Gelre Ziekenhuizen

Apeldoorn, Netherlands

Gelre Ziekenhuizen

Apeldoorn, Netherlands
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Van Der Palen J.,University of Twente | Van Der Palen J.,Spectrum | Ginko T.,Praxis Inc. | Kroker A.,Studienzentrum KPPK | And 6 more authors.
Expert Opinion on Drug Delivery | Year: 2013

Objective: To assess preference, satisfaction and critical errors with a novel, breath-actuated, multi-dose dry powder inhaler (DPI; Genuair®/ Pressair™), versus a widely used, single-dose DPI (HandiHaler®) in patients with moderate-to-severe chronic obstructive pulmonary disease. Methods: In this randomised, open-label, multicentre, cross-over study, patients (aged ≥ 40 years) inhaled placebo once daily through both inhalers for 2 weeks in addition to current medication. The primary end point was percentage of patients who preferred Genuair to HandiHaler. Overall patient satisfaction (5-point scale: 1 = very dissatisfied; 5 = very satisfied), critical errors and willingness to continue using each inhaler (0 = not willing; 100 = definitely willing) were assessed. Results: Of 130 patients randomised, 105 were included in the intent-to-treat population (71.4% male; mean age 65.7 years). After 2 weeks, significantly more patients preferred Genuair than HandiHaler (79.1 vs 20.9%; p < 0.0001). Overall satisfaction scores (4.6 vs 3.8; p < 0.0001) and willingness to continue use scores (84.0 vs 62.5; p < 0.0001) were significantly higher with Genuair versus HandiHaler. Significantly fewer patients made ≥ 1 critical error with Genuair only compared with HandiHaler only (2.9 vs 19.0%; p < 0.0001). Conclusion: After 2 weeks' practice, patients preferred and were more willing to continue using Genuair than HandiHaler. Genuair was associated with higher patient satisfaction and fewer critical errors than HandiHaler. © Informa UK, Ltd.


Van Der Palen J.,Spectrum | Van Der Valk P.,Spectrum | Goosens M.,Gelre Ziekenhuizen | Groothuis-Oudshoorn K.,University of Twente | Brusse-Keizer M.,Spectrum
Expert Opinion on Drug Delivery | Year: 2013

Objectives: The objective of this randomised, cross-over study was to compare a new single-dose dry powder inhaler (Elpenhaler (EH)), with a widely used, multi-dose dry powder inhaler (Diskus (DK)) on critical errors, patient preference, and satisfaction with the inhalers. Methods: First, patients read the instructions of one device, followed by a first inhalation attempt. Inhalation errors were assessed and if mistakes were made, correct inhaler use was demonstrated. Then patients had to demonstrate again and mistakes were registered. This was repeated up to four times. After completing the first device, the same procedure was started with the second inhaler. Primary outcome was the percentage of patients making at least one critical error after reading the insert. Secondary outcomes were inhaler preference and satisfaction with the inhalers. Results: After reading the insert, 19 of 113 patients (17%) made at least one critical error with DK and 40 (35%) with EH (p = 0.001); 73% preferred the DK and 27% the EH (p < 0.001). The mean overall satisfaction score (1 = very satisfied; 5 = very dissatisfied) for DK was 1.59 and for EH 2.48 (p < 0.001). Conclusion: With DK fewer errors were made, more patients preferred DK over EH and patients were more satisfied with DK. This may enable DK to improve treatment outcomes more than EH. © 2013 Informa UK, Ltd.


Van Der Zaag E.S.,Gelre Ziekenhuizen | Bouma W.H.,Gelre Ziekenhuizen
Annals of Surgical Oncology | Year: 2012

