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Voorend CG, Berkhout-Byrne NC, van Bodegom-Vos L, Diepenbroek A, Franssen CF, Joosten H, Mooijaart SP, Bos WJW, van Buren M. Geriatric Assessment in CKD Care: An Implementation Study. Kidney Med 2024; 6:100809. [PMID: 38660344 PMCID: PMC11039322 DOI: 10.1016/j.xkme.2024.100809] [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] [Indexed: 04/26/2024] Open
Abstract
Rationale & Objective Older people with progressive chronic kidney disease (CKD) have complex health care needs. Geriatric evaluation preceding decision making for kidney replacement is recommended in guidelines, but implementation is lacking in routine care. We aimed to evaluate implementation of geriatric assessment in CKD care. Study Design Mixed methods implementation study. Setting & Participants Dutch nephrology centers were approached for implementation of geriatric assessment in patients aged ≥70 years and with an estimated glomerular filtration rate of ≤20 mL/min/1.73 m2. Quality Improvement Activities/Exposure We implemented a consensus-based nephrology-tailored geriatric assessment: a patient questionnaire and professionally administered test set comprising 16 instruments covering functional, cognitive, psychosocial, and somatic domains and patient-reported outcome measures. Outcomes We aimed for implementation in 10 centers and 200 patients. Implementation was evaluated by (i) perceived enablers and barriers of implementation, including integration in work routines (Normalization Measure Development Tool) and (ii) relevance of the instruments to routine care for the target population. Analytical Approach Variations in implementation practices were described based on field notes. The postimplementation survey among health care professionals was analyzed descriptively, using an explanatory qualitative approach for open-ended questions. Results Geriatric assessment was implemented in 10 centers among 191 patients. Survey respondents (n = 71, 88% response rate) identified determinants that facilitated implementation, ie, multidisciplinary collaboration (with geriatricians) -meetings and reports and execution of assessments by nurses. Barriers to implementation were patient illiteracy or language barrier, time constraints, and patient burden. Professionals considered geriatric assessment sufficiently integrated into work routines (mean, 6.7/10 ± 2.0 [SD]) but also subject to improvement. Likewise, the relevance of geriatric assessment for routine care was scored as 7.8/10 ± 1.2. The Clinical Frailty Score and Montreal Cognitive Assessment were perceived as the most relevant instruments. Limitations Selection bias of interventions' early adopters may limit generalizability. Conclusions Geriatric assessment could successfully be integrated in CKD care and was perceived relevant to health care professionals.
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Affiliation(s)
- Carlijn G.N. Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Noeleen C. Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Adry Diepenbroek
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper F.M. Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hanneke Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W. Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marjolijn van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
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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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FitzGerald TJ, Joosten H, van Buren M, Vinen K, Brown EA. A Review of Supportive Care for Older People with Advanced Chronic Kidney Disease. Clin Kidney J 2022; 16:635-646. [PMID: 37007693 PMCID: PMC10061438 DOI: 10.1093/ckj/sfac256] [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] [Received: 09/05/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Supportive care (SC) is a multidimensional and person-centred approach to managing advanced CKD that engages the person and their caregivers in shared decision making from the outset. Rather than focussing on disease-specific therapies, SC is a collection of adjuvant interventions and adaptations to conventional treatments that can be used to improve the individual's quality of life. Recognising that frailty, multi-morbidity, and polypharmacy are more common among older people with advanced chronic kidney disease (CKD) and that people in this group tend to prioritise quality of life over survival as a goal of care, SC represents an important adjunct to disease-specific therapies in CKD management. This review provides an overview of SC in the older person with advanced CKD.
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Affiliation(s)
- Ted J FitzGerald
- Department of Nephrology, Imperial College Hospital's NHS Trust , London , UK
| | | | | | - Katie Vinen
- Department of Nephrology, King's College Hospital NHS Trust , London , UK
| | - Edwina A Brown
- Department of Nephrology, Imperial College Hospital's NHS Trust , London , UK
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Voorend CGN, van Oevelen M, Nieberg M, Meuleman Y, Franssen CFM, Joosten H, Berkhout-Byrne NC, Abrahams AC, Mooijaart SP, Bos WJW, van Buren M. Impact of the COVID-19 pandemic on symptoms of anxiety and depression and health-related quality of life in older patients with chronic kidney disease. BMC Geriatr 2021; 21:650. [PMID: 34798817 PMCID: PMC8602979 DOI: 10.1186/s12877-021-02593-0] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Older patients with advanced chronic kidney disease are at increased risk for a severe course of the coronavirus disease-2019 (COVID-19) and vulnerable to mental health problems. We aimed to investigate prevalence and associated patient (demographic and clinical) characteristics of mental wellbeing (health-related quality of life [HRQoL] and symptoms of depression and anxiety) before and during the COVID-19 pandemic in older patients with advanced chronic kidney disease. METHODS An ongoing Dutch multicentre prospective cohort study enrols patients of ≥70 years with an eGFR < 20 mL/min/1.73m2 from October 2018 onward. With additional questionnaires during the pandemic (May-June 2020), disease-related concerns about COVID-19 and general anxiety symptoms were assessed cross-sectionally, and depressive symptoms, HRQoL, and emotional symptoms longitudinally. RESULTS The 82 included patients had a median age of 77.5 years (interquartile range 73.9-82.1), 77% were male and none had tested positive for COVID-19. Cross-sectionally, 67% of the patients reported to be more anxious about COVID-19 because of their kidney disease, and 43% of the patients stated that their quality of life was reduced due to the COVID-19 pandemic. Compared to pre-COVID-19, the presence of depressive symptoms had increased (11 to 22%; p = .022) and physical HRQoL declined (M = 40.4, SD = 10.1 to M = 36.1, SD = 10.4; p < .001), particularly in males. Mental HRQoL (M = 50.3, SD = 9.6 to M = 50.4, SD = 9.9; p = .913) and emotional symptoms remained similar. CONCLUSIONS Older patients with advanced chronic kidney disease suffered from disease-related anxiety about COVID-19, increased depressive symptoms and reduced physical HRQoL during the COVID-19 pandemic. The impact of the pandemic on this vulnerable patient group extends beyond increased mortality risk, and awareness of mental wellbeing is important. TRIAL REGISTRATION The study is registered at the Netherlands Trial Register (NTR), trial number NL7104. Date of registration: 06-06-2018.
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Affiliation(s)
- C G N Voorend
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - M van Oevelen
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - M Nieberg
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Y Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - C F M Franssen
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - N C Berkhout-Byrne
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - A C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - W J W Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M van Buren
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
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Voorend C, Joosten H, Berkhout-Byrne N, Diepenbroek A, Franssen C, Bos WJW, Van Buren M, Mooijaart S. MO879PROPOSAL OF A GERIATRIC ASSESSMENT TAILORED FOR OLDER CHRONIC KIDNEY DISEASE PATIENTS: RESULTS OF A PRAGMATIC CONSENSUS-BASED APPROACH. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab100.004] [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 and Aims
Unidentified cognitive decline and other geriatric impairments are prevalent in older patients with advanced kidney disease. Despite guideline recommendation of geriatric evaluation, routine geriatric assessment is not common in these patients. While high burden of vascular disease and existing pre-dialysis care pathways mandate a tailored geriatric assessment, no consensus exists on which instruments are most suitable in this population to identify geriatric impairments. Therefore, the aim of this study was to propose a geriatric assessment, based on multidisciplinary consensus, for older people with advanced chronic kidney disease.
Method
A pragmatic approach was chosen to reach agreement on a suitable set of instruments to routinely identify major geriatric impairments in older patients with advanced chronic kidney disease. This approach included focus group meetings to identify criteria for the assessment, literature review to identify potential instruments, questionnaire to inventory currently used instruments, an expert consensus meeting to ensure that the selection of tests was based on input from clinical experience in nephrology and geriatrics, and pilot testing to ensure practicability. In preparation of the consensus meeting we composed a project team and an expert panel (n=33), drafted selection criteria for the selection of instruments, and assessed potential instruments for the test-set.
Results
Selection criteria related to general geriatric domains, clinical relevance, feasibility and duration of the assessment. The consensus-set contains instruments in functional, cognitive, psychological, somatic, patient preferences, nutritional status, and social domains (Figure 1). Administration of (seven) patient questionnaires and (ten) professional-administered instruments, by nurse (practitioners), takes estimated 20 and 40 minutes, respectively. Results are discussed in a multi-disciplinary meeting including at least nephrology and geriatric expertise, informing nephrology treatment decisions and follow-up interventions amongst which comprehensive geriatric assessment.
Conclusion
This first multi-disciplinary consensus on nephrology-tailored geriatric assessment intent to benefit clinical care and enhance research comparability for older patients with advanced chronic kidney disease. The proposed geriatric assessment is currently implemented in multiple hospitals and studies. Future initiatives and studies should provide insights on effectiveness, feasibility, patient’s satisfaction and, value for shared treatment decision making and outcome improvement.
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Affiliation(s)
- Carlijn Voorend
- Leiden University Medical Center (LUMC), Leiden, Netherlands
| | | | | | | | | | | | | | - Simon Mooijaart
- Leiden University Medical Center (LUMC), Leiden, Netherlands
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6
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Voorend C, Van Oevelen M, Nieberg M, Meuleman Y, Franssen C, Joosten H, Berkhout-Byrne N, Abrahams AC, Bos WJW, Van Buren M. MO505IMPACT OF THE COVID-19 PANDEMIC ON SYMPTOMS OF ANXIETY AND DEPRESSION AND HEALTH-RELATED QUALITY OF LIFE IN OLDER PATIENTS WITH CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2021. [PMCID: PMC8195083 DOI: 10.1093/ndt/gfab087.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/13/2022] Open
Abstract
Background and Aims Older patients with advanced chronic kidney disease (CKD) are at increased risk for a severe course of the coronavirus disease-2019 (COVID-19) and vulnerable to mental health problems. We aimed to investigate prevalence and associated patient (demographic and clinical) characteristics of mental wellbeing (health-related quality of life [HRQoL] and symptoms of depression and anxiety) before and during the COVID-19 pandemic in older patients with advanced CKD. Method An ongoing Dutch multicentre prospective cohort study enrols patients of ≥70 years with an eGFR <20 mL/min/1.73m2 from October 2018 onward. With additional questionnaires during the pandemic (May-June 2020), disease-related concerns about COVID-19 and general anxiety symptoms were assessed cross-sectionally, and depressive symptoms, HRQoL, and emotional symptoms longitudinally. Results The 82 included patients had a median age of 77.5 years (inter-quartile range 73.9-82.1), 77% was male and none had tested positive for COVID-19. Cross-sectionally, 67% of the patients reported to be more anxious for COVID-19 because of their kidney disease, and 43% of the patients stated that their quality of life was reduced due to the COVID-19 pandemic (Figure 1). Higher COVID-19-related stress was associated with a lower education level (p=0.036), and patients who reported to feel more down due to COVID-19 were more often female (p=0.020). Anxiety scores were higher among females compared to males (median 4.0 [IQR 3.0-9.0] versus 2.0 [0.0-6.0], p=0.020), and weakly associated to a decline in eGFR (correlation coefficient 0.197, p=0.023). Compared to pre-COVID-19, presence of depressive symptoms had increased (11% to 22%; p=0.022) and physical HRQoL declined (40.4±10.1 to 36.1±10.4, p<0.001). Mental HRQoL (50.3±9.6 to 50.4±9.9; p=0.913) and emotional symptoms remained similar. Males showed a greater decline in physical HRQoL (mean -5.3, SD 8.5) compared to females (mean -0.9, SD 5.7; p=0.039). Conclusion Our findings show that older patients with advanced CKD suffered from disease-related anxiety for COVID-19, increased depressive symptoms, and reduced physical HRQOL during the COVID-19 pandemic. The impact of the pandemic on this vulnerable patient group extends beyond increased mortality risk, and awareness of mental health problems during the pandemic is essential. More in-depth investigation on disease-related COVID-19 concerns and its implications for the CKD population is needed.
