Zwolle, Netherlands
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Letitre S.L.,Isala Hospital | De Groot E.P.,Isala Hospital | Brand P.L.P.,Isala Hospital | Brand P.L.P.,University of Groningen
Archives of Disease in Childhood | Year: 2014

Objective: Although asthma has been linked to psychological morbidity, this relationship may be confounded by poor asthma control. We aimed to compare the prevalence of anxiety, depression and low level of self-esteem in children with well-controlled asthma with that of healthy peers. Setting: Dedicated asthma clinic in a general hospital. Patients: 70 patients with mostly well-controlled asthma and 70 matched healthy controls. Interventions: Comprehensive asthma education, management and follow-up for asthma patients. Main outcome measures: Validated Dutch versions of the Childhood Depression inventory (CDI), Revised Fear Survey for Children (RFSC), Self Perception Profile for Children (SPC-C) and Adolescents (SPC-A) and State-Trait Anxiety Inventory for Children (STAIC). Asthma control assessed by asthma control questionnaire. Results: No significant differences were found in total scores between asthmatics and controls (95% CI for difference -0.2 to 2.9 for CDI, -5.9 to 11.2 for RFSC, -19.9 to 6.3 for SPC-C, -24.1 to 5.0 for SPC-A and -2.7 to 0.01 for STAIC). There were also no significant differences between asthmatics and controls in the prevalence of scores exceeding cut-off levels for clinically relevant anxiety (13.3 vs 13.0%, p=0.605), depression (12.9 vs 5.7%, p=0.243) or low self-esteem (21.4 vs 12.9%, p=0.175). A significant correlation was found between poorer asthma control and CDI (p=0.012) and anxiety trait symptoms (p<0.001). Conclusions: Children with well-controlled asthma enrolled in a comprehensive asthma management programme do not have an increased risk of anxiety, depression and poor self-esteem. Earlier reports of psychological comorbidity in asthma may have been related to inadequately controlled asthma.

De Groot E.P.,Isala Hospital | Kreggemeijer W.J.,Isala Hospital | Brand P.L.P.,Isala Hospital | Brand P.L.P.,University of Groningen
Acta Paediatrica, International Journal of Paediatrics | Year: 2015

Aim The prevalence of true therapy-resistant asthma among children whose asthma remains uncontrolled, despite daily controller therapy, is unknown. The aim of this study was to investigate the underlying causes in children with uncontrolled asthma. Methods This was a retrospective chart review of 142 children aged from five to 17 years over a five-year period. The patients had uncontrolled asthma and were referred by general practitioners to a hospital-based paediatric asthma clinic. Results An underlying cause for uncontrolled asthma was found in 138 children (97.2%). The causes were poor adherence (n = 53, 37.3%), ongoing exposure to environmental triggers (n = 40, 28.2%), comorbidities (n = 28, 19.7%), incorrect inhaler technique (n = 11, 7.7%) and incorrect diagnosis (n = 6, 4.2%). After properly addressing these basics in asthma management, the asthma was well controlled in all 138 patients and lung function was normal. Only four children (2.8%) fulfilled the criteria for true therapy-resistant asthma. Conclusion A remedial cause in the basics of asthma management could be found in 97% of children with uncontrolled asthma referred to a hospital-based asthma clinic. True therapy-resistant asthma was found to be very rare in children. ©2015 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.

Dewilde W.J.M.,Twee Steden Hospital | Oirbans T.,St Antonius Hospital | Verheugt F.W.A.,Onze Lieve Vrouwe Gasthuis OLVG | Kelder J.C.,St Antonius Hospital | And 9 more authors.
The Lancet | Year: 2013

