Merel Kimman

University of Sydney, Sydney, New South Wales, Australia

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Publications (26)112.19 Total impact

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    ABSTRACT: BACKGROUND: This study assessed the extent to which individuals with surgically operable cancer in Southeast Asia experience financially catastrophic out-of-pocket costs, discontinuation of treatment, or death. METHODS: The ACTION study is a prospective, 8-country, cohort study of adult patients recruited consecutively with an initial diagnosis of cancer from public and private hospitals. Participants were interviewed at baseline and 3 months. In this paper, we identified 4,584 participants in whom surgery was indicated in initial treatment plans and assessed the following competing outcomes: death, financial catastrophe (out-of-pocket costs of >30% of annual household income), treatment discontinuation, and hospitalization without financial catastrophe incurred. We then analyzed a range of predictors using a multinomial regression model. RESULTS: Of the participants, 72% were female and 44% had health insurance at baseline. At 3 months, 31% of participants incurred financial catastrophe, 8% had died, 23% had discontinued treatment, and 38% were hospitalized but avoided financial catastrophe. Health insurance status was found to be associated with lower odds of treatment discontinuation (odds ratio [OR], 0.60; 95% CI, 0.47-0.77) relative to hospitalization without financial catastrophe. Women had greater odds of financial catastrophe than men (OR, 1.35; 95% CI, 1.05-1.74), whereas lower socioeconomic status (range of indicators) was generally found to be associated with higher odds of death, treatment discontinuation, and financial catastrophe. CONCLUSION: Priority should be given to measures such as programs to extend social health insurance to offset the out-of-pocket costs associated with surgery for cancer faced in particular by women, the uninsured, and individuals of low socioeconomic status in Southeast Asia.
    Surgery 06/2015; 57(6):971-82. DOI:10.1016/j.surg.2015.02.012. · 3.11 Impact Factor
  • Mark Woodward · Merel Kimman · Stephen Jan · Ait-Allah Mejri
    Asia-Pacific Journal of Clinical Oncology 12/2014; 10:43-43. · 1.06 Impact Factor
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    ABSTRACT: Nonadherence is a global problem undermining the cost-effectiveness of evidence-based medications. Aligning treatment choices with patient preferences may promote adherent behaviour: eliciting patient treatment preferences may help resolve the problem of nonadherence. As there is no reliable measure of nonadherent behaviour that can be used to derive preferences, stated-preference techniques offer a robust alternative. To understand patient preferences in medication nonadherence, we systematically appraised full-text English studies (from database inception to 24 February 2014) involving participants evaluating hypothetical scenarios to elicit preferences as an explicit means to understand medication nonadherence. Study characteristics (e.g. setting, disease, stated-preference method), attribute type and influence on choice were extracted. Seventeen full-text articles (4,456 patients) were included in the review, which reports stated-preference elicitation studies across a wide range of chronic and acute conditions. All studies were conducted in high-income settings. The influence of drug-related factors was predominant in patients' preferences for treatment. Patients preferred efficacious over safe medications except when considering the duration of therapy, but dosing and cost appeared more important when contemplating adherence. Patient characteristics, particularly medication experience, significantly influenced preferences. A disparity between stated preferences for treatment and adherence was reported. When using stated-preference techniques to understand nonadherence, this manuscript highlights that there is much room for methodological development. Studies outside of high-income settings are needed, particularly in relation to chronic diseases, for which nonadherence poses a substantial economic burden to health systems and patients. To inform the problem of sustaining adherence, prospective research is needed to understand how preferences change with time. The usefulness of stated-preference techniques to inform policy and practice requires a better understanding of how stated preferences relate to actual adherence behaviour.
