[Show abstract][Hide abstract] ABSTRACT: Hypothesis / aims of study
Urinary incontinence (UI) is a widespread problem with great impact on quality of life and with high annual costs for patients and
society. Pregnancy and delivery are the most prominent risk factors for the onset of pelvic floor injuries and -later-on- UI. Intensive
supervised pelvic floor muscle training (PFMT) during and after pregnancy is proven effective for the prevention of UI on the short
term. However, only a minority of women do participate in preventive PFMT programs. Therefore, an analysis of barriers and
facilitators from the perspective of postpartum women for participation in a preventive PFMT program was performed.
Study design, materials and methods
A web-based survey was held in 3-months post-partum women in four regions in the Netherlands. All participating women gave
their informed consent to the health professionals who approached them for the survey. To find barriers and facilitators for
participation in a preventive PFMT program, postpartum women were asked for their willingness to participate (WTP) in such a
preventive intensive PFMT program. To find specific factors that might be associated with prevalence of pelvic floor dysfunctions
(PFDs) and the WTP, participants reported on demographic and clinical characteristics, i.e. obstetrical and urogynecological
history, knowledge and experience with PFMT and preconditions for actual WTP.
Frequencies and percentages are reported for categorical data. Bivariate analysis was performed in cross tabulations (with L2
statistics) to explore the relationship between WTP and various independent categorical variables. A linear regression analysis
was done to analyse which variables are associated with WTP using listwise deletion of missing cases. A p-value less than 0.05
is considered statistically significant. SPSS 21 is used for data analysis.
The web-based questionnaire was filled in by 169 adult white women (64%). The age of the majority of the women was between
25 and 34 years and 79.2% finished tertiary education. Almost half of the women had ever experienced UI and over half of them
had UI during and after the last pregnancy.
The large majority of all postpartum women (over 95%) want professional information on the prevention of –later onset- PFDs
and acknowledge that intensive supervised preventive PFMT during and after pregnancy may be very important to prevent future
pelvic floor problems. Women prefer to be informed during pregnancy (75%), either individually by a health professional (43%) or
through a folder or website (43%). However, when asked for their willingness to actively participate in an intensive preventive
PFMT program one out of three women reported to be willing to participate and 41% of the women reported to be in doubt, 11.9%
already participates in PFMT and 15.4% is not interested (at all). No statistically significant association was found between WTP
and risk and prognostic factors for PFDs (maternal age, parity, birth weight, BMI, pelvic floor injuries).
Further analysis showed that women with a better general health and women with a higher UI severity sumscore and POP
symptoms are statistically significantly more ‘willing to participate’ in a preventive PFMT program (p < 0.001, p = 0.010 and p =
Preconditions for those women who are willing to participate or those in doubt are program costs. Up to €100 is acceptable for
the majority of these women. However, one of five of the women in doubt is not prepared to pay for a PFMT program at all. Next
to this, travel time should not exceed 15 minutes.
Interpretation of results
It is obvious that the large majority of women who recently had a baby do want professional information on the prevention of PFDs
and do acknowledge the importance of preventive PFMT during and after pregnancy. However, several barriers and facilitators
for change in actual WTP in preventive PFMT from the perspective of postpartum women are found. The study results show that
there is no association between the awareness of the preventive effects and the existence of PFDs, even controlled for risk and
prognostic factors for PFDs. Further research should focus on solutions how to support both women and health professionals
(obstetricians, midwives, family physicians, physiotherapists) to improve awareness of risk and/or prognostic factors for PFDs, to
inform on the benefits of a good PFM function and to facilitate motivation of postpartum women for active participation and
adherence to preventive PFMT programs (multidisciplinary supported and tailor made intensive supervised evidence based
program). Next to this, taking into consideration preconditions can facilitate actual participation of postpartum women in preventive
Looking at the perspective of postpartum women, there is room for quality improvement of preventive PF management. Further
research should focus on solutions to tackle major barriers and to introduce facilitators for postpartum women to participate and
adhere to intensive PFMT programs to prevent –later onset- PFDs.
