Isala Clinics

Zwolle, Netherlands

Isala Clinics

Zwolle, Netherlands
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Mutsaerts M.A.Q.,University of Groningen | Kuchenbecker W.K.H.,Isala Clinics | Land J.A.,University of Groningen | Hoek A.,University of Groningen
Human Reproduction | Year: 2013

STUDY QUESTION: What are the dropout rates in lifestyle intervention programs (LIPs) for overweight and obese infertile women and can intervention- or patient-related baseline factors associated with dropout be identified in these women?SUMMARY ANSWERThe median dropout rate was 24% in overweight and obese infertile women who participated in a LIP; clinical useful intervention or patient-related factors associated with dropout could not be identified.WHAT IS KNOWN ALREADYOverweight and obese infertile women might improve their chance of conception when they improve their lifestyle and lose weight. Dropout from LIPs reduces the chance of losing considerable weight and is therefore considered to be an important limiting factor of the success of LIPs.STUDY DESIGN, SIZE, DURATIONThis systematic review included 15 studies published between January 1980 and December 2012.PARTICIPANTS/MATERIALS, SETTING, METHODSThe included studies investigated the effect of LIPs for overweight and obese infertile women with infertility. From these studies, dropout rates and intervention- and patient-related baseline factors associated with dropout, as well as weight loss and pregnancy rates, were recorded. MAIN RESULTS AND THE ROLE OF CHANCE: There were 15 studies identified, of which 10 reported dropout rates. The median dropout rate was 24% (range: 0-31%). Four studies reported baseline characteristics of women who dropped out, but modifiable predictors of dropout could not be identified. Weight loss and pregnancy rates were lower in women who dropped out than in women who completed the LIPs. LIMITATIONS, REASONS FOR CAUTION: There were limited numbers of studies investigating patient-related factors associated with dropout. The heterogeneity in the studies precluded us from drawing firm conclusions on the relation between the type of intervention and dropout. WIDER IMPLICATIONS OF THE FINDINGS: Dropout from LIPs is a major drawback because it predisposes to less weight loss and lower pregnancy rates. Identification of predictors of dropout is needed to identify overweight and obese infertile women who are prone for dropout. These women might benefit from extra support and monitoring, to potentially increasing adherence rates, weight loss and pregnancy chances. STUDY FUNDING/COMPETING INTEREST(S): M.A.Q.M. was supported by a research grant from the Dutch Organization for Health Research and Development (ZonMw). The department of obstetrics and gynaecology received research grants from Merck Sharpe and Dohme BV, feering pharmaceuticals, Merck Serono, the Netherlands. © 2013 The Author.


Struijk-Mulder M.C.,Isala Clinics | Ettema H.B.,Isala Clinics | Verheyen C.C.,Isala Clinics
Journal of Thrombosis and Haemostasis | Year: 2010

Different guidelines exist regarding the prevention of venous thromboembolism (VTE) in orthopedic surgery. Objectives: We aimed to compare (inter)national guidelines and analyse differences. Methods: MEDLINE, the Cochrane Library and the internet were searched for guidelines on the prevention of VTE in orthopedic surgery. From these, we constructed a table comparing the different antithrombotic regimens during different orthopedic surgical and plaster cast treatments. Results: Eleven guidelines from nine different countries and one international guideline were included. Few guidelines advise on thrombosis prophylaxis after plaster cast immobilization, (prolonged) arthroscopic surgery and isolated lower extremity trauma. Different opinions exist on the sole use of aspirin and mechanical prophylaxis and on the use of vitamin K antagonists after major hip and knee surgery. Conclusion: Based on the same available literature, different guidelines recommend different thromboprophylactic regimens. Ideally, the grade of recommendation should be based on the same level of evidence world-wide. Whilst there is no agreement on the relevance of different endpoints (e.g. asymptomatic DVT), it is very difficult to reach a consensus. Thromboprophylaxis guidelines should be reviewed and updated on a regular basis, because the evidence is evolving rapidly. © 2009 International Society on Thrombosis and Haemostasis.


