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van Hal AFRL, Vlot J, van Rosmalen J, Wijnen RMH, van Gils-Frijters APJM, Gischler SJ, Staals LM, IJsselstijn H, Rietman AB. Minimally invasive surgical approach in children treated for oesophageal atresia is associated with attention problems at school age: a prospective cohort study. Eur J Pediatr 2024; 183:2131-2140. [PMID: 38363392 PMCID: PMC11035457 DOI: 10.1007/s00431-024-05449-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 02/17/2024]
Abstract
The long-term neurodevelopment of children born with oesophageal atresia (OA) is unclear. Therefore, we assessed the neurocognitive domains and their predictors. Patients born with OA between February 2006 and December 2014, who were routinely seen at eight years as part of a structured prospective longitudinal follow-up program, were included. Main outcome measures were need for school support, performance in various neurocognitive domains and potential predictors of neurocognitive problems. We analysed data of 65 children with a mean (SD) age of 8.1 (0.2) years, of whom 89% with OA type C. Thirty-five (54%) surgical corrections were minimally invasive; the median (interquartile range) duration of exposure to anaesthetics in the first 24 months was 398 (296 - 710) minutes. Forty-four (68%) attended regular education without extra support and intelligence was within normal range (99-108). More than 50% had z-scores ≤ -2 on one or more neurocognitive domains, of which attention was the most frequently affected domain. The speed on the sustained attention task was significantly below normal (z-score -1.48 (2.12), p < .001), as was fluctuation of sustained attention (z-score -3.19 (3.80), p < .001). The minimally invasive approach and a lower socio-economic status (both p = 0.006) proved significant predictors for sustained attention problems in multivariable analyses. Conclusion: Children who undergo minimally invasive surgery for OA correction are at risk for sustained attention problems at school age. Future studies unravelling the effects of perioperative events on neurodevelopment should lead to optimal surgical, anaesthesiological, and intensive care management in the neonatal period. What is Known: • School-aged children born with oesophageal atresia have normal intelligence but problems with sustained attention at eight years. What is New: • Oesophageal atresia patients, who undergo minimally invasive surgery or who have a background of lower socioeconomic status are at serious risk for sustained attention problems at school age. • Moreover, those who have been intubated for a longer period are at risk for stronger fluctuations in sustained attention.
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Affiliation(s)
- Anne-Fleur R L van Hal
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - John Vlot
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Annabel P J M van Gils-Frijters
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Saskia J Gischler
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Lonneke M Staals
- Department of Anaesthesiology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - André B Rietman
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
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Zeilmaker-Roest G, de Vries-Rink C, van Rosmalen J, van Dijk M, de Wildt SN, Knibbe CAJ, Koomen E, Jansen NJG, Kneyber MCJ, Maebe S, Van den Berghe G, Haghedooren R, Vlasselaers D, Bogers AJJC, Tibboel D, Wildschut ED. Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial. Crit Care 2024; 28:143. [PMID: 38689310 PMCID: PMC11061924 DOI: 10.1186/s13054-024-04905-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND To determine whether intermittent intravenous (IV) paracetamol as primary analgesic would significantly reduce morphine consumption in children aged 0-3 years after cardiac surgery with cardiopulmonary bypass. METHODS Multi-center, randomized, double-blinded, controlled trial in four level-3 Pediatric Intensive Care Units (PICU) in the Netherlands and Belgium. Inclusion period; March 2016-July 2020. Children aged 0-3 years, undergoing cardiac surgery with cardiopulmonary bypass were eligible. Patients were randomized to continuous morphine or intermittent IV paracetamol as primary analgesic after a loading dose of 100 mcg/kg morphine was administered at the end of surgery. Rescue morphine was given if numeric rating scale (NRS) pain scores exceeded predetermined cutoff values. Primary outcome was median weight-adjusted cumulative morphine dose in mcg/kg in the first 48 h postoperative. For the comparison of the primary outcome between groups, the nonparametric Van Elteren test with stratification by center was used. For comparison of the proportion of patients with one or more NRS pain scores of 4 and higher between the two groups, a non-inferiority analysis was performed using a non-inferiority margin of 20%. RESULTS In total, 828 were screened and finally 208 patients were included; parents of 315 patients did not give consent and 305 were excluded for various reasons. Fourteen of the enrolled 208 children were withdrawn from the study before start of study medication leaving 194 patients for final analysis. One hundred and two patients received intermittent IV paracetamol, 106 received continuous morphine. The median weight-adjusted cumulative morphine consumption in the first 48 h postoperative in the IV paracetamol group was 5 times lower (79%) than that in the morphine group (median, 145.0 (IQR, 115.0-432.5) mcg/kg vs 692.6 (IQR, 532.7-856.1) mcg/kg; P < 0.001). The rescue morphine consumption was similar between the groups (p = 0.38). Non-inferiority of IV paracetamol administration in terms of NRS pain scores was proven; difference in proportion - 3.1% (95% CI - 16.6-10.3%). CONCLUSIONS In children aged 0-3 years undergoing cardiac surgery, use of intermittent IV paracetamol reduces the median weight-adjusted cumulative morphine consumption in the first 48 h after surgery by 79% with equal pain relief showing equipoise for IV paracetamol as primary analgesic. Trial Registration Clinicaltrials.gov, Identifier: NCT05853263; EudraCT Number: 2015-001835-20.
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MESH Headings
- Humans
- Morphine/therapeutic use
- Morphine/administration & dosage
- Acetaminophen/therapeutic use
- Acetaminophen/administration & dosage
- Male
- Female
- Infant
- Double-Blind Method
- Pain, Postoperative/drug therapy
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Belgium
- Netherlands
- Infant, Newborn
- Administration, Intravenous
- Cardiac Surgical Procedures/methods
- Child, Preschool
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/therapeutic use
- Intensive Care Units, Pediatric/organization & administration
- Intensive Care Units, Pediatric/statistics & numerical data
- Pain Measurement/methods
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Affiliation(s)
- Gerdien Zeilmaker-Roest
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
| | - Christine de Vries-Rink
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Monique van Dijk
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Saskia N de Wildt
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catherijne A J Knibbe
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
- Department of Clinical Pharmacy, St. Antonius Hospital Nieuwegein/Utrecht, Utrecht, The Netherlands
| | - Erik Koomen
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolaas J G Jansen
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin C J Kneyber
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Sofie Maebe
- Department of Pediatrics, Maastricht University Medical Center+, MosaKids Children's Hospital, Maastricht, The Netherlands
| | | | | | - Dirk Vlasselaers
- Department of Intensive Care Medicine, UZ Leuven, Louvain, Belgium
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Enno D Wildschut
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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Meulenbeld A, Toivonen J, Vinkenoog M, Brits T, Swanevelder R, de Clippel D, Compernolle V, Karki S, Welvaert M, van den Hurk K, van Rosmalen J, Lesaffre E, Janssen M, Arvas M. Predicting haemoglobin deferral using machine learning models: Can we use the same prediction model across countries? Vox Sang 2024. [PMID: 38637123 DOI: 10.1111/vox.13643] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND AND OBJECTIVES Personalized donation strategies based on haemoglobin (Hb) prediction models may reduce Hb deferrals and hence costs of donation, meanwhile improving commitment of donors. We previously found that prediction models perform better in validation data with a high Hb deferral rate. We therefore investigate how Hb deferral prediction models perform when exchanged with other blood establishments. MATERIALS AND METHODS Donation data from the past 5 years from random samples of 10,000 donors from Australia, Belgium, Finland, the Netherlands and South Africa were used to fit random forest models for Hb deferral prediction. Trained models were exchanged between blood establishments. Model performance was evaluated using the area under the precision-recall curve (AUPR). Variable importance was assessed using SHapley Additive exPlanations (SHAP) values. RESULTS Across the validation datasets and exchanged models, the AUPR ranged from 0.05 to 0.43. Exchanged models performed similarly within validation datasets, irrespective of the origin of the training data. Apart from subtle differences, the importance of most predictor variables was similar in all trained models. CONCLUSION Our results suggest that Hb deferral prediction models trained in different blood establishments perform similarly within different validation datasets, regardless of the deferral rate of their training data. Models learn similar associations in different blood establishments.
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Affiliation(s)
- Amber Meulenbeld
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jarkko Toivonen
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Marieke Vinkenoog
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Tinus Brits
- Business Intelligence, South African National Blood Service, Johannesburg, South Africa
| | - Ronel Swanevelder
- Business Intelligence, South African National Blood Service, Johannesburg, South Africa
| | | | - Veerle Compernolle
- Dienst voor het Bloed, Belgian Red Cross Ugent, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Surendra Karki
- Research and Development, Australian Red Cross Lifeblood, Sydney, Australia
| | - Marijke Welvaert
- Research and Development, Australian Red Cross Lifeblood, Sydney, Australia
| | - Katja van den Hurk
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Mart Janssen
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Mikko Arvas
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
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4
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Westenend P, Meurs C, van Bekkum S, van Rosmalen J, Menke-Pluijmers M, Siesling S. ASO Author Reflections: What Can Prediction Models for Upstaging of DCIS Diagnosed on Biopsy Tell Us About DCIS Surveillance Trials? Ann Surg Oncol 2024; 31:2272-2273. [PMID: 38270829 DOI: 10.1245/s10434-024-14964-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Affiliation(s)
| | - Claudia Meurs
- Department of HTSR, Department of Research, University of Twente, Enschede, The Netherlands
- CMAnalyzing, Zevenaar, The Netherlands
| | - Sara van Bekkum
- Albert Schweitzer Hospital, Department of Surgery, Dordrecht, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Sabine Siesling
- Department of HTSR, Department of Research, University of Twente, Enschede, The Netherlands
- Comprehensive Cancer Organisation, Utrecht, The Netherlands
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5
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van der Maas NG, Versluis J, Nasserinejad K, van Rosmalen J, Pabst T, Maertens J, Breems D, Manz M, Cloos J, Ossenkoppele GJ, Floisand Y, Gradowska P, Löwenberg B, Huls G, Postmus D, Pignatti F, Cornelissen JJ. Bayesian interim analysis for prospective randomized studies: reanalysis of the acute myeloid leukemia HOVON 132 clinical trial. Blood Cancer J 2024; 14:56. [PMID: 38538587 PMCID: PMC10973506 DOI: 10.1038/s41408-024-01037-3] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/07/2024] Open
Abstract
Randomized controlled trials (RCTs) are the gold standard to establish the benefit-risk ratio of novel drugs. However, the evaluation of mature results often takes many years. We hypothesized that the addition of Bayesian inference methods at interim analysis time points might accelerate and enforce the knowledge that such trials may generate. In order to test that hypothesis, we retrospectively applied a Bayesian approach to the HOVON 132 trial, in which 800 newly diagnosed AML patients aged 18 to 65 years were randomly assigned to a "7 + 3" induction with or without lenalidomide. Five years after the first patient was recruited, the trial was negative for its primary endpoint with no difference in event-free survival (EFS) between experimental and control groups (hazard ratio [HR] 0.99, p = 0.96) in the final conventional analysis. We retrospectively simulated interim analyses after the inclusion of 150, 300, 450, and 600 patients using a Bayesian methodology to detect early lack of efficacy signals. The HR for EFS comparing the lenalidomide arm with the control treatment arm was 1.21 (95% CI 0.81-1.69), 1.05 (95% CI 0.86-1.30), 1.00 (95% CI 0.84-1.19), and 1.02 (95% CI 0.87-1.19) at interim analysis 1, 2, 3 and 4, respectively. Complete remission rates were lower in the lenalidomide arm, and early deaths more frequent. A Bayesian approach identified that the probability of a clinically relevant benefit for EFS (HR < 0.76, as assumed in the statistical analysis plan) was very low at the first interim analysis (1.2%, 0.6%, 0.4%, and 0.1%, respectively). Similar observations were made for low probabilities of any benefit regarding CR. Therefore, Bayesian analysis significantly adds to conventional methods applied for interim analysis and may thereby accelerate the performance and completion of phase III trials.
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Affiliation(s)
- Niek G van der Maas
- Department of Hematology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jurjen Versluis
- Department of Hematology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kazem Nasserinejad
- Department of Hematology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Thomas Pabst
- University Hospital, Inselspital, Bern, Switzerland
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | | | | | - Markus Manz
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
- University Hospital Zurich, Zurich, Switzerland
| | - Jacqueline Cloos
- Amsterdam UMC, location VUMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Gert J Ossenkoppele
- Amsterdam UMC, location VUMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Patrycja Gradowska
- Department of Hematology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
- HOVON Foundation, Rotterdam, the Netherlands
| | - Bob Löwenberg
- Department of Hematology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gerwin Huls
- University Medical Center, University Groningen, Groningen, the Netherlands
| | - Douwe Postmus
- Oncology and Hematology Office, European Medicines Agency, Amsterdam, the Netherlands
| | - Francesco Pignatti
- Oncology and Hematology Office, European Medicines Agency, Amsterdam, the Netherlands
| | - Jan J Cornelissen
- Department of Hematology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
- Oncology and Hematology Office, European Medicines Agency, Amsterdam, the Netherlands.
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6
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de Leeuw TG, Boerlage AA, van West HM, Renkens JJM, van Rosmalen J, Staals LME, Weber F, Tibboel D, de Wildt SN. Pain during the first year after scoliosis surgery in adolescents, an exploratory, prospective cohort study. Front Pediatr 2024; 12:1293588. [PMID: 38312922 PMCID: PMC10834739 DOI: 10.3389/fped.2024.1293588] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Objective Approximately 50% of adolescents who have undergone scoliosis surgery still experience severe pain one year postoperatively. We explored the postoperative pain trajectory and the potential value of preoperative Thermal Quantitative Sensory Testing (T-QST) as predictor of chronic postsurgical pain after scoliosis surgery. Design Single-center prospective cohort study in adolescents undergoing scoliosis surgery. Outcomes Prevalence of chronic postsurgical pain (CPSP) one year after scoliosis surgery and postsurgical pain course during this year. The need for rescue medication and the relationship between pre-operative T-QST, acute pain and CPSP. Results Thirty-nine patients (mean age 13.9 years; SD 1.9 years) completed the study. One year postoperatively, ten patients (26%) self-reported pain [numeric rating scale (NRS) score ≥ 4]) when moving and two (5%) when in rest. Four of these patients (10.3%) experienced neuropathic pain. The pre-operative cold pain threshold was lower (p = 0.002) in patients with CPSP at 12 months. Preoperative cold and heat pain thresholds were correlated with the number of moderate or severe pain reports (NRS ≥ 4) in the first week postoperatively (r -.426; p = 0.009 and r.392; p = 0.016, respectively). Conclusions One year after scoliosis surgery, a significant part of patients (26%) still reported pain, some with neuropathic characteristics. Better diagnosis and treatment is needed; our study suggests that T-QST could be further explored to better understand and treat children with this negative outcome.