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Affiliation(s)
- Carlijn Voorend
- Leiden University Medical Center (LUMC), Internal Medicine, Leiden, The Netherlands
| | - Mathijs Van Oevelen
- Leiden University Medical Center (LUMC), Internal Medicine, Leiden, The Netherlands
| | - Margot Nieberg
- Leiden University Medical Center (LUMC), Internal Medicine, Leiden, The Netherlands
| | - Yvette Meuleman
- Leiden University Medical Center (LUMC), Epidemiology, Leiden, The Netherlands
| | - Casper Franssen
- University Medical Center Groningen, Nephrology, Groningen, The Netherlands
| | - Hanneke Joosten
- Maastricht University Medical Center+, Geriatric Medicine, Maastricht, The Netherlands
| | | | | | - Willem Jan W Bos
- Leiden University Medical Center (LUMC), Internal Medicine, Leiden, The Netherlands
- St. Antonius Hospital, Internal Medicine, Nieuwegein, The Netherlands
| | - Marjolijn Van Buren
- Leiden University Medical Center (LUMC), Internal Medicine, Leiden, The Netherlands
- Haga Hospital (Leyweg), Internal Medicine, Den Haag, The Netherlands
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7
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Voorend CGN, Joosten H, Berkhout-Byrne NC, Diepenbroek A, Franssen CFM, Bos WJW, Van Buren M, Mooijaart SP. Design of a consensus-based geriatric assessment tailored for older chronic kidney disease patients: results of a pragmatic approach. Eur Geriatr Med 2021; 12:931-942. [PMID: 33871790 PMCID: PMC8463384 DOI: 10.1007/s41999-021-00498-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/08/2021] [Indexed: 12/15/2022]
Abstract
Aim To propose a consensus-based geriatric assessment for optimizing both routine care and research in older patients with advanced chronic kidney disease. Findings Using a pragmatic approach, we reached consensus on a suitable nephrology-tailored geriatric assessment to routinely identify major geriatric impairments in older patients with advanced chronic kidney disease. This geriatric assessment contains instruments in functional, cognitive, psychological, somatic, patient preferences, nutritional status, and social domains, and can be administered with patient questionnaires and professional-administered instruments by nurse (practitioners) in approximately 20 and 40 minutes, respectively. Message We propose a consensus test set for standardized nephrology-tailored geriatric assessment, which is currently being implemented in multiple hospitals and studies, to benefit clinical care for older patients with advanced chronic kidney disease and enhance research comparability. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00498-0. Purpose Unidentified cognitive decline and other geriatric impairments are prevalent in older patients with advanced chronic kidney disease (CKD). Despite guideline recommendation of geriatric evaluation, routine geriatric assessment is not common in these patients. While high burden of vascular disease and existing pre-dialysis care pathways mandate a tailored geriatric assessment, no consensus exists on which instruments are most suitable in this population to identify geriatric impairments. Therefore, the aim of this study was to propose a geriatric assessment, based on multidisciplinary consensus, to routinely identify major geriatric impairments in older people with advanced CKD. Methods A pragmatic approach was chosen, which included focus groups, literature review, inventory of current practices, an expert consensus meeting, and pilot testing. In preparation of the consensus meeting, we composed a project team and an expert panel (n = 33), drafted selection criteria for the selection of instruments, and assessed potential instruments for the geriatric assessment. Results Selection criteria related to general geriatric domains, clinical relevance, feasibility, and duration of the assessment. The consensus-assessment contains instruments in functional, cognitive, psychological, somatic, patient preferences, nutritional status, and social domains. Administration of (seven) patient questionnaires and (ten) professional-administered instruments, by nurse (practitioners), takes estimated 20 and 40 min, respectively. Results are discussed in a multidisciplinary meeting including at least nephrology and geriatric expertise, informing nephrology treatment decisions, and follow-up interventions among which comprehensive geriatric assessment. Conclusion This first multidisciplinary consensus on nephrology-tailored geriatric assessment intent to benefit clinical care and enhance research comparability for older patients with advanced CKD. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00498-0.
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Affiliation(s)
- Carlijn G N Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands.
| | - Hanneke Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Noeleen C Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Adry Diepenbroek
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper F M Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, St. Antonius hospital, Nieuwegein, The Netherlands
| | - Marjolijn Van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Haga Hospital, The Hague, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
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van Eersel MEA, Joosten H, Gansevoort RT, Slaets JPJ, Izaks GJ. Treatable Vascular Risk and Cognitive Performance in Persons Aged 35 Years or Older: Longitudinal Study of Six Years. J Prev Alzheimers Dis 2020; 6:42-49. [PMID: 30569085 PMCID: PMC6515561 DOI: 10.14283/jpad.2018.47] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Poor cognitive performance is associated with high vascular risk. However,
this association is only investigated in elderly. As neuropathological changes
precede clinical symptoms of cognitive impairment by several decades, it is likely
that cognitive performance is already associated with vascular risk at
middle-age. Objectives To investigate the association of cognitive performance with treatable
vascular risk in middle-aged and old persons. Design Longitudinal study with three measurements during follow-up period of 5.5
years. Setting City of Groningen, the Netherlands. Participants Cohort of 3,572 participants (age range, 35–82 years; mean age, 54 years; men,
52%). Exposure Treatable vascular risk as defined by treatable components of the Framingham
Risk Score for Cardiovascular Disease at the first measurement (diabetes mellitus,
smoking, hypercholesterolemia and hypertension). Measurements Change in cognitive performance during follow-up. Cognitive performance was
measured with Ruff Figural Fluency Test (RFFT) and Visual Association Test (VAT),
and calculated as the average of the standardized RFFT and VAT score per
participant. Results The mean (SD) cognitive performance changed from 0.00 (0.79) at the first
measurement to 0.15 (0.83) at second measurement and to 0.39 (0.82) at the third
measurement (Ptrend<0.001). This change was negatively associated with
treatable vascular risk: the change in cognitive performance between two
measurements decreased with 0.004 per one-point increment of treatable vascular
risk (95%CI, -0.008 to 0.000; P=0.05) and with 0.006 per one-year increment of age
(95%CI, -0.008 to -0.004; P<0.001). Conclusions Change in cognitive performance was associated with treatable vascular risk in
persons aged 35 years or older. Electronic Supplementary Material Supplementary material is available for this article at 10.14283/jpad.2018.47 and is accessible for authorized users.
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Affiliation(s)
- M E A van Eersel
- Marlise E.A. van Eersel (MEAE), University Center for Geriatric Medicine, University Medical Center Groningen, Internal Postcode: AA41, PO Box 30.001, 9700 RB Groningen, The Netherlands, Phone: 0031(0)50 361 39 21, Fax: 0031(0)50 361 90 69,
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Brouns SH, Brüggemann R, Linkens AEMJH, Magdelijns FJ, Joosten H, Heijnen R, Ten Cate-Hoek AJ, Schols JMGA, Ten Cate H, Spaetgens B. Mortality and the Use of Antithrombotic Therapies Among Nursing Home Residents with COVID-19. J Am Geriatr Soc 2020; 68:1647-1652. [PMID: 32633418 PMCID: PMC7361386 DOI: 10.1111/jgs.16664] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND/OBJECTIVES Nursing home (NH) residents are a vulnerable population, susceptible to respiratory disease outbreaks such as coronavirus disease 2019 (COVID‐19). Poor outcome in COVID‐19 is at least partly attributed to hypercoagulability, resulting in a high incidence of thromboembolic complications. It is unknown whether commonly used antithrombotic therapies may protect the vulnerable NH population with COVID‐19 against mortality. This study aimed to investigate whether the use of oral antithrombotic therapy (OAT) was associated with a lower mortality in NH residents with COVID‐19. DESIGN A retrospective case series. SETTING Fourteen NH facilities from the NH organization Envida, Maastricht, the Netherlands PARTICIPANTS A total of 101 NH residents with COVID‐19 were enrolled. MEASUREMENTS The primary outcome was all‐cause mortality. The association between age, sex, comorbidity, OAT, and mortality was assessed using logistic regression analysis. RESULTS Overall mortality was 47.5% in NH residents from 14 NH facilities. Age, comorbidity, and medication use were comparable among NH residents who survived and who died. OAT was associated with a lower mortality in NH residents with COVID‐19 in the univariable analysis (odds ratio (OR) = 0.89; 95% confidence interval (CI) = 0.41–1.95). However, additional adjustments for sex, age, and comorbidity attenuated this difference. Mortality in males was higher compared with female residents (OR = 3.96; 95% CI = 1.62–9.65). Male residents who died were younger compared with female residents (82.2 (standard deviation (SD) = 6.3) vs 89.1 (SD = 6.8) years; P < .001). CONCLUSION NH residents in the 14 facilities we studied were severely affected by the COVID‐19 pandemic, with a mortality of 47.5%. Male NH residents with COVID‐19 had worse outcomes than females. We did not find evidence for any protection against mortality by OAT, necessitating further research into strategies to mitigate poor outcome of COVID‐19 in vulnerable NH populations. J Am Geriatr Soc 68:1647‐1652, 2020.