    The patient 11/2014; DOI:10.1007/s40271-014-0099-3 · 1.96 Impact Factor
  • Merel Kimman · Stephen Jan · Helen Monaghan · Mark Woodward
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    ABSTRACT: Purpose We investigate whether cancer patients’ economic characteristics are independent determinants of health-related quality of life (HRQoL) in low- and middle-income settings to identify priorities for health policy and research. Methods A cross-sectional survey of 9,513 cancer patients from Southeast Asia provided data on demographics, economic status and HRQoL. HRQoL was measured using the EORTC QLQ-C30 and EQ-5D. Information on cancer site and stage was collected using the patients’ medical records. Multiple linear regression analysis estimated the relative impact of economic characteristics (i.e. health insurance, employment status, household income and economic hardship) on HRQoL. Results All economic characteristics were significant independent determinants of HRQoL, when we controlled for demographic and clinical characteristics. Economic hardship was found to be most important. The adjusted mean differences in HRQoL scores between patients who had experienced economic hardship in the year before diagnosis compared to patients who did not were −5.6, −6.7, −7.3 and −0.06, respectively, for global health, physical function, emotional function and the EQ-5D index (all p values
    Quality of Life Research 10/2014; 24(4). DOI:10.1007/s11136-014-0828-z · 2.86 Impact Factor
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    ABSTRACT: To determine the nature, scope and effectiveness of interventions to reduce the household economic burden of illness or injury. We systematically reviewed reports published on or before 31 January 2014 that we found in the CENTRAL, CINAHL, Econlit, Embase, MEDLINE, PreMEDLINE and PsycINFO databases. We extracted data from prospective controlled trials and assessed the risk of bias. We narratively synthesized evidence. Nine of the 4330 studies checked met our inclusion criteria - seven had evaluated changes to existing health-insurance programmes and two had evaluated different modes of delivering information. The only interventions found to reduce out-of-pocket expenditure significantly were those that eliminated or substantially reduced co-payments for a given patient population. However, the reductions only represented marginal changes in the total expenditures of patients. We found no studies that had been effective in addressing broader household economic impacts - such as catastrophic health expenditure - in the disease populations investigated. In general, interventions designed to reduce the complex household economic burden of illness and injury appear to have had little impact on household economies. We only found a few relevant studies using rigorous study designs that were conducted in defined patient populations. The studies were limited in the range of interventions tested and they evaluated only a narrow range of household economic outcomes. There is a need for method development to advance the measurement of the household economic consequences of illness and injury and facilitate the development of innovative interventions to supplement the strategies based on health insurance.
    Bulletin of the World Health Organisation 01/2014; Accepted (19th Nov 2014)(2). DOI:10.2471/BLT.14.139287 · 5.11 Impact Factor
  • Australian and New Zealand Journal of Public Health 04/2013; 37(2):192-3. DOI:10.1111/1753-6405.12043 · 1.90 Impact Factor
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    ABSTRACT: The impact of the presence and awareness of individual health states on quality of life (HRQoL) is often documented. However, the impacts of different health states have rarely been compared amongst each other, whilst quality of life data from Asia are relatively sparse. We examined and compared the effects of different health states on quality of life in a Thai population. In 2008-2009, 5,915 corporate employees were invited to participate in a survey where HRQoL was measured by the Short Form 36 (SF-36) questionnaire. The adjusted mean SF-36 scores were calculated for each self-reported illness, number of chronic conditions, lifestyle factors and awareness of diabetes and hypertension. The effect sizes (ES) were compared using Cohen's d. The response rate was 82% and 4,683 (79.1%) had complete data available for analysis. Physical and Mental Component Summary (PCS and MCS) scores decreased as the number of chronic conditions increased monotonically (p<0.0001). Diabetes and hypertension negatively influenced PCS (mean score differences -0.6 and -1.5, p<0.001 respectively) but not MCS, whereas awareness of diabetes and hypertension negatively influenced MCS (-2.9 and -1.6, p<0.005 respectively) but not PCS. Arthritis had the largest ES on PCS (-0.37), while awareness of diabetes had the largest ES on MCS (-0.36). CVD moderately affected PCS and MCS (ES -0.34 and -0.27 respectively). Obesity had a negative effect on PCS (ES -0.27). Exercise positively affected PCS and MCS (ES +0.08 and +0.21 (p<0.01) respectively). Health promotion to reduce the prevalence of chronic diseases is important to improve the quality of life in Asian populations. Physical activity is an important part of such programs. Awareness of diseases may have greater impacts on mental health than having the disease itself. This has implications for the evaluation of the cost-benefit of screening and labeling of individuals with pre-disease states.
