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Ezendam N.P.M.,University of Tilburg | Ezendam N.P.M.,Comprehensive Cancer Center the Netherland | Ezendam N.P.M.,Comprehensive Cancer Center the Netherlands | Nicolaije K.A.H.,University of Tilburg | And 8 more authors.
Journal of Cancer Survivorship | Year: 2014

Results: A questionnaire was returned by 266 PCPs (76 %). One third of the PCPs in the SCP-care arm indicated having received an SCP. PCPs in the SCP-care arm were more likely to have had personal contact with the medical specialist (52 vs. 37 %, p = 0.01) but were equally satisfied with the information as PCPs in the usual care arm (7.2 vs. 6.9 on a scale from 1 to 10, p = 0.25). Of all PCPs, 82 % indicated they would want to receive an SCP in the future. A quarter of the PCPs who received an SCP reported that the SCP supported contact with the patient. However, the SCP was found too long.Purpose: This study assesses the effect of sending a Survivorship Care Plan (SCP) to primary care physicians (PCP) on the communication of the PCP with the medical specialist and the patient and to describe PCPs’ opinions regarding the SCP.Methods: In a pragmatic cluster randomized controlled trial conducted in 12 hospitals, the PCP of endometrial and ovarian cancer patients received usual information, while in addition the SCP-care arm received a copy of the patient’s SCP.Conclusions: Supplying an SCP to PCPs potentially has a positive effect on the communication between the PCP and the medical specialist. The SCP should be concise and focused on PCPs’ needs, such as contact information and tailored information on patient diagnosis, treatment, and possible consequences.Implications for Cancer Survivors: In the light of transition of cancer care to PCPs, survivors may benefit from improved information provision and communication. © 2014, Springer Science+Business Media New York.


Kessing D.,University of Tilburg | Denollet J.,University of Tilburg | Widdershoven J.,University of Tilburg | Widdershoven J.,Elisabeth TweeSteden Hospital | Kupper N.,University of Tilburg
Psychosomatic Medicine | Year: 2016

Objective Psychological distress has been associated with poor outcomes in patients with chronic heart failure (HF), which is assumed to be partly due to poor HF self-care behavior. This systematic review and meta-analysis describes the current evidence concerning psychological determinants of self-care in patients with chronic HF. Methods Eligible studies were systematically identified by searching electronic databases PubMed, PsycINFO, and the Conference Proceedings Citation Index (Web of Science) for relevant literature (1980-October 17, 2014). Study quality was assessed according to the level of risk of bias. Quantitative data were pooled using random-effects models. Results Sixty-five studies were identified for inclusion that varied considerably with respect to sample and study characteristics. Risk of bias was high in the reviewed studies and most problematic with regard to selection bias (67%). Depression (r =-0.19, p <.001), self-efficacy (r = 0.37, p <.001), and mental well-being (r = 0.14, p =.030) were significantly associated with self-reported self-care. Anxiety was not significantly associated with either self-reported (r =-0.18, p =.24) or objective self-care (r =-0.04, p =.79), neither was depression associated with objectively measured medication adherence (r =-0.05, p =.44). Conclusions Psychological factors (depression, self-efficacy, and mental well-being) were associated with specific self-care facets in patients with chronic HF. These associations were predominantly observed with self-reported indices of self-care and not objective indices. Methodological heterogeneity and limitations preclude definite conclusions about the association between psychological factors and self-care and should be addressed in future research. © 2016 Lippincott Williams & Wilkins.


Theunissen C.M.J.,Elisabeth TweeSteden Hospital | Guelinckx N.,Elisabeth TweeSteden Hospital | Maring J.K.,Elisabeth TweeSteden Hospital | Langenhoff B.S.,Elisabeth TweeSteden Hospital
Obesity Surgery | Year: 2016