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Affiliation(s)
- Steffie H Brouns
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Renée Brüggemann
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Aimée E M J H Linkens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Fabienne J Magdelijns
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hanneke Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ron Heijnen
- Envida Care Organization, Maastricht, The Netherlands
| | - Arina J Ten Cate-Hoek
- Thrombosis Expert Center Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry, Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - Jos M G A Schols
- Envida Care Organization, Maastricht, The Netherlands.,Caphri, Department of Health Services Research and Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Thrombosis Expert Center Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry, Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
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van Eersel MEA, Visser ST, Joosten H, Gansevoort RT, Slaets JPJ, Izaks GJ. Pharmacological treatment of increased vascular risk and cognitive performance in middle-aged and old persons: six-year observational longitudinal study. BMC Neurol 2020; 20:242. [PMID: 32532237 PMCID: PMC7291556 DOI: 10.1186/s12883-020-01822-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Lowering vascular risk is associated with a decrease in the prevalence of cardiovascular disease and dementia. However, it is still unknown whether lowering of vascular risk with pharmacological treatment preserves cognitive performance in general. Therefore, we compared the change in cognitive performance in persons with and without treatment of vascular risk factors. Methods In this longitudinal observational study, 256 persons (mean age, 58 years) were treated for increased vascular risk during a mean follow-up period of 5.5 years (treatment group), whereas 1678 persons (mean age, 50 years) did not receive treatment (control group). Cognitive performance was three times measured during follow-up using the Ruff Figural Fluency Test (RFFT) and Visual Association Test (VAT), and calculated as the average of standardized RFFT and VAT score per participant. Because treatment allocation was nonrandomized, additional analyses were performed in demographic and vascular risk-matched samples and adjusted for propensity scores. Results In the treatment group, mean (SD) cognitive performance changed from − 0.30 (0.80) to − 0.23 (0.80) to 0.02 (0.87), and in control group, from 0.08 (0.77) to 0.24 (0.79) to 0.49 (0.74) at the first, second and third measurement, respectively (ptrend < 0.001). After adjustment for demographics and vascular risk, the change in cognitive performance during follow-up was not statistically significantly different between the treatment and control group: mean estimated difference, − 0.10 (95%CI − 0.21 to 0.01; p = 0.08). Similar results were found in matched samples and after adjustment for propensity score. Conclusion Change in cognitive performance during follow-up was similar in treated and untreated persons. This suggests that lowering vascular risk preserves cognitive performance.
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Affiliation(s)
- Marlise E A van Eersel
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, AA41, PO Box 30.001, 9700, RB, Groningen, The Netherlands.
| | - Sipke T Visser
- Department of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics (PTE2), University of Groningen, Groningen, the Netherlands
| | - Hanneke Joosten
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joris P J Slaets
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, AA41, PO Box 30.001, 9700, RB, Groningen, The Netherlands
| | - Gerbrand J Izaks
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, AA41, PO Box 30.001, 9700, RB, Groningen, The Netherlands
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11
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Gaudig G, Krebs M, Joosten H. Sphagnum growth under N saturation: interactive effects of water level and P or K fertilization. Plant Biol (Stuttg) 2020; 22:394-403. [PMID: 31999043 DOI: 10.1111/plb.13092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
Sphagnum biomass is a promising material that could be used as a substitute for peat in growing media and can be sustainably produced by converting existing drainage-based peatland agriculture into wet, climate-friendly agriculture (paludiculture). Our study focuses on yield maximization of Sphagnum as a crop. We tested the effects of three water level regimes and of phosphorus or potassium fertilization on the growth of four Sphagnum species (S. papillosum, S. palustre, S. fimbriatum, S. fallax). To simulate field conditions in Central and Western Europe we carried out a glasshouse experiment under nitrogen-saturated conditions. A constant high water table (remaining at 2 cm below capitulum during growth) led to highest productivity for all tested species. Water table fluctuations between 2 and 9 cm below capitulum during growth and a water level 2 cm below capitulum at the start but falling relatively during plant growth led to significantly lower productivity. Fertilization had no effect on Sphagnum growth under conditions with high atmospheric deposition such as in NW Germany (38 kg N, 0.3 kg P, 7.6 kg K·ha-1 ·year-1 ). Large-scale maximization of Sphagnum yields requires precise water management, with water tables just below the capitula and rising with Sphagnum growth. The nutrient load in large areas of Central and Western Europe from atmospheric deposition and irrigation water is high but, with an optimal water supply, does not hamper Sphagnum growth, at least not of regional provenances of Sphagnum.
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Affiliation(s)
- G Gaudig
- Institute of Botany and Landscape Ecology, University of Greifswald, partner in the Greifswald Mire Centre, Greifswald, Germany
| | - M Krebs
- Institute of Botany and Landscape Ecology, University of Greifswald, partner in the Greifswald Mire Centre, Greifswald, Germany
| | - H Joosten
- Institute of Botany and Landscape Ecology, University of Greifswald, partner in the Greifswald Mire Centre, Greifswald, Germany
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van Loon IN, Joosten H, Iyasere O, Johansson L, Hamaker ME, Brown EA. The prevalence and impact of falls in elderly dialysis patients: Frail elderly Patient Outcomes on Dialysis (FEPOD) study. Arch Gerontol Geriatr 2019; 83:285-291. [PMID: 31132548 DOI: 10.1016/j.archger.2019.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/21/2019] [Accepted: 05/17/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND As the numbers of older patients on dialysis rise, geriatric problems such as falling become more prevalent. We aimed to assess the prevalence of falls and the impact on mortality and quality of life in frail elderly patients on assisted PD (aPD) and hemodialysis (HD) from the FEPOD Study. METHODS Data on falls and quality of life were collected with questionnaires at baseline and every six months during 2-year follow-up. Multiple regression analysis was used to evaluate factors associated with falls. Additionally, we performed a review of literature concerning the relation between falls and poor outcome. RESULTS Baseline fall data were available for 203 patients and follow-up data for 114 patients. Dialysis modality was equally distributed (49% HD and 51% aPD). Mean (SD) age was 75 ± 7 years. Fall rate was 1.00 falls/patient year, comparable in HD and aPD. Falls led to fear of falling, resulting in less activities in 68% vs 42% (p < 0.01) and leaving the house less in 59% vs 31% (p < 0.01) of patients. Patients with diabetes mellitus were twice as likely to report falls at baseline (OR 1.91 [95%CI 1.00-3.63], p = 0.05) and falls at baseline were associated with falls during follow-up (OR 2.53 [95%CI 1.06-6.04] p = 0.03). Literature revealed frailty was a strong risk factor for falling and falling results in a higher mortality and hospitalization rate. CONCLUSION Falls were frequent in older dialysis patients and have a negative impact on quality of life. Fall incidence is comparable between aPD and HD.
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Affiliation(s)
- Ismay N van Loon
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands.
| | - Hanneke Joosten
- Department of Internal Medicine, Division of Medicine for the Elderly, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Osasuyi Iyasere
- John Walls Renal unit, Leicester General Hospital, Leicester, United Kingdom
| | - Lina Johansson
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Marije E Hamaker
- Departments Geriatrics, Diakonessenhuis Utrecht, the Netherlands
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
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13
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Carlioz V, Faivre C, Balme B, Joosten H, Pradier T, Skowron F. [Zosteriform cutaneous metastasis in melanoma]. Ann Dermatol Venereol 2018; 145:113-115. [PMID: 29217081 DOI: 10.1016/j.annder.2017.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/21/2017] [Revised: 07/20/2017] [Accepted: 10/31/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cutaneous metastases are common in patients with malignant melanoma. In rare cases, they are distributed on a dermatome, in which case they are known as zosteriform metastases. OBSERVATION We report the case of a patient with zosteriform metastasis of a malignant melanoma, progressing unfavourably despite surgical excision and immunotherapy. DISCUSSION The physiopathology of this condition continues to be poorly understood.
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Affiliation(s)
- V Carlioz
- Service de dermatologie, centre hospitalier de Valence, 179, boulevard Maréchal-Juin, 26000 Valence, France.
| | - C Faivre
- Service de dermatologie, centre hospitalier de Valence, 179, boulevard Maréchal-Juin, 26000 Valence, France
| | - B Balme
- Service de dermato-pathologie, centre hospitalier Lyon Sud, 69495 Pierre-Benite, France
| | - H Joosten
- Service d'oncologie, centre hospitalier de Valence, 179, boulevard Maréchal-Juin, 26000 Valence, France
| | - T Pradier
- Service de chirurgie viscérale, centre hospitalier de Valence, 179, boulevard Maréchal-Juin, 26000 Valence, France
| | - F Skowron
- Service de dermatologie, centre hospitalier de Valence, 179, boulevard Maréchal-Juin, 26000 Valence, France
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Farrington K, Covic A, Nistor I, Aucella F, Clyne N, De Vos L, Findlay A, Fouque D, Grodzicki T, Iyasere O, Jager KJ, Joosten H, Macias JF, Mooney A, Nagler E, Nitsch D, Taal M, Tattersall J, Stryckers M, van Asselt D, Van den Noortgate N, van der Veer S, van Biesen W. Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR<45 mL/min/1.73 m2): a summary document from the European Renal Best Practice Group. Nephrol Dial Transplant 2017; 32:9-16. [PMID: 28391313 DOI: 10.1093/ndt/gfw411] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [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: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 11/14/2022] Open
Abstract
The population of patients with moderate and severe CKD is growing. Frail and older patients comprise an increasing proportion. Many studies still exclude this group, so the evidence base is limited. In 2013 the advisory board of ERBP initiated, in collaboration with European Union of Geriatric Medicine Societies (EUGMS), the development of a guideline on the management of older patients with CKD stage 3b or higher (eGFR >45 mL/min/1.73 m2). The full guideline has recently been published and is freely available online and on the website of ERBP (www.european-renal-best-practice.org). This paper summarises main recommendations of the guideline and their underlying rationales.
