14 results on '"Berg-Vos, R.M. van den"'
Search Results
2. Experiences with information provision and preferences for decision making of patients with acute stroke
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Prick, J.C.M., Zonjee, V.J., Schaik, S.M. van, Dahmen, R., Garvelink, M.M., Brouwers, P., Saxena, R., Keus, S.H., Deijle, I.A., Uden-Kraan, C.F. van, Wees, P.J. van der, Berg-Vos, R.M. van den, Prick, J.C.M., Zonjee, V.J., Schaik, S.M. van, Dahmen, R., Garvelink, M.M., Brouwers, P., Saxena, R., Keus, S.H., Deijle, I.A., Uden-Kraan, C.F. van, Wees, P.J. van der, and Berg-Vos, R.M. van den
- Abstract
Contains fulltext : 251103.pdf (Publisher’s version ) (Open Access), OBJECTIVE: The aim of this study was to gain insight into experiences of patients with acute stroke regarding information provision and their preferred involvement in decision-making processes during the initial period of hospitalisation. METHODS: A sequential explanatory design was used in two independent cohorts of patients with stroke, starting with a survey after discharge from hospital (cohort 1) followed by observations and structured interviews during hospitalisation (cohort 2). Quantitative data were analysed descriptively. RESULTS: In total, 72 patients participated in this study (52 in cohort 1 and 20 in cohort 2). During hospitalisation, the majority of the patients were educated about acute stroke and their treatment. Approximately half of the patients preferred to have an active role in the decision-making process, whereas only 21% reported to be actively involved. In cohort 2, 60% of the patients considered themselves capable to carefully consider treatment options. CONCLUSIONS: Active involvement in the acute decision-making process is preferred by approximately half of the patients with acute stroke and most of them consider themselves capable of doing so. However, they experience a limited degree of actual involvement. PRACTICE IMPLICATIONS: Physicians can facilitate patient engagement by explicitly emphasising when a decision has to be made in which the patient's opinion is important.
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- 2022
3. Clinical and Imaging Markers Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke
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Kranendonk, K.R. van, Treumiet, K.M., Boers, A.M.M., Berkhemer, O.A., Berg, L.A. van den, Chalos, V., Lingsma, H.F., Zwam, W.H. van, Lugt, A. van der, Oostenbrugge, R.J. van, Dippel, D.W.J., Roos, Y.B.W.E.M., Marquering, H.A., Majoie, C.B.L.M., Fransen, P.S.S., Beumer, D., Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wenner, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Oostayen, J.A. van, Nijeholt, G.J.L.A., Boiten, J., Brouwer, P.A., Emmet, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., R.H. lo, Dijk, E.J. van, Vries, J. de, Kort, P.L.M. de, Rooij, W.J.J. van, Berg, J.S.P. van den, Hassell, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Visser, M.C., Bot, J.C.J., Vroomen, P.C., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Steyerberg, E.W., Flach, H.Z., Sprengers, M.E.S., Jenniskens, S.F.M., Beenen, L.F.M., Berg, R. van den, Koudstaal, P.J., MR CLEAN Investigators, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: MA AIOS Neurologie (9), MUMC+: MA Med Staf Spec Neurologie (9), Graduate School, Radiology and Nuclear Medicine, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ANS - Neurovascular Disorders, Neurology, Radiology and nuclear medicine, VU University medical center, Amsterdam Neuroscience - Neurovascular Disorders, Radiology & Nuclear Medicine, Orthopedics and Sports Medicine, and Public Health
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medicine.medical_specialty ,Population ,infarction ,intracranial hemorrhages ,Infarction ,BLOOD-PRESSURE ,Tissue plasminogen activator ,All institutes and research themes of the Radboud University Medical Center ,Hematoma ,Internal medicine ,medicine ,risk factors ,atrial fibrillation ,education ,Stroke ,TISSUE-PLASMINOGEN ACTIVATOR ,Advanced and Specialized Nursing ,HEALTH-CARE PROFESSIONALS ,education.field_of_study ,business.industry ,INTRAVENOUS ALTEPLASE ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,blood pressure ,Atrial fibrillation ,SYMPTOMATIC INTRACRANIAL HEMORRHAGE ,Odds ratio ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,medicine.disease ,stroke ,n/a OA procedure ,reperfusion ,Blood pressure ,THROMBOLYTIC THERAPY ,ENDOVASCULAR TREATMENT ,Cardiology ,RISK-FACTORS ,TRIAL ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,INTRAARTERIAL TREATMENT - Abstract
