Program Development Center

CIRO, Netherlands

Program Development Center

CIRO, Netherlands
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Sillen M.J.H.,Program Development Center | Wouters E.F.M.,Ciro | Wouters E.F.M.,Maastricht University | Franssen F.M.E.,Program Development Center | And 2 more authors.
Lung | Year: 2011

Transcutaneous neuromuscular electrical stimulation (NMES) involves the application of an electrical current through electrodes placed on the skin over the targeted muscles. During high-frequency NMES (HF-NMES), oxygen uptake, minute ventilation, and the degree of symptom perception (dyspnea and fatigue) have been shown to be acceptable in chronic obstructive pulmonary disease (COPD). Currently, oxygen uptake and ventilation load have never been assessed during low-frequency NMES (LF-NMES) of the lower-limb muscles. The purpose of this study was to compare prospectively oxygen uptake, ventilation, and symptom perception during a single session of LF-NMES versus a single session of HF-NMES of quadriceps muscles in patients with COPD. In 17 COPD patients (mean FEV 1 = 45% predicted, mean body mass index = 26.2 kg/m2), peak exercise capacity, functional exercise capacity, and the Medical Research Council dyspnea grade were evaluated. In addition, oxygen uptake, minute ventilation, heart rate, and Borg symptom scores were assessed during one session of LF-NMES (15 Hz) and one session of HF-NMES (75 Hz) and compared with peak values. Mean oxygen uptake (LF-NMES: 327 ml/min vs. HF-NMES: 315 ml/min), minute ventilation (LF-NMES: 14 L vs. HF-NMES: 15 L), and heart rate (LF-NMES: 86 BPM vs. HF-NMES: 83 BPM) were similar during both NMES frequencies. Patients used a relatively low proportion of their peak aerobic capacity during both NMES sessions (LF-NMES: 34% vs. HF-NMES: 33%; P = 0.397). In addition, symptom Borg scores for dyspnea and leg fatigue were also comparable. Oxygen uptake, ventilation, and symptoms of dyspnea and fatigue were comparable and tolerable during LF-NMES and HF-NMES in patients with COPD. Therefore, LF-NMES and HF-NMES may both be suitable rehabilitative modalities to be used in severely dyspneic patients with lower-limb muscle dysfunction. © 2010 Springer Science+Business Media, LLC.


Cleutjens F.A.H.M.,Program Development Center | Janssen D.J.A.,Program Development Center | Gijsen C.,Program Development Center | Dijkstra J.B.,School for Mental Health and Neurosciences MHeNS | And 2 more authors.
Tijdschrift voor Gerontologie en Geriatrie | Year: 2014

COPD (Chronic Obstructive Pulmonary Disease) is a respiratory disease characterized by progressive and largely irreversible airway limitation and extrapulmonary problems. The prevalence of COPD increases with age. Mental health problems, including cognitive capacity limitations, occur frequently. Patients with COPD may have problems with cognitive functioning, either globally or in single cognitive domains, such as information processing, attention and concentration, memory, executive functioning and self-regulation. Possible causes are hypoxemia, hypercapnia, exacerbations and decreased physical activity. Cognitive problems in these patients may be related to structural brain abnormalities, such as gray matter pathologic changes and the loss of white matter integrity. Because of the negative impact on health and daily life, 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.


Janssen D.J.A.,Program Development Center | Spruit M.A.,Program Development Center | Uszko-Lencer N.H.,Program Development Center | Schols J.M.G.A.,Maastricht University | And 2 more authors.
Journal of Palliative Medicine | Year: 2011

Background: Patients with advanced chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) may experience significant symptom distress. For development of palliative care programs that adequately address symptoms of patients with COPD or CHF, it is necessary to know severity of symptom distress and to gain insight in comorbidities and current provision of health care. Objective of the present cross-sectional observational study was to assess severity of symptoms, presence of comorbidities, and current provision of health care in outpatients with advanced COPD or CHF. Methods: A total of 105 outpatients with clinically stable but advanced COPD (Global initiative for chronic Obstructive Lung Disease [GOLD] stage III or IV) and 80 patients with advanced CHF (New York Heart Association [NYHA] class III or IV) were assessed for demographics, clinical characteristics, self-reported comorbidities, and severity of symptoms using visual analogue scales. In addition, current health care and symptom-related interventions have been assessed. Results: Comorbidities were reported by 96.3% of the CHF patients and 61.9% of the COPD patients. Patients suffered from multiple symptoms, like dyspnea, fatigue, muscle weakness, coughing, low mood, sleeplessness, and frequent micturition. For most symptoms, only the minority of patients had received symptom-related treatment. Involvement of allied health care professionals was low. The majority of COPD and CHF patients had received home adaptation and medical aids. Conclusions: Patients with advanced COPD or CHF experience comorbidities and suffer from multiple symptoms, which are often under treated. Further development and implementation of palliative care programs, consisting of regular assessment of the patients' comorbidities and symptoms as well as the provision of patient-tailored interventions is needed. © 2011 Mary Ann Liebert, Inc.


