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Imkamp MS, Theunissen M, van Kuijk SM, Haumann J, Corli O, Bosetti C, Leppert W, Brunelli C, Zecca E, van den Beuken-van Everdingen MH. Finding predictors for successful opioid response in cancer patients: An analysis of data from four randomized controlled trials. Pain Pract 2024; 24:101-108. [PMID: 37650142 DOI: 10.1111/papr.13292] [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: 01/27/2023] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
CONTEXT There is no consensus on which "strong" (or step 3 WHO analgesic ladder) opioid to prescribe to a particular patient with cancer-related pain. A better understanding of opioid and patient characteristics on treatment response will contribute to a more personalized opioid treatment. OBJECTIVES Assessment of potential predictors for successful opioid treatment response in patients with cancer pain. METHODS An international partnership between four cancer pain research groups resulted in a combined individual-level database from four relevant randomized controlled trials (RCTs; n = 881). Together, these RCTs investigated the short-term (1 week) and medium-term (4 or 5 weeks) treatment responses for morphine, buprenorphine, methadone, oxycodone, and fentanyl. Candidate predictors for treatment response were sex, age, pain type, pain duration, depression, anxiety, Karnofsky performance score, opioid type, and use of anti-neuropathic drug. RESULTS Opioid type and pain type were found statistically significant predictors of short-term treatment success. Sex, age, pain type, anxiety, and opioid type were statistically, significantly associated with medium-term treatment success. However, these models showed low discriminative power. CONCLUSION Fentanyl and methadone, and mixed pain were found to be statistically significant predictors of treatment success in patients with cancer-related pain. With the predictors currently assessed our data did not allow for the creation of a clinical prediction model with good discriminative power. Additional - unrevealed - predictors are necessary to develop a future prediction model.
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Affiliation(s)
- Maike S Imkamp
- Department of Clinical Epidemiology and Medical Technology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Maurice Theunissen
- Center of Expertise for Palliative Care, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Sander M van Kuijk
- Department of Clinical Epidemiology and Medical Technology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Johan Haumann
- Department of Anaesthesiology and Pain Management, OLVG, Amsterdam, The Netherlands
| | - Oscar Corli
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Wojciech Leppert
- Department of Palliative Medicine, Institute of Medical Sciences, University of Zielona Góra, Zielona Góra, Poland
- University Hospital of Heliodor Święcicki, Poznań, Poland
| | - Cinzia Brunelli
- Department of Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ernesto Zecca
- Department of Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Pijls N, Joosten H, Theunissen M, van Leendert J, Courtens A, Magdelijns F, van den Beuken-van Everdingen M. Bedside palliative care and geriatric consultations: adherence rate in hospitalised patients. BMJ Support Palliat Care 2023:spcare-2023-004453. [PMID: 37679026 DOI: 10.1136/spcare-2023-004453] [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: 06/30/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES This study examined the adherence rate of recommendations of a palliative consultation team (PCT) and a geriatric consultation team (GCT). Secondary aims were to investigate which factors and/or recommendation characteristics influence adherence rates. METHODS This retrospective cohort study was performed in the Maastricht University Medical Center+ in the Netherlands and included hospitalised patients who received a consultation by the PCT or the GCT. Baseline data on consultations were collected for the total population and for the GCT and PCT separately. The adherence rate of the recommendations was evaluated by checking evidence of implementation. The nature of recommendations given (solicited or unsolicited) was documented per domain (somatic, psychological/cognitive, social, spiritual, functional, and existential). The association with adherence was evaluated for solicited and unsolicited recommendations separately. Exploration of potentially associated factors was performed using OpenEpi. RESULTS Overall, 507 consultations of individual patients were performed (n=131) by the GCT and (n=376) by the PCT. Most recommendations given were solicited (865/1201=72%). Over 80% of both solicited and unsolicited recommendations were implemented in the majority of domains. No potentially modifiable factors associated with the adherence of the advices were found. CONCLUSIONS The overall adherence rate of the GCT and PCT consultations was high. In addition, in certain domains, many recommendations were unsolicited. However, also the majority of these recommendations were implemented.
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Affiliation(s)
- Noor Pijls
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
| | - Hanneke Joosten
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
| | - Maurice Theunissen
- Center of Expertise for Palliative Care, MUMC+, Maastricht, The Netherlands
| | - Jannic van Leendert
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
| | - Annemie Courtens
- Center of Expertise for Palliative Care, MUMC+, Maastricht, The Netherlands
| | - Fabienne Magdelijns
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
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Karačić A, Brkić J, Theunissen M, Sović S, Karimollahi M, Bakula B, Karačić J, Rosmarin DH. Are religious patients less afraid of surgery? A cross-sectional study on the relationship between dimensions of religiousness and surgical fear. PLoS One 2023; 18:e0287451. [PMID: 37440556 PMCID: PMC10343077 DOI: 10.1371/journal.pone.0287451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Surgical fear is common and has a negative impact on surgery and its outcome. Recent research has identified individual religiousness as an important factor among patients with associations to mental health, particularly anxiety. OBJECTIVE This study aimed to examine associations between religiousness and surgical fear in a representative sample of adult surgical patients in Croatia. DESIGN Cross-sectional study among elective surgery patients at different departments of a single hospital. SETTING University Hospital Sveti Duh, a tertiary health care facility in Croatia. MEASUREMENTS Religiousness and surgical fear were the variables of interest and assessed through self-report instruments. The Croatian version of the Duke Religiosity Index questionnaire (DUREL) assessed organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiousness (IR). The Croatian version of the Surgical Fear Questionnaire (SFQ) measured surgical fear and its subscales the fear of the short-term and long-term consequences of surgery. Additionally, sociodemographic characteristics and medical history were assessed. Analyses were carried out using descriptive and linear regression analyses. RESULTS 178 subjects were included for data analysis. Univariate linear regression found two dimensions of religiousness (non-organizational religious activity, intrinsic religiousness) to be weak, but significant predictors of greater surgical fear (adj. R2 = 0.02 and 0.03 respectively). In the multiple linear regression model together with age, gender, education and type of surgery, all three dimensions of religiousness were found to be significant independent predictors of greater surgical fear. LIMITATIONS The study was single-center and cross-sectional and did not assess patients' specific religious identity. CONCLUSIONS This study demonstrated significant positive associations between dimensions of religiousness and surgical fear, potentially suggesting that surgical patients experience increased religiousness to cope with heightened anxiety. Assessment and intervention to address patient religiousness is warranted in the context of surgical fear among religious patients, and the importance of religiousness in the context of surgical fear needs to be further addressed in research.
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Affiliation(s)
- Andrija Karačić
- Department of General Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Jure Brkić
- Department of General Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Maurice Theunissen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Slavica Sović
- Statistics Department, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Branko Bakula
- Department of General Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Jelena Karačić
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, Basel, Switzerland
| | - David H. Rosmarin
- Spirituality & Mental Health Program, McLean Hospital, Belmont, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Karačić A, Theunissen M, Sović S, Sever M, Bakula B, Semanjski K. VALIDATION OF THE CROATIAN VERSION OF THE SURGICAL FEAR QUESTIONNAIRE (SFQ) IN ADULT PATIENTS WAITING FOR ELECTIVE SURGERY. Acta Clin Croat 2023; 62:153-161. [PMID: 38304381 PMCID: PMC10829953 DOI: 10.20471/acc.2023.62.01.18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/12/2021] [Indexed: 02/03/2024] Open
Abstract
The Surgical Fear Questionnaire (SFQ) is an instrument for self-assessment of surgical fear and consists of two subscales, one assessing the fear of short-term consequences (SFQ-s) and another one of long-term consequences (SFQ-l) of surgery. The aim of this study was to test the Croatian version of the SFQ with regard to its psychometric properties. This prospective cohort study included patients who presented to the Department of Surgery for elective surgery in the inpatient setting at a tertiary health care facility in Croatia between April 1 and May 31, 2019. Data on 144 patients were suitable for data analysis. Data collection was performed in the afternoon before surgery using the Personal Information Form, Numerical Rating Scale self-report instruments (NRS), SFQ and Hospital Anxiety and Depression Scale (HADS) assessing sociodemographic factors, surgical fear via NRS and SFQ, expected pain and emotional state. The Cronbach alpha value as a statistical measure for reliability of psychometric tests for the SFQ-s subscale was 0.79, for SFQ-L subscale 0.84, and for total SFQ 0.81. The exploratory factor analysis (EFA) showed a two-factor structure. Significant correlations of the SFQ with the NRS and HADS-anxiety subscale were demonstrated. Our study demonstrated the Croatian version of the SFQ to have a high level of reliability and hence can be used as a self-report instrument for surgical fear with two subscales. Convergent validity of the SFQ with other self-report instruments is shown.
