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Mitrovic D, van Elp M, Visser L, van Rein N, van den Bemt P, van Hulst M, Dreijer A, Lameijer H, Veeger N, Meijer K, van Roon E. Adherence to protocols for the use of reversal agents in patients treated with direct oral anticoagulants. Curr Med Res Opin 2023; 39:865-871. [PMID: 37114434 DOI: 10.1080/03007995.2023.2204767] [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: 12/29/2022] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES This study aimed to evaluate the adherence to protocols for the use of reversal agents in direct oral anticoagulant (DOAC) users in Dutch hospitals. METHODS A retrospective cohort study was conducted in seven hospitals in the Netherlands. Treatment protocols for bleeding and (urgent) procedures in patients on DOAC were collected from each hospital. All patient data on the use of reversal agents were retrospectively collected from September 2021 to April 2022 and compared to the protocols. The degree of per-protocol adherence (compliance score) was categorized into four levels as follows: poor (<45%), moderate (45-79%), high (80-89%), and full (> 90%) adherence rates. RESULTS A total of 290 patients were included in our study. In patients with bleeding under DOAC, the protocol adherence for prothrombin complex concentrate (PCC) was "moderate" (61%). In the remaining cases (39%), non-adherence was mainly caused by underdosing (68%), overdosing (12%), and a lack of indication (14%). Furthermore, idarucizumab was administered for bleeding with "full" adherence (96%). For andexanet alfa, adherence to the hospital bleeding protocol was "moderate" (67%), with a lack of indication being the only reason for non-adherence. In case of reversal for an urgent procedure, the protocol adherence for PCC was "low" (45%), with underdosing, a lack of indication, and missing lab data being the main reasons for non-adherence. Missing lab data on dabigatran plasma concentration before reversal was the main reason for "low" adherence (26%) in idarucizumab. The adherence for andexanet alfa was also "low" (0%). CONCLUSION In case of reversal for bleeding under DOAC, overall adherence to the protocol was "moderate"; however, in patients needing an urgent procedure, it was "low." The major reasons for non-adherence were underdosing, off-label use, and a lack of specific lab testing. The results of this study can assist in improving the implementation of hospital protocols.
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Affiliation(s)
- Darko Mitrovic
- Department of Hospital Pharmacy, Tjongerschans, Heerenveen, The Netherlands
| | - Margriet van Elp
- Department of Hospital Pharmacy, Tjongerschans, Heerenveen, The Netherlands
| | - Loes Visser
- Department of Hospital Pharmacy, Haga Hospital, The Hague, The Netherlands
| | - Nienke van Rein
- Department of Hospital Pharmacy, University Medical Centre Leiden, Leiden, The Netherlands
| | - Patricia van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marinus van Hulst
- Department of Hospital Pharmacy, Martini Hospital Groningen, Groningen, The Netherlands
- Department of Hospital Pharmacy, Treant Hospital Emmen, Emmen, The Netherlands
| | - Albert Dreijer
- Department of Hospital Pharmacy, Treant Care Group, Hoogeveen, The Netherlands
| | - Heleen Lameijer
- Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Nic Veeger
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- MCL Academy Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Karina Meijer
- Department of Haematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eric van Roon
- Department of Pharmacotherapy, Epidemiology and Economy, Faculty of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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van Zwieten T, Okkema S, van Det M, Pereboom I, Veeger N, Pierie JP. Assessment methods in laparoscopic colorectal surgery: a systematic review of available instruments. Int J Colorectal Dis 2023; 38:105. [PMID: 37074421 PMCID: PMC10115727 DOI: 10.1007/s00384-023-04395-9] [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] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Laparoscopic surgery has become the golden standard for many procedures, requiring new skills and training methods. The aim of this review is to appraise literature on assessment methods for laparoscopic colorectal procedures and quantify these methods for implementation in surgical training. MATERIALS AND METHODS PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched in October 2022 for studies reporting learning and assessment methods for laparoscopic colorectal surgery. Quality was scored using the Downs and Black checklist. Included articles were categorized in procedure-based assessment methods and non-procedure-based assessment methods. A second distinction was made between capability for formative and/or summative assessment. RESULTS In this systematic review, nineteen studies were included. These studies showed large heterogeneity despite categorization. Median quality score was 15 (range 0-26). Fourteen studies were categorized as procedure-based assessment methods (PBA), and five as non-procedure-based assessment methods. Three studies were applicable for summative assessment. CONCLUSIONS The results show a considerable diversity in assessment methods with varying quality and suitability. To prevent a sprawl of assessment methods, we argue for selection and development of available high-quality assessment methods. A procedure-based structure combined with an objective assessment scale and possibility for summative assessment should be cornerstones.
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Affiliation(s)
- Tom van Zwieten
- Department of Surgery, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934AD, Leeuwarden, The Netherlands.
- Postgraduate School of Medicine, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
| | - Sietske Okkema
- Department of Surgery, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934AD, Leeuwarden, The Netherlands
| | - Marc van Det
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - Ilona Pereboom
- Department of Surgery, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934AD, Leeuwarden, The Netherlands
| | - Nic Veeger
- Department of Surgery, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934AD, Leeuwarden, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jean-Pierre Pierie
- Department of Surgery, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934AD, Leeuwarden, The Netherlands
- Postgraduate School of Medicine, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
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Rozema J, Graafsma J, Hoogendoorn M, Kibbelaar R, Veeger N, van Roon E. Treatment patterns in older patients with myelodysplastic syndromes: A population-based analysis reflecting the real world. J Geriatr Oncol 2023; 14:101418. [PMID: 36657246 DOI: 10.1016/j.jgo.2022.101418] [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: 03/02/2022] [Revised: 06/27/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Treatment for myelodysplastic syndromes (MDS) is complex, options are limited, and insight into consecutive treatments is lacking. We performed this study to assess the outcomes in a real-world cohort of patients with MDS. MATERIALS AND METHODS An observational population-based study was performed using the HemoBase registry. Treatment patterns and overall survival (OS) were analyzed with Kaplan-Meier analyses. RESULTS In 144 of 280 (51.4%) patients with MDS >50 years, first-line treatment was initiated. The median age was 75.1 years (range: 52.6-92.0); the majority were male (72.2%). Hypomethylating agents (HMA), intensive chemotherapy, lenalidomide, and erythropoiesis-stimulating agents (ESA) were given as first-line treatment to 31.1% (n = 45), 12.5% (n = 18), 2.8% (n = 4), and 53.5% (n = 77) of the population, respectively. The median treatment duration was 5.8 months (95% Confidence Interval [CI]: 1.1-10.4) for HMA, 1.7 months (95%CI: 0.9-2.6) for intensive chemotherapy, 10.8 months (95%CI: 4.7-17.0) for lenalidomide, and 14.8 months (95%CI: 11.4-18.1) for ESA. Consecutive treatments were given to 27.2% of patients. The main reasons for first-line treatment discontinuation were treatment failure (45.8%), toxicity (6.9%), or death (20.1%). Median OS after termination of the initial, second, and third treatment was 5.8 months (95%CI: 3.2-8.5), 9.3 months (95%CI: 0.0-19.6), and 1.0 months (95%CI: 0.0-5.1), respectively. DISCUSSION This study shows the treatment outcomes in a real-world population of older patients with MDS. Treatment duration and median OS after treatment discontinuation were relatively limited. There is still an urgent need for new treatment options, strategies to further optimize duration of existing treatments, and communication of realistic treatment goals and expectations, especially for older, higher-risk patients with MDS with a poor prognosis.
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Affiliation(s)
- Johanne Rozema
- Unit of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, Groningen, the Netherlands; Department of Clinical Pharmacy & Pharmacology, Medical Centre Leeuwarden, Henri Dunantweg 2, Leeuwarden, the Netherlands.
| | - Jetske Graafsma
- Unit of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, Groningen, the Netherlands
| | - Mels Hoogendoorn
- Department of Internal Medicine, Medical Centre Leeuwarden, Henri Dunantweg 2, Leeuwarden, the Netherlands
| | - Robby Kibbelaar
- Pathology Friesland, Jelsumerstraat 6a, Leeuwarden, the Netherlands
| | - Nic Veeger
- MCL Academy, Medical Centre Leeuwarden, Henri Dunantweg 2, Leeuwarden, the Netherlands; Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Eric van Roon
- Unit of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, Groningen, the Netherlands; Department of Clinical Pharmacy & Pharmacology, Medical Centre Leeuwarden, Henri Dunantweg 2, Leeuwarden, the Netherlands
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Mitrovic D, Stapel L, Veeger N, Lameijer H, Meijer K, van Roon E. Protocolized management of bleeding in hospitals in The Netherlands in patients treated with direct oral anticoagulants. Curr Med Res Opin 2023; 39:71-79. [PMID: 36097788 DOI: 10.1080/03007995.2022.2124073] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate and describe the protocolized treatment of DOAC-related bleeds in all Dutch hospitals. METHODS From August to December 2020 a nationwide survey among all 70 hospitals in the Netherlands was conducted on their protocols for management of bleeding in patients treated with direct oral anticoagulants (DOACs, i.e. apixaban, edoxaban, rivaroxaban and dabigatran). The protocols were assessed the following characteristics: bleeding definitions (mild, moderate and severe bleed), diagnostic parameters (hemoglobin [Hb], loss of blood, surgical procedure needed, etc), first and second choice of treatment, effectiveness criteria and the level of evidence/references upon which protocols were based. RESULTS All 70 hospitals responded (100%). We received 69 protocols in total, 6 of which were identical because hospitals worked together. In 35 (50%) of the protocols a definition of minor, moderate or severe bleeds was described. Diagnostic parameters for bleeds were present in 2%, 41% and 47% of protocols for a mild, moderate and severe bleed. While the first choice treatment for severe bleeding under dabigatran was idarucizumab in 96% of protocols, considerably more therapeutic options (mostly different prothrombin complex concentrate (PCC) doses) are described for Xa inhibitors. When considering criteria for effectiveness more than 90% of protocols did not have a clear description. CONCLUSION This study provides an overview of the current state of protocols for management of DOAC-related bleeding in The Netherlands. Protocols vary in the content of information provided and often do not include information, especially for diagnostic criteria and criteria for establishing the effectiveness of the intervention. The results of this study can assist in improving and harmonizing the protocols.
