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El-Magd ES, Schouten RW, Nadort E, Shaw PKC, Smets YFC, Vleming LJ, Dekker FW, Broekman BFP, Honig A, Siegert CEH. Dialysis withdrawal and symptoms of anxiety and depression: a prospective cohort study. BMC Nephrol 2023; 24:219. [PMID: 37488483 PMCID: PMC10367409 DOI: 10.1186/s12882-023-03267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND An important aspect of end-of-life decisions in dialysis patients is elective withdrawal from dialysis therapy. Several studies have shown that clinical factors, such as comorbidity, play a role in dialysis withdrawal. The role of symptoms of anxiety and depression is largely unknown. The. METHODS A prospective multi-center study has been set up to investigate anxiety and depressive symptoms longitudinally in dialysis patients. Anxiety and depressive symptoms were investigated using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) as baseline. Adverse events, including dialysis withdrawal and mortality were registered during follow-up. Multivariable cox proportional hazard models were used with anxiety and depression as the independent variable and dialysis withdrawal as the outcome variable. Models included age, sex, ethnicity and a set of clinical comorbidities. RESULTS A total of 687 patients were included between 2012 and 2017, with a median follow-up of 3.2 years. A total of 48 patients (7%) withdrew from dialysis therapy, and subsequently deceased. Anxiety and depressive symptoms at baseline showed an association with dialysis withdrawal with hazard ratios of 2.31 (1.09-4.88) for anxiety and 2.56 (1.27-5.15) for depressive symptoms, independent of somatic comorbidities. DISCUSSION Withdrawal from dialysis therapy is associated with anxiety and depressive symptoms. Dialysis patients with more severe depressive and anxiety symptoms were more vulnerable for dialysis withdrawal. Insight in factors that play a role in dialysis withdrawal could aid patients and clinicians making an informed decision and develop clinical guidelines.
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Affiliation(s)
- Essam S El-Magd
- Department of Nephrology, OLVG Hospital, Amsterdam, The Netherlands.
| | - Robbert W Schouten
- Department of Nephrology, OLVG Hospital, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Els Nadort
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Yves F C Smets
- Department of Nephrology, OLVG Hospital, Amsterdam, The Netherlands
| | - Louis-Jean Vleming
- Department of Nephrology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Birit F P Broekman
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Mental Health, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Carl E H Siegert
- Department of Nephrology, OLVG Hospital, Amsterdam, The Netherlands
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Nadort E, van Geenen NJK, Schouten RW, Boeschoten RE, Chandie Shaw P, Vleming LJ, Schouten M, Farhat K, Dekker FW, van Oppen P, Siegert CEH, Broekman BFP. Validation of Two Screening Tools for Anxiety in Hemodialysis Patients. J Pers Med 2022; 12:jpm12071077. [PMID: 35887577 PMCID: PMC9318791 DOI: 10.3390/jpm12071077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Symptoms of anxiety are often unrecognized and untreated in dialysis patients. We investigated the diagnostic accuracy of two widely used screening tools for anxiety in hemodialysis patients. Methods: For this cross-sectional validation study, chronic hemodialysis patients from eight dialysis centers in the Netherlands were included. The Beck Anxiety Inventory (BAI) and Hospital Anxiety and Depression Scale—Anxiety subscale (HADS-A) were validated by the Mini International Neuropsychiatric Inventory (MINI) diagnostic interview. Receiver operating characteristic curves were used to determine the optimal cut-off values. Results: Of 65 participants, 13 (20%) were diagnosed with one or more anxiety disorders on the MINI, of which 5 were included in the analysis. ROC curves showed a good diagnostic accuracy of the BAI and HADS-A. The optimal cut-off value for the BAI was ≥13 (sensitivity 100%, specificity 85%) and for the HADS-A was ≥10 (sensitivity 80%, specificity 100%). Conclusions: Based on our limited data, both the BAI and the HADS-A seem to be valid screening instruments for anxiety in hemodialysis patients that can be used in routine dialysis care. The HADS-A consists of fewer items and showed fewer false-positive results than the BAI, which might make it more useful in clinical practice.
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Affiliation(s)
- Els Nadort
- Department of Psychiatry, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands; (N.J.K.v.G.); (B.F.P.B.)
- Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (R.E.B.); (P.v.O.)
- Correspondence:
| | - Noëlle J. K. van Geenen
- Department of Psychiatry, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands; (N.J.K.v.G.); (B.F.P.B.)
| | - Robbert W. Schouten
- Department of Nephrology, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands; (R.W.S.); (C.E.H.S.)
| | - Rosa E. Boeschoten
- Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (R.E.B.); (P.v.O.)
| | - Prataap Chandie Shaw
- Department of Nephrology, Haaglanden Medisch Centrum, Lijnbaan 32, 2512 VA The Hague, The Netherlands;
| | - Louis Jean Vleming
- Department of Nephrology, HagaZiekenhuis, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands;
| | - Marcel Schouten
- Department of Nephrology, Tergooi Ziekenhuis, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands;
| | - Karima Farhat
- Department of Nephrology, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC Haarlem, The Netherlands;
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (R.E.B.); (P.v.O.)
| | - Carl E. H. Siegert
- Department of Nephrology, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands; (R.W.S.); (C.E.H.S.)
| | - Birit F. P. Broekman
- Department of Psychiatry, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands; (N.J.K.v.G.); (B.F.P.B.)
- Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (R.E.B.); (P.v.O.)
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Nadort E, Schouten RW, Boeschoten RE, Smets Y, Chandie Shaw P, Vleming LJ, Dekker MJE, Westerman M, Hoogeveen EK, Bos WJW, Schouten M, Farhat K, Dekker FW, van Oppen P, Broekman BFP, Siegert CEH. Internet-based treatment for depressive symptoms in hemodialysis patients: A cluster randomized controlled trial. Gen Hosp Psychiatry 2022; 75:46-53. [PMID: 35134703 DOI: 10.1016/j.genhosppsych.2022.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a guided internet-based self-help intervention for hemodialysis patients with depressive symptoms. METHOD Chronic hemodialysis patients from nine Dutch hospitals with a depression score on the Beck Depression Inventory - second edition (BDI-II) of ≥10, were cluster-randomized into a five modules guided internet-based self-help problem solving therapy intervention or a parallel care-as-usual control group. Clusters were based on hemodialysis shift. The primary outcome depression was measured with the BDI-II. Analysis was performed with linear mixed models. RESULTS A total of 190 hemodialysis patients were cluster-randomized to the intervention (n = 89) or control group (n = 101). Post-intervention measurement was completed by 127 patients (67%) and more than half of the patients (54%) completed the intervention. No significant differences were found on the BDI-II score between the groups (mean difference - 0.1, 95%CI -3.0; 2.7, p = 0.94). Per protocol sensitivity analysis showed comparable results. No significant differences in secondary outcomes were observed between groups. CONCLUSIONS Guided internet-based self-help problem solving therapy for hemodialysis patients with depressive symptoms does not seem to be effective in reducing these symptoms as compared to usual care. Future research should examine how to best design content and accessibility of an intervention for depressive symptoms in hemodialysis patients. TRIAL REGISTRATION Dutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).
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Affiliation(s)
- Els Nadort
- Department of Psychiatry, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Robbert W Schouten
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
| | - Rosa E Boeschoten
- Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Yves Smets
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
| | - Prataap Chandie Shaw
- Department of Nephrology, Haaglanden Medisch Centrum, Lijnbaan 32, 2512 VA, The Hague, the Netherlands.
| | - Louis Jean Vleming
- Department of Nephrology, HagaZiekenhuis, Els Borst-Eilersplein 275, 2545 AA The Hague, the Netherlands.
| | - Marijke J E Dekker
- Department of Nephrology, Maasstad Ziekenhuis, Maasstadweg 21, 3079 DZ, Rotterdam, the Netherlands.
| | - Michiel Westerman
- Department of Nephrology, Franciscus Gasthuis & Vlietland Ziekenhuis, Kleiweg 500, 3045 PM Rotterdam, the Netherlands.
| | - Ellen K Hoogeveen
- Department of Nephrology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ s-Hertogenbosch, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Willem J W Bos
- Department of Internal Medicine, St. Antonius Ziekenhuis, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands; Department of Internal Medicine, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Marcel Schouten
- Department of Nephrology, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, the Netherlands.
| | - Karima Farhat
- Department of Nephrology, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC Haarlem, the Netherlands.
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Birit F P Broekman
- Department of Psychiatry, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Carl E H Siegert
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
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Uitvlugt EB, Janssen MJA, Siegert CEH, Kneepkens EL, van den Bemt BJF, van den Bemt PMLA, Karapinar-Çarkit F. Medication-Related Hospital Readmissions Within 30 Days of Discharge: Prevalence, Preventability, Type of Medication Errors and Risk Factors. Front Pharmacol 2021; 12:567424. [PMID: 33927612 PMCID: PMC8077030 DOI: 10.3389/fphar.2021.567424] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 02/11/2021] [Indexed: 02/04/2023] Open
Abstract
Background: Hospital readmission rates are increasingly used as a measure of healthcare quality. Medicines are the most common therapeutic intervention but estimating the contribution of adverse drug events as a cause of readmissions is difficult. Objectives: To assess the prevalence and preventability of medication-related readmissions within 30 days after hospital discharge and to describe the risk factors, type of medication errors and types of medication involved in these preventable readmissions. Design: A cross-sectional observational study. Setting: The study took place across the cardiology, gastroenterology, internal medicine, neurology, psychiatry, pulmonology and general surgery departments in the OLVG teaching hospital, Netherlands. Participants: Patients with an unplanned readmission within 30 days after discharge from an earlier hospitalization (index hospitalization: IH) were reviewed. Measurements: The prevalence and preventability of medication-related readmissions were assessed by residents in multidisciplinary meetings. A senior internist and hospital pharmacist reassessed the prevalence and preventability of identified cases. Generalized estimating equation with logistic regression was performed to identify risk factors of potentially preventable medication-related readmissions. Results: Of 1,111 included readmissions, 181 (16%) were medication-related, of which 72 (40%) were potentially preventable. The number of medication changes at IH (Adjusted odds ratio [ORadj]: 1.14; 95% CI: 1.05–1.24) and having ≥3 hospitalizations 6 months before IH (ORadj: 2.11; 95% CI: 1.12–3.98) were risk factors of a preventable medication-related readmission. Of these preventable readmissions, 35% were due to prescribing errors, 35% by non-adherence and 30% by transition errors. Medications most frequently involved were diuretics and antidiabetics. Conclusion: This study shows that 16% of readmissions are medication-related, of which 40% are potentially preventable. If the results are confirmed in larger multicentre studies, this may indicate that more attention should be paid to medication-related harm in order to lower the overall readmission rates.