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Affiliation(s)
- Ken Farrington
- Renal Unit, Lister Hospital, Stevenage, Hertfordshire, UK
| | - Adrian Covic
- Clinic of Nephrology, C. I. Parhon University Hospital, Gr T. Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Ionut Nistor
- Clinic of Nephrology, C. I. Parhon University Hospital, Gr T. Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Filippo Aucella
- Nephrology and Dialysis Unit at the Research Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy
| | | | - Leen De Vos
- Department of Nephrology, Ghent University Hospital, Ghent Belgium
| | - Andrew Findlay
- Renal Unit, Lister Hospital, Stevenage, Hertfordshire, UK
| | - Denis Fouque
- Division of Nephrology, Université de Lyon, UCBL, INSERM, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - Tomasz Grodzicki
- Department of Internal Medicine and Geriatrics, University Hospital of Krakow, Poland
| | | | - Kitty J Jager
- Department of Medical Informatics, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Hanneke Joosten
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Andrew Mooney
- Renal Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Evi Nagler
- Department of Nephrology, Ghent University Hospital, Ghent Belgium
| | - Dorothea Nitsch
- London School of Hygiene & Tropical Medicine, London, United Kingdom UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Maarten Taal
- Department of Renal Medicine, Royal Derby Hospital, Derby, UK Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - James Tattersall
- Renal Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Dieneke van Asselt
- Department of Geriatric Medicine of the Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Wim van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent Belgium
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Farrington K, Covic A, Aucella F, Clyne N, de Vos L, Findlay A, Fouque D, Grodzicki T, Iyasere O, Jager KJ, Joosten H, Macias JF, Mooney A, Nitsch D, Stryckers M, Taal M, Tattersall J, Van Asselt D, Van den Noortgate N, Nistor I, Van Biesen W. Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR <45 mL/min/1.73 m2). Nephrol Dial Transplant 2016; 31:ii1-ii66. [DOI: 10.1093/ndt/gfw356] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Margot H, Zwietering M, Joosten H, Stephan R. Determination of single cell lag times of Cronobacter spp. strains exposed to different stress conditions: Impact on detection. Int J Food Microbiol 2016; 236:161-6. [DOI: 10.1016/j.ijfoodmicro.2016.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 07/23/2016] [Accepted: 08/01/2016] [Indexed: 11/27/2022]
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Chazot C, Farrington K, Nistor I, Van Biesen W, Joosten H, Teta D, Siriopol D, Covic A. Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients. Int Urol Nephrol 2015; 47:1809-16. [PMID: 26377489 DOI: 10.1007/s11255-015-1107-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein-energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients' outcome. The most important issue is that all studies performed with extended/alternative dialysis regimens do not specifically address this particular type of patients and therefore all the inferences are derived from the general ESRD population. Care planning should be responsive to end-of-life needs whatever the treatment modality. Care in this setting should focus on symptom control and quality of life rather than life extension. We conclude that, similar to the general dialysed population, extensive application of more intensive dialysis schedules is not based on solid evidence. However, after a thorough clinical evaluation, a limited period of a trial of intensive dialysis could be prescribed in more problematic patients.
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Affiliation(s)
| | - Ken Farrington
- Renal Unit, Lister Hospital, Stevenage, Hertfordshire, UK
- Postgraduate Medical School, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Ionut Nistor
- ERBP, Ghent University Hospital, Ghent, Belgium
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Wim Van Biesen
- ERBP, Ghent University Hospital, Ghent, Belgium
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Hanneke Joosten
- Department of Internal Medicine, UMCG, Groningen, The Netherlands
| | - Daniel Teta
- Service of Nephrology, Department of Medicine, University Hospital Lausanne, Lausanne, Switzerland
| | - Dimitrie Siriopol
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
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van Hateren KJJ, Landman GWD, Arnold JFH, Joosten H, Groenier KH, Navis GJ, Sparwasser A, Bakker SJL, Bilo HJG, Kleefstra N. Serum Proenkephalin A Levels and Mortality After Long-Term Follow-Up in Patients with Type 2 Diabetes Mellitus (ZODIAC-32). PLoS One 2015. [PMID: 26218633 PMCID: PMC4517864 DOI: 10.1371/journal.pone.0133065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Two previous studies concluded that proenkephalin A (PENK-A) had predictive capabilities for stroke severity, recurrent myocardial infarction, heart failure and mortality in patients with stroke and myocardial infarction. OBJECTIVES This study aimed to investigate the value of PENK-A as a biomarker for predicting mortality in patients with type 2 diabetes mellitus. METHODS Patients with type 2 diabetes mellitus were included from the prospective observational ZODIAC (Zwolle Outpatient Diabetes project Integrating Available Care) study. The present analysis incorporated two ZODIAC cohorts (1998 and 2001). Since blood was drawn for 1204 out of 1688 patients (71%), and information on relevant confounders was missing in 47 patients, the final sample comprised 1157 patients. Cox proportional hazard models were used for evaluating the relationship between PENK-A and (cardiovascular) mortality. Risk prediction capabilities were assessed with Harrell's C statistics and the integrated discrimination improvement (IDI). RESULTS After a follow-up period of 14 years, 525 (45%) out of 1157 patients had died, of which 224 (43%) were attributable to cardiovascular factors. Higher Log PENK-A levels were not independently associated with increased (cardiovascular) mortality. Patients with PENK-A values in the highest tertile had a 49% (95%CI 1%-121%) higher risk of cardiovascular mortality compared to patients in the reference category (lowest tertile). C-values were not different after removing PENK-A from the Cox models and there were no significant differences in IDI values. CONCLUSIONS The associations between PENK-A and mortality were strongly attenuated after accounting for all traditional risk factors. Furthermore, PENK-A did not seem to have additional value beyond conventional risk factors when predicting all-cause and cardiovascular mortality.
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Affiliation(s)
| | - Gijs W. D. Landman
- Diabetes Centre, Isala, Zwolle, the Netherlands
- Department of Internal Medicine, Gelre hospital, Apeldoorn, the Netherlands
| | | | - Hanneke Joosten
- Diabetes Centre, Isala, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Klaas H. Groenier
- Diabetes Centre, Isala, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
| | - Gerjan J. Navis
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Andrea Sparwasser
- Research Department, B.R.A.H.M.S GmbH (Thermo Fisher Scientific), Hennigsdorf/Berlin, Germany
| | - Stephan J. L. Bakker
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Henk J. G. Bilo
- Diabetes Centre, Isala, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
- Department of Internal Medicine, Isala, Zwolle, the Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
- Langerhans Medical Research Group, Zwolle, the Netherlands
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Joosten H, Visser ST, van Eersel ME, Gansevoort RT, Bilo HJG, Slaets JP, Izaks GJ. Statin use and cognitive function: population-based observational study with long-term follow-up. PLoS One 2014; 9:e115755. [PMID: 25541708 PMCID: PMC4277319 DOI: 10.1371/journal.pone.0115755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 11/12/2014] [Indexed: 01/18/2023] Open
Abstract
We aimed to evaluate the association between statin use and cognitive function. Cognitive function was measured with the Ruff Figural Fluency Test (RFFT; worst score, 0; best score, 175 points) and the Visual Association Test (VAT; low performance, 0-10; high performance, 11-12 points) in an observational study that included 4,095 community-dwelling participants aged 35-82 years. Data on statin use were obtained from a computerized pharmacy database. Analysis were done for the total cohort and subsamples matched on cardiovascular risk (N = 1232) or propensity score for statin use (N = 3609). We found that a total of 904 participants (10%) used a statin. Statin users were older than non-users: mean age (SD) 61 (10) vs. 52 (11) years (p<0.001). The median duration of statin use was 3.8 (interquartile range, 1.6-4.5) years. Unadjusted, statin users had worse cognitive performance than non-users. The mean RFFT score (SD) in statin users and non-users was 58 (23) and 72 (26) points, respectively (p<0.001). VAT performance was high in 261 (29%) statin users and 1351 (43%) non-users (p<0.001). However, multiple regression analysis did not show a significant association of RFFT score with statin use (B, -0.82; 95%CI, -2.77 to 1.14; p = 0.41) nor with statin solubility, statin dose or duration of statin use. Statin users with high doses or long-term use had similar cognitive performance as non-users. This was found in persons with low as well as high cardiovascular risk, and in younger as well as older subjects. Also, the mean RFFT score per quintile of propensity score for statin use was comparable for statin users and non-users. Similar results were found for the VAT score as outcome measure. In conclusion, statin use was not associated with cognitive function. This was independent of statin dose or duration of statin use.
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Affiliation(s)
- Hanneke Joosten
- University of Groningen, University Medical Center Groningen (UMCG), Department of Internal medicine, Groningen, The Netherlands
| | - Sipke T. Visser
- University of Groningen, Department of Pharmacy, PharmacoEpidemiology and PharmacoEconomics (PE2), Groningen, The Netherlands
| | - Marlise E. van Eersel
- University of Groningen, University Medical Center Groningen (UMCG), University Center for Geriatric Medicine, Groningen, The Netherlands
| | - Ron T. Gansevoort
- University of Groningen, University Medical Center Groningen (UMCG), Department of Internal medicine, Division of Nephrology, Groningen, The Netherlands
| | - Henk J. G. Bilo
- University of Groningen, University Medical Center Groningen (UMCG), Department of Internal medicine, Groningen, The Netherlands
- Department of Internal medicine, Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
| | - Joris P. Slaets
- University of Groningen, University Medical Center Groningen (UMCG), University Center for Geriatric Medicine, Groningen, The Netherlands
| | - Gerbrand J. Izaks
- University of Groningen, University Medical Center Groningen (UMCG), University Center for Geriatric Medicine, Groningen, The Netherlands
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van Eersel MEA, Joosten H, Gansevoort RT, Dullaart RPF, Slaets JPJ, Izaks GJ. The interaction of age and type 2 diabetes on executive function and memory in persons aged 35 years or older. PLoS One 2013; 8:e82991. [PMID: 24367577 PMCID: PMC3867457 DOI: 10.1371/journal.pone.0082991] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 02/12/2013] [Accepted: 11/07/2013] [Indexed: 01/14/2023] Open
Abstract
It is generally assumed that type 2 diabetes increases the risk of cognitive dysfunction in old age. As type 2 diabetes is frequently diagnosed before the age of 50, diabetes-related cognitive dysfunction may also occur before the age of 50. Therefore, we investigated the association of type 2 diabetes with cognitive function in people aged 35-82 years. In a cross-sectional study comprising 4,135 participants of the Prevention of Renal and Vascular ENd-stage Disease study (52% men; mean age (SD), 55 (12) years) diabetes was defined according to the criteria of the American Diabetes Association. Executive function was measured with the Ruff Figural Fluency Test (RFFT; worst score, 0 points; best score, 175 points), and memory was measured with the Visual Association Test (VAT; worst score, 0 points; best score, 12 points). The association of diabetes with cognitive function was investigated with multiple linear or, if appropriate, logistic regression analysis adjusting for other cardiovascular risk factors and APOE ε4 carriership. Type 2 diabetes was ascertained in 264 individuals (6%). Persons with diabetes had lower RFFT scores than persons without diabetes: mean (SD), 51 (19) vs. 70 (26) points (p<0.001). The difference in RFFT score was largest at age 35-44 years (mean difference 32 points; 95% CI, 15 to 49; p<0.001) and gradually decreased with increasing age. The association of diabetes with RFFT score was not modified by APOE ε4 carriership. Similar results were found for VAT score as outcome measure although these results were only borderline statistically significant (p≤0.10). In conclusion, type 2 diabetes was associated with cognitive dysfunction, especially in young adults. This was independent of other cardiovascular risk factors and APOE ε4 carriership.
