Elisabeth TweeSteden Hospital

Tilburg, Netherlands

Elisabeth TweeSteden Hospital

Tilburg, Netherlands
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van Rijsbergen M.W.A.,University of Tilburg | Mark R.E.,University of Tilburg | Kop W.J.,University of Tilburg | de Kort P.L.M.,Elisabeth TweeSteden Hospital | Sitskoorn M.M.,University of Tilburg
European Journal of Neurology | Year: 2017

Background and purpose: Objective cognitive performance (OCP) is often impaired in patients post-stroke but the consequences of OCP for patient-reported subjective cognitive complaints (SCC) are poorly understood. We performed a detailed analysis on the association between post-stroke OCP and SCC. Methods: Assessments of OCP and SCC were obtained in 208 patients 3 months after stroke. OCP was evaluated using conventional and ecologically valid neuropsychological tests. Levels of SCC were measured using the CheckList for Cognitive and Emotional (CLCE) consequences following stroke inventory. Multivariate hierarchical regression analyses were used to evaluate the association of OCP with CLCE scores adjusting for age, sex and intelligence quotient. Analyses were performed to examine the global extent of OCP dysfunction (based on the total number of impaired neuropsychological tests, i.e. objective cognitive impairment index) and for each OCP test separately using the raw neuropsychological (sub)test scores. Results: The objective cognitive impairment index for global OCP was positively correlated with the CLCE score (Spearman's rho = 0.22, P = 0.003), which remained significant in multivariate adjusted models (β = 0.25, P = 0.01). Results for the separate neuropsychological tests indicated that only one task (the ecologically valid Rivermead Behavioural Memory Test) was independently associated with the CLCE in multivariate adjusted models (β = −0.34, P < 0.001). Conclusions: Objective neuropsychological test performance, as measured by the global dysfunction index or an ecologically valid memory task, was associated with SCC. These data suggest that cumulative deficits in multiple cognitive domains contribute to subjectively experienced poor cognitive abilities in daily life in patients post-stroke. © 2016 EAN

Mommersteeg P.M.C.,University of Tilburg | Arts L.,University of Tilburg | Zijlstra W.,University of Tilburg | Widdershoven J.W.,University of Tilburg | And 3 more authors.
Circulation: Cardiovascular Quality and Outcomes | Year: 2017

Background - Patients with nonobstructive coronary artery disease (NOCAD; wall irregularities, stenosis <60%), and women with NOCAD in particular, remain underinvestigated. We examined sex and gender (S&G) differences in health status, psychological distress, and personality between patients with NOCAD and the general population, as well as S&G differences within the NOCAD population. Methods and Results - In total, 523 patients with NOCAD (61±9 years, 52% women) were included via coronary angiography and computed tomography as part of the TWIST (Tweesteden Mild Stenosis) study. Generic health status (12-item Short Form physical and mental scales and fatigue), psychological distress (Hospital Anxiety and Depression Scale anxiety and depressive symptoms and Global Mood Scale negative and positive affect), and personality (Type D personality) were compared between patients with NOCAD and an age- and sex-matched group of 1347 people from the general population. Frequency matching was performed to obtain a similar sex distribution in each age-decile group. Both men and women with NOCAD reported impaired health status, more psychological distress, and Type D personality compared with men and women in the reference group. Women reported more psychosocial distress compared with men, but no significant sex-by-group interaction effects were observed. Women with NOCAD reported impaired health status, more anxiety, and less positive affect, but no differences in depressive symptoms, angina, or Type D personality when compared with men with NOCAD. Age, education, employment, partner, and alcohol use explained these S&G differences within the NOCAD group. Conclusions - In both men and women, NOCAD was associated with impaired health status, more psychological distress, and Type D personality when compared with a reference population. Factors reflecting S&G differences explained these S&G findings in patient-reported outcomes. © 2016 The Authors.

Visser E.,Elisabeth TweeSteden Hospital
Journal of Trauma and Acute Care Surgery | Year: 2017

