Fred H M Nieman

Maastricht University, Maestricht, Limburg, Netherlands

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Publications (120)485.63 Total impact

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    ABSTRACT: Pregnancy and delivery are the most prominent risk factors for the onset of pelvic floor injuries and – later-on – urinary incontinence. Supervised pelvic floor muscle training during and after pregnancy is proven effective for the prevention of urinary incontinence on the short term. However, only a minority of women do participate in preventive pelvic floor muscle training programs. Our aim was to analyze willingness to participate (WTP) in an intensive preventive pelvic floor muscle training (PFMT) program and influencing factors, from the perspective of postpartum women, for participation.
    No preview · Article · Nov 2015 · European journal of obstetrics, gynecology, and reproductive biology
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    ABSTRACT: (i) To describe and analyse pelvic floor dysfunction symptoms in women referred to a Pelvic Care Centre (PCC). (ii) To describe the triage process of the same patients based on response to a first-contact interview. Triage started with a telephone interview using previously constructed questions, asking for seven types of PF complaints during the preceding 6 months. If present, complaint severity was registered on a 0-10 scale. Next, these first-contact complaints were used to describe patient case mix profiles using cross-tabular analysis. Later on, at first PCC visit, an intake questionnaire containing questions on specific PF health problem(s) was filled out. This procedure contributed to a firm baseline characterization of the individual patient profile and a clinically valid allocation to structured, predefined assessment, and treatment. From 2005 to 2013, 4473 first-time patients (mean age 56.9 (SD 16.2) have been referred to the PCC. Most frequently mentioned complaints: voiding dysfunction (59.5%), urinary incontinence (46.6%), prolapse (41.1%), fecal incontinence (15.1%), constipation (12.6%), and sexual problems (4.6%). A first appointment to a single specialist was determined in 3.110 (69.5%) patients, in 1.192 (26.7%) consultation of >1 specialist. Data analysis revealed higher-order interactions between PF complaints, suggesting patient profile complexity and patient population heterogeneity. More than one out of four PCC patients showed multifactorial problems, needing >1 specialist. PF complaints either turned out to stand alone or cluster with others, or even to strengthen, weaken, nullify, or inverse relationships. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    No preview · Article · Mar 2015 · Neurourology and Urodynamics
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    ABSTRACT: Gesuperviseerde looptraining is de eerste keus in de conservatieve behandeling van patiënten met claudicatio intermittens. Diabetes mellitus is een vaak voorkomende comorbiditeit bij patiënten met perifeer arterieel vaatlijden (PAV). Het huidige veronderstelde werkingsmechanisme van looptraining suggereert dat looptraining leidt tot gunstige fysiologische veranderingen in de skeletspiermetabolisme en de endotheelfunctie, wat zich uit in een toename van de loopafstand.
    No preview · Article · Feb 2015
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    ABSTRACT: (i) To describe and analyse pelvic floor dysfunction symptoms in men referred to a Pelvic Care Centre (PCC). (ii) To describe the triage process of the same patients based on response to a first-contact interview. Triage started with a telephone interview using previously constructed questions, asking for six types of PF complaints during the preceding 6 months. If present, complaint severity was registered on a 0-10 scale. Next, these first-contact complaints were used to describe patient case mix profiles using cross-tabular analysis. Later on, at first PCC visit, an intake questionnaire regarding specific PF health problem(s) was filled out. This procedure contributed to a firm baseline characterization of the individual patient profile and a clinically valid allocation to structured, predefined assessment and treatment. From 2005 to 2013 985 first-time patients (mean age 58.2 years (SD 15.3) have been referred to the PCC. Most frequently mentioned complaints: voiding dysfunctions (73.9%), urinary incontinence (29.5%), sexual problems (16.6%), faecal incontinence (13.9%), constipation (9.6%), and prolapse (0.3%). A first appointment to a single specialist was determined in 805 (81.7%) patients, in 137 (13.9%) consultation of >1 specialist. Data analysis revealed higher-order interactions between PF complaints, suggesting patient profile complexity and patient population heterogeneity. One out of seven PCC patients showed multifactorial problems, needing >1 specialist. PF complaints either turned out to stand alone or cluster with others, or even to strengthen, weaken, nullify or inverse relationships. Neurourol. Urodynam. 9999:1-5, 2014. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    No preview · Article · Jan 2015 · Neurourology and Urodynamics
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    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. Results 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 = 0.001 respectively). 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 PFMT programs. Concluding message 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. References 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: 10.1002/14651858.CD007471.pub2.; (10). 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. Disclosures 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
    Full-text · Conference Paper · Oct 2014
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    ABSTRACT: Background Post-operative atrial fibrillation (POAF) is considered to be a transient arrhythmia in the first week after surgery. Objectives 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. Methods 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. Results 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). Conclusion 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.
    Full-text · Article · Jul 2014 · Heart rhythm: the official journal of the Heart Rhythm Society
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    ABSTRACT: Congestive heart failure is frequent and leads to reduced exercise capacity, reduced quality of life (QoL), and depression in many patients. Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD) offer therapeutic options and may have an impact on QoL and depression. This study was performed to evaluate physical and mental health in patients undergoing ICD or combined CRT/ICD-implantation (CRT-D). Echocardiography, spiroergometry, and psychometric questionnaires [Beck Depression Inventory, General World Health Organization Five Well-being Index (WHO-5), Brief Symptom Inventory and 36-item Short Form (SF-36)] were obtained in 39 patients (ICD: 17, CRT-D: 22) at baseline and 6-month follow-up (FU) after device implantation. CRT-D patients had a higher NYHA class and broader left bundle branch block than ICD patients at baseline. At FU, ejection fraction (EF), peak oxygen uptake, and NYHA class improved significantly in CRT-D patients but remained unchanged in ICD patients. Patients with CRT-D implantation showed higher levels of depressive symptoms, psychological distress, and impairment in QoL at baseline and FU compared to ICD patients. These impairments remained mostly unchanged in all patients after 6 months. Overall, these findings imply that there is a need for careful assessment and treatment of psychological distress and depression in ICD and CRT-D patients in the course of device implantation as psychological burden seems to persist irrespective of physical improvement.
    No preview · Article · Jun 2013 · Heart and Vessels

