1
|
Kalverda KA, Ninaber MK, Wijmans L, von der Thüsen J, Jonkers RE, Daniels JM, Miedema JR, Dickhoff C, Hölters J, Heineman D, Kant M, Radonic T, Shahin G, Cohen D, Boerrigter B, Nijman S, Nossent E, Braun J, Mathot B, Poletti V, Hetzel J, Dijkgraaf M, Korevaar DA, Bonta PI, Annema JT. Transbronchial cryobiopsy followed by as-needed surgical lung biopsy versus immediate surgical lung biopsy for diagnosing interstitial lung disease (the COLD study): a randomised controlled trial. Lancet Respir Med 2024:S2213-2600(24)00074-2. [PMID: 38640934 DOI: 10.1016/s2213-2600(24)00074-2] [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] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND An adequate diagnosis for interstitial lung disease (ILD) is important for clinical decision making and prognosis. In most patients with ILD, an accurate diagnosis can be made by clinical and radiological data assessment, but in a considerable proportion of patients, a lung biopsy is required. Surgical lung biopsy (SLB) is the most common method to obtain tissue, but it is associated with high morbidity and even mortality. More recently, transbronchial cryobiopsy has been introduced, with fewer adverse events but a lower diagnostic yield than SLB. The aim of this study is to compare two diagnostic strategies: a step-up strategy (transbronchial cryobiopsy, followed by SLB if the cryobiopsy is insufficiently informative) versus immediate SLB. METHODS The COLD study was a multicentre, randomised controlled trial in six hospitals across the Netherlands. We included patients with ILD with an indication for lung biopsy as assessed by a multidisciplinary team discussion. Patients were randomly assigned in a 1:1 ratio to the step-up or immediate SLB strategy, with follow-up for 12 weeks from the initial procedure. Patients, clinicians, and pathologists were not masked to the study treatment. The primary endpoint was unexpected chest tube drainage, defined as requiring any chest tube after transbronchial cryobiopsy, or prolonged (>24 h) chest tube drainage after SLB. Secondary endpoints were diagnostic yield, in-hospital stay, pain, and serious adverse events. A modified intention-to-treat analysis was performed. This trial is registered with the Dutch Trial Register, NL7634, and is now closed. FINDINGS Between April 8, 2019, and Oct 24, 2021, 122 patients with ILD were assessed for study participation; and 55 patients were randomly assigned to the step-up strategy (n=28) or immediate SLB (n=27); three patients from the immediate SLB group were excluded. Unexpected chest tube drainage occurred in three of 28 patients (11%; 95% CI 4-27%) in the step-up group, and the number of patients for whom the chest tube could not be removed within 24 h was 11 of 24 patients (46%; 95% CI 2-65%) in the SLB group, with an absolute risk reduction of 35% (11-56%; p=0·0058). In the step-up strategy, the multidisciplinary team diagnostic yield after transbronchial cryobiopsy alone was 82% (64-92%), which increased to 89% (73-96%) when subsequent SLB was performed after inconclusive transbronchial cryobiopsy. In the immediate surgery strategy, the multidisciplinary team diagnostic yield was 88% (69-97%). Total in-hospital stay was 1 day (IQR 1-1) in the step-up group versus 5 days (IQR 4-6) in the SLB group. One (4%) serious adverse event occurred in step-up strategy versus 12 (50%) in the immediate SLB strategy. INTERPRETATION In ILD diagnosis, if lung tissue assessment is required, a diagnostic strategy starting with transbronchial cryobiopsy, followed by SLB when transbronchial cryobiopsy is inconclusive, appears to result in a significant reduction of patient burden and in-hospital stay with a similar diagnostic yield versus immediate SLB. FUNDING Netherlands Organisation for Health Research and Development (ZonMW) and Amsterdam University Medical Centers.
Collapse
Affiliation(s)
- Kirsten A Kalverda
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
| | - Maarten K Ninaber
- Department of Respiratory Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Lizzy Wijmans
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, Netherlands
| | - René E Jonkers
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes M Daniels
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jelle R Miedema
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jürgen Hölters
- Department of Respiratory Diseases, Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
| | - David Heineman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Merijn Kant
- Department of Respiratory Diseases, Amphia Hospital, Breda, Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ghada Shahin
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Bart Boerrigter
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Suzan Nijman
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Esther Nossent
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jerry Braun
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Bas Mathot
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, Netherlands
| | - Venerino Poletti
- Department of Medical Specialties, Giovan Battista Morgagni Hospital, University of Forlì, Forlì, Italy; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Jürgen Hetzel
- Department of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany; Department of Pneumology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Marcel Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Daniel A Korevaar
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Peter I Bonta
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jouke T Annema
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
2
|
Versteegh M, Dijkgraaf M. [The qaly: informing decision-making in health care]. Ned Tijdschr Geneeskd 2023; 167:D7138. [PMID: 37493301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
In this 'perspective' article, the pandemic and other examples are used to provide a basic explanation of the quality adjusted life year (QALY), when it can, and when it can't be used. QALYs are intended to compare the population health gains or losses of interventions, regardless of indication area. That information feeds into decision-making that aims to improve societal health outcomes.
