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Rietkerk W, Gerritsen DL, Kollen BJ, Hofman CS, Wynia K, Slaets JPJ, Zuidema SU. Effects Of Increasing The Involvement Of Community-Dwelling Frail Older Adults In A Proactive Assessment Service: A Pragmatic Trial. Clin Interv Aging 2019; 14:1985-1995. [PMID: 31814713 PMCID: PMC6858288 DOI: 10.2147/cia.s206100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Older adults and care professionals advocate a more integrated and proactive care approach. This can be achieved by proactive outpatient assessment services that offer comprehensive geriatric assessments to better understand the needs of older adults and deliver person-centered and preventive care. However, the effects of these services are inconsistent. Increased involvement of the older adult during the assessment service could increase the effects on older adult's well-being. METHODS We studied the effect of an assessment service (Sage-atAge) for community-dwelling frail adults aged ≥65 years. After studying the local experiences, this service was adapted with the aim to increase participant involvement through individual goal setting and using motivational interviewing techniques by health-care professionals (Sage-atAge+). Within Sage-atAge+, when finishing the assessment, a "goal card" was written together with the older adult: a summary of the assessment, including goals and recommendations. We measured well-being with a composite endpoint consisting of health, psychological, quality of life, and social components. With regression analysis, we compared the effects of the Sage-atAge and Sage-atAge+ services on the well-being of participants. RESULTS In total, 453 older adults were eligible for analysis with a mean age of 77 (± 7.0) years of whom 62% were women. We found no significant difference in the change in well-being scores between the Sage-atAge+ service and the original Sage-atAge service (B, 0.037; 95% CI, -0.188 to 0.263). Also, no change in well-being scores was found even when selecting only those participants for the Sage-atAge+ group who received a goal card. CONCLUSION Efforts to increase the involvement of older adults through motivational interviewing and goal setting showed no additional effect on well-being. Further research is needed to explore the relationship between increased participant involvement and well-being to further develop person-centered care for older adults.
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Affiliation(s)
- W Rietkerk
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - DL Gerritsen
- Department of Primary and Community Care and Radboud Alzheimer Centre, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - BJ Kollen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - CS Hofman
- Department of Innovation and Research, Vilans, Centre of Expertise on Long-Term Care, Utrecht, the Netherlands
| | - K Wynia
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - JPJ Slaets
- Faculty of Medical Sciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Leyden Academy On Vitality And Ageing, Leiden, the Netherlands
| | - SU Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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2
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Nitsche C, Westerlaken-van Ginkel CD, Kollen BJ, Sprikkelman AB, Koppelman GH, Dubois AEJ. Eliciting dose is associated with tolerance development in peanut and cow's milk allergic children. Clin Transl Allergy 2019; 9:58. [PMID: 31709035 PMCID: PMC6833210 DOI: 10.1186/s13601-019-0298-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/23/2019] [Indexed: 11/11/2022] Open
Abstract
Background Tolerance development rates differ between food allergies. Almost all previous studies have not used the gold standard method, the double-blind, placebo-controlled food challenge (DBPCFC), which may affect the reported prevalence rates. Little is known about the association of the eliciting dose (ED) obtained during the initial DBPCFC with later tolerance development. Methods This was a retrospective, tertiary care study of children who had a positive DBPCFC to either peanut, milk or egg, and at least one follow-up food challenge (open or DBPCFC) with the same food. The association between ED and negative (tolerant) follow-up food challenge outcome was analyzed by logistic regression, with adjustment for confounders. Suspected confounders were initial DBPCFC test characteristics, atopic comorbidities and serum specific IgE (sIgE) levels. Results In 47 peanut allergic children, tolerance developed in 27.7% (median follow-up duration of 43 months). In 80 milk (follow-up 23 months) and 55 egg (follow-up 37 months) allergic children, tolerance developed in 55.0% and 65.5%. The ED obtained during the initial DBPCFC was significantly associated with tolerance development in peanut and milk allergy, but not in egg allergy. Conclusion Approximately 1 out of 4 children with DBPCFC confirmed peanut allergy developed tolerance, compared to more than half of the children with milk or egg allergy, respectively. Tolerance development in peanut and milk allergy is significantly associated with ED at initial DBPCFC.