Background. The clinical impact of sentinel lymph node (SN) biopsy in colorectal cancer is still controversial. The aim of our study was to determine the accuracy of this procedure from published data and to identify factors that contribute to the conflicting reports. Methods. A systematic search of the Medline, Embase, and Cochrane databases up to July 2011 revealed 98 potentially eligible studies, of which 57 were analyzed including 3,934 patients (3,944 specimens). Results. The pooled SN identification rate was 90.7 % (95 % CI 88.2-93.3), with a significant higher identification rate in studies including more than 100 patients or studies using the ex vivo SN technique. The pooled sensitivity of the SN procedure was 69.6 % (95 % CI 64.7-74.6). Including the immunohistochemical findings increased the pooled sensitivity of SN procedure to 80.2 % (95 % CI 4.7-10.7). Subgroups with significantly higher sensitivity could be identified: ≥4 SNs versus <4 SNs (85.2 vs. 66.3 %, p = 0.003), colon versus rectal cancer (77.6 vs. 65.7 %, p = 0.04), early T1 or T2 versus advanced T3 or T4 carcinomas (93.4 vs. 58.8 %, p = 0.01). Serial sectioning and immunohistochemistry resulted in a mean upstaging of 18.9 % (range 0-50 %). True upstaging defined as micrometastases (pN1mi?) rather than isolated tumor cells (pN0itc+) was 7.7 %. Conclusions. The SN procedure in colorectal cancer has an overall sensitivity of 70 %, with increased sensitivity and refined staging in early-stage colon cancer. Because the ex vivo SN mapping is an easy technique it should be considered. © Society of Surgical Oncology 2012.


Stapleton N.M.,Sanquin Research and Landsteiner Laboratory | Einarsdottir H.K.,Sanquin Research and Landsteiner Laboratory | Stemerding A.M.,Gelre Ziekenhuizen | Vidarsson G.,Sanquin Research and Landsteiner Laboratory
Immunological Reviews | Year: 2015

The neonatal Fc receptor, FcRn, is best known for its role in transporting IgG in various tissues, providing newborns with humoral immunity, and for prolonging the half-life of IgG. Recent findings implicate the involvement of FcRn in a far wider range of biological and immunological processes, as FcRn has been found to bind and extend the half-life of albumin; to be involved in IgG transport and antigen sampling at mucosal surfaces; and to be crucial for efficient IgG-mediated phagocytosis. Herein, the function of FcRn will be reviewed, with emphasis on its recently documented significance for IgG polymorphisms affecting the half-life and biodistribution of IgG3, on its role in phagocyte biology, and the subsequent role for the presentation of antigens to lymphocytes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Donswijk L.F.,Gelre Ziekenhuizen | Gale E.A.M.,University of Bristol
BMJ (Online) | Year: 2015

Objective: To determine whether trial publications of glucose lowering drugs are dominated by a small group of highly prolific authors ("supertrialists") and to identify some of their characteristics. Design: Bibliographic analysis of trial publications. Data sources and review methods We searched PubMed for all randomised controlled trials (RCTs) relating to glucose lowering drugs published between 1 January 1993 and 31 December 2013. From these publications we identified the 110 most prolific authors using PubReMiner. The 991 RCTs they published were examined for various characteristics such as author number, commercial sponsorship, company authorship, conflicts of interest, etc. The track record of the top 11 authors was studied in more detail. Main outco me measure: Proportion of articles published by the top 110 and the top 11 authors. Results: 3782 articles from 13 592 authors were identified. The top 110 authors were named in 1227 (32.4%) of all articles, and the top 11 authors in 397 (10.5%) of all articles. The top 110 authors published 991 RCTs for a median of 20 (range 4-77) RCTs per author; the top 11 published 354 RCTs for a median of 42 (36-77) RCTs per author. Of the 110 top authors, 48 were employed by a pharmaceutical company. Of the 991 RCTs, 906 were commercially sponsored. Of 704 articles that could be assessed for conflicts of interest, only 42 (6%) were considered fully independent. Medical writing assistance was acknowledged in 439 (44.3%) of 991 RCTs. Conclusion: The past two decades have seen an explosive increase in the number of published clinical trials regarding glucose lowering treatment. Some authors have made a disproportionate contribution to the therapeutic evidence base; one third of the RCT evidence base on glucose lowering drug treatment for diabetes was generated by less than 1% of authors. Of these, 44% were company employees and 56% were academics who work closely with the pharmaceutical companies. ©BMJ Publishing Group Ltd 2015.


