St Lucas Andreas Hospital

Amsterdam, Netherlands

St Lucas Andreas Hospital

Amsterdam, Netherlands
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Teunissen P.W.,Maastricht University | Westerman M.,St Lucas Andreas Hospital
Medical Education | Year: 2011

Objectives The alleged medical education continuum is interrupted by a number of major transitions. After starting medical school, the first transition students encounter is that from non clinical to clinical training. The second transition is that of graduated student to junior doctor or specialist trainee, and the third concerns the specialist trainee's transition to medical specialist. As a first step towards a better understanding of the effects of transitions, this paper provides a critical overview of how these transitions have been conceptualised in the medical education domain. The findings are complemented with perspectives from the fields of transitional psychology and organisational socialisation. The transition into medical school is not reviewed.Methods Using the term 'transition', six leading medical education journals were searched for relevant articles. A snowballing technique on the reference lists of the 44 relevant articles yielded 29 additional publications. Studies were reviewed and categorised as representing objectifying, clarifying, or descriptive and/or justifying research.Results When students enter clinical training, they need to relearn what they thought they knew and they must learn new things in a more self directed way. As junior doctors or specialist trainees, their main challenges involve handling the many responsibilities that accompany the delivery of patient care while simultaneously learning from the process of providing that care. As medical specialists, new non medical tasks and decisions on how to delegate responsibilities become issues.Conclusions Research on transitions has objectified the challenges students and doctors face. Clarifying studies often lack conceptual frameworks that could help us to gain deeper insight into the observed phenomena. Psychology offers valuable theoretical perspectives that are applicable to medical education transitions. To transform a transition from a threat to a learning opportunity, medical education should assist students and doctors in developing the coping skills they need to effectively deal with the challenges presented by new environments. © Blackwell Publishing Ltd 2010.

Theuns D.A.M.J.,Erasmus University Rotterdam | Elvan A.,Isala Klinieken | De Voogt W.,St Lucas Andreas Hospital | De Cock C.C.,VU University Amsterdam | And 2 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2012

Background: The Riata family of implantable cardioverter-defibrillator (ICD) leads is prone to a specific insulation abrasion characterized by externalization of conductor cables. The objective of this study was to determine the prevalence of externalized conductors and electrical abnormalities in Riata ICD leads by fluoroscopic screening and standard ICD interrogation. Methods and Results: All ICD implantation centers were contacted by the Netherlands Heart Rhythm Association Device Advisory Committee to identify all patients with an active Riata ICD lead and to perform fluoroscopic screening of the lead. In addition, the electrical integrity of the lead was assessed. As of March 1, 2012, data for 1029 active Riata leads were available; 47% of these were 8-F Riata and 53% were 7-F Riata ST. Externalized conductors were observed in 147 leads (14.3%). Proportion of externalized conductors was higher in 8-F Riata compared with 7-F Riata ST (21.4% vs 8.0%; P<0.001). Median time from implantation to detection of externalized conductors was 65.3 months. The estimated rates of externalized conductors were 6.9% and 36.6% at 5 and 8 years after implantation, respectively. Of the 147 leads with externalized conductors, 10.9% had abnormal electrical parameters vs 3.5% in nonexternalized leads (P<0.001). Conclusions: The prevalence of externalized conductors in Riata leads is significantly high (14.3%) using fluoroscopic screening. The majority of externalized conductors are not detectable with standard ICD interrogation. Screening with fluoroscopy is reasonable. © 2012 American Heart Association, Inc.

