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Nijmeijer HGB, Huinck WJ, Kramer SE, Donders ART, van der Wilt GJ, Mylanus EAM. Changes on clinical and participatory outcomes in people with severe-to-profound hearing loss after cochlear implantation: protocol of a multicentre prospective observational cohort study - Societal Merit of Intervention on Hearing Loss Evaluation (SMILE). BMJ Open 2023; 13:e072689. [PMID: 37369408 PMCID: PMC10410821 DOI: 10.1136/bmjopen-2023-072689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Cochlear implantation (CI) is a (cost-)effective intervention for people with severe or profound hearing loss. Since its introduction experience increased and the technology evolved, leading to better results and relaxation of CI eligibility criteria. Meanwhile, with national healthcare costs increasing there is a need for evidence of healthcare technology's value. This protocol describes a study to investigate clinical and participatory outcomes after CI for the currently (expanded) eligible hearing impaired population. The study adds to the current evidence base through its multicentre design, long-term follow-up and use of participatory outcomes alongside standard clinical outcomes. METHODS This multicentre prospective observational cohort study will include at least 156 adult patients with severe-to-profound hearing loss, approximately evenly divided into two groups (1, ages 18-65 years and 2, age >65 years). The measurements consist of audiometry, cognition tests, listening effort tests and multiple generic and disease specific questionnaires. Questionnaires will be administered twice before CI, soon after inclusion at CI referral and shortly before CI surgery, with an annual follow-up of 3 years after CI. The Impact on Participation and Autonomy questionnaire will be used to assess participation. Generalised models (linear, logistic, Poisson) will be used. Mixed effects models will be used to investigate changes over time while exploring differences in subgroups and the influence of covariates. ETHICS AND DISSEMINATION The study has received ethical approval from the Medical Ethical Committee of all participating centres. The results could provide valuable insights into changes in participatory outcomes of people with severe-to-profound hearing loss after CI. Results will be disseminated through peer-reviewed journals, scientific conferences and professional and patient organisation meetings. TRIAL REGISTRATION NUMBER NCT05525221.
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Affiliation(s)
- Hugo G B Nijmeijer
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Wendy J Huinck
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Sophia E Kramer
- Otolaryngology-Head and Neck Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Gert Jan van der Wilt
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Department for Health Evidence, Radboudumc, Nijmegen, Netherlands
| | - Emmanuel A M Mylanus
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
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Cladder-Micus MB, Vrijsen JN, Fest A, Spijker J, Donders ART, Becker ES, Speckens AEM. Follow-up outcomes of Mindfulness-Based Cognitive Therapy (MBCT) for patients with chronic, treatment-resistant depression. J Affect Disord 2023; 335:410-417. [PMID: 37178825 DOI: 10.1016/j.jad.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Mindfulness-based cognitive therapy (MBCT) is an evidence-based treatment for depression. The current study focused on the long-term effects of MBCT for chronically, treatment-resistant depressed patients during a 6-months follow-up period. Additionally, predictors of treatment outcomes were explored. METHOD The outcomes of MBCT on depressive symptoms, remission rates, quality of life, rumination, mindfulness skills and self-compassion were investigated in a cohort of chronically, treatment-resistant depressed outpatients (N = 106), who had taken part in an RCT comparing MBCT with treatment-as-usual (TAU). Measures were assessed pre-MBCT, post-MBCT, at 3-months follow-up, and at 6-months follow-up. RESULTS Results of linear mixed effect models and Bayesian repeated measures ANOVA's reveal that depressive symptoms, quality of life, rumination, mindfulness skills and self-compassion consolidated during follow-up. Remission rates even further increased over the course of follow-up. When controlling for symptoms at baseline, higher baseline levels of rumination predicted lower depressive symptoms and quality of life at 6-month follow-up. No other predictors (i.e. duration of current depressive episode, level of treatment-resistance, childhood trauma, mindfulness skills, self-compassion) were found. LIMITATIONS All participants received MBCT, therefore time or other non-specific effects might have influenced the results and replication in studies including a control condition is needed. CONCLUSIONS Results indicate that the clinical benefits of MBCT for chronically, treatment-resistant depressed patients persist up to 6 months after completing MBCT. Duration of the current episode, level of treatment-resistance, childhood trauma and baseline levels of mindfulness skills and self-compassion did not predict treatment outcome. When controlling for baseline depressive symptoms participants with high levels of rumination seem to benefit more; however more research is needed. TRIAL REGISTRY Dutch Trial Registry, number NTR4843.
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Affiliation(s)
- Mira B Cladder-Micus
- Depression Expertise Centre, Pro Persona Mental Health Care, the Netherlands; Behavioural Science Institute, Radboud University Nijmegen, the Netherlands.
| | - Janna N Vrijsen
- Depression Expertise Centre, Pro Persona Mental Health Care, the Netherlands; Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, the Netherlands
| | - Antine Fest
- Department of Psychiatry, Radboud university medical center, the Netherlands
| | - Jan Spijker
- Depression Expertise Centre, Pro Persona Mental Health Care, the Netherlands; Behavioural Science Institute, Radboud University Nijmegen, the Netherlands
| | - A Rogier T Donders
- Department for Health Evidence, Radboud University Medical Center, the Netherlands
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, the Netherlands
| | - Anne E M Speckens
- Department of Psychiatry, Radboud university medical center, the Netherlands
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Willems LH, Thijssen DHJ, Groh LA, Kooijman NI, Ten Cate H, Spronk HMH, Donders ART, van der Vijver-Coppen RJ, van Hoek F, Nagy M, Reijnen MMPJ, Warlé MC. Dual pathway inhibition as compared to acetylsalicylic acid monotherapy in relation to endothelial function in peripheral artery disease, a phase IV clinical trial. Front Cardiovasc Med 2022; 9:979819. [PMID: 36277757 PMCID: PMC9583941 DOI: 10.3389/fcvm.2022.979819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Dual pathway inhibition (DPI) by combining acetylsalicylic acid (ASA) with low-dose rivaroxaban has been shown to reduce cardiovascular events in patients with peripheral arterial disease (PAD) when compared to ASA monotherapy. A potential explanation is that inhibition of factor Xa improves endothelial function through crosstalk between coagulation and inflammatory pathways, subsequently attenuating the occurrence of cardiovascular events. We hypothesize that the addition of rivaroxaban to ASA in PAD patients leads to improved endothelial function. Design An investigator-initiated, multicentre trial investigating the effect of DPI on endothelial function. Methods Patients, diagnosed with PAD, were enrolled in two cohorts: cohort A (Rutherford I-III) and cohort B (Rutherford IV-VI). Participants received ASA monotherapy for a 4-weeks run-in period, followed by 12 weeks of DPI. Macro- and microvascular endothelial dysfunction were studied by measuring carotid artery reactivity upon sympathetic stimulus and by measuring plasma endothelin-1 concentrations, respectively. All measurements were performed during the use of ASA (baseline) and after 12 weeks of DPI. Results 159 PAD patients (111 cohort A, 48 cohort B) were enrolled. Twenty patients discontinued study drugs early. Carotid artery constriction upon sympathetic stimulation at baseline (ASA) and after 12 weeks of DPI was similar in the total group, 22.0 vs. 22.7% (p = 1.000), and in the subgroups (Cohort A 22.6 vs. 23.7%, p = 1.000; cohort B 20.5 vs. 20.5%, p = 1.000), respectively. The mean concentration of plasma endothelin-1 at baseline and after 12 weeks of DPI did not differ, 1.70 ± 0.5 vs. 1.66 ± 0.64 pmol/L (p = 0.440) in the total group, 1.69 ± 0.59 vs. 1.62 ± 0.55 pmol/L in cohort A (p = 0.202), and 1.73 ± 0.53 vs. 1.77 ± 0.82 pmol/L in cohort B (p = 0.682), respectively. Conclusion Macro- and microvascular endothelial dysfunction, as reflected by carotid artery reactivity and plasma endothelin-1 concentrations, are not influenced in PAD patients by addition of low-dose rivaroxaban to ASA monotherapy for 12 weeks. Trial registration https://clinicaltrials.gov/ct2/show/NCT04218656.
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Affiliation(s)
- Loes H. Willems
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands,*Correspondence: Loes H. Willems
| | - Dick H. J. Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Laszlo A. Groh
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nina I. Kooijman
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hugo Ten Cate
- Departments of Internal Medicine and Biochemistry, Maastricht University Medical Center (MUMC) and Cardiovascular Research Institute Maastricht (CARIM) School for Cardiovascular Diseases, Maastricht, Netherlands,Center for Thrombosis and Haemostasis, Gutenberg University Medical Center, Mainz, Germany
| | - Henri M. H. Spronk
- Departments of Internal Medicine and Biochemistry, Maastricht University Medical Center (MUMC) and Cardiovascular Research Institute Maastricht (CARIM) School for Cardiovascular Diseases, Maastricht, Netherlands
| | - A. Rogier T. Donders
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Frank van Hoek
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Magdolna Nagy
- Departments of Internal Medicine and Biochemistry, Maastricht University Medical Center (MUMC) and Cardiovascular Research Institute Maastricht (CARIM) School for Cardiovascular Diseases, Maastricht, Netherlands
| | - Michel M. P. J. Reijnen
- Department of Surgery, Rijnstate Hospital, Arnhem, Netherlands,Multi-Modality Medical Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Michiel C. Warlé
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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Roudijk B, Donders ART, Stalmeier PFM. A Head-On Ordinal Comparison of the Composite Time Trade-Off and the Better-Than-Dead Method. Value Health 2020; 23:236-241. [PMID: 32113629 DOI: 10.1016/j.jval.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/18/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The valuation of health states worse than dead is challenging. Currently used time trade-off methods face problems in (1) detecting time-dependent preferences and (2) insensitivity toward severity for states worse than dead. The better-than-dead (BTD) method has the potential to detect time-dependent preferences. This study compares the BTD and composite time trade-off (cTTO) methods at the ordinal level. METHODS An experiment was conducted in a convenience sample in which respondents (N = 200) valued the same set of 7 health states in the BTD method and cTTO method. Binary BTD responses were used, with response categories of better than dead and worse than dead. Ternary cTTO responses were used, with the additional equal-to-dead response category. Polychoric correlations were used to determine the agreement between these methods. Consistency and test-retest reliability were assessed within methods. RESULTS Overall agreement between the cTTO and BTD method equaled 77.1% and differed between health states and respondents. For both methods, there were few inconsistencies, and the test-retest reliability was comparable (88%). Health states were more often considered worse than dead in the BTD method (BTD: 54.7%, cTTO: 37.2%). CONCLUSIONS The high agreement between both methods and the comparable amount of inconsistencies and test-retest reliability suggest that the methods have similar measurement properties. The BTD method yielded higher frequencies of worse-than-dead responses while essentially asking respondents to make similar choices. This accounts for part of the disagreement between the methods. Several explanations are offered for this difference, yet more research is needed to explain this phenomenon.
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Affiliation(s)
- Bram Roudijk
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; EuroQol Research Foundation, Rotterdam, The Netherlands.
| | - A Rogier T Donders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Peep F M Stalmeier
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Dekkers LMA, Janssen AJWM, Donders ART, Nijhuis-van der Sanden MWG, de Swart BJM. Construct Validity of the Observable Movement Quality Scale in Pediatrics: Hypothesis Testing of a Formative Measurement Model. Phys Ther 2019; 100:346-358. [PMID: 32031656 PMCID: PMC7246075 DOI: 10.1093/ptj/pzz166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/23/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Observable Movement Quality (OMQ) Scale measures generic movement quality. Each item of the OMQ Scale focuses on a different element; together, the 15 items assess the whole construct of movement quality. OBJECTIVE The aim of this study was to determine the construct validity of the OMQ Scale using 7 hypotheses defined to conform to the Consensus-Based Standards for the Selection of Health Measurement Instruments. DESIGN This was an exploratory validation study. METHODS A pediatric physical therapist assessed motor performance in 101 children using an age-specific motor test and the OMQ Scale. The direction, magnitude, and rationale for 7 hypotheses, which concerned relationships (n = 2), probability of low scores (n = 4), and difference between diagnosis subgroups (n = 1), were defined. RESULTS The results confirmed 6 of the 7 hypotheses, indicating sufficient construct validity. Significant positive relationships were found between OMQ Scale total scores and the severity of motor disabilities (r = 0.72) and z scores on motor tests (r = 0.60). Probabilities for low scores on OMQ Scale items-exceeding the chi-square critical value-were confirmed for children diagnosed with spasticity, psychomotor retardation, mitochondrial diseases, and ataxia; however, probabilities for low OMQ Scale item scores on strength regulation in children with ataxia were not confirmed. OMQ Scale total scores for children who were not ambulatory because of neurological conditions were significantly different from those for children who were not ambulatory because of fatigue (r = 0.66). LIMITATIONS The sample of children was based on theoretical assumptions about relevant variations in clinical representations; on the basis of the results, it appears that children with low strength regulation were underrepresented. CONCLUSION The confirmation of nearly all hypotheses supported the validity of the OMQ Scale for measuring movement quality in clinical practice in addition to standardized age-adequate motor performance tests.