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Affiliation(s)
- Thomas G. de Leeuw
- Department of Anesthesiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Anneke A. Boerlage
- Department of Anesthesiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Neonatal and Pediatric Intensive Care, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Hanneke M. van West
- Department of Orthopedic Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Jeroen J. M. Renkens
- Department of Orthopedic Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
| | - Lonneke M. E. Staals
- Department of Anesthesiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Frank Weber
- Department of Anesthesiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Dick Tibboel
- Department of Neonatal and Pediatric Intensive Care, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Saskia N. de Wildt
- Department of Neonatal and Pediatric Intensive Care, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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7
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Schafthuizen L, van Dijk M, van Rosmalen J, Ista E. Mobility level and factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms. BMC Nurs 2024; 23:11. [PMID: 38163905 PMCID: PMC10759502 DOI: 10.1186/s12912-023-01648-4] [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: 06/15/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Although stimulating patients' mobility is considered a component of fundamental nursing care, approximately 35% of hospitalized patients experience functional decline during or after hospital admission. The aim of this study is to assess mobility level and to identify factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms (SPRs) on general wards. METHODS Mobility level was quantified with the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) and EQ-5D-3L. GENEActiv accelerometer data over 24 h were collected in a subset of patients. Data were analyzed using generalized ordinal logistic regression analysis. The STROBE reporting checklist was applied. RESULTS Wearing pajamas during daytime, having pain, admission in an isolation room, and wearing three or more medical equipment were negatively associated with mobilization level. More than half of patients (58.9%) who were able to mobilize according to the EQ-5D-3L did not achieve the highest possible level of mobility according to the JH-HLM. The subset of patients that wore an accelerometer spent most of the day in sedentary behavior (median 88.1%, IQR 85.9-93.6). The median total daily step count was 1326 (range 22-5362). CONCLUSION We found that the majority of participating hospitalized patients staying in single-occupancy patient rooms were able to mobilize. It appeared, however, that most of the patients who are physically capable of walking, do not reach the highest possible level of mobility according to the JH-HLM scale. Nurses should take their responsibility to ensure that patients achieve the highest possible level of mobility.
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Affiliation(s)
- Laura Schafthuizen
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Monique van Dijk
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands
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8
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van den Berg R, Blok K, Tebayna N, van Dijk M, van Rosmalen J, de Beukelaar J. Reasons Patients With Primary Progressive Multiple Sclerosis Contact Their Specialist Nurses. Int J MS Care 2024; 26:30-35. [PMID: 38213677 PMCID: PMC10779713 DOI: 10.7224/1537-2073.2022-056] [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] [Indexed: 01/13/2024]
Abstract
BACKGROUND Questions asked by patients with primary progressive multiple sclerosis (PPMS) during patient-initiated MS nurse consultations may contain salient information that can help health care providers understand their needs, which, in turn, can help tailor counseling and treatment. METHODS Records of all patients with PPMS visiting the MS center of a large teaching hospital in the Netherlands between January 2007 and January 2021 were studied retrospectively. Number and type (scheduled or patient initiated) of MS nurse consultations, reasons for consultations (in prespecified categories), and frequency of subsequent referrals were registered. Association between factors (living with partner, Expanded Disability Status Scale score, comorbidities, age, sex) and number of patient-initiated consultations was studied using negative binomial regression analysis. RESULTS In total, 98 patients with PPMS were included, with 720 MS nurse consultations during follow-up (median duration, 8.1 years), of which 274 (38%) were patient initiated. Patients had a broad spectrum of reasons to contact MS nurses. The most common categories were treatment (36%) and micturition and defecation (31%). Patients living without a partner (incidence rate ratio, 2.340; 95% CI, 1.057-5.178) and male patients (incidence rate ratio, 1.890; 95% CI, 0.925-3.861) consulted MS nurses more frequently. The MS nurses made 146 referrals (20% of all contacts); 59 were after patient-initiated consultation (22%). The most frequent referrals were to neurologists, urologists, and rehabilitation specialists. CONCLUSIONS Multiple sclerosis nurses have a pivotal role in PPMS care, especially for patients living without a partner and male patients. Recurring questions about (new) treatment options illustrate the pressing need for highly effective treatment. Micturition and defecation problems are also a considerable concern and warrant close monitoring.
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Affiliation(s)
- Rosaline van den Berg
- From the Department of Neurology, Multiple Sclerosis Center (RvdB, KB, NT, JdB) and the Science Office (RvdB), Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Katelijn Blok
- From the Department of Neurology, Multiple Sclerosis Center (RvdB, KB, NT, JdB) and the Science Office (RvdB), Albert Schweitzer Hospital, Dordrecht, the Netherlands
- Multiple Sclerosis Center ErasMS of the Department of Neurology (KB)
| | - Nura Tebayna
- From the Department of Neurology, Multiple Sclerosis Center (RvdB, KB, NT, JdB) and the Science Office (RvdB), Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Monique van Dijk
- Nursing Science Section of the Department of Internal Medicine (MvD)
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9
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Drop JG, Wildschut ED, de Maat MPM, van Rosmalen J, de Boode WP, de Hoog M, Heleen van Ommen C. Acquired von Willebrand disease in children undergoing extracorporeal membrane oxygenation: a prospective observational study. J Thromb Haemost 2023; 21:3383-3392. [PMID: 37579879 DOI: 10.1016/j.jtha.2023.08.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) provides cardiopulmonary support for children with severe cardiac and/or pulmonary failure. The incidence of bleeding complications during ECMO support is high. Acquired von Willebrand disease (AVWD) might contribute to the development of bleeding complications. OBJECTIVE To study the incidence and longitudinal profile of AVWD during the first 14 days of ECMO support in children and to investigate the association between AVWD and bleeding complications. METHODS This prospective observational study included pediatric patients (0-17 years) receiving ECMO. Blood was sampled prior to and after ECMO start, daily and 12 to 24 hours after stopping ECMO. von Willebrand factor (VWF) parameters and multimer patterns were determined. Clinical data were collected for each patient. AVWD was defined as loss of high-molecular weight multimers (ie, decreased compared with baseline) or a VWF:collagen binding/VWF: antigen (Ag) ratio or VWF:activity/VWF:Ag ratio below 0.7. RESULTS All of 50 (100%) patients developed AVWD during ECMO. The VWF:collagen binding /VWF:Ag ratio, VWF:activity/VWF:Ag ratio, and high-molecular weight multimers decreased during the initial days and recovered to baseline level within 24 hours after stopping ECMO. The incidence and longitudinal profile of AVWD were similar in patients with and without major bleeding complications. CONCLUSION Children receiving ECMO support commonly develop AVWD. AVWD develops rapidly after ECMO initiation and recovers quickly after ECMO cessation. Importantly, AVWD appears to be independent of major bleeding.
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Affiliation(s)
- Joppe G Drop
- Department of Paediatrics, Division of Paediatric Hematology, Erasmus Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Paediatrics, Division of Pediatric Intensive care and Pediatric surgery, Erasmus Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Enno D Wildschut
- Department of Paediatrics, Division of Pediatric Intensive care and Pediatric surgery, Erasmus Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Moniek P M de Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Willem P de Boode
- Division of Neonatology, Dept. of Perinatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Matthijs de Hoog
- Department of Paediatrics, Division of Pediatric Intensive care and Pediatric surgery, Erasmus Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - C Heleen van Ommen
- Department of Paediatrics, Division of Paediatric Hematology, Erasmus Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands.
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10
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Blok KM, Smolders J, van Rosmalen J, Martins Jarnalo CO, Wokke B, de Beukelaar J. Real-world challenges in the diagnosis of primary progressive multiple sclerosis. Eur J Neurol 2023; 30:3799-3808. [PMID: 37578087 DOI: 10.1111/ene.16042] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND AND PURPOSE Despite the 2017 revisions to the McDonald criteria, diagnosing primary progressive multiple sclerosis (PPMS) remains challenging. To improve clinical practice, the aim was to identify frequent diagnostic challenges in a real-world setting and associate these with the performance of the 2010 and 2017 PPMS diagnostic McDonald criteria. METHODS Clinical, radiological and laboratory characteristics at the time of diagnosis were retrospectively recorded from designated PPMS patient files. Possible complicating factors were recorded such as confounding comorbidity, signs indicative of alternative diagnoses, possible earlier relapses and/or incomplete diagnostic work-up (no cerebrospinal fluid examination and/or magnetic resonance imaging brain and spinal cord). The percentages of patients fulfilling the 2010 and 2017 McDonald criteria were calculated after censoring patients with these complicating factors. RESULTS A total of 322 designated PPMS patients were included. Of all participants, it was found that n = 28/322 had confounding comorbidity and/or signs indicative of alternative diagnoses, n = 103/294 had possible initial relapsing and/or uncertainly progressive phenotypes and n = 73/191 received an incomplete diagnostic work-up. When applying the 2010 and 2017 diagnostic PPMS McDonald criteria on n = 118 cases with a full diagnostic work-up and a primary progressive disease course without a better alternative explanation, these were met by 104/118 (88.1%) and 98/118 remaining patients (83.1%), respectively (p = 0.15). CONCLUSION Accurate interpretation of the initial clinical course, consideration of alternative diagnoses and a full diagnostic work-up are the cornerstones of a PPMS diagnosis. When these conditions are met, the 2010 and 2017 McDonald criteria for PPMS perform similarly, emphasizing the importance of their appropriate application in clinical practice.
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Affiliation(s)
- Katelijn M Blok
- Department of Neurology, MS Center of the Albert Schweitzer Hospital, Dordrecht, The Netherlands
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost Smolders
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Immunology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, The Netherlands
- Neuroimmunology Research Group, Netherlands Institute for Neurosciences, Amsterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carine O Martins Jarnalo
- Department of Radiology, MS Center of the Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Beatrijs Wokke
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Janet de Beukelaar
- Department of Neurology, MS Center of the Albert Schweitzer Hospital, Dordrecht, The Netherlands
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11
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Erdem Ö, de Graaff JC, Hilty MP, Kraemer US, de Liefde II, van Rosmalen J, Ince C, Tibboel D, Kuiper JW. Microcirculatory Monitoring in Children with Congenital Heart Disease Before and After Cardiac Surgery. J Cardiovasc Transl Res 2023; 16:1333-1342. [PMID: 37450208 PMCID: PMC10721654 DOI: 10.1007/s12265-023-10407-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
In this prospective observational study, we investigated whether congenital heart disease (CHD) affects the microcirculation and whether the microcirculation is altered following cardiac surgery with cardiopulmonary bypass (CPB). Thirty-eight children with CHD undergoing cardiac surgery with CPB and 35 children undergoing elective, non-cardiac surgery were included. Repeated non-invasive sublingual microcirculatory measurements were performed with handheld vital microscopy. Before surgery, children with CHD showed similar perfused vessel densities and red blood cell velocities (RBCv) but less perfused vessels (p < 0.001), lower perfusion quality (p < 0.001), and higher small vessel densities (p = 0.039) than children without CHD. After cardiac surgery, perfused vessel densities and perfusion quality of small vessels declined (p = 0.025 and p = 0.032), while RBCv increased (p = 0.032). We demonstrated that CHD was associated with decreased microcirculatory perfusion and increased capillary recruitment. The microcirculation was further impaired after cardiac surgery. Decreased microcirculatory perfusion could be a warning sign for altered tissue oxygenation and requires further exploration.
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Affiliation(s)
- Özge Erdem
- Intensive Care and department of Pediatric Surgery, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Jurgen C de Graaff
- Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Matthias P Hilty
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Ulrike S Kraemer
- Intensive Care and department of Pediatric Surgery, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Inge I de Liefde
- Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Can Ince
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan Willem Kuiper
- Intensive Care and department of Pediatric Surgery, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
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12
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Blok KM, van Rosmalen J, Tebayna N, Smolders J, Wokke B, de Beukelaar J. Disease activity in primary progressive multiple sclerosis: a systematic review and meta-analysis. Front Neurol 2023; 14:1277477. [PMID: 38020591 PMCID: PMC10661414 DOI: 10.3389/fneur.2023.1277477] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Disease activity in multiple sclerosis (MS) is defined as presence of relapses, gadolinium enhancing lesions and/or new or enlarging lesions on MRI. It is associated with efficacy of immunomodulating therapies (IMTs) in primary progressive MS (PPMS). However, a thorough review on disease activity in PPMS is lacking. In relapsing remitting MS, the prevalence of activity decreases in more contemporary cohorts. For PPMS, this is unknown. Aim To review disease activity in PPMS cohorts and identify its predictors. Methods A systematic search in EMBASE, MEDLINE, Web of science Core Collection, COCHRANE CENTRAL register of trials, and GOOGLE SCHOLAR was performed. Keywords included PPMS, inflammation, and synonyms. We included original studies with predefined available data, extracted cohort characteristics and disease activity outcomes and performed meta-regression analyses. Results We included 34 articles describing 7,109 people with PPMS (pwPPMS). The weighted estimated proportion of pwPPMS with overall disease activity was 26.8% (95% CI 20.6-34.0%). A lower age at inclusion predicted higher disease activity (OR 0.91, p = 0.031). Radiological activity (31.9%) was more frequent than relapses (9.2%), and was predicted by longer follow-up duration (OR 1.27, p = 0.033). Year of publication was not correlated with disease activity. Conclusion Inflammatory disease activity is common in PPMS and has remained stable over the last decades. Age and follow-up duration predict disease activity, advocating prolonged monitoring of young pwPPMS to evaluate potential IMT benefits.
