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Oud FMM, Schut MC, Spies PE, van der Zaag-Loonen HJ, de Rooij SE, Abu-Hanna A, van Munster BC. Interaction between geriatric syndromes in predicting three months mortality risk. Arch Gerontol Geriatr 2022; 103:104774. [PMID: 35849976 DOI: 10.1016/j.archger.2022.104774] [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: 03/23/2022] [Revised: 06/03/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Capturing frailty using a quick tool has proven to be challenging. We hypothesise that this is due to the complex interactions between frailty domains. We aimed to identify these interactions and assess whether adding interactions between domains improves mortality predictability. METHODS In this retrospective cohort study, we selected all patients aged 70 or older who were admitted to one Dutch hospital between April 2015 and April 2016. Patient characteristics, frailty screening (using VMS (Safety Management System), a screening tool used in Dutch hospital care), length of stay, and mortality within three months were retrospectively collected from electronic medical records. To identify predictive interactions between the frailty domains, we constructed a classification tree with mortality as the outcome using five variables: the four VMS-domains (delirium risk, fall risk, malnutrition, physical impairment) and their sum. To determine if any domain interactions were predictive for three-month mortality, we performed a multivariable logistic regression analysis. RESULTS We included 4,478 patients. (median age: 79 years; maximum age: 101 years; 44.8% male) The highest risk for three-month mortality included patients that were physically impaired and malnourished (23% (95%-CI 19.0-27.4%)). Subgroups had comparable three-month mortality risks based on different domains: malnutrition without physical impairment (15.2% (96%-CI 12.4-18.6%)) and physical impairment and delirium risk without malnutrition (16.3% (95%-CI 13.7-19.2%)). DISCUSSION We showed that taking interactions between domains into account improves the predictability of three-month mortality risk. Therefore, when screening for frailty, simply adding up domains with a cut-off score results in loss of valuable information.
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Affiliation(s)
- F M M Oud
- Department of Geriatrics and Centre of Excellence for Old Age Medicine, Gelre Ziekenhuizen Apeldoorn and Zutphen, the Netherlands; Department of Internal Medicine, University Medical Centre Groningen, Groningen, the Netherlands.
| | - M C Schut
- Department of Medical Informatics, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - P E Spies
- Department of Geriatrics and Centre of Excellence for Old Age Medicine, Gelre Ziekenhuizen Apeldoorn and Zutphen, the Netherlands
| | - H J van der Zaag-Loonen
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, the Netherlands
| | - S E de Rooij
- Department of Medical Informatics, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Amstelland Hospital, Amstelveen, the Netherlands
| | - A Abu-Hanna
- Department of Medical Informatics, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - B C van Munster
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, the Netherlands
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Argillander TE, Schäfer S, van Westreenen HL, Kamper A, van der Zaag-Loonen HJ, van Duijvendijk P, van Munster BC. The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer. J Geriatr Oncol 2022; 13:888-891. [PMID: 35339404 DOI: 10.1016/j.jgo.2022.03.005] [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: 02/19/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Affiliation(s)
- T E Argillander
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands; University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands.
| | - S Schäfer
- University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands
| | | | - A Kamper
- Department of Geriatrics, Isala Hospital, Zwolle, the Netherlands
| | - H J van der Zaag-Loonen
- University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands
| | | | - B C van Munster
- University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands
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van Gestel T, Groen LCB, Puik JR, van Rooijen SJ, van der Zaag-Loonen HJ, Schoonmade LJ, Danjoux G, Daams F, Schreurs WH, Bruns ERJ. Fit4Surgery for cancer patients during covid-19 lockdown – A systematic review and meta-analysis. European Journal of Surgical Oncology 2022; 48:1189-1197. [PMID: 35183411 PMCID: PMC8828288 DOI: 10.1016/j.ejso.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022]
Affiliation(s)
- T van Gestel
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands.
