BACKGROUND: Colonoscopy is used for the detection of neoplastic polyps,
although a significant miss rate has been reported. Limited data suggest
that the administration of the antispasmodic hyoscine N-butylbromide during
colonoscopy improves polyp detection.
OBJECTIVE: To investigate whether the use of 20 mg hyoscine N-butylbromide intravenously during colonoscopy improves polyp detection or removal.
DESIGN: A prospective, double-blind, placebo-controlled, randomized,
clinical trial.
SETTING: Nonacademic teaching hospital.
PATIENTS: This study involved 674 patients who were routinely referred and
accepted for either diagnostic or screening colonoscopy.
INTERVENTION: Intravenous injection of either 1 mL hyoscine N-butylbromide (n = 340) or 0.9% NaCl solution (n = 334) when withdrawal was started.
MAIN OUTCOME MEASUREMENTS: Polyp detection rate (PDR), adenoma
detection rate (ADR), and the advanced lesion detection rate (ALDR), 5%
trimmed mean number of polyps, mean withdrawal time.
RESULTS: The cecal intubation rate was 96%. The PDR, ADR, and ALDR
were 56% versus 60%, 30% versus 31%, and 14% versus 14% in the hyoscine N-butylbromide and placebo groups, respectively (all P values > .25). The
means of the total number of detected, removed, and harvested polyps per
patient were 1.13 versus 1.21, 1.03 versus 1.06, and 0.89 versus 0.89 in the
hyoscine N-butylbromide and placebo groups, respectively (all P values > .37).
Mean withdrawal time was 561 versus 584 seconds in the hyoscine N-butylbromide and placebo groups, respectively (P = .34). Multivariate analysis demonstrated no effect of hyoscine N-butylbromide on the investigated parameters.
LIMITATIONS: Only experienced colonoscopists participated in the study.
CONCLUSION: We found no evidence to support the use of hyoscine N-butylbromide during withdrawal of the colonoscope to improve polyp detection
or removal. (Clinical trial registration number: ISRCTN25405865.).
Publicaties
[Acute obstructive colon carcinoma and liver metastases: how to treat?].
[Article in Dutch]
Buis CI, Bosker RJ, ter Borg F, de Noo ME, Liem MS.
Ned Tijdschr Geneeskd. 2012;156(43):A4817.
Source
Deventer Ziekenhuis, Afd. Chirurgie, Deventer, the Netherlands.
Abstract
Zie Heelkunde
Severe hepatitis with coagulopathy due to HSV-1 in an immunocompetent man.
Wind L, van Herwaarden M, Sebens F, Gerding M.
Neth J Med. 2012 Jun;70(5):227-9.
Source
Department of Internal Medicine, Deventer Hospital, the Netherlands.
Abstract
Zie Interne Geneeskunde
Nurse endoscopists perform colonoscopies according to the international standard and with high patient satisfaction.
van Putten PG, Ter Borg F, Adang RP, Koornstra JJ, Romberg-Camps MJ,
Timmer R, Poen AC, Kuipers EJ, Van Leerdam ME.
Endoscopy. 2012 Dec;44(12):1127-32.
Author information
Department of Gastroenterology and Hepatology, Erasmus MC University
Medical Center, Rotterdam, The Netherlands.
Abstract
BACKGROUND AND STUDY AIMS: Colonoscopy is increasingly performed
by nurse endoscopists. We aimed to assess the endoscopic quality and pa-
Hyoscine N-butylbromide does not improve polyp detection during colonoscopy: a double-blind, randomized, placebo-controlled, clinical trial.
de Brouwer EJ, Arbouw ME, van der Zwet WC, van Herwaarden MA,
Ledeboer M, Jansman FG, ter Borg F.
Gastrointest Endosc. 2012 Apr;75(4):835-40.
Source
Department of Gastroenterology, Deventer Hospital, Deventer, The Netherlands.
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Maag, Darm en Leverziekten
Evaluation of Prevent ID and Quantum Blue rapid tests for fecal
calprotectin.
Hessels J, Douw G, Yildirim DD, Meerman G, van Herwaarden MA,
van den Bergh FA.
Clin Chem Lab Med. 2012 Jan 13;50(6):1079-82.
Source
Laboratory for Clinical Chemistry, Deventer Ziekenhuis, Deventer,
The Netherlands.
Abstract
Zie Klinische Chemie
tient experience of these procedures.
PATIENTS AND METHODS: This prospective multicenter study analyzed
100 consecutive colonoscopies each for 10 trained nurse endoscopists with
respect to endoscopic quality and patient experience. Colonoscopies were
performed under the supervision of a gastroenterologist, using the techniques and protocols of the participating hospitals. Patient experience was
assessed using a questionnaire.
RESULTS: Most nurse endoscopists were female (90 %; median age 43
[range 35 - 49]). Before the start of the study, they had performed a median of
528 colonoscopies (range 208 - 2103). For the 1000 patients, mean age was
56 ± 15 years; 55 % were women; and 96 % were in class I or II according to
the American Society of Anesthesiologists’ physical status classification system. Colonoscopies were performed for screening or surveillance in 42 %; for
symptomatic indications in 58 % of patients. The unassisted cecal intubation
rate was 94 %; the mean withdrawal time was 10 ± 5 minutes. The adenoma
detection rate was 26.7 %. In 229 of the colonoscopies (23 %), the nurse
endoscopists required assistance from the supervising gastroenterologist.
The complication rate was 0.2 %: one perforation and one cardiopulmonary
complication. The questionnaire was completed by 734 /1000 patients (73 %)
and of these 694 /734 (95 %) were satisfied with the endoscopic procedure.
Among the respondents 530 /734 (72 %) had no specific preference for a
physician or nurse endoscopist, whereas 113 /734 (15 %) preferred a physician endoscopist, and 91 /734 (12 %) preferred a nurse endoscopist.
CONCLUSION: The nurse endoscopists performed colonoscopies according to
the internationally recognized quality standards and with high patient satisfaction.
≥95%) and ten healthy controls (HC) were included. Two weeks prior to
duodenal biopsy collection, ten patients discontinued proton pump inhibitor
(PPI) treatment and ten took maximum dose PPI. RNA was profiled on an
Affymetrix Human Genome U133 Plus 2.0 array (Affymetrix, Santa Clara,
CA, USA). Genes exhibiting a fold change ≥ 1.4 (t test p value <1E-4) were
considered differentially expressed. A subset of 21 differentially expressed
genes was selected for confirmatory TaqMan low-density array RT-PCR.
Mucosal apolipoprotein A-IV (apoA-IV) and cholecystokinin (CCK) concentrations were determined by ELISA and RIA, respectively.
RESULTS: In GERD patients off PPI, 23 up- and 23 down-regulated genes
relative to HC were found. In GERD patients on PPI, 33 and five genes were
higher, respectively, lower expressed. The majority of up-regulated genes
were associated with lipid absorption, particularly triglyceride resynthesis
and intracellular vesicular transport, rate-limiting processes for chylomicron
production and secretion. Differential expression of 11 genes was confirmed
by RT-PCR. Mucosal apoA-IV and CCK concentrations (signaling proteins
released upon chylomicron secretion) were similar in GERD patients and HC.
CONCLUSIONS: The identified mRNA expression differences suggest that
in GERD patients’ duodenum, the chylomicron production and secretion
potential is elevated, and may underlie a mechanism by which postprandial
duodenal signaling contributes to GERD symptom generation.
In gastroesophageal reflux disease, differential gene expression in
the duodenum points towards enhanced chylomicron production and
secretion.
de Vries DR, ter Linde JJ, van Boxel OS, van Herwaarden MA, Shephard P,
Geng MM, Schwartz MP, Samsom M.
Dig Dis Sci. 2012 Jun;57(6):1475-85.
Author information
Department of Gastroenterology and Hepatology, University Medical Center
Utrecht, Utrecht, The Netherlands.
Abstract
BACKGROUND: Duodenal signaling affects esophageal motility and perception, both pathophysiological factors in gastroesophageal reflux disease
(GERD). Duodenal gene expression abnormalities, contributing to altered
esophageal sensorimotor function, have not been reported to date.
AIM: To identify differentially expressed genes in GERD patients’ duodenum.
METHODS: Twenty GERD patients (total 24-h acid exposure 6-12%, SAP
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Maag, Darm en Leverziekten
The Global Rating Scale in clinical practice: a comprehensive quality
assurance programme for endoscopy departments.
Sint Nicolaas J, de Jonge V, de Man RA, ter Borg F, Cahen DL, Moolenaar W, Stolk MF, van Tilburg AJ, Valori RM, van Leerdam ME, Kuipers EJ;
SCoPE consortium.
Dig Liver Dis. 2012 Nov;44(11):919-24.
Author information
The Departments of Gastroenterology and Hepatology of Erasmus MC University Medical Center, Rotterdam, The Netherlands
Abstract
BACKGROUND: The Global Rating Scale is an endoscopy quality assurance programme, successfully implemented in England. It remains uncertain whether it is applicable in another health care setting.
AIM: To assess the applicability of the Global Rating Scale as benchmark
tool in an international context.
METHODS: Eleven Dutch endoscopy departments were included for a Global Rating Scale-census, performed as a cross-sectional evaluation, July
2010. Two Global Rating Scale-dimensions - ‘clinical quality’ and ‘patient
experience’ - were assessed across six items using a range of levels: from
level-D (basic) to level-A (excellent). Construct validity was assessed by
of patients reported being sufficiently informed about what to do in case of
problems after discharge (79 %, range 43 - 98 %; P < 0.001), and 85 % of
individuals stated that they would be willing to repeat the colonoscopy procedure (range 72 - 92 %; P < 0.001). Factors associated with a decreased
willingness to return were the burdensome bowel preparation (odds ratio
[OR] = 0.25; P < 0.001), “rushing staff” attitude (OR = 0.57; P < 0.05), low
acceptance of the procedure (OR = 0.42; P < 0.01), and more discomfort
than expected (OR = 0.54; P < 0.05).
CONCLUSION: Overall patient experiences with colonoscopy were satisfactory, but they also showed considerable variation. This study shows that use
of a GRS patient questionnaire is feasible in the Dutch endoscopy setting for
the assessment of patient experience. The significant variability between endoscopy units can be used to benchmark services and enable shortcomings
to be identified.
Benchmarking patient experiences in colonoscopy using the Global
Rating Scale.
Sint Nicolaas J, de Jonge V, Korfage IJ, Ter Borg F, Brouwer JT, Cahen DL,
Lesterhuis W, Ouwendijk RJ, Kuipers EJ, van Leerdam ME.
Endoscopy. 2012 May;44(5):462-72.
Author information
Department of Gastroenterology and Hepatology, Erasmus MC University
Medical Center, Rotterdam, The Netherlands.
Abstract
INTRODUCTION: The Global Rating Scale (GRS) is a quality assurance
program that was developed in England to assess patient-centered care in
endoscopy. The aim of the current study was to evaluate patient experiences
of colonoscopy using the GRS in order to compare different departments
and to provide benchmarks. The study also evaluated factors associated
with patient satisfaction.
METHODS: A GRS questionnaire was used both before and after the procedure in outpatients undergoing colonoscopy. The questionnaire assessed the
processes associated with the colonoscopy, from making the appointment up
until discharge. Mean values and ranges of 12 endoscopy departments were
calculated together with P values in order to assess heterogeneity.
RESULTS: In total, 1904 pre-procedure and 1532 (80 %) post-procedure
questionnaires were returned from 12 endoscopy departments. The mean
time patients had to wait for their procedure was 4.3 weeks (range 3.1 5.8 weeks), and 54 % (range 35 - 64 %; P < 0.001) reported being given
a choice of appointment dates/times. Discomfort during colonoscopy was
reported by 20 % (range 8 - 40 %; P < 0.001). Recovery room privacy was
satisfactory for 76 % of patients (range 66 - 90 %; P < 0.05). The majority
Follow-up of premalignant lesions in patients at risk for progression
to gastric cancer.
den Hoed CM, Holster IL, Capelle LG, de Vries AC, den Hartog B, Ter Borg
F, Biermann K, Kuipers EJ.
Endoscopy. 2013;45(4):249-56.
Author information
Department of Gastroenterology and Hepatology, Erasmus MC University
Medical Center, Rotterdam, The Netherlands.
Abstract
BACKGROUND AND STUDY AIMS: A recent international guideline recommends surveillance of premalignant gastric lesions for patients at risk of
progression to gastric cancer. The aim of this study was to identify the role of
the distribution and severity of premalignant lesions in risk categorization.
PATIENTS AND METHODS: Patients with a previous diagnosis of atrophic
gastritis, intestinal metaplasia, or low grade dysplasia were invited for surveillance endoscopy with non-targeted biopsy sampling. Biopsy specimens
were evaluated by pathologists (four general and one expert) using the Sydney and the operative link for gastric intestinal metaplasia (OLGIM) systems,
and scores were compared using kappa statistics.
RESULTS: 140 patients were included. In 37 % (95 % confidence interval
[CI] 29 % - 45 %) the severity of premalignant lesions was less than at baseline, while 6 % (95 %CI 2 % - 10 %) showed progression to more severe lesions. Intestinal metaplasia in the corpus was most likely to progress to more
than one location (57 %; 95 %CI 36 % - 76 %). The proportion of patients
with multilocated premalignant lesions increased from 24 % at baseline to
31 % at surveillance (P = 0.014). Intestinal metaplasia was the premalignant lesion most frequently identified in subsequent endoscopies. Intestinal
Wetenschappelijk overzicht 2012 - 2013
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Maag, Darm en Leverziekten
Maag, Darm en Leverziekten
comparing department-specific colonoscopy audit data to GRS-levels.
RESULTS: For ‘clinical quality’, variable scores were achieved in items
‘safety’ (9%=B, 27%=C, 64%=D) and ‘communication’ (46%=A, 18%=C,
36%=D). All departments achieved a basic score in ‘quality’ (100%=D). For
‘patient experience’, variable scores were achieved in ‘timeliness’ (18%=A,
9%=B, 73%=D) and ‘booking-choice’ (36%=B, 46%=C, 18%=D). All departments achieved basic scores in ‘equality’ (100%=D). Departments obtaining
level-C or above in ‘information’, ‘comfort’, ‘communication’, ‘timeliness’ and
‘aftercare’, achieved significantly better audit outcomes compared to those
obtaining level-D (p<0.05).
CONCLUSION: The Global Rating Scale is appropriate to use outside England. There was significant variance across departments in dimensions.
Most Global Rating Scale-levels were in line with departments’ audit outcomes, indicating construct validity.
metaplasia regressed in 27 % compared with 44 % for atrophic gastritis and
100 % for low grade dysplasia. Interobserver agreement was excellent for
intestinal metaplasia (k = 0.81), moderate for dysplasia (k = 0.42), and poor
for atrophic gastritis (k < 0).
CONCLUSIONS: Premalignant gastric lesions found in the corpus have the
highest risk of progression, especially intestinal metaplasia, which has excellent interobserver agreement. This supports the importance of intestinal metaplasia as marker for follow-up in patients with premalignant gastric lesions.
plasia was not associated with AA or NAA.
CONCLUSIONS: Large size and number, villous histology, proximal location
of adenomas, insufficient bowel preparation, and poor colonoscopy reach
were associated with detection of AA during surveillance based on data from
community-based practice. These characteristics should be used jointly to
develop surveillance policies for adenoma patients.
Reply to Dr. Tursi.
van Putten PG, ter Borg F, Adang RP, Koornstra JJ, Romberg-Camps MJ,
Timmer R, Poen AC, Kuipers EJ, van Leerdam ME.
Endoscopy. 2013;45(5):409.
Comment on
Colonoscopy by nurse endoscopists: the right answer for the growing demand for colonoscopy in clinical practice? [Endoscopy. 2013]
Nurse endoscopists perform colonoscopies according to the international
standard and with high patient satisfaction. [Endoscopy. 2012]
Wetenschappelijk overzicht 2012 - 2013
Reply to Thoufeeq.
van Putten PG, ter Borg F, Adang RP, Koornstra JJ, Romberg-Camps MJ,
Timmer R, Poen AC, van Leerdam ME, Kuipers EJ.
Endoscopy. 2013;45(5):407.
Comment on
Nurse endoscopists perform colonoscopies according to the international
standard and with high patient satisfaction. [Endoscopy. 2012]
Nurse endoscopists: the unsung Florence Nightingales. [Endoscopy. 2013]
Collaborations
Yield of routine molecular analyses in colorectal cancer patients ≤70
years to detect underlying Lynch syndrome.
van Lier MG, Leenen CH, Wagner A, Ramsoekh D, Dubbink HJ, van den
Ouweland AM, Westenend PJ, de Graaf EJ, Wolters LM, Vrijland WW, Kuipers EJ, van Leerdam ME, Steyerberg EW, Dinjens WN; LIMO Study Group.
J Pathol. 2012 Apr;226(5):764-74.
Collaborators (23)
ter Borg F.
Author information
Department of Gastroenterology and Hepatology, Erasmus MC, University
Medical Centre, Rotterdam, The Netherlands.
Abstract
Zie Heelkunde
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Maag, Darm en Leverziekten
Maag, Darm en Leverziekten
Features of adenoma and colonoscopy associated with recurrent
colorectal neoplasia based on a large community-based study.
van Heijningen EM, Lansdorp-Vogelaar I, Kuipers EJ, Dekker E, Lesterhuis
W, Ter Borg F, Vecht J, De Jonge V, Spoelstra P, Engels L, Bolwerk CJ,
Timmer R, Kleibeuker JH, Koornstra JJ, van Ballegooijen M, Steyerberg EW.