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Affiliation(s)
- Darko Mitrovic
- Department of Hospital Pharmacy, Tjongerschans Hospital, Heerenveen, The Netherlands
| | - Lilian Stapel
- Department of Hospital Pharmacy, Tjongerschans Hospital, Heerenveen, The Netherlands
| | - Nic Veeger
- Department of Pharmacotherapy-Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Heleen Lameijer
- Department of Emergency Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Karina Meijer
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eric van Roon
- Department of Pharmacotherapy-Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Mitrovic D, van Elp M, Veeger N, Lameijer H, Meijer K, van Roon E. Protocols for perioperative management of direct oral anticoagulants in hospitals: opportunities for improvement. Curr Med Res Opin 2023; 39:13-18. [PMID: 36305802 DOI: 10.1080/03007995.2022.2141962] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To investigate and describe the protocolized perioperative management in patient using Direct oral anticoagulants (DOACs) in Dutch hospitals. METHODS Between August and December 2020, a nationwide survey in 70 hospitals in the Netherlands was conducted. We asked hospital pharmacists to submit their protocols for perioperative management of DOAC (apixaban, dabigatran, edoxaban and rivaroxaban) users. The protocols were assessed for a number of parameters divided into categories: interruption and restart timetables DOACs for elective procedures, criteria for the start of an urgent procedure without antidotes, criteria for the use of antidotes and advised antidotes for urgent procedures. RESULTS A total of 49 hospitals (70%) sent a protocol for perioperative management of DOACs. Two pairs of protocols were identical because hospitals cooperated closely, leaving 47 individual protocols for analysis. Thirty-five of these protocols contained a policy for both elective and urgent procedure; five protocols contained only a policy for elective and seven only for urgent procedures. In protocols for elective procedure, we found great variation in interruption and restart timetables intended for patients with renal impairment (Estimated Glomerular Filtration Ratio < 80 ml/min). In case of urgent procedures, there is variation in choice of antidote, criteria for administration of an antidote and antidote dosing. CONCLUSION This study provides an overview of the current state of the perioperative protocols in the Netherlands in patients treated with direct oral anticoagulants. Protocols are often not complete and show important and unwanted variation. We have found that national guidelines do not provide unambiguous advice on all points (urgent procedures) and are therefore often elaborated at a local level. The results of this research can help in improving and harmonizing the perioperative protocols on a national level.
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Affiliation(s)
- Darko Mitrovic
- Department of Hospital Pharmacy, Tjongerschans, Heerenveen, the Netherlands
| | - Margriet van Elp
- Department of Hospital Pharmacy, Tjongerschans, Heerenveen, the Netherlands
| | - Nic Veeger
- Department of Pharmacotherapy, Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, the Netherlands
- Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Heleen Lameijer
- Department of Emergency Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Karina Meijer
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eric van Roon
- Department of Pharmacotherapy, Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, the Netherlands
- Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
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Mitrovic D, Veeger N, van Roon E. Impact of minor bleeds on confidence in anticoagulation therapy, adherence to treatment and quality of life in patients using a non-vitamin K antagonist oral anticoagulant for atrial fibrillation. Curr Med Res Opin 2022; 38:1485-1488. [PMID: 35656940 DOI: 10.1080/03007995.2022.2085963] [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] [Indexed: 12/27/2022]
Abstract
OBJECTIVE In a previous study on the reasons for discontinuation of novel oral anticoagulation therapy (NOAC) in patients with atrial fibrillation, we showed that minor bleeding was the second most important reason for NOAC discontinuation. This finding suggest that the impact of minor bleeds on the patient's perspective on NOACs cannot be ignored, especially those minor bleeds for which the patient searched medical care. We therefore performed a study in which we explored the impact of minor bleed (clinically relevant non-major bleeds) on patient confidence in therapy, adherence to treatment and quality of life in AF patients using NOAC's. METHODS Details on NOAC therapy, level of confidence, adherence and quality of life were assessed using a semi-structured telephone interview. Questions related to annoyance, concern and trust were scored on a scale of 1-10, with score 10 representing the highest level of impact or trust. For the adherence to treatment before and after a minor bleed the Medication Adherence Rating Scale (MARS-5) questionnaire was used. The total MARS-5 score ranges from 5 to 25; score 5 is indicative of poor adherence and 25 suggest perfect adherence. Furthermore, the impact (restrictions) of a bleed on physical activities and daily life was assessed using a VAS score ranging from 1 to 10; score 10 representing the highest level of restriction. RESULTS A total of 142 patients were included. During NOAC treatment, minor bleeds were reported by 87 patients (61%) of whom 16 (11%) suffered from a CRNMB. All patients that suffered from a CRNMB contacted their treating physician and 13 received treatment. The most frequently reported CRNMBs were epistaxis (n = 6), a bleed after injury (n = 3), rectal bleed (n = 2) and an eye bleed (n = 2). With regard to the impact of a CRNMB, the median level of annoyance was 8 (min-max 2-10)) and the level of concern 4 (min-max 1-10). The MARS-5 score for adherence to treatment was only marginally influenced. Also the level of trust remained high after the CRNMB. Out of 12 patients, only 2 patients reported a reduction of 1 and 8 points, respectively. Ten patients scored no change and one patient scored a 1 point increase in the level of trust. The mean reduction in trust was 0.7 (95%CI -0.8 to 2.2). With regard to the reported restrictions on physical activities, 8 out of 12 patients reported no (score 1) or only marginal impact (score 2), 2 patients reported a moderate impact (score 5 and 6) and 2 patients reported a high impact score 7 (mean score 2.9 (95%CI 1.3-4.5). For the daily life impact question, 5 out of 9 patients reported no or only marginal impact, 3 patients reported a moderate impact (scores 4 and 5) and 1 patient reported maximal impact (score 10) (mean score 3.2 (95%CI 0.9-5.5)). CONCLUSION In our study the level of trust, annoyance and concern were not significantly impacted by the CRNMB, nor the adherence to treatment and impact on daily life and physical activities. However, on an individual basis, there were patients that reported a high impact. We hope that future data on impact of this type of minor bleeds will help us identify and guide suboptimaly adherent NOAC patients in shared decision manner.
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Affiliation(s)
- Darko Mitrovic
- Department of Hospital Pharmacy Tjongerschans, Heerenveen, The Netherlands
| | - Nic Veeger
- Department of Pharmacotherapy, Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Eric van Roon
- Department of Pharmacotherapy, Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy Medical Centre Leeuwarden, Leeuwarden, the Netherlands
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Rozema J, Roon EV, Vogelzang L, Kibbelaar R, Veeger N, van de Loosdrecht A, Mels H. Management of infection prophylaxis in Dutch patients with myelodysplastic syndromes, a web-based case vignette questionnaire: the MINDSET study. Eur J Haematol Suppl 2022; 109:381-387. [PMID: 35753043 PMCID: PMC9544536 DOI: 10.1111/ejh.13820] [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] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
Objectives Infections are a major cause of morbidity and mortality in patients with myelodysplastic syndromes (MDS). The objective of the MINDSET study was to evaluate haematologists' management of infection prevention in MDS patients using a case vignette study and to assess the availability of guidelines. Methods We conducted a web‐based, nationwide survey amongst haematologists in the Netherlands between September and December 2021. The survey included a set of case vignettes. In addition, the availability of protocols was evaluated. Results Sixty responses were obtained (23.6%). These responses were well distributed across hospital types as well as level of experience. No protocols regarding infection prophylaxis specifically for MDS patients were received. In the case vignette of a 75‐year‐old MDS patient, respondents would primarily prescribe infection prophylaxis in case of recurrent infections (96.7%) and neutropenia (75.0% for absolute neutrophil count [ANC] < 0.2 × 109/L and 53.3% for ANC < 0.5 × 109/L), especially in combination with hypomethylating agents (80.0%), lenalidomide (66.7%) or chemotherapy (51.7%). Respondents would predominantly choose antibacterial agents (85.0%), followed by antifungal agents (71.7%). Conclusions This study showed diverse reasons and considerations of haematologists regarding whether to prescribe infection prophylaxis in MDS patients. Given the seriousness of infections in MDS patients, patient‐tailored recommendations might be valuable in clinical decision‐making.
