Search

Your search keyword '"Gussekloo, J."' showing total 988 results
Start Over Author "Gussekloo, J."
988 results on '"Gussekloo, J."'

51. The APOP screener and clinical outcomes in older hospitalised internal medicine patients

Author

Blomaard, L.C., Lucke, J.A., Gelder, J. de, Anten, S., Alsma, J., Schuit, S.C.E., Gussekloo, J., Groot, B. de, Mooijaart, S.P., and Internal Medicine

Subjects
Aged, 80 and over, Male, Frailty, risk stratification, Length of Stay, Risk Assessment, Severity of Illness Index, geriatric emergency medicine, Hospitalization, older people, internal medicine, Treatment Outcome, Humans, Female, Emergency Service, Hospital, Geriatric Assessment, Aged, Netherlands
Abstract

Background: Acutely hospitalised older patients with indications related to internal medicine have high risks of adverse outcomes. We investigated whether risk stratification using the Acutely Presenting Older Patient (APOP) screening tool associates with clinical outcomes in this patient group.Methods: Patients aged >= 70 years who visited the Emergency Department (ED) and were acutely hospitalised for internal medicine were followed prospectively. The APOP screener assesses demographics, physical and cognitive function at ED presentation, and predicts 3-month mortality and functional decline in the older ED population. Patients with a predicted risk >= 45% were considered 'high risk'. Clinical outcome was hospital length of stay (LOS), and adverse outcomes were mortality and functional decline, 3 and 12 months after hospitalisation.Results: We included 319 patients, with a median age of 80 (IQR 74-85) years, of whom 94 (29.5%) were categorised as 'high risk' by the APOP screener. These patients had a longer hospital LOS compared to 'low risk' patients (5 (IQR 3-10) vs. 3 (IQR 1-7) days, respectively; p = 0.006). At 3 months, adverse outcomes were more frequent in 'high risk' patients compared to 'low risk' patients (59.6% vs. 34.7%, respectively; p < 0.001). At 12 months, adverse outcomes (67.0% vs. 46.2%, respectively; p = 0.001) and mortality (48.9% vs. 28.0%, respectively; p < 0.001) were greater in 'high risk' compared to 'low risk' patients.Conclusion: The APOP screener identifies acutely hospitalised internal medicine patients at high risk for poor short and long-term outcomes. Early risk stratification at admission could aid in individualised treatment decisions to optimise outcomes for older patients.

Published
2020

52. Potentially inappropriate medication and attitudes of older adults towards deprescribing

Author

Achterhof, A.B., Rozsnyai, Z., Reeve, E., Jungo, K.T., Floriani, C., Poortvliet, R.K.E., Rodondi, N., Gussekloo, J., and Streit, S.

Subjects
Male, Questionnaires, Patients, Epidemiology, Health Care Providers, Science, Social Sciences, 610 Medicine & health, Comorbidity, Research and Analysis Methods, Deprescriptions, Elderly, Adverse Reactions, Psychological Attitudes, 360 Social problems & social services, Physicians, hemic and lymphatic diseases, Medicine and Health Sciences, Humans, Psychology, Adults, Medical Personnel, Potentially Inappropriate Medication List, Aged, Aged, 80 and over, Pharmacology, Survey Research, Biology and Life Sciences, Patient Acceptance of Health Care, Health Care, Professions, Cross-Sectional Studies, Geriatrics, Age Groups, Research Design, Medical Risk Factors, People and Places, Polypharmacy, Medicine, Female, Population Groupings, Self Report, Attitude to Health, Research Article
Abstract

IntroductionMultimorbidity and polypharmacy are current challenges when caring for the older population. Both have led to an increase of potentially inappropriate medication (PIM), illustrating the need to assess patients' attitudes towards deprescribing. We aimed to assess the prevalence of PIM use and whether this was associated with patient factors and willingness to deprescribe.MethodWe analysed data from the LESS Study, a cross-sectional study on self-reported medication and on barriers and enablers towards the willingness to deprescribe (rPATD questionnaire). The survey was conducted among multimorbid (≥3 chronic conditions) participants ≥70 years with polypharmacy (≥5 long-term medications). A subset of the Beers 2019 criteria was applied for the assessment of medication appropriateness.ResultsData from 300 patients were analysed. The mean age was 79.1 years (SD 5.7). 53% had at least one PIM (men: 47.8%%, women: 60.4%%; p = 0.007). A higher number of medications was associated with PIM use (p = 0.002). We found high willingness to deprescribe in both participants with and without PIM. Willingness to deprescribe was not associated with PIM use (p = 0.25), nor number of PIMs (p = 0.81).ConclusionThe willingness of older adults with polypharmacy towards deprescribing was not associated with PIM use in this study. These results suggest that patients may not be aware if they are taking PIMs. This implies the need for raising patients' awareness about PIMs through education, especially in females, in order to implement deprescribing in daily practice.