Gastroenterology. 2013 Jun;144(7):1410-8.
Author information
Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Abstract
BACKGROUND & AIMS: We investigated adenoma and colonoscopy characteristics that are associated with recurrent colorectal neoplasia based on
data from community-based surveillance practice.
METHODS: We analyzed data of 2990 consecutive patients (55% male;
mean age 61 years) newly diagnosed with adenomas from 1988 to 2002 at
10 hospitals throughout The Netherlands. Medical records were reviewed
until December 1, 2008. We excluded patients with hereditary colorectal
cancer (CRC) syndromes, a history of CRC, inflammatory bowel disease, or
without surveillance data. We analyzed associations among adenoma number, size, grade of dysplasia, villous histology, and location with recurrence
of advanced adenoma (AA) and nonadvanced adenoma (NAA). We performed a multivariable multinomial logistic regression analysis to estimate odds
ratios (ORs) and 95% confidence intervals (CIs).
RESULTS: During the surveillance period, 203 (7%) patients were diagnosed with AA and 954 (32%) patients with NAA. The remaining 1833 (61%)
patients had no adenomas during a median follow-up of 48 months. Factors
associated with AA during the surveillance period included baseline number
of adenomas (ORs ranging from 1.6 for 2 adenomas; 95% CI: 1.1-2.4 to 3.3
for ≥5 adenomas; 95% CI: 1.7-6.6), adenoma size ≥10 mm (OR = 1.7; 95%
CI: 1.2-2.3), villous histology (OR = 2.0; 95% CI: 1.2-3.2), proximal location
(OR = 1.6; 95% CI: 1.2-2.3), insufficient bowel preparation (OR = 3.4; 95%
CI: 1.6-7.4), and only distal colonoscopy reach (OR = 3.2; 95% CI: 1.2-8.5).
Adenoma number had the greatest association with NAA. High-grade dys-
Microbiologie
Voordrachten
Hyoscine N-butylbromide does not improve polyp detection during
colonoscopy: a double-blind, randomized, placebo-controlled, clinical
trial.
De Brouwer EJ, Arbouw ME, Van der Zwet WC, Van Herwaarden MA,
Ledeboer M, Jansman FGA, Ter Borg F
Digestive Disease Week
San Diego California, May 19 – 22 2012.
San Diego, 19 oktober 2013
Publicaties
The first case record of a female patient with buboniclymphogranuloma venereum (LGV), serovariant L2b
Stephan P Verweij, Sander Ouburg, Harry de Vries, Servaas A Morre´,
Cees J W van Ginkel, Hanna Bos, Fré W Sebens
Sex Transm Infect. 2012;88(5):346-7.
Abstract
Zie Dermatologie
A randomised trial of honey barrier cream versus zinc oxide ointment.
Nijhuis WA, Houwing RH, Van der Zwet WC, Jansman FG.
Br J Nurs. 2012 Nov 8-21;21(20):9-10, 12-3.
Author information
Ziekenhis Gelderse Vallei Ede, University Groningen, Department of Pharmacotherapy and Pharmaceutical Care, Groningen, The Netherlands.
Abstract
Zie Dermatologie
Hyoscine N-butylbromide does not improve polyp detection during colonoscopy: a double-blind, randomized, placebo-controlled, clinical trial.
de Brouwer EJ, Arbouw ME, van der Zwet WC, van Herwaarden MA, Ledeboer M, Jansman FG, ter Borg F.
Gastrointest Endosc. 2012 Apr;75(4):835-40.
Source
Department of Gastroenterology, Deventer Hospital, Deventer, The Netherlands.
Abstract
Zie Maag Darm Leverziekten
Wetenschappelijk overzicht 2012 - 2013
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Microbiologie
Maag, Darm en Leverziekten
Severe hepatitis with coagulopathy due to HSV-1 in an immunocompetent man.
Wind L, van Herwaarden M, Sebens F, Gerding M.
Neth J Med. 2012 Jun;70(5):227-9.
Source
Department of Internal Medicine, Deventer Hospital, the Netherlands.
Abstract
Zie Interne Geneeskunde
Clinical breakpoint changes and their impact on surveillance of antimicrobial resistance in Escherichia coli causing bacteraemia.
van der Bij AK, van Dijk K, Muilwijk J, Thijsen SF, Notermans DW, de Greeff
S, van de Sande-Bruinsma N; ISIS-AR study group.
Clin Microbiol Infect. 2012 Nov;18(11):E466-72.
Collaborators (47)
Sebens FW
Abstract
Dutch laboratories are currently changing their breakpoint criteria from mostly
Clinical Laboratory and Standards Institute (CLSI) breakpoints to European
Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints. To
evaluate the impact of these changes, we studied antimicrobial resistance
trends of Escherichia coli in blood specimens from January 2008 to January
2012 using CLSI and EUCAST breakpoints and compared them with the antimicrobial susceptibility test (AST) interpretations reported by Dutch laboratories participating in the Infectious Disease Surveillance Information System
for Antibiotic Resistance (ISIS-AR). ISIS-AR collects AST interpretations,
including underlying minimal inhibitory concentrations (MICs) of routinely cultured bacterial species on a monthly basis from Dutch laboratories. MICs of
Etests or automated systems were reinterpreted according to the CLSI 2009
and EUCAST 2010 guidelines. Trends in non-susceptibility (i.e. intermediate
resistant and resistant) over time were analysed by the Cochran-Armitage
test for trend. The effects of the change from CLSI to EUCAST breakpoints
on non-susceptibility were small. There were no differences in non-susceptibility to amoxicillin, amoxicillin/clavulanic acid, cefuroxim, gentamicin and cotrimoxazol and only small differences (1-1.5%) for ciprofloxacin between AST
interpretations by CLSI or EUCAST. However, for ceftazidime, and cefotaxime/ceftriaxone the proportion of non-susceptibility was substantially higher
when EUCAST breakpoints were used (2-3%). The effects on time trends of
the change in guidelines were limited, with only substantial differences for
the oxymino-cephalosporins. Our study shows that the implementation of
EUCAST breakpoints has a limited effect on the proportion of non-susceptible
isolates and time trends in E. coli for most, but not all, antimicrobial agents.
Collaborations
Wetenschappelijk overzicht 2012 - 2013
Consequences of switching from a fixed 2 : 1 ratio of amoxicillin/
clavulanate (CLSI) to a fixed concentration of clavulanate (EUCAST) for
susceptibility testing of Escherichia coli.
Leverstein-van Hall MA, Waar K, Muilwijk J, Cohen Stuart J; ISIS-AR Study
Group.
J Antimicrob Chemother. 2013 Nov;68(11):2636-40
Collaborators (46)
Sebens FW
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Microbiologie
Microbiologie
Population distribution of Beta-lactamase conferring resistance to
third-generation cephalosporins in human clinical Enterobacteriaceae
in the Netherlands.
Voets GM, Platteel TN, Fluit AC, Scharringa J, Schapendonk CM, Stuart JC,
Bonten MJ, Hall MA; National ESBL Surveillance Working Group.
PLoS One. 2012;7(12):e52102
Collaborators (32)
Sebens FW
Author information
Department of Medical Microbiology, University Medical Centre Utrecht,
Utrecht, The Netherlands. Abstract
There is a global increase in infections caused by Enterobacteriaceae with
plasmid-borne β-lactamases that confer resistance to third-generation cephalosporins. The epidemiology of these bacteria is not well understood, and
was, therefore, investigated in a selection of 636 clinical Enterobacteriaceae
with a minimal inhibitory concentration >1 mg/L for ceftazidime/ceftriaxone
from a national survey (75% E. coli, 11% E. cloacae, 11% K. pneumoniae,
2% K. oxytoca, 2% P. mirabilis). Isolates were investigated for extendedspectrum β-lactamases (ESBLs) and ampC genes using microarray, PCR,
gene sequencing and molecular straintyping (Diversilab and multi-locus
sequence typing (MLST)). ESBL genes were demonstrated in 512 isolates
(81%); of which 446 (87%) belonged to the CTX-M family. Among 314 randomly selected and sequenced isolates, bla(CTX-M-15) was most prevalent
(n = 124, 39%), followed by bla(CTX-M-1) (n = 47, 15%), bla(CTX-M-14)
(n = 15, 5%), bla(SHV-12) (n = 24, 8%) and bla(TEM-52) (n = 13, 4%). Among
181 isolates with MIC ≥16 mg/L for cefoxitin plasmid encoded AmpCs were
detected in 32 and 27 were of the CMY-2 group. Among 102 E. coli isolates
with MIC ≥16 mg/L for cefoxitin ampC promoter mutations were identified
in 29 (28%). Based on Diversilab genotyping of 608 isolates (similarity cutoff >98%) discriminatory indices of bacteria with ESBL and/or ampC genes
were 0.994, 0.985 and 0.994 for E. coli, K. pneumoniae and E. cloacae, respectively. Based on similarity cut-off >95% two large clusters of E. coli were
apparent (of 43 and 30 isolates) and 21 of 21 that were typed by belonged
to ST131 of which 13 contained bla(CTX-M-15). Our findings demonstrate
that bla(CTX-M-15) is the most prevalent ESBL and we report a larger than
previously reported prevalence of ampC genes among Enterobacteriaceae
responsible for resistance to third-generation cephalosporins.
Author information
Centre for Infectious Disease Control (CIb), National Institute for Public
Health and the Environment (RIVM), Bilthoven, The Netherlands.
Abstract
OBJECTIVES: The CLSI recommends a fixed 2 : 1 ratio of co-amoxiclav for
broth microdilution susceptibility testing of Enterobacteriaceae, while EUCAST recommends a fixed 2 mg/L clavulanate concentration. The aims of
this study were: (i) to determine the influence of a switch from CLSI to EUCAST methodology on Escherichia coli susceptibility rates; (ii) to compare
susceptibility results obtained using EUCAST-compliant microdilution with
those from disc diffusion and the Etest; and (iii) to evaluate the clinical outcome of patients with E. coli sepsis treated with co-amoxiclav in relation to
the susceptibility results obtained using either method.
METHODS: Resistance rates were determined in three laboratories that
switched from CLSI to EUCAST cards with the Phoenix system (Becton Dickinson) as well as in 17 laboratories that continued to use CLSI cards with
the VITEK 2 system (bioMérieux). In one laboratory, isolates were simultaneously tested by both the Phoenix system and either disc diffusion (n = 471)
or the Etest (n = 113). Medical and laboratory records were reviewed for E.
coli sepsis patients treated with co-amoxiclav monotherapy.
RESULTS: Only laboratories that switched methodology showed an increase in resistance rates - from 19% in 2010 to 31% in 2011 (P < 0.0001). All
isolates that tested susceptible by microdilution were also susceptible by
disc diffusion or the Etest, but of 326 isolates that tested resistant by microdilution, 43% and 59% tested susceptible by disc diffusion and the Etest,
respectively. Among the 89 patients included there was a better correlation
between clinical response and measured MICs using the Phoenix system
than the Etest.
CONCLUSIONS: EUCAST methodology resulted in higher co-amoxiclav E.
coli resistance rates than CLSI methodology, but correlated better with clinical outcome. EUCAST-compliant microdilution and disc diffusion provided
discrepant results.
Author information
Department of Medical Microbiology, SALTRO, Utrecht, The Netherlands
Abstract
The concurrent presence of bla CTX-M-1 and bla TEM-52 genes on similar
plasmids of Escherichia coli isolated from poultry, chicken meat and humans
supports the occurrence of food-borne transmission of extended-spectrum
beta-lactamase (ESBL) genes. ESBL-producing E. coli (ESBL-E. coli) are
most frequently detected in hospitalised patients and are known to spread
in healthcare settings. We hypothesised that poultry-associated (PA) ESBL
genes are predominant in the community, where acquisition is fuelled by
food contamination, whereas non-PA ESBL genes are predominant in hospitals, with acquisition fuelled by cross-transmission. Then, differences in
antimicrobial selective pressure in hospitals and poultry would create differences in co-resistance between PA and non-PA ESBL-E. coli. We, therefore,
determined the prevalence and co-resistance of PA and non-PA ESBL-E. coli
in community-acquired and nosocomial urinary tract infections in humans
and bla CTX-M-1 and bla TEM-52 isolates from poultry. A total of 134 human
ESBL-E. coli urine isolates were included in this study. Isolates containing
bla CTX-M-1 or bla TEM-52 were considered to be PA, with the remainder
being non-PA. Also, 72 poultry ESBL-E. coli were included. Minimum inhibitory concentration (MIC) values were determined by broth microdilution. The
prevalence of PA ESBL genes in isolates obtained in general practice and
hospitals was 28 % versus 30 % (n.s.). Human PA ESBL-E. coli were more
frequently susceptible to ciprofloxacin (51 % vs. 25 %; p = 0.0056), gentamicin (86 % vs. 63 %; p = .0.0082), tobramycin (91 % vs. 34 %; p = 0.0001) and
amikacin (98 % vs. 67 %; p = 0.0001) compared to human non-PA ESBL-E.
coli. PA ESBL-E. coli are not more prevalent in community acquired than
nosocomial urine samples, but are more often susceptible to ciprofloxacin
and aminoglycosides than non-PA ESBL-E. coli. This does not support the
existence of different reservoirs of ESBL genes.
Voordrachten
Wetenschappelijk overzicht 2012 - 2013
Hyoscine N-butylbromide does not improve polyp detection during colonoscopy: a double-blind, randomized, placebo-controlled, clinical trial.
De Brouwer EJ, Arbouw ME, Van der Zwet WC, Van Herwaarden MA,
Ledeboer M, Jansman FGA, Ter Borg F
Digestive Disease Week
San Diego, 19 oktober 2013
116
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Microbiologie
Microbiologie
Differences in the antibiotic susceptibility of human Escherichia coli
with poultry-associated and non-poultry-associated extended-spectrum beta-lactamases.
Platteel TN, Leverstein-Van Hall MA, Cohen Stuart JW, Voets GM, van den
Munckhof MP, Scharringa J, van de Sande N, Fluit AC, Bonten MJ; ESBL
National Surveillance Working Group.
Eur J Clin Microbiol Infect Dis. 2013 Aug;32(8):1091-5.
Collaborators (41)
Sebens FW
Outbreak of Clostridium difficile ribotype 027 in the Deventer Hospital and a nursing home.
Van der Zwet WC, Wolf I, Bergervoet PWM, Sebens FW, Notermans DW,
Kuijper EJ
22nd European Congress of Clinical Microbiology and Infectious Diseases
Londen, 2 april 2012
Dragerschap van Extended-Spectrum Beta-Lactamases (ESBL’s) bij
hemodialysepatiënten: retrospectief onderzoek naar het nut van routinematige screening naar ESBL-dragerschap en contactisolatie tijdens
dialyseren.
Oosterwijk PR, Bergervoet PHM, Van der Zwet WC, Sluiter HE
Wetenschapsavond Deventer Ziekenhuis
Deventer, 1 november 2012
Antibiotic disks stable for many months: do not throw them away.
Van der Zwet WC, Viceisza-Blijden CD, Passcier CJ
Voorjaarsvergadering Nederlandse Vereniging voor Medische Microbiologie
Papendal, 17 april 2013
Wetenschappelijke Stages
Microbiologie
Effect van een Antimicrobial Stewardship Program op het antibioticagebruik in het Deventer Ziekenhuis
Auteur
: C. van der Kolk
Begeleider: W.C. van der Zwet
Samenvatting
INTRODUCTIE: De laatste jaren neemt de antimicrobiële resistentie toe, wat
voornamelijk wordt veroorzaakt door niet correct en onnodig gebruik van
antibiotica.
Door middel van een antimicrobial stewardship program (ASP) kan het
antibioticagebruik in een ziekenhuis verbeterd worden, met als doel het
vertragen of voorkomen van antimicrobiële resistentie, optimaliseren van
keuze en duur van antimicrobiële therapie, verminderen van bijwerkingen
van antimicrobiële therapie en het verminderen van morbiditeit, mortaliteit,
ligduur en kosten ten gevolge van microbiële ziekte. In eerdere onderzoeken
zijn ASP’s effectief gebleken in het verbeteren van correct antibioticagebruik
Wetenschappelijk overzicht 2012 - 2013
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en het verminderen van antimicrobiële resistentie. Richtlijnen voor het antibioticagebruik in het Deventer Ziekenhuis (DZ) zijn gebaseerd op de nationale
antibioticarichtlijn van de Stichting Werkgroep Antibiotica Beleid (SWAB).
DOELSTELLINGEN: Deze studie bestaat uit twee onderdelen. Ten eerste
werd onderzocht of een ASP het antibioticagebruik in het DZ kon verbeteren.
Ten tweede werd het antibioticagebruik en de antimicrobiële resistentie in
het DZ vergeleken met de landelijke cijfers.
METHODE: Een 12 weken durend prospectief cohortonderzoek werd verricht van 14-04-2012 t/m 20-07-2012. Alle patiënten die in deze periode werden behandeld met antibiotica werden geïncludeerd. Voor elke voorgeschreven antibioticakuur werd er onderzocht of deze was voorgeschreven volgens
de lokale antibioticarichtlijn. Na 6 weken werden de artsen geïnformeerd
over de studie en aandacht werd gevraagd voor het naleven van de antibioticarichtlijn. Hierna volgde wederom 6 weken inclusie
van patiënten. Het verschil in correct antibioticagebruik voor en na de interventie werd met elkaar vergeleken. Verder werd het antibioticagebruik in het
Deventer Ziekenhuis vergeleken met het landelijk antibioticagebruik door
middel van de PReventie van ZIEkenhuisinfecties door Surveillance (PREZIES) studie. Ook werden de resistentiepercentages in het Deventer Ziekenhuis door middel van de Infectieziekten Surveillance Informatie Systeem
– Antimicrobiële resistentie (ISIS-AR) database vergeleken met de landelijke
resistentiepercentages.