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Affiliation(s)
- Johanne Rozema
- Unit of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,Department of Clinical Pharmacy & Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Eric van Roon
- Unit of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,Department of Clinical Pharmacy & Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Lars Vogelzang
- Unit of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands
| | | | - Nic Veeger
- MCL Academy, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.,Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Arjan van de Loosdrecht
- Department of Haematology, Amsterdam University Medical Centre, Location VUmc, Amsterdam, the Netherlands
| | - Hoogendoorn Mels
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
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Rozema J, Van Asten I, Kwant B, Kibbelaar R, Veeger N, De Wit H, Van Roon E, Hoogendoorn M. Topic: AS08-Treatment/AS08j-Supportive care - Iron overload. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106681.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mitrovic D, Plomp M, Folkeringa R, Veeger N, Feenstra T, van Roon E. Costs of minor bleeds in atrial fibrillation patients using a non-vitamin K antagonist oral anticoagulant. Curr Med Res Opin 2021; 37:1461-1466. [PMID: 33989088 DOI: 10.1080/03007995.2021.1929893] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND A very common side effect of non-vitamin K antagonist oral anticoagulant (NOAC) is (minor) bleeding. Data about impact and costs of minor bleeds in NOAC therapy is still limited or not present in current literature. In this patient orientated study, we aim to provide an estimate of the costs of minor bleeds in patients with atrial fibrillation (AF) treated with a NOAC. METHODS A retrospective observational cohort study was conducted. Patients with AF and on NOAC therapy were included. Data was obtained by questionnaires and information from electronic patient records. Reference prices were used to calculate the costs per patient. Furthermore, cost of minor bleeds per patient is compared with literature-based costs of minor and major bleeding. RESULTS 139 patients were included. A total of 94 minor bleed were reported by 71 patients. The sum of minor bleeding costs from societal perspective were €9,851.49, or on average €70,87 (95% CI €54,37- €85,68) per patient with AF. The biggest cost drivers were rectal and vaginal bleeds, epistaxis was most commonly reported. CONCLUSION Total costs of minor bleeds from a societal perspective, in AF patients using NOACs, are non-trivial and exceed the costs presented in existing literature.
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Affiliation(s)
- Darko Mitrovic
- Department of Hospital Pharmacy, Tjongerschans, Heerenveen, Netherlands
| | - Marlies Plomp
- Department of Hospital Pharmacy, Tjongerschans, Heerenveen, Netherlands
| | - Richard Folkeringa
- Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, Netherlands
| | - Nic Veeger
- Department of Epidemiology, University of Groningen University Medical Centre, Groningen, Netherlands
- Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, Netherlands
| | - Talitha Feenstra
- Department of Pharmacotherapy, -Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, Netherlands
| | - Eric van Roon
- Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, Netherlands
- Department of Pharmacotherapy, -Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, Netherlands
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van Furth AM, de Heide LJM, Emous M, Veeger N, van Beek AP. Dumping Syndrome and Postbariatric Hypoglycemia: Supporting Evidence for a Common Etiology. Surg Obes Relat Dis 2021; 17:1912-1918. [PMID: 34144916 DOI: 10.1016/j.soard.2021.05.020] [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: 01/19/2021] [Revised: 04/03/2021] [Accepted: 05/11/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Dumping syndrome (DS) and postbariatric hypoglycemia (PBH) are frequent complications of bariatric surgery. Previously known as "early and late dumping," these complications have been separated due to differences in their onset and behaviors. OBJECTIVES To investigate a potentially common etiology of DS and PBH using an analysis of a mixed meal test (MMT) study. SETTING A large teaching hospital in the Netherlands. METHODS From all patients who underwent bariatric surgery in 2008-2011, a random selection completed an MMT (n = 47). Patients scored complaints related to DS and PBH with a standardized questionnaire at several time intervals. The groups were divided into patients with (DS+; n = 22) and without (DS-; n = 25) an increase in DS symptoms after the start of the MMT. Glucose and gut hormone levels were compared. Hypoglycemia was defined as a blood glucose level below 3.3 mmol/L. RESULTS The DS+ group had lower blood glucose values compared to the DS- group, which reached significance at 90 and 120 minutes (P < .05). For the DS+ group, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and satiety were higher at various time intervals (P < .05) compared to the DS- group. No differences were found for insulin and hunger score. GLP-1 and PYY were correlated with symptoms of DS. CONCLUSION Patients with DS complaints had lower postprandial glucose values. GLP-1 and PYY values were elevated in the DS+ group early and late during the test. These hormones also correlated with DS. These findings support the hypothesis of a common etiology of DS and PBH and a role of GLP-1 and PYY in both complications.
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Affiliation(s)
- A Marrit van Furth
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Loek J M de Heide
- Centre for Obesity Northern Netherlands, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marloes Emous
- Centre for Obesity Northern Netherlands, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Nic Veeger
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - André P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Centre for Obesity Northern Netherlands, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Brouwer TA, van Roon EN, Rosier PFWM, Kalkman CJ, Veeger N. Postoperative urinary retention: risk factors, bladder filling rate and time to catheterization: an observational study as part of a randomized controlled trial. Perioper Med (Lond) 2021; 10:2. [PMID: 33397468 PMCID: PMC7784306 DOI: 10.1186/s13741-020-00167-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background Knowledge of risk factors for postoperative urinary retention may guide appropriate and timely urinary catheterization. We aimed to determine independent risk factors for postoperative urinary catheterization in general surgical patients. In addition, we calculated bladder filling rate and assessed the time to spontaneous voiding or catheterization. We used the patients previously determined individual maximum bladder capacity as threshold for urinary catheterization. Methods Risk factors for urinary catheterization were prospectively determined in 936 general surgical patients. Patients were at least 18 years of age and operated under general or spinal anesthesia without the need for an indwelling urinary catheter. Patients measured their maximum bladder capacity preoperatively at home, by voiding in a calibrated bowl after a strong urge that could no longer be ignored. Postoperatively, bladder volumes were assessed hourly with ultrasound. When patients reached their maximum bladder capacity and were unable to void, they were catheterized by the nursing staff. Bladder filling rate and time to catheterization were determined. Results Spinal anesthesia was the main independent modifiable risk factor for urinary catheterization (hyperbaric bupivacaine, relative risk 8.1, articaine RR 3.1). Unmodifiable risk factors were a maximum bladder capacity < 500 mL (RR 6.7), duration of surgery ≥ 60 min (RR 5.5), first scanned bladder volume at the Post Anesthesia Care Unit ≥250mL (RR 2.1), and age ≥ 60 years (RR 2.0). Urine production varied from 100 to 200 mL/h. Catheterization or spontaneous voiding took place approximately 4 h postoperatively. Conclusion Spinal anesthesia, longer surgery time, and older age are the main risk factors for urinary retention catheterization. Awareness of these risk factors, regularly bladder volume scanning (at least every 3 h) and using the individual maximum bladder capacity as volume threshold for urinary catheterization may avoid unnecessary urinary catheterization and will prevent bladder overdistention with the attendant risk of lower urinary tract injury. Trial registration Dutch Central Committee for Human Studies registered trial database: NL 21058.099.07. Current Controlled Trials database: Preventing Bladder Catheterization after an Operation under General or Spinal Anesthesia by Using the Patient’s Own Maximum Bladder Capacity as a Limit for Maximum Bladder Volume. ISRCTN97786497. Registered 18 July 2011 -Retrospectively registered. The original study started 19 May 2008, and ended 30 April 2009, when the last patient was included.
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Affiliation(s)
- Tammo A Brouwer
- Department of Anesthesiology, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901, BR, Leeuwarden, The Netherlands.
| | - E N van Roon
- Department of Pharmacotherapy, Epidemiology & Economics, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy & Pharmacology, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901, BR, Leeuwarden, The Netherlands
| | - P F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C J Kalkman
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N Veeger
- Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
AIMS We sought to investigate the magnitude of minor bleeding and identify risk factors for minor bleeds during non-vitamin-K antagonist oral anticoagulant (NOAC) therapy. METHODS This was an observational cohort study of patients with atrial fibrillation (AF) referred to a regional NOAC outpatient clinic between February 2013 and October 2017. The study population consisted of 875 consecutive patients with AF who visited the NOAC outpatient unit to initiate treatment with apixaban (N = 303), dabigatran (N = 267) or rivaroxaban (N = 305) for long-term ischemic stroke prophylaxis. Minor bleed was defined as every overt bleeding that does not fulfil the criteria of major or non-major clinically relevant bleeding according to the International Society on Thrombosis and Haemostasis. RESULTS Overall rate of minor bleeds was 19.2 per 100 patient years of follow-up. Bleeding rates for apixaban, dabigatran and rivaroxaban were 26, 8.3 and 23 per 100 patient-years of follow-up. Next to the type of NOAC, the main risk indicators for minor bleedings during NOAC therapy were a HAS-BLED score of 3 or higher and novel anticoagulant use (no history of vitamin K antagonist use). LIMITATION This was a retrospective observational study evaluating NOAC treatment in a non-randomized setting. CONCLUSION Our data showed that minor bleeds are common in novel NOAC users, especially when using apixaban and rivaroxaban. In the latter two NOACs, hematoma (bruises) and nose bleeds were more frequently observed and accounted for the difference with dabigatran. Besides type of NOAC, a higher HAS-BLED score and novel anticoagulant drug use were associated with an increased risk of minor bleeding.
