68 results on '"Römkens, P"'
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2. Predicting mucosal inflammation in IBD patients using patient-reported symptom scores and a faecal calprotectin home test: protocol for a multicentre prospective validation study
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Lloyd Brandts, Zlatan Mujagic, M Pierik, Tessa EH Römkens, Laura Janssen, Mariëlle Romberg-Camps, Reinier Cornelis Anthonius van Linschoten, Rachel Louise West, and Lennard P L Gilissen
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Medicine - Abstract
Introduction Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) with a relapsing-remitting nature. With adequate non-invasive prediction of mucosal inflammation, endoscopies can be prevented and treatment optimised earlier for better disease control. We aim to validate and recalibrate commonly used patient-reported symptom scores combined with a faecal calprotectin (FC) home test as non-invasive diagnostic tool for remote monitoring of IBD, both in daily practice and in a strict trial setting. Endoscopy will be used as the gold standard.Methods and analysis In this multicentre prospective validation study, adult IBD patients are asked to fill out questionnaires regarding disease activity (Monitor IBD At Home, mobile Health Index, Manitoba IBD Index, IBD control and patient-HBI/patient-Simple Clinical Colitis Activity Index), perform a FC home test and collect a stool sample for routine laboratory FC measurement, before the start of the bowel preparation for the ileocolonoscopy. Endoscopic disease activity will be scored according to the simplified endoscopic score for Crohn’s disease (CD) for CD patients or Ulcerative Colitis Endoscopic Index for Severity and Mayo Endoscopic Subscore for ulcerative colitis patients. The main study outcome is the diagnostic test accuracy of the various patient-reported scores to assess mucosal inflammation in combination with a FC home test.Ethics and dissemination This study is approved by the Medical Research Ethics Committee of azM/UM in Maastricht dated 03 March 2021 (METC 20–085) and is monitored by the Clinical Trial Centre Maastricht according to Good Clinical Practice guidelines. Written informed consent will be obtained from all patients. Study results will be published in international peer-reviewed medical journals.Trial registration number NCT05886322
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- 2024
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3. Effectiveness of Mindfulness-Based Cognitive Therapy in reducing psychological distress and improving sleep in patients with Inflammatory Bowel Disease: study protocol for a multicentre randomised controlled trial (MindIBD).
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ter Avest, Milou M, van Velthoven, Annelieke S M, Speckens, Anne E M, Dijkstra, Gerard, Dresler, Martin, Horjus, Carmen S, Römkens, Tessa E H, Witteman, Ellen M, van Dop, Willemijn A, Bredero, Quirine M, Nissen, Loes H C, and Huijbers, Marloes J
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- 2023
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4. Effectiveness of Mindfulness-Based Cognitive Therapy in reducing psychological distress and improving sleep in patients with Inflammatory Bowel Disease: study protocol for a multicentre randomised controlled trial (MindIBD).
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Milou M ter Avest, Annelieke S M van Velthoven, Anne E M Speckens, Gerard Dijkstra, Martin Dresler, Carmen S Horjus, Tessa E H Römkens, Ellen M Witteman, Willemijn A van Dop, Quirine M Bredero, Loes H C Nissen, and Marloes J Huijbers
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Mindfulness ,Mindfulness-Based Cognitive Therapy ,Inflammatory Bowel Disease ,Crohn’s disease ,Ulcerative colitis ,Randomised controlled trial ,Psychology ,BF1-990 - Abstract
Abstract Background Many patients with Inflammatory Bowel Diseases (IBD) suffer from psychological distress, fatigue and sleep disturbances, which are associated with reduced quality of life (QoL) and increased societal costs. Only limited psychosocial treatment options are available. As Mindfulness-Based Cognitive Therapy (MBCT) has demonstrated to improve psychological distress, QoL and sleep in other populations, MBCT might also be effective in patients with IBD. Methods The MindIBD study is a prospective, multicentre, randomised controlled trial comparing MBCT plus Treatment As Usual (TAU) versus TAU alone in a targeted number of 136 IBD patients in remission, aged 16 years and older with at least mild psychological distress (Hospital Anxiety and Depression Scale (HADS) total score ≥ 11). Primary outcome is reduction of psychological distress post-intervention, measured by the HADS. In addition, the effect of MBCT on sleep quality (including actigraphy and electroencephalography recordings), fatigue, disease activity, perceived disease control, QoL and positive mental health will be examined. Assessments will be conducted at baseline and at 3, 6, 9 and 12 months follow-up. Cost-effectiveness will be determined and a process evaluation will be conducted. Discussion This study will provide valuable insight into the clinical effect of MBCT on psychological distress, sleep quality, fatigue and QoL in IBD patients and into the cost-effectiveness. If effective, MBCT can be a valuable addition to the available psychosocial interventions for patients with IBD. Moreover, findings from this study may also be applicable in patients with other chronic conditions. Trial registration ClinicalTrials.gov: NCT04646785, registered on 30/11/2020.
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- 2023
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5. Prediction of the mobility and persistence of eight antibiotics based on soil characteristics
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R.P.J.J. Rietra, B.J.A. Berendsen, Y. Mi-Gegotek, P.F.A.M. Römkens, and A.M. Pustjens
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Antibiotics ,Manure ,Sorption ,Persistence ,Fate ,Degradation ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
Antibiotics are widely used in intensive animal husbandry in the Netherlands and are subsequently emitted to soil via manure. To predict degradation and mobility in soil, generic sorption models have been derived. However, most of the coefficients used in generic models are based on a limited range of soils and have not been validated for agricultural soils in the Netherlands. To improve model predictions and assess to what extent differences among soils affect sorption and degradation, an experimental study has been performed. Using a recently developed experimental approach, both the degradation (DT50) and mobility (Kd) of eight selected commonly used antibiotics were determined in 29 typical Dutch agricultural soils. Median DT50 values range from 5.3 days for Sulfadiazine to 120 days for Trimethoprim but are affected by soil type. The ratio of the lowest and highest DT50 for a given antibiotic among soils can be as large as 151, for Tylosin. Measured values of the logKd also range from 0.19 for Sulfadiazine to more than 2 for Doxycycline, Flumequine, Trimethoprim, Tylosin and Enrofloxacine. The impact of soil on Kd is large, especially for more mobile antibiotics such as Sulfadoxine and Sulfadiazine. Both the range in DT50 and Kd can be predicted reasonably well using a Freundlich type regression model that accounts for the variation in soil type and sampling depth. Organic matter, iron oxides, pH and clay content appear to be the main constituents and explain between 29 % (Trimethoprim) and 77 % of the variation in DT50 and between 64 % (Lincomycin) and 87 % (Sulfadoxine and Sulfadiazine) of the variation of Kd. The effect of depth on DT50 and Kd is however limited. The information thus obtained in combination with local data on soil type can be used to more accurately predict the potential risk of relevant antibiotics in soil and transport to ground- and nearby surface waters.
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- 2024
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6. Health State Questionnaires Deployed in Ulcerative Colitis Patients: The Medical, Psychological, and Economic Perspective
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Damien S.E. Broekharst, Pepijn W.A. Thomas, Maurice G.V.M. Russel, Rachel L. West, Jeroen M. Jansen, Sjaak Bloem, and Tessa E.H. Römkens
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Health state ,Health state questionnaire ,Ulcerative colitis ,Disease severity ,Health experience ,Health utility ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and Aims: To determine how the health state of ulcerative colitis patients is impacted by their disease, different health state questionnaires are deployed. This study examines to what extent these health state questionnaires determine the same underlying health state concept and to what extent the complementary use of the health state questionnaires has added value for physicians. Methods: In total, 307 patients were enrolled in this cross-sectional multicenter cohort study. Medical, psychological, economic, and composite health state questionnaires were administered to determine reliability, convergent validity, and explained variance. Reliability was determined using Cronbach’s alpha. Convergent validity was measured using Spearman’s correlation coefficients. Explained variance was interpreted using R-squared coefficients. Results: All questionnaires can be considered reliable. The medical, psychological, and economic health state questionnaires show weak to moderate convergent validity with each other. The medical, psychological, and economic health state questionnaires also explain limited variance in each other’s outcomes. The composite health state questionnaire shows moderate to strong convergent validity with the other health state questionnaires. The composite health state questionnaire further explains considerable variance in the outcomes of the other health state questionnaires. Conclusion: Deploying divergent medical, psychological, and economic health state questionnaires may have added value as they provide a multiperspective holistic insight into patients’ health states. Deploying the composite health state questionnaire combined with other health state questionnaires may have added value as it provides additional understanding of their outcomes. Deploying an independent psychological health state questionnaire may have added value as it shows particularly limited convergent validity and explained variance regarding other health state questionnaires.
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- 2023
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7. Effect of combined water drinking test and dark room provocative testing in Caucasian eyes with narrow angles
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Römkens, Hellen C. S., Beckers, Henny J. M., Schouten, Jan S. A. G., Berendschot, Tos T. J. M., and Webers, Carroll A. B.
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- 2022
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8. Therapeutic Drug Monitoring of Vedolizumab in Inflammatory Bowel Disease Patients during Maintenance Treatment—TUMMY Study
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Merve Sivridaş, Rob H. Creemers, Dennis R. Wong, Paul J. Boekema, Tessa E. H. Römkens, Lennard P. L. Gilissen, Adriaan A. van Bodegraven, Floris C. Loeff, Theo Rispens, and Luc J. J. Derijks
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vedolizumab ,trough level ,therapeutic drug monitoring ,maintenance ,IBD ,ulcerative colitis ,Pharmacy and materia medica ,RS1-441 - Abstract
There are limited data on therapeutic drug monitoring (TDM) in inflammatory bowel disease (IBD) patients treated with vedolizumab (VDZ). Although an exposure–response relation has been demonstrated in the post-induction phase, this relationship is more uncertain in the maintenance phase of treatment. The aim of our study was to determine whether there is an association between VDZ trough concentration and clinical and biochemical remission in the maintenance phase. A prospective, observational multicenter study has been performed on patients with IBD on VDZ in the maintenance treatment (≥14 weeks). Patient demographics, biomarkers, and VDZ serum trough concentrations were collected. Clinical disease activity was scored by the Harvey Bradshaw Index (HBI) for Crohn’s disease (CD) and the Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC). Clinical remission was determined as HBI < 5 and SCCAI < 3. Biochemical remission was defined as fecal calprotectin p = 0.019). In this population, higher trough VDZ concentrations were associated with biochemical remission but not with clinical remission.
