To compare postoperative alignment and sensory functions in children with primary exotropia who were operated at an early age (< 7 years) with patients who were operated at an older age (> 7 years). In a consecutive... more
To compare postoperative alignment and sensory functions in children with primary exotropia who were operated at an early age (< 7 years) with patients who were operated at an older age (> 7 years). In a consecutive retrospective cohort study, 112 patients who had a surgical intervention for primary exotropia between 1997 and 2003 were evaluated for postoperative results. After applying criteria for eligibility, the group of patients was divided into two groups: those who had surgical intervention before the age of seven years (n = 24) and those who had surgery after the age of seven years (n = 36). Age at surgery, preoperative alignment and sensory functions were correlated with the postoperative status. The follow-up was at least one year (1.0 year to 7 years; median: 2.3 and 3.5 years, respectively). Children who had surgery before the age of seven had significantly better alignment and sensory functions. The univariate logistic regression model confirmed a statistically significant association between motor outcome (exodeviation less than 10 prism-diopters) and age at the time of surgery (before or after the age of seven; p = 0.002). In the multivariate model, the association between age at time of surgery and motor outcome was even stronger. The number of reoperations in the group operated before the age of 7 years was significantly less than in the group operated after the age of seven (2 versus 12, p = 0.023). The postoperative alignment and sensory functions in patients with primary exotropia who had surgical intervention before the age of seven years were, in this study, better than in patients who had surgery after the age of seven years.
Research Interests: Binocular vision, Treatment Outcome, Adolescent, Strabismus, Humans, and 17 moreChild, Female, Male, Statistical Significance, Cohort Study, Infant, Aged, Middle Aged, Optometry and Ophthalmology, Adult, Time Factors, Retrospective Studies, Logistic Regression Model, Cohort Studies, Postoperative Period, Reoperation, and Child preschool
To be able to distinguish end-stage palliative sedation from euthanasia without having to refer to intentions that are difficult to verify, physicians must be able to manage palliative sedation appropriately (i.e., see that death is not... more
To be able to distinguish end-stage palliative sedation from euthanasia without having to refer to intentions that are difficult to verify, physicians must be able to manage palliative sedation appropriately (i.e., see that death is not hastened as a result of disproportionate medication). In the present study, we assessed whether or not this requirement is met in the Netherlands. We sent a retrospective questionnaire to 1,464 medical specialists, general practitioners, and nursing home physicians in the Netherlands. Furthermore, we held two sets of 20 and 22 semi-structured in-depth interviews with general practitioners, internists, lung specialists, and nursing home physicians. Although most guidelines discourage the administration of opioids alone for purposes of palliative sedation, opioids alone were administered for 22% of all the patients reported upon. Those physicians who were more experienced, general practitioners, and physicians who had consulted a palliative care expert administered only opioids significantly less often than the other physicians. The interviewees reported difficulties in assessing the appropriateness of medication, feeling uncertain about the pharmacokinetics of drugs used in moribund patients. Given that no more than 2% of the respondents perceived palliative sedation to be used as a form of euthanasia and that the use of opioids alone was not associated with shorter survival rates, the inappropriate use of opioids can only be attributed to a lack of knowledge or skill and/or a tradition of alleviating refractory dyspnoea with the use of opioids and not as an intentional means of hastening death.
Research Interests: Palliative Care, Euthanasia, Family Practice, Palliative Medicine, Drug Use, and 13 moreHumans, Female, Male, Netherlands, Nursing Home, Middle Aged, Questionnaires, Public health systems and services research, Survival Rate, General practitioner, Clinical Competence, Terminal care, and Conscious Sedation
Research Interests: Decision Making, Risk assessment, Adolescent, Inflammatory Bowel Disease, Humans, and 23 moreFemale, Male, Young Adult, Risk factors, ROC Curve, Length of Stay, Clinical Sciences, Aged, Great Britain, Middle Aged, Adult, Morbidity, Retrospective Studies, Prognosis, Risk Factors, Risk Assessment, Colon, Case Control Study, Area Under the Curve, Diverticulitis, Inflammatory Bowel Diseases, Colorectal Neoplasms, and Postoperative Complications
Although colonic diverticulitis is a common disorder, there is no clear treatment strategy for patients with recurrent episodes of diverticulitis. We investigated whether colonic resection or conservative or medical treatments have the... more
Although colonic diverticulitis is a common disorder, there is no clear treatment strategy for patients with recurrent episodes of diverticulitis. We investigated whether colonic resection or conservative or medical treatments have the greatest effects on quality-adjusted life years (QALYs). A Markov model simulating patients with 2 episodes of non-surgically treated diverticulitis was used to simulate all relevant outcomes of each treatment strategy. A 1 y cycle length with 10 y follow-up period was used to allow for chance of recurrent diverticulitis. Primary outcome was QALYs gained from each strategy. Factors considered were morbidity, mortality, chance of colostomy formation, risk of recurrence, and persistence of abdominal pain.The probabilities of clinical events were determined using the best available published data. A strategy in which colonic resection was performed after 2 episodes of diverticulitis was associated with the lowest quality-adjusted survival (a gain of 8.66...