    PLoS ONE 11/2012; 7(11):e49921. DOI:10.1371/journal.pone.0049921 · 3.23 Impact Factor
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    ABSTRACT: PURPOSE: To assess the construct validity of the Thai EuroQoL (EQ-5D) among an occupational population in Thailand. METHODS: Data were derived from a large cohort study among employees of the Electricity Generating Authority of Thailand. In 2008 and 2009, 4,850 participants completed the Thai EQ-5D and Short-Form 36 version 2 (SF-36v2). Thai preferences weights were used to convert EQ-5D health states into EQ-5D index scores. Construct validity of the Thai EQ-5D was examined by specifying and testing hypotheses about the relationships between the EQ-5D, SF-36v2, and participants' demographic and medical characteristics. RESULTS: Construct validity of the Thai EQ-5D was supported by expected relationships with SF-36v2 scale and summary scores. For example, SF-36v2 scores on the mental health scale were much lower for participants who reported having problems on the EQ-5D anxiety/depression dimension compared to those reporting no problems (mean norm-based SF-36v2 scores: 52.9 vs. 41.8, p < 0.001). Additionally, reporting a problem in a given EQ-5D dimension was generally associated with lower SF-36v2 summary scores. The EQ-5D index score distinguished between groups of participants in the expected manner, on the basis of sex, age, education and self-reported health, thus providing evidence of known-groups validity. CONCLUSION: The study demonstrated good construct validity of the Thai EQ-5D in a large occupational population in Thailand.
    Quality of Life Research 08/2012; 22(6). DOI:10.1007/s11136-012-0251-2 · 2.86 Impact Factor
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    ABSTRACT: Customized care can be beneficial for patients when preferences for health care programs are heterogeneous. Yet, there is little guidance on how individual-specific preferences and cost data can be combined to inform health care decisions about customized care. Therefore, we propose a discrete choice experiment-based approach that illustrates how to analyze the cost-effectiveness of customized (and noncustomized) care programs to provide information for hospital managers. We exploit the fact that choice models make it possible to determine whether preference heterogeneity exists and to obtain individual-specific parameter estimates. We present an approach of how to combine these individual-specific parameter estimates from a random parameter model (mixed logit model) with cost data to analyze the cost-effectiveness of customized care and demonstrate our method in the case of follow-up after breast cancer treatment. We found that there is significant preference heterogeneity for all except two attributes of breast cancer treatment follow-up and that the fully customized care program leads to higher utility and lower costs than the current standardized program. Compared with the single alternative program, the fully customized care program has increased benefits and higher costs. Thus, it is necessary for health care decision makers to judge whether the use of resources for customized care is cost-effective. Decision makers should consider using the results obtained from our methodological approach when they consider implementing customized health care programs, because it may help to find ways to save costs and increase patient satisfaction.
    Value in Health 07/2012; 15(5):680-9. DOI:10.1016/j.jval.2012.04.007 · 2.89 Impact Factor
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    ABSTRACT: Research on radiation oncologists has indicated that there is a shortage in supply of specialist workers in this field internationally, and also within Australia. However, there are no current estimates as to what the future Australian radiotherapy workforce will look like. This paper aims to review the current status and capacity of the three main disciplines that make up the radiation oncology workforce in Australia and project the workforce supply and demand for 2014 and 2019. Using data on the workforce from a survey of all radiotherapy facilities operating in Australia in 2008 a workforce model was constructed. This study found that there will be a future shortfall of radiation oncologists, radiation therapists and radiation oncology medical physicists working in radiation oncology treatment. By 2014 there will be 109 fewer radiation oncologists than what will be demanded, and by 2019 this figure will increase to a shortfall of 155 radiation oncologists. There was a projected shortfall of 612 radiation therapists by 2014, with this figure slightly decreasing to a shortfall of 593 radiation therapists in 2019. In 2014, there was projected to be a deficit of 104 radiation oncology medical physicists with a persisting shortfall of 78 in 2019. This future projected shortage highlights the need for radiation oncology workforce planning.