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- 2023
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9. Impact of nationwide enhanced implementation of best practices in pancreatic cancer care (PACAP-1): a multicenter stepped-wedge cluster randomized controlled trial
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T. M. Mackay, F. J. Smits, A. E. J. Latenstein, A. Bogte, B. A. Bonsing, H. Bos, K. Bosscha, L. A. A. Brosens, L. Hol, O. R. C. Busch, G. J. Creemers, W. L. Curvers, M. den Dulk, S. van Dieren, L. M. J. W. van Driel, S. Festen, E. J. M. van Geenen, L. G. van der Geest, D. J. A. de Groot, J. W. B. de Groot, N. Haj Mohammad, B. C. M. Haberkorn, J. T. Haver, E. van der Harst, G. J. M. Hemmink, I. H. de Hingh, C. Hoge, M. Y. V. Homs, N. C. van Huijgevoort, M. A. J. M. Jacobs, E. D. Kerver, M. S. L. Liem, M. Los, H. Lubbinge, S. A. C. Luelmo, V. E. de Meijer, L. Mekenkamp, I. Q. Molenaar, M. G. H. van Oijen, G. A. Patijn, R. Quispel, L. B. van Rijssen, T. E. H. Römkens, H. C. van Santvoort, J. M. J. Schreinemakers, H. Schut, T. Seerden, M. W. J. Stommel, A. J. ten Tije, N. G. Venneman, R. C. Verdonk, J. Verheij, F. G. I. van Vilsteren, J. de Vos-Geelen, A. Vulink, C. Wientjes, F. Wit, F. J. Wessels, B. Zonderhuis, C. H. van Werkhoven, J. E. van Hooft, C. H. J. van Eijck, J. W. Wilmink, H. W. M. van Laarhoven, M. G. Besselink, and for the Dutch Pancreatic Cancer Group
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Pancreatic cancer ,Survival ,Quality of life ,Stepped-wedge cluster randomized controlled trial ,Implementation ,Best practices ,Medicine (General) ,R5-920 - Abstract
Abstract Background Pancreatic cancer has a very poor prognosis. Best practices for the use of chemotherapy, enzyme replacement therapy, and biliary drainage have been identified but their implementation in daily clinical practice is often suboptimal. We hypothesized that a nationwide program to enhance implementation of these best practices in pancreatic cancer care would improve survival and quality of life. Methods/design PACAP-1 is a nationwide multicenter stepped-wedge cluster randomized controlled superiority trial. In a per-center stepwise and randomized manner, best practices in pancreatic cancer care regarding the use of (neo)adjuvant and palliative chemotherapy, pancreatic enzyme replacement therapy, and metal biliary stents are implemented in all 17 Dutch pancreatic centers and their regional referral networks during a 6-week initiation period. Per pancreatic center, one multidisciplinary team functions as reference for the other centers in the network. Key best practices were identified from the literature, 3 years of data from existing nationwide registries within the Dutch Pancreatic Cancer Project (PACAP), and national expert meetings. The best practices follow the Dutch guideline on pancreatic cancer and the current state of the literature, and can be executed within daily clinical practice. The implementation process includes monitoring, return visits, and provider feedback in combination with education and reminders. Patient outcomes and compliance are monitored within the PACAP registries. Primary outcome is 1-year overall survival (for all disease stages). Secondary outcomes include quality of life, 3- and 5-year overall survival, and guideline compliance. An improvement of 10% in 1-year overall survival is considered clinically relevant. A 25-month study duration was chosen, which provides 80% statistical power for a mortality reduction of 10.0% in the 17 pancreatic cancer centers, with a required sample size of 2142 patients, corresponding to a 6.6% mortality reduction and 4769 patients nationwide. Discussion The PACAP-1 trial is designed to evaluate whether a nationwide program for enhanced implementation of best practices in pancreatic cancer care can improve 1-year overall survival and quality of life. Trial registration ClinicalTrials.gov, NCT03513705 . Trial opened for accrual on 22th May 2018.
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- 2020
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10. Lower gastrointestinal bleeding in a patient receiving sevelamer: Case report
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Tessa S Schoot, Tessa EH Römkens, and Ellen K Hoogeveen
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Medicine (General) ,R5-920 - Abstract
Phosphate binders such as sevelamer are widely used in patients with chronic kidney disease to lower serum phosphate levels. We present a case of a 67-year-old woman with lower gastrointestinal bleeding after 9 days of using sevelamer carbonate (Renvela ® ). Sigmoidoscopy revealed multiple deep ulcers (diameter 10–15 mm) and mucosal oedema. Histologic examination showed deposition of sevelamer crystals in these rectal ulcers. We hypothesized that the lower gastrointestinal bleeding was caused by deposition of sevelamer crystals. After cessation of sevelamer, gastrointestinal bleeding stopped. Deposition of sevelamer crystals in the gastrointestinal tract is a rare complication of sevelamer therapy. There are only 17 other recorded cases of gastrointestinal deposition of sevelamer crystals. This adverse effect should be considered in all patients taking sevelamer who present with gastrointestinal symptoms, such as gastrointestinal bleeding and abdominal pain. When sevelamer is discontinued, symptoms and mucosal damage appear to revert.
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- 2021
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11. Role of endoscopic ultrasonography in the diagnostic work-up of idiopathic acute pancreatitis (PICUS): study protocol for a nationwide prospective cohort study
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Frank P Vleggaar, Paul Fockens, Hjalmar C van Santvoort, Jeanin E van Hooft, Menno A Brink, Jan-Werner Poley, Robert C Verdonk, Hendrik M van Dullemen, Liesbeth M Kager, Devica S Umans, Hester C Timmerhuis, Nora D Hallensleben, Stefan A Bouwense, Marie-Paule GF Anten, Abha Bhalla, Rina A Bijlsma, Lieke Hol, Wouter L Curvers, Brechje C van Eijck, G Willemien Erkelens, Erwin J M van Geenen, Wouter L Hazen, Chantal V Hoge, Akin Inderson, Sjoerd D Kuiken, Lars E Perk, Rutger Quispel, Tessa EH Römkens, Adriaan CITL Tan, Annemieke Y Thijssen, Niels G Venneman, Annet MCJ Voorburg, Roy LJ van Wanrooij, and Ben J Witteman
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Medicine - Published
- 2020
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12. Lengthening adalimumab dosing interval in quiescent Crohn’s disease patients: protocol for the pragmatic randomised non-inferiority LADI study
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J Jansen, L J T Smits, R W M Pauwels, W Kievit, D J de Jong, A C de Vries, F Hoentjen, C J van der Woude, A.A. van Bodegraven, A.G.L. Bodelier, P.J. Boekema, N. de Boer, P.C.J. ter Borg, A.A. den Broeder, I.A.M Gisbertz, F.M Jansen, S.V. Jansen, D.J. de Jong, W. Kievit, R.C.A. van Linschoten, M Löwenberg, M.W.M.D. Lutgens, R.C. Mallant-Hent, A.E. van der Meulen, B. Oldenburg, R.W.M. Pauwels, M Pierik, M.J.L. Romberg-Camps, T.E.H. Römkens, M.G.V.M. Russel, L.J.T. Smits, A.C.I.T.L. Tan, M.L. Verhulst, A.C. de Vries, R.L. West, F.H.J. Wolfhagen, and C.J. van der Woude
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Medicine - Abstract
Introduction Adalimumab is effective for maintenance of remission in patients with Crohn’s disease (CD) at a dose of 40 mg subcutaneously every 2 weeks. However, adalimumab is associated with (long-term) adverse events and is costly. The aim of this study is to demonstrate non-inferiority and cost-effectiveness of disease activity guided adalimumab interval lengthening compared to standard dosing of every other week (EOW).Methods and analysis The Lengthening Adalimumab Dosing Interval (LADI) study is a pragmatic, multicentre, open label, randomised controlled non-inferiority trial. Non-inferiority is reached if the difference in cumulative incidence of persistent (>8 weeks) flares does not exceed the non-inferiority margin of 15%. 174 CD patients on adalimumab maintenance therapy in long-term (>9 months) clinical and biochemical remission will be included (C-reactive protein (CRP) 250 µg/g, CRP≥10 mg/l, HBI≥5. Secondary outcomes include cumulative incidence of transient flares, adverse events, predictors for successful dose reduction and cost-effectiveness.Ethics and dissemination The study is approved by the Medical Ethics Committee Arnhem-Nijmegen, the Netherlands (registration number NL58948.091.16). Results will be published in peer-reviewed journals and presented at international conferences.Trial registration numbers EudraCT registry (2016-003321-42); Clinicaltrials.gov registry (NCT03172377); Dutch trial registry (NTRID6417).
