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Landman AJEMC, de Boer MA, Visser L, Nijman TAJ, Hemels MAC, Naaktgeboren CN, van der Weide MC, Mol BW, van Laar JOEH, Papatsonis DNM, Bekker MN, van Drongelen J, van Pampus MG, Sueters M, van der Ham DP, Sikkema JM, Zwart JJ, Huisjes AJM, van Huizen ME, Kleiverda G, Boon J, Franssen MTM, Hermes W, Visser H, de Groot CJM, Oudijk MA. Evaluation of low-dose aspirin in the prevention of recurrent spontaneous preterm labour (the APRIL study): A multicentre, randomised, double-blinded, placebo-controlled trial. PLoS Med 2022; 19:e1003892. [PMID: 35104279 PMCID: PMC8806064 DOI: 10.1371/journal.pmed.1003892] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/14/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Preterm birth is the leading cause of neonatal morbidity and mortality. The recurrence rate of spontaneous preterm birth is high, and additional preventive measures are required. Our objective was to assess the effectiveness of low-dose aspirin compared to placebo in the prevention of preterm birth in women with a previous spontaneous preterm birth. METHODS AND FINDINGS We performed a parallel multicentre, randomised, double-blinded, placebo-controlled trial (the APRIL study). The study was performed in 8 tertiary and 26 secondary care hospitals in the Netherlands. We included women with a singleton pregnancy and a history of spontaneous preterm birth of a singleton between 22 and 37 weeks. Participants were randomly assigned to aspirin 80 mg daily or placebo initiated between 8 and 16 weeks of gestation and continued until 36 weeks or delivery. Randomisation was computer generated, with allocation concealment by using sequentially numbered medication containers. Participants, their healthcare providers, and researchers were blinded for treatment allocation. The primary outcome was preterm birth <37 weeks of gestation. Secondary outcomes included a composite of poor neonatal outcome (bronchopulmonary dysplasia, periventricular leukomalacia > grade 1, intraventricular hemorrhage > grade 2, necrotising enterocolitis > stage 1, retinopathy of prematurity, culture proven sepsis, or perinatal death). Analyses were performed by intention to treat. From May 31, 2016 to June 13, 2019, 406 women were randomised to aspirin (n = 204) or placebo (n = 202). A total of 387 women (81.1% of white ethnic origin, mean age 32.5 ± SD 3.8) were included in the final analysis: 194 women were allocated to aspirin and 193 to placebo. Preterm birth <37 weeks occurred in 41 (21.2%) women in the aspirin group and 49 (25.4%) in the placebo group (relative risk (RR) 0.83, 95% confidence interval (CI) 0.58 to 1.20, p = 0.32). In women with ≥80% medication adherence, preterm birth occurred in 24 (19.2%) versus 30 (24.8%) women (RR 0.77, 95% CI 0.48 to 1.25, p = 0.29). The rate of the composite of poor neonatal outcome was 4.6% (n = 9) versus 2.6% (n = 5) (RR 1.79, 95% CI 0.61 to 5.25, p = 0.29). Among all randomised women, serious adverse events occurred in 11 out of 204 (5.4%) women allocated to aspirin and 11 out of 202 (5.4%) women allocated to placebo. None of these serious adverse events was considered to be associated with treatment allocation. The main study limitation is the underpowered sample size due to the lower than expected preterm birth rates. CONCLUSIONS In this study, we observed that low-dose aspirin did not significantly reduce the preterm birth rate in women with a previous spontaneous preterm birth. However, a modest reduction of preterm birth with aspirin cannot be ruled out. Further research is required to determine a possible beneficial effect of low-dose aspirin for women with a previous spontaneous preterm birth. TRIAL REGISTRATION Dutch Trial Register (NL5553, NTR5675) https://www.trialregister.nl/trial/5553.
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Affiliation(s)
- Anadeijda J. E. M. C. Landman
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Marjon A. de Boer
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Laura Visser
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Tobias A. J. Nijman
- Department of Obstetrics and Gynaecology, Haaglanden Medical Centre, Den Haag, the Netherlands
| | | | - Christiana N. Naaktgeboren
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Marijke C. van der Weide
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Ben W. Mol
- Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Aberdeen Centre for Women’s Health Research, University of Aberdeen Aberdeen, United Kingdom
| | | | | | - Mireille N. Bekker
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joris van Drongelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Marieke Sueters
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - David P. van der Ham
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, the Netherlands
| | - J. Marko Sikkema
- Department of Obstetrics and Gynaecology, Hospital Group Twente Almelo, Almelo, the Netherlands
| | - Joost J. Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands
| | - Anjoke J. M. Huisjes
- Department of Obstetrics and Gynaecology, Gelre Hospitals Apeldoorn, Apeldoorn, the Netherlands
| | | | - Gunilla Kleiverda
- Department of Obstetrics and Gynaecology, Flevo Hospital Almere, Almere, the Netherlands
| | - Janine Boon
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, the Netherlands
| | - Maureen T. M. Franssen
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Wietske Hermes
- Department of Obstetrics and Gynaecology, Haaglanden Medical Centre, Den Haag, the Netherlands
| | - Harry Visser
- Department of Obstetrics and Gynaecology, Tergooi Hospitals, Hilversum, the Netherlands
| | - Christianne J. M. de Groot
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Martijn A. Oudijk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
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Landman A, de Boer M, Visser L, Hemels M, Naaktgeboren C, Jansen-van der Weide M, Mol B, van Laar J, Papatsonis D, Bekker M, van Drongelen J, van Pampus M, Sueters M, van der Ham D, Sikkema M, Zwart J, Huisjes A, van Huizen M, Kleiverda G, Boon J, Franssen M, Hermes W, Visser H, de Groot CJ, Oudijk MA. 9 Low dose aspirin for the prevention of recurrent preterm labor (APRIL): a randomized controlled trial. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lammers AJJ, Brohet RM, Theunissen REP, Koster C, Rood R, Verhagen DWM, Brinkman K, Hassing RJ, Dofferhoff A, El Moussaoui R, Hermanides G, Ellerbroek J, Bokhizzou N, Visser H, van den Berge M, Bax H, Postma DF, Groeneveld PHP. Early hydroxychloroquine but not chloroquine use reduces ICU admission in COVID-19 patients. Int J Infect Dis 2020; 101:283-289. [PMID: 33007454 PMCID: PMC7524430 DOI: 10.1016/j.ijid.2020.09.1460] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The global push for the use of hydroxychloroquine (HCQ) and chloroquine (CQ) against COVID-19 has resulted in an ongoing discussion about the effectivity and toxicity of these drugs. Recent studies report no effect of (H)CQ on 28-day mortality. We investigated the effect of HCQ and CQ in hospitalized patients on the non-ICU COVID-ward. METHODS A nationwide, observational cohort study was performed in The Netherlands. Hospitals were given the opportunity to decide independently on the use of three different COVID-19 treatment strategies: HCQ, CQ, or no treatment. We compared the outcomes between these groups. The primary outcomes were 1) death on the COVID-19 ward, and 2) transfer to the intensive care unit (ICU). RESULTS The analysis included 1064 patients from 14 hospitals: 566 patients received treatment with either HCQ (n = 189) or CQ (n = 377), and 498 patients received no treatment. In a multivariate propensity-matched weighted competing regression analysis, there was no significant effect of (H)CQ on mortality on the COVID ward. However, HCQ was associated with a significantly decreased risk of transfer to the ICU (hazard ratio (HR) = 0.47, 95% CI = 0.27-0.82, p = 0.008) when compared with controls. This effect was not found in the CQ group (HR = 0.80, 95% CI = 0.55-1.15, p = 0.207), and remained significant after competing risk analysis. CONCLUSION The results of this observational study demonstrate a lack of effect of (H)CQ on non-ICU mortality. However, we show that the use of HCQ - but not CQ - is associated with a 53% reduction in risk of transfer of COVID-19 patients from the regular ward to the ICU. Recent prospective studies have reported on 28-day, all-cause mortality only; therefore, additional prospective data on the early effects of HCQ in preventing transfer to the ICU are still needed.
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Affiliation(s)
| | - R M Brohet
- Department of Epidemiology and Statistics, Isala Academy, Zwolle, The Netherlands
| | | | | | - R Rood
- Diakonessen Hospital, Utrecht, The Netherlands
| | - D W M Verhagen
- Medisch Centrum Jan van Goyen, Amsterdam, The Netherlands
| | | | | | - A Dofferhoff
- Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | | | - J Ellerbroek
- Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - N Bokhizzou
- BovenIJ Hospital, Amsterdam, The Netherlands
| | - H Visser
- Beatrix Hospital Gorinchem, The Netherlands
| | | | - H Bax
- Erasmus MC Rotterdam, The Netherlands
| | - D F Postma
- University Medical Center Groningen, Groningen, The Netherlands
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Ruijters VJ, Visser H, Grady BPX. An unexpected infectious disease in wintertime. Neth J Med 2020; 78:305. [PMID: 33093261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- V J Ruijters
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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Ruijters VJ, Visser H, Grady BPX. Answer to Photo Quiz An unexpected infectious disease in wintertime. Neth J Med 2020; 78:306. [PMID: 33093262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Zeilstra IM, Visser H. [Intra-abdominal bleeding following spontaneous vaginal delivery]. Ned Tijdschr Geneeskd 2019; 163:D3689. [PMID: 31769638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Intra-abdominal bleeding following spontaneous delivery is a rare but potentially life-threatening complication. Usually the haemorrhage is the result of a rupture of a pseudoaneurysm of the uterine artery. CASE DESCRIPTION A 38-year-old female (gravida 4, para 2) was, at her own request and at 40 2/7 weeks of gestation, admitted to the delivery suite for induction of labour. A few hours following the uncomplicated delivery she suddenly developed severe pain in the upper abdomen. Laboratory diagnostics showed a haemoglobin level of 5.8 mmol/l. Ultrasound identified a lot of intra-abdominal fluid. ACT-angiogram confirmed the presence of intra-abdominal fluid, highly suggestive of a bleeding from the uterine artery or right ovarian vein. Therapeutic angiography was conducted, during which embolization of the right uterine artery was performed. CONCLUSION In post-partum women who experience severe abdominal pain and anaemia, but no vaginal blood loss, it is important to consider intra-abdominal bleeding.