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Affiliation(s)
- C Nitsche
- 1University of Oldenburg, Oldenburg, Germany.,Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, CA43, PO BOX 30.001, 9700 RB Groningen, The Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C D Westerlaken-van Ginkel
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, CA43, PO BOX 30.001, 9700 RB Groningen, The Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B J Kollen
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A B Sprikkelman
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, CA43, PO BOX 30.001, 9700 RB Groningen, The Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, CA43, PO BOX 30.001, 9700 RB Groningen, The Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, CA43, PO BOX 30.001, 9700 RB Groningen, The Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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3
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Alma HJ, de Jong C, Jelusic D, Wittmann M, Schuler M, Kollen BJ, Sanderman R, Schultz K, Kocks JWH, Van der Molen T. Assessing health status over time: impact of recall period and anchor question on the minimal clinically important difference of copd health status tools. Health Qual Life Outcomes 2018; 16:130. [PMID: 29940980 PMCID: PMC6019834 DOI: 10.1186/s12955-018-0950-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/30/2018] [Indexed: 12/17/2022] Open
Abstract
Background The Minimal Clinically Important Difference (MCID) assesses what change on a measurement tool can be considered minimal clinically relevant. Although the recall period can influence questionnaire scores, it is unclear if it influences the MCID. This study is the first to examine longitudinally the impact of the recall period of an anchor question and its design on the MCID of COPD health status tools using the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and the St. George’s Respiratory Questionnaire (SGRQ). Methods Moderate to very severe COPD patients without respiratory co-morbidities were recruited during 3-week Pulmonary Rehabilitation (PR). CAT, CCQ and SGRQ were completed at baseline, discharge, 3, 6, 9 and 12 months. A 15-point Global Rating of Change scale (GRC) was completed at each follow-up. A five-point GRC was used as second anchor at 12 months. Mean change scores of a subset of patients indicating a minimal improvement on each of the anchor questions were considered the MCID. The MCID estimates over different time periods were compared with one another by evaluating the degree of overlap of Confidence Intervals (CI) adjusted for dependency. Results In total 451 patients were included (57.9 ± 6.6 years, 65% male, 50/39/11% GOLD II/III/IV), of which 309 completed follow-up. Baseline health status scores were 20.2 ± 7.3 (CAT), 2.9 ± 1.2 (CCQ) and 50.7 ± 17.3 (SGRQ). MCID estimates for improvement ranged − 3.1 to − 1.4 for CAT, − 0.6 to − 0.3 for CCQ, and − 10.3 to − 7.6 for SGRQ. Absolute higher – though not significant – MCIDs were observed for CAT and CCQ directly after PR. Significantly absolute lower MCID estimates were observed for CAT (difference − 1.4: CI -2.3 to − 0.5) and CCQ (difference − 0.2: CI -0.3 to −0.1) using a five-point GRC. Conclusions The recall period of a 15-point anchor question seemed to have limited impact on the MCID for improvement of CAT, CCQ and SGRQ during PR; although a 3-week MCID estimate directly after PR might lead to absolute higher values. However, the design of the anchor question was likely to influence the MCID of CAT and CCQ. Trial registration RIMTCORE trial #DRKS00004609 and #12107 (Ethik-Kommission der Bayerischen Landesärztekammer). Electronic supplementary material The online version of this article (10.1186/s12955-018-0950-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H J Alma
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands. .,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.
| | - C de Jong
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - D Jelusic
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - M Wittmann
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - M Schuler
- University of Wuerzburg, Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Wuerzburg, Germany
| | - B J Kollen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands
| | - R Sanderman
- University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands.,University of Twente, Department of Psychology, Health and Technology, Enschede, The Netherlands
| | - K Schultz
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - J W H Kocks
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - T Van der Molen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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4
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Saleh-Langenberg J, de Vries S, Bak E, Kollen BJ, Flokstra-de Blok BMJ, Dubois AEJ. Incomplete and incorrect epinephrine auto-injector training to food-allergic patients by pharmacists in the Netherlands. Pediatr Allergy Immunol 2017; 28:238-244. [PMID: 27992679 DOI: 10.1111/pai.12688] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Successful treatment of anaphylaxis in the community relies on early and correct use of epinephrine auto-injectors (EAI). In the Netherlands, pharmacists supply EAIs to patients and have a crucial role in instructing patients in how and when to use EAI. However, there are currently no data in Europe on the quality of such instruction provided by pharmacists. Therefore, the aims of this study were to investigate the knowledge, attitudes, and beliefs regarding food allergy among pharmacists in the Netherlands and to investigate the quality of EAI instructions and demonstrations to patients by pharmacists. METHODS Pharmacists were asked to complete an online questionnaire. Quality of instructions and demonstration accuracy were assessed in mystery guest visits to randomly selected pharmacies. For the statistical analysis, descriptive methods were used. RESULTS In total, 25 of 115 questionnaires were completed. Only two (8%) respondents gave correct answers concerning the proper EAI demonstration. Twenty-one (84%) respondents thought that the provision of instructions was the responsibility of pharmacists. In total, ten pharmacies were included in simulated patient visits. Five of them (50%) demonstrated the EAI. None of them demonstrated the EAI use correctly. CONCLUSION Food-allergic patients at high risk for anaphylaxis who receive their EAI from a community pharmacy are often not instructed on how to use an EAI or receive incorrect instructions. Pharmacists show considerable gaps in knowledge about food allergy and its management. These data suggest that opportunities exist to improve the quality of care provided by pharmacies to high-risk food-allergic patients.
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Affiliation(s)
- J Saleh-Langenberg
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - S de Vries
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - E Bak
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B J Kollen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B M J Flokstra-de Blok
- GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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5
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Kocks JWH, Blom CMG, Kasteleyn MJ, Oosterom W, Kollen BJ, Van der Molen T, Chavannes NH. Feasibility and applicability of the paper and electronic COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ) in primary care: a clinimetric study. NPJ Prim Care Respir Med 2017; 27:20. [PMID: 28352087 PMCID: PMC5434785 DOI: 10.1038/s41533-017-0023-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/03/2017] [Accepted: 02/27/2017] [Indexed: 11/19/2022] Open
Abstract
Three questionnaires are recommended in the management of chronic obstructive pulmonary disease by the global initiative for obstructive lung disease, of which two are the more comprehensive assessments: the chronic obstructive pulmonary disease assessment test and the clinical chronic obstructive pulmonary disease questionnaire. Both are carefully designed high-quality questionnaires, but information on the feasibility for routine use is scarce. The aim of this study was to compare the time to complete the chronic obstructive pulmonary disease assessment test and the clinical chronic obstructive pulmonary disease questionnaire and the acceptability of the questionnaires. Furthermore, the agreement between electronic and paper versions of the questionnaires was explored. The time to complete the electronic versions of the questionnaires was 99.6 [IQR 74; 157] vs. 97.5 [IQR 68; 136] seconds for clinical clinical chronic obstructive pulmonary disease questionnaire and chronic obstructive pulmonary disease assessment test, respectively. The difference in time to complete the questionnaire was not significant. The two questionnaires did not differ in “easiness to complete” or “importance of issues raised in questionnaires”. Electronic vs. paper versions revealed high agreement (ICC CCQ = 0.815 [0.712; 0.883] and ICC CAT = 0.751 [0.608; 0.847]) between the administration methods. Based on this study it can be concluded that both questionnaires are equally suitable for use in routine clinical practice, because they are both quick to complete and have a good acceptability by the patient. Agreement between electronic and paper versions of the questionnaires was high, so use of electronic versions is justified. Two questionnaires commonly used to manage chronic obstructive pulmonary diseases (COPD) are equally suitable for routine primary care. Researchers in The Netherlands, led by Janwillem Kocks from the University Medical Center Groningen, administered both the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ) to 95 patients with the lung disease. These two tests are the most comprehensive assessments recommended by the global initiative for obstructive lung disease for guiding treatment decisions. The researchers found that both tests took approximately 95–100 s on average. Both tests were also equally easy to complete and provided similar types of information. Most patients said they had no preference for either one, and they filled out both electronic and paper versions of the questionnaires in much the same way. The authors conclude that both tests seem fine for routine use.