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- 2020
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13. Reference values for anterior chamber morphometrics with swept-source optical coherence tomography in a Caucasian population
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Römkens HC, Beckers HJ, Schouten JSAG, Berendschot TT, and Webers CA
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reference value ,anterior chamber ,optical coherence tomography ,Caucasian ,Ophthalmology ,RE1-994 - Abstract
Hellen CS Römkens, Henny JM Beckers, Jan SAG Schouten, Tos TJM Berendschot, Carroll AB Webers Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, the Netherlands Purpose: The aim of this study is to generate reference values for anterior chamber morphometrics to facilitate the interpretation of anterior chamber images acquired with swept-source optical coherence tomography (SS-OCT) in a Caucasian population.Materials and methods: Non-glaucomatous Caucasian subjects, who were newly referred to the outpatient department of the University Eye Clinic Maastricht UMC+, were asked to undergo anterior segment assessment with SS-OCT imaging prior to routine eye examination (including visual acuity and refractive error measurements, Goldmann applanation tonometry, slit lamp examination and funduscopy).Results: A total of 647 Caucasian subjects, aged 40–80 years, were included. Mean age (± standard deviation) was 61.7±10.3 years, and 294 were male (45%). Mean refractive error was -0.63±3.17 D. OCT images and measurements were obtained in all cases. The mean temporal trabecular iris angle at 500 µm (TIA500) was 27.04°±12.04°, the mean nasal TIA500 was 27.43°±11.75°, the mean anterior chamber depth (ACD) was 2.75±0.39 mm and the mean lens vault (LV) was 0.44±0.30 mm. A smaller temporal TIA500, shallower ACD and higher LV were found in female and hyperopic subjects.Conclusion: Reference values for anterior chamber morphometrics in Caucasians were generated, quantified and presented. These values offer tools for the interpretation of anterior segment images of Caucasians and differentiation between presumed mechanisms of angle closure. Keywords: reference value, anterior chamber, optical coherence tomography, Caucasian
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- 2018
14. Long-Term Outcome of Immediate Versus Postponed Intervention in Patients With Infected Necrotizing Pancreatitis (POINTER)
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Van Veldhuisen, Charlotte L., Sissingh, Noor J., Boxhoorn, Lotte, van Dijk, Sven M., van Grinsven, Janneke, Verdonk, Robert C., Boermeester, Marja A., Bouwense, Stefan A.W., Bruno, Marco J., Cappendijk, Vincent C., van Duijvendijk, Peter, van Eijck, Casper H J., Fockens, Paul, van Goor, Harry, Hadithi, Muhammed, Haveman, Jan Willem, Jacobs, Maarten A.J.M., Jansen, Jeroen M., Kop, Marnix P.M., Manusama, Eric R., Mieog, J. Sven D., Molenaar, I. Quintus, Nieuwenhuijs, Vincent B., Poen, Alexander C., Poley, Jan-Werner, Quispel, Rutger, Römkens, Tessa E.H., Schwartz, Matthijs P., Seerden, Tom C., Dijkgraaf, Marcel G.W., Stommel, Martijn W.J., Straathof, Jan Willem A., Venneman, Niels G., Voermans, Rogier P., van Hooft, Jeanin E., van Santvoort, Hjalmar C., and Besselink, Marc G.
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- 2024
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15. Implementation of Best Practices in Pancreatic Cancer Care in the Netherlands: A Stepped-Wedge Randomized Clinical Trial
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Mackay, Tara M., Latenstein, Anouk E. J., Augustinus, Simone, van der Geest, Lydia G., Bogte, Auke, Bonsing, Bert A., Cirkel, Geert A., Hol, Lieke, Busch, Olivier R., den Dulk, Marcel, van Driel, Lydi M. J.W., Festen, Sebastiaan, de Groot, Derk-Jan A., de Groot, Jan-Willem B., Groot Koerkamp, Bas, Haj Mohammad, Nadia, Haver, Joyce T., van der Harst, Erwin, de Hingh, Ignace H., Homs, Marjolein Y. V., Los, Maartje, Luelmo, Saskia A. C., de Meijer, Vincent E., Mekenkamp, Leonie, Molenaar, I. Quintus, Patijn, Gijs A., Quispel, Rutger, Römkens, Tessa E. H., van Santvoort, Hjalmar C., Stommel, Martijn W.J., Venneman, Niels G., Verdonk, Robert C., van Vilsteren, Frederike G. I., de Vos-Geelen, Judith, van Werkhoven, C. Henri, van Hooft, Jeanin E., van Eijck, Casper H. J., Wilmink, Johanna W., van Laarhoven, Hanneke W. M., and Besselink, Marc G.
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IMPORTANCE: Implementation of new cancer treatment strategies as recommended by evidence-based guidelines is often slow and suboptimal. OBJECTIVE: To improve the implementation of guideline-based best practices in the Netherlands in pancreatic cancer care and assess the impact on survival. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, stepped-wedge cluster randomized trial compared enhanced implementation of best practices with usual care in consecutive patients with all stages of pancreatic cancer. It took place from May 22, 2018 through July 9, 2020. Data were analyzed from April 1, 2022, through February 1, 2023. It included all patients in the Netherlands with pathologically or clinically diagnosed pancreatic ductal adenocarcinoma. This study reports 1-year follow-up (or shorter in case of deceased patients). INTERVENTION: The 5 best practices included optimal use of perioperative chemotherapy, palliative chemotherapy, pancreatic enzyme replacement therapy (PERT), referral to a dietician, and use of metal stents in patients with biliary obstruction. A 6-week implementation period was completed, in a randomized order, in all 17 Dutch networks for pancreatic cancer care. MAIN OUTCOMES AND MEASURES: The primary outcome was 1-year survival. Secondary outcomes included adherence to best practices and quality of life (European Organisation for Research and Treatment of Cancer [EORTC] global health score). RESULTS: Overall, 5887 patients with pancreatic cancer (median age, 72.0 [IQR, 64.0-79.0] years; 50% female) were enrolled, 2641 before and 2939 after implementation of best practices (307 during wash-in period). One-year survival was 24% vs 23% (hazard ratio, 0.98, 95% CI, 0.88-1.08). There was no difference in the use of neoadjuvant chemotherapy (11% vs 11%), adjuvant chemotherapy (48% vs 51%), and referral to a dietician (59% vs 63%), while the use of palliative chemotherapy (24% vs 30%; odds ratio [OR], 1.38; 95% CI, 1.10-1.74), PERT (34% vs 45%; OR, 1.64; 95% CI, 1.28-2.11), and metal biliary stents increased (74% vs 83%; OR, 1.78; 95% CI, 1.13-2.80). The EORTC global health score did not improve (area under the curve, 43.9 vs 42.8; median difference, −1.09, 95% CI, −3.05 to 0.94). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, implementation of 5 best practices in pancreatic cancer care did not improve 1-year survival and quality of life. The finding that most patients received no tumor-directed treatment paired with the poor survival highlights the need for more personalized treatment options. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03513705
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- 2024
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16. Cost-Effectiveness Analysis of Increased Adalimumab Dose Intervals in Crohn's Disease Patients in Stable Remission: The Randomized Controlled LADI Trial.
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Jansen, Fenna M, Linschoten, Reinier C A van, Kievit, Wietske, Smits, Lisa J T, Pauwels, Renske W M, Jong, Dirk J de, Vries, Annemarie C de, Boekema, Paul J, West, Rachel L, Bodelier, Alexander G L, Gisbertz, Ingrid A M, Wolfhagen, Frank H J, Römkens, Tessa E H, Lutgens, Maurice W M D, Bodegraven, Adriaan A van, Oldenburg, Bas, Pierik, Marieke J, Russel, Maurice G V M, Boer, Nanne K de, and Mallant-Hent, Rosalie C
- Abstract
Background and Aims We aimed to assess cost-effectiveness of increasing adalimumab dose intervals compared to the conventional dosing interval in patients with Crohn's disease [CD] in stable clinical and biochemical remission. Design We conducted a pragmatic, open-label, randomized controlled non-inferiority trial, comparing increased adalimumab intervals with the 2-weekly interval in adult CD patients in clinical remission. Quality of life was measured with the EQ-5D-5L. Costs were measured from a societal perspective. Results are shown as differences and incremental net monetary benefit [iNMB] at relevant willingness to accept [WTA] levels. Results We randomized 174 patients to the intervention [ n = 113] and control [ n = 61] groups. No difference was found in utility (difference: −0.017, 95% confidence interval [−0.044; 0.004]) and total costs (−€943, [−€2226; €1367]) over the 48-week study period between the two groups. Medication costs per patient were lower (−€2545, [−€2780; −€2192]) in the intervention group, but non-medication healthcare (+€474, [+€149; +€952]) and patient costs (+€365 [+€92; €1058]) were higher. Cost–utility analysis showed that the iNMB was €594 [−€2099; €2050], €69 [−€2908; €1965] and −€455 [−€4,096; €1984] at WTA levels of €20 000, €50 000 and €80 000, respectively. Increasing adalimumab dose intervals was more likely to be cost-effective at WTA levels below €53 960 per quality-adjusted life year. Above €53 960 continuing the conventional dose interval was more likely to be cost-effective. Conclusion When the loss of a quality-adjusted life year is valued at less than €53 960, increasing the adalimumab dose interval is a cost-effective strategy in CD patients in stable clinical and biochemical remission. Clinical Trial Registration Number ClinicalTrials.gov , number NCT03172377. [ABSTRACT FROM AUTHOR]
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- 2023
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17. Ashes from fluidized bed combustion of residual forest biomass: recycling to soil as a viable management option
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Cruz, Nuno C., Rodrigues, Sónia M., Carvalho, Lina, Duarte, Armando C., Pereira, Eduarda, Römkens, Paul F.A.M., and Tarelho, Luís A.C.
