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Ten Buuren AAA, Poolman TB, Bongers MY, Bullens LM, Van Hanegem N, Klerkx WM, Timmermans A, Zuithoff NPA, Kwee A. Patient preferences for disposable and reusable vaginal specula and their willingness to compromise in the era of climate change: A cross-sectional study. BJOG 2024; 131:684-689. [PMID: 38073255 DOI: 10.1111/1471-0528.17733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/15/2023] [Accepted: 11/24/2023] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To evaluate patient satisfaction on gynaecological examination with metal, plastic and biobased plastic vaginal specula, and to investigate whether patients are willing to compromise on comfort for a more sustainable healthcare system. DESIGN Cross-sectional study: population-based survey. SETTING Gynaecological outpatient clinics in five Dutch hospitals. POPULATION Patients during general gynaecology consultation hours. METHODS A survey containing two questions about patient demographics, four about comfort and five about sustainability and healthcare was distributed. MAIN OUTCOME MEASURES Comfort score (scale 1-10). SECONDARY OUTCOMES (1) temperature, size and ease of insertion, (2) willingness to compromise for a more sustainable healthcare system. RESULTS In all, 196 patients completed the survey. Biobased plastic vaginal specula scored significantly higher on comfort than the metal ones (mean 8.03 ± 1.65 versus 7.26 ± 1.51 respectively; P < 0.001). The biobased plastic vaginal speculum is significantly the most comfortable on temperature, whereas the metal speculum is the least comfortable (P < 0.007). Most patients are willing to compromise on comfort or are open to the reuse of disposables to contribute to a more sustainable healthcare. The majority of patients (77%) urge healthcare organisations to combat climate change. CONCLUSIONS There is a small but statistically significant difference in favour of a biobased plastic speculum regarding comfort score, although it might be questioned whether this is clinically relevant. Furthermore, patients are willing to compromise on comfort for a more sustainable healthcare, which should be a contributing factor in speculum selection.
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Affiliation(s)
- Amber A A Ten Buuren
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Tessa B Poolman
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Grow Research School of Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Lauren M Bullens
- Department of Obstetrics and Gynaecology, Streekziekenhuis Koningin Beatrix, Winterswijk, The Netherlands
| | - Nehalennia Van Hanegem
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Wenche M Klerkx
- Department of Obstetrics and Gynaecology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Anne Timmermans
- Department of Obstetrics and Gynaecology, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Nicolaas P A Zuithoff
- Department of Data Science and Biostatistics, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anneke Kwee
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Zorgevaluatie en Gepast Gebruik (ZE&GG), Diemen, The Netherlands
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Groenewegen A, Zwartkruis VW, Rienstra M, Zuithoff NPA, Hollander M, Koffijberg H, Oude Wolcherink M, Cramer MJ, van der Schouw YT, Hoes AW, Rutten FH, de Boer RA. Diagnostic yield of a proactive strategy for early detection of cardiovascular disease versus usual care in adults with type 2 diabetes or chronic obstructive pulmonary disease in primary care in the Netherlands (RED-CVD): a multicentre, pragmatic, cluster-randomised, controlled trial. Lancet Public Health 2024; 9:e88-e99. [PMID: 38134944 DOI: 10.1016/s2468-2667(23)00269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/18/2023] [Accepted: 10/20/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Progressive cardiovascular diseases (eg, heart failure, atrial fibrillation, and coronary artery disease) are often diagnosed late in high-risk individuals with common comorbidities that might mimic or mask symptoms, such as chronic obstructive pulmonary disease (COPD) and type 2 diabetes. We aimed to assess whether a proactive diagnostic strategy consisting of a symptom and risk factor questionnaire and low-cost and accessible tests could increase diagnosis of progressive cardiovascular diseases in patients with COPD or type 2 diabetes in primary care. METHODS In this multicentre, pragmatic, cluster-randomised, controlled trial (RED-CVD), 25 primary care practices in the Netherlands were randomly assigned to usual care or a proactive diagnostic strategy conducted during routine consultations and consisting of a validated symptom questionnaire, followed by physical examination, N-terminal-pro-B-type natriuretic peptide measurement, and electrocardiography. We included adults (≥18 years) with type 2 diabetes, COPD, or both, who participated in a disease management programme. Patients with an established triple diagnosis of heart failure, atrial fibrillation, and coronary artery disease were excluded. In the case of abnormal findings, further work-up or treatment was done at the discretion of the general practitioner. The primary endpoint was the number of newly diagnosed cases of heart failure, atrial fibrillation, and coronary artery disease, adjudicated by an expert clinical outcome committee using international guidelines, at 1-year follow-up, in the intention-to-treat population. FINDINGS Between Jan 31, 2019, and Oct 7, 2021, we randomly assigned 25 primary care centres: 11 to usual care and 14 to the intervention. We included patients between June 21, 2019, and Jan 31, 2022. Following exclusion of ineligible patients and those who did not give informed consent, 1216 participants were included: 624 (51%) in the intervention group and 592 (49%) in the usual care group. The mean age of participants was 68·4 years (SD 9·4), 482 (40%) participants were female, and 734 (60%) were male. During 1 year of follow-up, 50 (8%) of 624 participants in the intervention group and 18 (3%) of 592 in the control group were newly diagnosed with heart failure, atrial fibrillation, or coronary artery disease (adjusted odds ratio 2·97 [95% CI 1·66-5·33]). This trial is registered with the Netherlands Trial Registry, NTR7360, and was completed on Jan 31, 2023. INTERPRETATION An easy-to-use, proactive, diagnostic strategy more than doubled the number of new diagnoses of heart failure, atrial fibrillation, and coronary artery disease in patients with type 2 diabetes or COPD in primary care compared with usual care. Although the effect on patient outcomes remains to be studied, our diagnostic strategy might contribute to improved early detection and timely initiation of treatment in individuals with cardiovascular disease. FUNDING Dutch Heart Foundation.
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Affiliation(s)
- Amy Groenewegen
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
| | - Victor W Zwartkruis
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Nicolaas P A Zuithoff
- Department of Data Science & Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Monika Hollander
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology & Services Research, University of Twente, Enschede, Netherlands
| | - Martijn Oude Wolcherink
- Department of Health Technology & Services Research, University of Twente, Enschede, Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Yvonne T van der Schouw
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Arno W Hoes
- Medical Faculty and Executive Board, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Frans H Rutten
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, Netherlands
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3
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Knipping K, Kartaram SW, Teunis M, Zuithoff NPA, Buurman N, M’Rabet L, van Norren K, Witkamp R, Pieters R, Garssen J. Salivary concentrations of secretory leukocyte protease inhibitor and matrix metallopeptidase-9 following a single bout of exercise are associated with intensity and hydration status. PLoS One 2023; 18:e0291297. [PMID: 37992002 PMCID: PMC10664895 DOI: 10.1371/journal.pone.0291297] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/25/2023] [Indexed: 11/24/2023] Open
Abstract
AIM To investigate the effects of exercise on salivary concentrations of inflammatory markers by analyzing a panel of 25 inflammatory markers in subjects who had participated in bicycle ergometer tests varying in workload and hydration status. METHODS Fifteen healthy young men (20-35 years) had performed 4 different exercise protocols of 1 hour duration in a randomly assigned cross-over design, preceded by a rest protocol. Individual workloads depended on participant's pre-assessed individual maximum workload (Wmax): rest (protocol 1), 70% Wmax in hydrated (protocol 2) and dehydrated (protocol 3) state, 50% Wmax (protocol 4) and intermittent 85%/55% Wmax in 2 min blocks (protocol 5). Saliva samples were collected before (T0) and immediately after exercise (T1), and at several time points after exercise (2 hours (T3), 3 hours (T4), 6 hours (T5) and 24 hours (T6)). Secretory Leukocyte Protease Inhibitor (SLPI), Matrix Metallopeptidase-9 (MMP-9) and lactoferrin was analyzed using a commercial ELISA kit, a panel of 22 cytokines and chemokines were analyzed using a commercial multiplex immunoassay. Data was analyzed using a multilevel mixed linear model, with multiple test correction. RESULTS Among a panel of 25 inflammatory markers, SLPI concentrations were significantly elevated immediately after exercise in all protocols compared to rest and higher concentrations reflected the intensity of exercise and hydration status. MMP-9 showed a significant increase in the 70% Wmax dehydrated, 50% Wmax and intermittent protocols. CONCLUSIONS Salivary concentrations of SLPI and MMP-9 seem associated with exercise intensity and hydration status and may offer non-invasive biomarkers to study (local) inflammatory responses to different exercise intensities in human studies.
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Affiliation(s)
- Karen Knipping
- Danone Nutricia Research, Utrecht, The Netherlands
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Shirley W. Kartaram
- Research Group Innovative Testing in Life Sciences and Chemistry, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Marc Teunis
- Research Group Innovative Testing in Life Sciences and Chemistry, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Laura M’Rabet
- Research Group Innovative Testing in Life Sciences and Chemistry, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Klaske van Norren
- Nutritional Biology, Division Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Renger Witkamp
- Nutritional Biology, Division Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Raymond Pieters
- Research Group Innovative Testing in Life Sciences and Chemistry, University of Applied Sciences Utrecht, Utrecht, The Netherlands
- Institute for Risk Assessment Sciences, Immunotoxicology (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Johan Garssen
- Danone Nutricia Research, Utrecht, The Netherlands
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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de Sonnaville WFC, Speksnijder CM, Zuithoff NPA, Heijstek MW, Wulffraat NM, Steenks MH, Rosenberg AJWP. Clinically Established Temporomandibular Involvement in Adults With Juvenile Idiopathic Arthritis. J Rheumatol 2023; 50:1462-1470. [PMID: 37399466 DOI: 10.3899/jrheum.2023-0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To study clinical variables defining temporomandibular function in adults with juvenile idiopathic arthritis (JIA) and healthy controls. METHODS In this cross-sectional study, the temporomandibular joint (TMJ) screening protocol, mandibular range of motion (MROM), and anterior maximum voluntary bite force (AMVBF) were compared between adults with JIA and healthy controls. Unadjusted and adjusted models with corrections for sex and disease duration were constructed for active maximum interincisal mouth opening (AMIO) and AMVBF. RESULTS A total of 100 adults with JIA and 59 healthy adults were included in this study. In adults with JIA, 56% had clinically established TMJ involvement. AMIO was the MROM variable most reduced by TMJ involvement; AMIO was 8.8 mm (95% CI -11.40 to -6.12; P < 0.001) less in adults with JIA with TMJ involvement compared to JIA without TMJ involvement. No differences of AMIO were found between healthy adults and adults with JIA without TMJ involvement (-2.52, 95% CI -5.13 to 0.10; P = 0.06). Male sex was associated with a higher AMIO, and disease duration was associated with a decreased AMIO. Collinearity between the subtype prebiologic era and disease duration was found. AMVBF did not differ between adults with JIA and healthy adults. CONCLUSION The high prevalence of clinically established TMJ involvement in adults with JIA indicates the need for awareness of TMJ problems in adults with JIA. TMJ involvement negatively influenced AMIO and should therefore be part of the TMJ screening in adults with JIA. AMVBF seems to have less utility for TMJ screening in adult populations.
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Affiliation(s)
- Willemijn F C de Sonnaville
- W.F.C. de Sonnaville, MD, C.M. Speksnijder, PT, MSc, PhD, M.H. Steenks, DDS, PhD, A.J.W.P. Rosenberg, DMD, MD, Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University;
| | - Caroline M Speksnijder
- W.F.C. de Sonnaville, MD, C.M. Speksnijder, PT, MSc, PhD, M.H. Steenks, DDS, PhD, A.J.W.P. Rosenberg, DMD, MD, Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University
| | - Nicolaas P A Zuithoff
- N.P.A. Zuithoff, MSc, PhD, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
| | - Marloes W Heijstek
- M.W. Heijstek, MD, PhD, Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht
| | - Nico M Wulffraat
- N.M. Wulffraat, MD, PhD, Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, and European Reference Network (RITA), Utrecht, the Netherlands
| | - Michel H Steenks
- W.F.C. de Sonnaville, MD, C.M. Speksnijder, PT, MSc, PhD, M.H. Steenks, DDS, PhD, A.J.W.P. Rosenberg, DMD, MD, Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University
| | - Antoine J W P Rosenberg
- W.F.C. de Sonnaville, MD, C.M. Speksnijder, PT, MSc, PhD, M.H. Steenks, DDS, PhD, A.J.W.P. Rosenberg, DMD, MD, Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University
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5
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Mensing LA, van Tuijl RJ, Greving JP, Velthuis BK, van der Schaaf IC, Wermer MJH, Verbaan D, Vandertop WP, Zuithoff NPA, Rinkel GJE, Ruigrok YM. Aneurysm Prevalence and Quality of Life During Screening in Relatives of Patients With Unruptured Intracranial Aneurysms: A Prospective Study. Neurology 2023; 101:e904-e912. [PMID: 37414571 PMCID: PMC10501091 DOI: 10.1212/wnl.0000000000207475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/17/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Screening for unruptured intracranial aneurysms (UIAs) is effective for first-degree relatives (FDRs) of patients with aneurysmal subarachnoid hemorrhage (aSAH). Whether screening is also effective for FDRs of patients with UIA is unknown. We determined the yield of screening in such FDRs, assessed rupture risk and treatment decisions of aneurysms that were found, identified potential high-risk subgroups, and studied the effects of screening on quality of life (QoL). METHODS In this prospective cohort study, we included FDRs, aged 20-70 years, of patients with UIA without a family history of aSAH who visited the Neurology outpatient clinic in 1 of 3 participating tertiary referral centers in the Netherlands. FDRs were screened for UIA with magnetic resonance angiography between 2017 and 2021. We determined UIA prevalence and developed a prediction model for UIA risk at screening using multivariable logistic regression. QoL was evaluated with questionnaires 6 times during the first year after screening and assessed with a linear mixed-effects model. RESULTS We detected 24 UIAs in 23 of 461 screened FDRs, resulting in a 5.0% prevalence (95% CI 3.2-7.4). The median aneurysm size was 3 mm (interquartile range [IQR] 2-4 mm), and the median 5-year rupture risk assessed with the PHASES score was 0.7% (IQR 0.4%-0.9%). All UIAs received follow-up imaging, and none were treated preventively. After a median follow-up of 24 months (IQR 13-38 months), no UIA had changed. Predicted UIA risk at screening ranged between 2.3% and 14.7% with the highest risk in FDRs who smoke and have excessive alcohol consumption (c-statistic: 0.76; 95% CI 0.65-0.88). At all survey moments, health-related QoL and emotional functioning were comparable with those in a reference group from the general population. One FDR with a positive screening result expressed regret about screening. DISCUSSION Based on the current data, we do not advise screening FDRs of patients with UIA because all identified UIAs had a low rupture risk. We observed no negative effect of screening on QoL. A longer follow-up should determine the risk of aneurysm growth requiring preventive treatment.