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Affiliation(s)
- Lieke M A Dekkers
- Department of Allied Health Studies, HAN University of Applied Sciences, PO Box 6960, 6503 GL Nijmegen, the Netherlands; Pediatric Physical Therapy, Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands,Address all correspondence to Mrs Dekkers at:
| | - Anjo J W M Janssen
- Pediatric Physical Therapy, Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center
| | | | - Maria W G Nijhuis-van der Sanden
- Scientific Institute for Quality of Health Care, and Pediatric Physical Therapy, Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center
| | - Bert J M de Swart
- Department of Allied Health Studies, HAN University of Applied Sciences; and Pediatric Physical Therapy, Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center
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Abstract
Introduction. Health utilities are widely used in health care. The distributions of utilities differ between countries; some countries more often report worse than dead health states, while mild states are valued more or less the same. We hypothesize that cultural values explain these country-related utility differences. Research Question. What is the effect of sociodemographic background, methodological factors, and cultural values on differences in health utilities? Methods and Analyses. Time tradeoff data from 28 EQ-5D valuation studies were analyzed, together with their sociodemographic variables. The dependent variable was Δu, the utility difference between mild and severe states. Country-specific cultural variables were taken from the World Values Survey. Multilevel models were used to analyze the effect of sociodemographic background, methodology (3L v. 5L), and cultural values on Δu. Intraclass correlation (ICC) for country variation was used to assess the impact of the predicting variables on the variation between countries. Results. Substantial variation in Δu was found between countries. Adding cultural values did not reduce ICCs for country variation. Sociodemographic background variables were only weakly associated with Δu and did not affect the ICC. Δu was 0.118 smaller for EQ-5D-5L studies. Discussion. Δu varies between countries. These differences were not explained by national cultural values. In conclusion, despite correction for various variables, utility differences between countries remain substantial and unexplained. This justifies the use of country-specific value sets for instruments such as the EQ-5D.
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Affiliation(s)
- Bram Roudijk
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Gelderland, the Netherlands
| | - A Rogier T Donders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Gelderland, the Netherlands
| | - Peep F M Stalmeier
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Gelderland, the Netherlands
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Janssen L, Kan CC, Carpentier PJ, Sizoo B, Hepark S, Schellekens MPJ, Donders ART, Buitelaar JK, Speckens AEM. Mindfulness-based cognitive therapy v. treatment as usual in adults with ADHD: a multicentre, single-blind, randomised controlled trial. Psychol Med 2019; 49:55-65. [PMID: 29486807 DOI: 10.1017/s0033291718000429] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 12/25/2022]
Abstract
BACKGROUND There is a high need for evidence-based psychosocial treatments for adult attention-deficit hyperactivity disorder (ADHD) to offer alongside treatment as usual (TAU). Mindfulness-based cognitive therapy (MBCT) is a promising psychosocial treatment. This trial investigated the efficacy of MBCT + TAU v. TAU in reducing core symptoms in adults with ADHD. METHODS A multicentre, single-blind, randomised controlled trial (ClinicalTrials.gov: NCT02463396). Participants were randomly assigned to MBCT + TAU (n = 60), an 8-weekly group therapy including meditation exercises, psychoeducation and group discussions, or TAU only (n = 60), which reflected usual treatment in the Netherlands and included pharmacotherapy and/or psychoeducation. Primary outcome was ADHD symptoms rated by blinded clinicians. Secondary outcomes included self-reported ADHD symptoms, executive functioning, mindfulness skills, self-compassion, positive mental health and general functioning. Outcomes were assessed at baseline, post-treatment, 3- and 6-month follow-up. Post-treatment effects at group and individual level, and follow-up effects were examined. RESULTS In MBCT + TAU patients, a significant reduction of clinician-rated ADHD symptoms was found at post-treatment [M difference = -3.44 (-5.75, -1.11), p = 0.004, d = 0.41]. This effect was maintained until 6-month follow-up. More MBCT + TAU (27%) than TAU participants (4%) showed a ⩾30% reduction of ADHD symptoms (p = 0.001). MBCT + TAU patients compared with TAU patients also reported significant improvements in ADHD symptoms, mindfulness skills, self-compassion and positive mental health at post-treatment, which were maintained until 6-month follow-up. Although patients in MBCT + TAU compared with TAU reported no improvement in executive functioning at post-treatment, they did report improvement at 6-month follow-up. CONCLUSIONS MBCT might be a valuable treatment option alongside TAU for adult ADHD aimed at alleviating symptoms.
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Affiliation(s)
- Lotte Janssen
- Department of Psychiatry,Radboud University Medical Centre,Nijmegen,The Netherlands
| | - Cornelis C Kan
- Department of Psychiatry,Radboud University Medical Centre,Nijmegen,The Netherlands
| | | | | | - Sevket Hepark
- Department of Psychiatry,Radboud University Medical Centre,Nijmegen,The Netherlands
| | | | - A Rogier T Donders
- Department for Health Evidence,Radboud University Medical Centre,Nijmegen,The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience,Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre,Nijmegen,The Netherlands
| | - Anne E M Speckens
- Department of Psychiatry,Radboud University Medical Centre,Nijmegen,The Netherlands
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Cladder‐Micus MB, Speckens AE, Vrijsen JN, T. Donders AR, Becker ES, Spijker J. Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial. Depress Anxiety 2018; 35:914-924. [PMID: 30088834 PMCID: PMC6175087 DOI: 10.1002/da.22788] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Chronic and treatment-resistant depressions pose serious problems in mental health care. Mindfulness-based cognitive therapy (MBCT) is an effective treatment for remitted and currently depressed patients. It is, however, unknown whether MBCT is effective for chronic, treatment-resistant depressed patients. METHOD A pragmatic, multicenter, randomized-controlled trial was conducted comparing treatment-as-usual (TAU) with MBCT + TAU in 106 chronically depressed outpatients who previously received pharmacotherapy (≥4 weeks) and psychological treatment (≥10 sessions). RESULTS Based on the intention-to-treat (ITT) analysis, participants in the MBCT + TAU condition did not have significantly fewer depressive symptoms than those in the TAU condition (-3.23 [-6.99 to 0.54], d = 0.35, P = 0.09) at posttreatment. However, compared to TAU, the MBCT + TAU group reported significantly higher remission rates (χ2 (2) = 4.25, φ = 0.22, P = 0.04), lower levels of rumination (-3.85 [-7.55 to -0.15], d = 0.39, P = 0.04), a higher quality of life (4.42 [0.03-8.81], d = 0.42, P = 0.048), more mindfulness skills (11.25 [6.09-16.40], d = 0.73, P < 0.001), and more self-compassion (2.91 [1.17-4.65], d = 0.64, P = 0.001). The percentage of non-completers in the MBCT + TAU condition was relatively high (n = 12, 24.5%). Per-protocol analyses revealed that those who completed MBCT + TAU had significantly fewer depressive symptoms at posttreatment compared to participants receiving TAU (-4.24 [-8.38 to -0.11], d = 0.45, P = 0.04). CONCLUSION Although the ITT analysis did not reveal a significant reduction in depressive symptoms of MBCT + TAU over TAU, MBCT + TAU seems to have beneficial effects for chronic, treatment-resistant depressed patients in terms of remission rates, rumination, quality of life, mindfulness skills, and self-compassion. Additionally, patients who completed MBCT showed significant reductions in depressive symptoms. Reasons for non-completion should be further investigated.
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Affiliation(s)
- Mira B. Cladder‐Micus
- Behavioural Science InstituteRadboud University NijmegenNijmegenThe Netherlands,Depression Expertise CentrePro Persona Mental Health CareNijmegenThe Netherlands,Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands
| | - Anne E.M. Speckens
- Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands
| | - Janna N. Vrijsen
- Depression Expertise CentrePro Persona Mental Health CareNijmegenThe Netherlands,Department of PsychiatryDonders Institute for BrainCognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - A. Rogier T. Donders
- Department for Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
| | - Eni S. Becker
- Behavioural Science InstituteRadboud University NijmegenNijmegenThe Netherlands
| | - Jan Spijker
- Behavioural Science InstituteRadboud University NijmegenNijmegenThe Netherlands,Depression Expertise CentrePro Persona Mental Health CareNijmegenThe Netherlands
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Janssen L, Kan CC, Carpentier PJ, Sizoo B, Hepark S, Schellekens MPJ, Donders ART, Buitelaar JK, Speckens AEM. Mindfulness-Based Cognitive Therapy v. treatment as usual in adults with ADHD: a multicentre, single-blind, randomised controlled trial - ERRATUM. Psychol Med 2018; 48:1920. [PMID: 29655378 DOI: 10.1017/s0033291718000776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Wassenaar A, Schoonhoven L, Devlin JW, van Haren FMP, Slooter AJC, Jorens PG, van der Jagt M, Simons KS, Egerod I, Burry LD, Beishuizen A, Matos J, Donders ART, Pickkers P, van den Boogaard M. Delirium prediction in the intensive care unit: comparison of two delirium prediction models. Crit Care 2018; 22:114. [PMID: 29728150 PMCID: PMC5935943 DOI: 10.1186/s13054-018-2037-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/13/2018] [Indexed: 12/12/2022]
Abstract
Background Accurate prediction of delirium in the intensive care unit (ICU) may facilitate efficient use of early preventive strategies and stratification of ICU patients by delirium risk in clinical research, but the optimal delirium prediction model to use is unclear. We compared the predictive performance and user convenience of the prediction model for delirium (PRE-DELIRIC) and early prediction model for delirium (E-PRE-DELIRIC) in ICU patients and determined the value of a two-stage calculation. Methods This 7-country, 11-hospital, prospective cohort study evaluated consecutive adults admitted to the ICU who could be reliably assessed for delirium using the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist. The predictive performance of the models was measured using the area under the receiver operating characteristic curve. Calibration was assessed graphically. A physician questionnaire evaluated user convenience. For the two-stage calculation we used E-PRE-DELIRIC immediately after ICU admission and updated the prediction using PRE-DELIRIC after 24 h. Results In total 2178 patients were included. The area under the receiver operating characteristic curve was significantly greater for PRE-DELIRIC (0.74 (95% confidence interval 0.71–0.76)) compared to E-PRE-DELIRIC (0.68 (95% confidence interval 0.66–0.71)) (z score of − 2.73 (p < 0.01)). Both models were well-calibrated. The sensitivity improved when using the two-stage calculation in low-risk patients. Compared to PRE-DELIRIC, ICU physicians (n = 68) rated the E-PRE-DELIRIC model more feasible. Conclusions While both ICU delirium prediction models have moderate-to-good performance, the PRE-DELIRIC model predicts delirium better. However, ICU physicians rated the user convenience of E-PRE-DELIRIC superior to PRE-DELIRIC. In low-risk patients the delirium prediction further improves after an update with the PRE-DELIRIC model after 24 h. Trial registration ClinicalTrials.gov, NCT02518646. Registered on 21 July 2015. Electronic supplementary material The online version of this article (10.1186/s13054-018-2037-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annelies Wassenaar
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Lisette Schoonhoven
- Faculty of Health Sciences and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, Southampton, UK.,Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - John W Devlin
- School of Pharmacy, Northeastern University, Boston, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, USA
| | - Frank M P van Haren
- Intensive Care Unit, The Canberra Hospital, Canberra, Australia.,Faculty of Health, University of Canberra, Canberra, Australia.,College of Health and Medicine, Australian National University, Canberra, Australia
| | - Arjen J C Slooter
- Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Philippe G Jorens
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Antwerp, Belgium
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Koen S Simons
- Department of Intensive Care Medicine, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
| | - Ingrid Egerod
- Intensive Care Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lisa D Burry
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Mount Sinai Hospital, Sinai Health System, Toronto, Canada
| | - Albertus Beishuizen
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Joaquim Matos
- Department of Intensive Care Medicine, Hospital Espírito Santo, Evora, Portugal
| | - A Rogier T Donders
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.,Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
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11
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Abstract
Introduction. Scaling severe states can be a difficult task. First, the method of measurement affects whether a health state is considered better or worse than dead. Second, in discrete choice experiments, different models to anchor health states on 0 (dead) and 1 (perfect health) produce varying amounts of health states worse than dead. Research Question. Within the context of the quality-adjusted life year (QALY) model, this article provides insight into the value assigned to dead and its consequences for decision making. Our research questions are 1) what are the arguments set forth to assign dead the number 0 on the health–utility scale? And 2) what are the effects of the position of dead on the health–utility scale on decision making? Methods. A literature review was conducted to explore the arguments set forth to assign dead a value of 0 in the QALY model. In addition, scale properties and transformations were considered. Results. The review uncovered several practical and theoretical considerations for setting dead at 0. In the QALY model, indifference between 2 health episodes is not preserved under changes of the origin of the duration scale. Ratio scale properties are needed for the duration scale to preserve indifferences. In combination with preferences and zero conditions for duration and health, it follows that dead should have a value of 0. Conclusions. The health–utility and duration scales have ratio scale properties, and dead should be assigned the number 0. Furthermore, the position of dead should be carefully established, because it determines how life-saving and life-improving values are weighed in cost–utility analysis.
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Affiliation(s)
- Bram Roudijk
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Gelderland, the Netherlands
| | - A Rogier T Donders
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Gelderland, the Netherlands
| | - Peep F M Stalmeier
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Gelderland, the Netherlands
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12
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Berende A, Nieuwenhuis L, ter Hofstede HJM, Vos FJ, Vogelaar ML, Tromp M, van Middendorp H, Donders ART, Evers AWM, Kullberg BJ, Adang EMM. Cost-effectiveness of longer-term versus shorter-term provision of antibiotics in patients with persistent symptoms attributed to Lyme disease. PLoS One 2018; 13:e0195260. [PMID: 29608590 PMCID: PMC5880374 DOI: 10.1371/journal.pone.0195260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 03/17/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The treatment of persistent symptoms attributed to Lyme disease remains controversial. Recently, the PLEASE study did not demonstrate any additional clinical benefit of longer-term versus shorter-term antibiotic treatment. However, the economic impact of the antibiotic strategies has not been investigated. METHODS This prospective economic evaluation, adhering a societal perspective, was performed alongside the PLEASE study, a multicenter, placebo-controlled, double-blind 1:1:1 randomized clinical trial in which all patients received open-label intravenous ceftriaxone for two weeks before the 12-week randomized blinded oral antibiotic regimen (doxycycline, clarithromycin plus hydroxychloroquine, or placebo). Between 2010 and 2013, patients (n = 271) with borreliosis-attributed persistent symptoms were enrolled and followed for one year. Main outcomes were costs, quality-adjusted life years, and incremental net monetary benefit of longer-term versus shorter-term antibiotic therapy. RESULTS Mean quality-adjusted life years (95% CI) were not significantly different (p = 0.96): 0.82 (0.77-0.88) for ceftriaxone/doxycycline (n = 82), 0.81 (0.76-0.88) for ceftriaxone/clarithromycin-hydroxychloroquine (n = 93), and 0.81 (0.76-0.86) for ceftriaxone/placebo (n = 96). Total societal costs per patient (95% CI) were not significantly different either (p = 0.35): €11,995 (€8,823-€15,670) for ceftriaxone/doxycycline, €12,202 (€9,572-€15,253) for ceftriaxone/clarithromycin-hydroxychloroquine, and €15,249 (€11,294-€19,781) for ceftriaxone/placebo. Incremental net monetary benefit (95% CI) for ceftriaxone/doxycycline compared to ceftriaxone/placebo varied from €3,317 (-€2,199-€8,998) to €4,285 (-€6,085-€14,524) over the willingness-to-pay range, and that of ceftriaxone/clarithromycin-hydroxychloroquine compared to ceftriaxone/placebo from €3,098 (-€888-€7,172) to €3,710 (-€4,254-€11,651). For every willingness-to-pay threshold, the incremental net monetary benefits did not significantly differ from zero. CONCLUSION The longer-term treatments were similar with regard to costs, effectiveness and cost-effectiveness compared to shorter-term treatment in patients with borreliosis-attributed persistent symptoms after one year of follow-up. Given the results of this study, and taking into account the external costs associated with antibiotic resistance, the shorter-term treatment is the antibiotic regimen of first choice.