Background and Purpose— Hemorrhagic transformation (HT) after acute ischemic stroke may cause severe neurological deterioration and affects functional outcome. Identifying patients most likely to suffer from this complication could potentially be used for future treatment selection. Reperfusion after endovascular therapy could be associated with different risk factors for HT than intravenous thrombolytics as these treatments largely differ. In this study, we aimed to identify clinical and imaging markers that are associated with HT subtypes in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) population. Methods— In this post hoc analysis, all patients with follow-up imaging were included. HT was classified according to ECASS II (European Cooperative Acute Stroke Study). Variables with an association of P Results— Of the 478 out of 500 included patients in this subanalysis, 46% had HT (n=222). Of these, 66% had hemorrhagic infarction (n=147) and 34% PH (n=75). Symptomatic intracranial hemorrhage was observed in 7.3% (n=35) of all patients. Baseline National Institutes of Health Stroke Scale (odds ratio [OR], 1.05,95% CI, 1.01–1.09 per point) and absent/poor collaterals (OR, 1.90; 95% CI, 1.05–3.42) were significantly associated with hemorrhagic infarction. Increased systolic blood pressure (OR, 1.17; 95% CI, 1.05–1.31 per 10 mm Hg) and atrial fibrillation (OR, 1.94; 95% CI, 1.08–3.48) were associated with PH. Increased systolic blood pressure (OR, 1.28; 95% CI, 1.12–1.48) and antiplatelet use (OR, 2.6; 95% CI, 1.08–6.3) were associated with symptomatic intracranial hemorrhage. Conclusions— Clinical and imaging stroke severity parameters were associated with HT, both in hemorrhagic infarction and PH, whereas baseline patients characteristics like systolic blood pressure, atrial fibrillation, and antiplatelet use were only associated with PH or symptomatic intracranial hemorrhage. Clinical Trial Registration— URL: http://www.controlled-trials.com . Unique identifier: ISRCTN10888758.
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- 2019
4. Nonfocal Transient Neurological Attacks Are Associated With Cerebral Small Vessel Disease
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Oudeman, E.A., Greving, J.P., Berg-Vos, R.M. van den, Biessels, G.J., Bron, E.E., Oostenbrugge, R. van, Bresser, J. de, Kappelle, L.J., Heart-Brain Connection Consortium, Medical Informatics, Radiology & Nuclear Medicine, RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: CARIM - R3.03 - Cerebral small vessel disease, and MUMC+: MA Med Staf Spec Neurologie (9)
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Male ,medicine.medical_specialty ,SYMPTOMS ,Ischemia ,Clinical Neurology ,Vision Disorders ,Amnesia ,Unconsciousness ,Dizziness ,neurologic manifestations ,Paraparesis ,Internal medicine ,medicine ,Dementia ,odds ratio ,Humans ,Advanced and Specialised Nursing ,Paresthesia ,Confusion ,Stroke ,Gait Disorders, Neurologic ,ISCHEMIC ATTACK ,Aged ,Advanced and Specialized Nursing ,RISK ,business.industry ,ABNORMALITIES ,Odds ratio ,Recovery of Function ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,White Matter ,Hyperintensity ,Logistic Models ,Ischemic Attack, Transient ,Heart failure ,Case-Control Studies ,Cerebral Small Vessel Diseases ,Cardiology ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Cardiology and Cardiovascular Medicine ,STROKE - Abstract
Background and Purpose— Nonfocal transient neurological attacks (TNAs), such as unsteadiness, bilateral weakness, or confusion, are associated with an increased risk of stroke and dementia. Cerebral ischemia plays a role in their pathogenesis, but the precise mechanisms are unknown. We hypothesized that cerebral small vessel disease is involved in the pathogenesis of TNAs and assessed the relation between TNAs and manifestations of cerebral small vessel disease on magnetic resonance imaging. Methods— We included participants from the HBC (Heart-Brain Connection) study. In this study, hemodynamic and cardiovascular contributions to cognitive impairment have been studied in patients with heart failure, carotid artery occlusion, or possible vascular cognitive impairment, as well as in a reference group. We excluded participants with a history of stroke or transient ischemic attacks. The occurrence of the following 8 TNAs was assessed with a standardized interview: unconsciousness, confusion, amnesia, unsteadiness, bilateral leg weakness, blurred vision, nonrotatory dizziness, and paresthesias. The occurrence of TNAs was related to the presence of lacunes or white matter hyperintensities (Fazekas score, ≥2; early confluent or confluent lesions) in logistic regression analysis, adjusted for age, sex, and hypertension. Results— Of 304 participants (60% men; mean age, 67±9 years), 63 participants (21%) experienced ≥1 TNAs. Lacunes and early confluent or confluent white matter hyperintensities were more common in participants with TNAs than in participants without TNAs (35% versus 20%; adjusted odds ratio, 2.32 [95% CI, 1.22–4.40] and 48% versus 27%; adjusted odds ratio, 2.65 [95% CI, 1.44–4.90], respectively). Conclusions— In our study, TNAs are associated with the presence of lacunes and early confluent or confluent white matter hyperintensities of presumed vascular origin, which indicates that cerebral small vessel disease might play a role in the pathogenesis of TNAs.
