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Nutma S, Beishuizen A, van den Bergh WM, Foudraine NA, le Feber J, Filius PMG, Cornet AD, van der Palen J, van Putten MJAM, Hofmeijer J. Ghrelin for Neuroprotection in Post-Cardiac Arrest Coma: A Randomized Clinical Trial. JAMA Neurol 2024:2818471. [PMID: 38709502 DOI: 10.1001/jamaneurol.2024.1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Importance Out-of-hospital cardiac arrest survival rates have markedly risen in the last decades, but neurological outcome only improved marginally. Despite research on more than 20 neuroprotective strategies involving patients in comas after cardiac arrest, none have demonstrated unequivocal evidence of efficacy; however, treatment with acyl-ghrelin has shown improved functional and histological brain recovery in experimental models of cardiac arrest and was safe in a wide variety of human study populations. Objective To determine safety and potential efficacy of intravenous acyl-ghrelin to improve neurological outcome in patients in a coma after cardiac arrest. Design, Setting, and Participants A phase 2, double-blind, placebo-controlled, multicenter, randomized clinical trial, Ghrelin Treatment of Comatose Patients After Cardiac Arrest: A Clinical Trial to Promote Cerebral Recovery (GRECO), was conducted between January 18, 2019, and October 17, 2022. Adult patients 18 years or older who were in a comatose state after cardiac arrest were assessed for eligibility; patients were from 3 intensive care units in the Netherlands. Expected death within 48 hours or unfeasibility of treatment initiation within 12 hours were exclusion criteria. Interventions Patients were randomized to receive intravenous acyl-ghrelin, 600 μg (intervention group), or placebo (control group) within 12 hours after cardiac arrest, continued for 7 days, twice daily, in addition to standard care. Main Outcomes and Measures Primary outcome was the score on the Cerebral Performance Categories (CPC) scale at 6 months. Safety outcomes included any serious adverse events. Secondary outcomes were mortality and neuron-specific enolase (NSE) levels on days 1 and 3. Results A total of 783 adult patients in a coma after cardiac arrest were assessed for eligibility, and 160 patients (median [IQR] age, 68 [57-75] years; 120 male [75%]) were enrolled. A total of 81 patients (51%) were assigned to the intervention group, and 79 (49%) were assigned to the control group. The common odds ratio (OR) for any CPC improvement in the intervention group was 1.78 (95% CI, 0.98-3.22; P = .06). This was consistent over all CPC categories. Mean (SD) NSE levels on day 1 after cardiac arrest were significantly lower in the intervention group (34 [6] μg/L vs 56 [13] μg/L; P = .04) and on day 3 (28 [6] μg/L vs 52 [14] μg/L; P = .08). Serious adverse events were comparable in incidence and type between the groups. Mortality was 37% (30 of 81) in the intervention group vs 51% (40 of 79) in the control group (absolute risk reduction, 14%; 95% CI, -2% to 29%; P = .08). Conclusions and Relevance In patients in a coma after cardiac arrest, intravenous treatment with acyl-ghrelin was safe and potentially effective to improve neurological outcome. Phase 3 trials are needed for conclusive evidence. Trial Registration Clinicaltrialsregister.eu: EUCTR2018-000005-23-NL.
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Affiliation(s)
- Sjoukje Nutma
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Albertus Beishuizen
- Department of Critical Care, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Joost le Feber
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands
| | - P Margreet G Filius
- Department of Clinical Pharmacology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Alexander D Cornet
- Department of Critical Care, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands
- Section of Cognition, Data and Education, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands
| | - Michel J A M van Putten
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Jeannette Hofmeijer
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
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Koevoets EW, Petr J, Monninkhof EM, Geerlings MI, Witlox L, van der Wall E, Stuiver MM, Sonke GS, Velthuis MJ, Jobsen JJ, van der Palen J, Mutsaerts HJMM, de Ruiter MB, May AM, Schagen SB. Effect of Physical Exercise on MRI-Assessed Brain Perfusion in Chemotherapy-Treated Breast Cancer Patients: A Randomized Controlled Trial. J Magn Reson Imaging 2024; 59:1667-1680. [PMID: 37801027 DOI: 10.1002/jmri.28967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Exercise is a promising intervention to alleviate cognitive problems in breast cancer patients, but studies on mechanisms underlying these effects are lacking. PURPOSE Investigating whether an exercise intervention can affect cerebral blood flow (CBF) in cognitively impaired breast cancer patients and to determine if CBF changes relate to memory function. STUDY TYPE Prospective. POPULATION A total of 181 chemotherapy-treated stage I-III breast cancer patients with cognitive problems and relatively low physical activity levels (≤150 minutes moderate to vigorous physical activity per week), divided into an exercise (N = 91) or control group (N = 90). FIELD STRENGTH/SEQUENCE Two-dimensional echo planar pseudo-continuous arterial spin labeling CBF sequence at 3 T. ASSESSMENT The 6-month long intervention consisted of (supervised) aerobic and strength training, 4 × 1 hour/week. Measurements at baseline (2-4 years post-diagnosis) and after 6 months included gray matter CBF in the whole brain, hippocampus, anterior cingulate cortex, and posterior cingulate cortex. Physical fitness and memory function were also assessed. Subgroup analyses were performed in patients with high fatigue levels at baseline. STATISTICAL TESTS Multiple regression analyses with a two-sided alpha of 0.05 for all analyses. RESULTS There was a significant improvement in physical fitness (VO2peak in mL/minute/kg) in the intervention group (N = 53) compared to controls (N = 51, β = 1.47 mL/minute/kg, 95% CI: 0.44-2.50). However, no intervention effects on CBF were found (eg, whole brain: P = 0.565). Highly fatigued patients showed larger but insignificant treatment effects on CBF (eg, whole brain: P = 0.098). Additionally, irrespective of group, a change in physical fitness was positively associated with changes in CBF (eg, whole brain: β = 0.75, 95% CI: 0.07-1.43). There was no significant relation between CBF changes and changes in memory performance. DATA CONCLUSION The exercise intervention did not affect CBF of cognitively affected breast cancer patients. A change in physical fitness was associated with changes in CBF, but changes in CBF were not associated with memory functioning. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 5.
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Affiliation(s)
- Emmie W Koevoets
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan Petr
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mirjam I Geerlings
- Department of General Practice, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life and Personalized Medicine, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, The Netherlands
| | - Lenja Witlox
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martijn M Stuiver
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Jan J Jobsen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
- Section Cognition, Data and Education, Universiteit Twente, Enschede, The Netherlands
| | - Henk J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Michiel B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Brain and Cognition Group, University of Amsterdam, Amsterdam, The Netherlands
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Oonk NGM, Dorresteijn LDA, te Braake E, Movig KLL, van der Palen J, Nijmeijer HW, van Kesteren ME, Bode C. Structured medication reviews in Parkinson's disease: pharmacists' views, experiences and needs - a qualitative study. Ther Adv Drug Saf 2024; 15:20420986241237071. [PMID: 38694547 PMCID: PMC11062216 DOI: 10.1177/20420986241237071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/28/2023] [Indexed: 05/04/2024] Open
Abstract
Background Executing structured medication reviews (SMRs) in primary care to optimize drug treatment is considered standard care of community pharmacists in the Netherlands. Patients with Parkinson's disease (PD) often face complex drug regimens for their symptomatic treatment and might, therefore, benefit from an SMR. However, previously, no effect of an SMR on quality of life in PD was found. In trying to improve the case management of PD, it is interesting to understand if and to what extent SMRs in PD patients are of added value in the pharmacist's opinion and what are assumed facilitating and hindering factors. Objectives To analyse the process of executing SMRs in PD patients from a community pharmacist's point of view. Design A cross-sectional, qualitative study was performed, consisting of face-to-face semi-structured in-depth interviews. Methods The interviews were conducted with community pharmacists who executed at least one SMR in PD, till data saturation was reached. Interviews were transcribed verbatim, coded and analysed thematically using an iterative approach. Results Thirteen pharmacists were interviewed. SMRs in PD were considered of added value, especially regarding patient contact and bonding, individualized care and its possible effect in the future, although PD treatment is found already well monitored in secondary care. Major constraints were time, logistics and collaboration with medical specialists. Conclusion Although community pharmacist-led SMRs are time-consuming and sometimes logistically challenging, they are of added value in primary care in general, and also in PD, of which treatment occurs mainly in secondary care. It emphasizes the pharmacist's role in PD treatment and might tackle future drug-related issues. Improvements concern multidisciplinary collaboration for optimized SMR execution and results.
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Affiliation(s)
- Nicol G. M. Oonk
- Department of Neurology, Medisch Spectrum Twente, PO Box 50000, Enschede 7500 KA, The Netherlands
- Department of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | | | - Eline te Braake
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Kris L. L. Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
- Section Cognition, Data and Education, University of Twente, Enschede, The Netherlands
| | | | | | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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van Dijk SHB, Brusse-Keizer MGJ, Bucsán CC, Ploumen EH, van Beurden WJC, van der Palen J, Doggen CJM, Lenferink A. Lack of Evidence Regarding Markers Identifying Acute Heart Failure in Patients with COPD: An AI-Supported Systematic Review. Int J Chron Obstruct Pulmon Dis 2024; 19:531-541. [PMID: 38414719 PMCID: PMC10898598 DOI: 10.2147/copd.s437899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
Background Due to shared symptoms, acute heart failure (AHF) is difficult to differentiate from an acute exacerbation of COPD (AECOPD). This systematic review aimed to identify markers that can diagnose AHF underlying acute dyspnea in patients with COPD presenting at the hospital. Methods All types of observational studies and clinical trials that investigated any marker's ability to diagnose AHF in acutely dyspneic COPD patients were considered eligible for inclusion. An AI tool (ASReview) supported the title and abstract screening of the articles obtained from PubMed, Scopus, Web of Science, the Cochrane Library, Embase, and CINAHL until April 2023. Full text screening was independently performed by two reviewers. Twenty percent of the data extraction was checked by a second reviewer and the risk of bias was assessed in duplicate using the QUADAS-2 tool. Markers' discriminative abilities were evaluated in terms of sensitivity, specificity, positive and negative predictive values, and the area under the curve when available. Results The search identified 10,366 articles. After deduplication, title and abstract screening was performed on 5,386 articles, leaving 153 relevant, of which 82 could be screened full text. Ten distinct studies (reported in 16 articles) were included, of which 9 had a high risk of bias. Overall, these studies evaluated 12 distinct laboratory and 7 non-laboratory markers. BNP, NT-proBNP, MR-proANP, and inspiratory inferior vena cava diameter showed the highest diagnostic discrimination. Conclusion There is not much evidence for the use of markers to diagnose AHF in acutely dyspneic COPD patients in the hospital setting. BNPs seem most promising, but should be interpreted alongside imaging and clinical signs, as this may lead to improved diagnostic accuracy. Future validation studies are urgently needed before any AHF marker can be incorporated into treatment decision-making algorithms for patients with COPD. Protocol Registration CRD42022283952.
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Affiliation(s)
- Sanne H B van Dijk
- Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marjolein G J Brusse-Keizer
- Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Charlotte C Bucsán
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
- Cognition, Data & Education, Faculty of Behavioural, Management & Social Sciences, University of Twente, Enschede, the Netherlands
| | - Eline H Ploumen
- Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Wendy J C van Beurden
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
- Cognition, Data & Education, Faculty of Behavioural, Management & Social Sciences, University of Twente, Enschede, the Netherlands
| | - Carine J M Doggen
- Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands
| | - Anke Lenferink
- Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands
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Shaer SA, van der Palen J, Teunissen J, Fink A, van der Heijden B, Zöphel O. An alternative treatment for degenerative triangular fibrocartilage complex injuries with distal radioulnar joint instability: first experience with 48 patients. J Hand Surg Eur Vol 2024; 49:240-249. [PMID: 37694851 PMCID: PMC10845826 DOI: 10.1177/17531934231197942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
Treatment of ulnar impaction syndrome combined with distal radioulnar joint instability due to irreparable degenerative triangular fibrocartilage complex injuries can be complex. We describe the outcomes of a novel technique for restoring distal radioulnar stability due to ulnar impaction syndrome using a distally based extensor carpi ulnaris tendon strip combined with ulnar shortening osteotomy in 48 patients. Patients were assessed using standardized outcome measurements. The patient-rated wrist/hand evaluation total score improved from 66 (SD 15) at intake to 40 (SD 25) at 3 months, and 28 (SD 23) at 12 months postoperatively (p < 0.001). Wrist extension and flexion improved significantly at 12 months from 53° (SD 11) to 65° (SD 8) (p < 0.001) and from 45° (SD 10) to 56° (SD 12) (p = 0.01), respectively. Adding a distally based longitudinal extensor carpi ulnaris strip to ulnar shortening osteotomy for restoring distal radioulnar joint stability seems to be an effective treatment in patients with irreparable degenerative triangular fibrocartilage complex injuries due to ulnar impaction syndrome. Level of evidence: IV.
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Affiliation(s)
- Sanharib Al Shaer
- Department of Surgery, UMC Utrecht, Utrecht, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede & Section Cognition, Data and Education, Faculty BMS, University of Twente, Enschede, The Netherlands
| | - Joris Teunissen
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Alexandra Fink
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Ziekenhuis ‘s-Hertogenbosch, The Netherlands
| | - Oliver Zöphel
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Ziekenhuisgroep Twente, Hengelo, The Netherlands
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van der Maten G, Meijs MFL, Timmer JR, Brouwers PJAM, von Birgelen C, Coutinho JM, Bouma BJ, Kerkhoff H, Helming AM, van Tuijl JH, van der Meer NA, Saxena R, Ebink C, van der Palen J, den Hertog HM. Routine transthoracic echocardiography in ischaemic stroke or transient ischaemic attack of undetermined cause: a prospective multicentre study. Neth Heart J 2024; 32:91-98. [PMID: 37870709 PMCID: PMC10834921 DOI: 10.1007/s12471-023-01819-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Guidelines recommend routine transthoracic echocardiography (TTE) after ischaemic stroke or transient ischaemic attack of undetermined cause; yet, only limited scientific evidence exists. Therefore, we aimed to determine in these patients the prevalence of TTE-detected major cardiac sources of embolism (CSE), which are abnormalities leading to therapeutic changes. METHODS Six Dutch hospitals conducted a prospective observational study that enrolled patients with ischaemic stroke or transient ischaemic attack of undetermined cause. Patients underwent TTE after comprehensive diagnostic evaluation on stroke units, including blood chemistry, 12-lead electrocardiogram (ECG), ≥ 24 h continuous ECG monitoring, brain imaging and cervical artery imaging. Primary outcome measure was the proportion of patients with TTE-detected major CSE. RESULTS From March 2018 to October 2020, 1084 patients, aged 66.6 ± 12.5 years, were enrolled; 456 (42.1%) patients were female and 869 (80.2%) had ischaemic stroke. TTE detected major CSE in only 11 (1.0%) patients. Ten (90.9%) of these patients also had major ECG abnormalities (previous infarction, major repolarisation abnormalities, or previously unknown left bundle branch block) that would have warranted TTE assessment regardless of stroke evaluation. Such ECG abnormalities were present in 11.1% of the total study population. A single patient (0.1%) showed a major CSE despite having no ECG abnormality. CONCLUSIONS This multicentre cross-sectional study in patients who-after workup on contemporary stroke units-were diagnosed with ischaemic stroke or transient ischaemic attack of undetermined cause found TTE-detected major CSE in only 1% of all patients. Most of these patients also had major ECG abnormalities. These findings question the value of routine TTE assessment in this clinical setting.
