Hamaker M.E.,Diakonessenhuis Hospital |
Jonker J.M.,Slotervaart Hospital |
Vos A.G.,Diakonessenhuis Hospital |
Smorenburg C.H.,Medical Center Alkmaar |
van Munster B.C.,Gelre Hospitals
The Lancet Oncology | Year: 2012
Comprehensive geriatric assessment (CGA) is done to detect vulnerability in elderly patients with cancer so that treatment can be adjusted accordingly; however, this process is time-consuming and pre-screening is often used to identify fit patients who are able to receive standard treatment versus those in whom a full CGA should be done. We aimed to assess which of the frailty screening methods available show the best sensitivity and specificity for predicting the presence of impairments on CGA in elderly patients with cancer. We did a systematic search of Medline and Embase, and a hand-search of conference abstracts, for studies on the association between frailty screening outcome and results of CGA in elderly patients with cancer. Our search identified 4440 reports, of which 22 publications from 14 studies, were included in this Review. Seven different frailty screening methods were assessed. The median sensitivity and specificity of each screening method for predicting frailty on CGA were as follows: Vulnerable Elders Survey-13 (VES-13), 68% and 78%; Geriatric 8 (G8), 87% and 61%; Triage Risk Screening Tool (TRST 1+; patient considered frail if one or more impairments present), 92% and 47%, Groningen Frailty Index (GFI) 57% and 86%, Fried frailty criteria 31% and 91%, Barber 59% and 79%, and abbreviated CGA (aCGA) 51% and 97%. However, even in case of the highest sensitivity, the negative predictive value was only roughly 60%. G8 and TRST 1+ had the highest sensitivity for frailty, but both had poor specificity and negative predictive value. These findings suggest that, for now, it might be beneficial for all elderly patients with cancer to receive a complete geriatric assessment, since available frailty screening methods have insufficient discriminative power to select patients for further assessment. © 2012 Elsevier Ltd.
Dallal R.M.,Albert Einstein Medical Center |
Celik F.,Slotervaart Hospital |
Gerdes V.E.,Slotervaart Hospital
Diabetes Care | Year: 2012
OBJECTIVE - It has been postulated that the effectiveness of bariatric surgery varies between ethnic groups. However, data regarding this topic are inconclusive, as most studies included few patients from minority groups. We conducted a meta-analysis to determine the difference in percentage of excess weight loss (%EWL) 1-2 years after bariatric surgery in people of African and Caucasian descent. We also studied differences in diabetes mellitus (DM) remission. RESEARCH DESIGN AND METHODS - We performed a MEDLINE and EMBASE search for studies reporting %EWL and/or DM remission after bariatric surgery and including both African Americans and Caucasians. The 613 publications obtained were reviewed. We included 14 studies (1,087 African Americans and 2,714 Caucasians); all provided data on %EWL and 3 on DM remission. We extracted surgery type, %EWL, and DM remission 1-2 years after surgery. After analyzing %EWL for any surgery type, we performed subanalyses for malabsorptive and restrictive surgery. RESULTS - The overall absolute mean %EWL difference between African Americans and Caucasians was -8.36% (95% CI -10.79 to -5.93) significantly in favor of Caucasians. Results were similar for malabsorptive (-8.39% [-11.38 to -5.40]) and restrictive (-8.46% [-12.95 to -3.97]) surgery. The remission of DM was somewhat more frequent in African American patients than in Caucasian patients (1.41 [0.56-3.52]). However, this was not statistically significant. CONCLUSIONS - In %EWL terms, bariatric surgery is more effective in Caucasians than in African Americans, regardless of procedure type. Further studies are needed to investigate the exact mechanisms behind these disparities and to determine whether ethnic differences exist in the remission of comorbidities after bariatric surgery. © 2012 by the American Diabetes Association.