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Affiliation(s)
- Liselore A Mensing
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands.
| | - Rick J van Tuijl
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Jacoba P Greving
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Birgitta K Velthuis
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Irene C van der Schaaf
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Marieke J H Wermer
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Dagmar Verbaan
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - W Peter Vandertop
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Nicolaas P A Zuithoff
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Gabriël J E Rinkel
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Ynte M Ruigrok
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
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6
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Spekhorst LS, Boesjes CM, Loman L, Zuithoff NPA, Bakker DS, Kamphuis E, Kamsteeg M, Haeck IM, Oosting AJ, van Lumig PPM, van Lynden-van Nes AMT, Tupker RA, Flinterman A, Garritsen FM, Touwslager WRH, de Bruin-Weller MS, Schuttelaar MLA, de Graaf M. Successful tapering of dupilumab in patients with atopic dermatitis with low disease activity: a large pragmatic daily practice study from the BioDay registry. Br J Dermatol 2023; 189:327-335. [PMID: 37177895 DOI: 10.1093/bjd/ljad159] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/05/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Limited data are available regarding patient-centred dosing of dupilumab for atopic dermatitis (AD) in daily practice. OBJECTIVES To evaluate our patient-centred dupilumab dosing regimen in daily practice, to assess prognostic factors for successful tapering and to estimate medication-related cost savings. METHODS This prospective multicentre study included adult patients with AD, participating in the BioDay registry, treated with dupilumab for ≥ 1.3 years. Interval prolongation was considered in the case of dupilumab standard dose for ≥ 1 year and persistent controlled AD [Eczema Area and Severity Index (EASI) ≤ 7; ≥ 6 months]. Primary endpoints were the mean EASI and Numeric Rating Scale (NRS)-pruritus after the start of tapering. Prognostic factors for successful tapering were analysed with logistic regression and a cost-savings analysis was performed. RESULTS A total of 595 patients were included, of whom 401 patients [mean EASI 2.5 (SD 2.3); NRS-pruritus of 2.4 (SD 1.9) at the start of tapering] prolonged their dupilumab interval. In 83.3% of these patients tapering was successful; most patients used dupilumab every 3 or 4 weeks (Q3W/Q4W). A significant small increase was observed for EASI (highest mean 3.5) and NRS-pruritus (highest mean 3.2) (P < 0.001); however, scores remained low. Predicting successful tapering showed nonsignificant odds ratios for all incorporated variables. The estimated cost savings was €3 977 033.98 for 401 patients between January 2019 and June 2022. CONCLUSIONS This study showed successful tapering of dupilumab in 83.3% of patients with AD who attempted tapering, while maintaining controlled disease and with the majority using Q3W/Q4W. Interval prolongation can be beneficial both for the patient and from a socio-economic perspective.
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Affiliation(s)
- Lotte S Spekhorst
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Celeste M Boesjes
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daphne S Bakker
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Esmé Kamphuis
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Marijke Kamsteeg
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Inge M Haeck
- Department of Dermatology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Albert J Oosting
- Department of Dermatology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Paula P M van Lumig
- Department of Dermatology, University Medical Center Maastricht, Maastricht, the Netherlands
| | | | - Ron A Tupker
- Department of Dermatology, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | | | - Marjolein S de Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Marlies de Graaf
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
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Koopman I, van Dijk BJ, Zuithoff NPA, Sluijs JA, van der Kamp MJ, Baldew ZAV, Frijns CJM, Rinkel GJE, Hol EM, Vergouwen MDI. Glial cell response and microthrombosis in aneurysmal subarachnoid hemorrhage patients: An autopsy study. J Neuropathol Exp Neurol 2023; 82:798-805. [PMID: 37478478 PMCID: PMC10440719 DOI: 10.1093/jnen/nlad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
Neuroinflammation and microthrombosis may be underlying mechanisms of brain injury after aneurysmal subarachnoid hemorrhage (aSAH), but they have not been studied in relation to each other. In postmortem brain tissue, we investigated neuroinflammation by studying the microglial and astrocyte response in the frontal cortex of 11 aSAH and 10 control patients. In a second study, we investigated the correlation between microthrombosis and microglia by studying the microglial surface area around vessels with and without microthrombosis in the frontal cortex and hippocampus of 8 other aSAH patients. In comparison with controls, we found increased numbers of microglia (mean ± SEM 50 ± 8 vs 20 ± 5 per 0.0026 mm³, p < 0.01), an increased surface area (%) of microglia (mean ± SEM 4.2 ± 0.6 vs 2.2 ± 0.4, p < 0.05), a higher intensity of the astrocytic intermediate filament protein glial fibrillary acidic protein (GFAP) (mean ± SEM 184 ± 28 vs 92 ± 23 arbitrary units, p < 0.05), and an increased GFAP surface area (%) (mean ± SEM 21.2 ± 2.6 vs 10.7 ± 2.1, p < 0.01) in aSAH tissue. Microglia surface area was approximately 40% larger around vessels with microthrombosis than those without microthrombosis (estimated marginal means [95% CI]; 6.1 [5.4-6.9] vs 4.3 [3.6-5.0], p < 0.001). Our results show that the microglial and astrocyte surface areas increased after aSAH and that microthrombosis and microglia are interrelated.
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Affiliation(s)
- Inez Koopman
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Bart J van Dijk
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jacqueline A Sluijs
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marije J van der Kamp
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Zelonna A V Baldew
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Catharina J M Frijns
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Elly M Hol
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Crnko S, Printezi MI, Zwetsloot PPM, Leiteris L, Lumley AI, Zhang L, Ernens I, Jansen TPJ, Homsma L, Feyen D, van Faassen M, du Pré BC, Gaillard CAJM, Kemperman H, Oerlemans MIFJ, Doevendans PAFM, May AM, Zuithoff NPA, Sluijter JPG, Devaux Y, van Laake LW. The circadian clock remains intact, but with dampened hormonal output in heart failure. EBioMedicine 2023; 91:104556. [PMID: 37075492 PMCID: PMC10131037 DOI: 10.1016/j.ebiom.2023.104556] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/19/2022] [Revised: 03/09/2023] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Circadian (24-h) rhythms are important regulators in physiology and disease, but systemic disease may disrupt circadian rhythmicity. Heart failure (HF) is a systemic disease affecting hormonal regulation. We investigate whether HF affects the rhythmic expression of melatonin and cortisol, main endocrine products of the central clock, and cardiac-specific troponin in patients. We corroborate the functionality of the peripheral clock directly in the organs of translational models, inaccessible in human participants. METHODS We included 46 HF patients (71.7% male, median age of 60 years, NYHA class II (32.6%) or III (67.4%), ischemic cardiomyopathy (43.5%), comorbidities: diabetes 21.7%, atrial fibrillation 30.4%), and 24 matched controls. Blood was collected at seven time-points during a 24-h period (totalling 320 HF and 167 control samples) for melatonin, cortisol, and cardiac troponin T (cTnT) measurements after which circadian rhythms were assessed through cosinor analyses, both on the individual and the group level. Next, we analysed peripheral circadian clock functionality using cosinor analysis in male animal HF models: nocturnal mice and diurnal zebrafish, based on expression of core clock genes in heart, kidneys, and liver, every 4 h during a 24-h period in a light/darkness synchronised environment. FINDINGS Melatonin and cortisol concentrations followed a physiological 24-h pattern in both patients and controls. For melatonin, acrophase occurred during the night for both groups, with significantly decreased amplitude (median 5.2 vs 8.8, P = 0.0001) and circadian variation ([maximum]/[minimum]) in heart failure patients. For cortisol, mesor showed a significant increase for HF patients (mean 331.9 vs 275.1, P = 0.017) with a difference of 56.8 (95% CI 10.3-103.3) again resulting in a relatively lower variation: median 3.9 vs 6.3 (P = 0.0058). A nocturnal blood pressure dip was absent in 77.8% of HF patients. Clock gene expression profiles (Bmal, Clock, Per, Cry) were similar and with expected phase relations in animal HF models and controls, demonstrating preserved peripheral clock functionality in HF. Furthermore, oscillations in diurnal zebrafish were expectedly in opposite phases to those of nocturnal mice. Concordantly, cTnT concentrations in HF patients revealed significant circadian oscillations. INTERPRETATION Central clock output is dampened in HF patients while the molecular peripheral clock, as confirmed in animal models, remains intact. This emphasises the importance of taking timing into account in research and therapy for HF, setting the stage for another dimension of diagnostic, prognostic and therapeutic approaches. FUNDING Hartstichting.
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Affiliation(s)
- Sandra Crnko
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands; Regenerative Medicine Centre, Circulatory Health Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Markella I Printezi
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Peter-Paul M Zwetsloot
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Laurynas Leiteris
- Regenerative Medicine Centre, Circulatory Health Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Andrew I Lumley
- Cardiovascular Research Unit, Luxembourg Institute of Health, Luxembourg
| | - Lu Zhang
- Cardiovascular Research Unit, Luxembourg Institute of Health, Luxembourg
| | - Isabelle Ernens
- Cardiovascular Research Unit, Luxembourg Institute of Health, Luxembourg
| | - Tijn P J Jansen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lilian Homsma
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Dries Feyen
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Martijn van Faassen
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Bastiaan C du Pré
- Division of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Carlo A J M Gaillard
- Division of Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Hans Kemperman
- Central Diagnostic Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marish I F J Oerlemans
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Pieter A F M Doevendans
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands; Central Military Hospital, Utrecht, the Netherlands
| | - Anne M May
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Nicolaas P A Zuithoff
- Department of Data Science and Biostatistics, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Joost P G Sluijter
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands; Regenerative Medicine Centre, Circulatory Health Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands
| | - Yvan Devaux
- Cardiovascular Research Unit, Luxembourg Institute of Health, Luxembourg
| | - Linda W van Laake
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands; Regenerative Medicine Centre, Circulatory Health Laboratory, University Medical Centre Utrecht, Utrecht, the Netherlands.
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Nasib LG, Winter-van Rossum I, Zuithoff NPA, Boudewijns ZSRM, Leucht S, Kahn RS. Generalizability of the Results of Efficacy Trials in First-Episode Schizophrenia: Comparing Outcome and Study Discontinuation of Groups of Participants in the Optimization of Treatment and Management of Schizophrenia in Europe (OPTiMiSE) Trial. J Clin Psychiatry 2023; 84. [PMID: 36988483 DOI: 10.4088/jcp.22m14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Objective: In the majority of randomized controlled trials (RCTs) conducted in schizophrenia populations, patients suffering from a substance use disorder (SUD) or suicidality are excluded. Excluding these patients from RCTs might impact the generalizability of results. The aim of this study is to determine whether excluding patients with suicidality and/or SUD impacts RCT results on symptomatic remission, premature study discontinuation, symptom severity, and social functioning. Methods: Across Europe and Israel, 481 patients with first-episode schizophrenia, schizophreniform disorder, or schizoaffective disorder, based on DSM-IV criteria, were recruited between May 26, 2011, and May 15, 2016, for the Optimization of Treatment and Management of Schizophrenia in Europe (OPTiMiSE) trial. Baseline characteristics and follow-up assessments were compared between patients with versus without baseline SUD and/or suicidality. Results: A total of 446 patients met eligibility criteria for the OPTiMiSE trial and initiated amisulpride treatment, of whom 404 (91%) had data available on suicidality, SUD, duration of illness, and CDS score. Of the 360 eligible patients with baseline data on suicidality and SUD, 106 patients had comorbid suicidality and/or SUD while 254 patients had neither of these comorbidities. No significant differences in the likelihood to achieve symptomatic remission or to prematurely discontinue the study were found when comparing comorbid versus non-comorbid patients (P = .27). There were no significant differences in symptom severity and social functioning between the groups. Comorbid patients had a higher level of depressive symptoms and more impaired social functioning compared to non-comorbid patients. Discussion: Excluding first-episode schizophrenia patients with comorbidities from clinical trials unlikely affects key outcome measures. It is recommended to include patients with comorbidities in clinical trials while carefully monitoring suicidality and implementing safety plans to gain insight into efficacy and safety of treatment in this substantial patient population. Trial Registration: ClinicalTrials.gov identifier: NCT01248195.
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Affiliation(s)
- Lyliana G Nasib
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- Corresponding author: Lyliana G. Nasib, PhD, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht
| | - Inge Winter-van Rossum
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, New York
| | - Nicolaas P A Zuithoff
- Department of Biostatistics and Research Support, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Zimbo S R M Boudewijns
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Stefan Leucht
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - René S Kahn
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, New York
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Spekhorst LS, van der Rijst LP, de Graaf M, van Megen M, Zuithoff NPA, Knulst AC, de Bruin-Weller MS, Le TM. Dupilumab has a profound effect on specific-IgE levels of several food allergens in atopic dermatitis patients. Allergy 2023; 78:875-878. [PMID: 36420598 DOI: 10.1111/all.15591] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/19/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Lotte S Spekhorst
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa P van der Rijst
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marlies de Graaf
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maxime van Megen
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - André C Knulst
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein S de Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thuy-My Le
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
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Bekker MN, Koster MPH, Keusters WR, Ganzevoort W, de Haan-Jebbink JM, Deurloo KL, Seeber L, van der Ham DP, Zuithoff NPA, Frederix GWJ, van den Heuvel JFM, Franx A. Home telemonitoring versus hospital care in complicated pregnancies in the Netherlands: a randomised, controlled non-inferiority trial (HoTeL). Lancet Digit Health 2023; 5:e116-e124. [PMID: 36828605 DOI: 10.1016/s2589-7500(22)00231-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Women with complicated pregnancies often require hospital admission. Telemonitoring at home is a promising alternative that fulfils a worldwide need in obstetric health care. Moreover, the COVID-19 pandemic has accelerated the transformation to digital care. The aim of this study was to evaluate safety, clinical effectiveness, patient satisfaction, and costs of home telemonitoring against hospital care in complicated pregnancies. METHODS We did a multicentre, randomised, controlled, non-inferiority trial in six hospitals (four general teaching hospitals and two university hospitals) in the Netherlands (located in Utrecht, Amsterdam, and Groningen). Women aged 18 years and older with singleton pregnancies (>26 weeks gestation) requiring monitoring for pre-eclampsia, fetal growth restriction, fetal anomaly, preterm rupture of membranes, reduced fetal movements, or history of fetal death were included in the study. Participants were randomly assigned to either hospital admission or telemonitoring in (1:1), stratified for the six diagnoses for inclusion and the six centres of inclusion, using block randomisation (block sizes of four and six). When assigned to telemonitoring, participants went home with devices for cardiotocography and blood pressure measurements and had daily contact with their care providers after digitally sending their home measurements. When assigned to hospital admission, participants received care as usual on the ward until the postpartum period. The primary outcome was a composite of adverse perinatal outcomes assessed after delivery, including mortality; an Apgar score below 7 after 5 min or an umbilical arterial pH at birth below 7·05; maternal morbidity; admission of the newborn to the neonatal intensive care unit; and rate of caesarean section. The primary outcome was assessed in the intention-to-treat population. The non-inferiority margin for the primary outcome was a 10% absolute increase in composite primary endpoint based on baseline 20% incidence. The study was registered at the Dutch Trial Registration (NL5888) and is now closed to new participants. FINDINGS From Dec 1, 2016, to Nov 30, 2019, 201 pregnant women were randomly assigned to an intervention procedure. 101 women were allocated to the telemonitoring group and 100 to the hospital admission group. One participant in the telemonitoring group withdrew consent before the intervention was initiated, and 100 participants were analysed for the primary outcome. In the hospital admission group, four participants did not receive the allocated intervention because they did not accept hospital admission. 100 participants in each group were analysed for the primary outcome according to the intention-to-treat principal. No participants were lost to follow-up. The primary outcome occurred in 31 (31%) of 100 participants in the telemonitoring group and in 40 (40%) of 100 participants in the hospital admission group. Adjusted for centre of inclusion, diagnosis, and nulliparity, the risk difference in primary outcome between both groups was 10·3% (95% CI -22·4 to 2·2) lower in the telemonitoring group, below the pre-defined non-inferiority margin of 10% absolute increase. A similar distribution for each of the individual components within the composite primary outcome was seen between groups. Five serious adverse events were reported: one neonatal death in the hospital admission group, in addition to one intra-uterine fetal death, two neonatal deaths, and one case of eclampsia in the telemonitoring group, all unrelated to the study. INTERPRETATION This non-inferiority trial shows the first evidence that telemonitoring might be as safe as hospital admission for monitoring complicated pregnancies. FUNDING Stichting Achmea Gezondheidszorg and ICT Healthcare Technology Solutions.