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Affiliation(s)
- Gerlinde van der Maten
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Matthijs F L Meijs
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Jorik R Timmer
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | | | - Clemens von Birgelen
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - Henk Kerkhoff
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Anne Mijn Helming
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Julia H van Tuijl
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | | | - Ritu Saxena
- Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Corné Ebink
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Job van der Palen
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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van Erp RAL, de Rooij SE, Wymenga ANM, Zeegers AVCME, van der Palen J. Feasibility study of the Digital Patient Benefit Assessment Scale (P-BAS): A Digital Tool to Assess Individual Patient Goals. Gerontol Geriatr Med 2024; 10:23337214241230159. [PMID: 38328389 PMCID: PMC10848793 DOI: 10.1177/23337214241230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Abstract
The study objective was to assess the feasibility of the Patient Benefit Assessment Scale (P-BAS), a digital tool designed to enable older outpatients (≥70 years) to elucidate at home their individual goals regarding their current medical issue. Several digital tools are developed to assist older people in identifying their goals, thereby facilitating the process of shared decision making. However, studies on the feasibility of these digital tools, especially in older patients, are limited. Data were collected from 36 older patients. The study comprised three stages. In stage I and II, cognitive interviews were conducted to strengthen the feasibility of the P-BAS. In stage III, 80% of the patients completed the P-BAS independently at home. The cognitive interviews provided insight into patients' interpretation and individual understanding of the digital visual P-BAS and associated opportunities for improvement, which were subsequently implemented. One conclusion is that the digital visual P-BAS might be of added value for patients and contributes to the process of shared decision making, assuring that the goals of the patient will be into account in treatment options. Findings are useful for researchers interested in technological tools that contribute to shared decision making.
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Affiliation(s)
- Rozemarijn A L van Erp
- University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Enschede, The Netherlands
| | - Sophia E de Rooij
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
| | | | | | - Job van der Palen
- University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Enschede, The Netherlands
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8
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Franssen RFW, Berkel AEM, Ten Cate DWG, van der Palen J, van Meeteren NLU, Vogelaar FJ, Slooter G, Klaase JM, Janssen-Heijnen MLG, Bongers BC. A retrospective analysis of the association of effort-independent cardiopulmonary exercise test variables with postoperative complications in patients who underwent elective colorectal surgery. Langenbecks Arch Surg 2023; 409:7. [PMID: 38093118 DOI: 10.1007/s00423-023-03197-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE This study aimed to investigate the association of effort-independent variables derived from the preoperative cardiopulmonary exercise test (CPET) with 30-day postoperative complications after elective colorectal surgery. METHODS A multicenter (n=4) retrospective explorative study was performed using data of patients who completed a preoperative CPET and underwent elective colorectal surgery. The preoperative slope of the relation between minute ventilation and carbon dioxide production (VE/VCO2-slope) and the oxygen uptake efficiency slope (OUES), as well as 30-day postoperative complications, were assessed. Multivariable logistic regression analyses and receiver operating characteristic (ROC) curves were used to investigate the prognostic value of the relationship between these preoperative CPET-derived effort-independent variables and postoperative complications. RESULTS Data from 102 patients (60.1% males) with a median age of 72.0 (interquartile range 67.8-77.4) years were analyzed. Forty-four patients (43.1%) had one or more postoperative complications (of which 52.3% general and 77.3% surgical complications). Merely 10 (9.8%) patients had a general complication only. In multivariate analysis adjusted for surgical approach (open versus minimally invasive surgery), the VE/VCO2-slope (odds ratio (OR) 1.08, confidence interval (CI) 1.02-1.16) and OUES (OR 0.94, CI 0.89-1.00) were statistically significant associated with the occurrence of 30-day postoperative complications. CONCLUSION The effort-independent VE/VCO2-slope and OUES might be used to assist in future preoperative risk assessment and could especially be of added value in patients who are unable or unwilling to deliver a maximal cardiorespiratory effort. Future research should reveal the predictive value of these variables individually and/or in combination with other prognostic (CPET-derived) variables for postoperative complications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT05331196.
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Affiliation(s)
- Ruud F W Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Center, Tegelseweg 210, 5912, BL, Venlo, The Netherlands.
- Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Annefleur E M Berkel
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- General Practice, Rijk-Berkel, Hengelo, The Netherlands
| | - David W G Ten Cate
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectum Twente, Enschede, The Netherlands
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Nico L U van Meeteren
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Top Sector Life Sciences & Health, The Hague, The Netherlands
| | - F Jeroen Vogelaar
- Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Gerrit Slooter
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Joost M Klaase
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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9
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van der Maten G, Meijs MFL, van der Palen J, Brouwers PJAM, von Birgelen C, van Opstal J, den Hertog HM. Atrial fibrillation detected with outpatient cardiac rhythm monitoring in patients with ischemic stroke or TIA of undetermined cause. J Stroke Cerebrovasc Dis 2023; 32:107400. [PMID: 37801878 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVES Guidelines advise cardiac rhythm monitoring for 3 up to 30 days for detecting atrial fibrillation (AF) in patients with ischemic stroke of undetermined cause. However, the optimal monitoring duration is unknown. We aimed to determine the AF detection rate during 7-day outpatient cardiac rhythm monitoring in this patient group. METHODS Participants from a large tertiary hospital in a prospective observational study (ATTEST) underwent outpatient cardiac rhythm monitoring after a negative standard diagnostic evaluation (i.e., 12-lead electrocardiogram and in-hospital telemetry). Primary outcome was the rate of newly detected AF. RESULTS We examined 373 patients [age: 67.8±11.6 years; women: 166(44.5%); stroke: 278(74.5%)]. Median monitoring duration was 7 days (Inter Quartile Range (IQR) 7-7), performed after median of 36 days (IQR 27-47). AF was newly detected in 17(4.6%) patients, 5.4% of patients with ischemic stroke and 2.1% of patients with TIA. 53% of AF was detected on day-1, after day-3 73% of new AF was found. First AF episodes were detected up to day-7. Diabetes and increasing age were independent predictors of new AF. CONCLUSION After ischemic stroke or TIA of undetermined cause, 7-day outpatient cardiac rhythm monitoring detected new AF in 4.6%. Patients with AF had significantly more cardiovascular risk factors. Although about 50% of first AF episodes occurred during the first day of monitoring, new AF was detected up to day-7, implying that the recommended minimum of 3 days cardiac rhythm monitoring after ischemic stroke of undetermined cause is insufficient. Subsequent long-term rhythm monitoring should be considered in selected patients.
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Affiliation(s)
- Gerlinde van der Maten
- Department of Neurology, Medisch Spectrum Twente, Koningstraat 1, PO box 50 000, KA 7500, Enschede, The Netherlands; Department of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands.
| | - Matthijs F L Meijs
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job van der Palen
- Section Cognition, Education and Data, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands; Medical School wente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Paul J A M Brouwers
- Department of Neurology, Medisch Spectrum Twente, Koningstraat 1, PO box 50 000, KA 7500, Enschede, The Netherlands
| | - Clemens von Birgelen
- Department of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands; Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jurren van Opstal
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
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10
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de Vries MI, Effing TW, van der Palen J, Schrijver J, van der Valk P, Lenferink A. Evaluation of Exacerbation and Symptom-Free Time in Patients with COPD. COPD 2023; 20:9-17. [PMID: 37552476 DOI: 10.1080/15412555.2022.2136066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 08/09/2023]
Abstract
In clinical practice, clinicians mainly focus on Chronic Obstructive Pulmonary Disease (COPD) exacerbations and symptoms, while patients may prefer to evaluate periods free of COPD exacerbations and deteriorated symptoms. The latter would suit the positive health approach that centralizes people and their beliefs. We aimed to identify patient characteristics and health outcomes relating to: 1) COPD exacerbation-free days; 2) days with no more symptoms than usual; and 3) combined COPD exacerbation and comorbid flare-up-free days (i.e. chronic heart failure, anxiety, depression flare-ups) using negative binomial regression analyzes. Data were obtained from two self-management intervention trials including COPD patients with and without comorbidities. 313 patients (mean age 66.0 years, 63.6% male, 68.7% comorbidity) were included. Better baseline chronic respiratory questionnaire (CRQ) fatigue (incidence rate ratio (IRR) = 1.03 (95% CI 1.01-1.05), p = 0.02) and mastery scores (IRR = 1.03 (95% CI 1.00-1.06), p = 0.04) and fewer courses of antibiotics (IRR = 0.95 (95% CI 0.94-0.96), p < 0.01) were related to more COPD exacerbation-free days. Additionally, better baseline CRQ fatigue (IRR = 1.05 (95% CI 1.00-1.10), p = 0.04) and mastery scores (IRR = 1.06 (95% CI 1.00-1.12), p = 0.04), fewer courses of antibiotics (IRR = 0.94 (95% CI 0.91-0.96), p < 0.01), and improved CRQ dyspnea scores over 12 months of follow-up (IRR = 1.07 (95% CI 1.01-1.12), p < 0.01) were correlated to more days free of deteriorated symptoms. Less baseline dyspnea (modified Medical Research Council score) (IRR = 0.95 (95% CI 0.92-0.98), p < 0.01) and fewer courses of antibiotics (IRR = 0.94 (95% CI 0.93-0.95), p < 0.01) were associated with more combined COPD exacerbation and comorbid flare-up-free days. Healthcare professionals should be aware that less fatigue and better mastering of COPD relate to more exacerbation and symptom-free time in COPD patients.
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Affiliation(s)
- Mirthe I de Vries
- Health Technology and Services Research, Faculty of Behavioral, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
| | - Tanja W Effing
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
- Cognition, Data and Education, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Jade Schrijver
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Cognition, Data and Education, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Paul van der Valk
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
| | - Anke Lenferink
- Health Technology and Services Research, Faculty of Behavioral, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, Netherlands
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11
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van Dijk SHB, Brusse-Keizer MGJ, Effing T, van der Valk PDLPM, Ploumen EH, van der Palen J, Doggen CJM, Lenferink A. Exploring Patterns of COPD Exacerbations and Comorbid Flare-Ups. Int J Chron Obstruct Pulmon Dis 2023; 18:2633-2644. [PMID: 38022827 PMCID: PMC10657781 DOI: 10.2147/copd.s428960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/04/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Comorbidities are known to complicate disease management in patients with Chronic Obstructive Pulmonary Disease (COPD). This is partly due to lack of insight into the interplay of acute exacerbations of COPD (AECOPD) and comorbid flare-ups. This study aimed to explore patterns of AECOPDs and comorbid flare-ups. Methods Data of increased symptoms were extracted from a 12-month daily symptom follow-up database including patients with COPD and comorbidities (chronic heart failure (CHF), anxiety, depression) and transformed to visualizations of AECOPDs and comorbid flare-up patterns over time. Patterns were subsequently categorized using an inductive approach, based on both predominance (ie, which occurs most often) of AECOPDs or comorbid flare-ups, and their simultaneous (ie, simultaneous start in ≥ 50%) occurrence. Results We included 48 COPD patients (68 ± 9 years; comorbid CHF: 52%, anxiety: 40%, depression: 38%). In 25 patients with AECOPDs and CHF flare-ups, the following patterns were identified: AECOPDs predominant (n = 14), CHF flare-ups predominant (n = 5), AECOPDs nor CHF flare-ups predominant (n = 6). Of the 24 patients with AECOPDs and anxiety and/or depression flare-ups, anxiety and depression flare-ups occurred simultaneously in 15 patients. In 9 of these 24 patients, anxiety or depression flare-ups were observed independently from each other. In 31 of the included 48 patients, AECOPDs and comorbid flare-ups occurred mostly simultaneously. Conclusion Patients with COPD and common comorbidities show a variety of patterns of AECOPDs and comorbid flare-ups. Some patients, however, show repetitive patterns that could potentially be used to improve personalized disease management, if recognized.
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Affiliation(s)
- Sanne H B van Dijk
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marjolein G J Brusse-Keizer
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Tanja Effing
- College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | | | - Eline H Ploumen
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
- Cognition, Data & Education, BMS Faculty, University of Twente, Enschede, the Netherlands
| | - Carine J M Doggen
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands
| | - Anke Lenferink
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands
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12
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Hepping AM, Barvelink B, Ploegmakers JJW, van der Palen J, Geertzen JHB, Bulstra SK, Harbers JS, Stevens M. Functional recovery after reduced pediatric fractures of the forearm with respect to perceived limitations, common post-traumatic symptoms, range of motion, and dexterity: a prospective study. Disabil Rehabil 2023; 45:3560-3566. [PMID: 36214289 DOI: 10.1080/09638288.2022.2131006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Studies on functional recovery after pediatric forearm fractures are scarce. Outcome measures are usually (retrospectively) incorporated to compare treatments. How these parameters recover has only rarely fallen within the scope. Aim was to provide insight into "normal recovery" by evaluating how limitations, post-traumatic symptoms, range of motion (ROM) and dexterity recuperate. MATERIALS AND METHODS Prospective observational study regarding children 4 and 18 years with a reduced forearm fracture. Limitations, post-traumatic symptoms, ROM, and dexterity were evaluated 6 weeks, 3 and 6 months post-trauma. ROM of the unaffected side was used as a baseline. RESULTS Of 54 participants 25.9% and 5.9% perceived limitations after 3 respectively 6 months. Pain, swelling and hypertrichosis were common symptoms. Movements distal from the elbow were restrained 6 weeks post-trauma. Supination and palmar flexion were most affected, followed by dorsal flexion and pronation. Palmar flexion and pronation were still affected after 3 months and associated with treatment invasiveness. Dexterity was diminished at 6 weeks only. CONCLUSIONS Mild limitations are common. Further investigation of the association between pain, reduced sensitivity and hypertrichosis with treatment invasiveness is warranted. Regarding ROM supination, pronation, palmar and dorsal flexion should be incorporated in future studies. Dexterity is an unsuitable outcome measure.IMPLICATIONS FOR REHABILITATIONThis study relates to monitoring recovery from pediatric forearm fractures.Physicians ought to realize that one in four children experience limitations preceding 3 months post-trauma, in which case involvement of a hand therapist should be considered.Pain, swelling and especially hypertrichosis are common post-traumatic symptoms in children and should on itself not immediately raise concerns for complex regional pain syndrome (CRPS).To assess recovery of range of motion measuring pronation, supination, dorsal, and palmar flexion is sufficient.
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Affiliation(s)
- Ann M Hepping
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
- Roessingh Center for Rehabilitation, Enschede, The Netherlands
| | - Britt Barvelink
- Department of Orthopedics, Erasmus Medical Center Rotterdam, The Netherlands
| | - Joris J W Ploegmakers
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Job van der Palen
- Section Cognition, Data and Education, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jan H B Geertzen
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jorrit S Harbers
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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13
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van Dijk SHB, Brusse-Keizer MGJ, Bucsán CC, van der Palen J, Doggen CJM, Lenferink A. Artificial intelligence in systematic reviews: promising when appropriately used. BMJ Open 2023; 13:e072254. [PMID: 37419641 PMCID: PMC10335470 DOI: 10.1136/bmjopen-2023-072254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Systematic reviews provide a structured overview of the available evidence in medical-scientific research. However, due to the increasing medical-scientific research output, it is a time-consuming task to conduct systematic reviews. To accelerate this process, artificial intelligence (AI) can be used in the review process. In this communication paper, we suggest how to conduct a transparent and reliable systematic review using the AI tool 'ASReview' in the title and abstract screening. METHODS Use of the AI tool consisted of several steps. First, the tool required training of its algorithm with several prelabelled articles prior to screening. Next, using a researcher-in-the-loop algorithm, the AI tool proposed the article with the highest probability of being relevant. The reviewer then decided on relevancy of each article proposed. This process was continued until the stopping criterion was reached. All articles labelled relevant by the reviewer were screened on full text. RESULTS Considerations to ensure methodological quality when using AI in systematic reviews included: the choice of whether to use AI, the need of both deduplication and checking for inter-reviewer agreement, how to choose a stopping criterion and the quality of reporting. Using the tool in our review resulted in much time saved: only 23% of the articles were assessed by the reviewer. CONCLUSION The AI tool is a promising innovation for the current systematic reviewing practice, as long as it is appropriately used and methodological quality can be assured. PROSPERO REGISTRATION NUMBER CRD42022283952.