1. Boyle R, Hay-Smith E, Cody J, Morkved S. Pelvic floor muscle training for prevention and treatment of urinary and faecal
incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2012, DOI:
2. DeLancey JOL, Kane Low L, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor
disorders: an integrated life span model. Am J Obstet Gynecol. 2008;199(6):610.e1-.e5.
3. Buurman MBR, Lagro-Janssen ALM. Women’s perception of postpartum pelvic floor dysfunction and their help-seeking
behaviour: a qualitative interview study. Scand J Caring Sci. 2013;27(2):406-13.
Funding: NA Clinical Trial: No Subjects: HUMAN Ethics not Req'd: Upon consultation, the Medical Ethics Committee of the
region Maastricht, stated that ethical approval was not needed given the non-invasive character of the survey. However, all
participating women gave their informed consent to the health professionals that approached them for the survey. Helsinki: Yes
Informed Consent: Yes
[Show abstract][Hide abstract] ABSTRACT: Background
Post-operative atrial fibrillation (POAF) is considered to be a transient arrhythmia in the first week after surgery.
The aim of this study was to determine the 30-day incidence and predictors of POAF and the value of postoperative overdrive biatrial pacing in prevention of POAF.
Patients (n=148) without a history of AF undergoing aortic valve replacement (AVR) or coronary artery bypass graft (CABG) were randomized into a pacing group (n=75) and a control group. Patients were treated with standardized Sotalol post-operatively. Rhythm was continuously monitored for 30 days by a trans-telephonic event recorder.
POAF occurred in 73 patients (49.3%) of whom 60 patients (40.5%) showed POAF during post-operative days (POD) 0-5 and 37 patients (25%) during POD 6-30. Prolonged aortic cross clamp time (ACCT) was an important univariate predictor of 30-day and of late POAF (POD 6-30) (p=0.017, p= 0.03 respectively). Best-fit model analysis using 15 predetermined risk factors for POAF showed different positive interactive effects for early POAF (i.e. baseline C-reactive protein (CRP) levels with a history of myocardial infaction (MI) or low Body mass index (BMI)) and late POAF (i.e. high BMI, diabetes mellitus, baseline CRP, early POAF, creatinine levels, type of operation, smoking and male gender). Biatrial pacing reduced the late POAF incidence in patients with ACCT > 50 minutes (p=0.006).
POAF is not limited to the first week after cardiac surgery but also occurs frequently in the post-operative month. It is desirable to regularly follow POAF patients for AF recurrences after discharge.
Heart rhythm: the official journal of the Heart Rhythm Society 07/2014; · 4.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Primary treatment for patients with intermittent claudication is exercise therapy. Diabetes mellitus (DM) is a frequently occurring comorbidity in patients with intermittent claudication, and in these patients, exercise tolerance is decreased. However, there is little literature about the increase in walking distance after supervised exercise therapy (SET) in patients with both intermittent claudication and DM. The objective of this study was to determine the effectiveness of SET for intermittent claudication in patients with DM.
Consecutive patients with intermittent claudication who started SET were included. Exclusion criteria were Rutherford stage 4 to 6 and the inability to perform the standardized treadmill test. SET was administered according to the guidelines of the Royal Dutch Society for Physiotherapy. At baseline and at 1, 3, and 6 months of follow-up, a standardized treadmill exercise test was performed. The primary outcome measurement was the absolute claudication distance (ACD).
We included 775 patients, of whom 230 had DM (29.7%). At 6 months of follow-up, data of 440 patients were available. Both ACD at baseline and at 6 months of follow-up were significantly lower in patients with DM (P < 0.001). However, increase in ACD after 6 months of SET did not differ significantly (P = 0.48) between the DM group and the non-DM group (270 m and 400 m, respectively).
In conclusion, SET for patients with intermittent claudication is equally effective in improving walking distance for both patients with and without DM, although ACD remains lower in patients with DM.