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Affiliation(s)
- Marlise E. A. van Eersel
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
| | - Hanneke Joosten
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Nephrology, Groningen, The Netherlands
| | - Ron T. Gansevoort
- University of Groningen, University Medical Center Groningen, Department of Nephrology, Groningen, The Netherlands
| | - Robin P. F. Dullaart
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Joris P. J. Slaets
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Alzheimer Center Groningen, Groningen, The Netherlands
| | - Gerbrand J. Izaks
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Alzheimer Center Groningen, Groningen, The Netherlands
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Aries MJH, Joosten H, Thien T. Letter by Aries et al regarding article, "Systolic blood pressure after intravenous antihypertensive treatment and clinical outcomes in hyperacute intracerebral hemorrhage: the Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study". Stroke 2013; 44:e152. [PMID: 24046007 DOI: 10.1161/strokeaha.113.002897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marcel J H Aries
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Joosten H, van Eersel ME, Gansevoort RT, Bilo HJ, Slaets JP, Izaks GJ. Cardiovascular Risk Profile and Cognitive Function in Young, Middle-Aged, and Elderly Subjects. Stroke 2013; 44:1543-9. [DOI: 10.1161/strokeaha.111.000496] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background and Purpose—
Cognitive decline occurs earlier than previously realized and is already evident at the age of 45. Because cardiovascular risk factors are established risk factors for cognitive decline in old age, we investigated whether cardiovascular risk factors are also associated with cognitive decline in young and middle-aged groups.
Methods—
The cross-sectional study included 3778 participants aged 35 to 82 years (mean age, 54 years) and free of cardiovascular disease and stroke. Cognitive function was measured with the Ruff Figural Fluency Test (RFFT; worst score, 0; best score, 175 points) and the Visual Association Test (VAT; worst score, 0; best score, 12 points). Overall cardiovascular risk was assessed with the Framingham Risk Score (FRS) for general cardiovascular disease (best score, −5; worst score, 33 points).
Results—
Mean RFFT score (SD) was 70 (26) points, median VAT score (interquartile range) was 10 (9–11) points, and mean FRS (SD) was 10 (6) points. Using linear regression analysis adjusting for educational level, RFFT was negatively associated with FRS. RFFT score decreased by 1.54 points (95% confidence interval, −1.66 to −1.44;
P
<0.001) per point increase in FRS. This negative association was not only limited to older age groups, but also found in the young (35–44 years). The main influencing components of the FRS were age (
P
<0.001), diabetes mellitus (
P
=0.001), and smoking (
P
<0.001). Similar results were found for VAT score as outcome measure.
Conclusions—
In this large population–based cohort, a worse overall cardiovascular risk profile was associated with poorer cognitive function. This association was already present in young adults aged 35 to 44 years.
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Affiliation(s)
- Hanneke Joosten
- From Department of Internal Medicine (H.J.), University Center for Geriatric Medicine (M.E.A.E., J.P.J.S., G.J.I.), Department of Nephrology (H.J., R.T.G.), and Alzheimer Center Groningen (J.P.J.S., G.J.I.), University Medical Center Groningen, the University of Groningen, Groningen, The Netherlands; and Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands (H.J.G.B.)
| | - Marlise E.A. van Eersel
- From Department of Internal Medicine (H.J.), University Center for Geriatric Medicine (M.E.A.E., J.P.J.S., G.J.I.), Department of Nephrology (H.J., R.T.G.), and Alzheimer Center Groningen (J.P.J.S., G.J.I.), University Medical Center Groningen, the University of Groningen, Groningen, The Netherlands; and Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands (H.J.G.B.)
| | - Ron T. Gansevoort
- From Department of Internal Medicine (H.J.), University Center for Geriatric Medicine (M.E.A.E., J.P.J.S., G.J.I.), Department of Nephrology (H.J., R.T.G.), and Alzheimer Center Groningen (J.P.J.S., G.J.I.), University Medical Center Groningen, the University of Groningen, Groningen, The Netherlands; and Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands (H.J.G.B.)
| | - Henk J.G. Bilo
- From Department of Internal Medicine (H.J.), University Center for Geriatric Medicine (M.E.A.E., J.P.J.S., G.J.I.), Department of Nephrology (H.J., R.T.G.), and Alzheimer Center Groningen (J.P.J.S., G.J.I.), University Medical Center Groningen, the University of Groningen, Groningen, The Netherlands; and Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands (H.J.G.B.)
| | - Joris P.J. Slaets
- From Department of Internal Medicine (H.J.), University Center for Geriatric Medicine (M.E.A.E., J.P.J.S., G.J.I.), Department of Nephrology (H.J., R.T.G.), and Alzheimer Center Groningen (J.P.J.S., G.J.I.), University Medical Center Groningen, the University of Groningen, Groningen, The Netherlands; and Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands (H.J.G.B.)
| | - Gerbrand J. Izaks
- From Department of Internal Medicine (H.J.), University Center for Geriatric Medicine (M.E.A.E., J.P.J.S., G.J.I.), Department of Nephrology (H.J., R.T.G.), and Alzheimer Center Groningen (J.P.J.S., G.J.I.), University Medical Center Groningen, the University of Groningen, Groningen, The Netherlands; and Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands (H.J.G.B.)
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Joosten H, Drion I, Boogerd KJ, van der Pijl EV, Slingerland RJ, Slaets JPJ, Jansen TJ, Schwantje O, Gans ROB, Bilo HJG. Optimising drug prescribing and dispensing in subjects at risk for drug errors due to renal impairment: improving drug safety in primary healthcare by low eGFR alerts. BMJ Open 2013; 3:e002068. [PMID: 23355668 PMCID: PMC3563134 DOI: 10.1136/bmjopen-2012-002068] [Citation(s) in RCA: 29] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 12/09/2012] [Accepted: 12/19/2012] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess the risk of medication errors in subjects with renal impairment (defined as an estimated glomerular filtration rate (eGFR) ≤40 ml/min/1.73 m(2)) and the effectiveness of automatic eGFR ≤40-alerts relayed to community pharmacists. DESIGN Clinical survey. SETTING The city of Zwolle, The Netherlands, in a primary care setting including 22 community pharmacists and 65 general practitioners. PARTICIPANTS All adults who underwent ambulatory creatine measurements which triggered an eGFR ≤40-alert. PRIMARY AND SECONDARY OUTCOME MEASURES The total number of ambulatory subjects with an eGFR ≤40-alert during the study period of 1 year and the number of medication errors related to renal impairment. The type and number of proposed drug adjustments recommended by the community pharmacist and acceptance rate by the prescribing physicians. Classification of all medication errors on their potential to cause an adverse drug event (ADE) and the actual occurrence of ADEs (limited to those identified through hospital record reviews) 1 year after the introduction of the alerts. RESULTS Creatine measurements were performed in 25 929 adults. An eGFR ≤40-alert was indicated for 5.3% (n=1369). This group had a median (IQR) age of 78 (69, 84) years, and in 73% polypharmacy (≥5 drugs) was present. In 15% (n=211) of these subjects, a medication error was detected. The proportion of errors increased with age. Pharmacists recommended 342 medication adjustments, mainly concerning diuretics (22%) and antibiotics (21%). The physicians' acceptance rate was 66%. Of all the medication errors, 88% were regarded as potential ADEs, with most classified as significant or serious. At follow-up, the ADE risk (n=40) appeared highest when the proposed medication adjustments were not implemented (38% vs 6%). CONCLUSIONS The introduction of automatic eGFR-alerts identified a considerable number of subjects who are at risk for ADEs due to renal impairment in an ambulatory setting. The nationwide implementation of this simple protocol could identify many potential ADEs, thereby substantially reducing iatrogenic complications in subjects with impaired renal function.
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Affiliation(s)
- Hanneke Joosten
- University of Groningen, University Medical Centre Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - Iefke Drion
- Isala Clinics, Department of Internal Medicine, Diabetes Centre, Zwolle, The Netherlands
| | - Kees J Boogerd
- Pharmacy De Fenix (previously Boogerd Kluin), Zwolle, The Netherlands
| | | | - Robbert J Slingerland
- Isala Clinics, Department of Clinical Chemistry and Laboratory Medicine, Zwolle, The Netherlands
| | - Joris P J Slaets
- University of Groningen, University Medical Centre Groningen, Department of Internal Medicine, Groningen, The Netherlands
- University of Groningen, University Medical Centre Groningen, Department of Internal Medicine, University Center for Geriatric Medicine, Groningen, The Netherlands
| | | | | | - Reinold O B Gans
- University of Groningen, University Medical Centre Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - Henk J G Bilo
- Isala Clinics, Department of Internal Medicine, Diabetes Centre, Zwolle, The Netherlands
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Drion I, van Hateren KJJ, Joosten H, Alkhalaf A, Groenier KH, Kleefstra N, Wetzels JFM, Bilo HJG. Chronic kidney disease and mortality risk among older patients with type 2 diabetes mellitus (ZODIAC-24). Age Ageing 2012; 41:345-50. [PMID: 22314695 DOI: 10.1093/ageing/afs002] [Citation(s) in RCA: 9] [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] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE to investigate the association between a decreased estimated glomerular filtration rate (eGFR), albuminuria and mortality in elderly patients with type 2 diabetes mellitus (T2DM). DESIGN prospective observational cohort study. SETTING primary care. SUBJECTS eight hundred and ten patients, ≥65 years with T2DM. Analyses were performed in age strata: 65-75 (n = 471), >75 (n = 339) years. METHODS Cox proportional hazard modelling was used to investigate the association between eGFR, albuminuria and all-cause and cardiovascular mortality after a median follow-up of 9.8 years. RESULTS an eGFR <45 and 45-60 ml/min/1.73 m(2) is associated with increased cardiovascular mortality in patients of 65-75 years, hazard ratio (HR): 3.29 (1.58-6.86) and 1.78 (1.09-2.90), respectively; in those >75 years increased cardiovascular mortality was observed when eGFR was <45 ml/min/1.73 m(2): 2.42 (1.47-3.69). Compared with patients of 65-75 years, an eGFR >60 ml/min/1.73 m(2) and normo-albuminuria, fully adjusted HRs for cardiovascular mortality were 2.26 (1.04-4.92) and 4.86 (2.33-10.15) for those aged 65-75 years, an eGFR of 45-60 ml/min/1.73 m(2) and normo-albuminuria or albuminuria, respectively; HRs were 1.33 (0.67-2.66) and 2.01 (1.02-3.94), respectively, for those >75 years. CONCLUSIONS an eGFR of 45-60 ml/min/1.73 m(2) in T2DM patients is associated with increased mortality in patients aged 65-75 years but not in those >75 years. Albuminuria is associated with increased mortality in patients >65 years.
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Affiliation(s)
- Iefke Drion
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands.