Geelen T.H.,Maastricht University | Gaajetaan G.R.,Maastricht University | Wouters E.F.,Maastricht University | Rohde G.G.,Maastricht University | And 5 more authors.
Respiratory Medicine | Year: 2014

Background: There is compelling evidence that infections with non-typeable Haemophilus influenzae (NTHi) are associated with exacerbations in COPD patients. However, NTHi has also been isolated frequently during clinically stable disease. In this study we tested the hypothesis that genetically distinct NTHi isolates obtained from COPD patients differ in virulence which could account for dissimilarities in the final outcome of an infection (stable vs. exacerbation). Results: NTHi isolates (n = 32) were obtained from stable COPD patients, or during exacerbations. Genetically divergent NTHi isolates were selected and induction of inflammation was assessed as an indicator of virulence using different in vitro models. Despite marked genomic differences among NTHi isolates, in vitro studies could not distinguish between NTHi isolates based on their inflammatory capacities. Alternatively, when using a whole blood assay results demonstrated marked inter-, but not intra-individual differences in cytokine release between healthy volunteers irrespective of the origin of the NTHi isolate used. Conclusion: Results suggest that the individual immune reactivity might be an important predictor for the clinical outcome (exacerbation vs. no exacerbation) following NTHi infection. © 2013 Elsevier Ltd. All rights reserved.


PubMed | Program Development Center and Maastricht University
Type: Journal Article | Journal: Respiratory medicine | Year: 2014

There is compelling evidence that infections with non-typeable Haemophilus influenzae (NTHi) are associated with exacerbations in COPD patients. However, NTHi has also been isolated frequently during clinically stable disease. In this study we tested the hypothesis that genetically distinct NTHi isolates obtained from COPD patients differ in virulence which could account for dissimilarities in the final outcome of an infection (stable vs. exacerbation).NTHi isolates (n=32) were obtained from stable COPD patients, or during exacerbations. Genetically divergent NTHi isolates were selected and induction of inflammation was assessed as an indicator of virulence using different in vitro models. Despite marked genomic differences among NTHi isolates, in vitro studies could not distinguish between NTHi isolates based on their inflammatory capacities. Alternatively, when using a whole blood assay results demonstrated marked inter-, but not intra-individual differences in cytokine release between healthy volunteers irrespective of the origin of the NTHi isolate used.Results suggest that the individual immune reactivity might be an important predictor for the clinical outcome (exacerbation vs. no exacerbation) following NTHi infection.


Vaes A.W.,Program Development Center | Cheung A.,Catharina Hospital | Atakhorrami M.,Philips | Groenen M.T.J.,Program Development Center | And 4 more authors.
Annals of Medicine | Year: 2013

Aim. This review evaluated the effects of activity monitor-based counseling on physical activity (PA) and generic and disease-specific health-related outcomes in adults with diabetes mellitus type II (DMII), chronic obstructive pulmonary disease (COPD), or chronic heart failure (CHF). Methods. Four electronic databases were searched for randomized controlled trials using activity monitor-based counseling versus control intervention or usual care in adults with DMII, COPD, or CHF. Pooled effect sizes were calculated using a random effects model. Results. Twenty-four articles were included: 21 DMII studies and 3 COPD studies. No CHF studies were identified. Pooled analysis showed that activity monitor-based counseling resulted in a significantly greater improvement in PA compared to control intervention or usual care in DMII. Furthermore, these interventions had a beneficial effect on hemoglobin A1c (HbA1c), systolic blood pressure, and body mass index (BMI) (P < 0.05), whereas no differences were found on diastolic blood pressure, and health-related quality of life. Meta-analysis of COPD studies was not possible due to lack of available data. Conclusion. Activity monitor-based counseling had a beneficial effect on PA, HbA1c, systolic blood pressure, and BMI in patients with DMII. Data in patients with COPD and CHF are limited or non-existing, respectively. © 2013 Informa UK, Ltd.


Vaes A.W.,Program Development Center | Wouters E.F.M.,Program Development Center | Franssen F.M.E.,Program Development Center | Uszko-Lencer N.H.M.K.,Cardiology | And 6 more authors.
Chest | Year: 2011