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Affiliation(s)
- Elien B Uitvlugt
- Onze Lieve Vrouwe Gasthuis OLVG, Department of Hospital Pharmacy, Amsterdam, Netherlands
| | - Marjo J A Janssen
- Onze Lieve Vrouwe Gasthuis OLVG, Department of Hospital Pharmacy, Amsterdam, Netherlands
| | - Carl E H Siegert
- Onze Lieve Vrouwe Gasthuis OLVG, Department of Internal Medicine, Amsterdam, Netherlands
| | - Eva L Kneepkens
- Onze Lieve Vrouwe Gasthuis OLVG, Department of Hospital Pharmacy, Amsterdam, Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, Netherlands
| | - Fatma Karapinar-Çarkit
- Onze Lieve Vrouwe Gasthuis OLVG, Department of Hospital Pharmacy, Amsterdam, Netherlands
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Nadort E, Schouten RW, Witte SHS, Broekman BFP, Honig A, Siegert CEH, van Oppen P. Treatment of current depressive symptoms in dialysis patients: A systematic review and meta-analysis. Gen Hosp Psychiatry 2020; 67:26-34. [PMID: 32919306 DOI: 10.1016/j.genhosppsych.2020.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Symptoms of depression are highly prevalent and undertreated in dialysis patients. To aid clinicians in offering treatment to patients with depression, we conducted a systematic review and meta-analysis on the treatment of current depressive symptoms in dialysis patients. METHODS Nine databases were searched on January 8th 2020 for randomized controlled trials on the treatment of depressive symptoms in dialysis patients. In contradiction to previous reviews, we only included studies who selected patients with a score above a defined cut-off for depressive symptoms and used an inactive control group, to investigate the effectiveness of treatments in currently depressed patients. All interventions aimed to treat depressive symptoms were accepted for inclusion. Standardized mean differences were calculated in a random effect meta-analysis. RESULTS Seventeen studies were included in the systematic review (1640 patients). Nine studies could be included in the meta-analysis. A pooled analysis of 7 studies on psychotherapy showed a standardized mean difference of -0.48 [-0.87; -0.08], with a moderate heterogeneity (I2 = 52%, X2 = 12.56, p = .05). All studies on psychotherapy performed a per protocol analysis and scored high on potential bias. A pooled analysis of two studies on SSRI's showed no statistically significant improvement of depressive symptoms (SMD -0.57 [-6.17; 5.02], I2 = 71%, X2 = 0.2474, p = .06). CONCLUSIONS Psychotherapy is a promising treatment for currently depressed dialysis patients, although quality of evidence is low. More evidence is needed regarding the efficacy of SSRI's, exercise therapy and dietary supplements in this population. PROSPERO CRD42018073969.
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Affiliation(s)
- Els Nadort
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands; Department of Psychiatry, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
| | - Robbert W Schouten
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
| | - Simon H S Witte
- Department of Psychiatry, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
| | - Birit F P Broekman
- Department of Psychiatry, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Center, GGZinGeest, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands.
| | - Adriaan Honig
- Department of Psychiatry, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Center, GGZinGeest, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands.
| | - Carl E H Siegert
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam University Medical Center, GGZinGeest, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands.
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Schouten RW, Nadort E, van Ballegooijen W, Loosman WL, Honig A, Siegert CEH, Meuleman Y, Broekman BFP. General distress and symptoms of anxiety and depression: A factor analysis in two cohorts of dialysis patients. Gen Hosp Psychiatry 2020; 65:91-99. [PMID: 32554264 DOI: 10.1016/j.genhosppsych.2020.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Depression and anxiety often coexist in patients with end-stage-kidney disease. Recently, studies showed that a composite 'general distress score' which combines depression and anxiety symptoms provides a good fit in dialysis and oncology patients. We aim to investigate if the three most frequently used self-report questionnaires to measure depression and anxiety in dialysis patients are sufficiently unidimensional to warrant the use of such a general distress score in two cohorts of dialysis patients. METHODS This study includes two prospective observational cohorts of dialysis patients (total n = 749) which measured depression and anxiety using Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analyses was used to investigate both a strictly unidimensional model and a multidimensional bifactor model that includes a general distress, depression and anxiety factor. The comparative fit index (CFI) and The Root Mean Square Error of Approximation (RMSEA) were used as model fit indices. RESULTS Factor analysis did not show a good fit for a strictly unidimensional general distress factor for both the BDI/BAI and HADS (CFI 0.690 and 0.699, RMSEA 0.079 and 0.125 respectively). The multidimensional model performed better with a moderate fit for the BDI/BAI and HADS (CFI 0.873 and 0.839, RMSEA 0.052 and 0.102). CONCLUSIONS This data shows that the BDI/BAI and HADS are insufficiently unidimensional to warrant the use of a general distress score in dialysis patients without also investigating anxiety and depression separately. Future research is needed whether the use of a general distress score might be beneficial to identify patients in need of additional (psychological) support.
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Affiliation(s)
- Robbert W Schouten
- Department of Nephrology, OLVG Hospital, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Els Nadort
- Department of Psychiatry, OLVG Hospital, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical Psychology, Amsterdam UMC, VUmc, Amsterdam, the Netherlands; Department of Specialized Mental Health Care, GGZ InGeest, Amsterdam, the Netherlands
| | - Wim L Loosman
- Department of Nephrology, OLVG Hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, VUmc, Amsterdam, the Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG Hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, VUmc, Amsterdam, the Netherlands
| | - Carl E H Siegert
- Department of Nephrology, OLVG Hospital, Amsterdam, the Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands
| | - Birit F P Broekman
- Department of Psychiatry, OLVG Hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, VUmc, Amsterdam, the Netherlands
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7
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Schouten RW, Nadort E, Harmse V, Honig A, van Ballegooijen W, Broekman BFP, Siegert CEH. Symptom dimensions of anxiety and their association with mortality, hospitalization and quality of life in dialysis patients. J Psychosom Res 2020; 133:109995. [PMID: 32272296 DOI: 10.1016/j.jpsychores.2020.109995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Symptoms of anxiety are highly prevalent in dialysis patients and are associated with adverse clinical outcomes. Identifying symptom dimensions may help to understand the pathophysiology, improve screening and guide treatment. Currently, there are no data on symptom dimensions of anxiety in dialysis patients. This study aimed to identify the best fitting dimensional model for anxiety in dialysis patients and assess the association between symptom dimensions of anxiety and adverse clinical outcomes. METHODS This study is a prospective observational cohort study including patients from 10 urban dialysis centers between 2012 and 2017. Anxiety symptoms were measured using the self-reported questionnaire Beck Anxiety Inventory. Confirmatory factor analysis was used to identify symptom dimensions. The association between dimensions and mortality, hospitalization and quality of life was investigated using stepwise cox, poisson and lineair regression models. Multivariable models included demographic, social, laboratory and clinical variables to adjust for possible confounding. RESULTS In total 687 chronic dialysis patients were included. A Somatic and Subjective anxiety dimension were identified. Only Somatic anxiety symptoms showed an association with increased risk of hospitalization and mortality (Rate Ratio 1.73 (1.45-2.06) p = .007 and Hazard Ratio 1.65 (1.15-2.37) p = .007 respectively). These associations were independent from somatic comorbidity. All symptom dimensions of anxiety showed an association with Quality of Life. CONCLUSION This study shows that anxiety is common in chronic dialysis patients and comprises of a somatic, subjective, and a total score. The discrimination between anxiety dimensions can be useful for clinical practice, as they are related to different clinical outcomes.
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Affiliation(s)
| | - Els Nadort
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands
| | - Victor Harmse
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical Psychology, Amsterdam UMC, VUmc, Amsterdam, the Netherlands; Department of Specialized Mental Health Care, GGZ Ingeest, Amsterdam, the Netherlands
| | - Birit F P Broekman
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands
| | - Carl E H Siegert
- Department of Nephrology, OLVG hospital, Amsterdam, the Netherlands
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8
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van der Does AMB, Kneepkens EL, Uitvlugt EB, Jansen SL, Schilder L, Tokmaji G, Wijers SC, Radersma M, Heijnen JNM, Teunissen PFA, Hulshof PBJE, Overvliet GM, Siegert CEH, Karapinar-Çarkit F. Preventability of unplanned readmissions within 30 days of discharge. A cross-sectional, single-center study. PLoS One 2020; 15:e0229940. [PMID: 32240185 PMCID: PMC7117704 DOI: 10.1371/journal.pone.0229940] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/17/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives To identify the preventability, determinants and causes of unplanned hospital readmissions within 30 days of discharge using a multidisciplinary approach and including patients’ perspectives. Design A prospective cross-sectional single-center study. Setting Urban teaching hospital in Amsterdam, the Netherlands. Participants 430 patients were included. Inclusion criteria were: age ≥ 18 years, discharged from one of seven participating clinical departments and an unplanned readmission within 30 days. Methods Residents from the participating departments individually assessed whether the readmission was caused by healthcare, the preventability and possible causes of readmissions using a tool. Thereafter, the preventability of the cases was discussed in a multidisciplinary meeting with residents of all participating departments and clinical pharmacists. The primary outcome was the proportion of readmissions that were potentially preventable. Secondary outcomes were the determinants for a readmission, causes for preventable readmissions, the change in the final decision on preventability after the multidisciplinary meeting and the value of patient interviews in assessing preventability. Differences in characteristics of potentially preventable readmissions (PPRs) and non-PPRs were analyzed using multivariable logistic regression. Results Of 430 readmissions, 56 (13%) were assessed as PPRs. Age was significantly associated with a PPR (adjusted OR: 2.42; 95%, CI 1.23–4.74; p = 0.01). The main causes for PPRs were diagnostic (30%), medication (27%) and management problems (27%). During the multidisciplinary meeting, the final decision on preventability changed in 11% of the cases. When a patient interview was available, it was used as a source of information to assess preventability in 26% of readmissions. In 7% of cases, the patient interview was mentioned as the most important source. Conclusion and implications 13% of readmissions were potentially preventable with diagnostic, medication or management problems being main causes. A multidisciplinary review approach and including the patient’s perspective could contribute to a better understanding of the complexity of readmissions and possible improvements.