Annals of Vascular Surgery 08/2012; 26(7):957-63. · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Scand J Caring Sci; 2012 Consumer satisfaction among patients and their general practitioners about involving nurse specialists in primary care for patients with urinary incontinence Background: Urinary incontinence (UI) is a very common problem, but existing guidelines on UI are not followed. To bring care in line with guidelines, we planned an intervention to involve nurse specialists on UI in primary care and assessed this in a randomised controlled trial. Alongside this intervention, we assessed consumer satisfaction among patients and general practitioners (GPs). Methods: Patients' satisfaction with the care provided by either nurse specialists (intervention group) or GPs (control group), respectively, was measured with a self-completed questionnaire. GPs' views on the involvement of nurse specialists were measured in a structured telephone interview. Results: The patient satisfaction score on the care offered by nurse specialists was 8.4 (scale 1-10), vs. 6.7 for care-as-usual by GPs. Over 85% of patients would recommend nurse specialist care to their best friends and 77% of the GPs considered the role of the nurse specialist to be beneficial, giving it a mean score of 7.2. Conclusions: Although the sample was relatively small and the stability of the results only provisionally established, substituting UI care from GP to nurse specialist appears to be welcomed by both patients and GPs. Small changes like giving additional UI-specific information and devoting more attention to UI (which had been given little attention before) would provide a simple instrument to stimulate patients to change their behaviour in the right direction.
Scandinavian Journal of Caring Sciences 05/2012; · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sacral neuromodulation therapy has been successfully applied in adult patients with urinary and fecal incontinence and in adults with constipation not responding to intensive conservative treatment. No data, however, are available on sacral neuromodulation therapy as a treatment option in adolescents with refractory functional constipation.
This study aimed to describe the short-term results of sacral neuromodulation in adolescents with chronic functional constipation refractory to intensive conservative treatment.
This is a retrospective review.
This study took place at the Department of Surgery, Maastricht University Medical Centre, The Netherlands.
Thirteen patients (all girls, age 10-18 years) with functional constipation according to the ROME III criteria not responding to intensive oral and rectal laxative treatment were assigned for sacral neuromodulation.
When improvement of symptoms was observed during the testing phase, a permanent stimulator was implanted. Patients were prospectively followed up to at least 6 months after implantation of the permanent stimulator by interviews, bowel diaries, and Cleveland Clinic constipation score. Improvement was defined as spontaneous defecation ≥ 2 times a week.
At presentation, none of the patients had spontaneous defecation or felt the urge to defecate. All patients had severe abdominal pain. Regular school absenteeism was present in 10 patients. After the testing phase, all but 2 patients had spontaneous defecation ≥ 2 times a week with a reduction in abdominal pain. After implantation, 11 (of 12) had a normal spontaneous defecation pattern of ≥ 2 times a week without medication, felt the urge to defecate, and perceived less abdominal pain without relapse of symptoms until 6 months after implantation. The average Cleveland Clinic constipation score decreased from 20.9 to 8.4. One lead revision and 2 pacemaker relocations were necessary.
This study is limited by its small sample size, single-institution bias, and retrospective nature.
Sacral neuromodulation appears to be a promising new treatment option in adolescents with refractory functional constipation not responding to intensive conservative therapy. Larger randomized studies with long-term follow-up are required.
Diseases of the Colon & Rectum 03/2012; 55(3):278-85. · 3.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sarcoidosis is a multisystemic inflammatory granulomatous disease. The prevalence of hepatic involvement is not clear.
The aim of this study was to establish the presence and severity of the liver-test abnormalities in sarcoidosis.
Retrospectively, patients with confirmed sarcoidosis (n=837) presented with the liver-test abnormalities [alkaline phosphatase, γ-glutamyl transaminase, alanine aminotransferase or aspartate aminotransferase >1.5 times the upper limit of normal (ULN)] who were classified according to severity into mild (zero liver tests ≥3×ULN), moderate (one or two liver tests ≥3×ULN) and severe (three or four liver tests ≥3×ULN) were evaluated. Moreover, the relationship between severity of liver tests and histology was examined.