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Affiliation(s)
- Darko Mitrovic
- Department of Hospital Pharmacy, Tjongerschans, Heerenveen, The Netherlands
| | - Richard Folkeringa
- Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Nic Veeger
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Eric van Roon
- Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
- Department of Pharmacotherapy, Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, The Netherlands
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Abstract
Aims: We sought to investigate the reasons for, and rates of, novel oral anticoagulant (DOAC) therapy discontinuation.Methods: This was an observational cohort study of patients with atrial fibrillation (AF) referred to a regional DOAC outpatient clinic between February 2013 and October 2017. The study population consisted of 875 consecutive patients with AF who visited the DOAC outpatient unit to initiate treatment with apixaban (N = 303), dabigatran (N = 267) or rivaroxaban (N = 305) for long-term ischemic stroke prophylaxis. All the patients came from the Leeuwarden Medical Center cardiology outpatient clinic, which offers a well structured and nurse-run DOAC unit in cooperation with the hospital's thrombosis service. This clinic operates according to the Dutch nationwide guidelines on integration of anticoagulation services.Results: Overall rate of discontinuation was 11.9 per 100 patient-years of follow-up. Discontinuation rates for apixaban, dabigatran and rivaroxaban were 8.1, 16.6 and 11.5 per 100 patient-years of follow-up.Apixaban had the lowest rate of discontinuation during the 36 month follow-up period. Dabigatran and rivaroxaban had high discontinuation rates during the 3-6 month period following DOAC therapy initiation. The main reasons for discontinuation of DOAC therapy were adverse side effects, patient-initiated discontinuation and any bleed.Limitation: This was a retrospective and non-randomized study, and our results should be interpreted in light of these observations.Conclusion: DOAC discontinuation rates varied significantly and appeared related to drug-specific side effects, patient-initiated discontinuation and bleeding. We observed longer-term administration of apixaban, suggesting that this drug is better tolerated than dabigatran or rivaroxaban.
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Affiliation(s)
- Darko Mitrovic
- Department of Hospital Pharmacy, Tjongerschans Hospital, Heerenveen, The Netherlands
| | - Richard Folkeringa
- Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Nic Veeger
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Eric van Roon
- Department of Pharmacotherapy, Epidemiology and Economy, Faculty Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Janssen W, Harskamp L, Veeger N, Waanders F, Bartels G, Keers J. FP478PERITONEAL DIALYSIS IMPROVES QUALITY OF LIFE IN END-STAGE CONGESTIVE HEART FAILURE: A RANDOMIZED CLINICAL TRIAL. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp478] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- W Janssen
- Nephrology, Martini Hospital, Groningen, Netherlands
| | - L Harskamp
- Nephrology, Martini Hospital, Groningen, Netherlands
| | - N Veeger
- Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands
| | - F Waanders
- Nephrology, Isala Hospital, Zwolle, Netherlands
| | - G Bartels
- Cardiology, Martini Hospital, Groningen, Netherlands
| | - J Keers
- Scientific department, Martini Hospital, Groningen, Netherlands
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Abdoellakhan RA, Khorsand N, Van Hest RM, Veeger N, Ter Avest E, Ypma PF, Faber LM, Meijer K. Randomised controlled trial protocol to evaluate a fixed dose prothrombin complex concentrate against the variable dose in vitamin K antagonist related bleeding (PROPER3). BMJ Open 2018; 8:e020764. [PMID: 29540424 PMCID: PMC5857685 DOI: 10.1136/bmjopen-2017-020764] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION There is currently little evidence for the optimal dosing strategy of four-factor prothrombin complex concentrates (PCC) in vitamin K antagonist (VKA)-related bleeds. The generally accepted dosing strategy is the use of a variable dose calculated using patient-specific characteristics as per manufacturer's instruction. However, evidence exists that the use of a fixed low dose of 1000 international units of factor IX (IU fIX) might also suffice. Recent studies indicate that in terms of haemostatic effectiveness, the fixed dosing strategy might be even superior to the variable dosing strategy. The PROPER3 (PROthrombin complex concentrate: Prospective Evaluation and Rationalisation, number 3) study aims to confirm the non-inferiority, and explore superiority, in haemostatic effectiveness of the fixed PCC dosing strategy compared with the variable dosing strategy in VKA-related extracranial bleeding emergencies. METHODS AND ANALYSIS The study is designed as a randomised controlled multicentre non-inferiority trial. Eligibility criteria are an indication for PCC due to VKA-related extracranial bleeding in subjects 18 years of age or older. The control group will receive a variable dose, determined by patient-specific bodyweight and international normalised ratio. The intervention group is dosed a fixed 1000 IU fIX PCC. Primary outcome is the haemostatic effectiveness of both treatments, as defined by the 2016 International Society on Thrombosis and Haemostasis (ISTH) criteria. The sample size is set at 155 patients per treatment arm, requiring 310 patients in total. Non-inferiority on the proportion (risk) difference of the primary outcome will be evaluated using the asymptotic Wald test for non-inferiority. The non-inferiority margin is set at 6%. The primary analysis will be based on the per-protocol population. ETHICS AND DISSEMINATION Study results will be published in an international journal, communicated to discipline-specific associations and presented at (inter)national meetings and congresses. TRIAL REGISTRATION NUMBER EUCTR2014-000392-33; Pre-results.
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Affiliation(s)
- Rahat A Abdoellakhan
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Reinier M Van Hest
- Department of Pharmacy, Academical Medical Center, Amsterdam, The Netherlands
| | - Nic Veeger
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ewoud Ter Avest
- Department of Emergency Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Paula F Ypma
- Department of Haematology, Hagaziekenhuis, HagaZiekenhuis van Den Haag, The Hague, The Netherlands
| | - Laura M Faber
- Department of Haematology, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - Karina Meijer
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Brouwer TA, van den Boogaard C, van Roon EN, Kalkman CJ, Veeger N. Non-invasive bladder volume measurement for the prevention of postoperative urinary retention: validation of two ultrasound devices in a clinical setting. J Clin Monit Comput 2018. [PMID: 29516310 PMCID: PMC6209055 DOI: 10.1007/s10877-018-0123-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 02/02/2023]
Abstract
Ultrasound scanning of bladder volume is used for prevention of postoperative urinary retention (POUR). Accurate assessment of bladder volume is needed to allow clinical decision-making regarding the need for postoperative catheterization. Two commonly used ultrasound devices, the BladderScan® BVI 9400 and the newly released Prime® (Verathon Medical®, Bothell, WA, USA), with or without the ‘pre-scan’ option, have not been validated in clinical practice. The aim of this study was to assess the performance of these devices in daily clinical practice. Between June and September 2016 a prospective observational study was conducted in 318 surgical patients (18 years or older) who needed a urinary catheter perioperatively for clinical reasons. For acceptable performance, we required that the volume as estimated by the BladderScan® differs by no more than 5% from the actual urine volume after catheterization. The Schuirmann’s two one-sided test was performed to assess equivalence between the BladderScan® estimate and catheterization. The BVI 9400® overestimated the actual bladder volume by + 17.5% (95% CI + 8.8 to + 26.3%). The Prime® without pre-scan underestimated by − 4.1% (95% CI − 8.8 to + 0.5%) and the Prime® with pre-scan underestimated by − 6.3% (95% CI − 11.6 to − 1.1%). This study shows that while both ultrasound devices were able to approximate current bladder volume, both BVI 9400® and Prime®—with and without pre-scan—were not able to measure the actual bladder volume within our predefined limit of ± 5%. Using the pre-scan feature of the Prime® did not further improve accuracy.
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Affiliation(s)
- Tammo A. Brouwer
- Department of Anaesthesiology, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901 BR Leeuwarden, The Netherlands
| | - Charina van den Boogaard
- Institute for Science, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901 BR Leeuwarden, The Netherlands
| | - Eric N. van Roon
- Department of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Cor J. Kalkman
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nic Veeger
- Clinical Epidemiologist, Department of Epidemiology, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901 BR Leeuwarden, The Netherlands
- Department of Epidemiology, University Medical Center, Groningen, The Netherlands
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17
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van de Poel M, Coppens M, Hamulyák K, Prins M, van der Meer J, Veeger N, Büller H, Middeldorp S, Bank I. Absolute annual incidences of first events of venous thromboembolism and arterial vascular events in individuals with elevated FVIII:c. Thromb Haemost 2017. [DOI: 10.1160/th07-04-0293] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryElevated levels of factor VIII:c (elevated FVIII:c) are associated with an increased risk for venous thromboembolism (VTE) and arterial vascular events, and are at least in part determined genetically. We prospectively followed 192 asymptomatic individuals with elevated FVIII:c (>150%) and 340 with normal levels for an average duration of 31 months (range 7 to 56 months) to investigate the risk of VTE and arterial vascular events. Participants were first degree relatives of consecutive patients with elevated FVIII:c and VTE or arterial vascular events before the age of 50 years. The incidences ofVTE were 1.25% (0.46–2.73) per year in the subjects with elevated FVIII:c, versus 0.23% (0.03–0.82) in those with normal levels (OR 5.5 [1.1–27.3]). The annual incidences of arterial vascular events were 1.04% (0.34–2.42) and 0.23% (0.03–0.82) in relatives with and without elevated levels of FVIII:c, respectively (OR: 4.5 [0.9–23.5]). After adjustment for age, smoking, known diabetes mellitus, hyperlipidemia, and hypertension, the odds ratio for any event was 3.7 (1.1–13.1). In conclusion, asymptomatic individuals with elevated FVIII:c levels and a positive family history of VTE or arterial vascular events before the age of 50 appear to have a high annual incidence of first VTE and arterial vascular events. Elevated FVIII:c may be a common risk factor for both clinical entities.