RESULTATEN: Na de interventie verbeterde het antibioticagebruik volgens
de SWAB niet significant (van 67,8% naar 71,9% p-waarde 0,257). Het correcte antibioticagebruik verbeterde eveneens niet significant (van 72,9%
naar 77,0% pwaarde 0,181). De correcte switch van intraveneuze naar orale
antibiotica verbeterde significant (van 60,7% naar 80,8%, p-waarde 0,000).
Uit de PREZIES prevalentie studie bleek dat het DZ in vergelijking met landelijke ziekenhuizen meer cefalosporinen gebruikt en minder amoxicilline/
clavulaanzuur. De antimicrobiële resistentie in het DZ komt overeen met de
landelijke antimicrobiële resistentie.
CONSLUSIE: Een interventie leidt in dit onderzoek niet significant tot een
verbetering in het voorschrijven van antibiotica volgens de SWABrichtlijn en
het correcte antibioticagebruik. Het switchen van intraveneuze naar orale
therapie verbeterd significant door een interventie. In de toekomst zou een
langer onderzoek en een uitgebreidere interventie mogelijk tot betere resultaten leiden.In het Deventer Ziekenhuis lijken meer cefalosporinen gebruikt
te worden, waar landelijk meer amoxicilline/clavulaanzuur gebruikt wordt. De
antimicrobiële resistentie in het Deventer Ziekenhuis lijkt gelijk te zijn met de
landelijke antimicrobiële resistentie. Voor de toekomst lijkt het belangrijk om
een ASP te ontwikkelen en te gebruiken om het correct antibioticagebruik te
verbeteren en antimicrobiële resistentie te verminderen.
Posters
Neurologie
MAIN OUTCOME MEASURES: The primary endpoint was the level of physical activity, measured every six months with a standardised seven day recall
(LASA physical activity questionnaire-LAPAQ). Secondary endpoints included two other measures of physical activity (activity diary and ambulatory
activity monitor), quality of life (Parkinson’s disease questionnaire-PDQ-39),
and fitness (six minute walk test).
RESULTS: 540 (92.2%) patients completed the primary outcome. During
follow-up, overall time spent on physical activities (LAPAQ) was comparable
between the groups (adjusted group difference 7%, 95% confidence interval
-3 to 17%; P=0.19). Analyses of three secondary outcomes indicated increased physical activity in ParkFit patients, as suggested by the activity diary
(difference 30%; P<0.001), the activity monitor (difference 12%; P<0.001),
and the six minute walk test (difference 4.8 m; P=0.05). PDQ-39 did not differ between ParkFit patients and controls (difference -0.9 points; P=0.14).
The number of fallers was comparable between ParkFit patients (184/299;
62%) and controls (191/287; 67%).
CONCLUSIONS: The ParkFit behavioural change programme did not increase overall physical activity, as measured with the LAPAQ. The analysis
of the secondary endpoints justifies further work into the possible merits of
behavioural change programmes to increase physical activities in daily life in
Parkinson’s disease.
TRIAL REGISTRATION: Clinical trials NCT00748488.
Collaborations
Warfarin and aspirin in patients with heart failure and sinus rhythm.
Homma S, Thompson JL, Pullicino PM, Levin B, Freudenberger RS, Teerlink
JR, Ammon SE, Graham S, Sacco RL, Mann DL, Mohr JP, Massie BM,
Labovitz AJ, Anker SD, Lok DJ, Ponikowski P, Estol CJ, Lip GY, Di Tullio
MR, Sanford AR, Mejia V, Gabriel AP, del Valle ML, Buchsbaum R; WARCEF
Investigators.
N Engl J Med. 2012 May 17;366(20):1859-69.
Collaborators (550)
ten Holter JB
Abstract : zie Cardiologie
Wetenschappelijk overzicht 2012 - 2013
Neurologie
Neurologie
Promotion of physical activity and fitness in sedentary patients with
Parkinson’s disease: randomised controlled trial.
van Nimwegen M, Speelman AD, Overeem S, van de Warrenburg BP,
Smulders K, Dontje ML, Borm GF, Backx FJ, Bloem BR, Munneke M; ParkFit
Study Group.
BMJ. 2013 Mar 1;346:f576.
Collaborators (31)
Lohmann HJ
Author information
Department of Neurology, Radboud University Nijmegen Medical Centre,
Nijmegen Centre for Evidence Based Practice, Nijmegen, Netherlands.
Abstract
OBJECTIVE: To evaluate whether a multifaceted behavioural change programme increases physical activities in patients with Parkinson’s disease.
DESIGN: Multicentre randomised controlled trial.
SETTING: 32 community hospitals in the Netherlands, collaborating in a
nationwide network (ParkinsonNet).
PARTICIPANTS: 586 sedentary patients with idiopathic Parkinson’s disease
aged between 40 and 75 years with mild to moderate disease severity
(Hoehn and Yahr stage ≤ 3).
INTERVENTION: Patients were randomly assigned to the ParkFit programme or a matched general physiotherapy intervention. ParkFit is a multifaceted behavioural change programme, designed specifically to achieve an
enduring increase in the level of physical activity (coaches using motivational
strategies; ambulatory feedback).
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Oogheelkunde
reveal any pathogenic changes, and microsatellite marker analysis showed
that the chromosomal region did not segregate within the disease in this family. Genome-wide homozygosity mapping using single nucleotide polymorphism microarrays revealed a 28-Mb homozygous region encompassing the
CRB1 gene, and direct sequencing disclosed a novel homozygous missense
mutation (p.Gly833Asp) in CRB1.
CONCLUSIONS: Previous studies associated mutations in the MFRP gene
with the syndrome nanophthalmos-retinitis pigmentosa-foveoschisis-optic
disc drusen. In this study, we demonstrated that a similar disease complex
can be caused by mutations in the CRB1 gene.
Publicaties
Methylmalonic acid and homocysteine assessment in the detection
of vitamin B12 deficiency in patients with bilateral visual loss.
Pott JW, Klein Wassink-Ruiter JS, van Vliet A.
Acta Ophthalmol. 2012 May;90(3):e252-3.
High incidence of adverse reactions to locoregional anaesthesia containing hyaluronidase after uneventful ophthalmic surgery.
Dieleman M, Bettink-Remeijer MW, Jansen J, Hoppenreijs VP, van der Pol
R, Baarsma S, van Dijk K, de Waard-van der Spek FB, van Wijk RG, Zijlmans BL.
Acta Ophthalmol. 2012 May;90(3):e245-6.
A novel crumbs homolog 1 mutation in a family with retinitis pigmentosa, nanophthalmos, and optic disc drusen.
Paun CC, Pijl BJ, Siemiatkowska AM, Collin RW, Cremers FP, Hoyng CB,
den Hollander AI.
Mol Vis. 2012;18:2447-53.
Author information
Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Abstract
PURPOSE: The purpose of this study is to identify the genetic defect in a
Turkish family with autosomal recessive retinitis pigmentosa, nanophthalmos, and optic disc drusen.
METHODS: Ophthalmological examinations consisted of measuring the
best-corrected visual acuity and the refractive error, electroretinography, optical coherence tomography, B-mode ultrasonography, and fundus photography. The involvement of the membrane frizzled-related protein (MFRP) gene
in this family was studied with direct DNA sequencing of the coding exons of
MFRP and with linkage analysis with microsatellite markers. After MFRP was
excluded, genome-wide homozygosity mapping was performed with 250 K
single nucleotide polymorphism (SNP) microarrays. Mutation analysis of the
crumbs homolog 1 (CRB1) gene was performed with direct sequencing.
RESULTS: Ophthalmological evaluation of both affected individuals in the
family revealed a decreased axial length (18-19 mm), retinal dystrophy, macular edema, and hyperopia of >+8.0 diopters. Sequencing of MFRP did not
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Oogheelkunde
Oogheelkunde
Purified triamcinolone acetonide as antifibrotic adjunct in glaucoma
filtering surgery.
Hogewind BF, Pijl B, Hoyng CB, Theelen T.
Graefes Arch Clin Exp Ophthalmol. 2013 Apr;251(4):1213-8.
Author information
Department of Ophthalmology, Medical Centre Haaglanden, Lijnbaan 32,
2512 VA The Hague, the Netherlands
Abstract
BACKGROUND: The purpose of this study is to compare the effects of mitomycin C (MMC) and triamcinolone acetonide (TAC) during and after glaucoma filtering surgery.
METHODS: Retrospective interventional consecutive case series. All eyes
underwent primary guarded trabeculectomy with either MMC or sub-Tenon
TAC injection. Intraoperative and postoperative complications up to 5 years
after the filtering surgery were evaluated. Differences between the two regimens were tested for statistical significance.
RESULTS: A total of 64 trabeculectomies, of which 39 with MMC and 25 with
TAC, were compared. At the 5-year follow-up examination three of the eyes
treated with MMC (7.7 %) and none of the eyes treated with TAC had an
intraocular pressure of more than 18 mmHg (p = 0.08). In the MMC group,
three eyes required repeated glaucoma surgery (7.7 %; one trabeculectomy,
one Baerveldt drainage implant, one cyclodiode laser treatment), while this
was two eyes in the TAC group (8.0 %; one Baerveldt drainage implant, one
cyclodiode laser treatment) (p = 0.97).
CONCLUSION: The present study demonstrates that in primary trabeculectomy, the 5-year risk profiles of MMC and purified TAC are comparable,
suggesting that as an antifibrotic agent TAC is at least as effective as MMC.
Prospective randomized trials will need to confirm the agents’ relative longterm benefits.
Opleidingsinstituut
Collaborations
Wetenschappelijk overzicht 2012 - 2013
Publicaties
Medisch-wetenschappelijk onderzoek in Nederland: Hoge kwaliteit
door samenwerking UMC’s en opleidingsziekenhuizen
Marcel Levi, Henk E. Sluiter, Thed van Leeuwen, Maarten Rook en Guy
Peeters
Ned Tijdschr Geneeskd 2013;157:A6081.
Doel: Het meten van de omvang en kwaliteit van het wetenschappelijk
onderzoek in de UMC’s en in de Nederlandse opleidingsziekenhuizen, verenigd in de Samenwerkende Topklinische Opleidingsziekenhuizen (STZ).
Opzet: Bibliometrische analyse.
Methode: Het Centrum voor Wetenschap en Technologie Studies (CWTS)
analyseerde de omvang en kwaliteit van het Nederlandse wetenschappelijk
onderzoek in de UMC’s en de STZ-centra aan de hand van citatiescores. Als
maat voor de kwaliteit werd de ‘mean normalized citation score’ (MNCS) gehanteerd. Deze werd berekend per ziekenhuis (STZ-ziekenhuis of UMC) en
per discipline. De analyse betrof alle publicaties van de STZ-ziekenhuizen
en UMC’s opgenomen in de ‘Web of Science’-database in de periode 19982010.
Resultaten: Uit de CWTS-analyses kwam naar voren dat de MNCS van
alle Nederlandse UMC’s ver boven het wereldgemiddelde ligt. Bij de STZziekenhuizen was de gemiddelde citatiescore lager bij onderzoek dat niet
in samenwerking met een UMC wordt verricht, terwijl onderzoek dat door
STZ-ziekenhuizen in samenwerking met een UMC was uitgevoerd zeer hoge
citatiescores had.
Conclusie: In Nederland wordt naar internationale maatstaven veel en
goed medisch onderzoek gedaan en gepubliceerd. De uitkomsten van het
CWTS-onderzoek leiden tot de conclusie dat het goed is als UMC’s en STZziekenhuizen doorgaan met het doen van gezamenlijk onderzoek. Deze
ontwikkeling kan worden gestimuleerd door de huidige Onderwijs- en Opleidingsregio’s (OOR’s) om te vormen tot OORR’s (Onderwijs-, Opleiding- en
Research Regio’s). Voor deze infrastructuur is het wel nodig dat er voldoende financiering beschikbaar blijft.
Wetenschappelijk onderzoek in STZ ziekenhuizen.
Sluiter HE.
Wetenschap@Gelre 2012:5:6-7
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Opleidingsinstituut
Oogheelkunde
The incidence of rhegmatogenous retinal detachment in
The Netherlands.
Van de Put MA, Hooymans JM, Los LI; Dutch Rhegmatogenous Retinal
Detachment Study Group.
Ophthalmology. 2013 Mar;120(3):616-22.
Collaborators (48)
Hoppenreijs VP.
Author information
Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Abstract
OBJECTIVE: To estimate the incidence and characteristics of rhegmatogenous retinal detachment (RRD) in The Netherlands in 2009.
DESIGN: Retrospective, observational case series.
PARTICIPANTS: All patients with RRD in the Dutch population in 2009.
METHODS: By reviewing surgical logs, cases of primary RRD repair in 2009
were identified. Exclusion criteria included RRD before 2009 and exudative,
tractional, or traumatic retinal detachments. Patient demographics, date
of surgery, and lens status were documented. Incidence of RRD and 95%
confidence intervals (CIs) were calculated based on the Poisson distribution.
Age distribution, male-to-female ratio, and proportion of RRD patients with
prior cataract extraction (CE) were determined. A Student t test was used to
examine differences in the incidence of RRD between groups.
MAIN OUTCOME MEASURES: Annual RRD incidence in the population and
per gender-adjusted age category and proportion of RRD patients with prior CE.
RESULTS: The annual RRD incidence was 18.2 per 100 000 people (95%
CI, 11.4-18.8), with a peak incidence of 52.5 per 100 000 people (95% CI,
29.4-56.8) between 55 and 59 years of age. The Bilateral RRD rate was
1.67%. Macula-off presentation occurred in 54.5% of all RRD patients. Prior
CE was noted in 33.5% of RRD eyes. The male-to-female ratio was 1.3:1,
and RRD incidence was statistically significantly more frequent in males
(P<0.0001).
CONCLUSIONS: Rhegmatogenous retinal detachment is predominantly a
disease of the population older than 50 years, and males are more susceptible to RRD. The annual RRD incidence is highly dependent on demographic
characteristics.
Orthopedie
Knee Surg Sports Traumatol Arthrosc. 2012 Nov 18. [Epub ahead of
print]
Source
Department of Orthopedic Surgery, Deventer Hospital, PO Box 5001, 7400
GC, Deventer, The Netherlands
Abstract
PURPOSE: Anterior knee pain (AKP) following total knee replacement (TKR)
is both prevalent and clinically relevant. The purpose of this study was to
systematically review the peer-reviewed literature, and to identify and assess
the different modifiable and non-modifiable determinants that may be associated with the development of AKP in patients following primary TKR.
METHODS: A systematic computerized database search (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials,
MEDLINE, EMBASE, and Google Scholar) was performed in January 2012.
The quality of the studies was assessed using the GRADE approach.
RESULTS: A total of 54 articles met the inclusion criteria. Variables that have
been researched with regard to the prevalence of AKP include patient and
knee-specific characteristics, prosthetic design, operative technique, treatment of the patella, and time of assessment. A weak correlation with AKP
was found for specific retained presurgery gait patterns. A weak recommendation can be given for the use of femoral components with a posterior centre of rotation, resection of Hoffa’s fat pad, patellar rim electrocautery, and
preventing combined component internal rotation. The correlation between
postsurgical AKP and the degree of patellar cartilage wear, tibial component
bearing strategies, and patellar resurfacing is inconclusive. Due to substantial heterogeneity of the included studies, no meta-analysis was performed.
CONCLUSIONS: No single variable is likely to explain the differences in the
reported rates of AKP, although variables leading to abnormal patellofemoral
joint loading appear to be of special significance.
LEVEL OF EVIDENCE: III.
Publicaties
Effects of short-term addition of NSAID to diuretics and/or RAASinhibitors on blood pressure and renal function.
Nygård P, Jansman FG, Kruik-Kollöffel WJ, Barnaart AF, Brouwers JR.
Int J Clin Pharm. 2012 Jun;34(3):468-74.
Author information
Department of Pharmacy, Diaconessen Hospital Meppel & Bethesda Hospital Hoogeveen, Hoogeveenseweg 38, Postbox 502, 7940 AM, Meppel, The
Netherlands.
Abstract: zie Ziekenhuisfarmacie
Determinants of anterior knee pain following total knee replacement:
a systematic review.
van Jonbergen HP, Reuver JM, Mutsaerts EL, Poolman RW.
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127
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Orthopedie
Orthopedie
Differences in the stress distribution in the distal femur between
patellofemoral joint replacement and total knee replacement: a finite
element study.
van Jonbergen HP, Innocenti B, Gervasi GL, Labey L, Verdonschot N.
J Orthop Surg Res. 2012 Jun 15;7(1):28.
Abstract
BACKGROUND: Patellofemoral joint replacement is a successful treatment
option for isolated patellofemoral osteoarthritis. However, results of later
conversion to total knee replacement may be compromised by periprosthetic bone loss. Previous clinical studies have demonstrated a decrease in
distal femoral bone mineral density after patellofemoral joint replacement.
It is unclear whether this is due to periprosthetic stress shielding. The main
objective of the current study was to evaluate the stress shielding effect of
prosthetic replacement with 2 different patellofemoral prosthetic designs and
with a total knee prosthesis.