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Affiliation(s)
- Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Willem R Keusters
- Department of Julius Center, Health Sciences, University Medical Center Utrecht, Utrecht, Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Jiska M de Haan-Jebbink
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Koen L Deurloo
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, Netherlands
| | - Laura Seeber
- Department of Obstetrics and Gynaecology, Sint Antonius Hospital, Nieuwegein, Netherlands
| | - David P van der Ham
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, Netherlands
| | - Nicolaas P A Zuithoff
- Department of Julius Center, Health Sciences, University Medical Center Utrecht, Utrecht, Netherlands
| | - Geert W J Frederix
- Department of Julius Center, Health Sciences, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Arie Franx
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands; Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, Netherlands
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de Sévaux JLH, Damoiseaux RAMJ, Hullegie S, Sanders EAM, de Wit GA, Zuithoff NPA, Yardley L, Anthierens S, Little P, Hay AD, Schilder AGM, Venekamp RP. Effectiveness of analgesic ear drops as add-on treatment to oral analgesics in children with acute otitis media: study protocol of the OPTIMA pragmatic randomised controlled trial. BMJ Open 2023; 13:e062071. [PMID: 36813504 PMCID: PMC9950909 DOI: 10.1136/bmjopen-2022-062071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Ear pain is the most prominent symptom of childhood acute otitis media (AOM). To control the pain and reduce reliance on antibiotics, evidence of effectiveness for alternative interventions is urgently needed. This trial aims to investigate whether analgesic ear drops added to usual care provide superior ear pain relief over usual care alone in children presenting to primary care with AOM. METHODS AND ANALYSIS This is a pragmatic, two-arm, individually randomised, open, superiority trial with cost-effectiveness analysis and nested mixed-methods process evaluation in general practices in the Netherlands. We aim to recruit 300 children aged 1-6 years with a general practitioner (GP) diagnosis of AOM and ear pain. Children will be randomly allocated (ratio 1:1) to either (1) lidocaine hydrochloride 5 mg/g ear drops (Otalgan) one to two drops up to six times daily for a maximum of 7 days in addition to usual care (oral analgesics, with/without antibiotics); or (2) usual care. Parents will complete a symptom diary for 4 weeks as well as generic and disease-specific quality of life questionnaires at baseline and 4 weeks. The primary outcome is the parent-reported ear pain score (0-10) over the first 3 days. Secondary outcomes include proportion of children consuming antibiotics, oral analgesic use and overall symptom burden in the first 7 days; number of days with ear pain, number of GP reconsultations and subsequent antibiotic prescribing, adverse events, complications of AOM and cost-effectiveness during 4-week follow-up; generic and disease-specific quality of life at 4 weeks; parents' and GPs' views and experiences with treatment acceptability, usability and satisfaction. ETHICS AND DISSEMINATION The Medical Research Ethics Committee Utrecht, the Netherlands, has approved the protocol (21-447/G-D). All parents/guardians of participants will provide written informed consent. Study results will be submitted for publication in peer-reviewed medical journals and presented at relevant (inter)national scientific meetings. TRIAL REGISTRATION The Netherlands Trial Register: NL9500; date of registration: 28 May 2021. At the time of publication of the study protocol paper, we were unable to make any amendments to the trial registration record in the Netherlands Trial Register. The addition of a data sharing plan was required to adhere to the International Committee of Medical Journal Editors guidelines. The trial was therefore reregistered in ClinicalTrials.gov (NCT05651633; date of registration: 15 December 2022). This second registration is for modification purposes only and the Netherlands Trial Register record (NL9500) should be regarded as the primary trial registration.
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Affiliation(s)
- Joline L H de Sévaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roger A M J Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia Hullegie
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabeth A M Sanders
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital University Medical Center, Utrecht, The Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIMV), Bilthoven, The Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucy Yardley
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- School of Psychological Science, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Anne G M Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Biomedical Research Centre, NIHR University College London Hospitals, London, UK
- evidENT, Ear Institute, University College London, London, UK
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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13
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de Sonnaville WFC, Steenks MH, Zuithoff NPA, Wulffraat NM, Rosenberg AJWP, Speksnijder CM. Reliability and measurement error of anterior maximum voluntary bite force in children with juvenile idiopathic arthritis and healthy children. PLoS One 2023; 18:e0280763. [PMID: 36662800 PMCID: PMC9858014 DOI: 10.1371/journal.pone.0280763] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/08/2023] [Indexed: 01/21/2023] Open
Abstract
In children with juvenile idiopathic arthritis (JIA) the temporomandibular joint (TMJ) can be involved. As a consequence, the oral function can be impaired due to joint and/or muscle involvement of the masticatory system with a negative influence on the maximum bite force. The aim of this cross-sectional study was to establish the reliability of AMVBF in children with JIA and healthy children. Children with JIA and healthy children conducted three attempts of AMVBF. The reliability of AMVBF measurement was determined by the intra-class correlation coefficient (ICC) by age, standard error of measurement (SEM), smallest detectable change (SDC), and limits of agreement (LoA). A total of 298 children with JIA and 168 healthy children were examined. The AMVBF measurements showed an good to excellent reliability in children with JIA based on the ICCs corrected for age (0.782-0.979). In healthy children, the reliability was moderate to excellent (0.546-0.999). The SDC in our study indicated that values above 11.4N might be a clinical relevant change over time in children with JIA. The LoA showed a wide spread of variability in both children with JIA (-72.6-44.4N) and healthy children (-79.9-72.8N). The Bland-Altman plots indicated that the differences between the test and retest increased in value proportionally to the biteforce value.
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Affiliation(s)
- Willemijn F. C. de Sonnaville
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michel H. Steenks
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nico M. Wulffraat
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Antoine J. W. P. Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Caroline M. Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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14
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Spekhorst LS, de Graaf M, van der Rijst LP, Zuithoff NPA, Schweizer RC, Kamsteeg M, Haeck I, van Lynden‐van Nes AMT, van Lumig P, Romeijn GLE, Schuttelaar M, de Bruin‐Weller MS. The positive effect of dupilumab on comorbid asthma in patients with atopic dermatitis. Clin Transl Allergy 2023; 13:e12219. [PMID: 36705510 PMCID: PMC9842782 DOI: 10.1002/clt2.12219] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Lotte S. Spekhorst
- Department of Dermatology and AllergologyNational Expertise Center for Atopic DermatitisUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marlies de Graaf
- Department of Dermatology and AllergologyNational Expertise Center for Atopic DermatitisUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Lisa P. van der Rijst
- Department of Dermatology and AllergologyNational Expertise Center for Atopic DermatitisUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - René C. Schweizer
- Department of PulmonologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marijke Kamsteeg
- Department of DermatologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Inge Haeck
- Department of DermatologyReinier de Graaf GasthuisDelftThe Netherlands
| | | | - Paula van Lumig
- Department of DermatologyUniversity Medical Center MaastrichtMaastrichtThe Netherlands
| | | | | | - Marjolein S. de Bruin‐Weller
- Department of Dermatology and AllergologyNational Expertise Center for Atopic DermatitisUniversity Medical Center UtrechtUtrechtThe Netherlands
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15
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Kamphuis E, Boesjes CM, Loman L, Bakker DS, Poelhekken M, Zuithoff NPA, Kamsteeg M, Romeijn GLE, van Wijk F, de Bruin-Weller MS, de Graaf M, Schuttelaar MLA. Dupilumab in daily practice for the treatment of pediatric atopic dermatitis: 28-week clinical and biomarker results from the BioDay registry. Pediatr Allergy Immunol 2022; 33:e13887. [PMID: 36564878 PMCID: PMC10107870 DOI: 10.1111/pai.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/07/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dupilumab has proven to be an effective and safe treatment for atopic dermatitis (AD) in pediatric patients in clinical trials. However, few daily practice studies are available. The aim of this study is to evaluate the effect of 28 weeks dupilumab treatment on effectiveness, safety, and serum biomarkers in pediatric patients with moderate-to-severe AD in daily practice. METHODS Patients visited the outpatient clinic at baseline, 4, 16, and 28 weeks of treatment. Disease severity was assessed by the Eczema Area and Severity Index (EASI), Investigator Global Assessment (IGA), Numeric Rating Scale (NRS)-pruritus and -pain, and the Patient-Oriented Eczema Measure (POEM). Side effects were evaluated. Nineteen severity-associated serum biomarkers were measured. Predicted-EASI (p-EASI) was calculated. RESULTS Sixty-one patients were included. Respectively 75.4%, 49.2%, and 24.6% reached EASI-50, EASI-75, and EASI-90 and 36.1% achieved an IGA-score (almost) clear. Improvement of ≥4 points on POEM, NRS-pruritus, and NRS-pain was reached by 84.7%, 45.3%, and 77.4%, respectively. Most reported side effects were conjunctivitis (n = 10) and headache (n = 4). Biomarkers TARC, PARC, periostin, sIL-2Ra, and eotaxin-3 significantly decreased during treatment. The p-EASI showed a significant correlation with disease severity. CONCLUSION Dupilumab treatment significantly improved disease severity and disease-associated symptoms and decreased severity-associated serum biomarkers in pediatric AD patients in daily practice.
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Affiliation(s)
- Esmé Kamphuis
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Celeste M Boesjes
- Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Daphne S Bakker
- Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Mila Poelhekken
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marijke Kamsteeg
- Department of Dermatology, Radboud University Medical Center, Radboud University, Nijmegen, the Netherlands
| | - Geertruida L E Romeijn
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Marjolein S de Bruin-Weller
- Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Marlies de Graaf
- Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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16
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Spekhorst LS, de Graaf M, Loeff F, Zuithoff NPA, Bakker D, Boesjes CM, Thijs J, Achten R, van Wijk F, Rispens T, de Bruin-Weller MS. Association of Serum Dupilumab Levels at 16 Weeks With Treatment Response and Adverse Effects in Patients With Atopic Dermatitis: A Prospective Clinical Cohort Study From the BioDay Registry. JAMA Dermatol 2022; 158:1409-1413. [PMID: 36322072 PMCID: PMC9631227 DOI: 10.1001/jamadermatol.2022.4639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/24/2022] [Indexed: 12/24/2022]
Abstract
Importance The registered dose of dupilumab for adult patients with atopic dermatitis (AD) is 300 mg every other week. At present, it is unknown whether serum dupilumab levels are associated with treatment response or adverse effects. Objectives To evaluate serum dupilumab levels at 16 weeks of treatment and to explore the association of serum dupilumab levels with treatment response and adverse effects in patients with AD. Design, Setting, and Participants This clinical, prospective, observational cohort study used data from the prospective BioDay Registry including adult patients with AD who started dupilumab treatment and for whom a serum sample was available at 16 weeks of treatment. All patients were treated according to the BioDay protocol in the University Medical Center Utrecht in the Netherlands. Patients received a loading dose of dupilumab 600 mg subcutaneously, followed by 300 mg every other week. Patients who had a dose adjustment or discontinued treatment before 16 weeks of treatment were excluded. Data analyses were performed from January to June 2022. Main Outcomes and Measures Disease severity of AD was assessed at baseline and at weeks 16 and 52 using the Eczema Area and Severity Index (EASI). Treatment response was defined as the percent reduction in EASI score vs the baseline score (eg, EASI 90 indicated a 90% reduction) and as an absolute EASI cutoff score of 7 or lower (controlled AD). Adverse effects were recorded during the first year. At 16 weeks, dupilumab serum levels and treatment responses were measured and analyzed. Multivariate logistic regression modeling was used to determine the prediction of response (EASI 90; EASI ≤7) and adverse effects at 52 weeks, with serum dupilumab levels at 16 weeks in the presence of the covariates age and sex. Results Among the total of 295 patients with AD (mean [SD] age, 41.5 [15.9] years; 170 [57.6%] men), the median (IQR [range]) drug level was 86.6 μg/mL (64.6-110.0 μg/mL [10.1-382.0 μg/mL]) at 16 weeks of treatment. No significant differences were found in serum dupilumab levels between responder statuses (EASI, <50, 50, 75, or 90) at week 16. Multivariate logistic regression analysis showed nonsignificant odds ratios (ORs) for serum dupilumab levels at 16 weeks regarding prediction of long-term response (EASI ≥90: OR, 0.96 [95% CI, 0.90-1.04; P = .34] and EASI ≤7: OR, 1.03 [95% CI, 0.93-1.14; P = .55]) and adverse effects (OR, 1.01 [95% CI, 0.95-1.07; P = .83]). Conclusion and Relevance This prospective clinical cohort study found a broad range of serum dupilumab levels at 16 weeks of treatment and no association with treatment response and adverse effects during first year of treatment. Response may be dependent on target availability of the interleukin-4 receptor subunit α, with an interpatient variability producing heterogeneity in response.
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Affiliation(s)
- Lotte S. Spekhorst
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marlies de Graaf
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris Loeff
- Sanquin Diagnostic Services, Sanquin, Amsterdam, the Netherlands
| | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daphne Bakker
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Celeste M. Boesjes
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Judith Thijs
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roselie Achten
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, Division of Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marjolein S. de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
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17
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Ghaznawi R, Rissanen I, de Bresser J, Kuijf HJ, Zuithoff NPA, Hendrikse J, Geerlings MI. Carotid Artery Stenosis and Progression of Hemispheric Brain Atrophy: The SMART-MR Study. Cerebrovasc Dis 2022; 52:226-233. [PMID: 36096114 DOI: 10.1159/000526261] [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: 12/30/2021] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION It has been hypothesized that carotid artery stenosis (CAS) may lead to greater atrophy of subserved brain regions; however, prospective studies on the impact of CAS on progression of hemispheric brain atrophy are lacking. We examined the association between CAS and progression of hemispheric brain atrophy. METHODS We included 654 patients (57 ± 9 years) of the SMART-MR study, a prospective cohort study of patients with manifest arterial disease. Patients had baseline CAS duplex measurements and a 1.5T brain MRI at baseline and after 4 years of follow-up. Mean change in hemispheric brain volumes (% of intracranial volume [ICV]) was estimated between baseline and follow-up for left-sided and right-sided CAS across three degrees of stenosis (mild [≤29%], moderate [30-69%], and severe [≥70%]), adjusting for demographics, cerebrovascular risk factors, and brain infarcts. RESULTS Mean decrease in left and right hemispheric brain volumes was 1.15% ICV and 0.82% ICV, respectively, over 4 years of follow-up. Severe right-sided CAS, compared to mild CAS, was associated with a greater decrease in volume of the left hemisphere (B = -0.49% ICV, 95% CI: -0.86 to -0.13) and more profoundly of the right hemisphere (B = -0.90% ICV, 95% CI: -1.27 to -0.54). This pattern was independent of cerebrovascular risk factors, brain infarcts, and white matter hyperintensities on MRI, and was also observed when accounting for the presence of severe bilateral CAS. Increasing degrees of left-sided CAS, however, was not associated with greater volume loss of the left or right hemisphere. CONCLUSIONS Our data indicate that severe (≥70%) CAS could represent a risk factor for greater ipsilateral brain volume loss, independent of cerebrovascular risk factors, brain infarcts, or white matter hyperintensities on MRI. Further longitudinal studies in other cohorts are warranted to confirm this novel finding.
