Hilversum, Netherlands
Hilversum, Netherlands

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Van Rossem C.C.,Tergooi Hospital
British Journal of Surgery | Year: 2015

Background Non-operative management may be an alternative for uncomplicated appendicitis, but preoperative distinction between uncomplicated and complicated disease is challenging. This study aimed to develop a scoring system based on clinical and imaging features to distinguish uncomplicated from complicated appendicitis. Methods Patients with suspected acute appendicitis based on clinical evaluation and imaging were selected from two prospective multicentre diagnostic accuracy studies (OPTIMA and OPTIMAP). Features associated with complicated appendicitis were included in multivariable logistic regression analyses. Separate models were developed for CT and ultrasound imaging, internally validated and transformed into scoring systems. Results A total of 395 patients with suspected acute appendicitis based on clinical evaluation and imaging were identified, of whom 110 (27·8 per cent) had complicated appendicitis, 239 (60·5 per cent) had uncomplicated appendicitis and 46 (11·6 per cent) had an alternative disease. CT was positive for appendicitis in 284 patients, and ultrasound imaging in 312. Based on clinical and CT features, a model was created including age, body temperature, duration of symptoms, white blood cell count, C-reactive protein level, and presence of extraluminal free air, periappendiceal fluid and appendicolith. A scoring system was constructed, with a maximum possible score of 22 points. Of the 284 patients, 150 had a score of 6 points or less, of whom eight (5·3 per cent) had complicated appendicitis, giving a negative predictive value (NPV) of 94·7 per cent. The model based on ultrasound imaging included the same predictors except for extraluminal free air. The ultrasound score (maximum 19 points) was calculated for 312 patients; 105 had a score of 5 or less, of whom three (2·9 per cent) had complicated appendicitis, giving a NPV of 97·1 per cent. Conclusion With use of novel scoring systems combining clinical and imaging features, 95 per cent of the patients deemed to have uncomplicated appendicitis were correctly identified as such. The score can aid in selection for non-operative management in clinical trials. Useful score for future trials © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.


Cense H.A.,Red Cross | Engel A.F.,Zaans Medical Center | Gerhards M.F.,Onze Lieve Vrouwe Gasthuis | Van Wagensveld B.A.,Sint Lucas Andreas Hospital | And 3 more authors.
Annals of Surgery | Year: 2011

OBJECTIVE:: To investigate which perioperative treatment, ie, laparoscopic or open surgery combined with fast track (FT) or standard care, is the optimal approach for patients undergoing segmental resection for colon cancer. SUMMARY BACKGROUND DATA:: Important developments in elective colorectal surgery are the introduction of laparoscopy and implementation of FT care, both focusing on faster recovery. METHODS:: In a 9-center trial, patients eligible for segmental colectomy were randomized to laparoscopic or open colectomy, and to FT or standard care, resulting in 4 treatment groups. Primary outcome was total postoperative hospital stay (THS). Secondary outcomes were postoperative hospital stay (PHS), morbidity, reoperation rate, readmission rate, in-hospital mortality, quality of life at 2 and 4 weeks, patient satisfaction and in-hospital costs. Four hundred patients were required to find a minimum difference of 1 day in hospital stay. RESULTS:: Median THS in the laparoscopic/FT group was 5 (interquar-tile range: 4-8) days; open/FT 7 (5-11) days; laparoscopic/standard 6 (4.5-9.5) days, and open/standard 7 (6-13) days (P < 0.001). Median PHS in the laparoscopic/FT group was 5 (4-7) days; open/FT 6 (4.5-10) days; laparoscopic/standard 6 (4-8.5) days and open/standard 7 (6-10.5) days (P < 0.001). Secondary outcomes did not differ significantly among the groups. Regression analysis showed that laparoscopy was the only independent predictive factor to reduce hospital stay and morbidity. CONCLUSIONS:: Optimal perioperative treatment for patients requiring segmental colectomy for colon cancer is laparoscopic resection embedded in a FT program. If open surgery is applied, it is preferentially done in FT care. This study was registered under NTR222 (www.trialregister.nl). Copyright C © 2011 by Lippincott Williams & Wilkins.