METHODS: We developed a finite element model of an intact patellofemoral joint, and finite element models of patellofemoral joint replacement with
a Journey PFJ prosthesis, a Richards II prosthesis, and a Genesis II total
knee prosthesis. For each of these 4 finite element models, the average Von
Mises stress in 2 clinically relevant regions of interest were evaluated during
a simulated squatting movement until 120 degrees of flexion.
RESULTS: During deep knee flexion, in the anterior region of interest, the
average Von Mises stress with the Journey PFJ design was comparable to
the physiological knee, while reduced by almost 25% for both the Richards II
design and the Genesis II total knee joint replacement design. The average
Von Mises stress in the supracondylar region of interest was similar for both
patellofemoral prosthetic designs and the physiological model, with slightly
lower stress for the Genesis II design.
CONCLUSIONS: Patellofemoral joint replacement results in periprosthetic
stress-shielding, although to a smaller degree than in total knee replacement. Specific patellofemoral prosthetic design properties may result in differences in femoral stress shielding.
Is there evidence for accelerated polyethylene wear in uncemented
compared to cemented acetabular components? A systematic review
of the literature.
van der Veen HC, van Jonbergen HP, Poolman RW, Bulstra SK, van Raay JJ.
Int Orthop. 2013 Jan;37(1):9-14.
Author information
Department of Orthopaedic Surgery, Martini Hospital, Groningen,
The Netherlands.
Abstract
Joint arthroplasty registries show an increased rate of aseptic loosening in
uncemented acetabular components as compared to cemented acetabular
components. Since loosening is associated with particulate wear debris, we
postulated that uncemented acetabular components demonstrate a higher
polyethylene wear rate than cemented acetabular components in total hip
arthroplasty. We performed a systematic review of the peer-reviewed literature, comparing the wear rate in uncemented and cemented acetabular
components in total hip arthroplasty. Studies were identified using MEDLINE
(PubMed), EMBASE and the Cochrane Central Register of Controlled Trials.
Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The search resulted
in 425 papers. After excluding duplicates and selection based on title and abstracts, nine studies were found eligible for further analysis: two randomised
controlled trials, and seven observational studies. One randomised controlled trial found a higher polyethylene wear rate in uncemented acetabular
components, while the other found no differences. Three out of seven observational studies showed a higher polyethylene wear in uncemented acetabular component fixation; the other four studies did not show any differences in
wear rates. The available evidence suggests that a higher annual wear rate
may be encountered in uncemented acetabular components as compared to
cemented components.
a systematic computerized database search and literature review (Cochrane
Database of Systematic Reviews, Cochrane Central Register of Controlled
Trials, MEDLINE, and EMBASE). The quality of the included studies was
assessed using the GRADE approach.
RESULTS: A Total of 12 articles met the inclusion criteria. Patient satisfaction
has been assessed using a multitude of scoring systems. In total, 170 of
the 266 patients (64%) were satisfied with the results of secondary patellar
resurfacing.
CONSLUSION AND RECOMMENDATION: Based on the best available
evidence, in patients having persistent anterior knee pain following primary
total knee replacement without patellar resurfacing, secondary resurfacing is
an available surgical treatment option. However, the number of patients not
satisfied with the results emphasizes the need for proper patient counseling.
Patient satisfaction after secondary patellar resurfacing following
primary Total knee replacement: results of two cases and review of the
literature.
Ashvin V. Boeddha, Hans-Peter W. van Jonbergen
Nederlands Tijdschrift voor Orthopedie 2013;20(4):110-6.
Abstract
BACKGROUND: Treatment of anterior knee pain following primary total knee
replacement with secondary patellar resurfacing is a controversial procedure
with uncertain outcomes.
METHODS: With use of the PICO-format, we present two cases of patients
having anterior knee pain after primary total knee replacement, followed by
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129
Wetenschappelijk overzicht 2012 - 2013
Orthopedie
Orthopedie
High prevalence of pseudotumors in patients with a Birmingham Hip
Resurfacing prosthesis: a prospective cohort study of one hundred
and twenty-nine patients.
Bisschop R, Boomsma MF, Van Raay JJ, Tiebosch AT, Maas M, Gerritsma CL.
J Bone Joint Surg Am. 2013 Sep 4;95(17):1554-60.
Author information
Department of Orthopedics, Martini Hospital, Van Swietenplein 1, 9728 NT
Groningen, The Netherlands.
Abstract
BACKGROUND: Recently, concern has emerged about pseudotumors (lesions that are neither malignant nor infective in the soft tissues surrounding
total hip arthroplasty components) after hip arthroplasties with metal-onmetal bearings. Patients treated in our hospital for degenerative arthritis of
the hip with a Birmingham Hip Resurfacing (BHR) prosthesis were invited
to return for follow-up evaluation. The prevalence and clinical relevance of
pseudotumors were investigated. Risk factors for pseudotumor formation
were sought.
METHODS: A single-center cross-sectional prospective cohort study was
conducted and included all patients who received a BHR from 2005 to 2010
in Martini Hospital, Groningen, The Netherlands. Data were collected on patient and surgical characteristics, clinical hip outcome scores (Harris hip score
and Oxford score), serum metal ion levels (cobalt and chromium), and radiographs. A computed tomographic scan (without metal suppression) was made.
In patients who had a revision, tissue samples were histologically examined.
RESULTS: Originally, there were 129 patients with 149 BHRs. Four patients
(six hips; 4%) were lost to follow-up. Our final cohort consisted of 125 patients (143 hips). From this final cohort, eleven patients (twelve hips) had a
revision, and three of them (three hips) had the revision before the present
Differences in the stress distribution in the distal femur between
patellofemoral joint replacement and total knee replacement: A finite
element study.
H.P.W. van Jonbergen
2nd research forum, Knee Center
Leuven, 20 november 2012
study was conducted. Seven patients (eight hips; 5.6%) had a revision because of a symptomatic pseudotumor. Survival analysis showed an implant
survival rate of 87.5% at five years (failure was defined as a revision for any
reason). A pseudotumor was found on computed tomography in thirty-nine
patients (forty hips; 28%). Of those patients, ten (eleven hips; 28%) had
complaints involving groin pain and discomfort, a noticeable mass, or paresthesia. Symptomatic pseudotumors were significantly larger than asymptomatic pseudotumors (a mean volume of 53.3 cm3 compared with 16.3 cm3;
p = 0.05). A serum cobalt level of >85 nmol/L was a predictor for pseudotumor formation (odds ratio, 4.9).
CONCLUSIONS: Pseudotumor formation occurred in 28% of hips after an
average follow-up of forty-one months. Most pseudotumors (72.5%) were
asymptomatic. Larger pseudotumors were associated with more complaints.
Survival analysis showed an implant survival of 87.5% at five years. Failure
occurred in 5.6% (eight) of 143 hips because of a symptomatic pseudotumor.
Posters
Single shot femoral nerve block offers superior postoperative mobilisation at an equal analgesia level after total.
Knee arthroplasty compared to continuous nerve block using a catheter.
Author(s): Heeremans E.H., Pape N., Koorevaar R.C.T., Cobben J.M.G.
European Society of Anesthesiology
Parijs 9-12 juni 2012
Intermittent pain around the hip.
Egbert Veen, Daniëlle Langeloo
BMJ 2013;347:f4972.
Collaborations
Bias towards dementia: are hip fracture trials excluding too many
patients? A systematic review.
Hebert-Davies J, Laflamme GY, Rouleau D; HEALTH and FAITH investigators.
Injury. 2012 Dec;43(12):1978-84.
Collaborators (604)
van Jonbergen HP, Reuver JM, Barnaart AF,Koorevaar R
Author information
University of Montréal, Hôpital du Sacré Cœur, 5400 Gouin Ouest, Local
J-3245, Montréal, Québec, Canada H4J 1C5.
Abstract : Zie Heelkunde
Voordrachten
Orthopedie
Orthopedie
Anatomy, physiology and electrocauterisation of the patellofemoral
joint.
H.P.W. van Jonbergen
IMUKA
Maastricht, 29 maart 2012
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Radiologie
suspicious LNs were located outside the conventional clinical target volume.
Therefore, these techniques could help to individualize treatment selection
and enable image-guided radiotherapy for patients with PCa LN metastases.
Publicaties
Clear cell sarcoma of the ankle.
Wiersma HW, de Jonge MC, Bras J, Schaap GR, Maas M.
JBR-BTR. 2012 May-Jun;95(3):172-3.
Source
Department of Radiology, Deventer Ziekenhuis, Deventer, The Netherlands.
Wetenschappelijk overzicht 2012 - 2013
AIRP best cases in radiologic-pathologic correlation: Brunner gland
hamartoma.
Houwers JB, de Bie SH, Hofstee N.
Radiographics. 2012 Jan-Feb;32(1):213-8.
Source
Department of Radiology and Pathology, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE Deventer, the Netherlands.
Een turnster met pijnlijke polsen.
Bart Lubberts, Diederik T.D. Oei, Robin E. Westerbeek
Ned Tijdschr Geneeskd. 2013;157:A5899.
Casus
Een 11-jarige turnster kwam op de polikliniek Sportgeneeskunde met pijn aan
beide polsen die sinds 1 jaar bestond. Patiënte vertelde dat de pijn tijdens en
na elke training optrad. Anamnestisch was er geen evident trauma bekend.
Bij lichamelijk onderzoek zagen wij een niet-afwijkende stand van de polsen,
zonder zwellingen of bewegingsbeperkingen. Als de polsen in de eindstanden
van dorsale en palmaire flexie werden bewogen, was dit rondom de gehele
pols gevoelig. Alle weerstandstesten waren positief, maar de kracht was niet
verminderd. Een röntgenfoto van de linker pols toonde een verwijding van de
epifysairschijven en onregelmatige contouren van de metafysen van de distale
radius en ulna (figuur). Op de röntgenfoto van de rechter pols waren enigszins
onregelmatige contouren van de metafyse van de distale radius zichtbaar,
maar geen verbreding van de epifysairschijf. Wij stelden de diagnose ‘gymnast’s wrist’ beiderzijds. Deze aandoening komt vaker voor bij meisjes, voornamelijk bij jonge, actieve turners en gewichtheffers in de leeftijd 9-16 jaar.
Tijdens afzet- en tiloefeningen is de pols naar dorsaal geflecteerd en ontstaat
er veel axiale compressie. Door de repeterende belasting treden er microfracturen op, met als gevolg reversibele ischemie van de epifysairschijven. Dit
leidt tot osteolyse en vertraagde skeletrijping. De behandeling is conservatief:
geen belastende activiteiten tot de klachten verdwenen zijn. Zodra de patiënt
klachtenvrij is, mag de belasting weer langzaam worden opgebouwd.
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Radiologie
Radiologie
Value of PET/CT and MR Lymphography in Treatment of Prostate
Cancer Patients with Lymph Node Metastases.
Fortuin AS, Deserno WM, Meijer HJ, Jager GJ, Takahashi S, Debats OA,
Reske SN, Schick C, Krause BJ, van Oort I, Witjes AJ, Hoogeveen YL, Th
van Lin EN, Barentsz JO.
Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):712-8.
Source
Department of Radiology, Radboud University Nijmegen Medical Centre,
Nijmegen, The Netherlands.
Abstract
PURPOSE: To determine the clinical value of two novel molecular imaging
techniques: (11)C-choline positron emission tomography (PET)/computed tomography (CT) and ferumoxtran-10 enhanced magnetic resonance imaging
(magnetic resonance lymphography [MRL]) for lymph node (LN) treatment in
prostate cancer (PCa) patients. Therefore, we evaluated the ability of PET/
CT and MRL to assess the number, size, and location of LN metastases in
patients with primary or recurrent PCa.
METHODS AND MATERIALS: A total of 29 patients underwent MRL and
PET/CT for LN evaluation. The MRL and PET/CT data were analyzed independently. The number, size, and location of the LN metastases were
determined. The location was described as within or outside the standard
clinical target volume for elective pelvic irradiation as defined by the Radiation Therapy Oncology Group. Subsequently, the results from MRL and PET/
CT were compared.
RESULTS: Of the 738 LNs visible on MRL, 151 were positive in 23 of 29
patients. Of the 132 LNs visible on PET/CT, 34 were positive in 13 of 29
patients. MRL detected significantly more positive LNs (p < 0.001) in more
patients than PET/CT (p = 0.002). The mean diameter of the detected suspicious LNs on MRL was significantly smaller than those detected by PET/CT,
4.9 mm and 8.4 mm, respectively (p < 0.0001). In 14 (61%) of 23 patients,
suspicious LNs were found outside the clinical target volume with MRL and
in 4 (31%) of 13 patients with PET/CT.
CONCLUSION: In patients with PCa, both molecular imaging techniques,
MRL and (11)C-choline PET/CT, can detect LNs suspicious for metastasis,
irrespective of the existing size and shape criteria for CT and conventional
magnetic resonance imaging. On MRL and PET/CT, 61% and 31% of the
Echogeleide musculoskeletale interventies.
Westerbeek E
HVDO; bij- en nascholing
Deventer, 2-3 oktober 2013
Voordrachten
Diffusion Weighted Imaging (DWI) as a mammacarcinoma characteristic: association of Apparent Diffusion Coefficient (ADC) and pathological outcome in patients treated with neoadjuvant chemotherapie.
V.H.P. Tran
ECR 2012, European Society of Radiology
Wenen, 1 maart 2012
Echografie in acute buik & interventieradiologie
Klok CFM
HVDO; bij- en nascholing
Deventer, 2-3 oktober 2013
Fracturen.
R.E. Westerbeek
Co-assistenten onderwijsdag
Deventer, 4 juli 2012
Apofyseolyse in de bekkenregio bij jong volwassenen.
Derks RPH, van Dijk RAJM, Westerbeek RE
Radiologendagen
’s-Hertogenbosch, 26 september 2013
Echogeleide MSK-interventies.
R.E. Westerbeek
Radiologie in de praktijk.
Thema avond Regionaal Genootschap Fysiotherapie Twente en IJsselzoom
Apeldoorn, 25 september 2012
Volume dependency of bladder wall thickniess in children: effects on
normal cut off values.
Seehofnerová A, van Dijk RAJM
Radiologendagen
’s-Hertogenbosch, 26 september 2013
Posters
Kennismaking met de radiologie in vogelvlucht.
R.E. Westerbeek
Radiologie in de praktijk.
Thema avond Regionaal Genootschap Fysiotherapie Twente en IJsselzoom
Apeldoorn, 25 september 2012
Delayed enhancement versus first-pass perfusion imaging at rest
Swart LE, Koster K, Jaspers MMJJR, Van Wijngaarden J, Uijlings R,
Badings E, Martens FMAC
99th Scientific Assembly and Annual Meeting of the Radiological
Society of North America
Chicago USA, 5 dec 2013
Schouderluxaties
C.J. Van Manen, R.A.J.M. van Dijk, R.E. Westerbeek
Radiologendagen
’s Hertogenbosch, 28 september 2012
Dislocations of the glenohumeral joint.
Van Manen CJ, Van Dijk RAJM, Westerbeek RE
ECR 2013, European Congres of Radiology
Wenen, Oostenrijk, 7 maart 2013
Post-procedural infection after sonographically guided percutaneous
needle lavage in calcific tendinitis of the shoulder using only local
sterilization of the skin and probe.
Tran VHP, Westerbeek RE
ESSR 2013, European Society of Musculoskeletal Radiology
Marbella, Spanje, 13 juni 2013
CaSc en CCTA: Tool voor Huisarts?
Koster K
HVDO; bij- en nascholing.
Deventer, 2-3 oktober 2013
Wetenschappelijk overzicht 2012 - 2013
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Radiologie
Naam
Radiologie
Beeldvorming en work up bij osteoporose.
Westerbeek RE
HVDO; bij- en nascholing.
Deventer, 2-3 oktober 2013
Spoedeisende Hulp
Ultrasound imaging of colorectal liver metastases: still relevant of
already outdated?
Al Ali C, van Dijk RAJM, Bosker RJI, Klok CFM, Liem MSL
Essen, Duitsland, 2013
Publicaties
The role of FDG PET-CT in the preoperative work up of colorectal
liver metastasis.
Al Ali C, Manders JMB, Smit FW, Bosker RJI, Liem MSL
Essen, Duitsland, 2013
[An 85-year-old woman with an kyphosis and dyspnea].
[Article in Dutch]
Langenberg LC, Tebbes M, de Leeuw B.
Ned Tijdschr Geneeskd. 2012;156(25):A3308.
Source
Deventer Ziekenhuis, Deventer, Afd. Spoedeisende Hulp, the Netherlands.
Abstract
An 85-year-old woman with a severe kyphosis presented at the emergency
room because of progressive dyspnea and cough, without other complaints.
During auscultation, peristaltic sounds were heard over the thorax. A massive diaphragmatic hernia with intrathoracic stomach, small intestine and
colon, was seen on CT-scan.
Cost-effectiveness of 3T MRI versus 1,5T in imaging of the lumbar
spine in a general radiology practice.
R.E. Westerbeek, B Zonneveld, B.G Ziedses des Plantes
European Society of Skeletal Radiology, annual meeting 2012
Innsbruck, 29 juni 2012
Presynaptic dopamine transporter SPET scanning for the differential
diagnosis of parkingsonism in Tartu University Hospital.