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Affiliation(s)
- Inge M Zeilstra
- Tergooi, afd. Gynaecologie en Obstetrie, Blaricum
- Contact: I.M. Zeilstra
| | - Harry Visser
- Tergooi, afd. Gynaecologie en Obstetrie, Blaricum
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Hageman IMG, Visser H, Veenstra J, Baas F, Siegert CEH. Familial Mediterranean Fever (FMF): a single centre retrospective study in Amsterdam. Neth J Med 2019; 77:177-182. [PMID: 31264586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Familial Mediterranean Fever (FMF) is the earliest described and most prevalent hereditary auto-inflammatory disease. Its clinical presentation is diverse, leading to possible delay in diagnosis and treatment. Due to immigration, FMF became common in non-Mediterranean European regions. In the present single centre retrospective study, the clinical, demographic, and genetic characteristics of patients with FMF of different ancestry in Amsterdam are described. METHODS Case records of patients with FMF, who met the Tel-Hashomer diagnostic criteria, were retrospectively analysed. The international disease severity score was used. RESULTS Between 1990-2012, 53 patients were identified, 28 were female. Main country of origin was Turkey. The mean age at the time of analysis was 29.1 years; 13.8 years at onset of symptoms; and at time of diagnosis, 22.0 years. Most frequent symptoms were peritonitis (91%) and fever (81%). The mean C-reactive protein and erythrocyte sedimentation rate during acute attacks were 133 mg/l and 37 mm/first hour, respectively. One patient developed amyloidosis as a complication. Seventeen patients underwent abdominal surgery before diagnosis. Most patients (92%) received colchicine treatment and were responsive (81%). Most patients classified their disease as a mild disease (42%). MEFV gene mutation analysis was performed in 46 patients; most patients were compound heterozygotes (n = 17), and the most frequent mutation was M694V (n = 18). CONCLUSION FMF in Amsterdam is diagnosed in relatively young patients and the delay to diagnosis is 8.2 years. Disease manifestations and genetic distribution of our FMF patients are comparable to those in Mediterranean regions, suggesting that ancestry is more important than environment.
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Affiliation(s)
- I M G Hageman
- Department of Internal Medicine, OLVG, location West, Amsterdam, the Netherlands
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8
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Stegwee SI, Jordans IPM, van der Voet LF, Bongers MY, de Groot CJM, Lambalk CB, de Leeuw RA, Hehenkamp WJK, van de Ven PM, Bosmans JE, Pajkrt E, Bakkum EA, Radder CM, Hemelaar M, van Baal WM, Visser H, van Laar JOEH, van Vliet HAAM, Rijnders RJP, Sueters M, Janssen CAH, Hermes W, Feitsma AH, Kapiteijn K, Scheepers HCJ, Langenveld J, de Boer K, Coppus SFPJ, Schippers DH, Oei ALM, Kaplan M, Papatsonis DNM, de Vleeschouwer LHM, van Beek E, Bekker MN, Huisjes AJM, Meijer WJ, Deurloo KL, Boormans EMA, van Eijndhoven HWF, Huirne JAF. Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development - the 2Close study: a multicentre randomised controlled trial. BMC Pregnancy Childbirth 2019; 19:85. [PMID: 30832681 PMCID: PMC6399840 DOI: 10.1186/s12884-019-2221-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Double-layer compared to single-layer closure of the uterus after a caesarean section (CS) leads to a thicker myometrial layer at the site of the CS scar, also called residual myometrium thickness (RMT). It possibly decreases the development of a niche, which is an interruption of the myometrium at the site of the uterine scar. Thin RMT and a niche are associated with gynaecological symptoms, obstetric complications in a subsequent pregnancy and delivery and possibly with subfertility. METHODS Women undergoing a first CS regardless of the gestational age will be asked to participate in this multicentre, double blinded randomised controlled trial (RCT). They will be randomised to single-layer closure or double-layer closure of the uterine incision. Single-layer closure (control group) is performed with a continuous running, unlocked suture, with or without endometrial saving technique. Double-layer closure (intervention group) is performed with the first layer in a continuous unlocked suture including the endometrial layer and the second layer is also continuous unlocked and imbricates the first. The primary outcome is the reported number of days with postmenstrual spotting during one menstrual cycle nine months after CS. Secondary outcomes include surgical data, ultrasound evaluation at three months, menstrual pattern, dysmenorrhea, quality of life, and sexual function at nine months. Structured transvaginal ultrasound (TVUS) evaluation is performed to assess the uterine scar and if necessary saline infusion sonohysterography (SIS) or gel instillation sonohysterography (GIS) will be added to the examination. Women and ultrasound examiners will be blinded for allocation. Reproductive outcomes at three years follow-up including fertility, mode of delivery and complications in subsequent deliveries will be studied as well. Analyses will be performed by intention to treat. 2290 women have to be randomised to show a reduction of 15% in the mean number of spotting days. Additionally, a cost-effectiveness analysis will be performed from a societal perspective. DISCUSSION This RCT will provide insight in the outcomes of single- compared to double-layer closure technique after CS, including postmenstrual spotting and subfertility in relation to niche development measured by ultrasound. TRIAL REGISTRATION Dutch Trial Register ( NTR5480 ). Registered 29 October 2015.
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Affiliation(s)
- S. I. Stegwee
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - I. P. M. Jordans
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - L. F. van der Voet
- Department of Obstetrics and Gynaecology, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, the Netherlands
| | - M. Y. Bongers
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, the Netherlands
- Department of Obstetrics and Gynaecology, Research school ‘GROW’, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - C. J. M. de Groot
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - C. B. Lambalk
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - R. A. de Leeuw
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - W. J. K. Hehenkamp
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - P. M. van de Ven
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - J. E. Bosmans
- Department of Health sciences, Faculty of Science, Research institute ‘Amsterdam Public Health’, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - E. Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - E. A. Bakkum
- Department of Obstetrics and Gynaecology, OLVG-oost, Oosterpark 9, 1091 AC Amsterdam, the Netherlands
| | - C. M. Radder
- Department of Obstetrics and Gynaecology, OLVG-west, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands
| | - M. Hemelaar
- Department of Obstetrics and Gynaecology, Westfriesgasthuis, Maelsonstraat 3, 1624 NP Hoorn, the Netherlands
| | - W. M. van Baal
- Department of Obstetrics and Gynaecology, Flevo hospital, Hospitaalweg 1, 1315 RA Almere, the Netherlands
| | - H. Visser
- Department of Obstetrics and Gynaecology, Tergooi hospital, Rijksstraatweg 1, 1261 AN Blaricum, the Netherlands
| | - J. O. E. H. van Laar
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, the Netherlands
| | - H. A. A. M. van Vliet
- Department of Obstetrics and Gynaecology, Catharina hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - R. J. P. Rijnders
- Department of Obstetrics and Gynaecology, Jeroen Bosch hospital, Henri Dunantstraat 1, 5223 GZ ‘s-Hertogenbosch, the Netherlands
| | - M. Sueters
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - C. A. H. Janssen
- Department of Obstetrics and Gynaecology, Groene Hart hospital, Bleulandweg 10, 2803 HH Gouda, the Netherlands
| | - W. Hermes
- Department of Obstetrics and Gynaecology, Haaglanden Medical Centre – Westeinde hospital, Lijnbaan 32, 2512 VA Den Haag, the Netherlands
| | - A. H. Feitsma
- Department of Obstetrics and Gynaecology, Haga hospital, Els-Borst-Eilersplein 275, 2545 AA Den Haag, the Netherlands
| | - K. Kapiteijn
- Department of Obstetrics and Gynaecology, Reinier de Graaf hospital, Reinier de Graafweg 5, 2625 AD Delft, the Netherlands
| | - H. C. J. Scheepers
- Department of Obstetrics and Gynaecology, Research school ‘GROW’, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - J. Langenveld
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, the Netherlands
| | - K. de Boer
- Department of Obstetrics and Gynaecology, Rijnstate hospital, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands
| | - S. F. P. J. Coppus
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - D. H. Schippers
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, the Netherlands
| | - A. L. M. Oei
- Department of Obstetrics and Gynaecology, Bernhoven hospital, Nistelrodeseweg 10, 5406 PT Uden, the Netherlands
| | - M. Kaplan
- Department of Obstetrics and Gynaecology, Röpcke-Zweers hospital, Jan Weitkamplaan 4a, 7772 SE Hardenberg, the Netherlands
| | - D. N. M. Papatsonis
- Department of Obstetrics and Gynaecology, Amphia hospital, Langendijk 75, 4819 EV Breda, the Netherlands
| | - L. H. M. de Vleeschouwer
- Department of Obstetrics and Gynaecology, Sint Franciscus hospital, Kleiweg 500, 3045 PM Rotterdam, the Netherlands
| | - E. van Beek
- Department of Obstetrics and Gynaecology, Sint Antonius hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
| | - M. N. Bekker
- Department of Obstetrics and Gynaecology, Birth Centre Wilhelmina Children hospital/University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - A. J. M. Huisjes
- Department of Obstetrics and Gynaecology, Gelre hospital – location Apeldoorn, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, the Netherlands
| | - W. J. Meijer
- Department of Obstetrics and Gynaecology, Gelre hospital – location Zutphen, Den Elterweg 77, 7207 AE Zutphen, the Netherlands
| | - K. L. Deurloo
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, the Netherlands
| | - E. M. A. Boormans
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Maatweg 3, 3813 TZ Amersfoort, the Netherlands
| | - H. W. F. van Eijndhoven
- Department of Obstetrics and Gynaecology, Isala clinics, Dokter van Heesweg 2, 8025 AB Zwolle, the Netherlands
| | - J. A. F. Huirne
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
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9
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Bui BN, Torrance HL, Janssen C, Cohlen B, de Bruin JP, den Hartog JE, van der Linden PJQ, Deurloo KL, Maas JWM, van Oppenraaij R, Cantineau A, Lambalk CB, Visser H, Brinkhuis E, van Disseldorp J, Schoot BC, Lardenoije C, van Wely M, Eijkemans MJC, Broekmans FJM. Does endometrial scratching increase the rate of spontaneous conception in couples with unexplained infertility and a good prognosis (Hunault > 30%)? Study protocol of the SCRaTCH-OFO trial: a randomized controlled trial. BMC Pregnancy Childbirth 2018; 18:511. [PMID: 30594169 PMCID: PMC6311044 DOI: 10.1186/s12884-018-2160-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022] Open
Abstract
Background In the Netherlands, couples with unexplained infertility and a good prognosis to conceive spontaneously (i.e. Hunault > 30%) are advised to perform timed intercourse for at least another 6 months. If couples fail to conceive within this period, they will usually start assisted reproductive technology (ART). However, treatment of unexplained infertility by ART is empirical and can involve significant burdens. Intentional endometrial injury, also called ‘endometrial scratching’, has been proposed to positively affect the chance of embryo implantation in patients undergoing in vitro fertilization (IVF). It might also be beneficial for couples with unexplained infertility as defective endometrial receptivity may play a role in these women. The primary aim of this study is to determine whether endometrial scratching increases live birth rates in women with unexplained infertility. Method A multicentre randomized controlled trial will be conducted in Dutch academic and non-academic hospitals starting from November 2017. A total of 792 women with unexplained infertility and a good prognosis for spontaneous conception < 12 months (Hunault > 30%) will be included, of whom half will undergo endometrial scratching in the luteal phase of the natural cycle. The women in the control group will not undergo endometrial scratching. According to Dutch guidelines, both groups will subsequently perform timed intercourse for at least 6 months. The primary endpoint is cumulative live birth rate. Secondary endpoints are clinical and ongoing pregnancy rate; miscarriage rate; biochemical pregnancy loss; multiple pregnancy rate; time to pregnancy; progression to intrauterine insemination (IUI) or IVF; pregnancy complications; complications of endometrial scratching; costs and endometrial tissue parameters associated with reproductive success or failure. The follow-up duration is 12 months. Discussion Several small studies show a possible beneficial effect of endometrial scratching in women with unexplained infertility trying to conceive naturally or through IUI. However, the quality of this evidence is very low, making it unclear whether these women will truly benefit from this procedure. The SCRaTCH-OFO trial aims to investigate the effect of endometrial scratching on live birth rate in women with unexplained infertility and a good prognosis for spontaneous conception < 12 months. Trial registration NTR6687, registered August 31st, 2017. Protocol version Version 2.6, November 14th, 2018.