  • No preview · Article · Jan 2013 · Heart and Vessels
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    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.
    Full-text · Article · Aug 2012 · Annals of Vascular Surgery
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    ABSTRACT: Scand J Caring Sci; 2013; 27; 253–259 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.
    Full-text · Article · May 2012 · Scandinavian Journal of Caring Sciences
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    ABSTRACT: WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The efficacy target of AUC : MIC > 125 is based on the study of Forrest et al. in 1993. • Recent studies have shown that in ICU patients the ciprofloxacin efficacy target of AUC : MIC > 125 is often not reached. WHAT THIS STUDY ADDS • The efficacy targets of ciprofloxacin in patients in general wards are often not reached. Most patients have low AUC with current i.v. dosing regimens. We suggest increasing the standard dose of ciprofloxacin to 1200 mg intravenously 24 h–1. • Patients in general wards have high interindividual variability of pharmacokinetic parameters and therapeutic drug monitoring could be useful to support dosing. AIM The aim of this study was to determine the ciprofloxacin serum concentrations in hospitalized patients and to determine which percentage reached the efficacy target of AUC : MIC > 125. Additionally, the influence of demographic anthropomorphic and clinical parameters on the pharmacokinetics and pharmacodynamics of ciprofloxacin were investigated. METHODS In serum of 80 hospitalized patients ciprofloxacin concentrations were measured with reverse phase high performance liquid chromatography with fluorescence detection. The ciprofloxacin dose was 400–1200 mg day−1 i.v. in two or three doses depending on renal function and causative bacteria. Pharmacokinetic parameters were calculated with maximum a posteriori Bayesian estimation (MW\PHARM 3.60). A two compartment open model was used. RESULTS Mean (± SD) age was 66 (± 17) years, the mean clearance corrected for bodyweight was 0.24 l h−1 kg−1 and the mean AUC was 49 mg l−1 h. Ciprofloxacin clearance and thus AUC were associated with both age and serum creatinine. Of all patients, 21% and 75% of the patients, did not reach the proposed ciprofloxacin AUC : MIC > 125 target with MICs of 0.25 and 0.5 mg l−1, respectively. A computer simulated increase in the daily dose from 800 mg to 1200 mg, decreased these percentages to 1% and 37%, respectively. CONCLUSION A substantial proportion of the hospitalized patients did not reach the target ciprofloxacin AUC : MIC and are suboptimally dosed with recommended doses. Taking into account the increasing resistance to ciprofloxacin worldwide, a ciprofloxacin dose of 1200 mg i.v. daily in patients with normal renal function is necessary to reach the targeted AUC : MIC > 125.
    Full-text · Article · May 2012 · British Journal of Clinical Pharmacology
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    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.
    Preview · Article · Mar 2012 · Diseases of the Colon & Rectum
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    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.
    Full-text · Article · Jan 2012 · European journal of gastroenterology & hepatology
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    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.
    No preview · Article · Sep 2011 · Neurourology and Urodynamics
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    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.
    Full-text · Article · Aug 2011 · Transfusion
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    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.
    No preview · Article · Aug 2011 · BJU International
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    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.
    Full-text · Article · Jun 2011 · Journal of the American Society of Nephrology
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    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.
    Preview · Article · May 2011 · Human Reproduction
