Sint Nicolaasga, Netherlands
Sint Nicolaasga, Netherlands

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Kuijpers A.M.J.,Netherlands Cancer Institute | Mirck B.,Netherlands Cancer Institute | Aalbers A.G.J.,Netherlands Cancer Institute | Nienhuijs S.W.,Catharina Hospital Eindhoven | And 9 more authors.
Annals of Surgical Oncology | Year: 2013

Purpose. This nationwide study evaluated results of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastasis of colorectal origin in the Netherlands following a national protocol. Methods. In a multi-institutional study prospective databases of patients with peritoneal carcinomatosis (PC) from colorectal cancer and pseudomyxoma peritonei (PMP) treated according to the Dutch HIPEC protocol, a uniform approach for the CRS and HIPEC treatment, were reviewed. Primary end point was overall survival and secondary end points were surgical outcome and progression- free survival. Results. Nine-hundred sixty patients were included; 660 patients (69 %) were affected by PC of colorectal carcinoma and the remaining suffered from PMP (31 %). In 767 procedures (80 %), macroscopic complete cytoreduction was achieved. Three-hundred and thirty one patients had grade III-V complications (34 %). Thirty-two patients died perioperatively (3 %). Median length of hospital stay was 16 days (range 0-166 days). Median follow-up period was 41 months (95 % confidence interval (CI), 36-46 months). Median progression-free survival was 15 months (95 % CI 13-17 months) for CRC patients and 53 months (95 % CI 40-66 months) for PMP patients. Overall median survival was 33 (95 % CI 28-38 months) months for CRC patients and 130 months (95 % CI 98-162 months) for PMP patients. Three- and five-year survival rates were 46 and 31 % respectively in case of CRC patients and 77 and 65 % respectively in case of PMP patients. Conclusions. The results underline the safety and efficacy of cytoreduction and HIPEC for PC from CRC and PMP. It is assumed the uniform Dutch HIPEC protocol was beneficial. © 2013 Society of Surgical Oncology.


PubMed | Sint Antonius Hospital Nieuwegein, University of Groningen, Netherlands Cancer Institute and Catharina Hospital Eindhoven
Type: Comparative Study | Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology | Year: 2016

CytoReductive Surgery and Hyperthermic IntraPEritoneal Chemotherapy (CRS-HIPEC) is now the preferred treatment of many peritoneal surface malignancies. In this retrospective study we aimed to analyze how several performance indicators changed during the first 100 CRS-HIPEC procedures in hospitals which recently introduced this treatment, and compare those with an experienced institution.The first consecutive 100 CRS-HIPEC procedures of three institutions were compared to those of the pioneer hospital. The training provided by the pioneer hospital consisted of hands-on training during the first ten procedures; hereafter guidance was available on consult basis. Operation characteristics, morbidity and completeness of cytoreduction were evaluated by case sequence. Locally-estimated-scatter-plot smoothing was used to evaluate the learning curve.From four institutions 372 cases were included. A macroscopic complete cytoreduction was reached in 66% of the cases in the pioneer hospital and in 86% in the new hospitals (p<0.001). Complete cytoreduction rates were higher at start off in the new institutions compared with the experienced institution and increased significantly in the first 100 procedures. The new hospitals started with lower morbidity than the experienced hospital, which did not significantly decrease during the study period.New institutions that were trained and mentored by an experienced CRS-HIPEC hospital performed better from the beginning with regard to complete cytoreduction and morbidity rate with than the experienced center. An improvement in complete cytoreduction rate during the first 100 procedures was observed in the new institutions.


Van Nieuwenhove Y.,Ghent University | Dambrauskas Z.,Kaunas University of Medicine Hospital | Campillo-Soto A.,Hospital General Universitario rales Meseguer | Van Dielen F.,Maxima Medisch Centrum | And 4 more authors.
Archives of Surgery | Year: 2011

