Doetinchem, Netherlands
Doetinchem, Netherlands

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Grimme F.A.B.,Slingeland Hospital | Grimme F.A.B.,Rijnstate Hospital | Spithoven J.H.,Slingeland Hospital | Zeebregts C.J.,University of Groningen | And 2 more authors.
Journal of Endovascular Therapy | Year: 2012

Purpose: To evaluate the 4-year results of polytetrafluoroethylene (PTFE)-covered stents in the treatment of iliac artery occlusive disease. Methods: Between January 2003 and September 2010, PTFE-covered stents were implanted in 115 iliac arteries of 87 patients (73 men; mean age 60±11 years) in a single center. The lesions were classified as TASC II A (n=40), B (n=41), C (n=7), and D (n=27). There were 69 primary endograft placements, while 46 procedures were performed after previous bare metal stent placement (reintervention group). Follow-up consisted of clinical investigation, ankle-brachial index (ABI) measurement, and duplex ultrasound scanning. In this retrospective analysis, outcomes were reported on a per-limb basis. Results: The median Rutherford classification decreased from category 3 at baseline to 0 after the procedure (p< 0.001) and the ABI increased from 0.66±0.24 to 0.89±0.21 (p<0.001). The primary limb patency was significantly higher in the primary treatment group (p=0.03): 88.7% at 1 year, 86.4% at 2 years, and 71.5% at 4 years compared to the reintervention group (77.9%, 72.1%, and 53.0%, respectively). Univariate analysis revealed prior stent placement as the only factor associated with loss of primary patency. The freedom from target lesion revascularization (TLR) in the primary treatment group was 95.2% at 1 year, 89.6% at 2 years, and 74.4% at 4 years, which did not differ significantly from rates in the reintervention group (88.0%, 82.3%, and 63.8%, respectively). Conclusion: The use of PTFE-covered stents for occlusive disease in the iliac arteries is related to satisfactory limb patency rates and high freedom from TLR. Previous stent placement was related to a lower primary patency rate. Additional studies are indicated to establish subgroups that may specifically benefit from covered stents. © 2012 by the International Society of Endovascular Specialists.


Burgerhart J.S.,University Utrecht | Schotborgh C.A.I.,Catharina Hospital | Schoon E.J.,Catharina Hospital | Smulders J.F.,Catharina Hospital | And 3 more authors.
Obesity Surgery | Year: 2014

Laparoscopic sleeve gastrectomy (LSG) is effective as a stand-alone bariatric procedure. Despite its positive effect with regard to weight loss and improvement of obesity-related co-morbidities, some patients develop gastroesophageal reflux symptoms postoperatively. The pathogenesis of these symptoms is not completely understood. Hence, this study aimed to assess the effect of sleeve gastrectomy on acid and non-acid gastroesophageal reflux, reflux symptoms and esophageal function. In a prospective study, patients underwent esophageal function tests (high-resolution manometry (HRM) and 24-h pH/impedance metry) before and 3 months after LSG. Preoperative and postoperative symptoms were assessed using the Reflux Disease Questionnaire (RDQ). In total, 20 patients (4 male/16 female, mean age 43±12 years, mean weight 137.3±25 kg, and mean BMI 47.6±6.1 kg/m2) participated in this study. GERD symptoms did not significantly change after sleeve gastrectomy, but other upper gastrointestinal symptoms, particularly belching, epigastric pain and vomiting increased. Esophageal acid exposure significantly increased after sleeve gastrectomy: upright from 5.1±4.4 to 12.6±9.8 % (p=0.003), supine from 1.4±2.4 to 11±15 % (p=0.003) and total acid exposure from 4.1±3.5 to 12±10.4 % (p=0.004). The percentage of normal peristaltic contractions remained unchanged, but the distal contractile integral decreased after LSG from 2,006.0±1,806.3 to 1,537.4±1,671.8 mmHg•cm•s (p=0.01). The lower esophageal sphincter (LES) pressure decreased from 18.3±9.2 to 11.0±7.0 mmHg (p=0.02). After LSG, patients have significantly higher esophageal acid exposure, which may well be due to a decrease in LES resting pressure following the procedure. © 2014 Springer Science+Business Media.