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Affiliation(s)
- Rashid Ghaznawi
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands,
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
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18
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Spekhorst LS, de Graaf M, Zuithoff NPA, van den Reek JMPA, Kamsteeg M, Boesjes CM, Romeijn GLE, Loman L, Haeck I, Oosting AJ, de Boer-Brand A, Touwslager WRH, Flinterman A, van Lynden-van Nes AMT, Gostynski AH, de Bruin-Weller MS, Schuttelaar ML. Dupilumab Drug Survival and Associated Predictors in Patients With Moderate to Severe Atopic Dermatitis: Long-term Results From the Daily Practice BioDay Registry. JAMA Dermatol 2022; 158:1048-1056. [PMID: 35947364 PMCID: PMC9366658 DOI: 10.1001/jamadermatol.2022.3014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/03/2022] [Indexed: 11/14/2022]
Abstract
Importance Long-term data on dupilumab drug survival in patients with atopic dermatitis (AD) are scarce. Furthermore, little is known about the factors associated with drug survival of dupilumab in AD. Objective To describe the drug survival of dupilumab in patients with AD and to identify associated predictors. Design, Setting, and Participants This cohort study was based on data from the multicenter prospective daily practice BioDay registry, in which 4 university and 10 nonuniversity hospitals in the Netherlands participated. Analysis included patients (age ≥18 years) participating in the BioDay registry with a follow-up of at least 4 weeks. The first patient treated with dupilumab was recorded in the BioDay registry in October 2017; data lock took place in December 2020, and data analysis was performed from October 2017 to December 2020. Main Outcomes and Measures Drug survival was analyzed by Kaplan-Meier survival curves and associated characteristics by using univariate and multivariate Cox regression analysis. Results A total of 715 adult patients with AD (mean [SD] age, 41.8 [16.0] years; 418 [58.5%] were male) were included with a 1-year, 2-year, and 3-year overall dupilumab drug survival of 90.3%, 85.9%, and 78.6%, respectively. Characteristics associated with shorter drug survival owing to ineffectiveness were the use of immunosuppressant drugs at baseline (hazard ratio [HR], 2.64; 95% CI, 1.10-6.37) and being a nonresponder at 4 weeks (HR, 8.68; 95% CI, 2.97-25.35). Characteristics associated with shorter drug survival owing to adverse effects were the use of immunosuppressant drugs at baseline (HR, 2.69; 95% CI, 1.32-5.48), age 65 years or older (HR, 2.94; 95% CI, 1.10-7.87), and Investigator Global Assessment score of very severe AD (HR, 3.51; 95% CI, 1.20-10.28). Conclusions and Relevance This cohort study demonstrated a good overall 1-year, 2-year, and 3-year dupilumab drug survival. Patients using immunosuppressive therapy at baseline and those with an absence of treatment effect at week 4 tended to discontinue treatment owing to ineffectiveness more frequently. Using immunosuppressant drugs at baseline, older age, and Investigator Global Assessment score of very severe AD were characteristics associated with an increased risk for discontinuation owing to adverse effects. These data provide more insight and new perspectives regarding dupilumab treatment in AD and can contribute to the optimization of patient outcomes.
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Affiliation(s)
- Lotte S. Spekhorst
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marlies de Graaf
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Marijke Kamsteeg
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Celeste M. Boesjes
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Inge Haeck
- Department of Dermatology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Albert J. Oosting
- Department of Dermatology, Spaarnegasthuis, Haarlem, the Netherlands
| | | | | | | | | | - Antoni H. Gostynski
- Department of Dermatology, University Medical Center Maastricht, Maastricht, the Netherlands
| | - Marjolein S. de Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
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19
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Meijs TA, Muller SA, Minderhoud SCS, de Winter RJ, Mulder BJM, van Melle JP, Hoendermis ES, van Dijk APJ, Zuithoff NPA, Krings GJ, Doevendans PA, Spiering W, Witsenburg M, Roos-Hesselink JW, van den Bosch AE, Bouma BJ, Voskuil M. Hypertensive response to exercise in adult patients with repaired aortic coarctation. Heart 2022; 108:1121-1128. [PMID: 34987066 DOI: 10.1136/heartjnl-2021-320333] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/30/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The clinical and prognostic implications of a hypertensive response to exercise after repair of coarctation of the aorta (CoA) remain controversial. We aimed to determine the prevalence of a hypertensive response to exercise, identify factors associated with peak exercise systolic blood pressure (SBP) and explore the association of peak exercise SBP with resting blood pressure and cardiovascular events during follow-up. METHODS From the Dutch national CONgenital CORvitia (CONCOR) registry, adults with repaired CoA who underwent exercise stress testing were included. A hypertensive response to exercise was defined as a peak exercise SBP ≥210 mm Hg in men and ≥190 mm Hg in women. Cardiovascular events consisted of coronary artery disease, stroke, aortic complications and cardiovascular death. RESULTS Of the original cohort of 920 adults with repaired CoA, 675 patients (median age 24 years (range 16-72 years)) underwent exercise stress testing. Of these, 299 patients (44%) had a hypertensive response to exercise. Mean follow-up duration was 10.1 years. Male sex, absence of a bicuspid aortic valve and elevated resting SBP were independently associated with increased peak exercise SBP. Peak exercise SBP was positively predictive of office SBP (β=0.11, p<0.001) and 24-hour SBP (β=0.05, p=0.03) at follow-up, despite correction for baseline SBP. During follow-up, 100 patients (15%) developed at least 1 cardiovascular event. Peak exercise SBP was not significantly associated with the occurrence of cardiovascular events (HR 0.994 (95% CI 0.987 to 1.001), p=0.11). CONCLUSIONS A hypertensive response to exercise was present in nearly half of the patients in this large, prospective cohort of adults with repaired CoA. Risk factors for increased peak exercise SBP were male sex, absence of a bicuspid aortic valve and elevated resting SBP. Increased peak exercise SBP independently predicted hypertension at follow-up. These results support close follow-up of patients with a hypertensive response to exercise to ensure timely diagnosis and treatment of future hypertension.
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Affiliation(s)
- Timion A Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands .,Department of Cardiology, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | - Steven A Muller
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Robbert J de Winter
- Department of Cardiology, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | - Joost P van Melle
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Elke S Hoendermis
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nicolaas P A Zuithoff
- Department of Epidemiology and Biostatistics, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Gregor J Krings
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Central Military Hospital, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maarten Witsenburg
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | - Berto J Bouma
- Department of Cardiology, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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20
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Achten RE, Bakker DS, van Luijk CM, van der Wal M, de Graaf M, van Wijk F, Zuithoff NPA, van der Rijst LP, Boesjes CM, Thijs JL, de Boer JH, de Bruin-Weller MS. Ocular surface disease is common in moderate-to-severe atopic dermatitis patients. Clin Exp Allergy 2022; 52:801-805. [PMID: 35294787 PMCID: PMC9313815 DOI: 10.1111/cea.14127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Roselie E Achten
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daphne S Bakker
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chantal M van Luijk
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marlot van der Wal
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marlies de Graaf
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa P van der Rijst
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Celeste M Boesjes
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith L Thijs
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein S de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Verkouteren DRC, de Sonnaville WFC, Zuithoff NPA, Wulffraat NM, Steenks MH, Rosenberg AJWP. Growth curves for mandibular range of motion and maximum voluntary bite force in healthy children. Eur J Oral Sci 2022; 130:e12869. [PMID: 35482417 PMCID: PMC9321901 DOI: 10.1111/eos.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
Mandibular range of motion and bite force are indispensable variables for the evaluation of mandibular function. There are a variety of medical and dental conditions that can negatively affect mandibular function. Values for mandibular range of motion (i.e., active and passive maximum interincisal mouth opening, protrusion, and laterotrusion) and anterior maximum voluntary bite force (AMVBF) in healthy children and adolescents can help in recognizing temporomandibular dysfunction. In this longitudinal study, 169 healthy children aged 6-18 years were included. They were examined at four time points over 1 year. Mixed model analysis was performed to produce growth curves of mandibular range of motion and AMVBF. Average active maximum interincisal mouth opening was significantly higher in boys with 50.0 mm compared to 47.8 mm in girls. Boys also had a significantly higher AMVBF than girls with an average of 169.0 N versus 140.0 N, respectively. Growth curves of active and passive maximum interincisal mouth opening showed an increase with age, albeit levelling off through puberty. The growth curves of AMVBF in girls reach a plateau phase at ages 12-14 years, after which the curve descends; in boys, the AMVBF tended to increase up to 18 years of age, although a slow-down after 14 years of age was noted.
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Affiliation(s)
- Daan R C Verkouteren
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Willemijn F C de Sonnaville
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michel H Steenks
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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22
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Sanders ARJ, de Wit NJ, Zuithoff NPA, van Dulmen S. The effect of shared decision-making on recovery from non-chronic aspecific low back pain in primary care; a post-hoc analysis from the patient, physician and observer perspectives. BMC Prim Care 2022; 23:22. [PMID: 35172742 PMCID: PMC8809011 DOI: 10.1186/s12875-022-01624-y] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/15/2021] [Indexed: 12/02/2022]
Abstract
Background Although shared decision-making (SDM) is increasingly accepted in healthcare and has demonstrated merits for several psychological outcomes, the effect on recovery from somatic conditions is still subject to debate. The objective of this study is to measure the effect of SDM on recovery from non-chronic aspecific low back pain (LBP). Methods This study is a post-hoc analysis of data from a cluster-randomised trial that evaluated the effectiveness of SDM on recovery in patients with non-chronic aspecific LBP. In this analysis, we re-evaluate the impact of SDM from three perspectives: that of external observers, participating GPs and participating patients. Recovery was measured with the Visual Analogue Scale (VAS) for pain and with the Roland Morris Disability questionnaire (RMD) and defined as a VAS < 30 and an RMD < 4. Logistic regression was used to analyse the effect of SDM on recovery at 6 and 26 weeks. Results At 26 weeks, 105 (74%) of all 176 included patients had recovered. No significant effect of SDM on recovery at 6 or 26 weeks after the consultation was found when considering SDM from an observer perspective or a patient perspective. From a GP perspective SDM had a significant effect on recovery, but at 26 weeks only, and with the lowest probability of recovery observed at a medium level of GP-perceived SDM. Conclusions We found no evidence that SDM as perceived by the patient or by external observation improves recovery from non-chronic aspecific low back pain. The long-term recovery may be better for patients in whom the GP perceives SDM during their consultations. Further research should highlight the hierarchy and the relation between the perspectives, which is needed to come to an integral effect evaluation of SDM. Trial registration The Netherlands National Trial Register (NTR) number: NTR1960. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01624-y.
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Affiliation(s)
- Ariëtte R J Sanders
- Julius centre for health sciences and primary care, University medical centre Utrecht, P.O. box 85500, 3508, GA, Utrecht, the Netherlands.
| | - Niek J de Wit
- Julius centre for health sciences and primary care, University medical centre Utrecht, P.O. box 85500, 3508, GA, Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius centre for health sciences and primary care, University medical centre Utrecht, P.O. box 85500, 3508, GA, Utrecht, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), P.O. Box 1568, 3500, BN, Utrecht, the Netherlands.,Department of primary and community care, Radboud university edical center, Radboud institute for health sciences, Nijmegen, The Netherlands
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23
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Groen VH, van Schie M, Zuithoff NPA, Monninkhof EM, Kunze-Busch M, de Boer JCJ, van der Voort van Zijp J, Pos FJ, Smeenk RJ, Haustermans K, Isebaert S, Draulans C, Depuydt T, Verkooijen HM, van der Heide UA, Kerkmeijer LGW. Urethral and bladder dose-effect relations for late genitourinary toxicity following external beam radiotherapy for prostate cancer in the FLAME trial. Radiother Oncol 2021; 167:127-132. [PMID: 34968470 DOI: 10.1016/j.radonc.2021.12.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE or objectives The FLAME trial (NCT01168479) showed that by adding a focal boost to conventional fractionated EBRT in the treatment of localized prostate cancer, the five-year biochemical disease-free survival increased, without significantly increasing toxicity. The aim of the present study was to investigate the association between radiation dose to the bladder and urethra and genitourinary (GU) toxicity grade ≥2 in the entire cohort. MATERIAL AND METHODS The dose-effect relations of the urethra and bladder dose, separately, and GU toxicity grade ≥2 (CTCAE 3.0) up to five years after treatment were assessed. A mixed model analysis for repeated measurements was used, adjusting for age, diabetes mellitus, T-stage, baseline GU toxicity grade ≥1 and institute. Additionally, the association between the dose and separate GU toxicity subdomains were investigated. RESULTS Dose-effect relations were observed for the dose (Gy) to the bladder D2cm3 and urethra D0.1cm3, with adjusted odds ratios of 1.14 (95% CI 1.12-1.16, p<0.0001) and 1.12 (95% CI 1.11-1.14, p<0.0001), respectively. Additionally, associations between the dose to the urethra and bladder and the subdomains urinary frequency, urinary retention and urinary incontinence were observed. CONCLUSION Further increasing the dose to the bladder and urethra will result in a significant increase in GU toxicity following EBRT. Focal boost treatment plans should incorporate a urethral dose-constraint. Further treatment optimization to increase the focal boost dose without increasing the dose to the urethra and other organs at risk should be a focus for future research, as we have shown that a focal boost is beneficial in the treatment of prostate cancer.
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Affiliation(s)
- Veerle H Groen
- University Medical Center Utrecht, Radiation Oncology, Utrecht, The Netherlands
| | - Marcel van Schie
- The Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands
| | - Nicolaas P A Zuithoff
- University Medical Center, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Evelyn M Monninkhof
- University Medical Center, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Martina Kunze-Busch
- Radboud University Medical Center, Radiation Oncology, Nijmegen, The Netherlands
| | | | | | - Floris J Pos
- The Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands
| | - Robert Jan Smeenk
- Radboud University Medical Center, Radiation Oncology, Nijmegen, The Netherlands
| | | | - Sofie Isebaert
- University Hospitals Leuven, Radiation Oncology, Leuven, Belgium
| | - Cédric Draulans
- University Hospitals Leuven, Radiation Oncology, Leuven, Belgium
| | - Tom Depuydt
- University Hospitals Leuven, Radiation Oncology, Leuven, Belgium
| | | | | | - Linda G W Kerkmeijer
- University Medical Center Utrecht, Radiation Oncology, Utrecht, The Netherlands; Radboud University Medical Center, Radiation Oncology, Nijmegen, The Netherlands.
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24
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Meijs TA, Minderhoud SCS, Muller SA, de Winter RJ, Mulder BJM, van Melle JP, Hoendermis ES, van Dijk APJ, Zuithoff NPA, Krings GJ, Doevendans PA, Witsenburg M, Roos‐Hesselink JW, van den Bosch AE, Bouma BJ, Voskuil M. Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation. J Am Heart Assoc 2021; 10:e023199. [PMID: 34755532 PMCID: PMC8751912 DOI: 10.1161/jaha.121.023199] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background The long-term burden of cardiovascular disease after repair of coarctation of the aorta (CoA) has not been elucidated. We aimed to determine the incidence of and risk factors for cardiovascular events in adult patients with repaired CoA. Additionally, mortality rates were compared between adults with repaired CoA and the general population. Methods and Results Using the Dutch Congenital Corvitia (CONCOR) registry, patients aged ≥16 years with previous surgical or transcatheter CoA repair from 5 tertiary referral centers were included. Cardiovascular events were recorded, comprising coronary artery disease, stroke/transient ischemic attack, aortic complications, arrhythmias, heart failure hospitalizations, endocarditis, and cardiovascular death. In total, 920 patients (median age, 24 years [range 16-74 years]) were included. After a mean follow-up of 9.3±5.1 years, 191 patients (21%) experienced at least 1 cardiovascular event. A total of 270 cardiovascular events occurred, of which aortic complications and arrhythmias were most frequent. Older age at initial CoA repair (hazard ratio [HR], 1.017; 95% CI, 1.000-1.033 [P=0.048]) and elevated left ventricular mass index (HR, 1.009; 95% CI, 1.005-1.013 [P<0.001]) were independently associated with an increased risk of cardiovascular events. The mortality rate was 3.3 times higher than expected based on an age- and sex-matched cohort from the Dutch general population (standardized mortality ratio, 3.3; 95% CI, 2.3-4.4 [P<0.001]). Conclusions This large, prospective cohort of adults with repaired CoA showed a high burden of cardiovascular events, particularly aortic complications and arrhythmias, during long-term follow-up. Older age at initial CoA repair and elevated left ventricular mass index were independent risk factors for the occurrence of cardiovascular events. Mortality was 3.3-fold higher compared with the general population. These results advocate stringent follow-up after CoA repair and emphasize the need for improved preventive strategies.