H. Lindmae, P. Taba, K. Ulst
EFNS
Stockholm, 9 september 2012
Wetenschappelijk overzicht 2012 - 2013
Spoedeisende Hulp
Radiologie
Accuracy of Magnetic Resonance Direct Thrombus Imaging (MRDTI)
As a Novel Tool in the Diagnosis of Acute Ipsilateral Recurrent Deep
Vein Thrombosis
Melanie Tan, MD*,1, Gerben C Mol, MD*,2, Marcel A Van de Ree, MD, PhD*,2,
Cornelis J Van Rooden, MD, PhD*,3, Robin E Westerbeek, MD*,4, Antonio
Iglesias del Sol, MD, PhD*,5, Albert de Roos, MD, PhD*,6 and Menno V. Huisman, MD, PhD*,1
1
Thrombosis and Haemostasis, Leiden University Medical Center, Leiden,
Netherlands,
2
Internal Medicine, Diakonessenhuis, Utrecht, Netherlands,
3
Radiology, Haga Teaching Hospital, The Hague, Netherlands,
4
Radiology, Deventer Hospital, Deventer, Netherlands,
5
Internal Medicine, Rijnland Hospital, Leiderdorp, Netherlands,
6
Radiology, Leiden University Medical Center, Leiden, Netherlands
54th ASH Annual meeting and exposition
Atlanta, 10 december 2012
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Abstract
Relevancy of potential drug-drug interactions (pDDIs) is crucial in alerting
system design. However, the way this relevancy is perceived is not well
understood. The main objective of this study was to gauge and identify differences in perceptions of intensivists and pharmacists about pDDI relevancy
in the ICU. Interactions were defined according to the national medication
database using a computerized algorithm. Intensivists and pharmacists
filled in a questionnaire to score their perceptions on relevancy of encountered pDDIs types. We conducted a focus group session to discuss pDDIs
receiving markedly different relevancy scores. The questionnaire addressed
53 pDDI types. Pharmacists rated 29 pDDI types (54.7%) in the broad category “relevant” versus 16 (30.2%) for intensivists (p-value&lt;0.001). The
pharmacists and intensivists gave the same scores for 23 pDDI types (12 as
relevant, and 11 as not relevant), and scored 30 types differently. The focus
group discussion resulted in a total of 36 relevant and 17 not relevant types.
Compared to the pharmacists in this panel, the intensivists were less inclined
to consider a pDDI type as relevant. It is important to tailor medication databases with information about evidence and severity of pDDIs to the environment in which they are used.
Publicaties
Dopamine agonists and ischemic complications in Parkinson’s
disease: a nested case-control study.
Arbouw ME, Movig KL, Guchelaar HJ, Neef C, Egberts TC.
Eur J Clin Pharmacol. 2012 Jan;68(1):83-8.
Abstract
BACKGROUND: It has been suggested that ergoline dopamine agonists can
cause ischemic complications. The effect of dopamine agonists in general on
the prevalence of ischemic events in patients with Parkinson’s disease (PD)
has not been studied.
OBJECTIVE: Our aim was to investigate the association between the use
of dopamine agonists and hospitalization due to ischemic events in patients
with PD.
METHODS: We performed a nested case-control study using the PHARMO
Institute for Drug Outcome Research database. All patients issued at least
one prescription for levodopa after the age of 55 years between 1994 and
2006 were initially identified. Cases were patients who were hospitalized for
the first time after November 1997 for an ischemic event and were matched
to as many as four controls. Exposure to dopamine agonists during the year
preceding the index date was identified.
RESULTS: The study population consisted of 542 cases and 2,155 controls.
The mean effect of dopamine agonist use 1 year prior to the index date on
ischemic events requiring hospitalization is shown with 95% probability in the
0.95-1.49 range. Stratified results according to the type of dopamine agonist
showed no risk differences between ergoline and nonergoline agonists.
CONCLUSIONS: This study does not support an association between dopamine agonist use and an increased risk of ischemic events requiring hospitalization.
Relevance of drug-drug interaction in the ICU - perceptions of
intensivists and pharmacists.
Askari M, Eslami S, Louws M, Dongelmans D, Wierenga P, Kuiper R,
Abu-Hanna A.
Stud Health Technol Inform. 2012;180:716-20.
Author information
Dep. of Medical Informatics, Academic Medical Center, Amsterdam,
the Netherlands.
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Ziekenhuisfarmacie
Acute intoxication patients presenting to an emergency department in
The Netherlands: admit or not? Prospective testing of two algorithms.
Ambrosius RG, Vroegop MP, Jansman FG, Hoedemaekers CW, Aarnoutse
RE, van der Wilt GJ, Kramers C.
Emerg Med J. 2012 Jun;29(6):467-72.
Author information
Department of Pharmacology and Toxicology, Radboud University Nijmegen
Medical Centre, PO Box 9101, 6525 EZ Nijmegen, The Netherlands.
Abstract
STUDY OBJECTIVE: After acute intoxication, most patients presenting to
the emergency department (ED)--76% of them in The Netherlands--are admitted to hospital. Many will not need medical treatment on the ward. The
authors tested two algorithms in the ED, based on vital parameters, ECG
findings, and ingested substances, to identify patients who will receive treatment in hospital.
METHODS: This prospective inception study enrolled patients aged 14 years
and older presenting with acute intoxication between January 2006 and April
2008 to a Dutch university hospital. An algorithm was developed based on
a previous retrospective study and the medical literature. In a second algorithm the clinical course during the stay in the ED was also taken into account.
RESULTS: Of 313 patients presenting with acute intoxication to the ED,
134 (42.8%) were admitted to a ward for somatic care, but only 74 (23.6%)
Ziekenhuisfarmacie
Studies pertaining to the ACOVE quality criteria: a systematic review.
Askari M, Wierenga PC, Eslami S, Medlock S, De Rooij SE, Abu-Hanna A.
Int J Qual Health Care. 2012 Feb;24(1):80-7.
Abstract
PURPOSE: /st> To identify and uniformly describe studies employing the
Assessing Care Of Vulnerable Elders (ACOVE) quality indicators within a
comprehensive thematic model that reflects how the indicators were used.
DATA SOURCES: /st> A systematic search of MEDLINE, EMBASE and CINAHL was conducted.
STUDY SELECTION: /st> English-language studies meeting our criteria
published prior to January 2010. Data extraction Included studies were analyzed and described by two independent researchers.
RESULTS OF DATA SYNTHESIS: /st> A total of 41 articles met our selection
criteria. Studies were classified into the themes ‘Application of indicators’ (32
studies) and ‘
ANALYSIS: and development of indicators’ (13 studies). ‘Application’ studies
included assessing quality of care, influencing behavior of health professionals and examining the association of quality of care with other factors. ‘Analysis and development’ included studies developing new indicator sets, and
those adapting and validating the original quality indicators to new settings.
CONCLUSIONS: st> The indicators were used in a wide range of applications with two main foci: the assessment of quality of care for elderly
patients, and investigating the feasibility of similar indicators and their adaptation to new settings. Very few of the studies published to date have
addressed the goal of care improvement. We foresee an important role for
application of indicators that proactively help health-care professionals to
deliver the right care at the right time, for example by resorting to decision
support systems.
Wetenschappelijk overzicht 2012 - 2013
Clomipramine concentration and withdrawal symptoms in
10 neonates.
Ter Horst PG, van der Linde S, Smit JP, den Boon J, van Lingen RA,
Jansman FG, De Jong-van den Berg LT, Wilffert B.
Br J Clin Pharmacol. 2012 Feb;73(2):295-302.
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Analysis of medication information exchange at discharge from a
Dutch hospital.
van Berlo-van de Laar IR, Driessen E, Merkx MM, Jansman FG.
Int J Clin Pharm. 2012 Aug;34(4):524-8.
Source
Clinical Pharmacy Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands. Abstract
BACKGROUND: At hospitalisation and discharge the risk of errors in medication information transfer is high.
OBJECTIVE: To study the routes by which medication information is transferred during discharge from Deventer Hospital, and to improve medication
information transfer.
SETTING: Eight hospital wards of the Deventer Hospital.
METHOD: From December 6 to 17th 2010, the following data was recorded
across eight hospital wards: the identification number of discharged patients,
the date of discharge and the route by which medication information was
transferred. The possible route categories recorded were the Pharmacy
Service Point, the hospital’s public pharmacy, and “other” routes (which had
to be specified). Validation of the data was performed by cross-checking the
information collected by the hospital’s Admission Office, the Pharmacy Service Point and the hospital’s public pharmacy, in addition to electronic patient
files, interviews with ward staff and, where necessary, interviews with the
concerned patients. Main outcome measure Route of medication information
transfer at discharge in all discharged patients.
RESULTS: A total of 629 patients were included in the study. The routes of
transfer were: Pharmacy Service Point 281 patients (44 %), the hospital’s
public pharmacy 54 patients (9 %), and other routes 44 patients (7 %). Other
routes were most recorded at the children’s ward, the short stay and cardiology ward. In 250 patients (40 %), there was no transfer of information by the
Pharmacy Service Point because they were registered as using no medication or as experiencing no medication changes during hospitalisation.
CONCLUSION: Medication information was transferred for 53 % of the
discharged patients, which is close to the maximum achievable result.
Further improvement of medication transfer in Deventer Hospital can be
made by adjusting the current procedure and by educating the ward staff
about the importance and the clinical practice of this procedure.
were treated on the ward. Algorithm 1 had 91.9% sensitivity (95% CI 82.6%
to 96.7%) and 53.6% specificity (95% CI 47.0% to 60.0%). Algorithm 2 had
90.5% sensitivity (95% CI 80.9% to 95.8%) and 65.3% specificity (95% CI
58.8% to 71.2%). In line with hospital policy, several patients received Nacetylcysteine treatment for subtoxic paracetamol ingestion because they
presented outside of office hours, when no measurements of blood paracetamol concentration are performed by the laboratory. When these patients
are considered as untreated, both algorithms had 98.5% sensitivity (95% CI
90.6% to 99.9%).
CONCLUSION: The algorithms had good sensitivity and better specificity
than current clinical practice in most hospitals. It is too early to advocate their
implementation, but results indicate that it is possible to use clinical parameters objectively to reduce unnecessary admissions to the ward.
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Antidepressants are
associated with withdrawal symptoms after in utero exposure. Half-life of
clomipramine in neonates is prolonged compared with that in adults.
WHAT THIS STUDY ADDS: We present 10 cases of neonates exposed in
utero to clomipramine, with detailed information about withdrawal symptoms
and pharmacokinetics.There is a high and severe complication rate in our
cohort regarding the mother and the neonate.
AIM: After in utero exposure to tricyclic antidepressants, neonatal withdrawal
symptoms have been reported with an estimated incidence between 20 and
50%; however, few data are available for clomipramine. This could also be
the case for neonatal pharmacokinetic clomipramine parameters and so this
study was set up.
METHODS: Babies exposed to clomipramine in utero were included in an
observational study, approved by the local ethics committee, after written
informed consent. Withdrawal symptoms were scored at 12, 24 and 48h after birth using the Finnegan score. Plasma concentrations were determined
using an in-house-developed, validated liquid chromatography with mass
detection (LC-MSMS) method at 0, 12, 24 and 48h after birth.
RESULTS: We found that three of 11 pregnancies were complicated with
pre-eclampsia. Ten neonates were observed for clomipramine withdrawal
symptoms. The observed withdrawal symptoms were too short a period
of sleep after feeding (6), poor feeding (3), mild to severe tremors (6), hyperactive Moro reflex (3) and respiratory rate >60 breaths min(-1. Serious
withdrawal reactions, such as tachycardia and cyanosis, were seen. We
calculated a half-life value of 42 ± 16h for clomipramine in neonates. Only a
weak correlation was found between withdrawal reactions and clomipramine
plasma concentration or desmethylclomipramine plasma concentration.
CONCLUSIONS: In neonates, clomipramine is eliminated with a half-life
value of 42h, compared with 20h in adults. In two of 10 neonates, tachycardia and cyanosis were seen as serious withdrawal symptoms after maternal
use of clomipramine.
Abstract
BACKGROUND: The combined post-operative use of diuretics and/or reninangiotensin-aldosterone system (RAAS) inhibitors may increase the risk of
nonsteroidal anti-inflammatory drug (NSAID) associated renal failure because of a drug-drug interaction.
OBJECTIVE: The aim of this study was to investigate the effect of the shortterm (<4 days) post-operative combined use of NSAIDs with diuretics and/or
RAAS inhibitors on renal function and blood pressure.
SETTING: One teaching hospital in the Netherlands.
METHOD: The study-design was a prospective, observational cohort-study.
Based on postoperative treatment with NSAIDs, the intervention-group was
compared to a control-group (no NSAIDs treatment).
MAIN OUTCOME MEASURE: Systolic blood pressure and renal function
expressed by the estimated glomular filtration rate (eGFR) calculated with
the modification of renal desease formula.
RESULTS: 97 patients were included in the intervention-group, 53 patients in
the control-group. Patient characteristics were comparable except for one variable: ‘combined use of a diuretic with a RAAS inhibitor’ which was higher in the
control-group (62 vs. 43 %, p = 0.046). Odds ratio for clinically relevant increase
in systolic blood pressure was 0.66 (CI95 % 0.3-1.5). Odds ratio for clinical relevant decrease in renal function was 2.44 (CI95 % 1.1-5.2). On day 4 eGFR of 3
patients in the intervention- and 1 in the control-group was <50 ml/min/1.73 m(2).
CONCLUSION: Odds ratios showed no significant difference of a clinically
relevant increase in systolic blood pressure but showed a higher risk for a
clinically relevant decrease in renal function in the intervention group. However this decrease resulted in a relevant impaired renal function (<50 ml/
min/1.73 m(2)) in only 3 patients in the interventiongroup and 1 patient in
the control-group. In the post-operative patient, without preexisting impaired
renal function, concurrent diuretics and/or renin-angiotensinaldosterone system inhibitor therapy can be combined with short-term NSAID treatment.
Effects of short-term addition of NSAID to diuretics and/or RAASinhibitors on blood pressure and renal function.
Nygård P, Jansman FG, Kruik-Kollöffel WJ, Barnaart AF, Brouwers JR.
Int J Clin Pharm. 2012 Jun;34(3):468-74.
Author information
Department of Pharmacy, Diaconessen Hospital Meppel & Bethesda Hospital Hoogeveen, Hoogeveenseweg 38, Postbox 502, 7940 AM, Meppel,
The Netherlands.
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Ziekenhuisfarmacie
Hyoscine N-butylbromide does not improve polyp detection during
colonoscopy: a double-blind, randomized, placebo-controlled, clinical
trial.
de Brouwer EJ, Arbouw ME, van der Zwet WC, van Herwaarden MA,
Ledeboer M, Jansman FG, ter Borg F.
Gastrointest Endosc. 2012 Apr;75(4):835-40.
Source
Department of Gastroenterology, Deventer Hospital, Deventer,
The Netherlands.
Abstract
Zie Maag Darm Leverziekten
Inventarisatie van potentieel geneesmiddelgerelateerde problemen
bij oncologiepatiënten (ONCOMIND)
Bulsink A, Boor SD, Imholz ALT, Brouwers JRBJ, Jansman FGA
PW Wetenschappelijk Platform 2012;6:85-8.
Abstract
OBJECTIVE: To evaluate the occurrence of potential drug-related problems
(pDRPs) among oncology patients.
DESIGN AND METHODS: A prospective, longitudinal observational study
was carried out from March 2010 through March 2011 at the Deventer Teaching Hospital, Deventer, The Netherlands. All patients older than 18 years,
receiving anticancer drugs prescribed by an internal medicine-oncologist
or a pulmonologist-oncologist, were included. pDRPs were identified using
screening methods according to Dutch guidelines.
RESULTS: Among 546 patients with cancer, 760 oncology-related pDRPs
were identified. These were mainly drug interactions (246 in 157 patients)
and potential contraindications (201 in 143 patients). Most oncology-related
interactions could be attributed to NSAIDs (40%) and vitamin K antagonists
(23%) in combination with one or more anticancer drugs or oncology-related
supportive care, and were classified as having minor (50%) and moderate
(48%) interaction severity levels. Analysis of patient-verified medication lists,
supplementary to analysis of drug dispensing history records (DDHRs), led
to identification of 20 additional oncologyrelated interactions compared to
95 oncology-related interactions with DDHR alone. Patient interview supplementary to analysis of patient-verified medication list combined with DDHR
led to identification of 1 additional oncology-related interaction.
CONCLUSION: Most identified pDRPs in cancer patients were interactions
and potential contraindications. Most frequently occurring oncologyrelated
interactions had minor or moderate severity and their clinical relevance was
limited due to non-chronic use, simultaneous use of preventive drugs to reduce the risk of harmful effects (proton pump inhibitors), or therapeutic monitoring of laboratory parameters.Patient involvement in verifying medication
list did lead to identification of differences in usages but not to identification
of additional pDRPs.
A randomised trial of honey barrier cream versus zinc oxide ointment.
Nijhuis WA, Houwing RH, Van der Zwet WC, Jansman FG.
Br J Nurs. 2012 Nov 8-21;21(20):9-10, 12-3.
Author information
Ziekenhis Gelderse Vallei Ede, University Groningen, Department of
Pharmacotherapy and Pharmaceutical Care, Groningen, The Netherlands.
Abstract : zie Dermatologie
Wetenschappelijk overzicht 2012 - 2013
Pleconaril revisited: clinical course of chronic enteroviral meningoencephalitis after treatment correlates with in vitro susceptibility.
Wildenbeest JG, van den Broek PJ, Benschop KS, Koen G, Wierenga PC,
Vossen AC, Kuijpers TW, Wolthers KC.
Antivir Ther. 2012;17(3):459-66.
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Ziekenhuisfarmacie
Association between acute geriatric syndromes and medicationrelated hospital admissions.
Wierenga PC, Buurman BM, Parlevliet JL, van Munster BC, Smorenburg
SM, Inouye SK, de Rooij SE.
