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Schmidt AK, van Gorp M, van Wely L, Ketelaar M, Hilberink SR, Roebroeck ME, van Meeteren J, van der Slot W, Stam H, Dallmeijer AJ, de Groot V, Voorman JM, Smits DW, Wintels SC, Reinders‐Messelink HA, Gorter JW, Verheijden J. Autonomy in participation in cerebral palsy from childhood to adulthood. Dev Med Child Neurol 2020; 62:363-371. [PMID: 31578717 DOI: 10.1111/dmcn.14366] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 11/30/2022]
Abstract
AIM To determine the long-term development of autonomy in participation of individuals with cerebral palsy (CP) without intellectual disability. METHOD Individuals with CP (n=189, 117 males, 72 females; mean age [SD] 21y 11mo [4y 11mo], range 12-34y); were assessed cross-sectionally (46%) or up to four times (54%), between the ages of 12 and 34 years. Autonomy in participation was classified using phase 3 of the Rotterdam Transition Profile. A logistic generalized estimating equation regression model was used to analyse autonomy in six domains (independent variables: age, Gross Motor Function Classification System [GMFCS] level, and interaction between age and GMFCS level). Proportions of autonomy were compared to references using binomial tests (p<0.05). RESULTS In most domains, over 90% of participants (n=189, 400 observations, 80% in GMFCS levels I and II) reached autonomy in participation in their late twenties, except for intimate/sexual relationships. Those in GMFCS levels III to V compared to those in GMFCS levels I and II had less favourable development of autonomy in the transportation, intimate relationships, employment, and housing domains, and more favourable development in the finances domain. Compared to references, fewer individuals with CP were autonomous in participation. INTERPRETATION This knowledge of autonomy may guide the expectations of young people with CP and their caregivers. Furthermore, rehabilitation professionals should address autonomy development in intimate relationships, employment, and housing, especially in individuals with lower gross motor function. WHAT THIS PAPER ADDS Individuals with cerebral palsy without intellectual disability achieved autonomy in most participation domains. Regarding intimate relationships, they continued to have less experience compared to age-matched references. Development of autonomy was less favourable for individuals in Gross Motor Function Classification System levels III to V.
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Affiliation(s)
- Ann Katrin Schmidt
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Marloes van Gorp
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Leontien van Wely
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Sander R Hilberink
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Rijndam Rehabilitation, Rotterdam, the Netherlands
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van Ginneken AM, Timmers’ T, Stam H, Weber RFA, Pierik FH. Restructuring Routinely Collected Patient Data: ORCA Applied to Andrology. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1636842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Hospital information systems do not always cover all required detail per specialty. This may lead to scattering of data over disparate systems and the paper record. The ORCA (Open Record for CAre) CPR offers a generic structure for record sharing, and record keeping tailored to specific needs. We studied whether a semantic integration of existing and new data was possible, using the ORCA structure. Existing andrology data, originating from separate sources, were utilized for this purpose. During normalization, validation and explication steps, latent problems in the source data were exposed and removed, followed by a merge with new data items. By conversion of source data to ORCA, a unique representation of medical concepts in the database was attained, facilitating retrieval of univocal data for multiple purposes. We conclude that the expansion to the andrology domain, including transparent integration of existing data, provides support for the generality of ORCA.
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Abstract
AbstractThe introduction of computer-based patient records (CPRs) that fully replace paper records proves especially difficult in specialized care, despite the potential advantages of CPRs for patient care and research. Improved data legibility, availability, sharing of records, and decision support may directly benefit patient care. Barriers to the introduction of CPR applications at institutions may be caused by lack of infrastructure, or by financial or organizational issues. To have clinicians interactively enter data at the point of care is still a big challenge. This paper presents an overview of ORCA (Open Record of CAre): a generic CPR, designed for integration with existing systems, presentation of multi-media patient data, and the collection of structured data, directly by clinicians. ORCA can easily be tailored to the needs of a variety of medical specialists without the need for changes to its data model, functionality, or interface. The paper describes the essence of the architecture of ORCA and the user benefits with emphasis on the support of structured data entry.
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Stam H, Borg K, Andersson A. A time for change! J Rehabil Med 2018. [DOI: 10.2340/16501977-2319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Schasfoort F, Dallmeijer A, Pangalila R, Catsman C, Stam H, Becher J, Steyerberg E, Polinder S, Bussmann J. Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study. J Rehabil Med 2018; 50:22-29. [DOI: 10.2340/16501977-2267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Borg K, Stam H. New Editors of Journal of Rehabilitation Medicine. J Rehabil Med 2016. [DOI: 10.2340/16501977-2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Praet S, Mankowski R, Michael S, Rozenberg R, Stokla S, Stam H. Heart-rate variability threshold, a valid alternative for ventilatory threshold testing and training purposes? J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Versteegh FG, Neijens HJ, Bogaard JM, Stam H, Robijn RJ, Kerrebijn KF. Relationship between pulmonary function, O2 saturation during sleep and exercise, and exercise responses in children with cystic fibrosis. Adv Cardiol 2015; 35:151-5. [PMID: 3565133 DOI: 10.1159/000413448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Bogaard JM, Scholte HR, Busch HF, Stam H, Versprille A. Anaerobic threshold as detected from ventilatory and metabolic exercise responses in patients with mitochondrial respiratory chain defect. Adv Cardiol 2015; 35:135-45. [PMID: 2951982 DOI: 10.1159/000413446] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Postma K, Vlemmix L, Haisma J, Groot S, Sluis T, Stam H, Bussmann J. Longitudinal association between respiratory muscle strength and cough capacity in persons with spinal cord injury: An explorative analysis of data from a randomized controlled trial. J Rehabil Med 2015; 47:722-6. [DOI: 10.2340/16501977-1986] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pangalila R, Bos G, Bartels B, Bergen M, Kampelmacher M, Stam H, Roebroeck M. Quality of life of adult men with Duchenne muscular dystrophy in the Netherlands: Implications for care. J Rehabil Med 2015; 47:161-6. [DOI: 10.2340/16501977-1898] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Geffen M, Hoeve N, Sunamura M, Stam H, Domburg R, Berg-Emons R. Fatigue during and after cardiac rehabilitation. J Rehabil Med 2015; 47:569-74. [DOI: 10.2340/16501977-1967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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van Leeuwen M, Krijgsheld P, Bleichrodt R, Menke H, Stam H, Stark J, Wösten H, Dijksterhuis J. Germination of conidia of Aspergillus niger is accompanied by major changes in RNA profiles. Stud Mycol 2013; 74:59-70. [PMID: 23449598 PMCID: PMC3563291 DOI: 10.3114/sim0009] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [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] [Indexed: 11/07/2022] Open
Abstract
The transcriptome of conidia of Aspergillus niger was analysed during the first 8 h of germination. Dormant conidia started to grow isotropically two h after inoculation in liquid medium. Isotropic growth changed to polarised growth after 6 h, which coincided with one round of mitosis. Dormant conidia contained transcripts from 4 626 genes. The number of genes with transcripts decreased to 3 557 after 2 h of germination, after which an increase was observed with 4 780 expressed genes 8 h after inoculation. The RNA composition of dormant conidia was substantially different than all the subsequent stages of germination. The correlation coefficient between the RNA profiles of 0 h and 8 h was 0.46. They were between 0.76-0.93 when profiles of 2, 4 and 6 h were compared with that of 8 h. Dormant conidia were characterised by high levels of transcripts of genes involved in the formation of protecting components such as trehalose, mannitol, protective proteins (e.g. heat shock proteins and catalase). Transcripts belonging to the Functional Gene Categories (FunCat) protein synthesis, cell cycle and DNA processing and respiration were over-represented in the up-regulated genes at 2 h, whereas metabolism and cell cycle and DNA processing were over-represented in the up-regulated genes at 4 h. At 6 h and 8 h no functional gene classes were over- or under-represented in the differentially expressed genes. Taken together, it is concluded that the transcriptome of conidia changes dramatically during the first two h and that initiation of protein synthesis and respiration are important during early stages of germination.