Background If percutaneous coronary intervention (PCI) is required in patients taking oral anticoagulants, antiplatelet therapy with aspirin and clopidogrel is indicated, but such triple therapy increases the risk of serious bleeding. We investigated the safety and efficacy of clopidogrel alone compared with clopidogrel plus aspirin. Methods We did an open-label, multicentre, randomised, controlled trial in 15 centres in Belgium and the Netherlands. From November, 2008, to November, 2011, adults receiving oral anticoagulants and undergoing PCI were assigned clopidogrel alone (double therapy) or clopidogrel plus aspirin (triple therapy). The primary outcome was any bleeding episode within 1 year of PCI, assessed by intention to treat. This study is registered with, number NCT00769938. Findings 573 patients were enrolled and 1-year data were available for 279 (98·2%) patients assigned double therapy and 284 (98·3%) assigned triple therapy. Mean ages were 70·3 (SD 7·0) years and 69·5 (8·0) years, respectively. Bleeding episodes were seen in 54 (19·4%) patients receiving double therapy and in 126 (44·4%) receiving triple therapy (hazard ratio [HR] 0·36, 95% CI 0·26-0·50, p<0·0001). In the double-therapy group, six (2·2%) patients had multiple bleeding events, compared with 34 (12·0%) in the triple-therapy group. 11 (3·9%) patients receiving double therapy required at least one blood transfusion, compared with 27 (9·5%) patients in the triple-therapy group (odds ratio from Kaplan-Meier curve 0·39, 95% CI 0·17-0·84, p=0·011). Interpretation Use of clopiogrel without aspirin was associated with a significant reduction in bleeding complications and no increase in the rate of thrombotic events. Funding Antonius Ziekenhuis Foundation, Strect Foundation. © 2013 Elsevier Ltd.

News Article | March 3, 2017

International medical imaging IT and cybersecurity company Sectra (STO: SECT B) has signed a ten-year contract with Isala Hospital, in the Netherlands. The contract comprises Sectra's IT solution for reviewing diagnostic images. The solution enables physicians at Isala Hospital to access and review medical images from any of its two hospitals, regardless of where current and prior images were taken. The joint solution also enables the two sites to efficiently share resources. Isala Hospital's two facilities are located in the Dutch cities Zwolle and Meppel, and Sectra's solution will replace the two imaging solutions that are currently used at the two sites. It will handle approximately 400,000 examinations each year. "With this joint solution from Sectra, information will follow the patient instead of the other way around. Sectra's proven track record of extremely high system availability was another important aspect for us in the choice of vendor and is also key in delivering efficient healthcare," says Roel Venema, member of the board of directors at Isala Hospital. The solution ordered by Isala Hospital is part of Sectra's complete enterprise imaging offering which is modular and supports the most image-intense departments—radiology, pathology, cardiology and orthopaedics. Being built on the same technical platform, customers can easily extend a departmental solution to create a comprehensive VNA and enterprise image management solution without major investments or the replacement of existing components. Meet Sectra at ECR 2017 Sectra's Enterprise Image Management solution will be showcased at booth #411 at ECR in Vienna, 2-5 March. Read more about Sectra at ECR and book a meeting at For further information, please contact: This information was brought to you by Cision,c2203785 The following files are available for download:

De Luca G.,University of Piemonte Orientale | Savonitto S.,Manzoni Hospital | Van't Hof A.W.J.,Isala Hospital | Suryapranata H.,Njimegen University
Drugs | Year: 2015