| | - L C B Groen
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - J R Puik
- Department of Surgery, Amsterdam University Medical Center Location VU, Amsterdam, the Netherlands
| | - S J van Rooijen
- Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - L J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - G Danjoux
- South Tees Hospitals NHS Foundation Trust, UK; Honorary Professor, Hull York Medical School and Teesside University, UK
| | - F Daams
- Department of Surgery, Amsterdam University Medical Center Location VU, Amsterdam, the Netherlands
| | - W H Schreurs
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - E R J Bruns
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
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Oud FMM, Wolzak NK, Spies PE, Zaag-Loonen HJVD, van Munster BC. The predictive value of the 'VMS frail older patients' for adverse outcomes in geriatric inpatients. Arch Gerontol Geriatr 2021; 97:104514. [PMID: 34571343 DOI: 10.1016/j.archger.2021.104514] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE The Dutch Safety Management system (VMS) screening for frail older patients is used as a predictor for adverse outcomes. We aimed to determine the predictive value of the VMS for adverse outcomes in geriatric inpatients. DESIGN Retrospective cohort study in geriatric inpatients. Outcomes were institutionalization, readmission and mortality (3- and 12-months). Logistic regression analysis was performed to assess the predictive value of the number of positive VMS domains, a VMS score ≥1, and individual domains for adverse outcomes. RESULTS We included 477 patients. Median age was 85 years (54-99) and 37% were male. Eighty-seven % scored positive on delirium risk, 57% on fall risk, 39% on malnutrition and 64% on physical impairment. One-hundred-thirty-five patients (28%) were institutionalized, 78 patients (16%) were readmitted and mortality rate was 127(27%) at 3 months and 184 (39%) at one year. The VMS was not predictive for readmission (OR 1.6; 95%-CI 0.2-13.7) and mortality, (OR 0.6 95%-CI 0.2-2.0 and OR 1.1; 95%-CI 0.3-3.7). For institutionalization, delirium risk (OR 2.2; 95%-CI 1.1-4.4), physical impairment (OR 1.8; 95%-CI 1.1-2.9) and a positive score on all four domains were predictive (OR 12.1 95%-CI-1.4-101.7). Malnutrition was predictive for readmission (OR 1.74; 95%-CI 1.05-2.91) and three-month mortality (OR 1.69; 95%-CI 1.11-2.57), delirium risk for one -year mortality (OR 2.0; 95%-CI 1.0-4.0) . CONCLUSIONS Almost all geriatric inpatients scored positive on at least one domain of the VMS. The number of positive VMS domains had some predictive value for institutionalization. Individual domains were able to predict adverse outcomes.
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Affiliation(s)
- Frederike M M Oud
- Department of geriatrics, Gelre Ziekenhuizen, the Netherlands; Universitair Medisch Centrum Groningen, the Netherlands.
| | - Nena K Wolzak
- Department of geriatrics, Gelre Ziekenhuizen, the Netherlands
| | - Petra E Spies
- Department of geriatrics, Gelre Ziekenhuizen, the Netherlands
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van Esch BF, Abolhosseini K, Masius-Olthof S, van der Zaag-Loonen HJ, van Benthem PPG, Bruintjes TD. Video-head impulse test results in patients with Menière's disease related to duration and stage of disease. J Vestib Res 2019; 28:401-407. [PMID: 30856139 PMCID: PMC9249308 DOI: 10.3233/ves-190654] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND: The video-head impulse test employs the vestibulo-ocular reflex (VOR) to assess vestibular function. To this day, no consensus has been reached among scientists in terms of whether or not vHIT results change in MD patients as the disease progresses. OBJECTIVE: To assess whether the vHIT is more often abnormal in later stages of MD compared to earlier stages. METHODS: We retrospectively analyzed patients with ‘definite’ MD who had undergone a vHIT and caloric test between 2012 and 2015. Patients were evaluated based on duration of disease in years (≤1, >1≤5, >5≤10, >10) and stage of disease (stage I and II versus III and IV). For the vHIT, an abnormal vestibulo-ocular reflex was defined as a gain cut-off value of≤0.8 and presence of correction saccades including subanalyses using a cut-off value of≤0.9. RESULTS: In 89 definite MD patients (42 (47%) male, mean age 55±5 (SD)), data on both the caloric test and the vHIT were available. The risk of an abnormal vHIT was 25% in patients with a duration of disease over 10 years compared to 22% in the patients with a disease duration of 10 years or less (risk difference 3%, 95% CI:– 28% to 35%), p = 0.82). The risk for an abnormal vHIT in the Stage I and Stage II was 17% compared to 26% in Stage III and IV (risk difference 9%, 95% CI:– 30% to 11%). When using a cut-off value of 0.9 we also did not demonstrate a relationship between the duration of disease and the proportion of abnormal vHIT test results. CONCLUSIONS: There is no relationship between the proportion of abnormal vHIT test results in patients with MD in either duration or stage of disease.