Collapse
Affiliation(s)
| | - Marcel Dijkgraaf
- Amsterdam UMC, afd. Klinische Epidemiologie, Biostatistiek en Bio-informatica, Amsterdam
| |
Collapse
|
3
|
Löwenberg M, Volkers A, van Gennep S, Mookhoek A, Montazeri N, Clasquin E, Duijvestein M, van Bodegraven A, Rietdijk S, Jansen J, van Asseldonk D, van der Zanden E, Dijkgraaf M, West R, de Boer N, D'Haens G. Mercaptopurine for the treatment of ulcerative colitis - a randomised placebo-controlled trial. J Crohns Colitis 2023:7058824. [PMID: 36847130 PMCID: PMC10394500 DOI: 10.1093/ecco-jcc/jjad022] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND AND AIMS Scepticism about the efficacy of thiopurines for ulcerative colitis (UC) is rising.This study aimed to evaluate mercaptopurine treatment for UC. METHODS In this prospective, randomised, double-blind, placebo-controlled trial, patients with active UC, despite treatment with 5-aminosalicylates (5-ASA), were randomised for therapeutic drug monitoring (TDM)-guided mercaptopurine treatment or placebo for 52 weeks. Corticosteroids were given in the first eight weeks and 5-ASA was continued. Proactive metabolite-based mercaptopurine and placebo dose adjustments were applied from week six onwards by unblinded clinicians. The primary endpoint was corticosteroid-free clinical remission and endoscopic improvement (total Mayo score ≤2 points and no item >1) at week 52 in an intention-to-treat analysis. RESULTS Between December 2016 and April 2021, 70 patients were screened and 59 were randomised at six centres. In the mercaptopurine group, 16/29 (55.2%) patients completed the 52-week study, compared to 13/30 (43.3%) on placebo. The primary endpoint was achieved by 14/29 (48.3%) patients on mercaptopurine and 3/30 (10%) receiving placebo (Δ=38.3%, 95% CI 17.1-59.4, p=0.002). Adverse events occurred more frequently with mercaptopurine (808.8 per 100 patient years) compared to placebo (501.4 per 100 patient years). Five serious adverse events occurred; four on mercaptopurine and one on placebo. TDM-based dose adjustments were executed in 22/29 (75.9%) patients, leading to lower mercaptopurine doses at week 52 compared to baseline. CONCLUSIONS Optimised mercaptopurine treatment was superior to placebo in achieving clinical, endoscopic and histological outcomes at one year following corticosteroid induction treatment in UC patients. More adverse events occurred in the mercaptopurine group.
Collapse
Affiliation(s)
- Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Adriaan Volkers
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Sara van Gennep
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Aart Mookhoek
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Nahid Montazeri
- Biostatistics Unit, Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Esmé Clasquin
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, RadboudUMC, Nijmegen, the Netherlands
| | - Adriaan van Bodegraven
- Department of Gastroenterology and Hepatology, AGEM Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (Co-MIK), Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands
| | - Svend Rietdijk
- Department of Gastroenterology and Hepatology, OLVG, Amsterdam, the Netherlands
| | - Jeroen Jansen
- Department of Gastroenterology and Hepatology, OLVG, Amsterdam, the Netherlands
| | - Dirk van Asseldonk
- Department of Gastroenterology and Hepatology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Esmerij van der Zanden
- Department of Gastroenterology and Hepatology, Amstelland Ziekenhuis, Amstelveen, the Netherlands
| | - Marcel Dijkgraaf
- Department of Epidemiology and Data Science, University Medical Center, Amsterdam, the Netherlands
| | - Rachel West
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - Nanne de Boer
- Department of Gastroenterology and Hepatology, AGEM Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Geert D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Geitenbeek R, Burghgraef T, Hompes R, Zimmerman D, Dijkgraaf M, Postma M, Ranchor A, Verheijen P, Consten E. Prospective multicentre observational cohort to assess quality of life, functional outcomes and cost-effectiveness following minimally invasive surgical techniques for rectal cancer in 'dedicated centres' in the Netherlands (VANTAGE trial): a protocol. BMJ Open 2022; 12:e057640. [PMID: 35985776 PMCID: PMC9396149 DOI: 10.1136/bmjopen-2021-057640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Total mesorectal excision is the standard of care for rectal cancer, which can be performed using open, laparoscopic, robot-assisted and transanal technique. Large prospective (randomised controlled) trials comparing these techniques are lacking, do not take into account the learning curve and have short-term or long-term oncological results as their primary endpoint, without addressing quality of life, functional outcomes and cost-effectiveness. Comparative data with regard to these outcomes are necessary to identify the optimal minimally invasive technique and provide guidelines for clinical application. METHODS AND ANALYSIS This trial will be a prospective observational multicentre cohort trial, aiming to compare laparoscopic, robot-assisted and transanal total mesorectal excision in adult patients with rectal cancer performed by experienced surgeons in dedicated centres. Data collection will be performed in collaboration with the prospective Dutch ColoRectal Audit and the Prospective Dutch ColoRectal Cancer Cohort. Quality of life at 1 year postoperatively will be the primary outcome. Functional outcomes, cost-effectiveness, short-term outcomes and long-term oncological outcomes will be the secondary outcomes. In total, 1200 patients will be enrolled over a period of 2 years in 26 dedicated centres in the Netherlands. The study is registered at https://www.trialregister.nl/9734 (NL9734). ETHICS AND DISSEMINATION Data will be collected through collaborating parties, who already obtained approval by their medical ethical committee. Participants will be included in the trial after having signed informed consent. Results of this study will be disseminated to participating centres, patient organisations, (inter)national society meetings and peer-reviewed journals.