Hypothesis: A 14-day very low-calorie diet (VLCD) regimen before a laparoscopic gastric bypass procedure will improve perioperative and postoperative outcomes. Design: Multicenter, randomized, single-blind study. Setting: Five high-volume bariatric centers in Sweden, the Netherlands, Lithuania, Spain, and Belgium. Patients: Two hundred ninety-eight morbidly obese patients undergoing laparoscopic gastric bypass from March 1, 2009, through December 5, 2010. Intervention: Patients were randomly allocated to a 2-week preoperative VLCD regimen or no preoperative dietary restriction (control group). Main Outcome Measures: Operating time, surgeon's perceived difficulty of the operation, liver lacerations, intraoperative bleeding and complications, 30-day weight loss, and morbidity. Results: Mean (SD) preoperative weight change was -4.9 (3.6) kg in the VLCD group vs -0.4 (3.2) kg in the control group (P<.001). Although the surgeon's perceived difficulty of the procedure was lower in the VLCD group (median [interquartile range], 26 [15-42] vs 35 [18-50] mmon a visual analog scale; P=.04), no differences were found regarding mean (SD) operating time (81 [21] vs 80 [23] min; P=.53), estimated blood loss (P=.62), or intraoperative complications (P=.88). At the 30-day follow-up, the number of complications was greater in the control compared with the VLCD group (18 vs 8; P=.04). Conclusions: Although weight reduction with a 14-day VLCD regimen before laparoscopic gastric bypass performed in high-volume centers seems to reduce the perceived difficulty of the procedure, only minor effects on operating time, intraoperative complications, and short-term weight loss could be expected. However, the finding of reduced postoperative complication rates suggests that such a regimen should be recommended before bariatric surgery. ©2011 American Medical Association. All rights reserved.


Elberse K.,National Institute for Public Health and the Environment RIVM | van Mens S.,Sint Antonius Hospital Nieuwegein | Cremers A.J.,Radboud University Nijmegen | Meijvis S.C.A.,Sint Antonius Hospital Nieuwegein | And 7 more authors.
BMC Infectious Diseases | Year: 2015

Treatment of community acquired pneumonia (CAP) patients with antibiotics before laboratory-confirmed diagnosis leads to loss of knowledge on the causative bacterial pathogen. Therefore, an increasing number of pneumococcal infections is identified using non-culture based techniques. However, methods for serotyping directly on the clinical specimen remain scarce. Here we present three approaches for detection and serotyping of pneumococci using samples from patients with CAP. Methods: The first approach is quantitative PCR (qPCR) analysis on blood samples (n = 211) followed by capsular sequence typing (CST) to identify the serotype. The second approach, a urinary antigen assay (n = 223), designated as inhibition multiplex immunoassay (IMIA), is based on Luminex technology targeting 14 serotypes. The third approach is a multiplex immunoassay (MIA) (n = 171) also based on Luminex technology which detects serologic antibody responses against 14 serotypes. The three alternative assays were performed on samples obtained from 309 adult hospitalized CAP patients in 2007-2010 and the results were compared with those obtained from conventional laboratory methods to detect pneumococcal CAP, i.e. blood cultures, sputum cultures and BinaxNOW® urinary antigen tests. Results: Using qPCR, MIA and IMIA, we were able to detect the pneumococcus in samples of 56% more patients compared to conventional methods. Furthermore, we were able to assign a serotype to the infecting pneumococcus from samples of 25% of all CAP patients, using any of the three serotyping methods (CST, IMIA and MIA). Conclusion: This study indicates the usefulness of additional molecular methods to conventional laboratory methods for the detection of pneumococcal pneumonia. Direct detection and subsequent serotyping on clinical samples will improve the accuracy of pneumococcal surveillance to monitor vaccine effectiveness. © Elberse et al.


PubMed | Sint Antonius Hospital Nieuwegein, National Institute for Public Health and the Environment RIVM and Radboud University Nijmegen
Type: | Journal: BMC infectious diseases | Year: 2015

Treatment of community acquired pneumonia (CAP) patients with antibiotics before laboratory-confirmed diagnosis leads to loss of knowledge on the causative bacterial pathogen. Therefore, an increasing number of pneumococcal infections is identified using non-culture based techniques. However, methods for serotyping directly on the clinical specimen remain scarce. Here we present three approaches for detection and serotyping of pneumococci using samples from patients with CAP.The first approach is quantitative PCR (qPCR) analysis on blood samples (n=211) followed by capsular sequence typing (CST) to identify the serotype. The second approach, a urinary antigen assay (n=223), designated as inhibition multiplex immunoassay (IMIA), is based on Luminex technology targeting 14 serotypes. The third approach is a multiplex immunoassay (MIA) (n=171) also based on Luminex technology which detects serologic antibody responses against 14 serotypes. The three alternative assays were performed on samples obtained from 309 adult hospitalized CAP patients in 2007-2010 and the results were compared with those obtained from conventional laboratory methods to detect pneumococcal CAP, i.e. blood cultures, sputum cultures and BinaxNOW urinary antigen tests.Using qPCR, MIA and IMIA, we were able to detect the pneumococcus in samples of 56% more patients compared to conventional methods. Furthermore, we were able to assign a serotype to the infecting pneumococcus from samples of 25% of all CAP patients, using any of the three serotyping methods (CST, IMIA and MIA).This study indicates the usefulness of additional molecular methods to conventional laboratory methods for the detection of pneumococcal pneumonia. Direct detection and subsequent serotyping on clinical samples will improve the accuracy of pneumococcal surveillance to monitor vaccine effectiveness.