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Affiliation(s)
- B F van Esch
- Apeldoorn Dizziness Centre, Gelre Hospital, Apeldoorn, The Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, The Netherlands
| | - K Abolhosseini
- School of Audiology, Pacific University, Hillsboro, OR, USA
| | - S Masius-Olthof
- Apeldoorn Dizziness Centre, Gelre Hospital, Apeldoorn, The Netherlands
| | | | - P P G van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, The Netherlands
| | - Tj D Bruintjes
- Apeldoorn Dizziness Centre, Gelre Hospital, Apeldoorn, The Netherlands
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Cozijnsen L, van der Zaag-Loonen HJ, Cozijnsen MA, Braam RL, Heijmen RH, Bouma BJ, Mulder BJM. Differences at surgery between patients with bicuspid and tricuspid aortic valves. Neth Heart J 2018; 27:93-99. [PMID: 30547414 PMCID: PMC6352617 DOI: 10.1007/s12471-018-1214-1] [Citation(s) in RCA: 4] [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] [Indexed: 11/25/2022] Open
Abstract
Aim To determine differences in surgical procedures and clinical characteristics at the time of surgery between native bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) in patients being followed up after aortic valve surgery (AVS). Methods In this retrospective cohort study in a non-academic hospital, we identified patients who had a surgeon’s report of the number of native valve cusps and were still being followed up. We selected patients with BAV and TAV, and used multivariable regression analyses to identify associations between BAV-TAV and pre-specified clinical characteristics. Results Of 439 patients, 140 had BAV (32%) and 299 TAV (68%). BAV patients were younger at the time of surgery (mean age 58.6 ± 13 years) than TAV patients (69.1 ± 12 years, p < 0.001) and were more often male (64% vs 53%; p = 0.029). Cardiovascular risk factors were less prevalent in BAV than in TAV patients at the time of surgery (hypertension (31% vs 55%), hypercholesterolaemia (29% vs 58%) and diabetes (7% vs 16%); all p < 0.005). Concomitant coronary artery bypass grafting (CABG) was performed less often in BAV than in TAV patients (14% vs 39%, p < 0.001), even when adjusted for confounders (adjusted odds ratio (adj.OR) 0.45; 95% CI: 0.25–0.83). In contrast, surgery of the proximal aorta was performed more often (31% vs 11%, respectively, p < 0.001; adj.OR 2.3; 95% CI: 1.3–4.0). Conclusions Whereas mechanical stress is the supposed major driver of valvulopathy towards AVS in BAV, prevalent cardiovascular risk factors are a suspected driver towards the requirement for AVS and concomitant CABG in TAV, an observation based on surgical determination of the number of valve cusps.
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Affiliation(s)
- L Cozijnsen
- Department of Cardiology, Gelre Hospital, Apeldoorn, The Netherlands.
| | | | - M A Cozijnsen
- Department of Paediatric Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - R L Braam
- Department of Cardiology, Gelre Hospital, Apeldoorn, The Netherlands
| | - R H Heijmen
- Department of Cardiothoracic Surgery, Nieuwegein, The Netherlands
| | - B J Bouma
- Department of Cardiology, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
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7
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Mahieu R, Coenen MNO, van Bemmel T, van der Zaag-Loonen HJ, Theuvenet WJ. Detecting intrinsic muscle weakness of the hallux as an addition to early-stage screening of the feet in patients with diabetes. Diabetes Res Clin Pract 2016; 119:83-7. [PMID: 27497143 DOI: 10.1016/j.diabres.2016.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/16/2016] [Indexed: 12/25/2022]
Abstract
AIMS Present-day screening of the diabetic foot involves the Semmes Weinstein Monofilament Test for evaluating loss of sensibility, while testing for intrinsic muscle weakness is not implied. Just as with the early detection of sensibility loss, early detection of intrinsic muscle weakness might have important implications for the prevention of both ulceration and deformity in patients with diabetes. The purpose of this study is to investigate the prevalence of patients with diabetes presenting intrinsic muscle weakness of the hallux, but with a normal sensibility of the sole of the foot. METHODS A cross-sectional study design was applied. Intrinsic muscle function of the hallux was measured with the Paper Grip Test, while sensibility of the sole of the foot was measured with the Semmes Weinstein Monofilament Test 5.07/10-g. RESULTS In a period of three months a total of 266 patients with diabetes (mean age 60, 134 females (50%), 177 type 2 diabetes mellitus (67%)) met the inclusion criteria and were examined for both intrinsic muscle weakness of the hallux and sensibility of the soles of the feet. The results showed that intrinsic muscle weakness was present more frequent in patients with impaired sensibility (P=0.001), also 20% of the population had intrinsic muscle weakness in the presence of normal sensibility. Multivariate regression analysis showed that only age is associated with patients with diabetes presenting normal sensibility but impaired intrinsic muscle function (P=0.017). CONCLUSIONS The Paper Grip Test could have added value to current physical examination of the feet in patients with diabetes.