Badrising S.,Tergooi Hospital | Van Der Noort V.,Netherlands Cancer Institute | Van Oort I.M.,Radboud University Nijmegen | Van Den Berg H.P.,Tergooi Hospital | And 8 more authors.
Cancer | Year: 2014

BACKGROUND Enzalutamide (Enz) and abiraterone acetate (AA) are hormone treatments that have a proven survival advantage in patients with metastatic, castration-resistant prostate cancer who previously received docetaxel (Doc). Recently, limited activity of AA after Enz and of Enz after AA was demonstrated in small cohort studies. Here, the authors present the activity and tolerability of Enz in patients who previously received AA and Doc in the largest cohort to date. METHODS The efficacy and tolerability of Enz were investigated in men with progressive, metastatic, castrate-resistant prostate cancer who previously received Doc and AA. Toxicity, progression-free survival, time to prostate-specific antigen (PSA) progression, and overall survival were retrospectively evaluated. RESULTS Sixty-one patients were included in the analysis. The median age was 69 years (interquartile range [IQR], 64-74 years), 57 patients (93%) had an Eastern Cooperative Oncology Group performance status from 0 to 2, 48 patients (79%) had bone metastases, 33 patients (54%) had lymph node metastases, and 13 patients (21%) had visceral metastases. The median duration of Enz treatment was 14.9 weeks (IQR, 11.1-20.0 weeks), and 13 patients (21%) had a maximum PSA decline ≥50%. The median progression-free survival was 12.0 weeks (95% confidence interval [CI], 11.1-16.0 weeks), the median time to PSA progression was 17.4 weeks (95% CI, >16.0 weeks), and the median overall survival was 31.6 weeks (95% CI, >28.7 weeks). Enz was well tolerated, and fatigue and musculoskeletal pain were the most frequent grade ≥2 adverse events. The PSA response to Doc and AA did not predict the PSA response to Enz. CONCLUSIONS Enz has modest clinical activity in patients with metastatic, castrate-resistant prostate cancer who previously received Doc and AA. PSA response to Doc and AA does not predict for PSA response to ENz. © 2013 American Cancer Society.


Bakker M.F.,University Utrecht | Jacobs J.W.G.,University Utrecht | Welsing P.M.J.,University Utrecht | Verstappen S.M.M.,Arthritis Research UK Epidemiology Unit | And 10 more authors.
Annals of Internal Medicine | Year: 2012

Background: Treatment strategies for tight control of early rheumatoid arthritis (RA) are highly effective but can be improved. Objective: To investigate whether adding prednisone, 10 mg/d, at the start of a methotrexate (MTX)-based treatment strategy for tight control in early RA increases its effectiveness. Design: A 2-year, prospective, randomized, placebo-controlled, double-blind, multicenter trial (CAMERA-II [Computer Assisted Management in Early Rheumatoid Arthritis trial-II]). (International Standard Randomised Controlled Trial Number: ISRCTN 70365169) Setting: 7 hospitals in the Netherlands. Patients: 236 patients with early RA (duration <1 year). Intervention: Patients were randomly assigned to an MTX-based, tight control strategy starting with either MTX and prednisone or MTX and placebo. Methotrexate treatment was tailored to the individual patient at monthly visits on the basis of predefined response criteria aiming for remission. Measurements: The primary outcome was radiographic erosive joint damage after 2 years. Secondary outcomes included response criteria, remission, and the need to add cyclosporine or a biologic agent to the treatment. Results: Erosive joint damage after 2 years was limited and less in the group receiving MTX and prednisone (n = 117) than in the group receiving MTX and placebo (n = 119). The MTX and prednisone strategy was also more effective in reducing disease activity and physical disability, achieving sustained remission, and avoiding the addition of cyclosporine or biologic treatment. Adverse events were similar in both groups, but some occurred less in the MTX and prednisone group. Limitation: A tight control strategy for RA implies monthly visits to an outpatient clinic, which is not always feasible. Conclusion: Inclusion of low-dose prednisone in an MTX-based treatment strategy for tight control in early RA improves patient outcomes. © 2012 American College of Physicians.