Joosten H.,University of Groningen | Van Eersel M.E.A.,University of Groningen | Gansevoort R.T.,University of Groningen | Bilo H.J.G.,Isala Clinics | And 2 more authors.
Stroke | Year: 2013

Background and Purpose-Cognitive decline occurs earlier than previously realized and is already evident at the age of 45. Because cardiovascular risk factors are established risk factors for cognitive decline in old age, we investigated whether cardiovascular risk factors are also associated with cognitive decline in young and middle-aged groups. Methods-The cross-sectional study included 3778 participants aged 35 to 82 years (mean age, 54 years) and free of cardiovascular disease and stroke. Cognitive function was measured with the Ruff Figural Fluency Test (RFFT; worst score, 0; best score, 175 points) and the Visual Association Test (VAT; worst score, 0; best score, 12 points). Overall cardiovascular risk was assessed with the Framingham Risk Score (FRS) for general cardiovascular disease (best score,-5; worst score, 33 points). Results-Mean RFFT score (SD) was 70 (26) points, median VAT score (interquartile range) was 10 (9-11) points, and mean FRS (SD) was 10 (6) points. Using linear regression analysis adjusting for educational level, RFFT was negatively associated with FRS. RFFT score decreased by 1.54 points (95% confidence interval,-1.66 to-1.44; P<0.001) per point increase in FRS. This negative association was not only limited to older age groups, but also found in the young (35-44 years). The main influencing components of the FRS were age (P<0.001), diabetes mellitus (P=0.001), and smoking (P<0.001). Similar results were found for VAT score as outcome measure. Conclusions-In this large population-based cohort, a worse overall cardiovascular risk profile was associated with poorer cognitive function. This association was already present in young adults aged 35 to 44 years. © 2013 American Heart Association, Inc.


Cantineau A.E.P.,University of Groningen | Cohlen B.J.,Isala Clinics | Klip H.,Research Bureau | Heineman M.J.,University of Amsterdam
Human Reproduction | Year: 2011

Background: This multicenter, double-blinded RCT investigated the efficacy of GnRH antagonists in cycles with mild ovarian hyperstimulation (MOH) followed by IUI in subfertile women.MethodsCouples diagnosed with unexplained, male factor subfertility or associated with the presence of minimal or mild endometriosis were randomized with a computer-generated list of numbers by a third party in a double-blinded setting to receive either a GnRH antagonists or a placebo in 12 institutional or academic hospitals. All women were treated with recombinant FSH in a low-dose step-up regimen starting on Day 24 of the cycle. A GnRH antagonist was added when one or more follicles of 14 mm diameter or more were visualized. When at least one follicle reached a size of <18 mm, ovulation was induced by hCG injection. A single IUI was performed 3840 h later. Couples were offered a maximum of three consecutive cycles. The primary outcome of the trial was live births. Secondary outcomes were pregnancy rates, multiple pregnancy rates, miscarriages and ovarian hyperstimulation syndrome rate.ResultsA total of 233 couples were included from January 2006 to February 2009, starting 572 treatment cycles. Live birth rates were not significantly different between the group treated with GnRH antagonist (8.4; 23/275) and the placebo group (12; 36/297) (P 0.30). Three twin pregnancies occurred in the GnRH antagonist group and two twin pregnancies in the placebo group. Conclusions Adding a GnRH antagonist in cycles with MOH in an IUI program does not increase live birth rates.Dutch Trial Register no: NTR497. © 2011 The Author.


Zaidi A.,University of London | Sheikh N.,University of London | Jongman J.K.,Isala Clinics | Gati S.,University of London | And 6 more authors.
Journal of the American College of Cardiology | Year: 2015

Background Physiological cardiac adaptation to regular exercise, including biventricular dilation and T-wave inversion (TWI), may create diagnostic overlap with arrhythmogenic right ventricular cardiomyopathy (ARVC). Objectives The goal of this study was to assess the accuracy of diagnostic criteria for ARVC when applied to athletes exhibiting electrocardiographic TWI and to identify discriminators between physiology and disease. Methods The study population consisted of athletes with TWI (n = 45), athletes without TWI (n = 35), and ARVC patients (n = 35). Subjects underwent electrocardiography (ECG), signal-averaged electrocardiography (SAECG), echocardiography, cardiac magnetic resonance imaging (CMRI), Holter monitoring, and exercise testing. Results There were no electrical, structural, or functional cardiac differences between athletes exhibiting TWI and athletes without TWI. When athletes were compared with ARVC patients, markers of physiological remodeling included early repolarization, biphasic TWI, voltage criteria for right ventricular (RV) or left ventricular hypertrophy, and symmetrical cardiac enlargement. Indicators of RV pathology included the following: syncope; Q waves or precordial QRS amplitudes <1.8 mV; 3 abnormal SAECG parameters; delayed gadolinium enhancement, RV ejection fraction ≤45%, or wall motion abnormalities at CMRI; >1,000 ventricular extrasystoles (or >500 non-RV outflow tract) per 24 h; and symptoms, ventricular tachyarrhythmias, or attenuated blood pressure response during exercise. Nonspecific parameters included the following: prolonged QRS terminal activation; 2 abnormal SAECG parameters; RV dilation without wall motion abnormalities; RV outflow tract ectopy; and exercise-induced T-wave pseudonormalization. Conclusions TWI and balanced biventricular dilation are likely to represent benign manifestations of training in asymptomatic athletes without relevant family history. Diagnostic criteria for ARVC are nonspecific in such individuals. Comprehensive testing using widely available techniques can effectively differentiate borderline cases. © 2015 American College of Cardiology Foundation.