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Affiliation(s)
- M.R. van Leeuwen
- Applied and Industrial Mycology, CBS-KNAW Fungal Biodiversity Centre, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - P. Krijgsheld
- Microbiology and Kluyver Centre for Genomics of Industrial Fermentation, Molecular Microbiology, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - R. Bleichrodt
- Microbiology and Kluyver Centre for Genomics of Industrial Fermentation, Molecular Microbiology, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - H. Menke
- DSM Food Specialties, PO Box 1, 2600 MA Delft, The Netherlands
| | - H. Stam
- DSM Food Specialties, PO Box 1, 2600 MA Delft, The Netherlands
| | - J. Stark
- DSM Food Specialties, PO Box 1, 2600 MA Delft, The Netherlands
| | - H.A.B. Wösten
- Microbiology and Kluyver Centre for Genomics of Industrial Fermentation, Molecular Microbiology, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - J. Dijksterhuis
- Applied and Industrial Mycology, CBS-KNAW Fungal Biodiversity Centre, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
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van Leeuwen MR, Krijgsheld P, Wyatt TT, Golovina EA, Menke H, Dekker A, Stark J, Stam H, Bleichrodt R, Wösten HAB, Dijksterhuis J. The effect of natamycin on the transcriptome of conidia of Aspergillus niger. Stud Mycol 2012; 74:71-85. [PMID: 23449730 PMCID: PMC3563292 DOI: 10.3114/sim0013] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The impact of natamycin on Aspergillus niger was analysed during the first 8 h of germination of conidia. Polarisation, germ tube formation, and mitosis were inhibited in the presence of 3 and 10 μM of the anti-fungal compound, while at 10 μM also isotropic growth was affected. Natamycin did not have an effect on the decrease of microviscosity during germination and the concomitant reduction in mannitol and trehalose levels. However, it did abolish the increase of intracellular levels of glycerol and glucose during the 8 h period of germination. Natamycin hardly affected the changes that occur in the RNA profile during the first 2 h of germination. During this time period, genes related to transcription, protein synthesis, energy and cell cycle and DNA processing were particularly up-regulated. Differential expression of 280 and 2586 genes was observed when 8 h old germlings were compared with conidia that had been exposed to 3 μM and 10 μM natamycin, respectively. For instance, genes involved in ergosterol biosynthesis were down-regulated. On the other hand, genes involved in endocytosis and the metabolism of compatible solutes, and genes encoding protective proteins were up-regulated in natamycin treated conidia.
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Affiliation(s)
- M R van Leeuwen
- Applied and Industrial Mycology, CBS-KNAW Fungal Biodiversity Centre, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
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Smith SC, Collins A, Ferrari R, Holmes DR, Logstrup S, McGhie DV, Ralston J, Sacco RL, Stam H, Taubert K, Wood DA, Zoghbi WA. Our time: a call to save preventable death from cardiovascular disease (heart disease and stroke). Eur Heart J 2012; 33:2910-6. [DOI: 10.1093/eurheartj/ehs313] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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van der Beek NAME, van Capelle CI, van der Velden-van Etten KI, Hop WCJ, van den Berg B, Reuser AJJ, van Doorn PA, van der Ploeg AT, Stam H. Rate of progression and predictive factors for pulmonary outcome in children and adults with Pompe disease. Mol Genet Metab 2011; 104:129-36. [PMID: 21763167 DOI: 10.1016/j.ymgme.2011.06.012] [Citation(s) in RCA: 71] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 06/16/2011] [Indexed: 12/18/2022]
Abstract
Respiratory insufficiency is a serious threat to patients with Pompe disease, a neuromuscular disorder caused by lysosomal acid alpha-glucosidase deficiency. Innovative therapeutic options which may stabilize pulmonary function have recently become available. We therefore determined proportion and severity of pulmonary involvement in patients with Pompe disease, the rate of progression of pulmonary dysfunction, and predictive factors for poor respiratory outcome. In a single-center, prospective, cohort study, we measured vital capacity (VC) in sitting and supine positions, as well as maximum inspiratory (MIP) and expiratory (MEP) mouth pressures, and end expiratory CO(2) in 17 children and 75 adults with Pompe disease (mean age 42.7 years, range 5-76 years). Seventy-four percent of all patients, including 53% of the children, had some degree of respiratory dysfunction. Thirty-eight percent had obvious diaphragmatic weakness. Males appeared to have more severe pulmonary involvement than females: at a group level, their mean VC was significantly lower than that of females (p<0.001), they used mechanical ventilation more often than females (p=0.042) and the decline over the course of the disease was significantly different between males and females (p=0.003). Apart from male gender, severe skeletal muscle weakness and long disease duration were the most important predictors of poor respiratory status. During follow-up (average 1.6 years, range 0.5-4.2 years), three patients became ventilator dependent. Annually, there were average decreases in VC in upright position of 0.9% points (p=0.09), VC in supine position of 1.2% points (p=0.049), MIP of 3.2% points (p=0.018) and MEP of 3.8% points (p<0.01). We conclude that pulmonary dysfunction in Pompe disease is much more common than generally thought. Males, patients with severe muscle weakness, and those with advanced disease duration seem most at risk.