PubMed | Sint Antonius Hospital Nieuwegein, University Utrecht, Leiden University and Ghent University
Type: Journal Article | Journal: Nursing in critical care | Year: 2016

Nurses participation in decisions about new care procedures and protocols is potentially of benefit for patient outcomes. Whether nurses participation in decisions is allowed in the implementation of innovations depends on the implementation approach used for the introduction. A planned change implementation approach does not allow it, an emergent change implementation approach does.To compare a planned change and an emergent change implementation approach to introduce an intensive insulin therapy to an intensive care unit (ICU).A prospective comparative study in an ICU in the Netherlands of two teams of nurses using either implementation approach.Pre-introduction of the comparability of the two teams was assessed. The nurse compliance to the protocol was assessed as being nurses behaviour according to the protocol and leading to acceptable glucose values. The effectiveness of the implementation was assessed by measuring the percentage of patients glucose values within the target range, the occurrence of hypoglycaemic events and the time to glucose value normalization. Data were collected from December 2007 till January 2009.In the emergent change approach team there was better nurse compliance measurements than in the planned change approach team (83.5% vs 66,8% conform protocol), a better percentage of glucose values in the target range (53,5% vs 52.8%) and a shorter time to glucose value normalization.The implementation approach allowing nurse participation was associated with better nurse compliance and patient outcome measurements. The implementation approach did not conflict with introducing an evidence-based innovation. It was also associated with more effective adaptation of the protocol to changing circumstances.When a new treatment requires adaptability to changing circumstances to be most effective, nurses participation in decisions about the implementation of the treatment should be considered.


Bruggemann R.J.M.,Radboud University Nijmegen | Van Der Velden W.J.F.M.,Radboud University Nijmegen | Knibbe C.A.J.,Sint Antonius Hospital Nieuwegein | Knibbe C.A.J.,Leiden Academic Center for Drug Research | And 5 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2014

Objectives: Reduced-frequency dosing strategies of anidulafungin may offer a more convenient way of providing adequate antifungal prophylaxis to patients at high risk of invasive fungal diseases. We aimed to provide the pharmacological rationale for the applicability of reduced-frequency dosing regimens. Methods: We defined two groups of 10 patients that were to receive anidulafungin at 200 mg every 48 h or 300 mg every 72 h. Blood samples were drawn daily and two pharmacokinetic curves were constructed after 1 and 2 weeks of treatment. A population pharmacokinetic model was developed using non-linear mixed-effects modelling. ClinicalTrials.gov identifier: NCT01249820. Results: The AUC over a 6 day period (IQR) for a typical patient on 200 mg every 48 h or 300 mg every 72 h resulted in 348 mg.h/L (310.6-386.7) and 359 mg.h/L (319.1-400.9), respectively, comparable to the licensed regimen [397.0 mg.h/L (352.4-440.5)]. In the final model, the volume of distribution proved to be dependent on the lean body mass and CL of cyclosporine A. All three regimens resulted in comparable dose-normalized exposure over time. Conclusions: We now have sufficient evidence to start using less frequent dosing regimens and demonstrate their value in clinical practice. These less frequently applied infusions enable more personalized care in an outpatient setting with reduced costs. © The Author 2014.


Paantjens A.W.M.,University Utrecht | van de Graaf E.A.,University Utrecht | Kwakkel-van Erp J.M.,University Utrecht | Hoefnagel T.,University Utrecht | And 3 more authors.
Clinical and Experimental Immunology | Year: 2011