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To systematically study the effects of shared medical appointments (SMAs) compared with individual appointments for patients with a chronic neuromuscular disorder and their partners. In this randomized controlled trial with a follow-up of... more
To systematically study the effects of shared medical appointments (SMAs) compared with individual appointments for patients with a chronic neuromuscular disorder and their partners. In this randomized controlled trial with a follow-up of 6 months, we included patients with a chronic neuromuscular disorder and their partners. Participants were randomly allocated to an SMA or an individual outpatient appointment. The primary outcome measure was patients' health-related quality of life (QOL) (36-Item Short Form Health Survey). Secondary outcome measures included self-efficacy, social support, patient and partner satisfaction with the appointment, and time available per patient. Two hundred seventy-two patients and 149 partners were included. Health-related QOL showed greater improvement in patients who had attended an SMA (mean difference 2.8 points, 95% confidence interval 0.0-5.7, p = 0.05). Secondary outcomes showed small improvements in the control group for satisfaction with ...
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The lack of pathognomonic findings and the chance of complicated disease have resulted in the widespread use of additional imaging to diagnose acute colonic diverticulitis (ACD). The added value of additional imaging in the diagnostic... more
The lack of pathognomonic findings and the chance of complicated disease have resulted in the widespread use of additional imaging to diagnose acute colonic diverticulitis (ACD). The added value of additional imaging in the diagnostic workup of patients suspected of ACD is not well defined. The aim of this study was to systematically review the literature of the accuracy of the clinical evaluation and diagnostic modalities for patients with suspected ACD, to come to an evidence-based approach to diagnose ACD. A systematic review and meta-analysis of studies that reported diagnostic accuracy of the clinical diagnosis and diagnostic modalities in patients with suspected diverticulitis were performed. Study quality was assessed with the STARD checklist. True-positive, true-negative, false-positive, and false-negative findings were extracted and pooled estimates of sensitivity and specificity per diagnostic test were calculated, if applicable. The overall quality of the studies reportin...
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Research Interests: Epidemiology, Cytokines, Survival Analysis, Inflammatory Immune Response, Models, and 18 moreExperimental Pathology, Weight Loss, Animals, Blood sampling, Male, Animal Model, Sterilization, Clinical Sciences, Rats, Rat, Feces, Bacteremia, Wistar Rats, Peritonitis, Bacteroides Fragilis, Escherichia Coli Infections, Surgical Treatment, and Inflammatory response
Complex Regional Pain Syndrome Type I (CRPS I) is a continuation of symptoms and signs due to a pathological exaggerated reaction in an extremity of the human body after an injury or operation. Although the clinical picture of CRPS I in... more
Complex Regional Pain Syndrome Type I (CRPS I) is a continuation of symptoms and signs due to a pathological exaggerated reaction in an extremity of the human body after an injury or operation. Although the clinical picture of CRPS I in the majority of patients is well known, the underlying pathophysiology remains unclear. In The Netherlands, intravenous mannitol administration used as hydroxyl radical scavenger for patients who do not respond to conservative treatment of CRPS I is advocated but little evidence supports this salvage strategy. In this study the effect of mannitol as salvage medication was evaluated in a well-defined multimodal step-up treatment protocol. A consecutive group of 68 adult patients with persistent CRPS I was analysed, who underwent a total of 100 mannitol infusions. The effect of treatment was considered per sign and per symptom according to the Veldman et al. criteria for CRPS I. Overall improvement of CRPS I after mannitol treatment was successful in 24% after 1 week, and in 30% after 1 month. Mannitol treatment had some effect in patients with initially warm CRPS I in contrast to patients with cold CRPS I (OR=6.30 with CI [2.37-16.75]). Also patients with CRPS I at the upper extremity had more benefit than patients with CRPS I at the lower extremity (OR=3.26 with CI [1.34-7.93]). Poor results of mannitol treatment were associated with cold CRPS I (p<0.001), chronic CRPS I (p=0.04) and multiple mannitol treatments (p=0.04). Mannitol did not significantly contribute to the overall success of treatment in patients with CRPS I. Patients, presenting with acute, warm CRPS I in the upper extremity may have some benefit.