Carl E H Siegert

St. Lucas Andreas Hospital, Amsterdamo, North Holland, Netherlands

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Publications (30)87.33 Total impact

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    ABSTRACT: No abstract available.
    The Netherlands Journal of Medicine 11/2013; 71(9):480-484. · 2.38 Impact Factor
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    ABSTRACT: Studies performed in the United States showed that blacks progress from CKD to ESRD faster than do whites. Possible explanations are differences in health care system factors. This study investigated whether progression is also faster in a universal health care system, where all patients receive comparable care. Data from the PREdialysis PAtient REcord study, a multicenter follow-up study of patients with CKD who started predialysis care in The Netherlands (1999-2011), were analyzed. Time-dependent Cox proportional hazards models were used to estimate the hazard ratio (HR) for starting renal replacement therapy (RRT), and linear mixed models were used to compare renal function decline (RFD) between blacks and whites. To explore possible mechanisms, analyses were adjusted for patient characteristics. At initiation of predialysis care, blacks (n=49) were younger and had more diabetes mellitus, higher proteinuria levels, and a higher estimated GFR than whites (n=946). Median follow-up time in months was similar (blacks: 13.9 [boundaries of interquartile range (IQR), 5.3 to 19.5]; whites: 13.1 [IQR, 5.1 to 24.0]). For blacks compared with whites, the crude HR for starting RRT within the first 15 months was 0.86 (95% confidence interval [CI], 0.55 to 1.34) and from 15 months onward, 1.93 (95% CI, 1.02 to 3.68), which increased after adjustment. RFD was faster by 0.18 (95% CI, 0.05 to 0.32) ml/min per 1.73 m(2) per month in blacks compared with whites. Blacks receiving predialysis care in a universal health care system have faster disease progression than whites, suggesting that health care system factors have a less influential role than had been thought in explaining black-white differences.
    Clinical Journal of the American Society of Nephrology 07/2013; · 5.07 Impact Factor
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    ABSTRACT: No abstract available.
    The Netherlands Journal of Medicine 06/2013; 71(5):257-261. · 2.38 Impact Factor
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    ABSTRACT: Objective Depressive symptoms are associated with mortality among patients on chronic dialysis therapy. It is currently unknown how different courses of depressive symptoms are associated with both cardiovascular and non-cardiovascular mortality.Methods In a Dutch prospective nation-wide cohort study among incident patients on chronic dialysis, 1077 patients completed the Mental Health Inventory, both at 3 and 12 months after starting dialysis. Cox regression models were used to calculate crude and adjusted hazard ratios (HRs) for mortality for patients with depressive symptoms at 3 months only (baseline only), at 12 months only (new-onset), and both at 3 and 12 months (persistent), using patients without depressive symptoms at 3 and 12 months as reference group.ResultsDepressive symptoms at baseline only seemed to be a strong marker for non-cardiovascular mortality (HRadj 1.91, 95% CI 1.26–2.90), whereas cardiovascular mortality was only moderately increased (HRadj 1.41, 95% CI 0.85–2.33). In contrast, new-onset depressive symptoms were moderately associated with both cardiovascular (HRadj 1.66, 95% CI 1.06–2.58) and non-cardiovascular mortality (HRadj 1.46, 95% CI 0.97–2.20). Among patients with persistent depressive symptoms, a poor survival was observed due to both cardiovascular (HRadj 2.14, 95% CI 1.42–3.24) and non-cardiovascular related mortality (HRadj 1.76, 95% CI 1.20–2.59).Conclusion This study showed that different courses of depressive symptoms were associated with a poor survival after the start of dialysis. In particular, temporary depressive symptoms at the start of dialysis may be a strong marker for non-cardiovascular mortality, whereas persistent depressive symptoms were associated with both cardiovascular and non-cardiovascular mortality.