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Wang Y, Incrocci L, Zolnay A, Joosten H, Breedveld S, McNutt T, Heijmen B, Petit S. PD-0346 A NOVEL SOFTWARE TOOL TO GUIDE DOSIMETRISTS TO EFFICIENTLY GENERATE HIGH QUALITY PROSTATE IMRT TREATMENT PLANS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Drion I, Joosten H, Groenier KH, Lieverse AG, Kleefstra N, Wetzels JFM, Bilo HJG. Equations estimating renal function in patients with diabetes. Neth J Med 2011; 69:455-460. [PMID: 22058268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- I Drion
- Diabetes Centre Isala Clinics, Zwolle, the Netherlands.
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27
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Joosten H, Izaks GJ, Slaets JPJ, de Jong PE, Visser ST, Bilo HJG, Gansevoort RT. Association of cognitive function with albuminuria and eGFR in the general population. Clin J Am Soc Nephrol 2011; 6:1400-9. [PMID: 21566108 PMCID: PMC3109938 DOI: 10.2215/cjn.05530610] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [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: 06/28/2010] [Accepted: 01/30/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent studies found different associations of cognitive function with albuminuria or estimated GFR (eGFR). Most studies were limited to the elderly or did not take both renal variables into account. Therefore, this study analyzed the association of cognitive function with albuminuria and eGFR in community-dwelling persons aged 35 to 82 years. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a cross-sectional study comprising 4095 participants of the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study. Cognitive function, measured with the Ruff Figural Fluency Test (RFFT), was treated as the dependent variable, and albuminuria and eGFR were treated as independent variables. RESULTS The prevalence of albuminuria <10, 10 to 29, and ≥30 mg/24 h was 54%, 31%, and 15%, respectively. Mean eGFR (± SD) was 79 ± 15 ml/min per 1.73 m(2). Because of interaction between albuminuria and age, analyses were performed per age tertile. After multivariate adjustment, albuminuria ≥ 30 mg/24 h, but not eGFR, was associated with lower RFFT score in the youngest tertile (B -5.3; 95% CI, -0.6 to -9.2; P = 0.05), but not in older tertiles. Moreover, subjects in the youngest tertile with increasing albuminuria (5-15 and >15 mg/24 h) before RFFT measurement had lower mean RFFT scores than subjects with stable albuminuria: mean difference -4.9 (P = 0.3) and -6.7 (P = 0.03), respectively. CONCLUSIONS In this community-based cohort, elevated albuminuria was associated with worse cognitive function in young but not in old persons. There was no association of eGFR with cognitive function.
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Affiliation(s)
- Hanneke Joosten
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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van der Velde M, Matsushita K, Coresh J, Astor BC, Woodward M, Levey A, de Jong P, Gansevoort RT, van der Velde M, Matsushita K, Coresh J, Astor BC, Woodward M, Levey AS, de Jong PE, Gansevoort RT, Levey A, El-Nahas M, Eckardt KU, Kasiske BL, Ninomiya T, Chalmers J, Macmahon S, Tonelli M, Hemmelgarn B, Sacks F, Curhan G, Collins AJ, Li S, Chen SC, Hawaii Cohort KP, Lee BJ, Ishani A, Neaton J, Svendsen K, Mann JFE, Yusuf S, Teo KK, Gao P, Nelson RG, Knowler WC, Bilo HJ, Joosten H, Kleefstra N, Groenier KH, Auguste P, Veldhuis K, Wang Y, Camarata L, Thomas B, Manley T. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int 2011; 79:1341-52. [PMID: 21307840 DOI: 10.1038/ki.2010.536] [Citation(s) in RCA: 641] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Screening for chronic kidney disease is recommended in people at high risk, but data on the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause and cardiovascular mortality are limited. To clarify this, we performed a collaborative meta-analysis of 10 cohorts with 266,975 patients selected because of increased risk for chronic kidney disease, defined as a history of hypertension, diabetes, or cardiovascular disease. Risk for all-cause mortality was not associated with eGFR between 60-105 ml/min per 1.73 m², but increased at lower levels. Hazard ratios at eGFRs of 60, 45, and 15 ml/min per 1.73 m² were 1.03, 1.38 and 3.11, respectively, compared to an eGFR of 95, after adjustment for albuminuria and cardiovascular risk factors. Log albuminuria was linearly associated with log risk for all-cause mortality without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios of 10, 30 and 300 mg/g were 1.08, 1.38, and 2.16, respectively compared to a ratio of five. Albuminuria and eGFR were multiplicatively associated with all-cause mortality, without evidence for interaction. Similar associations were observed for cardiovascular mortality. Findings in cohorts with dipstick data were generally comparable to those in cohorts measuring albumin-to-creatinine ratios. Thus, lower eGFR and higher albuminuria are risk factors for all-cause and cardiovascular mortality in high-risk populations, independent of each other and of cardiovascular risk factors.
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Affiliation(s)
- Marije van der Velde
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Drion I, Joosten H, Santing L, Logtenberg SJJ, Groenier KH, Lieverse AG, Kleefstra N, Bilo HJG. The Cockcroft-Gault: a better predictor of renal function in an overweight and obese diabetic population. Obes Facts 2011; 4:393-9. [PMID: 22166760 PMCID: PMC6444492 DOI: 10.1159/000333399] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The performance of the Cockcroft-Gault (CG) equation, the Modification of Diet in Renal Disease (MDRD) formula, and the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) was evaluated in body mass index (BMI) categories. MATERIAL AND METHODS In this retrospective cohort study in diabetic patients, creatinine clearance was measured by collecting 24-hour urines. Renal function was estimated using the CG, MDRD, and CKD-EPI. The performance of the equations was evaluated using correlation, Krippendorff's coefficient, bias, precision, and accuracy. RESULTS The bias of the MDRD and CKD-EPI increased from -13.9 ml/min/1.73 m(2) and -14.0 ml/min/1.73 m(2) (BMI < 25 kg/m(2)), respectively, to -31.7 ml/min/1.73 m(2) and -29.6 ml/min/1.73 m(2) (BMI > 30 kg/m(2)), respectively. Bias of the CG decreased from -13.4 ml/min (BMI < 25 kg/m(2)) to -3.2 ml/min (BMI > 30 kg/m(2)). With an accepted 30% dispersion, CG had the largest accuracy in the overweight and obese group (76.9 and 76.8%, respectively). The MDRD and CKD-EPI had an accuracy of 45.8 and 34.0% (overweight group), respectively,and 51.9 and 37.3% (obese group), respectively. CONCLUSIONS All renal function prediction equations are biased when used in overweight or obese diabetic populations with preserved renal function. The CG provides the best estimate of kidney function. The limitations of renal function prediction equations should be kept in mind when making clinical decisions.
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Affiliation(s)
- Iefke Drion
- Diabetes Centre, Isala Clinics, Zwolle, the Netherlands.
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Drion I, Joosten H, van Hateren KJJ, Kleefstra N, Krabbe JG, Wetzels JFM, Bilo HJG. [Employing age-related cut-off values results in fewer patients with renal impairment in secondary care]. Ned Tijdschr Geneeskd 2011; 155:A3091. [PMID: 21771358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To describe the consequences on the burden for primary and secondary care in the Netherlands, of using age-related cut-off values for renal function which follow the Dutch national transmural agreement (LTA) for 'Chronic renal impairment', rather than the 'Kidney disease outcome quality initiative' (K/DOQI) guidelines. DESIGN Observational cross-sectional study. METHODS 82,424 patients whose serum creatinine had been determined in 2009 were identified from the laboratory registry of the Isala Clinics in Zwolle, the Netherlands. The glomerular filtration rate was estimated using the abbreviated Modification of Diet in Renal Disease (MDRD) equation (eGFR). Burden of care was defined as the necessity for referral or consultation in secondary care. The number of people that would have been referred using the K/DOQI guideline that refers all those with an eGFR < 60 ml/min/1.73 m², was compared to a situation using age-related cut-off values in the referral policy. RESULTS The study population contained 82,424 people; 45.3% were men; age range was 19-106 years; 38.7% were > 65 years. 19% of the population (n = 15,637) had an eGFR < 60 ml/min/1.73 m2 and would have been referred had the K/DOQI guidelines been applied; 11,935 of those 15,637 were > 65 years. The use of the LTA for 'Chronic renal impairment', that includes age as one of the criteria, would have resulted in the referral of 3,303/15,637 patients (2,011 of those 3,303 were > 65 years), and resulted in consultation with a nephrologist for 5,748/15,637 patients (3,338/5,748 were > 65 years). The majority of patients aged > 65 years and with an eGFR < 60 ml/min/1.73 m2 (55%) could be treated in primary care without consultation of secondary care or referral. CONCLUSION The categorization applied by the current LTA for 'Chronic renal impairment', whereby age-related cut-off values are used in the referral policy, will result in more targeted referral to secondary care, especially in the elderly patient group, when compared to application of the K/DOQI guidelines.
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Affiliation(s)
- Iefke Drion
- Isala Klinieken, Zwolle, Diabetes Kenniscentrum, the Netherlands.
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Abstract
The susceptibility of 13 amine-forming lactobacilli to several bacteriocins was investigated by an agar diffusion assay. All strains were susceptible to nisin and to five bacteriocins of enterococcal origin. Pediocin PA-1, bavaricin A, lactococcin A, and a bacteriocin from Enterococcus faecalis 1061 did not show inhibitory activity. Two bacteriocin-producing enterococci and a nisin-producing Lactococcus lactis strain were employed as starters in separate cheese-making experiments. Outgrowth of histamine producer Lactobacillus buchneri St2A, which was added to the milk at levels of up to 190 CFU/ml, was almost completely inhibited. No histamine formation was detected in the cheeses made with bacteriocin-producing starters. In the control cheese without bacteriocin, St2A reached levels of 1.1 x 10(sup8) CFU/g, and 200 mg of histamine per kg was found after 4 months of ripening. To our knowledge, this is the first report of bacteriocin-mediated inhibition of histamine formation in foods.
