PMID: 26843001
Vermeij A, Kessels RPC, Heskamp L, Simons EMF, Dautzenberg PLJ, Claassen JAHR. Prefrontal activation may predict working-memory training gain in normal aging and mild cognitive impairment. Brain Imaging Behav. 2017 Feb;11(1):141-154. doi: 10.1007/s11682-016-9508-7.
Cognitive training has been shown to result in improved behavioral performance in normal aging and mild cognitive impairment (MCI), yet little is known about the neural correlates of cognitive plasticity, or about individual differences in responsiveness to cognitive training. In this study, 21 healthy older adults and 14 patients with MCI received five weeks of adaptive computerized working-memory (WM) training. Before and after training, functional Near-Infrared Spectroscopy (fNIRS) was used to assess the hemodynamic response in left and right prefrontal cortex during performance of a verbal n-back task with varying levels of WM load. After training, healthy older adults demonstrated decreased prefrontal activation at high WM load, which may indicate increased processing efficiency. Although MCI patients showed improved behavioral performance at low WM load after training, no evidence was found for training-related changes in prefrontal activation. Whole-group analyses showed that a relatively strong hemodynamic response at low WM load was related to worse behavioral performance, while a relatively strong hemodynamic response at high WM load was related to higher training gain. Therefore, a ‘youth-like’ prefrontal activation pattern at older age may be associated with better behavioral outcome and cognitive plasticity.
PMID: 26969198
van Baaren GJ, Broekhuijsen K, van Pampus MG, Ganzevoort W, Sikkema JM, Woiski MD, Oudijk MA, Bloemenkamp K, Scheepers H, Bremer HA, Rijnders R, van Loon AJ, Perquin D, Sporken J, Papatsonis D, van Huizen ME, Vredevoogd CB, Brons J, Kaplan M, van Kaam AH, Groen H, Porath M, van den Berg PP, Mol B, Franssen M, Langenveld J; HYPITAT-II Study Group. An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II).
BJOG. 2017 Feb;124(3):453-461. doi: 10.1111/1471-0528.13957. Epub 2016 Mar 10.
OBJECTIVE: To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy.
DESIGN: A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II).
SETTING: Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands.
POPULATION: Women diagnosed with non-severe hypertensive disorders of pregnancy between 340/7 and 370/7 weeks of gestation, randomly allocated to either immediate delivery or expectant monitoring.
METHODS: A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge.
MAIN OUTCOME MEASURES: Health outcomes were expressed as the prevalence of respiratory distress syndrome, defined as the need for supplemental oxygen for >24 hours combined with radiographic findings typical for respiratory distress syndrome. Costs were estimated from a healthcare perspective until maternal and neonatal discharge.
RESULTS: The average costs of immediate delivery (n = 352) were €10 245 versus €9563 for expectant monitoring (n = 351), with an average difference of €682 (95% confidence interval, 95% CI -€618 to €2126). This 7% difference predominantly originated from the neonatal admissions, which were €5672 in the immediate delivery arm and €3929 in the expectant monitoring arm.
CONCLUSION: In women with mild hypertensive disorders between 340/7 and 370/7 weeks of gestation, immediate delivery is more costly than expectant monitoring as a result of differences in neonatal admissions. These findings support expectant monitoring, as the clinical outcomes of the trial demonstrated that expectant monitoring reduced respiratory distress syndrome for a slightly increased risk of maternal complications.
TWEETABLE ABSTRACT: Expectant management in preterm hypertensive disorders is less costly compared with immediate delivery.
© 2016 Royal College of Obstetricians and Gynaecologists.
PMID: 27055805
Stewart T, Spelman T, Havrdova E, Horakova D, Trojano M, Izquierdo G, Duquette P, Girard M, Prat A, Lugaresi A, Grand’Maison F, Grammond P, Sola P, Shaygannejad V, Hupperts R, Alroughani R, Oreja-Guevara C, Pucci E, Boz C, Lechner-Scott J, Bergamaschi R, Van Pesch V, Iuliano G, Ramo C, Taylor B, Slee M, Spitaleri D, Granella F, Verheul F, McCombe P, Hodgkinson S, Amato MP, Vucic S, Gray O, Cristiano E, Barnett M, Sanchez Menoyo JL, van Munster E, Saladino ML, Olascoaga J, Prevost J, Deri N, Shaw C, Singhal B, Moore F, Rozsa C, Shuey N, Skibina O, Kister I, Petkovska-Boskova T, Ampapa R, Kermode A, Butzkueven H, Jokubaitis V, Kalincik T; MSBase Study Group. Contribution of different relapse phenotypes to disability in multiple sclerosis.