Published
2020
Full Text
View/download PDF

55. Predictive value of traditional risk factors for cardiovascular disease in older people: A systematic review

Author

Bussel, E.F. van, Hoevenaar-Blom, M.P., Poortvliet, R.K.E., Gussekloo, J., Dalen, J. van, Gool, W.A. van, Richard, E., Moll van Charante, E.P., Bussel, E.F. van, Hoevenaar-Blom, M.P., Poortvliet, R.K.E., Gussekloo, J., Dalen, J. van, Gool, W.A. van, Richard, E., and Moll van Charante, E.P.

Abstract

Contains fulltext : 218901.pdf (Publisher’s version ) (Open Access), With increasing age, associations between traditional risk factors (TRFs) and cardiovascular disease (CVD) shift. It is unknown which mid-life risk factors remain relevant predictors for CVD in older people. We systematically searched PubMed and EMBASE on August 16th 2019 for studies assessing predictive ability of >1 of fourteen TRFs for fatal and non-fatal CVD, in the general population aged 60+. We included 12 studies, comprising 11 unique cohorts. TRF were evaluated in 2 to 11 cohorts, and retained in 0-70% of the cohorts: age (70%), diabetes (64%), male sex (57%), systolic blood pressure (SBP) (50%), smoking (36%), high-density lipoprotein cholesterol (HDL) (33%), left ventricular hypertrophy (LVH) (33%), total cholesterol (22%), diastolic blood pressure (20%), antihypertensive medication use (AHM) (20%), body mass index (BMI) (0%), hypertension (0%), low-density lipoprotein cholesterol (0%). In studies with low to moderate risk of bias, systolic blood pressure (SBP) (80%), smoking (80%) and HDL cholesterol (60%) were more often retained. Model performance was moderate with C-statistics ranging from 0.61 to 0.77. Compared to middle-aged adults, in people aged 60+ different risk factors predict CVD and current prediction models perform only moderate at best. According to most studies, age, sex and diabetes seem valuable predictors of CVD in old-age. SBP, HDL cholesterol and smoking may also have predictive value. Other blood pressure and cholesterol related variables, BMI, and LVH seem of very limited or no additional value. Without competing risk analysis, predictors are overestimated.

Published
2020

56. Effectiveness of intramuscular gluteal glucocorticoid injection versus intra-articular glucocorticoid injection in knee osteoarthritis: design of a multicenter randomized, 24 weeks comparative parallel-group trial

Author

Mol, M.F. (Marianne), Runhaar, J. (Jos), Bos, P.K. (Koen), Dorleijn, D.M.J. (Desirée), Vis, M. (Marijn), Gussekloo, J. (Jacobijn), Bindels, P.J.E. (Patrick), Bierma-Zeinstra, S.M. (Sita), Mol, M.F. (Marianne), Runhaar, J. (Jos), Bos, P.K. (Koen), Dorleijn, D.M.J. (Desirée), Vis, M. (Marijn), Gussekloo, J. (Jacobijn), Bindels, P.J.E. (Patrick), and Bierma-Zeinstra, S.M. (Sita)

Abstract

BACKGROUND: The knee is symptomatically the most frequent affected joint in osteoarthritis and, in the Netherlands and other Western countries, is mainly managed by general practitioners (GPs). An intra-articular glucocorticoid injection is recommended in (inter) national guidelines for patients with knee osteoarthritis as an option for a flare of knee pain and/or for those who are not responding well to pain medication. An innovative approach that could replace the intra-articular injection is an intramuscular gluteal glucocorticoid injection. An intramuscular injection is easier to perform than an intra-articular injection with lesser risk of severe local adverse reactions. We hypothesize that intramuscular gluteal glucocorticoid injection is non-inferior in reducing knee pain compared to intra-articular glucocorticoid injection, with potentially a longer lasting effect than intra-articular injection. METHODS/DESIGN: The study will be a pragmatic randomized controlled non-inferiority trial with two parallel groups. A total of 140 patients aged 45 years and older with knee osteoarthritis who contacted their general practitioner and have persistent knee pain (score ≥ 3 on 0-10 numerical rating scale; 0 = no knee pain) will be included. Patients will be randomly allocated (1:1) to an injection of 40

Published
2020
Full Text
View/download PDF

57. Geriatric Screening, Triage Urgency, and 30-Day Mortality in Older Emergency Department Patients

Author

Blomaard, L.C. (Laura C.), Speksnijder, C. (Corianne), Lucke, J.A. (Jacinta A.), de Gelder, J. (Jelle), Anten, S. (Sander), Klein Nagelvoort-Schuit, S.C.E. (Stephanie), Steyerberg, E.W. (Ewout), Gussekloo, J. (Jacobijn), de Groot, B. (Bas), Mooijaart, S.P. (Simon), Blomaard, L.C. (Laura C.), Speksnijder, C. (Corianne), Lucke, J.A. (Jacinta A.), de Gelder, J. (Jelle), Anten, S. (Sander), Klein Nagelvoort-Schuit, S.C.E. (Stephanie), Steyerberg, E.W. (Ewout), Gussekloo, J. (Jacobijn), de Groot, B. (Bas), and Mooijaart, S.P. (Simon)