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Affiliation(s)
- Anneleen Berende
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
- * E-mail:
| | - Lisette Nieuwenhuis
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Epidemiology, CAPHRI—School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Hadewych J. M. ter Hofstede
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Fidel J. Vos
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
- Sint Maartenskliniek, Nijmegen, Netherlands
| | - Michiel L. Vogelaar
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mirjam Tromp
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henriët van Middendorp
- Institute of Psychology; Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - A. Rogier T. Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Andrea W. M. Evers
- Institute of Psychology; Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Bart Jan Kullberg
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eddy M. M. Adang
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
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13
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van den Wijngaart LS, Roukema J, Boehmer ALM, Brouwer ML, Hugen CAC, Niers LEM, Sprij AJ, Rikkers-Mutsaerts ERVM, Rottier BL, Donders ART, Verhaak CM, Pijnenburg MW, Merkus PJFM. A virtual asthma clinic for children: fewer routine outpatient visits, same asthma control. Eur Respir J 2017; 50:50/4/1700471. [PMID: 28982775 DOI: 10.1183/13993003.00471-2017] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/02/2017] [Indexed: 11/05/2022]
Abstract
eHealth is an appealing medium to improve healthcare and its value (in addition to standard care) has been assessed in previous studies. We aimed to assess whether an eHealth intervention could improve asthma control while reducing 50% of routine outpatient visits.In a multicentre, randomised controlled trial with a 16-month follow-up, asthmatic children (6-16 years) treated in eight Dutch hospitals were randomised to usual care (4-monthly outpatient visits) and online care using a virtual asthma clinic (VAC) (8-monthly outpatient visits with monthly web-based monitoring). Outcome measures were the number of symptom-free days in the last 4 weeks of the study, asthma control, forced expiratory volume in 1 s, exhaled nitric oxide fraction, asthma exacerbations, unscheduled outpatient visits, hospital admissions, daily dose of inhaled corticosteroids and courses of systemic corticosteroids.We included 210 children. After follow-up, symptom-free days differed statistically between the usual care and VAC groups (difference of 1.23 days, 95% CI 0.42-2.04; p=0.003) in favour of the VAC. In terms of asthma control, the Childhood Asthma Control Test improved more in the VAC group (difference of 1.17 points, 95% CI 0.09-2.25; p=0.03). No differences were found for other outcome measures.Routine outpatient visits can partly be replaced by monitoring asthmatic children via eHealth.
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Affiliation(s)
- Lara S van den Wijngaart
- Dept of Paediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jolt Roukema
- Dept of Paediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Marianne L Brouwer
- Dept of Paediatrics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Cindy A C Hugen
- Dept of Paediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Arwen J Sprij
- Dept of Paediatric Pulmonology, Juliana Children's Hospital, Haga Hospital, The Hague, The Netherlands
| | | | - Bart L Rottier
- Paediatric Pulmonology and Allergology, Groningen Research Institute for Asthma and COPD, Beatrix Children's Hospital, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A Rogier T Donders
- Dept for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Chris M Verhaak
- Dept of Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mariëlle W Pijnenburg
- Dept of Paediatric Pulmonology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Peter J F M Merkus
- Dept of Paediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
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14
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Bartels DJP, van Laarhoven AIM, Stroo M, Hijne K, Peerdeman KJ, Donders ART, van de Kerkhof PCM, Evers AWM. Minimizing nocebo effects by conditioning with verbal suggestion: A randomized clinical trial in healthy humans. PLoS One 2017; 12:e0182959. [PMID: 28910291 PMCID: PMC5598922 DOI: 10.1371/journal.pone.0182959] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 07/25/2017] [Indexed: 11/19/2022] Open
Abstract
Nocebo effects, i.e., adverse treatment effects which are induced by patients' expectations, are known to contribute to the experience of physical symptoms such as pain and itch. A better understanding of how to minimize nocebo responses might eventually contribute to enhanced treatment effects. However, little is known about how to reduce nocebo effects. In the current randomized controlled study, we tested whether nocebo effects can be minimized by positive expectation induction with respect to electrical and histaminic itch stimuli. First, negative expectations about electrical itch stimuli were induced by verbal suggestion and conditioning (part 1: induction of nocebo effect). Second, participants were randomized to either the experimental group or one of the control groups (part 2: reversing nocebo effect). In the experimental group, positive expectations were induced by conditioning with verbal suggestion. In the control groups either the negative expectation induction was continued or an extinction procedure was applied. Afterwards, a histamine application test was conducted. Positive expectation induction resulted in a significantly smaller nocebo effect in comparison with both control groups. Mean change itch NRS scores showed that the nocebo effect was even reversed, indicating a placebo effect. Comparable effects were also found for histamine application. This study is the first to demonstrate that nocebo effects can be minimized and even reversed by conditioning with verbal suggestion. The results of the current study indicate that learning via counterconditioning and verbal suggestion represents a promising strategy for diminishing nocebo responses.
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Affiliation(s)
- Danielle J. P. Bartels
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands
- * E-mail:
| | - Antoinette I. M. van Laarhoven
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands
| | - Michiel Stroo
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Kim Hijne
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Kaya J. Peerdeman
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands
| | - A. Rogier T. Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Andrea W. M. Evers
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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15
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Oostendorp LJM, Ottevanger PB, Donders ART, van de Wouw AJ, Schoenaker IJH, Smilde TJ, van der Graaf WTA, Stalmeier PFM. Decision aids for second-line palliative chemotherapy: a randomised phase II multicentre trial. BMC Med Inform Decis Mak 2017; 17:130. [PMID: 28859646 PMCID: PMC5580234 DOI: 10.1186/s12911-017-0529-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 01/25/2017] [Accepted: 08/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing recognition of the delicate balance between the modest benefits of palliative chemotherapy and the burden of treatment. Decision aids (DAs) can potentially help patients with advanced cancer with these difficult treatment decisions, but providing detailed information could have an adverse impact on patients' well-being. The objective of this randomised phase II study was to evaluate the safety and efficacy of DAs for patients with advanced cancer considering second-line chemotherapy. METHODS Patients with advanced breast or colorectal cancer considering second-line treatment were randomly assigned to usual care (control group) or usual care plus a DA (intervention group) in a 1:2 ratio. A nurse offered a DA with information on adverse events, tumour response and survival. Outcome measures included patient-reported well-being (primary outcome: anxiety) and quality of the decision-making process and the resulting choice. RESULTS Of 128 patients randomised, 45 were assigned to the control group and 83 to the intervention group. Median age was 62 years (range 32-81), 63% were female, and 73% had colorectal cancer. The large majority of patients preferred treatment with chemotherapy (87%) and subsequently commenced treatment with chemotherapy (86%). No adverse impact on patients' well-being was found and nurses reported that consultations in which the DAs were offered went well. Being offered the DA was associated with stronger treatment preferences (3.0 vs. 2.5; p=0.030) and increased subjective knowledge (6.7 vs. 6.3; p=0.022). Objective knowledge, risk perception and perceived involvement were comparable between the groups. CONCLUSIONS DAs containing detailed risk information on second-line palliative treatment could be delivered to patients with advanced cancer without having an adverse impact on patient well-being. Surprisingly, the DAs only marginally improved the quality of the decision-making process. The effectiveness of DAs for palliative treatment decisions needs further exploration. TRIAL REGISTRATION Netherlands Trial Registry (NTR): NTR1113 (registered on 2 November 2007).
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Affiliation(s)
| | | | | | - Agnes J van de Wouw
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
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16
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van Beugen S, Ferwerda M, Spillekom-van Koulil S, Smit JV, Zeeuwen-Franssen MEJ, Kroft EBM, de Jong EMGJ, Otero ME, Donders ART, van de Kerkhof PCM, van Middendorp H, Evers AWM. Tailored Therapist-Guided Internet-Based Cognitive Behavioral Treatment for Psoriasis: A Randomized Controlled Trial. Psychother Psychosom 2017; 85:297-307. [PMID: 27508937 DOI: 10.1159/000447267] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/28/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Patients with somatic conditions, such as psoriasis, frequently suffer from high burden of their disease in daily life and might benefit from internet-based cognitive behavioral therapy (ICBT) tailored to their adjustment problems. The aim of this multicenter randomized controlled trial was to examine the effects of therapist-guided, individually tailored ICBT in a clinical sample of patients with psoriasis. METHODS A total of 131 patients with psoriasis, who were screened for a psychological risk profile, were randomized to either care as usual (CAU, n = 66) or ICBT in addition to CAU (n = 65). Participants filled out standardized self-report questionnaires assessing physical and psychological functioning and impact on daily activities at baseline, posttreatment assessment, and 6-month follow-up. RESULTS In covariate-controlled linear mixed-model analyses, significantly larger improvements in ICBT compared to CAU were found in the primary outcomes physical functioning (p = 0.03, d = 0.36) and impact on daily activities (p = 0.04, d = 0.35), but not in psychological functioning (p = 0.32), up to 6 months after treatment compared to baseline. In explorative analyses, the working alliance measured at the beginning of ICBT treatment predicted improved physical (p = 0.02) and psychological (p < 0.001) outcomes. CONCLUSIONS Results underline the promise of therapist-guided, individually tailored ICBT to improve physical functioning and reduce the impact of psoriasis on daily activities in patients with a psychological risk profile. Establishing a good therapeutic relationship early on may be an important factor that influences treatment outcomes in personalized ICBT interventions. Further research is needed to evaluate ICBT effectiveness in additional samples and to explore its underlying mechanisms.
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Affiliation(s)
- Sylvia van Beugen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
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17
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Poort H, Verhagen CAHHVM, Peters MEWJ, Goedendorp MM, Donders ART, Hopman MTE, Nijhuis-van der Sanden MWG, Berends T, Bleijenberg G, Knoop H. Study protocol of the TIRED study: a randomised controlled trial comparing either graded exercise therapy for severe fatigue or cognitive behaviour therapy with usual care in patients with incurable cancer. BMC Cancer 2017; 17:81. [PMID: 28129746 PMCID: PMC5273841 DOI: 10.1186/s12885-017-3076-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 06/29/2016] [Accepted: 01/19/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Fatigue is a common and debilitating symptom for patients with incurable cancer receiving systemic treatment with palliative intent. There is evidence that non-pharmacological interventions such as graded exercise therapy (GET) or cognitive behaviour therapy (CBT) reduce cancer-related fatigue in disease-free cancer patients and in patients receiving treatment with curative intent. These interventions may also result in a reduction of fatigue in patients receiving treatment with palliative intent, by improving physical fitness (GET) or changing fatigue-related cognitions and behaviour (CBT). The primary aim of our study is to assess the efficacy of GET or CBT compared to usual care (UC) in reducing fatigue in patients with incurable cancer. METHODS The TIRED study is a multicentre three-armed randomised controlled trial (RCT) for incurable cancer patients receiving systemic treatment with palliative intent. Participants will be randomised to GET, CBT, or UC. In addition to UC, the GET group will participate in a 12-week supervised exercise programme. The CBT group will receive a 12-week CBT intervention in addition to UC. Primary and secondary outcome measures will be assessed at baseline, post-intervention (14 weeks), and at follow-up assessments (18 and 26 weeks post-randomisation). The primary outcome measure is fatigue severity (Checklist Individual Strength subscale fatigue severity). Secondary outcome measures are fatigue (EORTC-QLQ-C30 subscale fatigue), functional impairments (Sickness Impact Profile total score, EORTC-QLQ-C30 subscale emotional functioning, subscale physical functioning) and quality of life (EORTC-QLQ-C30 subscale QoL). Outcomes at 14 weeks (primary endpoint) of either treatment arm will be compared to those of UC participants. In addition, outcomes at 18 and 26 weeks (follow-up assessments) of either treatment arm will be compared to those of UC participants. DISCUSSION To our knowledge, the TIRED study is the first RCT investigating the efficacy of GET and CBT on reducing fatigue during treatment with palliative intent in incurable cancer patients. The results of this study will provide information about the possibility and efficacy of GET and CBT for severely fatigued incurable cancer patients. TRIAL REGISTRATION NTR3812 ; date of registration: 23/01/2013.