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Affiliation(s)
| | - Eva L. Kneepkens
- Department of Clinical Pharmacy, OLVG, Amsterdam, The Netherlands
| | | | | | - Louise Schilder
- Department of Internal medicine, OLVG, Amsterdam, The Netherlands
| | - George Tokmaji
- Department of Cardiology, OLVG, Amsterdam, The Netherlands
| | | | - Marijn Radersma
- Department of Gastroenterology, OLVG, Amsterdam, The Netherlands
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Nadort E, Schouten RW, Dekker FW, Honig A, van Oppen P, Siegert CEH. The (cost) effectiveness of guided internet-based self-help CBT for dialysis patients with symptoms of depression: study protocol of a randomised controlled trial. BMC Psychiatry 2019; 19:372. [PMID: 31775685 PMCID: PMC6881986 DOI: 10.1186/s12888-019-2363-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Only a minority of dialysis patients with depressive symptoms are diagnosed and receive treatment. Depressive symptoms are highly prevalent in this population and are associated with adverse clinical outcomes. Underlying factors for this undertreatment may be the lack of evidence for the safety and effectivity of antidepressant medication, the reluctance of patients to adhere to antidepressant medication, the lack of mental healthcare provision in somatic healthcare environments and end-stage renal disease (ESRD) related physical limitations that complicate face-to-face psychotherapy. Guided Internet-based self-help treatment has demonstrated to be effective for depressive symptoms in other chronic patient populations and may overcome these barriers. The aim of this study is to investigate the (cost) effectiveness of a guided Internet-based self-help intervention for symptoms of depression in dialysis patients. METHODS This study is a cluster randomized controlled trial (RCT) that investigates the effectiveness of a 5-week Internet-based self-help Problem Solving Therapy (PST) for depressive symptoms in dialysis patients. Depressive symptoms will be measured using the Beck Depression Inventory - second edition (BDI-II), with a cut-off score of ≥10. We aim to include 206 dialysis patients with depressive symptoms who will be cluster randomized to the intervention or the Care as Usual (CAU) control group. Secondary outcomes will include anxiety symptoms, quality of life, economic costs and clinical outcomes, such as inflammatory factors and hair cortisol levels. Assessments will take place at baseline (T0), 2 weeks after intervention (T1) and 6 months (T2), 12 months (T3) and 18 months (T4) after intervention. The control group will be measured at the same time points. Analysis will be based on the intention-to-treat principle. Mixed models will be used to assess the changes within each condition between pre-treatment and post-treatment. DISCUSSION If demonstrated to be (cost) effective, Internet-based PST will offer new possibilities to treat dialysis patients with depressive symptoms and to improve their quality of care. TRIAL REGISTRATION Dutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).
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Affiliation(s)
- Els Nadort
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, Netherlands. .,Department of Psychiatry, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, Netherlands. .,Department of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands.
| | - Robbert W. Schouten
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands ,grid.440209.bDepartment of Psychiatry, OLVG, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands ,0000 0004 0435 165Xgrid.16872.3aDepartment of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
| | - Friedo W. Dekker
- 0000000089452978grid.10419.3dDepartment of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Adriaan Honig
- grid.440209.bDepartment of Psychiatry, OLVG, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands ,0000 0004 0435 165Xgrid.16872.3aDepartment of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
| | - Patricia van Oppen
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands ,Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, Netherlands
| | - Carl E. H. Siegert
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands
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10
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Uitvlugt EB, Janssen MJA, Siegert CEH, Leenders AJA, van den Bemt BJF, van den Bemt PMLA, Karapinar-Çarkit F. Patients' and providers' perspectives on medication relatedness and potential preventability of hospital readmissions within 30 days of discharge. Health Expect 2019; 23:212-219. [PMID: 31733100 PMCID: PMC6978863 DOI: 10.1111/hex.12993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/03/2019] [Accepted: 10/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background Hospital readmissions are increasingly used as an indicator of quality in health care. One potential risk factor of readmissions is polypharmacy. No studies have explored the patients’ perspectives on the medication relatedness and potential preventability of their readmissions. Objective To compare the patients’ perspectives on the medication relatedness and potential preventability of their readmissions with the providers’ perspectives. Methods Patients unplanned readmitted within 30 days after discharge at one of the participating departments of OLVG Hospital in Amsterdam were interviewed during their readmission. Patients’ perspectives regarding medication relatedness of their readmissions, the potential preventability, possible preventable interventions, and satisfaction with medication information were examined. Health‐care providers also reviewed files of these readmitted patients. Primary outcome was the percentage of medication‐related and potentially preventable readmissions according to the patient vs the provider. Descriptive data analysis was used. Results According to patients, 36 of 172 (21%) readmissions were medication‐related, and of these, 21 (58%) were potentially preventable. According to providers, 26 (15%) readmissions were medication‐related and 6 (23%) of these were potentially preventable. Patients and providers agreed on the medication relatedness in 11 of the 172 readmissions, and in two of these, agreement on the potential preventability existed. According to patients, preventive interventions belonged mostly to the hospital level, followed by the primary care level and patient level. Conclusion Patients and providers differ substantially on their perspectives regarding the medication relatedness and preventability of readmissions. Patients were more likely to view medication‐related readmissions as preventable.
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Affiliation(s)
- Elien B Uitvlugt
- Department of Hospital Pharmacy, OLVG, Amsterdam, The Netherlands
| | | | - Carl E H Siegert
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | | | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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11
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Schouten RW, Haverkamp GL, Loosman WL, Chandie Shaw PK, van Ittersum FJ, Smets YFC, Vleming LJ, Dekker FW, Honig A, Siegert CEH. Ethnic Differences in the Association of Depressive Symptoms with Clinical Outcome in Dialysis Patients. J Racial Ethn Health Disparities 2019; 6:990-1000. [PMID: 31215016 PMCID: PMC6736895 DOI: 10.1007/s40615-019-00600-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/25/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Studies show mixed results on the association between depressive symptoms and adverse clinical outcomes in patients on dialysis therapy. Ethnicity may play a role in these heterogeneous results. No studies have investigated the interplay between ethnicity and depressive symptoms on clinical outcome in this patient population. This study aims to examine interaction between ethnicity and depressive symptoms on hospitalization and mortality in dialysis patients. METHODS A multi-ethnic cohort in 10 dialysis centers included 687 dialysis patients between 2012 and 2017, with an average follow-up of 3.2 years. Depressive symptoms were measured using the Beck Depression Inventory. Interaction was assessed by investigating excess risk on an additive scale using both absolute rates and relative risks. Multivariable regression models included demographic, social, and clinical variables. RESULTS Adverse outcomes are more pronounced in native patients, compared to immigrant patients. The risk for mortality and hospitalization is considerably higher in native patients compared to immigrants. An excess risk on an additive scale indicates the presence of possible causal interaction. CONCLUSIONS Depressive symptoms are a risk factor for hospitalization and mortality, especially in native dialysis patients. Adverse clinical events associated with depressive symptoms differ among ethnic groups. This differential association could play a role in the conflicting findings in literature. Ethnicity is an important factor when investigating depressive symptoms and clinical outcome in dialysis patients. Future research should focus on the possible mechanisms and pathways involved in these differential associations.
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Affiliation(s)
- Robbert W Schouten
- Department of Nephrology, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands. .,Department of Psychiatry, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands.
| | - Gerlinde L Haverkamp
- Department of Nephrology, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands
| | - Wim L Loosman
- Department of Nephrology, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands
| | | | | | - Yves F C Smets
- Department of Nephrology, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands
| | - Louis-Jean Vleming
- Department of Nephrology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carl E H Siegert
- Department of Nephrology, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands
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12
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Hageman IMG, Visser H, Veenstra J, Baas F, Siegert CEH. Familial Mediterranean Fever (FMF): a single centre retrospective study in Amsterdam. Neth J Med 2019; 77:177-182. [PMID: 31264586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Familial Mediterranean Fever (FMF) is the earliest described and most prevalent hereditary auto-inflammatory disease. Its clinical presentation is diverse, leading to possible delay in diagnosis and treatment. Due to immigration, FMF became common in non-Mediterranean European regions. In the present single centre retrospective study, the clinical, demographic, and genetic characteristics of patients with FMF of different ancestry in Amsterdam are described. METHODS Case records of patients with FMF, who met the Tel-Hashomer diagnostic criteria, were retrospectively analysed. The international disease severity score was used. RESULTS Between 1990-2012, 53 patients were identified, 28 were female. Main country of origin was Turkey. The mean age at the time of analysis was 29.1 years; 13.8 years at onset of symptoms; and at time of diagnosis, 22.0 years. Most frequent symptoms were peritonitis (91%) and fever (81%). The mean C-reactive protein and erythrocyte sedimentation rate during acute attacks were 133 mg/l and 37 mm/first hour, respectively. One patient developed amyloidosis as a complication. Seventeen patients underwent abdominal surgery before diagnosis. Most patients (92%) received colchicine treatment and were responsive (81%). Most patients classified their disease as a mild disease (42%). MEFV gene mutation analysis was performed in 46 patients; most patients were compound heterozygotes (n = 17), and the most frequent mutation was M694V (n = 18). CONCLUSION FMF in Amsterdam is diagnosed in relatively young patients and the delay to diagnosis is 8.2 years. Disease manifestations and genetic distribution of our FMF patients are comparable to those in Mediterranean regions, suggesting that ancestry is more important than environment.