Alloreactive T cells that infiltrate the graft after lung transplantation (LTx) play a role in chronic rejection. Chemokines such as thymus and activation-regulated chemokine (TARC), macrophage-derived chemokine (MDC) and monocyte chemotactic protein-1 (MCP-1) are produced locally in the lung and attract T cells via chemokine receptor 4 (CCR4). In a TARC gradient, cells expressing CCR4 ++ migrate more efficiently than CCR4 +-expressing cells. In this study, we compared the CCR4 expression of T cells in blood from 20 lung transplant recipients to healthy controls. We then examined whether CCR4 expression is associated with the occurrence of chronic rejection. The CCR4 ++ expression was decreased on CD4 T cells from LTx patients (P<0·0001) when compared to healthy controls. The analysis of CD4 T cell subsets showed that this decrease was present on central memory, effector memory and terminally differentiated T cells (P=0·0007, P<0·0001 and P=0·05, respectively), while a trend was found for naive CD4 T cells (P=0·06). Also, the expression of CCR4 + on regulatory T cells (T regs) was decreased in LTx patients when compared to healthy controls (P=0·02). Interestingly, the CCR4 ++ expression on CD4 effector memory T cells was decreased in patients developing chronic rejection sometimes more than a year before the clinical diagnosis when compared to patients who did not (P=0·04). The analysis of CD8 T cell subsets only showed the CCR4 + expression to be increased significantly on effector memory and terminally differentiated CD8 T cells (P=0·02, P=0·03, respectively) in LTx patients, but no relation was found in chronic rejection. In conclusion, the expression of CCR4 on T cell subsets was altered after LTx and appears to be related to chronic rejection. © 2011 The Authors. Clinical and Experimental Immunology © 2011 British Society for Immunology.


Van Der Wulp I.,Julius Center for Health science and Primary Care | Sturms L.M.,Julius Center for Health science and Primary Care | De Jong A.,Sint Antonius Hospital Nieuwegein | Schot-Balfoort M.,Sint Antonius Hospital Nieuwegein | And 2 more authors.
Emergency Medicine Journal | Year: 2011

Objective: Pain is one of the six general discriminators of the Manchester triage system (MTS). The frequency of pain assessments conducted at triage with the MTS, and patient, nurse and triage characteristics associated with pain assessments were studied. Also, nurses' reasons for not assessing pain at triage were studied. Methods: The study consisted of two parts. In part 1, nurses from two emergency departments (ED) registered patient characteristics and the process of triage for every presenting patient during 1 week in May 2009. The characteristics of triage nurses were registered on a second form. In part 2 of the study, 13 nurses were interviewed about reasons for not assessing pain at triage. Results: According to the MTS guidelines, pain assessments should have been conducted in 86.1% of the patient presentations. It was only assessed in 32.2% of these patients. Characteristics associated with conducting pain assessments were children under 12 years of age, patients referred by others than a general practitioner or ambulance service, intake of medication before an ED visit, experience of the nurse with the MTS and the duration of triage. Reasons for not assessing pain according to the guidelines included the thought of triage nurses that pain assessments result in overtriage. Conclusions: Pain assessments at triage are conducted infrequently because of insufficient education, conducting activities at triage that are not necessary for estimating urgency and a lack of clarity in the MTS guidelines. Changes in these areas are necessary to improve the reliability and validity of pain assessments and the MTS.


Kessing B.F.,Academic Medical Center Amsterdam | Bredenoord A.J.,Academic Medical Center Amsterdam | Weijenborg P.W.,Academic Medical Center Amsterdam | Hemmink G.J.M.,Sint Antonius Hospital Nieuwegein | And 2 more authors.
American Journal of Gastroenterology | Year: 2011

Objectives: Intraluminal baseline impedance levels are determined by the conductivity of the esophageal wall and can be decreased in gastroesophageal reflux disease (GERD) patients. The aim of this study was to investigate the baseline impedance in GERD patients, on and off proton pump inhibitor (PPI), and in healthy controls. Methods: Ambulatory 24-h pH-impedance monitoring was performed in (i) 24 GERD patients with and 24 without pathological esophageal acid exposure as well as in 10 healthy controls and in (ii) 20 patients with refractory GERD symptoms despite PPI, once on PPI and once off PPI. Baseline impedance levels in the most distal and the most proximal impedance channels were assessed. Results: Median (interquartile range) distal baseline impedance in patients with physiological (2,090 (1,537-2,547)ω) and pathological (781 (612-1,137)ω) acid exposure was lower than in controls (2,827 (2,127-3,270)ω, P<0.05 and P<0.001). A negative correlation between 24-h acid exposure time and baseline impedance was observed (r=0.7, P<0.001). In patients measured off and on PPI, median distal baseline impedance off PPI was significantly lower than on PPI (886 (716-1,354) vs. 1,372 (961-1,955)ω, P<0.05) and distal baseline impedance in these groups was significantly lower than in healthy controls (P<0.05 and P<0.001). Proximal baseline impedance did not differ significantly between the patients off PPI and on PPI (1,793 (1,384-2,489) vs. 1,893 (1,610-2,561)ω ); however, baseline impedance values in both measurements were significantly lower than in healthy controls (3,648 (2,815-3,932)ω, both P<0.001). Conclusions: These findings suggest that baseline impedance is related to esophageal acid exposure and could be a marker of reflux-induced changes to the esophageal mucosa. © 2011 by the American College of Gastroenterology.

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