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Affiliation(s)
- Andrija Karačić
- Division of Digestive Surgery, Department of Surgery, Sveti Duh University Hospital, Zagreb, Croatia
| | - Maurice Theunissen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Slavica Sović
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marko Sever
- Division of Digestive Surgery, Department of Surgery, Sveti Duh University Hospital, Zagreb, Croatia
| | - Branko Bakula
- Division of Digestive Surgery, Department of Surgery, Sveti Duh University Hospital, Zagreb, Croatia
| | - Kristina Semanjski
- Division of Digestive Surgery, Department of Surgery, Sveti Duh University Hospital, Zagreb, Croatia
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5
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Gruiskens JRJH, van Hoef L, Theunissen M, Courtens AM, van den Beuken-van Everdingen MHJ, Gidding-Slok AHM, van Schayck OCP. The Psychosocial Impact of the COVID-19 Pandemic on Chronic Care Patients. J Am Med Dir Assoc 2023; 24:426-433.e2. [PMID: 36781063 PMCID: PMC9841072 DOI: 10.1016/j.jamda.2023.01.003] [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: 08/17/2022] [Revised: 12/01/2022] [Accepted: 01/07/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has had a profound and pervasive impact on psychosocial health and disrupted care systems world-wide. Our research aims to assess the psychosocial impact of the pandemic and related changes in chronic care provision on patients with chronic obstructive pulmonary disease (COPD) and heart failure. DESIGN A qualitative survey using semi-structured interviews was held among patients with COPD and heart failure. SETTING AND PARTICIPANTS Using randomized sampling, 23 patients with COPD, heart failure, or both were recruited to participate in semi-structured interviews. Interviews were held by phone or videocall. The survey was held during the summer of 2021, when strict national containment strategies were widely implemented but gradually loosened and vaccination was ongoing. METHODS Inductive coding using Gioia's approach was used to analyze the data in Atlas.Ti 9.1 software. Using an iterative approach, the data were synthesized in a data structure and data table, which was analyzed using an interpretative approach. RESULTS We found 3 aggregate dimensions in which the COVID-19 pandemic has a negative impact on psychosocial health of patients with chronic disease: (1) perceived vulnerability to disease, (2) influence of health policy, and (3) a mismatch of supply and demand of health care. In these dimensions, the impact of the COVID-19 crisis was found to have a negative impact on psychosocial well-being, compounded by national strategies to contain the pandemic and a disruption of chronic care for patients. CONCLUSIONS AND IMPLICATIONS Health care providers should be aware of a multidimensional nature of psychosocial distress for chronic disease patients due to the COVID-19 crisis. Future practice and health policy could be improved by increasing awareness among health care providers, promote regular attention for psychosocial well-being of patients, provision of clear information related to the pandemic, and strategies to secure continuity of care. Results of this study might be further explored in larger studies.
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Affiliation(s)
- Jeroen R J H Gruiskens
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Liesbeth van Hoef
- Expertise Centre for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maurice Theunissen
- Expertise Centre for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Annemie M Courtens
- Expertise Centre for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Annerika H M Gidding-Slok
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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6
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Lukas A, Theunissen M, Boer DDKD, van Kuijk S, Van Noyen L, Magerl W, Mess W, Buhre W, Peters M. AMAZONE: prevention of persistent pain after breast cancer treatment by online cognitive behavioral therapy-study protocol of a randomized controlled multicenter trial. Trials 2022; 23:595. [PMID: 35879728 PMCID: PMC9310687 DOI: 10.1186/s13063-022-06549-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Surviving breast cancer does not necessarily mean complete recovery to a premorbid state of health. Among the multiple psychological and somatic symptoms that reduce the quality of life of breast cancer survivors, persistent pain after breast cancer treatment (PPBCT) with a prevalence of 15–65% is probably the most invalidating. Once chronic, PPBCT is difficult to treat and requires an individualized multidisciplinary approach. In the past decades, several somatic and psychological risk factors for PPBCT have been identified. Studies aiming to prevent PPBCT by reducing perioperative pain intensity have not yet shown a significant reduction of PPBCT prevalence. Only few studies have been performed to modify psychological distress around breast cancer surgery. The AMAZONE study aims to investigate the effect of online cognitive behavioral therapy (e-CBT) on the prevalence of PPBCT. Methods The AMAZONE study is a multicenter randomized controlled trial, with an additional control arm. Patients (n=138) scheduled for unilateral breast cancer surgery scoring high for surgical or cancer-related fears, general anxiety or pain catastrophizing are randomized to receive either five sessions of e-CBT or online education consisting of information about surgery and a healthy lifestyle (EDU). The first session is scheduled before surgery. In addition to the online sessions, patients have three online appointments with a psychotherapist. Patients with low anxiety or catastrophizing scores (n=322) receive treatment as usual (TAU, additional control arm). Primary endpoint is PPBCT prevalence 6 months after surgery. Secondary endpoints are PPBCT intensity, the intensity of acute postoperative pain during the first week after surgery, cessation of postoperative opioid use, PPBCT prevalence at 12 months, pain interference, the sensitivity of the nociceptive and non-nociceptive somatosensory system as measured by quantitative sensory testing (QST), the efficiency of endogenous pain modulation assessed by conditioned pain modulation (CPM) and quality of life, anxiety, depression, catastrophizing, and fear of recurrence until 12 months post-surgery. Discussion With perioperative e-CBT targeting preoperative anxiety and pain catastrophizing, we expect to reduce the prevalence and intensity of PPBCT. By means of QST and CPM, we aim to unravel underlying pathophysiological mechanisms. The online application facilitates accessibility and feasibility in a for breast cancer patients emotionally and physically burdened time period. Trial registration NTR NL9132, registered December 16 2020.
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Affiliation(s)
- Anne Lukas
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Maurice Theunissen
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Dianne de Korte-de Boer
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lotte Van Noyen
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Walter Magerl
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Ruprecht-Karls-University Heidelberg, Medical Faculty Mannheim, Heidelberg, Germany
| | - Werner Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wolfgang Buhre
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Madelon Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
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7
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Stoorvogel H, van Haastregt J, Theunissen M, Schoenmaekers J, Hoeben A, van den Beuken-van Everdingen M. Unacceptable pain in oncology: The patients' perspective on reasons for absence of pain interventions. Eur J Cancer Care (Engl) 2022; 31:e13628. [PMID: 35662290 PMCID: PMC9541915 DOI: 10.1111/ecc.13628] [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: 11/25/2021] [Revised: 04/29/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022]
Abstract
Objective Around 40% of oncology patients receive inadequate pain treatment. A previous study reported pain interventions for only 70% of patients who reported unacceptable pain at the self‐service registration desk. The aim of this study is to gain insight in reasons for the absence of pain intervention among oncology patients who reported unacceptable pain. Methods In this mixed methods study, 20 patients visiting the oncology outpatient clinic were selected via patient record assessment and interviewed about their perceived reasons for absence of pain intervention. Results The reasons mentioned by the patients for absence of pain intervention included reluctance of the patient to discuss pain, no treatment preferred by the patient, focus of the physician on treatment of the disease, pain treatment difficult or impossible, and the perception that pain is an inevitable consequence of the cancer treatment. Almost 50% of the patients considered the physician responsible for the absence of pain intervention. Conclusion In conclusion, a variety of reasons for absence of pain intervention are reported by patients, including patient‐related and health professional‐related reasons. Improvements can be made by promoting regular discussion of pain during hospital visits and empowerment of patients.