    Journal of psychosomatic research 06/2013; 74(6):511–517. · 2.91 Impact Factor
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    ABSTRACT: Context The supervision of specialty registrars during on-call shifts is essential to ensure the quality of both health care and medical education, but has been identified as a major novelty and stressor for new consultants in the transition from specialty training. There is a paucity of research on how consultants deal with their new supervisory roles and which factors influence this process. These issues are addressed in a prospective study designed to gather insights that can inform measures to ensure the provision of high-quality supervision and specialty training. Methods A longitudinal qualitative study was performed in the Netherlands. Semi-structured interviews were conducted with new consultants. The study was guided by an interpretative phenomenological approach until saturation was reached. At 3-month intervals between July 2011 and March 2012, eight novice consultants in internal medicine were interviewed three times each about their supervisory role while on call. Interviews focused on their preparation for the role in training, the actions they took to master the role, and their progression over time. Results Three interrelated domains of relevant factors emerged from the data: preparedness; personal characteristics, and contextual characteristics. Preparedness referred to the extent to which new consultants were prepared by training to take full responsibility for registrars' actions while supervising them from a distance. Personal characteristics, such as coping strategies and views on supervision, guided consultants' development as supervisors. Essential to this process were contextual characteristics, especially those concerning the extent to which the consultant knew the registrar, was familiar with departmental procedures, and had access to support from colleagues. Conclusions New consultants should be prepared for their supervisory role by training and by being given a proper introduction to their workplace. The former requires progressive independence and exposure to supervisory tasks during specialty training; the latter requires an induction programme to enable new consultants to familiarise themselves with the departmental environment and the registrars they will be supervising.
    Medical Education 04/2013; 47(4):408-416. · 3.55 Impact Factor
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    ABSTRACT: Background: Insight into the transition from specialist registrar to hospital consultant is needed to better align specialty training with starting as a consultant and to facilitate this transition. Aims: This study investigates whether preparedness regarding medical and generic competencies, perceived intensity, and social support are associated with burnout among new consultants. Method: A population-based study among all 2643 new consultants in the Netherlands (all specialties) was conducted in June 2010. A questionnaire covering preparedness for practice, intensity of the transition, social support, and burnout was used. Structural equation modelling was used for statistical analysis. Results: Data from a third of the population were available (32% n = 840) (43% male/57% female). Preparation in generic competencies received lower ratings than in medical competencies. A total of 10% met the criteria for burnout and 18% scored high on the emotional exhaustion subscale. Perceived lack of preparation in generic competencies correlated with burnout (r = 0.15, p < 0.001). No such relation was found for medical competencies. Furthermore, social support protected against burnout. Conclusions: These findings illustrate the relevance of generic competencies for new hospital consultants. Furthermore, social support facilitates this intense and stressful stage within the medical career.
    Medical Teacher 03/2013; · 1.82 Impact Factor
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    ABSTRACT: Introduction: Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and generic competencies, perceived intensity and burnout were compared. Additionally, effects of differences in working conditions and cultural dimensions were explored. Methods: All consultants registered in the Netherlands in 2007-2009 (n = 2643) and Denmark in 2007-2010 (n = 1336) received in June 2010 and April 2011, respectively, a survey about their preparation for medical and generic competencies, perceived intensity and burnout. Power analysis resulted in required sample sizes of 542. Descriptive statistics and independent t-tests were used for analysis. Results: Data were available of 792 new consultants in the Netherlands and 677 Danish new consultants. Compared to their Dutch counterparts, Danish consultants perceived specialty training and the transition less intensely, reported higher levels of preparation for generic competencies and scored lower on burnout. Conclusions: The importance of contextual aspects in the transition is underscored and shows that Denmark appears to succeed better in aligning training with practice. Regulations regarding working hours and progressive independence of trainees appear to facilitate the transition.
    Medical Teacher 03/2013; · 1.82 Impact Factor
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    ABSTRACT: Familial LCAT deficiency (FLD) is a recessive lipid disorder ultimately leading to end-stage renal disease (ESRD). We present two brothers with considerable variation in the age at which they developed ESRD. Kidney biopsies revealed both tubular and glomerular pathology. To date, no causal therapy is available, yet enzyme replacement therapy is in development.