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Affiliation(s)
- Hanneke Poort
- Expert Center for Chronic Fatigue, Radboud university medical center, Nijmegen, The Netherlands.
| | | | - Marlies E W J Peters
- Department of Medical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Martine M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Rogier T Donders
- Department of Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Thea Berends
- Expert Center for Chronic Fatigue, Radboud university medical center, Nijmegen, The Netherlands
| | - Gijs Bleijenberg
- Expert Center for Chronic Fatigue, Radboud university medical center, Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam Public Health research institute, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands.,Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
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18
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Huijbers MJ, Crane RS, Kuyken W, Heijke L, van den Hout I, Donders ART, Speckens AEM. Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome. Mindfulness (N Y) 2017; 8:960-972. [PMID: 28757901 PMCID: PMC5506231 DOI: 10.1007/s12671-016-0672-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As mindfulness-based cognitive therapy (MBCT) becomes an increasingly mainstream approach for recurrent depression, there is a growing need for practitioners who are able to teach MBCT. The requirements for being competent as a mindfulness-based teacher include personal meditation practice and at least a year of additional professional training. This study is the first to investigate the relationship between MBCT teacher competence and several key dimensions of MBCT treatment outcomes. Patients with recurrent depression in remission (N = 241) participated in a multi-centre trial of MBCT, provided by 15 teachers. Teacher competence was assessed using the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) based on two to four randomly selected video-recorded sessions of each of the 15 teachers, evaluated by 16 trained assessors. Results showed that teacher competence was not significantly associated with adherence (number of MBCT sessions attended), possible mechanisms of change (rumination, cognitive reactivity, mindfulness, and self-compassion), or key outcomes (depressive symptoms at post treatment and depressive relapse/recurrence during the 15-month follow-up). Thus, findings from the current study indicate no robust effects of teacher competence, as measured by the MBI:TAC, on possible mediators and outcome variables in MBCT for recurrent depression. Possible explanations are the standardized delivery of MBCT, the strong emphasis on self-reliance within the MBCT learning process, the importance of participant-related factors, the difficulties in assessing teacher competence, the absence of main treatment effects in terms of reducing depressive symptoms, and the relatively small selection of videotapes. Further work is required to systematically investigate these explanations.
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Affiliation(s)
- Marloes J Huijbers
- Department of Psychiatry, Radboud University Nijmegen Medical Centre, Reinier Postlaan 10, 6525 GC Nijmegen, The Netherlands
| | - Rebecca S Crane
- Centre for Mindfulness Research and Practice, School of Psychology, Bangor University, Bangor, LL57 2AS UK
| | - Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Lot Heijke
- Present Mind, Mindfulness Training and Education, 1053 RN Amsterdam, The Netherlands
| | - Ingrid van den Hout
- Outpatient Clinic for Mental Health, Dokter Bosman, Houttuinlaan 16A, 3447 GM Woerden, The Netherlands
| | - A Rogier T Donders
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands
| | - Anne E M Speckens
- Department of Psychiatry, Radboud University Nijmegen Medical Centre, Reinier Postlaan 10, 6525 GC Nijmegen, The Netherlands
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19
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Hofman CS, Lutomski JE, Olde Rikkert MGM, Melis RJF, Donders ART. Examining Consistency Between Self-Assessed and Peer-Rated Quality of Life in Older Persons. J Am Geriatr Soc 2016; 64:e104-e105. [PMID: 27711970 DOI: 10.1111/jgs.14358] [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: 11/26/2022]
Affiliation(s)
- Cynthia S Hofman
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jennifer E Lutomski
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Anu Research Centre, University College Cork, Cork, Ireland
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - René J F Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A Rogier T Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
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20
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van Nimwegen KJM, Kievit W, van der Wilt GJ, Schieving JH, Willemsen MAAP, Donders ART, Verhaak CM, Grutters JPC. Parental quality of life in complex paediatric neurologic disorders of unknown aetiology. Eur J Paediatr Neurol 2016; 20:723-31. [PMID: 27321953 DOI: 10.1016/j.ejpn.2016.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/13/2016] [Accepted: 05/17/2016] [Indexed: 02/05/2023]
Abstract
Complex paediatric neurology (CPN) patients generally present with non-specific symptoms, such as developmental delay, impaired movement and epilepsy. The diagnostic trajectory in these disorders is usually complicated and long-lasting, and may be burdensome to the patients and their parents. Additionally, as caring for a chronically ill child can be stressful and demanding, parents of these patients may experience impaired health-related quality of life (HRQoL). This study aims to assess parental HRQoL and factors related to it in CPN. Physical and mental HRQoL of 120 parents was measured and compared to the general population using the SF-12 questionnaire. Parents also completed this questionnaire for the measurement of patient HRQoL. Additional questionnaires were used to measure parental uncertainty (Visual Analogue Scale) and worry phenomena (Penn State Worry Questionnaire), and to obtain socio-demographic data. A linear mixed model with random effect was used to investigate which of these variables were associated with parental HRQoL. As compared to the general population, HRQoL of these parents appeared diminished. Fathers showed both lowered physical (51.76, p < 0.05) and mental (49.41, p < 0.01) HRQoL, whereas mothers only showed diminished mental (46.46, p < 0.01) HRQoL. Patient HRQoL and parental worry phenomena were significantly correlated with overall and mental parental HRQoL. The reduction in parental mental HRQoL is alarming, also because children strongly rely on their parents and parental mental health is known to influence children's health. Awareness of these problems among clinicians, and supportive care if needed are important to prevent exacerbation of the problems.
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Affiliation(s)
- K J M van Nimwegen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, Nijmegen, The Netherlands.
| | - W Kievit
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, Nijmegen, The Netherlands.
| | - G J van der Wilt
- Radboud University Medical Center, Donders Centre for Neuroscience, Department for Health Evidence, Nijmegen, The Netherlands.
| | - J H Schieving
- Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands.
| | - M A A P Willemsen
- Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands.
| | - A R T Donders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, Nijmegen, The Netherlands.
| | - C M Verhaak
- Radboud University Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands.
| | - J P C Grutters
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, Nijmegen, The Netherlands.
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21
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Berende A, ter Hofstede HJM, Vos FJ, van Middendorp H, Vogelaar ML, Tromp M, van den Hoogen FH, Donders ART, Evers AWM, Kullberg BJ. Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease. N Engl J Med 2016; 374:1209-20. [PMID: 27028911 DOI: 10.1056/nejmoa1505425] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [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: 11/19/2022]
Abstract
BACKGROUND The treatment of persistent symptoms attributed to Lyme disease remains controversial. We assessed whether longer-term antibiotic treatment of persistent symptoms attributed to Lyme disease leads to better outcomes than does shorter-term treatment. METHODS In a randomized, double-blind, placebo-controlled trial conducted in Europe, we assigned patients with persistent symptoms attributed to Lyme disease--either related temporally to proven Lyme disease or accompanied by a positive IgG or IgM immunoblot assay for Borrelia burgdorferi--to receive a 12-week oral course of doxycycline, clarithromycin plus hydroxychloroquine, or placebo. All study groups received open-label intravenous ceftriaxone for 2 weeks before initiating the randomized regimen. The primary outcome measure was health-related quality of life, as assessed by the physical-component summary score of the RAND-36 Health Status Inventory (RAND SF-36) (range, 15 to 61, with higher scores indicating better quality of life), at the end of the treatment period at week 14, after the 2-week course of ceftriaxone and the 12-week course of the randomized study drug or placebo had been completed. RESULTS Of the 281 patients who underwent randomization, 280 were included in the modified intention-to-treat analysis (86 patients in the doxycycline group, 96 in the clarithromycin-hydroxychloroquine group, and 98 in the placebo group). The SF-36 physical-component summary score did not differ significantly among the three study groups at the end of the treatment period, with mean scores of 35.0 (95% confidence interval [CI], 33.5 to 36.5) in the doxycycline group, 35.6 (95% CI, 34.2 to 37.1) in the clarithromycin-hydroxychloroquine group, and 34.8 (95% CI, 33.4 to 36.2) in the placebo group (P=0.69; a difference of 0.2 [95% CI, -2.4 to 2.8] in the doxycycline group vs. the placebo group and a difference of 0.9 [95% CI, -1.6 to 3.3] in the clarithromycin-hydroxychloroquine group vs. the placebo group); the score also did not differ significantly among the groups at subsequent study visits (P=0.35). In all study groups, the SF-36 physical-component summary score increased significantly from baseline to the end of the treatment period (P<0.001). The rates of adverse events were similar among the study groups. Four serious adverse events thought to be related to drug use occurred during the 2-week open-label ceftriaxone phase, and no serious drug-related adverse event occurred during the 12-week randomized phase. CONCLUSIONS In patients with persistent symptoms attributed to Lyme disease, longer-term antibiotic treatment did not have additional beneficial effects on health-related quality of life beyond those with shorter-term treatment. (Funded by the Netherlands Organization for Health Research and Development ZonMw; PLEASE ClinicalTrials.gov number, NCT01207739.).
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Affiliation(s)
- Anneleen Berende
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Hadewych J M ter Hofstede
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Fidel J Vos
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Henriët van Middendorp
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Michiel L Vogelaar
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Mirjam Tromp
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Frank H van den Hoogen
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - A Rogier T Donders
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Andrea W M Evers
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Bart Jan Kullberg
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
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22
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Balemans MCM, Kooloos JGM, Donders ART, Van der Zee CEEM. Actual drawing of histological images improves knowledge retention. Anat Sci Educ 2016; 9:60-70. [PMID: 26033842 DOI: 10.1002/ase.1545] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/26/2015] [Accepted: 04/28/2015] [Indexed: 06/04/2023]
Abstract
Medical students have to process a large amount of information during the first years of their study, which has to be retained over long periods of nonuse. Therefore, it would be beneficial when knowledge is gained in a way that promotes long-term retention. Paper-and-pencil drawings for the uptake of form-function relationships of basic tissues has been a teaching tool for a long time, but now seems to be redundant with virtual microscopy on computer-screens and printers everywhere. Several studies claimed that, apart from learning from pictures, actual drawing of images significantly improved knowledge retention. However, these studies applied only immediate post-tests. We investigated the effects of actual drawing of histological images, using randomized cross-over design and different retention periods. The first part of the study concerned esophageal and tracheal epithelium, with 384 medical and biomedical sciences students randomly assigned to either the drawing or the nondrawing group. For the second part of the study, concerning heart muscle cells, students from the previous drawing group were now assigned to the nondrawing group and vice versa. One, four, and six weeks after the experimental intervention, the students were given a free recall test and a questionnaire or drawing exercise, to determine the amount of knowledge retention. The data from this study showed that knowledge retention was significantly improved in the drawing groups compared with the nondrawing groups, even after four or six weeks. This suggests that actual drawing of histological images can be used as a tool to improve long-term knowledge retention.
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Affiliation(s)
- Monique C M Balemans
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Applied Sciences, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Jan G M Kooloos
- Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Rogier T Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina E E M Van der Zee
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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23
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Huijbers MJ, Spinhoven P, Spijker J, Ruhé HG, van Schaik DJF, van Oppen P, Nolen WA, Ormel J, Kuyken W, van der Wilt GJ, Blom MBJ, Schene AH, Donders ART, Speckens AEM. Adding mindfulness-based cognitive therapy to maintenance antidepressant medication for prevention of relapse/recurrence in major depressive disorder: Randomised controlled trial. J Affect Disord 2015; 187:54-61. [PMID: 26318271 DOI: 10.1016/j.jad.2015.08.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/08/2015] [Accepted: 08/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied. Our aim was to investigate whether the addition of MBCT to mADM is a more effective prevention strategy than mADM alone. METHODS This study is one of two multicenter randomised trials comparing the combination of MBCT and mADM to either intervention on its own. In the current trial, recurrently depressed patients in remission who had been using mADM for 6 months or longer (n=68), were randomly allocated to either MBCT+mADM (n=33) or mADM alone (n=35). Primary outcome was depressive relapse/recurrence within 15 months. Key secondary outcomes were time to relapse/recurrence and depression severity. Analyses were based on intention-to-treat. RESULTS There were no significant differences between the groups on any of the outcome measures. LIMITATIONS The current study included patients who had recovered from depression with mADM and who preferred the certainty of continuing medication to the possibility of participating in MBCT. Lower expectations of mindfulness in the current trial, compared with the parallel trial, may have caused selection bias. In addition, recruitment was hampered by the increasing availability of MBCT in the Netherlands, and even about a quarter of participants included in the trial who were allocated to the control group chose to get MBCT elsewhere. CONCLUSIONS For this selection of recurrently depressed patients in remission and using mADM for 6 months or longer, MBCT did not further reduce their risk for relapse/recurrence or their (residual) depressive symptoms.
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Affiliation(s)
- Marloes J Huijbers
- Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 10, 6525 GC Nijmegen, The Netherlands.
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jan Spijker
- Pro Persona Nijmegen, Reinier Postlaan 6, 6525 GC Nijmegen, The Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Digna J F van Schaik
- GGZ InGeest and VU University Medical Center, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Patricia van Oppen
- GGZ InGeest and VU University Medical Center, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Willem A Nolen
- Department of Psychiatry, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Johan Ormel
- Department of Psychiatry, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
| | - Gert Jan van der Wilt
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands
| | - Marc B J Blom
- Parnassia Bavo Psychiatric Institute, Lijnbaan 4, 2512 VA The Hague, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 10, 6525 GC Nijmegen, The Netherlands
| | - A Rogier T Donders
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands
| | - Anne E M Speckens
- Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 10, 6525 GC Nijmegen, The Netherlands
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24
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El Messaoudi S, Wouters CW, van Swieten HA, Pickkers P, Noyez L, Kievit PC, Abbink EJ, Rasing-Hoogveld A, Bouw TP, Peters JG, Coenen MJH, Donders ART, Riksen NP, Rongen GA. Effect of dipyridamole on myocardial reperfusion injury: A double-blind randomized controlled trial in patients undergoing elective coronary artery bypass surgery. Clin Pharmacol Ther 2015; 99:381-9. [PMID: 25773594 DOI: 10.1002/cpt.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 03/02/2015] [Indexed: 11/09/2022]
Abstract
Dipyridamole reduces reperfusion-injury in preclinical trials and may be beneficial in patients undergoing coronary angioplasty, but its effect on patients undergoing coronary artery bypass grafting (CABG) is unknown. We hypothesized that dipyridamole limits myocardial reperfusion-injury in patients undergoing CABG. The trial design was a double-blind trial randomizing between pretreatment with dipyridamole or placebo. In all, 94 patients undergoing elective on-pump CABG were recruited between February 2010 and June 2012. The primary endpoint was plasma high-sensitive (hs-) troponin-I at 6, 12, and 24 hours after reperfusion. Secondary endpoints were the occurrence of bleeding, arrhythmias, need for inotropic support, and intensive care unit length of stay. Finally, 79 patients (33 dipyridamole) were included in the per-protocol analysis. Dipyridamole did not significantly affect postoperative hs-troponin-I (change in plasma hs-troponin I -3% [95% confidence interval -23% to 36%]; P > 0.1). Secondary endpoints did not differ between groups. Dipyridamole prior to CABG does not significantly reduce postoperative hs-troponin release.