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Affiliation(s)
- N A M E van der Beek
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Pourrier S, Nieuwstraten W, Cranenburgh B, Schreuders T, Stam H, Selles R. Three cases of referred sensation in traumatic nerve injury of the hand; Implications for understanding central nervous system reorganization. J Rehabil Med 2010; 42:357-61. [DOI: 10.2340/16501977-0526] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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van Gestel YRBM, Hoeks SE, Sin DD, Huzeir V, Stam H, Mertens FW, van Domburg RT, Bax JJ, Poldermans D. COPD and cancer mortality: the influence of statins. Thorax 2009; 64:963-7. [DOI: 10.1136/thx.2009.116731] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van Tilburg PMB, Stam H, Hoogsteden HC, van Klaveren RJ. Pre-operative pulmonary evaluation of lung cancer patients: a review of the literature. Eur Respir J 2009; 33:1206-15. [PMID: 19407054 DOI: 10.1183/09031936.00020508] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Complete anatomical resection of the primary tumour is still the standard of care in patients with early stage lung cancer. Because these patients are usually smokers who also suffer from chronic obstructive pulmonary disease, regional differences in pulmonary function due to lung tissue destruction exist. The purpose of the present article is to evaluate the currently available guidelines and to discuss novel methods for the pre-operative functional and anatomical pulmonary evaluation in lung cancer patients. Despite the fact that knowledge on the pre-operative evaluation of the pulmonary function has substantially increased during the past decade, the majority of the studies are small, underpowered and, with exception of a proposed algorithm, not prospectively validated in independent cohorts. The future harmonisation of guidelines is required and novel imaging techniques should be incorporated in the pre-operative evaluation in chronic obstructive pulmonary disease patients with borderline pulmonary function.
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Affiliation(s)
- P M B van Tilburg
- Department of Pulmonology, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
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Buffart L, Ploeg H, Bauman A, Asbeck F, Stam H, Roebroeck M, Berg-Emons R. Sports participation in adolescents and young adults with myelomeningocele and its role in total physical activity behaviour and fitness. J Rehabil Med 2008; 40:702-8. [DOI: 10.2340/16501977-0239] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Haisma J, Post M, Woude L, Stam H, Bergen M, Sluis T, Berg-Emons H, Bussmann J. Functional independence and health-related functional status following spinal cord injury: A prospective study of the association with physical capacity. J Rehabil Med 2008; 40:812-8. [DOI: 10.2340/16501977-0258] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Stam H, Grootenhuis MA, Caron HN, Last BF. Quality of life and current coping in young adult survivors of childhood cancer: positive expectations about the further course of the disease were correlated with better quality of life. Psychooncology 2006; 15:31-43. [PMID: 15751002 DOI: 10.1002/pon.920] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [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: 11/09/2022]
Abstract
OBJECTIVES As a result of advances in the treatment of childhood cancer many patients who may previously have had a limited life expectancy, are now surviving into adulthood. More insight is needed into the long-term adjustment of young adult survivors of childhood cancer. The purpose of this study was to (1) assess health-related quality of life (HRQoL), and (2) to explore the role of cognitive coping in relation to HRQoL. METHODS HRQoL of 353 Dutch young adult survivors of childhood cancer was compared with HRQoL of 507 peers. Linear regression analyses predicted survivors' HRQoL by cognitive coping, independent of the impact of demographics and medical variables. RESULTS Survivors reported a lower HRQoL than their peers. Health status was the best predictor of the Physical Component Scale of the RAND-36; health status and cognitive coping contributed almost equally well to the Mental Component Scale. The explanatory value of cognitive coping could mainly be attributed to the use of predictive control strategies. CONCLUSIONS Because current coping seemed to be an important predictor of HRQoL, interventions directed at the coping strategies of survivors should be useful. The strong association between predictive coping and HRQoL stresses the importance of focusing at having positive expectations about the further course of the disease.
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Affiliation(s)
- H Stam
- Paediatric Psychosocial Department, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, G8-224 Meibergdreef 9, NL-1105 AZ Amsterdam, The Netherlands.
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Negrini S, Christodoulou N, Giustini A, Ring H, Stam H. Europa Medicophysica is indexed by Medline: opening new perspectives for European, Mediterranean and Italian physical and rehabilitation medicine. Eura Medicophys 2005; 41:203-5. [PMID: 16249776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Abstract
The developmental consequences in adulthood of growing up with childhood cancer are not well understood. The Course of life questionnaire was developed to assess the attainment of developmental milestones retrospectively and socio-demographic outcomes in young adulthood. The aim of this study was to assess the course of life and socio-demographic outcomes in young adult survivors of childhood cancer. Knowledge about possible gaps in the course of life could enable health care providers to aim for the most favourable course of life. A total of 353 Dutch survivors and a comparison group of 508 peers without a history of cancer, all aged between 18 and 30, filled in the Course of life questionnaire. The course of life of the survivors was found to be hampered. The young adult survivors of childhood cancer in the Netherlands turned out to have achieved fewer milestones than their peers with respect to autonomy development, social development, and psycho-sexual development, or to have achieved the milestones when they were older than their peers. In addition, survivors displayed less risk behaviour than the comparison group. The survivors and the comparison group also differed on some socio-demographic issues. A considerably lower percentage of survivors than peers in the comparison group were married or living together, and/or employed. Their educational level, on the other hand, was as high as that of their peers.
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Affiliation(s)
- H Stam
- Paediatric Psychosocial Department, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, The Netherlands.