Collapse
Affiliation(s)
- Ritch Geitenbeek
- Department of Surgery, University Medical Centre, Groningen, The Netherlands
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - Thijs Burghgraef
- Department of Surgery, University Medical Centre, Groningen, The Netherlands
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - Roel Hompes
- Department of Surgery, UMC Locatie AMC, Amsterdam, The Netherlands
| | - David Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Marcel Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, UMC - Locatie AMC, Amsterdam, The Netherlands
| | - Maarten Postma
- Department of Pharmacoepidemiology and Pharmacoeconomics, University Medical Centre, Groningen, The Netherlands
| | - Adelita Ranchor
- Department of Health Psychology, University of Groningen, Groningen, The Netherlands
| | - Paul Verheijen
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - Esther Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| |
Collapse
|
5
|
Huijboom M, Maarse M, Aarnink E, van Dijk V, Swaans M, van der Heijden J, IJsselmuiden S, Folkeringa R, Blaauw Y, Elvan A, Stevenhagen J, Vlachojannis G, van der Voort P, Westra S, Chaldoupi M, Khan M, de Groot J, van der Kley F, van Mieghem N, van Dijk E, Dijkgraaf M, Tijssen J, Boersma L. COMPARE LAAO: Rationale and design of the randomized controlled trial "COMPARing Effectiveness and safety of Left Atrial Appendage Occlusion to standard of care for atrial fibrillation patients at high stroke risk and ineligible to use oral anticoagulation therapy". Am Heart J 2022; 250:45-56. [PMID: 35537503 DOI: 10.1016/j.ahj.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) provides an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). In patients with a long-term or permanent contraindication for OAC randomized controlled trial (RCT) data is lacking. STUDY OBJECTIVES To assess the efficacy and safety of LAAO in AF patients who are ineligible to use OAC. The co-primary efficacy endpoint is (1) time to first occurrence of stroke (ischemic, hemorrhagic, or undetermined) and (2) time to first occurrence of the composite of stroke, transient ischemic attack (TIA), and systemic embolism (SE). The primary safety endpoint is the 30-day rate of peri-procedural complications. STUDY DESIGN This is a multicenter, investigator-initiated, open-label, blinded endpoint (PROBE), superiority-driven RCT. Patients with AF, a CHA₂DS₂-VASc score ≥2 for men and ≥3 for women and a long-term or permanent contraindication for OAC will be randomized in a 2:1 fashion to the device- or control arm. Patients in the device arm will undergo percutaneous LAAO and will receive post-procedural dual antiplatelet therapy (DAPT) per protocol, while those in the control arm will continue their current treatment consisting of no antithrombotic therapy or (D)APT as deemed appropriate by the primary responsible physician. In this endpoint-driven trial design, assuming a 50% lower stroke risk of LAAO compared to conservative treatment, 609 patients will be followed for a minimum of 1 and a maximum of 5 years. Cost-effectiveness and budget impact analyses will be performed to allow decision-making on reimbursement of LAAO for the target population in the Netherlands. SUMMARY The COMPARE LAAO trial will investigate the clinical superiority in preventing thromboembolic events and cost-effectiveness of LAAO in AF patients with a high thromboembolic risk and a contraindication for OAC use. NCT TRIAL NUMBER NCT04676880.