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Affiliation(s)
- Katelijn M. Blok
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Nura Tebayna
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Joost Smolders
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Immunology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
- Neuroimmunology Researchgroup, Netherlands Institute for Neuroscience, Amsterdam, Netherlands
| | - Beatrijs Wokke
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Janet de Beukelaar
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
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13
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Meurs CJC, van Bekkum S, van Rosmalen J, Menke-Pluijmers MBE, Siesling S, Westenend PJ. Validation and Clinical Utility of a Prediction Model for the Risk of Upstaging to Invasive Breast Cancer After a Biopsy Diagnosis Ductal Carcinoma In Situ. Ann Surg Oncol 2023; 30:7069-7080. [PMID: 37541961 PMCID: PMC10562335 DOI: 10.1245/s10434-023-13929-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/24/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND This study aimed to validate the DCIS-upstage model, a previously developed model to predict the risk of upstaging to invasive breast cancer in patients with biopsy-proven ductal carcinoma in situ (DCIS) in a more recent cohort and to assess the model's clinical utility. METHODS The model was validated in a registry cohort (n = 2269) and in an institution cohort (n = 302). A calibration plot was made, followed by a decision curve analysis (DCA). The model's area under the curve (AUC) was compared with the AUC of another published model and with the AUCs of new models using the risk factors of the DCIS-upstage model and additional risk factors. RESULTS The DCIS-upstage model had an AUC of 0.67 at development; in the validation, the AUC was 0.65 in the registry cohort and 0.73 in the institution cohort. The DCA showed that the model has clinical utility. The other published model had an AUC of 0.66 in the institution cohort. Adding risk factors to the DCIS-upstage model slightly increased the AUC. CONCLUSIONS The DCIS-upstage prediction model is valid in other cohorts. The model has clinical utility and may be used to select patients with biopsy-proven DCIS for sentinel lymph node biopsy.
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Affiliation(s)
- Claudia J C Meurs
- Department of HTSR, University of Twente, Enschede, The Netherlands.
- CMAnalyzing, Zevenaar, The Netherlands.
| | - Sara van Bekkum
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Sabine Siesling
- Department of HTSR, University of Twente, Enschede, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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14
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Drop J, Letunica N, Van Den Helm S, Heleen van Ommen C, Wildschut E, de Hoog M, van Rosmalen J, Barton R, Yaw HP, Newall F, Horton SB, Chiletti R, Johansen A, Best D, McKittrick J, Butt W, d’Udekem Y, MacLaren G, Linden MD, Ignjatovic V, Attard C, Monagle P. Factors XI and XII in extracorporeal membrane oxygenation: longitudinal profile in children. Res Pract Thromb Haemost 2023; 7:102252. [PMID: 38193071 PMCID: PMC10772870 DOI: 10.1016/j.rpth.2023.102252] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 01/10/2024] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) is used in children with cardiopulmonary failure. While the majority of ECMO centers use unfractionated heparin, other anticoagulants, including factor XI and factor XII inhibitors are emerging, which may prove suitable for ECMO patients. However, before these anticoagulants can be applied in these patients, baseline data of FXI and FXII changes need to be acquired. Objectives This study aimed to describe the longitudinal profile of FXI and FXII antigenic levels and function before, during, and after ECMO in children. Methods This is a prospective observational study in neonatal and pediatric patients with ECMO (<18 years). All patients with venoarterial ECMO and with sufficient plasma volume collected before ECMO, on day 1 and day 3, and 24 hours postdecannulation were included. Antigenic levels and functional activity of FXI and FXII were determined in these samples. Longitudinal profiles of these values were created using a linear mixed model. Results Sixteen patients were included in this study. Mean FXI and FXII antigenic levels (U/mL) changed from 7.9 and 53.2 before ECMO to 6.0 and 34.5 on day 3 and they recovered to 8.8 and 39.4, respectively, after stopping ECMO. Function (%) of FXI and FXII decreased from 59.1 and 59.0 to 49.0 and 50.7 on day 3 and recovered to 66.0 and 54.4, respectively. Conclusion This study provides the first insights into changes of the contact pathway in children undergoing ECMO. FXI and FXII antigen and function change during ECMO. Results from this study can be used as starting point for future contact pathway anticoagulant studies in pediatric patients with ECMO.
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Affiliation(s)
- Joppe Drop
- Department of Paediatrics, Division of Paediatric Hematology, Erasmus Medical Centre—Sophia Children’s Hospital, Rotterdam, South Holland, The Netherlands
- Department of Paediatrics, Division of Paediatric Intensive Care and Paediatric Surgery, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, South Holland, The Netherlands
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Natasha Letunica
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Suelyn Van Den Helm
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - C. Heleen van Ommen
- Department of Paediatrics, Division of Paediatric Hematology, Erasmus Medical Centre—Sophia Children’s Hospital, Rotterdam, South Holland, The Netherlands
| | - Enno Wildschut
- Department of Paediatrics, Division of Paediatric Intensive Care and Paediatric Surgery, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, South Holland, The Netherlands
| | - Matthijs de Hoog
- Department of Paediatrics, Division of Paediatric Intensive Care and Paediatric Surgery, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, South Holland, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, South Holland, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, South Holland, The Netherlands
| | - Rebecca Barton
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Clinical Haematology, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Hui Ping Yaw
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Fiona Newall
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Clinical Haematology, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Stephen B. Horton
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Roberto Chiletti
- Department of Intensive Care, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Paediatric Intensive Care Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amy Johansen
- Department of Intensive Care, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Paediatric Intensive Care Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Derek Best
- Department of Intensive Care, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Paediatric Intensive Care Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Joanne McKittrick
- Department of Intensive Care, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Warwick Butt
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Paediatric Intensive Care Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yves d’Udekem
- Department of Cardiac Surgery, Children’s National Heart Institute, Washington DC, USA
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Health System, Singapore
| | - Matthew D. Linden
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Johns Hopkins All Children’s Institute for Clinical and Translational Research, St Petersburg, Florida, USA
- Department of Paediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chantal Attard
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Clinical Haematology, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
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15
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Meurs CJC, van Bekkum S, van Rosmalen J, Menke-Pluijmers MBE, Siesling S, Westenend PJ. ASO Visual Abstract: Validation and Clinical Utility of a Prediction Model for the Risk of Upstaging to Invasive Breast Cancer After a Biopsy Diagnosis of Ductal Carcinoma In Situ. Ann Surg Oncol 2023; 30:7148-7149. [PMID: 37566288 DOI: 10.1245/s10434-023-14090-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Claudia J C Meurs
- Department of HTSR, University of Twente, Enschede, The Netherlands.
- CMAnalyzing, Zevenaar, The Netherlands.
| | - Sara van Bekkum
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Sabine Siesling
- Department of HTSR, University of Twente, Enschede, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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16
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Geurts KAM, Ozcan B, van Hoek M, van de Laar R, van Teeffelen J, van Rosmalen J, van Rossum EFC, Berk KA. The (cost) effectiveness of a very low-energy diet intervention with the use of eHealth in patients with type 2 diabetes and obesity: study protocol for a randomised controlled non-inferiority trial (E-diet trial). Trials 2023; 24:642. [PMID: 37798620 PMCID: PMC10557281 DOI: 10.1186/s13063-023-07620-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Despite preventive measures, the number of people with type 2 diabetes and obesity is increasing. Obesity increases morbidity and mortality in people with type 2 diabetes, making weight loss a cornerstone of treatment. We previously developed a very low energy diet (VLED) intervention that effectively reduced weight in people with type 2 diabetes in the long term. However, this intervention requires considerable time and manpower, which reduces the number of people who can benefit from it. eHealth offers more efficient solutions but has proven to be less effective than face-to-face interventions. Therefore, we want to investigate whether a blended version of our VLED intervention (in which face-to-face contact is partly replaced by an eHealth (mobile) application (E-VLED)) would be more cost-effective than the current face-to-face intervention. METHODS We will conduct a randomised, controlled trial with non-inferiority design in patients with type 2 diabetes and obesity (BMI > 30 kg/m2), aged 18-75 years. The control group will receive the usual care VLED intervention, while the intervention group will receive the E-VLED intervention for 1 year, where face-to-face contact will be partly replaced by an eHealth (mobile) application. The main study endpoint is the difference in weight (% change) between the control and intervention group after 1 year, plus the difference between the total costs (euro) of the treatment in the control and intervention groups. The secondary aims are to investigate the effectiveness of the E-VLED diet intervention regarding cardiovascular risk factors, quality of life, patient satisfaction, compliance, and to study whether there is a difference in effectiveness in pre-specified subgroups. General linear models for repeated measurements will be applied for the statistical analysis of the data. DISCUSSION We hypothesise that the E-VLED intervention will be equally effective compared to the usual care VLED but lower in costs due to less time invested by the dietician. This will enable to help more people with type 2 diabetes and obesity to effectively lose weight and improve their health-related quality of life. TRIAL REGISTRATION Netherlands Trial Register, NL7832, registered on 26 June 2019.
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Affiliation(s)
- Karlijn A M Geurts
- Department of Internal Medicine, Division of Dietetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Behiye Ozcan
- Department of Internal Medicine, Division of Diabetology and Division of Vascular Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mandy van Hoek
- Department of Internal Medicine, Division of Diabetology and Division of Vascular Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Roel van de Laar
- Department of Internal Medicine, Ikazia Hospital, Montessoriweg 1, 3083 AN, Rotterdam, The Netherlands
| | - Jolande van Teeffelen
- Dietician Practice Health Risk Control, Henk Speksnijderstraat 27, 3067 AC, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Division of Endocrinology, Obesity Center CGG, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Kirsten A Berk
- Department of Internal Medicine, Division of Dietetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Billar R, Kappen P, Mohammadian S, van den Berg C, de Rijke Y, van den Akker E, van Rosmalen J, Schnater JM, Vincent A, Dirven C, Klimek M, Wijnen R, Jeekel J, Huygen F, Tiemensma J. The effect of recorded music on pain endurance (CRESCENDo) - A randomized controlled trial. Complement Ther Med 2023; 77:102969. [PMID: 37579996 DOI: 10.1016/j.ctim.2023.102969] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/05/2023] [Accepted: 08/10/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION Clarifying the effect of music on pain endurance in an experimental design could aid in how music should be applied during both surgical and non-surgical interventions. This study aims to investigate the effect of music on pain endurance and the involvement of the sympathetic adrenomedullary axis (SAM) and the hypothalamic-pituitary-adrenocortical axis (HPA). MATERIALS AND METHODS In this randomized controlled trial all participants received increasing electric stimuli through their non-dominant index finger. Participants were randomly assigned to the music group (M) receiving a 20-minute music intervention or control group (C) receiving a 20-minute resting period. The primary outcome was pain endurance, defined as amount milliampere tolerated. Secondary outcomes included anxiety level, SAM-axis based on heart rate variability (HRV) and salivary alpha-amylase, and HPA-axis activity based on salivary cortisol. RESULTS In the intention-to-treat analysis, the effect of music on pain tolerance did not statistically differ between the M and C group. A significant positive effect of music on pain endurance was noted after excluding participants with a high skin impedance (p = 0.013, CI 0.35; 2.85). Increased HRV was observed in the M-group compared to the C-group for SDNN (B/95%CI:13.80/2.22;25.39, p = 0.022), RMSSD (B/95%CI:15.97/1.64;30.31, p = 0.032), VLF (B/95%CI:212.08/60.49;363.67, p = 0.008) and HF (B/95%CI:821.15/150.78;1491.52, p = 0.0190). No statistical significance was observed in other secondary outcomes. CONCLUSIONS The effect of the music intervention on pain endurance was not statistically significant in the intention-to-treat analysis. The subgroup analyses revealed an increase in pain endurance in the music group after correcting for skin impedance, which could be attributed to increased parasympathetic activation.
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Affiliation(s)
- Ryan Billar
- Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Pablo Kappen
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sepehr Mohammadian
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Corinne van den Berg
- Department of Anesthesiology, Center for Pain Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yolanda de Rijke
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Erica van den Akker
- Department of Pediatric Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - J Marco Schnater
- Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Arnaud Vincent
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Clemens Dirven
- Department of Anesthesiology, Center for Pain Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Markus Klimek
- Department of Anesthesiology, Center for Pain Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - René Wijnen
- Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Johannes Jeekel
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Frank Huygen
- Department of Anesthesiology, Center for Pain Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jitske Tiemensma
- Department of Anesthesiology, Center for Pain Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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Kraemer US, Kamphuis LS, Ciet P, Visser L, Tibboel D, Bartelds B, Cochius-den Otter SCM, de Blaauw I, van Rosmalen J, Gischler SJ, Schnater JM, IJsselstijn H. Cardiopulmonary Morbidity in Adults Born With Congenital Diaphragmatic Hernia. Pediatrics 2023; 152:e2023062341. [PMID: 37750210 DOI: 10.1542/peds.2023-062341] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/25/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES Studies concerning cardiopulmonary outcomes of adults born with congenital diaphragmatic hernia (CDH) are sparse. Moreover, they don't include participants who have been treated with extracorporeal membrane oxygenation (ECMO) during the neonatal period. This study evaluated the cardiopulmonary morbidities in young adults born with CDH. METHODS We assessed 68 participants between the ages of 18 and 30 years. The assessment included auxology assessment, lung function tests, pulmonary imaging, cardiopulmonary exercise testing, and echocardiography. RESULTS Lung function parameters in the overall group were significantly worse than normal values. Mean (SD) scores postbronchodilator forced expiratory volume in 1 second were -2.91 (1.38) in the ECMO-treated and -1.20 (1.53) in the non-ECMO-treated participants. Chest computed tomography scans showed mild to moderate abnormal lung structure in all ECMO-treated participants, and to a lesser extent in non-ECMO treated participants. A recurrent diaphragmatic defect was observed in 77% of the ECMO-treated group and in 43% of the non-ECMO-treated group. Except for 2 cases with acute symptoms, no clinical problems were noted in cases of recurrence. Cardiopulmonary exercise testing revealed mean (SD) percentage predicted peak oxygen consumption per kilogram of 73 (14)% and 88 (16)% in ECMO-treated and non-ECMO-treated participants, respectively. The mean (SD) workload was normal in the non-ECMO-treated group (111 [25]% predicted); in the ECMO-treated group, it was 89 (23)%. Cardiac evaluation at rest revealed no signs of pulmonary hypertension. CONCLUSIONS In young adults who survived treatment of CDH, significant pulmonary morbidity, reduced exercise capacity, and frequent hernia recurrence should be anticipated. Lifelong follow-up care, with the emphasis on prevention of further decline, is to be recommended.