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Affiliation(s)
- I M G Hageman
- Department of Internal Medicine, OLVG, location West, Amsterdam, the Netherlands
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13
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Schouten RW, Haverkamp GL, Loosman WL, Chandie Shaw PK, van Ittersum FJ, Smets YFC, Vleming LJ, Dekker FW, Honig A, Siegert CEH. Anxiety Symptoms, Mortality, and Hospitalization in Patients Receiving Maintenance Dialysis: A Cohort Study. Am J Kidney Dis 2019; 74:158-166. [PMID: 31027882 DOI: 10.1053/j.ajkd.2019.02.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/09/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Anxiety symptoms are common in dialysis patients and have a large impact on quality of life. The association of anxiety symptoms with adverse clinical outcomes in dialysis patients is largely unknown. This study examined the association of anxiety symptoms with hospitalization and mortality in patients receiving maintenance dialysis. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Maintenance dialysis patients treated at 10 dialysis centers in the Netherlands between 2012 and 2016. EXPOSURES Time-varying symptoms of anxiety and depression using the Beck Anxiety Inventory and Beck Depression Inventory. OUTCOMES All-cause mortality, 1-year hospitalization rate, and hospital length of stay. ANALYTICAL APPROACH Cox proportional hazards and Poisson regression models adjusted for sociodemographic and clinical variables. Sensitivity analyses included multiple imputation of missing data and restriction to incident patients only. RESULTS 687 patients were included, composed of 433 prevalent and 242 incident dialysis patients. Median follow-up time was 3.1 (IQR, 3.0-3.5) years, during which 172 deaths occurred. 22% of patients had anxiety symptoms and 42% had depressive symptoms. Anxiety symptoms were associated with all-cause mortality and 1-year hospitalization rate and length of stay in all multivariable models. Anxiety symptoms showed a clear dose-response relationship with mortality. LIMITATIONS Depression and anxiety often coexist and share symptoms. The observational design of this study limits inferences about causal mechanisms between anxiety and clinical outcomes. CONCLUSIONS Anxiety symptoms are independently associated with increased risk for mortality and 1-year hospitalization. Anxiety symptoms are a clinically relevant risk factor for morbidity and mortality in dialysis patients and warrant further research on effective treatment.
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Affiliation(s)
- Robbert W Schouten
- Department of Nephrology, OLVG, Amsterdam, the Netherlands; Department of Psychiatry, OLVG, Amsterdam, the Netherlands.
| | - Gertrud L Haverkamp
- Department of Nephrology, OLVG, Amsterdam, the Netherlands; Department of Psychiatry, OLVG, Amsterdam, the Netherlands
| | - Wim L Loosman
- Department of Nephrology, OLVG, Amsterdam, the Netherlands; Department of Psychiatry, OLVG, Amsterdam, the Netherlands
| | | | | | - Yves F C Smets
- Department of Nephrology, OLVG, Amsterdam, the Netherlands
| | - Louis-Jean Vleming
- Department of Nephrology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
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14
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van Tienhoven AJ, van Beers CAJ, Siegert CEH. Agreement between arterial and peripheral venous lactate levels in the ED: A systematic review. Am J Emerg Med 2019; 37:746-750. [PMID: 30686538 DOI: 10.1016/j.ajem.2019.01.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In the Emergency Department, lactate measurement is a useful tool to risk-stratify critically ill patients. However, it is unclear whether arterial or peripheral venous lactate levels can be used interchangeably for this purpose. In this systematic review, we provide an overview of studies investigating the agreement between arterial and peripheral venous lactate levels in the Emergency Department. METHODS PubMed, Embase, the Cochrane Central Register of Controlled Trials/Wiley, Web of Science/Clarivate Analytics, and references of selected articles were assessed for all studies comparing arterial and peripheral venous lactate levels in adult patients in the emergency department. Two reviewers independently screened all potentially relevant titles and abstracts for eligibility using a standardized data-worksheet. RESULTS Nine studies were included. Peripheral venous lactate levels tend to be higher than arterial lactate levels with mean differences ranging from 0.18 mmol/l to 1.06 mmol/l. Importantly, poorer agreement occurs in hyperlactatemia. At a cut-of level of 1.6 mmol/l, peripheral venous lactate can rule out arterial hyperlactatemia with a sensitivity between 94% and 100%. At a cut off value of 2 mmol/l, sensitivities of 97% and 100% were found. CONCLUSION Agreement between arterial and peripheral venous lactate is poor in hyperlactatemia, making peripheral venous lactate an unreliable parameter to use interchangeably in the ED. In clinical practice, peripheral venous lactate can be used as a screening tool to rule out arterial hyperlactatemia at a cut-off value of 2 mmol/l. However, hyperlactatemia should be confirmed using arterial sampling in case of a peripheral venous lactate level > 2 mmol/l.
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Affiliation(s)
| | - C A J van Beers
- Departments of Internal Medicine, OLVG, Amsterdam, the Netherlands
| | - C E H Siegert
- Departments of Internal Medicine, OLVG, Amsterdam, the Netherlands
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15
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Loosman WL, Haverkamp GLG, van den Beukel TO, Hoekstra T, Dekker FW, Chandie Shaw PK, Smets YFC, Vleming LJ, Ter Wee PM, Siegert CEH, Honig A. Depressive and Anxiety Symptoms in Dutch Immigrant and Native Dialysis Patients. J Immigr Minor Health 2018; 20:1339-1346. [DOI: 10.1007/s10903-018-0722-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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16
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Abstract
A case is presented of a dialysis catheter induced SVC syndrome aggravated by a recently surgically created AV fistula. Conventional angiography as well as computed tomography showed a catheter induced stenosis in the SVC. Removal of the catheter and treatment with anticoagulants resulted in resolution of the syndrome without the need for invasive endovascular intervention.
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Affiliation(s)
- W H M Verbeek
- Department of Nephrology, St. Lucas Andreas Hospital, Amsterdam, The Netherlands
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17
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Uitvlugt EB, Suijker R, Janssen MJA, Siegert CEH, Karapinar-Çarkit F. Quality of medication related information in discharge letters: A prospective cohort study. Eur J Intern Med 2017; 46:e23-e25. [PMID: 28986157 DOI: 10.1016/j.ejim.2017.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Elien B Uitvlugt
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Regina Suijker
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Marjo J A Janssen
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Carl E H Siegert
- OLVG, Department of Internal Medicine, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Fatma Karapinar-Çarkit
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
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18
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Abstract
Lactic acidosis is a commonly observed clinical condition that is associated with a poor prognosis, especially in malignancies. We describe a case of an 81-year-old patient who presented with symptoms of tachypnea and general discomfort. Arterial blood gas analysis showed a high anion gap acidosis with a lactate level of 9.5 mmol/L with respiratory compensation. CT scanning showed no signs of pulmonary embolism or other causes of impaired tissue oxygenation. Despite treatment with sodium bicarbonate, the patient developed an adrenalin-resistant cardiac arrest, most likely caused by the acidosis. Autopsy revealed Gleason score 5 + 5 metastatic prostate cancer as the most probable cause of the lactic acidosis. Next-generation sequencing indicated a nonsense mutation in the TP53 gene (887delA) and an activating mutation in the PIK3CA gene (1634A>G) as candidate molecular drivers. This case demonstrates the prevalence and clinical relevance of metabolic reprogramming, frequently referred to as "the Warburg effect," in patients with prostate cancer.
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Affiliation(s)
- Johannes C van der Mijn
- Department of Internal Medicine, OLVG West Amsterdam, Amsterdam, The Netherlands.,Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mathijs J Kuiper
- Department of Internal Medicine, OLVG West Amsterdam, Amsterdam, The Netherlands
| | - Carl E H Siegert
- Department of Internal Medicine, OLVG West Amsterdam, Amsterdam, The Netherlands
| | | | | | - Aernout C Ogilvie
- Department of Internal Medicine, OLVG West Amsterdam, Amsterdam, The Netherlands
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19
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van der Gaag S, Janssen MJA, Wessemius H, Siegert CEH, Karapinar-Çarkit F. An evaluation of medication reconciliation at an outpatient Internal Medicines clinic. Eur J Intern Med 2017; 44:e32-e34. [PMID: 28693941 DOI: 10.1016/j.ejim.2017.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Suzanne van der Gaag
- OLVG Hospital, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands.
| | - Marjo J A Janssen
- OLVG Hospital, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands.
| | - Hanneke Wessemius
- OLVG Hospital, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands.
| | - Carl E H Siegert
- OLVG Hospital, Department of Internal Medicine, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands.
| | - Fatma Karapinar-Çarkit
- OLVG Hospital, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands.