Collapse
Affiliation(s)
- Marina Huijboom
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands; Amsterdam University Medical Center, location AMC, Cardiology Department, Amsterdam, The Netherlands.
| | - Moniek Maarse
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands; Amsterdam University Medical Center, location AMC, Cardiology Department, Amsterdam, The Netherlands
| | - Errol Aarnink
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands; Amsterdam University Medical Center, location AMC, Cardiology Department, Amsterdam, The Netherlands
| | - Vincent van Dijk
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Martin Swaans
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Richard Folkeringa
- Medical Center Leeuwarden, Cardiology Department, Leeuwarden, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Arif Elvan
- Cardiology Department, Isala Hospital, Zwolle, The Netherlands
| | - Jeroen Stevenhagen
- Medical Spectrum Twente, Department of Cardiology, Enschede, The Netherlands
| | - George Vlachojannis
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Sjoerd Westra
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marisevi Chaldoupi
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Muchtiar Khan
- Cardiology Department, OLVG, Amsterdam, The Netherlands
| | - Joris de Groot
- Amsterdam University Medical Center, location AMC, Cardiology Department, Amsterdam, The Netherlands
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nicolas van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ewoud van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Dijkgraaf
- Location AMC, Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan Tijssen
- Clinical Epidemiology & Biostatistics, Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lucas Boersma
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands; Amsterdam University Medical Center, location AMC, Cardiology Department, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Affiliation(s)
| | - Marco Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam
| | - Marcel Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
7
|
Bakkers C, Rovers K, Rijken A, Mols F, Simkens G, Brandt-Kerkhof A, Tuynman J, Aalbers A, Kok N, Wiezer M, Reuver PD, Grevenstein WV, Hemmer P, Dijkgraaf M, Punt C, Tanis P, Hingh ID. P-275 Quality of life and symptoms in patients undergoing CRS-HIPEC with or without perioperative systemic treatment for colorectal peritoneal metastases: Results from the randomised CAIRO6 trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.357] [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: 11/25/2022] Open
|
8
|
Rovers K, Bakkers C, Nienhuijs S, Burger J, Creemers G, Brandt-Kerkhof A, Tuynman J, Aalbers A, Wiezer M, Reuver PD, Hemmer P, Grevenstein WV, Erve IV', Snaebjornsson P, Nederend J, Lahaye M, Dijkgraaf M, Punt C, Tanis P, Hingh ID. LBA-6 Safety, feasibility, tolerability, and preliminary efficacy of perioperative systemic therapy for resectable colorectal peritoneal metastases: Pilot phase of a randomised trial (CAIRO6). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.081] [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: 10/23/2022] Open
|
9
|
Voskens FJ, van Rein EAJ, van der Sluijs R, Houwert RM, Lichtveld RA, Verleisdonk EJ, Segers M, van Olden G, Dijkgraaf M, Leenen LPH, van Heijl M. Accuracy of Prehospital Triage in Selecting Severely Injured Trauma Patients. JAMA Surg 2019; 153:322-327. [PMID: 29094144 DOI: 10.1001/jamasurg.2017.4472] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance A major component of trauma care is adequate prehospital triage. To optimize the prehospital triage system, it is essential to gain insight in the quality of prehospital triage of the entire trauma system. Objective To prospectively evaluate the quality of the field triage system to identify severely injured adult trauma patients. Design, Setting, and Participants Prehospital and hospital data of all adult trauma patients during 2012 to 2014 transported with the highest priority by emergency medical services professionals to 10 hospitals in Central Netherlands were prospectively collected. Prehospital data collected by the emergency medical services professionals were matched to hospital data collected in the trauma registry. An Injury Severity Score of 16 or more was used to determine severe injury. Main Outcomes and Measures The quality and diagnostic accuracy of the field triage protocol and compliance of emergency medical services professionals to the protocol. Results A total of 4950 trauma patients were evaluated of which 436 (8.8%) patients were severely injured. The undertriage rate based on actual destination facility was 21.6% (95% CI, 18.0-25.7) with an overtriage rate of 30.6% (95% CI, 29.3-32.0). Analysis of the protocol itself, regardless of destination facility, resulted in an undertriage of 63.8% (95% CI, 59.2-68.1) and overtriage of 7.4% (95% CI, 6.7-8.2). The compliance to the field triage trauma protocol was 73% for patients with a level 1 indication. Conclusions and Relevance More than 20% of the patients with severe injuries were not transported to a level I trauma center. These patients are at risk for preventable morbidity and mortality. This finding indicates the need for improvement of the prehospital triage protocol.