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Affiliation(s)
- S El Messaoudi
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C W Wouters
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H A van Swieten
- Department of Cardio-thoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L Noyez
- Department of Cardio-thoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P C Kievit
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E J Abbink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A Rasing-Hoogveld
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - T P Bouw
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J G Peters
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M J H Coenen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A R T Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - N P Riksen
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - G A Rongen
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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25
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Peerdeman KJ, van Laarhoven AIM, Donders ART, Hopman MTE, Peters ML, Evers AWM. Inducing Expectations for Health: Effects of Verbal Suggestion and Imagery on Pain, Itch, and Fatigue as Indicators of Physical Sensitivity. PLoS One 2015; 10:e0139563. [PMID: 26448183 PMCID: PMC4598027 DOI: 10.1371/journal.pone.0139563] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 09/15/2015] [Indexed: 11/20/2022] Open
Abstract
Research into placebo effects has convincingly shown that inducing positive outcome expectations can reduce pain and other physical sensations. However, the comparative effects of different expectation inductions, such as verbal suggestion or mental imagery, and their generic effects on physical sensitivity, to different sensations such as pain, itch, and fatigue, are still largely unknown. In the current study, we assessed the individual and combined effects of verbal suggestion and imagery on pain, itch, and fatigue as indicators of physical sensitivity in a randomized study design. Healthy participants (n = 116) were given an inert (placebo) capsule that was said to be effective for reducing physical sensitivity in either the majority (positive verbal suggestion) or the minority (control verbal suggestion) of users. Subsequently, they imagined either their best possible health (positive imagery) or a typical day (control imagery). Sensitivity to pain, itch, and fatigue was tested using a cold pressor test, histamine iontophoresis, and a bicycle test, respectively. Heart rate and skin conductance were recorded continuously. Results showed that positive verbal suggestion and imagery successfully induced positive expectations, but they did not affect physical sensitivity, as indicated by sensitivity to pain, itch, or fatigue, or concurrent physiological responses. These results could indicate that the specificity and concreteness of expectation inductions might be important for their applicability in the treatment of physical symptoms.
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Affiliation(s)
- Kaya J. Peerdeman
- Unit Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, the Netherlands
- * E-mail:
| | - Antoinette I. M. van Laarhoven
- Unit Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, the Netherlands
| | | | | | - Madelon L. Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Andrea W. M. Evers
- Unit Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, the Netherlands
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26
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Compen FR, Bisseling EM, Van der Lee ML, Adang EMM, Donders ART, Speckens AEM. Study protocol of a multicenter randomized controlled trial comparing the effectiveness of group and individual internet-based Mindfulness-Based Cognitive Therapy with treatment as usual in reducing psychological distress in cancer patients: the BeMind study. BMC Psychol 2015; 3:27. [PMID: 26273472 PMCID: PMC4535375 DOI: 10.1186/s40359-015-0084-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 07/23/2015] [Indexed: 12/21/2022] Open
Abstract
Background Mindfulness-based interventions have shown to reduce psychological distress in cancer patients. The accessibility of mindfulness-based interventions for cancer patients could be further improved by providing mindfulness using an individual internet-based format. The aim of this study is to test the effectiveness of a Mindfulness-Based Cognitive Therapy (MBCT) group intervention for cancer patients in comparison with individual internet-based MBCT and treatment as usual (TAU). Methods/Design A three-armed multicenter randomized controlled trial comparing group-based MBCT to individual internet-based MBCT and TAU in cancer patients who suffer from at least mild psychological distress (Hospital Anxiety and Depression Scale (HADS) ≥ 11). Measurements will be conducted prior to randomization (baseline), post-treatment and at 3 months and 9 months post-treatment. Participants initially allocated to TAU are subsequently randomized to either group- or individual internet-based MBCT and will receive a second baseline measurement after 3 months. Thus, the three-armed comparison will have a time span of approximately 3 months. The two-armed intervention comparison includes a 9-month follow-up and will also consist of participants randomized to the intervention after TAU. Primary outcome will be post-treatment psychological distress (HADS). Secondary outcomes are fear of cancer recurrence (Fear of Cancer Recurrence Inventory), rumination (Rumination and Reflection Questionnaire), positive mental health (Mental Health Continuum – Short Form), and cost-effectiveness (health-related quality of life (EuroQol –5D and Short Form-12) and health care usage (Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness). Potential predictors: DSM-IV-TR mood/anxiety disorders (SCID-I) and neuroticism (NEO-Five Factor Inventory) will be measured. Mediators of treatment effect: mindfulness skills, (Five-Facets of Mindfulness Questionnaire- Short Form), working alliance (Working Alliance Inventory) and group cohesion (Group Cohesion Questionnaire) will also be measured. Discussion This trial will provide valuable information on the clinical and cost-effectiveness of group versus internet-based MBCT versus TAU for distressed cancer patients. Trial registration Clinicaltrials.gov NCT02138513. Registered 6 May 2014.
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Affiliation(s)
- F R Compen
- Department of Psychiatry, Radboud University Nijmegen Medical Centre for Mindfulness, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - E M Bisseling
- Department of Psychiatry, Radboud University Nijmegen Medical Centre for Mindfulness, Postbus 9101, 6500 HB Nijmegen, The Netherlands ; Scientific Research Department, Helen Dowling Institute, Centre for Psycho-Oncology, Bilthoven, The Netherlands
| | - M L Van der Lee
- Scientific Research Department, Helen Dowling Institute, Centre for Psycho-Oncology, Bilthoven, The Netherlands
| | - E M M Adang
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - A R T Donders
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - A E M Speckens
- Department of Psychiatry, Radboud University Nijmegen Medical Centre for Mindfulness, Postbus 9101, 6500 HB Nijmegen, The Netherlands
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El Messaoudi S, Nederlof R, Zuurbier CJ, van Swieten HA, Pickkers P, Noyez L, Dieker HJ, Coenen MJ, Donders ART, Vos A, Rongen GA, Riksen NP. Effect of metformin pretreatment on myocardial injury during coronary artery bypass surgery in patients without diabetes (MetCAB): a double-blind, randomised controlled trial. Lancet Diabetes Endocrinol 2015; 3:615-23. [PMID: 26179504 DOI: 10.1016/s2213-8587(15)00121-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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] [Received: 03/10/2015] [Revised: 04/15/2015] [Accepted: 04/17/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND During coronary artery bypass graft (CABG) surgery, ischaemia and reperfusion damage myocardial tissue, and increased postoperative plasma troponin concentration is associated with a worse outcome. We investigated whether metformin pretreatment limits cardiac injury, assessed by troponin concentrations, during CABG surgery in patients without diabetes. METHODS We did a placebo-controlled, double-blind, single-centre study in an academic hospital in Nijmegen (Netherlands) in adult patients without diabetes undergoing an elective on-pump CABG procedure. We randomly assigned patients (1:1) in blocks of ten via a computer-generated randomisation sequence to either metformin hydrochloride (500 mg three times per day) or placebo (three times per day) for 3 days before surgery. The last dose was given roughly 3 h before surgery. Patients, investigators, trial staff, and the statistician were all masked to treatment allocation. The primary endpoint was the plasma concentration of high-sensitive troponin I at 6, 12, and 24 h postreperfusion after surgery, analysed in the per-protocol population with a mixed-model analysis using all these timepoints. Secondary endpoints included the occurrence of clinically relevant arrhythmias within 24 hours after reperfusion, the need for inotropic support, time to detubation, duration of stay in the intensive-care unit, and postoperative use of insulin. This study is registered with ClinicalTrials.gov, number NCT01438723. FINDINGS Between Nov 8, 2011, and Nov 22, 2013, we randomly assigned 111 patients to treatment (57 to metformin and 54 to placebo). Five patients dropped out from the metformin group, and six from the placebo group. 52 patients in the metformin group and 48 patients in the placebo group were included in the per-protocol analysis. Geometric mean high-sensitivity troponin I increased from 0 μg/L to 3·67 μg/L (95% CI 3·06-4·41) with metformin and to 3·32 μg/L (2·75-4·01) with placebo at 6 h after reperfusion; 2·84 μg/L (2·37-3·41) and 2·45 μg/L (2·02-2·96), respectively, at 12 h; and to 1·77 μg/L (1·47-2·12) and 1·60 μg/L (1·32-1·94) at 24 h. The concentrations did not differ significantly between the groups (difference 12·3% for all timepoints [95% CI -12·4 to 44·1] p=0·35). Occurrence of arrhythmias did not differ between groups (three [5·8%] of 52 patients who received metformin vs three [6·3%] of 48 patients who received placebo; p=1·00). There was no difference between groups in the need for inotropic support, time to detubation, duration of stay in the intensive-care unit, or postoperative use of insulin. No patients died within 30 days after surgery. Occurrence of gastrointestinal discomfort (mostly diarrhoea) was significantly higher with metformin than with placebo (11 [21·2%] of 52 vs two [4·2%] of 48 patients; p=0·01). INTERPRETATION Short-term metformin pretreatment, although safe, does not seem to be an effective strategy to reduce periprocedural myocardial injury in patients without diabetes undergoing CABG surgery. FUNDING Netherlands Organisation for Health Research and Development and Netherlands Heart Foundation.
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Affiliation(s)
- Saloua El Messaoudi
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rianne Nederlof
- Laboratory of Experimental Intensive Care and Anesthesiology, Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands
| | - Coert J Zuurbier
- Laboratory of Experimental Intensive Care and Anesthesiology, Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands
| | - Henry A van Swieten
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Luc Noyez
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hendrik-Jan Dieker
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marieke J Coenen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - A Rogier T Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Annemieke Vos
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gerard A Rongen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Niels P Riksen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
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van Aalderen JR, Donders ART, Peffer K, Speckens AEM. LONG-TERM OUTCOME OF MINDFULNESS-BASED COGNITIVE THERAPY IN RECURRENTLY DEPRESSED PATIENTS WITH AND WITHOUT A DEPRESSIVE EPISODE AT BASELINE. Depress Anxiety 2015; 32:563-9. [PMID: 25869231 DOI: 10.1002/da.22369] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND In a previous randomized controlled trial in patients with three or more previous depressive episodes, mindfulness-based cognitive therapy (MBCT) appeared to be equally effective in those who were depressed and those who were in remission at the start of the trial. AIM The aim of this study is to compare the 1-year outcome of MBCT in 124 remitted and 58 depressed patients who participated in the original trial and who were all offered MBCT either immediately or after a waiting period of 3 months. METHODS The course of depressive symptoms, rumination, mindfulness skills, and quality of life over the course of treatment and the 1-year follow-up period was analyzed. Linear mixed modeling was used to compare the outcome between remitted and depressed patients at baseline. RESULTS In the whole sample, levels of depression and rumination decreased and mindfulness and quality of life increased over treatment. Levels of depressive symptoms, mindfulness, and quality of life remained stable over the 1-year follow-up period. Rumination further decreased. Remitted and depressed patients at the start of the trial did not differ in terms of outcome during or after treatment. CONCLUSIONS Long-term outcome after MBCT in depressed patients was comparable to those who were in remission at the start of the trial. These findings lend further support to the notion that recurrent depressed patients meeting the criteria of a depressive episode do not need to be excluded from MBCT.