Background: The adjustable gastric band (AGB) is a bariatric procedure that used to be widely performed. However, AGB failure—signifying band-related complications or unsatisfactory weight loss, resulting in revision surgery (redo operations)—frequently occurs. Often this entails a conversion to a laparoscopic Roux-en-Y gastric bypass (LRYGB). This can be performed as a one-step or two-step (separate band removal) procedure. Methods: Data were collected from patients operated from 2012 to 2014 in a single bariatric centre. We compared 107 redo LRYGB after AGB failure with 1020 primary LRYGB. An analysis was performed of the one-step vs. two-step redo procedures. All redo procedures were performed by experienced bariatric surgeons. Results: No difference in major complication rate was seen (2.8 vs. 2.3 %, p = 0.73) between redo and primary LRYGB, and overall complication severity for redos was low (mainly Clavien–Dindo 1 or 2). Weight loss results were comparable for primary and redo procedures. The one-step and two-step redos were comparable regarding complication rates and readmissions. The operating time for the one-step redo LRYGB was 136 vs. 107.5 min for the two-step (median, p < 0.001), excluding the operating time of separate AGB removal (mean 61 min, range 36–110). Conclusions: Removal of a failed AGB and LRYGB in a one-step procedure is safe when performed by experienced bariatric surgeons. However, when erosion or perforation of the AGB occurs, we advise caution and would perform the redo LRYGB as a two-step procedure. Equal weights can be achieved at 1 year post redo LRYGB as after primary LRYGB procedures. © 2016 Springer Science+Business Media New York


Smeijers L.,University of Tilburg | Szabo B.M.,Elisabeth TweeSteden Hospital | Kop W.J.,University of Tilburg
Netherlands Heart Journal | Year: 2016

Background Takotsubo cardiomyopathy (TCC) is a transient condition characterised by severe left ventricular dysfunction combined with symptoms and signs mimicking myocardial infarction. Emotional triggers are common, but little is known about the psychological background characteristics of TCC. This study examined whether patients with TTC have higher levels of psychological distress (depres-sive symptoms, perceived stress, general anxiety), illness-related anxiety and distinct personality factors compared with healthy controls and patients with heart failure. Methods and Results Patients with TCC (N = 18; mean age 68.3 ± 11.7 years, 77.8 % women) and two comparison groups (healthy controls: N = 19, age 60.0 ± 7.6, 68.4 % women and patients with chronic heart failure: N = 19, age 68.8 ± 10.1, 68.4 % women) completed standardised questionnaires to measure depression (PHQ-9), perceived stress (PSS-10), general anxiety (GAD-7), illness-related anxiety (WI-7) and personality factors (NEO-FFI and DS-14). Psychological measures were obtained at 23 ± 18 months following the acute TTC event. Results showed that patients with TCC had higher levels of depressive symptoms (5.2 ± 5.2 vs. 2.5 ± 2.4, p = 0.039) and illness-related anxiety (2.1 ± 1.7 vs. 0.7 ± 1.3, p = 0.005) compared with healthy controls. Patients with TCC did not display significantly elevated perceived stress (p = 0.072) or general anxiety (p = 0.170). Regarding personality factors, levels of openness were lower in TCC compared with healthy controls (34.2 ± 4.3 vs. 38.2 ± 5.6, p = 0.021). No differences between TCC and heart failure patients were found regarding the psychological measures. Conclusions TCC is associated with higher levels of depressive symptoms, more illness-related anxiety and less openness compared with healthy controls. These data suggest that TCC is associated with adverse psychological factors that may persist well after the acute episode. © The Author(s) 2016.


Van Der Meulen J.F.,Maxima Medical Center | Pijnenborg J.M.A.,Elisabeth TweeSteden Hospital | Boomsma C.M.,Bravis Hospital | Verberg M.F.G.,Spectrum | And 2 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2016