Van Der Valk M.E.,University Utrecht | Mangen M.-J.J.,University Utrecht | Leenders M.,University Utrecht | Dijkstra G.,University of Groningen | And 17 more authors.
Gut | Year: 2014

Objective The introduction of anti tumour necrosis factor-α (anti-TNFα) therapy might impact healthcare expenditures, but there are limited data regarding the costs of inflammatory bowel diseases (IBD) following the introduction of these drugs. We aimed to assess the healthcare costs and productivity losses in a large cohort of IBD patients. Design Crohn's disease (CD) and ulcerative colitis (UC) patients from seven university hospitals and seven general hospitals were invited to fill-out a web-based questionnaire. Cost items were derived from a 3 month follow-up questionnaire and categorised in outpatient clinic, diagnostics, medication, surgery and hospitalisation. Productivity losses included sick leave of paid and unpaid work. Costs were expressed as mean 3-month costs per patients with a 95% CI obtained using non-parametric bootstrapping. Results A total of 1315 CD patients and 937 UC patients were included. Healthcare costs were almost three times higher in CD as compared with UC, €1625(95% CI €1476 to €1775) versus €595 (95% CI €505 to €685), respectively (p<0.01). Anti-TNFα use was the main costs driver, accounting for 64% and 31% of the total cost in CD and UC. Hospitalisation and surgery together accounted for 19% and <1% of the healthcare costs in CD and 23% and 1% in UC, respectively. Productivity losses accounted for 16% and 39% of the total costs in CD and UC. Conclusions We showed that healthcare costs are mainly driven by medication costs, most importantly by anti-TNFα therapy. Hospitalisation and surgery accounted only for a minor part of the healthcare costs.


Palm-Meinders I.H.,Leiden University | Koppen H.,Leiden University | Koppen H.,Haga Hospital | Terwindt G.M.,Leiden University | And 10 more authors.
JAMA - Journal of the American Medical Association | Year: 2012

Context: A previous cross-sectional study showed an association of migraine with a higher prevalence of magnetic resonance imaging (MRI)-measured ischemic lesions in the brain. Objective: To determine whether women or men with migraine (with and without aura) have a higher incidence of brain lesions 9 years after initial MRI, whether migraine frequency was associated with progression of brain lesions, and whether progression of brain lesions was associated with cognitive decline. Design, Setting, and Participants: In a follow-up of the 2000 Cerebral Abnormalities in Migraine, an Epidemiological Risk Analysis cohort, a prospective population-based observational study of Dutch participants with migraine and an age- and sex-matched control group, 203 of the 295 baseline participants in the migraine group and 83 of 140 in the control group underwent MRI scan in 2009 to identify progression of MRI-measured brain lesions. Comparisons were adjusted for age, sex, hypertension, diabetes, and educational level. The participants in the migraine group were a mean 57 years (range, 43-72 years), and 71% were women. Those in the control group were a mean 55 years (range, 44-71 years), and 69% were women. Main Outcome Measures: Progression of MRI-measured cerebral deep white matter hyperintensities, infratentorial hyperintensities, and posterior circulation territory infarctlike lesions. Change in cognition was also measured. Results: Of the 145 women in the migraine group, 112 (77%) vs 33 of 55 women (60%) in the control group had progression of deep white matter hyperintensities (adjusted odds ratio [OR], 2.1; 95%CI, 1.0-4.1; P=.04). There were no significant associations of migraine with progression of infratentorial hyperintensities: 21 participants (15%) in themigraine group and 1 of 57 participants (2%) in the control group showed progression (adjusted OR, 7.7; 95% CI, 1.0-59.5; P=.05) or new posterior circulation territory infarctlike lesions: 10 of 203 participants (5%) in the migraine group but none of 83 in the control group (P=.07). There was no association of number or frequency of migraine headaches with progression of lesions. There was no significant association of high vs nonhigh deep white matter hyperintensity load with change in cognitive scores (-3.7 in the migraine group vs 1.4 in the control group; 95% CI, -4.4 to 0.2; adjusted P=.07). Conclusions: In a community-based cohort followed up after 9 years, women with migraine had a higher incidence of deep white matter hyperintensities but did not have significantly higher progression of other MRI-measured brain changes. There was no association of migraine with progression of any MRI-measured brain lesions in men. ©2012 American Medical Association. All rights reserved.