Mult Scler. 2017 Feb;23(2):266-276. doi: 10.1177/1352458516643392.
OBJECTIVE: This study evaluated the effect of relapse phenotype on disability accumulation in multiple sclerosis.
METHODS: Analysis of prospectively collected data was conducted in 19,504 patients with relapse-onset multiple sclerosis and minimum 1-year prospective follow-up from the MSBase cohort study. Multivariable linear regression models assessed associations between relapse incidence, phenotype and changes in disability (quantified with Expanded Disability Status Scale and its Functional System scores). Sensitivity analyses were conducted.
RESULTS: In 34,858 relapses recorded during 136,462 patient-years (median follow-up 5.9 years), higher relapse incidence was associated with greater disability accumulation (β = 0.16, p < 0.001). Relapses of all phenotypes promoted disability accumulation, with the most pronounced increase associated with pyramidal (β = 0.27 (0.25-0.29)), cerebellar (β = 0.35 (0.30-0.39)) and bowel/bladder (β = 0.42 (0.35-0.49)) phenotypes (mean (95% confidence interval)). Higher incidence of each relapse phenotype was associated with an increase in disability in the corresponding neurological domain, as well as anatomically related domains.
CONCLUSION: Relapses are associated with accumulation of neurological disability. Relapses in pyramidal, cerebellar and bowel/bladder systems have the greatest association with disability change. Therefore, prevention of these relapses is an important objective of disease-modifying therapy. The differential impact of relapse phenotypes on disability outcomes could influence management of treatment failure in multiple sclerosis.
PMID: 27135753
Ploos van Amstel FK, Tol J, Sessink KH, van der Graaf WT, Prins JB, Ottevanger PB. A Specific Distress Cutoff Score Shortly After Breast Cancer Diagnosis.
Cancer Nurs. 2017 May/Jun;40(3):E35-E40.
Trefwoorden: borstkanker, stress
BACKGROUND: High levels of distress are expected shortly after the diagnosis breast cancer. The Distress Thermometer (DT) is commonly used to screen for distress, using a cutoff score of 4 or 5; however, this score might not be appropriate for detecting distress in women with recently diagnosed breast cancer.
OBJECTIVES: The aims of this study were to establish the optimal DT cutoff score for detecting high distress shortly after breast cancer diagnosis and to correlate this score with the reported problems.
METHODS: We selected for this study Dutch women who completed the DT and the Hospital Anxiety and Depression Scale within 1 month after breast cancer diagnosis. Receiver operating characteristic analysis of DT scores was performed, with the Hospital Anxiety and Depression Scale being used as the criterion standard for the level of distress. The sensitivity, specificity, positive predictive value, and negative predictive value of each DT score were calculated.
RESULTS: In total, 181 women participated in the study. The optimal DT cutoff score for detecting distress was 7 with a sensitivity of 0.73, specificity of 0.84, positive predictive value of 69%, and negative predictive value of 87%. Emotional problems were the most frequently reported concerns.
CONCLUSION: We consider a cutoff score of 7, shortly after breast cancer is diagnosed, optimal to identify those women with high distress and therefore at risk of chronic distress.
IMPLICATIONS FOR PRACTICE: The findings are clinically important because they can enable healthcare professionals to direct their time and resources to those most in need of their assistance.
PMID: 27189850
Boersma D, de Borst GJ, Moll FL. A proof-of-concept study of the VeinScrew: A new percutaneous venous closure device.
Vascular. 2017 Feb;25(1):105-109. doi: 10.1177/1708538116644117.
Objective This study evaluated the concept of percutaneous closure of insufficient veins using the VeinScrew principle. Methods The VeinScrew is designed to place a spring-shaped implant that contracts and clamps around the vein. The ability of the device to occlude adequately was tested in a bench model experiment. The feasibility of accurate placement and adequate venous occlusion was evaluated in an animal experiment and in a human cadaveric experiment. Results The VeinScrew implant occluded up to a pressure of 135 mmHg. In vivo studies confirmed that deployment was challenging but technically feasible, and subsequent phlebography showed closure of the vein. The cadaveric study showed that percutaneous placement of the evolved VeinScrew around the great saphenous vein was feasible and accurate. Conclusions The current studies show the feasibility of the VeinScrew concept. Future developments and translational studies are necessary to determine the potential of this technique as a new option in the phlebologist’s toolbox.