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Affiliation(s)
- Joël R van Aalderen
- Department of Psychiatry, Radboud University Nijmegen Medical Centre, The Netherlands
| | - A Rogier T Donders
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Karlijn Peffer
- Sanquin Research, Department Donor Studies, Nijmegen, The Netherlands
| | - Anne E M Speckens
- Department of Psychiatry, Radboud University Nijmegen Medical Centre, The Netherlands
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de Brouwer SJM, van Middendorp H, Kraaimaat FW, Radstake TRDJ, Joosten I, Donders ART, Eijsbouts A, Spillekom-van Koulil S, van Riel PLCM, Evers AWM. Immune responses to stress after stress management training in patients with rheumatoid arthritis. Arthritis Res Ther 2014; 15:R200. [PMID: 24274618 PMCID: PMC3978719 DOI: 10.1186/ar4390] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 11/06/2013] [Indexed: 01/16/2023] Open
Abstract
Introduction Psychological stress may alter immune function by activating physiological stress pathways. Building on our previous study, in which we report that stress management training led to an altered self-reported and cortisol response to psychological stress in patients with rheumatoid arthritis (RA), we explored the effects of this stress management intervention on the immune response to a psychological stress task in patients with RA. Methods In this study, 74 patients with RA, who were randomly assigned to either a control group or a group that received short stress management training, performed the Trier Social Stress Test (TSST) 1 week after the intervention and at a 9-week follow-up. Stress-induced changes in levels of key cytokines involved in stress and inflammatory processes (for example, interleukin (IL)-6 and IL-8) were assessed. Results Basal and stress-induced cytokine levels were not significantly different in patients in the intervention and control groups one week after treatment, but stress-induced IL-8 levels were lower in patients in the intervention group than in the control group at the follow-up assessment. Conclusions In line with our previous findings of lower stress-induced cortisol levels at the follow-up of stress management intervention, this is the first study to show that relatively short stress management training might also alter stress-induced IL-8 levels in patients with RA. These results might help to determine the role of immunological mediators in stress and disease. Trial registration The Netherlands National Trial Register (NTR1193)
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van den Berg TNA, Deinum J, Bilos A, Donders ART, Rongen GA, Riksen NP. The effect of eplerenone on adenosine formation in humans in vivo: a double-blinded randomised controlled study. PLoS One 2014; 9:e111248. [PMID: 25356826 PMCID: PMC4214740 DOI: 10.1371/journal.pone.0111248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022] Open
Abstract
Background It has been suggested that mineralocorticoid receptor antagonists have direct cardioprotective properties, because these drugs reduce mortality in patients with heart failure. In murine models of myocardial infarction, mineralocorticoid receptor antagonists reduce infarct size. Using gene deletion and pharmacological approaches, it has been shown that extracellular formation of the endogenous nucleoside adenosine is crucial for this protective effect. We now aim to translate this finding to humans, by investigating the effects of the selective mineralocorticoid receptor antagonist eplerenone on the vasodilator effect of the adenosine uptake inhibitor dipyridamole, which is a well-validated surrogate marker for extracellular adenosine formation. Methods and Results In a randomised, double-blinded, placebo-controlled, cross-over study we measured the forearm blood flow response to the intrabrachial administration of dipyridamole in 14 healthy male subjects before and after treatment with placebo or eplerenone (50 mg bid for 8 days). The forearm blood flow during administration of dipyridamole (10, 30 and 100 µg·min−1·dl−1) was 1.63 (0.60), 2.13 (1.51) and 2.71 (1.32) ml·dl−1·min−1 during placebo use, versus 2.00 (1.45), 2.68 (1.87) and 3.22 (1.94) ml·dl−1·min−1 during eplerenone treatment (median (interquartile range); P = 0.51). Concomitant administration of the adenosine receptor antagonist caffeine attenuated dipyridamole-induced vasodilation to a similar extent in both groups. The forearm blood flow response to forearm ischemia, as a stimulus for increased formation of adenosine, was similar during both conditions. Conclusion In a dosage of 50 mg bid, eplerenone does not augment extracellular adenosine formation in healthy human subjects. Therefore, it is unlikely that an increased extracellular adenosine formation contributes to the cardioprotective effect of mineralocorticoid receptor antagonists. Trial Registration ClinicalTrials.gov, NCT01837108
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Affiliation(s)
- T. N. A. van den Berg
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jaap Deinum
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Albert Bilos
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A. Rogier T. Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerard A. Rongen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Niels P. Riksen
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
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Berende A, ter Hofstede HJM, Donders ART, van Middendorp H, Kessels RPC, Adang EMM, Vos FJ, Evers AWM, Kullberg BJ. Persistent Lyme Empiric Antibiotic Study Europe (PLEASE)--design of a randomized controlled trial of prolonged antibiotic treatment in patients with persistent symptoms attributed to Lyme borreliosis. BMC Infect Dis 2014; 14:543. [PMID: 25318999 PMCID: PMC4203907 DOI: 10.1186/s12879-014-0543-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/03/2014] [Indexed: 11/21/2022] Open
Abstract
Background Lyme borreliosis, a potentially severe tick-borne infection caused by Borrelia burgdorferi, can cause multi-system inflammatory disease. The incidence has been increasing, as has the number of patients with persistent symptoms attributed to Borrelia. These symptoms, also referred to as post-Lyme disease syndrome, may follow an erythema migrans or other Lyme manifestations, and include pain, fatigue, and cognitive disturbances. The optimal duration of treatment for these symptoms is a subject of controversy. The PLEASE study is designed to determine whether prolonged antibiotic treatment leads to better patient outcome than standard treatment. Methods/Design The PLEASE study is a double-blind, randomized, placebo-controlled trial. Based on power analysis and compensating for possible loss to follow-up, a minimum of 255 patients with borreliosis-attributed persistent symptoms are included. These symptoms are either (a) temporally related to an erythema migrans or otherwise proven symptomatic borreliosis, or (b) accompanied by a positive B. burgdorferi IgG or IgM immunoblot. All patients receive open-label ceftriaxone for two weeks. Patients are then randomized (ratio 1:1:1) to blinded oral follow-up treatment for 12 weeks with (I) doxycycline, (II) clarithromycin combined with hydroxychloroquine, or (III) placebo. The primary outcome is the physical component summary score (PCS) of the RAND-36 Health Status Inventory (RAND SF-36) at week 14. Secondary outcomes include physical and mental aspects of health-related quality of life (assessed by the subscales of the RAND SF-36), fatigue, neuropsychological evaluation, physical activity, and cost-effectiveness. Discussion This article describes the background and design issues of the PLEASE study protocol. The results of this study may provide evidence for prescribing or withholding prolonged antibiotic treatment. Trial registration ClinicalTrials.gov: NCT01207739, Netherlands Trial Register: NTR2469 Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0543-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anneleen Berende
- Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Hadewych J M ter Hofstede
- Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - A Rogier T Donders
- Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical, and Neuropsychology Unit, Leiden University, P.O. Box 9555, 2300 RB, Leiden, the Netherlands. .,Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Roy P C Kessels
- Department of Neuropsychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands. .,Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, P.O. Box 9104, 6500 HE, Nijmegen, the Netherlands.
| | - Eddy M M Adang
- Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Fidel J Vos
- Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Department of Internal Medicine, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, the Netherlands.
| | - Andrea W M Evers
- Institute of Psychology, Health, Medical, and Neuropsychology Unit, Leiden University, P.O. Box 9555, 2300 RB, Leiden, the Netherlands. .,Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Bart Jan Kullberg
- Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Brocken P, van der Heijden EHFM, Oud KTM, Bootsma G, Groen HJM, Donders ART, Dekhuijzen PNR, Prins JB. Distress in suspected lung cancer patients following rapid and standard diagnostic programs: a prospective observational study. Psychooncology 2014; 24:433-41. [DOI: 10.1002/pon.3660] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 07/14/2014] [Accepted: 08/01/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Pepijn Brocken
- Dept. of Pulmonary Diseases; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | | | - Karen T. M. Oud
- Dept. of Pulmonary Diseases; Gelderse Vallei Medical Centre; Ede The Netherlands
| | - Gerben Bootsma
- Dept. of Pulmonary Diseases; Atrium Medical Centre; Heerlen The Netherlands
| | - Harry J. M. Groen
- Dept. of Pulmonary Diseases; University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
| | - A. Rogier T. Donders
- Dept. of Epidemiology, Biostatistics and Health Technology Assessment; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - P. N. Richard Dekhuijzen
- Dept. of Pulmonary Diseases; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Judith B. Prins
- Dept. of Medical Psychology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
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van Hoorn RA, Donders ART, Oppe M, Stalmeier PFM. The better than dead method: feasibility and interpretation of a valuation study. Pharmacoeconomics 2014; 32:789-799. [PMID: 24846761 DOI: 10.1007/s40273-014-0168-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Traditionally, the valuation of health states worse than being dead suffers from two problems: [1] the use of different elicitation methods for positive and negative values, necessitating arbitrary transformations to map negative to positive values; and [2] the inability to quantify that values are time dependent. The Better than Dead (BTD) method is a health-state valuation method where states with a certain duration are compared with being dead. It has the potential to overcome these problems. OBJECTIVES To test the feasibility of the BTD method to estimate values for the EQ-5D system. METHODS A representative sample of 291 Dutch respondents (aged 18-45 years) was recruited. In a web-based questionnaire, preferences were elicited for a selection of 50 different health states with six durations between 1 and 40 years. Random-effects models were used to estimate the effects of socio-demographic and experimental variables, and to estimate values for the EQ-5D. Test-retest reliability was assessed in 41 respondents. RESULTS Important determinants for BTD were a religious life stance [odds ratio 4.09 (2.00-8.36)] and the educational level. The fastest respondents more often preferred health-state scenarios to being dead and had lower test-retest reliability (0.45 versus 0.77 and 0.84 for fast, medium and slow response times, respectively). The results showed a small number of so-called maximal endurable time states. CONCLUSION Valuating health states using the BTD method is feasible and reliable. Further research should explore how the experimental setting modifies how values depend on time.
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Affiliation(s)
- R A van Hoorn
- Department for Health Evidence, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands,
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Magis-Escurra C, Later-Nijland HMJ, Alffenaar JWC, Broeders J, Burger DM, van Crevel R, Boeree MJ, Donders ART, van Altena R, van der Werf TS, Aarnoutse RE. Population pharmacokinetics and limited sampling strategy for first-line tuberculosis drugs and moxifloxacin. Int J Antimicrob Agents 2014; 44:229-34. [PMID: 24985091 DOI: 10.1016/j.ijantimicag.2014.04.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [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: 11/21/2013] [Revised: 04/17/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
Therapeutic drug monitoring (TDM) of tuberculosis (TB) drugs currently focuses on peak plasma concentrations, yet total exposure [area under the 24-h concentration-time curve (AUC₀₋₂₄)] is probably most relevant to the efficacy of these drugs. We therefore assessed population AUC₀₋₂₄ data for all four first-line TB drugs (rifampicin, isoniazid, pyrazinamide and ethambutol) as well as moxifloxacin and developed limited sampling strategies to estimate AUC₀₋₂₄ values conveniently. AUC₀₋₂₄ and other pharmacokinetic (PK) parameters were determined following intensive PK sampling in two Dutch TB referral centres. Best subset selection multiple linear regression was performed to derive limited sampling equations. Median percentage prediction error and median absolute percentage prediction error were calculated via jackknife analysis to evaluate bias and imprecision of the predictions. Geometric mean AUC₀₋₂₄ values for rifampicin, isoniazid, pyrazinamide, ethambutol and moxifloxacin were 41.1, 15.2, 380, 25.5 and 33.6 hmg/L, respectively. Limited sampling at various fixed sampling points enabled an accurate and precise prediction of AUC₀₋₂₄ values of all drugs separately and simultaneously. In the absence of clinically validated target values for AUC₀₋₂₄, average AUC₀₋₂₄ values can be used as reference values in TDM. Limited sampling of AUC₀₋₂₄ is feasible in many settings and allows for TDM to be performed at a larger scale.
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Affiliation(s)
- C Magis-Escurra
- Radboud University Medical Centre, Department of Pulmonary diseases, Nijmegen and University Centre for Chronic Diseases Dekkerswald, Groesbeek, The Netherlands.
| | - H M J Later-Nijland
- Radboud University Medical Centre, Department of Pharmacy, Nijmegen, The Netherlands
| | - J W C Alffenaar
- University Medical Centre Groningen, Department of Hospital and Clinical Pharmacy, Groningen, The Netherlands
| | - J Broeders
- Radboud University Medical Centre, Department of Pharmacy, Nijmegen, The Netherlands
| | - D M Burger
- Radboud University Medical Centre, Department of Pharmacy, Nijmegen, The Netherlands
| | - R van Crevel
- Radboud University Medical Centre, Department of Internal Medicine, Nijmegen, The Netherlands
| | - M J Boeree
- Radboud University Medical Centre, Department of Pulmonary diseases, Nijmegen and University Centre for Chronic Diseases Dekkerswald, Groesbeek, The Netherlands
| | - A R T Donders
- Radboud University Medical Centre, Department for Epidemiology, Biostatistics and HTA, Nijmegen, The Netherlands
| | - R van Altena
- University Medical Centre Groningen, Tuberculosis Centre Beatrixoord, Haren, The Netherlands
| | - T S van der Werf
- University Medical Centre Groningen, Tuberculosis Centre Beatrixoord, Haren, The Netherlands; University Medical Centre Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - R E Aarnoutse
- Radboud University Medical Centre, Department of Pharmacy, Nijmegen, The Netherlands
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Koene S, de Laat P, van Tienoven DH, Vriens D, Brandt AM, Sweep FCGJ, Rodenburg RJT, Donders ART, Janssen MCH, Smeitink JAM. Serum FGF21 levels in adult m.3243A>G carriers: clinical implications. Neurology 2014; 83:125-33. [PMID: 24907231 DOI: 10.1212/wnl.0000000000000578] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To determine the value of fibroblast growth factor 21 (FGF21), a recently discovered biomarker for mitochondrial disease, in predicting clinical disease severity and disease progression in adult carriers of the m.3243A>G mutation. METHODS In the context of a national inventory, the heteroplasmy levels of the m.3243A>G mutation were measured in leukocytes and urinary epithelial cells. The Newcastle Mitochondrial Disease Adult Scale score was determined and blood was drawn for measuring FGF21 concentration. Twenty-five of the included initial patients studied were then selected randomly for a follow-up study. RESULTS This prognostic study included 99 adult carriers of the m.3243A>G mutation. Our analysis revealed a moderate, significant correlation between FGF21 concentration and disease severity (r = 0.49; p = <0.001). No significant correlations were found between disease severity and the heteroplasmy percentage determined in urinary epithelial cells or the heteroplasmy percentage determined in leukocytes. Weak but significant correlations were also found between FGF21 concentration and the severity of the myopathy (r = 0.38; p = <0.001) and between the concentration of FGF21 and the severity of the encephalopathy (r = 0.30; p = <0.001). Repeated measurements following 25 subjects for 2 years revealed no significant correlation between FGF21 concentration and disease progression. CONCLUSIONS Measuring FGF21 concentration had little added value in monitoring and predicting the disease course in this specific patient group.