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Affiliation(s)
- Timion A. Meijs
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Steven A. Muller
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Robbert J. de Winter
- Department of CardiologyAmsterdam UMC, Location Academic Medical CenterAmsterdamThe Netherlands
| | - Barbara J. M. Mulder
- Department of CardiologyAmsterdam UMC, Location Academic Medical CenterAmsterdamThe Netherlands
| | - Joost P. van Melle
- Department of CardiologyUniversity Medical Center GroningenGroningenThe Netherlands
| | - Elke S. Hoendermis
- Department of CardiologyUniversity Medical Center GroningenGroningenThe Netherlands
| | - Arie P. J. van Dijk
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Nicolaas P. A. Zuithoff
- Department of Epidemiology and BiostatisticsJulius Center for Health Sciences and Primary CareUtrechtThe Netherlands
| | - Gregor J. Krings
- Department of Pediatric CardiologyWilhelmina Children’s HospitalUtrechtThe Netherlands
| | - Pieter A. Doevendans
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands,Department of CardiologyCentral Military HospitalUtrechtThe Netherlands,Netherlands Heart InstituteUtrechtThe Netherlands
| | | | | | | | - Berto J. Bouma
- Department of CardiologyAmsterdam UMC, Location Academic Medical CenterAmsterdamThe Netherlands
| | - Michiel Voskuil
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
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25
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Versteeg JPM, Thijs KM, Zuithoff NPA, Backx FJG, Huisstede BMA. Hamstring‐and‐lower‐back flexibility is not related to hamstring‐and‐lower‐back injuries in elite female soccer players. Translational Sports Med 2021. [DOI: 10.1002/tsm2.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Joyce P. M. Versteeg
- Department of Rehabilitation, Physical Therapy Science & Sports University Medical Center Utrecht Brain Center Utrecht University Utrecht The Netherlands
| | - Karin M. Thijs
- Department of Rehabilitation, Physical Therapy Science & Sports University Medical Center Utrecht Brain Center Utrecht University Utrecht The Netherlands
- Sports Medical Centre FIFA Medical Center Royal Netherlands Football Association Zeist The Netherlands
| | | | - Frank J. G. Backx
- Department of Rehabilitation, Physical Therapy Science & Sports University Medical Center Utrecht Brain Center Utrecht University Utrecht The Netherlands
| | - Bionka M. A. Huisstede
- Department of Rehabilitation, Physical Therapy Science & Sports University Medical Center Utrecht Brain Center Utrecht University Utrecht The Netherlands
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26
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Hartman EAR, Groen WG, Heltveit-Olsen SR, Lindbaek M, Hoye S, Sundvall PD, Gunnarsson R, Skoglund I, Snaebjörnsson Arnljots E, Godycki-Cwirko M, Kowalczyk A, Platteel TN, Zuithoff NPA, Monnier AA, Verheij TJM, Hertogh CMPM, van de Pol AC. Multifaceted antibiotic stewardship intervention using a participatory-action-research approach to improve antibiotic prescribing for urinary tract infections in frail elderly (ImpresU): study protocol for a European qualitative study followed by a pragmatic cluster randomised controlled trial. BMJ Open 2021; 11:e052552. [PMID: 34620666 PMCID: PMC8499316 DOI: 10.1136/bmjopen-2021-052552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Almost 60% of antibiotics in frail elderly are prescribed for alleged urinary tract infections (UTIs). A substantial part of this comprises prescriptions in case of non-specific symptoms or asymptomatic bacteriuria, for which the latest guidelines promote restrictiveness with antibiotics. We aim to reduce inappropriate antibiotic use for UTIs through an antibiotic stewardship intervention (ASI) that encourages to prescribe according to these guidelines. To develop an effective ASI, we first need a better understanding of the complex decision-making process concerning suspected UTIs in frail elderly. Moreover, the implementation approach requires tailoring to the heterogeneous elderly care setting. METHODS AND ANALYSIS First, we conduct a qualitative study to explore factors contributing to antibiotic prescribing for UTIs in frail elderly, using semi-structured interviews with general practitioners, nursing staff, patients and informal caregivers. Next, we perform a pragmatic cluster randomised controlled trial in elderly care organisations. A multifaceted ASI is implemented in the intervention group; the control group receives care as usual. The ASI is centred around a decision tool that promotes restrictive antibiotic use, supported by a toolbox with educational materials. For the implementation, we use a modified participatory-action-research approach, guided by the results of the qualitative study. The primary outcome is the number of antibiotic prescriptions for suspected UTIs. We aim to recruit 34 clusters with in total 680 frail elderly residents ≥70 years. Data collection takes place during a 5-month baseline period and a 7-month follow-up period. Finally, we perform a process evaluation. The study has been delayed for 6 months due to COVID-19 and is expected to end in July 2021. ETHICS AND DISSEMINATION Ethical approvals and/or waivers were obtained from the ethical committees in Poland, the Netherlands, Norway and Sweden. The results will be disseminated through publication in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT03970356.
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Affiliation(s)
- Esther A R Hartman
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wim G Groen
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Silje Rebekka Heltveit-Olsen
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten Lindbaek
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sigurd Hoye
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Pär-Daniel Sundvall
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Ronny Gunnarsson
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Ingmarie Skoglund
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Egill Snaebjörnsson Arnljots
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Maciej Godycki-Cwirko
- Centre for Family and Community Medicine, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland
| | - Anna Kowalczyk
- Centre for Family and Community Medicine, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland
| | - Tamara N Platteel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Annelie A Monnier
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Theo J M Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alma C van de Pol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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27
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van der Kamp LT, Rinkel GJE, Verbaan D, van den Berg R, Vandertop WP, Murayama Y, Ishibashi T, Lindgren A, Koivisto T, Teo M, St George J, Agid R, Radovanovic I, Moroi J, Igase K, van den Wijngaard IR, Rahi M, Rinne J, Kuhmonen J, Boogaarts HD, Wong GKC, Abrigo JM, Morita A, Shiokawa Y, Hackenberg KAM, Etminan N, van der Schaaf IC, Zuithoff NPA, Vergouwen MDI. Risk of Rupture After Intracranial Aneurysm Growth. JAMA Neurol 2021; 78:1228-1235. [PMID: 34459846 DOI: 10.1001/jamaneurol.2021.2915] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Unruptured intracranial aneurysms not undergoing preventive endovascular or neurosurgical treatment are often monitored radiologically to detect aneurysm growth, which is associated with an increase in risk of rupture. However, the absolute risk of aneurysm rupture after detection of growth remains unclear. Objective To determine the absolute risk of rupture of an aneurysm after detection of growth during follow-up and to develop a prediction model for rupture. Design, Setting, and Participants Individual patient data were obtained from 15 international cohorts. Patients 18 years and older who had follow-up imaging for at least 1 untreated unruptured intracranial aneurysm with growth detected at follow-up imaging and with 1 day or longer of follow-up after growth were included. Fusiform or arteriovenous malformation-related aneurysms were excluded. Of the 5166 eligible patients who had follow-up imaging for intracranial aneurysms, 4827 were excluded because no aneurysm growth was detected, and 27 were excluded because they had less than 1 day follow-up after detection of growth. Exposures All included aneurysms had growth, defined as 1 mm or greater increase in 1 direction at follow-up imaging. Main Outcomes and Measures The primary outcome was aneurysm rupture. The absolute risk of rupture was measured with the Kaplan-Meier estimate at 3 time points (6 months, 1 year, and 2 years) after initial growth. Cox proportional hazards regression was used to identify predictors of rupture after growth detection. Results A total of 312 patients were included (223 [71%] were women; mean [SD] age, 61 [12] years) with 329 aneurysms with growth. During 864 aneurysm-years of follow-up, 25 (7.6%) of these aneurysms ruptured. The absolute risk of rupture after growth was 2.9% (95% CI, 0.9-4.9) at 6 months, 4.3% (95% CI, 1.9-6.7) at 1 year, and 6.0% (95% CI, 2.9-9.1) at 2 years. In multivariable analyses, predictors of rupture were size (7 mm or larger hazard ratio, 3.1; 95% CI, 1.4-7.2), shape (irregular hazard ratio, 2.9; 95% CI, 1.3-6.5), and site (middle cerebral artery hazard ratio, 3.6; 95% CI, 0.8-16.3; anterior cerebral artery, posterior communicating artery, or posterior circulation hazard ratio, 2.8; 95% CI, 0.6-13.0). In the triple-S (size, site, shape) prediction model, the 1-year risk of rupture ranged from 2.1% to 10.6%. Conclusion and Relevance Within 1 year after growth detection, rupture occurred in approximately 1 of 25 aneurysms. The triple-S risk prediction model can be used to estimate absolute risk of rupture for the initial period after detection of growth.
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Affiliation(s)
- Laura T van der Kamp
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - René van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Yuichi Murayama
- Department of Neurosurgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Antti Lindgren
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Mario Teo
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, United Kingdom
| | - Jerome St George
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, United Kingdom
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging and Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neuroradiology, Joint Department of Medical Imaging and Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Junta Moroi
- Department of Surgical Neurology, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Keiji Igase
- Department of Advanced Neurosurgery, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan
| | | | - Melissa Rahi
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Jaakko Rinne
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Johanna Kuhmonen
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - George K C Wong
- Department of Surgery, Prince of Wales Hospital, Hong Kong, China
| | - Jill M Abrigo
- Department of Imaging and Interventional Radiology, Basement, Yue Kong Pao Centre for Cancer and the Lady Pao Children's Cancer Centre, Prince of Wales Hospital, Hong Kong, China
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | | | - Katharina A M Hackenberg
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Irene C van der Schaaf
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
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28
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Brons M, Rutten FH, Zuithoff NPA, Oerlemans MIFJ, Asselbergs FW, Koudstaal S. Disease management with home telemonitoring aimed at substitution of usual care in the Netherlands: Post-hoc analyses of the e-Vita HF study. J Cardiol 2021; 79:1-5. [PMID: 34454810 DOI: 10.1016/j.jjcc.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Home telemonitoring in heart failure (HF) patients may reduce workload of HF nurses by reducing face-to-face contacts. The aim of this study is to assess whether telemonitoring as a substitution could have negative effects as expressed by less reduction in circulating natriuretic peptide levels between baseline and one-year of follow up compared to usual care. METHODS A post-hoc analysis of the e-Vita HF trial, a three-arm parallel randomized trial conducted in stable HF patients. Patients were randomized into three arms: (i) usual HF outpatient care, (ii) usual care combined with the use of the website heartfailurematters.org, and (iii) telemonitoring (e-Vita HF platform) instead of face-to-face consultations. Mixed linear model analyses were applied to assess differences in the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels between the three arms over a year. RESULTS A total of 223 participants could be included (mean age 67.1 ± 10.1 years, 27% women, New York Heart Association class I-IV; 39%, 38%, 14%, and 9%). The mean left ventricular ejection fraction was 35 ± 10%. The median of routine face-to-face contacts over a year was 1.0 lower (2.0 vs. 3.0) in the third arm compared with usual care. Median NT-proBNP levels did not significantly differ between the three arms. CONCLUSION In stable and optimally treated HF patients, telemonitoring causing a reduction of routine face-to-face contacts seems not to negatively affect hemodynamic status as measured by NT-proBNP levels over time.
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Affiliation(s)
- Maaike Brons
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, P.O. Box 85500, Utrecht, GA 3508, the Netherlands.
| | - Frans H Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marish I F J Oerlemans
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, P.O. Box 85500, Utrecht, GA 3508, the Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, P.O. Box 85500, Utrecht, GA 3508, the Netherlands; Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, UK; Institute of Health Informatics, University College London, London, UK
| | - Stefan Koudstaal
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, P.O. Box 85500, Utrecht, GA 3508, the Netherlands
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de Sonnaville WFC, Speksnijder CM, Zuithoff NPA, Verkouteren DRC, Wulffraat NW, Steenks MH, Rosenberg AJWP. Mandibular range of motion in children with juvenile idiopathic arthritis with and without clinically established temporomandibular joint involvement and in healthy children; a cross-sectional study. Pediatr Rheumatol Online J 2021; 19:106. [PMID: 34217306 PMCID: PMC8254997 DOI: 10.1186/s12969-021-00583-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/08/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Recognition of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA) has gained increasing attention in the past decade. The clinical assessment of mandibular range of motion characteristics is part of the recommended variables to detect TMJ involvement in children with JIA. The aim of this study was to explore explanatory variables for mandibular range of motion outcomes in children with JIA, with and without clinically established TMJ involvement, and in healthy children. METHODS This cross-sectional study included children with JIA and healthy children of age 6-18 years. Mandibular range of motion variables included active and passive maximum interincisal opening (AMIO and PMIO), protrusion, laterotrusion, dental midline shift in AMIO and in protrusion. Additionally, the TMJ screening protocol and palpation pain were assessed. Adjusted linear regression analyses of AMIO, PMIO, protrusion, and laterotrusion were performed to evaluate the explanatory factors. Two adjusted models were constructed: model 1 to compare children with JIA and healthy children, and model 2 to compare children with JIA with and without TMJ involvement. RESULTS A total of 298 children with JIA and 169 healthy children were included. Length was an explanatory variable for the mandibular range of motion excursions. Each centimeter increase in length increased AMIO (0.14 mm), PMIO (0.14 mm), and protrusion (0.02 mm). Male gender increased AMIO by 1.35 mm. Having JIA negatively influenced AMIO (3.57 mm), PMIO (3.71 mm), and protrusion (1.03 mm) compared with healthy children, while the discrepancy between left and right laterotrusion raised 0.68 mm. Children with JIA and TMJ involvement had a 8.27 mm lower AMIO, 7.68 mm lower PMIO and 0.96 mm higher discrepancy in left and right laterotrusion compared to healthy children. CONCLUSION All mandibular range of motion items were restricted in children with JIA compared with healthy children. In children with JIA and TMJ involvement, AMIO, PMIO and the discrepancy between left and right laterotrusion were impaired more severely. The limitation in protrusion and laterotrusion was hardly clinically relevant. Overall, AMIO is the mandibular range of motion variable with the highest restriction (in millimeters) in children with JIA and clinically established TMJ involvement compared to healthy children.