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Affiliation(s)
- Ulrike S Kraemer
- Department of Pediatric Surgery
- Division of Pediatric Intensive Care, Department of Pediatric & Neonatal Intensive Care
| | | | | | | | | | - Beatrijs Bartelds
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
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19
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Van den Dop LM, Van Egmond S, Heijne J, van Rosmalen J, de Goede B, Wijsmuller AR, Kleinrensink GJ, Tanis PJ, Jeekel J, Lange JF. Twelve-year outcomes of watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 years and older: a randomised controlled trial. EClinicalMedicine 2023; 64:102207. [PMID: 37936657 PMCID: PMC10626166 DOI: 10.1016/j.eclinm.2023.102207] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 11/09/2023] Open
Abstract
Background Inguinal hernia belongs to the most common surgical pathology worldwide. Approximately, one third is asymptomatic. The value of watchful waiting (WW) in patients with asymptomatic or mildly symptomatic inguinal hernia has been established in a few randomised controlled trials (RCTs). The aim of this study was to assess long-term outcomes of a RCT comparing WW and elective surgery. Methods In the original study, men aged ≥50 years with an asymptomatic or mildly symptomatic inguinal hernia were randomly assigned to WW or elective repair. In the present study, the primary outcome was the 12-year crossover rate to surgery, secondary outcomes were time-to-crossover, patient regret, pain, quality of life and incarceration. Dutch Trial Registry: NTR629. Findings Out of 496 originally analysed patients, 488 (98.4%) were evaluable for chart review (WW: n = 258, surgery: n = 230), and 200 (41.0%) for telephone contact (WW: n = 106, surgery: n = 94) between November 2021 and March 2022 with a median 12 years follow-up (IQR 9-14). After 12 years, the estimated cumulative crossover rate to surgery was 64.2%, which was higher in mildly symptomatic than in asymptomatic patients (71.7% versus 60.4%, HR 1.451, 95% CI: 1.064-1.979). Time-to-crossover was longer in asymptomatic patients (50% after 6.0 years versus 2.0 years, p = 0.019). Patient regret was higher in the WW group (37.7 versus 18.0%, p = 0.002), as well as pain/discomfort (p = 0.031). Quality of life did not differ (p = 0.737). In the WW group, incarceration occurred in 10/255 patients (3.9%). Interpretation During 12-year follow-up, most WW patients crossed over to surgery, significantly earlier with mildly symptomatic hernia. Considering the relatively low incarceration rate, WW might still be an option in asymptomatic patients with a clear preference and being well-informed about pros and cons. Funding The initial trial was funded by the Netherlands Organisation for Health Research and Development (ZonMW). This long-term study did not receive funding.
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Affiliation(s)
| | - Sarah Van Egmond
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jort Heijne
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Barry de Goede
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Surgery, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Arthur R. Wijsmuller
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Gert-Jan Kleinrensink
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Pieter J. Tanis
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johannes Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johan F. Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Martínez EP, van Rosmalen J, Jacobs J, Sanders P, van Geijlswijk IM, Heederik DJJ, Verbon A. Seasonality of antimicrobial use in Dutch food-producing animals. Prev Vet Med 2023; 219:106006. [PMID: 37647721 DOI: 10.1016/j.prevetmed.2023.106006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
Due to globally increasing antimicrobial resistance (AMR), it is pivotal to understand factors contributing to antimicrobial use (AMU) to enable development and implementation of AMR-reducing interventions. Therefore, we explored seasonal variations of systemic AMU in food-producing animals in the Netherlands. Dutch surveillance data from January 2013 to December 2018 from cattle, pig, and broiler farms were used. AMU was expressed as the number of Defined Daily Dosages Animal per month (DDDA/animal-month) per farm by animal sector, antimicrobial line (first, second, and third), antimicrobial class, and farm type. Seasonality of AMU was analyzed using Generalized Additive Models (GAMs) with DDDA/animal-month as outcome variable, and year and month as independent variables. Year and month were modelled as smooth terms represented with penalized regression splines.Significant seasonality of AMU was found in the cattle and pig sectors, but not in broilers. Significant seasonality of AMU was found mainly for first-line antimicrobials. In the cattle sector, a significant increase during winter was found for the use of amphenicols (an increase of 23.8%) and long-acting macrolides (an increase of 3.4%). In the pig sector, seasonality of AMU was found for pleuromutilins (p < 0.001) with an increase of 20% in October-November. The seasonality of pleuromutilins was stronger in sows/piglets (an increase of 47%) than in fattening pigs (16% increase). Only in fattening pigs, the use of amphenicols showed a significant seasonality with an increase of 11% during winter (P < 0.001). AMU in cattle and pig sectors shows seasonal variations likely caused by seasonality of diseases. In broilers, no AMU seasonality was observed, possibly due to the controlled environment in Dutch farms. In the context of the one health concept, future studies are necessary to explore whether this seasonality is present in other populations and whether it has implications for antimicrobial resistance in humans through the food chain.
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Affiliation(s)
- Evelyn Pamela Martínez
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Jerónimo Leiton s/n y Gatto Sobral, Quito 170103, Ecuador; Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Jose Jacobs
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Yalelaan 2, 3584 CM Utrecht, the Netherlands; The Netherlands Veterinary Medicines Institute (SDa), Yalelaan 114, 3584 CM Utrecht, the Netherlands.
| | - Pim Sanders
- The Netherlands Veterinary Medicines Institute (SDa), Yalelaan 114, 3584 CM Utrecht, the Netherlands.
| | - Ingeborg M van Geijlswijk
- The Netherlands Veterinary Medicines Institute (SDa), Yalelaan 114, 3584 CM Utrecht, the Netherlands; Pharmacy Department, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 106, 3584 CM Utrecht, the Netherlands.
| | - Dick J J Heederik
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Yalelaan 2, 3584 CM Utrecht, the Netherlands; The Netherlands Veterinary Medicines Institute (SDa), Yalelaan 114, 3584 CM Utrecht, the Netherlands.
| | - Annelies Verbon
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
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Schafthuizen L, Spruit-Bentvelzen L, van Dijk M, van Rosmalen J, Ista E. Implementation of a nursing oral health care protocol in a university teaching hospital: A cluster-randomized stepped-wedge design. Int J Dent Hyg 2023. [PMID: 37722075 DOI: 10.1111/idh.12748] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 01/24/2023] [Accepted: 07/30/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Providing oral care is an essential part of basic nursing care but receives little priority in daily practice, with a risk of adverse events. Also, nurses report many barriers to adequate provision of oral care, such as time restraints, insufficient materials, fear of causing pain, lack of knowledge and a negative attitude towards providing oral care. METHODS We performed a cluster-randomized, stepped-wedge study to explore the effect of the the implementation of a new nursing evidence-based oral care protocol on nurses' knowledge, attitude and protocol adherence. The study population included both nursing students, graduated nurses and patients in selected wards. The implementation strategy included oral and written information, instruction videos and reminders. Nurses' knowledge and attitude towards oral care were assessed at baseline and after the implementation of the protocol with a validated 47-item questionnaire with a score range of 0-100. Secondarily, nurses' protocol adherence to teeth brushing, measured in Activities of Daily Living (ADL) dependent patients, was evaluated. The Standards for Reporting Implementation Studies (StaRI) Statement was used. RESULTS At baseline, the questionnaire was completed by 226 nurses; after implementation by 283. Knowledge had significantly improved from 68.8 to 72.3. Nurses' attitude improved not significantly. Protocol adherence was assessed in 73 ADL-dependent patients at baseline, in 51 after implementation. Adherence to teeth brushing significantly decreased in patients with permanent teeth. Also, adherence to both teeth brushing and usage of soap decreased in patients with (partial) dentures. CONCLUSION Nurses' knowledge and attitude of oral care increased somewhat after the implementation of a new nursing evidence-based protocol. After implementation, there was an unexplained decreased adherence to oral care in ADL-dependent patients.
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Affiliation(s)
- Laura Schafthuizen
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Lotte Spruit-Bentvelzen
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
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22
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van Bekkum S, Clarijs ME, van der Veen FJC, van Rosmalen J, Koppert LB, Menke-Pluijmers MBE. What affects women's decision-making on breast reconstruction after mastectomy for breast cancer? Breast Cancer 2023; 30:772-784. [PMID: 37303033 DOI: 10.1007/s12282-023-01471-4] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/20/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE To establish the breast reconstruction rate in a large Dutch teaching hospital, and to gain insight into the motives of women to opt for or reject post-mastectomy breast reconstruction. METHODS In a retrospective, cross-sectional study, all consecutive patients who underwent mastectomy for invasive breast cancer or ductal carcinoma in situ (DCIS) were identified and categorized into two groups based on subsequent breast reconstruction or not. Patient-reported outcomes were assessed with the validated Breast-Q and a short survey about the decision-making process in breast reconstruction. These outcomes were compared between the two groups using univariable analyses, multivariable logistic regression, and multiple linear regression analyses. The Breast-Q scores were also compared to Dutch normative values. RESULTS A total of 319 patients were identified of whom 68% had no breast reconstruction. Of the 102 patients with breast reconstruction, the majority (93%) received immediate, instead of delayed breast reconstruction. The survey was completed by 155 (49%) patients. The non-reconstruction group, on average, reported significantly poorer psychosocial well-being, compared to the reconstruction group as well as compared to the normative data. However, the majority of the non-reconstruction group (83%) stated that they had no desire for breast reconstruction. In both groups, most patients stated that the provided information was sufficient. CONCLUSION Patients have personal motives to opt for or reject breast reconstruction. It seemed that patients differ in their rating of values that affect their decision since the same arguments were used to opt for or reject reconstruction. Notably, patients were well-informed in their decision making.
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Affiliation(s)
- Sara van Bekkum
- Department of Surgery, Albert Schweitzer Hospital, P.O. Box 444, 3300 AK, Dordrecht, The Netherlands
| | - Marloes E Clarijs
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
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Mandigers L, den Uil CA, Belliato M, Raemen H, Rossi E, van Rosmalen J, Rietdijk WJR, Melis JR, Gommers D, van Thiel RJ, Dos Reis Miranda D. Higher mean cerebral oxygen saturation shortly after extracorporeal cardiopulmonary resuscitation in patients who regain consciousness. Artif Organs 2023; 47:1479-1489. [PMID: 37042484 DOI: 10.1111/aor.14548] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION In cardiac arrest, cerebral ischemia and reperfusion injury mainly determine the neurological outcome. The aim of this study was to investigate the relation between the course of cerebral oxygenation and regain of consciousness in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR). We hypothesized that rapid cerebral oxygenation increase causes unfavorable outcomes. METHODS This prospective observational study was conducted in three European hospitals. We included adult ECPR patients between October 2018 and March 2020, in whom cerebral regional oxygen saturation (rSO2 ) measurements were started minutes before ECPR initiation until 3 h after. The primary outcome was regain of consciousness, defined as following commands, analyzed using binary logistic regression. RESULTS The sample consisted of 26 ECPR patients (23% women, Agemean 46 years). We found no significant differences in rSO2 values at baseline (49.1% versus 49.3% for regain versus no regain of consciousness). Mean cerebral rSO2 values in the first 30 min after ECPR initiation were higher in patients who regained consciousness (38%) than in patients who did not regain consciousness (62%, odds ratio 1.23, 95% confidence interval 1.01-1.50). CONCLUSION Higher mean cerebral rSO2 values in the first 30 min after initiation of ECPR were found in patients who regained consciousness.
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Affiliation(s)
- Loes Mandigers
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corstiaan A den Uil
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands
| | - Mirko Belliato
- UOC Anestesia e Rianimazione 2, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hannelore Raemen
- Emergency Department, University Hospital Antwerp, Antwerp, Belgium
| | - Eleonora Rossi
- UOC Anestesia e Rianimazione 1, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wim J R Rietdijk
- Department of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Joo-Ree Melis
- Department of Traumatology, University Hospital Antwerp, Antwerp, Belgium
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert J van Thiel
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dinis Dos Reis Miranda
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Ten Barge JA, Moelchand M, van Dijk M, Simons SHP, van Rosmalen J, van den Akker ELT, Tibboel D, van den Bosch GE. The influence of intensive care treatment in infancy on cortisol levels in childhood and adolescence. Early Hum Dev 2023; 184:105823. [PMID: 37478692 DOI: 10.1016/j.earlhumdev.2023.105823] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/09/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Infants admitted to the intensive care unit experience numerous early-life stressors, which may have long-term effects on hypothalamic-pituitary-adrenal axis functioning. AIMS To determine the effects of intensive care treatment and related exposure to stress, pain, and opioids in infancy on cortisol levels in childhood and adolescence. STUDY DESIGN Cross-sectional study. SUBJECTS Children and adolescents aged 8 to 18 years with a history of intensive care treatment in infancy and healthy controls. The intensive care treatment cohort consisted of four subgroups with varying levels of exposure to stress, pain, and opioids in infancy. They received either mechanical ventilation, extracorporeal membrane oxygenation, major surgery, or excochleation of a giant congenital melanocytic nevus. OUTCOME MEASURES Between-group differences in stress reactivity to a study visit consisting of pain threshold testing and an MRI examination and diurnal cortisol levels, as measured in saliva. RESULTS After adjustment for age, sex, and gestational age, the diurnal cortisol output (AUCg) in the overall intensive care group (N = 76) was 18 % (approximately 1000 nmol/L) (95 % CI [-31 %, -3 %], P = 0.022) lower than that in the control group (N = 67). Cortisol awakening response, diurnal decline, and stress reactivity neither differed significantly between the overall intensive care group and control group, nor between the intensive care subgroups and control group. CONCLUSION Children and adolescents with a history of intensive care treatment in infancy have similar cortisol profiles to those of healthy controls, except for an 18 % lower diurnal cortisol output. The clinical relevance of this reduction is yet to be determined.
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Affiliation(s)
- Judith A Ten Barge
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Madhvi Moelchand
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sinno H P Simons
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Erica L T van den Akker
- Department of Pediatrics, Division of Pediatric Endocrinology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Dick Tibboel
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Gerbrich E van den Bosch
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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Schafthuizen L, Ista E, van der Heijden M, van Heel L, Maben J, van Rosmalen J, van Eijck CHJ, van Dijk M. Hospitalized Patients' Sleep Quality Compared Between Multioccupancy Rooms and Single-Patient Rooms. HERD 2023; 16:119-133. [PMID: 37143320 PMCID: PMC10328146 DOI: 10.1177/19375867231168895] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To evaluate patients' sleep quality in a former hospital with two-and four-bedded rooms compared to a new hospital that incorporated evidence-based design features, including exclusively single-patient rooms (SPRs). BACKGROUND Hospitalized patients often report poor sleep quality due to both patient-related factors and hospital environmental factors. It is unclear if staying in an SPR in a hospital designed as a healing environment is associated with better sleep quality. METHODS In a before-after study, sleep quality, duration, and efficiency over 72 hr were measured with a sleep diary, GENEActiv accelerometer, and the Richards-Campbell Sleep Questionnaire (RCSQ) with scores ranging from 0 to 100, with higher scores reflecting better sleep. Participants were either staying alone in the former hospital with two-and four-bedded rooms (Group 1), sharing a room with one to three fellow patients (Group 2), or staying alone in a newly designed hospital with 100% SPRs (Group 3). RESULTS We included 17 patients in Group 1, 32 patients in Group 2, and 56 patients in Group 3. Univariable linear mixed model analysis, controlling for night number, revealed that the RCSQ total score was lowest in Group 2 compared to the other two groups. In the multivariable analysis, the RCSQ score was also the lowest in Group 2, with a significant effect from covariate "use of night medication." CONCLUSION Self-reported sleep quality of hospitalized patients in a hospital with 100% SPRs designed as a healing environment was slightly better than that of patients staying in multioccupancy rooms with fellow patients.