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Affiliation(s)
- Hester Stoorvogel
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Centre of Expertise for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jolanda van Haastregt
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Maurice Theunissen
- Centre of Expertise for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Janna Schoenmaekers
- Centre of Expertise for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ann Hoeben
- Centre of Expertise for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Medical Oncology, GROW-School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marieke van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
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8
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Lardenoye S, Theunissen M, van der Horst-Schrivers ANA, van den Beuken-van Everdingen MHJ. Letter to the Editor on "A missed opportunity in the ED: Palliative care consult delays during inpatient admission " in reaction to the publication of Bright et al. (published in January 2022). Am J Emerg Med 2022; 58:345-346. [PMID: 35459563 DOI: 10.1016/j.ajem.2022.04.014] [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] [Received: 04/05/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- S Lardenoye
- Department of Emergency Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - M Theunissen
- Center of Expertise Palliative Care, Maastricht University Medical Center+, Maastricht, the Netherlands
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9
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Zeleníková R, Kovářová K, Bujok P, Theunissen M. The Czech version of the Surgical Fear Questionnaire: measuring validity and reliability. Cent Eur J Nurs Midw 2022. [DOI: 10.15452/cejnm.2021.12.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Theunissen M, Magdelijns FJ, Janssen DJ, Naaktgeboren MW, Courtens A, van Kuijk SM, van den Beuken-van Everdingen M. The Surprise Question in Older Hospitalized Patients: To Use or Not to Use? J Am Med Dir Assoc 2022; 23:894-896.e1. [DOI: 10.1016/j.jamda.2022.01.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 01/23/2023]
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11
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Pouwels BDC, Simons SO, Theunissen M, Peters ML, Schoenmaekers JJ, Bekkers SC, van den Beuken-van Everdingen MHJ. Healthcare use during COVID-19 and the effect on psychological distress in patients with chronic cardiopulmonary disorders in the Netherlands: a cross-sectional study. BMJ Open 2021; 11:e046883. [PMID: 34193494 PMCID: PMC8249168 DOI: 10.1136/bmjopen-2020-046883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic caused a massive shift in the focus of healthcare. Such changes could have affected health status and mental health in vulnerable patient groups. We aimed to investigate whether patients with chronic pulmonary and cardiac diseases had experienced high levels of psychological distress during the COVID-19 pandemic in the Netherlands. DESIGN A cross-sectional study. SETTING COVID-19 pandemic-related changes in healthcare use, health status and psychological distress were investigated among patients with chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (PF) and congestive heart failure (CHF), using an online nationwide survey. PARTICIPANTS 680 patients completed the survey. COPD was the most often reported diagnosis 334 (49%), followed by congestive heart failure 219 (32%) and PF 44 (7%). There were 79 (12%) patients with primary diagnosis 'other' than chronic cardiopulmonary disease, who also completed this survey. INTERVENTIONS Psychological distress was assessed via the DASS-21 score (Depression Anxiety Stress Scale). Moreover, specific worries and anxieties regarding COVID-19 were explored. RESULTS The frequency of contact with healthcare professionals changed in 52%. Changes in treatment were reported in 52%. Deterioration in health status was self-reported in 39%. Moderate to extremely severe levels of depression, anxiety and stress was observed in 25.8%, 28.5% and 14%, respectively. Over 70% reported specific worries and anxieties, such as about their own health and fear of being alone. Both the deterioration in health status and increased levels of anxiety were significantly (p<0.001, p<0.006) associated with changes in treatment. Exploratory analyses indicated that lack of social support may further increase anxiety. CONCLUSION Healthcare use changed during the COVID-19 pandemic in the Netherlands. It was associated with a decrease in health status, and increased psychological stress among patients with chronic cardiopulmonary disorders. Provision of healthcare should be more sensitive to the mental health needs of these patients during subsequent COVID-19 waves.
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Affiliation(s)
- Beau D C Pouwels
- Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sami O Simons
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maurice Theunissen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Madelon L Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Janna J Schoenmaekers
- Respiratory Medicine and Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
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12
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Willems AAJM, Kudrashou AF, Theunissen M, Hoeben A, Van den Beuken-Van Everdingen MHJ. Measuring pain in oncology outpatients: Numeric Rating Scale versus acceptable/non acceptable pain. A prospective single center study. Pain Pract 2021; 21:871-876. [PMID: 34170618 PMCID: PMC9292439 DOI: 10.1111/papr.13053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/05/2021] [Accepted: 06/11/2021] [Indexed: 12/20/2022]
Abstract
Objectives During all stages of oncologic diseases, pain is still a major problem. The Numeric Rating Scale (NRS) is one of the most frequently used tools for pain assessment, although interpretation is difficult. The main objective of this study is to compare two types of pain evaluation scales: NRS versus (non) acceptable pain evaluation scale. The secondary aim is to analyze a 10% sample of patients indicating non acceptable pain more in‐depth. Methods To assess the pain evaluation scales, a prospective observational study, with a nested retrospective in‐depth exploration, was conducted. One‐year data of patients visiting the outpatient clinic of the oncology center of a university hospital were used. Besides the pain scores of all patients, a 10% sample of patients indicating non acceptable pain was analyzed more in‐depth. Results During 1 year, a total of 37,580 patients registered at the outpatient clinic, of whom approximately 10% indicated non acceptable pain. The mean NRS of patients indicating non acceptable pain was 6.5 (n = 2153). For patients indicating acceptable pain, the mean NRS was 1.6 (n = 21,010). Although the presence of pain recorded in the patient record increased substantially over the year, the percentage of reported interventions only slightly increased. Conclusion The (non) acceptable pain evaluation seems a valuable addition to the NRS for assessing pain among patients with cancer. As interpretation of the NRS appears to be difficult, using the (non) acceptable pain evaluation is recommended. Moreover, creating awareness among specialists to discuss pain has a positive effect on the amount of pain discussed during consultation.
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Affiliation(s)
- Aniek Anna Julia Martine Willems
- Department of Medical Oncology, School for Oncology and Developmental Biology (GROW, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Aliaksandr Fedorovich Kudrashou
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Center+ (MUMC+, Maastricht, The Netherlands
| | - Maurice Theunissen
- Centre of Expertise for Palliative Care, Maastricht University Medical Center+ (MUMC+, Maastricht, The Netherlands
| | - Ann Hoeben
- Department of Medical Oncology, School for Oncology and Developmental Biology (GROW, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Centre of Expertise for Palliative Care, Maastricht University Medical Center+ (MUMC+, Maastricht, The Netherlands
| | - Marieke Henrica Johanna Van den Beuken-Van Everdingen
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Center+ (MUMC+, Maastricht, The Netherlands.,Centre of Expertise for Palliative Care, Maastricht University Medical Center+ (MUMC+, Maastricht, The Netherlands
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13
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Theunissen M, de Wolff M. Is the Strengths and Difficulties Questionnaire applicable to lower educated adolescents? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.342] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Strengths and Difficulties Questionnaire self-report (SDQ-SR) is a widely used instrument to identify emotional and behavioral problems by Preventive Child Healthcare (PCH). It is a valid instrument in more highly educated adolescents, however evidence regarding lower educated adolescents (vocational school) is lacking. The aim of this study was to compare the psychometric properties of the SDQ-SR when used with less well and more highly educated ('higher') adolescents, and to explore opinions of adolescents and PCH professionals regarding its suitability.
Methods
We included 426 adolescents (130 lower and 296 higher educated), who completed the SDQ-SR. We compared how the psychometric properties (i.e. internal consistency) applied to lower and higher educated adolescents. We assessed whether the five-factor structure of the SDQ is invariant across different educational levels. Moreover, we interviewed 24 adolescents from pre-vocational secondary education schools, and performed online focus group interviews with 17 PCH professionals.
Results
The internal consistencies (Cronbach's alphas) per SDQ scale were comparable for lower and higher educated adolescents. On most subscales the lower educated adolescents had higher mean scores than the higher educated adolescents. Findings on differences by educational level for the other psychometric properties, i.e. multi-group invariance and single group (CFA) analyses, were inconsistent, with some measures showing unequal factor loadings but others not. Although professionals and lower educated adolescents reported that the SDQ includes many outdated and difficult words, professionals nevertheless perceived the SDQ-SR as a valid instrument.
Conclusions
The psychometric properties of the SDQ-SR are sufficient for use among lower educated adolescents. However, for optimal implementation in PCH there is a need for improvement in the wording of the SDQ, as expressed by both professionals and adolescents.
Key messages
The psychometric properties of the SDQ are sufficient for use among lower educated adolescents. For optimal implementation the SDQ needs to be updated in more understandable language.
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14
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Theunissen M. Triage in Preventive Child Healthcare: A novel triage protocol to identify health problems. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.914] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A triage approach to routine health assessments was introduced to improve the efficiency of Preventive Child Healthcare (PCH): PCH assistants carry out pre-assessments of all children and send the children with suspected health problems to follow-up assessments conducted by a physician or nurse. Each PCH service use their own protocol (with health themes such as visuals disorders, sleeping- and psychosocial problems) to determine whether a follow-up assessment is needed. In this study a novel standardized triage protocol was developed. The aim was to improve the quality of detection of health problems in primary school children by PCH by investigating the quality of detection of health problems and satisfaction of this novel triage protocol.
Methods
We included 459 primary school children undergoing routine health assessments in 2 PCH services across the Netherlands. We used parent-reported child problems and PCH registry data. After each assessment PCH professionals reported whether they had identified any problems and carried out any additional actions (e.g., additional assessments, referral). The validity of the protocol is assessed, with problems identified by PCH professionals and performing additional actions as criteria.
Results
Results showed that the psychometric properties of the novel triage protocol were moderate to good. Sensitivity (true positives) and specificity (true negatives) for the novel triage protocol were 0.73 and 0.62, respectively for the identification of any problems, and were 0.91 and 0.41, respectively, for additional PCH actions.
Conclusions
The novel triage protocol is a valid tool for the detection of health problem in primary school children by PCH. Few children with health problems were missed. Professionals and parents were very satisfied with the novel protocol. Professionals made specific recommendations about adaptations of the protocol to improve efficiency and facilitate implementation in daily PCH practice.
Key messages
The novel triage protocol is a valid tool for the detection of health problem in primary school children. For optimal implementation in preventive child healthcare the novel triage protocol needs some minor adaptations.