Background Laparoscopic morcellation is frequently used for tissue removal after laparoscopic hysterectomy or myomectomy and may result in parasitic myomas, due to seeding of remained tissue fragments in the abdominal cavity. However, little is known about the incidence and risk factors of this phenomenon. Objectives To identify the incidence and risk factors for the development of parasitic myoma after laparoscopic morcellation. Search strategy A systematic review of the literature in Pubmed (MEDLINE) and Embase was conducted. Reference lists of identified relevant articles were checked for missing case reports. Selection criteria Studies reporting on incidence or cases of parasitic myoma diagnosed after laparoscopic morcellation were selected. Studies were excluded when history of laparoscopic morcellation was lacking or final pathology demonstrated a malignancy or endometriosis. Data collection and analysis Data were extracted and analysed on incidence of parasitic myomas and characteristics of case reports. Main results Fourty-four studies were included. Sixty-nine women diagnosed with parasitic myomas after laparoscopic morcellation were identified. Mean age was 40.8 (± 7.5) years (range 24-57), median time between surgery and diagnosis was 48.0 months (range 1-192) and mean number of parasitic myomas was 2.9 (± 3.3) (range 1-16). The overall incidence of parasitic myomas after laparoscopic morcellation was 0.12-0.95%. Conclusion Although the incidence is relatively low, it is important to discuss the risk of parasitic myoma after laparoscopic morcellation with women and balance towards alternative treatment options. The duration of steroid exposure after laparoscopic morcellation might be a risk factor for development of parasitic myomas. Tweetable abstract Systematic review on the incidence and risk factors for parasitic myoma after laparoscopic morcellation. Tweetable abstract Systematic review on the incidence and risk factors for parasitic myoma after laparoscopic morcellation. © 2015 Royal College of Obstetricians and Gynaecologists.


Mans S.,Elisabeth Tweesteden Hospital | Reinders Folmer E.,Elisabeth Tweesteden Hospital | De Jongh M.A.C.,Elisabeth Tweesteden Hospital | Lansink K.W.W.,Elisabeth Tweesteden Hospital
Injury | Year: 2016

Introduction Several studies have suggested that severely injured patients should be transported directly to a trauma centre bypassing the nearest hospital. However, the evidence remains inconclusive. The purpose of this study was to examine the benefits in terms of mortality of direct transport to a trauma centre versus primary treatment in a level II or III centre followed by inter hospital transfer to a trauma centre for severely injured patients without Traumatic Brain Injury (TBI). Patients and methods We used the regional trauma registry and included all patients with an Injury Severity Score (ISS) >15 and an Abbreviated Injury Score <4 for head injury. We adjusted for survival bias by including "potential transfers": patients who died at the nearest hospitals before transportation to a trauma centre. Results A total of 439 patients was included. The majority of patients (349/439, 79%) was transported directly to the level I trauma centre (direct group). The transferred group was formed by the remaining 90 patients, of whom 81 were transferred to the level I trauma centre after initial stabilisation elsewhere and 9 patients died in the emergency room before transfer to a level 1 trauma centre could occur. There were no significant differences in baseline and injury characteristics between the groups. Overall, 60 patients died in-hospital including 41 of the 349 patients (12%) in the direct group and 19 of the 90 patients (21%) in the transferred group. Nine of the 19 deaths in the transferred group were ascribed to potential transfers. After adjusting for prehospital Revised Trauma Score (RTS) and ISS, the odds ratio of death was 2.40 (95%CI: 1.07-5.40) for patients in the transfer group. When potential transfer patients were excluded from the analysis, the adjusted odds ratio of death was 1.14 (95%CI: 0.43-3.01). Conclusions After adjusting for survivor bias by including potential transfers, the results of this study suggest a lower risk of death for patients who are directly transported to a level I trauma centre than for patients who receive primary treatment in a level II or III centre and are transferred to a trauma centre. However, this finding was only significant when adjusting for survival bias and therefore we conclude that it is still uncertain if there is a lower risk of death for patients who are transported directly to a level I trauma centre. © 2015 Elsevier Ltd. All rights reserved.


PubMed | Slingeland Hospital, Robert Bosch GmbH, Elisabeth TweeSteden Hospital and University of Tilburg
Type: Journal Article | Journal: Current oncology (Toronto, Ont.) | Year: 2017

There is wide variation in the application of adjuvant chemotherapy in early-stage epithelial ovarian cancer. Our aim was to assess differences in health-related quality of life (hrqol) between patients with early-stage ovarian cancer who did or did not receive chemotherapy as adjuvant treatment.All patients diagnosed with early-stage ovarian cancer between 2000 and 2010 within the population-based Eindhoven Cancer Registry (Of the 107 patients (56%) who returned the questionnaires, 57 (53.3%) had received adjuvant chemotherapy and 50 (46.7%) had been treated with surgery alone. Significant differences in hrqol between those groups were found in the symptom scales for peripheral neuropathy, attitude toward sickness, and financial situation, with worse scores in the chemotherapy group.Results of our study show that patients who receive adjuvant chemotherapy have a significantly worse score for 3 aspects of hrqol. Efforts should be made to reduce use of adjuvant chemotherapy in early-stage ovarian cancer. Moreover, preventive strategies to improve long-term quality of life for those who need adjuvant chemotherapy should be explored.