Liver-test abnormalities were found in 204 of 837 patients with chronic sarcoidosis (24.4%), among which 127 (15.2%) were suspected of having hepatic sarcoidosis (79 of 127 males, 111 Caucasian, eight African-American). In 22 of 127 patients (17.3%), a liver biopsy was obtained; 21 were compatible with hepatic sarcoidosis. In these 21 patients, severity of liver-test abnormalities was significantly associated with extensiveness of granulomatous inflammation (ρ=0.58, P=0.006) and degree of fibrosis (ρ=0.64, P=0.002). These results remained in the multiple regression analysis when controlled for treatment status, sex, genetics, ethnicity and age.
Liver-test abnormalities were present in 24% of the studied patients; in 15% highly because of hepatic involvement of sarcoidosis. Moderate and severe liver-test abnormalities seemed to be associated with more advanced histopathological disease. Therefore, in the management of sarcoidosis, for patients with moderate or severe liver-test abnormalities a liver biopsy is recommended.
European journal of gastroenterology & hepatology 01/2012; 24(1):17-24. · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Standard treatment of newly diagnosed HFE hemochromatosis patients is phlebotomy. Erythrocytapheresis provides a new therapeutic modality that can remove up to three times more red blood cells per single procedure and could thus have a clinical and economic benefit.
To compare the number of treatment procedures between erythrocytapheresis and phlebotomy needed to reach the serum ferritin (SF) target level of 50 µg/L, a two-treatment-arms, randomized trial was conducted in which 38 newly diagnosed patients homozygous for C282Y were randomly assigned in a 1:1 ratio to undergo either erythrocytapheresis or phlebotomy. A 50% decrease in the number of treatment procedures for erythrocytapheresis compared to phlebotomy was chosen as the relevant difference to detect.
Univariate analysis showed a significantly lower mean number of treatment procedures in the erythrocytapheresis group (9 vs. 27; ratio, 0.33; 95% confidence interval [CI], 0.25-0.45; Mann-Whitney p < 0.001). After adjustments for the two important influential factors initial SF level and body weight, the reduction ratio was still significant (0.43; 95% CI, 0.35-0.52; p < 0.001). Cost analysis showed no significant difference in treatment costs between both procedures. The costs resulting from productivity loss were significantly lower for the erythrocytapheresis group.
Erythrocytapheresis is highly effective treatment to reduce iron overload and from a societal perspective might potentially also be a cost-saving therapy.
[Show abstract][Hide abstract] ABSTRACT: What's known on the subject? and What does the study add? Sacral neuromodulation (SNM) is a well-established treatment for patients with chronic LUTS. The selection of eligible candidates could be improved by identifying factors that can predict a successful response. In the present study, we evaluated the role of various psychological and psychiatric factors in relation to SNM treatment.
• To evaluate if psychological and psychiatric factors can predict the outcome of test stimulation or permanent treatment with sacral neuromodulation (SNM).
• Between 2006 and 2009, patients with overactive bladder syndrome or non-obstructive urinary retention who were eligible for test stimulation were included. • All patients completed the Amsterdam Biographic Questionnaire (ABQ), which measures the personality traits of the patient, and the Symptom Check-List-90-Revised (SCL-90-R), which is a screening instrument for neuroticism, and for current level of complaints. • The results of the questionnaires were compared with the outcomes of test stimulation and permanent treatment. • In addition to the questionnaires, we also included the psychiatric history as a potential predictive factor.
• On univariate analysis there was no relationship between the psychological characteristics and the outcome of test stimulation or the occurrence of adverse events (AEs) with permanent treatment. • A history of psychiatric disease was not related to the outcome of test stimulation, but was shown to be a positive predictor for the occurrence of AEs with permanent SNM treatment.
• In the present study there was no evidence that psychological screening with the ABQ or SCL-90-R can predict the outcome of SNM treatment. • Patients with a medical history of psychiatric disease appear to be more likely to encounter AEs with permanent SNM treatment.