PMID: 27341122
Ten Eikelder ML, van de Meent MM, Mast K, Rengerink KO, Jozwiak M, de Graaf IM, Scholtenhuis MA, Roumen FJ, Porath MM, van Loon AJ, van den Akker ES, Rijnders RJ, Feitsma AH, Adriaanse AH, Muller MA, de Leeuw JW, Visser H, Woiski MD, Weerd SR, van Unnik GA, Pernet PJ, Versendaal H, Mol BW, Bloemenkamp KW. Women’s Experiences with and Preference for Induction of Labor with Oral Misoprostol or Foley Catheter at Term.
Objective: We assessed experience and preferences among term women undergoing induction of labor with oral misoprostol or Foley catheter.
Study Design:In 18 of the 29 participating hospitals in the PROBAAT-II trial, women were asked to complete a questionnaire within 24 hours after delivery. We adapted a validated questionnaire about expectancy and experience of labor and asked women whether they would prefer the same method again in a future pregnancy. Results:The questionnaire was completed by 502 (72%) of 695 eligible women; 273 (54%) had been randomly allocated to oral misoprostol and 229 (46%) to Foley catheter. Experience of the duration of labor, pain during labor, general satisfaction with labor, and feelings of control and fear related to their expectation were comparable between both the groups. In the oral misoprostol group, 6% of the women would prefer the other method if induction is necessary in future pregnancy, versus 12% in the Foley catheter group (risk ratio: 0.70; 95% confidence interval: 0.55-0.90; p = 0.02). Conclusion: Women’s experiences of labor after induction with oral misoprostol or Foley catheter are comparable. However, women in the Foley catheter group prefer more often to choose a different method for future inductions.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
PMID: 27412726
Custers JA, Gielissen MF, de Wilt JH, Honkoop A, Smilde TJ, van Spronsen DJ, van der Veld W, van der Graaf WT, Prins JB.
Towards an evidence-based model of fear of cancer recurrence for breast cancer survivors.
J Cancer Surviv. 2017 Feb;11(1):41-47. doi: 10.1007/s11764-016-0558-z.
PURPOSE: In order to understand the multidimensional mechanism of fear of cancer recurrence (FCR) and to identify potential targets for interventions, it is important to empirically test the theoretical model of FCR. This study aims at assessing the validity of Lee-Jones et al.’s FCR model.
METHODS: A total of 1205 breast cancer survivors were invited to participate in this study. Participants received a questionnaire booklet including questionnaires on demographics and psychosocial variables including FCR. Data analysis consisted of the estimation of direct and indirect effects in mediator models.
RESULTS: A total of 460 women (38 %) participated in the study. Median age was 55.8 years (range 32-87). Indirect effects of external and internal cues via FCR were found for all mediation models with limited planning for the future (R 2 = .28) and body checking (R 2 = .11-.15) as behavioral response variables, with the largest effects for limited planning for the future. A direct relation was found between feeling sick and seeking professional advice, not mediated by FCR.
CONCLUSIONS: In the first tested models of FCR, all internal and external cues were associated with higher FCR. In the models with limited planning for the future and body checking as behavioral response, an indirect effect of cues via FCR was found supporting the theoretical model of Lee-Jones et al.
IMPLICATIONS FOR CANCER SURVIVORS: An evidence-based model of FCR may facilitate the development of appropriate interventions to manage FCR in breast cancer survivors.
PMID: 27454758
Zweegers J, Roosenboom B, van de Kerkhof PC, van den Reek JM, Otero ME, Atalay S, Kuijpers AL, Koetsier MI, Arnold WP, Berends MA, Weppner-Parren L, Bijen M, Njoo MD, Mommers JM, van Lümig PP, Driessen RJ, Kievit W, de Jong EM Frequency and predictors of a high clinical response in patients with psoriasis on biological therapy in daily practice: results from the prospective, multicenter BioCAPTURE cohort.
Br J Dermatol. 2017 Mar;176(3):786-793.
Trefwoorden: psoriasis en biologicals
BACKGROUND: It is important to assess which patients with psoriasis are more likely to achieve high clinical responses on biologics.
OBJECTIVES: To assess the number of treatment episodes (TEs) that achieve a 100% improvement in Psoriasis Area and Severity Index (PASI 100), PASI 90 or PASI ≤ 5 at week 24 of biological treatment, and which baseline patient characteristics predict treatment response.
METHODS: Data from patients with psoriasis treated with adalimumab, etanercept, infliximab or ustekinumab were extracted from a prospective cohort. TEs with high clinical responses were described. Uni- and multivariate regression analyses were performed with the generalized estimating equation method to elucidate which baseline patient characteristics were predictors for PASI 90 and PASI ≤ 5 at week 24.