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Affiliation(s)
- R Mahieu
- Department of Internal Medicine, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands; University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - M N O Coenen
- Department of Internal Medicine, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands; University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - T van Bemmel
- Department of Internal Medicine, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands
| | - H J van der Zaag-Loonen
- Department of Epidemiology, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands
| | - W J Theuvenet
- Department of Plastic Surgery, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands.
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Bruens ML, van der Zaag-Loonen HJ, Steenstra F, Stemerding AM, Wijngaarden S. [Septic arthritis after intra-articular injection is rare: does the Taskforce Infection Prevention use a sledgehammer to crack a nut?]. Ned Tijdschr Geneeskd 2016; 160:D789. [PMID: 27924736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the incidence of septic arthritis (SA) after a joint puncture and reconsider the value of the hygiene measures stipulated by the Taskforce Infection Prevention (TIF). DESIGN Prospective study. METHOD We determined the number of joint punctures among general practitioners and specialists in the Apeldoorn area during a three-month period (from October 1, 2013 to December 31, 2013). Secondly, we performed an analysis on the incidence of SAs in this period and the subsequent month, and ascertained if these were related to a joint puncture. Finally, we conducted a retrospective analysis on joint puncture related SA during the period January 2008 - December 2013. This was executed to determine whether our results were representative. RESULTS The incidence of SA after a joint puncture was 1 in 27,000. CONCLUSION The incidence of SA after a joint puncture can be considered low. Due to the low baseline incidence, we anticipate that it is unlikely that the prescriptive measures outlined by TIF will lead to a cost-effective reduction in incidence of SA.
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Abstract
The objective of the study was to assess absenteeism from work due to dizziness in patients referred to a tertiary centre. Consecutive patients with a paid employment completed the WHO Health and work Performance Questionnaire, including items on work absence in the past 7 days and 4 weeks, and the Dizziness Handicap Inventory. Of the 400 patients [55% females, mean age 46.3 years (SD 10.8), range 18-68 years], 46 (12%) indicated they were completely disabled to work due to dizziness, while 202 (51%) patients indicated they had worked less than expected due to dizziness. Patients with more disease-related disabilities had more absenteeism from work. Half of the patients who are referred to a tertiary centre for dizziness report work absenteeism due to their complaints, and 12% is completely disabled to work.
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van der Zaag-Loonen HJ, van Leeuwen RB, Bruintjes TD, van Munster BC. Prevalence of unrecognized benign paroxysmal positional vertigo in older patients. Eur Arch Otorhinolaryngol 2014; 272:1521-4. [PMID: 25488279 DOI: 10.1007/s00405-014-3409-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/06/2014] [Indexed: 10/24/2022]
Abstract
Dizziness is a relatively common complaint which occurs more often with increasing age. Benign paroxysmal positional vertigo (BPPV) is an important cause which can easily be treated but is frequently not recognized by professionals. The aim of this study was to assess the prevalence of unrecognized BPPV in older patients. Patients ≥70 years of age (n = 989) indicated whether they experienced dizziness, and if so whether the symptoms were typical for BPPV. If affirmed, a diagnostic maneuver was performed. Positive patients were treated at once. All suspected patients completed quality of life questionnaires and were followed for 3 and 6 months. Positive BPPV patients were compared with negative (but suspected) patients. Almost one quarter of the patients (226 patients, 23 %) suffered from dizziness, among whom 101 were suspected of BPPV. Less than half (n = 45) underwent the diagnostic maneuver, of whom 13 (29 %) were positive for BPPV. At follow-up, one patient developed BPPV, leading to a total of 14 positive patients (overall prevalence 1.4 %). BPPV positive patients did not differ from BPPV negative patients. Among a large group of older patients, one quarter experiences dizziness, and 1.4 % has definite BPPV.