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20
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Karapinar-Çarkıt F, van der Knaap R, Bouhannouch F, Borgsteede SD, Janssen MJA, Siegert CEH, Egberts TCG, van den Bemt PMLA, van Wier MF, Bosmans JE. Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital. PLoS One 2017; 12:e0174513. [PMID: 28445474 PMCID: PMC5406030 DOI: 10.1371/journal.pone.0174513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 03/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective. Methods A controlled clinical trial was performed at the Internal Medicine department of a general teaching hospital. All admitted patients using at least one prescription drug were included. The COACH program consisted of medication reconciliation, patient counselling at discharge, and communication to healthcare providers in primary care. The primary outcome was the proportion of patients with an unplanned rehospitalisation within three months after discharge. Also, the number of quality-adjusted life-years (QALYs) was assessed. Cost data were collected using cost diaries. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios between the groups was estimated by bootstrapping. Results In the COACH program, 168 patients were included and in usual care 151 patients. There was no significant difference in the proportion of patients with unplanned rehospitalisations (mean difference 0.17%, 95% CI -8.85;8.51), and in QALYs (mean difference -0.0085, 95% CI -0.0170;0.0001). Total costs for the COACH program were non-significantly lower than usual care (-€1160, 95% CI -3168;847). Cost-effectiveness planes showed that the program was not cost-effective compared with usual care for unplanned rehospitalisations and QALYs gained. Conclusion The COACH program was not cost-effective in comparison with usual care. Future studies should focus on high risk patients and include other outcomes (e.g. adverse drug events) as this may increase the chances of a cost-effective intervention. Dutch trial register NTR1519
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Affiliation(s)
| | | | | | | | | | | | - Toine C. G. Egberts
- Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
- Division Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Marieke F. van Wier
- Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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21
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Kraaijenbrink BVC, Lambers WM, Mathus-Vliegen EMH, Siegert CEH. Incidence of refeeding syndrome in internal medicine patients. Neth J Med 2016; 74:116-121. [PMID: 27020991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Refeeding syndrome is a potentially fatal shift of fluids and electrolytes that may occur after reintroducing nutrition in a malnourished patient. Its incidence in internal medicine patients is not known. We aimed at determining the incidence in a heterogeneous group of patients acutely admitted to a department of internal medicine. METHODS All patients acutely admitted to the department of internal medicine of a teaching community hospital in Amsterdam, the Netherlands, between 22 February 2011 and 29 April 2011, were included. We applied the National Institute for Health and Care Excellence (NICE) criteria for determining people at risk of refeeding syndrome and took hypophosphataemia as the main indicator for the presence of this syndrome. RESULTS Of 178 patients included in the study, 97 (54%) were considered to be at risk of developing refeeding syndrome and 14 patients actually developed the syndrome (14% of patients at risk and 8% of study population). Patients with a malignancy or previous malignancy were at increased risk of developing refeeding syndrome (p < 0.05). Measurement of muscle strength over time was not associated with the occurrence of refeeding syndrome. The Short Nutritional Assessment Questionnaire score had a positive and negative predictive value of 13% and 95% respectively. CONCLUSION The incidence of refeeding syndrome was relatively high in patients acutely admitted to the department of internal medicine. Oncology patients are at increased risk of developing refeeding syndrome. When taking the occurrence of hypophosphataemia as a hallmark, no other single clinical or composite parameter could be identified that accurately predicts the development of refeeding syndrome.
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22
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Haverkamp GLG, Loosman WL, van den Beukel TO, Hoekstra T, Dekker FW, Chandie Shaw PK, Smets YFC, Vleming LJ, Ter Wee PM, Honig A, Siegert CEH. The association of acculturation and depressive and anxiety symptoms in immigrant chronic dialysis patients. Gen Hosp Psychiatry 2016; 38:26-30. [PMID: 26724601 DOI: 10.1016/j.genhosppsych.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Among immigrant chronic dialysis patients, depressive and anxiety symptoms are common. We aimed to examine the association of acculturation, i.e. the adaptation of immigrants to a new cultural context, and depressive and anxiety symptoms in immigrant chronic dialysis patients. METHODS The DIVERS study is a prospective cohort study in five urban dialysis centers in the Netherlands. The association of five aspects of acculturation ("Skills", "Social integration", "Traditions", "Values and norms" and "Loss") and the presence of depressive and anxiety symptoms was determined using linear regression analyses, both univariate and multivariate. RESULTS A total of 249 immigrant chronic dialysis patients were included in the study. The overall prevalence of depressive and anxiety symptoms was 51% and 47%, respectively. "Skills" and "Loss" were significantly associated with the presence of depressive and anxiety symptoms, respectively ("Skills" β=0.34, CI: 0.11-0.58, and "Loss" β=0.19, CI: 0.01-0.37; "Skills" β=0.49, CI: 0.25-0.73, and "Loss" β=0.33, CI: 0.13-0.53). The associations were comparable after adjustment. No significant associations were found between the other subscales and depressive and anxiety symptoms. CONCLUSION This study demonstrates that less skills for living in the Dutch society and more feelings of loss are associated with the presence of both depressive and anxiety symptoms in immigrant chronic dialysis patients.
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Affiliation(s)
- Gertrud L G Haverkamp
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands; Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.
| | - Wim L Loosman
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands; Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | | | - Tiny Hoekstra
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Yves F C Smets
- Department of Nephrology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Pieter M Ter Wee
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Carl E H Siegert
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
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van den Beukel TO, Hommel K, Kamper AL, Heaf JG, Siegert CEH, Honig A, Jager KJ, Dekker FW, Norredam M. Differences in survival on chronic dialysis treatment between ethnic groups in Denmark: a population-wide, national cohort study. Nephrol Dial Transplant 2015; 31:1160-7. [PMID: 26492925 DOI: 10.1093/ndt/gfv359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 09/15/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In Western countries, black and Asian dialysis patients experience better survival compared with white patients. The aim of this study is to compare the survival of native Danish dialysis patients with that of dialysis patients originating from other countries and to explore the association between the duration of residence in Denmark before the start of dialysis and the mortality on dialysis. METHODS We performed a population-wide national cohort study of incident chronic dialysis patients in Denmark (≥18 years old) who started dialysis between 1995 and 2010. RESULTS In total, 8459 patients were native Danes, 344 originated from other Western countries, 79 from North Africa or West Asia, 173 from South or South-East Asia and 54 from sub-Saharan Africa. Native Danes were more likely to die on dialysis compared with the other groups (crude incidence rates for mortality: 234, 166, 96, 110 and 53 per 1000 person-years, respectively). Native Danes had greater hazard ratios (HRs) for mortality compared with the other groups {HRs for mortality adjusted for sociodemographic and clinical characteristics: 1.32 [95% confidence interval (CI) 1.14-1.54]; 2.22 [95% CI 1.51-3.23]; 1.79 [95% CI 1.41-2.27]; 2.00 [95% CI 1.10-3.57], respectively}. Compared with native Danes, adjusted HRs for mortality for Western immigrants living in Denmark for ≤10 years, >10 to ≤20 years and >20 years were 0.44 (95% CI 0.27-0.71), 0.56 (95% CI 0.39-0.82) and 0.86 (95% CI 0.70-1.04), respectively. For non-Western immigrants, these HRs were 0.42 (95% CI 0.27-0.67), 0.52 (95% CI 0.33-0.80) and 0.48 (95% CI 0.35-0.66), respectively. CONCLUSIONS Incident chronic dialysis patients in Denmark originating from countries other than Denmark have a better survival compared with native Danes. For Western immigrants, this survival benefit declines among those who have lived in Denmark longer. For non-Western immigrants, the survival benefit largely remains over time.
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Affiliation(s)
- Tessa O van den Beukel
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Kristine Hommel
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark
| | | | - James G Heaf
- Department of Medicine, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Carl E H Siegert
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Sint Lucas Andreas Hospital and VU University Medical Center, Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Loosman WL, Rottier MA, Honig A, Siegert CEH. Association of depressive and anxiety symptoms with adverse events in Dutch chronic kidney disease patients: a prospective cohort study. BMC Nephrol 2015; 16:155. [PMID: 26390864 PMCID: PMC4578821 DOI: 10.1186/s12882-015-0149-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/10/2015] [Indexed: 11/10/2022] Open
Abstract
Background Depressive symptoms have been reported to be associated with adverse clinical outcome in patients with chronic kidney disease (CKD) not on dialysis. This association has not been examined in Europe. Anxiety and depressive symptoms often co-occur. However, as yet there are no data concerning a possible association of anxiety symptoms with adverse clinical outcome. We examined the association of depressive and anxiety symptoms with adverse clinical outcome in Dutch CKD patients not on dialysis. Methods In this 3-year follow-up prospective cohort study, CKD patients not on dialysis with an estimated glomerular filtration rate (eGFR) ≤ 35 ml/min/1.73 m2 from an urban teaching hospital were selected. Symptoms of depression and anxiety were evaluated using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Cox proportional hazards models were used to calculate hazard ratio’s (HRs) with a composite event of death, initiation of dialysis, and hospitalization as outcome. HRs were adjusted for age, gender, diabetes, cardiovascular disease and eGFR. Results Of 100 included CKD patients depressive and anxiety symptoms were present in 34 and 31 %, respectively. Adjusted HRs for the composite event for patients with depressive and anxiety symptoms were 2.0 (95 % confidence interval (CI) 1.2–3.5) and 1.6 (95 % CI 0.9–2.7), respectively. Twenty three patients had both depressive and anxiety symptoms of whom adjusted HRs were 2.2 (95 % CI 1.2–4.0) for a composite event. Conclusions Depressive and anxiety symptoms are common in patients with CKD in The Netherlands. Depressive symptoms are associated with an increased risk of poor clinical outcome. Anxiety symptoms show a trend for an increased risk of poor clinical outcome. There seems to be no additive effect of anxiety symptoms in addition to depressive symptoms with regard to poor clinical outcome.
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Affiliation(s)
- Wim L Loosman
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands. .,Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.
| | - Marcus A Rottier
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.
| | - Adriaan Honig
- Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands. .,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
| | - Carl E H Siegert
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.
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25
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Uitvlugt EB, Siegert CEH, Janssen MJA, Nijpels G, Karapinar-Çarkit F. Completeness of medication-related information in discharge letters and post-discharge general practitioner overviews. Int J Clin Pharm 2015; 37:1206-12. [PMID: 26337836 DOI: 10.1007/s11096-015-0187-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication and documentation of medication-related information are needed to improve continuity of care. OBJECTIVE To assess the completeness of medication-related information in discharge letters and post-discharge general practitioner (GP)-overviews. SETTING A general teaching hospital in Amsterdam, the Netherlands. METHOD An observational study was performed. Patients from several departments were included after medication reconciliation at hospital discharge. In liaison with the resident and patient, a pharmacy team prepared a Transitional Pharmaceutical Care (TPC)-overview of current medications, including changes and allergies. The resident was instructed to download the TPC-overview into the discharge letter instead of typing a self-made medication list. Medication overviews were gathered from the GP 2 weeks after the handover of the discharge letter. The TPC-overview (gold standard) was compared with the information in the discharge letter and post-discharge GP-overviews regarding correct medications and allergies. Descriptive data analysis was used. MAIN OUTCOME MEASURE The number and percentage of complete medication-related information in the discharge letter and the GP-overview were compared to the TPC-overview. RESULTS Ninety-nine patients were included. Medication-related information was complete in 62 (63 %) of 99 discharge letters. Sixteen of 99 GP-overviews (16 %) were complete. Communication of medication-related information increased documentation by the GP, but the medication history could still be incomplete, mainly regarding medication changes and allergies. CONCLUSIONS Medication-related information is lost in discharge letters and GP-overviews post-discharge despite in-hospital medication reconciliation. This could result in discontinuity of care.