BJU International 08/2011; 108(11):1834-8. · 3.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Inflammation, interstitial fibrosis (IF), and tubular atrophy (TA) precede chronic transplant dysfunction, which is a major cause of renal allograft loss. There is an association between IF/TA and loss of peritubular capillaries (PTCs) in advanced renal disease, but whether PTC loss occurs in an early stage of chronic transplant dysfunction is unknown. Here, we studied PTC number, IF/TA, inflammation, and renal function in 48 patients who underwent protocol biopsies. Compared with before transplantation, there was a statistically significant loss of PTCs by 3 months after transplantation. Fewer PTCs in the 3-month biopsy correlated with high IF/TA and inflammation scores and predicted lower renal function at 1 year. Predictors of PTC loss during the first 3 months after transplantation included donor type, rejection, donor age, and the number of PTCs at the time of implantation. In conclusion, PTC loss occurs during the first 3 months after renal transplantation, associates with increased IF and TA, and predicts reduced renal function.
Journal of the American Society of Nephrology 06/2011; 22(6):1024-9. · 9.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Knowledge of patients' preferences for elective single embryo transfer (eSET) or double embryo transfer (DET) and for singletons or twins is of great importance in counselling for embryo transfer (ET) strategies. In this study, the stability of IVF patients' preferences over time for either a healthy single child or healthy twins was measured and we investigated which factors could explain preference shifts.
Infertile women (n = 177) who participated in an RCT comparing one cycle eSET with one cycle DET were included. A satisfaction questionnaire was developed to measure patient preferences and attitudes at two moments in time, i.e. at 2 weeks before ET and at 2 weeks following ET, after the results of the pregnancy test. Regression analysis examined the effect of several variables on preference shifts.
Before ET, most patients expressed a preference for a singleton, whereas most patients were indifferent 2 weeks after ET, resulting in an overall preference shift towards twins (P = 0.002; n = 145). Overall, 62% of patients showed a preference shift. Preference shifts were explained by patients' global satisfaction of the information given by the fertility clinic staff received by the fertility clinic staff, and an interaction between the occurrence of pregnancy and transfer policy (eSET or DET).
In general, patients' preferences for a singleton or twins are not stable during IVF treatment. Possible explanations of a shift in preference are that pregnant patients attuned their preferences to what they expect their pregnancy to result in, whereas non-pregnant patients shifted towards a preference for twins in order to be able to fulfil their ultimate child wish.
Human Reproduction 05/2011; 26(8):2092-100. · 4.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We evaluated the effect of pulse rate changes on the clinical response to and stimulation related pain symptoms of sacral neuromodulation treatment.
In this pilot study we evaluated the effect of 4 pulse rates, including 5.2, 10, 21 and 40 Hz, in patients with a suboptimal response to sacral neuromodulation. The effect of each frequency was evaluated during a 6-day test period. To avoid the carryover effect stimulation was discontinued for 24 hours between consecutive test periods. On the last 3 days of each test period a voiding diary and questionnaire were completed. Changes in the clinical response and pain symptoms were compared between the 4 pulse rates using multivariate analysis.
Of the 50 patients included in the study 40 (80%) were female. Mean ± SD age was 55.5 ± 12.3 years. Of the patients 41 (82%) had overactive bladder symptoms and 9 (18%) were in chronic nonobstructive urinary retention. No significant difference was found in clinical outcome on the voiding diary and questionnaire between the pulse rates and none of the 4 rates was significantly related to sacral neuromodulation associated pain. However, individuals appeared to benefit from changing the pulse rate in terms of treatment efficacy and stimulation related pain.
On the group level none of the 4 pulse rates appeared to have a significantly different effect on clinical outcome or sacral neuromodulation related pain. However, an individualized approach to optimize treatment efficacy by changing the pulse rate appears to be useful.
The Journal of urology 03/2011; 185(5):1781-5. · 3.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare the patient's response rate to the Percutaneous Nerve Evaluation test (PNE) and the 1st stage tined-lead placement test (FSTLP) for sacral neuromodulation therapy (SNM).