PubMed | University Utrecht and Elisabeth Tweesteden Hospital
Type: | Journal: Applied nursing research : ANR | Year: 2017

Explore the practice of nurses working with bar-coded medication administration technology, to gain insight in the impact it has on their work.The widespread presumption of using Barcoded Medication Administration Technology (BCMA) is that it will effectively reduce the number of errors in the dispensing of medication to patients. However, it remains unclear whether this is the case in actual practice.Two distinct but overlapping research methodologies of Institutional Ethnography and Praxeology were combined as a means to uncover the highly complex practice of BCMA by nurses.The implementation of BCMA creates a series of problems leading to nurses constantly tinkering with the technology. At the same time they are continuously deliberating the best ways of tailoring the BCMA to each of their patients.Although working with BCMA is often misconstrued as being mindless and automatic, conforming to the technology, this tinkering with BCMA in fact always entails thorough deliberation by nurses.


PubMed | Ikazia Hospital, Sint Franciscus Hospital, Reinier Of Graaf Hospital, Erasmus Medical Center and 3 more.
Type: | Journal: Acta chirurgica Belgica | Year: 2017

The completeness of the pathological examination of resected colon cancer specimens is important for further clinical management. We reviewed the pathological reports of 356 patients regarding the five factors (pT-stage, tumor differentiation grade, lymphovascular invasion, tumor perforation and lymph node metastasis status) that are used to identify high-risk stage II colon cancers, as well as their impact on overall survival (OS).All patients with stage II colon cancer who were included in the first five years of the MATCH study (1 July 2007 to 1 July 2012) were selected (n=356). The hazard ratios of relevant risk factors were calculated using Cox Proportional Hazards analyses.In as many as 69.1% of the pathology reports, the desired information on one or more risk factors was considered incomplete. In multivariable analysis, age (HR: 1.07, 95%CI 1.04-1.10, p<.001), moderately- (HR: 0.35, 95%CI 0.18-0.70, p=.003) and well (HR 0.11, 95%CI 0.01-0.89, p=.038) differentiated tumors were significantly associated with OS.Pathology reports should better describe the five high-risk factors, in order to enable proper patient selection for further treatment. Chemotherapy may be offered to stage II patients only in select instances, yet a definitive indication is still unavailable.


PubMed | Elisabeth TweeSteden Hospital and Erasmus University Rotterdam
Type: | Journal: Injury | Year: 2017

Over the past decades, the number of survivors of injuries has rapidly grown. It has become important to focus more on the determinants of non-fatal outcome. Although socio-economic status (SES) is considered to be a fundamental determinant of health in general, the role of SES as a determinant of non-fatal outcome after injury is largely unknown.An online search was conducted in November 2015 using Embase, Medline, Web of Science, Cinahl, Cochrane, Google scholar and PubMed. Studies examining the relation between SES and a physical or psychological outcome measure, or using SES as a confounder in a general trauma population were included. There were no restrictions regarding study design. The Quality in Prognostic Studies tool was used to assess the methodological quality of the included studies.The 24 included studies showed large variations in methodological quality. The number of participants ranged from 56 to 4639, and assessments of the measures ranged from immediately to 6year post-injury. Studies used a large number of variables as indicators of SES. Participants educational level was used most frequently. The majority of the studies used a multivariable technique to analyse the relation between SES and non-fatal outcome after injury. All studies found a positive association (80% of studies significant, n=19) between increased SES and better non-fatal outcome after injury.Although an adequate and valid measure of SES is lacking, the results of this review showed that SES is an important determinant of non-fatal outcome after injury. Future research should focus on the definition and measurement of SES and should further underpin the effect of SES on non-fatal outcome after injury.

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