Hofma S.H.,Medical Center Leeuwarden | Brouwer J.,Medical Center Leeuwarden | Velders M.A.,Medical Center Leeuwarden | Van'T Hof A.W.J.,Isala Clinics | And 4 more authors.
Journal of the American College of Cardiology | Year: 2012

Objectives: The goal of this study was to compare the efficacy and safety of second-generation everolimus-eluting stents (EES) with first-generation sirolimus-eluting stents (SES) in primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Background: Drug-eluting stents (DES) in AMI are still feared for possible late and very late stent thrombosis (ST). Newer-generation DES, with more hemocompatible polymers and improved healing, may show promise regarding increased efficacy of DES with improved safety. However, no randomized trials in AMI are available. Methods: A total of 625 patients with AMI were randomized (2:1) to receive EES or SES in the XAMI (XienceV Stent vs Cypher Stent in Primary PCI for Acute Myocardial Infarction) trial. Primary endpoint was major adverse cardiac events (MACE) at 1 year consisting of cardiac death, nonfatal AMI, or any target vessel revascularization. The study was powered for noninferiority of EES. Secondary endpoints comprised ST rates and MACE rate up to 3 years. Results: The MACE rate was 4.0% for EES and 7.7% for SES; the absolute difference was -3.7% (95% confidence interval: -8.28 to -0.03; p = 0.048) and relative risk was 0.52 (95% confidence interval: 0.27 to 1.00). One-year cardiac mortality was low at 1.5% for EES versus 2.7% for SES (p = 0.36), and 1-year incidence of definite and/or probable ST was 1.2% for EES versus 2.7% for SES (p = 0.21). Conclusions: In this all-comer, randomized, multicenter AMI trial, second-generation EES was noninferior to SES, and superiority for MACE was suggested. ST rate in EES at 1-year was low, but long-term follow-up and larger studies will have to show whether very late ST rates will also be improved in newer DES. (XienceV Stent vs Cypher Stent in Primary PCI for Acute Myocardial Infarction [XAMI]; NTR1123) © 2012 American College of Cardiology Foundation.


Witt F.,TU Hamburg - Harburg | Bosker B.H.,Isala Clinics | Bishop N.E.,TU Hamburg - Harburg | Ettema H.B.,Isala Clinics | And 2 more authors.
Journal of Bone and Joint Surgery - American Volume | Year: 2014

Background: Revision of hip implants due to adverse tissue reactions to metal debris has been associated with wear and corrosion of the metal-on-metal bearing articulation and the modular taper interface. Bearing articulation wear is increased in conditions of poor lubrication, which can also lead to high friction moments that may cause corrosion at the taper interface. This suggests that wear of the bearing and increased corrosion of the taper interface should occur simultaneously, which was investigated in this study.Methods: Forty-three large-diameter cobalt-chromium bearings of the same design, implanted with a titanium stem using a titanium adapter, were retrieved at revision at a single center. Retrievals were grouped according to visual inspection of the female taper surface of the adapter into slight and severe corrosion groups. Volume change of bearing and taper surfaces was assessed using a coordinate measurement machine. Serum ion concentrations were determined for fortythree patients, whereas tissue metal concentration was measured for twelve patients.Results: Severe taper corrosion was observed in 30% of the retrievals. Corrosion was observed either as material deposition or wear. The overall bearing wear rate was significantly higher in the group with severe taper corrosion than in the group with slight corrosion (7.2 ± 9.0 mm3/yr versus 3.1 ± 6.8 mm3/yr, respectively; p = 0.023) as were the serum cobalt (40.5 ± 44.9 mg/L versus 15.2 ± 23.9 mg/L, respectively; p = 0.024) and chromium ion concentrations (32.7 ± 32.7 mg/L versus 12.0 ± 15.1 mg/L, respectively; p = 0.019). Serum metal ion concentrations were more consistent indicators of wear than tissue metal concentrations.Conclusions: The increased bearing articulation wear and serum metal ion concentrations in cases with taper interface corrosion support the hypothesis that increased friction in the joint articulation is one of the factors responsible for simultaneous articulation and taper damage. However, independent taper or bearing damage was also observed, suggesting that other factors are involved in the process. © 2014 by The Journal of Bone and Joint Surgery, Incorporated.