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Affiliation(s)
- Elien B Uitvlugt
- Department of Hospital Pharmacy, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - Carl E H Siegert
- Department of Internal Medicine, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Marjo J A Janssen
- Department of Hospital Pharmacy, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Giel Nijpels
- Department of General Practice, EMGO Institute VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Fatma Karapinar-Çarkit
- Department of Hospital Pharmacy, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
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26
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Loosman WL, Hoekstra T, van Dijk S, Terwee CB, Honig A, Siegert CEH, Dekker FW. Short-Form 12 or Short-Form 36 to measure quality-of-life changes in dialysis patients? Nephrol Dial Transplant 2015; 30:1170-6. [PMID: 25829325 DOI: 10.1093/ndt/gfv066] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/16/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Short-Form 36 (SF-36) is a self-report health-related quality-of-life (HRQOL) questionnaire, widely used in dialysis patients. It consists of physical and mental component scores (PCS/MCS), ranging from 0 to 100. To improve efficiency, the Short-Form 12 (SF-12) was developed to reproduce PCS and MCS. We assessed the ability of SF-12 versus SF-36 to detect change over time, and the association of SF-12 versus SF-36 with short-term and long-term mortality in dialysis patients. METHODS Patients were selected from the Netherlands Cooperative Study on the Adequacy of Dialysis (N = 1379), a prospective follow-up study among incident dialysis patients (62.1% HD) who completed SF-36 measurements every 6 months. Changes in scores of SF-12 versus SF-36 were compared with intra-class correlation coefficients (ICCs). Subsequently, Bland-Altman plots were used to assess limits of agreement. Relationship with mortality was assessed with Cox models with and without a time-dependent variable, adjusted for age, sex, ethnicity, comorbidity and dialysis modality at baseline. RESULTS ICC for change in scores was 0.90 for MCS and 0.84 for PCS. Mean difference was -0.1 and 0.2, respectively, and limits of agreement were -8.3 to 8.4 for MCS change in scores and -8.8 to 9.2 for PCS. Adjusted hazard ratio's for mortality per 5 units increment were 0.87 (95% CI: 0.84-0.91) for MCS12, 0.87 (95% CI: 0.84-0.90) for MCS36, 0.79 (95% CI: 0.76-0.83) for PCS12 and 0.75 (95% CI: 0.71-0.78) for PCS36. CONCLUSIONS SF-12 can be used to detect change in HRQOL in cohort studies on dialysis patients. SF-12 and SF-36 were similarly associated with short-term and long-term mortality. However, the wide limits of agreement indicate that SF-12 and SF-36 can give different scores on the individual level, suggesting that for individual purposes SF-36 instead of SF-12 should be used.
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Affiliation(s)
- Wim L Loosman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Tiny Hoekstra
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sandra van Dijk
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health, Care Research VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Sint Lucas Andreas Hospital/VU University Medical Center, Amsterdam, The Netherlands
| | - Carl E H Siegert
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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27
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Lambers WM, Kraaijenbrink B, Siegert CEH. [The refeeding syndrome]. Ned Tijdschr Geneeskd 2015; 159:A8610. [PMID: 25827151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The refeeding syndrome may occur during reintroduction of carbohydrates in malnourished patients. This syndrome is characterized by reduced plasma electrolyte levels, hypophosphataemia being most prevalent. The symptoms can vary from minor symptoms to severe neurological or cardiac symptoms. The pathophysiological mechanism comprises an increase in insulin levels, resulting in shifts of phosphate, potassium and magnesium into the intracellular environment, as well as fluid retention and relative deficiency of vitamin B1. There is growing interest in the screening and treatment of patients with malnutrition, due to which the incidence of refeeding syndrome is probably increasing. Currently, there is no single definition of this syndrome and therefore there is no solid scientific basis for screening and treatment. In this article we describe the rationale for screening and additional laboratory investigations. A prospective, controlled trial is important to define the clinical relevance of the refeeding syndrome and optimize its treatment.
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28
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Bosma JW, Bijl JM, Siegert CEH, Vasmel WLE. [Recurrent isolated angioedema as a result of acquired C1 inhibitor deficiency]. Ned Tijdschr Geneeskd 2014; 158:A7184. [PMID: 24666532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Isolated angioedema may be the presenting symptom of acquired C1 inhibitor (C1-INH) deficiency. C1-INH deficiency is associated with lymphoproliferative disorders. Treatment of the underlying disease can result in a complete reversal of clinical and complement abnormalities. We describe a 41-year-old woman who was referred to our emergency department with recurrent episodes of isolated angioedema. Initially, her angioedema was linked to the use of angiotensin receptor blockers. However, after discontinuation of this drug angioedema recurred. Additional investigations revealed the presence of acquired C1-INH deficiency caused by an indolent non-Hodgkin's lymphoma. Treatment with rituximab resulted in complete clinical and biochemical remission of the acquired angioedema.
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Affiliation(s)
- Jacob W Bosma
- Sint Lucas Andreas Ziekenhuis, afd. Interne geneeskunde, Amsterdam
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29
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Tonneijck L, Schouten M, Weijmer MC, Siegert CEH. A male with extensive renal vein thrombosis. Neth J Med 2013; 71:480-484. [PMID: 24218423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- L Tonneijck
- Department of Nephrology, St. Lucas Andreas Hospital, Amsterdam, the Netherlands
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30
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Snoeks LL, Ogilvie AC, van Haarst EP, Siegert CEH. New treatment options for patients with metastatic prostate cancer. Neth J Med 2013; 71:290-294. [PMID: 23956309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Prostate cancer is one of the most common cancers in men. When metastasised (40% of patients), classic anti-androgen therapy is the first-line treatment. Usually, this treatment becomes ineffective when castration-resistant prostate cancer (CRPC) develops. Thus far, docetaxel was the only chemotherapeutic option that has shown to be able to extend overall survival and improve quality of life in these patients. Recently, cabazitaxel and abiraterone have shown significant survival benefits for patients progressive on or after docetaxel treatment, as did enzalutamide and radium-223. In North America, immune therapy (sipuleucel-T) became available for a subgroup of CRPC patients. These new treatment options will change the treatment paradigm of patients with metastatic castration resistant prostate cancer. A multidisciplinary approach by both medical oncologists and urologists seems mandatory.
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Affiliation(s)
- L L Snoeks
- Department of Internal Medicine, Sint Lucas Andreas Hospital, Amsterdam, the Netherlands.
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31
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Tonneijck L, Fuijkschot WW, Schouten M, Siegert CEH. A 76-year-old male with a blue toe and livedo reticularis. Neth J Med 2013; 71:257-261. [PMID: 23799313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- L Tonneijck
- Department of Nephrology, St. Lucas Andreas Hospital, Amsterdam, The Netherlands.
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32
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Westerman M, Teunissen PW, Jørgensen RL, Fokkema JPI, Siegert CEH, Van der Vleuten CPM, Scherpbier AJJA, Ringsted C, Scheele F. The transition to hospital consultant: Denmark and the Netherlands compared on preparedness for practice, perceived intensity and contextual factors. Med Teach 2013; 35:481-9. [PMID: 23464840 DOI: 10.3109/0142159x.2013.774332] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and generic competencies, perceived intensity and burnout were compared. Additionally, effects of differences in working conditions and cultural dimensions were explored. METHODS All consultants registered in the Netherlands in 2007-2009 (n = 2643) and Denmark in 2007-2010 (n = 1336) received in June 2010 and April 2011, respectively, a survey about their preparation for medical and generic competencies, perceived intensity and burnout. Power analysis resulted in required sample sizes of 542. Descriptive statistics and independent t-tests were used for analysis. RESULTS Data were available of 792 new consultants in the Netherlands and 677 Danish new consultants. Compared to their Dutch counterparts, Danish consultants perceived specialty training and the transition less intensely, reported higher levels of preparation for generic competencies and scored lower on burnout. CONCLUSIONS The importance of contextual aspects in the transition is underscored and shows that Denmark appears to succeed better in aligning training with practice. Regulations regarding working hours and progressive independence of trainees appear to facilitate the transition.
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Affiliation(s)
- Michiel Westerman
- Department of Education, St Lucas Andreas Hospital, Jan Tooropstraat 164, Amsterdam, the Netherlands.
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33
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Westerman M, Teunissen PW, Fokkema JPI, Siegert CEH, van der Vleuten CPM, Scherpbier AJJA, Scheele F. New consultants mastering the role of on-call supervisor: a longitudinal qualitative study. Med Educ 2013; 47:408-16. [PMID: 23488760 DOI: 10.1111/medu.12129] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
CONTEXT The supervision of specialty registrars during on-call shifts is essential to ensure the quality of both health care and medical education, but has been identified as a major novelty and stressor for new consultants in the transition from specialty training. There is a paucity of research on how consultants deal with their new supervisory roles and which factors influence this process. These issues are addressed in a prospective study designed to gather insights that can inform measures to ensure the provision of high-quality supervision and specialty training. METHODS A longitudinal qualitative study was performed in the Netherlands. Semi-structured interviews were conducted with new consultants. The study was guided by an interpretative phenomenological approach until saturation was reached. At 3-month intervals between July 2011 and March 2012, eight novice consultants in internal medicine were interviewed three times each about their supervisory role while on call. Interviews focused on their preparation for the role in training, the actions they took to master the role, and their progression over time. RESULTS Three interrelated domains of relevant factors emerged from the data: preparedness; personal characteristics, and contextual characteristics. Preparedness referred to the extent to which new consultants were prepared by training to take full responsibility for registrars' actions while supervising them from a distance. Personal characteristics, such as coping strategies and views on supervision, guided consultants' development as supervisors. Essential to this process were contextual characteristics, especially those concerning the extent to which the consultant knew the registrar, was familiar with departmental procedures, and had access to support from colleagues. CONCLUSIONS New consultants should be prepared for their supervisory role by training and by being given a proper introduction to their workplace. The former requires progressive independence and exposure to supervisory tasks during specialty training; the latter requires an induction programme to enable new consultants to familiarise themselves with the departmental environment and the registrars they will be supervising.