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Affiliation(s)
- B N Bui
- University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - H L Torrance
- University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - C Janssen
- Groene Hart Hospital, Gouda, The Netherlands
| | - B Cohlen
- Isala Fertility Clinic, Zwolle, The Netherlands
| | - J P de Bruin
- Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - J E den Hartog
- Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | | | - J W M Maas
- Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - A Cantineau
- University Medical Centre Groningen, Groningen, The Netherlands
| | - C B Lambalk
- Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
| | - H Visser
- Tergooi Hospital, Hilversum, The Netherlands
| | - E Brinkhuis
- Meander Medical Centre, Amersfoort, The Netherlands
| | | | - B C Schoot
- Catharina Hospital, Eindhoven, The Netherlands
| | | | - M van Wely
- Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynecology - NVOG Consortium 2.0, Amsterdam, The Netherlands
| | - M J C Eijkemans
- University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - F J M Broekmans
- University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
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Visser H, van Megen H, van Balkom T. The Effectiveness of the Inference Based Approach to Treating Obsessive-compulsive Disorder with Poor Insight; a Randomized Controlled Multicentre Trial. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BackgroundThere is an urgent need for an effective psychological treatment for patients with obsessive compulsive disorder (OCD) with poor insight, since this disorder is associated with severe suffering and a low quality of life. The inference based approach (IBA), a new psychotherapy for OCD specifically targets insight in OCD. In a randomized controlled multicentre trial, the effectiveness of IBA was compared to the effectiveness of CBT for treating patients with OCD with poor insight. In this study, 24 sessions of IBA were tested versus 24 sessions of CBT. Ninety patients with a main diagnosis of OCD with poor insight according to the DSM-IV criteria participated in the study. The primary outcome was reduction of the obsessive-compulsive symptoms.ResultsIn both conditions, a significant OCD symptom reduction was reached, but no condition effects were established. Post hoc, in a small subgroup of patients with the worst insight (n = 23), it was found that the patients treated with the IBA reached a significantly higher OCD symptom reduction than patients treated with CBT [estimated marginal mean = –7.77, t(219.45) = –2.4, P = 0.017]. Of patients treated with IBA, 41.9% were responder and 20.9% completely recovered. Of the patients treated with CBT, 42.6% were responder and 12.8% recovered.ConclusionPatients with OCD with poor insight improve significantly after psychological treatment. The results of this study suggest that both CBT and the IBA are effective treatments for OCD with poor insight. The IBA might be more promising than CBT for patients with more extreme poor insight.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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11
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Vankan E, Schoorel EN, van Kuijk SM, Mol BWJ, Nijhuis JG, Aardenburg R, Alink M, de Boer K, Delemarre FM, Dirksen CD, van Dooren IM, Franssen MT, Kaplan M, Kleiverda G, Kuppens SM, Kwee A, Langenveld J, Lim FT, Melman S, Sikkema MJ, Smits LJ, Visser H, woiski M, Scheepers HC, Hermens RP. Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: a retrospective cohort study. Acta Obstet Gynecol Scand 2017; 96:158-165. [DOI: 10.1111/aogs.13059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Emy Vankan
- Department of Obstetrics and Gynecology; GROW-School for Oncology and Developmental Biology; Maastricht University Medical Center+; Maastricht the Netherlands
| | - Ellen N. Schoorel
- Department of Obstetrics and Gynecology; GROW-School for Oncology and Developmental Biology; Maastricht University Medical Center+; Maastricht the Netherlands
| | - Sander M. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA); Maastricht University; Maastricht the Netherlands
| | - Ben-Willem J. Mol
- Department of Obstetrics and Gynecology; The Robinson Research Institute; University of Adelaide; Adelaide South Australia Australia
| | - Jan G. Nijhuis
- Department of Obstetrics and Gynecology; GROW-School for Oncology and Developmental Biology; Maastricht University Medical Center+; Maastricht the Netherlands
| | - Robert Aardenburg
- Department of Obstetrics and Gynecology; Zuyderland Medical Center; Sittard the Netherlands
| | - Marleen Alink
- Department of Obstetrics and Gynecology; GROW-School for Oncology and Developmental Biology; Maastricht University Medical Center+; Maastricht the Netherlands
| | - Karin de Boer
- Department of Obstetrics and Gynecology; Hospital Rijnstate; Arnhem the Netherlands
| | - Friso M.C. Delemarre
- Department of Obstetrics and Gynecology; Elkerliek Hospital; Helmond the Netherlands
| | - Carmen D. Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA); Maastricht University; Maastricht the Netherlands
| | - Ivo M. van Dooren
- Department of Obstetrics and Gynecology; Sint Jans Gasthuis; Weert the Netherlands
| | - Maureen T.M. Franssen
- Department of Obstetrics and Gynecology; Groningen University Medical Center; Groningen the Netherlands
| | - Mesrure Kaplan
- Department of Obstetrics and Gynecology; Röpcke-Zweers Hospital; Hardenberg the Netherlands
| | - Gunilla Kleiverda
- Department of Obstetrics and Gynecology; Flevo Hospital; Almere the Netherlands
| | - Simone M.I. Kuppens
- Department of Obstetrics and Gynecology; Catharina Hospital; Eindhoven the Netherlands
| | - Anneke Kwee
- Department of Obstetrics and Gynecology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Josje Langenveld
- Department of Obstetrics and Gynecology; Zuyderland Medical Center; Heerlen the Netherlands
| | - Frans T. Lim
- Department of Obstetrics and Gynecology; IJsselland Hospital; Capelle aan den IJssel the Netherlands
| | - Sonja Melman
- Department of Obstetrics and Gynecology; GROW-School for Oncology and Developmental Biology; Maastricht University Medical Center+; Maastricht the Netherlands
| | - Marko J. Sikkema
- Department of Obstetrics and Gynecology; ZiekenhuisGroep Twente; Almelo the Netherlands
| | - Luc J. Smits
- Caphri School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | - Harry Visser
- Department of Obstetrics and Gynecology; Tergooi Hospital; Hilversum the Netherlands
| | - Mallory woiski
- Department of Obstetrics and Gynecology; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
| | - Hubertina C. Scheepers
- Department of Obstetrics and Gynecology; GROW-School for Oncology and Developmental Biology; Maastricht University Medical Center+; Maastricht the Netherlands
| | - Rosella P. Hermens
- Scientific Institute for Quality of Healthcare (IQ healthcare); Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
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12
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Ten Eikelder MLG, van de Meent MM, Mast K, Rengerink KO, Jozwiak M, de Graaf IM, Scholtenhuis MAGHO, Roumen FJME, Porath MM, van Loon AJ, van den Akker ES, Rijnders RJP, Feitsma AH, Adriaanse AH, Muller MA, de Leeuw JW, Visser H, Woiski MD, Weerd SRD, van Unnik GA, Pernet PJM, Versendaal H, Mol BW, Bloemenkamp KWM. Women's Experiences with and Preference for Induction of Labor with Oral Misoprostol or Foley Catheter at Term. Am J Perinatol 2017; 34:138-146. [PMID: 27341122 DOI: 10.1055/s-0036-1584523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective We assessed experience and preferences among term women undergoing induction of labor with oral misoprostol or Foley catheter. Study Design In 18 of the 29 participating hospitals in the PROBAAT-II trial, women were asked to complete a questionnaire within 24 hours after delivery. We adapted a validated questionnaire about expectancy and experience of labor and asked women whether they would prefer the same method again in a future pregnancy. Results The questionnaire was completed by 502 (72%) of 695 eligible women; 273 (54%) had been randomly allocated to oral misoprostol and 229 (46%) to Foley catheter. Experience of the duration of labor, pain during labor, general satisfaction with labor, and feelings of control and fear related to their expectation were comparable between both the groups. In the oral misoprostol group, 6% of the women would prefer the other method if induction is necessary in future pregnancy, versus 12% in the Foley catheter group (risk ratio: 0.70; 95% confidence interval: 0.55-0.90; p = 0.02). Conclusion Women's experiences of labor after induction with oral misoprostol or Foley catheter are comparable. However, women in the Foley catheter group prefer more often to choose a different method for future inductions.
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Affiliation(s)
| | | | - Kelly Mast
- Department of Obstetrics and Gynecology, Maastricht Medical Center, Maastricht, The Netherlands
| | - Katrien Oude Rengerink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marta Jozwiak
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Irene M de Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Frans J M E Roumen
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Martina M Porath
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, The Netherlands
| | - Aren J van Loon
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, The Netherlands
| | | | - Robbert J P Rijnders
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - A Hanneke Feitsma
- Department of Obstetrics and Gynecology, HAGA Hospital, Den Haag, The Netherlands
| | - Albert H Adriaanse
- Department of Obstetrics and Gynecology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Moira A Muller
- Department of Obstetrics and Gynecology, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Jan W de Leeuw
- Department of Obstetrics and Gynecology, Ikazia Hospital, Rotterdam, The Netherlands
| | - Harry Visser
- Department of Obstetrics and Gynecology, Ter Gooi Hospital, Hilversum, The Netherlands
| | - Mallory D Woiski
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sabina Rombout-de Weerd
- Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Gijs A van Unnik
- Department of Obstetrics and Gynecology, Diaconessenhuis, Leiden, The Netherlands
| | - Paula J M Pernet
- Department of Obstetrics and Gynecology, Kennemer Gasthuis, Haarlem, The Netherlands
| | - Hans Versendaal
- Department of Obstetrics and Gynecology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Ben W Mol
- The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Kitty W M Bloemenkamp
- Division Women and Baby, Department of Obstetrics, Birth Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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13
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Melman S, Schoorel ECN, de Boer K, Burggraaf H, Derks JB, van Dijk D, van Dillen J, Dirksen CD, Duvekot JJ, Franx A, Hasaart THM, Huisjes AJM, Kolkman D, van Kuijk S, Kwee A, Mol BW, van Pampus MG, de Roon-Immerzeel A, van Roosmalen JJM, Roumen FJME, Smid-Koopman E, Smits L, Spaans WA, Visser H, van Wijngaarden WJ, Willekes C, Wouters MGAJ, Nijhuis JG, Hermens RPMG, Scheepers HCJ. Development and Measurement of Guidelines-Based Quality Indicators of Caesarean Section Care in the Netherlands: A RAND-Modified Delphi Procedure and Retrospective Medical Chart Review. PLoS One 2016; 11:e0145771. [PMID: 26783742 PMCID: PMC4718610 DOI: 10.1371/journal.pone.0145771] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS) rates. METHOD Eighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery. RESULTS The expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1) suspected fetal distress (frequency 17%, adherence 46%), 2) non-progressive labour (frequency 12%, CS performed too early in over 75%), 3) continuous support during labour (frequency 88%, adherence 37%) and 4) previous CS (frequency 12%), with adequate counselling in 15%. CONCLUSIONS We identified four concrete target groups for improvement of obstetrical care, which can be used as a starting point to reduce CS rates worldwide.