Ten Voorde M.,Gelre Ziekenhuizen | Van Der Zaag-Loonen H.J.,Gelre Ziekenhuizen | Van Leeuwen R.B.,Gelre Ziekenhuizen
Quality of Life Research | Year: 2012

Purpose: Relatively little is known about the level of impairment in patients with dizziness. Research question: How much does dizziness impair the quality of life of patients referred to a multidisciplinary dizziness unit? Patients and methods: All 2,252 patients completed the Dutch version of the Dizziness Handicap Inventory (DHI-D; score 0-100 with higher scores representing more impairment). The results were classified into three categories: mild, moderate, and severe impairment. The three domains in the DHI representing physical, functional, and emotional aspects of dizziness were compared, as well as DHI scores of men versus women, between diagnoses, and the relationship between DHI and age. Results: A total of 2,242 patients (64% women, mean age 54 years) completed the DHI with a mean score of 40.6. Almost 70% of patients had moderate or severe complaints. The handicap perceived by patients was primarily caused by physical and functional factors and less by emotional factors. Female patients and patients with hyperventilation syndrome and/or anxiety disorder had significantly higher DHI scores on all subscales. There was an S-shaped relationship between DHI score and age, and older patients reported more impairment. Conclusion: Dizziness has considerable impact on health-related quality of life of dizzy patients. © 2011 Springer Science+Business Media B.V.


De Ru J.A.,Central Military Hospital | Van Benthem P.P.G.,Gelre Ziekenhuizen
Otology and Neurotology | Year: 2011

Objective: To critically appraise the topic, questioning whether administering antiviral medication in case of Ramsay Hunt syndrome improves the restoration of facial nerve function. Methods: We reviewed the literature on this subject and calculated the odds ratios for the different treatment modalities. Results: Our study clearly shows that antiviral medication in combination with corticosteroids improves the outcome for patients with Ramsay Hunt syndrome. Conclusion: Contrary to a recent Cochrane Library review, we conclude that patients with Ramsay Hunt syndrome should be treated with combination therapy including antivirals. Copyright © 2011 Otology & Neurotology, Inc.


To assess interobserver agreement between pathologists in judging photographs of lymph node preparations of occult tumour cells of patients with colon cancer. Descriptive and comparative study of interobserver variability. All lymph nodes of 82 pN0 patients with colon cancer were analysed using three monoclonal antibodies against epithelial cells. Digital pictures of the 37 lesions detected were placed on a secured website. Forty pathologists selected at random were asked to examine the pictures and to categorize the lesions into 'micro metastases', 'isolated tumour cells' or something else. The degree of agreement was calculated by the Kendall W coefficient (with a range of 0.0-1.0). Thirty-five pathologists (88%) categorized the 37 lesions. Five lesions (14%) were categorized unanimously as micro metastases or isolated tumour cells. In 26 pictures (70%) the degree of agreement was poor to moderate. When the analysis was performed only on those diagnoses of which the pathologists were confident about their judgment, the percentage of lesions with good agreement rose to 49%. Differences in agreement were principally associated with multifocal lesions, clusters of tumour cells < 0.2 mm with proliferation characteristics in the parenchyma of the lymph node and lymphangio invasion. The differentiation between micro metastases and isolated tumour cells in lymph nodes of patients with colon cancer was not uniform. If this classification has clinical relevance to colon cancer then better definitions are needed.


Bouhbouh S.,Gelre Ziekenhuizen
Nederlands tijdschrift voor geneeskunde | Year: 2011

A central venous catheter was inserted in a 37-year-old man. During placement the catheter took a route to the left side of the heart. On CT it appeared the catheter was placed in a persisting left V. cava superior.


Bouhbouh S.,Gelre Ziekenhuizen
Nederlands tijdschrift voor geneeskunde | Year: 2011

BACKGROUND: Ingestion of certain Cortinarius species may lead to renal failure. In the Netherlands, this type of poisoning has not been previously described. CASUS: A 58-year-old female presented with headache, vomiting and oliguria, preceded by a few days of burning, painful thirst and malaise. She had acute and irreversible renal failure of unknown cause. History revealed that two days before the onset of her symptoms, she had eaten a ragout prepared with mushrooms that were picked in a forest. A renal biopsy demonstrated interstitial nephritis with proximal tubular necrosis. In the leftovers of the ragout two fragments of Cortinarius mushroom, probably belonging to the complex of Cortinarius cinnamomeus (cinnamon webcap), were found. First signs and symptoms, and the course are compatible with those described in the literature on Cortinarius poisoning. Despite haemodialysis and administration of acetylcysteine and glucocorticoids, her renal function did not recover. CONCLUSION: This case is the first description of mushroom poisoning by a species of the genus Cortinarius in the Netherlands.

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