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Affiliation(s)
- Laura Schafthuizen
- Department of Internal Medicine, section Nursing Science, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine, section Nursing Science, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marianne van der Heijden
- Department of Internal Medicine, section Nursing Science, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Liesbeth van Heel
- Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Casper H. J. van Eijck
- Department of Surgery, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, section Nursing Science, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
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Lin YS, O'Mahony JF, van Rosmalen J. A Simple Cost-Effectiveness Model of Screening: An Open-Source Teaching and Research Tool Coded in R. Pharmacoecon Open 2023:10.1007/s41669-023-00414-1. [PMID: 37261616 DOI: 10.1007/s41669-023-00414-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 06/02/2023]
Abstract
Applied cost-effectiveness analysis models are an important tool for assessing health and economic effects of healthcare interventions but are not best suited for illustrating methods. Our objective is to provide a simple, open-source model for the simulation of disease-screening cost-effectiveness for teaching and research purposes. We introduce our model and provide an initial application to examine changes to the efficiency frontier as input parameters vary and to demonstrate face validity. We described a vectorised, discrete-event simulation of screening in R with an Excel interface to define parameters and inspect principal results. An R Shiny app permits dynamic interpretation of simulation outputs. An example with 8161 screening strategies illustrates the cost and effectiveness of varying the disease sojourn time, treatment effectiveness, and test performance characteristics and costs on screening policies. Many of our findings are intuitive and straightforward, such as a reduction in screening costs leading to decreased overall costs and improved cost-effectiveness. Others are less obvious and depend on whether we consider gross outcomes or those net to no screening. For instance, enhanced treatment of symptomatic disease increases gross effectiveness, but reduces the net effectiveness and cost-effectiveness of screening. A lengthening of the preclinical sojourn time has ambiguous effects relative to no screening, as cost-effectiveness improves for some strategies but deteriorates for others. Our simple model offers an accessible platform for methods research and teaching. We hope it will serve as a public good and promote an intuitive understanding of the cost-effectiveness of screening.
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Affiliation(s)
- Yi-Shu Lin
- Centre for Health Policy and Management, Trinity College Dublin, 2-4 Foster Place, Dublin, D02 T253, Ireland.
| | - James F O'Mahony
- Centre for Health Policy and Management, Trinity College Dublin, 2-4 Foster Place, Dublin, D02 T253, Ireland
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Polak TB, Cucchi DGJ, Schelhaas J, Ahmed SS, Khoshnaw N, van Rosmalen J, Uyl-de Groot CA. Results from Expanded Access Programs: A Review of Academic Literature. Drugs 2023:10.1007/s40265-023-01879-4. [PMID: 37199856 DOI: 10.1007/s40265-023-01879-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Although expanded access is an increasingly used pathway for patients to access investigational medicine, little is known on the magnitude and content of published scientific research collected via expanded access. METHODS We performed a review of all peer-reviewed expanded access publications between January 1, 2000 and January 1, 2022. We analyzed the publications for drugs, diseases, disease area, patient numbers, time, geographical location, subject, and research methodology (single center/multicenter, international/national, prospective/retrospective). We additionally analyzed endpoints reported in all COVID-19-related expanded access publications. RESULTS We screened 3810 articles and included 1231, describing 523 drugs for 354 diseases for 507,481 patients. The number of publications significantly increased over time ([Formula: see text]). Large geographical disparities existed as Europe and the Americas accounted for 87.4% of all publications, whereas Africa only accounted for 0.6%. Oncology and hematology accounted for 53% of all publications. Twenty-nine percent of all expanded access patients (N = 197,187) reported on in 2020 and 2021 were treated in the context of COVID-19. CONCLUSIONS By summarizing characteristics of patients, diseases, and research methods described in all scientific literature published on expanded access, we provide a unique dataset for future research. We show that published scientific research on expanded access has surged over the past decades, partly due to COVID-19. However, international collaboration and equity in geographic access remain an issue of concern. Lastly, we stress the need for harmonization of research legislation and guidance on the value of expanded access data within real-world data frameworks to improve equity in patient access and streamline future expanded access research.
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Affiliation(s)
- Tobias B Polak
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands.
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - David G J Cucchi
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Jasmin Schelhaas
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands
| | - Syed S Ahmed
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands
| | - Naima Khoshnaw
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Sreeram II, Schnater JM, van Rosmalen J, Cochius-den Otter SCM, Peters NCJ, Rottier RJ, Gischler SJ, Wijnen RMH, IJsselstijn H, Rietman AB. Longitudinal Health Status and Quality of Life in Congenital Diaphragmatic Hernia. Pediatrics 2023:191286. [PMID: 37199110 DOI: 10.1542/peds.2022-060385] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES To longitudinally evaluate self-reported health status (HS) and quality of life (QoL) in 8- and 12-year-old survivors of congenital diaphragmatic hernia (CDH). We hypothesized that HS would improve with age-as associated health problems tend to decline-whereas QoL would decrease, as the children start to compare themselves with peers. METHODS Self-reported HS and QoL of 133 children born between 1999 and 2013 who had joined our standardized follow-up program were routinely assessed at the ages of 8 and 12 with generic, internationally validated, standardized instruments. Longitudinal evaluation of total and subscale scores was performed using general linear model analyses. In addition, we compared these scores to sex- and age-specific normative data. RESULTS Between ages 8 and 12, boys born with CDH perceived a decline in HS (mean difference -7.15, P < .001). Self-reported QoL did not change over time in both boys and girls. At both ages, HS was significantly lower than that of healthy peers (effect size = 0.71, P = .001 for boys, and effect size = 0.69, P = .003 for girls), whereas differences in QoL were small. CONCLUSIONS Children born with CDH are at risk for declining HS between 8 and 12 years, but not QoL, compared with healthy peers. Given that children born with CDH tend to grow into deficits, our findings highlight the need for continued somatic and psychological assessments in adolescent and adult CDH survivors.
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Affiliation(s)
| | | | - Joost van Rosmalen
- Departments of Biostatistics, and
- Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Nina C J Peters
- Obstetrics and Gynecology, Subdivision of Obstetrics and Fetal Medicine
| | | | | | | | | | - André B Rietman
- Departments of Pediatric Surgery and Intensive Care
- Child and Adolescent Psychiatry and Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
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van Bekkum S, Drukker C, van Rosmalen J, Menke-Pluijmers MBE, Westenend PJ. A low risk of recurrence after breast-conserving surgery for DCIS: A single-institution experience. Cancer Treat Res Commun 2023; 35:100706. [PMID: 37058969 DOI: 10.1016/j.ctarc.2023.100706] [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: 01/30/2023] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Previously published studies report up to 30% recurrence rates after DCIS, so it would be desirable to identify those women at risk for recurrence and adapt adjuvant management. This study aimed to identify the locoregional recurrence rate after breast conserving surgery (BCS) for DCIS, and to evaluate the possible role of immunohistochemical (IHC) staining in predicting the risk of recurrence. PATIENTS AND METHODS In a retrospective cohort study, patients who underwent BCS for pure DCIS were identified. Data on well-established clinical-pathological risk factors and development of locoregional recurrence was gathered from patient files. In addition, IHC stains of ER, PR, HER2, p53, and ki67 were performed on original tumor samples. Univariable Cox regression analyses were performed to identify possible risk factors for locoregional recurrence. RESULTS 190 patients were included. At a median follow-up time of 12.8 years fifteen (8%) patients developed locoregional recurrence: 7 invasive cancer and 8 DCIS. These recurrences were diagnosed within a range of 1.7 to 19.6 years after the initial diagnosis. Univariable Cox regression analysis did only show a significant association between p53 and locoregional recurrence. Our re-excision rate to obtain free margins was 30.5%, and 90% received radiotherapy. Endocrine treatment was not used. CONCLUSIONS At 12.8 years follow-up, patients with DCIS treated with BCS have a very low locoregional recurrence of 8%. Although we could demonstrate that increased p53 expression is a risk factor for locoregional recurrence, we think this is of little clinical value in our population with such a low recurrence rate. MICROABSTRACT With a published recurrence rate up to 30% after DCIS, it would be desirable to identify those at risk to adapt treatment and follow-up. We aimed to evaluate the role of immunohistochemical staining to determine the risk of locoregional recurrence, in addition to established clinical and pathological risk factors. At a median follow-up of 12.8 years, we found a locoregional recurrence rate of 8%. Increased expression of p53 is associated with an increased risk of locoregional recurrence.
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Affiliation(s)
- Sara van Bekkum
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht the Netherlands
| | - Caroline Drukker
- Department of Surgical Oncology, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Pieter J Westenend
- Department of Pathology, Laboratory of Pathology, Dordrecht, the Netherlands.
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30
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Meurs CJC, van Rosmalen J, Menke-Pluijmers MBE, Siesling S, Westenend PJ. Predicting Lymph Node Metastases in Patients with Biopsy-Proven Ductal Carcinoma In Situ of the Breast: Development and Validation of the DCIS-met Model. Ann Surg Oncol 2023; 30:2142-2151. [PMID: 36496490 PMCID: PMC10027636 DOI: 10.1245/s10434-022-12900-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE In patients with a biopsy-proven ductal carcinoma in situ (DCIS), axillary staging is frequently performed, but in hindsight often turns out to be superfluous. The aim of this observational study was to develop a prediction model for risk of lymph node metastasis in patients with a biopsy-proven DCIS. METHODS Data were received from the Dutch Pathology Databank and the Netherlands Cancer Registry. The population-based cohort consisted of all biopsy-proven DCIS patients diagnosed in the Netherlands in 2011 and 2012. The prediction model was evaluated with the area under the curve (AUC) of the receiver operating characteristic, and a calibration plot and a decision curve analysis and was validated in a Dutch cohort of patients diagnosed in the period 2016-2019. RESULTS Of 2892 biopsy-proven DCIS patients, 127 had metastasis (4.4%). Risk factors were younger age (OR = 0.97, 95% CI 0.95-0.99), DCIS not detected by screening (OR = 1.55, 95% CI 1.01-2.38), suspected invasive component at biopsy (OR = 1.86, 95% CI 1.01-3.41), palpable tumour (OR = 2.06, 95% CI 1.34-3.18), BI-RADS score 5 (OR = 2.41, 95% CI 1.53-3.78), intermediate-grade DCIS (OR = 3.01, 95% CI 1.27-7.15) and high-grade DCIS (OR = 3.20, 95% CI 1.36-7.54). For 24% (n = 708) of the patients, the predicted risk of lymph node metastasis was above 5%. Based on the decision curve analysis, the model had a net benefit for a predicted risk below 25%. The AUC was 0.745. Of the 2269 patients in the validation cohort, 53 (2.2%) had metastasis and the AUC was 0.741. CONCLUSIONS This DCIS-met model can support clinical decisions on axillary staging in patients with biopsy-proven DCIS.
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Affiliation(s)
- Claudia J C Meurs
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- CMAnalyzing, Zevenaar, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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31
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Meurs CJC, van Rosmalen J, Menke-Pluijmers MBE, Siesling S, Westenend PJ. ASO Visual Abstract: Predicting Lymph Node Metastases in Patients with Biopsy-Proven Ductal Carcinoma In Situ of the Breast: Development and Validation of the DCIS-met Model. Ann Surg Oncol 2023; 30:2152-2153. [PMID: 36695996 DOI: 10.1245/s10434-022-13067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Claudia J C Meurs
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- CMAnalyzing, Zevenaar, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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32
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Martínez EP, Golding SE, van Rosmalen J, Vinueza-Burgos C, Verbon A, van Schaik G. Antibiotic prescription patterns and non-clinical factors influencing antibiotic use by Ecuadorian veterinarians working on cattle and poultry farms: A cross-sectional study. Prev Vet Med 2023; 213:105858. [PMID: 36724619 DOI: 10.1016/j.prevetmed.2023.105858] [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: 08/18/2022] [Revised: 12/10/2022] [Accepted: 01/22/2023] [Indexed: 01/24/2023]
Abstract
Understanding antibiotic prescription patterns and non-clinical factors influencing antibiotic use is essential for implementing strategies to promote appropriate antibiotic use. There is, however, limited research exploring these issues with Ecuadorian veterinarians. Therefore, a questionnaire was developed and applied cross-sectionally to veterinarians (n = 173) from two professional organizations to explore the antibiotic prescription patterns and non-clinical factors (e.g., attitudes and perceptions) influencing antibiotic use, and to identify strategies to reduce antibiotic use. The response rate was 78.4%. Responses were compared between veterinarians working mainly on cattle and poultry farms using Mann-Whitney U tests. The most important attitudes, beliefs and perceptions towards antimicrobial resistance (AMR) and antibiotic use were identified with the Relative Importance Index (RII). Veterinarians showed high awareness of AMR and its implications for public health, as well as the necessity of reducing antibiotic use. However, some veterinarians appear to underestimate the potential contribution of veterinary antibiotic use on AMR in humans. Veterinarians self-reported high prescription (> 20%) of antibiotics for cattle and poultry that are critically important for human medicine, such as 3rd and 4th generation cephalosporins, polymyxins and quinolones. Further, antibiotic therapy was not tailored to disease type. Cattle and poultry veterinarians perceived similar barriers to increasing antibiotic stewardship including: poor biosecurity measures, animal confinement, low feed quality, farmers' behaviors (such as stopping antibiotic treatment, storing antibiotics on farms, buying antibiotics in veterinary supply stores), and sales agents' roles as non-professional prescribers of antibiotics. Overall, veterinarians were broadly supportive (>90%) of most strategies to promote appropriate antibiotic use. They saw more merit in improving biosecurity of farms and implementing educational programs for farmers and veterinarians. This study provides insight into the complexity of antibiotic use on Ecuadorian farms and the need for holistic strategies in a One Health context, to achieve antibiotic stewardship.
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Affiliation(s)
- Evelyn Pamela Martínez
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito 170103, Ecuador; Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Sarah E Golding
- School of Psychology, Faculty of Health and Medical Sciences, Stag Hill Campus, University of Surrey, GU2 7XH Guildford, United Kingdom.
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Christian Vinueza-Burgos
- Unidad de Investigación de Enfermedades Transmitidas por Alimentos y Resistencia a los Antimicrobianos (UNIETAR), Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito 170103, Ecuador.
| | - Annelies Verbon
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Gerdien van Schaik
- Department of Population Health Sciences, Unit Farm Animal Health, Utrecht University, Yalelaan 7, 3584 CL Utrecht, the Netherlands; Royal GD, Deventer, the Netherlands.