Van Kesteren E.R.,St Lucas Andreas Hospital | Van Maanen J.P.,St Lucas Andreas Hospital | Hilgevoord A.A.J.,St Lucas Andreas Hospital | Laman D.M.,St Lucas Andreas Hospital | De Vries N.,St Lucas Andreas Hospital
Sleep | Year: 2011

Study Objectives: To test the hypothesis that head position, separately from trunk position, is an additionally important factor for the occurrence of apnea in obstructive sleep apnea (OSA) patients. Design: Prospective cohort study. Setting: St. Lucas Andreas Hospital, Amsterdam, the Netherlands. Patients and Participants: Three hundred patients referred to our department because of clinically suspected OSA. Interventions: N/A Measurements and Results: Patients underwent overnight polysomnography with 2 position sensors: one on the trunk, and one in the mid-forehead. Of the 300 subjects, 241 were diagnosed with OSA, based on an AHI > 5. Of these patients, 199 could be analyzed for position-dependent OSA based on head and trunk position sensors (AHI in supine position twice as high as AHI in non-supine positions): 41.2% of the cases were not position dependent, 52.3% were supine position dependent based on the trunk sensor, 6.5% were supine position dependent based on the head sensor alone. In 46.2% of the trunk supine position-dependent group, head position was of considerable influence on the AHI (AHI was > 5 higher when the head was also in supine position compared to when the head was turned to the side). Conclusions: The results of this study confirm our hypothesis that the occurrence of OSA may also be dependent on the position of the head. Therefore in patients with a suspicion of position-dependent OSA, sleep recording with dual position sensors placed on both trunk and head should be considered.

The number of Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) procedures for morbid obesity and type 2 diabetes mellitus will increase worldwide, and therefore, an increase in perioperative morbidity can be anticipated. The authors present three cases based on different complications after LRYGB to demonstrate the diagnostic challenge that clinicians face in this particular group of patients. Also, a review of the literature covering the value of different imaging in these particular cases is provided by the authors. The role of imaging in the diagnostic process is discussed.

van Munster C.E.P.,St Lucas Andreas Hospital | Jonkman L.E.,St Lucas Andreas Hospital | Weinstein H.C.,St Lucas Andreas Hospital | Uitdehaag B.M.,St Lucas Andreas Hospital | Geurts J.J.,St Lucas Andreas Hospital
Neuroscience | Year: 2015

Traditionally, multiple sclerosis (MS) is considered to be a disease primarily affecting the white matter (WM). However, the development of some clinical symptoms such as cognitive impairment cannot be fully explained by the severity of WM pathology alone. During the past decades it became clear that gray matter (GM) damage of the brain is also of major importance in patients with MS. Thanks to improved magnetic resonance imaging techniques, the in vivo detection of GM pathology became possible, enabling a better understanding of the manifestation of various clinical symptoms, such as cognitive impairment. Using higher field strengths and specific sequences, detection of cortical lesions was increased. However, despite these improvements, visualization of cortical MS lesions remains difficult (only about 30-50% of histopathologically confirmed lesions can be detected at 7. Tesla magnetic resonance imaging (MRI)). Furthermore, more research is needed to understand the exact interplay of cortical lesions, GM atrophy and WM pathology in the development of clinical symptoms. In this review, we summarize the historical background that preceded current research and provide an overview of the current knowledge on clinical consequences of GM pathology in MS in terms of disability, cognitive impairment and other clinically important signs such as epileptic seizures. © 2015 IBRO. Published by Elsevier Ltd.

Lagerveld B.W.,St Lucas Andreas Hospital | Brenninkmeijer M.,St Lucas Andreas Hospital | Van Der Zee J.A.,St Lucas Andreas Hospital | Van Haarst E.P.,St Lucas Andreas Hospital
Journal of Endourology | Year: 2014