Collapse
Affiliation(s)
- Frank J Voskens
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Eveline A J van Rein
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Roderick M Houwert
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Utrecht Trauma Center, Utrecht, the Netherlands
| | - Robert Anton Lichtveld
- Regional Ambulance Facility Utrecht, Regionale Ambulance Voorziening Utrecht, Utrecht, the Netherlands
| | - Egbert J Verleisdonk
- Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, the Netherlands
| | - Michiel Segers
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Ger van Olden
- Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands
| | - Marcel Dijkgraaf
- Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
10
|
Bus S, Mejaiti N, Dijkgraaf M. Cost-effectiveness of offloading-improved custom-made footwear to prevent plantar foot ulcer recurrence in high-risk patients with diabetes. Footwear Science 2019. [DOI: 10.1080/19424280.2019.1606335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sicco Bus
- Amersterdam UMC, location AMC, University of Amsterdam, Department of Rehabilitation, Amsterdam, The Netherlands
| | - Nora Mejaiti
- Amersterdam UMC, location AMC, University of Amsterdam, Department of Rehabilitation, Amsterdam, The Netherlands
| | | |
Collapse
|
11
|
Kusen J, van der Vet P, Wijdicks FJ, Houwert M, Dijkgraaf M, Hamaker M, Geraghty O, Verleisdonk EJ, van der Velde D. Different approaches towards geriatric trauma care for hip fracture patients: an inter-hospital comparison. Eur J Trauma Emerg Surg 2019; 47:557-564. [PMID: 31020360 DOI: 10.1007/s00068-019-01129-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/01/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Hip fractures in geriatric patients have high morbidity and mortality rates. The implementation of a multidisciplinary geriatric care pathway (GCP) may improve treatment for this patient population. This study focusses on two level II hospitals with a different treatment protocols. A comparison was made between a multidisciplinary GCP and extensive standard care with a focus on geriatric hip fracture patients to assess if a multidisciplinary GCP leads to lower mortality and morbidity. METHODS This retrospective cohort study included patients aged 70 years or older with a unilateral proximal hip fracture who underwent surgery between January 2014 and December 2015. The primary outcome measures complications and 30-day mortality. Secondary outcome measures were time to surgery, hospital length of stay (HLOS) and secondary surgical interventions. RESULTS This study included a total of 898 patients. No differences were found between major postoperative complications, 30-day mortality, HLOS or the amount of secondary surgical interventions. CONCLUSIONS Mortality, major complications, HLOS and the amount of secondary surgical interventions showed no differences between both hospitals. This inter-hospital comparison of two types of geriatric care models showed no outcome that favours one specific geriatric care model over another. This provides opportunities for future studies to get a better understanding of what specific factors of geriatric care models contribute most to an improvement in the treatment of this patient population and decide which approach is most cost effective.
Collapse
Affiliation(s)
- Jip Kusen
- Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat Utrecht 1, 3582 KE, Utrecht, The Netherlands
| | - Puck van der Vet
- Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat Utrecht 1, 3582 KE, Utrecht, The Netherlands
| | - Frans-Jasper Wijdicks
- Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat Utrecht 1, 3582 KE, Utrecht, The Netherlands.
| | - Marijn Houwert
- Department of Surgery, UMC Utrecht, Utrecht, The Netherlands
| | - Marcel Dijkgraaf
- Department of Clinical Epidemiology, AMC Amsterdam, Amsterdam, The Netherlands
| | - Marije Hamaker
- Department of Geriatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Olivia Geraghty
- Department of Geriatrics, Antoniusziekenhuis Nieuwegein, Nieuwegein, The Netherlands
| | - Egbert-Jan Verleisdonk
- Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat Utrecht 1, 3582 KE, Utrecht, The Netherlands
| | - Detlef van der Velde
- Department of Surgery, Antoniusziekenhuis Nieuwegein, Nieuwegein, The Netherlands
| |
Collapse
|
12
|
Verschuur CVM, Suwijn SR, Post B, Dijkgraaf M, Bloem BR, van Hilten JJ, van Laar T, Tissingh G, Deuschl G, Lang AE, de Haan RJ, de Bie RMA. Protocol of a randomised delayed-start double-blind placebo-controlled multi-centre trial for Levodopa in EArly Parkinson's disease: the LEAP-study. BMC Neurol 2015; 15:236. [PMID: 26584951 PMCID: PMC4653886 DOI: 10.1186/s12883-015-0491-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/07/2015] [Indexed: 02/02/2023] Open
Abstract
Background The aim of this study is to investigate if early treatment with levodopa has a beneficial disease modifying effect on Parkinson’s disease (PD) symptoms and functional health, improves the ability to (maintain) work, and reduces the use of (informal) care, caregiver burden, and costs. Additionally, cost-effectiveness and cost-utility of early levodopa treatment will be assessed. Methods To differentiate between the direct symptomatic effects and possible disease modifying effects of levodopa, we use a randomised delayed-start double-blind placebo-controlled multi-centre trial design. Patients with early stage PD whose functional health does not yet necessitate initiation of PD-medication will be randomised to either 40 weeks of treatment with levodopa/carbidopa 100/25 mg TID including 2 weeks of dose escalation or to 40 weeks placebo TID. Subsequently, all patients receive levodopa/carbidopa 100/25 mg TID for 40 weeks. There are 8 assessments: at baseline and at 4, 22, 40, 44, 56, 68, and 80 weeks. The primary outcome measure is the difference in the mean total Unified Parkinson’s Disease Rating Scale scores between the early- and delayed-start groups at 80 weeks. Secondary outcome measures are rate of progression, the AMC Linear Disability Score, side effects, perceived quality of life with the Parkinson’s Disease Questionnaire-39, the European Quality of Life-5 Dimensions (EQ-5D), ability to (maintain) work, the use of (informal) care, caregiver burden, and costs. 446 newly diagnosed PD patients without impaired functional health need to be recruited in order to detect a minimal clinical relevant difference of 4 points on the total UPDRS at 80 weeks. Discussion The LEAP-study will provide insights into the possible disease modifying effects of early levodopa. Trial registration ISRCTN30518857, EudraCT number 2011-000678-72
Collapse
Affiliation(s)
- Constant V M Verschuur
- Department of Neurology, Academic Medical Center, University of Amsterdam, PO BOX 22600, 1100 DD, Amsterdam, The Netherlands.