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Affiliation(s)
- Sanne H B van Dijk
- Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marjolein G J Brusse-Keizer
- Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Charlotte C Bucsán
- Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
- Cognition, Data & Education, Faculty of Behavioural, Management & Social Sciences, University of Twente, Enschede, The Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
- Cognition, Data & Education, Faculty of Behavioural, Management & Social Sciences, University of Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, The Netherlands
| | - Anke Lenferink
- Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, The Netherlands
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14
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Kort S, Brusse-Keizer M, Schouwink H, Citgez E, de Jongh FH, van Putten JWG, van den Borne B, Kastelijn EA, Stolz D, Schuurbiers M, van den Heuvel MM, van Geffen WH, van der Palen J. Diagnosing Non-Small Cell Lung Cancer by Exhaled Breath Profiling Using an Electronic Nose: A Multicenter Validation Study. Chest 2023; 163:697-706. [PMID: 36243060 DOI: 10.1016/j.chest.2022.09.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 05/04/2022] [Revised: 09/02/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Despite the potential of exhaled breath analysis of volatile organic compounds to diagnose lung cancer, clinical implementation has not been realized, partly due to the lack of validation studies. RESEARCH QUESTION This study addressed two questions. First, can we simultaneously train and validate a prediction model to distinguish patients with non-small cell lung cancer from non-lung cancer subjects based on exhaled breath patterns? Second, does addition of clinical variables to exhaled breath data improve the diagnosis of lung cancer? STUDY DESIGN AND METHODS In this multicenter study, subjects with non-small cell lung cancer and control subjects performed 5 min of tidal breathing through the aeoNose, a handheld electronic nose device. A training cohort was used for developing a prediction model based on breath data, and a blinded cohort was used for validation. Multivariable logistic regression analysis was performed, including breath data and clinical variables, in which the formula and cutoff value for the probability of lung cancer were applied to the validation data. RESULTS A total of 376 subjects formed the training set, and 199 subjects formed the validation set. The full training model (including exhaled breath data and clinical parameters from the training set) were combined in a multivariable logistic regression analysis, maintaining a cut off of 16% probability of lung cancer, resulting in a sensitivity of 95%, a specificity of 51%, and a negative predictive value of 94%; the area under the receiver-operating characteristic curve was 0.87. Performance of the prediction model on the validation cohort showed corresponding results with a sensitivity of 95%, a specificity of 49%, a negative predictive value of 94%, and an area under the receiver-operating characteristic curve of 0.86. INTERPRETATION Combining exhaled breath data and clinical variables in a multicenter, multi-device validation study can adequately distinguish patients with lung cancer from subjects without lung cancer in a noninvasive manner. This study paves the way to implement exhaled breath analysis in the daily practice of diagnosing lung cancer. CLINICAL TRIAL REGISTRATION The Netherlands Trial Register; No.: NL7025; URL: https://trialregister.nl/trial/7025.
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Affiliation(s)
- Sharina Kort
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands.
| | - Marjolein Brusse-Keizer
- Medical School Twente, Enschede, The Netherlands; Universiteit of Twente, Faculty of Behavioural Management and Social Sciences, Enschede, The Netherlands
| | - Hugo Schouwink
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands
| | - Emanuel Citgez
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands
| | - Frans H de Jongh
- Department of Respiratory Medicine, Medisch Spectrum Twente Enschede, Enschede, The Netherlands; Universiteit of Twente, Faculty of Behavioural Management and Social Sciences, Enschede, The Netherlands
| | - Jan W G van Putten
- Department of Respiratory Medicine, Martini Ziekenhuis, Groningen, The Netherlands
| | - Ben van den Borne
- Department of Respiratory Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Elisabeth A Kastelijn
- Department of Respiratory Medicine, Sint Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Daiana Stolz
- Clinic for Pulmonary Medicine and Respiratory Cell Research, Universitätspital Basel, Basel, Switzerland; Clinic for Respiratory Medicine, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Milou Schuurbiers
- Department of Respiratory Medicine, Radboud UMC, Nijmegen, The Netherlands
| | | | - Wouter H van Geffen
- Department of Respiratory Medicine, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Job van der Palen
- Medical School Twente, Enschede, The Netherlands; Universiteit of Twente, Faculty of Behavioural Management and Social Sciences, Enschede, The Netherlands
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15
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Bosnic-Anticevich S, Bakerly ND, Chrystyn H, Hew M, van der Palen J. Advancing Digital Solutions to Overcome Longstanding Barriers in Asthma and COPD Management. Patient Prefer Adherence 2023; 17:259-272. [PMID: 36741814 PMCID: PMC9891071 DOI: 10.2147/ppa.s385857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/09/2022] [Indexed: 01/30/2023] Open
Abstract
Maintenance therapy delivered via inhaler is central to asthma and chronic obstructive pulmonary disease (COPD) management. Poor adherence to inhaled medication and errors in inhalation technique have long represented major barriers to the optimal management of these chronic conditions. Technological innovations may provide a means of overcoming these barriers. This narrative review examines ongoing advances in digital technologies relevant to asthma and COPD with the potential to inform clinical decision-making and improve patient care. Digital inhaler devices linked to mobile apps can help bring about changes in patients' behaviors and attitudes towards disease management, particularly when they build in elements of interactivity and gamification. They can also support ongoing technique education, empowering patients and helping providers maximize the value of consultations and develop effective action plans informed by insights into the patient's inhaler use patterns and their respiratory health. When combined with innovative techniques such as machine learning, digital devices have the potential to predict exacerbations and prompt pre-emptive intervention. Finally, digital devices may support an advanced precision medicine approach to respiratory disease management and help support shared decision-making. Further work is needed to increase uptake of digital devices and integrate their use into care pathways before their full potential in personalized asthma and COPD management can be realized.
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Affiliation(s)
- Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Correspondence: Sinthia Bosnic-Anticevich, Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, 2037, NSW, Australia, Tel +61 414 015 614, Email
| | - Nawar Diar Bakerly
- Manchester Metropolitan University, Manchester, United Kingdom, Salford Royal NHS Foundation Trust, Manchester, UK
| | | | - Mark Hew
- Allergy, Asthma, and Clinical Immunology, Alfred Health, Melbourne, VIC, Australia
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands, and Section Cognition, Data and Education, University of Twente, Enschede, the Netherlands
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16
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van der Palen J, Slade D, Rehal S, Verma M, Plank M. A randomized, cross-over study comparing critical and overall errors, learning time, and preference of the ELLIPTA versus BREEZHALER dry powder inhalers in patients with asthma. Respir Med 2022; 205:107031. [PMID: 36368290 DOI: 10.1016/j.rmed.2022.107031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many patients with asthma make errors using inhalers, affecting the amount of medication received. Previous evidence demonstrated that patients with asthma or chronic obstructive pulmonary disease make fewer critical errors with the ELLIPTA inhaler after reading the patient information leaflet (PIL) versus other dry powder inhalers. We assessed errors made by patients with asthma using placebo ELLIPTA or BREEZHALER inhalers. METHODS This randomized, multicenter, open-label placebo inhaler-handling study (ClinicalTrials.gov: NCT04813354) with 2x2 complete block crossover design was conducted at three centers in the Netherlands and enrolled patients aged ≥18 years with mild-to-moderate asthma. Inclusion criteria were inhaler use for ≥12 weeks prior to enrollment and naivety to ELLIPTA and BREEZHALER inhalers. Patients were randomized to ELLIPTA or BREEZHALER inhaler first and were assessed for errors in use of both inhalers after 1) reading PIL instructions, 2) receiving further instruction from a healthcare professional (HCP) if they made an error. RESULTS 114 patients with asthma (57% female; mean age of 55.3 years) were assessed. After reading the PIL, 6% of patients made ≥1 critical error with ELLIPTA versus 26% with BREEZHALER (odds ratio [OR]: 0.11 [95% confidence interval (CI): 0.01-0.40]; p < 0.001). With ELLIPTA, 27% of patients made ≥1 overall error after reading the PIL versus 41% with BREEZHALER (OR: 0.25 [95% CI: 0.03-0.74]; p = 0.005). Fewer patients required HCP instruction with ELLIPTA than BREEZHALER (25% versus 32%). CONCLUSIONS Fewer patients made critical and overall errors using the ELLIPTA inhaler versus BREEZHALER after reading the PIL.
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Affiliation(s)
- Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente and Section Cognition, Data and Education, Faculty of Behavioral Science, University of Twente, Enschede, the Netherlands
| | | | | | | | - Maximilian Plank
- GSK, Abbotsford, VIC, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
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17
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Schaap G, Wensink M, Doggen CJM, van der Palen J, Vonkeman HE, Bode C. "It Really Is an Elusive Illness"-Post-COVID-19 Illness Perceptions and Recovery Strategies: A Thematic Analysis. Int J Environ Res Public Health 2022; 19:13003. [PMID: 36293582 PMCID: PMC9602798 DOI: 10.3390/ijerph192013003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
A substantial number of patients report persisting symptoms after a COVID-19 infection: so-called post-COVID-19 syndrome. There is limited research on patients' perspectives on post-COVID-19 symptoms and ways to recover. This qualitative study explored the illness perceptions and recovery strategies of patients who had been hospitalised for COVID-19. Differences between recovered and non-recovered patients were investigated. Semi-structured in-depth interviews were held with 24 participating patients (8 recovered and 16 non-recovered) 7 to 12 months after hospital discharge. Data were interpreted using reflexive thematic analysis. Four overarching themes were identified: (I) symptoms after hospital discharge; (II) impact of COVID-19 on daily life and self-identity; (III) uncertainty about COVID-19; and (IV) dealing with COVID-19. Formerly hospitalised post-COVID-19 patients seem to have difficulties with making sense of their illness and gaining control over their recovery. The majority of non-recovered participants continue to suffer mostly from weakness or fatigue, dyspnoea and cognitive dysfunction. No notable differences in illness beliefs were observed between recovered and non-recovered participants.
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Affiliation(s)
- Gerko Schaap
- Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Marleen Wensink
- Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Carine J. M. Doggen
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands
- Clinical Research Centre, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands
- Section Cognition, Data and Education, University of Twente, 7522 NB Enschede, The Netherlands
| | - Harald E. Vonkeman
- Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands
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18
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Scheepers MHMC, Al-Difaie ZJJ, Wintjens AGWE, Engelen SME, Havekes B, Lubbers T, Coolsen MME, van der Palen J, van Ginhoven TM, Vriens M, Bouvy ND. Detection of differentiated thyroid carcinoma in exhaled breath with an electronic nose. J Breath Res 2022; 16. [PMID: 35688135 DOI: 10.1088/1752-7163/ac77a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/14/2022] [Accepted: 06/10/2022] [Indexed: 11/12/2022]
Abstract
This proof-of-principle study investigates the diagnostic performance of the Aeonose in differentiating malignant from benign thyroid diseases based on volatile organic compound analysis in exhaled breath. All patients with a suspicious thyroid nodule planned for surgery, exhaled in the Aeonose. Definitive diagnosis was provided by histopathological determination after surgical resection. Breath samples were analyzed utilizing artificial neural networking. About 133 participants were included, 48 of whom were diagnosed with well-differentiated thyroid cancer. A sensitivity of 0.73 and a negative predictive value (NPV) of 0.82 were found. The sensitivity and NPV improved to 0.94 and 0.95 respectively after adding clinical variables via multivariate logistic regression analysis. This study demonstrates the feasibility of the Aeonose to discriminate between malignant and benign thyroid disease. With a high NPV, low cost, and non-invasive nature, the Aeonose may be a promising diagnostic tool in the detection of thyroid cancer.
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Affiliation(s)
- Max H M C Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Zaid J J Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Anne G W E Wintjens
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Sanne M E Engelen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bas Havekes
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tim Lubbers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marielle M E Coolsen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Job van der Palen
- Section Cognition, Data and Education, University of Twente, Enschede, The Netherlands.,Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Tessa M van Ginhoven
- Department of Surgery, Erasmus University, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Menno Vriens
- Department of Surgery, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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19
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Hengeveld VS, Lammers N, van der Kamp MR, van der Palen J, Thio BJ. Can the response to a single dose of beclomethasone dipropionate predict the outcome of long-term treatment in childhood exercise-induced bronchoconstriction? Pediatr Allergy Immunol 2022; 33:e13808. [PMID: 35754119 DOI: 10.1111/pai.13808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exercise-induced bronchoconstriction (EIB) is a frequent and highly specific symptom of childhood asthma. Inhaled corticosteroids (ICS) are the mainstay of controller therapy for EIB and asthma; however, a proportion of asthmatic children and adolescents is less responsive to ICS. We hypothesized that a single dose response to ICS could function as a predictor for individual long-term efficacy of ICS. OBJECTIVE To assess the predictive value of the bronchoprotective effect of a single-dose beclomethasone dipropionate (BDP) against EIB for the bronchoprotective effect of 4 weeks of treatment, using an exercise challenge test (ECT). METHODS Thirty-two steroid-naïve children and adolescents aged 6 to 18 years with EIB were included in this prospective cohort study. They performed an ECT at baseline, after a single-dose BDP (200µg) and after 4 weeks of BDP treatment (100 µg twice daily) to assess EIB severity. RESULTS The response to a single-dose BDP on exercise-induced fall in FEV1 showed a significant correlation with the response on exercise-induced fall in FEV1 after 4 weeks of BDP treatment (r = .38, p = .004). A reduction in post-exercise fall in FEV1 of more than 8% after a single-dose BDP could predict BDP efficacy against EIB after 4 weeks of treatment with a positive predictive value of 100% (CI: 86.1-100%) and a negative predictive value of 29.4% (CI: 11.7%-53.7%). CONCLUSION We found that the individual response to a single-dose BDP against EIB has a predictive value for the efficacy of long-term treatment with BDP. This could support clinicians in providing personalized management of EIB in childhood asthma.
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Affiliation(s)
- Vera S Hengeveld
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Natasja Lammers
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mattienne R van der Kamp
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Job van der Palen
- Clinical Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Bernard J Thio
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, The Netherlands
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20
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Kruik-Kollöffel WJ, Vallejo-Yagüe E, Movig KLL, Linssen GCM, Heintjes EM, van der Palen J. Non-cardiovascular medication and readmission for heart failure: an observational cohort study. Int J Clin Pharm 2022; 44:762-768. [PMID: 35633434 DOI: 10.1007/s11096-022-01418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/31/2021] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Abstract
Background Among heart failure (HF) patients, hospital readmissions are a major concern. The medication taken by a patient may provide information on comorbidities and conditions and may be used as an indicator to identify populations at an increased risk of HF readmission. Aim This study explored the use of non-cardiovascular medication at hospital discharge from the first HF admission in search of indicators of high risk of readmission for HF. Method The study included 22,476 HF patients from the Dutch PHARMO Database Network at their first HF hospitalization. The data was divided into training and validation sets. A Cox regression model with demographics, date of first HF hospital admission and non-cardiovascular medication present at discharge, adjusted for cardiovascular medication, was developed in the training set and subsequently implemented in the validation set. Results The study included 22,476 patients, mean age 76.7 years (range 18-104) and median follow-up time 2.5 years (range 0-15.7 years). During the study period 6,725 (29.9%) patients were readmitted for HF, with a median time-to-readmission of 7 months (range 0-14.3 years). Non-cardiovascular medication associated with a high risk of readmission for HF were identified as indicators of high risk, with no implied causal relationship. Patients prescribed antigout medications presented a 25% increased risk of readmission (HR 1.25, 95%CI 1.09-1.45, P = 0.002). Patients using insulin had an 18% higher risk of readmission versus patients not using insulin (HR 1.18, 95%CI 1.06-1.32, P = 0.002), but not versus patients treated with other blood-glucose-lowering drugs. No association between the risk of readmission and NSAIDs use was observed. Conclusion The results suggest that diabetes is responsible for the higher HF-readmission risk observed in patients prescribed insulin. The observed risk in users of antigout medication should be further investigated. The absence of an association with the use of NSAIDs should be interpreted with caution.