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Abstract
In recent years the necessity of measuring quality of life in childhood cancer survivors has been stressed. This paper gives an overview of the results of studies into the quality of life (QL) of young adult survivors of childhood cancer and suggest areas for future research. The review located 30 empirical studies published up to 2001. The results are described in terms of the following QL dimensions: physical functioning (QL, general health), psychological functioning (overall emotional functioning, depression and anxiety, self-esteem), social functioning (education, employment, insurance, living situation, marital status and family), and sexual functioning. Factors related to survivors' QL are reported: demographics and illness- and treatment related variables. Although the literature yields some inconsistent findings, a number of clear trends can be identified: (a) most survivors reported being in good health, with the exception of some bone tumour survivors; (b) most survivors function well psychologically; (c) survivors of CNS tumours and survivors of acute lymphoblastic leukaemia (ALL) are at risk for educational deficits; (d) job discrimination, difficulties in obtaining work and problems in obtaining health and life insurance were reported; (e) survivors have lower rates of marriage and parenthood; (f) survivors worry about their reproductive capacity and/or about future health problems their children might experience as a result of their cancer history. There is a need for methodological studies that measure QL among survivors of childhood cancer more precisely by taking into account the effects of the severity of the cancer and the long-term impact of different treatments. Additional data are needed to help us understand the needs of survivors and to identify those subgroups of survivors who are at greatest risk for the adverse sequelae of the disease and its treatment.
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Affiliation(s)
- N E Langeveld
- Department of Paediatric Oncology, Emma Kinderziekenhuis, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Abstract
An overview is given of the social and emotional adjustment in young survivors of childhood cancer. The results are described in terms of self-esteem, anxiety, depression and posttraumatic stress (emotional adjustment), and in terms of behavioral functioning, social competence and school performance (socio-behavioral adjustment). Furthermore, factors related to survivors' adjustment are reported: demographics, illness- and treatment-related factors, coping and social support, and family and parental functioning. Limitations of the studies and consequences for future research are discussed. On the whole, the adjustment of young cancer survivors as a group was reasonably good, but the findings with respect to the emotional and social adjustment were inconsistent. This might be attributed to limitations of the study designs and the fact that the studies were not all directly comparable. In order to gain more insight into the predictors of adjustment, longitudinal studies are recommended, which should include control groups or standardized instruments with norm data, and use cancer-specific measures in addition to generic measures.
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Affiliation(s)
- H Stam
- Emma Kinderziekenhuis Academic Medical Center, University of Amsterdam, The Netherlands.
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van den Berg-Emons H, Bussmann J, Balk A, Keijzer-Oster D, Stam H. Level of activities associated with mobility during everyday life in patients with chronic congestive heart failure as measured with an "activity monitor". Phys Ther 2001; 81:1502-11. [PMID: 11688587] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Because of dyspnea and fatigue, patients with congestive heart failure (CHF) may be restricted in the performance of normal everyday activities. The aim of this study was to obtain a preliminary indication of the level of activities associated with mobility during everyday life and between-day variance in activities in patients with mild to moderate CHF as measured with an "Activity Monitor." SUBJECTS AND METHODS The "Activity Monitor" is based on long-term (>24 hours) ambulatory monitoring of signals from accelerometers fixed to the subject's body during everyday activities with the aim of assessing the level of activities associated with mobility. Measurements were obtained over 3 days from 5 male subjects with CHF (mean age=64 years, SD=5, range=59-72) and over 2 days from 5 matched comparison subjects (mean age=65 years, SD=4, range=61-71). RESULTS Mean duration of movement-related activities (walking, cycling, or general movement) (expressed as a percentage of the duration of the measurement day) was lower in the subjects with CHF (X=3.9, SD=1.5, range=2.2-6.7) than in the comparison subjects (X=11.3, SD=3.0, range=6.6-14.1). In the patients, between-day variance was smaller for different weekdays (eg, Monday versus Tuesday) than for similar weekdays (eg, 2 Mondays) (1.11% and 7.28%, respectively). DISCUSSION AND CONCLUSION The results show how activities associated with mobility during everyday life may be restricted in people with CHF.
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Affiliation(s)
- H van den Berg-Emons
- Institute of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands.
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Röling WF, Kerler J, Braster M, Apriyantono A, Stam H, van Verseveld HW. Microorganisms with a taste for vanilla: microbial ecology of traditional Indonesian vanilla curing. Appl Environ Microbiol 2001; 67:1995-2003. [PMID: 11319073 PMCID: PMC92828 DOI: 10.1128/aem.67.5.1995-2003.2001] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2000] [Accepted: 02/14/2001] [Indexed: 11/20/2022] Open
Abstract
The microbial ecology of traditional postharvesting processing of vanilla beans (curing) was examined using a polyphasic approach consisting of conventional cultivation, substrate utilization-based and molecular identification of isolates, and cultivation-independent community profiling by 16S ribosomal DNA based PCR-denaturing gradient gel electrophoresis. At two different locations, a batch of curing beans was monitored. In both batches a major shift in microbial communities occurred after short-term scalding of the beans in hot water. Fungi and yeast disappeared, although regrowth of fungi occurred in one batch during a period in which process conditions were temporarily not optimal. Conventional plating showed that microbial communities consisting of thermophilic and thermotolerant bacilli (mainly closely related to Bacillus subtilis, B. licheniformis, and B. smithii) developed under the high temperatures (up to 65 degrees C) that were maintained for over a week after scalding. Only small changes in the communities of culturable bacteria occurred after this period. Molecular analysis revealed that a proportion of the microbial communities could not be cultured on conventional agar medium, especially during the high-temperature period. Large differences between both batches were observed in the numbers of microorganisms, in species composition, and in the enzymatic abilities of isolated bacteria. These large differences indicate that the effects of microbial activities on the development of vanilla flavor could be different for each batch of cured vanilla beans.
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Affiliation(s)
- W F Röling
- Section of Molecular Microbial Ecology, Department of Molecular Cell Physiology, Faculty of Biology, Research School SENSE, Vrije Universiteit, NL-1081 HV Amsterdam, The Netherlands
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Abstract
In this study, the effects of psychoeducational family support groups in the Netherlands on relatives' burden were investigated, using a quasi-experimental design. The experimental group consisted of 119 participants of 19 family support groups, the control group of 45 relatives of once-only informational meetings. Subjects from both groups filled in a questionnaire before the group started and one year later. While controlling for confounding variables in multiple regression analyses, significant effects of family support groups were found on elements of burnout and burden.