    Asian Pacific journal of cancer prevention: APJCP 04/2012; 13(4):1159-66. DOI:10.7314/APJCP.2012.13.4.1159 · 2.51 Impact Factor
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    ABSTRACT: Cancer can be a major cause of poverty. This may be due either to the costs of treating and managing the illness as well as its impact upon people's ability to work. This is a concern that particularly affects countries that lack comprehensive social health insurance systems and other types of social safety nets. The ACTION study is a longitudinal cohort study of 10,000 hospital patients with a first time diagnosis of cancer. It aims to assess the impact of cancer on the economic circumstances of patients and their households, patients' quality of life, costs of treatment and survival. Patients will be followed throughout the first year after their cancer diagnosis, with interviews conducted at baseline (after diagnosis), three and 12 months. A cross-section of public and private hospitals as well as cancer centers across eight member countries of the Association of Southeast Asian Nations (ASEAN) will invite patients to participate. The primary outcome is incidence of financial catastrophe following treatment for cancer, defined as out-of-pocket health care expenditure at 12 months exceeding 30% of household income. Secondary outcomes include illness induced poverty, quality of life, psychological distress, economic hardship, survival and disease status. The findings can raise awareness of the extent of the cancer problem in South East Asia and its breadth in terms of its implications for households and the communities in which cancer patients live, identify priorities for further research and catalyze political action to put in place effective cancer control policies.
    Asian Pacific journal of cancer prevention: APJCP 02/2012; 13(2):421-5. DOI:10.7314/APJCP.2012.13.2.421 · 2.51 Impact Factor
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    ABSTRACT: This paper presents the most recent data on cancer rates and the burden of cancer in the ASEAN region. Epidemiological data were sourced from GLOBOCAN 2008 and disability adjusted life years (DALYs) lost were estimated using the standard methodology developed within the World Health Organization's Global Burden of Disease study. Overall, it was estimated there were over 700,000 new cases of cancer and 500,000 cancer deaths in ASEAN in the year 2008, leading to approximately 7.5 million DALYs lost in one year. The most commonly diagnosed cancers were lung (98,143), breast (86,842) and liver cancers (74,777). The most common causes of cancer death were lung cancer (85,772), liver cancer (69,115) and colorectal cancer (44,280). The burden of cancer in terms of DALYs lost was highest in Laos, Viet Nam and Myanmar and lowest in Brunei, Singapore and the Philippines. Significant differences in the patterns of cancer from country to country were observed. Another key finding was the major impact played by population age distribution on cancer incidence and mortality. Cancer rates in ASEAN are expected to increase with ageing of populations and changes in lifestyles associated with economic development. Therefore, ASEAN member countries are strongly encouraged to put in place cancer-control health care policies, focussed on strengthening the health systems to cope with projected increases in cancer prevention, treatment and management needs.
    Asian Pacific journal of cancer prevention: APJCP 02/2012; 13(2):411-20. DOI:10.7314/APJCP.2012.13.2.411 · 2.51 Impact Factor
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    Stephen Jan · Merel Kimman · David Kingston · Mark Woodward
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    ABSTRACT: The ACTION (Asean CosTs In ONcology) Study will be one of the largest observational studies of the burden of cancer ever conducted in Asia. The study will involve 10,000 newly diagnosed patients with cancer and will be carried out across eight low- and middle income countries within the ASEAN region (Indonesia, Thailand, Malaysia, Cambodia, Myanmar, Viet Nam, Laos and the Philippines). Patients will be interviewed three times over 12 months to assess their health, use of health care services, out of pocket costs related to their illness, social and quality of life issues. The project is a collaboration between the George Institute for Global Health, the ASEAN Foundation and Roche. The aim of the study is to assess the health and socioeconomic impact of cancer on patients in ASEAN communities, and the factors that may impact on these outcomes.