RESULTS: In total, 454 TEs were extracted (159 adalimumab; 193 etanercept; 19 infliximab; 83 ustekinumab) from 326 patients. At week 24, in 3%, 15% and 59% of TEs, respectively, PASI 100, PASI 90 and PASI ≤ 5 was reached. In TEs without a PASI 100 or PASI 90 response, PASI
≤ 5 was still achieved in 58% and 52%, respectively. Baseline PASI ≥ 10 was a strong predictor for achieving PASI 90; baseline PASI < 10 and a lower baseline body mass index (BMI) were significant predictors for PASI ≤ 5 at week 24.
CONCLUSIONS: A limited number of patients achieved PASI 100 or PASI 90 at 24 weeks of biological treatment. Including an absolute PASI score in the assessment of psoriasis severity is important. Baseline BMI was an important, modifiable predictor for a high response.
© 2016 British Association of Dermatologists.
PMID: 27487525
Holleman M, Vink M, Nijland R, Schmand B. Effects of intensive neuropsychological rehabilitation for acquired brain injury.
Neuropsychol Rehabil. 2018 Jun;28(4):649-662. doi: 10.1080/09602011.2016.1210013.
The objective of the study was to examine the effects of a comprehensive neuropsychological rehabilitation programme (Intensive NeuroRehabilitation, INR) on the emotional and behavioural consequences of acquired brain injury (ABI). The participants were 75 adult patients suffering from ABI (33 traumatic brain injury, 14 stroke, 10 tumour, 6 hypoxia, 12 other), all of whom were admitted to the INR treatment programme. The main outcome measures were: general psychological well-being (Symptom-Checklist-90), depression and anxiety (Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, State Trait Anxiety Inventory), and quality of life (Quality of Life in Brain Injury). The study was a non-blinded, waiting-list controlled trial. During the waiting-list period no or minimal care was provided. Multivariate analysis of the main outcome measures showed large effect sizes for psychological well-being (partial η2 = .191, p < .001), depression (partial η2 = .168, p < .001), and anxiety (partial η2 = .182, p < .001), and a moderate effect size for quality of life (partial η2 = .130, p = .001). Changes on neuropsychological tests did not differ between the groups. It was concluded that the INR programme improved general psychological well-being, depressive symptoms, anxiety, and quality of life. The programme does not affect cognitive functioning.
PMID: 27497436
van Balveren JA, Huijskens MJ, Gemen EF, Péquériaux NC, Kusters R. Effects of time and temperature on 48 routine chemistry, haematology and coagulation analytes in whole blood samples.
Ann Clin Biochem. 2017 Jul;54(4):448-462. doi: 10.1177/0004563216665868. Epub 2016 Sep 28.
Background Phlebotomy for the purpose of blood analysis is often performed at remote locations, and samples are usually temporarily stored before transport to a central laboratory for analysis. The circumstances during storage and shipment may not meet the necessary requirements. If analysed anyway, false results may be generated. We therefore examined the influence of precentrifugation time and temperature of the most frequently requested tests in whole blood. Methods Healthy volunteers donated blood in which 48 analytes were tested. Routine chemistry was performed in lithium heparin tubes, haematology in ethylenediaminetetraacetic acid tubes, coagulation in citrate tubes and glucose in sodium fluoride tubes. One tube was measured directly. The others were kept at different temperatures (4, 8, 20 or
temperatures. Calcium, lactate dehydrogenase, potassium and sodium are particularly affected at low temperatures, while phosphate is mainly affected at and above room temperature after 8 h. Conclusion We established the influence of time and temperature on a broad range of analytes, which may be applied to set the limits in transportation and storage of whole blood samples.
PMID: 27549241
Brooke RJ, Teunis PF, Kretzschmar ME, Wielders CC, Schneeberger PM, Waller LA. Use of a Dose-Response Model to Study Temporal Trends in Spatial Exposure to Coxiella burnetii: Analysis of a Multiyear Outbreak of Q Fever.
Zoonoses Public Health. 2017 Mar;64(2):118-126. doi: 10.1111/zph.12288.
The Netherlands underwent a large Q fever outbreak between 2007 and 2009. In this paper, we study spatial and temporal Coxiella burnetii exposure trends during this large outbreak as well as validate outcomes against other published studies and provide evidence to support hypotheses on the causes of the outbreak. To achieve this, we develop a framework using a dose-response model to translate acute Q fever case incidence into exposure estimates. More specifically, we incorporate a geostatistical model that accounts for spatial and temporal correlation of exposure estimates from a human Q fever dose-response model to quantify exposure trends during the outbreak. The 2051 cases, with the corresponding age, gender and residential addresses, reside in the region with the highest attack rates during the outbreak in the Netherlands between 2006 and 2009. We conclude that the multiyear outbreak in the Netherlands is caused by sustained release of infectious bacteria from the same sources, which suggests that earlier implementation of interventions may have prevented many of the cases. The model predicts the risk of infection and acute symptomatic Q fever from multiple exposure sources during a multiple-year outbreak providing a robust, evidence-based methodology to support decision-making and intervention design.