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Affiliation(s)
- H Stam
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht
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32
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van der Linde K, van Hal PT, Stam H, Pattynama PM, Kwekkeboom DJ, de Man RA. [Cyanosis and liver cirrhosis: hepatopulmonary syndrome]. Ned Tijdschr Geneeskd 2000; 144:2527-8. [PMID: 11155512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Abstract
OBJECTIVE The effectiveness of family interventions may be improved by concentrating on elements of objective burden that best predict subjective burden. The relationship between subjective burden and objective burden was investigated among caregivers of patients with serious mental illness in the Netherlands who were attending psychoeducational support groups. METHODS The study used pretest data from an intervention study in which psychoeducational family support groups in the Netherlands were evaluated. A total of 164 participants from 19 psychoeducational groups organized by nine community mental health centers completed the Dutch translation of the Maslach Burnout Inventory and the Involvement Evaluation Questionnaire. Regression analyses were conducted, with elements of subjective burden as dependent variables and elements of objective burden, demographic characteristics, and characteristics of the patient's disorder as predictors. RESULTS Burden in general and emotional exhaustion were the aspects of subjective burden best predicted by objective burden. In two regression models, objective burden together with the other predictors explained 57 percent and 54 percent of the variance in subjective burden. Two aspects of objective burden-strain on the relationship with the patient and ability to cope with the patient's behavior-were related to almost all the investigated aspects of subjective burden. CONCLUSIONS Strong evidence was found for the relationship between objective and subjective burden and for the hypothesis that particular elements of objective burden contribute more to subjective burden than others. The findings suggest that psychoeducation should concentrate on helping relatives cope with the strain on the relationship with the patient and on improving their ability to cope with the patient's behavior.
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Affiliation(s)
- P Cuijpers
- Trimbos Institute, the Netherlands Institute of Mental Health and Addiction, Utrecht.
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Abstract
BACKGROUND In healthy volunteers, the single-breath diffusing capacity of the lung for carbon monoxide (DLCO) decreases and DLCO normalized per liter alveolar volume (VA; DLCO/VA) increases if VA is decreased. We hypothesized that comparison of DLCO/VA with its predicted value at predicted total lung capacity (TLC) will result in an underestimation of the diffusion disorder in patients with a restrictive lung disease, if a similar relationship exists between DLCO/VA and lung volume as found in healthy volunteers. OBJECTIVE To test this hypothesis, we studied total gas transfer DLCO and DLCO/VA as functions of VA in patients who developed a restrictive lung disease and a diffusion disorder in a short period of time. DESIGN An observational survey. SETTING Pulmonary function department. PATIENTS Thirteen patients without any initial pulmonary pathology who developed the mentioned pulmonary pathology due to bleomycin treatment. INTERVENTIONS Bleomycin treatment. MEASUREMENTS AND RESULTS We performed the single-breath test at various VA levels before, during, and after bleomycin treatment. In the majority of the patients, the DLCO vs VA relationship remained parabolic, but shifted downwards during therapy. Therefore, the linear DLCO/VA vs VA relationship shifted downwards, while the negative slope was not changed, indicating the development of a decreased gas transfer. Six patients also developed a volume restriction. CONCLUSIONS The agreement of the data with the hypothesis increased its probability. Consequently, to evaluate a diffusion disorder, DLCO/VA at a lower actual TLC of patients with a lung restriction should be compared to a reference DLCO/VA at a lung volume equal to the actual TLC.
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Affiliation(s)
- H Stam
- Pathophysiology Laboratory of the Department of Pulmonary Diseases, Erasmus University, Rotterdam, the Netherlands
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van Ginneken AM, Stam H, van Mulligen EM, de Wilde M, van Mastrigt R, van Bemmel JH. ORCA: the versatile CPR. Methods Inf Med 1999; 38:332-8. [PMID: 10805024] [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: 02/16/2023]
Abstract
The introduction of computer-based patient records (CPRs) that fully replace paper records proves especially difficult in specialized care, despite the potential advantages of CPRs for patient care and research. Improved data legibility, availability, sharing of records, and decision support may directly benefit patient care. Barriers to the introduction of CPR applications at institutions may be caused by lack of infrastructure, or by financial or organizational issues. To have clinicians interactively enter data at the point of care is still a big challenge. This paper presents an overview of ORCA (Open Record of CAre): a generic CPR, designed for integration with existing systems, presentation of multi-media patient data, and the collection of structured data, directly by clinicians. ORCA can easily be tailored to the needs of a variety of medical specialists without the need for changes to its data model, functionality, or interface. The paper describes the essence of the architecture of ORCA and the user benefits with emphasis on the support of structured data entry.
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Affiliation(s)
- A M van Ginneken
- Dept. of Medical Informatics, Erasmus University Rotterdam, The Netherlands.
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van Bemmel JH, van Ginneken AM, Stam H, Assanelli D, Macfarlane PW, Maglaveras N, Rubel P, Zeelenberg C, Zywietz C. Integration and communication for the continuity of cardiac care (I4C). J Electrocardiol 1999; 31 Suppl:60-8. [PMID: 9988007 DOI: 10.1016/s0022-0736(98)90290-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/30/2022]
Abstract
The project I4C (Integration and Communication for the Continuity of Cardiac Care) is carried out for the advancement of cardiac care, from prevention to follow-up. The goals of I4C are: (1) integrated access to patient data, wherever they are stored; (2) support of evidence-based care; (3) consistent recording of patient data (eg, patient history, electrocardiograms IECGs] or cine-angios) in a multimedia patient record; and (4) a documented reference data set for research. In several clinics, workstations are being installed to serve the four goals. Integration with other information systems in clinical care is realized by encapsulation. A computer-based patient record (ORCA) has been developed to support the collection, consultation, and sharing of patient data. In I4C, ORCA is intended for use in a research setting as well as routine patient care. The functionality of ORCA covers the collection of patient history data in a highly structured manner, the recording of drug prescriptions, an overview of laboratory test results, and viewers for ECGs and angiographic images. At present, structured data entry and consultation is supported in six European languages.