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15
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Theunissen M, Rideaux-Seferina S, Magdelijns FJ, Janssen DJA, van den Beuken-van Everdingen MHJ. Local Oral Pilocarpine Drops for Relieving Xerostomia (Dry Mouth) in the Elderly: A Pilot Study. J Am Med Dir Assoc 2020; 22:185-186. [PMID: 32800514 DOI: 10.1016/j.jamda.2020.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Maurice Theunissen
- Center of Expertise for Palliative Care, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Shanly Rideaux-Seferina
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands
| | - Fabienne J Magdelijns
- Division of General Medicine, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands
| | - Daisy J A Janssen
- Department of Health Services Research, Care and Public Health Research Institute Maastricht University, Maastricht, the Netherlands; Department of Research and Development, CIRO, Horn, the Netherlands
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16
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Dedden SJ, van Ditshuizen MAE, Theunissen M, Maas JWM. Hysterectomy and sexual (dys)function: An analysis of sexual dysfunction after hysterectomy and a search for predictive factors. Eur J Obstet Gynecol Reprod Biol 2020; 247:80-84. [PMID: 32078980 DOI: 10.1016/j.ejogrb.2020.01.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Research about sexual function after hysterectomy is inconclusive. Possible predictive factors for sexual (dys)function are yet to be identified. The aim of this study is to assess the effect of hysterectomy on sexual function in women 3 and 12 months after hysterectomy for benign indications. Furthermore hypothesized predictive factors will be evaluated. STUDY DESIGN A prospective multicentre cohort study with follow-up at 3 and 12 months after hysterectomy was performed. To assess sexual function a short-form FSFI was used, a score ≤ 19 means sexual dysfunction). Linear mixed model repeated measure analysis was used to assess changes in sexual function in women who were sexually active at all three measure points (N = 260). Linear mixed model analyses were also used for the predictor analyses. RESULTS The FSFI score increased from 20.94 at baseline to 23.81 at 12 months post hysterectomy. The number of women experiencing sexual dysfunction was 86 (33.1 %). Women without preoperative sexual dysfunction had a significantly higher FSFI score 4.5 (95 % CI 3.5-5.6) one year after the operation than women indicating sexual dysfunction before surgery. Women who were living alone had a significantly higher FSFI score of 2.31 (0.7-4.0) when compared to women who were married or living together. CONCLUSION FSFI score increases significantly after hysterectomy, which indicates a better sexual function after the operation. Sexual dysfunction before hysterectomy (FSFI score ≤ 19) and being married or living together are predictive factors for a lower FSFI score post hysterectomy.
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Affiliation(s)
- Suzanne J Dedden
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, the Netherlands; Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands.
| | | | - Maurice Theunissen
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+, the Netherlands
| | - Jacques W M Maas
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands
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17
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Theunissen M, Martens M, Janssen DJA, Schols JMGA, van den Beuken-van Everdingen MHJ. Premature Ending of a Medication Study in Dying Patients: Lessons Learned. J Pain Symptom Manage 2019; 58:e4-e7. [PMID: 31404647 DOI: 10.1016/j.jpainsymman.2019.07.027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Maurice Theunissen
- Centre of Expertise in Palliative Care, Maastricht UMC+, Maastricht, The Netherlands.
| | - Mark Martens
- Centre of Expertise in Palliative Care, Maastricht UMC+, Maastricht, The Netherlands; Department of Palliative Care, Zuyderland, Sittard-Geleen, The Netherlands
| | - Daisy J A Janssen
- Department of Research & Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Health Services Research & Department of Family Medicine, CAPHRI-Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research & Department of Family Medicine, CAPHRI-Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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18
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Sloekers JCT, Bos M, Hoogland G, Bastiaenen C, van Kuijk S, Theunissen M, Rijkers K, Dings J, Colon A, Rouhl RPW, Schijns OEMG. Assessing the effectiveness of perioperative s-ketamine on new-onset headache after resective epilepsy surgery (ESPAIN-trial): protocol for a randomised, double-blind, placebo-controlled trial. BMJ Open 2019; 9:e030580. [PMID: 31481375 PMCID: PMC6731791 DOI: 10.1136/bmjopen-2019-030580] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Effective treatment of new-onset headache after craniotomy, especially anterior temporal lobectomy (ATL) and amygdalohippocampectomy for drug-resistant temporal lobe epilepsy, is a challenge. The current practice, acetaminophen combined with opioids is often reported by patients as insufficient and sometimes accompanied by opioid-related adverse effects. Based on expert opinion, anaesthesiologists therefore frequently consider s-ketamine as add-on therapy. This randomised parallel group design trial compares s-ketamine with a placebo as add on medication to a multimodal pain approach. METHODS AND ANALYSIS In total 62 adult participants, undergoing ATL for drug resistant epilepsy under general anaesthesia, will be randomised to either receive a 0.25 mg/kg bolus followed by a continuous infusion of 0.1 mg/kg/hour of s-ketamine or placebo (0.9% NaCl) starting before incision and continued for 48 hours as an addition to acetaminophen and opioids administered in a patient-controlled analgesia pump. The primary outcome measure is the cumulative postoperative opioid consumption. Patient recruitment started August 2018 and will end in 2021. Secondary outcome measures are postoperative pain intensity scores, psychological parameters, length of hospital stay and adverse events and will be reassessed at 3 and 6 months after surgery, with a baseline measurement preoperatively. All data are collected by researchers who are blinded to the treatment. The data will be analysed by multivariable linear mixed-effects regression. ETHICS AND DISSEMINATION Ethical approval has been given by the local medical ethical committee (NL61666.068.17). This study will be conducted in accordance with the Dutch Medical Research Involving Human Subjects Act and the Declaration of Helsinki. The results of this trial will be publicly disclosed and submitted for publication in an international peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER NTR6480.
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Affiliation(s)
| | - Michael Bos
- Anaesthesiology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Govert Hoogland
- Neurosurgery, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
- MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Sander van Kuijk
- Clinical Epidemiology and Medical Technology Assessment, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Maurice Theunissen
- Anaesthesiology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Kim Rijkers
- Neurosurgery, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Jim Dings
- Neurosurgery, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Albert Colon
- Academic Centre for Epileptology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
- Academic Centre for Epileptology, Kempenhaeghe, Heeze, The Netherlands
| | - Rob P W Rouhl
- Neurology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Olaf Elisabeth Maria Ghislaine Schijns
- Neurosurgery, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
- MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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19
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Hoofwijk DMN, Reij RRI, Rutten BPF, Kenis G, Theunissen M, Joosten EA, Buhre WF, den Hoogen NJ. Genetic polymorphisms and prediction of chronic post-surgical pain after hysterectomy-a subgroup analysis of a multicenter cohort study. Acta Anaesthesiol Scand 2019; 63:1063-1073. [PMID: 31206175 DOI: 10.1111/aas.13413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/26/2019] [Accepted: 05/08/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic post-surgical pain (CPSP) is a serious problem. Clinical and psychological variables have not been able to explain all observed variance in prevalence and severity of CPSP. The first objective is to determine the association between genetic polymorphisms and the prevalence of CPSP after hysterectomy. The second objective is to analyze if the implementation of genetic polymorphisms into a previously performed clinical and psychological predictor analysis on the development of CPSP after hysterectomy will improve its discriminatory power. METHODS A prospective multicenter cohort study was performed in patients undergoing hysterectomy for benign indication. Clinical and psychological variables were collected by questionnaires in the week before surgery, post-operatively up to day 4, 3 and 12 months after hysterectomy. Blood was collected and 16 polymorphisms previously suggested to be correlated to CPSP (COMT, GCH1, KCNS1, CACNG2, and OPRM1) were genotyped. Logistic regression analyses were performed. RESULTS Three hundred and forty-five patients were available for the genetic analyses. The prevalence of CPSP 3 months post-operatively was 10.5% and after 12 months 7.9%. The polymorphism rs4818 within the COMT gene was associated with the prevalence of CPSP after 3 months. No polymorphisms were associated with CPSP after 12 months. The addition of rs4818 to the prediction model did not change its discriminatory power significantly. CONCLUSION The rs4818 polymorphism within the COMT gene was associated with the prevalence of CPSP 3 months after hysterectomy, but the implementation of rs4818 into the prediction model did not significantly improve the chance of identifying hysterectomy patients at risk for CPSP.
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Affiliation(s)
- Daisy M. N. Hoofwijk
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
| | - Roel R. I. Reij
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
| | - Bart P. F. Rutten
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
- Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology Maastricht University Medical Center+ Maastricht The Netherlands
| | - Gunter Kenis
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
- Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology Maastricht University Medical Center+ Maastricht The Netherlands
| | - Maurice Theunissen
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
| | - Elbert A. Joosten
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
| | - Wolfgang F. Buhre
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
| | - Nynke J. den Hoogen
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
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20
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Vrancken D, Theunissen M, Joosten EA, Fiddelers AAA, Hoofwijk DMN, Buhre WFFA, Gramke HF, Stessel B. Procedure-Specific Pain Intensity Four Days After Day Surgery and the Relationship with Preoperative Pain: A Prospective Cohort Study. Anesth Pain Med 2019; 8:e81366. [PMID: 30719413 PMCID: PMC6347732 DOI: 10.5812/aapm.81366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/01/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
Background Identification of painful procedures is essential for the development of procedure-specific pain-treatment schedules. The aim of this study was firstly, to analyze the prevalence of acute postsurgical pain (APSP) after various types of day surgery on the fourth postoperative day, and secondly, to assess the predictive value of preoperative pain for the development of APSP after different types of surgical procedures. Methods From November 2008 to April 2010, patients scheduled for elective day surgery were enrolled in this prospective cohort study. Data were collected one week preoperatively and four days postoperatively. The 11-point Numeric Rating Scale (NRS) was used for pain measurement. Moderate pain was defined as an NRS 4 to 5, and severe pain as an NRS > 5. The predictive value of preoperative pain for development of APSP was analyzed using a univariate logistic regression, stratified for the surgical procedure. Results From a total of 1123 included patients, 182 patients experienced moderate pain (16.3%) and 136 patients experienced severe pain (12.1%) on the fourth postoperative day. A large procedure-specific variability in APSP was observed, with shoulder, anal and dental surgery associated with the highest pain levels. Overall, preoperative pain significantly predicted postoperative pain on the fourth day (OR 4.45). This predictive value showed a procedure-specific variation and was not noted after various well-defined procedures. Conclusions The prevalence of moderate to severe APSP was high four days after day surgery and showed a significant procedure-specific variation. Furthermore, there was a strong relationship between preoperative and postoperative pain, likewise characterized by a significant procedure-specific variation.