Single center study on patients with refractory idiopathic overactive bladder syndrome (OAB) or non-obstructive urinary retention, screened with both PNE and FSTLP. Patients were followed prospectively and their response rate based on bladder diary after PNE was compared to that after FSTLP. More than 50% improvement in at least two relevant urinary symptoms was considered a positive response. A Wilcoxon paired test was done to compare the rates of the two screening options and logistic regression to determine possible associations. A follow-up was conducted to determine the long-term failure rate.
One hundred patients were included (82 female, 69 OAB). The mean age was 55 years (SD 13). The positive response rate on PNE was 47%. FSTLP showed a 69% positive response rate, which was negatively related to age. The 22% gain in positive response was statistically significant (P < 0.001) and positively associated with female gender and younger age. All 69 patients with a positive response to FSTLP received SNM treatment. Failure rate after an average of 2 years was 2.9%.
This study suggests that FSTLP may be a more sensitive screening method than PNE to identify patients eligible for SNM therapy, warranting randomized trials.
Neurourology and Urodynamics 03/2011; 30(7):1249-52. · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We systematically assessed long-term satisfaction and patient experience with sacral nerve modulation therapy.
All patients who received sacral neuromodulation between 1990 and 2007 at our center and who still had the implant were included in the survey. All received a postal questionnaire regarding satisfaction and experiences with the system, such as side effects, complications, burden, impact on sexuality and defecation changes.
Of the 275 questionnaires sent 207 were returned for a 75% response rate. The population was 83% female. Overall treatment was done for overactive bladder syndrome, nonobstructive urinary retention, combined overactive bladder and retention, and pelvic pain in 55%, 24%, 20% and 1% of patients, respectively. Overall satisfaction with sacral neuromodulation was high at 90%. No correlations were found between the satisfaction rate, and pretreatment age, gender, complaint type, sexual dysfunction or therapy duration. However, 56% of patients reported side effects, such as pain at the internal nerve stimulator site and due to stimulation. However, 89% of these patients did not seek further therapy. Of patients with additional defecation problems 47% experienced relief of complaints.
This study shows a high satisfaction rate in patients with sacral neuromodulation. There was no relation between patient age, complaint type, therapy duration or side effects and the satisfaction rate. The number of side effects was limited but further analysis in prospective cohorts should identify patients who are likely to have side effects or stop sacral neuromodulation treatment.
The Journal of urology 02/2011; 185(2):588-92. · 3.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sacral neuromodulation is a well researched and successful treatment for functional bowel disorders. Indications have expanded throughout the years and various studies have been published on clinical efficacy or on technique improvement. The main goal of this retrospective study was to systematically evaluate daily experiences with this treatment and measure the long-term satisfaction of sacral neuromodulation therapy for functional bowel disorders.
After institutional review board approval a new, self-designed postal questionnaire was sent to all patients in our center who were being treated with sacral neuromodulation. Only patients with a minimal follow-up of 1 year were included in the survey. Implantation years range from 2000 to 2007.
A total of 174 patients received the questionnaire regarding patient satisfaction and experience with sacral neuromodulation therapy. The response rate after reminder letter was 71.8% (n = 125) including 114 (91.2%) females. Patient satisfaction was high: 81 patients (65.3%) reported their results as very satisfying, 30 patients (24.2%) were moderately satisfied, and 13 patients (10.4%) were not satisfied. Analysis showed that patient satisfaction can be explained by both patient perception of present bowel function and their evaluation of the quality of daily life. No significant relationship was found with patient demographics, self-ascribed (co)morbidity, behavioral habits, or therapy duration. A total of 47 patients (38.2%) reported having some concerns regarding the future with sacral neuromodulation treatment. Twenty-eight patients (23.1%) reported a temporary loss of effect at any time during sacral neuromodulation therapy. Pain at the implantation site was reported by 65 patients (52.4%).
This study shows that patients treated with sacral neuromodulation, in general, are very satisfied. The main problems mentioned by patients are pain, loss of efficacy, and general concerns.