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Affiliation(s)
- Sonja Melman
- GROW- School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- * E-mail:
| | - Ellen C. N. Schoorel
- GROW- School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Karin de Boer
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, P.O. Box 9555, 6800 TA Arnhem, The Netherlands
| | - Henriëtte Burggraaf
- Midwives Zaltbommel en Maasdriel, Hogeweg 141, 5301 LL Zaltbommel, The Netherlands
| | - Jan B. Derks
- Department of Obstetrics and Gynaecology, University Medical Hospital Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Det van Dijk
- Department of Obstetrics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Carmen D. Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Johannes J. Duvekot
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, University Medical Hospital Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Tom H. M. Hasaart
- Department of Obstetrics and Gynaecology, Catharina-Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - Anjoke J. M. Huisjes
- Department of Obstetrics and Gynaecology, Gelre Hospital, P.O. Box 9014, 7300 DS Apeldoorn, the Netherlands
| | - Diny Kolkman
- Royal Dutch Organization of Midwives (KNOV), Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Sander van Kuijk
- Department of Epidemiology, Caphri School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anneke Kwee
- Department of Obstetrics and Gynaecology, University Medical Hospital Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Ben W. Mol
- Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Mariëlle G. van Pampus
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Alieke de Roon-Immerzeel
- Royal Dutch Organization of Midwives (KNOV), Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Jos J. M. van Roosmalen
- Department of Obstetrics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Frans J. M. E. Roumen
- Department of Obstetrics and Gynaecology, Atrium Medical Center Parkstad, P.O. Box 4446, 6401 CX Heerlen, The Netherlands
| | - Ellen Smid-Koopman
- Department of Obstetrics and Gynaecology, Ruwaard van Putten Hospital, P.O. Box 777, 3200 GA Spijkenisse, The Netherlands
| | - Luc Smits
- Department of Epidemiology, Caphri School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wilbert A. Spaans
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME ‘s-Hertogenbosch, The Netherlands
| | - Harry Visser
- Department of Obstetrics and Gynaecology, Tergooi Hospital Blaricum, P.O. Box 10016, 1201 DA Hilversum, The Netherlands
| | - Wim J. van Wijngaarden
- Department of Obstetrics and Gynaecology, Bronovo Hospital, P.O. Box 96900, 2509 JH Den Haag, The Netherlands
| | - Christine Willekes
- GROW- School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Maurice G. A. J. Wouters
- Department of Obstetrics and Gynaecology, VU University Medical Center Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Jan G. Nijhuis
- GROW- School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Rosella P. M. G. Hermens
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Hubertina C. J. Scheepers
- GROW- School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
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Holtzer-Goor KM, Schaafsma MR, Joosten P, Posthuma EFM, Wittebol S, Huijgens PC, Mattijssen EJM, Vreugdenhil G, Visser H, Peters WG, Erjavec Z, Wijermans PW, Daenen SMGJ, van der Hem KG, van Oers MHJ, Uyl-de Groot CA. Quality of life of patients with chronic lymphocytic leukaemia in the Netherlands: results of a longitudinal multicentre study. Qual Life Res 2015. [PMID: 26205768 PMCID: PMC4615661 DOI: 10.1007/s11136-015-1039-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose To describe the health-related quality of life (HRQoL) of an unselected population of patients with chronic lymphocytic leukaemia (CLL) including untreated patients. Methods HRQoL was measured by the EORTC QLQ-C30 including the CLL16 module, EQ-5D, and VAS in an observational study over multiple years. All HRQoL measurements per patient were connected and analysed using area under the curve analysis over the entire study duration. The total patient group was compared with the general population, and three groups of CLL patients were described separately, i.e. patients without any active treatment (“watch and wait”), chlorambucil treatment only, and patients with other treatment(s). Results HRQoL in the total group of CLL patients was compromised when compared with age- and gender-matched norm scores of the general population. CLL patients scored statistically worse on the VAS and utility score of the EQ-5D, all functioning scales of the EORTC QLQ-C30, and the symptoms of fatigue, dyspnoea, sleeping disturbance, appetite loss, and financial difficulties. In untreated patients, the HRQoL was slightly reduced. In all treatment stages, HRQoL was compromised considerably. Patients treated with chlorambucil only scored worse on the EORTC QLQ-C30 than patients who were treated with other treatments with regard to emotional functioning, cognitive functioning, bruises, uncomfortable stomach, and apathy. Conclusions CLL patients differ most from the general population on role functioning, fatigue, concerns about future health, and having not enough energy. Once treatment is indicated, HRQoL becomes considerably compromised. This applies to all treatments, including chlorambucil, which is considered to be a mild treatment. Electronic supplementary material The online version of this article (doi:10.1007/s11136-015-1039-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K M Holtzer-Goor
- Department of Health Policy and Management, Erasmus University Rotterdam, Institute for Medical Technology Assessment, P.O. Box 1738, 3000DR, Rotterdam, The Netherlands.
| | | | - P Joosten
- Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - E F M Posthuma
- Leiden University Medical Center, Leiden, The Netherlands.,Reinier de Graaf Groep, Delft, The Netherlands
| | - S Wittebol
- Meander Medisch Centrum, Amersfoort, The Netherlands
| | - P C Huijgens
- VU University Medical Center, Amsterdam, The Netherlands
| | | | - G Vreugdenhil
- Máxima Medisch Centrum, Veldhoven, The Netherlands.,MUMC+, Maastricht, The Netherlands
| | - H Visser
- Medisch Centrum Alkmaar, Alkmaar, The Netherlands
| | - W G Peters
- Catharina-ziekenhuis, Eindhoven, The Netherlands
| | - Z Erjavec
- Ommelander Ziekenhuis Groep, Delfzijl, The Netherlands
| | | | - S M G J Daenen
- UMCG, University of Groningen, Groningen, The Netherlands
| | | | - M H J van Oers
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C A Uyl-de Groot
- Department of Health Policy and Management, Erasmus University Rotterdam, Institute for Medical Technology Assessment, P.O. Box 1738, 3000DR, Rotterdam, The Netherlands
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Manders S, van de Laar M, Rongen-van Dartel S, Bos R, Visser H, Brus H, Jansen T, Vonkeman H, van Riel P, Kievit W. FRI0345 Tapering MTX in Patients with RA Using TNFI Treatment is Possible: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Schouten M, Nossent EJ, Visser H, de Vocht J, van Jaarsveld BC. An immunocompromised woman with a lung tumour. Neth J Med 2015; 73:139-141. [PMID: 25852116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- M Schouten
- Departments of Nephrology, VU Medical Center, Amsterdam, the Netherlands
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Manders S, Kievit W, Adang E, Brus H, Bernelot Moens H, Hartkamp A, Schilder A, Vonkeman H, Brouwer E, Westhovens R, Visser H, van de Laar M, van Riel P. SAT0253 Cost-Effectiveness of Abatacept, Rituximab or A TNFI after Failure of the First TNFI Treatment in RA: Results of A Multi-Centered Pragmatic RCT in the DREAM Registry. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Manders S, Kievit W, Adang E, Brus H, Bernelot Moens H, Hartkamp A, Hendriks L, Vonkeman H, Brouwer E, Westhovens R, Visser H, van de Laar M, van Riel P. FRI0336 Effectiveness of Abatacept, Rituximab or A TNFI after Failure of the First Tnfi: Results of A Multi-Centered Pragmatic Rct. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Schoorel ENC, van Kuijk SMJ, Melman S, Nijhuis JG, Smits LJM, Aardenburg R, de Boer K, Delemarre FMC, van Dooren IM, Franssen MTM, Kaplan M, Kleiverda G, Kuppens SMI, Kwee A, Lim FTH, Mol BWJ, Roumen FJME, Sikkema JM, Smid-Koopman E, Visser H, Woiski M, Hermens RPMG, Scheepers HCJ. Vaginal birth after a caesarean section: the development of a Western European population-based prediction model for deliveries at term. BJOG 2014; 121:194-201; discussion 201. [PMID: 24373593 DOI: 10.1111/1471-0528.12539] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop and internally validate a model that predicts the outcome of an intended vaginal birth after caesarean (VBAC) for a Western European population that can be used to personalise counselling for deliveries at term. DESIGN Registration-based retrospective cohort study. SETTING Five university teaching hospitals, seven non-university teaching hospitals, and five non-university non-teaching hospitals in the Netherlands. POPULATION A cohort of 515 women with a history of one caesarean section and a viable singleton pregnancy, without a contraindication for intended VBAC, who delivered at term. METHODS Potential predictors for a vaginal delivery after caesarean section were chosen based on literature and expert opinions. We internally validated the prediction model using bootstrapping techniques. MAIN OUTCOME MEASURES Predictors for VBAC. For model validation, the area under the receiver operating characteristic curve (AUC) for discriminative capacity and calibration-per-risk-quantile for accuracy were calculated. RESULTS A total of 371 out of 515 women had a VBAC (72%). Variables included in the model were: estimated fetal weight greater than the 90(th) percentile in the third trimester; previous non-progressive labour; previous vaginal delivery; induction of labour; pre-pregnancy body mass index; and ethnicity. The AUC was 71% (95% confidence interval, 95% CI = 69-73%), indicating a good discriminative ability. The calibration plot shows that the predicted probabilities are well calibrated, especially from 65% up, which accounts for 77% of the total study population. CONCLUSION We developed an appropriate Western European population-based prediction model that is aimed to personalise counselling for term deliveries.