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Bontje HF, van de Pol G, van der Zaag-Loonen HJ, Spaans WA. Follow-up of mesh complications using the IUGA/ICS category-time-site coding classification. Int Urogynecol J 2014; 25:817-22. [PMID: 24515543 DOI: 10.1007/s00192-013-2321-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/25/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The International Urogynecological Association (IUGA) and the International Continence Society (ICS) developed a complication classification to facilitate international comparison and to improve our understanding of complications. This code was applied to surgical cases for the analysis of complications after mesh insertion. METHODS The study included patients who had undergone vaginal prolapse repair with a trocar-guided polypropylene mesh between 2006 and 2010 in a Dutch peripheral hospital. Complications were assessed at secondary follow-up and classified using category (C), timing (T), and site (S) components (CTS). RESULTS Of the 107 women included, 84 returned for secondary follow-up (response rate 80 %, median time after surgery 36 months, range 12-64). In 45 patients no complications occurred. In the remaining 39 patients, 43 complication codes were established. Six of the seven categories of complications were found at all different time codes. Concerning the site of the complication codes S1, S2, and S3 were applicable. Perioperative complications (6 %) included hemorrhage and bladder perforation. Six patients were reoperated for symptomatic mesh exposure or local pain. At secondary follow-up exposure was diagnosed in another 4 patients (12 %). In 36 % mesh wrinkling or shrinkage was discovered, although without complaints in most. Eight women had daily complaints or dyspareunia. Eighty-two percent of patients indicated strong improvement after surgery. Several limitations of the classification are discussed. CONCLUSIONS Despite limitations, the IUGA/ICS code is demonstrated to be useful in describing mesh complications. We advise the use of the CTS code at follow-up consultations after a minimum of 2 years for improved insight into and knowledge on the occurrence of complications.
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Affiliation(s)
- H F Bontje
- Department of Gynecology and Obstetrics, Gelre Ziekenhuizen Apeldoorn, Zuster Meyboomlaan 9, 7334, DX, Apeldoorn, The Netherlands
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12
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van Wensen E, van Leeuwen RB, van der Zaag-Loonen HJ, Masius-Olthof S, Bloem BR. Benign paroxysmal positional vertigo in Parkinson's disease. Parkinsonism Relat Disord 2013; 19:1110-2. [PMID: 23948517 DOI: 10.1016/j.parkreldis.2013.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/16/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dizziness is a frequent complaint of patients with Parkinson's disease (PD), and orthostatic hypotension (OH) is often thought to be the cause. We studied whether benign paroxysmal positional vertigo (BPPV) could also be an explanation. AIM To assess the prevalence of benign paroxysmal positional vertigo in patients with Parkinson's disease, with and without dizziness. METHODS 305 consecutive outpatients with PD completed the Movement Disorders Society-sponsored revision of the Unified Parkinsons' Disease Rating Scale-motor score, the Dizziness Handicap Inventory, the Dix-Hallpike maneuver and a test for orthostatic hypotension. When positive for benign paroxysmal positional vertigo, a repositioning maneuver was performed. Patients were followed for three months to determine the clinical response. RESULTS 305 patients responded (186 men (61%), mean age 70.5 years (Standard Deviation 9.5 years)), of whom 151 (49%) complained of dizziness. 57 (38%) of the dizzy patients appeared to have orthostatic hypotension; 12 patients (8%) had a classical but previously unrecognized benign paroxysmal positional vertigo. A further four patients (3%) had a more atypical presentation of benign paroxysmal positional vertigo. Three months after treatment, 11 (92%) of patients with classical benign paroxysmal positional vertigo were almost or completely without complaints. We found no 'hidden' benign paroxysmal positional vertigo among patients without dizziness. The prevalence of benign paroxysmal positional vertigo among all patients with PD was 5.3%. CONCLUSION Among Parkinson patients with symptoms of dizziness, up to 11% may have benign paroxysmal positional vertigo, which can be treated easily and successfully.
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Affiliation(s)
- E van Wensen
- Gelre Hospitals, Apeldoorn, A. Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands.