Diseases of the Colon & Rectum 01/2011; 54(1):95-100. · 3.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was performed to assess the cost-effectiveness of concomitant ablation surgery (AS) compared to regular cardiac surgery in atrial fibrillation (AF) patients over a one-year follow-up. Cost analysis was performed from a societal perspective alongside a prospective, randomised, double-blinded, multicentre trial. One hundred and fifty patients with documented AF were randomly assigned to undergo cardiac surgery with or without AS. One hundred and thirty-two patients were included in the cost-effectiveness study. All costs (medical and non-medical) were measured during follow-up. Costs data were combined with quality adjusted life years (QALYs) to obtain the incremental costs per QALY. Total costs of the AS group were significantly higher compared to the regular cardiac surgery group [cost difference bootstrap: €4,724; 95% uncertainty interval (UI), €2,770-€6,678]. The bootstrapped difference in QALYs was not statistically significant (0.06; 95% UI: -0.024 to 0.14). The incremental cost-effectiveness ratio is €73,359 per QALY. The acceptability curve showed that, even in the case of a maximum threshold value of €80,000 per QALY gained, the probability of AS being more cost-effective than regular cardiac surgery did not reach beyond 50%. Concluding that concomitant AS in AF is not cost-effective after a one-year follow-up compared to regular cardiac surgery.
Interactive Cardiovascular and Thoracic Surgery 12/2010; 12(3):394-8. · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: (18)F-Fluoride PET/CT is a relatively undervalued diagnostic test to measure bone metabolism in bone diseases. Hyperostosis cranialis interna (HCI) is a (hereditary) bone disease characterised by endosteal hyperostosis and osteosclerosis of the skull and the skull base. Bone overgrowth causes entrapment and dysfunction of several cranial nerves. The aim of this study is to compare standardised uptake values (SUVs) at different sites in order to quantify bone metabolism in the affected anatomical regions in HCI patients.
Nine affected family members, seven non-affected family members and nine non-HCI non-family members underwent (18)F-fluoride PET/CT scans. SUVs were systematically measured in the different regions of interest: frontal bone, sphenoid bone, petrous bone and clivus. Moreover, the average (18)F-fluoride uptake in the entire skull was measured by assessing the uptake in axial slides. Visual assessment of the PET scans of affected individuals was performed to discover the process of disturbed bone metabolism in HCI.
(18)F-Fluoride uptake is statistically significantly higher in the sphenoid bone and clivus regions of affected family members. Visual assessment of the scans of HCI patients is relevant in detecting disease severity and the pattern of disturbed bone metabolism throughout life.
(18)F-Fluoride PET/CT is useful in quantifying the metabolic activity in HCI and provides information about the process of disturbed bone metabolism in this specific disorder. Limitations are a narrow window between normal and pathological activity and the influence of age. This study emphasises that (18)F-fluoride PET/CT may also be a promising diagnostic tool for other metabolic bone disorders, even those with an indolent course.
European Journal of Nuclear Medicine 11/2010; 38(5):884-93. · 4.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This randomized clinical equivalence trial was designed to evaluate health-related quality of life (HRQoL) after fast-track treatment for low-risk coronary artery bypass (CABG) patients.
Four hundred and ten CABG patients were randomly assigned to undergo either short-stay intensive care treatment (SSIC, 8 h of intensive care stay) or control treatment (care as usual, overnight intensive care stay). HRQoL was measured at baseline and 1 month, and one year after surgery using the multidimensional index of life quality (MILQ), the EQ-5D, the Beck Depression Inventory and the State-Trait Anxiety Inventory.
At one month after surgery, no statistically significant difference in overall HRQoL was found (MILQ-score P-value=.508, overall MILQ-index P-value=.543, EQ-5D VAS P-value=.593). The scores on the MILQ-domains, physical, and social functioning were significantly higher at one month postoperatively in the SSIC group compared to the control group (P-value=.049; 95%CI: 0.01-2.50 and P-value=.014, 95% CI: 0.24-2.06, respectively). However, these differences were no longer observed at long-term follow-up.