    Asian Pacific journal of cancer prevention: APJCP 02/2012; 13(2):407-9. DOI:10.7314/APJCP.2012.13.2.407 · 2.51 Impact Factor
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    ABSTRACT: An economic evaluation was performed alongside a randomised controlled trial (ISRCTN 74071417) investigating the cost-effectiveness of nurse-led telephone follow-up instead of hospital visits, and of a short educational group programme (EGP) in the first year after breast cancer treatment. This economic evaluation (n = 299) compared the one-year costs and the effects of four follow-up strategies: (1) hospital follow-up; (2) nurse-led telephone follow-up; (3) hospital follow-up plus EGP; and (4) nurse-led telephone follow-up plus EGP. Costs were measured using cost diaries and hospital registrations. Quality-adjusted life years (QALYs) were measured using the EQ-5D. Outcomes were expressed in incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves. Hospital follow-up plus EGP yielded most QALYs (0.776), but also incurred the highest mean annual costs (€4914). The ICER of this strategy versus the next best alternative, nurse-led telephone follow-up plus EGP (0.772 QALYs and €3971), amounted to €235.750/QALY. Hospital and telephone follow-up without EGP both incurred higher costs and less QALYs than telephone follow-up plus EGP and were judged inferior. Hospital follow-up plus EGP was not considered cost-effective, therefore, telephone follow-up plus EGP was the preferred strategy. The probability of telephone follow-up plus EGP being cost-effective ranged from 49% to 62% for different QALY threshold values. Secondary and sensitivity analyses showed that results were robust. Nurse-led telephone follow-up plus EGP seems an appropriate and cost-effective alternative to hospital follow-up for breast cancer patients during their first year after treatment.
    European journal of cancer (Oxford, England: 1990) 05/2011; 47(8):1175-85. DOI:10.1016/j.ejca.2010.12.017 · 4.82 Impact Factor
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    ABSTRACT: To investigate whether frequent hospital follow-up in the first year after breast cancer treatment might partly be replaced by nurse-led telephone follow-up without deteriorating health-related quality of life (HRQoL), and whether a short educational group programme (EGP) would enhance HRQoL. A multicentre pragmatic randomised controlled trial (RCT) with a 2×2 factorial design was performed among 320 breast cancer patients who were treated with curative intent. Participants were randomised to follow-up care as usual (3-monthly outpatient clinic visits), nurse-led telephone follow-up, or the former strategies combined with an educational group programme. The primary outcome for both interventions was HRQoL, measured by EORTC QLQ-C30. Secondary outcomes were role and emotional functioning and feelings of control and anxiety. Data of 299 patients were available for evaluation. There was no significant difference in HRQoL between nurse-led telephone and hospital follow-up at 12 months after treatment (p = 0.42; 95% confidence interval (CI) for difference: -1.93-4.64) and neither between follow-up with or without EGP (p = 0.86; 95% CI for difference: -3.59-3.00). Furthermore, no differences between the intervention groups and their corresponding control groups were found in role and emotional functioning, and feelings of control and anxiety (all p-values > 0.05). Replacement of most hospital follow-up visits in the first year after breast cancer treatment by nurse-led telephone follow-up does not impede patient outcomes. Hence, nurse-led telephone follow-up seems an appropriate way to reduce clinic visits and represents an accepted alternative strategy. An EGP does not unequivocally affect positive HRQoL outcomes.