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Affiliation(s)
- J W H Kocks
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - C M G Blom
- Zorgdraad Foundation, Oosterbeek, The Netherlands
| | - M J Kasteleyn
- Department of Public Health and Primary Care LUMC Leiden, Leiden, The Netherlands.,Department of Pulmonology, LUMC Leiden, Leiden, The Netherlands
| | - W Oosterom
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B J Kollen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T Van der Molen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - N H Chavannes
- Department of Public Health and Primary Care LUMC Leiden, Leiden, The Netherlands
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6
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Perton FT, Mijnhout GS, Kollen BJ, Rondeel JMM, Franken AAM, Groeneveld PHP. Validation of the 1 μg short synacthen test: an assessment of morning cortisol cut-off values and other predictors. Neth J Med 2017; 75:14-20. [PMID: 28124663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Clinical practice shows that many low-dose short synacthen tests (LD-SSTs) for diagnosing adrenal insufficiency in an outpatient setting have a normal outcome and could be considered superfluous. The objective of this study is to provide a guideline to safely reduce the number of unnecessarily performed LD-SSTs. METHODS Data of LD-SSTs performed in outpatients were collected. Optimal morning cortisol cut-off values were determined using ROC analysis. Subsequently the predictive value of several variables was tested using univariable and multivariable logistic regression analyses. RESULTS A morning cortisol lower cut-off value of 145 nmol/l (specificity 89.9%, positive predictive value 90.0%) and an upper cut-off value of 375 nmol/l (sensitivity 100.0%, negative predictive value 100.0%) were found. Chronic fatigue symptoms and symptoms of hypotension or orthostasis as the main reason for performing the test predict a normal outcome. The use of glucocorticosteroids predicts an abnormal outcome of the LD-SST. Oral, topical, nasal and inhaled glucocorticosteroids are each significant predictors when analysed specifically for predicting central adrenal insufficiency. CONCLUSION By using morning cortisol cut-off values of 145 nmol/l and 375 nmol/l instead of the conventional cut-off values, the number of LD-SSTs performed in an outpatient setting can be reduced by 12%, while maintaining high sensitivity and specificity. Furthermore, the outcome of the LD-SST can be predicted by additional variables such as the indication for performing the test and the use of glucocorticosteroids. Different routes of administration of glucocorticosteroids such as inhalation or topical use should be taken into account when central insufficiency is suspected.
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Affiliation(s)
- F T Perton
- Department of Internal Medicine, Isala, Zwolle, the Netherlands
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7
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Saleh-Langenberg J, Bootsma GM, van Ginkel CD, Kollen BJ, Flokstra-de Blok BMJ, Dubois AEJ. The prevalence of food allergy and epinephrine auto-injectors in Dutch food-allergic adolescents. Pediatr Allergy Immunol 2016; 27:755-759. [PMID: 27378275 DOI: 10.1111/pai.12611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/29/2022]
Affiliation(s)
- J Saleh-Langenberg
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. .,GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - G M Bootsma
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - C D van Ginkel
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B J Kollen
- GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B M J Flokstra-de Blok
- GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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8
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Groenewoud ER, Cohlen BJ, Al-Oraiby A, Brinkhuis EA, Broekmans FJM, de Bruin JP, van den Dool G, Fleisher K, Friederich J, Goddijn M, Hoek A, Hoozemans DA, Kaaijk EM, Koks CAM, Laven JSE, van der Linden PJQ, Manger AP, Slappendel E, Spinder T, Kollen BJ, Macklon NS. A randomized controlled, non-inferiority trial of modified natural versus artificial cycle for cryo-thawed embryo transfer. Hum Reprod 2016; 31:1483-92. [PMID: 27179265 PMCID: PMC5853593 DOI: 10.1093/humrep/dew120] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [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: 01/19/2016] [Revised: 03/24/2016] [Accepted: 04/26/2016] [Indexed: 12/23/2022] Open