| | - S R Suwijn
- Department of Neurology, Academic Medical Center, University of Amsterdam, PO BOX 22600, 1100 DD, Amsterdam, The Netherlands.
| | - B Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - M Dijkgraaf
- Academic Medical Center, Clinical Research Unit, Amsterdam, The Netherlands.
| | - B R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - J J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| | - T van Laar
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands.
| | - G Tissingh
- Department of Neurology, Atrium-Orbis Medical Center Heerlen/Sittard, Heerlen, The Netherlands.
| | - G Deuschl
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany.
| | - A E Lang
- The Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - R J de Haan
- Academic Medical Center, Clinical Research Unit, Amsterdam, The Netherlands.
| | - R M A de Bie
- Department of Neurology, Academic Medical Center, University of Amsterdam, PO BOX 22600, 1100 DD, Amsterdam, The Netherlands.
| |
Collapse
|
13
|
Engelen M, Ofman R, Dijkgraaf M, van Geel B, de Visser M, Wanders R, Poll-The BT, Kemp S. Comment on the paper “Effect of statin treatment on adrenomyeloneuropathy with cerebral inflammation: A revisit”. Clin Neurol Neurosurg 2013; 115:2401-2. [DOI: 10.1016/j.clineuro.2013.07.040] [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] [Received: 05/22/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
|
14
|
Wijdicks FJ, Houwert M, Dijkgraaf M, de Lange D, Oosterhuis K, Clevers G, Verleisdonk EJ. Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison. Int Orthop 2012; 36:2139-45. [PMID: 22847116 PMCID: PMC3460104 DOI: 10.1007/s00264-012-1615-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The incidence of operative treatment of dislocated midshaft clavicle fractures (DMCF) is rising due to unsatisfactory results after non-operative treatment. Knowledge of complications is important for selection of the surgical technique and preoperative patient counselling. The aim of this study is to compare complications after plate fixation and elastic stable intramedullary nailing (ESIN) with a titanium elastic nail (TEN) for DMCF. METHODS A retrospective analysis of our surgical database was performed. From January 2005 to January 2010, 90 patients with DMCF were treated with plate fixation or ESIN. Complications were evaluated in both treatment groups and subsequently compared. RESULTS Seven implant failures occurred in six patients (14 %) of the plate group and one implant failure (2.1 %) was seen in the ESIN group (p = 0.051). Major revision surgery was performed in five cases in the plate group (11.6 %) and in one case (2.1 %) in the ESIN group (p = 0.100). Three refractures (7.0 %) were observed in the plate group after removal of the implant against none in the ESIN group (p = 0.105). Six minor revisions (13 %) were reported in the ESIN group and none were reported in the plate group (p = 0.027). CONCLUSIONS Compared to other studies we report higher rates of refracture (7.0 %), major revision surgery (11.6 %) and implant failure (14.0 %) after plate fixation. The frequency of implant failures differed almost significantly for patients treated with plate fixation compared to ESIN. Furthermore, a tendency towards refracture after implant removal and major revision surgery after plate fixation was observed.