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Affiliation(s)
- J H van Bemmel
- Dept of Medical Informatics, Erasmus University, Rotterdam, The Netherlands
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37
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Stam H, Beek AV, Grünberg K, de Ridder MA, de Jongste JC, Versprille A. A rebreathing method to determine carbon monoxide diffusing capacity in children: reference values for 6- to 18-year-olds [corrected] and validation in adult volunteers. Pediatr Pulmonol 1998; 25:205-12. [PMID: 9556013 DOI: 10.1002/(sici)1099-0496(199803)25:3<205::aid-ppul11>3.0.co;2-a] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The diffusing capacity of carbon monoxide (D(L,CO)) and its value normalized to alveolar volume (D(L,CO)/V(A)) are usually estimated with the single breath method at total lung capacity (TLC). Severely ill patients and small children are not able to deliver a satisfactory vital capacity (VC) or hold their breath for 10 s at TLC. The aim of this study was to develop a rebreathing procedure in which diffusing capacity can be determined during spontaneous tidal breathing. The conventional rebreathing method during hyperventilation was modified so that rebreathing volume and gas concentrations were kept constant by CO2 absorption and O2 supplementation. In adult healthy volunteers and in patients who were able to perform both tests, the diffusion indices obtained with this rebreathing method during resting ventilation were compared with those obtained by the single breath method. Predicted (reference) values for rebreathing D(L,CO) and D(L,CO)/V(A) for children were determined. D(L,CO)/V(A) decreased with alveolar volume (V(A)) and increased with alveolar ventilation (V'(A)). In adults at V'(A) above 35 L x min(-1) rebreathing D(L,CO)/V(A) was similar to single breath D(L,CO)/V(A) at similar alveolar volumes. The D(L,CO)/V(A) relative to their corresponding reference values were the same for both methods in adult patients, irrespective of ventilation distribution disturbances. In children the newly described diffusing capacity obtained by the rebreathing method during resting ventilation can serve as a valuable index to assess and follow a diffusion disorder.
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Affiliation(s)
- H Stam
- Department of Pulmonary Diseases, Erasmus University, Rotterdam, The Netherlands
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38
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van Mulligen EM, Stam H, van Ginneken AM. Clinical data entry. Proc AMIA Symp 1998:81-5. [PMID: 9929186 PMCID: PMC2232146] [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: 02/10/2023] Open
Abstract
Routine capture of patient data for a computer-based patient record system remains a subject of study. Time constraints that require fast data entry and maximal expression power are in favor of free text data entry. However, using patient data directly for decision support systems, for quality assessment, etc. requires structured data entry, which appears to be more tedious and time consuming. In this paper, a prototype clinical data entry application is described that combines free text and structured data entry in one single application and allows clinicians to smoothly switch between these two different input styles. A knowledge base involving a semantic network of clinical data entry terms and their properties and relationships is used by this application to support structured data entry. From structured data, sentences are generated and shown in a text processor together with the free text. This presentation metaphor allows for easy integrated presentation of structured data and free text.
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Affiliation(s)
- E M van Mulligen
- Dept. of Medical Informatics, Erasmus University Rotterdam, The Netherlands
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39
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Pierik FH, van Ginneken AM, Timmers T, Stam H, Weber RF. Restructuring routinely collected patient data: ORCA applied to andrology. Methods Inf Med 1997; 36:184-90. [PMID: 9293717] [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: 02/05/2023]
Abstract
Hospital information systems do not always cover all required detail per specialty. This may lead to scattering of data over disparate systems and the paper record. The ORCA (Open Record for CAre) CPR offers a generic structure for record sharing, and record keeping tailored to specific needs. We studied whether a semantic integration of existing and new data was possible, using the ORCA structure. Existing andrology data, originating from separate sources, were utilized for this purpose. During normalization, validation and explication steps, latent problems in the source data were exposed and removed, followed by a merge with new data items. By conversion of source data to ORCA, a unique representation of medical concepts in the database was attained, facilitating retrieval of univocal data for multiple purposes. We conclude that the expansion to the andrology domain, including transparent integration of existing data, provides support for the generality of ORCA.
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Affiliation(s)
- F H Pierik
- Department of Medical Informatics, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands.
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40
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Suykerbuyk ME, Kester HC, Schaap PJ, Stam H, Musters W, Visser J. Cloning and characterization of two rhamnogalacturonan hydrolase genes from Aspergillus niger. Appl Environ Microbiol 1997; 63:2507-15. [PMID: 9212401 PMCID: PMC168548 DOI: 10.1128/aem.63.7.2507-2515.1997] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [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: 02/04/2023] Open
Abstract
A rhamnogalacturonan hydrolase gene of Aspergillus aculeatus was used as a probe for the cloning of two rhamnogalacturonan hydrolase genes of Aspergillus niger. The corresponding proteins, rhamnogalacturonan hydrolases A and B, are 78 and 72% identical, respectively, with the A. aculeatus enzyme. In A. niger cultures which were shifted from growth on sucrose to growth on apple pectin as a carbon source, the expression of the rhamnogalacturonan hydrolase A gene (rhgA) was transiently induced after 3 h of growth on apple pectin. The rhamnogalacturonan hydrolase B gene was not induced by apple pectin, but the rhgB gene was derepressed after 18 h of growth on either apple pectin or sucrose. Gene fusions of the A. niger rhgA and rhgB coding regions with the strong and inducible Aspergillus awamori exlA promoter were used to obtain high-producing A. awamori transformants which were then used for the purification of the two A. niger rhamnogalacturonan hydrolases. High-performance anion-exchange chromatography of oligomeric degradation products showed that optimal degradation of an isolated highly branched pectin fraction by A. niger rhamnogalacturonan hydrolases A and B occurred at pH 3.6 and 4.1, respectively. The specific activities of rhamnogalacturonan hydrolases A and B were then 0.9 and 0.4 U/mg, respectively, which is significantly lower than the specific activity of A. aculeatus rhamnogalacturonan hydrolase (2.5 U/mg at an optimal pH of 4.5). Compared to the A enzymes, the A. niger B enzyme appears to have a different substrate specificity, since additional oligomers are formed.
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41
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van Ginneken AM, de Wilde M, van Mulligen EM, Stam H. Can data representation and interface demands be reconciled? Approach in ORCA. Proc AMIA Annu Fall Symp 1997:779-83. [PMID: 9357731 PMCID: PMC2233342] [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: 02/05/2023]
Abstract
Research in the domain of computer-based patient records had always faced the conflicting demands of efficiency for the practicing physician and suitability of the record contents for data analysis in view of decision support, research, and quality assessment. Interface and contents pose different demands on the data model underlying the record. The challenge is to combine the most suitable model for data representation with the interface that best fits the clinical setting. ORCA (Open Record for CAre) provides a solution by making the distinction between domain dependent and domain independent data and letting domain dependence be decisive for the choice of model. Interactive definition of custom-views provides interface flexibility for domain dependent data. Views on domain independent data need not cope with the limitations of multiple table views in relational DBMSs. A standard set of single table queries can support recording of domain independent data, irrespective of the clinical setting.