Abstract
STUDY QUESTION Are live birth rates (LBRs) after artificial cycle frozen-thawed embryo transfer (AC-FET) non-inferior to LBRs after modified natural cycle frozen-thawed embryo transfer (mNC-FET)? SUMMARY ANSWER AC-FET is non-inferior to mNC-FET with regard to LBRs, clinical and ongoing pregnancy rates (OPRs) but AC-FET does result in higher cancellation rates. WHAT IS ALREADY KNOWN Pooling prior retrospective studies of AC-FET and mNC-FET results in comparable pregnancy and LBRs. However, these results have not yet been confirmed by a prospective randomized trial. STUDY DESIGN, SIZE AND DURATION In this non-inferiority prospective randomized controlled trial (acronym 'ANTARCTICA' trial), conducted from February 2009 to April 2014, 1032 patients were included of which 959 were available for analysis. The primary outcome of the study was live birth. Secondary outcomes were clinical and ongoing pregnancy, cycle cancellation and endometrium thickness. A cost-efficiency analysis was performed. PARTICIPANT/MATERIALS, SETTING, METHODS This study was conducted in both secondary and tertiary fertility centres in the Netherlands. Patients included in this study had to be 18-40 years old, had to have a regular menstruation cycle between 26 and 35 days and frozen-thawed embryos to be transferred had to derive from one of the first three IVF or IVF-ICSI treatment cycles. Patients with a uterine anomaly, a contraindication for one of the prescribed medications in this study or patients undergoing a donor gamete procedure were excluded from participation. Patients were randomized based on a 1:1 allocation to either one cycle of mNC-FET or AC-FET. All embryos were cryopreserved using a slow-freeze technique. MAIN RESULTS AND THE ROLE OF CHANCE LBR after mNC-FET was 11.5% (57/495) versus 8.8% in AC-FET (41/464) resulting in an absolute difference in LBR of -0.027 in favour of mNC-FET (95% confidence interval (CI) -0.065-0.012; P = 0.171). Clinical pregnancy occurred in 94/495 (19.0%) patients in mNC-FET versus 75/464 (16.0%) patients in AC-FET (odds ratio (OR) 0.8, 95% CI 0.6-1.1, P = 0.25). 57/495 (11.5%) mNC-FET resulted in ongoing pregnancy versus 45/464 (9.6%) AC-FET (OR 0.7, 95% CI 0.5-1.1, P = 0.15). χ(2) test confirmed the lack of superiority. Significantly more cycles were cancelled in AC-FET (124/464 versus 101/495, OR 1.4, 95% CI 1.1-1.9, P = 0.02). The costs of each of the endometrial preparation methods were comparable (€617.50 per cycle in NC-FET versus €625.73 per cycle in AC-FET, P = 0.54). LIMITATIONS, REASONS FOR CAUTION The minimum of 1150 patients required for adequate statistical power was not achieved. Moreover, LBRs were lower than anticipated in the sample size calculation. WIDER IMPLICATIONS OF THE FINDINGS LBRs after AC-FET were not inferior to those achieved by mNC-FET. No significant differences in clinical and OPR were observed. The costs of both treatment approaches were comparable. STUDY FUNDING/COMPETING INTERESTS An educational grant was received during the conduct of this study. Merck Sharpe Dohme had no influence on the design, execution and analyses of this study. E.R.G. received an education grant by Merck Sharpe Dohme (MSD) during the conduct of the present study. B.J.C. reports grants from MSD during the conduct of the study. A.H. reports grants from MSD and Ferring BV the Netherlands and personal fees from MSD. Grants from ZonMW, the Dutch Organization for Health Research and Development. J.S.E.L. reports grants from Ferring, MSD, Organon, Merck Serono and Schering-Plough during the conduct of the study. F.J.M.B. receives monetary compensation as member of the external advisory board for Merck Serono, consultancy work for Gedeon Richter, educational activities for Ferring BV, research cooperation with Ansh Labs and a strategic cooperation with Roche on automated anti Mullerian hormone assay development. N.S.M. reports receiving monetary compensations for external advisory and speaking work for Ferring BV, MSD, Anecova and Merck Serono during the conduct of the study. All reported competing interests are outside the submitted work. No other relationships or activities that could appear to have influenced the submitted work. TRIAL REGISTRATION NUMBER Netherlands trial register, number NTR 1586. TRIAL REGISTRATION DATE 13 January 2009. FIRST PATIENT INCLUDED 20 April 2009.