Collapse
|
15
|
Takkenberg B, Terpstra V, Zaaijer H, Weegink C, Dijkgraaf M, Jansen P, Beld M, Reesink H. Intrahepatic response markers in chronic hepatitis B patients treated with peginterferon alpha-2a and adefovir. J Gastroenterol Hepatol 2011; 26:1527-35. [PMID: 21557773 DOI: 10.1111/j.1440-1746.2011.06766.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM We investigated whether intrahepatic markers could predict response in chronic hepatitis B virus (HBV) patients treated with peg-interferon and adefovir for 48 weeks. METHODS Intrahepatic covalently closed circular DNA (cccDNA), total intrahepatic HBV DNA and the proportion of hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) positive hepatocytes in 16 hepatitis B e antigen (HBeAg) positive and 24 HBeAg negative patients were measured at baseline and at end of treatment. RESULTS Baseline intrahepatic markers were not associated with sustained virological response (SVR) defined as HBV DNA < 2000 IU/mL and persistent normal alanine aminotransferase levels at the end of follow-up (week 72). At end of treatment, intrahepatic cccDNA and total intrahepatic HBV DNA in HBeAg positive patients were significantly lower in patients with HBeAg seroconversion (P = 0.016 and P = 0.010) with positive predictive values (PPV) for SVR of 80% and 80%, respectively. In HBeAg negative patients, intrahepatic cccDNA and total intrahepatic HBV DNA had declined significantly at end of treatment (P = 0.035 and P = 0.041) and corresponding PPV for SVR was 73% and 82%. In HBeAg positive patients, median proportion of HBcAg positive hepatocytes declined significantly (P = 0.002) at end of treatment. In HBeAg negative patients, the proportion of HBsAg positive hepatocytes had declined significantly at end of treatment (P = 0.0009). Using HBsAg ≤ 7.5% as a limit, PPV for SVR in HBeAg negative patients was 83%. CONCLUSIONS At end of treatment in HBeAg positive patients, intrahepatic cccDNA and total intrahepatic HBV DNA were predictive for SVR. In HBeAg negative patients a proportion of < 7.5% HBsAg positive hepatocytes at end of treatment was a strong predictor for SVR.
Collapse
Affiliation(s)
- Bart Takkenberg
- Departments of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Hazewinkel M, Derks M, Dijkgraaf M, Stalpers L, Roovers JP. Treatment of acute radiation cystitis: reply by the authors. Int Urogynecol J 2011. [PMCID: PMC3162146 DOI: 10.1007/s00192-011-1493-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Menke Hazewinkel
- Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marloes Derks
- Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marcel Dijkgraaf
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Lukas Stalpers
- Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan-Paul Roovers
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Affiliation(s)
- Menke Hazewinkel
- Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marloes Derks
- Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marcel Dijkgraaf
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Lukas Stalpers
- Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan-Paul Roovers
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Binnekade J, Wilde R, Slooter AJ, Sluijs J, Beenen O, Schultz M, Dijkgraaf M, Berg P, Vroom M. Multicenter randomized trial of sedation using daily wake-up calls, bispectral index or clinical sedation scores in a mixed medical–surgical ICU population. Crit Care 2009. [PMCID: PMC4084282 DOI: 10.1186/cc7560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - R Wilde
- LUMC, Leiden, the Netherlands
| | | | | | | | | | | | - P Berg
- LUMC, Leiden, the Netherlands
| | - M Vroom
- AMC, Amsterdam, the Netherlands
| |
Collapse
|
19
|
Schrooten W, Dreezen C, Borleffs J, Dijkgraaf M, Borchert M, De Graeve D, Hemmer R, Fleerackers Y, Colebunders R. Financial situation of people living with HIV in Europe. Int J STD AIDS 2002; 13:698-701. [PMID: 12396540 DOI: 10.1258/095646202760326453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective was to investigate the financial situation of people living with HIV in Europe. Two surveys using an anonymous questionnaire were organized in Europe among people living with HIV, the first in 1996-97 and the second in 1998-99. One thousand one hundred and sixty-one people from the 1996-97 survey and 899 from the 1998-99 survey were included. Four hundred and fifty-seven (42%) of the 1996-97 participants reported that their income had decreased since HIV diagnosis. The latter participants reported significantly more often difficulties in paying for housing (27% vs 20%), food (18% vs 12%) and transport (17% vs 12%) compared to 1998-99 participants. In multiple regression analysis, severity of HIV disease, not being on highly active antiretroviral therapy (HAART), younger age, lower education level and living in the South of Europe were associated with having financial difficulties. We concluded that since the introduction of HAART, the financial situation of persons living with HIV in Europe has improved, but a relatively large percentage of them still have financial difficulties.