    European journal of cancer (Oxford, England: 1990) 05/2011; 47(7):1027-36. DOI:10.1016/j.ejca.2010.12.003 · 4.82 Impact Factor
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    ABSTRACT: Current frequent follow-up after treatment for breast cancer does not meet its intended aims, but does depend on expensive and scarce specialized knowledge for routine history taking and physical examinations. The study described in this paper compared patient satisfaction with a reduced follow-up strategy, i.e. nurse-led telephone follow-up, to satisfaction with traditional hospital follow-up. Patient satisfaction was assessed among patients (n=299) who were participants of a randomized controlled trial investigating the cost-effectiveness of several follow-up strategies in the first year after treatment for breast cancer. Data on patient satisfaction were collected at baseline, three, six and 12 months after treatment, using the Dutch version of Ware's Patient Satisfaction Questionnaire III (PSQ III). In addition to general satisfaction, the PSQ III reports on satisfaction scores for technical competence, interpersonal aspects, and access of care. Regression analysis was used to predict satisfaction scores from whether or not nurse-led telephone follow-up was received. Nurse-led telephone follow-up had no statistically significant influence on general patient satisfaction (p=0.379), satisfaction with technical competence (p=0.249), and satisfaction with interpersonal aspects (p=0.662). Regarding access of care, patient satisfaction scores were significantly higher for patients receiving telephone follow-up (p=0.015). However, a mean difference at 12 months of 3.1 points was judged to be not clinically relevant. No meaningful differences were found in satisfaction scores between nurse-led telephone and hospital follow-up in the first year after breast cancer treatment. With high satisfaction scores and the potential to substantially reduce clinic visits, nurse-led telephone follow-up may be an acceptable alternative to traditional hospital follow-up. ISRCTN 74071417.
    BMC Cancer 04/2010; 10(1):174. DOI:10.1186/1471-2407-10-174 · 3.32 Impact Factor
  • EJC Supplements 03/2010; 8(3):207-207. DOI:10.1016/S1359-6349(10)70526-7 · 9.39 Impact Factor
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    ABSTRACT: Clinical guidelines for the follow-up after breast cancer recommend frequent outpatient clinic visits to be examined for a possible recurrence or a second primary breast tumour, and to receive information and psychosocial support. However, needs and preferences for follow-up may differ between patients, raising the question whether the current 'one size fits all' approach is appropriate. This study explored patients' preferences for follow-up. Patients and methods. A discrete choice experiment survey with 16 choice tasks was filled out by 331 breast cancer patients. Each choice task consisted of two hypothetical follow-up scenarios for the first year after treatment, described by levels of the following characteristics; attendance at an educational group programme, frequency of visits, waiting time, contact mode, and type of healthcare provider. Results. The healthcare provider and contact mode were the most important characteristics of follow-up to patients. The medical specialist was the most preferred to perform the follow-up, but a combination of the medical specialist and breast care nurse alternating was also acceptable to patients. Face-to-face contact was strongly preferred to telephone contact. Follow-up visits every three months were preferred over visits every four, six, or 12 months. Heterogeneity in preference between patients was strong, especially for the healthcare provider and attendance at an educational group programme. Age, education, and previous experience with follow-up characteristics influenced preferences, but treatment modality did not. Conclusion. The results of this study show that overall patient satisfaction would not differ significantly if patients have follow-up by medical specialist and breast care nurse alternating compared to follow-up by a medical specialist only. Furthermore, we found heterogeneity in preferences for most attributes, indicating that one strategy does not fit all. Individualised follow-up seems to offer the potential for significant increases in patient satisfaction.
    Acta oncologica (Stockholm, Sweden) 02/2010; 49(3):328-37. DOI:10.3109/02841860903536002 · 3.71 Impact Factor
  • EJC Supplements 09/2009; 7(3):18-18. DOI:10.1016/S1359-6349(09)72075-0 · 9.39 Impact Factor
  • M.M.F. Bloebaum · M.L. Kimman · R. Houben · L.J. Boersma
    EJC Supplements 09/2009; 7(2):319. DOI:10.1016/S1359-6349(09)71090-0 · 9.39 Impact Factor

Publication Stats

201 Citations
112.19 Total Impact Points

Institutions

  • 2012–2013
    • University of Sydney
      • NHMRC Clinical Trials Centre (CTC)
      Sydney, New South Wales, Australia
    • The George Institute for Global Health
      Sydney, New South Wales, Australia
  • 2007–2012
    • Maastricht University
      Maestricht, Limburg, Netherlands
  • 2009–2011
    • Maastricht Universitair Medisch Centrum
      • Central Diagnostic Laboratory
      Maestricht, Limburg, Netherlands
  • 2007–2011
    • Maastro Clinic
      Maestricht, Limburg, Netherlands