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Affiliation(s)
- E R Groenewoud
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, PO Box 888, 8901 HR Leeuwarden, The Netherlands
| | - B J Cohlen
- Isala Fertility Centre, Isala Clinics, PO Box 10400, 8000 GK Zwolle, The Netherlands
| | - A Al-Oraiby
- Department of Obstetrics and Gynaecology, Amphia Hospital, PO Box 90157, 4800 RL Breda, The Netherlands
| | - E A Brinkhuis
- Department of Obstetrics and Gynecology, Meander Medical Center, Postbus 1502, 3800 BM Amersfoort, The Netherlands
| | - F J M Broekmans
- Department for Reproductive Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - J P de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, PO Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands
| | - G van den Dool
- Department of Obstetrics and Gynaecology, Albert Schweitzer Hospital, PO Box 444, 3300 AK Dordrecht, The Netherlands
| | - K Fleisher
- Department of Obstetrics and Gynecology, University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - J Friederich
- Department of Obstetrics and Gynecology, Noordwest Ziekenhuisgroep, PO Box 750, 1782 GZ Den Helder, The Netherlands
| | - M Goddijn
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22600, 1100 DD Amsterdam, The Netherlands
| | - A Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - D A Hoozemans
- Department of Obstetrics and Gynaecology, Medical Spectrum Twente, PO Box 50000, 7500 KA Enschede, The Netherlands
| | - E M Kaaijk
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, PO Box 95500, 1090 HM Amsterdam, The Netherlands
| | - C A M Koks
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500 MB Veldhoven, The Netherlands
| | - J S E Laven
- Department of Obstetrics and Gynecology, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - P J Q van der Linden
- Department of Obstetrics and Gynecology, Deventer Hospital, PO Box 5001, 7400 GC Deventer, The Netherlands
| | - A P Manger
- Department of Obstetrics and Gynecology, Diakonessenhuis, PO Box 80250, 3508 TG Utrecht, The Netherlands
| | - E Slappendel
- Department of Obstetrics and Gynaecology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - T Spinder
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, PO Box 888, 8901 HR Leeuwarden, The Netherlands
| | - B J Kollen
- Department of General Practice, University of Groningen, University Medical Centre Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - N S Macklon
- Department of Obstetrics and Gynecology, Academic Unit of Human Development and Health, University of Southampton, University Road, Southampton SO17 1BJ, UK
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Panman C, Wiegersma M, Kollen BJ, Berger MY, Lisman-Van Leeuwen Y, Vermeulen KM, Dekker JH. Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care. BJOG 2016; 124:511-520. [PMID: 26996291 DOI: 10.1111/1471-0528.13992] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare effects and cost-effectiveness of pelvic floor muscle training (PFMT) and watchful waiting in women with pelvic organ prolapse. DESIGN Randomised controlled trial. SETTING Dutch general practice. POPULATION Women (≥55 years) with symptomatic mild prolapse, identified by screening. METHODS Linear multilevel analysis. MAIN OUTCOME MEASURES Primary outcome was change of pelvic floor symptoms (Pelvic-Floor-Distress-Inventory-20 [PFDI-20]) during 24 months. Secondary outcomes were condition-specific and general quality of life, costs, sexual functioning, prolapse stage, pelvic floor muscle function and women's perceived improvement of symptoms. RESULTS PFMT (n = 145) resulted in a 12.2-point (95% CI 7.2-17.2, P < 0.001) greater improvement in PFDI-20 score during 24 months compared with watchful waiting (n = 142). Participants randomised to PFMT more often reported improved symptoms (43% versus 14% for watchful waiting). Direct medical costs per person were €330 for PFMT and €91 for watchful waiting but costs for absorbent pads were lower in the PFMT group (€40 versus €77). Other secondary outcomes did not differ between groups. Post-hoc subgroup analysis demonstrated that PFMT was more effective in women experiencing higher pelvic floor symptom distress at baseline. CONCLUSION PFMT resulted in greater pelvic floor symptom improvement compared with watchful waiting. The difference was statistically significant, but below the presumed level of clinical relevance (15 points). PFMT more often led to women's perceived improvement of symptoms, lower absorbent pads costs, and was more effective in women experiencing higher pelvic floor symptom distress. Therefore, PFMT could be advised in women with bothersome symptoms of mild prolapse. TWEETABLE ABSTRACT Pelvic floor muscle training can be effective in women with bothersome symptoms of mild prolapse.
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Affiliation(s)
- Cmcr Panman
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M Wiegersma
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - B J Kollen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M Y Berger
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Y Lisman-Van Leeuwen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - K M Vermeulen
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - J H Dekker
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Bosker BH, Ettema HB, van Rossum M, Boomsma MF, Kollen BJ, Maas M, Verheyen CCPM. Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips. Arch Orthop Trauma Surg 2015; 135:417-25. [PMID: 25663048 DOI: 10.1007/s00402-015-2165-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The incidence and natural course of pseudotumors in metal-on-metal total hip arthroplasties is largely unknown. The objective of this study was to identify the true incidence and risk factors of pseudotumor formation in large head metal-on-metal total hip arthroplasties. MATERIALS AND METHODS Incidence, time course and risk factors for pseudotumor formation were analysed after large femoral head MoM-THA. We defined a pseudotumor as a (semi-)solid or cystic peri-prosthetic soft-tissue mass with a diameter ≥2 cm that could not be attributed to infection, malignancy, bursa or scar tissue. All patients treated in our clinic with MoM-THA's were contacted. CT scan, metal ions and X-rays were obtained. Symptoms were recorded. RESULTS After median follow-up of 3 years, 706 hips were screened in 626 patients. There were 228 pseudotumors (32.3 %) in 219 patients (35.0 %). Pseudotumor formation significantly increased after prolonged follow-up. Seventy-six hips (10.8 %) were revised in 73 patients (11.7 %), independent risk factors were identified. Best cutoff point for cobalt and chromium was 4 μg/l (68 and 77 nmol/l). CONCLUSIONS This study confirms a high incidence of pseudotumors, dramatically increasing after prolonged follow-up. Risk factors for pseudotumors are of limited importance. Pain was the strongest predictor for pseudotumor presence; cobalt chromium and swelling were considered poor predictors. Cross-sectional imaging is the main screening tool during follow-up.
