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Utrecht, Netherlands

Hamaker M.E.,Diakonessenhuis | Mitrovic M.,Innsbruck Medical University | Stauder R.,Innsbruck Medical University
Annals of Hematology | Year: 2014

The G8 screening tool was developed to separate fit older cancer patients who were able to receive standard treatment from those that should undergo a geriatric assessment to guide tailoring of therapy. We set out to determine the discriminative power and prognostic value of the G8 in older patients with a haematological malignancy. Between September 2009 and May 2013, a multi-dimensional geriatric assessment was performed in consecutive patients aged ≥67 years diagnosed with blood cancer at the Innsbruck University Hospital. The assessment included (instrumental) activities of daily living, cognition, mood, nutritional status, mobility, polypharmacy and social support. In parallel, the G8 was also administered (cut-off ≤ 14). Using a cut-off of ≥2 impaired domains, 70 % of the 108 included patients were considered as having an impaired geriatric assessment while 61 % had an impaired G8. The G8 lacked discriminative power for impairments on full geriatric assessment: sensitivity 69, specificity 79, positive predictive value 89 and negative predictive value 50 %. However, G8 was an independent predictor of mortality within the first year after inclusion (hazard ratio 3.93; 95 % confidence interval 1.67-9.22, p<0.001). Remarkably, patients with impaired G8 fared poorly, irrespective of treatment choices (p<0.001). This is the first report on the clinical and prognostic relevance of G8 in elderly patients with haematological malignancies. Although the G8 lacked discriminative power for outcome of multi-dimensional geriatric assessment, this score appears to be a powerful prognosticator and could potentially represent a useful tool in treatment decisions. This novel finding certainly deserves further exploration. © 2014 Springer-Verlag.

To compare the clinical competencies of second-year anaesthesiology residents and physician assistants (PA) in the preoperative anaesthesiology outpatient clinic. Comparative qualitative observational study. The two study groups were compared using 5 test stations representing 5 different cases of varying degrees of complexity with standardized patients. For each case, the patients and two anaesthesiologists assessed the results of the PAs and the residents using a quantitative scoring system for 4 clinical skills relevant to the preoperative anaesthesiology outpatient clinic. These skills were history-taking, physical examination, communication, and reporting. At each station, a score was calculated for each skill. The groups' scores were subsequently compared. 9 PAs and 11 residents carried out the station tests. There were no significant differences between the two groups of participants. In this study in a preoperative anaesthesiology outpatient clinic no difference in clinical competencies was found between PAs and second-year anaesthesiology residents.

van Lieshout A.,Diakonessenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2010

Anal cancer is a rare malignancy with a rapidly rising incidence. The most important risk factor for anal cancer is persistent infection with Human papillomavirus (HPV). In the Netherlands, the incidence of anal cancer increased from 71 to 149 new patients each year over the period 1989-2006. There has been a corresponding overall increase in mortality, although the exact level differs per year. Not enough research has been done to date to clarify why the incidence of anal cancer is increasing.

van Roeden S.E.,Diakonessenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

Domperidone is an antiemetic drug with relatively few side-effects. In the Netherlands, domperidone is available over the counter. Recently, discussion on the safety of domperidone has arisen because an association with sudden cardiac death has been suggested. We performed a systematic literature search to investigate whether these concerns can be justified. Three out of four case-control studies found statistically significant increased odds ratios for sudden cardiac death when using domperidone. A dose-response relationship was described in one study. Results may be influenced by several confounders. We conclude that there is a relationship between domperidone use and sudden cardiac death at doses of more than 30 mg per day. We recommend that the indication be weighed up properly, that domperidone be provided only on prescription, and dose advice be given. At a dose of 30 mg per day, domperidone can be prescribed safely.

Bokhorst L.P.,Diakonessenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2011

Cataracts are the most important cause of acquired blindness worldwide. The oldest known surgical treatment for cataracts dates back to around 1,000 years before Christ. The Indian surgeon Sushruta described the technique of 'couching', in which the opaque lens is pushed from the line of vision using a needle. At the time of Alexander the Great this technique spread across Europe and then to the rest of the world. Couching was the only available treatment for cataracts for a long time, until the discovery of lens extraction by Jacques Daviel in 1748. Since then lens extraction has replaced couching in the western world, because of poor results and high complication rates. This procedure is, however, still practiced in areas of Africa and Asia.

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