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- 2017
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18. Fluid hydration to prevent post-ERCP pancreatitis in average- to high-risk patients receiving prophylactic rectal NSAIDs (FLUYT trial): study protocol for a randomized controlled trial
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Smeets, Xavier J. N. M., da Costa, David W., Fockens, Paul, Mulder, Chris J. J., Timmer, Robin, Kievit, Wietske, Zegers, Marieke, Bruno, Marco J., Besselink, Marc G. H., Vleggaar, Frank P., van der Hulst, Rene W. M., Poen, Alexander C., Heine, Gerbrand D. N., Venneman, Niels G., Kolkman, Jeroen J., Baak, Lubbertus C., Römkens, Tessa E. H., van Dijk, Sven M., Hallensleben, Nora D. L., van de Vrie, Wim, Seerden, Tom C. J., Tan, Adriaan C. I. T. L., Voorburg, Annet M. C. J., Poley, Jan-Werner, Witteman, Ben J., Bhalla, Abha, Hadithi, Muhammed, Thijs, Willem J., Schwartz, Matthijs P., Vrolijk, Jan Maarten, Verdonk, Robert C., van Delft, Foke, Keulemans, Yolande, van Goor, Harry, Drenth, Joost P. H., van Geenen, Erwin J. M., and for the Dutch Pancreatitis Study Group
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- 2018
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19. Risicoschatting TGG voor de omgeving van de zeedijk Perkpolder (Zeeland). Evaluatie 2021
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Brand, E, Negash, A, Schouten, T, Römkens, P, van Breemen, P, Brand, E, Negash, A, Schouten, T, Römkens, P, and van Breemen, P
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RIVM rapport:Bij de aanleg van de zeedijk in Perkpolder is thermische gereinigde grond (TGG) gebruikt. TGG bevat stoffen, zoals metalen en zouten, die naar het grondwater en oppervlaktewater naast de dijk kunnen verspreiden. Het RIVM heeft voor de tweede keer onderzocht of deze stoffen voorkomen in de omgeving van de zeedijk en welke mogelijke effecten hierdoor op de gezondheid en het milieu kunnen ontstaan. De aanleiding is dat er meer meetgegevens beschikbaar zijn over de concentraties van de stoffen in de bodem, het grondwater en het oppervlaktewater. Ook hebben omwonenden vragen over de effecten op de gezondheid en de omgeving. Uit het onderzoek blijkt dat de verontreinigingen uit de TGG geen risico’s veroorzaken voor de gezondheid van omwonenden. De stoffen zijn soms van nature al aanwezig, of de aangetroffen concentraties zijn te laag om effecten te geven. De TGG heeft de bodemkwaliteit van de moestuinen niet beïnvloed. Verder is het veilig om op de dijk te wandelen en in het oppervlaktewater te zwemmen, ook al is dat niet als zwemwater bedoeld. Het onderzochte zoete grondwater is geschikt om gewassen mee water te geven en vee te laten drinken. De landbouwpercelen en de toplaag op de dijk zijn geschikt voor vee om te grazen en voor akkerbouw. Tijdens het onderzoek zijn in de omgeving van de dijk ook stoffen aangetroffen die zeer waarschijnlijk niet uit de TGG komen. Het gaat onder meer om PFAS, dioxines en arseen. De PFAS in het oppervlaktewater komen zeer waarschijnlijk uit de Westerschelde. Arseen kan misschien uit de TGG komen, maar komt in ieder geval van nature in hogere concentraties voor in Zeeland. Vanwege de PFAS, arseen en dioxines raadt het RIVM af om zelfgevangen vis uit dit gebied te eten. Ook raadt het RIVM aan om te onderzoeken of PFAS in zwemwateren in de omgeving voorkomen en zo ja, wat het effect daarvan is. Direct naast de dijk is het grond- en oppervlaktewater van nature zout. Daardoor raadt het RIVM af om dit water voor de landbouw te gebruiken. Om dez, Thermally cleaned soil (TCS) was used for the construction of Perkpolder’s dike. TCS contains substances such as metals and salts that could spread to the groundwater and surface water next to the dike. For the second time now the National Institute for Public Health and the Environment (RIVM) has carried out a study to ascertain whether these substances are present in the vicinity of the dike and what possible effects this could have on health and the environment. The study was prompted by the fact that more measurement data has become available on the concentrations of the substances in the soil, groundwater and surface water. In addition to this, local residents have asked questions on the effects on their health and the environment. The study reveals that contamination from the TCS does not pose any risks to local residents’ health. The substances are sometimes already naturally present or the concentrations found are too low to have any effects. The TCS has not influenced the soil quality of the vegetable gardens. Moreover, it is safe to walk on the embankment and swim in the surface water, even though it is not intended to be swimming water. The fresh groundwater examined, the strips of farmland and the topsoil on the dike are suitable for watering plants and for cows to drink and graze. They are also suitable for arable farming. During the study, other substances that are most likely not to have come from TCS were found as well. These include PFAS, dioxins and arsenic. The PFAS in the surface water are very likely to have come from the Western Scheldt. It is possible that arsenic could come from the TCS, but in any case it is naturally present in high concentrations in the province of Zeeland. Due to the presence of the PFAS, arsenic and dioxins, RIVM would advise not eating fish that you have caught yourself in this area. RIVM also recommends that a study be conducted to establish whether PFAS are present in swimming water in the area and if so, what the eff
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- 2022
20. Groen voor bodem, de bodem voor groen : Betekenis van de bodem voor het stadsecosysteem : special bodem
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Spijker, J., Römkens, P., Spijker, J., and Römkens, P.
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De stadsbodem is de standplaats voor stedelijk groen, het leefmilieu voor het bodemecosysteem en een belangrijke waterbuffer. Een optimaal functionerende bodem is daarom van levensbelang voor een goed functionerend stadsecosysteem. Helaas heeft de stadsbodem een gecompliceerd verleden en is het met de bodemgezondheid in veel gevallen matig gesteld. Met inzet van nieuwe kennis zijn stadsbodems en stadsecosystemen te versterken en optimaal in te zetten voor mens en dier.
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- 2022
21. Risicoschatting TGG voor de omgeving van de zeedijk Perkpolder (Zeeland): evaluatie 2021
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Brand, E., Negash, A., Schouten, T., Römkens, P., van Breemen, P., Brand, E., Negash, A., Schouten, T., Römkens, P., and van Breemen, P.
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Bij de aanleg van de zeedijk in Perkpolder is thermische gereinigde grond (TGG) gebruikt. TGG bevat stoffen, zoals metalen en zouten, die naar het grondwater en oppervlaktewater naast de dijk kunnen verspreiden. Het RIVM heeft voor de tweede keer onderzocht of deze stoffen voorkomen in de omgeving van de zeedijk en welke mogelijke effecten hierdoor op de gezondheid en het milieu kunnen ontstaan. De aanleiding is dat er meer meetgegevens beschikbaar zijn over de concentraties van de stoffen in de bodem, het grondwater en het oppervlaktewater. Ook hebben omwonenden vragen over de effecten op de gezondheid en de omgeving. Uit het onderzoek blijkt dat de verontreinigingen uit de TGG geen risico’s veroorzaken voor de gezondheid van omwonenden. De stoffen zijn soms van nature al aanwezig, of de aangetroffen concentraties zijn te laag om effecten te geven. De TGG heeft de bodemkwaliteit van de moestuinen niet beïnvloed. Verder is het veilig om op de dijk te wandelen en in het oppervlaktewater te zwemmen, ook al is dat niet als zwemwater bedoeld. Het onderzochte zoete grondwater is geschikt om gewassen mee water te geven en vee te laten drinken. De landbouwpercelen en de toplaag op de dijk zijn geschikt voor vee om te grazen en voor akkerbouw. Tijdens het onderzoek zijn in de omgeving van de dijk ook stoffen aangetroffen die zeer waarschijnlijk niet uit de TGG komen. Het gaat onder meer om PFAS, dioxines en arseen. De PFAS in het oppervlaktewater komen zeer waarschijnlijk uit de Westerschelde. Arseen kan misschien uit de TGG komen, maar komt in ieder geval van nature in hogere concentraties voor in Zeeland. Vanwege de PFAS, arseen en dioxines raadt het RIVM af om zelfgevangen vis uit dit gebied te eten. Ook raadt het RIVM aan om te onderzoeken of PFAS in zwemwateren in de omgeving voorkomen en zo ja, wat het effect daarvan is. Direct naast de dijk is het grond- en oppervlaktewater van nature zout. Daardoor raadt het RIVM af om dit water voor de landbouw te gebruiken. Om de
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- 2022
22. Long-term effectiveness and safety of ustekinumab in Crohn’s disease: a prospective cohort study
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Thomas, Pepijn W.A., van Caem, Mark, West, Rachel L., Russel, Maurice G.V.M, Jansen, Jeroen M., Römkens, Tessa E.H., and Hoentjen, Frank
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- 2023
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23. Favourable Tolerability and Drug Survival of Tioguanine Versus Methotrexate After Failure of Conventional Thiopurines in Crohn's Disease.
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Savelkoul, E H J, Maas, M H J, Bourgonje, A R, Crouwel, F, Biemans, V B C, Broeder, N den, Russel, M G V M, Römkens, T E H, Boer, N K de, Dijkstra, G, and Hoentjen, F
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Background and Aims Both methotrexate and tioguanine can be considered as treatment options in patients with Crohn's disease after failure of conventional thiopurines. This study aimed to compare tolerability and drug survival of methotrexate and tioguanine therapy after failure of conventional thiopurines in patients with Crohn's disease. Methods We conducted a retrospective, multicentre study, including patients with Crohn's disease initiating monotherapy methotrexate or tioguanine after failure [all causes] of conventional thiopurines. Follow-up duration was 104 weeks or until treatment discontinuation. The primary outcome was cumulative therapy discontinuation incidence due to adverse events. Secondary outcomes included total number of [serious] adverse events, and ongoing monotherapy. Results In total, 219 patients starting either methotrexate [ n = 105] or tioguanine [ n = 114] were included. In all 65 [29.7%] patients (methotrexate 43.8% [46/105 people], tioguanine 16.7% [19/114 people], p <0.001) discontinued their treatment due to adverse events during follow-up. Median time until discontinuation due to adverse events was 16 weeks (interquartile range [IQR] 7-38, p = 0.812). Serious adverse events were not significantly different. Patients treated with methotrexate experienced adverse events more often [methotrexate 83%, tioguanine 46%, p <0.001]. Total monotherapy drug survival after 104 weeks was 22% for methotrexate and 46% for tioguanine [ p <0.001]. Conclusions We observed a higher cumulative discontinuation incidence due to adverse events for methotrexate [44%] compared with tioguanine [17%] in Crohn's disease patients after failure of conventional thiopurines. The total adverse events incidence during methotrexate use was higher, whereas serious adverse events incidence was similar. These favourable results for tioguanine treatment may guide the selection of immunosuppressive therapy after failure of conventional thiopurines. [ABSTRACT FROM AUTHOR]
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- 2022
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24. Visiedocument gebruik van biobeschikbaarheid in bodembeoordeling : Mogelijkheden voor metalen in bodem en waterbodem
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Lijzen JPA, Verschoor AJ, Mesman M, de Boer PT, Osté L, Römkens P, DDB, and M&V
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quality assessment ,Total content ,ecotoxicologische risico's ,totaalgehaalte ,effecten ,soil ,bodem ,potential available concentration ,potentieel beschikbare concentratie ,sediment ,beleid ,effects ,biobeschikbaarheid ,kwaliteitsbeoordeling ,bioavailability ,RIVM rapport 2015-0215 ,policy - Abstract
Om te bepalen of de kwaliteit van een bodem geschikt is voor (her)gebruik, wordt een risicobeoordeling uitgevoerd. Daarmee wordt onder meer beoordeeld of de aanwezige metalen een risico vormen voor mens, plant en dier. Momenteel wordt hiervoor de totale concentratie van de aanwezige metalen gemeten. Bekend is echter dat niet al het aanwezige metaal schadelijke effecten veroorzaakt. Door de hoeveelheid metalen te bepalen die effecten kan veroorzaken, wordt de risicobeoordeling van metalen in land- en waterbodem verbeterd. Aanbevolen wordt een meetmethode met verdund salpeterzuur toe te passen waarmee dit kan. Het RIVM heeft een visiedocument opgesteld, waarin staat waar, hoe en waarom dit in het bodem- en waterbodembeleid mogelijk is. Het heeft de voorkeur de nieuwe werkwijze in de eerste stap van de risicobeoordeling voor land- en waterbodem te gebruiken. Met de voorgestelde methode wordt nauwkeuriger het deel van de metalen bepaald dat verantwoordelijk is voor effecten op organismen. Voor kwik in beide bodemsoorten blijkt deze methode vooralsnog niet geschikt. Geadviseerd wordt om uit te werken welke concentraties voor land- en waterbodem toelaatbaar zijn. Ook wordt aangeraden de consequenties van de voorgestelde methode in de eerste stap van de risicobeoordeling voor de uitvoering van het bodembeleid in de praktijk in beeld te brengen. De nieuwe werkwijze kan wel direct worden gebruikt als aanvullende risicobeoordeling (tweede stap) van land- en waterbodem en binnen het beleid voor de diepe plassen van de aankomende Omgevingswet.