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Affiliation(s)
- B H Bosker
- , pc Hoofdstraat 13, 8023, AJ, Zwolle, The Netherlands,
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Van Ginkel D, Koppelman GH, Kollen BJ, Heide S, Kukler J, Flokstra‐de Blok BMJ, Dubois AEJ. PD18 ‐ Filaggrin loss‐of‐function variants are associated with clinical reactivity to foods. Clin Transl Allergy 2014. [PMCID: PMC4082148 DOI: 10.1186/2045-7022-4-s1-p18] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dorien Van Ginkel
- Department of Pediatric Pulmonology and Pediatric AllergyUMCGGRIAC Research InstituteGroningenThe Netherlands
| | - GH Koppelman
- Department of Pediatric Pulmonology and Pediatric AllergyUMCGGRIAC Research InstituteGroningenThe Netherlands
| | - BJ Kollen
- Department of General PracticeUMCGGRIAC Research InstituteGroningenThe Netherlands
| | - S Heide
- Department of Laboratory MedicineUMCGGroningenThe Netherlands
| | - J Kukler
- Department of Pediatric Pulmonology and Pediatric AllergyUMCGGRIAC Research InstituteGroningenThe Netherlands
| | - BMJ Flokstra‐de Blok
- Department of General PracticeUMCGGRIAC Research InstituteGroningenThe Netherlands
| | - AEJ Dubois
- Department of Pediatric Pulmonology and Pediatric AllergyUMCGGRIAC Research InstituteGroningenThe Netherlands
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Horstmann WG, Swierstra MJ, Ohanis D, Castelein RM, Kollen BJ, Verheyen CCPM. Reduction of blood loss with the use of a new combined intra-operative and post-operative autologous blood transfusion system compared with no drainage in primary total hip replacement. Bone Joint J 2013; 95-B:616-22. [PMID: 23632670 DOI: 10.1302/0301-620x.95b5.30472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Autologous retransfusion and no-drainage are both blood-saving measures in total hip replacement (THR). A new combined intra- and post-operative autotransfusion filter system has been developed especially for primary THR, and we conducted a randomised controlled blinded study comparing this with no-drainage. A total of 204 THR patients were randomised to autologous blood transfusion (ABT) (n = 102) or no-drainage (n = 102). In the ABT group, a mean of 488 ml (sd 252) of blood was retransfused. The mean lowest post-operative haemoglobin level during the hospital stay was higher in the autotransfusion group (10.6 g/dl (7.8 to 13.9) vs 10.2 g/dl (7.5 to 13.3); p = 0.01). The mean haemoglobin levels for the ABT and no-drainage groups were not significantly different on the first day (11.3 g/dl (7.8 to 13.9) vs 11.0 g/dl (8.1 to 13.4); p = 0.07), the second day (11.1 g/dl (8.2 to 13.8) vs 10.8 g/dl (7.5 to 13.3); p = 0.09) or the third day (10.8 g/dl (8.0 to 13.0) vs 10.6 g/dl (7.5 to 14.1); p = 0.15). The mean total peri-operative net blood loss was 1464 ml (sd 505) in the ABT group and 1654 ml (sd 553) in the no-drainage group (p = 0.01). Homologous blood transfusions were needed in four patients (3.9%) in the ABT group and nine (8.8%) in the no-drainage group (p = 0.15). No statistically significant difference in adverse events was found between the groups. The use of a new intra- and post-operative autologous blood transfusion filter system results in less total blood loss and a smaller maximum decrease in haemoglobin levels than no-drainage following primary THR.
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Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Maas M, Verheyen CCPM. High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. ACTA ACUST UNITED AC 2012; 94:755-61. [PMID: 22628588 DOI: 10.1302/0301-620x.94b6.28373] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Peri-articular soft-tissue masses or 'pseudotumours' can occur after large-diameter metal-on-metal (MoM) resurfacing of the hip and conventional total hip replacement (THR). Our aim was to assess the incidence of pseudotumour formation and to identify risk factors for their formation in a prospective cohort study. A total of 119 patients who underwent 120 MoM THRs with large-diameter femoral heads between January 2005 and November 2007 were included in the study. Outcome scores, serum metal ion levels, radiographs and CT scans were obtained. Patients with symptoms or an identified pseudotumour were offered MRI and an ultrasound-guided biopsy. There were 108 patients (109 hips) eligible for evaluation by CT scan at a mean follow-up of 3.6 years (2.5 to 4.5); 42 patients (39%) were diagnosed with a pseudotumour. The hips of 13 patients (12%) were revised to a polyethylene acetabular component with small-diameter metal head. Patients with elevated serum metal ion levels had a four times increased risk of developing a pseudotumour. This study shows a substantially higher incidence of pseudotumour formation and subsequent revisions in patients with MoM THRs than previously reported. Because most revision cases were identified only after an intensive screening protocol, we recommend close monitoring of patients with MoM THR.
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Affiliation(s)
- B H Bosker
- Isala Klinieken, Department of Orthopaedic Surgery and Traumatology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands
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Goosen JHM, Verheyen CCPM, Kollen BJ, Tulp NJA. In vivo wear reduction of argon compared to air sterilized UHMW-polyethylene liners. Arch Orthop Trauma Surg 2009; 129:879-85. [PMID: 18989687 DOI: 10.1007/s00402-008-0771-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Indexed: 12/01/2022]
Abstract
INTRODUCTION To date, no studies have been published that report on the in vivo advantages of sterilisation in argon (ARGON) versus air (AIR) of UHMWPE liners with respect to wear extend and pattern in uncemented total hip arthroplasty. METHOD Femoral penetration rates were measured in 93 AIR and 79 ARGON liners, during a mean follow-up of 8 (3-12) years. RESULTS During the first 3 years after implantation, both groups showed no differences in mean wear rate (P = 0.13). Thereafter, the ARGON liner demonstrated a decrease in wear rate of 0.04 mm/year from 4 to 6 years (P = 0.006), 0.14 mm/year from 7 to 9 years (P < 0.001), and 0.33 mm/year beyond 9 years follow-up (P = 0.015) compared to the AIR liner. One AIR acetabular component required revision.
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Affiliation(s)
- J H M Goosen
- Department of Orthopaedic Surgery and Traumatology, Isala Clinics, P.O. Box 10500, 8000 GM, Zwolle, The Netherlands.