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Affiliation(s)
| | | | - Kris L L Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, The Netherlands
| | - Edith M Heintjes
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Section Cognition, Data and Education, University of Twente, Enschede, The Netherlands
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21
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Hendriks J, Schasfoort R, Koerselman M, Dannenberg M, Cornet AD, Beishuizen A, van der Palen J, Krabbe J, Mulder AHL, Karperien M. High Titers of Low Affinity Antibodies in COVID-19 Patients Are Associated With Disease Severity. Front Immunol 2022; 13:867716. [PMID: 35493512 PMCID: PMC9043688 DOI: 10.3389/fimmu.2022.867716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Almost 2 years from the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there is still a lot unknown how the humoral response affects disease progression. In this study, we investigated humoral antibody responses against specific SARS-CoV2 proteins, their strength of binding, and their relationship with COVID severity and clinical information. Furthermore, we studied the interactions of the specific receptor-binding domain (RBD) in more depth by characterizing specific antibody response to a peptide library. Materials and Methods We measured specific antibodies of isotypes IgM, IgG, and IgA, as well as their binding strength against the SARS-CoV2 antigens RBD, NCP, S1, and S1S2 in sera of 76 COVID-19 patients using surface plasmon resonance imaging. In addition, these samples were analyzed using a peptide epitope mapping assay, which consists of a library of peptides originating from the RBD. Results A positive association was observed between disease severity and IgG antibody titers against all SARS-CoV2 proteins and additionally for IgM and IgA antibodies directed against RBD. Interestingly, in contrast to the titer of antibodies, the binding strength went down with increasing disease severity. Within the critically ill patient group, a positive association with pulmonary embolism, d-dimer, and antibody titers was observed. Conclusion In critically ill patients, antibody production is high, but affinity is low, and maturation is impaired. This may play a role in disease exacerbation and could be valuable as a prognostic marker for predicting severity.
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Affiliation(s)
- Jan Hendriks
- Department of Developmental BioEngineering, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Richard Schasfoort
- Department of Medical Cell BioPhysics, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Michelle Koerselman
- Department of Developmental BioEngineering, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Maureen Dannenberg
- Department of Medical Cell BioPhysics, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | | | | | - Job van der Palen
- Medical School, Medisch Spectrum Twente, Enschede, Netherlands.,Section Cognition, Education and Data, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Johannes Krabbe
- Department of Clinical Chemistry, Medlon BV, Enschede, Netherlands.,Department of Clinical Chemistry and Laboratory Medicine, Medisch Spectrum Twente, Enschede, Netherlands
| | - Alide H L Mulder
- Department of Clinical Chemistry, Medlon BV, Enschede, Netherlands.,Department of Clinical Chemistry, Ziekenhuis Groep Twente, Almelo, Netherlands
| | - Marcel Karperien
- Department of Developmental BioEngineering, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
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22
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Ruijter BJ, Keijzer HM, Tjepkema-Cloostermans MC, Blans MJ, Beishuizen A, Tromp SC, Scholten E, Horn J, van Rootselaar AF, Admiraal MM, van den Bergh WM, Elting JWJ, Foudraine NA, Kornips FHM, van Kranen-Mastenbroek VHJM, Rouhl RPW, Thomeer EC, Moudrous W, Nijhuis FAP, Booij SJ, Hoedemaekers CWE, Doorduin J, Taccone FS, van der Palen J, van Putten MJAM, Hofmeijer J. Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest. N Engl J Med 2022; 386:724-734. [PMID: 35196426 DOI: 10.1056/nejmoa2115998] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [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: 12/24/2022]
Abstract
BACKGROUND Whether the treatment of rhythmic and periodic electroencephalographic (EEG) patterns in comatose survivors of cardiac arrest improves outcomes is uncertain. METHODS We conducted an open-label trial of suppressing rhythmic and periodic EEG patterns detected on continuous EEG monitoring in comatose survivors of cardiac arrest. Patients were randomly assigned in a 1:1 ratio to a stepwise strategy of antiseizure medications to suppress this activity for at least 48 consecutive hours plus standard care (antiseizure-treatment group) or to standard care alone (control group); standard care included targeted temperature management in both groups. The primary outcome was neurologic outcome according to the score on the Cerebral Performance Category (CPC) scale at 3 months, dichotomized as a good outcome (CPC score indicating no, mild, or moderate disability) or a poor outcome (CPC score indicating severe disability, coma, or death). Secondary outcomes were mortality, length of stay in the intensive care unit (ICU), and duration of mechanical ventilation. RESULTS We enrolled 172 patients, with 88 assigned to the antiseizure-treatment group and 84 to the control group. Rhythmic or periodic EEG activity was detected a median of 35 hours after cardiac arrest; 98 of 157 patients (62%) with available data had myoclonus. Complete suppression of rhythmic and periodic EEG activity for 48 consecutive hours occurred in 49 of 88 patients (56%) in the antiseizure-treatment group and in 2 of 83 patients (2%) in the control group. At 3 months, 79 of 88 patients (90%) in the antiseizure-treatment group and 77 of 84 patients (92%) in the control group had a poor outcome (difference, 2 percentage points; 95% confidence interval, -7 to 11; P = 0.68). Mortality at 3 months was 80% in the antiseizure-treatment group and 82% in the control group. The mean length of stay in the ICU and mean duration of mechanical ventilation were slightly longer in the antiseizure-treatment group than in the control group. CONCLUSIONS In comatose survivors of cardiac arrest, the incidence of a poor neurologic outcome at 3 months did not differ significantly between a strategy of suppressing rhythmic and periodic EEG activity with the use of antiseizure medication for at least 48 hours plus standard care and standard care alone. (Funded by the Dutch Epilepsy Foundation; TELSTAR ClinicalTrials.gov number, NCT02056236.).
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Affiliation(s)
- Barry J Ruijter
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Hanneke M Keijzer
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Marleen C Tjepkema-Cloostermans
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Michiel J Blans
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Albertus Beishuizen
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Selma C Tromp
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Erik Scholten
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Janneke Horn
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Anne-Fleur van Rootselaar
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Marjolein M Admiraal
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Walter M van den Bergh
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Jan-Willem J Elting
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Norbert A Foudraine
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Francois H M Kornips
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Vivianne H J M van Kranen-Mastenbroek
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Rob P W Rouhl
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Elsbeth C Thomeer
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Walid Moudrous
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Frouke A P Nijhuis
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Suzanne J Booij
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Cornelia W E Hoedemaekers
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Jonne Doorduin
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Fabio S Taccone
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Job van der Palen
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Michel J A M van Putten
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
| | - Jeannette Hofmeijer
- From the Department of Clinical Neurophysiology, Technical Medical Center (B.J.R., M.C.T.-C., M.J.A.M.P., J. Hofmeijer), and the Section of Cognition, Data, and Education (J.P.), University of Twente, and the Departments of Neurology and Clinical Neurophysiology (M.C.T.-C., M.J.A.M.P.), the Intensive Care Center (A.B.), and the Department of Epidemiology (J.P.), Medisch Spectrum Twente, Enschede, the Departments of Neurology (H.M.K., J. Hofmeijer) and Intensive Care (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Intensive Care Medicine (H.M.K., C.W.E.H.) and Neurology (H.M.K., J.D.) and the Donders Institute for Brain, Cognition, and Behavior (H.M.K.), Radboud University Medical Center, and the Department of Neurology, Canisius Wilhelmina Hospital (F.A.P.N., S.J.B.), Nijmegen, the Departments of Neurology and Clinical Neurophysiology (S.C.T.) and Intensive Care (E.S.), St. Antonius Hospital, Nieuwegein, the Department of Neurology, Leiden University Medical Center, Leiden (S.C.T.), the Amsterdam Coma Group (J. Horn, A.-F.R., M.M.A.), the Department of Intensive Care (J. Horn), and the Department of Neurology and Clinical Neurophysiology (A.-F.R., M.M.A.), Amsterdam University Medical Center, Amsterdam, the Departments of Critical Care (W.M.B.) and Neurology and Clinical Neurophysiology (J.W.J.E.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Intensive Care (N.A.F.) and Neurology (F.H.M.K.), VieCuri Medical Center, Venlo, the Departments of Clinical Neurophysiology (V.H.J.M.K.-M.) and Neurology (R.P.W.R.), Maastricht University Medical Center, and the Academic Center for Epileptology Kempenhaeghe and Maastricht UMC+ (V.H.J.M.K.-M., R.P.W.R.), Maastricht, and the Department of Neurology, Maasstad Hospital, Rotterdam (E.C.T., W.M.) - all in the Netherlands; and the Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels (F.S.T.)
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Berkel AEM, Bongers BC, Kotte H, Weltevreden P, de Jongh FHC, Eijsvogel MMM, Wymenga M, Bigirwamungu-Bargeman M, van der Palen J, van Det MJ, van Meeteren NLU, Klaase JM. Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial. Ann Surg 2022; 275:e299-e306. [PMID: 33443905 PMCID: PMC8746915 DOI: 10.1097/sla.0000000000004702] [Citation(s) in RCA: 113] [Impact Index Per Article: 56.5] [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] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the effects of a 3-week community-based exercise program on 30-day postoperative complications in high-risk patients scheduled for elective colorectal resection for (pre)malignancy. SUMMARY BACKGROUND DATA Patients with a low preoperative aerobic fitness undergoing colorectal surgery have an increased risk of postoperative complications. It remains, however, to be demonstrated whether prehabilitation in these patients reduces postoperative complications. METHODS This 2-center, prospective, single-blinded randomized clinical trial was carried out in 2 large teaching hospitals in the Netherlands. Patients (≥60 years) with colorectal (pre)malignancy scheduled for elective colorectal resection and with a score ≤7 metabolic equivalents on the veterans-specific activity questionnaire were randomly assigned to the prehabilitation group or the usual care group by using block-stratified randomization. An oxygen uptake at the ventilatory anaerobic threshold <11 mL/kg/min at the baseline cardiopulmonary exercise test was the final inclusion criterion. Inclusion was based on a power analysis. Patients in the prehabilitation group participated in a personalized 3-week (3 sessions per week, nine sessions in total) supervised exercise program given in community physical therapy practices before colorectal resection. Patients in the reference group received usual care. The primary outcome was the number of patients with one or more complications within 30 days of surgery, graded according to the Clavien-Dindo classification. Data were analyzed on an intention-to-treat basis. RESULTS Between February 2014 and December 2018, 57 patients [30 males and 27 females; mean age 73.6 years (standard deviation 6.1), range 61-88 years] were randomized to either prehabilitation (n = 28) or usual care (n = 29). The rate of postoperative complications was lower in the prehabilitation group (n = 12, 42.9%) than in the usual care group (n = 21, 72.4%, relative risk 0.59, 95% confidence interval 0.37-0.96, P = 0.024). CONCLUSIONS Exercise prehabilitation reduced postoperative complications in high-risk patients scheduled to undergo elective colon resection for (pre)malignancy. Prehabilitation should be considered as usual care in high-risk patients scheduled for elective colon, and probably also rectal, surgery.
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Affiliation(s)
- Annefleur E M Berkel
- Department of Surgery, Medisch Spectrum Twente, PO Box 50000, Enschede, The Netherlands
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, Maastricht, The Netherlands
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, Maastricht, The Netherlands
| | - Hayke Kotte
- Fysio Twente, J.J. van Deinselaan 34a, Enschede, The Netherlands
| | | | - Frans H C de Jongh
- Department of Pulmonology, Medisch Spectrum Twente, PO Box 50000, Enschede, The Netherlands
| | - Michiel M M Eijsvogel
- Department of Pulmonology, Medisch Spectrum Twente, PO Box 50000, Enschede, The Netherlands
| | - Machteld Wymenga
- Department of Internal Medicine, Medisch Spectrum Twente, PO Box 50000, Enschede, The Netherlands
| | | | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, PO Box 50000, Enschede, The Netherlands
| | - Marc J van Det
- Department of Surgery, Ziekenhuisgroep Twente, PO Box 7600, Almelo, The Netherlands
| | - Nico L U van Meeteren
- Top Sector Life Sciences & Health (Health∼Holland), PO Box 93035, The Hague, The Netherlands
- Department of Anesthesiology, Erasmus Medical Center, PO Box 2040, Rotterdam, The Netherlands
| | - Joost M Klaase
- Department of Surgery, Medisch Spectrum Twente, PO Box 50000, Enschede, The Netherlands
- Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, Groningen, The Netherlands
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Schrijver J, Lenferink A, Brusse-Keizer M, Zwerink M, van der Valk PD, van der Palen J, Effing TW. Self-management interventions for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2022; 1:CD002990. [PMID: 35001366 PMCID: PMC8743569 DOI: 10.1002/14651858.cd002990.pub4] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 01/30/2023]
Abstract
BACKGROUND Self-management interventions help people with chronic obstructive pulmonary disease (COPD) to acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable them to control their disease. Since the 2014 update of this review, several studies have been published. OBJECTIVES Primary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of health-related quality of life (HRQoL) and respiratory-related hospital admissions. To evaluate the safety of COPD self-management interventions compared to usual care in terms of respiratory-related mortality and all-cause mortality. Secondary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of other health outcomes and healthcare utilisation. To evaluate effective characteristics of COPD self-management interventions. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, EMBASE, trials registries and the reference lists of included studies up until January 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-randomised trials (CRTs) published since 1995. To be eligible for inclusion, self-management interventions had to include at least two intervention components and include an iterative process between participant and healthcare provider(s) in which goals were formulated and feedback was given on self-management actions by the participant. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. We contacted study authors to obtain additional information and missing outcome data where possible. Primary outcomes were health-related quality of life (HRQoL), number of respiratory-related hospital admissions, respiratory-related mortality, and all-cause mortality. When appropriate, we pooled study results using random-effects modelling meta-analyses. MAIN RESULTS We included 27 studies involving 6008 participants with COPD. The follow-up time ranged from two-and-a-half to 24 months and the content of the interventions was diverse. Participants' mean age ranged from 57 to 74 years, and the proportion of male participants ranged from 33% to 98%. The post-bronchodilator forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of participants ranged from 33.6% to 57.0%. The FEV1/FVC ratio is a measure used to diagnose COPD and to determine the severity of the disease. Studies were conducted on four different continents (Europe (n = 15), North America (n = 8), Asia (n = 1), and Oceania (n = 4); with one study conducted in both Europe and Oceania). Self-management interventions likely improve HRQoL, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score (lower score represents better HRQoL) with a mean difference (MD) from usual care of -2.86 points (95% confidence interval (CI) -4.87 to -0.85; 14 studies, 2778 participants; low-quality evidence). The pooled MD of -2.86 did not reach the SGRQ minimal clinically important difference (MCID) of four points. Self-management intervention participants were also at a slightly lower risk for at least one respiratory-related hospital admission (odds ratio (OR) 0.75, 95% CI 0.57 to 0.98; 15 studies, 3263 participants; very low-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over a mean of 9.75 months' follow-up was 15 (95% CI 8 to 399) for participants with high baseline risk and 26 (95% CI 15 to 677) for participants with low baseline risk. No differences were observed in respiratory-related mortality (risk difference (RD) 0.01, 95% CI -0.02 to 0.04; 8 studies, 1572 participants ; low-quality evidence) and all-cause mortality (RD -0.01, 95% CI -0.03 to 0.01; 24 studies, 5719 participants; low-quality evidence). We graded the evidence to be of 'moderate' to 'very low' quality according to GRADE. All studies had a substantial risk of bias, because of lack of blinding of participants and personnel to the interventions, which is inherently impossible in a self-management intervention. In addition, risk of bias was noticeably increased because of insufficient information regarding a) non-protocol interventions, and b) analyses to estimate the effect of adhering to interventions. Consequently, the highest GRADE evidence score that could be obtained by studies was 'moderate'. AUTHORS' CONCLUSIONS Self-management interventions for people with COPD are associated with improvements in HRQoL, as measured with the SGRQ, and a lower probability of respiratory-related hospital admissions. No excess respiratory-related and all-cause mortality risks were observed, which strengthens the view that COPD self-management interventions are unlikely to cause harm. By using stricter inclusion criteria, we decreased heterogeneity in studies, but also reduced the number of included studies and therefore our capacity to conduct subgroup analyses. Data were therefore still insufficient to reach clear conclusions about effective (intervention) characteristics of COPD self-management interventions. As tailoring of COPD self-management interventions to individuals is desirable, heterogeneity is and will likely remain present in self-management interventions. For future studies, we would urge using only COPD self-management interventions that include iterative interactions between participants and healthcare professionals who are competent using behavioural change techniques (BCTs) to elicit participants' motivation, confidence and competence to positively adapt their health behaviour(s) and develop skills to better manage their disease. In addition, to inform further subgroup and meta-regression analyses and to provide stronger conclusions regarding effective COPD self-management interventions, there is a need for more homogeneity in outcome measures. More attention should be paid to behavioural outcome measures and to providing more detailed, uniform and transparently reported data on self-management intervention components and BCTs. Assessment of outcomes over the long term is also recommended to capture changes in people's behaviour. Finally, information regarding non-protocol interventions as well as analyses to estimate the effect of adhering to interventions should be included to increase the quality of evidence.