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- 2020
25. Su1842 LIFESTYLE AND PSYCHOSOCIAL FACTORS IN IBD; PREVALENCE AND PATIENTS' PERSPECTIVE.
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Demers, Karlijn, Hendrix, Evelien, Ardabili, Ashkan Rezazadeh, Bredero, Quirine M., Van Bodegraven, Adriaan A., van der Horst, Daniëlle, Jonkers, Daisy M., Kimman, Merel L., Mujagic, Z, Romberg-Camps, Mariëlle, Römkens, Tessa E., Scherpenzeel, Menne, Schroevers, Maya J., Stassen, Laurents P., West, Rachel, Dijkstra, Gerard, and Pierik, Marie J.
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- 2024
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26. Validation and update of a prediction model for risk of relapse after cessation of anti-TNF treatment in Crohn’s disease
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ten Bokkel Huinink, Sebastiaan, de Jong, Djuna C., Nieboer, Daan, Thomassen, Doranne, Steyerberg, Ewout W., Dijkgraaf, Marcel G.W., Bodelier, Alexander G.L., West, Rachel L., Römkens, Tessa E.H., Hoentjen, Frank, Mallant, Rosalie C., van Tuyl, Bas A.C., Mares, Wout G.N., Wolfhagen, Frank H.J., Dijkstra, Gerard, Reijnders, Jurriën G.P., de Boer, Nanne K., Tan, Adriaan C.I.T.L., van Boeckel, Petra G.A., Tack, Greetje J., van Asseldonk, Dirk P., D’Haens, Geert R.A.M., van der Woude, C Janneke, Duijvestein, Marjolijn, and de Vries, Annemarie C
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- 2022
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27. De-escalation of biological therapy in inflammatory bowel disease patients following prior dose escalation
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Thomas, Pepijn W. A., Smits, Lisa J. T., Te Groen, Maarten, West, Rachel L., Russel, Maurice G. V. M., Jansen, Jeroen M., Römkens, Tessa E. H., and Hoentjen, Frank
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- 2022
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28. A Classification Algorithm for Types of Diabetes in Chronic Pancreatitis Using Epidemiological Characteristics
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Kempeneers, Marinus A., Issa, Yama, Ahmed Ali, Usama, Bruno, Marco J., van Geenen, Erwin J. M., van Hooft, Jeanin E., Römkens, Tessa E. H., Siersema, Peter D., Spanier, B. W. Marcel, Yahya, Ibtisam, DeVries, J. Hans, Besselink, Marc G., van Santvoort, Hjalmar C., and Boermeester, Marja A.
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Supplemental digital content is available in the text.
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- 2021
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29. Clinical Outcomes of Covid-19 in Patients With Inflammatory Bowel Disease: A Nationwide Cohort Study.
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Derikx, Lauranne A A P, Lantinga, Marten A, Jong, Dirk J de, Dop, Willemijn A van, Creemers, Rob H, Römkens, Tessa E H, Jansen, Jeroen M, Mahmmod, Nofel, West, Rachel L, Tan, Adriaan C I T L, Bodelier, Alexander G L, Gorter, Moniek H P, Boekema, Paul J, Halet, Eric R C, Horjus, Carmen S, Dijk, Maarten A van, Hirdes, Meike M C, Stippel, Ludger S M Epping, Jharap, Bindia, and Lutgens, Maurice W M D
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Background and Aims The COVID-19 risk and disease course in inflammatory bowel disease [IBD] patients remains uncertain. Therefore, we aimed to assess the clinical presentation, disease course, and outcomes of COVID-19 in IBD patients. Second, we determined COVID-19 incidences in IBD patients and compared this with the general population. Methods We conducted a multicentre, nationwide IBD cohort study in The Netherlands and identified patients with COVID-19. First, we assessed the COVID-19 disease course and outcomes. Second, we compared COVID-19 incidences between our IBD study cohort and the general Dutch population. Results We established an IBD cohort of 34 763 patients. COVID-19 was diagnosed in 100/34 763 patients [0.29%]; 20/100 of these patients [20%] had severe COVID-19 defined as admission to the intensive care unit, mechanical ventilation, and/or death. Hospitalisation occurred in 59/100 [59.0%] patients and 13/100 [13.0%] died. All patients who died had comorbidities and all but one were ≥65 years old. In line, we identified ≥1 comorbidity as an independent risk factor for hospitalisation (odds ratio [OR] 4.20, 95% confidence interval [CI] 1.58–11.17,; p = 0.004). Incidences of COVID-19 between the IBD study cohort and the general population were comparable (287.6 [95% CI 236.6–349.7] versus 333.0 [95% CI 329.3–336.7] per 100000 patients, respectively; p = 0.15). Conclusions Of 100 cases with IBD and COVID-19, 20% developed severe COVID-19, 59% were hospitalised and 13% died. A comparable COVID-19 risk was found between the IBD cohort [100/34 763 = 0.29%] and the general Dutch population. The presence of ≥1 comorbidities was an independent risk factor for hospitalisation due to COVID-19. [ABSTRACT FROM AUTHOR]
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- 2021
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30. Discrepancy between patient‐ and healthcare provider‐reported adverse drug reactions in inflammatory bowel disease patients on biological therapy
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Thomas, Pepijn W. A., Römkens, Tessa E. H., West, Rachel L., Russel, Maurice G. V. M., Jansen, Jeroen M., Lint, Jette A., Jessurun, Naomi T., and Hoentjen, Frank
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Only limited data is available on the extent and burden of adverse drug reactions (ADRs) to biological therapy in inflammatory bowel disease (IBD) patients in daily practice, especially from a patient's perspective. The aim of this study was to systematically assess patient‐reported ADRs during biological therapy in IBD patients and compare these with healthcare provider (HCP)‐reported ADRs. This multicentre, prospective, event monitoring study enrolled IBD patients on biological therapy. Patients completed bimonthly comprehensive web‐based questionnaires regarding description of biological induced ADRs, follow‐up of previous ADRs and experienced burden of the ADR using a five‐point Likert scale. The relationship between patient‐reported ADRs and biological therapy was assessed. HCP‐reported ADRs were extracted from the electronic healthcare records. In total, 182 patients (female 51%, mean age 42.2 [standard deviation 14.2] years, Crohn's disease 77%) were included and completed 728 questionnaires. At baseline, 60% of patients used infliximab, 30% adalimumab, 9% vedolizumab and 1% ustekinumab. Fifty percent of participants reported at least one ADR with a total of 239 unique ADRs. Fatigue (n= 26) and headache (n= 20) resulted in the highest burden and a correlation in time with the administration of the biological was described in 56% and 85% respectively. Out of 239 ADRs, 115 were considered biological‐related. HCPs reported 119 ADRs. Agreement between patient‐reported ADRs and HCP‐reported ADRs was only 13%. IBD patients often report ADRs during biological therapy. We observed an important significant difference between the type and frequency of patient‐reported ADRs versus HCP‐reported ADRs, leading to an underestimation of more subjective ADRs and patients' ADR‐related burden. Summarise the established knowledge on this subject Adverse drug reactions (ADRs) are severely underreported by healthcare providers (HCP) and do not capture the full spectrum of biological‐related ADRs.Patient self‐reporting may be used to detect ADRs and offers more insight in the patient's perception and experience of an ADR.Data on self‐reporting ADRs in inflammatory bowel disease (IBD) patients is limited. Adverse drug reactions (ADRs) are severely underreported by healthcare providers (HCP) and do not capture the full spectrum of biological‐related ADRs. Patient self‐reporting may be used to detect ADRs and offers more insight in the patient's perception and experience of an ADR. Data on self‐reporting ADRs in inflammatory bowel disease (IBD) patients is limited. What are the significant and/or new findings of this study? IBD patients frequently reported ADRs during biological use (50%) and 48% of these ADRs were considered biological‐related.Fatigue and headache resulted in the highest patient‐reported burden.Patients often reported a correlation in time (44%) for the top six patient‐reported ADRs.There was a significant difference between type and frequency of patient‐reported ADRs and HCP‐reported ADRs. IBD patients frequently reported ADRs during biological use (50%) and 48% of these ADRs were considered biological‐related. Fatigue and headache resulted in the highest patient‐reported burden. Patients often reported a correlation in time (44%) for the top six patient‐reported ADRs. There was a significant difference between type and frequency of patient‐reported ADRs and HCP‐reported ADRs.