    The Netherlands Journal of Medicine 01/2013; 71(1):29-31. · 2.38 Impact Factor
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    ABSTRACT: Patients with an elevated erythrocyte sedimentation rate (ESR) and non-specific symptoms often pose a diagnostic dilemma. PET/CT visualises infection, inflammation and malignancy, all of which may cause elevated ESR. The objective of this study was to determine the contribution of 18F-fluorodeoxglucose positron emission tomography (PET/CT) in the diagnostic work-up of referred patients with an elevated ESR, in whom initial routine evaluation did not reveal a diagnosis. We conducted a combined retrospective (A) and prospective (B) study in elderly (>50 years) patients with a significantly elevated ESR of≥50 mm/h and non-specific complaints. In study A, 30 patients were included. Malignancy (8 patients), auto-inflammatory disease (8 patients, including 5 with large-vessel vasculitis) and infection (3 patients) were suggested by PET/CT. Two scans showed non-specific abnormalities and 9 scans were normal. Of the 21 abnormal PET/CT results, 12 diagnoses were independently confirmed and two alternative diagnosis were made. Two diagnoses were established in patients with a normal scan. In study B, 58 patients in whom a prior protocolised work-up was non-diagnostic, were included. Of these, 25 PET/CT-scans showed suspected auto-inflammatory disease, particularly large-vessel vasculitis (14 cases). Infection and malignancy was suspected in 5 and 3 cases, respectively. Seven scans demonstrated non-specific abnormalities, 20 were normal. Of the 40 abnormal PET/CT results, 22 diagnoses were confirmed, 3 alternative diagnoses were established. Only one diagnosis was established in the 20 patients with a normal scan. In both studies, the final diagnosis was based on histology, clinical follow-up, response to therapy or additional imaging. In conclusion, PET/CT may be of potential value in the diagnostic work-up of patients with elevated ESR if routine evaluation reveals no diagnosis. In particular, large-vessel vasculitis appears to be a common finding. A normal PET/CT scan in these patients suggests that it is safe to follow a wait-and-see policy.
    PLoS ONE 01/2013; 8(3):e58917. · 3.73 Impact Factor
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    ABSTRACT: Background The Beck Depression Inventory (BDI) is a standard and validated questionnaire to screen for depressive symptoms in chronic dialysis patients, but is relatively extensive to use repeatedly in clinical practice. We investigated whether the five-item Mental Health Inventory (MHI-5) of the 36-item Short-Form Health Survey Questionnaire (SF-36) could be applied to screen for depressive symptoms in dialysis patients. Moreover, we determined the optimal MHI-5 cut-off score to assess depressive symptoms.Methods Chronic dialysis patients from three centres filled out the SF-36 and the BDI. A receiver operating characteristic (ROC) curve was constructed for the MHI-5 score with BDI ≥16 as reference standard to (i) calculate the area under the curve to determine whether the MHI-5 could be considered as a useful screening instrument for depressive symptoms and (ii) proxy the optimal cut-off score of the MHI-5 to assess depressive symptoms. The optimal cut-off score was determined by the value for which the sum of sensitivity and specificity had an optimum.ResultsOf 133 included patients, 23% had depressive symptoms as determined with BDI ≥16. The correlation of the BDI with MHI-5 was -0.64. The area under the ROC curve was 0.82 (95% confidence interval 0.74-0.90). The optimal cut-off point of the MHI-5 was 70. MHI-5 ≤70 had 77 sensitivity, 72 specificity, 44 positive predicting value and 91% negative predicting value with the presence of depressive symptoms determined with BDI ≥16.Conclusions The MHI-5 may help clinicians to screen for depressive symptoms in dialysis patients without using an additional depression screening questionnaire once the SF-36 is completed. A cut-off value of 70 can be used safely for the purposes of screening applications.