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Affiliation(s)
- Jade Schrijver
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Anke Lenferink
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Marjolein Brusse-Keizer
- Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Marlies Zwerink
- Value-Based Health Care, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - Job van der Palen
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Tanja W Effing
- College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
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Berkel AEM, van Wijk L, van Dijk DPJ, Prins SN, van der Palen J, van Meeteren NLU, Olde Damink SWM, Klaase JM, Bongers BC. The association between preoperative body composition and aerobic fitness in patients scheduled for colorectal surgery. Colorectal Dis 2022; 24:93-101. [PMID: 34612581 PMCID: PMC9298406 DOI: 10.1111/codi.15941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/24/2021] [Accepted: 09/28/2021] [Indexed: 02/08/2023]
Abstract
AIM Although cardiopulmonary exercise testing (CPET) is considered the gold standard, a preoperative abdominal CT scan might also provide information concerning preoperative aerobic fitness for risk assessment. This study aimed to investigate the association between preoperative CT-scan-derived body composition variables and preoperative CPET variables of aerobic fitness in colorectal surgery. METHOD In this retrospective cohort study, CT images at level L3 were analysed for skeletal muscle mass, skeletal muscle radiation attenuation, visceral adipose tissue (VAT) mass and subcutaneous adipose tissue mass. Regression analyses were performed to investigate the relation between CT-scan-derived body composition variables, CPET-derived aerobic fitness and other preoperative patient-related variables. Logistic regression analysis was performed to predict a preoperative anaerobic threshold (AT) ≤ 11.1 ml/kg/min as cut-off for having a high risk for postoperative complications. RESULTS Data from 78 patients (45 men; mean [SD] age 74.5 [6.4 years]) were analysed. A correlation coefficient of 0.55 was observed between absolute AT and skeletal muscle mass index. Absolute AT (R2 of 51.1%) was lower in patients with a lower skeletal muscle mass index, together with higher age, lower body mass and higher American Society of Anesthesiologists (ASA) score. Higher ASA score (odds ratio 5.64; P = 0.033) and higher VAT mass (odds ratio 1.02; P = 0.036) were associated with an increased risk of an AT ≤ 11.1 ml/kg/min. CONCLUSION Body composition variables from the preoperative CT scan were moderately associated with preoperative CPET-derived aerobic fitness. Higher ASA score and higher VAT mass were associated with an increased risk of an AT ≤ 11.1 ml/kg/min.
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Affiliation(s)
| | - Laura van Wijk
- Department of Hepatobiliary Surgery and Liver TransplantationUniversity Medical Center GroningenGroningenThe Netherlands
| | - David P. J. van Dijk
- Department of SurgeryNUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Sanne N. Prins
- Department of SurgeryMedisch Spectrum TwenteEnschedeThe Netherlands
| | - Job van der Palen
- Medical School TwenteMedisch Spectrum TwenteEnschedeThe Netherlands,Department of Research MethodologyMeasurement and Data AnalysisUniversity of TwenteEnschedeThe Netherlands
| | - Nico L. U. van Meeteren
- Top Sector Life Sciences and Health (Health~Holland)The HagueThe Netherlands,Department of AnesthesiologyErasmus Medical CenterRotterdamThe Netherlands
| | - Steven W. M. Olde Damink
- Department of SurgeryNUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Joost M. Klaase
- Department of Hepatobiliary Surgery and Liver TransplantationUniversity Medical Center GroningenGroningenThe Netherlands
| | - Bart C. Bongers
- Department of EpidemiologyCare and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands,Department of Nutrition and Movement SciencesNUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
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26
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Oonk NGM, Movig KLL, van der Palen J, Nibourg SAF, Koehorst-Ter Huurne K, Nijmeijer HW, van Kesteren ME, Dorresteijn LDA. The Effect of a Structured Medication Review on Quality of Life in Parkinson's Disease. J Parkinsons Dis 2022; 12:1295-1306. [PMID: 35253776 DOI: 10.3233/jpd-213021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Drug therapy is important for controlling symptoms in Parkinson's disease (PD). However, it often results in complex medication regimens and could easily lead to drug related problems (DRP), suboptimal adherence and reduced treatment efficacy. A structured medication review (SMR) could address these issues and optimize therapy, although little is known about clinical effects in PD patients. OBJECTIVE To analyze whether an SMR improves quality of life (QoL) in PD. METHODS In this multicenter randomized controlled trial, half of the 202 PD patients with polypharmacy received a community pharmacist-led SMR. The control group received usual care. Assessments at baseline, and after three and six months comprised six validated questionnaires. Primary outcome was PD specific QoL [(PDQ-39; range 0 (best QoL) - 100 (worst QoL)]. Secondary outcomes were disability score, non-motor symptoms, general health status, and personal care giver's QoL. Furthermore, DRPs, proposed interventions, and implemented modifications in medication schedules were analyzed. RESULTS No improvement in QoL was seen six months after an SMR, with a non-significant treatment effect difference of 2.09 (-0.63;4.80) in favor of the control group. No differences were found in secondary outcomes. In total, 260 potential DRPs were identified (2.6 (±1.8) per patient), of which 62% led to drug therapy optimization. CONCLUSION In the current setting, a community pharmacist-led SMR did not improve QoL in PD patients, nor improved other pre-specified outcomes.
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Affiliation(s)
- Nicol G M Oonk
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
- Section Cognition, Data and Education, University of Twente, Enschede, the Netherlands
| | - Kris L L Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Job van der Palen
- Section Cognition, Data and Education, University of Twente, Enschede, the Netherlands
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands
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27
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Zuur-Telgen MC, Citgez E, Zuur AT, VanderValk P, van der Palen J, Kerstjens HAM, Brusse-Keizer M. Predicting Mortality in COPD with Validated and Sensitive Biomarkers; Fibrinogen and Mid-Range-Proadrenomedullin (MR-proADM). COPD 2021; 18:643-649. [PMID: 34886719 DOI: 10.1080/15412555.2021.2009791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although fibrinogen is a FDA qualified prognostic biomarker in COPD, it still lacks sufficient resolution to be clinically useful. Next to replication of findings in different cohorts also the combination with other validated biomarkers should be investigated. Therefore, the aim of this study was to confirm in a large well-defined population of COPD patients whether fibrinogen can predict mortality and whether a combination with the biomarker MR-proADM can increase prognostic accuracy. From the COMIC cohort study we included COPD patients with a blood sample obtained in stable state (n = 640) and/or at hospitalization for an acute exacerbation of COPD (n = 262). Risk of death during 3 years of follow up for the separate and combined biomarker models was analyzed with Cox regression. Furthermore, logistic regression models for death after one year were constructed. When both fibrinogen and MR-proADM were included in the survival model, a doubling in fibrinogen and MR-proADM levels gave a 2.2 (95% CI 1.3-3.7) and 2.1 (95% CI 1.5-3.0) fold increased risk of dying, respectively. The prediction model for death after 1 year improved significantly when MR-proADM was added to the model with fibrinogen (AUC increased from 0.78 to 0.83; p = 0.02). However, the combined model was not significantly more adequate than the model with solely MR-proADM (AUC 0.83 vs 0.82; p = 0.34). The study suggests that MR-proADM is more promising than fibrinogen in prediciting mortality. Adding fibrinogen to a model containing MR-proADM does not significantly increase the predictive capacity of the model.
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Affiliation(s)
- Maaike C Zuur-Telgen
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Emanuel Citgez
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Abraham T Zuur
- Department of gastroenterology, Tjongerschans, Heerenveen, The Netherlands
| | - Paul VanderValk
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, The Netherlands.,Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonary Medicine, and Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Jobsen JJ, Struikmans H, van der Palen J, Siemerink EJM. Clinical relevance of the timing of radiotherapy after breast-conserving surgery : Results of a large, single-centre, population-based cohort study. Strahlenther Onkol 2021; 198:268-281. [PMID: 34845511 DOI: 10.1007/s00066-021-01877-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the effect of the timing of radiation therapy after breast-conserving surgery in relation to distant metastasis-free survival and disease-specific survival. METHODS The analysis was performed in relation to 4189 women all undergoing breast-conserving therapy (BCT). Three groups were defined with respect to lymph node status and the use of adjuvant systemic therapy (AST). Patients were categorized into time intervals: < 37 days, 37-53 days, 54-112 days and > 112 days. RESULTS For women without lymph node metastases and with favourable characteristics aged > 55 years, an improved treatment efficacy was noted when starting radiotherapy with a time interval of < 37 days. The same was observed for women with lymph nodes metastases receiving AST aged ≤ 50 years. Finally, for women aged > 50 years with negative lymph node status but with unfavourable characteristics and receiving AST, an improved treatment efficacy was noted when starting radiotherapy after a time interval of ≥ 37 days. CONCLUSION The results of our study further support the hypothesis that the timing of radiotherapy may have an impact on treatment efficacy and that further studies (preferably randomized trials) are indicated.
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Affiliation(s)
- Jan J Jobsen
- Department of Epidemiology, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ, Enschede, The Netherlands.
- Breast Clinic Oost-Nederland, ZGT, Hengelo, The Netherlands.
| | - Henk Struikmans
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ, Enschede, The Netherlands
- Departement of Research Methodology, Measurement, and Data Analysis, Faculty of Behavioural Science, University of Twente, Enschede, The Netherlands
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Hofste A, Soer R, Groen GJ, van der Palen J, Geerdink FJB, Oosterveld FGJ, Kiers H, Wolff AP, Hermens H. Functional and morphological lumbar multifidus characteristics in subgroups with low back pain in primary care. Musculoskelet Sci Pract 2021; 55:102429. [PMID: 34271415 DOI: 10.1016/j.msksp.2021.102429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since the contribution of the lumbar multifidus(LM) is not well understood in relation to non-specific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy. OBJECTIVES This study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls. DESIGN Multicenter case control study. METHOD Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included. Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, p-values<0.05, with Tukey's HSD post-hoc test were considered significant. RESULTS A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11-0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10-0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03). CONCLUSIONS Trunk ROM and LM thickness show differences between LBP patients and healthy controls.
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Affiliation(s)
- Anke Hofste
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands.
| | - Remko Soer
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Gerbrand J Groen
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, Netherlands; Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Frank J B Geerdink
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands
| | - Frits G J Oosterveld
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands
| | - Henri Kiers
- Institute for Human Movement Studies, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - André P Wolff
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Hermie Hermens
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands; Telemedicine Group, Roessingh Research and Development Enschede, the Netherlands
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30
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Oonk NGM, Movig KLL, van der Palen J, Nijmeijer HW, van Kesteren ME, Dorresteijn LDA. The Impact of Non-dopaminergic Medication on Quality of Life in Parkinson's Disease. Clin Drug Investig 2021; 41:809-816. [PMID: 34374959 DOI: 10.1007/s40261-021-01064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Quality of life (QoL) in Parkinson's disease (PD) depends on multiple factors. Due to PD treatment and accompanying, age-related or independent comorbidities, pill burden is often high. The relation of QoL and pharmacotherapy for comorbidities in PD has not been widely studied. This study investigated if and to what extent non-dopaminergic drugs are related to QoL in PD. Second, the impact of demographics and non-motor symptoms were evaluated. A better understanding of the impact of different non-dopaminergic drugs and polypharmacy on QoL will have added value in selecting appropriate (medication) interventions. METHODS In a cross-sectional analysis, medication prescription data of 209 PD patients were analyzed and grouped according to the Rx-Risk comorbidity index. QoL was measured using the PDQ-39 questionnaire. Non-motor symptoms were analyzed with the Non-Motor Symptoms questionnaire. Independent factors associated with a reduced QoL were identified with a multivariate linear regression analysis. RESULTS Non-dopaminergic drugs, subdivided into Rx-Risk comorbidity categories, were not associated with reduced QoL, except for the use of anti-epileptic drugs. However, using more daily non-dopaminergic drugs was also negatively associated with QoL, as well as female sex, increased PD severity, and more non-motor symptoms. Contraindicated non-dopaminergic medication was barely prescribed (0.4%). CONCLUSION Non-dopaminergic drugs are frequently prescribed, and higher numbers are associated with impaired QoL in PD. However, when divided in drug types, only anti-epileptic drugs were negatively associated with QoL. In these patients, physicians might improve QoL by further optimizing the condition it was prescribed for (e.g., pain or anxiety), or managing of side effects. TRIAL REGISTRATION Netherlands Trial Register; NL4360.
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Affiliation(s)
- Nicol G M Oonk
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Kris L L Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, The Netherlands
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Citgez E, van der Palen J, van der Valk P, Kerstjens HAM, Brusse-Keizer M. Stability in eosinophil categorisation during subsequent severe exacerbations of COPD. BMJ Open Respir Res 2021; 8:8/1/e000960. [PMID: 34376399 PMCID: PMC8354268 DOI: 10.1136/bmjresp-2021-000960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background The blood eosinophil count has been shown to be a promising biomarker for establishing personalised treatment strategies to reduce corticosteroid use, either inhaled or systemic, in chronic obstructive pulmonary disease (COPD). Eosinophil levels seem relatively stable over time in stable state, but little is known whether this is also true in subsequent severe acute exacerbations of COPD (AECOPD). Aims and objectives To determine the stability in eosinophil categorisation between two subsequent severe AECOPDs employing frequently used cut-off levels. Methods During two subsequent severe AECOPDs, blood eosinophil counts were determined at admission to the hospital in 237 patients in the Cohort of Mortality and Inflammation in COPD Study. The following four cut-off levels were analysed: absolute counts of eosinophils ≥0.2×10⁹/L (200 cells/µL) and ≥0.3×10⁹/L (300 cells/µL) and relative eosinophil percentage of ≥2% and ≥3% of total leucocyte count. Categorisations were considered stable if during the second AECOPD their blood eosinophil status led to the same classification: eosinophilic or not. Results Depending on the used cut-off, the overall stability in eosinophil categorisation varied between 70% and 85% during two subsequent AECOPDs. From patients who were eosinophilic at the first AECOPD, 34%–45% remained eosinophilic at the subsequent AECOPD, while 9%–21% of patients being non-eosinophilic at the first AECOPD became eosinophilic at the subsequent AECOPD. Conclusions The eosinophil variability leads to category changes in subsequent AECOPDs, which limits the eosinophil categorisation stability. Therefore, measurement of eosinophils at each new exacerbation seems warranted.
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Affiliation(s)
- Emanuel Citgez
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands .,Department of Research Methodology, Measurement, and Data analysis, University of Twente, Enschede, The Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement, and Data analysis, University of Twente, Enschede, The Netherlands.,Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Paul van der Valk
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonary Medicine, and Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Sloots J, Bakker M, van der Palen J, Eijsvogel M, van der Valk P, Linssen G, van Ommeren C, Grinovero M, Tabak M, Effing T, Lenferink A. Adherence to an eHealth Self-Management Intervention for Patients with Both COPD and Heart Failure: Results of a Pilot Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2089-2103. [PMID: 34290502 PMCID: PMC8289298 DOI: 10.2147/copd.s299598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/29/2020] [Accepted: 04/19/2021] [Indexed: 01/02/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) often coexist and share periods of symptom deterioration. Electronic health (eHealth) might play an important role in adherence to interventions for the self-management of COPD and CHF symptoms by facilitating and supporting home-based care. Methods In this pilot study, an eHealth self-management intervention was developed based on paper versions of multi-morbid exacerbation action plans and evaluated in patients with both COPD and CHF. Self-reporting of increased symptoms in diaries was linked to an automated decision support system that generated self-management actions, which was communicated via an eHealth application on a tablet. After participating in self-management training sessions, patients used the intervention for a maximum of four months. Adherence to daily symptom diary completion and follow-up of actions were analyzed. An add-on sensorized (Respiro®) inhaler was used to analyze inhaled medication adherence and inhalation technique. Results In total, 1148 (91%) of the daily diaries were completed on the same day by 11 participating patients (mean age 66.8 ± 2.9 years; moderate (55%) to severe (45%) COPD; 46% midrange left ventricular function (LVF) and 27% reduced LVF). Seven patients received a total of 24 advised actions because of increased symptoms of which 11 (46%) were followed-up. Of the 13 (54%) unperformed advised actions, six were “call the case manager”. Adherence to inhaled medication was 98.4%, but 51.9% of inhalations were performed incorrectly, with “inhaling too shortly” (<1.25 s) being the most frequent error (79.6%). Discussion Whereas adherence to completing daily diaries was high, advised actions were inadequately followed-up, particularly the action “call the case manager”. Inhaled medication adherence was high, but inhalations were poorly performed. Future research is needed to identify adherence barriers, further tailor the intervention to the individual patient and analyse the intervention effects on health outcomes.