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- 2021
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31. Publieke en private handhaving van het kartelverbod – een convergente toepassing van dezelfde norm?
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Römkens, Ellen, Prompers, Anke, Bouman, Aron, Kuijper, Marc, and Lamberti, Reinier
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Copyright of Markt en Mededinging is the property of Boom uitgevers Den Haag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2020
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32. Increased Discontinuation Rates of Anti-TNF Therapy in Elderly Inflammatory Bowel Disease Patients.
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Jong, M E de, Smits, L J T, Ruijven, B van, Broeder, N den, Russel, M G V M, Römkens, T E H, West, R L, Jansen, J M, and Hoentjen, F
- Abstract
Background and Aims There is paucity of data on safety and efficacy of anti-tumour necrosis factor [TNF] in elderly inflammatory bowel disease [IBD] patients. We aimed to compare the long-term treatment failure rates and safety of a first anti-TNF agent in IBD patients between different age groups [<40 years/40–59 years/≥60 years]. Methods IBD patients who started a first anti-TNF agent were identified through IBDREAM, a multicentre prospective IBD registry. Competing risk regression was used to study treatment failure, defined as time to drug discontinuation due to adverse events [AEs] or lack of effectiveness, with discontinuation due to remission as a competing risk. Results A total of 895 IBD patients were included; 546 started anti-TNF at age <40 [61.0%], 268 at age 40–59 [29.9%], and 81 at age ≥60 [9.1%]. Treatment failure rate was higher in the two older groups (subhazard rate [SHR] age ≥60 1.46, SHR age 40–59 1.21; p = 0.03). The SHR in the elderly [>60] was 1.52 for discontinuation due to AEs and 1.11 for lack of effectiveness. Concomitant thiopurine use was associated with a lower treatment failure rate (SHR 0.78, 95% confidence interval [CI] 0.62–0.98, p = 0.031). Serious adverse event [SAE] rate, as well as serious infection rate, were significantly higher in elderly IBD patients [61.2 versus 16.0 and 12.4 per 1000 patient-years, respectively] whereas the malignancy rate was low in all age groups. Conclusions Elderly IBD patients starting a first anti-TNF agent showed higher treatment failure rates, but concomitant thiopurine use at baseline was associated with lower failure rates. Elderly IBD patients demonstrated higher rates of SAEs and serious infections. [ABSTRACT FROM AUTHOR]
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- 2020
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33. Long-term Risk of Advanced Neoplasia After Colonic Low-grade Dysplasia in Patients With Inflammatory Bowel Disease: A Nationwide Cohort Study.
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Jong, Michiel E De, Tilburg, Sanne B Van, Nissen, Loes H C, Kievit, Wietske, Nagtegaal, Iris D, Horjus, Carmen S, Römkens, Tessa E H, Drenth, Joost P H, Hoentjen, Frank, and Derikx, Lauranne A A P
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Background and Aims The long-term risk of high-grade dysplasia [HGD] and colorectal cancer [CRC] following low-grade dysplasia [LGD] in inflammatory bowel disease [IBD] patients is relatively unknown. We aimed to determine the long-term cumulative incidence of advanced neoplasia [HGD and/or CRC], and to identify risk factors for advanced neoplasia in a nationwide IBD cohort with a history of LGD. Methods This is a nationwide cohort study using data from the Dutch National Pathology Registry [PALGA] to identify all IBD patients with LGD between 1991 and 2010 in the Netherlands. Follow-up data were collected until January 2016. We determined the cumulative incidence of advanced neoplasia and identified risk factors via multivariable Cox regression analysis. Results We identified 4284 patients with colonic LGD with a median follow-up of 6.4 years after initial LGD diagnosis. The cumulative incidence of subsequent advanced neoplasia was 3.6, 8.5, 14.4 and 21.7%, after 1, 5, 10 and 15 years, respectively. The median time to develop advanced neoplasia after LGD was 3.6 years. Older age [≥ 55 years] at moment of LGD (hazard ratio [HR] 1.73, 95% confidence interval [CI] 1.44–2.06), male sex [HR 1.33, 95% CI 1.10–1.60], and follow-up at an academic [vs non-academic] medical centre [HR 1.37, 95% CI 1.07–1.76] were independent risk factors for advanced neoplasia following LGD. Conclusions In a large nationwide cohort with long-term follow-up of IBD patients with LGD, the cumulative incidence of advanced neoplasia was 21.7% after 15 years. Older age at LGD [≥55 years], male sex and follow-up by a tertiary IBD referral centre were independent risk factors for advanced neoplasia development after initial LGD. [ABSTRACT FROM AUTHOR]
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- 2019
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34. Visiedocument gebruik van biobeschikbaarheid in bodembeoordeling : Mogelijkheden voor metalen in bodem en waterbodem
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DDB, M&V, Lijzen JPA, Verschoor AJ, Mesman M, de Boer PT, Osté L, Römkens P, DDB, M&V, Lijzen JPA, Verschoor AJ, Mesman M, de Boer PT, Osté L, and Römkens P
- Abstract
RIVM rapport:Om te bepalen of de kwaliteit van een bodem geschikt is voor (her)gebruik, wordt een risicobeoordeling uitgevoerd. Daarmee wordt onder meer beoordeeld of de aanwezige metalen een risico vormen voor mens, plant en dier. Momenteel wordt hiervoor de totale concentratie van de aanwezige metalen gemeten. Bekend is echter dat niet al het aanwezige metaal schadelijke effecten veroorzaakt. Door de hoeveelheid metalen te bepalen die effecten kan veroorzaken, wordt de risicobeoordeling van metalen in land- en waterbodem verbeterd. Aanbevolen wordt een meetmethode met verdund salpeterzuur toe te passen waarmee dit kan. Het RIVM heeft een visiedocument opgesteld, waarin staat waar, hoe en waarom dit in het bodem- en waterbodembeleid mogelijk is. Het heeft de voorkeur de nieuwe werkwijze in de eerste stap van de risicobeoordeling voor land- en waterbodem te gebruiken. Met de voorgestelde methode wordt nauwkeuriger het deel van de metalen bepaald dat verantwoordelijk is voor effecten op organismen. Voor kwik in beide bodemsoorten blijkt deze methode vooralsnog niet geschikt. Geadviseerd wordt om uit te werken welke concentraties voor land- en waterbodem toelaatbaar zijn. Ook wordt aangeraden de consequenties van de voorgestelde methode in de eerste stap van de risicobeoordeling voor de uitvoering van het bodembeleid in de praktijk in beeld te brengen. De nieuwe werkwijze kan wel direct worden gebruikt als aanvullende risicobeoordeling (tweede stap) van land- en waterbodem en binnen het beleid voor de diepe plassen van de aankomende Omgevingswet., Risk assessments are carried out to determine if the quality of the soil should be increased or to determine if it is fit for re-use. It is assessed if compounds, amongst which metals, cause a risk for men and environment. Currently the total content of metals is measured, of which is known that not all the metals present cause environmental impact. This study concludes that by measuring metals that potentially can cause an effect, the risk assessment of metals in soil and sediment can be improved. We recommend using the 'aqua nitrosa' method (with diluted nitric acid) for on soil and sediment assessments. The RIVM made a vision document, which describes where, how and why this method can be applied in policy on soil and sediment. It is preferred to use the method in the first step of the risk assessment of terrestrial soil as well as for sediment, because it more accurately measures the part that is responsible for effects on organisms. For mercury, this method currently is not suitable. It is advised to elaborate the accepted concentrations in soil and sediments in different legislations and to analyse the consequences of the proposed method before implementation into policy. In any case, the proposed method can be used as an additional measurement in the second step of soil risk assessment and in the oncoming risk assessment of deep freshwater pools in the oncoming Environment & Planning Act
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- 2017
35. Visiedocument gebruik van biobeschikbaarheid in bodembeoordeling : mogelijkheden voor metalen in bodem en waterbodem
- Author
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Lijzen, J.P.A., Verschoor, A.J., Mesman, M., Boer, P.T., Osté, L., Römkens, P., Lijzen, J.P.A., Verschoor, A.J., Mesman, M., Boer, P.T., Osté, L., and Römkens, P.
- Abstract
Om te bepalen of de kwaliteit van een bodem geschikt is voor (her)gebruik, wordt een risicobeoordeling uitgevoerd. Daarmee wordt onder meer beoordeeld of de aanwezige metalen een risico vormen voor mens, plant en dier. Momenteel wordt hiervoor de totale concentratie van de aanwezige metalen gemeten. Bekend is echter dat niet al het aanwezige metaal schadelijke effecten veroorzaakt. Door de hoeveelheid metalen te bepalen die effecten kan veroorzaken, wordt de risicobeoordeling van metalen in land- en waterbodem verbeterd. Aanbevolen wordt een meetmethode met verdund salpeterzuur toe te passen waarmee dit kan. Het RIVM heeft een visiedocument opgesteld, waarin staat waar, hoe en waarom dit in het bodem- en waterbodembeleid mogelijk is.