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15
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Ettema HB, Kollen BJ, Verheyen CCPM, Büller HR. Prevention of venous thromboembolism in patients with immobilization of the lower extremities: a meta-analysis of randomized controlled trials. J Thromb Haemost 2008; 6:1093-8. [PMID: 18429944 DOI: 10.1111/j.1538-7836.2008.02984.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is controversial whether the prevention of venous thromboembolism (VTE) in patients with lower-leg immobilization is necessary. OBJECTIVES To assess the benefits and complications of pharmacological thromboprophylaxis, we performed a meta-analysis of all available randomized controlled trials on this subject. METHODS We searched the MEDLINE and EMBASE electronic databases. We included English- and non-English language studies, we hand-searched journals, and we contacted manufacturers. We analyzed data from six randomized trials that investigated pharmacological prophylaxis for the prevention of VTE in 1456 patients with lower-leg immobilization in plaster cast or orthosis. Two reviewers independently assessed the trials for inclusion, extracted data, and assessed trial quality. Differences were resolved by consensus or arbitrage. RESULTS The pooled estimate from all trials revealed a highly significant and clinically relevant reduction in asymptomatic events with low-molecular-weight heparin (LMWH) prophylaxis, compared to placebo or untreated control [risk ratio (RR) 0.58; 95% confidence interval (CI) 0.39-0.86; P = 0.006). The mean rate of VTE decreased from 17.1% to 9.6% with the use of LMWH. Subgroup analysis of methodologically superior trials (RR 0.68; CI 0.50-0.92; P = 0.01), proximal deep vein thrombosis (RR 0.28; CI 0.11-0.72; P = 0.008), tendon ruptures (RR 0.60; CI 0.38-0.97; P = 0.04), and fractures (RR 0.62; CI 0.45-0.86; P = 0.004) confirmed the robustness of the overall result. Frequency of bleeding did not differ between LMWH prophylaxis and control groups (RR 1.22; CI 0.61-2.46; P = 0.57). CONCLUSIONS Our findings indicate that thromboprophylaxis with LMWH for immobilization of the lower extremities reduces the risk of VTE. This benefit is achieved with no excess bleeding.
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Affiliation(s)
- H B Ettema
- Department of Orthopaedic Surgery and Traumatology, Isala Clinics, Zwolle, The Netherlands
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16
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Landman GWD, Ubink-Veltmaat LJ, Kleefstra N, Kollen BJ, Bilo HJG. Increased cancer mortality in type 2 diabetes (ZODIAC-3). Anticancer Res 2008; 28:1373-1375. [PMID: 18505082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND It is unclear whether there is a relationship between type two diabetes and cancer mortality. It also is unclear whether obesity and body mass index (BMI) are associated with cancer in type 2 diabetes patients. PATIENTS AND METHODS In 1998, 1,145 patients with type two diabetes mellitus were enrolled in the Zwolle Outpatient Diabetes project Intergrating Available Care (ZODIAC) study. In this project, general practitioners (GPs) were assisted by hospital-based diabetes specialist nurses. Vital status was assessed in September 2004. The cancer mortality rate was evaluated using standardized mortality ratio (SMR) and its association with BMI (kg/m2) and obesity (>30 kg/m2) with the Cox proportional hazard ratio. RESULTS The median follow-up time was 5.8 years. A total of 335 patients had died, of whom 70 died from malignancy. The SMR for cancer mortality was 1.38 (95% CI 1.07-1.75). BMI and obesity were not associated with cancer death. CONCLUSION An increased cancer mortality rate was found in type two diabetes mellitus patients but there was no significant association between BMI or obesity and cancer mortality.
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Affiliation(s)
- G W D Landman
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands.
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17
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Goosen JHM, Ettema HB, Kollen BJ, Verheyen CCPM. [How many steps does a doctor take in the hospital? No difference between internists and general surgeons, but a relationship with age and BMI]. Ned Tijdschr Geneeskd 2008; 152:203-206. [PMID: 18320946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine the number of steps taken during working days in the hospital by both internists and general surgeons and whether there is a difference between housemen, registrars and members of the staff. DESIGN Comparative analysis. METHOD A validated pedometer was used to count the number of steps taken by housemen, registrars and staff members in the departments of internal medicine and general surgery. The 2 groups of doctors comprised 131 subjects from 13 training hospitals. Possible factors likely to affect the number of steps, such as age, sex, weight and height, were recorded. RESULTS The average number of steps taken per day was 5325 (range: 1105-10,250) and the average number per hour was 548 (range: 143-1105), with an average working day of 9.8 hours and 8.4 measured days. When corrected for age, sex and hierarchic status, no significant difference was observed between surgeons and internists (p = 0.097). There were also no differences within the hierarchic structure after correction (p = 0.936). Age and BMI seemed to be the most important factors predicting the number of steps in this population. Each additional year of age corresponded with an average decrease of 5 steps per hour on the job (p = 0.001), while each point rise in BMI (+1 kg/m) coincided with an average decrease of 20 steps per hour (p = 0.001). CONCLUSION After correcting for confounding factors, no differences were observed in the number of steps taken in the hospital by general surgeons and internists. There was also no difference between hierarchic levels. Age and BMI were the most important variables that predicted the number of steps taken per hour in this research population.