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Drion I, Joosten H, Dikkeschei LD, Groenier KH, Bilo HJG. eGFR and creatinine clearance in relation to metabolic changes in an unselected patient population. Eur J Intern Med 2009; 20:722-7. [PMID: 19818295 DOI: 10.1016/j.ejim.2009.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Revised: 12/27/2008] [Accepted: 07/06/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND It is widely assumed that moderate to severe renal failure (creatinine clearance <60 ml/min; or an MDRD-4 (Modification of Diet in Renal Disease equation) <60 ml/min/1.73 m(2)) is associated with metabolic changes, often needing further assessment and treatment. We investigated whether such abnormalities are already present at earlier stages of kidney disease, as assessed by 24-hour urine sampling and MDRD-4 calculation. METHODS A select, retrospective cohort study was conducted. Creatinine clearance was measured by collecting 24-hour urines. The individual eGFRs were calculated with the MDRD-4 formula and patients were then divided by renal function category (<15, 15-30, 30-45, 45-60, 60-90, >90 ml/min(/1.73 m(2))). Per clearance category the number of people with anaemia, hypokalaemia, uraemia and hyperphosphataemia was evaluated. RESULTS The median creatinine clearance rate was 67.3 ml/min (quartiles: 42.9-95.8) versus a median MDRD-4-eGFR of 51.6 ml/min/1.73 m(2) (35.8-67.7). Anaemia, hyperkalaemia, hypocalcaemia, and uraemia were found to be present at higher levels of creatinine clearance rate and eGFR than previously reported (p<0.0005). This increased prevalence was more pronounced in elderly subjects, particularly with respect to anaemia (OR 2.71 and 2.02 for MDRD-4 and creatinine clearance respectively, p<0.0005). The same holds for the proportion with uraemia (OR 1.85, p<0.0005) and hypocalcaemia (OR 1.97, p=0.011) for MDRD-4. CONCLUSION Metabolic changes in an in- and outpatient hospital population are present at earlier stages than was stated in recent guidelines, especially when creatinine clearance levels are used as indicators. This might have implications for testing and treatment of patients with suspected kidney disease and/or loss of renal function.
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Affiliation(s)
- I Drion
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands.
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Bilo HJG, Logtenberg SJJ, Joosten H, Groenier KH, Ubink-Veltmaat LJ, Kleefstra N. Modification of diet in renal disease and Cockcroft-Gault formulas do not predict mortality (ZODIAC-6). Diabet Med 2009; 26:478-82. [PMID: 19646186 DOI: 10.1111/j.1464-5491.2009.02709.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS An inverse relationship between estimates of renal function, with formulas such as the Modification of diet in renal disease (MDRD) study equation or the Cockcroft-Gault formula, and mortality has been suggested. These formulas both contain the variables sex, serum creatinine and age and the latter also contains body weight. We investigated whether these formulas predict mortality better than the variables they contain together in patients with Type 2 diabetes. METHODS In 1998, 1143 primary care patients with Type 2 diabetes participated in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) Study, in the Netherlands. Clinical and laboratory data were collected at baseline. Life status was assessed after 6 years. We used Cox proportional hazard modelling to investigate the association between estimates of renal function (continuous data) and the variables they contain and mortality, adjusting for confounders. Both formulas were compared with models consisting of the variables present in the formulas. Predictability was assessed using Bayesian information criterion (BIC) and Harrell's C statistics. RESULTS At follow-up, 335 patients had died. All variables, except sex, influenced mortality. Predictive capability, indicated by lower BIC values and higher Harrell's C values, was up to 10% better for models containing the separate variables as compared with Cockcroft-Gault or MDRD. CONCLUSIONS Using estimates of renal function to assess mortality risk decreases predictability as compared with the combination of the risk factors they contain. These formulas, therefore, could be used to estimate renal function; however, they should not be used as a tool to predict mortality risk.
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Affiliation(s)
- H J G Bilo
- Diabetes Centre, Isala Clinics, P.O. Box 10400, 8000 G.K., Zwolle, The Netherlands.
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Aries MJH, Joosten H, Wegdam HHJ, Ven van der AJAM. How innocent is the bite of a squirrel? Short report from central Ghana and literature review. Trop Doct 2007; 37:265-6. [PMID: 17988509 DOI: 10.1258/004947507782332801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M J H Aries
- Department of Surgery, Holy Family Municipal Hospital, PO Box 36, Techiman Brong Ahafo Region, Ghana.
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Abstract
Storage of water that was deliberately contaminated with enteric viruses in polyethylene terephthalate (PET) bottles led to a rapid decrease of the apparent viral load, thereby hampering the development of samples for a collaborative evaluation of viral detection methods for bottled water. To determine if this decrease was due to spontaneous inactivation or to adhesion, an elution protocol was developed and combined with a rapid and sensitive real-time reverse transcription-PCR-based method to quantify adsorbed norovirus (NV), hepatitis A virus (HAV), and rotavirus (RV) on bottle walls. The NV retention on PET bottle walls after 20 and 62 days reached an average level of 85% and 95% of the recovered inoculum, respectively. HAV and RV also showed adsorption onto PET bottles, reaching 90% and 80%, respectively, after 20 days of storage. NV and RV attachment was demonstrated to be dependent on the presence of autochthonous flora, whereas HAV adsorption was independent of it. Application of the elution and viral detection protocol to 294 commercially available water bottles obtained from 25 different countries did not give any positive result, thereby providing further evidence that the sources used for this product are free from enteric viruses and support for the theory that bottled water is not a vehicle for viral diseases.
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Affiliation(s)
- S Butot
- Quality & Safety Assurance Department, Nestlé Research Center, Vers-chez-les-Blanc, CH-1000 Lausanne 26, Switzerland
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Ariës MJH, Joosten H, Wegdam HHJ, van der Geest S. Fracture treatment by bonesetters in central Ghana: patients explain their choices and experiences. Trop Med Int Health 2007; 12:564-74. [PMID: 17445148 DOI: 10.1111/j.1365-3156.2007.01822.x] [Citation(s) in RCA: 32] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To understand factors influencing patients' decisions to choose either fracture treatment by a bonesetter or in the hospital and to explore patients' experiences with bonesetter treatment. METHOD In-depth interviews with 46 patients with a radiological proven fracture in a district hospital in central Ghana. RESULTS Traditional healers, such as bonesetters, play a substantial role in the Ghanaian healthcare system. Over a period of 3 months, 14 patients with a proven fracture left hospital for treatment by a bonesetter. The hospital is considered the only institution where emergency care can be provided and reliable, extensive diagnostic and treatment facilities are available for fracture treatment. Patients opting for bonesetter treatment are guided by the severity of the fracture, availability of the service, their financial status and past experiences. The healing methods used by different bonesetters are based on mutual comparable principles. CONCLUSION Fracture treatment can serve as a model for respectful and efficient co-existence of traditional and biomedical medicine.
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Affiliation(s)
- Marcel J H Ariës
- Department of General Surgery, Holy Family Municipal Hospital, Techiman, Ghana.
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Besancenot JF, Muller G, Gagnaire A, Devilliers H, Joosten H, Bielefeld P, Giroud M. Accident vasculaire cérébral ischémique de l'adulte jeune révélateur d'une maladie coeliaque: 2 observations. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.285] [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: 11/29/2022]
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van Baar JD, Joosten H, Car J, Freeman GK, Partridge MR, van Weel C, Sheikh A. Understanding reasons for asthma outpatient (non)-attendance and exploring the role of telephone and e-consulting in facilitating access to care: exploratory qualitative study. Qual Saf Health Care 2006; 15:191-5. [PMID: 16751469 PMCID: PMC2464862 DOI: 10.1136/qshc.2004.013342] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To understand factors influencing patients' decisions to attend for outpatient follow up consultations for asthma and to explore patients' attitudes to telephone and email consultations in facilitating access to asthma care. DESIGN Exploratory qualitative study using in depth interviews. SETTING Hospital outpatient clinic in West London. PARTICIPANTS Nineteen patients with moderate to severe asthma (12 "attenders" and 7 "non-attenders"). RESULTS Patients' main reasons for attending were the wish to improve control over asthma symptoms and a concern not to jeopardise the valued relationship with their doctor. Memory lapses, poor health, and disillusionment with the structure of outpatient care were important factors implicated in non-attendance. The patients were generally sceptical about the suggestion that greater opportunity for telephone consulting might improve access to care. They expressed concerns about the difficulties in effectively communicating through non-face to face media and were worried that clinicians would not be in a position to perform an adequate physical examination over the telephone. Email and text messaging were viewed as potentially useful for sending appointment reminders and sharing clinical information but were not considered to be acceptable alternatives to the face to face clinic encounter. CONCLUSIONS Memory lapses, impaired mobility due to poor health, and frustration with outpatient clinic organisation resulting in long waiting times and discontinuity of care are factors that deter patients from attending for hospital asthma assessments. The idea of telephone review assessments was viewed with scepticism by most study subjects. Particular attention should be given to explaining to patients the benefits of telephone consultations, and to seeking their views as to whether they would like to try them out before replacing face to face consultations with them. Email and text messaging may have a role in issuing reminders about imminent appointments.
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Affiliation(s)
- J D van Baar
- Department of General Practice, University of Nijmegen, The Netherlands
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Sánchez G, Populaire S, Butot S, Putallaz T, Joosten H. Detection and differentiation of human hepatitis A strains by commercial quantitative real-time RT-PCR tests. J Virol Methods 2005; 132:160-5. [PMID: 16280175 DOI: 10.1016/j.jviromet.2005.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Revised: 09/12/2005] [Accepted: 10/03/2005] [Indexed: 11/15/2022]
Abstract
Performance characteristics of two commercial quantitative Hepatitis A virus (HAV) RT-PCR assays, the LightCycler Hepatitis A virus quantification kit (Roche Diagnostics) and the RealArt HAV LC RT PCR kit (artus GmbH) for detection and quantification of HAV were evaluated. Both assays rely on reverse transcription and amplification of extracted RNA. Dilutions of two HAV strains, belonging to different subtypes, were prepared to determine the precision, accuracy, linearity and the detection limit. Both assays were found to be suitable for quantification measurement of HAV RNA, but only the Roche kit was able to distinguish the different HAV strains tested. The linear range for the artus assay was 10(4)-10(6)IU/ml and 2 x 10(4) to 2 x 10(8) RNA copies/ml for the Roche assay. The detection limit of Roche kit was 2 TCID(50)/ml or 500 RNA copies/ml and 5 TCID(50)/ml or 50 IU/ml for the artus kit. Despite these small differences it is concluded that both assays are very suitable for detection and quantification of most prevalent HAV subtypes.
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Affiliation(s)
- G Sánchez
- Quality and Safety Assurance Department, Nestlé Research Center, Vers-chez-les-Blanc, CH-1000 Lausanne 26, Switzerland.