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Affiliation(s)
- Saskia Koene
- From the Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Mitochondrial Disorders (S.K., P.d.L., R.J.T.R., M.C.H.J., J.A.M.S.), and Departments of Laboratory Medicine (D.H.v.T., A.M.B., F.C.G.J.S.), Radiology and Nuclear Medicine (D.V.), Health Evidence (A.R.T.D.), and General Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
| | - Paul de Laat
- From the Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Mitochondrial Disorders (S.K., P.d.L., R.J.T.R., M.C.H.J., J.A.M.S.), and Departments of Laboratory Medicine (D.H.v.T., A.M.B., F.C.G.J.S.), Radiology and Nuclear Medicine (D.V.), Health Evidence (A.R.T.D.), and General Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Doorlène H van Tienoven
- From the Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Mitochondrial Disorders (S.K., P.d.L., R.J.T.R., M.C.H.J., J.A.M.S.), and Departments of Laboratory Medicine (D.H.v.T., A.M.B., F.C.G.J.S.), Radiology and Nuclear Medicine (D.V.), Health Evidence (A.R.T.D.), and General Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Dennis Vriens
- From the Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Mitochondrial Disorders (S.K., P.d.L., R.J.T.R., M.C.H.J., J.A.M.S.), and Departments of Laboratory Medicine (D.H.v.T., A.M.B., F.C.G.J.S.), Radiology and Nuclear Medicine (D.V.), Health Evidence (A.R.T.D.), and General Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - André M Brandt
- From the Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Mitochondrial Disorders (S.K., P.d.L., R.J.T.R., M.C.H.J., J.A.M.S.), and Departments of Laboratory Medicine (D.H.v.T., A.M.B., F.C.G.J.S.), Radiology and Nuclear Medicine (D.V.), Health Evidence (A.R.T.D.), and General Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Fred C G J Sweep
- From the Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Mitochondrial Disorders (S.K., P.d.L., R.J.T.R., M.C.H.J., J.A.M.S.), and Departments of Laboratory Medicine (D.H.v.T., A.M.B., F.C.G.J.S.), Radiology and Nuclear Medicine (D.V.), Health Evidence (A.R.T.D.), and General Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Richard J T Rodenburg
- From the Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Mitochondrial Disorders (S.K., P.d.L., R.J.T.R., M.C.H.J., J.A.M.S.), and Departments of Laboratory Medicine (D.H.v.T., A.M.B., F.C.G.J.S.), Radiology and Nuclear Medicine (D.V.), Health Evidence (A.R.T.D.), and General Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - A Rogier T Donders
- From the Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Mitochondrial Disorders (S.K., P.d.L., R.J.T.R., M.C.H.J., J.A.M.S.), and Departments of Laboratory Medicine (D.H.v.T., A.M.B., F.C.G.J.S.), Radiology and Nuclear Medicine (D.V.), Health Evidence (A.R.T.D.), and General Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Mirian C H Janssen
- From the Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Mitochondrial Disorders (S.K., P.d.L., R.J.T.R., M.C.H.J., J.A.M.S.), and Departments of Laboratory Medicine (D.H.v.T., A.M.B., F.C.G.J.S.), Radiology and Nuclear Medicine (D.V.), Health Evidence (A.R.T.D.), and General Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Jan A M Smeitink
- From the Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Mitochondrial Disorders (S.K., P.d.L., R.J.T.R., M.C.H.J., J.A.M.S.), and Departments of Laboratory Medicine (D.H.v.T., A.M.B., F.C.G.J.S.), Radiology and Nuclear Medicine (D.V.), Health Evidence (A.R.T.D.), and General Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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de Brouwer SJM, van Middendorp H, Stormink C, Kraaimaat FW, Joosten I, Radstake TRDJ, de Jong EMGJ, Schalkwijk J, Donders ART, Eijsbouts A, van de Kerkhof PCM, van Riel PLCM, Evers AWM. Immune responses to stress in rheumatoid arthritis and psoriasis. Rheumatology (Oxford) 2014; 53:1844-8. [PMID: 24850878 DOI: 10.1093/rheumatology/keu221] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 11/13/2022] Open
Abstract
OBJECTIVE Stress is one of the factors that may exacerbate the progression of chronic inflammatory diseases such as RA and psoriasis. We exploratively compared the effects of acute stress on levels of circulating cytokines involved in disease progression and/or the stress response in patients with RA, patients with psoriasis and healthy subjects. METHODS Patients with RA, patients with psoriasis and healthy controls underwent a standardized psychosocial stress test (Trier Social Stress Test). Levels of circulating cytokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IFN-γ and TNF-α) were measured before and after the stress test. RESULTS The baseline levels of all cytokines, except IL-8, were significantly higher in patients with RA. After correction for baseline levels, patients with RA showed higher stress-induced levels of IL-1β and IL-2 than patients with psoriasis and healthy controls. CONCLUSION The results suggest that patients with RA have a different immune response to stress than patients with psoriasis or healthy controls. More needs to be learned about the complex interaction between stress, immune parameters and chronic inflammation.
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Affiliation(s)
- Sabine J M de Brouwer
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands. Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Henriët van Middendorp
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands. Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Claudia Stormink
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris W Kraaimaat
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Irma Joosten
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Timothy R D J Radstake
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elke M G J de Jong
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost Schalkwijk
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Rogier T Donders
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Agnes Eijsbouts
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter C M van de Kerkhof
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Piet L C M van Riel
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrea W M Evers
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands. Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Department of Dermatology, Radboud University Medical Center, Department for Health Evidence, Radboud University Medical Center, Department of Rheumatology, Sint Maartenskliniek and Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Lutomski JE, Donders ART, Melis RJF. Causal diagrams to better understand missingness. JAMA Pediatr 2014; 168:187. [PMID: 24492868 DOI: 10.1001/jamapediatrics.2013.3650] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jennifer E Lutomski
- Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - A Rogier T Donders
- Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - René J F Melis
- Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Schellekens MPJ, van den Hurk DGM, Prins JB, Molema J, Donders ART, Woertman WH, van der Drift MA, Speckens AEM. Study protocol of a randomized controlled trial comparing Mindfulness-Based Stress Reduction with treatment as usual in reducing psychological distress in patients with lung cancer and their partners: the MILON study. BMC Cancer 2014; 14:3. [PMID: 24386906 PMCID: PMC3893473 DOI: 10.1186/1471-2407-14-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 12/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death worldwide and characterized by a poor prognosis. It has a major impact on the psychological wellbeing of patients and their partners. Recently, it has been shown that Mindfulness-Based Stress Reduction (MBSR) is effective in reducing anxiety and depressive symptoms in cancer patients. The generalization of these results is limited since most participants were female patients with breast cancer. Moreover, only one study examined the effectiveness of MBSR in partners of cancer patients. Therefore, in the present trial we study the effectiveness of MBSR versus treatment as usual (TAU) in patients with lung cancer and their partners. METHODS/DESIGN A parallel group, randomized controlled trial is conducted to compare MBSR with TAU. Lung cancer patients who have received or are still under treatment, and their partners are recruited. Assessments will take place at baseline, post intervention and at three-month follow-up. The primary outcome is psychological distress (i.e. anxiety and depressive symptoms). Secondary outcomes are quality of life (only for patients), caregiver appraisal (only for partners), relationship quality and spirituality. In addition, cost-effectiveness ratio (only in patients) and several process variables are assessed. DISCUSSION This trial will provide information about the clinical and cost-effectiveness of MBSR compared to TAU in patients with lung cancer and their partners.
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Affiliation(s)
- Melanie P J Schellekens
- Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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D'Hauwers KWM, Gadet PFE, Donders ART, Tjalma WAA. Impact of medical education on knowledge and attitudes regarding the human papilloma virus and vaccination: comparison before and 6 years after the introduction of the vaccines. Vaccine 2013; 31:5843-7. [PMID: 24161571 DOI: 10.1016/j.vaccine.2013.09.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/26/2013] [Accepted: 09/30/2013] [Indexed: 11/20/2022]
Abstract
AIM The lifetime risk for acquiring a human papilloma virus (HPV) infection is 80% for sexually active people. High-risk HPVs are causally related to almost every case of cervical cancer, and to a subgroup of vaginal, vulvar, anal, penile and oral/oropharyngeal cancer. Low-risk HPVs are related to cutaneous, anogenital, and oral warts. Two prophylactic vaccines were launched in 2007: they were included in the national vaccination program in Belgium (2009) and in the Netherlands (2010). The objectives of the present study were to determine and compare knowledge and attitudes regarding HPV and vaccination among a study population in 2006 and in 2012. MATERIALS AND METHODS Shortly before the introduction, and three years after the inclusion, 715 (2006) and 678 participants (2012) were questioned. Participants were categorised as into non-medics, medics, or paramedics. RESULTS In general, knowledge about HPV has increased over time (p<0.01). Well-known facts are the relationship of HPV with cervical cancer (>94% in 2006; >96% in 2012), and that an HPV infection might be asymptomatic (>95% in 2006; >99% in 2012). In 2012, versus in 2006, paramedics and non-medics (both p<0.01), were more likely to vaccinate all female teenagers. Medics were less likely to support this (p=0.001). More respondents agreed to vaccinate their daughters (p<0.01), as well as their sons (p<0.01). In 2012, when compared with 2006, less non-medics and medics (both p<0.01) and more paramedics (p=0.001) would accept a free catch-up vaccination. Arguments against catch-up vaccination reflected the belief not being at risk and doubts about the vaccines' safety. CONCLUSION The facts that vaccination programs are regarded as being important, and that knowledge on HPV increased, do not automatically result in an increase in participation in HPV vaccination programs. To increase participation, information must be provided with arguments that cannot be misinterpreted.
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Affiliation(s)
- K W M D'Hauwers
- Radboud University Medical Center, Department of Urology, Route 659, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
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Evers AWM, Verhoeven EWM, van Middendorp H, Sweep FCGJ, Kraaimaat FW, Donders ART, Eijsbouts AE, van Laarhoven AIM, de Brouwer SJM, Wirken L, Radstake TRDJ, van Riel PLCM. Does stress affect the joints? Daily stressors, stress vulnerability, immune and HPA axis activity, and short-term disease and symptom fluctuations in rheumatoid arthritis. Ann Rheum Dis 2013; 73:1683-8. [DOI: 10.1136/annrheumdis-2012-203143] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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van Zaane B, Vergouwe Y, Donders ART, Moons KGM. Comparison of approaches to estimate confidence intervals of post-test probabilities of diagnostic test results in a nested case-control study. BMC Med Res Methodol 2012; 12:166. [PMID: 23114025 PMCID: PMC3536560 DOI: 10.1186/1471-2288-12-166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 10/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background Nested case–control studies become increasingly popular as they can be very efficient for quantifying the diagnostic accuracy of costly or invasive tests or (bio)markers. However, they do not allow for direct estimation of the test’s predictive values or post-test probabilities, let alone for their confidence intervals (CIs). Correct estimates of the predictive values itself can easily be obtained using a simple correction by the (inverse) sampling fractions of the cases and controls. But using this correction to estimate the corresponding standard error (SE), falsely increases the number of patients that are actually studied, yielding too small CIs. We compared different approaches for estimating the SE and thus CI of predictive values or post-test probabilities of diagnostic test results in a nested case–control study. Methods We created datasets based on a large, previously published diagnostic study on 2 different tests (D-dimer test and calf difference test) with a nested case–control design. We compared six different approaches; the approaches were: 1. the standard formula for the SE of a proportion, 2. adaptation of the standard formula with the sampling fraction, 3. A bootstrap procedure, 4. A approach, which uses the sensitivity, the specificity and the prevalence, 5. Weighted logistic regression, and 6. Approach 4 on the log odds scale. The approaches were compared with respect to coverage of the CI and CI-width. Results The bootstrap procedure (approach 3) showed good coverage and relatively small CI widths. Approaches 4 and 6 showed some undercoverage, particularly for the D-dimer test with frequent positive results (positive results around 70%). Approaches 1, 2 and 5 showed clear overcoverage at low prevalences of 0.05 and 0.1 in the cohorts for all case–control ratios. Conclusion The results from our study suggest that a bootstrap procedure is necessary to assess the confidence interval for the predictive values or post-test probabilities of diagnostic tests results in studies using a nested case–control design.
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Affiliation(s)
- Bas van Zaane
- Julius Center for Health Sciences and Primary Care And Division of Anesthesiology, Intensive Care Care and Emergency Medicine, University Medical Center Utrecht, PO box 85500, 3508 GA Utrecht, The Netherlands.
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Huijbers MJ, Spijker J, Donders ART, van Schaik DJF, van Oppen P, Ruhé HG, Blom MBJ, Nolen WA, Ormel J, van der Wilt GJ, Kuyken W, Spinhoven P, Speckens AEM. Preventing relapse in recurrent depression using mindfulness-based cognitive therapy, antidepressant medication or the combination: trial design and protocol of the MOMENT study. BMC Psychiatry 2012; 12:125. [PMID: 22925198 PMCID: PMC3469366 DOI: 10.1186/1471-244x-12-125] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 07/03/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Depression is a common psychiatric disorder characterized by a high rate of relapse and recurrence. The most commonly used strategy to prevent relapse/recurrence is maintenance treatment with antidepressant medication (mADM). Recently, it has been shown that Mindfulness-Based Cognitive Therapy (MBCT) is at least as effective as mADM in reducing the relapse/recurrence risk. However, it is not yet known whether combination treatment of MBCT and mADM is more effective than either of these treatments alone. Given the fact that most patients have a preference for either mADM or for MBCT, the aim of the present study is to answer the following questions. First, what is the effectiveness of MBCT in addition to mADM? Second, how large is the risk of relapse/recurrence in patients withdrawing from mADM after participating in MBCT, compared to those who continue to use mADM after MBCT? METHODS/DESIGN Two parallel-group, multi-center randomized controlled trials are conducted. Adult patients with a history of depression (3 or more episodes), currently either in full or partial remission and currently treated with mADM (6 months or longer) are recruited. In the first trial, we compare mADM on its own with mADM plus MBCT. In the second trial, we compare MBCT on its own, including tapering of mADM, with mADM plus MBCT. Follow-up assessments are administered at 3-month intervals for 15 months. Primary outcome is relapse/recurrence. Secondary outcomes are time to, duration and severity of relapse/recurrence, quality of life, personality, several process variables, and incremental cost-effectiveness ratio. DISCUSSION Taking into account patient preferences, this study will provide information about a) the clinical and cost-effectiveness of mADM only compared with mADM plus MBCT, in patients with a preference for mADM, and b) the clinical and cost-effectiveness of withdrawing from mADM after MBCT, compared with mADM plus MBCT, in patients with a preference for MBCT. TRIAL REGISTRATION ClinicalTrials.gov: NCT00928980.
