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Amsterdam-Zuidoost, Netherlands

Corvol A.,Rennes University Hospital Center | Gulsvik A.K.,University of Oslo | Kuper I.M.J.A.,Slotervaarthospital | Phylaktou P.,Larnaca Family Health Center | And 4 more authors.
European Geriatric Medicine | Year: 2014

Atrial fibrillation (AF) is the most common arrhythmia in older adults, and those with AF have an increased risk of developing stroke. Although the use of anticoagulants for stroke prevention is strongly recommended, many older people are not appropriately treated. Vitamin K antagonists (VKA) have been the only available oral anticoagulants for such patients, but recently, new oral anticoagulants have been approved for stroke prevention in AF as an alternative to VKA. Some characteristics make them an attractive treatment option; however, many gaps in evidence remain, especially in the population of older patients. This paper explores the use of anti-thrombotic treatment for the prevention of stroke in AF in old subjects in four different European countries. VKA seems to be the standard therapy in older patients, although anti-platelet drugs are still used widely in some countries. In many European countries, warfarin is replaced by coumadin derivatives. The use of new oral anticoagulants seems to be quite limited in older subjects and some degree of discrimination exists in access to these new drugs. European Society of Cardiology (ESC) 2010 and 2012 guidelines seem to be triggering a wide change in attitudes and practices. Many countries are incorporating such guidelines into official recommendations, and specific country recommendations on the use of new anticoagulants have been published, partly due to the high economic impact of these drugs. Geriatricians still have a marginal role in the prescription of anticoagulants, which in most countries usually lies on cardiologists. General practitioners are key for follow-up, as the role of anticoagulation clinics remains relevant only in The Netherlands. Most old patients have limited knowledge of anticoagulant treatment options, thus, their involvement in decision-making is low. © 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society. Source

Tromp W.G.,Slotervaarthospital | Van Den Heuvel B.,Medical Center | Dwars B.J.,Slotervaarthospital
Surgical Endoscopy and Other Interventional Techniques | Year: 2014

Background: It is generally stated that preoperative differentiation between indirect and direct inguinal hernias by physical examination is inaccurate and irrelevant. With the expansion of the laparoscopic technique, new relevance has emerged. Laparoscopic correction of an indirect hernia is more challenging and time consuming than laparoscopic correction of a direct hernia. Preoperative knowledge concerning the type of hernia informs the laparoscopic surgeon about the required expertise and the expected operative time, and this knowledge is useful for training programs and management. The authors therefore developed a new accurate and easy method of physical examination to differentiate types of inguinal hernia. A prospective study was conducted to determine the accuracy of this new method that combines physical examination with a hand-held Doppler device (not ultrasound) to differentiate types of inguinal hernia. Methods: This prospective diagnostics study consisted of two consecutive parts. Each part included 100 consecutive patients presenting with an inguinal hernia. The inguinal occlusion test was used to differentiate the types of inguinal hernia during physical examination in the first part of the study. A hand-held Doppler device was used for adequate localization of the epigastric vessels in addition to the occlusion test in the second part of the study. Preoperative remarks were compared with findings during laparoscopic inguinal hernia repair. The McNemar symmetry χ2 test was used for statistical evaluation Results: The first part of the study showed a preoperative accuracy of 35 % for direct inguinal hernias and 86 % for indirect inguinal hernias (p < 0.001). The second part of the study showed a preoperative accuracy of 79 % for direct inguinal hernias and 93 % for indirect inguinal hernias (p < 0.001) Conclusion: The inguinal occlusion test combined with the use of a handheld Doppler device is accurate in distinguishing direct and indirect inguinal hernias and provides useful management information in laparoscopic inguinal hernia repair. © 2014 Springer Science+Business Media. Source

Wisse W.,Slotervaarthospital | Rookhuizen M.B.,Slotervaarthospital | de Kruif M.D.,Slotervaarthospital | van Rossum J.,Slotervaarthospital | And 4 more authors.
Diabetes Research and Clinical Practice | Year: 2010

Objective: To assess the impact of personalized exercise prescription on habitual physical activity and glycemic control in sedentary, insulin treated type 2 diabetes patients during a 2-y intervention period. Research design and methods: 74 patients were randomized to the intervention (n=38) or control (n=36) group. The intervention group was stimulated to increase daily physical activity through regular, structured, and personalized exercise prescription by a physical therapist over the 2-y intervention period. Results: Physical activity levels at work or in leisure time were not modulated by the exercise prescription intervention. In accordance, no changes in body composition, glycemic control, medication use or risk factors for cardiovascular disease were observed. Conclusions: Long-term behavioral intervention programs, providing individualized exercise prescription, are not sufficient to change sedentary behavior and/or improve glycemic control in insulin treated, type 2 diabetes patients. © 2010 Elsevier Ireland Ltd. Source

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