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Guillaume-Gentil O, Sonnard V, Kandhai MC, Marugg JD, Joosten H. A simple and rapid cultural method for detection of Enterobacter sakazakii in environmental samples. J Food Prot 2005; 68:64-9. [PMID: 15690805 DOI: 10.4315/0362-028x-68.1.64] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A method was developed to detect and identify Enterobacter sakazakii in environmental samples. The method is based on selective enrichment at 45+/-0.5 degrees C in lauryl sulfate tryptose broth supplemented with 0.5 M NaCl and 10 mg/liter vancomycin (mLST) for 22 to 24 h followed by streaking on tryptone soy agar with bile salts. When exposed to light during incubation at 37 degrees C, E. sakazakii produces yellow colonies within 24 h; identification was confirmed by testing for alpha-glucosidase activity and by using API 20E strips. All of the E. sakazakii strains tested (n = 99) were able to grow in mLST at 45+/-0.5 degrees C, whereas 35 of 39 strains of potential competitors, all belonging to the Enterobacteriaceae, were suppressed. A survey was carried out with 192 environmental samples from four different milk powder factories. Using this new protocol, E. sakazakii was isolated from almost 40% of the samples, whereas the reference procedure (enrichment in buffered peptone water, isolation on violet red bile glucose agar, and biochemical identification of randomly chosen colonies) only yielded 26% positive results. This selective method can be very useful for the rapid and reliable detection of E. sakazakii in environmental samples.
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Affiliation(s)
- O Guillaume-Gentil
- Nestlé Research Centre, Quality and Safety Department, CH-1000 Lausanne 26, Switzerland.
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van Sornsen De Koste J, Lagerwaard F, Nijssen-Visser M, Schuchhard-Schipper R, Joosten H, Senan S. An analysis of the mobility of mediastinal nodes using multiple CT scans. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)02468-3] [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: 11/27/2022]
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Veening JG, Coolen LM, Spooren WJ, Joosten H, van Oorschot R, Mos J, Ronken E, Olivier B. Patterns of c-fos expression induced by fluvoxamine are different after acute vs. chronic oral administration. Eur Neuropsychopharmacol 1998; 8:213-26. [PMID: 9716316 DOI: 10.1016/s0924-977x(97)00072-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Fluvoxamine is a selective serotonin (5-HT) reuptake inhibitor (SSRI) with a broad spectrum of behavioral and therapeutic effects, e.g. in depressive illness. We used the expression of c-fos, after both acute and chronic oral administration of fluvoxamine in the rat, to study its immediate and long-term effects, in relation to the distribution of Galanin (GAL) and Vasoactive Intestinal Polypeptide (VIP). After acute oral administration, most consistent increases were apparent in (parts of); the nucleus of the solitary tract, medial part; the lateral parabrachial nucleus, external part; the bed nucleus of the stria terminalis, dorsolateral part; and the central nucleus of the amygdala, lateral part. After chronic administration, distribution of Fos-IR was similar to acute administration, although numbers of Fos-IR neurons were no longer significantly different from control values. It is concluded that activation of 5-HT3-receptors in the caudal brainstem or gastro-intestinal afferents of the vagal nerve may play a role in the observed pattern of Fos-IR after fluvoxamine administration. The relationship with the antidepressant effects of fluvoxamine needs further investigations.
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Affiliation(s)
- J G Veening
- Dept. of Anatomy and Embryology, Fac. of Medical Sciences, University of Nijmegen, Netherlands.
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Wagner F, Below R, Klerk PD, Dilcher DL, Joosten H, Kürschner WM, Visscher H. A natural experiment on plant acclimation: lifetime stomatal frequency response of an individual tree to annual atmospheric CO2 increase. Proc Natl Acad Sci U S A 1996; 93:11705-8. [PMID: 11607712 PMCID: PMC38122 DOI: 10.1073/pnas.93.21.11705] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Carbon dioxide (CO2) has been increasing in atmospheric concentration since the Industrial Revolution. A decreasing number of stomata on leaves of land plants still provides the only morphological evidence that this man-made increase has already affected the biosphere. The current rate of CO2 responsiveness in individual long-lived species cannot be accurately determined from field studies or by controlled-environment experiments. However, the required long-term data sets can be obtained from continuous records of buried leaves from living trees in wetland ecosystems. Fine-resolution analysis of the lifetime leaf record of an individual birch (Betula pendula) indicates a gradual reduction of stomatal frequency as a phenotypic acclimation to CO2 increase. During the past four decades, CO2 increments of 1 part per million by volume resulted in a stomatal density decline of approximately 0.6%. It may be hypothesized that this plastic stomatal frequency response of deciduous tree species has evolved in conjunction with the overall Cenozoic reduction of atmospheric CO2 concentrations.
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Affiliation(s)
- F Wagner
- Laboratory of Paleobotany and Palynology, Utrecht University, Utrecht, The Netherlands
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Veening JG, van der Meer MJ, Joosten H, Hermus AR, Rijnnkels CE, Geeraedts LM, Sweep CG. Intravenous administration of interleukin-1 beta induces Fos-like immunoreactivity in corticotropin-releasing hormone neurons in the paraventricular hypothalamic nucleus of the rat. J Chem Neuroanat 1993; 6:391-7. [PMID: 8142074 DOI: 10.1016/0891-0618(93)90013-t] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
It has been shown that acute administration of recombinant human interleukin 1 beta (IL-1) to rats elicits an activation of the pituitary-adrenal axis. In the present study we investigated immunohistochemically the expression of Fos-like immunoreactivity (Fos-LI) in the hypothalamus of rats following intravenous injection of IL-1. One, 2 and 4 h after IL-1 or physiological saline injections, rats were killed and perfused, and the brains processed for Fos-immunohistochemistry. Dense populations of neurons containing Fos-LI-positive nuclei were found in the paraventricular hypothalamic nuclei (PVH) of IL-1-treated rats. In particular, the dorsal medial parvocellular part, but also some of the other parvocellular subdivisions contained many Fos-LI neurons. Maximal induction of staining was found at a dose of 5 micrograms/rat after 1 or 2 h survival, while immunostaining had decreased to almost control levels after 4 h. No Fos-LI was found in the PVH of control animals. Double immunocytochemical staining for Fos and corticotropin-releasing hormone (CRH) revealed that Fos-LI was predominantly present in parvocellular CRH-containing neurons of the PVH. The finding that peripherally injected IL-1 induces Fos-LI in hypothalamic CRH neurons strengthens the hypothesis that these neurons are part of the circuitry mediating IL-1-induced activation of the pituitary-adrenal axis.
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Affiliation(s)
- J G Veening
- Department of Anatomy, St Radboud University Hospital, Nijmegen, The Netherlands
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Buma P, Veening J, Hafmans T, Joosten H, Nieuwenhuys R. Ultrastructure of the periaqueductal grey matter of the rat: an electron microscopical and horseradish peroxidase study. J Comp Neurol 1992; 319:519-35. [PMID: 1619043 DOI: 10.1002/cne.903190405] [Citation(s) in RCA: 24] [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] [Indexed: 12/27/2022]
Abstract
The neurons of the mesencephalic periaqueductal grey substance (PAG) in the rat are small and medium sized. The cells are frequently located in small clusters, without interdigitating glial elements and may be connected by direct membrane appositions or by gap junctions. The inner zone of the PAG is cell poor. In many cases, the cytoplasm of the cells is filled with extensive rough endoplasmic reticulum, free ribosomes, Golgi apparatus, and large lysosome-like granules. The nuclei show large indentations. The cells have a high nucleus-cytoplasm ratio. The neuropil is very extensive and particularly rich in large numbers of small unmyelinated axons, dendrites, axonal varicosities, and synaptic connections. Myelinated fibres are relatively scarce. The orientation of the fibres was studied in transverse and horizontal sections, in combination with HRP track tracing experiments. It appeared that throughout the PAG most of the fibres were orientated longitudinally. Quantitation showed that most fibres were present in the inner zones of the PAG. Moreover, the diameter of the fibres adjacent to the aqueduct was smaller than that of the fibres in the peripheral parts of the PAG. The thin unmyelinated fibres made extensive synaptic connections within the PAG. Many synaptic varicosities were found in the neuropil of the PAG. There were four types of synaptic varicosities, characterized by different populations of clear and dense-core secretory granules and by the different morphology of the synaptic specializations. In general, the different types of varicosity were homogeneously distributed in the different parts of the PAG. Electron dense secretory granules, when present, were located at some distance from the synaptic junction. Serial sections revealed varicosities which contained only dense-core secretory granules, without synaptic specializations. The dendrites of PAG neurons generally lacked synaptic spines. Many dendrites, particularly those of neurons located in the peripheral parts of the PAG, were directed toward the aqueduct. The present study shows that the PAG is a very complex brain area. The crisscrossing of axons and dendrites with synaptic connections at considerable distances from the cell bodies render it very difficult to unravel the relationships between the possible sources and destinations of ongoing information. This structure complicates the search for relationships between the functional organization and the cytoarchitectural borders in the PAG area.
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Affiliation(s)
- P Buma
- Department of Orthopaedics, University Hospital Nijmegen, The Netherlands
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Abstract
Adenine is produced (after hydrolysis) when 0.01 M solutions of HCN are adjusted to pH 9.2 with NH4OH and are frozen at -2 degrees C for 60-100 days. The addition of glycolonitrile (the cyanohydrin of formaldehyde) increases the yield of adenine under these conditions by about five-fold. These results confirm and extend an earlier suggestion that purine synthesis on the prebiotic Earth might have occurred in frozen, dilute solutions of HCN.
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Siboni K, Olsen H, Ravn E, Søgaard P, Hjorth A, Nielsen KN, Askgaard K, Secher B, Borghans J, Khing-Ting L, Joosten H, Frederiksen W, Jensen K, Mortensen N, Sebbesen O. Pseudomonas cepacia in 16 non-fatal cases of postoperative bacteremia derived from intrinsic contamination of the anaesthetic fentanyl. Clinical and epidemiological observations in Denmark and Holland. Scand J Infect Dis 1979; 11:39-45. [PMID: 419367 DOI: 10.3109/inf.1979.11.issue-1.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
From Nov. 15 to Dec. 17, 1977, Pseudomonas cepacia was isolated from the blood of 16 patients in Odense, Denmark, and Nijmegen, Holland, 2--5 days after an operation with general anaesthesia. The fever started 14--70 h after operation and lasted 2--4 days. All patients recovered. 14/15 patients examined 7--51 days later had agglutinating antibody titres of 400-3,200 against the epidemic strain. Ps. cepacia with identical biochemical characters and sensitivity pattern was isolated from unbroken vials containing the anaesthetic fentanyl, which had been given to all 16 patients. Two batches were contaminated, one heavily so (10(4)--10(5) cfu/0.1 ml). Seven other batches examined yielded no growth. The preservative added to the vials was a mixture of methyl- and propyl-p-hydroxybenzoates which not only allowed growth of the Ps. cepacia strain but could also serve as a carbon source as did citric and malonic acids. The concentration of preservative was not reduced in contaminated vials. The vials had not been sterilized after closure; too much reliance had been placed on an aseptic technique and insufficient preservatives.
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