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Mahmoodi B, Gansevoort R, Muntinghe F, Dullaart R, Kluin-Nelemans H, Veeger N, van Schouwenburg I, Meijer K. Lipid levels do not influence the risk of venous thromboembolism. Thromb Haemost 2017; 108:923-9. [DOI: 10.1160/th12-06-0426] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/07/2012] [Indexed: 11/05/2022]
Abstract
SummaryStudies on the association between lipid profile and venous thromboembolism (VTE) are inconsistent. This could be caused by classical lipoproteins being inferior to apolipoproteins as markers for VTE risk. Therefore, we examined whether apolipoproteins are more strongly related to VTE than lipoproteins. For this analysis we used the PREVEND prospective community based observational cohort study. Levels of apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), total cholesterol (TC), high-density lipoprotein (HDL), non-HDL, low-density lipoprotein (LDL), triglycerides (TG), lipoprotein(a), ApoB/ApoA1 and TC/HDL ratio were assessed. Subjects with VTE were identified using databases of the national registries of hospital discharge diagnoses, death certificates, and the regional anticoagulation clinic. Out of 7,627 subjects, 110 developed VTE during a median follow-up of 10.5 years. In both univariate and multivariable analyses no significant associations between apolipoproteins and overall VTE were observed. Of the classical lipoproteins, TC, non-HDL, LDL, TG, and TC/HDL ratio were significantly associated with overall VTE in univariate analysis. Significant associations were no longer present in multivariable analysis. TGL and LDL were significantly associated with unprovoked VTE in univariate analysis. After adjustment for age and sex this significance was lost. No significant associations between (apo-) lipoproteins and provoked VTE were found. We conclude that apolipoproteins are not better in predicting VTE risk than the classical lipoproteins. Our population-based cohort study does not show an association between both apolipoproteins and the classical lipoproteins and VTE risk.
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Coppens M, van de Poel M, Middeldorp S, Hamulyák K, Bank I, Veeger N, Prins M, Büller H, van der Meer J, Lijfering W. The risk of venous and arterial thrombosis in hyperhomocysteinaemia is low and mainly depends on concomitant thrombophilic defects. Thromb Haemost 2017. [DOI: 10.1160/th07-02-0138] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryAs homocysteine-lowering treatment has not reduced the risk of recurrent thrombosis in recent clinical trials, we hypothesized that mild hyperhomocysteinaemia is an epiphenomenon or associated with a low absolute risk of thrombosis. In this retrospective study, we enrolled 478 evaluable first-degree relatives of consecutive patients with venous thrombosis or premature atherosclerosis, and hyperhomocysteinemia. Absolute risks of thrombosis and effects of concomitant thrombophilic defects were compared. Relative risks were adjusted for clustering in families, age, sex, and atherosclerotic risk factors, where appropriate. Annual incidence of venous thrombosis was 0.16% (95% confidence interval [CI], 0.08–0.30) in hyperhomocysteinemic relatives versus 0.11% (CI, 0.05–0.20) in normohomocysteinemic relatives; adjusted relative risk 1.6 (CI, 0.6–4.5). Annual incidences of arterial thrombosis were 0.34% (CI, 0.21–0.52) and 0.24% (CI, 0.15–0.37) in hyperhomocysteinemic and normohomocysteinemic relatives, respectively; adjusted relative risk 1.5 (CI, 0.6–3.5). Concomitance of multiple thrombophilic risk factors increased the risk of venous thrombosis in hyperhomocysteinemic relatives 20 fold, but a comparable effect was demonstrated in normohomocysteinemic relatives. We conclude that hyperhomocysteinaemia is associated with a low absolute risk of venous and arterial thrombosis. Concomitant thrombophilic defects are probably main determinants on the risk of venous thrombosis, rather than hyperhomocysteinaemia itself.
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Brouwer JL, Lijfering W, Kate MKT, Kluin-Nelemans H, Veeger N, van der Meer J. High long-term absolute risk of recurrent venous thromboembolism in patients with hereditary deficiencies of protein S, protein C or antithrombin. Thromb Haemost 2017. [DOI: 10.1160/th08-06-0364] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryHereditary deficiencies of protein S, protein C and antithrombin are known risk factors for first venous thromboembolism. We assessed the absolute risk of recurrence, and the contribution of concomitant thrombophilic defects in a large cohort of families with these deficiencies. Annual incidence of recurrence was estimated in 130 deficient patients, with separate estimates for those with each of protein S, protein C, and antithrombin deficiency, and in eight non-deficient patients with prior venous thromboembolism. All patients were also tested for factor V Leiden, prothrombin G20210A, high levels of factors VIII, IX and XI, and hyperhomocysteinemia. There were 81 recurrent events among 130 deficient patients. Median follow-up was 4.6 years. Annual incidences (95% confidence interval) of recurrent venous thromboembolism were 8.4% (5.8–11.7) for protein S deficiency, 6.0% (3.9–8.7) for protein C deficiency, 10.0% (6.1–15.4) for antithrombin deficiency, and overall 7.7% (6.1–9.5). Relative risk of recurrence in patients with a spontaneous versus provoked first event was 1.5 (0.95–2.3). Cumulative recurrence rates at 1, 5 and 10 years were 15%, 38% and 53%. Relative risk of recurrence with concomitant defects was 1.4 (0.7–2.6) (1 defect) and 1.4 (0.8–2.7) (≥2 defects). Annual incidence was 1.0% (0.03–5.5) in eight non-deficient patients. Annual incidence of major bleeding in deficient patients on oral anticoagulant treatment was 0.5% (0.2–1.0). We conclude that patients with a hereditary protein S, protein C or antithrombin deficiency appear to have a high absolute risk of recurrence. This risk is increased after a first spontaneous event, and by concomitance of other thrombophilic defects.
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de Vries JC, Oortgiesen B, Hemmelder MH, van Roon E, Kibbelaar RE, Veeger N, Hoogendoorn M. Restoration of renal function in patients with newly diagnosed multiple myeloma is not associated with improved survival: a population-based study. Leuk Lymphoma 2017; 58:1-9. [DOI: 10.1080/10428194.2016.1277385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Joost C. de Vries
- Department of Hematology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Berdien Oortgiesen
- Department of Clinical Pharmacy & Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marc H. Hemmelder
- Department of Nephrology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Eric van Roon
- Department of Clinical Pharmacy & Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Robby E. Kibbelaar
- Department of Pathology, Pathology Friesland, Leeuwarden, The Netherlands
| | - Nic Veeger
- Department of Epidemiology, MCL Academy, Leeuwarden, The Netherlands
| | - Mels Hoogendoorn
- Department of Hematology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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22
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van de Geer J, Veeger N, Groot M, Zock H, Leget C, Prins J, Vissers K. Multidisciplinary Training on Spiritual Care for Patients in Palliative Care Trajectories Improves the Attitudes and Competencies of Hospital Medical Staff: Results of a Quasi-Experimental Study. Am J Hosp Palliat Care 2017; 35:218-228. [PMID: 28193104 DOI: 10.1177/1049909117692959] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 11/16/2022] Open
Abstract
OBJECTIVES Patients value health-care professionals' attention to their spiritual needs. However, this is undervalued in health-care professionals' education. Additional training is essential for implementation of a national multidisciplinary guideline on spiritual care (SC) in palliative care (PC). Aim of this study is to measure effects of a training program on SC in PC based on the guideline. METHODS A pragmatic multicenter trial using a quasi-experimental pretest-posttest design as part of an action research study. Eight multidisciplinary teams in regular wards and 1 team of PC consultants, in 8 Dutch teaching hospitals, received questionnaires before training about perceived barriers for SC, spiritual attitudes and involvement, and SC competencies. The effect on the barriers on SC and SC competencies were measured both 1 and 6 months after the training. RESULTS For nurses (n = 214), 7 of 8 barriers to SC were decreased after 1 month, but only 2 were still after 6 months. For physicians (n = 41), the training had no effect on the barriers to SC. Nurses improved in 4 of 6 competencies after both 1 and 6 months. Physicians improved in 3 of 6 competencies after 1 month but in only 1 competency after 6 months. SIGNIFICANCE OF RESULTS Concise SC training programs for clinical teams can effect quality of care, by improving hospital staff competencies and decreasing the barriers they perceive. Differences in the effects of the SC training on nurses and physicians show the need for further research on physicians' educational needs on SC.
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Affiliation(s)
- Joep van de Geer
- 1 Department of Chaplaincy/palliative care, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Nic Veeger
- 2 MCL Academy, Department of Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Marieke Groot
- 3 Department of Palliative care, Radboud UMC, Nijmegen, the Netherlands
| | - Hetty Zock
- 4 Faculty of Theology and Religious Studies, University of Groningen, Groningen, the Netherlands
| | - Carlo Leget
- 5 Ethics of Care and Spiritual Counselling Sciences, University of Humanistic Studies, Utrecht, the Netherlands
| | - Jelle Prins
- 2 MCL Academy, Department of Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Kris Vissers
- 3 Department of Palliative care, Radboud UMC, Nijmegen, the Netherlands
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Dammers D, El Moumni M, Hoogland II, Veeger N, Ter Avest E. Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2017; 25:1. [PMID: 28049498 PMCID: PMC5210260 DOI: 10.1186/s13049-016-0342-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/06/2016] [Indexed: 11/14/2022] Open
Abstract
Background Focussed Assessment with Sonography for Trauma (FAST) is a bedside ultrasonography technique used to detect free intraperitoneal fluid in patients presenting with blunt abdominal trauma (BAT) in the emergency department. Methods In this retrospective cohort study we investigated the potential of FAST as a risk stratification instrument in haemodynamically (HD) stable patients presenting after BAT by establishing the association between the FAST exam result and final outcome. An adverse outcome was defined in this context as the need for either a laparoscopy/laparotomy or an angiographic embolization or death due to abdominal injuries). Results A total of 421 patients with BAT were included, of which nine had an adverse outcome (2%). FAST was negative in 407 patients. Six of them turned out to have free intraperitoneal fluid (sensitivity 67 [41–86]%). FAST was positive in 14 patients, 12 of whom had free intraperitoneal fluid (specificity 99 [98–100]%). A positive FAST (positive likelihood ratio 34.3 [15.1–78.5]) was stronger associated with an adverse outcome than Injury Severity Score (ISS) or any individual clinical- or biochemical variables measured at presentation in the ED. Discussion The FAST exam can provide valuable prognostic information at minimal expenses during the early stages of resuscitation in haemodynamically stable patients presenting with BAT. Conclusions FAST exam should not be omitted in patients with BAT. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0342-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Dammers
- Department of Emergency Medicine, Medical Center Leeuwarden, Henry Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - M El Moumni
- Department of Trauma surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - I I Hoogland
- Medical Student, University of Groningen, Groningen, The Netherlands
| | - N Veeger
- Department of Epidemiology, University of Groningen, University Medical Center Groningen and Medical Center Leeuwarden, Groningen, The Netherlands
| | - E Ter Avest
- Department of Emergency Medicine, Medical Center Leeuwarden, Henry Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.