Abstract

BACKGROUND: Urgency triage in the emergency department (ED) is important for early identification of potentially lethal conditions and extensive resource utilization. However, in older patients, urgency triage systems could be improved by taking geriatric vulnerability into account. We investigated the association of geriatric vulnerability screening in addition to triage urgency levels with 30-day mortality in older ED patients. DESIGN: Secondary analysis of the observational multicenter Acutely Presenting Older Patient (APOP) study. SETTING: EDs within four Dutch hospitals. PARTICIPANTS: Consecutive patients, aged 70 years or older, who were prospectively included. MEASUREMENTS: Patients were triaged using the Manchester Triage System (MTS). In addition, the APOP screener was used as a geriatric screening tool. The primary outcome was 30-day mortality. Comparison was made between mortality within the geriatric high- and low-risk screened patients in every urgency triage category. We calculated the difference in explained variance of mortality by adding the geriatric screener (APOP) to triage urgency (MTS) by cal

Published
2020
Full Text
View/download PDF

58. Measuring daily functioning in older persons using a frailty index: a cohort study based on routine primary care data

Author

Ravensbergen, W.M., Blom, J.W., Evers, A.W.M., Numans, M.E., Waal, M.W. de, Gussekloo, J., Ravensbergen, W.M., Blom, J.W., Evers, A.W.M., Numans, M.E., Waal, M.W. de, and Gussekloo, J.

Abstract

Contains fulltext : 229629.pdf (Publisher’s version ) (Closed access), BACKGROUND: Electronic health records (EHRs) are increasingly used for research; however, multicomponent outcome measures such as daily functioning cannot yet be readily extracted. AIM: To evaluate whether an electronic frailty index based on routine primary care data can be used as a measure for daily functioning in research with community-dwelling older persons (aged ≥75 years). DESIGN AND SETTING: Cohort study among participants of the Integrated Systemic Care for Older People (ISCOPE) trial (11 476 eligible; 7285 in observational cohort; 3141 in trial; over-representation of frail people). METHOD: At baseline (T0) and after 12 months (T12), daily functioning was measured with the Groningen Activities Restriction Scale (GARS, range 18-72). Electronic frailty index scores (range 0-1) at T0 and T12 were computed from the EHRs. The electronic frailty index (electronic Frailty Index - Utrecht) was tested for responsiveness and compared with the GARS as a gold standard for daily functioning. RESULTS: In total, 1390 participants with complete EHR and follow-up data were selected (31.4% male; median age = 81 years, interquartile range = 78-85). The electronic frailty index increased with age, was higher for females, and lower for participants living with a partner. It was responsive after an acute major medical event; however, the correlation between the electronic frailty index and GARS at T0 and over time was limited. CONCLUSION: Because the electronic frailty index does not reflect daily functioning, further research on new methods to measure daily functioning with routine care data (for example, other proxies) is needed before EHRs can be a useful data source for research with older persons.

Published
2020

62. NHG-Standaard Dementie

Author

Wind, AW, primary, Gussekloo, J, additional, Vernooij-Dassen, MJFJ, additional, Bouma, M, additional, Boomsma, LJ, additional, and Boukes, FS, additional

Published
2011
Full Text
View/download PDF

63. NHG-Standaard Dementie

Author

Wind, A W, primary, Gussekloo, J, additional, Vernooij-Dassen, M J F J, additional, Bouma, M, additional, Boomsma, L J, additional, and Boukes, F S, additional

Published
2009
Full Text
View/download PDF

67. HPV type‐specific distribution among family members and linen in households of cutaneous wart patients.

Author

Ghorzang, E., de Koning, M.N.C., Bouwes Bavinck, J.N., Gussekloo, J., Quint, K.D., Goeman, J.J., Feltkamp, M.C.W., Bruggink, S.C., and Eekhof, J.A.H.

Subjects
HOUSEHOLD linens, WARTS, DISH towels, PAPILLOMAVIRUSES, GENERALIZED estimating equations
Abstract

Background: Common and plantar warts are caused by human papillomaviruses (HPV). Mode of transmission of wart HPVs within families is largely unknown. Objective: To demonstrate similarity of HPV type(s) among wart cases, family members and household linen. Methods: In a cross‐sectional study, swabs taken from 123 warts and foreheads of 62 index patients and 157 family members and from 58 kitchen towels and 59 bathroom mats were tested for DNA of 23 cutaneous wart‐associated HPV types. Generalized estimating equations (GEE) were used to estimate the chance of detecting the same HPV type as was found in the index patients on the family contacts and on the kitchen towels and bathroom mats. Results: HPV1, HPV2, HPV27 and HPV57 were the most prevalent types in the warts of the index patients. Altogether, 60 (42.3%) of the 142 family members without warts had HPV DNA on their foreheads. When HPV1 and HPV2 were found in the warts, these types were also frequently (>50%) found on the foreheads of index patients and their family members, as well as on the kitchen towels and the bathroom mats. HPV27 and HPV57 were less frequently found (<25%) on foreheads and linen. No associations were found for age, sex and site of HPV DNA presence. Conclusion: Dissemination of skin wart‐causing HPV types, from wart cases to household contacts and linen, such as kitchen towels and bathroom mats, is more likely for HPV1 and HPV2 than for HPV27 and HPV57. The role of towels and bathroom mats in HPV transmission deserves further investigation. Linked Commentary A. Kreuter and U. Wieland. J Eur Acad Dermatol Venereol 2022; 36: 11–12. https://doi.org/10.1111/jdv.17820. [ABSTRACT FROM AUTHOR]

Published
2022
Full Text
View/download PDF

71. Association Between Levothyroxine Treatment and Thyroid-Related Symptoms Among Adults Aged 80 Years and Older With Subclinical Hypothyroidism

Author

Mooijaart, Simon P., Puy, R.S. Du, Stott, D.J., Kearney, P.M., Rodondi, N., Westendorp, R.G., Smit, J.W.A., Langhorne, P., and Gussekloo, J.