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    ABSTRACT: Background Recent increasing prevalence of heart failure (HF) patients leads to an increasing burden to the health care system. Consequently, there is a need for innovative strategies to reduce HF hospitalizations. Methods We performed a multicentre randomized controlled trial to test the hypothesis that telemonitoring in patients with HF, by means of the Health Buddy® system (HB), will reduce HF hospitalizations and number of contacts with caregivers as compared to care as usual (CAU) during 1 year follow-up, from October 1, 2007, through December 31, 2008. Results Among 382 patients—197 in the HB and 185 in the CAU-group—226 (59%) were male, mean age was 71.5 (SD 11.2), 45.5% being ≥75 years of age; 57% of the patients were in NYHA HF class 2, 40% in class 3 and 3% in class 4. Both study groups were similar for demographic and clinical characteristics. Mean time to first heart failure related hospitalization was 161 days for the intervention group and 139 days for the usual-care group; hospitalizations occurred in 18 (9.1%) compared to 25 patients (13.5%) respectively (Kaplan–Meier p=0.151, hazard ratio 0.65, CI 0.35–1.17). Combined endpoint of heart failure admission and all cause mortality was similar for both groups (Kaplan–Meier p=0.641 hazard ratio 0.89, CI 0.69–1.83). Cox regression analysis disclosed an important interaction between group assignment and heart failure duration, p=0.007, OR=0.983, CI 0.970–0.995 indicating a significant decrease in heart failure hospitalizations in the intervention group if heart failure duration was <18 months, p=0.026, hazard ratio 0.26, CI 0.07–0.94. Contacts with the heart-failure-nurse were mean 1.36 (range 0–11) in the intervention group vs. 1.74 (0–8) in the usual-care group (Mann-Whitney p<0.001). Mortality was 18 (9.1%) in the intervention-group and 12 (6.5%) in the usual-care-group (Mann–Whitney p=0.34, Cox-regression analysis p=0.82). Conclusion Telemonitoring tends to reduce heart failure admissions and decreases contacts with specialized nurses. If heart failure duration is <18 months heart failure admissions and readmissions are significantly reduced.
    Full-text · Article · Apr 2011 · Journal of the American College of Cardiology
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    ABSTRACT: Young children and children with mental impairment that have to undergo magnetic resonance imaging (MRI) will require procedural sedation (PS) to maintain the necessary immobility. In the last decade severe accidents have occurred in the Netherlands in children during PS for MRI. It has been shown that well-established guidelines on PS-related safety are insufficiently implemented in Dutch general paediatrics. In addition major concerns exist regarding the limited effectiveness of standard PS practices. By the use of a questionnaire we surveyed the PS techniques that Dutch general pediatricians routinely apply for PS in MR. Findings were compared with the results of a systematic review (SR) of the recent literature. By the SR we aim to answer the clinical question: what is the safest and most effective technique of providing PS to children undergoing MRI? Dutch general pediatricians rarely make use of general anaes thesia for MRI in their patients. The majority applies a PS technique that is based on chloral hydratt, midazolam and/or lytic cocktails. The effectiveness of these sedatives is generally suboptimal, causing an undefined number of total or partial procedural failures. In addition, these drugs may cause severe adverse events, making extensive safety precautions and specific professional competences imperative. Of all studied sedatives the anaesthetic propofol has the highest level of effectiveness. There is good evidence that well-trained non-anaesthesiologists may provide propofol sedation safely. In the absence of these professionals, children in need for sedation for MRI should be referred to an anaesthesiologist.
    No preview · Article · Apr 2011 · Tijdschrift voor kindergeneeskunde

Publication Stats

3k Citations
485.63 Total Impact Points

Institutions

  • 1989-2015
    • Maastricht University
      • • Department of Dermatology
      • • Department of Internal Medicine
      • • Department of Epidemiology
      Maestricht, Limburg, Netherlands
  • 2012
    • Nederlands Instituut voor onderzoek van de Gezondheidszorg
      Utrecht, Utrecht, Netherlands
  • 1998-2012
    • Maastricht Universitair Medisch Centrum
      • Central Diagnostic Laboratory
      Maestricht, Limburg, Netherlands
  • 2011
    • Institute for Health and Care Research
      Maestricht, Limburg, Netherlands