Droogsma E.,Medical Center Leeuwarden | Van Asselt D.Z.B.,Medical Center Leeuwarden | Scholzel-Dorenbos C.J.M.,Slingeland Hospital | Van Steijn J.H.M.,Medical Center Leeuwarden | And 2 more authors.
Journal of Nutrition, Health and Aging | Year: 2013

Objetives: To determine the prevalence of malnutrition and its relation to various factors in community-dwelling elderly with newly diagnosed Alzheimer's disease (AD). Design: Retrospective crosssectional study. Setting: Memory clinic in a rural part of the Netherlands. Participants: 312 Community-dwelling AD patients, aged 65 years or older, were included. Measurements: At the time the diagnosis AD was made, socio-demographic characteristics and data on nutritional status (Mini Nutritional Assessment (MNA)), cognitive function (Mini Mental State Examination (MMSE), Cambridge Cognitive Examination (Camcog)), functional status (Interview for Deterioration in Daily Living Activities in Dementia (IDDD), Barthel Index (BI)) and behaviour (Revised Memory and Behaviour Problems Checklist (RMBPC)) were assessed. Characteristics of well-nourished patients (MNA score >23.5) were compared to characteristics of patients at risk of malnutrition (MNA score 17-23.5). Linear regression analysis was performed to assess the effect of various factors on nutritional status. Results: The prevalence of malnutrition was 0% and 14.1% was at risk of malnutrition. AD patients at risk of malnutrition were more impaired in basic and complex daily functioning than well-nourished AD patients (median IDDD score 41.5 [25th-75th percentile 38.8-48.0] versus median IDDD score 40.0 [25th-75th percentile 37.0-43.0], p = 0.028). The degree of impairment in basic and complex daily functioning (IDDD) was independently related to nutritional status (MNA) (p = 0.001, B = -0.062). Conclusion: One in seven community-dwelling elderly with newly diagnosed AD is at risk of malnutrition. The degree of impairment in daily functioning is independently related to nutritional status. Therefore, assessment of the nutritional status should be included in the comprehensive assessment of AD patients. The relation between daily functioning, nutritional status and AD warrants further investigation. © 2013 Serdi and Springer-Verlag France.


Haagsma J.A.,Erasmus Medical Center | Scholten A.C.,Erasmus Medical Center | Andriessen T.M.J.C.,Radboud University Nijmegen | Vos P.E.,Slingeland Hospital | And 2 more authors.
Journal of Neurotrauma | Year: 2015

Abstract The impact of disability following traumatic brain injury (TBI), assessed by functional measurement scales for TBI or by health-related quality of life (HRQoL), may vary because of a number of factors, including presence of depression or post-traumatic stress disorder (PTSD). The aim of this study was to assess prevalence and impact of depression and PTSD on functional outcome and HRQoL six and 12 months following mild TBI. We selected a sample of 1919 TBI patients who presented to the emergency department (ED) followed by either hospital admission or discharge to the home environment. The sample received postal questionnaires six and 12 months after treatment at the ED. The questionnaires included items regarding socio-demographics, the 36-item Short-Form Health Survey (SF-36), the Perceived Quality of Life Scale (PQoL), the Beck Depression Inventory, and the Impact of Event Scale. A total of 797 (42%) TBI patients completed the six-month follow-up survey. Depression and PTSD prevalence rates at both the six- and 12-month follow-up were 7% and 9%, respectively. Living alone was an independent predictor of depression and/or PTSD at six- and 12-month follow-up. Depression and PTSD were associated with a significantly decreased functional outcome (measured with Glasgow Outcome Scale Extended) and HRQoL (measured using the SF-36 and the PQoL). We conclude that depression and/or PTSD are relatively common in our sample of TBI patients and associated with a considerable decrease in functional outcome and HRQoL. © Copyright 2015, Mary Ann Liebert, Inc.