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de Waal EGM, Leene M, Veeger N, Vos HJ, Ong F, Smit WGJM, Hovenga S, Hoogendoorn M, Hogenes M, Beijert M, Diepstra A, Vellenga E. Progression of a solitary plasmacytoma to multiple myeloma. A population-based registry of the northern Netherlands. Br J Haematol 2016; 175:661-667. [PMID: 27605358 DOI: 10.1111/bjh.14291] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 04/11/2016] [Accepted: 06/17/2016] [Indexed: 11/30/2022]
Abstract
Plasmacytoma is characterized by a local accumulation of monoclonal plasma cells without criteria for multiple myeloma (MM). The current treatment regimen is local radiotherapy. However, more than 50% of patients develop MM within 2 years after treatment. A population-based registry was consulted for the diagnosis of solitary plasmacytoma between 1988 and 2011. Progression to MM and prognostic features for progression to MM were scored, including hypoxia inducible factors (HIF), vascular endothelial growth factor (VEGF, also termed VEGFA) and micro-vessel density (MVD) expression in biopsy material. A total of 76 patients were included, 34% having extramedullary plasmacytoma (EMP) while 66% had a solitary plasmacytoma of the bone (SBP). Median follow-up was 89 months, (7-293 months). In Seventy per cent of SBP patients developed MM with a median time to progression of 19 months (5-293). Three patients (12%) with EMP developed MM. High expression of VEGF and HIF-2α (also termed EPAS1) was demonstrated in conjunction with an increased MVD in 66% of the patients. No association could be shown between angiogenesis parameters and progression to MM. In conclusion, this population-based study demonstrates that SBP patients have a higher risk of developing MM following local radiotherapy, indicating that this group might benefit from added systemic chemotherapy.
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Affiliation(s)
- Esther G M de Waal
- Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marnix Leene
- Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Nic Veeger
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Hanneke J Vos
- Department of Radiotherapy, Isala Clinics, Zwolle, The Netherlands
| | - Francisca Ong
- Department of Radiotherapy, Medical Spectrum Twente, Enschede, The Netherlands
| | - Wilma G J M Smit
- Department of Radiotherapy, Radiotherapeutisch instituut Friesland, Leeuwarden, The Netherlands
| | - Sjoerd Hovenga
- Department of Haematology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - Mels Hoogendoorn
- Department of Haematology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Marieke Hogenes
- Laboratory for Pathology East Netherlands Hengelo, Hengelo, The Netherlands
| | - Max Beijert
- Department of Radiotherapy, University Medical Centre Groningen, Groningen, The Netherlands
| | - Arjan Diepstra
- Department of Pathology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Edo Vellenga
- Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands
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25
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Droogsma E, van Asselt D, van Steijn J, Diekhuis M, Veeger N, De Deyn PP. Long-term Course of Alzheimer Disease in Patients Treated According to the Dutch Dementia Guideline at a Memory Clinic. Alzheimer Dis Assoc Disord 2016; 30:53-9. [DOI: 10.1097/wad.0000000000000090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Brinkman I, Verstappen G, Veeger N, Boerma EC, Buter H. Evaluation of a vancomycin dosing protocol for intensive care unit patients. Neth J Med 2015; 73:195-198. [PMID: 25968297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Vancomycin is a glycopeptide antibiotic that needs to be dosed to achieve target trough levels of 15-20 mg/l. Dosing can be challenging in ICU patients. To optimise therapy, in ICU-pharmacy collaboration, a dosing protocol was introduced on the ICU of the Medical Center Leeuwarden, the Netherlands. The effectiveness in obtaining timely adequate trough levels was evaluated. We retrospectively analysed data from 59 patients. Results show that pharmacy involvement and introduction of the dosing protocol resulted in early adequate trough levels (p = 0.016). Introduction of the protocol alone resulted in non-significant early accurate trough levels. The protocol should be used with caution in patients with a possibly unreliable estimated glomerular filtration rate. Careful protocol introduction is important.
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Affiliation(s)
- I Brinkman
- Martini Hospital Groningen, the Netherlands
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27
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Droogsma E, van Asselt D, Bieze H, Veeger N, De Deyn PP. The relationship of weight change trajectory with medial temporal lobe atrophy in patients with mild Alzheimer's disease: results from a cohort study. Alzheimers Res Ther 2015; 7:18. [PMID: 25848400 PMCID: PMC4386098 DOI: 10.1186/s13195-015-0098-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 01/20/2015] [Indexed: 01/28/2023]
Abstract
Introduction Weight loss has been described in 20% to 45% of patients with Alzheimer’s disease (AD) and has been associated with adverse outcomes. Various mechanisms for weight loss in AD patients have been proposed, though none has been proven. This study aimed to elucidate a mechanism of weight loss in AD patients by examining the hypothesis that weight loss is associated with medial temporal lobe atrophy (MTA). Methods Patients from the Frisian Alzheimer’s disease cohort study (a retrospective, longitudinal study of 576 community-dwelling AD patients) were included when a brain MRI was performed on which MTA could be assessed. To investigate the hypothesis that weight loss is associated with MTA, we investigated whether the trajectory of body weight change depends on the severity of MTA at the time of diagnosis (that is baseline). We hypothesized that patients with more severe MTA at baseline would have a lower body weight at baseline and a faster decrease in body weight during the course of the disease. The generalized linear mixed model (GLMM) was used to determine the relationship of weight change trajectory with MTA severity. Results In total, 214 patients (median age 79 years, median MMSE 23, mean weight 73.9 kg) were included. Patients with moderate, severe or very severe MTA at baseline weighed 3.2 to 6.8 kg more than patients with no or mild MTA. During the 3.5 years, patients gained on average 1.7 kg in body weight, irrespective of the severity of their MTA at baseline. Conclusions We found no evidence that MTA is associated with weight loss in AD patients. Moreover, contrary to what was expected, AD patients did not lose but gained weight during follow-up.
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Affiliation(s)
- Erika Droogsma
- Department of Geriatric Medicine, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, the Netherlands
| | - Dieneke van Asselt
- Department of Geriatric Medicine, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, the Netherlands
| | - Hanneli Bieze
- Department of Geriatric Medicine, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, the Netherlands
| | - Nic Veeger
- Department of Epidemiology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, the Netherlands ; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands
| | - Peter Paul De Deyn
- Department of Neurology and Alzheimer Research Center, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands ; Department of Neurology and Memory Clinic, ZNA and Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp Belgium
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Droogsma E, van Asselt D, van Steijn J, Veeger N, van Dusseldorp I, De Deyn PP. Nutritional interventions in community-dwelling Alzheimer patients with (risk of) undernutrition: a systematic review. Int Psychogeriatr 2014; 26:1-9. [PMID: 24846712 DOI: 10.1017/s1041610214000817] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT Background: Weight loss and undernutrition are common in patients with Alzheimer's disease (AD) and associated with negative health outcomes. In the current guidelines on diagnosis and treatment of AD, no recommendations for treatment of (risk of) undernutrition in community-dwelling AD patients are given. Methods: We conducted a systematic review on the effect of nutritional interventions in community-dwelling AD patients with (risk of) undernutrition, according to the methods outlined by the Cochrane Collaboration. Three electronic databases and three trial registers were searched from inception till April 2013. Results: Literature search in the electronic databases yielded 546 records of which one was relevant for this review. This study, with a high risk of bias, demonstrated that oral nutritional supplements improved nutritional outcomes without effect on clinical and biochemical outcomes. The search in the trial registers yielded 369 records of which two were relevant. One trial was terminated because of failing inclusion, the other is ongoing. Conclusions: This systematic review on the effect of nutritional interventions in community-dwelling AD patients with (risk of) undernutrition, reveals a serious lack of evidence. Therefore, it is not possible to state what the best approach is.