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van der Maas N, Braam RL, van der Zaag-Loonen HJ, Meerman J, Cozijnsen L, Scholte AJHA. Right ventricular ejection fraction measured by multigated planar equilibrium radionuclide ventriculography is an independent prognostic factor in patients with ischemic heart disease. J Nucl Cardiol 2012; 19:1162-9. [PMID: 22932818 DOI: 10.1007/s12350-012-9613-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 08/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The number of studies on the prognostic value of the right ventricular ejection fraction (RVEF) in patients with ischemic heart disease (IHD) is limited, whereas it is widely accepted that the left ventricular ejection fraction (LVEF) is a strong prognostic factor. We assessed whether RVEF measured by multigated planar equilibrium radionuclide ventriculography (RNV) is an independent prognostic factor in patients with IHD. METHODS AND RESULTS We retrospectively identified 347 consecutive patients with IHD (mean age 71 ± 11 years; 18% women) who underwent multigated planar equilibrium RNV between 2004 and 2008 to determine the LVEF, which also provided the RVEF (mean 44.7% ± 11.0%). We categorized patients according to RVEF in ≥40% (n = 240) and <40% (n = 107). Patients were followed for a median of 826 days (range 3-2,400) for the occurrence of events [all-cause mortality (n = 60), cardiac mortality (n = 33), and cardiac hospitalization (n = 78)]. Cox regression analysis with significant univariate predictors [coronary artery revascularization (P = .003), diuretics (P = .03), and statins (P < .001)] showed that an RVEF <40% was associated with a 2.90 (1.68-5.00)-fold higher risk of all-cause death. Accordingly, a decreased RVEF was associated with a 2.15 (1.34-3.43)-fold increase in the risk of cardiac hospitalization and a 5.11(2.32-11.23)-fold risk of cardiac death. CONCLUSION RVEF measured by multigated planar equilibrium RNV is an independent prognostic factor in patients with chronic IHD.
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Affiliation(s)
- N van der Maas
- Department of Cardiology, Gelre Hospital, Apeldoorn, The Netherlands
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Breukink SO, van der Zaag-Loonen HJ, Bouma EMC, Pierie JPEN, Hoff C, Wiggers T, Meijerink WJHJ. Prospective evaluation of quality of life and sexual functioning after laparoscopic total mesorectal excision. Dis Colon Rectum 2007; 50:147-55. [PMID: 17160572 DOI: 10.1007/s10350-006-0791-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [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: 01/19/2023]
Abstract
PURPOSE This study was designed to investigate how the quality of life of patients with rectal cancer changes with time after laparoscopic total mesorectal excision. METHODS Patients completed the Medical Outcomes Study Short Form 36 and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire and a colorectal-specific European Organisation for Research and Treatment of Cancer quality of life questionnaire before laparoscopic total mesorectal excision, on discharge from the hospital and at 3, 6, and 12 months postoperatively. Patients were treated by laparoscopic low anterior resection or laparoscopic abdominoperineal resection. RESULTS Fifty-one patients (mean age, 64 years; 29 males (57 percent)) participated in this study, of whom 38 (75 percent) underwent laparoscopic low anterior resection and 13 (25 percent) laparoscopic abdominoperineal resection. Compared with preoperative scores on the Medical Outcomes Study Short Form 36, patients reported a deterioration in physical functioning (74 vs. 80; P = 0.009), and improved mental functioning (76 vs. 70; P = 0.007) at three months. Improvement in emotional well-being was reported both on the Medical Outcomes Study Short Form 36 (78 vs. 53; P = 0.006) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (84 vs. 69; P < 0.001). At one year, improvements in global quality of life (82 vs. 68; P = 0.001) and symptoms, such as fatigue (18 vs. 32; P < 0.001), pain (5 vs. 12; P = 0.009), and appetite loss (3 vs. 13; P = 0.01), were reported. Sexual functioning was worse from three months onward until one year after surgery (47 vs. 66; P = 0.004). Patients who underwent low anterior resection experienced less sexual dysfunction than patients after abdominoperineal resection (21 vs. 56; P = 0.004). CONCLUSIONS One year after laparoscopic total mesorectal excision for rectal cancer, patients reported improvement in some important quality of life outcomes, including global quality of life, despite a decrease in sexual functioning.
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Affiliation(s)
- S O Breukink
- Department of Surgery, University Medical Center Groningen, University of Groningen, Postbus 30001, 9700 RB, Groningen, The Netherlands.