De Kort E.H.M.,Radboud University Nijmegen | Vrancken S.L.A.G.,Radboud University Nijmegen | Van Heijst A.F.J.,Radboud University Nijmegen | Binkhorst M.,Radboud University Nijmegen | And 2 more authors.
Pediatrics | Year: 2011

We describe here the case of a boy who presented 2 days after birth with purpura fulminans on his feet and scalp. Laboratory investigations revealed signs of disseminated intravascular coagulation. An underlying coagulation disorder was suspected, and therapy with recombinant tissue plasminogen activator, fresh-frozen plasma, and unfractionated heparin was started. On the basis of plasma protein C activity and antigen levels of 0.02 and 0.03 IU/mL, respectively, after administration of fresh-frozen plasma, a diagnosis of severe protein C deficiency was established, and therapy with intravenous protein C concentrate (Ceprotin [Baxter, Deerfield, IL]) was started. Because of difficulties with venous access, we switched to subcutaneous administration after 6 weeks. The precise dosing schedule for subcutaneously administered protein C concentrate is unknown. In the literature, a trough level of protein C activity at >0.25 IU/mL is recommended to prevent recurrent thrombosis. During 1 year of follow-up our patient frequently had protein C activity levels at >0.25 IU/mL. Clinically, however, there was no recurrent thrombosis, and we kept the dosage unchanged. This report highlights 2 important points: (1) subcutaneously administered protein C concentrate is effective in treating severe protein C deficiency; and (2) in accordance with previous studies, after the acute phase trough levels of protein C activity at <0.25 IU/mL may not be necessary to prevent recurrent thrombosis. However, further research on the dosing, efficacy, and safety of protein C concentrate for prophylaxis and treatment of severe protein C deficiency is needed. Copyright © 2011 by the American Academy of Pediatrics.


van Erp W.S.,Radboud University Nijmegen | van Erp W.S.,University of Liège | Lavrijsen J.C.M.,Radboud University Nijmegen | van de Laar F.A.,Radboud University Nijmegen | And 3 more authors.
European Journal of Neurology | Year: 2014

One of the worst outcomes of acquired brain injury is the vegetative state, recently renamed 'unresponsive wakefulness syndrome' (VS/UWS). A patient in VS/UWS shows reflexive behaviour such as spontaneous eye opening and breathing, but no signs of awareness of the self or the environment. We performed a systematic review of VS/UWS prevalence studies and assessed their reliability. Medline, Embase, the Cochrane Library, CINAHL and PsycINFO were searched in April 2013 for cross-sectional point or period prevalence studies explicitly stating the prevalence of VS/UWS due to acute causes within the general population. We additionally checked bibliographies and consulted experts in the field to obtain 'grey data' like government reports. Relevant publications underwent quality assessment and data-extraction. We retrieved 1032 papers out of which 14 met the inclusion criteria. Prevalence figures varied from 0.2 to 6.1 VS/UWS patients per 100 000 members of the population. However, the publications' methodological quality differed substantially, in particular with regards to inclusion criteria and diagnosis verification. The reliability of VS/UWS prevalence figures is poor. Methodological flaws in available prevalence studies, the fact that 5/14 of the studies predate the identification of the minimally conscious state (MCS) as a distinct entity in 2002, and insufficient verification of included cases may lead to both overestimation and underestimation of the actual number of patients in VS/UWS. © 2014 EAN.