Schubart C.D.,Tergooi Hospital | Sommer I.E.C.,University Utrecht | Fusar-Poli P.,King's College London | de Witte L.,University Utrecht | And 2 more authors.
European Neuropsychopharmacology | Year: 2014

Although cannabis use is associated with an increased risk of developing psychosis, the cannabis constituent cannabidiol (CBD) may have antipsychotic properties. This review concisely describes the role of the endocannabinoid system in the development of psychosis and provides an overview of currently available animal, human experimental, imaging, epidemiological and clinical studies that investigated the antipsychotic properties of CBD. In this targeted literature review we performed a search for English articles using Medline and EMBASE. Studies were selected if they described experiments with psychosis models, psychotic symptoms or psychotic disorders as outcome measure and involved the use of CBD as intervention. Evidence from several research domains suggests that CBD shows potential for antipsychotic treatment. © 2013 Elsevier B.V. and ECNP.


Dharma S.,University of Indonesia | Kedev S.,University of Macedonia | Patel T.,Apex Heart Institute | Kiemeneij F.,Tergooi Hospital | Gilchrist I.C.,Pennsylvania State University
Catheterization and Cardiovascular Interventions | Year: 2015

Objective To evaluate whether administration of nitroglycerin through the sheath at the end of a transradial procedure might preserve the patency of the radial artery. Background: Despite the increasing acceptance of transradial approach, radial artery occlusion (RAO) continues to be a vexing problem of transradial access and limits utility of the radial artery as an access site in the future. Methods We conducted a multicenter, prospective, randomized, placebo-controlled, operator-blinded trial and enrolled 1,706 patients who underwent transradial catheterization in three experienced radial centers. Patients were randomized to receive either 500 μg nitroglycerin (n = 853) or placebo (n = 853), given intra-arterially through the sheath at the end of the radial procedure. The primary outcome was the incidence of RAO as confirmed by absence of antegrade flow at one day after the transradial procedure evaluated by duplex ultrasound of the radial artery. Results The use of nitroglycerin, as compared with placebo, reduced the risk of the primary outcome [8.3% vs. 11.7%; odds ratio, 0.62; 95% confidence interval (CI), 0.44-0.87; P = 0.006]. From a multivariable analysis, duration of hemostasis was a predictor of RAO (odds ratio, (odds ratio, 3.11; 95% CI, 1.66 to 5.82; P < 0.001). There were no significant differences between the groups with respect to the sheath size (P = 0.311), number of puncture attempts (P = 0.941), duration of hemostasis (P = 0.379) and procedural time (P = 0.095). Conclusion The administration of nitroglycerin at the end of a transradial catheterization, reduced the incidence of RAO, examined 1 day after the radial procedure by ultrasound. Postprocedural/prehemostasis pharmacologic regimens may represent a novel target for further investigation to reduce RAO. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.


Tijdink J.K.,VU University Amsterdam | Tijdink J.K.,Tergooi Hospital | Vergouwen A.C.M.,Saint Lucas Andreas Hospital | Smulders Y.M.,VU University Amsterdam
PLoS ONE | Year: 2013

Background:Publication of scientific research papers is important for professionals working in academic medical centres. Quantitative measures of scientific output determine status and prestige, and serve to rank universities as well as individuals. The pressure to generate maximum scientific output is high, and quantitative aspects may tend to dominate over qualitative ones. How this pressure influences professionals' perception of science and their personal well-being is unknown.Methods and Findings:We performed an online survey inviting all medical professors (n = 1206) of the 8 academic medical centres in The Netherlands to participate. They were asked to fill out 2 questionnaires; a validated Publication Pressure Questionnaire and the Maslach Burnout Inventory. In total, 437 professors completed the questionnaires. among them, 54% judge that publication pressure 'has become excessive', 39% believe that publication pressure 'affects the credibility of medical research' and 26% judge that publication pressure has a 'sickening effect on medical science'. The burn out questionnaire indicates that 24% of medical professors have signs of burn out. The number of years of professorship was significantly related with experiencing less publication pressure. Significant and strong associations between burn out symptoms and the level of perceived publication pressure were found. The main limitation is the possibility of response bias.Conclusion:A substantial proportion of medical professors believe that publication pressure has become excessive, and have a cynical view on the validity of medical science. These perceptions are statistically correlated to burn out symptoms. Further research should address the effects of publication pressure in more detail and identify alternative ways to stimulate the quality of medical science. © 2013 Tijdink et al.