Potron A.,University Paris - Sud |
Kalpoe J.,Slotervaart Hospital |
Poirel L.,University Paris - Sud |
Nordmann P.,University Paris - Sud
Clinical Microbiology and Infection | Year: 2011
A Klebsiella pneumoniae isolate with decreased susceptibility to carbapenems was isolated in April 2011 in a hospital in Amsterdam (the Netherlands) and later found to be the source of an important outbreak in a Rotterdam hospital. The strain, belonging to sequence type (ST) 395, carried the blaOXA-48 gene located onto a c 62-kb conjugative plasmid, together with the extended-spectrum β-lactamase gene blaCTX-M-15. It was closely related or identical to other OXA-48-positive Klebsiella pneumoniae isolates belonging to the same ST type and identified in France and Morocco. This study sheds light on the European dissemination of a single OXA-48K. pneumoniae clone. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.
Appels B.A.,Slotervaart Hospital |
Scherder E.,VU University Amsterdam
American Journal of Alzheimer's Disease and other Dementias | Year: 2010
Early screening for dementia is crucial for identifying reversible causes as well as managing, counseling, and other therapeutic interventions. Many reviews have compared the suitability of very brief screening instruments for use in primary care, but reviews on more extensive instruments in secondary care are scarce. In addition, results on diagnostic accuracy are often biased due to methodological shortcomings, differences in the spectrum of patients or reporting. This systematic review reports the diagnostic accuracy of dementia-screening instruments with an administration time of 10 to 45 minutes, validated in secondary care, restricted to mild dementia and validation studies of "high quality". Characteristics such as cognitive domains and reliability figures are also highlighted. © 2010 The Author(s).
Teeuw W.J.,University of Amsterdam |
Gerdes V.E.A.,University of Amsterdam |
Gerdes V.E.A.,Slotervaart Hospital |
Loos B.G.,University of Amsterdam
Diabetes Care | Year: 2010
OBJECTIVE - There is growing evidence that periodontitis may affect general health. This study was assigned to explore the robustness of observations that periodontal therapy leads to the improvement of glycemic control in diabetic patients. RESEARCH DESIGN AND METHODS - A literature search (until March 2009) was carried out using two databases (MEDLINE and the Cochrane Library) with language restriction to English. Selection of publications was based on 1) original investigations, 2) controlled periodontal intervention studies where the diabetic control group received no periodontal treatment, and 3) study duration of ≥3 months. RESULTS - Screening of the initial 639 identified studies and reference checking resulted in five suitable articles. A total of 371 patients were included in this analysis with periodontitis as predictor and the actual absolute change in A1C (ΔA1C) as the outcome. The duration of follow-up was 3-9 months. All studies described a research population of type 2 diabetic patients in whom glycemic control improved after periodontal therapy compared with the control group (range ΔA1C:Δ-1.17 up to Δ-0.05%). The studies in a meta-analysis demonstrated a weighted mean difference of ΔA1C before and after therapy of -0.40% (95% CI -0.77 to -0.04%, P = 0.03) favoring periodontal intervention in type 2 diabetic patients. Nevertheless, this improvement in %A1C must be interpreted with care due to limited robustness as evidenced by heterogeneity among studies (59.5%, P = 0.04). CONCLUSIONS - The present meta-analysis suggests that periodontal treatment leads to an improvement of glycemic control in type 2 diabetic patients for at least 3 months. © 2010 by the American Diabetes Association.
Gerards M.C.,Slotervaart Hospital |
Terlou R.J.,Academical Medical Center |
Yu H.,Antoni van Leeuwenhoek Hospital |
Koks C.H.W.,Antoni van Leeuwenhoek Hospital |
Gerdes V.E.A.,Slotervaart Hospital
Atherosclerosis | Year: 2015
Objective: To verify the safety and effectiveness of traditional Chinese red yeast rice-extract (RYR) for reduction of LDL cholesterol. Methods: Systematic literature review and meta-analysis. Medline and EMBASE were searched until November 2014. We selected randomized studies in which RYR with a known content of the active substance monacolin K was tested against placebo or an active control group. Outcome measures were the effect of RYR on LDL cholesterol and incidence of adverse reactions with emphasis on liver and kidney injury and muscle symptoms. Results: Twenty studies were analyzed. Quality of safety assessment was low in the majority of studies. RYR lowered LDL cholesterol with 1.02mmol/L [-1.20;-0.83] compared to placebo. Effect of RYR on LDL was not different from statin therapy (0.03mmol/L [-0.36; 0.41]). The incidence of liver and kidney injury was 0-5% and the risk was not different between treatment and control groups (risk difference-0.01 [-0.01; 0.0] and 0.0 [-0.01; 0.02]). Conclusions: RYR exerts a clinically and statistically significant reduction of 1.02mmol/L LDL cholesterol. Only when the mild profile of adverse reactions can be affirmed in studies with adequate methodology for safety assessment, RYR might be a safe and effective treatment option for dyslipidemia and cardiovascular risk reduction in statin intolerant patients. © 2015 Elsevier Ireland Ltd.