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Affiliation(s)
- Michiel Westerman
- Department of Education, St Lucas Andreas Hospital, Amsterdam, the Netherlands.
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34
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Westerman M, Teunissen PW, Fokkema JPI, van der Vleuten CPM, Scherpbier AJJA, Siegert CEH, Scheele F. The transition to hospital consultant and the influence of preparedness, social support, and perception: A structural equation modelling approach. Med Teach 2013; 35:320-7. [PMID: 23527864 DOI: 10.3109/0142159x.2012.735381] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Insight into the transition from specialist registrar to hospital consultant is needed to better align specialty training with starting as a consultant and to facilitate this transition. AIMS This study investigates whether preparedness regarding medical and generic competencies, perceived intensity, and social support are associated with burnout among new consultants. METHOD A population-based study among all 2643 new consultants in the Netherlands (all specialties) was conducted in June 2010. A questionnaire covering preparedness for practice, intensity of the transition, social support, and burnout was used. Structural equation modelling was used for statistical analysis. RESULTS Data from a third of the population were available (32% n = 840) (43% male/57% female). Preparation in generic competencies received lower ratings than in medical competencies. A total of 10% met the criteria for burnout and 18% scored high on the emotional exhaustion subscale. Perceived lack of preparation in generic competencies correlated with burnout (r = 0.15, p < 0.001). No such relation was found for medical competencies. Furthermore, social support protected against burnout. CONCLUSIONS These findings illustrate the relevance of generic competencies for new hospital consultants. Furthermore, social support facilitates this intense and stressful stage within the medical career.
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Affiliation(s)
- Michiel Westerman
- Department of Onderwijsunie, St. Lucas Andreas Hospital, the Netherlands.
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35
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Stoekenbroek RM, van den Bergh Weerman MA, Hovingh GK, Potter van Loon BJ, Siegert CEH, Holleboom AG. Familial LCAT deficiency: from renal replacement to enzyme replacement. Neth J Med 2013; 71:29-31. [PMID: 23412821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Familial LCAT deficiency (FLD) is a recessive lipid disorder ultimately leading to end-stage renal disease (ESRD). We present two brothers with considerable variation in the age at which they developed ESRD. Kidney biopsies revealed both tubular and glomerular pathology. To date, no causal therapy is available, yet enzyme replacement therapy is in development.
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Affiliation(s)
- R M Stoekenbroek
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
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36
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van den Beukel TO, Siegert CEH, van Dijk S, Ter Wee PM, Dekker FW, Honig A. Comparison of the SF-36 Five-item Mental Health Inventory and Beck Depression Inventory for the screening of depressive symptoms in chronic dialysis patients. Nephrol Dial Transplant 2012; 27:4453-7. [PMID: 22879393 DOI: 10.1093/ndt/gfs341] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Beck Depression Inventory (BDI) is a standard and validated questionnaire to screen for depressive symptoms in chronic dialysis patients, but is relatively extensive to use repeatedly in clinical practice. We investigated whether the five-item Mental Health Inventory (MHI-5) of the 36-item Short-Form Health Survey Questionnaire (SF-36) could be applied to screen for depressive symptoms in dialysis patients. Moreover, we determined the optimal MHI-5 cut-off score to assess depressive symptoms. METHODS Chronic dialysis patients from three centres filled out the SF-36 and the BDI. A receiver operating characteristic (ROC) curve was constructed for the MHI-5 score with BDI ≥ 16 as reference standard to (i) calculate the area under the curve to determine whether the MHI-5 could be considered as a useful screening instrument for depressive symptoms and (ii) proxy the optimal cut-off score of the MHI-5 to assess depressive symptoms. The optimal cut-off score was determined by the value for which the sum of sensitivity and specificity had an optimum. RESULTS Of 133 included patients, 23% had depressive symptoms as determined with BDI ≥ 16. The correlation of the BDI with MHI-5 was -0.64. The area under the ROC curve was 0.82 (95% confidence interval 0.74-0.90). The optimal cut-off point of the MHI-5 was 70. MHI-5 ≤ 70 had 77 sensitivity, 72 specificity, 44 positive predicting value and 91% negative predicting value with the presence of depressive symptoms determined with BDI ≥ 16. CONCLUSIONS The MHI-5 may help clinicians to screen for depressive symptoms in dialysis patients without using an additional depression screening questionnaire once the SF-36 is completed. A cut-off value of 70 can be used safely for the purposes of screening applications.
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van den Beukel TO, Verduijn M, le Cessie S, Jager KJ, Boeschoten EW, Krediet RT, Siegert CEH, Honig A, Dekker FW. The role of psychosocial factors in ethnic differences in survival on dialysis in the Netherlands. Nephrol Dial Transplant 2011; 27:2472-9. [PMID: 22121230 DOI: 10.1093/ndt/gfr631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Ethnic minority patients on dialysis are reported to have better survival rates relative to Caucasians. The reasons for this finding are not fully understood and European studies are scarce. This study examined whether ethnic differences in survival could be explained by patient characteristics, including psychosocial factors. METHODS We analysed data of the Netherlands Cooperative Study on the Adequacy of Dialysis study, an observational prospective cohort study of patients who started dialysis between 1997 and 2007 in the Netherlands. Ethnicity was classified as Caucasian, Black or Asian, assessed by local nurses. Data collected at the start of dialysis treatment included demographic, clinical and psychosocial characteristics. Psychosocial characteristics included data on health-related quality of life (HRQoL), mental health status and general health perception. Cox proportional hazards analysis was used to explore ethnic survival differences. RESULTS One thousand seven hundred and ninety-one patients were Caucasian, 45 Black and 108 Asian. The ethnic groups differed significantly in age, residual glomerular filtration rate, diabetes mellitus, erythropoietin use, plasma calcium, parathormone and creatinine, marital status and general health perception. No ethnic differences were found in HRQoL and mental health status. Crude hazard ratios (HRs) for mortality for Caucasians compared to Blacks and Asians were 3.1 [95% confidence interval (CI) 1.6-5.9] and 1.1 (95% CI 0.9-1.5), respectively. After adjustment for a range of potential explanatory variables, including psychosocial factors, the HRs were 2.5 (95% CI 1.2-4.9) compared with Blacks and 1.2 (95% CI 0.9-1.6) compared with Asians. CONCLUSIONS Although patient numbers were rather small, this study demonstrates, with 95% confidence, better survival for Black compared to Caucasian dialysis patients and equal survival for Asian compared to Caucasian dialysis patients in the Netherlands. This could not be explained by patient characteristics, including psychosocial factors.
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Affiliation(s)
- Tessa O van den Beukel
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
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Visser H, Lettinga KD, Siegert CEH. [Health risks and advice for Hajj pilgrims]. Ned Tijdschr Geneeskd 2011; 155:A3962. [PMID: 22027471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Hajj, the pilgrimage to Mecca, is the largest mass migration in the world. Each year, 2.5 million Muslims from over 160 countries travel to the same place, 5000-6000 of these being from the Netherlands. During the Hajj, the pilgrims undergo great physical and emotional strain. Good medical preparation including vaccinations is very important for pilgrims who undertake the Hajj, in particular for those who are older and have chronic disease. The chance of transmission of infective disease is also high and rapid contagion of Hajj pilgrims could cause a pandemic. It is therefore important that the responsible doctor is aware of the health risks to the Hajj pilgrim and his environment.
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Affiliation(s)
- Hannah Visser
- Sint Lucas Andreas Ziekenhuis, afd. Interne geneeskunde, Amsterdam, the Netherlands.
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Westerman M, Teunissen PW, van der Vleuten CPM, Scherpbier AJJA, Siegert CEH, van der Lee N, Scheele F. Understanding the transition from resident to attending physician: a transdisciplinary, qualitative study. Acad Med 2010; 85:1914-9. [PMID: 20978429 DOI: 10.1097/acm.0b013e3181fa2913] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE There is a paucity of research into the processes surrounding the transition from residency to the position of attending physician. This report retrospectively investigates the question: Are attending physicians adequately prepared and trained to perform the tasks and duties of their new position? This study aimed at formulating a conceptual framework that captures the transition and is applicable beyond discipline- or location-specific boundaries. METHOD Individual semistructured interviews were conducted and analyzed using a qualitative, grounded theory approach. Between January and May 2009, 14 physicians were interviewed who had commenced an attending post in internal medicine or obstetrics-gynecology between six months and two years earlier, within the Netherlands. Interviews focused on the attendings' perceptions of the transition, their socialization within the new organization, and the preparation they had received during residency training. The interview transcripts were openly coded, and through constant comparison, themes emerged. The research team discussed the results until full agreement was reached. RESULTS A conceptual framework emerged from the data, consisting of three themes interacting in a longitudinal process. The framework describes how novel disruptive elements (first theme) due to the transition from resident to attending physician are perceived and acted on (second theme), and how this directs new attendings' personal development (third theme). CONCLUSIONS The conceptual framework finds support in transition psychology and notions from organizational socialization literature. It provides insight into the transition from resident to attending physician that can inform measures to smooth the intense transition.
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van den Beukel TO, Jager KJ, Siegert CEH, Schoones JW, Dekker FW. Racial minority groups on dialysis in Europe: a literature review. Clin Nephrol 2010; 74 Suppl 1:S78-S84. [PMID: 20979969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
AIMS To provide an overview of the existing data on non-Caucasian dialysis patients within Europe, and to explore whether these data confirm differences between non-Caucasian and Caucasian dialysis patients that were found in other parts of the world. METHOD A query consisting of the combination "dialysis", "ethnicity", and "Europe" was applied in PubMed, EMBASE, Web of Science, CINAHL, and the Cochrane Library. RESULTS Ten papers were included in this study. Studies from the United Kingdom (UK) and the Netherlands confirm the higher incidence of end-stage renal disease (ESRD) in non-Caucasians. In other European countries these findings were not confirmed. In studies from the UK, the Netherlands, and Spain a younger age at initiation of dialysis treatment for non-Caucasians compared to Caucasians was reported, this is also found in non-European studies. Regarding comorbid conditions at the start of renal replacement therapy (RRT), vascular disease was less common, while diabetes was more common among non-Caucasians compared to Caucasians. Large non-European studies also demonstrated less vascular disease among non-Caucasians initiating RRT than among Caucasians. The survival advantage for non-Caucasian compared to Caucasian RRT patients is confirmed in one large study from the UK and in a Dutch study. Reasons for the better survival of non-Caucasians are not understood completely. CONCLUSIONS Only a few studies are available on non-Caucasian dialysis patients in Europe. The available data confirm findings of other studies throughout the world on racial differences on dialysis. More research is needed to understand the higher incidence and better survival in non-Caucasian patients, and also in countries where there are currently no relevant data.