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Arabin B, Roos C, Kollen B, van Eyck J. Comparison of transvaginal sonography in recumbent and standing maternal positions to predict spontaneous preterm birth in singleton and twin pregnancies. Ultrasound Obstet Gynecol 2006; 27:377-86. [PMID: 16514620 DOI: 10.1002/uog.2694] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To evaluate whether serial transvaginal sonographic examination of the cervix with the woman in a standing position improves the prediction of spontaneous preterm birth (SPB) compared with the conventional posture. METHODS For both a recumbent and upright maternal position, the inter- and intraobserver agreement of cervical length (CL) measurement was calculated. In 363 pregnancies at risk for SPB, we determined prospectively CL and funnel width (FW) including differences between the positions and between longitudinal measurements from 15 weeks onwards. Multivariate logistic regression analysis, contingency tables and receiver-operating characteristics (ROC) curves were used. Data were stratified according to singleton or twin pregnancy, maternal position, gestational age at examination and different cut-off values to predict SPB < 36 weeks. RESULTS The interobserver variability in each position was similar, with an interclass correlation coefficient (95% CI) of 0.952 (0.811-0.984) in the recumbent and 0.942 (0.837-0.978) in the upright maternal position. After exclusion of pregnancies with iatrogenic preterm birth, 15/138 (11%) singletons and 29/153 (19%) twin pairs were born at <36 weeks. The incidence of funneling was greater in an upright compared with a recumbent maternal position by 12.3% in singleton and 13.1% in twin pregnancies before 25 weeks, and by 13.0% and 21.6% between 25 and 30 weeks, respectively. This resulted in an earlier and more accurate prediction of SPB by transvaginal ultrasound in an upright compared with a recumbent maternal position, which could be shown by all applied statistical methods. The influence of posture on the prognostic value of the CL varied depending on the cut-off value. Differences in CL or FW between 15-20 and 25-30 weeks predicted SPB better than did differences between shorter intervals. CONCLUSIONS Evaluation of the cervix with the woman in the upright position permits earlier detection of funneling. This may enable earlier and more appropriate intervention to avoid SPB.
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Affiliation(s)
- B Arabin
- Clara Angela Foundation/Isala Clinics, Zwolle, The Netherlands.
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Arabin B, Roos C, Kollen B, van Eyck J. Comparison of Transvaginal Sonography in a Recumbent and Standing Position to Predict Spontaneous Preterm Birth. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-923069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
OBJECTIVE To assess long term effects at 1 year after stroke in patients who participated in an upper and lower limb intensity training programme in the acute and subacute rehabilitation phases. DESIGN A three group randomised controlled trial with repeated measures was used. METHOD One hundred and one patients with a primary middle cerebral artery stroke were randomly allocated to one of three groups for a 20 week rehabilitation programme with an emphasis on (1) upper limb function, (2) lower limb function or (3) immobilisation with an inflatable pressure splint (control group). Follow up assessments within and between groups were compared at 6, 9, and 12 months after stroke. RESULTS No statistically significant effects were found for treatment assignment from 6 months onwards. At a group level, the significant differences in efficacy demonstrated at 20 weeks after stroke in favour of the lower limb remained. However, no significant differences in functional recovery between groups were found for Barthel index (BI), functional ambulation categories (FAC),action research arm test (ARAT), comfortable and maximal walking speed, Nottingham health profile part 1(NHP-part 1), sickness impact profile-68 (SIP-68), and Frenchay activities index (FAI) from 6 months onwards. At an individual subject level a substantial number of patients showed improvement or deterioration in upper limb function (n=8 and 5, respectively) and lower limb function (n=19 and 9, respectively). Activities of daily living (ADL) scores showed that five patients deteriorated and four improved beyond the error threshold from 6 months onwards. In particular, patients with some but incomplete functional recovery at 6 months are likely to continue to improve or regress from 6 months onwards. CONCLUSIONS On average patients maintained their functional gains for up to 1 year after stroke after receiving a 20 week upper or lower limb function training programme. However, a significant number of patients with incomplete recovery showed improvements or deterioration in dexterity, walking ability, and ADL beyond the error threshold.
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Affiliation(s)
- G Kwakkel
- University Hospital Vrije Universiteit, Department of Physical Therapy and Research Institute for Fundamental and Clinical Human Movement Sciences, Amsterdam, The Netherlands.
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Abstract
Research articles on the prognosis of stroke patients were analysed to identify studies that met sound methodological principles of prognostic research as well as to identify variables capable of predicting functional outcome (ADL) after stroke. Data sources comprised a computer-aided search of published prognostic studies and references to literature used in prognostic studies. Seventy-eight studies were tested for adherence to the following key methodological criteria: reliability and validity of measurement instruments used to assess dependent and independent variables; inclusion of an inception cohort; adequate and uniform end-point of observation; control for drop-outs during period of observation; statistical testing of presumed relationship between dependent and independent variables; sufficient sample size in relation to number of determinants; control for multicollinearity; specification of patient characteristics (i.e. age, type, recurrent stroke and localization of stroke); description of interfering treatment effects during the period of observation, and cross-validation of the prediction model in a second independent group of patients. Only three studies satisfied nine out 11 criteria and ten studies eight criteria for the determination of valid prognostic research. The results of these studies indicate that the following variables are valid predictors for functional recovery after stroke: age; previous stroke; urinary continence; consciousness at onset; disorientation in time and place; severity of paralysis; sitting balance; admission ADL score; level of social support and metabolic rate of glucose outside the infarct area in hypertensive patients. This study supports the general opinion that not only are differences in objectives and heterogeneity in stroke patients responsible for the lack of accuracy in predicting functional outcome, but also the methodological flaws in published prognostic research.
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Affiliation(s)
- G Kwakkel
- Department of Physiotherapy, University Hospital Vrije Universiteit, Amsterdam, The Netherlands
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