Colen S.,University Hospitals Leuven |
Van Den Bekerom M.P.J.,Spaarne Hospital |
Mulier M.,University Hospitals Leuven |
Haverkamp D.,Slotervaart Hospital
BioDrugs | Year: 2012
Background: Although accepted as a conservative treatment option for knee osteoarthritis, the debate about the effectiveness of intra-articular treatment with hyaluronic acid (HA) is still ongoing because of contrasting outcomes in different clinical studies. Several well designed clinical studies showed a significant improvement in pain at follow-up compared with baseline but no significant improvement comparing the efficacy of HA with placebo (saline) or with other conservative treatment options. Notwithstanding the effectiveness of different types of intra-articular HA products, the question of whether one HA product is better than another is still unanswered. In this systematic review we compare the effects of intra-articularly administered HA with intra-articularly administered placebo in general and, more specifically, the effects of individual HA products with placebo. We also compare the efficacy of different HA products. Methods: Asystematic review of randomized controlled trials (RCTs)was conducted using databases including MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Clinical Trial Register and EMBASE. Results: Seventy-four RCTs were included in this systematic review. HA improves pain by approximately 40-50%compared with baseline levels. However, when compared with saline the difference in efficacy is not that large. Due to a large 'placebo effect' of saline (approximately 30% pain reduction, persisting for at least 3 months) we determined a weighted mean difference between the efficacy of HA and saline of just 10.20 using the visual analog scale for pain. It is debatable whether this difference reaches the minimum clinically important difference. Comparing the different HA products, which vary in the molecular weight, concentration, and volume of HA, we were not able to conclude that one brand has a better efficacy than another due to the heterogeneity of the studies and outcomes. Discussion: In the future it will be important to determine the exact mechanism of action of placebo as this may give us an idea of how to treat osteoarthritis more efficiently. Due to the limitations of this review (follow-up of just 3 months and large heterogeneity of the included studies), it is also important to compare the different HA products to determine which product(s), or which molecular weight range, concentration, or volume ofHAis the best option to treat osteoarthritis. Our recommendation is to start large (multicenter) RCTs to give us more evidence about the efficacy of the different HA products. © 2012 Springer International Publishing AG. All rights reserved.
Smits A.J.,VU University Amsterdam |
Giannakopoulos G.F.,Slotervaart Hospital |
Zuidema W.P.,VU University Amsterdam
Injury | Year: 2014
Background and aim: This study assessed the long-term outcome (>6 months, with a mean of 46 months after injury) of the conservatively treated radial head fracture type 1 of the Broberg-Morrey (B-M) modification of the Mason classification. The main aim of this study is to assess the limitations in ADL activities on long term following a conservative treatment for B-M 1 radial head fractures. Patients and methods: Out of a total patient group of 312 patients, 94 patients responded to our invitation for participation in the long-term follow-up study. These patients were included with a mean age of 42 years at time of injury and average of 46 months after injury. Most patients were treated with an upper arm cast or pressure bandage. These 94 patients were invited to fill out the validated Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire for elbow functioning as well as a demographic questionnaire. Basic patient and treatment data were collected from the hospital and trauma registration systems. Results: Forty-two percent of patients scored 0 (no disabilities) on the DASH questionnaire, 38% had a DASH score between 0.1 and 10.1, and 20% scored over 10.1. Correlations of the non-operative treatment modalities; immobilisation type, physiotherapy, smoking at time of injury, injury mechanism and immobilisation period with DASH outcome have not been found. Conclusion: It appears that a B-M type 1 radial head fracture is not always accompanied with regaining full function on long term. To what extent these observed limitations influence patient behaviour and how treatment modalities influence these limitations should be the base of future prospective research. © 2014 Elsevier Ltd. All rights reserved.