Coronary artery disease and acute myocardial infarction still represent the leading cause of mortality in developed countries. Therefore, great efforts have been made in the last decades to improve reperfusion strategies and adjunctive antithrombotic therapies. In fact, despite optimal epicardial recanalisation, a large proportion of patients still experience impaired reperfusion and in-stent thrombosis. The adjunctive use of glycoprotein (GP) IIb-IIIa inhibitors may certainly contribute in the reduction of such complications, especially when administered in the early phase of infarction. In fact, in this phase a larger platelet composition of the thrombus and the presence of a larger amount of viable myocardium, as compared to a delayed phase, may increase the benefits from this therapy and counterbalance the potential higher risk of bleeding. A large body of evidence has been accumulated on the benefits from GP IIb-IIIa inhibitors in terms of prevention of stent thrombosis, and benefits in mortality, especially among high-risk patients and as upstream strategy. Therefore, based on current available data, GP IIb-IIIa inhibitors can be recommended as early as possible (upstream strategy) among high-risk patients, such as those with advanced Killip class or anterior myocardial infarction (MI), and those presenting within the first three hours. Even though it is not universally accepted, in our opinion this strategy should be implemented in a prehospital setting (in ambulance) or at first hospital admission (Emergency Room or Coronary Care Unit, irrespective of whether they are in the spoke or hub hospitals). Peri-procedural intracoronary administration of GP IIb-IIIa inhibitors has not provided additional benefits as compared to intravenous administration and therefore cannot be recommended. Even though the vast majority of trials have been conducted with abciximab, several meta-analyses comparing small molecules (mainly high-dose tirofiban rather than eptifibatide) versus abciximab showed similar angiographic and clinical results between the molecules. Several recent investigations and meta-analyses have documented the higher risk of stent thrombosis associated with bivalirudin as compared to unfractionated heparin (UFH). Being that these results are independent from the use of GP IIb-IIIa inhibitors, UFH should still remain the anticoagulation therapy of choice in ST-segment elevation myocardial infarction (STEMI) patients. Minimisation of bleeding complications by extensive use of the radial approach, in the setting of STEMI, may further contribute to the adoption of a more aggressive antithrombotic and antiplatelet therapy incorporating the use of GP IIb-IIIa inhibitors. The establishment of dedicated networks for STEMI, and the large STEMI campaign, will certainly contribute to increase the proportion of patients presenting at first medical contact within the early phase (3 h) of infarction and therefore highly suitable for a more aggressive pharmacoinvasive approach with upstream administration of GP IIb-IIIa inhibitors. In fact, although the current therapeutic targets of increased rates of timely reperfusion, mainly by primary percutaneous coronary intervention (PCI), has been achieved, a deep look into the future in the fight against MI will certainly put aborting infarction as the major desirable target to be achieved.

Steggerda S.J.,Leiden University | van Wezel-Meijler G.,Isala Hospital
Seminars in Fetal and Neonatal Medicine | Year: 2016

Cranial ultrasonography (CUS) is a reliable and non-invasive tool to detect frequently occurring brain abnormalities and to monitor brain development and maturation in high risk neonates. Standard CUS views are obtained through the anterior fontanel. However, evaluation of the posterior fossa is often suboptimal with this approach. Cerebellar injury occurs frequently in preterm infants and has important prognostic consequences. Early detection is therefore important. This review focuses on techniques that optimize the performance of CUS when studying the preterm cerebellum, including the use of the mastoid fontanel and the adaptation of focus points and scan frequencies. For illustration, CUS images of the normal posterior fossa anatomy as well as examples of abnormalities that may be encountered in preterm infants are included. We also discuss the limitations of CUS and the role of magnetic resonance imaging. © 2016 Elsevier Ltd.

OBJECTIVES: This study compared the prevalence of angiographic underestimation of left anterior descending artery (LAD) lesions with non-LAD lesions. BACKGROUND: Coronary angiography cannot assess the functional severity of a coronary stenosis. Previous studies suggested that lesions of the LAD are more often angiographically underestimated, but evidence is limited. MATERIALS AND METHODS: Fractional flow reserve (FFR) was performed in 335 coronary lesions (187 LAD lesions and 148 non-LAD lesions). A visually estimated diameter stenosis of at least 70% was considered functionally significant. An FFR value of up to 0.80 was considered significant. Multivariable analyses were carried out. RESULTS: Angiographically, LAD lesions as well as non-LAD lesions were considered functionally significant in 29% (P=0.94). FFR showed significant stenosis of the LAD in 52% compared with 24% in non-LAD lesions (P<0.001). Underestimation was observed in 30% of LAD lesions compared with 11% in non-LAD lesions (P<0.001). The adjusted odds ratio for underestimation in LAD lesions in comparison with non-LAD lesions was 3.48 (95% confidence interval 1.89–6.41; P<0.001). CONCLUSION: Underestimation of the functional severity of a coronary stenosis is more common in LAD lesions. FFR should be performed more often for intermediate stenosis of the LAD. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Marcos E.G.,Medical Center Leeuwarden | da Fonseca A.C.,Isala Hospital | Hofma S.H.,Medical Center Leeuwarden
Netherlands Heart Journal | Year: 2011