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15
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van de Wiel JCM, Wang Y, Xu DM, van der Zaag-Loonen HJ, van der Jagt EJ, van Klaveren RJ, Oudkerk M. Neglectable benefit of searching for incidental findings in the Dutch--Belgian lung cancer screening trial (NELSON) using low-dose multidetector CT. Eur Radiol 2007; 17:1474-82. [PMID: 17206426 DOI: 10.1007/s00330-006-0532-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Revised: 10/25/2006] [Accepted: 11/07/2006] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to prospectively determine the frequency and spectrum of incidental findings (IFs) and their clinical implications in a high risk population for lung cancer undergoing low-dose multidetector computed tomography (MDCT) screening for lung cancer. Scans of 1,929 participants were evaluated for lung lesions and IFs by two radiologists. IFs were categorised as not clinically relevant or possibly clinically relevant. Findings were considered possibly clinically relevant if they could require further evaluation or could have substantial clinical implications. All possibly clinically relevant IFs were reviewed by a third radiologist, who determined its clinical relevance. Of all 1,929 participants, 1,410 (73%) had not clinically relevant IFs and 163 (8%) had possibly clinically relevant IFs of which 129 (79%) were indeed considered clinically relevant. Additional imaging was performed mainly by ultrasound (112 of 118, 96%). All but one lesion were concluded to be benign, mostly cysts (n = 115, 80%). Only 21 (1%) participants had findings with clinical implications. In one participant a malignancy was found, yet without any clinical benefit since no curative treatment was possible. Based on our results, we advise against systematically searching for and reporting of IFs in lung cancer screening studies using low-dose MDCT.
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Affiliation(s)
- J C M van de Wiel
- University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
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van der Zaag-Loonen HJ, Dikkers R, de Bock GH, Oudkerk M. The clinical value of a negative multi-detector computed tomographic angiography in patients suspected of coronary artery disease: A meta-analysis. Eur Radiol 2006; 16:2748-56. [PMID: 16718450 DOI: 10.1007/s00330-006-0312-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Revised: 03/23/2006] [Accepted: 04/21/2006] [Indexed: 01/16/2023]
Abstract
The aim of this meta-analysis was to calculate the sensitivity of contrast-enhanced multi-detector computed tomography (MDCT) compared with coronary angiography (CAG) in incident patients suspected of coronary artery disease (CAD). We searched PubMed, Embase, bibliographies of original papers and reviews to identify original papers including > or =20 patients. Two independent reviewers selected papers and judged eligible papers on quality. Heterogeneity was assessed and homogeneous subgroups were pooled. Of the 15 included studies, ten provided moderately homogeneous patient-based analyses with absolute diagnostic numbers (n = 630 patients). Pooled sensitivity was 89% (95% confidence interval: 85-92%). Scanners with 16 detectors (n = 4) had higher sensitivities (pooled sensitivity: 91%) than four-detector scanners (n = 6; pooling not possible due to heterogeneity). Seven studies reported sensitivity for a proximal stenosis, but different definitions were used making pooling impossible; sensitivities ranged from 75 to 100%. The sensitivity of four- and 16-detector MDCT is not sufficient to rule out any stenosis in patients suspected of CAD. No conclusions can be drawn with respect to the sensitivity for clinically relevant or proximal stenoses.
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Affiliation(s)
- H J van der Zaag-Loonen
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
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Voskuijl WP, van der Zaag-Loonen HJ, Ketel IJG, Grootenhuis MA, Derkx BHF, Benninga MA. Health related quality of life in disorders of defecation: the Defecation Disorder List. Arch Dis Child 2004; 89:1124-7. [PMID: 15557046 PMCID: PMC1719773 DOI: 10.1136/adc.2003.037465] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [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: 01/28/2023]
Abstract
BACKGROUND Constipation and encopresis frequently cause problems with respect to emotional wellbeing, and social and family life. Instruments to measure Health Related Quality of Life (HRQoL) in these disorders are not available. METHODS A disease specific HRQoL instrument, the "Defecation Disorder List" (DDL) for children with constipation or functional non-retentive faecal soiling (FNRFS) was developed using accepted guidelines. For each phase of the process, different samples of patients were used. The final phase of development included 27 children. Reliability was assessed in two ways: internal consistency of domains with Cronbach's alpha, and test-retest reliability with intra-class correlation coefficients (ICC). To assess validity, comparable items and domains were correlated with Tacqol, a generic HRQoL instrument for children (TNO-AZL). RESULTS In the final phase of the development, 27 children completed the instrument. It consisted of 37 items in four domains. The response rate was 96%. Reliability was good for all domains, with Cronbach's alpha values ranging from 0.61 to 0.76. Measures of test-retest stability were good for all four domains with ICCs ranging from 0.82 to 0.92. Validity based on comparison with the Tacqol instrument was moderate. CONCLUSION The DDL is promising as a measure of HRQoL in childhood defecation disorders.
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Affiliation(s)
- W P Voskuijl
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands.