- Published
- 2017
36. Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis (APEC): a multicentre randomised controlled trial
- Author
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Schepers, Nicolien J, Hallensleben, Nora D L, Besselink, Marc G, Anten, Marie-Paule G F, Bollen, Thomas L, da Costa, David W, van Delft, Foke, van Dijk, Sven M, van Dullemen, Hendrik M, Dijkgraaf, Marcel G W, van Eijck, Casper H J, Erkelens, G Willemien, Erler, Nicole S, Fockens, Paul, van Geenen, Erwin J M, van Grinsven, Janneke, Hollemans, Robbert A, van Hooft, Jeanin E, van der Hulst, Rene W M, Jansen, Jeroen M, Kubben, Frank J G M, Kuiken, Sjoerd D, Laheij, Robert J F, Quispel, Rutger, de Ridder, Rogier J J, Rijk, Marno C M, Römkens, Tessa E H, Ruigrok, Carola H M, Schoon, Erik J, Schwartz, Matthijs P, Smeets, Xavier J N M, Spanier, B W Marcel, Tan, Adriaan C I T L, Thijs, Willem J, Timmer, Robin, Venneman, Niels G, Verdonk, Robert C, Vleggaar, Frank P, van de Vrie, Wim, Witteman, Ben J, van Santvoort, Hjalmar C, Bakker, Olaf J, and Bruno, Marco J
- Abstract
It remains unclear whether urgent endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy improves the outcome of patients with gallstone pancreatitis without concomitant cholangitis. We did a randomised trial to compare urgent ERCP with sphincterotomy versus conservative treatment in patients with predicted severe acute gallstone pancreatitis.
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- 2020
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37. Occurrence of Chloramphenicol in Crops through Natural Production by Bacteria in Soil
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Berendsen, Bjorn, Pikkemaat, Mariel, Römkens, Paul, Wegh, Robin, van Sisseren, Maarten, Stolker, Linda, and Nielen, Michel
- Abstract
Due to the unexpected findings of the banned antibiotic chloramphenicol in products of animal origin, feed, and straw, the hypothesis was studied that the drug is naturally present in soil, through production by soil bacteria, and subsequently can be transferred to crops. First, the stability of chloramphenicol in soil was studied. The fate of chloramphenicol highly depends on soil type and showed a half-life of approximately one day in nonsterile topsoil. It was found to be more stable in subsoil and sterile soils. Second, the production of chloramphenicol in soil was studied, and it was confirmed that Streptomyces venezuelaecan produce chloramphenicol at appreciable amounts in nonsterile soil. Third, a transfer study was carried out using wheat and maize grown on three different soils that were weekly exposed to aqueous chloramphenicol solutions at different levels. Chloramphenicol was taken up by crops as determined by chiral liquid chromatography coupled to tandem mass spectrometric analysis, and the levels in crops were found to be bioavailability related. It was concluded that chloramphenicol residues can occur naturally in crops as a result of the production of chloramphenicol by soil bacteria in their natural environment and subsequent uptake by crops.
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- 2024
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38. Advantages and limitations of chemical extraction tests to predict mercury soil-plant transfer in soil risk evaluations
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Monteiro, R. J. R., primary, Rodrigues, S. M., additional, Cruz, N., additional, Henriques, B., additional, Duarte, A. C., additional, Römkens, P. F. A. M., additional, and Pereira, E., additional
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- 2016
- Full Text
- View/download PDF
39. Assessment of Histological Remission in Ulcerative Colitis: Discrepancies Between Daily Practice and Expert Opinion.
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Römkens, Tessa E. H., Kranenburg, Pim, van Tilburg, Arjan, Bronkhorst, Carolien, Nagtegaal, Iris D., Drenth, Joost P. H., and Hoentjen, Frank
- Abstract
Background and Aims: Histological remission [HR] is a potential treatment target in ulcerative colitis [UC]. Limited 'real world' data are available on the reliability of histological scoring when assessing minimal histological inflammation. The aim of this study was to investigate the reliability of UC histological scores in colonic biopsies showing mucosal healing [MH] and limited histological inflammation, and to compare the 'daily practice' histological assessment with expert reviews by gastrointestinal [GI] pathologists. Methods: We performed a retrospective single-centre study. Colonic biopsies from UC patients with MH [Mayo score = 1] were included. All biopsies assessed in daily practice were reassessed by three blinded GI pathologists using three histological scores (Geboes score [GS], Riley score [RS], Harpaz [Gupta] Index [HGI]) and a global visual scale [GVS]. We evaluated inter- and intraobserver variation between GI pathologists and correlations between scores including the initial histological assessment using Cronbach's alpha and Spearman rho analysis. Results: In total, 270 biopsies from 39 UC patients were included. The inter-observer concordance for all histological indexes was substantial to almost perfect [GS 0.84; HGI 0.61; GVS 0.74, RS 0.91]. Correlation between the RS and GS was almost perfect [R = 0.86], but we found no correlation between the primary histological assessment and reassessment by GI pathologists. Conclusions: Current UC histological scores reliably assess limited histological inflammation in UC patients. The discrepancy between the initial histological assessment and the reassessment by dedicated GI pathologists suggests a gap between daily practice and academic expertise. This issue may limit the implementation of HR as a treatment target for UC in daily practice. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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40. The revised Atlanta criteria more accurately reflect severity of post-ERCP pancreatitis compared to the consensus criteria
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Smeets, XJNM, Bouhouch, N, Buxbaum, J, Zhang, H, Cho, J, Verdonk, RC, Römkens, TEH, Venneman, NG, Kats, I, Vrolijk, JM, Hemmink, GJM, Otten, A, Tan, ACITL, Elmunzer, BJ, Cotton, PB, Drenth, JPH, and Geenen, EJM
- Abstract
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most prevalent complication after ERCP with an incidence of 3.5%. PEP severity is classified according to either the consensus criteria or the revised Atlanta criteria. In this international cohort study we investigated which classification is the strongest predictor of PEP-related mortality. We reviewed 13,384 consecutive ERCPs performed between 2012 and 2017 in eight hospitals. We gathered data on all pancreatitis-related adverse events and compared the predictive capabilities of both classifications. Furthermore, we investigated the correlation between the two classifications and identified reasons underlying length of stay. The total sample consisted of 387 patients. The revised Atlanta criteria have a higher sensitivity (100 vs. 55%), specificity (98 vs. 72%) and positive predictive value (58 vs. 5%). There is a significant difference (p?0.001) between the two classifications. In 124 patients (32%), the length of stay was influenced by concomitant diseases. The revised Atlanta classification is superior in predicting mortality and better reflects PEP severity. This has important implications for researchers, clinicians and patients. For the diagnosis of PEP pancreatitis, the consensus criteria remain the golden standard. However, the revised Atlanta criteria are preferable for defining PEP severity.
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- 2019
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41. Evaluation of the Single Dilute (0.43 M) Nitric Acid Extraction to Determine Geochemically Reactive Elements in Soil.
- Author
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Groenenberg, Jan E., Römkens, Paul F. A. M., Van Zomeren, André, Rodrigues, Sonia M., and Comans, Rob N. J.
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- 2017
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42. Complete Endoscopic Healing Is Associated With Lower Relapse Risk After Anti-TNF Withdrawal in Inflammatory Bowel Disease.
- Author
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Mahmoud, Remi, Savelkoul, Edo H.J., Mares, Wout, Goetgebuer, Rogier, Witteman, Ben J.M., de Koning, Daan B., van Tuyl, Sebastiaan A.C., Minderhoud, Itta, Lutgens, Maurice W.M. D., Akol-Simsek, Dilek, van Schaik, Fiona D.M., Fidder, Herma H., Jansen, Jeroen M., van Boeckel, Petra G.A., Mahmmod, Nofel, Horjus-Talabur Horje, Carmen S., Römkens, Tessa E.H., Colombel, Jean-Frédéric, Hoentjen, Frank, and Jharap, Bindia
- Abstract
Discontinuation of anti–tumor necrosis factor-α treatment (anti-TNF) (infliximab and adalimumab) in patients with inflammatory bowel disease (IBD) is associated with a high relapse risk that may be influenced by endoscopic activity at the time of stopping. We assessed the relapse rate after anti-TNF withdrawal in patients with endoscopic healing and studied predictors of relapse including the depth of endoscopic healing. This was a multicenter, prospective study in adult patients with Crohn's disease (CD), ulcerative colitis (UC), or IBD-unclassified (IBDU), with ≥6 months of corticosteroid-free clinical remission (confirmed at baseline) and endoscopic healing (Mayo <2/SES-CD <5 without large ulcers), who discontinued anti-TNF between 2018 and 2020 in the Netherlands. We performed Kaplan-Meier and Cox regression analyses to assess the relapse rate and evaluate potential predictors: partial (Mayo 1/SES-CD 3–4) versus complete (Mayo 0/SES-CD 0–2) endoscopic healing, anti-TNF trough levels, and immunomodulator and/or mesalamine use. Among 81 patients (CD: n = 41, 51%) with a median follow-up of 2.0 years (interquartile range, 1.6–2.1), 40 patients (49%) relapsed. Relapse rates in CD and UC/IBDU patients were comparable. At 12 months, 70% versus 35% of patients with partial versus complete endoscopic healing relapsed, respectively (adjusted hazard rate [aHR], 3.28; 95% confidence interval [CI], 1.43–7.50). Mesalamine use was associated with fewer relapses in UC/IBDU patients (aHR, 0.08; 95% CI, 0.01–0.67). Thirty patients restarted anti-TNF, and clinical remission was regained in 73% at 3 months. The relapse risk was high after anti-TNF withdrawal in IBD patients with endoscopic healing, but remission was regained in most cases after anti-TNF reintroduction. Complete endoscopic healing and mesalamine treatment in UC/IBDU patients decreased the risk of relapse. [Display omitted] [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
43. Bestemd voor binnenlands gebruik: De invloed van de vrouwen- en mensenrechtenbeweging op het debat en de aanpak van gendergerelateerd geweld.