    Nephrology Dialysis Transplantation 08/2012; · 3.37 Impact Factor
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    ABSTRACT: Ethnic minority patients on dialysis are reported to have better survival rates relative to Caucasians. The reasons for this finding are not fully understood and European studies are scarce. This study examined whether ethnic differences in survival could be explained by patient characteristics, including psychosocial factors. We analysed data of the Netherlands Cooperative Study on the Adequacy of Dialysis study, an observational prospective cohort study of patients who started dialysis between 1997 and 2007 in the Netherlands. Ethnicity was classified as Caucasian, Black or Asian, assessed by local nurses. Data collected at the start of dialysis treatment included demographic, clinical and psychosocial characteristics. Psychosocial characteristics included data on health-related quality of life (HRQoL), mental health status and general health perception. Cox proportional hazards analysis was used to explore ethnic survival differences. One thousand seven hundred and ninety-one patients were Caucasian, 45 Black and 108 Asian. The ethnic groups differed significantly in age, residual glomerular filtration rate, diabetes mellitus, erythropoietin use, plasma calcium, parathormone and creatinine, marital status and general health perception. No ethnic differences were found in HRQoL and mental health status. Crude hazard ratios (HRs) for mortality for Caucasians compared to Blacks and Asians were 3.1 [95% confidence interval (CI) 1.6-5.9] and 1.1 (95% CI 0.9-1.5), respectively. After adjustment for a range of potential explanatory variables, including psychosocial factors, the HRs were 2.5 (95% CI 1.2-4.9) compared with Blacks and 1.2 (95% CI 0.9-1.6) compared with Asians. Although patient numbers were rather small, this study demonstrates, with 95% confidence, better survival for Black compared to Caucasian dialysis patients and equal survival for Asian compared to Caucasian dialysis patients in the Netherlands. This could not be explained by patient characteristics, including psychosocial factors.
    Nephrology Dialysis Transplantation 11/2011; 27(6):2472-9. · 3.37 Impact Factor
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    ABSTRACT: To systematically review the literature pertaining to the reversal of type 2 diabetes mellitus (DM2) after Roux-en-Y gastric bypass and adjustable gastric banding. We conducted a review of the literature using PubMed and searched the reference lists of published studies to identify additional studies. We selected all published articles that were relevant with respect to bariatric surgery and its metabolic effects. Only 9 original articles reporting on DM2 reversal rates after bariatric surgery were identified: 1 randomized controlled trial and 8 observational studies. Other referenced articles serve as background literature. Roux-en-Y gastric bypass leads to a reversal rate of DM2 of 83%. Adjustable gastric banding confers a reversal rate of 62%, and this effect is achieved later after surgery. Bariatric surgery leads to marked and long-lasting weight reduction. A large proportion of patients undergoing bariatric surgery have DM2. In fact, the presence of diabetes mellitus is a compelling argument to perform bariatric surgery in those who are eligible according to international criteria. Glycemic control improves in the months after laparoscopic adjustable gastric banding, but it improves more rapidly and completely after laparoscopic Roux-en-Y gastric bypass surgery. Thus, both types of surgery are capable of improving or even curing DM2, but the mechanisms may differ.
    Archives of surgery (Chicago, Ill.: 1960) 06/2011; 146(6):744-50. · 4.32 Impact Factor
  • Hannah Visser, Kamilla D Lettinga, Carl E H Siegert
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    ABSTRACT: The Hajj, the pilgrimage to Mecca, is the largest mass migration in the world. Each year, 2.5 million Muslims from over 160 countries travel to the same place, 5000-6000 of these being from the Netherlands. During the Hajj, the pilgrims undergo great physical and emotional strain. Good medical preparation including vaccinations is very important for pilgrims who undertake the Hajj, in particular for those who are older and have chronic disease. The chance of transmission of infective disease is also high and rapid contagion of Hajj pilgrims could cause a pandemic. It is therefore important that the responsible doctor is aware of the health risks to the Hajj pilgrim and his environment.