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Affiliation(s)
- Dirk Vrancken
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Corresponding Author: Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium. Tel: +32-479439183,
| | - Maurice Theunissen
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Elbert A. Joosten
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Audrey A. A. Fiddelers
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Daisy M. N. Hoofwijk
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wolfgang F. F. A. Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hans-Fritz Gramke
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Björn Stessel
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
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21
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Theunissen M, Eekhout I, Klein Velderman M. An efficient and valid test for the identification of children with emotional and behavioral problems. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.358] [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: 11/14/2022] Open
Affiliation(s)
| | - I Eekhout
- TNO Child Health, Leiden, Netherlands
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22
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Theunissen M, Jonker S, Schepers J, Nicolson NA, Nuijts R, Gramke HF, Marcus MAE, Peters ML. Validity and time course of surgical fear as measured with the Surgical Fear Questionnaire in patients undergoing cataract surgery. PLoS One 2018; 13:e0201511. [PMID: 30092085 PMCID: PMC6084852 DOI: 10.1371/journal.pone.0201511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 07/17/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The primary aim of the study was to assess the convergent validity of the Surgical Fear Questionnaire (SFQ) with other self-report instruments and biological indices of stress. Secondary aims were the examination of predictors of the level and time course of fear and preferences for fear treatment. METHODS In a prospective observational cohort study SFQ short-term (SFQ-s) and long-term (SFQ-l) scores were assessed one week, one day, and the morning before cataract surgery, together with salivary cortisol and alpha-amylase (sAA) levels, and numeric rating scale (NRS) fear score. SFQ-scores were also assessed before second eye surgery. Expected pain and recovery, and sociodemographic and medico-psychological predictors of fear were assessed at baseline. RESULTS Data of 98 patients were analyzed. Scores of both SFQ-subscales (range 0-40) were generally low, all mean ≤ 9.0. SFQ-s and SFQ-l correlated significantly with the other self-report instruments: NRS fear .83 and .89, expected pain .49 and .54, expected recovery -.27 and -.44. No association was found between SFQ-scores and cortisol or sAA level. Predictors of the level of fear were baseline pain and stress. Additional effects of time were found for subgroups based on educational level, antidepressant use, and presurgical stress (SFQ-l). SFQ-scores were significantly lower before the second cataract surgery than before the first, and higher in patients who would have appreciated treatment of fear. DISCUSSION Convergent validity of the SFQ with other self-report measures is shown. The sensitivity of the SFQ permits the detection of small variations in fear caused by time or other factors.
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Affiliation(s)
- Maurice Theunissen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
- * E-mail:
| | - Soraya Jonker
- Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jan Schepers
- Department of Methodology & Statistics, Maastricht University, Maastricht, the Netherlands
| | - Nancy A. Nicolson
- Department of Psychiatry & Neuropsychology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Rudy Nuijts
- Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Hans-Fritz Gramke
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marco A. E. Marcus
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Anesthesia/ICU, Pain & Palliative Care, Hamad Medical Corporation, Doha, Qatar
| | - Madelon L. Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
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Pieters BM, Theunissen M, van Zundert AA. Macintosh Blade Videolaryngoscopy Combined With Rigid Bonfils Intubation Endoscope Offers a Suitable Alternative for Patients With Difficult Airways. Anesth Analg 2018; 126:988-994. [DOI: 10.1213/ane.0000000000002739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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de Wolf MWP, van der Beek T, Hamaekers AE, Theunissen M, Enk D. A prototype small-bore ventilation catheter with a cuff: cuff inflation optimizes ventilation with the Ventrain. Acta Anaesthesiol Scand 2018; 62:328-335. [PMID: 29119549 PMCID: PMC5813189 DOI: 10.1111/aas.13030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 10/15/2017] [Accepted: 10/17/2017] [Indexed: 11/27/2022]
Abstract
Background Ventilation through small‐diameter tubes typically precludes use of a cuff as this will impede the necessary passive outflow of gas alongside the tube's outer surface. Ventrain assists expiration and enables oxygenation and normoventilation through small‐bore cannulas or catheters, particularly in obstructed airways. A small‐bore ventilation catheter (SBVC; 40 cm long, 2.2 mm inner diameter) with a separate pressure monitoring lumen and a cuff was developed. Efficacy of oxygenation and ventilation with Ventrain through this catheter was investigated in sealed and open airways in a porcine cross‐over study. Methods Six pigs were ventilated with Ventrain (15 l/min oxygen, frequency 30 breaths per min, I : E‐ratio 1 : 1) through the SBVC, both with the cuff inflated and deflated. Prior to each test they were ventilated conventionally until steady state was achieved. Results With an inflated cuff, PaO2 rose instantly and remained elevated (median [range] PaO2 61 [52–69] kPa after 30 min; P = 0.027 compared to baseline). PaCO2 remained stable at 4.9 [4.2–6.2] kPa. After cuff deflation, PaO2 was significantly lower (9 [5–28] kPa at 10 min, P = 0.028) and interventional ventilation had to be stopped prematurely in five pigs as PaCO2 exceeded 10.6 kPa. Pulmonary artery pressures increased markedly in these pigs. Intratracheal pressures were kept between 5 and 20 cmH2O with the cuff inflated, but never exceeded 2 cmH2O after cuff deflation. Conclusion The SBVC combines the benefits of a small diameter airway and a cuff. Cuff inflation optimizes oxygenation and ventilation with Ventrain.
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Affiliation(s)
- M. W. P. de Wolf
- Department of Anaesthesiology & Pain Therapy; Maastricht University Medical Centre; Maastricht The Netherlands
| | - T. van der Beek
- Department of Anaesthesiology & Pain Therapy; Maastricht University Medical Centre; Maastricht The Netherlands
| | - A. E. Hamaekers
- Department of Anaesthesiology & Pain Therapy; Maastricht University Medical Centre; Maastricht The Netherlands
| | - M. Theunissen
- Department of Anaesthesiology & Pain Therapy; Maastricht University Medical Centre; Maastricht The Netherlands
| | - D. Enk
- Department of Anaesthesiology; University Hospital Münster (UKM); Münster Germany
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Theunissen M, Peters ML, Schepers J, Schoot DC, Gramke HF, Marcus MA. Prevalence and predictors of depression and well-being after hysterectomy: An observational study. Eur J Obstet Gynecol Reprod Biol 2017; 217:94-100. [PMID: 28869813 DOI: 10.1016/j.ejogrb.2017.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess risk and predictive factors for depression and well-being, 3 and 12 months after elective hysterectomy. Secondary objectives were to assess the incidence of depression, level of well-being, and feelings of femininity. STUDY DESIGN A prospective multicenter cohort study was performed among 419 women, undergoing hysterectomy for benign indication. Data were collected in the week prior to surgery, and in the per- and postoperative period up to the fourth postoperative day and 3 and 12 months after surgery. Sociodemographic variables, baseline health status, psychosocial predictors, and surgery data were assessed. Outcome measures were Center for Epidemiological Studies-Depression scale (CES-D, range 0-60), the 12-item well-being questionnaire energy and positive well-being subscales (range 0-12), and feelings of femininity. Predictor analyses were performed using linear mixed model analyses. RESULTS Levels of depression, energy, and positive well-being after hysterectomy were predicted by their corresponding baseline levels (estimate 0.62 p<0.001, 0.39 p<0.001, 0.37 p<0.001, respectively) and baseline pain (0.31 p=0.003, -0.09 p=0.026, -0.10 p=0.008). Postoperative infection reported at 12 months affected CES-D and energy level. Several other gynaecological, psychosocial, or perioperative factors were also predictive for one of the outcomes. Prevalence of depression at baseline, 3 and 12 months was 24%, 19%, and 21%, respectively. In general, well-being scores were slightly higher 3 and 12 months after hysterectomy than at baseline. Feelings of femininity were not negatively affected in 92% of the patients. CONCLUSIONS Preoperative psychosocial status, perioperative pain, and postoperative infection were found as predictors of psychological outcome after hysterectomy. In the majority of patients we observed small but significant improvements with regard to postoperative depression and well-being, while feelings of femininity were unaffected.