Objective: Assessment of anatomical complexity with the RENAL (radius; exophytic/endophytic; nearness; anterior/posterior; location) and preoperative aspects and dimensions used for anatomical classification (PADUA) nephrometry indices is used to predict complications related to surgical extirpation treatment for patients with clinical T1a/b renal mass. This single center study aims to investigate the value of these indices to predict complications in a cohort of patients treated with laparoscopic cryoablation (LCA) for cT1 renal mass. Materials and Methods: Single institution data from consecutive LCA procedures were prospectively collected from December 2006 to April 2013. Renal mass anatomical complexity was categorized according to RENAL and PADUA indices. Comorbidity was assessed by the Charlson-index. Intraoperative complications (IOCs) were reviewed and categorized: blood loss >100 mL, conversion, tumor fracture, and incomplete ablation. Postoperative complications (POCs) were graded using the modified Clavien-index. Univariate and multivariate logistic regression models addressed the risk for complications. Results: Ninety-nine LCA procedures were included. The median RENAL-score was 7.0 (standard deviation [SD] 1.7), and the median PADUA-score was 8.0 (SD 1.6). IOC occurred in 19 procedures (19%). The risk for IOC was significantly correlated (p<0.05) with tumor diameter (mm), surface, volume, the RENAL domains "R-size," "N-nearness to collecting system," "RENAL score," and the PADUA domain "diameter." In multivariate analysis with surgical complication as the independent variable, tumor diameter, surface, and volume were determining factors. A threshold was set for 35 mm tumor diameter, it being predictive for an increased risk for IOC performing LCA. Twenty-three POC occurred in 20 patients. On univariate analysis, the RENAL domain "nearness to collecting system," and no PADUA domains, had a significant association with POC. Conclusion: The RENAL score, and not the PADUA score, is associated with a higher risk for IOC. A noncategorized method of scoring tumor diameter showed a more significant correlation with the risk for IOC than the categorized method of the nephrometry indices. As a result a threshold diameter of 35 mm was established. © Copyright 2014, Mary Ann Liebert, Inc. 2014.

Ravesloot M.J.L.,St Lucas Andreas Hospital | Van Maanen J.P.,St Lucas Andreas Hospital | Hilgevoord A.A.J.,St Lucas Andreas Hospital | Van Wagensveld B.A.,St Lucas Andreas Hospital | De Vries N.,St Lucas Andreas Hospital
European Archives of Oto-Rhino-Laryngology | Year: 2012

The aim of this study was to evaluate prevalence of obstructive sleep apnea among patients undergoing bariatric surgery and the predictive value of various clinical parameters: body mass index (BMI), neck circumference (NC) and the Epworth Sleepiness Scale (ESS). We performed a prospective, multidisciplinary, singlecenter observational study including all patients on the waiting list for bariatric surgery between June 2009 and June 2010, irrespective of history or clinical findings. Patients visited our ENT outpatient clinic for patient history, ENT and general examination and underwent a full night polysomnography, unless performed previously. As much as 69.9% of the patients fulfilled the criteria for OSA (mean BMI 44.2 ± SD 6.4 kg/m2); 40.4% of the patients met the criteria for severe OSA. The regression models found BMI to be the best clinical predictor, while the ROC curve found the NC to be the most accurate predictor of the presence of OSA. The discrepancy of the results and the poor statistical power suggest that all three clinical parameters are inadequate predictors of OSA. In conclusion, in this large patient series, 69.9% of patients undergoing BS meet the criteria for OSA. More than 40% of these patients have severe OSA. A mere 13.3% of the patients were diagnosed with OSA before being placed on the waiting list for BS. On statistical analysis, increased neck circumference, BMI and the ESS were found to be insufficient predictors of the presence of OSA. Polysomnography is an essential component of the preoperative workup of patients undergoing BS. When OSA is found, specific perioperative measures are indicated. © Springer-Verlag 2011.

Ravesloot M.J.L.,St Lucas Andreas Hospital | Hilgevoord A.A.J.,St Lucas Andreas Hospital | Van Wagensveld B.A.,St Lucas Andreas Hospital | De Vries N.,St Lucas Andreas Hospital
Obesity Surgery | Year: 2014