    Nederlands tijdschrift voor geneeskunde 01/2011; 155(42):A3962.
  • Annals of the rheumatic diseases 11/2010; 70(7):1341-2. · 8.11 Impact Factor
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    ABSTRACT: There is a paucity of research into the processes surrounding the transition from residency to the position of attending physician. This report retrospectively investigates the question: Are attending physicians adequately prepared and trained to perform the tasks and duties of their new position? This study aimed at formulating a conceptual framework that captures the transition and is applicable beyond discipline- or location-specific boundaries. Individual semistructured interviews were conducted and analyzed using a qualitative, grounded theory approach. Between January and May 2009, 14 physicians were interviewed who had commenced an attending post in internal medicine or obstetrics-gynecology between six months and two years earlier, within the Netherlands. Interviews focused on the attendings' perceptions of the transition, their socialization within the new organization, and the preparation they had received during residency training. The interview transcripts were openly coded, and through constant comparison, themes emerged. The research team discussed the results until full agreement was reached. A conceptual framework emerged from the data, consisting of three themes interacting in a longitudinal process. The framework describes how novel disruptive elements (first theme) due to the transition from resident to attending physician are perceived and acted on (second theme), and how this directs new attendings' personal development (third theme). The conceptual framework finds support in transition psychology and notions from organizational socialization literature. It provides insight into the transition from resident to attending physician that can inform measures to smooth the intense transition.
    Academic medicine: journal of the Association of American Medical Colleges 10/2010; 85(12):1914-9. · 2.34 Impact Factor
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    G Verhave, C E H Siegert
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    ABSTRACT: There is increasing evidence for health benefits accomplished by activated vitamin D through interaction with the vitamin D receptor (VDR) that go beyond calcium and bone homeostasis and regulation of parathyroid hormone (PTH) secretion. Treatment with vitamin D receptor agonists (VDRAs) is associated with reduced mortality in (pre)dialysis patients. Interestingly, these relations are independent of PTH levels and calcium x phosphorus product. This suggests the presence of biological functions of vitamin D that are independent of its interaction with the parathyroid glands. Because chronic kidney disease leads to increased cardiovascular mortality, mechanisms in which VDRAs can influence cardiovascular disease are discussed. These mechanisms comprise the potential ameliorating effects of VDRAs on atherosclerosis, arterial media calcification, cardiac hypertrophy, the renin-angiotensin system and thrombosis. Moreover, treatment strategies with VDRAs are discussed together with several recent observational studies. Treatment advice consists of correction of 25(OH) vitamin D deficiency, low-dose calcitriol in patients with secondary hyperparathyroidism, and activated vitamin D analogues may be indicated when higher doses are needed to suppress PTH secretion. New insights into biological and clinical effects of VDRAs may broaden the patient group that may benefit from VDRA treatment to patients with creatinine clearances in the 30 to 60 ml/min range.
    The Netherlands Journal of Medicine 03/2010; 68(3):113-8. · 2.38 Impact Factor
  • Jacob W Bosma, Juup J M van Meyel, Carl E H Siegert
    Nederlands tijdschrift voor geneeskunde 01/2010; 154:A1355.
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    ABSTRACT: To provide an overview of the existing data on non-Caucasian dialysis patients within Europe, and to explore whether these data confirm differences between non-Caucasian and Caucasian dialysis patients that were found in other parts of the world. A query consisting of the combination "dialysis", "ethnicity", and "Europe" was applied in PubMed, EMBASE, Web of Science, CINAHL, and the Cochrane Library. Ten papers were included in this study. Studies from the United Kingdom (UK) and the Netherlands confirm the higher incidence of end-stage renal disease (ESRD) in non-Caucasians. In other European countries these findings were not confirmed. In studies from the UK, the Netherlands, and Spain a younger age at initiation of dialysis treatment for non-Caucasians compared to Caucasians was reported, this is also found in non-European studies. Regarding comorbid conditions at the start of renal replacement therapy (RRT), vascular disease was less common, while diabetes was more common among non-Caucasians compared to Caucasians. Large non-European studies also demonstrated less vascular disease among non-Caucasians initiating RRT than among Caucasians. The survival advantage for non-Caucasian compared to Caucasian RRT patients is confirmed in one large study from the UK and in a Dutch study. Reasons for the better survival of non-Caucasians are not understood completely. Only a few studies are available on non-Caucasian dialysis patients in Europe. The available data confirm findings of other studies throughout the world on racial differences on dialysis. More research is needed to understand the higher incidence and better survival in non-Caucasian patients, and also in countries where there are currently no relevant data.