Tijdink J.K.,VU University Amsterdam | Tijdink J.K.,Tergooi Hospital | Vergouwen A.C.M.,St Lucas Andreas Hospital | Smulders Y.M.,VU University Amsterdam
BMC Medical Education | Year: 2014

Background: Although job-related burnout and its core feature emotional exhaustion are common among medical professionals and compromise job satisfaction and professional performance, they have never been systematically studied in medical professors, who have central positions in academic medicine.Methods. We performed an online nationwide survey inviting all 1206 medical professors in The Netherlands to participate. They were asked to fill out the Maslach Burnout Inventory, a 'professional engagement' inventory, and to provide demographic and job-specific data.Results: A total of 437 Professors completed the questionnaire. Nearly one quarter (23.8%) scored above the cut-off used for the definition of emotional exhaustion. Factors related to being in an early career stage (i.e. lower age, fewer years since appointment, having homeliving children, having a relatively low Hirsch index) were significantly associated with higher emotional exhaustion scores. There was a significant inverse correlation between emotional exhaustion and the level of professional engagement.Conclusions: Early career medical professors have higher scores on emotional exhaustion and may be prone for developing burnout. Based upon this finding, preventive strategies to prevent burnout could be targeted to young professors. © 2014Tijdink et al.; licensee BioMed Central Ltd.


Van Rossem C.C.,Tergooi Hospital | Schreinemacher M.H.F.,Tergooi Hospital | Treskes K.,Tergooi Hospital | Van Hogezand R.M.,Tergooi Hospital | Van Geloven A.A.W.,Tergooi Hospital
British Journal of Surgery | Year: 2014

Background Antibiotic treatment after appendicectomy for complicated appendicitis aims to reduce postoperative infections. However, available data on the duration of treatment are limited. This study compared the difference in infectious complications between two protocols, involving either 3 or 5-days of postoperative antibiotic treatment. Methods This was an observational cohort study of all adult patients who had an appendicectomy between January 2004 and December 2010 at either one of two hospitals in the same region. At location A, the protocol included 3-days of postoperative antibiotic treatment, whereas at location B it specified 5-days. The primary outcome was the development of postoperative infections as either superficial wound infection or deep intra-abdominal infections. Results A total of 1143 patients with acute appendicitis underwent appendicectomy, of whom 267 (23·4 per cent) had complicated appendicitis. The duration of postoperative antibiotic treatment was 3-days in 135 patients (50·6 per cent) and at least 5-days in 123 (46·1 per cent). No difference was found between antibiotic treatment for 3 or 5-days in terms of developing an intra-abdominal abscess (odds ratio (OR) 1·77, 95 per cent confidence interval 0·68 to 4·58; P = 0·242) or a wound infection (OR 2·74, 0·54 to 13·80; P = 0·223). In patients with complicated appendicitis, the laparoscopic approach was identified as a risk factor for developing an intra-abdominal abscess in univariable analysis (OR 2·46, 1·00 to 6·04; P = 0·049), but was not confirmed as an independent risk factor for this complication in multivariable analysis (OR 2·32, 0·75 to 7·14; P = 0·144). Conclusion After appendicectomy for complicated appendicitis, 3-days of antibiotic treatment is equally effective as 5-days in reducing postoperative infections. 3 days may do © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.


In order to obviate double arterial access for bi-coronary visualization during transradial intervention of chronic total coronary occlusions, a novel technique was used. A 3-in-6 mother-and-child technique was applied in which a 3 Fr intracoronary catheter was advanced via a 6 Fr guide into the artery supplying collaterals to the distal occluded segment of the right coronary artery (RCA). The same guide was used, with the 3 Fr catheter in situ, to visualize the occluded target vessel. With double contrast injections, the guidewire could be guided through the RCA occlusion while the intraluminal position could be visualized and confirmed. This was followed by successful drug-eluting stent implantation. This method to visualize both coronary arteries simultaneously is named the «Chameleon's technique.».

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