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Affiliation(s)
- Marloes J Huijbers
- Department of Psychiatry, Radboud University Nijmegen Medical Center, Reinier Postlaan 10, Nijmegen 6525 GC, The Netherlands.
| | - Jan Spijker
- Pro Persona Ede, Willy Brandtlaan 20, Ede 6716 RR, The Netherlands
| | - A Rogier T Donders
- Department of Epidemiology, Biostatistics, and Health Technology Assessment, Radboud University Nijmegen Medical Center, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands
| | - Digna JF van Schaik
- GGZ inGeest, partner VU University Medical Center, A.J. Ernststraat 1187, Amsterdam 1081 HL, The Netherlands
| | - Patricia van Oppen
- GGZ inGeest, partner VU University Medical Center, A.J. Ernststraat 1187, Amsterdam 1081 HL, The Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands
| | - Marc B J Blom
- Parnassia Bavo Psychiatric Institute, Lijnbaan 4, The Hague, 2512 VA, The Netherlands
| | - Willem A Nolen
- Department of Psychiatry, University Medical Center Groningen, Groningen University, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
| | - Johan Ormel
- Department of Psychiatry, University Medical Center Groningen, Groningen University, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
| | - Gert Jan van der Wilt
- Department of Epidemiology, Biostatistics, and Health Technology Assessment, Radboud University Nijmegen Medical Center, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands
| | - Willem Kuyken
- Mood Disorders Centre, School of Psychology, University of Exeter, The Queen's Drive Exeter, Devon, EX4 4QJ, UK
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Wassenaarseweg 52, AK Leiden 2333, The Netherlands
| | - Anne E M Speckens
- Department of Psychiatry, Radboud University Nijmegen Medical Center, Reinier Postlaan 10, Nijmegen 6525 GC, The Netherlands
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D'Hauwers KWM, Cornelissen T, Depuydt CE, Bogers J, Donders ART, Leuridan E, Van Damme P, Tjalma WAA. Anal human papillomavirus DNA in women at a colposcopy clinic. Eur J Obstet Gynecol Reprod Biol 2012; 164:69-73. [PMID: 22677508 DOI: 10.1016/j.ejogrb.2012.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 02/19/2012] [Accepted: 05/06/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To describe the type-specific prevalence of anal and cervical human papillomavirus (HPV) infections and the cytology in HIV-negative women without a history of cervical cancer, attending a colposcopy clinic. To examine if an HPV positive anal smear is related to anal pathology and consequently indicative for further examinations (high resolution anoscopy, anal biopsy). STUDY DESIGN From 149 consecutive women an anal swab and a cervical swab were taken, using the Cervex-Brush. The presence of 18 different HPV genotypes was determined using TaqMan-based real-time quantitative PCR targeting type-specific sequences of viral genes. From the fluid containing the cellular material, a liquid-based cytology sample was prepared of both collections with the robotic BD PrepStain Slide Processor. All slides were pre-screened by BD FocalPoint system and categorized from quintiles 1 to 5 and afterwards screened using targeted microscopic interpretation of selected suspicious fields using FocalPoint guided screening review stations. The 2001 Bethesda System Terminology was used for the anal slides. RESULTS Ninety-six anal samples and all 149 cervical samples were adequate. Overall presence of HPV in the anus was 56.3% and in the cervix 53.7%. Overall, cytological abnormalities were found in 10.8% of anal smears and in 32.8% of cervical smears. HPV genotypes were identified in 47 samples on both sites: partial or complete concordance was found in 85.1%. HPV types 6, 16 and 18 were found in 27.9% and in 26.6% of the anal and cervical samples, respectively. The top three HPV types in the anus were 16, 51 and 39; in the cervix 16, 39, 51 and 56 (a shared 3(rd) place). HPV type 11 was not found. CONCLUSIONS The presence of HPV genotypes is clearly multifocal in this study population of women attending a colposcopy clinic, with high concordance of genotypes. The number of anal HPV infections is high. Although cytological abnormalities are rare, the presence of HPV may lead to anal lesions later in life. From this perspective, complementary medical history and clinical examination of the anal region are advised.
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Affiliation(s)
- Kathleen W M D'Hauwers
- Radboud University Nijmegen, Medical Centre, Dept. of Urology, Geert Grooteplein Zuid 10, Internal Route 659, 6525 GA Nijmegen, The Netherlands.
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van Rijnsoever FJ, Meeus MT, Donders ART. The effects of economic status and recent experience on innovative behavior under environmental variability: An experimental approach. Research Policy 2012. [DOI: 10.1016/j.respol.2012.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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van Aalderen JR, Donders ART, Giommi F, Spinhoven P, Barendregt HP, Speckens AEM. The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled trial. Psychol Med 2012; 42:989-1001. [PMID: 22017808 DOI: 10.1017/s0033291711002054] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The aim of this study is to examine the efficacy of mindfulness-based cognitive therapy (MBCT) in addition to treatment as usual (TAU) for recurrent depressive patients with and without a current depressive episode. METHOD A randomized, controlled trial comparing MBCT+TAU (n=102) with TAU alone (n=103). The study population consisted of patients with three or more previous depressive episodes. Primary outcome measure was post-treatment depressive symptoms according to the Hamilton Rating Scale for Depression. Secondary outcome measures included the Beck Depression Inventory, rumination, worry and mindfulness skills. Group comparisons were carried out with linear mixed modelling, controlling for intra-group correlations. Additional mediation analyses were performed. Comparisons were made between patients with and without a current depressive episode. RESULTS Patients in the MBCT+TAU group reported less depressive symptoms, worry and rumination and increased levels of mindfulness skills compared with patients receiving TAU alone. MBCT resulted in a comparable reduction of depressive symptoms for patients with and without a current depressive episode. Additional analyses suggest that the reduction of depressive symptoms was mediated by decreased levels of rumination and worry. CONCLUSIONS The study findings suggest that MBCT is as effective for patients with recurrent depression who are currently depressed as for patients who are in remission. Directions towards a better understanding of the mechanisms of action of MBCT are given, although future research is needed to support these hypotheses.
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Affiliation(s)
- J R van Aalderen
- Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Groenwold RHH, White IR, Donders ART, Carpenter JR, Altman DG, Moons KGM. Missing covariate data in clinical research: when and when not to use the missing-indicator method for analysis. CMAJ 2012; 184:1265-9. [PMID: 22371511 DOI: 10.1503/cmaj.110977] [Citation(s) in RCA: 235] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
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Groenwold RHH, Donders ART, Roes KCB, Harrell FE, Moons KGM. Dealing with missing outcome data in randomized trials and observational studies. Am J Epidemiol 2012; 175:210-7. [PMID: 22262640 DOI: 10.1093/aje/kwr302] [Citation(s) in RCA: 274] [Impact Index Per Article: 22.8] [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: 11/14/2022] Open
Abstract
Although missing outcome data are an important problem in randomized trials and observational studies, methods to address this issue can be difficult to apply. Using simulated data, the authors compared 3 methods to handle missing outcome data: 1) complete case analysis; 2) single imputation; and 3) multiple imputation (all 3 with and without covariate adjustment). Simulated scenarios focused on continuous or dichotomous missing outcome data from randomized trials or observational studies. When outcomes were missing at random, single and multiple imputations yielded unbiased estimates after covariate adjustment. Estimates obtained by complete case analysis with covariate adjustment were unbiased as well, with coverage close to 95%. When outcome data were missing not at random, all methods gave biased estimates, but handling missing outcome data by means of 1 of the 3 methods reduced bias compared with a complete case analysis without covariate adjustment. Complete case analysis with covariate adjustment and multiple imputation yield similar estimates in the event of missing outcome data, as long as the same predictors of missingness are included. Hence, complete case analysis with covariate adjustment can and should be used as the analysis of choice more often. Multiple imputation, in addition, can accommodate the missing-not-at-random scenario more flexibly, making it especially suited for sensitivity analyses.
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Affiliation(s)
- Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
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Blom M, Kievit W, Donders ART, den Broeder AA, Straten VHHP, Kuper I, Visser H, Jansen TL, Brus HLM, Branten AJW, van de Laar MAFJ, van Riel PLCM. Effectiveness of a third tumor necrosis factor-α-blocking agent compared with rituximab after failure of 2 TNF-blocking agents in rheumatoid arthritis. J Rheumatol 2011; 38:2355-61. [PMID: 21885487 DOI: 10.3899/jrheum.101324] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To compare the effectiveness of a third tumor necrosis factor-α (TNF-α)-blocking agent with rituximab after failure of 2 TNF-blocking agents in patients with rheumatoid arthritis (RA) in daily clinical practice. METHODS Patients receiving a third TNF-blocking agent or rituximab after failure of 2 TNF-blocking agents were selected from a Dutch biologic registry. The primary outcome was the results from the Disease Activity Score of 28 joints (DAS28) over the first 12 months after start of the third biologic using mixed-model analyses. Secondary outcomes included the course of the Health Assessment Questionnaire (HAQ) and the separate components of the DAS28 over the first 12 months and the change from baseline in DAS28 and HAQ at 3 and 6 months. RESULTS The overall course of the DAS28 over the first 12 months was significantly better for rituximab (p = 0.0044), as also observed for the HAQ, although the latter results were not statistically significant (p = 0.0537). The erythrocyte sedimentation rates, C-reactive protein, and swollen joint counts showed a better course for rituximab (p = 0.0008, p = 0.0287, p = 0.0547, respectively), but not the tender joint counts or visual analog scale for general health. DAS28 decreased significantly in both groups at 3 and 6 months (p ≤ 0.024), but the change in HAQ was significant for rituximab only at 3 months (p = 0.009). CONCLUSION During the first 12 months of therapy, a larger improvement in disease activity and a trend toward a larger decrease in functional disability was observed in patients receiving rituximab. Switching to a biologic with another mechanism of action might be more effective after failure of 2 TNF-blocking agents in RA.
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Affiliation(s)
- Marlies Blom
- Department of Rheumatology, Radboud University Nijmegen Medical Centre, HB Nijmegen, The Netherlands.
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van Koulil S, Kraaimaat FW, van Lankveld W, van Helmond T, Vedder A, van Hoorn H, Donders ART, Thieme K, Cats H, van Riel PLCM, Evers AWM. Cognitive-behavioral mechanisms in a pain-avoidance and a pain-persistence treatment for high-risk fibromyalgia patients. Arthritis Care Res (Hoboken) 2011; 63:800-7. [PMID: 21312345 DOI: 10.1002/acr.20445] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The heterogeneity of cognitive-behavioral patterns in patients with fibromyalgia (FM) has been proposed to underlie the variability in treatment outcomes. It has previously been shown that pain-avoidance and pain-persistence treatments tailored to the patient's pattern are effective in improving physical and psychological functioning and overall impact in high-risk patients with heightened psychological distress. In the present study, the cognitive-behavioral effects of these treatments were evaluated to provide insight into the main proposed mechanisms, specifically pain-avoidance behaviors and activity pacing in the pain-avoidance and pain-persistence treatments, respectively. METHODS High-risk FM patients were classified into 2 groups, pain avoidance and pain persistence, and randomized in groups to the relevant treatment or waiting-list control condition. The pain-avoidance and pain-persistence treatments both comprised 16 twice-weekly sessions of cognitive-behavioral therapy and exercise training. Cognitive--behavioral factors assessed at pre- and posttreatment and 6 months of followup were evaluated using linear mixed models. RESULTS A significant treatment effect was found for pain-avoidance behavior in the pain-avoidance treatment and for activity pacing in the pain-persistence treatment, showing improvements in the treatment condition relative to the controls. Furthermore, the effect on functioning was mediated by changes in pain-avoidance behavior in the pain-avoidance treatment and by changes in activity pacing in the pain-persistence treatment. Both treatments also showed significant improvements in other relevant cognitive-behavioral factors. CONCLUSION Both the pain-avoidance and pain-persistence treatments are effective in improving cognitive-behavioral factors in high-risk FM patients. Pain-avoidance behavior and activity pacing might be important mediating mechanisms for beneficial outcomes in pain-avoidance and pain-persistence treatments, respectively.
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Affiliation(s)
- S van Koulil
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Oostendorp LJM, Stalmeier PFM, Donders ART, van der Graaf WTA, Ottevanger PB. Efficacy and safety of palliative chemotherapy for patients with advanced breast cancer pretreated with anthracyclines and taxanes: a systematic review. Lancet Oncol 2011; 12:1053-61. [PMID: 21621462 DOI: 10.1016/s1470-2045(11)70045-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
No standard monotherapy or combination palliative chemotherapy currently exists for patients with advanced breast cancer pretreated with anthracyclines and taxanes. In this systematic review we assess the current knowledge on the efficacy and safety of palliative single-agent chemotherapy drugs--capecitabine, vinorelbine, gemcitabine, and liposomal doxorubicin--commonly used in daily clinical practice. We identified 22 studies, of which ten investigated capecitabine, nine investigated vinorelbine, three investigated gemcitabine, and one investigated liposomal doxorubicin. The greatest amount of information was available for capecitabine and vinorelbine. These two drugs showed good efficacy. The disease control rate differed significantly between the four drugs, which is relevant in terms of how well tumour symptoms can be improved and whether quality of life can be maintained or even improved. To obtain more evidence of the efficacy and safety of chemotherapeutic agents used in this pretreated population of advanced breast cancer patients, randomised comparisons of the various drugs, as monotherapy and in combination with targeted agents, are needed.
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Affiliation(s)
- Linda J M Oostendorp
- Department of Epidemiology, Biostatistics, HTA, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
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