Drugs Aging. 2012 Aug 1;29(8):691-9.
Author information
Department of Clinical Pharmacy, Academic Medical Center, Amsterdam, the
Netherlands.
Abstract
BACKGROUND: Elderly patients are at a 4-fold higher risk of adverse drug
events (ADEs) and drug-related hospitalization. Hospitalization of an elderly
patient is often preceded by geriatric syndromes, like falls or delirium.
OBJECTIVES: The primary aim of this study was to investigate whether
geriatric syndromes were associated with ADEs in acutely admitted elderly
patients.
METHODS: Consecutive medical patients, aged 65 years or more, who were
acutely admitted, were enrolled. An initial multidisciplinary evaluation was
completed and baseline characteristics were collected. A fall before admission was retrieved from medical charts. Delirium was determined by the
Confusion Assessment Method.
RESULTS: A total of 641 patients were included. Over 25% had an ADE
present at admission, 26% presented with delirium and 12% with a fall. Delirium was associated with the use of antidepressants, antipsychotics and
antiepileptics. In all ADEs (n = 167), ADEs were associated with a fall, with
non-steroidal anti-inflammatory drugs or diuretics, but not with pre-existing
functioning, delirium or older age. For ADEs involving psychoactive medication (n = 35), an association was found between delirium, falls, opioids and
antipsychotics in bivariate analyses. A fall just before hospitalization (odds
ratio [OR] 3.69 [95% CI 1.41, 9.67]), antipsychotics (OR 3.70 [95% CI 1.19,
11.60]) and opioids (OR 14.57 [95% CI 2.02, 105.30]) remained independently associated with an ADE involving psychoactive medication.
CONCLUSION: This prospective study demonstrated that, in a cohort of
elderly hospital patients, a fall before admission and prevalent delirium are
associated with several pharmacological groups and/or with ADE-related
hospital admission.
Author information
Department of Pediatric Hematology, Immunology and Infectious Diseases,
Emma Children’s Hospital, Academic Medical Center, Amsterdam,
The Netherlands.
Abstract
BACKGROUND: Human enteroviruses (HEVs) can cause severe infections, especially in patients with a deficient humoral immune response, such
as X-linked agammaglobulinemia. In this patient group, chronic enteroviral
meningitis (CEMA) is feared because of extensive morbidity and high fatality
rate. Treatment options consist of intravenous immunoglobulin (IVIG), with
various outcomes. Pleconaril is an antiviral agent with in vitro activity against
HEVs that has been used in the treatment of HEV infections.
METHODS: The efficacy of pleconaril and IVIG against HEV isolated from
the patients was assessed in vitro in two patients with CEMA.
RESULTS: Echovirus 11 was found in the cerebrospinal fluid (CSF) of case
1. Treatment with high-dose IVIG and pleconaril did not provide any clinical
improvement and HEV PCR in CSF remained positive. Case 2 (echovirus
13 positive in CSF) was also treated with IVIG and pleconaril. The patient
recovered completely and HEV PCR in CSF became negative. Recent IVIG
batches contained low titres of neutralizing antibodies against the patient
strains. Echovirus 11 (case 1) was resistant to pleconaril in vitro, whereas
echovirus 13 (case 2) was susceptible, in accordance with virological response after treatment and subsequent clinical results.
CONCLUSIONS: This is the first report that evaluates efficacy of antiviral
treatment in CEMA patients in relation to in vitro susceptibility of clinical virus
isolates. Since pleconaril is no longer available for compassionate use we
strongly propagate that new drugs should be developed against these potential life threatening HEV infections.
Abstract
PURPOSE: Drug-drug interactions (DDIs) may compromise patient safety.
However, there are no good estimates of their frequency or understanding of
their nature in the intensive care unit (ICU). The objective of this study was to
determine the frequency and nature of potential DDIs (pDDIs) in the ICU when
assessed in light of documented and perceived clinical relevance.
METHODS: We developed a computerized algorithm to identify pDDI occurrence in ICU admissions with medication administration, on the basis of the
Dutch national drug database. A panel of nine local pharmacists and intensivists completed questionnaires to classify the perceived relevance of the
identified pDDI types for the ICU. A focus group discussed the conflicting classifications of relevance to reach consensus. For the pDDI types classified as
relevant, we calculated their number and frequency per admission days.
RESULTS: Out of 9644 admissions, 3892 had at least one pDDI. The pDDIs
corresponded to 85 types, 36 of which were deemed relevant on the basis of
the survey and focus group. These 36 types corresponded to 16,122 pDDIs
(rate: 33.6 per 100 admission days) and 1084 unique admissions. PDDIs
occurred in 11% of admissions to the general ICU, after limiting analysis to
severe and relevant DDI types. The most frequently encountered drug classes were antithrombotic agents and antibacterials for systemic use.
CONCLUSIONS: There are many potential DDIs with high perceived relevance in the ICU that appear to require attention and follow-up. Computerized decision support may help reduce the number of pDDIs but needs to be
tailored to the environment in which it operates.
Geen quetiapine bij slaapstoornissen.
Lineke M. Tak, Inge R.F. van Berlo-van de Laar, Bennard Doornbos
Ned Tijdschr Geneeskd. 2013;157:A5740.
Ziekenhuisfarmacie
Frequency and nature of drug-drug interactions in the intensive care
unit.
Askari M, Eslami S, Louws M, Wierenga PC, Dongelmans DA, Kuiper RA,
Abu-Hanna A.
Pharmacoepidemiol Drug Saf. 2013 Apr;22(4):430-7.
Author information
Department of Medical Informatics, Academic Medical Center, Amsterdam,
the Netherlands.
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Recognition of adverse drug events in older hospitalized medical
patients.
Klopotowska JE, Wierenga PC, Smorenburg SM, Stuijt CC, Arisz L, Kuks
PF, Dijkgraaf MG, Lie-A-Huen L, de Rooij SE; WINGS study group.
Eur J Clin Pharmacol. 2013 Jan;69(1):75-85.
Author information
Department of Hospital Pharmacy, Academic Medical Centre, Meibergdreef 9,
1105 AZ Amsterdam, The Netherlands.
Abstract
OBJECTIVE: To assess medical teams’ ability to recognize adverse drug
events (ADEs) in older inpatients.
METHODS: The study cohort comprised 250 patients aged 65 years or older
consecutively admitted to Internal Medicine wards of three hospitals in the Netherlands between April and November 2007. An independent expert team identified ADEs present upon admission or occurring during hospitalization by a structured retrospective patient chart review. For all ADEs identified, the expert team
assessed causality, severity, preventability, and recognition by medical teams.
RESULTS: The medical teams did not recognize 19.9 % of all ADEs present
upon admission {60.4 ADEs [95 % confidence interval (CI) 51.5-70.8] per
100 hospitalizations} and 20.3 % of all ADEs occurring during the hospital
stay [47.2 ADEs (95 % CI 39.4-56.5) per 100 hospitalizations]. Unrecognized
ADEs were significantly more often ADEs with possible causality (p=0.014,
df=1), ADEs caused by medication errors (p<0.001, df=1), and ADEs not
manifesting as new symptoms (p<0.001, df=1). The medical teams did not
recognize 23.2 % of mild to moderately severe ADEs and 16.5 % of severe,
life-threatening, or fatal ADEs. The recognition of ADEs varied with event type.
CONCLUSIONS: The recognition of ADEs by medical teams was substantial
for those ADEs with evident causality and with clinically apparent and severe
consequences. ADEs mimicking underlying pathologies with a lower severity
went unrecognized much more often, as did those resulting only in abnormal
laboratory values. Tools to improve the recognition of ADEs by medical teams
should, therefore, focus on those ADEs that are more challenging to detect.
resembling underlaying pathologies or with lower severity went unrecognized
much more often. Tools to improve recognition of ADEs by medical teams
should, therefore, focus on those ADEs more challenging to detect.
Adverse drug events in older hospitalized patients: results and reliability of a comprehensive and structured indentification strategy.
Klopotowska JE, Wierenga PC, Smorenburg SM, Stuijt CCM, Arisz L, Kuks
PFM, Dijkgraaf MGW, Lie-A-Huen L, De Rooij SE
PW Wetenschappelijk Platform 2013;7(2):a1305.
Abstract
OBJECTIVE: To assess medical teams’ ability to recognize adverse drug
events (ADEs) in elderly inpatients.
Design: Prospective cohort study
METHODS: From April till November 2007, 250 patients aged 65 years or
older, consecutively admitted to Internal Medicine wards of three hospitals
in the Netherlands, were included in the study. An independent expert panel,
consisting of a pharmacist and an internist, identified ADEs present upon
admission or occurring during hospitalization by a structured retrospective
patient chart review. For all ADEs identified, the experts assessed causality,
severity, preventability, and recognition by medical teams.
RESULTS: The medical teams did not recognize 20% of 151 ADEs present
upon admission, and 20% of 118 ADEs occurring during hospital stay. Unrecognized ADEs were more often ‘possible’ ADEs (p = 0.014; df = 1), ADEs
caused by medication errors (P < 0.001; df = 1) and ADEs not manifesting
as new symptoms (P < 0.001; df = 1). When only severe, life-threatening or
fatal ADEs were taken into account, the total percentage of unrecognized
ADEs decreased from 20% to 8%. The recognitions of ADEs also varied with
event type.
CONCLUSION: The recognition of ADEs was substantial for ADEs with
evident causality or with clinically apparent or severe consequences. ADEs
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Ziekenhuisfarmacie
Adverse drug events in older hospitalized patients: results and reliability of a comprehensive and structured identification strategy.
Klopotowska JE, Wierenga PC, Stuijt CC, Arisz L, Dijkgraaf MG, Kuks PF,
Asscheman H, de Rooij SE, Lie-A-Huen L, Smorenburg SM; WINGS Study
Group.
PLoS One. 2013 Aug 5;8(8):e71045.
Author information
Department of Hospital Pharmacy, Academic Medical Center, Amsterdam,
the Netherlands.
Abstract
BACKGROUND: Older patients are at high risk for experiencing Adverse
Drug Events (ADEs) during hospitalization. To be able to reduce ADEs in
these vulnerable patients, hospitals first need to measure the occurrence of
ADEs, especially those that are preventable. However, data on preventable
ADEs (pADEs) occurring during hospitalization in older patients are scarce,
and no ‘gold standard’ for the identification of ADEs exists.
METHODOLOGY: The study was conducted in three hospitals in the Netherlands in 2007. ADEs were retrospectively identified by a team of experts
using a comprehensive and structured patient chart review (PCR) combined
with a trigger-tool as an aid. This ADE identification strategy was applied to
a cohort of 250 older hospitalized patients. To estimate the intra- and interrater reliabilities, Cohen’s kappa values were calculated.
PRINCIPAL FINDINGS: In total, 118 ADEs were detected which occurred
in 62 patients. This ADE yield was 1.1 to 2.7 times higher in comparison
to other ADE studies in older hospitalized patients. Of the 118 ADEs, 83
(70.3%) were pADEs; 51 pADEs (43.2% of all ADEs identified) caused serious patient harm. Patient harm caused by ADEs resulted in various events.
The overall intra-rater agreement of the developed strategy was substantial
(κ = 0.74); the overall inter-rater agreement was only fair (κ = 0.24).
CONCLUSIONS/SIGNIFICANCE: The ADE identification strategy provided
a detailed insight into the scope of ADEs occurring in older hospitalized patients, and showed that the majority of (serious) ADEs can be prevented. Several strategy related aspects, as well as setting/study specific aspects, may
have contributed to the results gained. These aspects should be considered
whenever ADE measurements need to be conducted. The results regarding
pADEs can be used to design tailored interventions to effectively reduce
harm caused by medication errors. Improvement of the inter-rater reliability
of a PCR remains challenging.
Characteristics of potential drug-related problems among oncology
patients.
Bulsink A, Imholz AL, Brouwers JR, Jansman FG
Int J Clin Pharm. 2013 Jun;35(3):401-7.
Author information
Department of Clinical Pharmacy (E3.019), Deventer Hospital, PO-Box
5001, 7400 GC Deventer, The Netherlands.
Abstract
BACKGROUND: Oncology patients are more at risk for drug related problems because of treatment with (combinations of) anticancer drugs, as they
have a higher risk for organ failure or altered metabolism with progression of
their disease.
OBJECTIVE: The aim of this study was to characterize and to evaluate the frequency of potential drug related problems (pDRPs) among oncology patients.
SETTING: Outpatient- and day-care centres for Internal and Pulmonary Medicine at the Deventer Hospital, Deventer, The Netherlands.
METHOD: A prospective, descriptive, observational study was carried out from
March 2010 to March 2011 at the Deventer Hospital, Deventer, The Netherlands. All patients older than 18 years receiving anticancer drugs prescribed
by an internal medicineoncologist or pulmonologist-oncologist were included.
MAIN OUTCOME MEASURE: The primary outcome was the number and
type of pDRPs according to Dutch guidelines.
RESULTS: Among 546 patients with cancer, 952 pDRPs were identified, of
which 474 were oncology-related. These were mainly drug interactions (IA)
(246 IA in 157 patients) and potential contraindications (pCI) (201 pCI in 143
patients).
CONCLUSION: Most identified pDRPs in cancer patients were IAs and pCIs
and involved corticosteroids. The most frequently occurring oncology-related
IAs were classified as minor or moderate levels of severity.
latory cancer patients on oral anticancer treatment.
METHODS: A search was conducted in a computer-based medication prescription system for dispensing oral anticancer drugs to outpatients in three
Dutch centres. Potential drug-drug interactions were identified using electronic (Drug Interaction Fact software) and manual screening methods (peerreviewed reports).
RESULTS: In the 898 patients included in the study, 1359 PDDIs were identified in 426 patients (46%, 95% confidence interval (CI)=42-50%). In 143 patients (16%), a major PDDI was identified. The drug classes most frequently
involved in a major PDDI were coumarins and opioids. The majority of cases
concerned central nervous system interactions, PDDIs that can cause gastrointestinal toxicity and prolongation of QT intervals. In multivariate analysis,
concomitant use of more drugs (odds ratio (OR)=1.66, 95% CI=1.54-1.78,
P<0001) and genito-urinary cancer (OR=0.25, 95% CI=0.12-0.52, P<0001)
were risk factors.
CONCLUSION: Potential drug-drug interactions are very common among
cancer patients on oral cancer therapy. Physicians and pharmacists should
be more aware of these potential interactions.
Voordrachten
Doseren van cytostatica.
Jansman FGA
PUOZ : Doseren van geneesmiddelen bij obese patiënten
Utrecht, 19 maart 2012
Medicatiebewaking in de oncologie.
Jansman FGA
Nederlandse Ziekenhuisfarmaciedagen 2012
Nunspeet, 10 mei 2012
Wetenschappelijk overzicht 2012 - 2013
Farmacogenetica in de neurologie en oncologie.
Jansman FGA
Neurologie en Oncologie: Dilemma’s op het raakvlak van twee disciplines
Garderen, 22 juni 2012
Drug interactions in cancer patients treated with oral anti-cancer drugs.
Van Leeuwen RWF, Brundel DHS, Neef C, Mathijssen RHJ, Van Gelder T,
Burger DM, Jansman FGA
ESMO Congress 2012
Wenen, 28 september 2012
150
151
Wetenschappelijk overzicht 2012 - 2013
Ziekenhuisfarmacie
Ziekenhuisfarmacie
Prevalence of potential drug-drug interactions in cancer patients
treated with oral anticancer drugs.
van Leeuwen RW, Brundel DH, Neef C, van Gelder T, Mathijssen RH, Burger
DM, Jansman FG.
Br J Cancer. 2013 Mar 19;108(5):1071-8.
Author information
Department of Pharmacy, Erasmus University Medical Center, Rotterdam
3015CE, The Netherlands. Abstract
BACKGROUND:
Potential drug-drug interactions (PDDIs) in patients with cancer are common,
but have not previously been quantified for oral anticancer treatment. We
assessed the prevalence and seriousness of potential PDDIs among ambu-
Hyoscine N-butylbromide does not improve polyp detection during colonoscopy: a double-blind, randomized, placebo-controlled, clinical trial.
De Brouwer EJ, Arbouw ME, Van der Zwet WC, Van Herwaarden MA, Ledeboer M, Jansman FGA, Ter Borg F
Digestive Disease Week
San Diego, 19 oktober 2013
Posters
Metformin elimination by haemodialysis versus continuous
venovenous haemofiltration in renal failure patients with metformin associated lactic acidosis.
Bulsink A, Vermeij CG, Doorenbos CJ, van Berlo-van de Laar IRF
Nederlandse Ziekenhuisfarmaciedagen
Nunspeet, 11 mei 2012
Bloedspiegelbepalingen: nuttig of onzin?
Van Berlo IRF
Farmacotherapie symposium Dimence: Anders dan Anders
Deventer, 26 november 2013
Analysis of medication reconciliation at discharge from a Dutch hospital.
van Berlo-van de Laar IRF, Merkx MM, Jansman FGA
Nederlandse Ziekenhuisfarmaciedagen
Nunspeet, 10 mei 2012
Medicatieveiligheid en farmaceutische patiëntenzorg bij patiënten
met orale oncolytica.
Jansman FGA
Nederlandse Vereniging voor Poliklinische Farmacie
Symposium Oncologie
Utrecht, 16 april 2013
Promotie
Interactiebewaking en andere medicatiebegeleiding van (orale) oncolytica.