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Affiliation(s)
- Joanne Sloots
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Mirthe Bakker
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Job van der Palen
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Research Methodology, Measurement & Data Analysis, University of Twente, Enschede, the Netherlands
| | - Michiel Eijsvogel
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Paul van der Valk
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Gerard Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, the Netherlands
| | - Clara van Ommeren
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Monique Tabak
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands.,Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
| | - Tanja Effing
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Anke Lenferink
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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van der Maten G, Dijkstra S, Meijs MFL, von Birgelen C, van der Palen J, den Hertog HM. Cardiac imaging in ischemic stroke or transient ischemic attack of undetermined cause: Systematic review & meta-analysis. Int J Cardiol 2021; 339:211-218. [PMID: 34197841 DOI: 10.1016/j.ijcard.2021.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with ischemic stroke or transient ischemic attack (TIA) of undetermined cause often undergo cardiac imaging in search of a cardioembolic source. As the choice of the most appropriate imaging approach is controversial and therapeutic implications have changed over time, we aimed to identify in patients with "cryptogenic stroke or TIA" the yield of transthoracic or transesophageal echocardiography (TTE or TEE) and cardiac computed tomography (CT). METHODS AND RESULTS We performed a systematic review and meta-analysis according to the PRISMA guidelines. Included were studies that assessed consecutive patients with ischemic stroke or TIA of undetermined cause to evaluate the yield of TTE, TEE, or cardiac CT for detecting cardioembolic sources. For each type of cardioembolic source the pooled prevalence was calculated. Only six out of 1458 studies fulfilled the inclusion criteria (1022 patients). One study reported the yield of TTE, four of TEE, and one of both TTE and TEE; no study assessed cardiac CT. Mean patient age ranged from 44.3-71.2 years, 49.2-59.7% were male. TTE detected 43 cardioembolic sources in 316 patients (4 (1.3%) major, 39 (12.3%) minor), and TEE 248 in 937 patients (55 (5.9%) major, 193 (20.6%) minor). The most prevalent major cardioembolic source was left atrial appendage thrombus, yet results were heterogeneous among studies. CONCLUSIONS TTE and TEE infrequently detect major cardioembolic sources that require a change of therapy. Findings should be interpreted with caution due to the limited number of studies. A large-sized prospective clinical trial is warranted to support evidence-based decision-making.
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Affiliation(s)
- Gerlinde van der Maten
- Department of Neurology, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands.
| | - Saskia Dijkstra
- Department of Neurology, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, the Netherlands
| | - Matthijs F L Meijs
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, the Netherlands
| | - Clemens von Birgelen
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands; Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, the Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, the Netherlands; Department of Research Methodology, Measurement and Data Analysis, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands
| | - Heleen M den Hertog
- Department of Neurology, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands
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Koevoets E, Schagen SB, de Ruiter MB, Geerlings MI, Witlox L, Van Der Wall E, Stuiver MM, Sonke GS, Velthuis M, van der Palen J, Jobsen JJ, May AM, Monninkhof EM. Effect of physical exercise on cognitive function after chemotherapy in patients with breast cancer: A randomized controlled trial (PAM study). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
12015 Background: Chemotherapy is associated with cognitive problems. Physical exercise is a promising intervention. We investigated whether exercise improves cognition in chemotherapy-exposed breast cancer (BC) patients 2-4 years after diagnosis. Methods: In the PAM study, we randomized chemotherapy-exposed BC patients with self-reported and test-confirmed cognitive problems to an exercise or control group. The 6-month exercise intervention consisted of 2 hours of supervised aerobic and resistance training and two hours of Nordic/power walking. Memory function measured with the Hopkins Verbal Learning Test-Revised (HVLT-R) was our primary outcome. Further measurements included online neuropsychological tests (Amsterdam Cognition Scan; ACS), self-reported cognitive complaints (MDASI-MM, EORTC QLQ C-30 cognitive functioning), physical fitness (VO2peak), fatigue (MFI, EORTC fatigue), quality of life (QoL; EORTC), anxiety (HADS) and depression (HADS, PHQ9). HVLT-R total recall was analyzed with a Fisher exact test for clinically relevant improvement of ≥5 words. Other outcomes were analyzed using multiple regression analyses adjusted for baseline and stratification factors. An hypothesis driven but not pre-specified analysis in patients with high baseline EORTC fatigue levels (≥39) was performed. Results: We randomized 181 patients to the exercise (n = 91) or control group (n = 90). Two-third of the patients attended ≥ 80% of the exercise program and physical fitness significantly improved compared to the control patients ( VO2peak1.4 ml/min/kg, 95% CI 0.6; 2.2). No difference in favor of the intervention group was seen on the primary cognitive outcome or other cognitive tests. However, significant beneficial intervention effects were found for self-reported cognition (MDASI-MM Severity (-0.7, -1.2;-0.1)), fatigue (general fatigue (-2.2, -3.3; -1.1), physical fatigue (-3.3, -4.4; -2.2), mental fatigue (-1.0, -2.0; 0.0), reduced motivation (-1.1, -2.0; -0.2) and reduced activity (-2.1, -3.2; -1.1)), QoL (summary score (4.0, 1.2; 6.7), global health status (5.8, 1.1; 10.6), role functioning (7.2, 1.3; 13.1) and social functioning (5.9, 0.2; 11.6)) and depression (PHQ9 (-1.16, -2.19; -0.13)). In high-fatigued patients, exercise did show significant positive effects on objective cognitive function (ACS Reaction Time (-26.8, -52.9; -0.6) and ACS Wordlist Learning (4.4, 0.5; 8.3)). Conclusions: A 6-month exercise intervention did not improve objectively measured cognitive function in chemotherapy-exposed BC patients with cognitive problems. However, self-reported cognitive function, physical fitness, fatigue, QoL and depression did improve. Unplanned analysis indicated a small positive effect of exercise on cognitive functioning in high-fatigued patients. Clinical trial information: NTR6104.
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Affiliation(s)
- Emmie Koevoets
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Sanne B. Schagen
- Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michiel B. de Ruiter
- Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Lenja Witlox
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | | | - Martijn M. Stuiver
- Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences, Amsterdam, Netherlands
| | - Gabe S. Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Miranda Velthuis
- Comprehensive Cancer Centre the Netherlands, Utrecht, Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Jan J. Jobsen
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Anne Maria May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Evelyn M. Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
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Pelle T, van der Palen J, de Graaf F, van den Hoogen FHJ, Bevers K, van den Ende CHM. Use and usability of the dr. Bart app and its relation with health care utilisation and clinical outcomes in people with knee and/or hip osteoarthritis. BMC Health Serv Res 2021; 21:444. [PMID: 33971861 PMCID: PMC8112040 DOI: 10.1186/s12913-021-06440-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/02/2020] [Accepted: 04/26/2021] [Indexed: 01/19/2023] Open
Abstract
Background Self-management is of paramount importance in the non-surgical treatment of knee/hip osteoarthritis (OA). Modern technologies offer the possibility of 24/7 self-management support. We developed an e-self-management application (dr. Bart app) for people with knee/hip OA. The aim of this study was to document the use and usability of the dr. Bart app and its relation with health care utilisation and clinical outcomes in people with knee/hip OA. Methods For this study we used backend data for the first 26 weeks of use by the intervention group (N = 214) of an RCT examining the effectiveness of the dr. Bart app. A central element of the dr. Bart app is that it proposes a selection of 72 preformulated goals for health behaviours based on the ‘tiny habits method’ (e.g. after lunch I rise 12 times from my chair to train my leg muscles). The usability of the app was measured using the System Usability Scale questionnaire (SUS), on a scale of 0–100. To assess the association between the intensity of use of the app and health care utilisation (i.e., consultations in primary or secondary health care) and clinical outcomes (i.e., self-management behaviour, physical activity, health-related quality of life, illness perceptions, symptoms, pain, activities of daily living) we calculated Spearman rank correlation coefficients. Results Of the 214 participants, 171 (80%) logged in at least once with 151 (71%) choosing at least one goal and 114 (53%) completing at least one goal during the 26 weeks. Of those who chose at least one goal, 56 participants (37%) continued to log in for up to 26 weeks, 12 (8%) continued to select new goals from the offered goals and 37 (25%) continued to complete goals. Preformulated goals in the themes of physical activity (e.g., performing an exercise from the exercises library in the app) and nutrition (e.g., ‘eat two pieces of fruit today’) were found to be most popular with users. The mean usability scores (standard deviation) at the three and six month follow-ups were 65.9 (16.9) and 64.5 (17.5), respectively. The vast majority of associations between the intensity of use of the dr. Bart app and target outcomes were weak at ρ < (−) 0.25. Conclusions More than one-third of people with knee/hip OA who started using the app, continued to use it up to 26 weeks, though usability could be improved. Patients appear to have preferences for goals related to physical activity and nutrition, rather than for goals related to vitality and education. We found weak/no associations between the intensity of use of the dr. Bart app and health care utilisation and clinical outcomes. Trial registration (21 September 2017): Dutch Trial Register (Trial Number NTR6693/NL6505) Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06440-1.
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Affiliation(s)
- Tim Pelle
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands. .,Department of Rheumatic Diseases, Radboud University Medical Center, PO Box 9011, 6500, GM, Nijmegen, the Netherlands.
| | - Job van der Palen
- Department of Research Methodology, Measurement, and Data-Analysis, Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands.,Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Frank H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.,Department of Rheumatic Diseases, Radboud University Medical Center, PO Box 9011, 6500, GM, Nijmegen, the Netherlands
| | - Karen Bevers
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.,Department of Rheumatic Diseases, Radboud University Medical Center, PO Box 9011, 6500, GM, Nijmegen, the Netherlands
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van der Kolk A, Lammers N, Brusse-Keizer M, van der Palen J, Faber J, Spenkelink-Visser R, Thio BJ. Comparison of inhalation technique with the Diskus and Autohaler in asthmatic children at home. ERJ Open Res 2021; 7:00215-2019. [PMID: 33898617 PMCID: PMC8053909 DOI: 10.1183/23120541.00215-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/04/2021] [Indexed: 11/22/2022] Open
Abstract
Objective Asthma is the most common chronic disease in childhood and anti-inflammatory medication is the cornerstone of treatment. Inhalers are frequently used incorrectly when demonstrated in the hospital, suggesting poor technique at home. We aimed to 1) compare daily inhalation technique with the Diskus and Autohaler in asthmatic children by filming inhalations at home and 2) compare daily inhalation technique with technique demonstrated in the hospital. Methods We performed a randomised study in asthmatic children (aged 6–18 years) from the outpatient clinic of Medisch Spectrum Twente hospital (Enschede, The Netherlands) from July 2014 to April 2016. Children received inhalation instructions for the Diskus and Autohaler and were randomised to use one device in the morning and the other in the evening. During the 28-day study period, inhalations were filmed at home and subsequently demonstrated in the hospital. All inhalations were checked for seven critical errors per device. Results 636 videos with the Diskus and 663 with the Autohaler were provided by 27 children. The most common critical error in daily life was an incorrect device position during preparation of the Diskus (n=271) and an insufficiently deep inhalation (n=39) using the Autohaler. Percentage of correct days using the Diskus was 44%, compared to 96% with the Autohaler (p<0.001). The two most common errors with the Diskus were made at least twice as often at home than in the hospital. Conclusion Inhalation technique at home was markedly better with the Autohaler than with the Diskus. Paediatricians should be aware that hospital-based demonstrations can overestimate daily inhalation technique with the Diskus. Inhalation technique at home is markedly better with the Autohaler than with the Diskus. Paediatricians should be aware that hospital-based demonstrations can overestimate daily inhalation technique with the Diskus.https://bit.ly/3cYK4eq
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Affiliation(s)
| | - Natasja Lammers
- Dept of Pediatrics, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Dept of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Joyce Faber
- Dept of Pediatrics, Deventer Ziekenhuis, Deventer, The Netherlands
| | | | - Bernard J Thio
- Dept of Pediatrics, Medisch Spectrum Twente, Enschede, The Netherlands.,Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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Ter Huurne ED, de Haan HA, Postel MG, DeJong CAJ, VanDerNagel JEL, van der Palen J. Long-term effectiveness of web-based cognitive behavioral therapy for patients with eating disorders. Eat Weight Disord 2021; 26:911-919. [PMID: 32449152 DOI: 10.1007/s40519-020-00929-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the long-term effectiveness of a web-based therapist-delivered cognitive behavioral therapy (CBT) for patients with eating disorders (ED). METHODS We used follow-up data from a randomized controlled trial that evaluated a web-based CBT on ED psychopathology and related health, compared to a waiting list control (WL) condition. As participants of the WL condition started the intervention after their waiting period, follow-up data included participants from both groups. The primary outcome was change from baseline, at 3, 6, and 12-month intervals in ED psychopathology, analyzed using mixed models for repeated measures. Secondary outcomes included body dissatisfaction, BMI, physical health, mental health, self-esteem, quality of life, and social functioning. RESULTS The population comprised 212 participants in total, in three subgroups: bulimia nervosa (BN; n = 44), binge eating disorder (BED; n = 83), and ED not otherwise specified (EDNOS; n = 85). Treatment effects were sustained during follow-up, with generally large effect sizes for the reduction of ED psychopathology and body dissatisfaction, and small to moderate effect sizes for physical and mental health, self-esteem, social functioning, and quality of life. Most effects were found for all three subgroups, except for long-term improvements in self-esteem and quality of life among participants with BN and EDNOS. CONCLUSION This study showed long-term sustainability of treatment effects up to 1-year post-treatment of a web-based therapist-delivered CBT for patients with various ED. LEVEL OF EVIDENCE Level IV, evidence obtained from multiple time series analysis, with intervention. UNIQUE CLINICAL TRIAL NUMBER NTR2415-Dutch Trial Registry ( http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2415 ).