Objectives To evaluate stent-related adverse cardiac events and bleeding complications within 30 days after surgical procedures in patients with recent drug-eluting stent (DES) implantation, in whom a bridging protocol was used. Methods In our centre a bridging protocol is used in patients scheduled for cardiac or non-cardiac surgery within 6 months after PCI with DES implantation. Clopidogrel and in some cases also acetylsalicylic acid is discontinued 5 days prior to the planned intervention and patients are admitted 2 to 3 days before the intervention for tirofiban infusion. This is discontinued 4 h before intervention. Close postoperative monitoring is performed and double antiplatelet therapy is restarted as soon as possible. Thirty-six consecutive patients were included in the protocol, 15 receiving coronary artery bypass graft and 21 non-cardiac interventions. Thrombotic and bleeding complications were studied for up to 30 days after the bridged procedure. Results No incidences of stent thrombosis or other adverse cardiac events (mortality, myocardial infarction) were seen in up to 30 days of follow-up. However, 6 bleeding events were reported of which 5 required a blood transfusion. Conclusion Our bridging protocol in patients requiring surgery after recent PCI with DES seems adequate to prevent stent thrombosis in this high-risk group. The bleeding risk is not insignificant but in our patient group controllable without major late sequelae. Larger studies should be performed to establish safety and efficacy in order to develop guidelines for these patients. © Springer Media /Bohn Stafleu van Loghum 2011.

OBJECTIVES: To quantify the combined use of iterative model-based reconstruction (IMR) and orthopaedic metal artefact reduction (O-MAR) in reducing metal artefacts and improving image quality in a total hip arthroplasty phantom. METHODS: Scans acquired at several dose levels and kVps were reconstructed with filtered back-projection (FBP), iterative reconstruction (iDose) and IMR, with and without O-MAR. Computed tomography (CT) numbers, noise levels, signal-to-noise-ratios and contrast-to-noise-ratios were analysed. RESULTS: Iterative model-based reconstruction results in overall improved image quality compared to iDose and FBP (P < 0.001). Orthopaedic metal artefact reduction is most effective in reducing severe metal artefacts improving CT number accuracy by 50%, 60%, and 63% (P < 0.05) and reducing noise by 1%, 62%, and 85% (P < 0.001) whereas improving signal-to-noise-ratios by 27%, 47%, and 46% (P < 0.001) and contrast-to-noise-ratios by 16%, 25%, and 19% (P < 0.001) with FBP, iDose, and IMR, respectively. CONCLUSIONS: The combined use of IMR and O-MAR strongly improves overall image quality and strongly reduces metal artefacts in the CT imaging of a total hip arthroplasty phantom. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Van Vendeloo S.N.,Isala Hospital | Brand P.L.P.,Isala Hospital | Verheyen C.C.P.M.,Isala Hospital
Bone and Joint Journal | Year: 2014

We aimed to determine quality of life and burnout among Dutch orthopaedic trainees following a modern orthopaedic curriculum, with strict compliance to a 48-hour working week. We also evaluated the effect of the clinical climate of learning on their emotional well-being. We assessed burnout, quality of life and the clinical climate of learning in 105 orthopaedic trainees using the Maslach Burnout Inventory, linear analogue scale self-assessments, and Dutch Residency Educational Climate Test (D-RECT), respectively. A total of 19 trainees (18%) had poor quality of life and 49 (47%) were dissatisfied with the balance between their personal and professional life. Some symptoms of burnout were found in 29 trainees (28%). Higher D-RECT scores (indicating a better climate of learning) were associated with a better quality of life (r = 0.31, p = 0.001), more work-life balance satisfaction (r = 0.31, p = 0.002), fewer symptoms of emotional exhaustion (r = -0.21, p = 0.028) and depersonalisation (r = -0,28, p = 0.04). A reduced quality of life with evidence of burnout were still seen in a significant proportion of orthopaedic trainees despite following a modern curriculum with strict compliance to a 48-hour working week. It is vital that further work is undertaken to improve the quality of life and reduce burnout in this cohort. ©2014 The British Editorial Society of Bone & Joint Surgery.

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