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Affiliation(s)
- E N C Schoorel
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Schoorel ENC, Melman S, van Kuijk SMJ, Grobman WA, Kwee A, Mol BWJ, Nijhuis JG, Smits LJM, Aardenburg R, de Boer K, Delemarre FMC, van Dooren IM, Franssen MTM, Kleiverda G, Kaplan M, Kuppens SMI, Lim FTH, Sikkema JM, Smid-Koopman E, Visser H, Vrouenraets FPJM, Woiski M, Hermens RPMG, Scheepers HCJ. Predicting successful intended vaginal delivery after previous caesarean section: external validation of two predictive models in a Dutch nationwide registration-based cohort with a high intended vaginal delivery rate. BJOG 2014; 121:840-7; discussion 847. [DOI: 10.1111/1471-0528.12605] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2013] [Indexed: 11/27/2022]
Affiliation(s)
- ENC Schoorel
- Department of Obstetrics and Gynaecology of Maastricht University Medical Centre+; GROW-School for Oncology and Developmental Biology; Maastricht the Netherlands
| | - S Melman
- Department of Obstetrics and Gynaecology of Maastricht University Medical Centre+; GROW-School for Oncology and Developmental Biology; Maastricht the Netherlands
| | - SMJ van Kuijk
- Department of Epidemiology; Caphri School for Public Health and Primary Care; Maastricht University Medical Centre; Maastricht the Netherlands
| | - WA Grobman
- Feinberg School of Medicine; Northwestern University; Chicago IL USA
| | - A Kwee
- Department of Obstetrics; University Medical Centre Utrecht; Utrecht the Netherlands
| | - BWJ Mol
- Department of Obstetrics and Gynaecology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - JG Nijhuis
- Department of Obstetrics and Gynaecology of Maastricht University Medical Centre+; GROW-School for Oncology and Developmental Biology; Maastricht the Netherlands
| | - LJM Smits
- Department of Epidemiology; Caphri School for Public Health and Primary Care; Maastricht University Medical Centre; Maastricht the Netherlands
| | - R Aardenburg
- Department of Obstetrics and Gynaecology; Orbis Medical Centre; Sittard the Netherlands
| | - K de Boer
- Department of Obstetrics and Gynaecology; Hospital Rijnstate; Arnhem the Netherlands
| | - FMC Delemarre
- Department of Obstetrics and Gynaecology; Elkerliek Hospital; Helmond the Netherlands
| | - IM van Dooren
- Department of Obstetrics and Gynaecology; Sint Jans Gasthuis Weert; Weert the Netherlands
| | - MTM Franssen
- Department of Obstetrics and Gynaecology; Groningen University Medical Centre; Groningen the Netherlands
| | - G Kleiverda
- Department of Obstetrics and Gynaecology; Flevo Hospital; Almere the Netherlands
| | - M Kaplan
- Department of Obstetrics and Gynaecology; Röpcke-Zweers Hospital; Hardenberg the Netherlands
| | - SMI Kuppens
- Department of Obstetrics and Gynaecology; Catharina Hospital; Eindhoven the Netherlands
| | - FTH Lim
- Department of Obstetrics and Gynaecology; IJsselland Hospital; Capelle aan den IJssel the Netherlands
| | - JM Sikkema
- Department of Obstetrics and Gynaecology; ZiekenhuisGroepTwente; Almelo the Netherlands
| | - E Smid-Koopman
- Department of Obstetrics and Gynaecology; Ruwaard van Putten Ziekenhuis; Spijkenisse the Netherlands
| | - H Visser
- Department of Obstetrics and Gynaecology; Tergooi Hospital; Hilversum the Netherlands
| | - FPJM Vrouenraets
- Department of Obstetrics and Gynaecology; Atrium Medical Centre; Heerlen the Netherlands
| | - M Woiski
- Department of Obstetrics and Gynaecology; Radboud University Nijmegen Medical Centre; Nijmegen the Netherlands
| | - RPMG Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare); Radboud University Nijmegen Medical Centre; Nijmegen the Netherlands
| | - HCJ Scheepers
- Department of Obstetrics and Gynaecology of Maastricht University Medical Centre+; GROW-School for Oncology and Developmental Biology; Maastricht the Netherlands
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Manders S, Kievit W, Jansen T, Stolk J, Visser H, Bos R, van de Laar M, van Riel P. OP0069 Significantly Better Results for TNFI Combination Therapy with MTX Than TNFI Mono- and Combination Without MTX Therapy in Patients with RA: Results from the Dream Registry. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Holtzer-Goor KM, Bouwmans-Frijters CAM, Schaafsma MR, de Weerdt O, Joosten P, Posthuma EFM, Wittebol S, Huijgens PC, Mattijssen EJM, Vreugdenhil G, Visser H, Peters WG, Erjavec Z, Wijermans PW, Daenen SMGJ, van der Hem KG, van Oers MHJ, Groot CAUD. Real-world costs of chronic lymphocytic leukaemia in the Netherlands. Leuk Res 2013; 38:84-90. [PMID: 24268350 DOI: 10.1016/j.leukres.2013.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 10/31/2013] [Indexed: 11/25/2022]
Abstract
We performed a comprehensive cost calculation identifying the main cost drivers of treatment of chronic lymphocytic leukaemia in daily practice. In our observational study 160 patient charts were reviewed repeatedly to assess the treatment strategies from diagnosis till the study end. Ninety-seven patients (61%) received ≥1 treatment lines during an average follow-up time of 6.4 years. The average total costs per patient were €41,417 (€539 per month). The costs varied considerably between treatment groups and between treatment lines. Although patients were treated with expensive chemo(immuno-)therapy, the main cost driver was inpatient days for other reasons than administration of chemo(immuno-)therapy.
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Affiliation(s)
- K M Holtzer-Goor
- Department of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - C A M Bouwmans-Frijters
- Department of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M R Schaafsma
- Department of Haematology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - O de Weerdt
- Department of Haematology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - P Joosten
- Department of Haematology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - E F M Posthuma
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands; Department of Haematology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - S Wittebol
- Department of Haematology, Meander Medical Center, Amersfoort, The Netherlands
| | - P C Huijgens
- Department of Haematology, VU University Medical Center, Amsterdam, The Netherlands
| | - E J M Mattijssen
- Department of Haematology, Rijnstate Hospital, Arnhem, The Netherlands
| | - G Vreugdenhil
- Department of Haematology, Máxima Medical Center, Veldhoven, The Netherlands
| | - H Visser
- Department of Haematology, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - W G Peters
- Department of Haematology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Z Erjavec
- Department of Haematology, OZG Delfzicht Ziekenhuis, Delfzijl, The Netherlands
| | - P W Wijermans
- Department of Haematology, Haga Hospital, Den Haag, The Netherlands
| | - S M G J Daenen
- Department of Haematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K G van der Hem
- Department of Haematology, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - M H J van Oers
- Department of Haematology, Academic Medical Center, Amsterdam, The Netherlands
| | - C A Uyl-de Groot
- Department of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Liem S, Schuit E, Hegeman M, Bais J, de Boer K, Bloemenkamp K, Brons J, Duvekot H, Bijvank BN, Franssen M, Gaugler I, de Graaf I, Oudijk M, Papatsonis D, Pernet P, Porath M, Scheepers L, Sikkema M, Sporken J, Visser H, van Wijngaarden W, Woiski M, van Pampus M, Mol BW, Bekedam D. Cervical pessaries for prevention of preterm birth in women with a multiple pregnancy (ProTWIN): a multicentre, open-label randomised controlled trial. Lancet 2013; 382:1341-9. [PMID: 23924878 DOI: 10.1016/s0140-6736(13)61408-7] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In women with a multiple pregnancy, spontaneous preterm delivery is the leading cause of perinatal morbidity and mortality. Interventions to reduce preterm birth in these women have not been successful. We assessed whether a cervical pessary could effectively prevent poor perinatal outcomes. METHODS We undertook a multicentre, open-label randomised controlled trial in 40 hospitals in the Netherlands. We randomly assigned women with a multiple pregnancy between 12 and 20 weeks' gestation (1:1) to pessary or control groups, using a web-based application with a computer-generated list with random block sizes of two to four, stratified by hospital. Participants and investigators were aware of group allocation. For women in the pessary group, a midwife or obstetrician inserted a cervical pessary between 16 and 20 weeks' gestation. Women in the control group did not receive the pessary, but otherwise received similar obstetrical care to those in the pessary group. The primary outcome was a composite of poor perinatal outcome: stillbirth, periventricular leucomalacia, severe respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular haemorrhage, necrotising enterocolitis, proven sepsis, and neonatal death. Analyses were by modified intention to treat. This trial is registered in the Dutch trial registry, number NTR1858. FINDINGS Between Sept 21, 2009, and March 9, 2012, 813 women underwent randomisation, of whom 808 were analysed (401 in the pessary group; 407 in the control group). At least one child of 53 women (13%) in the pessary group had poor perinatal outcome, compared with 55 (14%) in the control group (relative risk 0·98, 95% CI 0·69-1·39). INTERPRETATION In unselected women with a multiple pregnancy, prophylactic use of a cervical pessary does not reduce poor perinatal outcome. FUNDING The Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Sophie Liem
- Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, Netherlands.