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Affiliation(s)
- Willemijn F. C. de Sonnaville
- grid.5477.10000000120346234Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, PO Box 85500, The Netherlands
| | - Caroline M. Speksnijder
- grid.5477.10000000120346234Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, PO Box 85500, The Netherlands
| | - Nicolaas P. A. Zuithoff
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daan R. C. Verkouteren
- grid.5477.10000000120346234Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, PO Box 85500, The Netherlands
| | - Nico W. Wulffraat
- grid.5477.10000000120346234Department of Pediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michel H. Steenks
- grid.5477.10000000120346234Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, PO Box 85500, The Netherlands
| | - Antoine J. W. P. Rosenberg
- grid.5477.10000000120346234Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, PO Box 85500, The Netherlands
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Sprengers JJ, van Andel DM, Zuithoff NPA, Keijzer-Veen MG, Schulp AJA, Scheepers FE, Lilien MR, Oranje B, Bruining H. Bumetanide for Core Symptoms of Autism Spectrum Disorder (BAMBI): A Single Center, Double-Blinded, Participant-Randomized, Placebo-Controlled, Phase-2 Superiority Trial. J Am Acad Child Adolesc Psychiatry 2021; 60:865-876. [PMID: 32730977 DOI: 10.1016/j.jaac.2020.07.888] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [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: 01/07/2020] [Revised: 06/28/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Recent trials have indicated positive effects of bumetanide in autism spectrum disorder (ASD). We tested efficacy of bumetanide on core symptom domains using a single center, parallel-group, participant-randomized, double-blind, placebo-controlled phase-2 superiority trial in a tertiary hospital in the Netherlands. METHOD Unmedicated children aged 7 to 15 years with ASD and IQ ≥55 were block-randomized 1:1 to oral-solution bumetanide versus placebo, titrated to a maximum of 1.0 mg twice daily for 91 days (D91), followed by a 28-day wash-out period. The primary outcome was difference in Social Responsiveness Scale-2 (SRS-2) total score at D91, analyzed by modified intention-to-treat with linear mixed models. RESULTS A total of 92 participants (mean age 10.5 [SD 2.4] years) enrolled between June 2016 and December 2018. In all, 47 children were allocated to bumetanide and 45 to placebo. Two participants dropped out per treatment arm. After 91 days, bumetanide was not superior to placebo on the primary outcome, the SRS-2 (mean difference -3.16, 95% CI = -9.68 to 3.37, p = .338). A superior effect was found on one of the secondary outcomes, the Repetitive Behavior Scale-Revised (mean difference -4.16, 95% CI = -8.06 to -0.25, p = .0375), but not on the Sensory Profile (mean difference 5.64, 95% CI = -11.30 to 22.57, p = .508) or the Aberrant Behavior Checklist Irritability Subscale (mean difference -0.65, 95% CI = -2.83 to 1.52, p = .552). No significant wash-out effect was observed. Significant adverse effects were predominantly diuretic effects (orthostatic hypotension (17 [36%] versus 5 [11%], p = .007); hypokalemia (24 [51%] versus 0 [0%], p < .0001), the occurrence of which did not statistically influence treatment outcome. CONCLUSION The trial outcome was negative in terms of no superior effect on the primary outcome. The secondary outcomes suggest efficacy on repetitive behavior symptoms for a subset of patients. CLINICAL TRIAL REGISTRATION INFORMATION Bumetanide in Autism Medication and Biomarker Study (BAMBI); https://www.clinicaltrialsregister.eu/; 2014-001560-35.
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Affiliation(s)
- Jan J Sprengers
- UMC Utrecht Brain Centre, University Medical Centre Utrecht, the Netherlands
| | - Dorinde M van Andel
- UMC Utrecht Brain Centre, University Medical Centre Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| | - Mandy G Keijzer-Veen
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, the Netherlands
| | - Annelien J A Schulp
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, the Netherlands
| | | | - Marc R Lilien
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, the Netherlands
| | - Bob Oranje
- UMC Utrecht Brain Centre, University Medical Centre Utrecht, the Netherlands
| | - Hilgo Bruining
- UMC Utrecht Brain Centre, University Medical Centre Utrecht, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, N=You centre, Amsterdam Neuroscience, Amsterdam Reproduction and Development, the Netherlands.
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Groen VH, Zuithoff NPA, van Schie M, Monninkhof EM, Kunze-Busch M, de Boer HCJ, van der Voort van Zyp J, Pos FJ, Smeenk RJ, Haustermans K, Isebaert S, Draulans C, Depuydt T, Verkooijen HM, van der Heide UA, Kerkmeijer LGW. Anorectal dose-effect relations for late gastrointestinal toxicity following external beam radiotherapy for prostate cancer in the FLAME trial. Radiother Oncol 2021; 162:98-104. [PMID: 34214614 DOI: 10.1016/j.radonc.2021.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The phase III FLAME trial (NCT01168479) showed an increase in five-year biochemical disease-free survival, with no significant increase in toxicity when adding a focal boost to external beam radiotherapy (EBRT) for localized prostate cancer [Kerkmeijer et al. JCO 2021]. The aim of this study was to investigate the association between delivered radiation dose to the anorectum and gastrointestinal (GI) toxicity (grade ≥2). MATERIAL AND METHODS All patients in the FLAME trial were analyzed, irrespective of treatment arm. The dose-effect relation of the anorectal dose parameters (D2cm3 and D50%) and GI toxicity grade ≥2 in four years of follow-up was assessed using a mixed model analysis for repeated measurements, adjusted for age, cardiovascular disease, diabetes mellitus, T-stage, baseline toxicity grade ≥1, hormonal therapy and institute. RESULTS A dose-effect relation for D2cm3 and D50% was observed with adjusted odds ratios of 1.17 (95% CI 1.13-1.21, p < 0.0001) and 1.20 (95% CI 1.14-1.25, p < 0.0001) for GI toxicity, respectively. CONCLUSION Although there was no difference in toxicity between study arms, a higher radiation dose to the anorectum was associated with a statistically significant increase in GI toxicity following EBRT for prostate cancer. This dose-effect relation was present for both large and small anorectal volumes. Therefore, further increase in dose to the anorectum should be weighed against the benefit of focal dose escalation for prostate cancer.
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Affiliation(s)
- Veerle H Groen
- University Medical Center Utrecht, Radiation Oncology, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, The Netherlands
| | - Marcel van Schie
- The Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, The Netherlands
| | - Martina Kunze-Busch
- Radboud University Medical Centre, Radiation Oncology, Nijmegen, The Netherlands
| | - Hans C J de Boer
- University Medical Center Utrecht, Radiation Oncology, The Netherlands
| | | | - Floris J Pos
- The Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands
| | - Robert Jan Smeenk
- Radboud University Medical Centre, Radiation Oncology, Nijmegen, The Netherlands
| | | | - Sofie Isebaert
- University Hospitals Leuven, Radiation Oncology, Belgium
| | | | - Tom Depuydt
- University Hospitals Leuven, Radiation Oncology, Belgium
| | | | | | - Linda G W Kerkmeijer
- University Medical Center Utrecht, Radiation Oncology, The Netherlands; Radboud University Medical Centre, Radiation Oncology, Nijmegen, The Netherlands.
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de Sonnaville WFC, Speksnijder CM, Zuithoff NPA, Verkouteren DRC, Wulffraat NW, Steenks MH, Rosenberg AJWP. Maximum bite force in children with juvenile idiopathic arthritis with and without clinical established temporomandibular joint involvement and in healthy children: a cross-sectional study. J Oral Rehabil 2021; 48:774-784. [PMID: 33780558 PMCID: PMC8251949 DOI: 10.1111/joor.13172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/27/2021] [Indexed: 12/14/2022]
Abstract
Background In children with juvenile idiopathic arthritis (JIA), the temporomandibular joint (TMJ) can be involved, resulting in dysfunction of the masticatory system. Bite force is one of the variables that reflects the function of the masticatory system. The aim of this study was to compare maximum bite force in children with JIA, with and without TMJ involvement and with healthy children. Methods Children with JIA and healthy children between the ages 6 and 18 were included in this cross‐sectional study. The clinical examination consisted of measuring the anterior maximum voluntary bite force (AMVBF), assessment of the TMJ screening protocol items and TMJ, masseter and temporal muscle palpation pain. Unadjusted linear regression analyses were performed to evaluate the explanatory factors for AMVBF. Two adjusted models were constructed with corrections for age and gender differences: model 1 to compare children with JIA and healthy children and model 2 to compare children with JIA with and without TMJ involvement. Results In this cross‐sectional study, 298 children with JIA and 169 healthy children participated. AMVBF was 24 Newton (N) lower in children with JIA, when compared with healthy children (95%CI: −35.5–−12.4, p = .000). When children with JIA also had clinically established TMJ involvement, AMVBF was reduced 42 N (component JIA:−16.78, 95% CI −28.96–−4.59, p = .007 and component TMJ involvement:−25.36, 95% CI −40.08–−10.63, p = .001). Age and male gender increased AMVBF. Conclusion Children with JIA had a reduction in the AMVBF compared with healthy children. In children with JIA and clinically established TMJ involvement, AMVBF was more reduced.
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Affiliation(s)
- Willemijn F C de Sonnaville
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daan R C Verkouteren
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nico W Wulffraat
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michel H Steenks
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Slot EMH, van Baarsen KM, Hoving EW, Zuithoff NPA, van Doormaal TPC. Cerebrospinal fluid leakage after cranial surgery in the pediatric population-a systematic review and meta-analysis. Childs Nerv Syst 2021; 37:1439-1447. [PMID: 33538867 PMCID: PMC8084768 DOI: 10.1007/s00381-021-05036-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/01/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage is a common complication after neurosurgical intervention. It is associated with substantial morbidity and increased healthcare costs. The current systematic review and meta-analysis aim to quantify the incidence of cerebrospinal fluid leakage in the pediatric population and identify its risk factors. METHODS The authors followed the PRISMA guidelines. The Embase, PubMed, and Cochrane database were searched for studies reporting CSF leakage after intradural cranial surgery in patients up to 18 years old. Meta-analysis of incidences was performed using a generalized linear mixed model. RESULTS Twenty-six articles were included in this systematic review. Data were retrieved of 2929 patients who underwent a total of 3034 intradural cranial surgeries. Surprisingly, only four of the included articles reported their definition of CSF leakage. The overall CSF leakage rate was 4.4% (95% CI 2.6 to 7.3%). The odds of CSF leakage were significantly greater for craniectomy as opposed to craniotomy (OR 4.7, 95% CI 1.7 to 13.4) and infratentorial as opposed to supratentorial surgery (OR 5.9, 95% CI 1.7 to 20.6). The odds of CSF leakage were significantly lower for duraplasty use versus no duraplasty (OR 0.41 95% CI 0.2 to 0.9). CONCLUSION The overall CSF leakage rate after intradural cranial surgery in the pediatric population is 4.4%. Risk factors are craniectomy and infratentorial surgery. Duraplasty use is negatively associated with CSF leak. We suggest defining a CSF leak as "leakage of CSF through the skin," as an unambiguous definition is fundamental for future research.
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Affiliation(s)
- Emma M. H. Slot
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kirsten M. van Baarsen
- Department of Neuro-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Eelco W. Hoving
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands ,Department of Neuro-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tristan P. C van Doormaal
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands ,Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
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Kodan LR, Verschueren KJC, Prüst ZD, Zuithoff NPA, Rijken MJ, Browne JL, Klipstein-Grobusch K, Bloemenkamp KWM, Grunberg AW. Postpartum hemorrhage in Suriname: A national descriptive study of hospital births and an audit of case management. PLoS One 2020; 15:e0244087. [PMID: 33338049 PMCID: PMC7748130 DOI: 10.1371/journal.pone.0244087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/03/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is the leading cause of direct maternal mortality globally and in Suriname. We aimed to study the prevalence, risk indicators, causes, and management of PPH to identify opportunities for PPH reduction. Methods A nationwide retrospective descriptive study of all hospital deliveries in Suriname in 2017 was performed. Logistic regression analysis was applied to identify risk indicators for PPH (≥ 500ml blood loss). Management of severe PPH (blood loss ≥1,000ml or ≥500ml with hypotension or at least three transfusions) was evaluated via a criteria-based audit using the national guideline. Results In 2017, the prevalence of PPH and severe PPH in Suriname was 9.2% (n = 808/8,747) and 2.5% (n = 220/8,747), respectively. PPH varied from 5.8% to 15.8% across the hospitals. Risk indicators associated with severe PPH included being of African descent (Maroon aOR 2.1[95%CI 1.3–3.3], Creole aOR 1.8[95%CI 1.1–3.0]), multiple pregnancy (aOR 3.4[95%CI 1.7–7.1]), delivery in Hospital D (aOR 2.4[95%CI 1.7–3.4]), cesarean section (aOR 3.9[95%CI 2.9–5.3]), stillbirth (aOR 6.4 [95%CI 3.4–12.2]), preterm birth (aOR 2.1[95%CI 1.3–3.2]), and macrosomia (aOR 2.8 [95%CI 1.5–5.0]). Uterine atony (56.7%, n = 102/180[missing 40]) and retained placenta (19.4%, n = 35/180[missing 40]), were the main causes of severe PPH. A criteria-based audit revealed that women with severe PPH received prophylactic oxytocin in 61.3% (n = 95/155[missing 65]), oxytocin treatment in 68.8% (n = 106/154[missing 66]), and tranexamic acid in 4.9% (n = 5/103[missing 117]). Conclusions PPH prevalence and risk indicators in Suriname were similar to international and regional reports. Inconsistent blood loss measurement, varied maternal and perinatal characteristics, and variable guideline adherence contributed to interhospital prevalence variation. PPH reduction in Suriname can be achieved through prevention by practicing active management of the third stage of labor in every birth and considering risk factors, early recognition by objective and consistent blood loss measurement, and prompt treatment by adequate administration of oxytocin and tranexamic acid according to national guidelines.
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Affiliation(s)
- Lachmi R. Kodan
- Department of Obstetrics and Gynecology, Academic Hospital Paramaribo, Paramaribo, Suriname, South Africa
- Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- * E-mail:
| | - Kim J. C. Verschueren
- Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Zita D. Prüst
- Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P. A. Zuithoff
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marcus J. Rijken
- Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joyce L. Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kitty W. M. Bloemenkamp
- Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Antoon W. Grunberg
- Board of Doctoral Graduations and Honorary Doctorate Awards, Anton de Kom University, Paramaribo, Suriname, South Africa
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Valk MJM, Hoes AW, Mosterd A, Landman MA, Zuithoff NPA, Broekhuizen BDL, Rutten FH. Training general practitioners to improve evidence-based drug treatment of patients with heart failure: a cluster randomised controlled trial. Neth Heart J 2020; 28:604-612. [PMID: 32997300 PMCID: PMC7596131 DOI: 10.1007/s12471-020-01487-x] [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] [Indexed: 12/27/2022] Open
Abstract
Aims To assess whether a single training session for general practitioners (GPs) improves the evidence-based drug treatment of heart failure (HF) patients, especially of those with HF with reduced ejection fraction (HFrEF). Methods and results A cluster randomised controlled trial was performed for which patients with established HF were eligible. Primary care practices (PCPs) were randomised to care-as-usual or to the intervention group in which GPs received a half-day training session on HF management. Changes in HF medication, health status, hospitalisation and survival were compared between the two groups. Fifteen PCPs with 200 HF patients were randomised to the intervention group and 15 PCPs with 198 HF patients to the control group. Mean age was 76.9 (SD 10.8) years; 52.5% were female. On average, the patients had been diagnosed with HF 3.0 (SD 3.0) years previously. In total, 204 had HFrEF and 194 HF with preserved ejection fraction (HFpEF). In participants with HFrEF, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers decreased in 6 months in both groups [5.2%; (95% confidence interval (CI) 2.0–10.0)] and 5.6% (95% CI 2.8–13.4)], respectively [baseline-corrected odds ratio (OR) 1.07 (95% CI 0.55–2.08)], while beta-blocker use increased in both groups by 5.2% (95% CI 2.0–10.0) and 1.1% (95% CI 0.2–6.3), respectively [baseline-corrected OR 0.82 (95% CI 0.42–1.61)]. For health status, hospitalisations or survival after 12–28 months there were no significant differences between the two groups, also not when separately analysed for HFrEF and HFpEF. Conclusion A half-day training session for GPs does not improve drug treatment of HF in patients with established HF. Electronic supplementary material The online version of this article (10.1007/s12471-020-01487-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J M Valk
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - A W Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Mosterd
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands
| | | | - N P A Zuithoff
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - B D L Broekhuizen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F H Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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Koopman I, Zuithoff NPA, Rinkel GJE, Vergouwen MDI. The course of cerebrospinal fluid parameters ≤ 20 days after aneurysmal subarachnoid hemorrhage. J Neurol Sci 2020; 415:116899. [PMID: 32480074 DOI: 10.1016/j.jns.2020.116899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/17/2020] [Accepted: 05/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) patients have an inflammatory response in the cerebrospinal fluid (CSF). We determined CSF cell counts, erythrocyte/leukocyte ratio, and glucose- and protein concentrations in patients ≤20 days after aSAH without bacterial meningitis. Such knowledge may help to interpret CSF parameters in patients with an external drain if nosocomial bacterial meningitis or ventriculitis is suspected. METHODS Patients with aSAH admitted between 2010 and 2017 with at least one CSF sample ≤ 20 days after ictus were included from a prospectively collected database. CSF samples were excluded if the patient used antibiotics or if the CSF culture was positive. We calculated estimated marginal means with 95% confidence intervals (CIs) with linear mixed models for CSF cell counts, glucose- and protein concentrations. RESULTS We included 209 patients with 306 CSF samples. Highest estimated median leukocyte count was 305 (95%CI:225-412) x10^6/L, and the lowest estimated median erythrocyte/leukocyte ratio was 109 (95%CI:73-163). Estimated mean glucose concentrations remained within the normal range. The estimated median protein concentration decreased from 3.3 g/L (95%CI:2.5-4.2) on day 0 to 1.0 g/L (95%CI:0.8-1.2) on day 14. CONCLUSION The limits we found for the inflammatory reaction in aSAH patients may help physicians to interpret CSF parameters in aSAH patients with an external CSF drain. Future studies are needed to compare CSF parameters in aSAH patients with and without bacterial meningitis or ventriculitis.