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Affiliation(s)
- A M van Ginneken
- Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.
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42
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Gouka RJ, Stam H, Fellinger AJ, Muijsenberg RJ, van de Wijngaard A, Punt PJ, Musters W, van den Hondel CA. Kinetics of mRNA and protein synthesis of genes controlled by the 1,4-beta-endoxylanase A promoter in controlled fermentations of Aspergillus awamori. Appl Environ Microbiol 1996; 62:3646-9. [PMID: 8837419 PMCID: PMC168171 DOI: 10.1128/aem.62.10.3646-3649.1996] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 02/02/2023] Open
Abstract
In this study, induction and repression kinetics of the expression of the Aspergillus awamori 1,4-beta-endoxylanase A (exlA) gene under defined physiological conditions was analyzed at the mRNA and the protein levels. Induction was analyzed by pulsing D-xylose to a sucrose-limited continuous culture of an A. awamori 1,4-beta-endoxylanase A (EXLA)-overproducing strain. Directly after the D-xylose pulse, exIA mRNA was synthesized, and it reached a constant maximal level after 45 to 60 min. This level was maintained as long as D-xylose was present. The kinetics of mRNA synthesis of the genes encoding Thermomyces lanuginosa lipase (lplA) and Escherichia coli beta-glucuronidase (uidA), which were also under the control of the exlA promoter, were similar to those observed for exlA mRNA. The repression of exlA expression was analyzed by pulsing D-glucose to a D-xylose-limited continuous culture. Immediately after the glucose pulse, the exlA mRNA level declined rapidly, with a half-life of approximately 20 to 30 min, and it reached a minimal level after 60 to 90 min. The time span between mRNA synthesis and the secretion of proteins was determined for EXLA and lipase. In both cases, mRNA became visible after approximately 7.5 min. After 1 h, both proteins became detectable in the medium but the rate of secretion of EXLA was faster than that of lipase.
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Affiliation(s)
- R J Gouka
- Department of Molecular Genetics and Gene Technology, TNO Nutrition and Food Research Institute, HV Kijswijk, The Netherlands
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43
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Gouka RJ, Hessing JG, Punt PJ, Stam H, Musters W, Van den Hondel CA. An expression system based on the promoter region of the Aspergillus awamori 1,4-beta-endoxylanase A gene. Appl Microbiol Biotechnol 1996; 46:28-35. [PMID: 8987532 DOI: 10.1007/s002530050779] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [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: 02/03/2023]
Abstract
A new, highly inducible fungal promoter derived from the Aspergillus awamori 1,4-beta-endoxylanase A (exlA) gene is described. Induction analysis, carried out with the wild-type strain in shake flasks, showed that exlA expression in regulated at the transcriptional level. Using a beta-glucuronidase (uidA) reporter strategy, D-xylose was shown to be an efficient inducer of the exlA promoter, whereas sucrose or maltodextrin were not. Upon D-xylose induction, the exlA promoter was threefold more efficient than the frequently used A. niger glucoamylase (glaA) promoter under maltodextrin induction. Detailed induction analyses demonstrated that induction was dependent on the presence of D-xylose in the medium. Carbon-source-limited chemostat cultures with the uidA reporter strain showed that D-xylose was also a very good inducer in a fermenter, even in the presence of sucrose.
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Affiliation(s)
- R J Gouka
- TNO Nutrition and Food Research Institute, Department of Molecular Genetics and Gene Technology, Rijswijk, The Netherlands
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44
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Abstract
Despite a number of well recognized shortcomings of paper medical records, the use of a Computer Patient Record (CPR) is not widespread among specialists. The complexity of specialized care combined with the diversity of their domains of expertise, make it a challenge to design a CPR that satisfies the needs of a specialist. Ideally, CPRs are tailored to the specific tasks of each user, and yet general enough to permit exchange and sharing of information. The basic philosophy behind our CPR is a 'mother' record, which is extended with specialized sub-records. Two different types of subrecords are discussed: one to accommodate standardized data entry in the context of a specialty or research protocol, and another for structured recording of accidental findings outside one's own domain of expertise. The CPR supports the entry of free text and does not impose structured data entry on the physician, but stimulates him to do so by confronting him with the benefits of a structured CPR.
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Affiliation(s)
- A M van Ginneken
- Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands
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45
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Abstract
The diffusing capacity, when normalized per liter of alveolar volume (DL,CO/VA) decreases in normal adults, whereas their total diffusing capacity (DL,CO) increases as alveolar volume (VA) increases. We studied these relationships in a group of normal children below 20 years of age. Diffusion variables were determined using the single breath technique. The effects of sex, age, and height on these relationships were estimated. DL,CO increased and DL,CO/VA decreased as alveolar volume increased. DL,CO and DL,CO/VA reference values at total lung capacity (TLC) appeared to be comparable to reference values at TLC in the literature. Reference values of DL,CO and DL,CO/VA derived from measurements at various alveolar volumes also predict similar values at TLC. The advantage of our reference equations is their applicability to patients with restrictive lung disease. Actual DL,CO/VA can be compared with reference DL,CO/VA at actual (restrictive) TLC instead of reference DL,CO/VA at reference TLC. This comparison extends the evaluation of a diffusion disorder.