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Duyndam A, Smit J, Heunks L, Molinger J, IJland M, van Rosmalen J, van Dijk M, Tibboel D, Ista E. Reference values of diaphragmatic dimensions in healthy children aged 0-8 years. Eur J Pediatr 2023:10.1007/s00431-023-04920-6. [PMID: 36939879 DOI: 10.1007/s00431-023-04920-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/21/2023]
Abstract
Diaphragmatic thickness (Tdi) and diaphragm thickening fraction (dTF) are widely used parameters in ultrasound studies of the diaphragm in mechanically ventilated children, but normal values for healthy children are scarce. We determined reference values of Tdi and dTF using ultrasound in healthy children aged 0-8 years old and assessed their reproducibility. In a prospective, observational cohort, Tdi and dTF were measured on ultrasound images across four age groups comprising at least 30 children per group: group 1 (0-6 months), group 2 (7 months-1 year), group 3 (2-4 years) and group 4 (5-8 years). Ultrasound images of 137 healthy children were included. Mean Tdi at inspiration was 2.07 (SD 0.40), 2.09 (SD 0.40), 1.69 (SD 0.30) and 1.72 (SD 0.30) mm for groups 1, 2, 3 and 4, respectively. Mean Tdi at expiration was 1.64 (SD 0.30), 1.67 (SD 0.30), 1.38 (SD 0.20) and 1.42 (SD 0.20) mm for groups 1, 2, 3 and 4, respectively. Mean Tdi at inspiration and mean Tdi at expiration for groups 1 and 2 were significantly greater than those for groups 3 and 4 (both p < 0.001). Mean dTF was 25.4% (SD 10.4), 25.2% (SD 8.3), 22.8% (SD 10.9) and 21.3% (SD 7.1) for group 1, 2, 3 and 4, respectively. The intraclass correlation coefficients (ICC) representing the level of inter-rater reliability between two examiners performing the ultrasounds was 0.996 (95% CI 0.982-0.999). ICC of the inter-rater reliability between the raters in 11 paired assessments was 0.989 (95% CI 0.973-0.995). Conclusion: Ultrasound measurements of Tdi and dTF were highly reproducible in healthy children aged 0-8 years. Trial registration: ClinicalTrials.gov identifier (NCT number): NCT04589910. What is Known: • Diaphragmatic thickness and diaphragm thickening fraction are widely used parameters in ultrasound studies of the diaphragm in mechanically ventilated children, but normal values for healthy children to compare these with are scarce. What is New: • We determined normal values of diaphragmatic thickness and diaphragm thickening fraction using ultrasound in 137 healthy children aged 0-8 years old. The diaphragmatic thickness of infants up to 1 year old was significantly greater than that of children from 2 to 8 years old. Diaphragmatic thickness decreased with an increase in body surface area. These normal values in healthy children can be used to assess changes in respiratory muscle thickness in mechanically ventilated children.
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Affiliation(s)
- Anita Duyndam
- Department of Pediatric Surgery and Intensive Care, Erasmus , Sophia Children's Hospital, MC, Rotterdam, the Netherlands.
| | - Joke Smit
- Department of Pediatric Surgery and Intensive Care, Erasmus , Sophia Children's Hospital, MC, Rotterdam, the Netherlands
| | - Leo Heunks
- Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeroen Molinger
- Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Division of Critical Care, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Marloes IJland
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Pediatric Surgery and Intensive Care, Erasmus , Sophia Children's Hospital, MC, Rotterdam, the Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus , Sophia Children's Hospital, MC, Rotterdam, the Netherlands.,Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Pediatric Surgery and Intensive Care, Erasmus , Sophia Children's Hospital, MC, Rotterdam, the Netherlands
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Kersten CM, Hermelijn SM, Dossche LWJ, Muthialu N, Losty PD, Schurink M, Rietman AB, Poley MJ, van Rosmalen J, Zanen-van den Adel TPL, Ciet P, von der Thüsen J, Brosens E, Ijsselstijn H, Tiddens HAWM, Wijnen RMH, Schnater JM. COllaborative Neonatal Network for the first European CPAM Trial (CONNECT): a study protocol for a randomised controlled trial. BMJ Open 2023; 13:e071989. [PMID: 36931672 PMCID: PMC10030930 DOI: 10.1136/bmjopen-2023-071989] [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] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION Consensus is lacking on the optimal management of asymptomatic congenital pulmonary airway malformation (CPAM). For future studies, the CONNECT consortium (the COllaborative Neonatal Network for the first European CPAM Trial)-an international collaboration of specialised caregivers-has established consensus on a core outcome set of outcome parameters concerning respiratory insufficiency, surgical complications, mass effect and multifocal disease. These outcome parameters have been incorporated in the CONNECT trial, a randomised controlled trial which, in order to develop evidence-based practice, aims to compare conservative and surgical management of patients with an asymptomatic CPAM. METHODS AND ANALYSIS Children are eligible for inclusion after the CPAM diagnosis has been confirmed on postnatal chest CT scan and they remain asymptomatic. On inclusion, children are randomised to receive either conservative or surgical management. Subsequently, children in both groups are enrolled into a standardised, 5-year follow-up programme with three visits, including a repeat chest CT scan at 2.5 years and a standardised exercise tolerance test at 5 years.The primary outcome is exercise tolerance at age 5 years, measured according to the Bruce treadmill protocol. Secondary outcome measures are molecular genetic diagnostics, validated questionnaires-on parental anxiety, quality of life and healthcare consumption-, repeated imaging and pulmonary morbidity during follow-up, as well as surgical complications and histopathology. This trial aims to end the continuous debate surrounding the optimal management of asymptomatic CPAM. ETHICS AND DISSEMINATION This study is being conducted in accordance with the Declaration of Helsinki. The Medical Ethics Review Board of Erasmus University Medical Centre Rotterdam, The Netherlands, has approved this protocol (MEC-2022-0441). Results will be disseminated through peer-reviewed scientific journals and conference presentations. TRIAL REGISTRATION NUMBER NCT05701514.
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Affiliation(s)
- Casper M Kersten
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Sergei M Hermelijn
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Louis W J Dossche
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Nagarajan Muthialu
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Paul D Losty
- Paediatric Surgery, Institute Of Life Course And Medical Sciences, University of Liverpool, Liverpool, UK
- Paediatric Surgery, Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Maarten Schurink
- Paediatric Surgery, Radboud University Medical Centre Amalia Children's Hospital, Nijmegen, the Netherlands, Nijmegen, Netherlands
| | - André B Rietman
- Child and Adolescent Psychiatry, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Marten J Poley
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Biostatistics, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
- Epidemiology, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | | | - Pierluigi Ciet
- Radiology and Nuclear Medicine, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Paediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Radiology and Medical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Erwin Brosens
- Clinical Genetics, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Erasmus MC Cancer Centre, Rotterdam, Zuid-Holland, Netherlands
| | - Hanneke Ijsselstijn
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Harm A W M Tiddens
- Radiology and Nuclear Medicine, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Paediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Rene M H Wijnen
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - J Marco Schnater
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
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Vinkenoog M, Toivonen J, Brits T, de Clippel D, Compernolle V, Karki S, Welvaert M, Meulenbeld A, van den Hurk K, van Rosmalen J, Lesaffre E, Arvas M, Janssen M. An international comparison of haemoglobin deferral prediction models for blood banking. Vox Sang 2023. [PMID: 36924102 DOI: 10.1111/vox.13426] [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: 11/02/2022] [Revised: 02/04/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Blood banks use a haemoglobin (Hb) threshold before blood donation to minimize donors' risk of anaemia. Hb prediction models may guide decisions on which donors to invite, and should ideally also be generally applicable, thus in different countries and settings. In this paper, we compare the outcome of various prediction models in different settings and highlight differences and similarities. MATERIALS AND METHODS Donation data of repeat donors from the past 5 years of Australia, Belgium, Finland, the Netherlands and South Africa were used to fit five identical prediction models: logistic regression, random forest, support vector machine, linear mixed model and dynamic linear mixed model. Only donors with five or more donation attempts were included to ensure having informative data from all donors. Analyses were performed for men and women separately and outcomes compared. RESULTS Within countries and overall, different models perform similarly well. However, there are substantial differences in model performance between countries, and there is a positive association between the deferral rate in a country and the ability to predict donor deferral. Nonetheless, the importance of predictor variables across countries is similar and is highest for the previous Hb level. CONCLUSION The limited impact of model architecture and country indicates that all models show similar relationships between the predictor variables and donor deferral. Donor deferral is found to be better predictable in countries with high deferral rates. Therefore, such countries may benefit more from deferral prediction models than those with low deferral rates.
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Affiliation(s)
- Marieke Vinkenoog
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Leiden Institute of Advanced Computer Science, Leiden University, Leiden, The Netherlands
| | - Jarkko Toivonen
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Tinus Brits
- Business Intelligence, South African National Blood Service, Johannesburg, South Africa
| | | | - Veerle Compernolle
- Dienst voor het Bloed, Belgian Red Cross Ugent, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Surendra Karki
- Research and Development, Australian Red Cross Lifeblood, Sydney, Australia
| | - Marijke Welvaert
- Research and Development, Australian Red Cross Lifeblood, Sydney, Australia
| | - Amber Meulenbeld
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Mikko Arvas
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Mart Janssen
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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36
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Akalu Banbeta, Lesaffre E, Martina R, van Rosmalen J. Bayesian Borrowing Methods for Count Data: Analysis of Incontinence Episodes in Patients with Overactive Bladder. Stat Biopharm Res 2023. [DOI: 10.1080/19466315.2023.2190933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Akalu Banbeta
- I-Biostat, UHasselt, Hasselt, Belgium
- Department of Statistics, Jimma University, Jimma, Ethiopia
| | | | - Reynaldo Martina
- Faculty of Science, Technology, Engineering and Mathematics, Open University, Milton Keynes, UK
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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37
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de Munck S, Otter SCMCD, Schnater JM, van Rosmalen J, Peters NCJ, van Gils-Frijters APJM, van Haren NEM, Gischler SJ, IJsselstijn H, Rietman AB. Neuropsychological outcome in survivors of congenital diaphragmatic hernia at 5 years of age, what does it tell? Eur J Pediatr 2023; 182:1057-1066. [PMID: 36565322 PMCID: PMC10023636 DOI: 10.1007/s00431-022-04696-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/24/2022] [Accepted: 11/05/2022] [Indexed: 12/25/2022]
Abstract
Previous studies have frequently reported neurocognitive deficits in children born with congenital diaphragmatic hernia (CDH) at school age, which may contribute to academic difficulties. Yet, age at onset of these deficits is currently unknown. We evaluated neurocognitive skills with possible determinants in preschool children born with CDH. Eligible 5-year-old children born with CDH (2010-2015) who participated in our prospective structural follow-up program were included. We used the WPPSI-III to assess intelligence, subtests of the Kaufman-ABC for memory, and NEPSY-II to assess inhibition and attention. We included 63 children. Their test scores generally were within or significantly above normal range: total IQ = 103.4 (15.7) (p = 0.13); Verbal memory = 10.2 (2.8) (p = 0.61); Visuospatial memory = 11.4 (2.6) (p < 0.01); Inhibition = 10.5 (2.2), (p = 0.10). In univariable analyses, length of ICU-stay was negatively associated with IQ, and maximum vasoactive inotropic score and open repair were negatively associated with inhibition skills. In multivariable regression analysis, the latter association remained (B = 5.52, p = 0.04 (CI 0.32-10.72)). Conclusions: In these tested 5-year-old children born with CDH, neuropsychological outcome was normal on average. While problems in 8-year-olds are common, we did not detect onset of these problems at age 5. Yet, we cannot rule out that this cohort had a relatively mild level of disease severity; therefore, conclusions should be interpreted with caution. However, given the growing-into-deficit hypothesis, meaning that deviant brain development in early life is revealed once higher cognitive brain functions are demanded, follow-up should be conducted up to school age, and preferably beyond. What is Known: • Children born with CDH are at risk for academic difficulties at school age. • Whether these difficulties can be detected already before school age is unknown. What is New: • At age 5 years, intelligence, inhibition, attention, and memory skills were all within normal range, or even above, in children with CDH. This is supportive of the growing-into-deficit hypothesis in this patient population. • Those who underwent open surgical correction had poorer inhibition skills than those who were corrected with minimal access surgery.
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Affiliation(s)
- Sophie de Munck
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Suzan C M Cochius-den Otter
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J Marco Schnater
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Nina C J Peters
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Annabel P J M van Gils-Frijters
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Neeltje E M van Haren
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Saskia J Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - André B Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
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38
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Meesters NJ, Dilles T, van Rosmalen J, van den Bosch GE, Simons SHP, van Dijk M. COMFORTneo scale: a reliable and valid instrument to measure prolonged pain in neonates? J Perinatol 2023; 43:595-600. [PMID: 36746985 DOI: 10.1038/s41372-023-01628-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We studied the reliability and validity of the COMFORTneo scale, designed to measure neonatal prolonged pain. STUDY DESIGN This prospective observational study evaluated four clinimetric properties of the COMFORTneo scale from NICU nurses' assessments of neonates' pain. Intra-rater reliability was determined from three video fragments at two time points. Inter-rater reliability and construct validity were determined in five neonates per nurse with the COMFORTneo and numeric rating scales (NRS) for pain and distress. Pain scores using N-PASS were correlated with COMFORTneo scores to further evaluate construct validity. RESULT Intra-rater reliability: Twenty-two nurses assessed pain twice with an intraclass correlation coefficient (ICC) of 0.70. Inter-rater reliability: The ICC for 310 COMFORTneo scores together with 62 nurses was 0.93. Construct validity: Correlation between COMFORTneo and NRS pain, distress, and N-PASS was 0.34, 0.72, and 0.70, respectively. CONCLUSION The COMFORTneo can be used to reliably and validly assess pain in NICU patients.