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Ferwerda M, Spillekom S, van Middendorp H, van Beugen S, Kievit W, Fransen J, Visser H, van Oijen P, Taal E, van Riel P, de Jong E, van de Kerkhof P, van der Laar M, Evers A. THU0590 The Patient-Therapist Relationship as An Indicator for Treatment Success in E-Health Treatments for Patients with Rheumatoid Arthritis and Psorias. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van der Veen YJJ, van Empelen P, de Zwart O, Visser H, Mackenbach JP, Richardus JH. Cultural tailoring to promote hepatitis B screening in Turkish Dutch: a randomized control study. Health Promot Int 2013; 29:692-704. [DOI: 10.1093/heapro/dat020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Melman S, Schoorel ENC, Dirksen C, Kwee A, Smits L, de Boer F, Jonkers M, Woiski MD, Mol BWJ, Doornbos JPR, Visser H, Huisjes AJM, Porath MM, Delemarre FMC, Kuppens SMI, Aardenburg R, Van Dooren IMA, Vrouenraets FPJM, Lim FTH, Kleiverda G, van der Salm PCM, de Boer K, Sikkema MJ, Nijhuis JG, Hermens RPMG, Scheepers HCJ. SIMPLE: implementation of recommendations from international evidence-based guidelines on caesarean sections in the Netherlands. Protocol for a controlled before and after study. Implement Sci 2013; 8:3. [PMID: 23281646 PMCID: PMC3547819 DOI: 10.1186/1748-5908-8-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 12/18/2012] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Caesarean section (CS) rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between 37 and 42 weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was obtained. It can be hypothesized that evidence-based guidelines on CS are not implemented sufficiently. Therefore, the present study has the following objectives: to develop quality indicators on the decision to perform a CS based on key recommendations from national and international guidelines; to use the quality indicators in order to gain insight into actual adherence of Dutch gynaecologists to guideline recommendations on the performance of a CS; to explore barriers and facilitators that have a direct effect on guideline application regarding CS; and to develop, execute, and evaluate a strategy in order to reduce the CS incidence for a similar neonatal outcome (based on the information gathered in the second and third objectives). METHODS An independent expert panel of Dutch gynaecologists and midwives will develop a set of quality indicators on the decision to perform a CS. These indicators will be used to measure current care in 20 hospitals with a population of 1,000 women who delivered by CS, and a random selection of 1,000 women who delivered vaginally in the same period. Furthermore, by interviewing healthcare professionals and patients, the barriers and facilitators that may influence the decision to perform a CS will be measured. Based on the results, a tailor-made implementation strategy will be developed and tested in a controlled before-and-after study in 12 hospitals (six intervention, six control hospitals) with regard to effectiveness, experiences, and costs. DISCUSSION This study will offer insight into the current CS care and into the hindering and facilitating factors influencing obstetrical policy on CS. Furthermore, it will allow definition of patient categories or situations in which a tailor-made implementation strategy will most likely be meaningful and cost effective, without negatively affecting the outcome for mother and child. TRIAL REGISTRATION http://www.clinicaltrials.gov: NCT01261676.
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Affiliation(s)
- Sonja Melman
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Liem S, Schuit E, Bais J, de Boer K, Bloemenkamp K, Brons J, Duvekot H, Bijvanck BN, Franssen M, Gaugler I, Molkenboer J, Oudijk M, Papatsonis D, Pernet P, Porath M, Scheepers L, Sikkema M, Sporken J, Visser H, van Wijngaarden W, Woiski M, van Pampus M, Mol BW, Bekedam D. 1: Pessaries in multiple pregnancy as a prevention of preterm birth (ProTWIN): a randomized controlled trial. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Melman S, Schoorel E, Vrouenraets F, Kwee A, Franssen M, Smid-Koopman E, Woiski M, Mol BW, Doornbos H, Visser H, Huisjes A, Porath M, Delemarre F, Kuppens S, Aardenburg R, Dooren van I, Kleiverda G, Salm van der P, Boer de K, Sikkema M, Dirksen C, van SK, Nijhuis J, Scheepers L, Hermens R. 780: Analysis of current Dutch practice on cesarean deliveries. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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van Dartel SAA, Fransen J, Kievit W, Flendrie M, den Broeder AA, Visser H, Hartkamp A, van de Laar MAFJ, van Riel PLCM. Difference in the risk of serious infections in patients with rheumatoid arthritis treated with adalimumab, infliximab and etanercept: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Ann Rheum Dis 2012; 72:895-900. [PMID: 22887849 DOI: 10.1136/annrheumdis-2012-201338] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Tumour necrosis factor (TNF)-inhibiting therapy increases the risk of serious infections in rheumatoid arthritis (RA). However, it is not clear whether this risk differs between TNF inhibitors. OBJECTIVE To analyse whether the risk of serious infections in patients with RA treated with an anti-TNF inhibitor is different for adalimumab, infliximab and etanercept. METHODS Data from the Dutch RA monitoring registry were used. Incidence rates were calculated from the observed number of first serious infections and follow-up time up to 5 years. A Cox proportional hazards model with time-to-first-serious infection was used to estimate risk differences among the anti-TNF treatment groups, with correction for confounders. RESULTS The unadjusted incidence rate of a first serious infection in patients with RA per 100 patient-years was 2.61 (95% CI 2.21 to 3.00) for adalimumab, 3.86 (95% CI 3.33 to 4.40) for infliximab and 1.66 (95% CI 1.09 to 2.23) for etanercept. Age, year of starting anti-TNF therapy, comorbidities at baseline and disease activity score 28 over time were included as confounders. No difference in risk for serious infections was found between adalimumab and infliximab with an adjusted HR (adjHR) of 0.90 (95% CI 0.55 to 1.48). The risk of serious infections was significantly lower in etanercept than in both infliximab (adjHR=0.49 (95% CI 0.29 to 0.83)) and adalimumab (adjHR=0.55 (95% CI 0.44 to 0.67)). CONCLUSIONS The risk of serious infections in patients with RA treated with adalimumab or infliximab was similar, while the risk of serious infections in patients with RA treated with etanercept was lower than with both adalimumab and infliximab.
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Affiliation(s)
- Sanne A A van Dartel
- Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Burgers J, van Hartingsveldt W, van Keulen J, Verkade PE, Visser H, Wepster BM. Preparation and constitution of a number of derivatives of Meta-di-Tert. butylbenzene. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/recl.19560751114] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Burgers J, Hoefnagel MA, Verkade PE, Visser H, Wepster BM. Steric effects on mesomerism. XVII. Some properties of aromatic nitro-, amino-, and acylamino compounds with bulky ortho-substituents. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/recl.19580770602] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Visser H, Verhoef L, Schop W, Gotz HM. Outbreak investigation in two groups of coach passengers with gastroenteritis returning from Germany to the Netherlands in February 2009. Euro Surveill 2010. [DOI: 10.2807/ese.15.28.19615-en] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- H Visser
- Municipal Public Health Service Rotterdam-Rijnmond, Department Infectious Disease Control, Rotterdam, the Netherlands
| | - L Verhoef
- National Institute for Public Health and the Environment (RIVM), Diagnostic Laboratory for Infectious Diseases, Bilthoven, the Netherlands
| | - W Schop
- Municipal Public Health Service Rotterdam-Rijnmond, Department Infectious Disease Control, Rotterdam, the Netherlands
| | - H M Gotz
- Municipal Public Health Service Rotterdam-Rijnmond, Department Infectious Disease Control, Rotterdam, the Netherlands
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Visser H, Verhoef L, Schop W, Götz HM. Outbreak investigation in two groups of coach passengers with gastroenteritis returning from Germany to the Netherlands in February 2009. Euro Surveill 2010; 15:19615. [PMID: 20650052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
In February 2009, an outbreak of 38 cases of gastroenteritis occurred among the participants of two Dutch coach trips (A and B) who visited the same hotel in Germany. We initiated an outbreak investigation to determine possible risk of food-borne infection. A retrospective cohort study was performed among 87 passengers using a self-administered questionnaire. The response rate was 75 of 87 (86%). Mean age was 65 years. Cases were defined as participants of the two coach trips who had diarrhoea and/or vomiting at least once within 24 hours in the period between 7 and 14 February 2009. We distinguished early and late cases, with symptoms starting within or after 72 hours of arrival in the hotel. Overall attack-rate was 38 of 75 (51%). Microbiological investigation was performed on stool samples of two passengers from Coach A and two passengers from Coach B. Identical norovirus genotype II.4 sequences were detected in all four samples. Univariate analysis revealed a potential risk for early cases from juice consumption , which was most clearly seen for Coach B on day of arrival (juice at lunch: relative risk (RR): 3.9, 95% confidence interval (CI): 1.3-11.7; juice at dinner: RR: 5.5, 95% CI: 1.6-18.1). A dose-response relationship was found. This outbreak was probably caused by using the taps of juice served in large containers with a tap for self-service, due to environmental contamination through person-to-person transmission. Still the role of either contaminated juice or contact with contaminated juice cannot be ruled out.
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Affiliation(s)
- H Visser
- Municipal Public Health Service Rotterdam-Rijnmond, Department Infectious Disease Control, Rotterdam, the Netherlands.
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Blom M, Kievit W, Kuper HH, Jansen TL, Visser H, den Broeder AA, Brus HLM, van de Laar MAFJ, van Riel PLCM. Frequency and effectiveness of dose increase of adalimumab, etanercept, and infliximab in daily clinical practice. Arthritis Care Res (Hoboken) 2010; 62:1335-41. [DOI: 10.1002/acr.20211] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Visser H, Hazes JMW, Luime J. The clinical relevance of a prediction rule for disease outcome in patients with undifferentiated arthritis: comment on the article by van der Helm-van Mil et al. Arthritis Rheum 2009; 60:2208-2210. [PMID: 19565508 DOI: 10.1002/art.24623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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van Mello NM, Mol F, Adriaanse AH, Boss EA, Dijkman AB, Doornbos JPR, Emanuel MH, Friederich J, Leeuw-Harmsen LVD, Lips JP, van Santbrink EJP, Verhoeve HR, Visser H, Ankum WM, Veen FVD, Mol BW, Hajenius PJ. The METEX study: methotrexate versus expectant management in women with ectopic pregnancy: a randomised controlled trial. BMC Womens Health 2008; 8:10. [PMID: 18565217 PMCID: PMC2453103 DOI: 10.1186/1472-6874-8-10] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 06/19/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with ectopic pregnancy (EP) and low serum hCG concentrations and women with a pregnancy of unknown location (PUL) and plateauing serum hCG levels are commonly treated with systemic methotrexate (MTX). However, there is no evidence that treatment in these particular subgroups of women is necessary as many of these early EPs may resolve spontaneously. The aim of this study is whether expectant management in women with EP or PUL and with low but plateauing serum hCG concentrations is an alternative to MTX treatment in terms of treatment success, future pregnancy, health related quality of life and costs. METHODS/DESIGN A multicentre randomised controlled trial in The Netherlands. Hemodynamically stable patients with an EP visible on transvaginal ultrasound and a plateauing serum hCG concentration < 1,500 IU/L or with a persisting PUL with plateauing serum hCG concentrations < 2,000 IU/L are eligible for the trial. Patients with a viable EP, signs of tubal rupture/abdominal bleeding, or a contra-indication for MTX will not be included. Expectant management is compared with systemic MTX in a single dose intramuscular regimen (1 mg/kg) in an outpatient setting. Serum hCG levels are monitored weekly; in case of inadequately declining, systemic MTX is installed or continued. In case of hemodynamic instability and/or signs of tubal rupture, surgery is performed. The primary outcome measure is an uneventful decline of serum hCG to an undetectable level by the initial intervention. Secondary outcomes are (re)interventions (additional systemic MTX injections and/or surgery), treatment complications, health related quality of life, financial costs, and future fertility. Analysis is performed according to the intention to treat principle. Quality of life is assessed by questionnaires before and at three time points after randomisation. Costs are expressed as direct costs with data on costs and used resources in the participating centres. Fertility is assessed by questionnaires after 6, 12, 18 and 24 months. Patients' preferences will be assessed using a discrete choice experiment. DISCUSSION This trial will provide guidance on the present management dilemmas in women with EPs and PULs with low and plateauing serum hCG concentrations. TRIAL REGISTRATION Current Controlled Trials ISRCTN 48210491.