Subjects
All institutes and research themes of the Radboud University Medical Center, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Abstract

Item does not contain fulltext

Published
2019

72. P755The impact of levothyroxine on cardiac function in older adults with subclinical hypothyroidism: a randomized clinical trial

Author

Gencer, B, Moutzouri, E, Blum, M, Feller, M, Collet, T H, Buffle, E, Monney, P, Gabus, V, Muller, H, Kearney, P, Gussekloo, J, Westendorp, R, Scott, D J, Bauer, D C, and Rodondi, N

Subjects
360 Social problems & social services, 610 Medicine & health, Cardiology and Cardiovascular Medicine
Abstract

Importance Subclinical hypothyroidism has been associated with heart failure, but no conclusive clinical trial assessed whether treating subclinical hypothyroidism with levothyroxine has an impact on cardiac function. Objective To assess the impact of levothyroxine treatment on cardiac function in subclinical hypothyroidism. Design This is a randomized, double-blind placebo-controlled, multicenter Swiss substudy within the TRUST trial. Participants Participants aged ≥65 years with subclinical hypothyroidism. Intervention Levothyroxine to achieve TSH normalization, or placebo including mock titrations. Main outcome measures Primary outcomes, assessed by echocardiography at the end of the trial were the left ventricular ejection fraction (LVEF, normal defined as >50%) for systolic function and the ratio between mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (e' (E/e' ratio) for diastolic function. Secondary outcomes included transmitral E and A waves, e' lateral/septal, left atrial (LA) volume index and systolic pulmonary artery pressure. Results Of 217 randomized Swiss participants of the TRUST trial, 185 (mean age 74.1 years, 47% women, mean TSH at baseline 6.35 ± SD 1.95 mIU/L) underwent echocardiography. After a median treatment duration of 18.4 months, the mean TSH among participants randomized to levothyroxine (n=95) decreased to 3.55 mIU/L, whereas it remained elevated in the placebo group (n=89; 5.29 mIU/L). The mean LVEF was similar in both arms (adjusted between-group difference 0.4%, 95% CI −1.8% to 2.5%, P=0.72) and no significant differences were found for the E/e' ratio (adjusted between-group difference 0.4, 95% CI −0.7 to 1.4, P=0.47). In intention-to-treat and per-protocol analyses, no clinically significant differences were found for secondary diastolic function parameters: e' lateral 8 vs. 8 cm/s, P=0.54; e' septal 6 vs. 6 cm/s, P=0.75; LA volume index 34 vs. 33 ml/m2, P=0.57; E/A ratio 0.8 vs. 0.8, P=0.94; E deceleration time 225 vs. 216 ms, P=0.27, except for systolic pulmonary artery pressure (37 mm Hg in the levothyoxine group vs. 33 mm Hg in the placebo group, P=0.02 intention-to-treat and P=0.06 per protocol) Conclusion Treatment of subclinical hypothyroidism with levothyroxine was not associated with benefits regarding systolic and diastolic heart function in older adults with subclinical hypothyroidism.

Published
2019
Full Text
View/download PDF

73. Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries

Author

Ploeg, M.A., Streit, S., Achterberg, W.P., Beers, E., Bohnen, A.M., Burman, R.A., Collins, C., Franco, F.G., Gerasimovska-Kitanovska, B., Gintere, S., Bravo, R. Gomez, Hoffmann, K., Iftode, C., Pestic, S.K., Koskela, T.H., Kurpas, D., Maisonneuve, H., Mallen, C.D., Merlo, C., Mueller, Y., Muth, C., Petrazzuoli, F., Rodondi, N., Rosemann, T., Sattler, M., Schermer, T.R., Ster, M.P., Svadlenkova, Z., Tatsioni, A., Thulesius, H., Tkachenko, V., Torzsa, P., Tsopra, R., Tuz, C., Vaes, B., Viegas, R.P.A., Vinker, S., Wallis, K.A., Zeller, A., Gussekloo, J., Poortvliet, R.K.E., Ploeg, M.A., Streit, S., Achterberg, W.P., Beers, E., Bohnen, A.M., Burman, R.A., Collins, C., Franco, F.G., Gerasimovska-Kitanovska, B., Gintere, S., Bravo, R. Gomez, Hoffmann, K., Iftode, C., Pestic, S.K., Koskela, T.H., Kurpas, D., Maisonneuve, H., Mallen, C.D., Merlo, C., Mueller, Y., Muth, C., Petrazzuoli, F., Rodondi, N., Rosemann, T., Sattler, M., Schermer, T.R., Ster, M.P., Svadlenkova, Z., Tatsioni, A., Thulesius, H., Tkachenko, V., Torzsa, P., Tsopra, R., Tuz, C., Vaes, B., Viegas, R.P.A., Vinker, S., Wallis, K.A., Zeller, A., Gussekloo, J., and Poortvliet, R.K.E.