According to our definition of clinical equivalence, the HRQoL of SSIC patients is similar to patients receiving care as usual. Since safety and the financial benefits of this intervention were demonstrated in a previously reported analysis, SSIC can be considered as an adequate fast-track intensive care treatment option for low-risk CABG patients.
Quality of Life Research 03/2010; 19(5):631-42. · 2.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Samenvatting Tijdens magnetisch resonantie-onderzoek (MRI) hebben jonge kinderen en kinderen met een vertraagde ontwikkeling een vorm van
procedurele sedatie (PS) nodig om voldoende (lang) bewegingloos te kunnen blijven liggen. In Nederland hebben zich in het
afgelopen decennium ernstige ongevallen voorgedaan tijdens PS voor MRI. Het is aangetoond dat essentiële veiligheidsrichtlijnen
ten aanzien van PS onvoldoende geïmplementeerd zijn in de Nederlandse algemene kindergeneeskundige praktijk. Tevens bestaan
er zorgen over de matige effectiviteit van vaak toegepaste PS-protocollen. Door middel van een enqueˆte onderzochten we welke
PS-technieken en -medicijnen algemeen kinderartsen meestal gebruiken voor MRI bij kinderen. De gemiddelde praktijk werd vergeleken
met de resultaten van een systematische review (SR) van de recente literatuur. Door middel van de SR proberen we de klinische
vraag te beantwoorden wat op de kinderleeftijd de veiligste en meest effectieve techniek is voor PS tijdens MRI. Nederlandse
kinderartsen doen voor MRI zelden beroep op anesthesie. Meestal wordt gebruikgemaakt van een PS op basis van chloralhydraat,
midazolam en/of lytische cocktails. Deze sedativa hebben een suboptimale effectiviteit. Het is onbekend hoeveel onderzoeken
hierdoor geheel of gedeeltelijk mislukken. Deze medicijnen hebben wel een reëel risico op ernstige complicaties. Het gebruik
moet daarom steeds gepaard gaan met verregaande voorzorgsmaatregelen en de aanwezigheid van competente professionals. Van
alle sedativa heeft propofol de hoogste effectiviteit. Propofol kan veilig worden gebruikt door competente nietanesthesiologen.
Indien deze professionals niet beschikbaar zijn, verdient het aanbeveling om kinderen die gesedeerd moeten worden voor MRI,
door te verwijzen naar een anesthesioloog.
Tijdschrift voor kindergeneeskunde 01/2010; 2011(2):42-54.
[Show abstract][Hide abstract] ABSTRACT: This is a multicenter, prospective, randomized controlled trial to determine the effect of add-on arrhythmia surgery on health-related quality of life during 1-year follow-up of cardiac surgery patients with atrial fibrillation.
150 patients with documented atrial fibrillation were randomly assigned to undergo cardiac surgery with or without add-on surgery. Patients completed quality of life questionnaires, comprising the RAND 36-item Health Survey 1.0 (SF-36), Multidimensional Fatigue Inventory-20 (MFI-20) and EuroQoL (EQ-5D and VAS) at baseline and 3, 6, and 12 months following operation.
132 patients completed the questionnaires at a minimum of one time-point during follow-up. At baseline patient characteristics, operative data and health-related quality of life were comparable. At 12-month follow-up 62 patients were free of atrial fibrillation without significant differences between groups (P = 0.28). Conversion to SR occurred in 69.8% (37/53) of patients with paroxysmal AF, in 28.2% (11/39) of patients with permanent AF and in 44.4% (12/27) of patients in persistent AF. Cardiac surgery in general resulted in an overall improvement of the RAND SF-36 and the MFI-20. However, the EQ-5D showed a significant deterioration in the subscale Pain/Discomfort for both groups (P < 0.001), with a significant worse outcome for the control group (P = 0.006).
Health-related quality of life in patients with paroxysmal, permanent and persistent atrial fibrillation improves after cardiac surgery regardless of giving add-on surgery or not, but this improvement is presumably more affected by treating the underlying heart disease than by restoring sinus rhythm.
Journal of Cardiovascular Electrophysiology 11/2009; 21(5):511-20. · 3.48 Impact Factor