Jansman FGA
PAO Farmacotherapie Uptodate
Groningen, 6 november 2013
Ziekenhuisfarmacie
Prevalence of potential drug-drug interactions in cancer patients
treated with oral anticancer drugs.
Van Leeuwen RWF, Brundel DHS, Neef C, Mathijssen RHJ, Van Gelder T,
Burger DM, Jansman FGA
Mededelingendag Nederlandse Vereniging voor Klinische Farmacologie en Biofarmacie
Utrecht, 26 maart 2013
Wetenschappelijk overzicht 2012 - 2013
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153
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Ziekenhuisfarmacie
Development and application of measurement methods focusing on
medication related problems in elderly hospitalised patients.
Wierenga PC.
Universiteit van Amsterdam
Amsterdam, 8 november 2013
Samenvatting
In conclusion, elderly hospitalised patients form a patient group that is at higher
risk for medication related problems compared to younger patients. In order to
measure medication related problems in hospitalised elderly and to ultimately
improve their pharmaceutical care we examined three possible levels of measurement one can choose. These three levels of focus (systems, process, and
outcome level) were practiced in three measurement methods. As a starting
point in an improvement trajectory a systems approach using the prospective
risk analysis method with the Bow-Tie model is recommended. For periodical
quality of care measurement and less resource intensive research it is best to
use explicit process measures like our QIs (or the original ACOVE QIs). For
research in which resources and time are not scarce and measuring actual
patient harm is of importance, the ADE measurement method of our WINGS
study is the best choice. Whereas explicit process measures, like our indicators, facilitate comparison of results of other studies using the same or comparable indicators, results of studies reporting ADEs should be compared with
utmost caution. Based on the results from all three measurement methods in
this thesis it can, however, be concluded that the quality of pharmaceutical care
for elderly patients is still poor and needs improvement.
Pre- en post-analytisch advies.
Jansman FGA
2e Lage Landen Symposium Intoxicaties
Gent, 13 september 2013
Radiotherapeutisch Instituut
Stedendriehoek en Omstreken (RISO)
Ziekenhuishygiëne
Posters
Dragerschap van Extended-Spectrum Beta-Lactamases (ESBL’s) bij
hemodialysepatienten: retrospectief onderzoek naar het nut van routinematige screening naar ESBL-dragerschap en contactisolatie tijdens
dialyseren.
Oosterwijk PR, Bergervoet PHM, Van der Zwet WC, Sluiter HE
Wetenschapsavond Deventer Ziekenhuis
Deventer, 1 november 2012
Ziekenhuishygiëne
Wetenschappelijk overzicht 2012 - 2013
154
Radiotherapeutisch Instituut Stedendriehoek en Omstreken (RISO)
Five-year quality of life of endometrial cancer patients treated in the
randomised Post Operative Radiation Therapy in Endometrial Cancer
(PORTEC-2) trial and comparison with norm data.
Nout RA, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, van der
Steen-Banasik EM, Mens JW, Slot A, Stenfert Kroese MC, Nijman HW,
van de Poll-Franse LV, Creutzberg CL.
Eur J Cancer. 2012 Jul;48(11):1638-48.
Abstract
BACKGROUND: The PORTEC-2 trial showed efficacy and reduced sideeffects of vaginal brachytherapy (VBT) compared with external beam pelvic
radiotherapy (EBRT) for patients with high-intermediate risk endometrial
cancer. The current analysis was done to evaluate long-term health related
quality of life (HRQL), and compare HRQL of patients to an age-matched
norm population.
METHODS: Patients were randomly allocated to EBRT (n=214) or VBT (n=213).
HRQL was assessed using EORTC QLQ-C30 and subscales from PR25 and
OV28 (bladder, bowel, sexual symptoms); and compared to norm data.
FINDINGS: Median follow-up was 65 months; 348 (81%) patients were evaluable for HRQL (EBRT n=166, VBT n=182). At baseline, patient functioning
was at lowest level, increasing during and after radiotherapy to reach a plateau after 12 months, within range of scores of the norm population. VBT patients reported better social functioning (p=0.005) and lower symptom scores
for diarrhoea, faecal leakage, need to stay close to a toilet and limitation in
daily activities due to bowel symptoms (p⩽0.001), compared to EBRT. There
were no differences in sexual functioning or symptoms between the treatment groups; however, sexual functioning was lower and sexual symptoms
more frequent in both treatment groups compared to the norm population.
INTERPRETATION: Patients who received EBRT reported clinically relevant
higher levels of bowel symptoms and related limitations in daily activities
with lower social functioning, 5 years after treatment. VBT provides a better
HRQL, which remained similar to that of an age-matched norm population,
except for sexual symptoms which were more frequent in both treatment
groups.
Relocatable fixation systems in intracranial stereotactic radiotherapy :
Accuracy of serial CT scans and patient acceptance in a randomized
design.
Theelen A, Martens J, Bosmans G, Houben R, Jager JJ, Rutten I, Lambin P,
Minken AW, Baumert BG.
Strahlenther Onkol. 2012 Jan;188(1):84-90.
Abstract
PURPOSE: The goal was to provide a quantitative evaluation of the accuracy of three different fixation systems for stereotactic radiotherapy and to
evaluate patients’ acceptance for all fixations.
METHODS: A total of 16 consecutive patients with brain tumours undergoing
fractionated stereotactic radiotherapy (SCRT) were enrolled after informed
consent (Clinical trials.gov: NCT00181350). Fixation systems evaluated
were the BrainLAB® mask, with and without custom made bite-block (fixations S and A) and a homemade neck support with bite-block (fixation B)
based on the BrainLAB® frame. The sequence of measurements was evaluated in a randomized manner with a cross-over design and patients’ acceptance by a questionnaire.
RESULTS: The mean three-dimensional (3D) displacement and standard
Fractionated stereotactic radiotherapy for uveal melanoma, late clinical results.
Muller K, Naus N, Nowak PJ, Schmitz PI, de Pan C, van Santen CA, Marijnissen JP, Paridaens DA, Levendag PC, Luyten GP.
Radiother Oncol. 2012 Feb;102(2):219-24.
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Radiotherapeutisch Instituut Stedendriehoek en Omstreken (RISO)
Abstract
PURPOSE: To determine local control, late toxicity and metastatic free survival (MFS) of patients treated with fractionated stereotactic radiation therapy
(fSRT) for uveal melanoma (UM).
METHODS AND MATERIALS: Between 1999 and 2007, 102 UM patients
were included in a prospective study of a single institution (median follow-up
(FU) 32months; median tumor thickness 6mm); five fractions of 10Gy were
given. Primary endpoints were local tumor control and late toxicity (including
visual outcome and eye preservation). Secondary endpoint was MFS.
RESULTS: Local tumor control was achieved in 96% of the patients. Fifteen
enucleations were performed, 2-85months after radiation. Four eyes were
enucleated because of local tumor progression. Nine patients developed
grade 3 or 4 neovascular glaucoma (NVG), 19 developed severe retinopathy, 13 developed opticoneuropathy grade 3 or 4, 10 developed cataract
grade 3, and 10 patients suffered from keratitis sicca. Best corrected visual
acuity (BCVA) decreased from a mean of 0.26 at diagnosis to 0.16, 3months
after radiation and it gradually declined to 0.03, 4years after therapy. The
5-year actuarial MFS was 75% (95% CIs: 62-84%).
CONCLUSIONS: fSRT is an effective treatment modality for uveal melanoma with a good local control. With that, fSRT is a serious eye sparing
treatment modality. However, our FU is relatively short. Also, the number of
secondary enucleations is substantial, mainly caused by NVG.
Publicaties
deviations were 1.16 ± 0.68 mm for fixation S, 1.92 ± 1.28 and 1.70 ± 0.83 mm
for fixations A and B, respectively. There was a significant improvement of the
overall alignment (3D vector) when using the standard fixation instead of fixation A or B in the craniocaudal direction (p = 0.037). Rotational deviations were
significantly less for the standard fixation S in relation to fixations A (p = 0.005)
and B (p = 0.03). EPI imaging with off-line correction further improved reproducibility. Five out of 8 patients preferred the neck support with the bite-block.
CONCLUSION: The mask fixation system in conjunction with a bite-block
is the most accurate fixation for SCRT reducing craniocaudal and rotational
movements. Patients favoured the more comfortable but less accurate neck
support. To optimize the accuracy of SCRT, additional regular portal imaging
is warranted.
Evaluation of the adherence to follow-up care guidelines for women
with breast cancer.
Grandjean I, Kwast AB, de Vries H, Klaase J, Schoevers WJ, Siesling S.
Eur J Oncol Nurs. 2012 Jul;16(3):281-5.
Abstract
PURPOSE: To evaluate adherence with follow-up criteria as suggested by
the national guideline for breast cancer patients.
METHOD: Patients diagnosed with breast cancer in 2003 in two hospitals
were identified from the Netherlands Cancer Registry (n = 198). Compliance
with the guideline was assessed retrospectively by extracting follow-up care
data from patient files for a period of five years.
RESULTS: Follow-up data were available for 196 patients. In the first year of
follow-up, fewer consultations were performed compared to guideline standards. In the second through the fifth year of follow-up, more consultations
were performed, with nearly double the number of consultations in the third
until the fifth year compared to the guideline (p < 0.05). This excess usage
was mainly associated with the fact that women had received radiotherapy
(p < 0.01). Physical examinations were performed during 97 percent of consultations. Mammograms were performed slightly less often than suggested.
CONCLUSIONS: Among women receiving follow-up care after breast cancer,
more consultations were provided compared to the guideline recommendations.
Mammograms were performed slightly less often than recommended. With
regard to the performance of physical examinations, the guideline was followed.
A quality assurance tool for helical tomotherapy using a step-wedge
phantom and the on-board MVCT detector.
Althof V, van Haaren P, Westendorp R, Nuver T, Kramer D, Ikink M, Bel
A, Minken A.
J Appl Clin Med Phys. 2012 Jan 5;13(1):3585.
Author information
Radiotherapeutic Institute RISO, Deventer, The Netherlands.
Abstract
The purpose of this study was to develop and evaluate filmless quality assurance (QA) tools for helical tomotherapy by using the signals from the
on-board megavoltage computed tomography (MVCT) detector and applying
a dedicated step-wedge phantom. The step-wedge phantom is a 15 cm long
step-like aluminum block positioned on the couch. The phantom was moved
through the slit beam and MVCT detector signals were analyzed. Two QA
Objective automated assessment of time trends in prostate edema
after (125)I implantation.
Westendorp H, Kattevilder R, Riet van ‘t A, Minken AW, Nuver TT,
Immerzeel JJ, Hoekstra CJ.
Brachytherapy. 2012 Sep-Oct;11(5):327-33.
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Radiotherapeutisch Instituut Stedendriehoek en Omstreken (RISO)
Radiotherapeutisch Instituut Stedendriehoek en Omstreken (RISO)
Source
Department of Medical Physics, Radiotherapeutic Institute RISO, Deventer,
The Netherlands.
Abstract
PURPOSE: To present an objective automated method to determine time
trends in prostatic edema resulting from iodine-125 brachytherapy.
METHODS AND MATERIALS: We followed 20 patients, implanted with
stranded seeds, with seven consecutive CT scans to establish a time trend
in prostate edema. Seed positions were obtained automatically from the
CT series. The change in seed positions was used as surrogate for edema.
Two approaches were applied to model changes in volume. (1) A cylindrical
model: seeds from the compared distribution were linked to the reference
distribution of Day 28. After alignment, the compared distribution was scaled
in cylindrical coordinates, leading to the changes in radial and craniocaudal
directions. The volume changes were calculated using these scaling factors.
(2) A spherical model: distances of seeds to the center of gravity of all seeds
were used as a measure to model volume changes.
RESULTS: With Day 28 as reference, the observed volume changes were
smaller than 18% ± 6% (1 standard deviation) for the cylindrical model and
12% ± 7% for the spherical model. One day after implantation, the implanted
prostate was less than 10% larger than in the reference scan for both models. Apart from Day 0, both models showed similar volume changes.
CONCLUSIONS: We present an objective automated method to determine
changes in the implanted prostate volume, eliminating the influence of an observer in the assessment of the prostate size. The implanted volume change
was less than 18% ± 7% for the studied group of 20 patients. Edema was
9% ± 5% from 1 day after implantation onward.
Abstract
BACKGROUND: Several French, Belgian and Dutch radiation oncologists
have reported good results with the combination of limited surgery after external beam radiotherapy (EBRT) followed by brachytherapy in early-stage
muscle-invasive bladder cancer.
PATIENTS AND METHODS: Data from 12 of 13 departments which are
using this approach have been collected retrospectively, in a multicenter
database, resulting in 1040 patients: 811 males and 229 females with a median age of 66 years, range 28-92 years. Results were analyzed according
to tumor stage and diameter, histology grade, age and brachytherapy technique, continuous low-dose rate (CLDR) and pulsed dose rate (PDR).
RESULTS: At 1, 3 and 5 years, the local recurrence-free probability was 91%,
80% and 75%, metastasis-free probability was 91%, 80% and 74%, diseasefree probability was 85%, 68% and 61% and overall survival probability was
91%, 74% and 62%, respectively. The differences in the outcome between the
contributing departments were small. After multivariate analysis, the only factor
influencing the local control rate was the brachytherapy technique. Toxicity
consisted mainly of 24 fistula, 144 ulcers/necroses and 93 other types.
CONCLUSIONS: EBRT followed by brachytherapy, combined with limited
surgery, offers excellent results in terms of bladder sparing for selected
groups of patients suffering from bladder cancer.
High-dose-rate prostate brachytherapy based on registered transrectal ultrasound and in-room cone-beam CT images.
Even AJ, Nuver TT, Westendorp H, Hoekstra CJ, Slump CH, Minken AW
Brachytherapy. 2013 Sep 13. pii: S1538-4721(13)00310-3.
Author information
Department of Medical Physics, Radiotherapeutic Institute RISO, Deventer,
The Netherlands; MIRA Institute for Biomedical Technology and Technical
Medicine, University of Twente, Enschede, The Netherlands.
Abstract
PURPOSE: To present a high-dose-rate (HDR) brachytherapy procedure for
prostate cancer using transrectal ultrasound (TRUS) to contour the regions
of interest and registered in-room cone-beam CT (CBCT) images for needle
reconstruction. To characterize the registration uncertainties between the two
imaging modalities and explore the possibility of performing the procedure
solely on TRUS.
METHODS AND MATERIALS: Patients were treated with a TRUS/CBCTbased HDR brachytherapy procedure. For 100 patients, dosimetric results
were analyzed. For 40 patients, registration uncertainties were examined by
determining differences in fiducial marker positions on TRUS and registered
CBCT. The accuracy of needle reconstruction on TRUS was investigated by
Brachytherapy after external beam radiotherapy and limited surgery
preserves bladders for patients with solitary pT1-pT3 bladder tumors.
Koning CC, Blank LE, Koedooder C, van Os RM, van de Kar M, Jansen E,
Battermann JJ, Beijert M, Gernaat C, van Herpen KA, Hoekstra C, Horenblas S, Jobsen JJ, Krol AD, Lybeert ML, van Onna IE, Pelger RC, Poortmans
P, Pos FJ, van der Steen-Banasik E, Slot A, Visser A, Pieters BR.
Ann Oncol. 2012 Nov;23(11):2948-53.
Author information
Department of Radiation Oncology, Academic Medical Centre, University of
Amsterdam, Amsterdam, The Netherlands.
Wetenschappelijk overzicht 2012 - 2013
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Radiotherapeutisch Instituut Stedendriehoek en Omstreken (RISO)
Radiotherapeutisch Instituut Stedendriehoek en Omstreken (RISO)
procedures were developed, with gantry fixed at 0°: 1) step-wedge procedure: to check beam energy consistency, field width, laser alignment with
respect to the virtual isocenter, couch movement, and couch velocity; and 2)
completion procedure: to check the accuracy of a field abutment made by
the tomotherapy system after a treatment interruption. The procedures were
designed as constancy tool and were validated by measurement of deliberately induced variations and comparison with a reference method. Two
Hi-Art II machines were monitored over a period of three years using the
step-wedge procedures. The data acquisition takes 5 minutes. The analysis
is fully automated and results are available directly after acquisition. Couch
speed deviations up to 2% were induced. The mean absolute difference
between expected and measured couch speed was 0.2% ± 0.2% (1 standard deviation SD). Field width was varied around the 10 mm nominal size,
between 9.7 and 11.1 mm, in steps of 0.2 mm. Mean difference between the
step-wedge analysis and the reference method was &lt; 0.01 mm ± 0.03 mm
(1 SD). Laser (mis)alignment relative to a reference situation was detected
with 0.3 mm precision (1SD). The step-wedge profile was fitted to a PDD in
water. The PDD ratio D20/D10, measured at depths of 20 cm and 10 cm,
was used to check beam energy consistency. Beam energy variations were
induced. Mean difference between step-wedge and water PDD ratios was
0.2% ± 0.3% (1SD). The completion procedure was able to reveal abutment
mismatches with a mean error of -0.6 mm ± 0.2 mm (1SD). The trending
data over a period of three years showed a mean deviation of 0.4% ± 0.1%
(1 SD) in couch speed. The spread in field width was 0.15 mm (1 SD). The
sagittal and transverse lasers showed a variation of 0.5 mm (1 SD). Beam
energy varied 1.0% (1 SD). A mean abutment mismatch was found of -0.4
mm ± 0.2 mm (1 SD) between interrupted treatments. The on-board MVCT
detector, in combination with the step-wedge phantom, is a suitable tool for a
QA program for helical tomotherapy. The method allowed frequent monitoring of machine behavior for the past three years.