Menting T.P.,Radboud University Nijmegen | Sterenborg T.B.,Radboud University Nijmegen | De Waal Y.,Radboud University Nijmegen | Donders R.,Radboud University Nijmegen | And 6 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2015

Background Despite the increasing use of pre- and post-hydration protocols and low osmolar instead of high osmolar iodine containing contrast media, the incidence of contrast induced nephropathy (CIN) is still significant. There is evidence that contrast media cause ischemia reperfusion injury of the renal medulla. Remote ischemic preconditioning (RIPC) is a non-invasive, safe, and low cost method to reduce ischemia reperfusion injury. The aim of this study is to investigate whether RIPC, as an adjunct to standard preventive measures, reduces contrast induced acute kidney injury in patients at risk of CIN. Methods The RIPCIN study is a multicenter, single blinded, randomized controlled trial in which 76 patients at risk of CIN received standard hydration combined with RIPC or hydration with sham preconditioning. RIPC was applied by four cycles of 5 min ischemia and 5 min reperfusion of the forearm. The primary outcome measure was the change in serum creatinine from baseline to 48 to 72 hours after contrast administration. Results With regard to the primary endpoint, no significant effect of RIPC was found. CIN occurred in four patients (2 sham and 2 RIPC). A pre-defined subgroup analysis of patients with a Mehran risk score ≥11, showed a significantly reduced change in serum creatinine from baseline to 48 to 72 hours in patients allocated to the RIPC group (Δ creatinine -3.3 ± 9.8 μmol/L) compared with the sham group (Δ creatinine +17.8 ± 20.1 μmol/L). Conclusion RIPC, as an adjunct to standard preventive measures, does not improve serum creatinine levels after contrast administration in patients at risk of CIN according to the Dutch guideline. However, the present data indicate that RIPC might have beneficial effects in patients at a high or very high risk of CIN (Mehran score ≥ 11). The RIPCIN study is registered at: http://www.controlled-trials.com/ISRCTN76496973. © 2015 European Society for Vascular Surgery. All rights reserved.


Van Empel I.W.H.,Radboud University Nijmegen | Nelen W.L.D.M.,Radboud University Nijmegen | Tepe E.T.,Slingeland Hospital | Van Laarhoven E.A.P.,Radboud University Nijmegen | And 2 more authors.
Human Reproduction | Year: 2010

BACKGROUND: The patients' role in assessing health care quality is increasingly recognized. Measuring patients' specific experiences and needs generates concrete information for care improvement, whereas satisfaction surveys only give an overoptimistic, undifferentiating picture. Therefore, this study aimed to investigate possible weaknesses, strengths and needs in fertility care by measuring patients' specific experiences. METHODS: Mixed (qualitative and quantitative) methods were used to identify weaknesses, strengths and needs in fertility care. Four focus groups with 21 infertile patients were used for documenting care aspects relevant to patients. The fully transcribed qualitative results were analysed and converted into a 124-item questionnaire, to investigate whether these aspects were regarded as weaknesses, strengths or needs in fertility care. The questionnaire was distributed to 369 eligible couples attending 13 Dutch fertility clinics. Descriptive statistics were used to determine the quantity of the weaknesses, strengths and needs. RESULTS: Overall, 286 women (78%) and 280 men (76%) completed the questionnaire. Patients experienced many weaknesses in fertility care, mostly regarding emotional support and continuity of care. Respect and autonomy and partner involvement were considered strengths in current care. Furthermore, women expressed their need for more doctors' continuity during their treatment, and couples strongly desired to have free access to their own medical record. The questionnaire's internal consistency and construct validity were sufficient. CONCLUSION: SInfertile couples experience strengths, but also many weaknesses and needs in current fertility care. Lack of patient centredness seems to be a major cause herein. Using mixed methods is a sensitive means for identifying these weaknesses and needs.

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