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Affiliation(s)
- Maurice Theunissen
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Madelon L Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Jan Schepers
- Department of Methodology and Statistics, Maastricht University, The Netherlands
| | - Dick C Schoot
- Department of Gynaecology, Catharina Hospital, Eindhoven, The Netherland; Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Hans-Fritz Gramke
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marco A Marcus
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Stessel B, Theunissen M, Marcus MA, Joosten EA, van Kuijk SMJ, Fiddelers AAA, Peters ML, Hoofwijk DMN, Buhre WFFA, Gramke HF. Prevalence and Predictors of Patient Nonadherence to Pharmacological Acute Pain Therapy at Home After Day Surgery: A Prospective Cohort Study. Pain Pract 2017; 18:194-204. [PMID: 28419729 DOI: 10.1111/papr.12589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/19/2017] [Accepted: 03/30/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Good adherence to prescribed analgesics can be crucial to suppress or even prevent acute postoperative pain after day surgery. The aim of this study was to analyze prevalence and predictors of analgesic nonadherence after day surgery. METHODS Elective patients scheduled for day surgery were prospectively enrolled from November 2008 to April 2010. Outcome parameters were measured by using questionnaire packages at 2 time points: 1 week preoperatively and 4 days postoperatively. The primary outcome parameter was analgesic nonadherence. Adherence was defined according to the patient's response to the questionnaire item "analgesia use as prescribed": full adherence, "yes"; partial adherence, "yes, sometimes"; nonadherence, "no." Bivariate and multivariate logistic regression analyses were performed to identify predictors of analgesic nonadherence. RESULTS A total of 1,248 patients were included. The prevalence rates of analgesic nonadherence and partial adherence were 21.6% and 20.0%, respectively, in the total study population but dropped to 9.4% and 19.8%, respectively, in patients with moderate to severe pain. Low postoperative pain intensity and short duration of surgery were the most important predictors of analgesic nonadherence. The most important preoperative predictors for analgesic nonadherence were low preoperative pain intensity, low preoperative expectations of pain, and low fear of short-term effects of surgery. CONCLUSION Analgesic nonadherence and partial adherence are common after day surgery but decrease as average pain intensity increases. Patients at risk for analgesic nonadherence can be identified during the preoperative period based on preoperative pain intensity, preoperative expectations of pain, and fear of surgery.
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Affiliation(s)
- Björn Stessel
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium.,Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maurice Theunissen
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marco A Marcus
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Anesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Elbert A Joosten
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Audrey A A Fiddelers
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Network Acute Care Limburg, Maastricht, The Netherlands
| | - Madelon L Peters
- Department of Clinical Psychological Science, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daisy M N Hoofwijk
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wolfgang F F A Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hans-Fritz Gramke
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Theunissen M, Peters ML, Schouten EGW, Fiddelers AAA, Willemsen MGA, Pinto PR, Gramke HF, Marcus MAE. Correction: Validation of the Surgical Fear Questionnaire in Adult Patients Waiting for Elective Surgery. PLoS One 2016; 11:e0162737. [PMID: 27611076 PMCID: PMC5017756 DOI: 10.1371/journal.pone.0162737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0100225.].
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Theunissen M, Peters ML, Schepers J, Maas JW, Tournois F, van Suijlekom HA, Gramke HF, Marcus MA. Recovery 3 and 12 months after hysterectomy: epidemiology and predictors of chronic pain, physical functioning, and global surgical recovery. Medicine (Baltimore) 2016; 95:e3980. [PMID: 27367998 PMCID: PMC4937912 DOI: 10.1097/md.0000000000003980] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Chronic postsurgical pain (CPSP) is 1 important aspect of surgical recovery. To improve perioperative care and postoperative recovery knowledge on predictors of impaired recovery is essential. The aim of this study is to assess predictors and epidemiological data of CPSP, physical functioning (SF-36PF, 0-100), and global surgical recovery (global surgical recovery index, 0-100%) 3 and 12 months after hysterectomy for benign indication.A prospective multicenter cohort study was performed. Sociodemographic, somatic, and psychosocial data were assessed in the week before surgery, postoperatively up to day 4, and at 3- and 12-month follow-up. Generalized linear model (CPSP) and linear-mixed model analyses (SF-36PF and global surgical recovery index) were used. Baseline data of 468 patients were collected, 412 (88%) patients provided data for 3-month evaluation and 376 (80%) patients for 12-month evaluation.After 3 and 12 months, prevalence of CPSP (numeric rating scale ≥ 4, scale 0-10) was 10.2% and 9.0%, respectively, SF-36PF means (SD) were 83.5 (20.0) and 85.9 (20.2), global surgical recovery index 88.1% (15.6) and 93.3% (13.4). Neuropathic pain was reported by 20 (5.0%) patients at 3 months and 14 (3.9%) patients at 12 months. Preoperative pain, surgery-related worries, acute postsurgical pain on day 4, and surgery-related infection were significant predictors of CPSP. Baseline level, participating center, general psychological robustness, indication, acute postsurgical pain, and surgery-related infection were significant predictors of SF-36PF. Predictors of global surgical recovery were baseline expectations, surgery-related worries, American Society of Anesthesiologists classification, type of anesthesia, acute postsurgical pain, and surgery-related infection.Several predictors were identified for CPSP, physical functioning, and global surgical recovery. Some of the identified factors are modifiable and optimization of patients' preoperative pain status and psychological condition as well as reduction of acute postsurgical pain and surgery-related infection may lead to improvement of outcome.
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Affiliation(s)
- Maurice Theunissen
- Department of Anesthesiology and Pain Management, Maastricht UMC+
- Correspondence: Maurice Theunissen, Department of Anesthesiology and Pain Management, Maastricht UMC+, PO Box 5800, 6202 AZ Maastricht, The Netherlands ()
| | - Madelon L. Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht
| | - Jan Schepers
- Department of Clinical Psychological Science, Maastricht University, Maastricht
| | | | - Fleur Tournois
- Department of Gynaecology, Maastricht UMC+, Maastricht/Orbis Medical Center, Sittard-Geleen
| | - Hans A. van Suijlekom
- Department of Anesthesiology and Pain Management, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Marco A.E. Marcus
- Department of Anesthesiology and Pain Management, Maastricht UMC+
- Department of Anesthesiology, ICU, and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
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Van Poucke S, Stevens K, Wetzels R, Kicken C, Verhezen P, Theunissen M, Kuiper G, van Oerle R, Henskens Y, Lancé M. Early platelet recovery following cardiac surgery with cardiopulmonary bypass. Platelets 2016; 27:751-757. [PMID: 27164510 DOI: 10.3109/09537104.2016.1173665] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 11/13/2022]
Abstract
Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) is frequently associated with low platelet count (PC) and disturbed platelet function (PF). While PC is easy to measure, PF is more difficult to assess. Moreover, the time-related platelet dysfunction and recovery after CPB is not fully elucidated. Platelet dysfunction could lead to bleeding but also to coronary graft failure. Laboratory tests could provide more insights into PF after CABG. The aim of the current study was to investigate the time-related PF induced by CPB. Blood samples of 20 patients with a preoperative PC of more than 250 × 109/L were collected before incision, after weaning from CPB, and 24 h postoperative. Platelet contribution to coagulation was quantified by PLTEM (calculated by means of EXTEM and FIBTEM results). PF was assessed by multiple electrode impedance aggregometry (MEIA) in whole blood and by light transmission aggregometry (LTA) in platelet-rich plasma after stimulation with arachidonic acid (AA), adenosine diphosphate, collagen, and thrombin-receptor-activating peptide. LTA and MEIA analysis demonstrated significant platelet dysfunction after CPB, with partial recovery within 24 h after surgery. AA-induced platelet aggregation increased to higher levels within 24 h after surgery compared to baseline values as measured by LTA. PLTEM maximum clot firmness remained unchanged throughout the study. Correlation analyses revealed that MEIA and rotational thromboelastometry (ROTEM), but not LTA, were dependent on PC and hematocrit. No correlations were found between LTA, MEIA, ROTEM, PC, and clinical outcome parameters. Our results demonstrate a reversible platelet dysfunction recovering within 24 h after CPB. Interestingly, AA-induced platelet aggregation increases to higher levels during the first 24 h postoperatively, which might be important for early initiation of antiplatelet therapy after CABG. MEIA as POC test is able to detect platelet dysfunction during cardiac surgery with a PC of ≥150 × 109/L.