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Affiliation(s)
- Elke D Ter Huurne
- Tactus Addiction Treatment, Enschede, The Netherlands. .,Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands. .,Faculty of Physical Science and Health, Saxion University of Applied Science, Enschede, The Netherlands.
| | - Hein A de Haan
- Tactus Addiction Treatment, Enschede, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands
| | - Marloes G Postel
- Tactus Addiction Treatment, Enschede, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands.,Department of Psychology Health and Technology, University of Twente, Enschede, The Netherlands
| | - Cor A J DeJong
- Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands.,Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Joanne E L VanDerNagel
- Tactus Addiction Treatment, Enschede, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands.,Department of Human Media Interaction, University of Twente, Enschede, The Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
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Pelle T, Bevers K, van den Hoogen F, van der Palen J, van den Ende C. Economic evaluation of the dr. Bart app in people with knee and/or hip osteoarthritis. Arthritis Care Res (Hoboken) 2021; 74:945-954. [PMID: 33768675 PMCID: PMC9314956 DOI: 10.1002/acr.24608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/02/2022]
Abstract
Objective To evaluate the cost‐utility and cost‐effectiveness of the dr. Bart app compared to usual care in people with osteoarthritis (OA) of the knees and hips, applying a health care payer perspective. Methods This economic evaluation was conducted alongside a 6‐month randomized controlled trial that included 427 participants. The dr. Bart app is a stand‐alone eHealth application that invites users to select pre‐formulated goals (i.e., “tiny habits”) and triggers for a healthier lifestyle. Self‐reported outcome measures were health care costs, quality‐adjusted life years (QALYs) according to the EuroQol 5‐dimension 3‐level (EQ‐5D‐3L) descriptive system, the EuroQol visual analog scale (QALY VAS), patient activation measure 13 (PAM‐13), and 5 subscales of the Knee Injury and Osteoarthritis Outcome Score/Hip Disability and Osteoarthritis Outcome Score. Missing data were multiply imputed, and bootstrapping was used to estimate statistical uncertainty. Results The mean ± SD age of the study participants was 62.1 ± 7.3 years, and the majority of participants were female (72%). Health care costs were lower in the intervention group compared to the group who received usual care (€−22 [95% confidence interval €−36, −3]). For QALY and QALY VAS, the probability of the dr. Bart app being cost‐effective compared to usual care was 0.71 and 0.67, respectively, at a willingness‐to‐pay (WTP) of €10,000 and 0.64 and 0.56, respectively, at a WTP of €80.000. For self‐management behavior, symptoms, pain, and activities of daily living, the probability that the dr. Bart app was cost‐effective was >0.82, and the probability that the dr. Bart app was cost‐effective in the areas of activities and quality of life was <0.40, regardless of WTP thresholds. Conclusion This economic evaluation showed that costs were lower for the dr. Bart app group compared to the group who received usual care. Given the noninvasive nature of the intervention and the moderate probability of it being cost‐effective for the majority of outcomes, the dr. Bart app has the potential to serve as a tool to provide education and goal setting in OA and its treatment options.
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Affiliation(s)
- Tim Pelle
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.,Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Karen Bevers
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Frank van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.,Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement, and Data-Analysis, Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands.,Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Cornelia van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.,Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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Schrijver J, Effing TW, Brusse-Keizer M, van der Palen J, van der Valk P, Lenferink A. Predictors of patient adherence to COPD self-management exacerbation action plans. Patient Educ Couns 2021; 104:163-170. [PMID: 32616320 DOI: 10.1016/j.pec.2020.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/23/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Identifying patient characteristics predicting categories of patient adherence to Chronic Obstructive Pulmonary Disease (COPD) exacerbation action plans. METHODS Data were obtained from self-treatment intervention groups of two COPD self-management trials. Patients with ≥1 exacerbation and/or ≥1 self-initiated prednisolone course during one-year follow-up were included. Optimal treatment was defined as 'self-initiating prednisolone treatment ≤2 days from the onset of a COPD exacerbation'. Predictors of adherence categories were identified by multinomial logistic regression analysis using patient characteristics. RESULTS 145 COPD patients were included and allocated to four adherence categories: 'optimal treatment' (26.2 %), 'sub optimal treatment' (11.7 %), 'significant delay or no treatment' (31.7 %), or 'treatment outside the actual exacerbation period' (30.3 %). One unit increase in baseline dyspnoea score (mMRC scale 0-4) increased the risk of 'significant delay or no treatment' (OR 1.64 (95 % CI 1.07-2.50)). Cardiac comorbidity showed a borderline significant increased risk of 'treatment outside the actual exacerbation period' (OR 2.40 (95 % CI 0.98-5.85)). CONCLUSION More severe dyspnoea and cardiac comorbidity may lower adherence to COPD exacerbation action plans. PRACTICE IMPLICATIONS Tailored self-management support with more focus on dyspnoea and cardiac disease symptoms may help patients to better act upon increased exacerbation symptoms and improve adherence to COPD exacerbation action plans.
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Affiliation(s)
- Jade Schrijver
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.
| | - Tanja W Effing
- College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia
| | | | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Research Methodology, Measurement, and Data-Analysis, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, the Netherlands
| | - Paul van der Valk
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Anke Lenferink
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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Kruik-Kollöffel WJ, van der Palen J, Doggen CJM, van Maaren MC, Kruik HJ, Heintjes EM, Movig KLL, Linssen GCM. Heart failure medication after a first hospital admission and risk of heart failure readmission, focus on beta-blockers and renin-angiotensin-aldosterone system medication: A retrospective cohort study in linked databases. PLoS One 2020; 15:e0244231. [PMID: 33351823 PMCID: PMC7755181 DOI: 10.1371/journal.pone.0244231] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/05/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This study assessed the association between heart failure (HF) medication (angiotensin-converting-enzyme inhibitors (ACEI)/angiotensin-receptor blockers (ARB), beta-blockers (BB), mineralocorticoid-receptor antagonists (MRA) and diuretics) and HF readmissions in a real-world unselected group of patients after a first hospital admission for HF. Furthermore we analysed readmission rates for ACEI versus ARB and for carvedilol versus β1-selective BB and we investigated the effect of HF medication in relation to time since discharge. METHODS AND FINDINGS Medication at discharge was determined with dispensing data from the Dutch PHARMO Database Network including 22,476 patients with HF between 2001 and 2015. After adjustment for age, gender, number of medications and year of admission no associations were found for users versus non-users of ACEI/ARB (hazard ratio, HR = 1.01; 95%CI 0.96-1.06), BB (HR = 1.00; 95%CI 0.95-1.05) and readmissions. The risk of readmission for patients prescribed MRA (HR = 1.11; 95%CI 1.05-1.16) or diuretics (HR = 1.17; 95%CI 1.09-1.25) was higher than for non-users. The HR for ARB relative to ACEI was 1.04 (95%CI 0.97-1.12) and for carvedilol relative to β1-selective BB 1.33 (95%CI 1.20-1.46). Post-hoc analyses showed a protective effect shortly after discharge for most medications. For example one month post discharge the HR for ACEI/ARB was 0.77 (95%CI 0.69-0.86). Although we did try to adjust for confounding by indication, probably residual confounding is still present. CONCLUSIONS Patients who were prescribed carvedilol have a higher or at least a similar risk of HF readmission compared to β1-selective BB. This study showed that all groups of HF medication -some more pronounced than others- were more effective immediately following discharge.
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Affiliation(s)
- Willemien J. Kruik-Kollöffel
- Department of Clinical Pharmacy, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo and Hengelo, the Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, the Netherlands
| | - Carine J. M. Doggen
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Marissa C. van Maaren
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - H. Joost Kruik
- Department of Cardiology, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo and Hengelo, the Netherlands
| | | | - Kris L. L. Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Gerard C. M. Linssen
- Department of Cardiology, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo and Hengelo, the Netherlands
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Abstract
Background: Little is known about the effects of targeting memories of adverse (childhood) events in people with a personality disorder (PD). Objective: Determining the effectiveness of brief EMDR therapy in individuals with PD. Method: In a randomized-controlled trial, 97 outpatients with a PD as main diagnosis were allocated to either five (90 minutes) sessions of EMDR therapy (n = 51) or a waiting list (WL) control condition (n = 46) followed by 3 months of treatment as usual for their PD. Individuals with posttraumatic stress disorder (PTSD) were excluded. Measurements were performed on psychological symptoms, psychological distress, and personality dysfunctioning. Outcomes were compared at baseline, post-treatment, and at 3-month follow up. Data were analysed as intent-to-treat with linear mixed models. Results: EMDR therapy yielded significant improvements with medium to large effect sizes for the primary outcomes after treatment, i.e. psychological symptoms (EMDR: d =.42; control group: d =.07), psychological distress (EMDR: d =.69; control group: d =.29), and personality functioning (EMDR: d =.41; control group: d = -.10) within groups. At 3-month follow-up, after 3 months of TAU, improvements were maintained. Significant differences were found between both groups regarding all outcome measures in favour of the EMDR group at post-treatment (ds between -.62 and -.65), and at follow-up, after 3 months of TAU (ds between -.45 and -.53). Conclusions: The results suggest that EMDR therapy can be beneficial in the treatment of patients with PDs. More rigorous outcome research examining long-term effects and using a longer treatment track is warranted.
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Affiliation(s)
| | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,Research Department, PSYTREC, Bilthoven, The Netherlands.,School of Health Sciences, Salford University, Manchester, UK.,Institute of Health and Society, University of Worcester, Worcester, UK.,School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede & Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
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Sportel ET, Oude Wolcherink MJ, van der Palen J, Lenferink A, Thio BJ, Movig KLL, Brusse-Keizer MGJ. Does immediate smart feedback on therapy adherence and inhalation technique improve asthma control in children with uncontrolled asthma? A study protocol of the IMAGINE I study. Trials 2020; 21:801. [PMID: 32943094 PMCID: PMC7499851 DOI: 10.1186/s13063-020-04694-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 08/16/2020] [Indexed: 12/12/2022] Open
Abstract
Background Many asthmatic children suffer from uncontrolled asthma with frequent exacerbations, despite an optimal treatment plan using inhalation medication. Studies have shown that therapy adherence and inhalation technique are often suboptimal in asthmatic children, but these have traditionally been hard to measure. A novel device functioning as an add-on to the inhaler has been developed to measure both aspects by recording vibration patterns during inhalation. This data can be converted to smart feedback and provided to patients immediately via a mobile application. The aim of this study is to improve asthma control in children between 6 and 18 years old by providing immediate smart feedback on the intake of inhalation medication. Asthma control will be measured by forced expiratory volume in 1 s, (Childhood) Asthma Control Test ((c-)ACT) score, and lung function variability and reversibility. Methods The study will be performed in Medisch Spectrum Twente (Enschede, The Netherlands). The goal is to include 68 uncontrolled moderate to severe asthmatic children between 6 and 18 years old who receive controller inhalation medication through the Nexthaler®, Ellipta®, or Spiromax®. The study consists of three phases. Phase 1 is observational and will last 4 weeks to observe the baseline adherence and inhalation technique as monitored by the add-on device. A randomised controlled trial lasting 6 weeks will be performed in phase 2. Patients in the intervention group will receive immediate smart feedback about the performed inhalations via a mobile application. In the control group, adherence and inhalation technique will be monitored, but patients will not receive feedback. In phase 3, also lasting 6 weeks, the feedback will be ceased for all children and revision of current therapy may occur, depending on the findings in phase 2. Asthma control can be assessed by means of spirometry (both at home and in the hospital) and (c-)ACT questionnaires. Discussion Immediate smart feedback may improve therapy adherence and inhalation technique, and thus asthma control in children and prevent unnecessary switches to targeted biologics. Performing this study in children is desired, since they are known to react differently to feedback and medication than adults. Trial registration Dutch Trial Register NL7705. Registered on 29 April 2019
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Affiliation(s)
- Esther T Sportel
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands.
| | | | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands.,Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Anke Lenferink
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Boony J Thio
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Kris L L Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
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Bunschoten JW, van der Palen J, Sander JW, Thijs RD. Medication burden in epilepsy: Exploring the impact of non-epilepsy concomitant drugs load. Seizure 2020; 81:104-110. [PMID: 32771822 DOI: 10.1016/j.seizure.2020.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/12/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine the burden of non-epilepsy drugs on people with epilepsy, using administrative health care data. METHODS The Achmea Health Insurance Database (AHID) contains health claims data from 25 % of the Dutch population. From the AHID, we selected all policyholders with coverage for at least one full calendar year between 2006-2009. We included adults with diagnostic codes for epilepsy and randomly selected two frequency-matched controls per case. We labeled drugs dispensed at least twice per calendar year as chronic and excluded antiseizure medications. We estimated and compared the prevalence of chronic medication use, number of chronic medications used, number of prescriptions dispensed, Rx Risk comorbidity index, and drug burden index (DBI) between people with epilepsy and controls. RESULTS Non-epilepsy chronic medication use was more frequent in people with epilepsy than controls (67 % versus 59 %, p < 0.001). People with epilepsy had an increased DBI (average 0.19 versus 0.10, p < 0.001), used more chronic medications (median 2 versus 1, p < 0.001) and had more prescriptions dispensed (median 7 versus 3, p < 0.001). The DBI and number of unique chronic medications were higher among older (>60 years) than younger (<60 years) subjects in cases and controls. Non-epilepsy chronic medication use was more prevalent in people with epilepsy across all therapeutic drug classes and most comorbidities measured using the Rx Risk score. CONCLUSION Chronic non-epilepsy medication use is more prevalent among people with epilepsy. The medication burden is higher among elderly with epilepsy and could partially explain the lower quality of life of people with epilepsy with comorbidities.
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Affiliation(s)
- Johanna W Bunschoten
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - Job van der Palen
- Medisch Spectrum Twente, Enschede, the Netherlands; University of Twente, Enschede, the Netherlands
| | - Josemir W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; UCL Queen Square Institute of Neurology, London, WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, United Kingdom
| | - Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands; UCL Queen Square Institute of Neurology, London, WC1N 3BG, United Kingdom.
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Collier DJ, Wielders P, van der Palen J, Heyes L, Midwinter D, Collison K, Preece A, Barnes N, Sharma R. Critical Error Frequency and the Impact of Training with Inhalers Commonly used for Maintenance Treatment in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:1301-1313. [PMID: 32606640 PMCID: PMC7294437 DOI: 10.2147/copd.s224209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/23/2019] [Accepted: 04/21/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Training in correct inhaler use, ideally in person or by video demonstration, can minimize errors but is rarely provided in clinics. This open-label, low-intervention study evaluated critical error rates with dry-powder inhalers (DPIs), before and after training, in patients with chronic obstructive pulmonary disease. Methods Patients prescribed an inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) (ELLIPTA, Turbuhaler, or DISKUS), long-acting muscarinic antagonist (LAMA)/LABA (ELLIPTA or Breezhaler), or LAMA-only DPI (ELLIPTA, HandiHaler, or Breezhaler) were enrolled. Critical errors were assessed before training (Visit 1 [V1]; primary endpoint) and 6 weeks thereafter (Visit 2 [V2]; secondary endpoint). Logistic regression models were used to calculate odds ratios (ORs) for between-group comparisons. Results The intent-to-treat population comprised 450 patients. At V1, fewer patients made ≥1 critical error with ELLIPTA (10%) versus other ICS/LABA DPIs (Turbuhaler: 40%, OR 4.66, P=0.005; DISKUS: 26%, OR 2.48, P=0.114) and other LAMA or LAMA/LABA DPIs (HandiHaler: 34%, OR 3.50, P=0.026; Breezhaler: 33%, OR 3.94, P=0.012). Critical error rates with the primary ICS/LABA DPI were not significantly different between ELLIPTA ICS/LABA (10%) and ICS/LABA plus LAMA groups (12–25%). Critical errors with the primary ICS/LABA DPI occurred less frequently with ELLIPTA ICS/LABA with or without LAMA (11%) versus Turbuhaler ICS/LABA with or without LAMA (39%, OR 3.99, P<0.001) and DISKUS ICS/LABA with or without LAMA (26%, OR 2.18, P=0.069). Simulating single-inhaler versus multiple-inhaler triple therapy, critical error rates were lower with ELLIPTA fluticasone furoate/vilanterol (FF/VI; 10%) versus ELLIPTA FF/VI plus LAMA (22%), considering errors with either DPI (OR 2.50, P=0.108). At V2, critical error rates decreased for all DPIs/groups, reaching zero only for ELLIPTA. Between-group comparisons were similar to V1. Conclusion Fewer patients made critical errors with ELLIPTA versus other ICS/LABA, and LAMA or LAMA/LABA DPIs. The effect of “verbal” training highlights its importance for reducing critical errors with common DPIs.