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Affiliation(s)
- Naomi J Meesters
- Department of Pediatrics, Division of Neonatology, Erasmus MC -Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Tinne Dilles
- Nursing and Midwifery Sciences, Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Gerbrich E van den Bosch
- Department of Pediatrics, Division of Neonatology, Erasmus MC -Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sinno H P Simons
- Department of Pediatrics, Division of Neonatology, Erasmus MC -Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Pediatrics, Division of Neonatology, Erasmus MC -Sophia Children's Hospital, Rotterdam, the Netherlands.,Intensive Care and Department of Pediatric Surgery, Erasmus MC -Sophia Children's Hospital, Rotterdam, the Netherlands
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39
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de Wijkerslooth EML, Boerma EJG, van Rossem CC, van Rosmalen J, Baeten CIM, Beverdam FH, Bosmans JWAM, Consten ECJ, Dekker JWT, Emous M, van Geloven AAW, Gijsen AF, Heijnen LA, Jairam AP, Melles DC, van der Ploeg APT, Steenvoorde P, Toorenvliet BR, Vermaas M, Wiering B, Wijnhoven BPL, van den Boom AL. 2 days versus 5 days of postoperative antibiotics for complex appendicitis: a pragmatic, open-label, multicentre, non-inferiority randomised trial. Lancet 2023; 401:366-376. [PMID: 36669519 DOI: 10.1016/s0140-6736(22)02588-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 07/14/2022] [Revised: 10/20/2022] [Accepted: 11/18/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The appropriate duration of postoperative antibiotics for complex appendicitis is unclear. The increasing global threat of antimicrobial resistance warrants restrictive antibiotic use, which could also reduce side-effects, length of hospital stay, and costs. METHODS In this pragmatic, open-label, non-inferiority trial in 15 hospitals in the Netherlands, patients with complex appendicitis (aged ≥8 years) were randomly assigned (1:1) to receive 2 days or 5 days of intravenous antibiotics after appendicectomy. Randomisation was stratified by centre, and treating physicians and patients were not masked to treatment allocation. The primary endpoint was a composite endpoint of infectious complications and mortality within 90 days. The main outcome was the absolute risk difference (95% CI) in the primary endpoint, adjusted for age and severity of appendicitis, with a non-inferiority margin of 7·5%. Outcome assessment was based on electronic patient records and a telephone consultation 90 days after appendicectomy. Efficacy was analysed in the intention-to-treat and per-protocol populations. Safety outcomes were analysed in the intention-to-treat population. This trial was registered with the Netherlands Trial Register, NL5946. FINDINGS Between April 12, 2017, and June 3, 2021, 13 267 patients were screened and 1066 were randomly assigned, 533 to each group. 31 were excluded from intention-to-treat analysis of the 2-day group and 30 from the 5-day group owing to errors in recruitment or consent. Appendicectomy was done laparoscopically in 955 (95%) of 1005 patients. The telephone follow-up was completed in 664 (66%) of 1005 patients. The primary endpoint occurred in 51 (10%) of 502 patients analysed in the 2-day group and 41 (8%) of 503 patients analysed in the 5-day group (adjusted absolute risk difference 2·0%, 95% CI -1·6 to 5·6). Rates of complications and re-interventions were similar between trial groups. Fewer patients had adverse effects of antibiotics in the 2-day group (45 [9%] of 502 patients) than in the 5-day group (112 [22%] of 503 patients; odds ratio [OR] 0·344, 95% CI 0·237 to 0·498). Re-admission to hospital was more frequent in the 2-day group (58 [12%] of 502 patients) than in the 5-day group (29 [6%] of 503 patients; OR 2·135, 1·342 to 3·396). There were no treatment-related deaths. INTERPRETATION 2 days of postoperative intravenous antibiotics for complex appendicitis is non-inferior to 5 days in terms of infectious complications and mortality within 90 days, based on a non-inferiority margin of 7·5%. These findings apply to laparoscopic appendicectomy conducted in a well resourced health-care setting. Adopting this strategy will reduce adverse effects of antibiotics and length of hospital stay. FUNDING The Netherlands Organization for Health Research and Development.
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Affiliation(s)
| | | | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC - University Medical Centre, Rotterdam, Netherlands; Department of Epidemiology, Erasmus MC - University Medical Centre, Rotterdam, Netherlands
| | - Coen I M Baeten
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands
| | | | | | - Esther C J Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, Netherlands; Department of Surgery, University Medical Centre Groningen, Netherlands
| | | | - Marloes Emous
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, Netherlands
| | | | - Anton F Gijsen
- Department of Surgery, Medical Spectrum Twente, Enschede, Netherlands
| | - Luc A Heijnen
- Department of Surgery, Northwest Clinics, Alkmaar, Netherlands
| | - An P Jairam
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - Damian C Melles
- Department of Medical Microbiology and Medical Immunology, Meander Medical Centre, Amersfoort, Netherlands
| | | | | | | | - Maarten Vermaas
- Department of Surgery, IJsselland Hospital, Capelle aan den Ijssel, Netherlands
| | - Bas Wiering
- Department of Surgery, Slingeland Hospital, Doetinchem, Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC - University Medical Centre, Rotterdam, Netherlands.
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40
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Qi H, Rizopoulos D, van Rosmalen J. Sample size calculation for clinical trials analyzed with the meta-analytic-predictive approach. Res Synth Methods 2023; 14:396-413. [PMID: 36625478 DOI: 10.1002/jrsm.1618] [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: 05/19/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
The meta-analytic-predictive (MAP) approach is a Bayesian method to incorporate historical controls in new trials that aims to increase the statistical power and reduce the required sample size. Here we investigate how to calculate the sample size of the new trial when historical data is available, and the MAP approach is used in the analysis. In previous applications of the MAP approach, the prior effective sample size (ESS) acted as a metric to quantify the number of subjects the historical information is worth. However, the validity of using the prior ESS in sample size calculation (i.e., reducing the number of randomized controls by the derived prior ESS) is questionable, because different approaches may yield different values for prior ESS. In this work, we propose a straightforward Monte Carlo approach to calculate the sample size that achieves the desired power in the new trial given available historical controls. To make full use of the available historical information to simulate the new trial data, the control parameters are not taken as a point estimate but sampled from the MAP prior. These sampled control parameters and the MAP prior based on the historical data are then used to derive the statistical power for the treatment effect and the resulting required sample size. The proposed sample size calculation approach is illustrated with real-life data sets with different outcomes from three studies. The results show that this approach to calculating the required sample size for the MAP analysis is straightforward and generic.
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Affiliation(s)
- Hongchao Qi
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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41
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Jessurun JG, Hunfeld NGM, de Roo M, van Onzenoort HAW, van Rosmalen J, van Dijk M, van den Bemt PMLA. Prevalence and determinants of medication administration errors in clinical wards: A two-centre prospective observational study. J Clin Nurs 2023; 32:208-220. [PMID: 35068001 DOI: 10.1111/jocn.16215] [Citation(s) in RCA: 2] [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: 06/25/2021] [Revised: 12/21/2021] [Accepted: 01/02/2022] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To identify the prevalence and determinants of medication administration errors (MAEs). BACKGROUND Insight into determinants of MAEs is necessary to identify interventions to prevent MAEs. DESIGN A prospective observational study in two Dutch hospitals, a university and teaching hospital. METHODS Data were collected by observation. The primary outcome was the proportion of administrations with one or more MAEs. Secondary outcomes were the type, severity and determinants of MAEs. Multivariable mixed-effects logistic regression analyses were used for determinant analysis. Reporting adheres to the STROBE guideline. RESULTS MAEs occurred in 352 of 2576 medication administrations (13.7%). Of all MAEs (n = 380), the most prevalent types were omission (n = 87) and wrong medication handling (n = 75). Forty-five MAEs (11.8%) were potentially harmful. The pharmaceutical forms oral liquid (odds ratio [OR] 3.22, 95% confidence interval [CI] 1.43-7.25), infusion (OR 1.73, CI 1.02-2.94), injection (OR 3.52, CI 2.00-6.21), ointment (OR 10.78, CI 2.10-55.26), suppository/enema (OR 6.39, CI 1.13-36.03) and miscellaneous (OR 6.17, CI 1.90-20.04) were more prone to MAEs compared to oral solid. MAEs were more likely to occur when medication was administered between 10 a.m.-2 p.m. (OR 1.91, CI 1.06-3.46) and 6 p.m.-7 a.m. (OR 1.88, CI 1.00-3.52) compared to 7 a.m.-10 a.m. and when administered by staff with higher professional education compared to staff with secondary vocational education (OR 1.68, CI 1.03-2.74). MAEs were less likely to occur in the teaching hospital (OR 0.17, CI 0.08-0.33). Day of the week, patient-to-nurse ratio, interruptions and other nurse characteristics (degree, experience, employment type) were not associated with MAEs. CONCLUSIONS This study identified a high MAE prevalence. Identified determinants suggest that focusing interventions on complex pharmaceutical forms and error-prone administration times may contribute to MAE reduction. RELEVANCE TO CLINICAL PRACTICE The findings of this study can be used to develop targeted interventions to improve patient safety.
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Affiliation(s)
- Janique Gabriëlle Jessurun
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicole Geertruida Maria Hunfeld
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michelle de Roo
- Department of Clinical Pharmacy, Amphia Hospital, Breda, The Netherlands
| | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patricia Maria Lucia Adriana van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
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42
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Duyndam A, Smit J, Houmes RJ, Heunks L, Molinger J, IJland M, van Rosmalen J, van Dijk M, Tibboel D, Ista E. No association between thickening fraction of the diaphragm and extubation success in ventilated children. Front Pediatr 2023; 11:1147309. [PMID: 37033174 PMCID: PMC10081691 DOI: 10.3389/fped.2023.1147309] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction In mechanically ventilated adults, thickening fraction of diaphragm (dTF) measured by ultrasound is used to predict extubation success. Whether dTF can also predict extubation success in children is unclear. Aim To investigate the association between dTF and extubation success in children. Second, to assess diaphragm thickness during ventilation and the correlation between dTF, diaphragm thickness (Tdi), age and body surface. Method Prospective observational cohort study in children aged 0-18 years old with expected invasive ventilation for >48 h. Ultrasound was performed on day 1 after intubation (baseline), day 4, day 7, day 10, at pre-extubation, and within 24 h after extubation. Primary outcome was the association between dTF pre-extubation and extubation success. Secondary outcome measures were Tdi end-inspiratory and Tdi end-expiratory and atrophy defined as <10% decrease of Tdi end-expiratory versus baseline at pre-extubation. Correlations were calculated with Spearman correlation coefficients. Inter-rater reliability was calculated with intraclass correlation (ICC). Results Fifty-three patients, with median age 3.0 months (IQR 0.1-66.0) and median duration of invasive ventilation of 114.0 h (IQR 55.5-193.5), were enrolled. Median dTF before extubation with Pressure Support 10 above 5 cmH2O was 15.2% (IQR 9.7-19.3). Extubation failure occurred in six children, three of whom were re-intubated and three then received non-invasive ventilation. There was no significant association between dTF and extubation success; OR 0.33 (95% CI; 0.06-1.86). Diaphragmatic atrophy was observed in 17/53 cases, in three of extubation failure occurred. Children in the extubation failure group were younger: 2.0 months (IQR 0.81-183.0) vs. 3.0 months (IQR 0.10-48.0); p = 0.045. At baseline, pre-extubation and post-extubation there was no significant correlation between age and BSA on the one hand and dTF, Tdi- insp and Tdi-exp on the other hand. The ICC representing the level of inter-rater reliability between the two examiners performing the ultrasounds was 0.994 (95% CI 0.970-0.999). The ICC of the inter-rater reliability between the raters in 36 paired assessments was 0.983 (95% CI 0.974-0.990). Conclusion There was no significant association between thickening fraction of the diaphragm and extubation success in ventilated children.
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Affiliation(s)
- Anita Duyndam
- Pediatric Intensive Care, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
- Correspondence: Anita Duyndam
| | - Joke Smit
- Pediatric Intensive Care, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Robert Jan Houmes
- Pediatric Intensive Care, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Leo Heunks
- Intensive Care Adults, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jeroen Molinger
- Intensive Care Adults, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Division of Critical Care, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
| | - Marloes IJland
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Monique van Dijk
- Pediatric Intensive Care, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
- Intensive Care Adults, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dick Tibboel
- Pediatric Intensive Care, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
- Intensive Care Adults, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Erwin Ista
- Pediatric Intensive Care, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
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Ten Kate CA, Teunissen NM, van Rosmalen J, Kamphuis LS, van Wijk MP, Joosten M, van Tuyll van Serooskerken ES, Wijnen R, IJsselstijn H, Rietman AB, Spaander MCW. Development and validation of a condition-specific quality of life instrument for adults with esophageal atresia: the SQEA questionnaire. Dis Esophagus 2022; 36:6957244. [PMID: 36562092 DOI: 10.1093/dote/doac088] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/01/2022] [Indexed: 12/24/2022]
Abstract
The importance of multidisciplinary long-term follow-up for adults born with esophageal atresia (EA) is increasingly recognized. Hence, a valid, condition-specific instrument to measure health-related quality of life (HRQoL) becomes imperative. This study aimed to develop and validate such an instrument for adults with EA. The Specific Quality of life in Esophageal atresia Adults (SQEA) questionnaire was developed through focus group-based item generation, pilot testing, item reduction and a multicenter, nationwide field test to evaluate the feasibility, reliability (internal and retest) and validity (structural, construct, criterion and convergent), in compliance with the consensus-based standards for the selection of health measurement instruments guidelines. After pilot testing (n = 42), items were reduced from 144 to 36 questions. After field testing (n = 447), three items were discarded based on item-response theory results. The final SQEA questionnaire (33 items) forms a unidimensional scale generating an unweighted total score. Feasibility, internal reliability (Cronbach's alpha 0.94) and test-retest agreement (intra-class coefficient 0.92) were good. Construct validity was discriminative for esophageal replacement (P < 0.001), dysphagia (P < 0.001) and airway obstruction (P = 0.029). Criterion validity showed a good correlation with dysphagia (area under the receiver operating characteristic 0.736). SQEA scores correlated well with other validated disease-specific HRQoL scales such as the GIQLI and SGRQ, but poorly with the more generic RAND-36. Overall, this first condition-specific instrument for EA adults showed satisfactory feasibility, reliability and validity. Additionally, it shows discriminative ability to detect disease burden. Therefore, the SQEA questionnaire is both a valid instrument to assess the HRQoL in EA adults and an interesting signaling tool, enabling clinicians to recognize more severely affected patients.