Intrafractional shifts during stereotactic body radiation therapy of
hepatic metastases.
Jacobs J, Niehoff I, Minken AWH, Westendorp H, Ruiter de Q, Muller K
ESTRO Forum
Geneve, 19-23 april 2013
determining the position differences of needle tips on TRUS and CBCT. The
dosimetric impact of reregistration and needle reconstruction on TRUS only
was studied for 8 patients.
RESULTS: The average prostate V100 was 97.8%, urethra D10 was 116.3%,
and rectum D1 cc was 66.4% of the prescribed dose. For 85% of the patients, registration inaccuracies were within 3 mm. Large differences were
found between needle tips on TRUS and CBCT, especially in cranial-caudal
direction, with a maximum of 10.4 mm. Reregistration resulted in a maximum
V100 reduction of 0.9%, whereas needle reconstruction on TRUS only gave
a maximum reduction of 9.4%.
CONCLUSIONS: HDR prostate brachytherapy based on TRUS combined
with CBCT is an accurate method. Registration uncertainties, and consequently dosimetric inaccuracies, are small compared with the uncertainties of
performing the procedure solely based on static TRUS images. CBCT
imaging is a requisite in our current procedure.
Dutch radiotherapy lung audit: Results of a national pilot.
Belderbos J, Henneman D, Verhoef C, Ploegmakers M, Bussink J, TissingTan C, Vonk E, Wel Van Der A, Verheij M, Dekker A
15th World Conference on Lung Cancer
Sydney, Australia, 27-21 oktober 2013
Posters
Voordrachten
Intraoperative dynamic planning and optimization as a routine
procedure for 1-125 prostate implants.
Kattevilder R, Westendorp R, Hoekstra C, Immerzeel J. Pol van de S,
Nuver T, Minken A
17th ISRRT World Congress and the 70th CAMRT Annual General
Conference
Toronto, 7-10 juni 2012
The additional value of MR imaging in radiation therapy treatment
planning of men with localized prostate cancer.
Grootjans W, Hoekstra CJM, Pol van de SMG, Westendorp R, Minken
AWH
ESTRO
Barcelona, mei 2012
CBCT guided intra-operative dynamic dosimetry significantly improves dosimetry for I1 25 prostate brachytherapy.
Westendorp R, Kattevilder R, Hoekstra C, Immerzeel J, Pol van de S,
Nuver T, Minken A
World Brachytherapy Congress
Barcelona, mei 2012
MVCT-detector based dosimetry replaces phantom measurements
for tomotherapy prostate treatments.
Nuver T, Kramer D, Althof V, Westendorp R, Minken A
ASTRO
Boston, sept-okt 2012
First experience with IMRT treatment plans created with RayStation.
Minken A, Kramer D, Ikink-Wispelweij M, Hilgers G, Westendorp R, Nuver T
ASTRO
Boston, sept-okt 2012
Chemotheradiation versus radiotherapy in postoperative cervical
cancer patients with poor prognostic factors: A retrospective Dutch
multicentre study.
Van der Steen-Banasik E, Nout R, Jobsen J, Mens JW, Beukema J,
Schultz-Jurgelink I, Slot A, Snijers A, Van de Berg H, Timmer P, Van de Pol S,
Ottevanger N, Van der Palen J
14th Biennial Meeting of the International Gynecologic Cancer Society
(IGCS)
Wetenschappelijk overzicht 2012 - 2013
No additional value of MRI to ultrasound imaging in external beam
radiation treatment planning of localized prostate cancer.
Grootjans W, Hoekstra CJM, Pol van de SMG, Westendorp R, Minken
AWH
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Radiotherapeutisch Instituut Stedendriehoek en Omstreken (RISO)
Radiotherapeutisch Instituut Stedendriehoek en Omstreken (RISO)
Dose coverage in image guided SBRT for NSCLC using tomotherapy.
Kerkmeijer LGW, Althof VC, Steenberg R, Vonk E
ESTRO
Barcelona, mei 2012
Wetenschapsprijzen Deventer Ziekenhuis
NVvTG congres
12 oktober 2012
Uitgereikt in 2012
I-I 25 Brachytherapy is safe in patients who underwent a prior TURP.
Kattevilder R, Hoekstra C, Niel C, Pol van de S, Minken A, Nuver T,
Westendorp R
ESTRO Forum
Genève, 19-23 april 2013
Jozefprijs uitreiking, 23 maart 2012
Jozefprijs: Tim Budding, co-assistent MDL
Location in the Right Hemi-Colon Is an Independent Risk Factor for Delayed
Post-Polypectomy Hemorrhage: A Multi-Center Case-Control Study.
Budding KT, Herngreen T, Haringsma J, Van der Zwet WC, Vleggelaar FP,
Breumelhof R, Ter Borg F.
Am J Gastroenterol 2011;106:1119-24.
Fiducial markers for liver SBRT using helical tomotherapy MVCT.
Muller K, Ruiter de Q, Jacobs J, Niehoff I, Minken A, Westendorp R
ESTRO Forum
Genève, 19-23 april 2013
Eervolle vermelding: Jan Hessels, klinisch chemicus
PeeSpot; urine home collection device. Innovatieve methode voor verzamelen van portie urine.
Hessels J, Cairo DW, Slettenhaar M, Dogger M.
Ned Tijdschr Klin Chem Labgeneesk 2011;36:249-251
CT metal artifact reduction in the pelvic area: Clinical evaluation of a
commercial product.
Hilgers G, Nuver T, Minken A
ESTRO Forum
Genève, 19-23 april 2013
Eervolle vermelding: Erik Badings, research arts cardiologie
Strategies to detect abnormal glucose metabolism in people at high risk of
cardiovascular disease from the ORIGIN (Outcome Reduction with Initial
Glargine Intervention) trial population.
Badings EA, Dyal L, Schoterman L, Lok DJ, Stoel I, Gerding MN, Gerstein
HC, Tijssen JG.
J Diabetes 2011;3:232-7.
HDR prostate brachytherapy base don registered TRUS and In-Room
Cone-Beam CT images.
Nuver T, Even A, Westendorp H, Hoekstra C, Minken A
ESTRO Forum
Genève, 19-23 april 2013
Wetenschapsavond, 1 november 2012
Beste voordracht: Suzan Korste (M3-coassistent interne geneeskunde)
Ureumklaring: Herleving van een oude analytische techniek?
Een retrospectieve pilotstudie over het gebruik van de gemiddelde klaring
van kreatinine en ureum voor het maken van een nauwkeurige schatting van
de nierfunctie, onderzocht bij niertransplantatiepatiënten
Korste SCC1, Sluiter HE2.
1
Coassistent Interne Geneeskunde,2Internist-Nefroloog, Deventer Ziekenhuis
Promotie
Fractionated stereotactic radiotherapy for uveal melanoma.
Karin Muller
Erasmus Universiteit Rotterdam, 7 september 2012
Wetenschappelijk overzicht 2012 - 2013
164
165
Wetenschappelijk overzicht 2012 - 2013
Wetenschapsprijzen Deventer Ziekenhuis
Radiotherapeutisch Instituut Stedendriehoek en Omstreken (RISO)
IMRT treatment for palliative irradiation of spinal bone metastasis.
Kant I, Spoolder M, Loeters E, Minken A, Niël C
ESTRO Forum
Genève, 19-23 april 2013
State of the Art Lectures 2012 - 2013
Beste poster: Ilse Wolf (deskundige infectiepreventie)
Wastafel op de IC is ESBL besmettingsbron voor patiënten.
Wolf I 1, Bergervoet PWM 1, van der Zwet WC 1, van den Oever HLA 2,
Savelkoul PHM 3, Sebens FW1
1
Laboratorium voor Medische Microbiologie en Infectiepreventie, Deventer
Ziekenhuis, 2 Intensive Care, Deventer Ziekenhuis, 3 Moleculaire diagnostiek
& Epidemiologie, VU medisch centrum, Amsterdam
2 februari 2012 Jurr Boer (dermatoloog)
Hidradenitis suppurativa. Etterende bulten en puisten in je liezen
en oksels; je zult het maar hebben !!
Beste M3 wetenschappelijke stage: Marleen Maats (M3-coassistent
interne geneeskunde)
Immuunhistochemische biomarkers en de relatie met overleving in BRCA1like en non-BRCA1-like subgroepen in triple-negatieve borstkanker.
Maats MEM1, Wesseling J2, Imholz ALT1, Lips EH2.
1
Afdeling interne geneeskunde Deventer ziekenhuis, 2Pathologie NKI-AVL
Amsterdam
4 april 2012 Bernard Elsman (chirurg)
Longchirurgie, van tomie naar scopie
7 juni 2012 Maurits Arbouw (ziekenhuisapotheker) en Marieke Zeeman
(specialist ouderengeneeskunde)
Polyfarmacie, uw probleem???
6 september 2012 Michiel Ledeboer (MDL-arts)
Het plaatsen van een endoprothese bij acute maligne dikke darm
afsluiting:
‘Expert opinion’ of ‘evidencebased’?
Publieksprijs: Sander Paas (M3-coassistent chirurgie)
Lange termijn resultaten van distale radius fracturen behandeld met een
volaire hoekstabiele plaat
PaasSFE1,2, van ManenCJ3, Westerbeek RE3, Roerdink WH1
1
Deventer Ziekenhuis, afdeling Heelkunde, 2Rijks Universiteit Groningen,
Universitair Medisch Centrum Groningen, 3Deventer Ziekenhuis, afdeling
radiologie
4 oktober 2012 Peter van de Tillaar (uroloog)
Neurostimulatie bij blaasfunctiestoornissen; of toch acupunctuur?
10 januari 2013 Monique Gorissen (kinderarts)
ANAFYLAXIE, een specialisme-overstijgend intrigerend ziektebeeld.
Hands On!
7 maart 2013 Fabrice MAC Martens (cardioloog)
De introductie van de Nieuwe Orale Anticoagulantia (NOACs)
4 april 2013 Hebste Shirango (klinisch patholoog)
Classificatie van hepatocellulair adenomen gebaseerd op genotype
en fenotype.
16 mei 2013 Joost Zwart (gynaecoloog)
Ernstige maternale morbiditeit: “de prijs van voortplanten”.
Wetenschappelijk overzicht 2012 - 2013
166
167
Wetenschappelijk overzicht 2012 - 2013
State of the Art Lectures 2012 - 2013
Wetenschapsprijzen Deventer Ziekenhuis
6 december 2012 Bernadette van Nesselrooij (klinisch geneticus, UMC
Utrecht)
It’s all in the genes!???
Impactfactors
5 september 2013 Daniëlle Langeloo (orthopedisch chirurg)
Voorste kruisbandletsel: reden tot reconstructie?
31 oktober 2013 D.Q. Ngo (neuroloog)
Zenuw in beeld.
12 december 2013 Esther Vogels & Rolf Mahne (Anesthesiologie & Pijncentrum Oost-Nederland)
Echogeleide analgesie.
State of the Art Lectures 2012 - 2013
Wetenschappelijk overzicht 2012 - 2013
168
169
Eur J Cancer
5.061
Eur J Clin Pharmacol
2.741
Eur J Oncol Nurs
1.685
Eur J Vasc Endovasc Surg
2.820
Eur Radiol
3.548
Fertil Steril
4.174
Gastroenterology
12.821
Gastrointest Endosc
5.210
Graefes Arch Clin
Exp Ophthalmol
1.932
Gynecol Obstet Invest
1.103
Heart
5.014
Hum Reprod
4.670
Injury
2.174
Int J Clin Pharm
0.859
Int J Pediatr Otorhinolaryngol 1.350
Int J Radiat Oncol Biol Phys 4.524
Int Orthop
2.319
J Am Soc Nephrol
8.987
J Appl Clin Med Phys
0.959
J Bone Joint Surg Am
3.234
J Cardiovasc Med
2.657
J Clin Pathol
2.439
J Eur Acad Dermatol Venereol 2.694
J Eval Clin Pract
1.508
J Med Internet Res
3.768
J Orthop Surg Res
1.013
J Pediatr
4.035
J Surg Oncol
2.644
JBR-BTR
0.261
Kidney Int
7.916
Knee Surg Sports
Traumatol Arthrosc
2.676
Leuk Lymphoma
2.301
Med Teach
1.824
Mol Vis
1.987
Neth Heart J
1.411
Neth J Med
2.383
N Engl J Med
51.685
Wetenschappelijk overzicht 2012 - 2013
Impactfactors
Acta Chir Belg
0.359
Acta Obstet Gynecol Scand 1.850
Acta Ophthalmol
2.345
Acta Paediatr
1.974
Am Heart J
4.497
Am J Cardiol
3.269
Ann Oncol
7.384
Ann Surg
6.329
Antivir Ther
3.073
Arch Otolaryngol
Head Neck Surg
1.779
B-ENT
0.355
BJOG
3.760
BMC Musculoskelet Disord
1.875
BMC Pregnancy Childbirth
2.516
BMC Womens Health
1.505
BMJ
17.215
BMJ Qual Saf
2.394
Br J Cancer
5.082
Br J Clin Pharmacol
3.578
Br J Dermatol
3.759
Br J Oral Maxillofac Surg
2.717
Brachytherapy
1.220
Cerebrovasc Dis
2.814
Circ Heart Fail
6.684
Clin Chem Lab Med
3.009
Clin J Sport Med
1.600
Clin Res Cardiol
3.667
Contact Dermatitis
2.925
Dev Med Child Neurol
2.776
Diabetes Care
7.735
Dig Dis Sci
2.260
Dig Liver Dis
3.162
Dig Surg
1.472
Drugs Aging
2.646
Early Hum Dev
2.020
Emerg Med J
1.645
Endoscopy
5.735
EuroIntervention
3.173
3 oktober 2013 Edwin Wijburg (plastisch chirurg i.s.m. handtherapeuten van
het DZ)
De internationale medische en paramedische standaardbehandeling
van de mallet anno 2013.
Pharmacoepidemiol Drug Saf
PLoS One
Radiographics
Radiother Oncol
Sex Transm Infect
2.897
3.730
2.791
4.520
2.611
Strahlenther Onkol
Support Care Cancer
Ultrasound Obstet Gynecol
Vox Sang
Auteurs index
4.163
2.649
3.557
2.847
Wetenschappelijk overzicht 2012 - 2013
170
171
Gerding M
Ginkel van CJ
Gorissen DM
Groenewegen-Sipkema KH
Groot de R
Grootjans W
Gutteling J
Haring CM
Hartmans E
Hem van der LG
Herwaarden van MA
Hessels J
Hilgers G
Hoekstra CJ
Hofstee N
Holter ten JB
Hoppenreijs VP
Hosson de SM
Hotho DM
Houtzager BA
Houwers JB
Houwing RH
Ikink M
Imholz ALT
Immerzeel JJ
Jacobs J
Jansman FG
Jaspers GW
Jaspers MMJJR
Jonbergen van HP
Kant I
Kattevilder R
Kerkmeijer LGW
Kessels L
Klok CFM
Klomp HA
Koehler EM
Kolk van der C
Koopman T
Koorevaar R
Korste SCC
Kortlandt F
Koster K
Kramer D
Kruik-Kollöffel WJ
Laarhoven van S
Langeloo D
Ledeboer M
Leeuw van der -Harmsen L
Liem MS
Linden van der PJ
Lindmae H
Loeters E
Lohmann HJ
Lok DJ
Lubberts B
Maats M
Manders JMB
Manen van CJ
Martens FMAC
Merkx MM
Minken AW
Muller K
Ngo DQ
Niebling M
Niehoff I
Niël C
Noo de ME
Nunspeet van L
Nuver TT
Oei DTD
Oosterwijk PR
Ordelman A
Paas S
Pijl BJ
Pol van de S
Wetenschappelijk overzicht 2012 - 2013
Auteurs index
Impactfactors
Al Ali C
Althof V
Arbouw ME
Badings E
Barnaart AF
Bergervoet PWM
Berlo van-Laar van
de IR
Bie de SH
Bisschop R
Boeddha AV
Boer J
Bom SJH
Borg ter F
Bosker RJ
Broeks IJ
Bruggink-André de la
Porte PW
Budding T
Buis CI
Bulsink A
Buwalda J
Cobben JMG
Dassel ACM
Deckers I
Derks RPH
Deure van der J
Diekman MJ
Dijk van RAJM
Dijkstra ML
Doorenbos CJ
Eddes EH
Eeftinck Schattenkerk
M
Elsman B
Even A
Flikweert ER
Fortuin AS
Frima AJ
Pruijsers-Lamers PH
Rensen JM
Reuver JM
Riet van ’t A
Rijssel van RH
Roerdink WH
Ruiter de Q
Schepers T
Schoevers WJ
Scholten I
Sebens FW
Shirango H
Sluis van der A
Sluiter HE
Smit FW
Smits MM
Spoolder M
Sprakel J
Steenberg R
Stenfert Kroese MC
Swart LE
Stigter RH
Tebbes M
Teeuwen GM
Tillaar van de P
Tongeren van RB
Tran VHP
Tuininga YS
Uijlings R
Veen E
Vermeij CG
Verwoolde LH
Vliet van A
Vloedgraven HG
Voet van der LF
Vonk E
Vries de H
Wendker-van Wattum M
Westendorp H
Westerbeek RE
Wieland CW
Wierenga P
Wiersma HW
Wijnands WJ
Wijngaarden van J
Wind LJN
Wolf I
Zeeman M
Zonneveld B
Zwart JJ
Zwaving H
Zwet van der WC
Auteurs index
Wetenschappelijk overzicht 2012 - 2013
172