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Affiliation(s)
- T O van den Beukel
- Department of Clinical Epidemiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
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Verhave G, Siegert CEH. Role of vitamin D in cardiovascular disease. Neth J Med 2010; 68:113-118. [PMID: 20308705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
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 x 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.
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Affiliation(s)
- G Verhave
- VU Medical Centre, Amsterdam, the Netherlands.
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Bosma JW, van Meyel JJM, Siegert CEH. [Hepatorenal syndrome]. Ned Tijdschr Geneeskd 2010; 154:A1355. [PMID: 20456764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Jacob W Bosma
- Sint Lucas Andreas Ziekenhuis, afd. Interne Geneeskunde-MDL, Amsterdam, The Netherlands
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Riezebos RK, Nauta KJ, Honig A, Dekker FW, Siegert CEH. The association of depressive symptoms with survival in a Dutch cohort of patients with end-stage renal disease. Nephrol Dial Transplant 2009; 25:231-6. [PMID: 19654227 DOI: 10.1093/ndt/gfp383] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIM To evaluate the prevalence and the influence on survival of depressive symptoms in a European cohort of end-stage renal disease (ESRD) patients on renal replacement therapy (RRT). METHODS In a prospective fashion, symptoms of depression were evaluated in ESRD patients on RRT using the depression subscore of the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal clinical events were determined during a 1-year follow-up. RESULTS Of 101 patients with ESRD, 42% showed manifest depressive symptoms, defined as a HADS-D score > or =7. No association was found between depressive symptoms and severity of somatic disease. During follow-up, all-cause mortality was significantly higher in patients with depressive symptoms above threshold (n = 42, mortality: 26%) compared to patients with depressive symptoms below threshold (n = 59, mortality 8%), (crude HR 3.3, CI 1.2-9.6, P = 0.02). The excess in mortality was mainly caused by a higher incidence of septicaemia (0 versus 12%, P = 0.01). After adjustment for clinical parameters, this association between depressive symptoms and mortality became even stronger. There was no significant difference observed in the incidence of cardiovascular events. CONCLUSIONS Patients with ESRD treated with dialysis show a high level of depressive symptoms that is independently associated with poor survival. Future research should address appropriate therapeutic regimens.
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Affiliation(s)
- Robert K Riezebos
- Department of Nephrology, Sint Lucas Andreas Hospital, The Netherlands.
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van den Beukel TO, Dekker FW, Siegert CEH. Increased survival of immigrant compared to native dialysis patients in an urban setting in the Netherlands. Nephrol Dial Transplant 2008; 23:3571-7. [PMID: 18577534 DOI: 10.1093/ndt/gfn336] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Data from the United States and Canada suggest that survival rates of Caucasian dialysis patients are lower compared to those of black patients and patients from Asian regions. Information regarding the survival rate of immigrant dialysis patients in Europe is scarce. METHODS We retrospectively analysed incident haemodialysis (HD) and peritoneal dialysis (PD) patients who entered an Amsterdam renal service between January 1996 and December 2005. To explore the origin of differences in survival between natives and immigrants, we ran a series of Cox models with adjustment for demographic, clinical and laboratory variables at baseline and initial adequacy variables. RESULTS Of 303 incident dialysis patients, 58% were natives and 42% were immigrants. Fifty-nine percent of natives and 54% of immigrants had HD as initial treatment modality. At initiation of dialysis, native patients were older and had higher rates of vascular and coronary artery diseases and malignancies and a lower prevalence of hypertension. Glomerulonephritis was more common among immigrants as primary kidney disease. Mean haematocrit and calcium levels for natives were higher compared to immigrants. Cox proportional hazards analysis revealed an increased relative mortality risk (RR) of 2.7 [95% confidence interval (CI) 1.9-3.9] for natives compared to immigrants. Adjustment for age at the start of dialysis attenuated the RR to 1.9 (CI 1.3-2.7). Adjustment for the other variables did not materially influence this RR. CONCLUSIONS We demonstrate increased survival for immigrant compared to native dialysis patients in an urban setting in the Netherlands. This survival advantage is only partly explained by younger age of immigrants at the start of dialysis compared to native patients.
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Sentveld B, van den Brink M, Brulez HFH, Potter van Loon BJ, Weijmer MC, Siegert CEH. The influence of blood volume-controlled ultrafiltration on hemodynamic stability and quality of life. Hemodial Int 2008; 12:39-44. [PMID: 18271839 DOI: 10.1111/j.1542-4758.2008.00238.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Dialysis hypotension occurs frequently and is associated with increased morbidity, mortality, and may influence quality of life. We investigated the influence of blood volume (BV)-controlled ultrafiltration on hemodynamic stability and quality of life in a prospective multiple crossover study. Nineteen patients were consecutively treated with standard hemodialysis (HD), BV-controlled ultrafiltration, and again with standard ultrafiltration during 3-week phases, during which different hemodynamic parameters, ultrafiltrate quantities, dry weight, and quality of life were measured. Blood volume-controlled ultrafiltration resulted in increased hemodynamic stability: systolic blood pressure was significantly higher after treatment with BV-controlled HD compared with both standard treatments (p=0.018 and 0.043, respectively). Also, systolic blood pressure reduction, as a measure of blood pressure stability, was significantly smaller during the BV-controlled phase (-3.9 mmHg) compared with both standard phases (-13.7 and -11.0 mmHg): p=0.003 and 0.035, respectively. No difference was found in the occurrence of large decreases of blood pressure (>30 mmHg), decreases below 90 mmHg systolic pressure, or subjective complaints during treatment or after treatment between both treatment modalities. During the course of the study, the dry weight decreased significantly from mean 73.3 to mean 70.9 kg, and the amount of ultrafiltrate was significantly larger using BV-controlled HD compared with standard treatment (mean 2407 vs. mean 2266 mL; p=0.035). Quality of life, measured by visual analog scales (VAS), showed discrete but no consistent differences between study phases. We conclude that BV-controlled HD increases hemodynamic stability and ultrafiltrate amount compared with a standard treatment. No consistent change in quality of life is found between both treatment modalities.
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Affiliation(s)
- Bas Sentveld
- Department of Nephrology, St Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands
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Chamuleau SAJ, Corssmit EPM, Pereira AM, van de Berg BTJ, Siegert CEH. A young woman with a severe bilateral pneumonia as the presenting sign of an adrenal carcinoma. Neth J Med 2008; 66:121-124. [PMID: 18349468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A severe bilateral, culture-negative pneumonia was diagnosed in a 22-year-old woman. Additional diagnostic procedures accidentally revealed a large adrenal carcinoma and hypercortisolism. The adrenal carcinoma was surgically removed, and she received mitotane treatment. This severe and life-threatening infection was the first sign of an immunosuppressive state as part of Cushing's syndrome due to the adrenal carcinoma.
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Affiliation(s)
- S A J Chamuleau
- Department of Internal Medicine, St Lucas Andreas Hospital, Amsterdam, the Netherlands.
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Weijmer MC, van den Dorpel MA, Van de Ven PJG, ter Wee PM, van Geelen JACA, Groeneveld JO, van Jaarsveld BC, Koopmans MG, le Poole CY, Schrander-Van der Meer AM, Siegert CEH, Stas KJF. Randomized, Clinical Trial Comparison of Trisodium Citrate 30% and Heparin as Catheter-Locking Solution in Hemodialysis Patients. J Am Soc Nephrol 2005; 16:2769-77. [PMID: 16033861 DOI: 10.1681/asn.2004100870] [Citation(s) in RCA: 200] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Interdialytic hemodialysis catheter-locking solutions could contribute to a reduction of catheter-related complications, especially infections. However, they can cause side effects because of leakage from the tip of the catheter. Recently, trisodium citrate (TSC) has been advocated because of its antimicrobial properties and local anticoagulation. In a multicenter, double-blind, randomized, controlled trial, TSC 30% was compared with unfractionated heparin 5000 U/ml for prevention of catheter-related infections, thrombosis, and bleeding complications. The study was stopped prematurely because of a difference in catheter-related bacteremia (CRB; P < 0.01). Of 363 eligible patients, 291 could be randomized. The study included 98 tunneled cuffed catheters and 193 untunneled. There were no significant differences in patient and catheter characteristics on inclusion. In the heparin group, 46% of catheters had to be removed because of any complication compared with 28% in the TSC group (P = 0.005). CRB rates were 1.1 per 1000 catheter-days for TSC versus 4.1 in the heparin group (P < 0.001). For tunneled cuffed catheters, the risk reduction for CRB was 87% (P < 0.001) and for untunneled catheters was 64% (P = 0.05). Fewer patients died from CRB in the TSC group (0 versus 5; P = 0.028). There were no differences in catheter flow problems and thrombosis (P = 0.75). No serious adverse events were encountered. Major bleeding episodes were significantly lower in the TSC group (P = 0.010). TSC 30% improves overall patency rates and reduces catheter-related infections and major bleeding episodes for both tunneled and untunneled hemodialysis catheters. Flow problems are not reduced.
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Affiliation(s)
- Marcel C Weijmer
- Department of Nephrology, Free University Medical Center, Amsterdam, The Netherlands.
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Pinedo S, Bos AJ, Siegert CEH. Relapsing Bacillus cereus peritonitis in two patients on peritoneal dialysis. Perit Dial Int 2002; 22:424-6. [PMID: 12227407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Affiliation(s)
- Sabine Pinedo
- Department of Internal Medicine, St Lucas Andreas Hospital, Amsterdam, The Netherlands
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