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Affiliation(s)
- Inez Koopman
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
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37
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Mueller-Schotte S, Zuithoff NPA, Van der Schouw YT, Schuurmans MJ, Bleijenberg N. Trends in Risk of Limitations in Instrumental Activities of Daily Living Over Age in Older Persons With and Without Multiple Chronic Conditions. J Gerontol A Biol Sci Med Sci 2020; 75:197-203. [PMID: 30772903 PMCID: PMC6909894 DOI: 10.1093/gerona/glz049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Indexed: 01/09/2023] Open
Abstract
Background To investigate trends over age by comorbidity status for the risk of limitations in individual activities of daily living for community-living older persons. Methods A longitudinal population-based study was conducted in 9,319 community-living Dutch persons aged 60 years and older. Self-reported multiple chronic conditions (MCC) and nine instrumental activities of daily livings (IADLs) were assessed in 15 studies of the Dutch National Care for the Elderly Program (TOPICS-MDS). Risks of limitations in IADLs, odds ratios (per 5 years), and rate ratios (per 5 years) were calculated with mixed logistic and negative binomial regression models with age as the underlying timescale, stratified by number of MCC (no, 1–2, ≥ 3 MCC), and corrected for confounders. Results At inclusion, the number of IADL limitations was highest for the “≥3 MCC” group (2.00 interquartile range [1.00–4.00]) and equal for “no MCC” or “1–2 MCC” (1.00 interquartile range [0.00–2.00]). Trends of individual IADLs depicted a higher risk in IADL limitation with increasing age over 2 years of follow-up, except for handling finances for the “no MCC” group. The longitudinal age effect on IADL limitations varied subject to MCC, being strongest for the “no MCC” group for most IADLs; grooming and telephone use were almost unaltered by age and MCC. Conclusion We observed a decline in IADL functioning with increasing age over 2 years of follow-up in persons with and without MCC. The impact of MCC on IADL decline varied per IADL activity.
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Affiliation(s)
- Sigrid Mueller-Schotte
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht).,Department for the Chronically Ill, University of Applied Sciences Utrecht, The Netherlands.,Department of Optometry and Orthoptics, University of Applied Sciences Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht)
| | - Yvonne T Van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht)
| | - Marieke J Schuurmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht).,Department for the Chronically Ill, University of Applied Sciences Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht).,Department for the Chronically Ill, University of Applied Sciences Utrecht, The Netherlands
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38
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Klein Nulent TJW, Valstar MH, Smit LA, Smeele LE, Zuithoff NPA, de Keizer B, de Bree R, van Es RJJ, Willems SM. Prostate-specific membrane antigen (PSMA) expression in adenoid cystic carcinoma of the head and neck. BMC Cancer 2020; 20:519. [PMID: 32503460 PMCID: PMC7275445 DOI: 10.1186/s12885-020-06847-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Treatment options for advanced head and neck adenoid cystic carcinoma (AdCC) are limited. Prostate-Specific Membrane Antigen (PSMA), a transmembrane protein that is known for its use in diagnostics and targeted therapy in prostate cancer, is also expressed by AdCC. This study aimed to analyse PSMA expression in a large cohort of primary, recurrent and metastasized AdCC of the head and neck. METHODS One hundred ten consecutive patients with histologically confirmed AdCC in the period 1990-2017 were included. An analysis was made of clinical details, revised pathology and semiquantitative immunohistochemical expression of PSMA on tissue microarray and whole slides. Associations of PSMA expression with clinicopathological parameters were explored and survival was analysed by multivariate Cox-proportional Hazard analysis. RESULTS PSMA expression was present in 94% of the 110 primary tumours, with a median of 31% positive cells (IQR 15-60%). Primary tumours (n = 18) that recurred (n = 15) and/or had metastases (n = 10) demonstrated 40, 60 and 23% expression respectively. Expression was not independently related to increased pathological stage, tumour grade, and the occurrence of locoregional recurrence or metastasis. After dichotomization, only primary tumour PSMA expression ≤10% appeared to be associated with reduced 10-years recurrence-free survival (HR 3.0, 95% CI 1.1-8.5, p = .04). CONCLUSIONS PSMA is highly expressed in primary, recurrent and metastatic AdCC of the salivary and seromucous glands. PSMA expression has no value in predicting clinical behaviour of AdCC although low expression may indicate a reduced recurrence-free survival. This study provides supporting results to consider using PSMA as target for imaging and therapy when other diagnostic and palliative treatment options fail.
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Affiliation(s)
- Thomas J W Klein Nulent
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, Utrecht, 3508, GA, The Netherlands.
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Matthijs H Valstar
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laura A Smit
- Department of Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Ludwig E Smeele
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, Utrecht, 3508, GA, The Netherlands
| | - Robert J J van Es
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, Utrecht, 3508, GA, The Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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Geersing GJ, Hendriksen JMT, Zuithoff NPA, Roes KC, Oudega R, Takada T, Schutgens REG, Moons KGM. Effect of tailoring anticoagulant treatment duration by applying a recurrence risk prediction model in patients with venous thromboembolism compared to usual care: A randomized controlled trial. PLoS Med 2020; 17:e1003142. [PMID: 32589630 PMCID: PMC7319277 DOI: 10.1371/journal.pmed.1003142] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with unprovoked (i.e., without the presence of apparent transient risk factors such as recent surgery) venous thromboembolism (VTE) are at risk of recurrence if anticoagulants are stopped after 3-6 months, yet their risk remains heterogeneous. Thus, prolonging anticoagulant treatment should be considered in high-risk patients, whereas stopping is likely preferred in those with a low predicted risk. The Vienna Prediction Model (VPM) could aid clinicians in estimating this risk, yet its clinical effects and external validity are currently unknown. The aim of this study was to investigate the clinical impact of this model on reducing recurrence risk in patients with unprovoked VTE, compared to usual care. METHODS AND FINDINGS In a randomized controlled trial, the decision to prolong or stop anticoagulant treatment was guided by predicted recurrence risk using the VPM (n = 441), which was compared with usual care (n = 442). Patients with unprovoked VTE were recruited from local thrombosis services in the Netherlands (in Utrecht, Harderwijk, Ede, Amersfoort, Zwolle, Hilversum, Rotterdam, Deventer, and Enschede) between 22 July 2011 and 30 November 2015, with 24-month follow-up complete for all patients by early 2018. The primary outcome was recurrent VTE during 24 months of follow-up. Secondary outcomes included major bleeding and clinically relevant non-major (CRNM) bleeding. In the total study population of 883 patients, mean age was 55 years, and 507 (57.4%) were men. A total of 96 recurrent VTE events (10.9%) were observed, 46 in the intervention arm and 50 in the control arm (risk ratio 0.92, 95% CI 0.63-1.35, p = 0.67). Major bleeding occurred in 4 patients, 2 in each treatment arm, whereas CRNM bleeding occurred in 20 patients (12 in intervention arm versus 8 in control arm). The VPM showed good discriminative power (c-statistic 0.76, 95% CI 0.69-0.83) and moderate to good calibration, notably at the lower spectrum of predicted risk. For instance, in 284 patients with a predicted risk of >2% to 4%, the observed rate of recurrence was 2.5% (95% CI 0.7% to 4.3%). The main limitation of this study is that it did not enroll the preplanned number of 750 patients in each study arm due to declining recruitment rate. CONCLUSIONS Our results show that application of the VPM in all patients with unprovoked VTE is unlikely to reduce overall recurrence risk. Yet, in those with a low predicted risk of recurrence, the observed rate was also low, suggesting that it might be safe to stop anticoagulant treatment in these patients. TRIAL REGISTRATION Netherlands Trial Register NTR2680.
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Affiliation(s)
- Geert-Jan Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- * E-mail:
| | - Janneke M. T. Hendriksen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Kit C. Roes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Biostatistics Research Group, Department of Health Evidence, Radboud University Medical Center, Radboud University, Nijmegen, the Netherlands
| | - Ruud Oudega
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roger E. G. Schutgens
- Van Creveld Clinic, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karel G. M. Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Vissers LET, Soedamah-Muthu SS, van der Schouw YT, Zuithoff NPA, Geleijnse JM, Sluijs I. Consumption of a diet high in dairy leads to higher 15:0 in cholesteryl esters of healthy people when compared to diets high in meat and grain. Nutr Metab Cardiovasc Dis 2020; 30:804-809. [PMID: 32139254 DOI: 10.1016/j.numecd.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS A higher dairy product intake has been associated to higher blood concentrations of 15:0 (pentadecanoic acid), 17:0 (margaric acid), and 14:0 (myristic acid). This study investigates whether a diet high in dairy products influences cholesteryl ester fatty acid concentrations of these specific fatty acids (FA). METHODS AND RESULTS In a randomized multiple cross-over study, 13 men and 17 women aged 22 ± 4 years with a BMI of 21.6 ± 2.2 kg/m2 received 3 isocaloric intervention diets (dairy, meat or grain) in random order. For this post-hoc analysis, FA in plasma cholesteryl esters were measured using gas chromatography. We performed a linear mixed model per centered log-ratio transformed FA, adjusting for period, and the interaction between diet and period. Consumed total fat intake per controlled intervention diet was 31.0 ± 0.9 en%/day (dairy), 31.5 ± 0.6 en%/day (meat), and 28.4 ± 1.2 en%/day (grain), respectively. The dairy diet led to higher relative concentrations of 15:0 when compared to diets high in meat and grain, (β; 0.27, 95%CI: 0.18,0.37; p = 1.2 × 10-5, and β: 0.15; 95%CI: 0.06,0.24; p = 1.2 × 10-2, respectively). The dairy diet also led to higher 14:0 when compared to the meat diet (β: 0.34; 95%CI: 0.21,0.46; p = 6.0 × 10-5), but not when compared to the grain diet. 17:0 did not differ between diets. CONCLUSION The plasma cholesteryl ester fraction after a diet high in dairy was characterized by higher 15:0 levels. Concentrations of 14:0 were only higher when comparing the FA profile after a diet high in dairy when compared to a diet high in meat. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01314040.
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Affiliation(s)
- Linda E T Vissers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Sabita S Soedamah-Muthu
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands; Center of Research on Psychological and Somatic Disorders (CORPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands; Institute for Food, Nutrition and Health, University of Reading, Reading, UK
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Ivonne Sluijs
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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Rotteveel AH, Lambooij MS, Zuithoff NPA, van Exel J, Moons KGM, de Wit GA. Valuing Healthcare Goods and Services: A Systematic Review and Meta-Analysis on the WTA-WTP Disparity. Pharmacoeconomics 2020; 38:443-458. [PMID: 32096146 DOI: 10.1007/s40273-020-00890-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The objective of this systematic review was to review the available evidence on the disparity between willingness to accept (WTA) and willingness to pay (WTP) for healthcare goods and services. METHODS A tiered approach consisting of (1) a systematic review, (2) an aggregate data meta-analysis, and (3) an individual participant data meta-analysis was used. MEDLINE, EMBASE, Scopus, Scisearch, and Econlit were searched for articles reporting both WTA and WTP for healthcare goods and services. Individual participant data were requested from the authors of the included studies. RESULTS Thirteen papers, reporting WTA and WTP from 19 experiments/subgroups, were included in the review. The WTA/WTP ratios reported in these papers, varied from 0.60 to 4.01, with means of 1.73 (median 1.31) for 15 estimates of the mean and 1.58 (median 1.00) for nine estimates of the median. Individual data obtained from six papers, covering 71.2% of the subjects included in the review, yielded an unadjusted WTA/WTP ratio of 1.86 (95% confidence interval 1.52-2.28) and a WTA/WTP ratio adjusted for age, sex, and income of 1.70 (95% confidence interval 1.42-2.02). Income category and age had a statistically significant effect on the WTA/WTP ratio. The approach to handling zero WTA and WTP values has a considerable impact on the WTA/WTP ratio found. CONCLUSIONS AND IMPLICATIONS The results of this study imply that losses in healthcare goods and services are valued differently from gains (ratio > 1), but that the degree of disparity found depends on the method used to obtain the WTA/WTP ratio, including the approach to zero responses. Irrespective of the method used, the ratios found in our meta-analysis are smaller than the ratios found in previous meta-analyses.
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Affiliation(s)
- Adriënne H Rotteveel
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Mattijs S Lambooij
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Ardine de Wit
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Housseine N, Punt MC, Mohamed AG, Said SM, Maaløe N, Zuithoff NPA, Meguid T, Franx A, Grobbee DE, Browne JL, Rijken MJ. Quality of intrapartum care: direct observations in a low-resource tertiary hospital. Reprod Health 2020; 17:36. [PMID: 32171296 PMCID: PMC7071714 DOI: 10.1186/s12978-020-0849-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 03/25/2019] [Accepted: 01/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background The majority of the world’s perinatal deaths occur in low- and middle-income countries. A substantial proportion occurs intrapartum and is avoidable with better care. At a low-resource tertiary hospital, this study assessed the quality of intrapartum care and adherence to locally-tailored clinical guidelines. Methods A non-participatory, structured, direct observation study was held at Mnazi Mmoja Hospital, Zanzibar, Tanzania, between October and November 2016. Women in active labour were followed and structure, processes of labour care and outcomes of care systematically recorded. Descriptive analyses were performed on the labour observations and compared to local guidelines and supplemented by qualitative findings. A Poisson regression analysis assessed factors affecting foetal heart rate monitoring (FHRM) guidelines adherence. Results 161 labouring women were observed. The nurse/midwife-to-labouring-women ratio of 1:4, resulted in doctors providing a significant part of intrapartum monitoring. Care during labour and two-thirds of deliveries was provided in a one-room labour ward with shared beds. Screening for privacy and communication of examination findings were done in 50 and 34%, respectively. For the majority, there was delayed recognition of labour progress and insufficient support in second stage of labour. While FHRM was generally performed suboptimally with a median interval of 105 (interquartile range 57–160) minutes, occurrence of an intrapartum risk event (non-reassuring FHR, oxytocin use or poor progress) increased assessment frequency significantly (rate ratio 1.32 (CI 1.09–1.58)). Conclusions Neither international nor locally-adapted standards of intrapartum routine care were optimally achieved. This was most likely due to a grossly inadequate capacity of birth attendants; without whom innovative interventions at birth are unlikely to succeed. This calls for international and local stakeholders to address the root causes of unsafe intrafacility care in low-resource settings, including the number of skilled birth attendants required for safe and respectful births.