BACKGROUND: Trauma patients suffer from Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD). It is unknown how these disorders develop over time and when treatment is effective. Our aim was to systematically review (i) the course and predictors of ASD and PTSD after trauma and (ii) which and when psychological treatments are effective. METHODS: Embase, Medline, Web of Science, Scopus, PsycInfo, Cinahl, Cochrane, Pubmed, and Google Scholar were searched up to September 14, 2015. Quality was assessed with STROBE and CONSORT checklists. RESULTS: Overall, 49 (69%) observational studies and 22 (31%) intervention studies were included. Fifty studies (70%) were of lower (Level of Evidence (LoE) 3) or poor quality (LoE 4). ASD was present during hospitalization (range 1%-37%) and about 30% experienced PTSD one month after trauma (LoE 3). The onset of PTSD was within three months up to 12 months after trauma (LoE 3). Especially in patients with ASD, patients showed PTSD symptoms after six years (LoE 3). ASD and PTSD were associated with socio-demographic factors (e.g. being female, younger age, financial problems and low income), reduced cognitive functioning, physical (e.g. pain), social (e.g. low social support), and psychological problems (e.g. hyper-arousal) or disorders (e.g. ASD). Early treatment in the first weeks after trauma can be preventive for PTSD, but effective treatment for ASD is still unclear. Compared to other psychological treatments, the most common examined treatment for PTSD was Cognitive Behavioral Therapy (CBT), which seems to be effective (LoE 2). CONCLUSIONS: A large number of poor qualitative studies present inconsistent findings on the course of ASD and PTSD. Predictors for ASD and PTSD were identified. Early treatment can prevent PTSD. CBT is effective, but mostly examined and it has limitations (e.g. engagement). Other intervention studies are necessary. Good qualitative observational and intervention studies are lacking and needed. LEVEL OF EVIDENCE: III, study type: systematic review and meta-analyses © 2017 Lippincott Williams & Wilkins, Inc.

Telleman J.A.,Elisabeth Tweesteden Hospital | Stellingwerff M.D.,Elisabeth Tweesteden Hospital | Brekelmans G.J.,Elisabeth Tweesteden Hospital | Visser L.H.,Elisabeth Tweesteden Hospital
Neurology | Year: 2017

Objective: To determine ultrasonographic peripheral nerve involvement in patients with asymptomatic neurofibromatosis type 1 (NF1). Methods: Thirteen asymptomatic and 4 minimally symptomatic patients with NF1 were included in this cross-sectional pilot study to detect asymptomatic abnormalities of the brachial plexus and upper and lower extremity nerves. Patients underwent clinical examination, nerve conduction studies (NCS), and high-resolution ultrasonography (HRUS). Results: HRUS showed abnormalities in 16 patients (94.1%). Neurofibromas were identified in 10 patients (58.8%): localized neurofibromas were found in 3 patients (17.6%), plexiform neurofibromas in 3 (17.6%), and both in 4 (23.5%). In 6 patients (35.3%), only nerve enlargement without an abnormal fascicular pattern was observed. Severe involvement of the peripheral nervous system with multiple plexiform neurofibromas was observed in 7 patients (41.2%), while 4 patients (23.5%) had no or only minor involvement. Both NCS and HRUS were performed on 73 individual nerve segments. In 5.5%, abnormalities were found with both tests; in 50.7%, only with HRUS; and in 1.4%, only with NCS. Conclusions: HRUS frequently showed subclinical involvement of the peripheral nerves in NF1, also when NCS were normal. HRUS findings ranged from normal to widespread peripheral nerve involvement. Because the presence of plexiform neurofibromas and the benign tumor load are risk factors for the development of a malignant peripheral nerve sheath tumor, HRUS may be a useful tool to identify a subgroup of patients who could benefit from regular follow-up. © 2017 American Academy of Neurology.

Vink A.S.,University of Amsterdam | Vink A.S.,Emma Childrens Hospital | Clur S.-A.B.,University of Amsterdam | Blank A.C.,University Utrecht | And 6 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2017

Background - In congenital long-QT syndrome, age, sex, and genotype have been associated with cardiac events, but their effect on the trend in QTc interval has never been established. We, therefore, aimed to assess the effect of age and sex on the QTc interval in children and adolescents with type 1 (LQT1) and type 2 (LQT2) long-QT syndrome. Methods and Results - QTc intervals of 12-lead resting electrocardiograms were determined, and trends over time were analyzed using a linear mixed-effects model. The study included 278 patients with a median follow-up of 4 years (interquartile range, 1-9) and a median number of 6 (interquartile range, 2-10) electrocardiograms per patient. Both LQT1 and LQT2 male patients showed QTc interval shortening after the onset of puberty. In LQT2 male patients, this was preceded by a progressive QTc interval prolongation. In LQT1, after the age of 12 years, male patients had a significantly shorter QTc interval than female patients. In LQT2, during the first years of life and from 14 to 26 years, male patients had a significantly shorter QTc interval than female patients. On the contrary, between 5 and 14 years, LQT2 male patients had significantly longer QTc interval than LQT2 female patients. Conclusions - There is a significant effect of age and sex on the QTc interval in long-QT syndrome, with a unique pattern per genotype. The age of 12 to 14 years is an important transitional period. In the risk stratification and management of long-QT syndrome patients, clinicians should be aware of these age-, sex-, and genotype-related trends in QTc interval and especially the important role of the onset of puberty. © 2017 American Heart Association, Inc.

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.

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.

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