- Author
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Römkens, Renée
- Abstract
In the field of international human rights, we currently face a paradox. Even with regional human rights instruments like the European Convention of Human Rights, or the recent Convention on preventing and combating violence against women and domestic violence (Istanbul Convention) many Dutch consider human rights mainly as intended for foreign consumption. In the field of violence against women this creates a stark contrast between national and international developments. In this inaugural speech, delivered on the occasion of the acceptance of the first Chair on gender based violence at the University of Amsterdam, several of the core issues in the social and legal debate on gender based violence are explored. The women's movements in the 1970s have been writing history when violence against women was reframed as a political concern instead of a personal problem. The recognition that the epidemic proportions of violence against women worldwide, regardless of culture, are both cause and effect of gender-based inequalities, was underlying this paradigm shift. The call on governments was to take measures against violence and simultaneously to address wider inequality concerns. Both social discourse and policy and legal measures in the 1980s and 1990s were resting upon these premises. In the new millennium, this very paradigm shift has become the subject of increasing debate in the Netherlands. Three intersecting counter-narratives on violence against women have evolved: minimization, culturalization (foregrounding violence against women in migrant muslim communities) and gender neutralization (foregrounding the domestic victimization of men by women in native white Dutch communities). These discourses have entered policy research and policy measures, as reflected in current social support structures as set up by local authorities. The net effect implies a de-politicization of violence against women since the recognition that violence against women is a form of discrimination is considered neither relevant nor valid anymore. It is argued that these narratives illustrate a profound ambiguity that entered public Dutch discourse and policies. This ambiguity has become more manifest with the Netherlands ratifying the Istanbul Convention early 2016. This human rights convention unambiguously frames violence against women as a form of gender based discrimination, requiring a coherent gender sensitive set of policy and other measures. In recent years, jurisprudence of the European Court of Human Rights, has increasingly underlined the discriminatory nature of domestic violence and how it obliges states to specifically address women's needs when victimized by their partner or ex-partner. It is concluded that two crucial questions deserve more attention in research. What is the impact of the tendency to minimize severity and gender neutralize domestic violence against white women, while selectively culturalizing violence against migrant women? A more fundamental question concerns the meaning and impact of binding international human rights law, when on a national level the relevance of gender to understand violence against women is contested. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
44. Early Phacoemulsification After Acute Angle Closure in Patients With Coexisting Cataract
- Author
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Römkens, Hellen C.S., Beckers, Henny J.M., Schouten, Jan S.A.G., Nuijts, Rudy M.M.A., Berendschot, Tos T.J.M., Breusegem, Christophe M., and Webers, Carroll A.B.
- Published
- 2018
- Full Text
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45. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial
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van Brunschot, Sandra, van Grinsven, Janneke, van Santvoort, Hjalmar C, Bakker, Olaf J, Besselink, Marc G, Boermeester, Marja A, Bollen, Thomas L, Bosscha, Koop, Bouwense, Stefan A, Bruno, Marco J, Cappendijk, Vincent C, Consten, Esther C, Dejong, Cornelis H, van Eijck, Casper H, Erkelens, Willemien G, van Goor, Harry, van Grevenstein, Wilhelmina M U, Haveman, Jan-Willem, Hofker, Sijbrand H, Jansen, Jeroen M, Laméris, Johan S, van Lienden, Krijn P, Meijssen, Maarten A, Mulder, Chris J, Nieuwenhuijs, Vincent B, Poley, Jan-Werner, Quispel, Rutger, de Ridder, Rogier J, Römkens, Tessa E, Scheepers, Joris J, Schepers, Nicolien J, Schwartz, Matthijs P, Seerden, Tom, Spanier, B W Marcel, Straathof, Jan Willem A, Strijker, Marin, Timmer, Robin, Venneman, Niels G, Vleggaar, Frank P, Voermans, Rogier P, Witteman, Ben J, Gooszen, Hein G, Dijkgraaf, Marcel G, Fockens, Paul, Manusama, Eric R, Hadithi, Mohammed, Rosman, Camiel, Schaapherder, Alexander F, and Schoon, Erik J
- Abstract
Infected necrotising pancreatitis is a potentially lethal disease and an indication for invasive intervention. The surgical step-up approach is the standard treatment. A promising alternative is the endoscopic step-up approach. We compared both approaches to see whether the endoscopic step-up approach was superior to the surgical step-up approach in terms of clinical and economic outcomes.
- Published
- 2018
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46. De Keulse kwestie: over de culturalisering van geweld en genderongelijkheid.
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Römkens, Renée
- Published
- 2015
47. Increased versus conventional adalimumab dose interval for patients with Crohn's disease in stable remission (LADI): a pragmatic, open-label, non-inferiority, randomised controlled trial
- Author
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van Linschoten, Reinier C A, Jansen, Fenna M, Pauwels, Renske W M, Smits, Lisa J T, Atsma, Femke, Kievit, Wietske, de Jong, Dirk J, de Vries, Annemarie C, Boekema, Paul J, West, Rachel L, Bodelier, Alexander G L, Gisbertz, Ingrid A M, Wolfhagen, Frank H J, Römkens, Tessa E H, Lutgens, Maurice W M D, van Bodegraven, Adriaan A, Oldenburg, Bas, Pierik, Marieke J, Russel, Maurice G V M, de Boer, Nanne K, Mallant-Hent, Rosalie C, ter Borg, Pieter C J, van der Meulen-de Jong, Andrea E, Jansen, Jeroen M, Jansen, Sita V, Tan, Adrianus C I T L, van der Woude, C Janneke, Hoentjen, Frank, Leemreis, Desirée, Hoekstra, Jildou, Kamphuis, Johannes T., Gorter, Moniek H.P., and van Esch, Aura A.J.
- Abstract
Despite its effectiveness in treating Crohn's disease, adalimumab is associated with an increased risk of infections and high health-care costs. We aimed to assess clinical outcomes of increased adalimumab dose intervals versus conventional dosing in patients with Crohn's disease in stable remission.
- Published
- 2023
- Full Text
- View/download PDF
48. Biomass ash formulations as sustainable improvers for mining soil health recovery: Linking soil properties and ecotoxicity.
- Author
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Mendes, Luís A., Avellan, Astrid, Cruz, Nuno C., Palito, Cátia, Römkens, Paul F.A.M., Amorim, Mónica J.B., Tarelho, Luís A.C., and Rodrigues, Sónia M.
- Subjects
MINE soils ,ACID soils ,SOILS ,FOREST biomass ,BIOMASS ,VOLCANIC soils - Abstract
There is a growing need to recover degraded soils to restore their essential ecosystem services and limit damages of anthropic activities onto these systems. Safe and sustainable solutions for long-term recovery must be designed, ideally by recycling existing resources. Using ash from combustion of residual forest biomass at the pulp and paper industry is an interesting and sustainable strategy to recover mining soils. However, formulations must be found to limit the potential toxicity associated with soluble salts and chloride that ash contains. Here, we assessed the effectiveness of three field ash-based amendments for the recovery of three highly acidic soils from Portuguese abandoned mines. Three amendments were tested: an un-stabilized mixture of ash and biological sludge, granulated ash, and granulated ash mixed with composted sludge. One year after application in open field plots (in the scope of LIFE No_Waste project), soil health restoration was evaluated through (i) soil physico-chemical characterization and (ii) soil habitat functions though standardized ecotoxicological tests. This study highlights that stabilized materials provided nutrients, organic matter and alkalinity that corrected soil pH and decreased metal bioavailability, while controlling the release of soluble salts and chloride from ash. This soil improvement correlated with improved soil model organisms' reproduction and survival. For similar amendment, the native soil properties studied (as soil native electrical conductivity) affected the level of organism response. This work provides evidence that ash stabilization, formulation and supplementation with organic matter could be sustainable strategies to restore highly degraded mining soils and to recover their ecological functions. It further highlights the importance of analyzing combined effects on soil physico-chemical properties and ecological function recovery to assess restoration strategy efficiencies in complex multi-stressor environments. • Ash-based formulations improved physico-chemical conditions in highly degraded mining soils. • Invertebrate reproduction benefits from stabilized ash granules and composted sludge application. • Organic carbon addition with composted sludge promotes E. crypticus reproduction. • Ash granulation reduced EC and soluble chloride-related hazard for model invertebrates. Ash-based amendments are a promising strategy to contribute to the recovery of mining soils' capacity to support ecosystems function and to recycling nutrients in relevant waste streams. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
49. Early Phacoemulsification After Acute Angle Closure in Patients With Coexisting Cataract
- Author
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Römkens, Hellen C.S., Beckers, Henny J.M., Schouten, Jan S.A.G., Nuijts, Rudy M.M.A., Berendschot, Tos T.J.M., Breusegem, Christophe M., and Webers, Carroll A.B.
- Published
- 2019
- Full Text
- View/download PDF
50. Aggressive fluid hydration plus non-steroidal anti-inflammatory drugs versus non-steroidal anti-inflammatory drugs alone for post-endoscopic retrograde cholangiopancreatography pancreatitis (FLUYT): a multicentre, open-label, randomised, controlled trial
- Author
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Sperna Weiland, Christina J, Smeets, Xavier J N M, Kievit, Wietske, Verdonk, Robert C, Poen, Alexander C, Bhalla, Abha, Venneman, Niels G, Witteman, Ben J M, da Costa, David W, van Eijck, Brechje C, Schwartz, Matthijs P, Römkens, Tessa E H, Vrolijk, Jan Maarten, Hadithi, Muhammed, Voorburg, Annet M C J, Baak, Lubbertus C, Thijs, Willem J, van Wanrooij, Roy L, Tan, Adriaan C I T L, Seerden, Tom C J, Keulemans, Yolande C A, de Wijkerslooth, Thomas R, van de Vrie, Wim, van der Schaar, Peter, van Dijk, Sven M, Hallensleben, Nora D L, Sperna Weiland, Ruud L, Timmerhuis, Hester C, Umans, Devica S, van Hooft, Jeanin E, van Goor, Harry, van Santvoort, Hjalmar C, Besselink, Marc G, Bruno, Marco J, Fockens, Paul, Drenth, Joost P H, and van Geenen, Erwin J M
- Abstract
Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Prophylactic rectal administration of non-steroidal anti-inflammatory drugs (NSAIDs) is considered as standard of care to reduce the risk of post-ERCP pancreatitis. It has been suggested that aggressive hydration might further reduce this risk. Guidelines already recommend aggressive hydration in patients who are unable to receive rectal NSAIDs, although it is laborious and time consuming. We aimed to evaluate the added value of aggressive hydration in patients receiving prophylactic rectal NSAIDs.
- Published
- 2021
- Full Text
- View/download PDF
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