Vlak M.H.M.,University Utrecht |
Vlak M.H.M.,Slotervaart Hospital |
Rinkel G.J.E.,University Utrecht |
Greebe P.,University Utrecht |
Algra A.,University Utrecht
Stroke | Year: 2013
Background and Purpose-Three percent of the population has an unruptured intracranial aneurysm (UIA). We aimed to identify independent risk factors from lifestyle and medical history for the presence of UIAs and to investigate the combined effect of well-established risk factors. Methods-We studied 206 patients with an UIA who never had a subarachnoid hemorrhage and 574 controls who were randomly retrieved from general practitioner files. All participants filled in a questionnaire on potential risk factors for UIAs. With logistic regression analysis, we identified independent risk factors for UIA and assessed their combined effect. Results-Independent risk factors were current smoking (odds ratio [OR], 3.0; 95% confidence interval [CI], 2.0-4.5), hypertension (OR, 2.9; 95% CI, 1.9-4.6), family history of stroke other than subarachnoid hemorrhage (OR, 1.6; 95% CI, 1.0-2.5), hypercholesterolemia (OR, 0.5; 95% CI, 0.3-0.9), and regular physical exercise (OR, 0.6; 95% CI, 0.3-0.9). The joint risk of smoking and hypertension was higher (OR, 8.3; 95% CI, 4.5-15.2) than the sum of the risks independently. Conclusions-Current smoking, hypertension, and family history of stroke increase the risk of UIA, with smoking and hypertension having an additive effect, whereas hypercholesterolemia and regular physical exercise decrease this risk. A healthy lifestyle probably reduces the risk of UIA and thereby possibly also that of aneurysmal subarachnoid hemorrhage. Whether smoking and hypertension increase the risk of aneurysmal subarachnoid hemorrhage only through an increased risk of aneurysm formation or also through an increased risk of rupture remains to be established. © 2013 American Heart Association, Inc.
Vlak M.H.M.,Rudolf Magnus Institute of Neuroscience |
Vlak M.H.M.,Slotervaart Hospital |
Rinkel G.J.E.,Rudolf Magnus Institute of Neuroscience |
Greebe P.,Rudolf Magnus Institute of Neuroscience |
And 2 more authors.
Stroke | Year: 2013
BACKGROUND AND PURPOSE-: Knowledge about risk factors contributes to understanding the pathophysiological mechanisms that cause intracranial aneurysm rupture and helps to develop possible treatment strategies. We aimed to study lifestyle and personal characteristics as risk factors for the rupture of intracranial aneurysms. METHODS-: We performed a case-control study with 250 patients with an aneurysmal subarachnoid hemorrhage and 206 patients with an unruptured intracranial aneurysm. All patients with an aneurysmal subarachnoid hemorrhage and patients with a unruptured intracranial aneurysm were asked to fill in a structured questionnaire about their lifestyle and medical history. For patients with an unruptured intracranial aneurysm, we also collected data on the indication for imaging. With logistic regression analysis, we identified independent risk factors for aneurysmal rupture. RESULTS-: Reasons for imaging in patients with an unruptured intracranial aneurysm were atherosclerotic disease (23%), positive family history (18%), headache (8%), preventive screening (3%), and other (46%). Factors that increased risk for aneurysmal rupture were smoking (odds ratio, 1.9; 95% confidence interval, 1.2-3.0) and migraine (2.4; 1.1-5.1); hypercholesterolemia decreased this risk (0.4; 0.2-1.0), whereas a history of hypertension did not independently influence the risk. CONCLUSIONS-: Smoking, migraine and, inversely, hypercholesterolemia are independent risk factors for aneurysmal rupture. Data from the questionnaire are insufficient to conclude whether hypercholesterolemia or its treatment with statins exerts a risk-reducing effect. The pathophysiological mechanisms through which smoking and migraine increase the risk of aneurysmal rupture should be investigated in further studies. Although a history of hypertension does not increase risk of rupture, a sudden rise in blood pressure might still trigger aneurysmal rupture. © 2013 American Heart Association, Inc.