Abstract

Contains fulltext : 208370.pdf (publisher's version ) (Open Access), BACKGROUND: Statins are widely used to prevent cardiovascular disease (CVD). With advancing age, the risks of statins might outweigh the potential benefits. It is unclear which factors influence general practitioners' (GPs) advice to stop statins in oldest-old patients. OBJECTIVE: To investigate the influence of a history of CVD, statin-related side effects, frailty and short life expectancy, on GPs' advice to stop statins in oldest-old patients. DESIGN: We invited GPs to participate in this case-based survey. GPs were presented with 8 case vignettes describing patients > 80 years using a statin, and asked whether they would advise stopping statin treatment. MAIN MEASURES: Cases varied in history of CVD, statin-related side effects and frailty, with and without shortened life expectancy (< 1 year) in the context of metastatic, non-curable cancer. Odds ratios adjusted for GP characteristics (ORadj) were calculated for GPs' advice to stop. KEY RESULTS: Two thousand two hundred fifty GPs from 30 countries participated (median response rate 36%). Overall, GPs advised stopping statin treatment in 46% (95%CI 45-47) of the case vignettes; with shortened life expectancy, this proportion increased to 90% (95CI% 89-90). Advice to stop was more frequent in case vignettes without CVD compared to those with CVD (ORadj 13.8, 95%CI 12.6-15.1), with side effects compared to without ORadj 1.62 (95%CI 1.5-1.7) and with frailty (ORadj 4.1, 95%CI 3.8-4.4) compared to without. Shortened life expectancy increased advice to stop (ORadj 50.7, 95%CI 45.5-56.4) and was the strongest predictor for GP advice to stop, ranging across countries from 30% (95%CI 19-42) to 98% (95% CI 96-99). CONCLUSIONS: The absence of CVD, the presence of statin-related side effects, and frailty were all independently associated with GPs' advice to stop statins in patients aged > 80 years. Overall, and within all countries, cancer-related short life expectancy was the strongest independent predictor of GPs' advice

Published
2019

74. Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries

Author

Ploeg, M.A. (Milly) van der, Streit, S., Achterberg, W.P., Beers, E., Bohnen, A.M. (Arthur), Burman, R.A., Collins, C. (Colin), Franco, F.G., Gerasimovska-Kitanovska, B., Gintere, S., Bravo, R.G., Hoffmann, K., Iftode, C., Pestic, S.K., Koskela, T.H., Kurpas, D., Maisonneuve, H., Mallen, C.D., Merlo, C., Mueller, Y., Muth, C., Petrazzuoli, F., Rodondi, N, Rosemann, T., Sattler, M., Schermer, T., Ster, M.P., Svadlenkova, Z., Tatsioni, A., Thulesius, H., Tkachenko, V. (Valery), Torzsa, P., Tsopra, R., Tuz, C., Vaes, B., Viegas, R.P.A., Vinker, S., Wallis, K.A., Zeller, A., Gussekloo, J. (Jacobijn), Poortvliet, R.K.E., Ploeg, M.A. (Milly) van der, Streit, S., Achterberg, W.P., Beers, E., Bohnen, A.M. (Arthur), Burman, R.A., Collins, C. (Colin), Franco, F.G., Gerasimovska-Kitanovska, B., Gintere, S., Bravo, R.G., Hoffmann, K., Iftode, C., Pestic, S.K., Koskela, T.H., Kurpas, D., Maisonneuve, H., Mallen, C.D., Merlo, C., Mueller, Y., Muth, C., Petrazzuoli, F., Rodondi, N, Rosemann, T., Sattler, M., Schermer, T., Ster, M.P., Svadlenkova, Z., Tatsioni, A., Thulesius, H., Tkachenko, V. (Valery), Torzsa, P., Tsopra, R., Tuz, C., Vaes, B., Viegas, R.P.A., Vinker, S., Wallis, K.A., Zeller, A., Gussekloo, J. (Jacobijn), and Poortvliet, R.K.E.