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Affiliation(s)
- H Stam
- Department of Pulmonary Diseases, Erasmus University, Rotterdam, Netherlands
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46
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Suykerbuyk ME, Schaap PJ, Stam H, Musters W, Visser J. Cloning, sequence and expression of the gene coding for rhamnogalacturonase of Aspergillus aculeatus; a novel pectinolytic enzyme. Appl Microbiol Biotechnol 1995; 43:861-70. [PMID: 7576553 DOI: 10.1007/bf02431920] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [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: 01/26/2023]
Abstract
Rhamnogalacturonase was purified from culture filtrate of Aspergillus aculeatus after growth in medium with sugar-beet pulp as carbon source. Purified protein was used to raise antibodies in mice and with the antiserum obtained a gene coding for rhamnogalacturonase (rhgA) was isolated from a lambda cDNA expression library. The cloned rhgA gene has an open-reading frame of 1320 base pairs encoding a protein of 440 amino acids with a predicted molecular mass of 45 962 Da. The protein contains a potential signal peptidase cleavage site behind Gly-18 and three potential sites for N-glycosylation. Limited homology with A. niger polygalacturonase amino acid sequences is found. A genomic clone of rhgA was isolated from a recombinant phage lambda genomic library. Comparison of the genomic and cDNA sequences revealed that the coding region of the gene is interrupted by three introns. Furthermore, amino acid sequences of four different peptides, derived from purified A. aculeatus rhamnogalacturonase, were also found in the deduced amino acid sequence of rhgA. A. aculeatus strains overexpressing rhamnogalacturonase were obtained by cotransformation using either the A. niger pyrA gene or the A. aculeatus pyrA gene as selection marker. For expression of rhamnogalacturonase in A. awamori the A. awamori pyrA gene was used as selection marker. Degradation patterns of modified hairy regions, determined by HPLC, show the recombinant rhamnogalacturonase to be active, and the enzyme was found to have a positive effect in the apple hot-mash liquefaction process.
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Affiliation(s)
- M E Suykerbuyk
- Molecular Genetics of Industrial Microorganisms, Wageningen Agricultural University, The Netherlands
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47
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Gouka RJ, Hessing JG, Stam H, Musters W, van den Hondel CA. A novel strategy for the isolation of defined pyrG mutants and the development of a site-specific integration system for Aspergillus awamori. Curr Genet 1995; 27:536-40. [PMID: 7553938 DOI: 10.1007/bf00314444] [Citation(s) in RCA: 27] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A homologous gene transfer system for Aspergillus awamori for site-specific integration is described, based on two components. First, a defined A. awamori pyrG mutant strain constructed by a selection strategy for gene-replacement in fungi. Second, a vector with a homologous pyrG selection marker containing a defined mutation at a site different from that of the mutations in the pyrG gene of the defined mutant strain. Defined mutation in the A. awamori pyrG gene, isolated from a genomic library by heterologous hybridisation with the A. niger pyrG gene as a probe, were introduced by specifically altering sequences at restriction sites in the coding region of the gene. After transformation of the A. awamori wild-type strain with vectors containing these mutated pyrG genes, and selection for 5-fluoro-orotic acid resistance (5-FOAR), on the average 60% of the 5-FOAR colonies originated from replacement of the wild-type pyrG gene by the mutated pyrG allele. After transformation of a mutant strain, carrying a mutation near the 5' end of the pyrG gene with vectors containing a mutation near the 3' end of the pyrG gene, 35% of the resulting transformants contained one copy of the vector at the pyrG locus.
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Affiliation(s)
- R J Gouka
- Department of Molecular Genetics and Gene Technology, TNO Nutrition and Food Research Institute, Rijswijk, The Netherlands
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Timmers T, Pierik F, Steenbergen M, Stam H, van Ginneken AM, van Mulligen EM, Weber RF. ARIS: integrating multi-source data for research in andrology. Proc Annu Symp Comput Appl Med Care 1995:445-8. [PMID: 8563321 PMCID: PMC2579132] [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: 01/31/2023]
Abstract
Although the concept of distributed systems for the storage of patient data is more and more commonly accepted, for some considerable time yet most patient data will be stored in centralized rather than departmental systems. An important advantage of storage in a central system is hospital-wide access to much of the patient data. Disadvantages are however that these data cannot be reviewed through one user interface, and that the structure of the data does not lend itself to exploitation for other purposes. We describe the implementation of an Andrology Research Information System in which these data are integrated in a well-structured database facilitating multiple views on the patient data through a graphical user interface, and clinical research, quality control and summary reports. The data can be analyzed directly using the Hermes workstation. In this way the strengths of the centralized system are combined with those of the dedicated ARIS system.
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Affiliation(s)
- T Timmers
- Dept. of Medical Informatics, Erasmus University Rotterdam, The Netherlands
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van Ginneken AM, Stam H. Can one patient record accommodate the diversity of specialized care? Proc Annu Symp Comput Appl Med Care 1995:406-10. [PMID: 8563312 PMCID: PMC2579124] [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: 01/31/2023]
Abstract
Despite a quarter century of developments, few specialists directly use a computerized patient record, that fully replaces the paper chart. Because of the diversity of domains in specialized care, medical decision-making and the continuity of care may suffer from scattering of patient data over various records. The challenge was to develop a computerized patient record, that would be versatile enough to tailor it to specific needs, while keeping it uniform enough to permit physicians to share data on the same patient. In our CPR, the key that reconciles versatility with uniformity lies in the design of the data model. The CPR consists of a mother record with specialized sub-records, that all share the same data model. A physician can enlarge his scope for decision-making by consulting other specialized records on the same patient or by viewing the combined information of all sub-records without the need to convert data or to familiarize himself with different interfaces.
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Affiliation(s)
- A M van Ginneken
- Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands
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Abstract
In this study we determined reference values of total diffusing capacity of carbon monoxide (DLCO) and DLCO per liter alveolar volume (DLCO/VA) at total lung capacity (TLC) and at lung volumes below TLC in sitting position. In 55 healthy nonsmoking volunteers (20-85 yr old), we determined reference values at TLC level in which age was the only parameter. In a subgroup (n = 16) these references did not change by correction for normal variability in hemoglobin concentration. In all volunteers DLCO decreased and DLCO/VA increased with decreasing VA. The increase in DLCO/VA was linear and less in older subjects. We derived equations to calculate reference values of DLCO/VA for lung volumes at and below TLC with two methods: 1) "random coefficients linear" model, which calculates the reference values directly, and 2) a conversion method, which calculates DLCO/VA for lower VA levels from reference values at TLC. An advantage of the conversion method is the suitability of DLCO/VA reference values at TLC of other populations. A disadvantage is the greater standard deviation of these reference values compared with those obtained by the random coefficients linear method. DLCO can be found by multiplying DLCO/VA with VA.
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Affiliation(s)
- H Stam
- Department of Pulmonary Diseases, Erasmus University, Rotterdam, The Netherlands
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