© 2016 Blackwell Verlag GmbH.
PMID: 27593688
Araújo T, Abayazid M, Rutten MJCM, Misra S. Segmentation and three-dimensional reconstruction of lesions using the automated breast volume scanner (ABVS).
Int J Med Robot. 2017 Sep;13(3). doi: 10.1002/rcs.1767.
BACKGROUND: Ultrasound is an effective tool for breast cancer diagnosis. However, its relatively low image quality makes small lesion analysis challenging. This promotes the development of tools to help clinicians in the diagnosis.
METHODS: We propose a method for segmentation and three-dimensional (3D) reconstruction of lesions from ultrasound images acquired using the automated breast volume scanner (ABVS). Segmentation and reconstruction algorithms are applied to obtain the lesion’s 3D geometry. A total of 140 artificial lesions with different sizes and shapes are reconstructed in gelatin-based phantoms and biological tissue.
Dice similarity coefficient (DSC) is used to evaluate the reconstructed shapes. The algorithm is tested using a human breast phantom and clinical data from six patients.
RESULTS: DSC values are 0.86 ± 0.06 and 0.86 ± 0.05 for gelatin-based phantoms and biological tissue, respectively. The results are validated by a specialized clinician.
CONCLUSIONS: Evaluation metrics show that the algorithm accurately segments and reconstructs various lesions. Copyright © 2016 John Wiley & Sons, Ltd.
Copyright © 2016 John Wiley & Sons, Ltd.
PMID: 27611610
Govaert JA, Fiocco M, van Dijk WA, Kolfschoten NE, Prins HA, Dekker JWT, Tollenaar RAEM, Tanis PJ, Wouters MWJM; Dutch Value Based Healthcare Study Group. Multicenter Stratified Comparison of Hospital Costs Between Laparoscopic and Open Colorectal Cancer Resections: Influence of Tumor Location and Operative Risk.
Ann Surg. 2017 Dec;266(6):1021-1028. doi: 10.1097/SLA.0000000000002000.
OBJECTIVE: To compare actual 90-day hospital costs between elective open and laparoscopic colon and rectal cancer resection in a daily practice multicenter setting stratified for operative risk.
BACKGROUND: Laparoscopic resection has developed as a commonly accepted surgical procedure for colorectal cancer. There are conflicting data on the influence of laparoscopy on hospital costs, without separate analyses based on operative risk.
METHODS: Retrospective analyses using a population-based database (Dutch Surgical Colorectal Audit). All elective resections for a T1-3N0-2M0 stage colorectal cancer were included between 2010 and 2012 in 29 Dutch hospitals. Operative risk was stratified for age (<75 years or
≥75 years) and ASA status (I-II/III-IV). Ninety-day hospital costs were measured uniformly in all hospitals based on time-driven activity-based costing.
RESULTS: Total 90-day hospital costs ranged from &OV0556;10474 to &OV0556;20865 in the predefined subgroups. For colon cancer surgery (N = 4202), laparoscopic resection was significant less expensive than open resection in all subgroups, savings because of laparoscopy ranged from &OV0556;409 (<75 years ASA I-II) to &OV0556;1932 (≥75 years ASA I-II). In patients ≥75 years and ASA I-II, laparoscopic resection was associated with 46% less mortality (P = 0.05), 41% less severe complications (P < 0.001), 25% less hospital stay (P = 0.013), and 65% less ICU stay (P < 0.001). For rectal cancer surgery (N=2328), all laparoscopic subgroups had significantly higher total hospital costs,
RESULTS: Total 90-day hospital costs ranged from &OV0556;10474 to &OV0556;20865 in the predefined subgroups. For colon cancer surgery (N = 4202), laparoscopic resection was significant less expensive than open resection in all subgroups, savings because of laparoscopy ranged from &OV0556;409 (<75 years ASA I-II) to &OV0556;1932 (≥75 years ASA I-II). In patients ≥75 years and ASA I-II, laparoscopic resection was associated with 46% less mortality (P = 0.05), 41% less severe complications (P < 0.001), 25% less hospital stay (P = 0.013), and 65% less ICU stay (P < 0.001). For rectal cancer surgery (N=2328), all laparoscopic subgroups had significantly higher total hospital costs,