Abstract

BACKGROUND: Statins are widely used to prevent cardiovascular disease (CVD). With advancing age, the risks of statins might outweigh the potential benefits. It is unclear which factors influence general practitioners’ (GPs) advice to stop statins in oldestold patients. OBJECTIVE: To investigate the influence of a history of CVD, statin-related side effects, frailty and short life expectancy, on GPs’ advice to stop statins in oldest-old patients. DESIGN: We invited GPs to participate in this case-based survey. GPs were presented with 8 case vignettes describing patients > 80 years using a statin, and asked whether they would advise stopping statin treatment. MAIN MEASURES: Cases varied in history of CVD, statinrelated side effects and frailty, with and without shortened life expectancy (< 1 year) in the context of metastatic, noncurable cancer. Odds ratios adjusted for GP characteristics (ORadj) were calculated for GPs’ advice to stop. KEY RESULTS: Two thousand two hundred fifty GPs from 30 countries participated (median response rate 36%). Overall, GPs advised stopping statin treatment in 46% (95%CI 45–47) of the case vignettes; with shortened life expectancy, this proportion increased to 90% (95CI% 89–90). Advice to stop was more frequent in case vignettes without CVD compared to those with CVD (ORadj 13.8, 95%CI 12.6–15.1), with side effects compared to without ORadj 1.62 (95%CI 1.5–1.7) and with frailty (ORadj 4.1, 95%CI 3.8–4.4) compared to without. Shortened life expectancy increased advice to stop (ORadj 50.7, 95%CI 45.5–56.4) and was the strongest predictor for GP advice to stop, ranging across countries from 30% (95%CI 19– 42) to 98% (95% CI 96–99). CONCLUSIONS: The absence of CVD, the presence of statin-related side effects, and frailty were all independently associated with GPs’ advice to stop statins in patients aged > 80 years. Overall, and within all countries, cancer-related short life expectancy was the strongest independent predictor of GPs’ advice t

Published
2019
Full Text
View/download PDF

75. Subclinical thyroid dysfunction and depressive symptoms: protocol for a systematic review and individual participant data meta-analysis of prospective cohort studies

Author

Wildisen, L. (Lea), Moutzouri, E. (Elisavet), Beglinger, S. (Shanthi), Syrogiannouli, L. (Lamprini), Cappola, A.R. (Anne), Asvold, B.O. (Bjorn O.), Bakker, S.J.L. (Stephan), Ceresini, G. (Graziano), Dullaart, R.P.F. (Robin P.F.), Ferrucci, L. (Luigi), Grabe, H.J. (Hans Jörgen), Jukema, J.W. (Jan Wouter), Nauck, M. (Matthias), Trompet, S. (Stella), Völzke, H. (Henry), Westendorp, R.G.J. (Rudi), Gussekloo, J. (Jacobijn), Peeters, R.P. (Robin), Klöppel, S. (Stefan), Aujesky, D. (Drahomir), Bauer, D.C. (Douglas), Rodondi, N. (Nicolas), Del Giovane, C. (Cinzia), Feller, M. (Martin), Wildisen, L. (Lea), Moutzouri, E. (Elisavet), Beglinger, S. (Shanthi), Syrogiannouli, L. (Lamprini), Cappola, A.R. (Anne), Asvold, B.O. (Bjorn O.), Bakker, S.J.L. (Stephan), Ceresini, G. (Graziano), Dullaart, R.P.F. (Robin P.F.), Ferrucci, L. (Luigi), Grabe, H.J. (Hans Jörgen), Jukema, J.W. (Jan Wouter), Nauck, M. (Matthias), Trompet, S. (Stella), Völzke, H. (Henry), Westendorp, R.G.J. (Rudi), Gussekloo, J. (Jacobijn), Peeters, R.P. (Robin), Klöppel, S. (Stefan), Aujesky, D. (Drahomir), Bauer, D.C. (Douglas), Rodondi, N. (Nicolas), Del Giovane, C. (Cinzia), and Feller, M. (Martin)

Abstract

INTRODUCTION: Prospective cohort studies on the association between subclinical thyroid dysfunction and depressive symptoms have yielded conflicting findings, possibly because of differences in age, sex, thyroid-stimulating hormone cut-off levels or degree of baseline depressive symptoms. Analysis of

Published
2019
Full Text
View/download PDF

76. Clinical medication review: one step beyond: Computer rules of personal goals?

Author

Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, Bouvy, Marcel, Gussekloo, J., Kwint, H, Verdoorn, Marguerita Alexandra, Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, Bouvy, Marcel, Gussekloo, J., Kwint, H, and Verdoorn, Marguerita Alexandra

Published
2019

77. Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries

Author

Ploeg, Milly, Streit, S, Achterberg, WP, Beers, E, Bohnen, Arthur, Burman, RA, Collins, C, Franco, FG, Gerasimovska-Kitanovska, B, Gintere, S, Bravo, RG, Hoffmann, K, Iftode, C, Pestic, SK, Koskela, TH, Kurpas, D, Maisonneuve, H, Mallen, CD, Merlo, C, Mueller, Y, Muth, C, Petrazzuoli, F, Rodondi, N, Rosemann, T, Sattler, M, Schermer, T, Ster, MP, Svadlenkova, Z, Tatsioni, A, Thulesius, H, Tkachenko, V, Torzsa, P, Tsopra, R, Tuz, C, Vaes, B, Viegas, RPA, Vinker, S, Wallis, KA, Zeller, A, Gussekloo, J, Poortvliet, RKE, Ploeg, Milly, Streit, S, Achterberg, WP, Beers, E, Bohnen, Arthur, Burman, RA, Collins, C, Franco, FG, Gerasimovska-Kitanovska, B, Gintere, S, Bravo, RG, Hoffmann, K, Iftode, C, Pestic, SK, Koskela, TH, Kurpas, D, Maisonneuve, H, Mallen, CD, Merlo, C, Mueller, Y, Muth, C, Petrazzuoli, F, Rodondi, N, Rosemann, T, Sattler, M, Schermer, T, Ster, MP, Svadlenkova, Z, Tatsioni, A, Thulesius, H, Tkachenko, V, Torzsa, P, Tsopra, R, Tuz, C, Vaes, B, Viegas, RPA, Vinker, S, Wallis, KA, Zeller, A, Gussekloo, J, and Poortvliet, RKE