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Affiliation(s)
- David J Collier
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.,Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Pascal Wielders
- Department of Pulmonary Diseases, Catharina Hospital, Eindhoven, Netherlands
| | - Job van der Palen
- Department of Pulmonology, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, Netherlands
| | - Logan Heyes
- Respiratory Therapy Area Unit, GlaxoSmithKline Plc., Stockley Park, Uxbridge, UK
| | - Dawn Midwinter
- Respiratory Therapy Area Unit, GlaxoSmithKline Plc., Stockley Park, Uxbridge, UK
| | - Kathryn Collison
- Respiratory Medical Franchise, GlaxoSmithKline Plc., Research Triangle Park, Durham, NC, USA
| | - Andy Preece
- Respiratory Therapy Area Unit, GlaxoSmithKline Plc., Stockley Park, Uxbridge, UK
| | - Neil Barnes
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.,Respiratory Therapy Area Unit, GlaxoSmithKline Plc., Stockley Park, Uxbridge, UK
| | - Raj Sharma
- Respiratory Therapy Area Unit, GlaxoSmithKline Plc., Stockley Park, Uxbridge, UK
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Hepping AM, Barvelink B, Ploegmakers JJW, van der Palen J, Geertzen JHB, Bulstra SK, Harbers JS, Stevens M. Recovery of strength after reduced pediatric fractures of the forearm, wrist or hand; A prospective study. PLoS One 2020; 15:e0230862. [PMID: 32236117 PMCID: PMC7112181 DOI: 10.1371/journal.pone.0230862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/23/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction The way strength recovers after reduction of pediatric fractures of the upper extremity has not previously been the specific scope of research. This is remarkable, since strength measurements are often used as an outcome measure in studies on trauma of the upper extremity. The aim of this study was to evaluate how strength recovers after sustainment of fractures of the forearm, wrist or hand treated by closed or open reduction in children and adolescents in the first 6 months after trauma. How much strength is lost at 6 weeks, 3 months and 6 months after trauma, and is this loss significant? Are there differences in the pattern of recovery between children who underwent a different treatment? And finally, which of the following factors are associated with an increase in the ratio between affected grip strength and expected strength: type of fracture, cast immobilization, occurrence of complications, and degree of pain? Design Prospective observational study. Participants Children and adolescents aged 4–18 years with a reduced fracture of the forearm, wrist or hand. Methods Grip strength, key grip and three-jaw chuck grip were measured twice in each hand 6 weeks, 3 months and 6 months after trauma. Details on fracture type and location, treatment received, cast immobilization and complications were obtained. Hand-dominance and pain were verbally confirmed. Results Loss of strength was more prominent and prolonged the more invasive the treatment, hence most extensive in the group receiving open reduction with internal fixation (ORIF), intermediate in the group receiving closed reduction with percutaneous pinning (CRIF), and least extensive in the group undergoing closed reduction without internal fixation (CR). Besides time passed, gender and age were of significant influence on strength, although there was no difference in pattern of recovery over time between children who received a different treatment. In the period of 6 weeks to 3 months after trauma, female gender, type of fracture sustained and occurrence of an unwanted event were associated with an increased ratio between affected and expected grip strength. For the later phase of recovery, between 3 and 6 months, this was only true for the occurrence of an unwanted event.
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Affiliation(s)
- Ann M. Hepping
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Roessingh Center for Rehabilitation, Enschede, The Netherlands
- * E-mail:
| | - Britt Barvelink
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joris J. W. Ploegmakers
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Medical School Twente, Enschede, The Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jorrit S. Harbers
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Kort S, Brusse-Keizer M, Gerritsen JW, Schouwink H, Citgez E, de Jongh F, van der Maten J, Samii S, van den Bogart M, van der Palen J. Improving lung cancer diagnosis by combining exhaled-breath data and clinical parameters. ERJ Open Res 2020; 6:00221-2019. [PMID: 32201682 PMCID: PMC7073409 DOI: 10.1183/23120541.00221-2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/14/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Exhaled-breath analysis of volatile organic compounds could detect lung cancer earlier, possibly leading to improved outcomes. Combining exhaled-breath data with clinical parameters may improve lung cancer diagnosis. Methods Based on data from a previous multi-centre study, this article reports additional analyses. 138 subjects with non-small cell lung cancer (NSCLC) and 143 controls without NSCLC breathed into the Aeonose. The diagnostic accuracy, presented as area under the receiver operating characteristic curve (AUC-ROC), of the Aeonose itself was compared with 1) performing a multivariate logistic regression analysis of the distinct clinical parameters obtained, and 2) using this clinical information beforehand in the training process of the artificial neural network (ANN) for the breath analysis. Results NSCLC patients (mean±sd age 67.1±9.1 years, 58% male) were compared with controls (62.1±7.0 years, 40.6% male). The AUC-ROC of the classification value of the Aeonose itself was 0.75 (95% CI 0.69–0.81). Adding age, number of pack-years and presence of COPD to this value in a multivariate regression analysis resulted in an improved performance with an AUC-ROC of 0.86 (95% CI 0.81–0.90). Adding these clinical variables beforehand to the ANN for classifying the breath print also led to an improved performance with an AUC-ROC of 0.84 (95% CI 0.79–0.89). Conclusions Adding readily available clinical information to the classification value of exhaled-breath analysis with the Aeonose, either post hoc in a multivariate regression analysis or a priori to the ANN, significantly improves the diagnostic accuracy to detect the presence or absence of lung cancer. Adding readily available clinical information to the classification value of exhaled-breath analysis with the Aeonose significantly improves the diagnostic accuracy to detect the presence or absence of lung cancerhttp://bit.ly/38ps6fH
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Affiliation(s)
- Sharina Kort
- Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | | | - Hugo Schouwink
- Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Emanuel Citgez
- Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Frans de Jongh
- Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Jan van der Maten
- Dept of Pulmonary Medicine, Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands
| | - Suzy Samii
- Dept of Pulmonary Medicine, Deventer Ziekenhuis, Deventer, the Netherlands
| | | | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands.,Dept of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, the Netherlands
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Lenferink A, van der Palen J, van der Valk PDLPM, Burt MG, Frith PA, Brusse-Keizer MGJ, Effing TW. It is time to further expand research in tailoring self-management of COPD exacerbations! Eur Respir J 2020; 55:55/1/1902225. [PMID: 31974121 DOI: 10.1183/13993003.02225-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Anke Lenferink
- Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands .,Dept of Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Job van der Palen
- Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.,Dept of Research Methodology, Measurement, and Data-Analysis, Faculty of Behavioural, Management and Social sciences, University of Twente, Enschede, The Netherlands
| | | | - Morton G Burt
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, Australia
| | - Peter A Frith
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Tanja W Effing
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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48
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van der Gaag E, Brandsema R, Nobbenhuis R, van der Palen J, Hummel T. Influence of Dietary Advice Including Green Vegetables, Beef, and Whole Dairy Products on Recurrent Upper Respiratory Tract Infections in Children: A Randomized Controlled Trial. Nutrients 2020; 12:nu12010272. [PMID: 31968697 PMCID: PMC7019298 DOI: 10.3390/nu12010272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Since no treatment exists for children suffering from upper respiratory tract infections (URTIs) without immunological disorders, we searched for a possible tool to improve the health of these children. Aim: We evaluated whether dietary advice (based on food matrix and food synergy), including standard supportive care, can decrease the number and duration of URTIs in children with recurrent URTIs. Design and Setting: This study was a multicenter randomized controlled trial in two pediatric outpatient clinics in the Netherlands, with 118 children aged one to four years with recurrent URTIs. The dietary advice group received dietary advice plus standard supportive care, while the control group received standard supportive care alone for six months. The dietary advice consisted of green vegetables five times per week, beef three times per week, 300 mL whole milk per day, and whole dairy butter on bread every day. Portion sizes were age-appropriate. Results and Conclusion: Children in the dietary advice group had 4.8 (1.6–9.5) days per month with symptoms of an URTI in the last three months of the study, compared to 7.7 (4.0–12.3) in the control group (p = 0.028). The total number of URTIs during the six-month study period was 5.7 (±0.55) versus 6.8 (±0.49), respectively (p = 0.068). The use of antibiotics was significantly reduced in the dietary advice group, as well as visits to a general practitioner, thereby possibly reducing healthcare costs. The results show a reduced number of days with symptoms of a URTI following dietary advice. The number of infections was not significantly reduced.
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Affiliation(s)
- Ellen van der Gaag
- Department of Pediatrics, Hospital Group Twente, 17609 PP Almelo, The Netherlands;
- Department of BMS, University Twente, 57522 NB Enschede, The Netherlands; (R.B.); (J.v.d.P.)
- Correspondence:
| | - Ruben Brandsema
- Department of BMS, University Twente, 57522 NB Enschede, The Netherlands; (R.B.); (J.v.d.P.)
| | - Rosan Nobbenhuis
- Department of Pediatrics, Hospital Group Twente, 17609 PP Almelo, The Netherlands;
| | - Job van der Palen
- Department of BMS, University Twente, 57522 NB Enschede, The Netherlands; (R.B.); (J.v.d.P.)
| | - Thalia Hummel
- Medical Spectrum Twente, 17512 KZ Enschede, The Netherlands;
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Lenferink A, van der Palen J, van der Valk PDLPM, Cafarella P, van Veen A, Quinn S, Groothuis-Oudshoorn CGM, Burt MG, Young M, Frith PA, Effing TW. Exacerbation action plans for patients with COPD and comorbidities: a randomised controlled trial. Eur Respir J 2019; 54:13993003.02134-2018. [PMID: 31413163 DOI: 10.1183/13993003.02134-2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/22/2019] [Indexed: 11/05/2022]
Abstract
This international randomised controlled trial evaluated whether COPD patients with comorbidities, trained in using patient-tailored multidisease exacerbation action plans, had fewer COPD exacerbation days than usual care (UC).COPD patients (Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification II-IV) with ≥1 comorbidity (ischaemic heart disease, heart failure, diabetes, anxiety, depression) were randomised to a patient-tailored self-management intervention (n=102) or UC (n=99). Daily symptom diaries were completed for 12 months. The primary outcome "COPD exacerbation days per patient per year" was assessed using intention-to-treat analyses.No significant difference was observed in the number of COPD exacerbation days per patient per year (self-management: median 9.6 (interquartile range (IQR) 0.7-31.1); UC: median 15.6 (IQR 3.0-40.3); incidence rate ratio (IRR) 0.87 (95% CI 0.54; 1.39); p=0.546). There was a significantly shorter duration per COPD exacerbation for self-management (self-management: median 8.1 (IQR 4.8-10.1) days; UC: median 9.5 (IQR 7.0-15.1) days; p=0.021), with no between-group differences in the total number of respiratory hospitalisations (IRR 0.76 (95% CI 0.42; 1.35); p=0.348), but a lower probability of ≥1 for respiratory-related hospitalisation compared to UC (relative risk 0.55 (95% CI 0.35; 0.87); p=0.008). No between-group differences were observed in all-cause hospitalisations (IRR 1.07 (95% CI 0.66; 1.72)) or mortality (self-management: n=4 (3.9%); UC: n=7 (7.1%); relative risk 0.55 (95% CI 0.17; 1.84)).Patient-tailored exacerbation action plans for COPD patients with comorbidities did not significantly reduce exacerbation days, but reduced the duration per COPD exacerbation and the risk of having at least one respiratory-related hospitalisation during follow-up, without excess all-cause mortality.
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Affiliation(s)
- Anke Lenferink
- Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands .,Dept of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Job van der Palen
- Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.,Dept of Research Methodology, Measurement, and Data-Analysis, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | | | - Paul Cafarella
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Dept of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Anneke van Veen
- Dept of Pulmonary Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Stephen Quinn
- Dept of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia
| | - Catharina G M Groothuis-Oudshoorn
- Dept of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Morton G Burt
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, Australia
| | - Mary Young
- Dept of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter A Frith
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tanja W Effing
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Dept of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
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Silvennoinen K, de Lange N, Zagaglia S, Balestrini S, Androsova G, Wassenaar M, Auce P, Avbersek A, Becker F, Berghuis B, Campbell E, Coppola A, Francis B, Wolking S, Cavalleri GL, Craig J, Delanty N, Johnson MR, Koeleman BPC, Kunz WS, Lerche H, Marson AG, O’Brien TJ, Sander JW, Sills GJ, Striano P, Zara F, van der Palen J, Krause R, Depondt C, Sisodiya SM. Comparative effectiveness of antiepileptic drugs in juvenile myoclonic epilepsy. Epilepsia Open 2019; 4:420-430. [PMID: 31440723 PMCID: PMC6698679 DOI: 10.1002/epi4.12349] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/11/2019] [Accepted: 06/22/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To study the effectiveness and tolerability of antiepileptic drugs (AEDs) commonly used in juvenile myoclonic epilepsy (JME). METHODS People with JME were identified from a large database of individuals with epilepsy, which includes detailed retrospective information on AED use. We assessed secular changes in AED use and calculated rates of response (12-month seizure freedom) and adverse drug reactions (ADRs) for the five most common AEDs. Retention was modeled with a Cox proportional hazards model. We compared valproate use between males and females. RESULTS We included 305 people with 688 AED trials of valproate, lamotrigine, levetiracetam, carbamazepine, and topiramate. Valproate and carbamazepine were most often prescribed as the first AED. The response rate to valproate was highest among the five AEDs (42.7%), and significantly higher than response rates for lamotrigine, carbamazepine, and topiramate; the difference to the response rate to levetiracetam (37.1%) was not significant. The rates of ADRs were highest for topiramate (45.5%) and valproate (37.5%). Commonest ADRs included weight change, lethargy, and tremor. In the Cox proportional hazards model, later start year (1.10 [1.08-1.13], P < 0.001) and female sex (1.41 [1.07-1.85], P = 0.02) were associated with shorter trial duration. Valproate was associated with the longest treatment duration; trials with carbamazepine and topiramate were significantly shorter (HR [CI]: 3.29 [2.15-5.02], P < 0.001 and 1.93 [1.31-2.86], P < 0.001). The relative frequency of valproate trials shows a decreasing trend since 2003 while there is an increasing trend for levetiracetam. Fewer females than males received valproate (76.2% vs 92.6%, P = 0.001). SIGNIFICANCE In people with JME, valproate is an effective AED; levetiracetam emerged as an alternative. Valproate is now contraindicated in women of childbearing potential without special precautions. With appropriate selection and safeguards in place, valproate should remain available as a therapy, including as an alternative for women of childbearing potential whose seizures are resistant to other treatments.
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Affiliation(s)
- Katri Silvennoinen
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St. PeterUK
| | - Nikola de Lange
- Luxembourg Centre for Systems BiomedicineUniversity of LuxembourgBelvauxLuxembourg
| | - Sara Zagaglia
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St. PeterUK
- Department of Experimental and Clinical MedicinePolytechnic University of MarcheAnconaItaly
| | - Simona Balestrini
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St. PeterUK
- Department of Experimental and Clinical MedicinePolytechnic University of MarcheAnconaItaly
| | - Ganna Androsova
- Luxembourg Centre for Systems BiomedicineUniversity of LuxembourgBelvauxLuxembourg
| | - Merel Wassenaar
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | - Pauls Auce
- Department of Molecular and Clinical Pharmacology, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
- The Walton Centre NHS Foundation TrustLiverpoolUK
| | - Andreja Avbersek
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Felicitas Becker
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Bianca Berghuis
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | | | - Antonietta Coppola
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenoaGenoaItaly
- Department of Neuroscience, Reproductive and Odontostomatological SciencesFederico II UniversityNaplesItaly
| | - Ben Francis
- Department of BiostatisticsUniversity of LiverpoolLiverpoolUK
| | - Stefan Wolking
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | | | - John Craig
- Belfast Health and Social Care TrustBelfastUK
| | - Norman Delanty
- Molecular and Cellular TherapeuticsRoyal College of Surgeons in IrelandDublinIreland
- Department of NeurologyBeaumont HospitalDublinIreland
| | | | | | | | - Holger Lerche
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Anthony G. Marson
- Department of Molecular and Clinical Pharmacology, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
- The Walton Centre NHS Foundation TrustLiverpoolUK
| | - Terence J. O’Brien
- Departments of Neuroscience and Neurology, Central Clinical SchoolMonash University, The Alfred HospitalMelbourneVic.Australia
| | - Josemir W. Sander
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St. PeterUK
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | - Graeme J. Sills
- Department of Molecular and Clinical Pharmacology, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto G. GasliniGenovaItaly
| | - Federico Zara
- Laboratory of Neurogenetics and NeuroscienceIRCCS Istituto G. GasliniGenovaItaly
| | | | - Roland Krause
- Luxembourg Centre for Systems BiomedicineUniversity of LuxembourgBelvauxLuxembourg
| | - Chantal Depondt
- Department of NeurologyHôpital Erasme, Université Libre de BruxellesBrusselsBelgium
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St. PeterUK
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