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Affiliation(s)
- Sven Van Poucke
- a Department of Anaesthesiology , Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg (ZOL) , Genk , Belgium
| | - Kris Stevens
- b Department of Anaesthesiology & Pain Treatment , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Rick Wetzels
- c Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Cécile Kicken
- b Department of Anaesthesiology & Pain Treatment , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Paul Verhezen
- c Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Maurice Theunissen
- b Department of Anaesthesiology & Pain Treatment , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Gerhardus Kuiper
- b Department of Anaesthesiology & Pain Treatment , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Rene van Oerle
- c Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Yvonne Henskens
- c Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
| | - Marcus Lancé
- b Department of Anaesthesiology & Pain Treatment , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.,d Department of Intensive Care , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands
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Hamaekers AE, van der Beek T, Theunissen M, Enk D. Rescue ventilation through a small-bore transtracheal cannula in severe hypoxic pigs using expiratory ventilation assistance. Anesth Analg 2015; 120:890-4. [PMID: 25565319 PMCID: PMC4358705 DOI: 10.1213/ane.0000000000000584] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Suction-generated expiratory ventilation assistance (EVA) has been proposed as a way to facilitate bidirectional ventilation through a small-bore transtracheal cannula (TC). In this study, we investigated the efficiency of ventilation with EVA for restoring oxygenation and ventilation in a pig model of acute hypoxia. METHODS Six pigs (61-76 kg) were anesthetized and ventilated (intermittent positive pressure ventilation) via a cuffed endotracheal tube (ETT). Monitoring lines were placed, and a 75-mm long, 2-mm inner diameter TC was inserted. After the baseline recordings, the ventilator was disconnected. After 2 minutes of apnea, reoxygenation with EVA was initiated through the TC and continued for 15 minutes with the ETT occluded. In the second part of the study, the experiment was repeated with the ETT either partially obstructed or left open. Airway pressures and hemodynamic data were recorded, and arterial blood gases were measured. Descriptive statistical analysis was performed. RESULTS With a completely or partially obstructed upper airway, ventilation with EVA restored oxygenation to baseline levels in all animals within 20 seconds. In a completely obstructed airway, PaCO2 remained stable for 15 minutes. At lesser degrees of airway obstruction, the time to reoxygenation was delayed. Efficacy probably was limited when the airway was completely unobstructed, with 2 of 6 animals having a PaO2 <85 mm Hg even after 15 minutes of ventilation with EVA and a mean PaCO2 increased up to 90 mm Hg. CONCLUSIONS In severe hypoxic pigs, ventilation with EVA restored oxygenation quickly in case of a completely or partially obstructed upper airway. Reoxygenation and ventilation were less efficient when the upper airway was completely unobstructed.
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Affiliation(s)
- Ankie E Hamaekers
- From the Department of Anesthesiology and Pain Therapy, Maastricht University Medical Center, Maastricht, The Netherlands
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Stessel B, Theunissen M, Fiddelers AA, Joosten EA, Kessels AG, Gramke HF, Marcus MA. Controlled-release oxycodone versus naproxen at home after ambulatory surgery: a randomized controlled trial. Curr Ther Res Clin Exp 2014; 76:120-5. [PMID: 25516773 PMCID: PMC4266769 DOI: 10.1016/j.curtheres.2014.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2014] [Indexed: 11/19/2022] Open
Abstract
Background Strong opioids in the home setting after ambulatory surgery have rarely been studied for fear of hazardous adverse effects such as respiratory depression. Objectives We compared the efficacy of paracetamol/controlled-release (CR) oxycodone and paracetamol/naproxen for treatment of acute postoperative pain at home after ambulatory surgery. Secondary outcomes were adverse effects of study medication, treatment satisfaction, and postoperative analgesic compliance. Methods Patients undergoing ambulatory knee arthroscopy or inguinal hernia repair surgery (n = 105) were randomized into 3 groups: Group1 paracetamol/naproxen (n = 35), Group 2 paracetamol/CR oxycodone for 24 hours (n = 35), and Group 3 paracetamol/CR oxycodone for 48 hours (n = 35). Pain intensity at movement and at rest using a visual analog scale as well as satisfaction with postoperative analgesia and side effects were recorded for up to 48 hours postoperatively. Compliance with study medication was also assessed. Results For pain at movement and at rest, no significant differences were found between the paracetamol/naproxen group and either the paracetamol/CR oxycodone for 24 hours group (β = 2.6 [4.9]; P = 0.597) or the paracetamol/CR oxycodone for 48 hours (β = –1.7 [5.1]; P = 0.736). No major adverse effects of study medication were registered and satisfaction with postoperative pain treatment was high in all groups. Compliance was comparable across the groups. Despite clear instructions, 8 patients with the lowest pain scores did not use any of the prescribed pain medication. Conclusions Paracetamol/CR oxycodone and paracetamol/naproxen are equally effective in treatment of acute postoperative pain at home after ambulatory surgery with comparable patient satisfaction level. We suggest paracetamol/CR oxycodone to be a valuable alternative for the current paracetamol/naproxen gold standard, particularly in patients with a contraindication for nonsteroidal anti-inflammatory drugs. ClinicalTrials.gov identifier: NCT02152592.
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Affiliation(s)
- Björn Stessel
- Department of Anesthesiology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- Current affiliation: Department of Anesthesiology and Pain Treatment, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Address correspondence to: Björn Stessel, MD, Department of Anesthesiology and Pain Treatment, Jessa Hospital – Hasselt, Virga-Jesse Campus, Stadsomvaart 11, 3500 Hasselt, Belgium.
| | - Maurice Theunissen
- Department of Anesthesiology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Audrey A. Fiddelers
- Department of Anesthesiology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Elbert A. Joosten
- Department of Anesthesiology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Alfons G. Kessels
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Hans-Fritz Gramke
- Department of Anesthesiology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Marco A. Marcus
- Department of Anesthesiology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- Current affiliation: Department of Anesthesia/ICU, Pain, and Palliative Care, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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Theunissen M, de Man I, Verdonk P, Bosma H, Feron F. Are Barbie and Ken too cool for school? A case-control study on the relation between gender and dropout. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bouman EAC, Theunissen M, Kessels AG, Keymeulen KB, Joosten EA, Marcus MA, Buhre WF, Gramke HF. Continuous paravertebral block for postoperative pain compared to general anaesthesia and wound infiltration for major oncological breast surgery. Springerplus 2014; 3:517. [PMID: 25279309 PMCID: PMC4169785 DOI: 10.1186/2193-1801-3-517] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/16/2014] [Indexed: 11/16/2022]
Abstract
We hypothesized that improved acute postoperative pain relief will be achieved using general anaesthesia (GA) either in combination with continuous thoracic paravertebral block (GA-cPVB) or single shot (GA-sPVB) as compared to GA supplemented by local wound infiltration (GA-LWI) after unilateral major breast cancer surgery. A randomised controlled trial was conducted in 46 adult women in a day-care or short-stay hospital setting after major breast cancer surgery. Pain-intensity was measured using an 11-point visual analogue scale (VAS) until postoperative day 2. GA-sPVB was stopped due to slow inclusion. No significant difference in VAS score was noted between GA-LWI (VAS median 0.5 (interquartile range 0.18–2.00)) and GA-cPVB, (VAS 0.3 (0.00–1.55, p = 0.195)) 24 hours after surgery or at any point postoperatively until postoperative day 2. We conclude that both GA-LWI and GA-cPVB anaesthetic techniques are equally effective in treatment of acute postoperative pain after major oncological breast surgery. As GA-LWI is easily to perform with fewer complications and it is more cost-effective it should be preferred over GA-cPVB.
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Affiliation(s)
- Esther A C Bouman
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Maurice Theunissen
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Alfons Gh Kessels
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kristien Bmi Keymeulen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elbert Aj Joosten
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Marco Ae Marcus
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands ; Department of Anaesthesiology, ICU and Perioperative Medicine, HMC, Doha, Qatar
| | - Wolfgang F Buhre
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Hans-Fritz Gramke
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
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Theunissen M, Peters ML, Schouten EGW, Fiddelers AAA, Willemsen MGA, Pinto PR, Gramke HF, Marcus MAE. Validation of the surgical fear questionnaire in adult patients waiting for elective surgery. PLoS One 2014; 9:e100225. [PMID: 24960025 PMCID: PMC4069058 DOI: 10.1371/journal.pone.0100225] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 05/23/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Because existing instruments for assessing surgical fear seem either too general or too limited, the Surgical Fear Questionnaire (SFQ) was developed. The aim of this study is to assess the validity and reliability of the SFQ. METHODS Based on existing literature and expert consultation the ten-item SFQ was composed. Data on the SFQ were obtained from 5 prospective studies (N = 3233) in inpatient or day surgery patients. These data were used for exploratory factor analysis (EFA), confirmatory factor analysis (CFA), reliability analysis and validity analysis. RESULTS EFA in Study 1 and 2 revealed a two-factor structure with one factor associated with fear of the short-term consequences of surgery (SFQ-s, item 1-4) and the other factor with fear of the long-term consequences of surgery (SFQ-l, item 5-10). However, in both studies two items of the SFQ-l had low factor loadings. Therefore in Study 3 and 4 the 2-factor structure was tested and confirmed by CFA in an eight-item version of the SFQ. Across all studies significant correlations of the SFQ with pain catastrophizing, state anxiety, and preoperative pain intensity indicated good convergent validity. Internal consistency (Cronbach's alpha) was between 0.765-0.920 (SFQ-total), 0.766-0.877 (SFQ-s), and 0.628-0.899 (SFQ-l). The SFQ proved to be sensitive to detect differences based on age, sex, education level, employment status and preoperative pain intensity. DISCUSSION The SFQ is a valid and reliable eight-item index of surgical fear consisting of two subscales: fear of the short-term consequences of surgery and fear of the long-term consequences.