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Affiliation(s)
- Norah M van Mello
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Femke Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert H Adriaanse
- Department of Obstetrics and Gynaecology, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Erik A Boss
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Antonius B Dijkman
- Department of Obstetrics and Gynaecology, Boven IJ Hospital, Amsterdam, The Netherlands
| | - Johannes PR Doornbos
- Department of Obstetrics and Gynaecology, Zaans Medical Centre, Zaandam, The Netherlands
| | - Mark Hans Emanuel
- Department of Obstetrics and Gynaecology, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Jaap Friederich
- Department of Obstetrics and Gynaecology, Gemini Hospital, Den Helder, The Netherlands
| | | | - Jos P Lips
- Department of Obstetrics and Gynaecology, Kennemer Gasthuis, Haarlem, The Netherlands
| | - Evert JP van Santbrink
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Harold R Verhoeve
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Harry Visser
- Department of Obstetrics and Gynaecology, Tergooi Hospital, Blaricum, The Netherlands
| | - Willem M Ankum
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Fulco van der Veen
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Petra J Hajenius
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Kremer JAM, Visser H. [Testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI) now allowed in the Netherlands]. Ned Tijdschr Geneeskd 2008; 152:164-166. [PMID: 18271466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
After a moratorium of more than 10 years, it is again possible in the Netherlands to perform testicular sperm extraction (TESE) in combination with intracytoplasmic sperm injection (ICSI). Under the strict conditions of a research protocol, couples, of whom the man has a non-obstructive azoospermia, have the chance to parent their own offspring. The described procedure is an important step in the careful introduction of this new reproductive technique in the Netherlands.
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Affiliation(s)
- J A M Kremer
- Universitair Medisch Centrum St Radboud, afd. Gynaecologie, Nijmegen.
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Meijer RJ, Visser H, Koudstaal PJ, Dippel DW. Lowering body temperature in acute ischemic stroke without artificial ventilation and heavy sedation: a feasibility study. J Stroke Cerebrovasc Dis 2007; 10:157-60. [PMID: 17903819 DOI: 10.1053/jscd.2001.26869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2001] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE We assessed the feasibility of inducing very mild hypothermia in 8 patients with acute ischemic anterior circulation stroke, without artificial ventilation and heavy sedation, until 24 hours after onset of symptoms. METHODS Four regimes (A, B, C, and D) with increasing monitoring and treatment intensity were studied. Two patients in in regime A were monitored only. In regime B, 2 patients were treated with acetaminophen suppositoria of 1 g at 4-hour intervals. Additionally, the patients in regime C were cooled with a cooling blanket until 24 hours after the onset of symptoms. The target body temperature was 35 degrees C to 36 degrees C. During the cooling procedure, slight sedation was induced by continuous intravenous administration of low-dose midazolam. In regime D, sponging with 70% alcohol could be applied. RESULTS In these 4 patients, the mean reduction in body temperature after 8 hours of treatment amounted to 1.25 degrees C. No clinically important changes in vital parameters occurred. CONCLUSIONS The present study suggests that mild hypothermia in noncomatose stroke patients during a period of 24 hours after the ictus may be accomplished with a cooling blanket and light sedation with midazolam in a well-equipped stroke unit.
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Affiliation(s)
- R J Meijer
- Department of Neurology, Erasmus University Medical Center Rotterdam, The Netherlands
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van de Riet JE, Oelke M, van der Veen F, Visser H. [Gynaecomastia and male infertility as symptoms of a nonpalpable Leydig cell tumour]. Ned Tijdschr Geneeskd 2006; 150:1839-43. [PMID: 16967596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A 35-year-old man and his partner were referred for intracytoplasmic sperm injection treatment (ICSI) because of secondary infertility due to severe oligoasthenoteratospermia. Three years earlier he had presented elsewhere with left unilateral gynaecomastia. A hypertrophic mammary gland had been excised one year later. Histopathological investigation showed benign hypertrophy. One year later he developed gynaecomastia on the other side. Physical examination and incomplete hormonal screening showed no abnormalities. The couple were referred to our tertiary clinic for ICSI treatment. The patient still had unilateral gynaecomastia. Hormonal screening showed not only severe oligoasthenoteratospermia, but also an elevated serum oestrogen level. Scrotal ultrasound revealed a 17 mm mass in his right testicle. Subsequently unilateral orchidectomy was performed. Histology showed a benign Leydig cell tumour for which no further therapy was required. Four months after surgery the gynaecomastia diminished, oestrogen levels became normal and improvement in semen parameters followed. Patients with severe male infertility or gynaecomastia are at a higher risk of developing a testicular neoplasm. Besides history taking, physical examination of breasts and testicles, hormonal screening and scrotal sonography should be performed as some testicular neoplasms are not apparent on palpation.
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Affiliation(s)
- J E van de Riet
- Academisch Medisch Centrum/Universiteit van Amsterdam, Postbus 22.660, 1100 DD Amsterdam.
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van Gaalen FA, Visser H, Huizinga TWJ. A comparison of the diagnostic accuracy and prognostic value of the first and second anti-cyclic citrullinated peptides (CCP1 and CCP2) autoantibody tests for rheumatoid arthritis. Ann Rheum Dis 2005; 64:1510-2. [PMID: 15800005 PMCID: PMC1755241 DOI: 10.1136/ard.2004.035089] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the diagnostic performance and prognostic value of the anti-cyclic citrullinated peptide (CCP1) and anti-CCP2 autoantibody tests in a clinical setting. METHODS Anti-CCP1 and anti-CCP2 antibody tests were performed on the same serum samples obtained from 467 patients with early arthritis from the Leiden Arthritis Cohort. The sensitivity, specificity, positive predictive value, and negative predictive value for discriminating between rheumatoid arthritis (RA) and non-RA at 1 year's follow up were calculated for both tests. Results were graphically presented using receiver operating characteristic curves. Progression of radiological joint damage was assessed over 4 years in patients with RA and used to assess the prognostics values of the CCP tests. RESULTS At a similar specificity the CCP2 test had a higher sensitivity than the CCP1 test. Both tests identified a subgroup of patients with RA with an increased rate of joint damage progression. The anti-CCP2 test identified more patients with an increased rate of joint damage progression than the anti-CCP1 test, and in multiple regression analysis CCP2 was the better predictor of joint damage. CONCLUSIONS The CCP2 test had better diagnostic and prognostic ability than the CCP1 test.
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Affiliation(s)
- F A van Gaalen
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
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van Venrooij WJ, Hazes JM, Visser H. Anticitrullinated protein/peptide antibody and its role in the diagnosis and prognosis of early rheumatoid arthritis. Neth J Med 2002; 60:383-8. [PMID: 12607587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- W J van Venrooij
- Department of Biochemistry (161), University of Nijmegen, PO Box 9101, 6500 HB Nijmegen, the Netherlands.
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Visser H, Vos K, Zanelli E, Verduyn W, Schreuder GMT, Speyer I, Breedveld FC, Hazes JMW. Sarcoid arthritis: clinical characteristics, diagnostic aspects, and risk factors. Ann Rheum Dis 2002; 61:499-504. [PMID: 12006321 PMCID: PMC1754119 DOI: 10.1136/ard.61.6.499] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES (a) To describe the clinical characteristics of acute sarcoid arthritis and the diagnostic value of its presenting clinical features; (b) to evaluate whether disease onset is seasonal; and (c) to evaluate whether smoking behaviour or the presence of HLA class II alleles is a risk factor for the disease. METHODS 579 consecutive patients with recent onset arthritis who had been newly referred to a rheumatology outpatient clinic were included in a prospective cohort study. The presenting clinical features, the smoking behaviour, and the results of HLA-DQ and HLA-DR DNA typing of 55 patients with sarcoid arthritis, 524 patients with other arthritides of recent onset, and samples of the normal population were compared. RESULTS In all cases the disease showed a self limiting arthritis and overall good prognosis. The diagnostic ability of a combination of four clinical features--symmetrical ankle arthritis, symptoms of less than two months, age below 40 years, and erythema nodosum--was exceptionally high. When test positivity is defined as the presence of at least three of four criteria the set rendered a sensitivity of 93%, a specificity of 99%, a positive predictive value of 75%, and a negative predictive value of 99.7%. The disease clustered in the months March-July. The disease was negatively associated with smoking (odds ratio (OR) 0.09; 95% confidence interval (95% CI) 0.02 to 0.37) and positively associated with the presence of the DQ2 (DQB1*0201)-DR3 (DRB1*0301) haplotype (OR 12.33; 95% CI 5.97 to 25.48). CONCLUSION The disease entity acute sarcoid arthritis has highly diagnostic clinical features. The seasonal clustering, the protective effect of smoking, and the association with specific HLA class II antigens support the hypothesis that it results from exposure of susceptible hosts to environmental agents through the lungs.
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Affiliation(s)
- H Visser
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
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43
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Lard LR, Boers M, Verhoeven A, Vos K, Visser H, Hazes JMW, Zwinderman AH, Schreuder GMT, Breedveld FC, De Vries RRP, van der Linden S, Zanelli E, Huizinga TWJ. Early and aggressive treatment of rheumatoid arthritis patients affects the association of HLA class II antigens with progression of joint damage. Arthritis Rheum 2002; 46:899-905. [PMID: 11953965 DOI: 10.1002/art.10151] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The presence of certain HLA class II antigens is strongly associated with the progression of joint destruction in rheumatoid arthritis (RA). Such antigens may be more effective than other class II antigens in inducing the formation of autoreactive T cells after presentation of (auto)antigens. We investigated whether early and aggressive treatment with disease-modifying antirheumatic drugs could modify this relationship. METHODS We analyzed data from 2 studies of patients with early RA treated according to different strategies. The first study consisted of 2 cohorts, one (n = 109; median disease duration before treatment 4 months) was treated according to the pyramid strategy (initial nonsteroidal antiinflammatory drugs, followed by chloroquine [CQ] or sulfasalazine [SSZ] when necessary), and the other (n = 97; median disease duration before treatment 2 weeks) was immediately treated with CQ or SSZ. The second study comprised 155 patients (median disease duration 4 months) from the Combinatietherapie Bij Reumatoide Artritis (COBRA) trial, in which patients were randomly assigned to combination treatment with step-down prednisolone, methotrexate (MTX), and SSZ (n = 76) or with SSZ alone (n = 79). Prednisolone and MTX dosages were tapered and stopped after 28 and 40 weeks, respectively. The extent of joint damage was measured by the modified Sharp method. RESULTS In the pyramid treatment cohort, the median increase in Sharp score after 2 years was 12 in patients positive for the shared epitope (SE) and 1 in SE- patients. In the immediate treatment cohort, the median increase was 3 in SE+ patients and 2 in SE- patients. In the SSZ group of the COBRA study, the median increase in Sharp score after 1 year was 11 in DR4+ patients and 3 in DR4- patients. In the combination treatment group, the median increase was 4 in DR4+ patients and 2 in DR4- patients. Significance was confirmed by multiple regression using log-transformed scores. CONCLUSION Early and aggressive antirheumatic drug treatment affects the association of HLA class II alleles with progression of joint damage in RA.