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Affiliation(s)
- Natasha Housseine
- Division Woman and Baby, University Medical Centre Utrecht, Utrecht, Netherlands. .,Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost nr. STR 6.131, P.O. Box 85500, 3508, Utrecht, Netherlands. .,Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania.
| | - Marieke C Punt
- Division Woman and Baby, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Ali Gharib Mohamed
- School of Health and Medical Science, State University of Zanzibar (SUZA), Zanzibar, Tanzania
| | - Said Mzee Said
- School of Health and Medical Science, State University of Zanzibar (SUZA), Zanzibar, Tanzania
| | - Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nicolaas P A Zuithoff
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost nr. STR 6.131, P.O. Box 85500, 3508, Utrecht, Netherlands
| | - Tarek Meguid
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania.,School of Health and Medical Science, State University of Zanzibar (SUZA), Zanzibar, Tanzania
| | - Arie Franx
- Division Woman and Baby, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Diederick E Grobbee
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost nr. STR 6.131, P.O. Box 85500, 3508, Utrecht, Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost nr. STR 6.131, P.O. Box 85500, 3508, Utrecht, Netherlands
| | - Marcus J Rijken
- Division Woman and Baby, University Medical Centre Utrecht, Utrecht, Netherlands.,Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost nr. STR 6.131, P.O. Box 85500, 3508, Utrecht, Netherlands
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43
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Jaarsma T, Klompstra L, Ben Gal T, Ben Avraham B, Boyne J, Bäck M, Chialà O, Dickstein K, Evangelista L, Hagenow A, Hoes AW, Hägglund E, Piepoli MF, Vellone E, Zuithoff NPA, Mårtensson J, Strömberg A. Effects of exergaming on exercise capacity in patients with heart failure: results of an international multicentre randomized controlled trial. Eur J Heart Fail 2020; 23:114-124. [PMID: 32167657 DOI: 10.1002/ejhf.1754] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Binyamin Ben Avraham
- Heart Failure Unit, Cardiology department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Division of Physiotherapy, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Oronzo Chialà
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Kenneth Dickstein
- University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | | | - Andreas Hagenow
- Center for Clinical Research Südbrandenburg, Elsterweda, Germany
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Eva Hägglund
- Department of Cardiology, Karolinska Theme of Heart and Vessel, Heart Failure, Karolinska University Hospital, Stockholm, Sweden
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza, Italy.,University of Parma, IT2 Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jan Mårtensson
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Division of Nursing, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
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44
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Klein Nulent TJW, van Es RJJ, Valstar MH, Smeele LE, Smit LA, Klein Gunnewiek R, Zuithoff NPA, de Keizer B, de Bree R, Willems SM. High CXCR4 expression in adenoid cystic carcinoma of the head and neck is associated with increased risk of locoregional recurrence. J Clin Pathol 2020; 73:476-482. [PMID: 31948995 DOI: 10.1136/jclinpath-2019-206273] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/30/2019] [Accepted: 12/16/2019] [Indexed: 01/05/2023]
Abstract
AIM Treatment options for head and neck adenoid cystic carcinoma (AdCC) are limited in advanced disease. Chemokine receptor type 4 (CXCR4) is present in various tumour types, including AdCC. Upregulation is associated with tumour recurrence and metastasis. New CXCR4-specific diagnostic and therapeutic target agents have recently been available. This study aimed to analyse CXCR4 expression in a cohort of primary head and neck AdCC. METHODS After histopathological revision, tumour tissues of 73 consecutive patients with AdCC over 1990-2016 were sampled on a tissue microarray. Slides were immunohistochemically stained for CXCR4 and semiquantitatively scored. Associations between protein expression and cliniopathological parameters were tested. HRs were calculated using a Cox proportional hazard model. RESULTS Sixty-six tumours could be analysed. CXCR4 expression was present in 81% of the tumours with a median of 29% (IQR 1-70) positive cells. Expression was univariately correlated to perineural growth (Spearman ρ .26, p=0.04) and bone invasion (Spearman ρ .32, p=0.01), but not with tumour grade.CXCR4 expression in the primary tumour was significantly higher in tumours that recurred as compared with those that did not recur (median 60%, IQR 33-72 vs 12%, IQR 1-70, Kruskal-Wallis p=0.01). After dichotomisation, >25% of CXCR4 expressions proved an independent prognosticator for a reduced recurrence-free survival (RFS) (HR 7.2, 95% CI 1.5 to 72.4, p=0.04). CONCLUSION CXCR4 is expressed in the majority of primary AdCCs and independently correlated to worse RFS, suggesting CXCR4 as a target for imaging and therapy purposes in patients with advanced AdCC.
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Affiliation(s)
- Thomas J W Klein Nulent
- Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands .,Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J van Es
- Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthijs H Valstar
- Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Oral and Maxillofacial Surgery, Amsterdam UMC Cancer Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Ludwig E Smeele
- Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Oral and Maxillofacial Surgery, Amsterdam UMC Cancer Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Laura A Smit
- Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart de Keizer
- Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Remco de Bree
- Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan M Willems
- Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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45
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Bourcier R, Lindgren A, Desal H, L'Allinec V, Januel AC, Koivisto T, Jääskeläinen JE, Slot EMH, Mensing L, Zuithoff NPA, Milot G, Algra A, Rinkel GJE, Ruigrok Y. Concordance in Aneurysm Size at Time of Rupture in Familial Intracranial Aneurysms. Stroke 2019; 50:504-506. [PMID: 30602357 DOI: 10.1161/strokeaha.118.021911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Intracranial aneurysm (IA) size and location are important determinants of aneurysm rupture risk. In familial IAs there is concordance of location; however, if such concordance exists for size is unknown. We analyzed the concordance of aneurysm size at time of rupture in familial IAs. Methods- In pairs of affected relatives with aneurysmal subarachnoid hemorrhage, the ratio between the largest and the smallest aneurysm size at time of rupture was calculated. We also compared the proportion of families in which both IAs ruptured at a size < or ≥7 mm with the proportion of families in which one IA ruptured at <7 mm and another ≥7 mm. We calculated the repeatability with corresponding 95% CI for aneurysm size at time of rupture. Results- About 130 patients from 64 families were included. Of the 68 affected pairs 18 (26%) had a ratio ≤1.2, 38 (57%) had a ratio >1.2, and 12 (17%) had a ratio ≥3. We found no difference between the proportion of families (n=31; 49%) who both had IA at time of rupture <7 mm (n=20; 31%) or both ≥7 mm (n=11; 18%) and the proportion of those families with one patient with an IA <7 mm and another with an IA ≥7 mm (n=33; 51%; P=0.86). Overall, the repeatability in aneurysm size at rupture within familial IAs was 0.10 (95% CI, 0-0.35). Conclusions- There is no good concordance in aneurysm size at rupture within familial IAs. These data suggest that size of a ruptured IA in a family member should not significantly impact on the management of a familial unruptured IA in a relative.
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Affiliation(s)
- Romain Bourcier
- From the INSERM, CNRS, Université de Nantes, l'institut du Thorax, France (R.B., H.D., V.L.).,Department of Neuroradiology, CHU Nantes, France (R.B., H.D., V.L.)
| | | | - Hubert Desal
- From the INSERM, CNRS, Université de Nantes, l'institut du Thorax, France (R.B., H.D., V.L.).,Department of Neuroradiology, CHU Nantes, France (R.B., H.D., V.L.)
| | - Vincent L'Allinec
- From the INSERM, CNRS, Université de Nantes, l'institut du Thorax, France (R.B., H.D., V.L.).,Department of Neuroradiology, CHU Nantes, France (R.B., H.D., V.L.)
| | - Anne Christine Januel
- Diagnostic and Interventional Neuroradiology, University Hospital, Toulouse, France (A.C.J.)
| | | | | | - Emma M H Slot
- Brain Center Rudolf Magnus, Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands (E.M.H.S., L.M., A.A., G.J.E.R., Y.R.)
| | - Liselore Mensing
- Brain Center Rudolf Magnus, Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands (E.M.H.S., L.M., A.A., G.J.E.R., Y.R.)
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands (N.P.A.Z., A.A.)
| | - Geneviève Milot
- Research Center of the Centre Hospitalier Universitaire, Quebec City, Canada (G.M.)
| | - Ale Algra
- Brain Center Rudolf Magnus, Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands (E.M.H.S., L.M., A.A., G.J.E.R., Y.R.).,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands (N.P.A.Z., A.A.)
| | - Gabriël J E Rinkel
- Brain Center Rudolf Magnus, Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands (E.M.H.S., L.M., A.A., G.J.E.R., Y.R.)
| | - Ynte Ruigrok
- Brain Center Rudolf Magnus, Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands (E.M.H.S., L.M., A.A., G.J.E.R., Y.R.)
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46
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Zijlstra WT, Os‐Medendorp H, Fieten KB, Sinnema G, Bruijnzeel‐Koomen CAFM, Zuithoff NPA, L'Hoir MP, Pasmans SGMA. Effects of shared medical appointments compared to individual appointments in children with atopic dermatitis: A pragmatic randomized controlled trial. Clin Exp Allergy 2019; 49:1095-1106. [DOI: 10.1111/cea.13416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Wieneke T. Zijlstra
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
- Department of Pediatrics OLVG Amsterdam Amsterdam The Netherlands
| | - Harmieke Os‐Medendorp
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
| | - Karin B. Fieten
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
| | - Gerben Sinnema
- Department of Pediatric Psychology and Social Work, Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht The Netherlands
| | | | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht The Netherlands
| | - Monique P. L'Hoir
- Human Nutrition Wageningen University & Research (WUR) Wageningen The Netherlands
| | - Suzanne G. M. A. Pasmans
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
- Department of Pediatric Dermatology, Sophia Children's Hospital Erasmus University Medical Centre Rotterdam The Netherlands
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47
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Dekker ARJ, Verheij TJM, Broekhuizen BDL, Butler CC, Cals JWL, Francis NA, Little P, Sanders EAM, Yardley L, Zuithoff NPA, van der Velden AW. Effectiveness of general practitioner online training and an information booklet for parents on antibiotic prescribing for children with respiratory tract infection in primary care: a cluster randomized controlled trial. J Antimicrob Chemother 2019; 73:1416-1422. [PMID: 29438547 DOI: 10.1093/jac/dkx542] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/25/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives Antibiotics are too often prescribed in childhood respiratory tract infection (RTI), despite limited effectiveness, potential side effects and bacterial resistance. We aimed to reduce antibiotic prescribing for children with RTI by online training for general practitioners (GPs) and information for parents. Methods A pragmatic cluster randomized controlled trial in primary care. The intervention consisted of online training for GPs and an information booklet for parents. The primary outcome was the antibiotic prescription rate for children presenting with RTI symptoms, as registered by GPs. Secondary outcomes were number of reconsultations within the same disease episode, consultations for new episodes, hospital referrals and pharmacy-dispensed antibiotic courses for children. This trial was registered at the Dutch Trial Register (NTR), registration number: NTR4240. Results After randomization, GPs from a total of 32 general practices registered 1009 consultations. An antibiotic was prescribed in 21% of consultations in the intervention group, compared with 33% in the usual care group, controlled for baseline prescribing (rate ratio 0.65, 95% CI 0.46-0.91). The probability of reconsulting during the same RTI episode did not differ significantly between the intervention and control groups, and nor did the numbers of consultations for new episodes and hospital referrals. In the intervention group antibiotic dispensing was 32 courses per 1000 children/year lower than the control group, adjusted for baseline prescribing (rate ratio 0.78, 95% CI 0.66-0.92). The numbers and proportion of second-choice antibiotics did not differ significantly. Conclusions Concise, feasible, online GP training, with an information booklet for parents, showed a relevant reduction in antibiotic prescribing for children with RTI.
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Affiliation(s)
- Anne R J Dekker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Theo J M Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berna D L Broekhuizen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jochen W L Cals
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Nick A Francis
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Little
- Primary Care Medical Group, University of Southampton Medical School, Southampton, UK
| | - Elisabeth A M Sanders
- Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Lucy Yardley
- Academic Unit of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alike W van der Velden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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48
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Flik CE, Laan W, Zuithoff NPA, van Rood YR, Smout AJPM, Weusten BLAM, Whorwell PJ, de Wit NJ. Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 2019; 4:20-31. [DOI: 10.1016/s2468-1253(18)30310-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 12/15/2022]
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49
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Mueller-Schotte S, Zuithoff NPA, van der Schouw YT, Schuurmans MJ, Bleijenberg N. Trajectories of Limitations in Instrumental Activities of Daily Living in Frail Older Adults With Vision, Hearing, or Dual Sensory Loss. J Gerontol A Biol Sci Med Sci 2018; 74:936-942. [DOI: 10.1093/gerona/gly155] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 06/28/2018] [Indexed: 01/27/2023] Open
Affiliation(s)
- Sigrid Mueller-Schotte
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht
- Department for the Chronically Ill, The Netherlands
- Department of Optometry and Orthoptics, University of Applied Sciences Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht
| | | | - Marieke J Schuurmans
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht
- Department for the Chronically Ill, The Netherlands
| | - Nienke Bleijenberg
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht
- Department for the Chronically Ill, The Netherlands
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50
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Bayés-Genis A, Lanfear DE, de Ronde MWJ, Lupón J, Leenders JJ, Liu Z, Zuithoff NPA, Eijkemans MJC, Zamora E, De Antonio M, Zwinderman AH, Pinto-Sietsma SJ, Pinto YM. Prognostic value of circulating microRNAs on heart failure-related morbidity and mortality in two large diverse cohorts of general heart failure patients. Eur J Heart Fail 2017; 20:67-75. [PMID: 28949058 DOI: 10.1002/ejhf.984] [Citation(s) in RCA: 51] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/11/2022] Open
Abstract
AIMS Small studies suggested circulating microRNAs (miRNAs) as biomarkers for heart failure (HF). However, standardized approaches and quality assessment for measuring circulating miRNAs are not uniformly established, and most studies have been small, so that results are inconsistent. We used a standardized data handling protocol, optimized for circulating miRNA qPCRs to remove noise and used it to assess which circulating miRNAs robustly add prognostic information in patients with HF. METHODS AND RESULTS We measured 12 miRNAs in two independent cohorts totalling 2203 subjects. Cohort I (Barcelona) comprised 834 chronic HF patients. Cohort II (Detroit) comprised 1369 chronic HF patients. Each sample was measured in duplicate, and normalized to a very abundant and stable miRNA (miR-486-5p). We used a multistep algorithm to distinguish false amplification signals and thus classify each miRNA measurement as 'valid', 'undetectable' or 'invalid'. Higher levels of miR-1254 and miR-1306-5p were significantly associated with risk of the combined endpoint of all-cause mortality and HF hospitalization in both cohorts, with hazard ratios ranging from 1.11 to 1.21 per log increase (P-values 0.004 to 0.009). However, adding these miRNAs to established predictors (age, sex, haemoglobin, renal function, and NT-proBNP) did not further augment the c-statistic beyond 0.69 (cohort I) or 0.70 (cohort II). CONCLUSION We used a stringent quality assessment for miRNA testing, and were able to replicate the association of miR-1254 and miR-1306-5p with risk of death and HF hospitalization in HF patients of two independent cohorts. However, these two circulating miRNAs failed to improve prognostication over established predictors.
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Affiliation(s)
- Antoni Bayés-Genis
- Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David E Lanfear
- Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA
| | - Maurice W J de Ronde
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Josep Lupón
- Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Zhen Liu
- ACS Biomarker BV, Amsterdam, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marinus J C Eijkemans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabet Zamora
- Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta De Antonio
- Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sara-Joan Pinto-Sietsma
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yigal M Pinto
- ACS Biomarker BV, Amsterdam, The Netherlands.,Heart Failure Research Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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