Background: Studies have reported significant improvement of obstructive sleep apnea (OSA) in obese patients after bariatric surgery (BS). Weight loss following BS is rapid in the first few months, but it can take at least 1 year to reach the final result. The aim of this study is to measure the effect of BS on various clinical, respiratory, and sleep parameters of OSA at two postoperative intervals. Methods: Prospectively, all patients being evaluated for BS underwent a polysomnography (PSG). Patients diagnosed with OSA preoperatively were invited to undergo a PSG at least 6 months postoperatively and if OSA persisted, again at least 12 months postoperatively. Results: One hundred ten patients underwent a first postoperative PSG 7.7 months after surgery. The mean apnea-hypopnea index (AHI) significantly decreased from 39.5 to 15.6/h. In 58.2 %, the AHI was reduced to below 10 and in 25.5 % to below 5. Fifty patients underwent a first PSG 7.1 months and a second PSG 16.9 months after surgery. The mean AHI decreased from 49.1 to 22.7 to 17.4/h following BS. Conclusions: BS initiates dramatic improvement and even remission of clinical and sleep parameters during the first 7 months, which continues at a slower rate over the next 10 months. We recommend a follow-up PSG after surgery to check for residual disease and if necessary retritration of continuous positive airway pressure, which may lead to higher treatment compliance. © 2013 Springer Science+Business Media New York.

Davies G.,St Lucas Andreas Hospital | Koenen M.,St Lucas Andreas Hospital
British Journal of Radiology | Year: 2011

Objective: The increasing quality of diagnostic ultrasound has resulted in the detection of greater numbers of potentially benign hepatic lesions. Current radiological practice requires contrast enhanced ultrasound, CT or MRI to confirm the diagnosis. Acoustic radiation force impulse (ARFI) elastography is an imaging technique measuring the elasticity of biological tissues. Recent technical advances in ultrasound have made it possible to generate shear waves, whose velocity in the liver is proportional to the degree of hepatic elasticity. Methods: This shear wave velocity (SWV) may be used as a marker for both focal and diffuse liver pathology.We used this technique to examine patients with normal livers and those with haemangiomata and metastases. Results: Patients with normal ultrasound examinations and normal liver enzymes, n=99, had SWVs of 1.24±0.23 m s -1 (mean ± standard deviation) independent of site of measurement, age or gender. Results of SWV measurements in haemangiomata, n=35, produced values of the same order, 1.35±0.48 m s -1. In contrast, patients with metastases, n=10, had SWVs of 4.23±0.59 m s -1. With a cut-off value of 2.5 m s -1, the sensitivity and specificity for haemangiomata were 97.1% and 100%, respectively, with an area under the curve of 0.999. Conclusion: ARFI elastography with SWV measurements is a promising new technique which could replace invasive investigations for benign hepatic lesions. © 2011 The British Institute of Radiology.

Siegert C.E.H.,St Lucas Andreas Hospital
Netherlands Journal of Medicine | Year: 2010

There is increasing evidence for health benefits accomplished by activated vitamin D through interaction with the vitamin D receptor (VDR) that go beyond calcium and bone homeostasis and regulation of parathyroid hormone (PTH) secretion. treatment with vitamin D receptor agonists (VDRAs) is associated with reduced mortality in (pre)dialysis patients. interestingly, these relations are independent of Pth levels and calcium × phosphorus product. this suggests the presence of biological functions of vitamin D that are independent of its interaction with the parathyroid glands. because chronic kidney disease leads to increased cardiovascular mortality, mechanisms in which VDRAs can influence cardiovascular disease are discussed. These mechanisms comprise the potential ameliorating effects of VDRAs on atherosclerosis, arterial media calcification, cardiac hypertrophy, the renin-angiotensin system and thrombosis. Moreover, treatment strategies with VDRAs are discussed together with several recent observational studies. treatment advice consists of correction of 25(OH) vitamin D deficiency, low-dose calcitriol in patients with secondary hyperparathyroidism, and activated vitamin D analogues may be indicated when higher doses are needed to suppress PTH secretion. new insights into biological and clinical effects of VDRAs may broaden the patient group that may benefit from VDRA treatment to patients with creatinine clearances in the 30 to 60 ml/min range. © Van Zuiden Communications B.V.

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