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Labrie J.,Universitair Medisch Centrum Utrecht | Berghmans L.C.M.,Maastricht UMC | Fischer K.,Universitair Medisch Centrum Utrecht | Lagro-Janssen A.L.M.,Radboundumc | Van Der Vaart C.H.,Universitair Medisch Centrum Utrecht
Nederlands Tijdschrift voor Geneeskunde | Year: 2014

OBJECTIVE: To compare midurethral sling surgery and pelvic floor physiotherapy as initial treatment in women with moderate to severe urinary stress incontinence. DESIGN: Multicentre randomised trial. METHOD: The study population was made up of women aged 35 to 80 years with moderate to severe stress incontinence. They received surgical treatment or pelvic floor physiotherapy, having been stratified according to incontinence severity. Crossover between groups was allowed during the follow-up period. Improvement at 12 months follow-up measured with the Patient Global Impression of Improvement score was the primary outcome measure (Dutch Trial Register number: NTR1248). RESULTS: We randomised 230 women to the sling surgery group and 230 to pelvic floor physiotherapy group. A total of 49% of women in the physiotherapy group and 11.2% of women in the surgery group crossed over to the alternative treatment. An improvement was reported by 90.8% of women in the surgery group and 64.4% of women in the physiotherapy group (absolute difference: 26.4 percentage points; 95% confidence interval: 18.1 to 34.5). A post hoc per-protocol analysis showed that women who underwent additional surgery after physiotherapy had similar outcomes to women initially assigned to surgery. CONCLUSION: The symptoms of women with moderate to severe stress incontinence were improved more with midurethral sling surgery than with pelvic floor exercises at 1 year.

Post thrombotic syndrome (PTS) is a common chronic complication of deep venous thrombosis (DVT). PTS has a negative impact on quality of life. Patients with a more serious form of this syndrome have increased rates of sick leave and incur increased medical costs. The underlying processes leading to PTS are not yet fully understood. Pressure increases in the deepvenous system, resulting in venous hypertension. Venous hypertension is the cause of the most important symptoms of PTS: pain, oedema and skin abnormalities. Compression therapy reduces oedema and pain in patients in the acute phase following DVT. Based on convincing results from randomised trials, elastic compression therapy was recommended for patients with DVT for many years, in order to prevent venous hypertension and PTS. Recent studies have led to discussion on the added value of elastic compression.

Hooff M.L.V.,Sint Maartenskliniek | Hooff M.L.V.,Dutch Institute for Clinical Auditing DICA | Jacobs W.C.H.,Leiden University | Willems P.C.,Maastricht UMC | And 6 more authors.
Acta Orthopaedica | Year: 2015

Background and purpose-We performed a systematic review and a survey in order to (1) evaluate the evidence for the impact of spine registries on the quality of spine care, and with that, on patient-related outcomes, and (2) evaluate the methodology used to organize, analyze, and report the "quality of spine care" from spine registries.Methods-To study the impact, the literature on all spinal disorders was searched. To study methodology, the search was restricted to degenerative spinal disorders. The risk of bias in the studies included was assessed with the Newcastle-Ottawa scale. Additionally, a survey among registry representatives was performed to acquire information about the methodology and practice of existing registries.Results-4,273 unique references up to May 2014 were identified, and 1,210 were eligible for screening and assessment. No studies on impact were identified, but 34 studies were identified to study the methodology. Half of these studies (17 of the 34) were judged to have a high risk of bias. The survey identified 25 spine registries, representing 14 countries. The organization of these registries, methods used, analytical approaches, and dissemination of results are presented.Interpretation-We found a lack of evidence that registries have had an impact on the quality of spine care, regardless of whether intervention was non-surgical and/or surgical. To improve the quality of evidence published with registry data, we present several recommendations. Application of these recommendations could lead to registries showing trends, monitoring the quality of spine care given, and ultimately improving the value of the care given to patients with degenerative spinal disorders. © 2015 Nordic Orthopaedic Federation.

Cleutjens F.A.H.M.,Program Development Center | Janssen D.J.A.,Program Development Center | Ponds R.W.H.M.,Maastricht UMC | Dijkstra J.B.,Maastricht UMC | Wouters E.F.M.,Program Development Center
BioMed Research International | Year: 2014

Over the past few decades, chronic obstructive lung disease (COPD) has been considered a disease of the lungs, often caused by smoking. Nowadays, COPD is regarded as a systemic disease. Both physical effects and effects on brains, including impaired psychological and cognitive functioning, have been demonstrated. Patients with COPD may have cognitive impairment, either globally or in single cognitive domains, such as information processing, attention and concentration, memory, executive functioning, and self-control. Possible causes are hypoxemia, hypercapnia, exacerbations, and decreased physical activity. Cognitive impairment in these patients may be related to structural brain abnormalities, such as gray-matter pathologic changes and the loss of white matter integrity which can be induced by smoking. Cognitive impairment can have a negative impact on health and daily life and may be associated with widespread consequences for disease management programs. It is important to assess cognitive functioning in patients with COPD in order to optimize patient-oriented treatment and to reduce personal discomfort, hospital admissions, and mortality. This paper will summarize the current knowledge about cognitive impairment as extrapulmonary feature of COPD. Hereby, the impact of smoking on cognitive functioning and the impact of cognitive impairment on smoking behaviour will be examined. © 2014 Fiona A. H. M. Cleutjens et al.

Basu N.,University of Aberdeen | Watts R.,University of East Anglia | Bajema I.,Leiden University | Baslund B.,Rigshospitalet | And 35 more authors.
Annals of the Rheumatic Diseases | Year: 2010

Objectives: The systemic vasculitides are multiorgan diseases where early diagnosis and treatment can significantly improve outcomes. Robust nomenclature reduces diagnostic delay. However, key aspects of current nomenclature are widely perceived to be out of date, these include disease definitions, classification and diagnostic criteria. Therefore, the aim of the present work was to identify deficiencies and provide contemporary points to consider for the development of future definitions and criteria in systemic vasculitis. Methods: The expert panel identified areas of concern within existing definitions/criteria. Consequently, a systematic literature review was undertaken looking to address these deficiencies and produce 'points to consider' in accordance with standardised European League Against Rheumatism (EULAR) operating procedures. In the absence of evidence, expert consensus was used. Results: There was unanimous consensus for re-evaluating existing definitions and developing new criteria. A total of 17 points to consider were proposed, covering 6 main areas: biopsy, laboratory testing, diagnostic radiology, nosology, definitions and research agenda. Suggestions to improve and expand current definitions were described including the incorporation of anti-neutrophil cytoplasm antibody and aetiological factors, where known. The importance of biopsy in diagnosis and exclusion of mimics was highlighted, while equally emphasising its problems. Thus, the role of alternative diagnostic tools such as MRI, ultrasound and surrogate markers were also discussed. Finally, structures to develop future criteria were considered. Conclusions: Limitations in current classification criteria and definitions for vasculitis have been identified and suggestions provided for improvement. Additionally it is proposed that, in combination with the updated evidence, these should form the basis of future attempts to develop and validate revised criteria and definitions of vasculitis.

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