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Affiliation(s)
- Erika Droogsma
- Department of Geriatric Medicine,Medical Center Leeuwarden,Leeuwarden,the Netherlands
| | - Dieneke van Asselt
- Department of Geriatric Medicine,Medical Center Leeuwarden,Leeuwarden,the Netherlands
| | - Jolanda van Steijn
- Department of Geriatric Medicine,Medical Center Leeuwarden,Leeuwarden,the Netherlands
| | - Nic Veeger
- Department of Epidemiology,Medical Center Leeuwarden,Leeuwarden,the Netherlands
| | | | - Peter Paul De Deyn
- Department of Neurology and Alzheimer Research Center,University Medical Center Groningen,University of Groningen,Groningen,the Netherlands
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29
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Droogsma E, Diekhuis M, Veeger N, van Walderveen P, Huinink E, van der Hooft C, van Asselt D. Effect of cholinesterase inhibitors on the long-term course of cognition in patients with Alzheimer's disease treated in a ‘real-life’ clinical setting: Results from The Frisian Alzheimer's Disease Cohort Study. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Droogsma E, Diekhuis M, Veeger N, Blaauw M, Schuur T, van Steijn J, van Asselt D. Effect of initial response to treatment with a cholinesterase inhibitor on the course of cognition in patients with Alzheimer's disease: Results from the Frisian Alzheimer's disease cohort study. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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van der Helm L, Alhan C, Wijermans P, van Marwijk Kooy R, Schaafsma R, Biemond B, Beeker A, Hoogendoorn M, van Rees B, de Weerdt O, Wegman J, Libourel E, Luykx-de Bakker S, Minnema M, Brouwer R, Croon-de Boer F, Eefting M, Jie A, van de Loosdrecht A, Koedam J, Veeger N, Vellenga E, Huls G. 190 Efficacy of azacitidine and predictive factors for response in MDS and AML patients in the Dutch compassionate patient named programme. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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32
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Lijfering W, Middeldorp S, Hamulyák K, Veeger N, Prins M, Büller H, Meer JVD, Mäkelburg A. Low absolute risk of venous and arterial thrombosis in hyperhomocysteinaemia – A prospective family cohort study in asymptomatic subjects. Thromb Haemost 2009. [DOI: 10.1160/th08-04-0224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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33
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Sturm HB, van Gilst WH, Veeger N, Haaijer-Ruskamp FM. Prescribing for chronic heart failure in Europe: does the country make the difference? A European survey. Pharmacoepidemiol Drug Saf 2007; 16:96-103. [PMID: 16528759 DOI: 10.1002/pds.1216] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE International differences in prescribing patterns for chronic heart failure (CHF) have been demonstrated repeatedly. It is not clear whether these differences arise entirely from patient characteristics or factors related to the country itself, such as health care systems or culture. We aim to assess the role of countries in this international variation, aside from the role of patient characteristics. METHODS In this European primary care practice survey (from 1999/2000) 11062 CHF patients from 14 countries were included. The influence of country (corrected for patient characteristics) on prescribed drug regimes was assessed by multinomial logistical regression. RESULTS Prescribing of guideline-recommended drug regimes ranged from 28.1% in Turkey to 61.8% in Hungary. Including additional regimes justifiable by patients' co-morbidities, increased overall 'rational' prescribing by 11%, but differences among countries remained similar. Multivariate analysis for one-drug and two-drug regimes explained between 35% and 42% of the total variance, country contributed 7%-8% (p < 0.005). Countries determined the number of drugs used and the likelihood of individual drug regimes. For example, in Czech Republic digoxin alone was more likely to be given than the recommended ACE-inhibitors (OR: 3.45; 95%CI: 2.56-4.64), while the combination of digoxin with ACE-inhibitors was as likely as the recommended combination of ACE-inhibitors and beta-blockers (OR: 1.17; 95%CI: 0.88-1.55). CONCLUSION Country of residence clearly influenced prescribed drug volume and choice of drug regimes. Therefore, optimal CHF management cannot be achieved without considering country specific factors. It remains to be established which factors within health-care systems are responsible for these effects.
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Affiliation(s)
- H B Sturm
- Department of Clinical Pharmacology, University Medical Center Groningen, Groningen, The Netherlands.
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Luttik ML, Jaarsma T, Veeger N, van Veldhuisen DJ. Marital status, quality of life, and clinical outcome in patients with heart failure. Heart Lung 2007; 35:3-8. [PMID: 16426930 DOI: 10.1016/j.hrtlng.2005.08.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 07/01/2005] [Accepted: 08/07/2005] [Indexed: 11/23/2022]
Abstract
AIM This study investigated the impact of having a partner on quality of life (QoL), the number of hospital readmissions, and 9-month survival in patients with heart failure (HF). METHODS The study population consisted of hospitalized patients with HF. QoL was measured by the Cantril Ladder of Life (0-10) during hospital admission. Clinical data, readmission rate, and number of deaths were registered by patient interview and chart review. RESULTS Of the 179 patients, 96 (54%) were married or were living with a partner. Differences in QoL between married patients and those living alone were most pronounced with regard to future expectations of QoL (6.5 vs 5.0, P=.00). However, in a multivariate model QoL was primarily associated with socioeconomic status, age, and gender. Married patients had 12% less events in the 9-month follow-up period compared with patients living alone (P=not significant). CONCLUSION This study indicates that most patients with HF who are living alone are mostly elderly women with a low socioeconomic status, who are at risk for recurrent events and a worse QoL.
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Affiliation(s)
- Marie Louise Luttik
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
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35
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Verschuuren E, Erasmus M, Hepkema B, Veeger N, Kallenberg C, van der Bij W. 136: Low rate of bronchiolitis obliterans syndrome following pre-emptive treatment of post-transplant lymphoproliferative disease after lung transplantation. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Korhonen T, Karppinen J, Paimela L, Malmivaara A, Lindgren KA, Bowman C, Hammond A, Kirkham B, Järvinen S, Niinimäki J, Veeger N, Haapea M, Torkki M, Tervonen O, Seitsalo S, Hurri H. The treatment of disc-herniation-induced sciatica with infliximab: one-year follow-up results of FIRST II, a randomized controlled trial. Spine (Phila Pa 1976) 2006; 31:2759-66. [PMID: 17108825 DOI: 10.1097/01.brs.0000245873.23876.1e] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [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: 02/07/2023]
Abstract
STUDY DESIGN A randomized controlled trial. OBJECTIVES To evaluate the long-term efficacy of infliximab, a monoclonal antibody against tumor necrosis factor alpha (TNF-alpha), in patients with acute/subacute sciatica secondary to herniated disc. SUMMARY OF BACKGROUND DATA The results of experimental studies and our open-label trial support the use of infliximab in sciatica. Here we report the 1-year results of a randomized controlled trial (FIRST II, Finnish Infliximab Related STudy) evaluating the efficacy and safety of a single infusion of infliximab for sciatic pain. METHODS Inclusion criteria were unilateral sciatic pain with a disc herniation concordant with the symptoms and signs of radicular pain. Patients had to be candidates for discectomy. Criteria for discectomy included (in addition to a symptomatic disc herniation on MRI) neural entrapment (straight leg raising [SLR] < or =60 degrees ) with either a short-term (2-4 weeks) severe or long-term (4-12 weeks) moderate leg pain. Forty patients were allocated to a single intravenous infusion of either infliximab 5 mg/kg or placebo. Differences in the clinical examination parameters (straight leg raise [SLR], muscle strength, sensory defects, tendon reflexes), patient-reported symptoms (leg and back pain using a visual analog scale [VAS], Oswestry disability, quality-of-life [RAND-36]), sick leaves, number of discectomies, and adverse effects between the two treatment groups over the 1-year follow-up were compared using Mann-Whitney U test or Student's t test, repeated-measures analysis, or Cox proportional hazards model. Logistic regression was used to assess the predictors of good response. RESULTS Sixty-seven percent of patients in the infliximab group reported no pain at 52 weeks compared with 63% in the control group (P = 0.72). Similar efficacy was observed between treatment groups for other outcomes. Eight patients in each group required surgery. Three nonserious adverse reactions were encountered in the infliximab group. The response (irrespective of the treatment) was significantly better with shorter symptom duration and less SLR restriction at baseline. Patients in the infliximab group appeared to especially benefit in cases of a L4-L5 (or L3-L4) herniation and if a Modic change was colocalized at the symptomatic level. CONCLUSIONS Although the long-term results of this randomized trial do not support the use of infliximab compared with placebo for lumbar radicular pain in patients with disc herniation-induced sciatica, further study in a subgroup of patients with L4-L5 or L3-L4 herniations, especially in the presence of Modic changes, appears to be warranted.
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Affiliation(s)
- Timo Korhonen
- Department of Physical Medicine and Rehabilitation, Oulu University Hospital, Oulu, Finland
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Autio RA, Karppinen J, Niinimäki J, Ojala R, Veeger N, Korhonen T, Hurri H, Tervonen O. The effect of infliximab, a monoclonal antibody against TNF-alpha, on disc herniation resorption: a randomized controlled study. Spine (Phila Pa 1976) 2006; 31:2641-5. [PMID: 17077730 DOI: 10.1097/01.brs.0000244616.64962.9e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized, controlled study. OBJECTIVE To evaluate the effect of infliximab on herniated nucleus pulposus (HNP) resorption. SUMMARY OF BACKGROUND DATA Although the effects of tumor necrosis factor alpha (TNF-alpha) on HNP resorption are not fully understood, TNF-alpha appears to be an essential mediator in HNP resorption. METHODS As part of a substudy of the FIRST II study, magnetic resonance images (MRIs) were obtained from 21 patients who were candidates for discectomy at weeks 0, 2, 12, and 26 after receiving a single infusion of either 5 mg/kg infliximab (11 patients) or placebo (10 patients). The volume (mm3) of HNP, thickness (mm) and extent (%) of rim enhancement, and presence of nerve root edema were assessed. RESULTS HNP volume decreased significantly from baseline to 6 months in both treatment groups (P < 0.01), with no difference noted between the infliximab and placebo groups. By week 2, rim enhancement thickness increased significantly in the infliximab group compared with the placebo group (P = 0.003). Two patients in each group required back surgery before the 6-month assessment. CONCLUSIONS Infliximab did not appear to interfere with disc herniation resorption over a 6-month period.