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van Laerhoven H, van der Zaag-Loonen HJ, Derkx BHF. A comparison of Likert scale and visual analogue scales as response options in children's questionnaires. Acta Paediatr 2004; 93:830-5. [PMID: 15244235 DOI: 10.1080/08035250410026572] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
AIM To examine which response options children prefer and which they find easiest to use, and to study the relative reliability of the different response options. METHODS A consecutive group of unselected children (n = 120) filled out three questionnaires in a paediatric outpatient clinic. Each questionnaire included seven similar questions, but had different response options: the Likert scale, the Visual Analogue Scale (VAS) and the numeric VAS. In general, the questions were not related to the children's particular diseases, but dealt with the frequency of simple activities, their feelings and opinions. The pages with the three different response options were offered in random order. Afterwards, the children rated their preference and ease of use of the different response options on a scale from one to 10. RESULTS Children preferred the Likert scale (median mark 9.0) over the numeric VAS (median mark 8.0) and the simple VAS (median 6.0). They considered the Likert scale easiest to fill out (median mark 10 vs 9 and 7.5 for the numeric and simple VAS, respectively). Results of the different response options correlated strongly with each other (rho = 0.67-0.90, p < 0.05). CONCLUSION Children prefer the Likert scale over the numeric and simple VAS and find it easiest to complete. The Likert scale, the simple VAS and the numeric VAS are of comparable reliability. The Likert scale is recommended for use in questionnaires for children, although research into larger and more diverse samples is needed.
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Affiliation(s)
- H van Laerhoven
- Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
OBJECTIVE This study aims to compare generic coping styles adopted by adolescents suffering from inflammatory bowel disease (IBD) to styles used by their healthy peers, and to assess the association between coping styles and health-related quality of life (HRQoL). METHODS A generic coping style instrument, a disease-related coping style instrument and a disease-specific HRQoL instrument were administered to 65 adolescents (12-18 years old) with IBD. Normative data from the generic instrument were available. Mean domain scores of IBD patients were compared to normative scores. Multivariate linear regression analyses were performed on models with HRQoL domains as dependent, and preselected demographic and disease-related characteristics and coping styles as independent variables. RESULTS Adolescents with IBD use more avoidant coping styles than their healthy peers. HRQoL is associated with disease-related coping styles and with disease activity. More use of a predictive coping style (having positive expectations about the disease) and less use of a depressive reaction pattern are associated with better HRQoL in three out of six HRQoL domains. CONCLUSION This study suggests an association between coping styles and HRQoL.
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Affiliation(s)
- H J van der Zaag-Loonen
- Department of Paediatric Gastroenterology and Nutrition, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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van der Zaag-Loonen HJ, Casparie M, Taminiau JAJM, Escher JC, Pereira RR, Derkx HHF. The incidence of pediatric inflammatory bowel disease in the Netherlands: 1999-2001. J Pediatr Gastroenterol Nutr 2004; 38:302-7. [PMID: 15076631 DOI: 10.1097/00005176-200403000-00014] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [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: 12/20/2022]
Abstract
BACKGROUND The incidence of inflammatory bowel disease (IBD) seems to be rising. Incidence studies could provide more insight into geographical differences and thereby lead to the identification of etiological factors. The aim of this study was to prospectively assess the incidence of pediatric IBD in the Netherlands from 1999 to 2001, using both an active physician case-reporting registry and a nationwide pathology database. METHODS All pediatricians in the Netherlands were sent monthly identification cards to be returned if they had diagnosed a new case of IBD in a pediatric patient. Follow-up questionnaires were sent to physicians reporting new cases of IBD. The pathology database contains reports from all cytologic and histologic diagnoses made in the Netherlands. Two independent raters searched the database for new IBD cases. Cases identified from the pathology database were labeled as "probable IBD" and "possible IBD." Cases were cross-checked across databases on the basis of gender, date of birth, date of biopsy, and place of residence. Age-specific incidence rates were calculated for the Dutch population for the year 2000. RESULTS Five hundred forty-six probable cases of IBD were identified; 217 cases were labeled as possible. The incidence rate was 5.2 new cases per 100000 children (<18 years) per year. An increase in incidence with age was observed. Only 24% of the cases were ascertained through the clinical registry. CONCLUSION The incidence of IBD cases in the Netherlands is comparable with that reported in other European countries. Epidemiological studies using case reporting by physicians may be underestimates of true incidence rates.
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