Collapse
Affiliation(s)
- W Schrooten
- Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgiu
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Hoogenveen R, Westert G, Dijkgraaf M, Schellevis F, de Bakker D. Disease prevalence estimations based on contact registrations in general practice. Stat Med 2002; 21:2271-85. [PMID: 12210638 DOI: 10.1002/sim.1085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper describes how to estimate the prevalence of chronic diseases in a population using data from contact registrations in general practice with a limited time length. Instead of using only total numbers of observed patients adjusted for the length of the observation period, we propose the use of (i) the time of the first contact of patients, (ii) the joint total numbers of patients and contacts, and (iii) the sets of patients in distinct time intervals, to generate prevalence rate estimates. The three new prevalence rate estimators have been developed assuming either a homogeneous or a parameterized heterogeneous patient population. Systematic and stochastic components of the estimators have been analysed by cross-validation for five chronic diseases using data from the Dutch 'Study on Chronic Conditions'. The results show that the first two estimators work well for diseases with a relatively structured visiting behaviour, such as hypertension and diabetes mellitus, assuming a time-constant contact rate and homogeneous patient population. For diseases such as ischaemic heart disease, chronic non-specific respiratory diseases and osteoarthritis, that do not satisfy these assumptions, the methods generally result in underestimations.
Collapse
Affiliation(s)
- Rudolf Hoogenveen
- National Institute of Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
| | | | | | | | | |
Collapse
|
21
|
de Vos WM, Voorhorst WG, Dijkgraaf M, Kluskens LD, Van der Oost J, Siezen RJ. Purification, characterization, and molecular modeling of pyrolysin and other extracellular thermostable serine proteases from hyperthermophilic microorganisms. Methods Enzymol 2001; 330:383-93. [PMID: 11210516 DOI: 10.1016/s0076-6879(01)30390-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- W M de Vos
- Laboratory of Microbiology, Wageningen Agricultural University, Wageningen, NL-6703 CT, The Netherlands
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
Studies from Denmark and the USA have reported a strong correlation between the seasonal pattern for stillbirths and the seasonal birth pattern for people who develop schizophrenia. It has been suggested that the correlation could be caused by a common seasonal factor (e. g. intra-uterine infections during the third trimester of pregnancy), which produces death in some fetuses and nonfatal brain changes in others, changes that are manifested in later life as schizophrenia. The aims of our study were (i) to assess the seasonal patterns for stillbirths and for pre-schizophrenic births in The Netherlands and (ii) to examine their relationship. The Dutch psychiatric registry provided data on all Dutch-born subjects who had been hospitalized at least once with a diagnosis of schizophrenia in the period 1970-1994. We selected data on patients born in the period 1926-1970 (n=29891). The government provided monthly numbers of live births and stillbirths in the latter period. Seasonality of birth was examined using Poisson regression analysis. The risk of an admission for schizophrenia was highest for people born in the months of May and June and lowest for those born in August and September. When the risk for subjects born in June was compared with the risk for subjects born in September, the Relative Risk was 1.14 [95% confidence interval (CI): 1.07 to 1.22]. The seasonal pattern of stillbirths was different, in that it showed a peak in the month of January. The low, however, as in schizophrenia, occurred in the months of August and September. The two seasonal patterns were found to be weakly correlated: Spearman's rank correlation coefficient rho=0.41 (95% CI: -0.22 to 0.80). This was the largest European study on birth seasonality in schizophrenia. The hypothesis that a common factor is responsible for a seasonal excess of stillbirths and for a seasonal birth excess of people who develop schizophrenia was not supported. The possibility remains, however, that a common factor explains seasonal (birth rate) deficits in these disorders.
Collapse
Affiliation(s)
- J P Selten
- Department of Psychiatry, University Hospital, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
23
|
Starace F, Dijkgraaf M, Houweling H, Postma M, Tramarin A. HIV-associated dementia: clinical, epidemiological and resource utilization issues. AIDS Care 1998; 10 Suppl 2:S113-21. [PMID: 9743733 DOI: 10.1080/09540129850124226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Among mental disorders associated with HIV infection, dementia is the one most likely to have a major impact on public health, both as a result of the high levels of individual disability, and the greater demand of health care resource utilization. Epidemiologic and economic impact of HIV-associated dementia needs to be estimated, in order to provide policy makers and health managers with the information required for decision making and resource allocation. An increase in HIV encephalopathy prevalence rates may be expected as a consequence of longer survival time in dementia patients and in patients with other AIDS defining disease (longer survival increases the risk of developing HIV encephalopathy). A resource utilization study shows that, in the chronic stage of the disease, in-patient days per person-year are almost double in AIDS subjects with neurological complications as compared with those without neurological complications; no major difference appears when considering out-patients consultations and day-care treatments. In conclusion, a significant rise in resource utilization and in related costs may be anticipated as a consequence of the increasing prevalence of HIV encephalopathy. Further studies seem necessary to compare different approaches in the management of this debilitating disease, in view of a more rational utilization and allocation of resources.
Collapse
Affiliation(s)
- F Starace
- Department of Primary Care & Population Sciences, RFHSM, London, UK
| | | | | | | | | |
Collapse
|