    Clinical nephrology 01/2010; 74 Suppl 1:S78-84. · 1.29 Impact Factor
  • W L Loosman, C E H Siegert, A Korzec, A Honig
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    ABSTRACT: To validate the Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory (BDI) for use in patients with end-stage renal disease (ESRD) and to compare the outcome of both screening measures with each other. Cross-sectional and between-subjects design. The independent variable was the diagnosis depression by the Mini International Neuropsychiatric Interview (MINI). The dependent variables were the HADS and BDI total score. All 130 patients with ESRD who were treated with haemodialysis (HD) or peritoneal dialyses in the Sint Lucas Andreas Hospital in Amsterdam were eligible for this study and were asked to fill out both HADS and BDI. The outcomes of both rating scales were compared with the diagnosis major depressive episode based on the MINI, which was seen as the gold standard. Receiver operating characteristic curves were used to choose optimal cut-off values. Of 62 enrolled subjects, 21 (34%) were diagnosed with a depressive disorder. Optimal cut-off values were ≥12 (HADS) and ≥13 (BDI). Sensitivity was 81.0% (HADS) and 75.0% (BDI). Specificity was 90.2% for both. Both HADS and BDI are valid screening instruments for the diagnosis depression in ESRD patients but there is no statistical difference found between both rating scales.
    British Journal of Clinical Psychology 12/2009; 49(Pt 4):507-16. · 1.90 Impact Factor
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    ABSTRACT: Formation of an intraluminal microbial biofilm is noted to play a significant role in the development of catheter-related infections (CRIs). Recently, it has been demonstrated that trisodium citrate (TSC) has superior antimicrobial effects over heparin for catheter locking. In this randomized controlled trial, we compared the influence of catheter locking with heparin and TSC on the in vivo intraluminal biofilm formation in haemodialysis catheters. Six patients were studied from the time of catheter insertion for haemodialysis treatment. They were randomly assigned to TSC 30% or heparin 5000 U/ml for catheter locking for the duration of 1 month. After elective guidewire exchange of the catheter, the locking solution was also changed. After removal, catheters were dissected in three segments and examined by standardized scanning electron microscopy (SEM) to assess quantitative biofilm formation. Furthermore, standardized cultures of all segments were performed to identify any microorganisms. In catheters filled with TSC, the average coverage by biofilm was 16% versus 63% in the heparin group (P < 0.001). A total of eight subsegments were associated with local catheter infection in the patients who were randomized to heparin locking versus three subsegments who were assigned to TSC (P < 0.05). Our study demonstrates that using TSC 30% for catheter locking reduces the formation of microbial biofilm in haemodialysis catheters and culture-positive colonization. It is likely that this is the explanation for the observed prevention of CRIs by TSC locking.
    Nephrology Dialysis Transplantation 11/2009; 25(4):1213-7. · 3.37 Impact Factor

Publication Stats

288 Citations
87.33 Total Impact Points

Institutions

  • 2008–2013
    • St. Lucas Andreas Hospital
      Amsterdamo, North Holland, Netherlands
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • Department of Clinical Epidemiology and Biostatistics
      Amsterdam, North Holland, Netherlands
  • 2010
    • VU University Medical Center
      Amsterdamo, North Holland, Netherlands