Van Den Brand J.A.J.G.,Radboud University Nijmegen | Van Dijk P.R.,Isala Clinics | Hofstra J.M.,Radboud University Nijmegen | Wetzels J.F.M.,Radboud University Nijmegen
Journal of the American Society of Nephrology | Year: 2014

Recently published Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend limiting the use of immunosuppressive drugs in idiopathic membranous nephropathy to patients at the highest risk of kidney failure. However, recommendations are based on natural history rather than direct assessment of a restrictive treatment strategy. Here, we describe the long-termoutcomes of treating a large cohort of patients with idiopathic membranous nephropathy according to a restrictive treatment policy. We analyzed data for 254 patients who visited our outpatient clinic between 1995 and 2009. All patients were treated with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. Immunosuppressive therapy was recommended in cases of deteriorating renal function or untreatable nephrotic syndrome. Primary outcomes for the present study were renal replacement therapy and death. Secondary outcomes included adverse events during follow-up and remission of proteinuria. In total, 124 patients (49%) received immunosuppressive therapy, which predominantly consisted of cyclophosphamide combined with steroids. Ten-year cumulative incidence rates were 3% for renal replacement therapy and 10% for death. Partial remission rates were 39%, 70%, and 83% after 1, 3, and 5 years, respectively; complete remission rateswere5%, 24%, and 38%at 1, 3, and 5 years, respectively. Aserious adverse event occurred in 23% of all patients. The most notable complications were infections (17%), leukopenia (18%), cardiovascular events (13%), and malignancies (8%). In conclusion, the use of a restrictive treatment strategy in this cohort of patients with idiopathic membranous nephropathy yielded favorable outcomes while limiting the number of patients exposed to toxic drugs. These results support current KDIGO guidelines. Copyright © 2014 by the American Society of Nephrology.


Bijvank S.W.A.N.,Isala Clinics | Duvekot J.J.,Erasmus Medical Center
Obstetrical and Gynecological Survey | Year: 2010

To evaluate the efficacy and safety of intravenous nicardipine for the treatment of severe hypertension in pregnancy. Articles were identified through electronic databases (Medline and Cochrane). No date or language restrictions were placed. Relevant citations were hand searched. The following search terms were used: pregnancy, severe hypertension and nicardipine. Patients included had chronic or gestational hypertension with or without marked proteinuria. Primary outcomes were reduction of systolic/diastolic and/or mean arterial pressure, time to target blood pressure, and severe maternal (hypotension, tachycardia) or severe fetal side effects (CTG abnormalities needing direct intervention). Five studies were found describing the use of nicardipine for treatment of severe hypertension in pregnancy. All studies were included in this review. One hundred forty-seven patients were treated. All patients had a significant reduction of both diastolic and systolic blood pressure. Treatment resulted in a 91% success rate in studies that defined success and 20% reduction of mean arterial blood pressure or systolic/diastolic blood pressure in 87%. Target blood pressure was reached within 23 minutes in 70% of the patients, 91% reached target blood pressure within 130 minutes. No severe maternal or fetal side effects were recorded. Nicardipine is a very effective therapy for treatment of severe hypertension in pregnancy and may be a better alternative to other available treatment options. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to evaluate the relative effectiveness of nicardipine for the treatment of severe hypertension in pregnancy. Compare the side effect profile of nicardipine to labetolol for the treatment of severe hypertension in pregnancy and calculate the appropriate dosing of nicardipine for the treatment of hypertension in pregnancy. Copyright © 2010 by Lippincott Williams & Wilkins.


Maas A.H.E.M.,Isala Clinics
Netherlands Heart Journal | Year: 2010

Cardiovascular disease develops 7 to 10 years later in women than in men and is still the major cause of death in women. The risk of heart disease in women is often underestimated due to the misperception that females are 'protected' against cardiovascular disease. The under-recognition of heart disease and differences in clinical presentation in women lead to less aggressive treatment strategies and a lower representation of women in clinical trials. Furthermore, self-awareness in women and identification of their cardiovascular risk factors needs more attention, which should result in a better prevention of cardiovascular events. In this review we summarise the major issues that are important in the diagnosis and treatment of coronary heart disease in women.

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