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Affiliation(s)
- Maurice Theunissen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Madelon L. Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Erik G. W. Schouten
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Audrey A. A. Fiddelers
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Mark G. A. Willemsen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Patrícia R. Pinto
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Hans-Fritz Gramke
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marco A. E. Marcus
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Anesthesia/ICU, Pain and Palliative Care, Hamad Medical Corporation, Doha, Qatar
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Bouman EA, Theunissen M, Bons SA, van Mook WN, Gramke HF, van Kleef M, Marcus MA. Reduced Incidence of Chronic Postsurgical Pain after Epidural Analgesia for Abdominal Surgery. Pain Pract 2013; 14:E76-84. [DOI: 10.1111/papr.12091] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 05/06/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Esther A. Bouman
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Maurice Theunissen
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Sabrina A. Bons
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Walther N. van Mook
- Department of Intensive Care; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Hans-F. Gramke
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Maarten van Kleef
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Marco A. Marcus
- Department of Anaesthesiology; Maastricht University Medical Center+; Maastricht The Netherlands
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Ševerdija EE, Heijmans JH, Theunissen M, Maessen JG, Roekaerts PH, Weerwind PW. Retrograde autologous priming reduces transfusion requirements in coronary artery bypass surgery. Perfusion 2011; 26:315-21. [DOI: 10.1177/0267659111408379] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The hypothesis was tested whether retrograde autologous priming (RAP) of the cardiopulmonary bypass system, compared to a standard primed system (NON-RAP group), results in less haemodilution and less transfusion of packed red blood cells. Retrospectively, data was collected from the medical charts of one hundred patients undergoing elective coronary artery bypass grafting using cardiopulmonary bypass. Fifty patients where RAP was used have been compared to fifty patients using NON-RAP. The prime volume in the NON-RAP group was 1,627±108 mL versus 782±96 mL in the RAP group (p<0.001). The lowest haematocrit during perfusion was 22% in the NON-RAP group versus 26% when the RAP technique was used (p<0.001). In the NON-RAP group, 26% of the patients received packed red cells in contrast to 6% in the RAP group (p<0.012). A positive association was found between RAP and less transfusion of packed red blood cells (p<0.012). In conclusion, retrograde autologous priming, reducing the prime volume of the cardiopulmonary bypass system, causes less haemodilution and reduces intraoperative transfusion of packed red blood cells.
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Affiliation(s)
- EE Ševerdija
- Department of Cardiothoracic surgery, Maastricht University Medical Centre and CARIM Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands,
| | - JH Heijmans
- Department of Anaesthesiology and Pain treatment, Maastricht University Medical Centre and CARIM Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - M. Theunissen
- Department of Anaesthesiology and Pain treatment, Maastricht University Medical Centre and CARIM Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - JG Maessen
- Department of Cardiothoracic surgery, Maastricht University Medical Centre and CARIM Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - PH Roekaerts
- Department of Intensive Care Medicine Maastricht University Medical Centre and CARIM Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - PW Weerwind
- Department of Cardiothoracic surgery, Maastricht University Medical Centre and CARIM Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
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Theunissen M, Bouman E, van Saet A, Gramke HF, Marcus M. 569. Thoracic Epidural Anesthesia: Comparison of 2 Different Catheters. Reg Anesth Pain Med 2008. [DOI: 10.1136/rapm-00115550-200809001-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bouman EAC, Gramke HF, Wetzel N, Vanderbroeck THT, Bruinsma R, Theunissen M, Kerkkamp HEM, Marcus MAE. Evaluation of two different epidural catheters in clinical practice. narrowing down the incidence of paresthesia! Acta Anaesthesiol Belg 2007; 58:101-5. [PMID: 17710897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Although epidural anesthesia is considered safe, several complications may occur during puncture and insertion of a catheter. Incidences of paresthesia vary between 0.2 and 56%. A prospective, open, cohort-controlled pilot study was conducted in 188 patients, ASA I-III, age 19-87 years, scheduled for elective surgery and epidural anesthesia. We evaluated a 20 G polyamide (standard) catheter and a 20 G combined polyurethane-polyamide (new) catheter. Spontaneous reactions upon catheter-insertion, paresthesia on questioning, inadvertent dural or intravascular puncture, and reasons for early catheter removal were recorded. The incidence of paresthesia reported spontaneously was 21.3% with the standard catheter and 16.7% with the new catheter. Systematically asking for paresthesia almost doubled the paraesthesia rate. Intravascular cannulation occurred in 5%. No accidental dural punctures occurred. An overall incidence of 13.3% of technical problems led to early catheter removal. The new catheter was at least equivalent to the standard regarding epidural success rate and safety : rate of paresthesia, intravascular and dural cannulation.
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Affiliation(s)
- E A C Bouman
- University Hospital Maastricht, Department of Anesthesiology, Maastricht, The Netherlands.
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Evenhuis HM, Theunissen M, Denkers I, Verschuure H, Kemme H. Prevalence of visual and hearing impairment in a Dutch institutionalized population with intellectual disability. J Intellect Disabil Res 2001; 45:457-464. [PMID: 11679051 DOI: 10.1046/j.1365-2788.2001.00350.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A screening of hearing and visual function was performed using clinical assessment methods in a Dutch institutionalized population of 672 people with mild to profound intellectual disability (ID). Because the studied population was not comparable to the total Dutch population with ID, subgroups were distinguished according to level of ID, age younger and older than 50 years, and the presence or absence of Down's syndrome (DS). The prevalences of both hearing and visual impairment were considerably increased in all subgroups, as compared with the general population. In the least affected group, i.e. those < 50 years with a mild or moderate ID by other causes than DS, the prevalences of hearing and visual impairment were 21% and 4%, respectively (as opposed to 2-7% and 0.2-1.9% in the general Dutch population <50 years, respectively). The prevalence of hearing impairment showed a sharp and highly significant increase in individuals with DS and subjects > or = 50 years. To a lesser extent, young adults with severe or profound ID had an increased risk of hearing impairment. Visual impairment and blindness were specifically highly prevalent in people with severe or profound ID (51% < 50 years of age). Down's syndrome and an age > or = 50 years were also significant risk factors for visual impairment. There was an alarmingly high prevalence of combined sensory impairment, especially in those with severe or profound ID (20%). Although hearing impairment had been diagnosed prior to this screen in 138 people and visual impairment in 65 individuals, a first diagnosis of hearing impairment was made in 128 subjects and of visual impairment in 90 cases. This highlights the tendency for sensory impairments to go unnoticed in people with ID, which is not restricted to those with severe or profound ID. Therefore, the present authors stress the importance of regular screening as outlined in the existing IASSID international consensus statement.
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Affiliation(s)
- H M Evenhuis
- Hooge Burch Centre for Persons with Intellectual Disability, Zwammerdam, the Netherlands.
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Blatter G, Ivlev B, Kagan Y, Theunissen M, Volokitin Y, Kes P. Quantum liquid of vortices in superconductors at T=0. Phys Rev B Condens Matter 1994; 50:13013-13016. [PMID: 9975479 DOI: 10.1103/physrevb.50.13013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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van Vugt JM, Ruissen KJ, Schouten HJ, Theunissen M, Hoogland HJ, de Haan J. Umbilical artery blood velocimetry: a prospective longitudinal study in search of the intrauterine growth-retarded fetus. Early Hum Dev 1988; 18:59-71. [PMID: 3069453 DOI: 10.1016/0378-3782(88)90043-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In a longitudinal prospective study involving 125 patients, blood velocity waveforms in the umbilical artery were recorded and analyzed from the 15th week of gestation until term to evaluate the predictive value of blood velocity parameters with regard to fetal growth retardation. Measurements were performed with a combined real-time linear array and 2-MHz pulsed Doppler technique. The mean values (+/- 2 S.D.) of the A/B ratio, resistance index (RI) and pulsatility index (PI) were calculated from the 15th to the 40th week of gestation. The degree of intrauterine growth retardation was related to postnatal catch-up growth. Three groups of patients were compared with regard to blood velocity waveform indices. Group NL-I/II: waveform indices (WI) within 2 S.D. of the population mean. Group EL-II: consistently WIs above 2 S.D. of the population mean. Significant differences with regard to neonatal growth variables were found between these groups. In spite of the fact that these differences in growth variables were statistically significant, no clear relationship was found between the velocity waveform indices and true intrauterine growth retardation, defined by a non-birthweight criterion. It seems that umbilical artery velocimetry cannot predict true intrauterine growth retardation.
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Affiliation(s)
- J M van Vugt
- Department of Obstetrics and Gynecology, Academic Hospital Maastricht, University of Limburg, The Netherlands
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