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Affiliation(s)
- L R Lard
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
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Vos K, Visser H, Schreuder GM, de Vries RR, Zwinderman AH, Breedveld FC, Hazes JM, Zanelli EH. Human leukocyte antigen-DQ and DR polymorphisms predict rheumatoid arthritis outcome better than DR alone. Hum Immunol 2001; 62:1217-25. [PMID: 11704283 DOI: 10.1016/s0198-8859(01)00315-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Conflicting data have been published on the value of the shared epitope (SE) hypothesis in predicting disease outcome in rheumatoid arthritis (RA). Recently we have proposed an alternative hypothesis, referred to as the RA protection (RAP) model. In this model, the HLA-DQ loci carry predisposition while HLA-DRB1 alleles encoding the motif DERAA provide protection against severe RA. In the present study, we have compared the respective values of the models in predicting both remission and erosions in early RA patients. We made use of an early arthritis clinic in which 158 RA patients and 138 patients with undifferentiated arthritis were enrolled. Patients were typed for HLA-DQ and -DR using high resolution DNA typing methods. Homozygosity for predisposing HLA-DQ alleles was associated with no remission and high erosion score. The presence of DERAA-bearing DRB1 alleles was negatively associated with erosions in otherwise predisposed individuals and increased the chance of being in remission. We found that the RAP model was significantly better than the SE model in predicting remission rate and erosion scores at one and two years in early RA patients. We conclude that HLA polymorphism does not only affect RA susceptibility, but also protects against severe disease at early stage.
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Affiliation(s)
- K Vos
- Department of Rheumatology, Leiden University Medical Centre, 2300 RC, The, Leiden, Netherlands.
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Lard LR, Visser H, Speyer I, vander Horst-Bruinsma IE, Zwinderman AH, Breedveld FC, Hazes JM. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med 2001; 111:446-51. [PMID: 11690569 DOI: 10.1016/s0002-9343(01)00872-5] [Citation(s) in RCA: 386] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the effect of delayed and early treatment strategies on disease outcome in patients with rheumatoid arthritis. SUBJECTS AND METHODS Between 1993 and 1995, 109 patients diagnosed with probable or definite rheumatoid arthritis of recent onset were initially treated with analgesics; if they had persistent active disease, they were treated subsequently with the disease-modifying drugs chloroquine or salazopyrine (delayed treatment). Between 1996 and 1998, similar patients (n = 97) were promptly treated with either chloroquine or salazopyrine (early treatment). RESULTS The median lag to the initiation of disease-modifying treatment was 15 days in the early treatment group and 123 days in the delayed treatment group. There was less radiologic joint damage after 2 years in the early treatment group (median Sharp score, 3.5; 95% confidence interval [CI]: 1 to 7) compared with the delayed treatment group (median Sharp score, 10; 95% CI: 5 to 15; P <0.05). The median area under the curve of the 2-year disease activity score was lower in the early treatment group (64 units; 95% CI: 59 to 69 units) compared with the delayed treatment group (73 units; 95% CI: 69 to 77 units; P = 0.002). CONCLUSION In this nonrandomized comparison, early introduction of disease-modifying antirheumatic drugs was associated with a better disease outcome after 2 years.
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Affiliation(s)
- L R Lard
- Department of Rheumatology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
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Abstract
A versatile spectroelectrochemical apparatus is introduced to study the changes in IR spectra of organic and inorganic compounds upon oxidation or reduction. The design is based on an attenuated total reflection device, which permits the study of a wide spectral range of 16,700 (600 nm)-250 cm(-1), with a small opaque region of 2250-1900 cm(-1). In addition, an IR data collection protocol is introduced to deal with electrochemically nonreversible background signals. This method is tested with ferrocene in acetonitrile; concentrations as low as 1 mM produce results that agree with those in the literature.
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Affiliation(s)
- H Visser
- Physical Biosciences Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720-5230, USA
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Messinger J, Robblee JH, Bergmann U, Fernandez C, Glatzel P, Visser H, Cinco RM, McFarlane KL, Bellacchio E, Pizarro SA, Cramer SP, Sauer K, Klein MP, Yachandra VK. Absence of Mn-centered oxidation in the S(2) --> S(3) transition: implications for the mechanism of photosynthetic water oxidation. J Am Chem Soc 2001. [PMID: 11493054 DOI: 10.1021/ja004307] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A key question for the understanding of photosynthetic water oxidation is whether the four oxidizing equivalents necessary to oxidize water to dioxygen are accumulated on the four Mn ions of the oxygen-evolving complex (OEC), or whether some ligand-centered oxidations take place before the formation and release of dioxygen during the S(3) --> [S(4)] --> S(0) transition. Progress in instrumentation and flash sample preparation allowed us to apply Mn Kbeta X-ray emission spectroscopy (Kbeta XES) to this problem for the first time. The Kbeta XES results, in combination with Mn X-ray absorption near-edge structure (XANES) and electron paramagnetic resonance (EPR) data obtained from the same set of samples, show that the S(2) --> S(3) transition, in contrast to the S(0) --> S(1) and S(1) --> S(2) transitions, does not involve a Mn-centered oxidation. On the basis of new structural data from the S(3)-state, manganese mu-oxo bridge radical formation is proposed for the S(2) --> S(3) transition, and three possible mechanisms for the O-O bond formation are presented.
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Affiliation(s)
- J Messinger
- Melvin Calvin Laboratory, Physical Biosciences Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA.
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Abstract
Patient radiation exposure was determined for conventional and direct-digital cephalometric radiography. An anthropomorphic phantom was positioned to expose lateral cephalographs from the patient's left side. The conventional radiographs were exposed with a Siemens Orthophos C unit (77 kV, 14 mA, 0.5 s) and a film-screen system of a relative speed of 400. The direct-digital radiographs were exposed with a Siemens Orthophos DS Ceph (73 kV, 15 mA, 15.8 s). A set of 108 thermoluminescence detectors (TLDs; Bicron STI/Harshaw, Solon, Ohio) was used for dose measurements. For each measurement, 84 TLDs were placed at the surface of the head and neck, as well as inside the phantom, at anatomically relevant positions. The remaining detectors were employed for calibration purposes and quality control. The highest absorbed doses were recorded for the conventional technique at the skin of the left parotid region (132 microGy), in the left parotid gland (103 microGy), and in the ocular lens of the left eye (81 microGy). Digital cephalometry resulted in an absorbed dose about 2 times lower than the dose received by the conventional technique. The effective doses had the same relation (conventional 2.3 microSv; digital 1.1 microSv). The results demonstrate that direct-digital cephalometric radiography cuts the patient's dose in half compared with the conventional screen-film technique. Direct-digital cephalometry is more advantageous than the conventional technique from the perspective of radiation protection.
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Affiliation(s)
- H Visser
- Dental School, Department of Conservative and Preventive Dentistry, University of Göttingen, Germany.
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Bergmann U, Glatzel P, Robblee JH, Messinger J, Fernandez C, Cinco R, Visser H, McFarlane K, Bellacchio E, Pizarro S, Sauer K, Yachandra VK, Klein MP, Cox BL, Nealson KH, Cramer SP. High-resolution X-ray spectroscopy of rare events: a different look at local structure and chemistry. J Synchrotron Radiat 2001; 8:199-203. [PMID: 11512725 PMCID: PMC4028048 DOI: 10.1107/s0909049500016484] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2000] [Accepted: 11/07/2000] [Indexed: 05/23/2023]
Abstract
The combination of large-acceptance high-resolution X-ray optics with bright synchrotron sources permits quantitative analysis of rare events such as X-ray fluorescence from very dilute systems, weak fluorescence transitions or X-ray Raman scattering. Transition-metal Kbeta fluorescence contains information about spin and oxidation state; examples of the characterization of the Mn oxidation states in the oxygen-evolving complex of photosystem II and Mn-consuming spores from the marine bacillus SG- are presented. Weaker features of the Kbeta spectrum resulting from valence-level and 'interatomic' ligand to metal transitions contain detailed information on the ligand- atom type, distance and orientation. Applications of this spectral region to characterize the local structure of model compounds are presented. X-ray Raman scattering (XRS) is an extremely rare event, but also represents a unique technique to obtain bulk-sensitive low-energy (<600 eV) X-ray absorption fine structure (XAFS) spectra using hard (approximately 10 keV) X-rays. A photon is inelastically scattered, losing part of its energy to promote an electron into an unoccupied level. In many cases, the cross section is proportional to that of the corresponding absorption process yielding the same X-ray absorption near-edge structure (XANES) and extended X-ray absorption fine structure (EXAFS) features. XRS finds application for systems that defy XAFS analysis at low energies, e.g. liquids or highly concentrated complex systems, reactive compounds and samples under extreme conditions (pressure, temperature). Recent results are discussed.
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Affiliation(s)
- U Bergmann
- Physical Biosciences Division, Lawrence Berkeley National Laboratory, CA 94720, USA.
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Visser H, Speyer I, Ozcan B, Breedveld FC, van Ogtrop ML, Hazes JM. The diagnostic value of streptococcal serology in early arthritis: a prospective cohort study. Rheumatology (Oxford) 2000; 39:1351-6. [PMID: 11136878 DOI: 10.1093/rheumatology/39.12.1351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic value of streptococcal serology in adult early arthritis patients in discriminating between post-streptococcal reactive arthritis (PSRA) and arthritis with other causes. METHODS The antistreptolysin-O (ASO) and anti-DNase B tests were performed at baseline in 366 consecutive, newly referred early arthritis patients. After 1 yr of follow-up the patients were classified according to international classification criteria and were evaluated for the presence of persistent arthritis. The outcome measures were the predictive value of streptococcal serology for the diagnosis of PSRA and the ability of this serology to discriminate at the first visit between the self-limiting and persistent forms of arthritis. RESULTS With a positive serological result, the probability of having PSRA increased from 2 to 9%, whereas the probabilities of having rheumatoid arthritis or undifferentiated arthritis continued to be high (23 and 29%). The serological tests did not discriminate between the self-limiting and persistent forms of arthritis. The major Jones criteria apart from arthritis were not observed. CONCLUSION Streptococcal serology has no diagnostic value in adult early arthritis patients in whom major Jones criteria other than arthritis are not present.
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Affiliation(s)
- H Visser
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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