Published
2019

78. Subclinical thyroid dysfunction and depressive symptoms: protocol for a systematic review and individual participant data meta-analysis of prospective cohort studies

Author

Wildisen, L, Moutzouri, E, Beglinger, S, Syrogiannouli, L, Cappola, AR, Asvold, BO, Bakker, SJ, Ceresini, G, Dullaart, R, Ferrucci, L, Grabe, H, Jukema, JW, Nauck, M, Trompet, S, Volzke, H, Westendorp, RG, Gussekloo, J, Peeters, Robin, Kloppel, S, Aujesky, D, Bauer, DC, Rodondi, N, Del Giovane, C, Feller, M, Wildisen, L, Moutzouri, E, Beglinger, S, Syrogiannouli, L, Cappola, AR, Asvold, BO, Bakker, SJ, Ceresini, G, Dullaart, R, Ferrucci, L, Grabe, H, Jukema, JW, Nauck, M, Trompet, S, Volzke, H, Westendorp, RG, Gussekloo, J, Peeters, Robin, Kloppel, S, Aujesky, D, Bauer, DC, Rodondi, N, Del Giovane, C, and Feller, M

Published
2019

84. Disability in the oldest old: 'can do' or 'do do'?

Author

Bootsma-van der Wiel, Annetje, Gussekloo, J., Craen, A.J.M. de, Exel, E. van, Knook, D.L., Lagaay, A.M., and Westendorp, R.G.J.

Subjects
Ability, Influence of age on -- Research, Old age -- Research, Activities of daily living -- Physiological aspects, Disability evaluation -- Research, Health, Seniors
Abstract

Research on assessing physical ability in very elderly persons reveals structural discrepancies between competence and performance, and suggestions for reducing disability levels are discussed. Data were obtained from 599 test subjects who were 85 years of age.

Published
2001

86. Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis

Author

Blom, J.W., Hout, W.B. van den, Elzen, W.P.J. den, Drewes, Y.M., Bleijenberg, N., Fabbricotti, I.N., Jansen, A.P.D., Kempen, G.I.J.M., Koopmans, R., Looman, W.M., Melis, R.J.F., Metzelthin, S.F., Charante, E.P.M. van, Muntinga, M.E., Numans, M.E., Ruikes, F.G.H., Spoorenberg, S.L.W., Stijnen, T., Suijker, J.J., Wit, N.J. de, Wynia, K., Wind, A.W., Gussekloo, J., and TOPICS-MDS Res Consortium

Subjects
older people, aged, primary care, integrated care
Published
2018

87. Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts

Author

Segna, D., Bauer, D.C., Feller, M., Schneider, C., Fink, H.A., Aubert, C.E., Collet, T.H., Costa, B.R. da, Fischer, K., Peeters, R.P., Cappola, A.R., Blum, M.R., Dorland, H.A. van, Robbins, J., Naylor, K., Eastell, R., Uitterlinden, A.G., Ramirez, F.R., Gogakos, A., Gussekloo, J., Williams, G.R., Schwartz, A., Cauley, J.A., Aujesky, D.A., Bischoff-Ferrari, H.A., Rodondi, N., Thyroid Studies Collaboration, Epidemiology, and Internal Medicine

Subjects
Male, Bone density, endocrine system diseases, OLDER MEN, FRACTURE RISK, Hyperthyroidism, Fractures, Bone, 0302 clinical medicine, Risk Factors, Medicine, 030212 general & internal medicine, Prospective cohort study, 610 Medicine & health, Subclinical infection, Bone mineral, Thyroid disease, Thyroid, WOMEN, bone density, medicine.anatomical_structure, Female, Life Sciences & Biomedicine, 360 Social problems & social services, medicine.medical_specialty, endocrine system, Clinical Sciences, 030209 endocrinology & metabolism, Article, 03 medical and health sciences, Rare Diseases, Medicine, General & Internal, Hypothyroidism, bone loss, OSTEOPOROTIC FRACTURES, SERUM TSH, Clinical Research, Internal medicine, General & Internal Medicine, Internal Medicine, Humans, hyperthyroidism, CORONARY-HEART-DISEASE, thyroid disease, Bone, METAANALYSIS, Femoral neck, Aged, Science & Technology, business.industry, Thyroid Studies Collaboration, HIP FRACTURE, 1103 Clinical Sciences, medicine.disease, prospective studies, Surgery, Cardiovascular System & Hematology, Musculoskeletal, Asymptomatic Diseases, Osteoporosis, hypothyroidism, business, INDIVIDUAL PARTICIPANT DATA, Fractures, Hormone
Abstract