Background: Patients with COPD generally have a poor peak aerobic capacity and, therefore, may experience more inconvenience during domestic activities of daily life (ADLs). Yet, task-related oxygen uptake and symptom perception during ADLs have been studied rarely in COPD. Therefore, it remains unknown whether and to what extent differences may exist in task-related oxygen uptake and symptom perception during ADLs in patients with COPD after stratifi cation for sex; GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage; Medical Research Council (MRC) dyspnea grade; or score on the BMI, obstruction, dyspnea, exercise capacity (BODE) index. Methods: Ninety-seven patients with COPD and 20 healthy elderly subjects performed the following fi ve self-paced domestic ADLs with 4-min rest intervals: putting on socks, shoes, and vest; folding eight towels; putting away groceries; washing four dishes, cups, and saucers; and sweeping the fl oor for 4 min. Task-related oxygen uptake was assessed using an Oxycon Mobile device, whereas Borg scores were used to assess task-related dyspnea and fatigue. Results: Patients with COPD used a signifi cantly higher proportion of their peak aerobic capacity and ventilation to perform ADLs than did the healthy subjects, accompanied by higher taskrelated Borg dyspnea scores. Patients with GOLD stage IV, MRC dyspnea grade 5, or BODE score ≥ 6 points had the highest task-related oxygen uptake and dyspnea perception during the performance of domestic ADLs. Results showed no sex-related differences. Conclusion: Patients with COPD experience a relatively high metabolic load and symptom perception during the performance of ADLs that is not the same as seen in their healthy peers, particularly in patients with GOLD stage IV, MRC dyspnea grade 5, or BODE score ≥ 6 points. © 2011 American College of Chest Physicians.


Vaes A.W.,Program Development Center | Franssen F.M.E.,Program Development Center | Meijer K.,School for Nutrition | Cuijpers M.W.J.,Program Development Center | And 3 more authors.
PLoS ONE | Year: 2012

Background: Patients with COPD use a higher proportion of their peak aerobic capacity during the performance of domestic activities of daily life (ADLs) compared to healthy peers, accompanied by a higher degree of task-related symptoms. To date, the influence of body mass index (BMI) on the task-related metabolic demands remains unknown in patients with COPD. Therefore, the aim of our study was to determine the effects of BMI on metabolic load during the performance of 5 consecutive domestic ADLs in patients with COPD. Methodology: Ninety-four COPD patients and 20 healhty peers performed 5 consecutive, self-paced domestic ADLs putting on socks, shoes and vest; folding 8 towels; putting away groceries; washing up 4 dishes, cups and saucers; and sweeping the floor for 4 min. Task-related oxygen uptake and ventilation were assessed using a mobile oxycon, while Borg scores were used to assess task-related dyspnea and fatigue. Principal Findings: 1. Relative task-related oxygen uptake after the performance of domestic ADLs was increased in patients with COPD compared to healthy elderly, whereas absolute oxygen uptake is similar between groups; 2. Relative oxygen uptake and oxygen uptake per kilogram fat-free mass were comparable between BMI groups; and 3. Borg symptom scores for dyspnea en fatigue were comparable between BMI groups. Conclusion: Patients with COPD in different BMI groups perform self-paced domestic ADLs at the same relative metabolic load, accompanied by comparable Borg symptom scores for dyspnea and fatigue. © 2012 Vaes et al.


PubMed | Program Development Center
Type: Journal Article | Journal: Journal of the American Medical Directors Association | Year: 2012

Exercise tolerance is an important clinical aspect of chronic obstructive pulmonary disease that can be easily and reliably measured with the 6-minute walking test (6MWT). To improve the utility of the 6MWT for patient and health care system management, the interpretation of the functional status measure in relation to death and hospitalization should be elucidated.Three-year, prospective, multicenter observational study to evaluate the predictive power of 6MWD for death or exacerbation-related hospitalization and to evaluate the factors that help determine 6MWD.We measured 6MWD at baseline and annually in 2110 patients with clinically stable Global Initiative for Obstructive Lung Disease (GOLD) stage II-IV COPD and recorded exacerbation-related hospitalizations and all-cause mortality. During the study, 200 patients died and 650 were hospitalized. Using receiver operating characteristics, the best predictive thresholds of the 6MWD were 334 m for increased risk of death and 357 m for exacerbation-related hospitalization (area under the curve 0.67 and 0.60 respectively); however, the discriminatory thresholds, especially for mortality, were influenced by age. The mean (SE) 6MWD declined by 1.6 (1.2) m per year in GOLD II, 9.8 (1.3) m per year in GOLD III, and 8.5 (2.4) m per year in GOLD IV.The 6MWD provides prognostic information that may be useful for identifying high-risk patients with COPD.


PubMed | Program Development Center
Type: Journal Article | Journal: Tijdschrift voor gerontologie en geriatrie | Year: 2014

COPD (Chronic Obstructive Pulmonary Disease) is a respiratory disease characterized by progressive and largely irreversible airway limitation and extrapulmonary problems. The prevalence of COPD increases with age. Mental health problems, including cognitive capacity limitations, occur frequently. Patients with COPD may have problems with cognitive functioning, either globally or in single cognitive domains, such as information processing, attention and concentration, memory, executive functioning and self-regulation. Possible causes are hypoxemia, hypercapnia, exacerbations and decreased physical activity. Cognitive problems in these patients may be related to structural brain abnormalities, such as gray matter pathologic changes and the loss of white matter integrity. Because of the negative impact on health and daily life, 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.

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