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Affiliation(s)
- Chantal A Ten Kate
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nadine M Teunissen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Lieke S Kamphuis
- Department of Pulmonology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Michiel P van Wijk
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers-Emma Children's Hospital, Amsterdam, The Netherlands
| | - Maja Joosten
- Department of Pediatric Surgery, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - René Wijnen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - André B Rietman
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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44
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Jessurun JG, Hunfeld NG, van Rosmalen J, van Dijk M, van den Bemt PM. Effect of a Pharmacy-based Centralized Intravenous Admixture Service on the Prevalence of Medication Errors: A Before-and-After Study. J Patient Saf 2022; 18:e1181-e1188. [PMID: 35786788 PMCID: PMC9698191 DOI: 10.1097/pts.0000000000001047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Intravenous admixture preparation errors (IAPEs) may lead to patient harm. The primary aim of this study was to assess the effect of a pharmacy-based centralized intravenous admixture service (CIVAS) on IAPEs. METHODS We conducted a before-and-after study in 3 clinical wards before CIVAS implementation and in the CIVAS unit 18 months after implementation. Intravenous admixture preparation error data were collected by disguised observation. The primary outcome was the proportion of admixtures with 1 or more IAPEs. Secondary outcomes were the type and potential severity of IAPEs, noncompliance to hygiene procedures, and nursing staff satisfaction with the CIVAS. The primary outcome was analyzed using a multivariable mixed-effects logistic regression model. RESULTS One or more IAPEs were identified in 14 of 543 admixtures (2.6%) in the CIVAS unit and in 148 of 282 admixtures (52.5%) in the clinical wards (odds ratio, 0.02; 95% confidence interval, 0.004-0.05). The most common IAPE types were wrong solvent or diluent (n = 95) and wrong volume of infusion fluid (n = 45). No potentially harmful IAPEs occurred in the CIVAS unit as opposed to 22 (7.8%) in the clinical wards. Disinfection procedures were better adhered to in the CIVAS unit. Overall nurse satisfaction with the CIVAS increased from a median of 70 (n = 166) 5 months after intervention to 77 (n = 115) 18 months after intervention ( P < 0.001) on a 100-point scale. CONCLUSIONS Centralized intravenous admixture service performed notably better than the clinical wards with regard to IAPEs and noncompliance to hygiene procedures. Nurses were satisfied with the CIVAS. Hence, the implementation of CIVAS is an important strategy to improve medication safety in hospitals.
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Affiliation(s)
| | | | - Joost van Rosmalen
- Biostatistics
- Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam
| | - Monique van Dijk
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen
| | - Patricia M.L.A. van den Bemt
- From the Departments of Hospital Pharmacy
- Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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45
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Qi H, Rizopoulos D, van Rosmalen J. Incorporating historical control information in ANCOVA models using the meta-analytic-predictive approach. Res Synth Methods 2022; 13:681-696. [PMID: 35439840 PMCID: PMC9790567 DOI: 10.1002/jrsm.1561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/09/2022] [Accepted: 04/07/2022] [Indexed: 12/31/2022]
Abstract
The meta-analytic-predictive (MAP) approach is a Bayesian meta-analytic method to synthesize and incorporate information from historical controls in the analysis of a new trial. Classically, only a single parameter, typically the intercept or rate, is assumed to vary across studies, which may not be realistic in more complex models. Analysis of covariance (ANCOVA) is often used to analyze trials with a pretest-posttest design, where both the intercept and the baseline effect (coefficient of the outcome at baseline) affect the estimated treatment effect. We extended the MAP approach to ANCOVA, to allow for variation in the intercept and the baseline effect across studies, and possibly also correlation between these parameters. The method was illustrated using data from the Alzheimer's Disease Cooperative Study (ADCS) and assessed with a simulation study. In the ADCS data, the proposed multivariate MAP approach yielded a prior effective sample size of 79 and 58 for the intercept and the baseline effect respectively and reduced the posterior standard deviation of the treatment effect by 12.6%. The result was robust to the choice of prior for the between-study variation. In the simulations, the proposed approach yielded power gains with a good control of the type I error rate. Ignoring the between-study correlation of the parameters or assuming no variation in the baseline effect generally led to less power gain. In conclusion, the MAP approach can be extended to a multivariate version for ANCOVA, which may improve the estimation of the treatment effect.
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Affiliation(s)
- Hongchao Qi
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands,Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| | - Dimitris Rizopoulos
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands,Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| | - Joost van Rosmalen
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands,Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
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46
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Peters R, van Trijffel E, van Rosmalen J, Mutsaers B, Pool-Goudzwaard A, Verhagen A, Koes B. Non-serious adverse events do not influence recovery in patients with neck pain treated with manual therapy; an observational study. Musculoskelet Sci Pract 2022; 61:102607. [PMID: 35772317 DOI: 10.1016/j.msksp.2022.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Renske Peters
- SOMT University of Physiotherapy, Amersfoort, the Netherlands; Department of General Practice, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - Emiel van Trijffel
- SOMT University of Physiotherapy, Amersfoort, the Netherlands; Experimental Anatomy Research Department, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.
| | - Bert Mutsaers
- Avans University of Applied Sciences, Breda, the Netherlands.
| | - Annelies Pool-Goudzwaard
- Department of General Practice, Erasmus Medical Centre, Rotterdam, the Netherlands; MOVE Research Institute, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands.
| | - Arianne Verhagen
- University of Technology Sydney, Discipline of Physiotherapy, Sydney, Australia.
| | - Bart Koes
- Department of General Practice, Erasmus Medical Centre, Rotterdam, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.
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47
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Tong-Minh K, van der Does Y, van Rosmalen J, Ramakers C, Gommers D, van Gorp E, Rizopoulos D, Endeman H. Joint Modeling of Repeated Measurements of Different Biomarkers Predicts Mortality in COVID-19 Patients in the Intensive Care Unit. Biomark Insights 2022; 17:11772719221112370. [PMID: 35859926 PMCID: PMC9290097 DOI: 10.1177/11772719221112370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/29/2022] [Accepted: 06/21/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction: Predicting disease severity is important for treatment decisions in patients with COVID-19 in the intensive care unit (ICU). Different biomarkers have been investigated in COVID-19 as predictor of mortality, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and soluble urokinase-type plasminogen activator receptor (suPAR). Using repeated measurements in a prediction model may result in a more accurate risk prediction than the use of single point measurements. The goal of this study is to investigate the predictive value of trends in repeated measurements of CRP, PCT, IL-6, and suPAR on mortality in patients admitted to the ICU with COVID-19. Methods: This was a retrospective single center cohort study. Patients were included if they tested positive for SARS-CoV-2 by PCR test and if IL-6, PCT, suPAR was measured during any of the ICU admission days. There were no exclusion criteria for this study. We used joint models to predict ICU-mortality. This analysis was done using the framework of joint models for longitudinal and survival data. The reported hazard ratios express the relative change in the risk of death resulting from a doubling or 20% increase of the biomarker’s value in a day compared to no change in the same period. Results: A total of 107 patients were included, of which 26 died during ICU admission. Adjusted for sex and age, a doubling in the next day in either levels of PCT, IL-6, and suPAR were significantly predictive of in-hospital mortality with HRs of 1.523 (1.012-6.540), 75.25 (1.116-6247), and 24.45 (1.696-1057) respectively. With a 20% increase in biomarker value in a subsequent day, the HR of PCT, IL-6, and suPAR were 1.117 (1.03-1.639), 3.116 (1.029-9.963), and 2.319 (1.149-6.243) respectively. Conclusion: Joint models for the analysis of repeated measurements of PCT, suPAR, and IL-6 are a useful method for predicting mortality in COVID-19 patients in the ICU. Patients with an increasing trend of biomarker levels in consecutive days are at increased risk for mortality.
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Affiliation(s)
- Kirby Tong-Minh
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yuri van der Does
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christian Ramakers
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eric van Gorp
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
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48
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Rier HN, Meinardi MC, van Rosmalen J, Westerweel PE, de Jongh E, Kitzen JJEM, van den Bosch J, Trajkovic M, Levin MD. Association Between Geriatric Assessment and Post-Chemotherapy Functional Status in Older Patients with Cancer. Oncologist 2022; 27:e878-e888. [PMID: 35861263 PMCID: PMC9632320 DOI: 10.1093/oncolo/oyac131] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/15/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Maintaining functional status is among the most important patient-centered outcomes for older adults with cancer. This study investigated the association between comprehensive geriatric assessment (CGA) and progressive disease or decline of IADL-independence 1 year after chemotherapy, overall survival (OS), and premature termination of chemotherapy. CGA-based functional status and quality of life (QOL) 1 year after chemotherapy are also described. METHODS This prospective cohort study involved patients aged ≥65 years treated with chemotherapy for any cancer type. CGA and the G8-screening tool were performed before and after the completion of chemotherapy. Analyses were adjusted for tumor type and treatment intent: (a) indolent hematological malignancies, (b) aggressive hematological malignancies, c) solid malignancies treated with curative intent, and (d) solid malignancies treated with palliative intent. RESULTS All 291 included patients lived in The Netherlands; 193 (67.4%) lived fully independent prior to chemotherapy. The median age was 72 years; 164 (56.4%) were male. IADL independence, CGA-based functional status, and QOL were maintained in half of the patients 1 year after chemotherapy. An abnormal G8-score before chemotherapy was a higher risk for progressive disease or a decline of IADL-independence (OR 3.60, 95% CI, 1.98-6.54, P < .0001), prematurely terminated chemotherapy (OR 2.12, 95% CI, 1.24-3.65, P = .006), and shorter median OS (HR 1.71, 95% CI, 1.16-2.52, P = .007). The impact of an abnormal G8-score differed across tumor type (oncological or hematological) and treatment indication (adjuvant or palliative). CONCLUSION An abnormal G8 score before chemotherapy is associated with progressive disease and functional decline after chemotherapy and shorter median OS, especially in patients with solid malignancies.
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Affiliation(s)
- Hánah N Rier
- Corresponding author: Hánah N. Rier, MD, PhD, Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3314 AT Dordrecht, The Netherlands. Tel: +31 621645973;
| | - Marieke C Meinardi
- Department of Geriatric Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Eva de Jongh
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Jos J E M Kitzen
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Joan van den Bosch
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Marija Trajkovic
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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49
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Polak TB, Cucchi DGJ, van Rosmalen J, Uyl-de Groot CA, Darrow JJ. Generating Evidence from Expanded Access Use of Rare Disease Medicines: Challenges and Recommendations. Front Pharmacol 2022; 13:913567. [PMID: 35677436 PMCID: PMC9168458 DOI: 10.3389/fphar.2022.913567] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/05/2022] [Indexed: 12/05/2022] Open
Abstract
Patients with rare diseases often have limited or no options for approved treatments or participation in clinical trials. In such cases, expanded access (or “compassionate use”) provides a potential means of accessing unapproved investigational medicines. It is also possible to capture and analyze clinical data from such use, but doing so is controversial. In this perspective, we offer examples of evidence derived from expanded access programs for rare diseases to illustrate its potential value to the decision-making of regulators and payers in the European Union and the United States. We discuss ethical and regulatory aspects to the use of expanded access data, with a focus on rare disease medicines. The heterogeneous approach to expanded access among countries within the European Union leaves uncertainties to what extent data can be collected and analyzed. We recommend the issuance of new guidance on data collection during expanded access, harmonization of European pathways, and an update of existing European compassionate use guidance. We hereby aim to clarify the supportive role of expanded access in evidence generation. Harmonization across Europe of expanded access regulations could reduce manufacturer burdens, improve patient access, and yield better data. These changes would better balance the need to generate quality evidence with the desire for pre-approval access to investigational medicine.
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Affiliation(s)
- Tobias B Polak
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Biostatistics, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus University Rotterdam, Rotterdam, Netherlands.,Real-World Data Department, myTomorrows, Amsterdam, Netherlands
| | - David G J Cucchi
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.,Department of Hematology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jonathan J Darrow
- Department of Law and Taxation, Bentley University, Waltham, MA, United States.,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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50
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Stipdonk LW, Boon RM, Franken MCJP, van Rosmalen J, Goedegebure A, Reiss IK, Dudink J. Language lateralization in very preterm children: associating dichotic listening to interhemispheric connectivity and language performance. Pediatr Res 2022; 91:1841-1848. [PMID: 34408271 DOI: 10.1038/s41390-021-01671-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Language difficulties of very preterm (VPT) children might be related to weaker cerebral hemispheric lateralization of language. Language lateralization refers to the development of an expert region for language processing in the left hemisphere during the first years of life. Children born VPT might not develop such a dominant left hemisphere for language processing. A dichotic listening task may be a functional task to show the dominance of the left hemisphere during language processing. During this task, different acoustic events are simultaneously presented to both ears. Due to crossing fibers in the brain, right ear stimuli are transferred directly to the left hemisphere, and left ear stimuli are transferred first to the right hemisphere and then, through the corpus callosum (CC), to the left hemisphere. Dichotic listening typically shows a right ear advantage, assuming to reflect left hemispherical language dominance. The CC, in particular the splenium, is associated with auditory processing and is considered important for language lateralization. The objective of this work was to explore whether dichotic listening performance in school-aged VPT children are associated with language performance and interhemispheric connectivity. METHODS This is a cross-sectional study of 58 VPT children and 30 full term controls at age 10 years. Language performance and dichotic digit test (DDT) were assessed. In 44 VPT children, additionally diffusion weighted imaging (DWI) was performed using a 3 T MRI scanner. Fractional anisotropy (FA) and mean diffusivity (MD) values of the splenium of the CC were extracted. RESULTS Poorer right ear DDT scores were associated with poorer language performance in VPT children only (p = 0.015). Association between right ear DDT scores and MD of the splenium approached the level of significance (p = 0.051). CONCLUSIONS These results support the hypothesis that poor language performance in VPT children may be a consequence of weaker lateralized language organization, due to a poorly developed splenium of the CC. Dichotic listening may reflect the level of language lateralization in VPT children. IMPACT Poor language performance in VPT children may be a consequence of weaker lateralized language organization, due to a poorly developed splenium of the CC. Dichotic listening performance may reflect the level of language lateralization in VPT children and right ear scores of a dichotic listening task are associated with both the splenium of the corpus callosum and language performance. If our results could be validated in future research, it suggests that poor CC development may indicate VPT children at risk for long-term language problems.
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Affiliation(s)
- Lottie W Stipdonk
- Department of Otorhinolaryngology at Erasmus Medical University Centre-Sophia Children's Hospital, Rotterdam, Netherlands.
| | - Rianne M Boon
- Division of Neonatology, Department of Pediatrics at UMCU-Wilhelmina Children's Hospital, Utrecht, Netherlands.,Faculty of Science at Vrije Universiteit, Amsterdam, Netherlands
| | - Marie-Christine J P Franken
- Department of Otorhinolaryngology at Erasmus Medical University Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical University Centre, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus Medical University Centre, Rotterdam, Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology at Erasmus Medical University Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Irwin K Reiss
- Division of Neonatology, Department of Pediatrics at Erasmus Medical University Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Jeroen Dudink
- Division of Neonatology, Department of Pediatrics at UMCU-Wilhelmina Children's Hospital, Utrecht, Netherlands
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