© 2017 The Association for the Publication of the Journal of Internal Medicine Background: Subclinical hyperthyroidism (SHyper) has been associated with increased risk of hip and other fractures, but the linking mechanisms remain unclear. Objective: To investigate the association between subclinical thyroid dysfunction and bone loss. Methods: Individual participant data analysis was performed after a systematic literature search in MEDLINE/EMBASE (1946–2016). Two reviewers independently screened and selected prospective cohorts providing baseline thyroid status and serial bone mineral density (BMD) measurements. We classified thyroid status as euthyroidism (thyroid-stimulating hormone [TSH] 0.45–4.49 mIU/L), SHyper (TSH < 0.45 mIU/L) and subclinical hypothyroidism (SHypo, TSH ≥ 4.50–19.99 mIU/L) both with normal free thyroxine levels. Our primary outcome was annualized percentage BMD change (%ΔBMD) from serial dual X-ray absorptiometry scans of the femoral neck, total hip and lumbar spine, obtained from multivariable regression in a random-effects two-step approach. Results: Amongst 5458 individuals (median age 72 years, 49.1% women) from six prospective cohorts, 451 (8.3%) had SHypo and 284 (5.2%) had SHyper. During 36 569 person-years of follow-up, those with SHyper had a greater annual bone loss at the femoral neck versus euthyroidism: %ΔBMD = −0.18 (95% CI: −0.34, −0.02; I2= 0%), with a nonstatistically significant pattern at the total hip: %ΔBMD = −0.14 (95% CI: −0.38, 0.10; I2= 53%), but not at the lumbar spine: %ΔBMD = 0.03 (95% CI: −0.30, 0.36; I2= 25%); especially participants with TSH < 0.10 mIU/L showed an increased bone loss in the femoral neck (%Δ BMD = −0.59; [95% CI: −0.99, −0.19]) and total hip region (%ΔBMD = −0.46 [95% CI: −1.05, −0.13]). In contrast, SHypo was not associated with bone loss at any site. Conclusion: Amongst adults, SHyper was associated with increased femoral neck bone loss, potentially contributing to the increased fracture risk.

Published
2018
Full Text
View/download PDF

88. The effectiveness of functional task exercise and physical therapy as prevention of functional decline in community dwelling older people with complex

Author

Siemonsma, P.C., Blom, J.W., Hofstetter, H., Hespen, A.T.H. van, Gussekloo, J., Drewes, Y.M., and Meeteren, N.L.U. van

Subjects
Male, Daily life activity, Case finding, Registration, Major clinical study, Home environment, Life, CH - Child Health, Observational study, Physiotherapist, Exercise, Functional training, Physiotherapy, Aged, Netherlands, Intervention study, Prevention, Very elderly, Health, Human experiment, Randomized controlled trial, Statistical analysis, Female, ELSS - Earth, Life and Social Sciences, Older people, General practice, Controlled study, Human
Abstract

Background: A physically active lifestyle in older people contributes to the preservation of good health. We assessed the influence of physiotherapy on daily functioning among community dwelling older people (75+) with complex health problems identified with screening, versus usual care. We also compared functional task exercise (FTE), with problems prioritized by older people, trained in the home environment, versus usual preventive physical therapy (PPT). Methods: Design: FTE and PPT were compared in a randomized controlled trial (RCT). Both interventions were compared with daily functioning in an observational study: control group. Setting/participants: Community-dwelling persons aged ≥75 years with daily activity limitations enlisted in 83 general practices (n = 155). Interventions: Both intervention groups (FTE, n = 76 and PPT, n = 79) received individual, 30 min treatments. The control group (n = 228) did not get any experimental intervention offered.Measurement: Groningen Activities of Daily Living Restriction Scale (GARS). Statisti analyses: Linear Mixed Model analysis, correcting for age, sex, baseline scores and clustering by physiotherapist were used to compare the different groups. Results: At baseline, 74% percent of the intervention trial group was female vs 79% in the control group. Median ages were 83.9 and 84.7 respectively. The median baseline GARS-score for the control group was 41.0 (25 and 75 percentile): 35.0; 48.0) and 40.0 (25 and 75 percentile: 32.3; 46.0) for the intervention group (FTE + PPT). The mean change over time was 3.3 (2.5; 4.1) for the control group. Mean difference in change over time between the intervention (FTE + PPT) and the control group was - 2.5 (- 4.3; - 0.6) (p = .009). Between FTE and PPT the difference in change was - 0.4 (95% CI: -2.3; 3.0, p = 0.795). Conclusion: An exercise intervention led by physiotherapists may slow down decline in self-reported daily functioning in older persons with daily activity limitations, identified by pro-active case finding.

Published
2018

90. P755The impact of levothyroxine on cardiac function in older adults with subclinical hypothyroidism: a randomized clinical trial

Author

Gencer, B, primary, Moutzouri, E, additional, Blum, M R, additional, Feller, M, additional, Collet, T H, additional, Buffle, E, additional, Monney, P, additional, Gabus, V, additional, Muller, H, additional, Kearney, P, additional, Gussekloo, J, additional, Westendorp, R, additional, Scott, D J, additional, Bauer, D C, additional, and Rodondi, N, additional

Published
2019
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results