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Affiliation(s)
- Reijo A Autio
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
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38
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Zähringer M, Sapoval M, Pattynama P, Beregi JP, Veeger N, Stoll HP, Talen A. Die GREAT Studie: Vergleich von Sirolimus beschichteten mit unbeschichteten Palmaz-Genesis-Stents bei ostialen Nierenarterienstenosen. Ergebnisse des 2-Jahres Follow up. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Korhonen T, Karppinen J, Paimela L, Malmivaara A, Lindgren KA, Järvinen S, Niinimäki J, Veeger N, Seitsalo S, Hurri H. The treatment of disc herniation-induced sciatica with infliximab: results of a randomized, controlled, 3-month follow-up study. Spine (Phila Pa 1976) 2005; 30:2724-8. [PMID: 16371894 DOI: 10.1097/01.brs.0000190815.13764.64] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [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: 02/07/2023]
Abstract
STUDY DESIGN A randomized controlled trial. OBJECTIVES To evaluate the efficacy of infliximab, a monoclonal antibody against tumor necrosis factor (TNF)-alpha in a randomized controlled setting. SUMMARY OF BACKGROUND DATA Recently, we obtained encouraging results in an open-label study of infliximab in patients with disc herniation-induced sciatica. Furthermore, the results of experimental studies support the use of infliximab in sciatica. Therefore, we initiated a randomized, controlled trial (FIRST II, Finnish Infliximab Related STudy) to confirm the efficacy of a single infusion of infliximab for sciatic pain. METHODS Inclusion criteria were unilateral moderate to severe sciatic pain with an MRI-confirmed disc herniation concordant with the symptoms and signs of radicular pain. Patients had to be candidates for discectomy, as evaluated by an independent orthopedic surgeon. Forty patients were allocated to a single intravenous infusion of either infliximab 5 mg/kg or placebo. Assessments at baseline and various time points included clinical examination with measurement of straight leg raising restriction; questionnaires related to subjective symptoms (leg and back pain by 100-mm visual analog scale, Oswestry disability); sick leaves; number of discectomies; and adverse effects possibly related to treatment. The primary endpoint was a reduction in leg pain from baseline to 12 weeks, which was analyzed using a Mann-Whitney U test and repeated-measures analysis. RESULTS A significant reduction in leg pain was observed in both groups, with no significant difference between treatment regimens. Similar efficacy was observed between treatment groups for secondary endpoints. Seven patients in each group required surgery. No adverse effects related to treatment were encountered. CONCLUSIONS The results of this randomized trial do not support the use of infliximab for lumbar radicular pain in patients with disc herniation-induced sciatica.
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Affiliation(s)
- Timo Korhonen
- Department of Physical Medicine and Rehabilitation, Oulu University Hospital, Oulu, Finland
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Sapoval M, Zähringer M, Pattynama P, Rabbia C, Vignali C, Maleux G, Boyer L, Szczerbo-Trojanowska M, Jaschke W, Hafsahl G, Downes M, Beregi JP, Veeger N, Talen A. Low-profile Stent System for Treatment of Atherosclerotic Renal Artery Stenosis: The GREAT Trial. J Vasc Interv Radiol 2005; 16:1195-202. [PMID: 16151060 DOI: 10.1097/01.rvi.0000171765.67665.d3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The Palmaz Genesis Peripheral Stainless Steel Balloon Expandable Stent in Renal Artery Treatment (GREAT) Trial was designed to assess the safety and performance of a low-profile stent for the treatment of obstructive renal artery disease by looking at 6-month renal artery patency uniformly analyzed by a Core Lab. MATERIALS AND METHODS Fifty-two consecutive patients (mean age, 63.7 years) were successfully treated with the Palmaz Genesis Peripheral Stent (Cordis, Miami, FL) on the Slalom 0.018-inch Delivery System (Cordis Europe N.V., Oosteinde 8, NLO-9301 LJ Roden, The Netherlands) at 11 investigational centers. Patients with severe renal failure and > 8-mm renal artery were excluded. Primary endpoint was angiographic determination of in-stent percent diameter stenosis at 6 months. Fifty-one patients were treated with one stent, one patient was treated with two stents to cover the complete lesion. RESULTS Mean percentage diameter stenosis before renal angioplasty was 68.2% +/- 12.0%. No stent implantation failure, displacement, need for additional stent implantation, or procedural complication was observed. Six-month angiography was performed in 41 of 52 patients (79%) resulting in a mean in-stent percent diameter stenosis or Quantitative Vessel analysis (QVA) at 6 months of 23.9%. The in-stent binary (percent diameter stenosis > 50%) restenosis rate at 6 months was 14.3%. No fatal events occurred up to 6 months after implantation. Major adverse events occurred in five patients: four patients (7.7%) required a revascularization and one patient (1.9%) experienced a cerebrovascular event, which regressed spontaneously. CONCLUSIONS The Palmaz Genesis stent (Cordis) provides good results for renal artery stent placement, with an in-stent binary restenosis rate (percent diameter stenosis > 50%) at 6 months of 14.3% as determined with angiography.
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Affiliation(s)
- Marc Sapoval
- Hôpital Européen Georges Pompidou, Clermont Ferrand, France.
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Zähringer M, Sapoval M, Pattynama P, Beregi JP, Veeger N, Talen A. Die GREAT-Studie: Vergleich von Sirolimus beschichteten mit unbeschichteten Palmaz-Genesis-Stents bei ostialen Nierenarterienstenosen. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tio RA, Tan ES, Jessurun GAJ, Veeger N, Jager PL, Slart RHJA, de Jong RM, Pruim J, Hospers GAP, Willemsen ATM, de Jongste MJL, van Boven AJ, van Veldhuisen DJ, Zijlstra F. PET for evaluation of differential myocardial perfusion dynamics after VEGF gene therapy and laser therapy in end-stage coronary artery disease. J Nucl Med 2004; 45:1437-43. [PMID: 15347709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
UNLABELLED The purpose of this study was to appraise the value of PET in the assessment of the effect of supposedly proangiogenic new therapies such as gene therapy with vascular endothelial growth factor (VEGF) gene and endomyocardial laser therapy. METHODS Thirty-five patients with end-stage coronary artery disease and class III (Canadian Cardiovascular Society) angina were included. Myocardial ischemia was evaluated with dipyridamole PET scanning and exercise tolerance with bicycle ergometry. Ten patients were treated with naked plasmid DNA encoding for human VEGF165 (VEGF) and 12 patients were treated with laser therapy (direct myocardial revascularization [DMR]) using an electromechanical mapping system. Thirteen patients were treated with standard medical therapy (control). RESULTS In both active treatment groups, angina was reduced in most subjects, except in 2 VEGF and 5 DMR patients. In the control group, no improvement in anginal classification was found, except in 3 subjects. On the PET scan, solely in the VEGF group, the stress perfusion was significantly improved (from 57 +/- 33 to 81 +/- 55 mL/min/100 g; P = 0.031). Furthermore, in the VEGF group, the number of ischemic segments was reduced from 274 +/- 41 to 234 +/- 48 segments (P = 0.004) but not in the DMR group (from 209 +/- 43 to 215 +/- 52 segments) or in the control group (from 218 +/- 18 to 213 +/- 28 segments). Bicycle exercise duration showed slight nonsignificant changes in the VEGF group (from 3.6 +/- 2.0 to 4.6 +/- 2.1 min), in the DMR group (from 5.1 +/- 1.5 to 4.7 +/- 1.3 min), and in the control group (from 3.3 +/- 1.8 to 3.5 +/- 2.3 min). CONCLUSION PET showed that intramyocardial gene therapy with the human VEGF165 gene in contrast to laser DMR treatment effectively reduces myocardial ischemia.
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Affiliation(s)
- René A Tio
- Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands.
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Tio RA, Monnink SHJ, Amoroso G, Jessurun GAJ, Veeger N, Volkers C, Hautvast R, Tan ES, van Gilst WH, van Boven AJ. Safety evaluation of routine intracoronary acetylcholine infusion in patients undergoing a first diagnostic coronary angiogram. J Investig Med 2002; 50:133-9. [PMID: 11930949 DOI: 10.2310/6650.2002.31305] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent findings imply prognostic significance of intracoronary acetylcholine infusion for endothelial function testing. We evaluated whether routine use of this test in coronary angiography patients is safe. METHODS Patients undergoing a first diagnostic coronary angiography were selected to receive intracoronary acetylcholine for endothelial function evaluation. The relation between adverse reactions during infusion and risk factors was analyzed with a logistic regression model. Included in the multiple logistic regression model were the variables with a univariate P value < 0.20. RESULTS Adverse reactions occurred in 16% (49/299) of the patients. This included two life-threatening events caused by occlusive spasm and flow limitation in the left coronary artery. Other adverse events were chest pain (n = 38), AV block or sinus bradycardia (n = 10), dyspnea (n = 3). Adverse reactions were more likely to occur in patients younger than 60 years of age (relative risk, 5.6 [2.2-14.3]). CONCLUSION Intracoronary acetylcholine infusion is safe, but may lead to serious adverse reactions. Care should be taken especially in patients younger than 60 years of age. Routine use of acetylcholine infusion can thus only be justified if it has important prognostic significance. This has to be proven further in large prospective studies.
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Affiliation(s)
- R A Tio
- Department of Cardiology, Thoraxcenter, University Hospital Groningen, The Netherlands.
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