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- 2019
5. Intracranial Carotid Artery Calcification and Effect of Endovascular Stroke Treatment MR CLEAN Subgroup Analysis
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Compagne, K.C.J., Clephas, P.R.D., Majoie, C.B.L.M., Roos, Y.B.W.E.M., Berkhemer, O.A., Oostenbrugge, R.J. van, Zwam, W.H. van, Es, A.C.G.M. van, Dippel, D.W.J., Lugt, A. van der, Bos, D., Fransen, P.S.S., Beumer, D., Berg, L.A. van den, Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, E., Oostayen, J.A. van, Nijeholt, G.J.L.A., Boiten, J., Brouwer, P.A., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., R.H. lo, Dijk, E.J. van, Vries, J. de, Kort, P.L.M. de, Berg, J.S.P. van den, Rooij, W.J.J. van, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Visser, M.C., Bot, J.C.J., Vroomen, P.C., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Marquering, H.A., Beenen, L.F., Sprengers, M.E.S., Jenniskens, S.F.M., Berg, R. van den, Yoo, A.J., Koudstaal, P.J., Flach, H.Z., Steyerberg, E.W., Lingsma, H.F., MR CLEAN Investigators, Radiology and nuclear medicine, VU University medical center, Neurology, Amsterdam Neuroscience - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: CARIM - R3.03 - Cerebral small vessel disease, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, Beeldvorming, MUMC+: MA AIOS Neurologie (9), and MUMC+: MA Med Staf Spec Neurologie (9)
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Tunica media ,medicine.medical_specialty ,IMPACT ,medicine.medical_treatment ,RECANALIZATION ,Subgroup analysis ,030204 cardiovascular system & hematology ,tomography ,Revascularization ,DISEASE ,03 medical and health sciences ,0302 clinical medicine ,carotid arteries ,Modified Rankin Scale ,Internal medicine ,medicine ,ACUTE ISCHEMIC-STROKE ,Stroke ,Advanced and Specialized Nursing ,business.industry ,MECHANICAL THROMBECTOMY ,Odds ratio ,medicine.disease ,Tunica intima ,stroke ,medicine.anatomical_structure ,thrombectomy ,tunica media ,Cardiology ,REVASCULARIZATION ,TRIAL ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Calcification - Abstract
Background and Purpose— Previous studies suggest that intracranial carotid artery calcification (ICAC) volume might influence the clinical outcome of patients after endovascular treatment (EVT) for acute ischemic stroke. Importantly, ICAC can be subtyped into a medial or intimal pattern that may differentially influence the effect of EVT in patients with acute ischemic stroke. Methods— All 500 patients included in the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular treatment for acute ischemic stroke in the Netherlands) were evaluated. Volume (mm 3 ) and location pattern (tunica intima or tunica media) of ICAC could be determined on baseline noncontrast computed tomography in 344 patients. Functional outcome at 90 days was assessed with the modified Rankin Scale. Next, we investigated the association of ICAC volume and pattern with functional outcome using adjusted ordinal logistic regression models. Effect modification by EVT was assessed with an interaction term between treatment allocation and ICAC aspect. Results— We found evidence for treatment effect modification by ICAC pattern ( P interaction=0.04). Patients with predominantly medial calcification had better functional outcome with EVT than without this treatment (adjusted common odds ratio, 2.32; 95% CI, 1.23–4.39), but we observed no effect of EVT in patients with predominantly intimal calcifications (adjusted common odds ratio, 0.82; 95% CI, 0.40–1.68). We did not find an association of ICAC volume with functional outcome (adjusted common odds ratio per unit increase ICAC volume 1.01 (95% CI, 0.89–1.13). Moreover, we found no evidence for effect modification by ICAC volume ( P interaction=0.61). Conclusions— The benefit of EVT in acute ischemic stroke patients with a medial calcification pattern is larger than the benefit in patients with an intimal calcification pattern. Clinical Trial Registration— URL: http://www.trialregister.nl . Unique identifier: NTR1804. URL: http://www.isrctn.com . Unique identifier: ISRCTN10888758.
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- 2018
6. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke
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Berkhemer, O.A., Fransen, P.S.S., Beumer, D., Berg, L.A. van den, Lingsma, H.F., Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Oostayen, J.A. van, Nijeholt, G.J.L.A., Boiten, J., Brouwer, P.A., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., R.H. lo, Dijk, E.J. van, Vries, J. de, Kort, P.L.M. de, Rooij, W.J.J. van, Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Visser, M.C., Bot, J.C.J., Vroomen, P.C., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Steyerberg, E.W., Flach, H.Z., Marquering, H.A., Sprengers, M.E.S., Jenniskens, S.F.M., Beenen, L.F.M., Berg, R. van den, Koudstaal, P.J., Zwam, W.H. van, Roos, Y.B.W.E.M., Lugt, A. van der, Oostenbrugge, R.J. van, Majoie, C.B.L.M., Dippel, D.W.J., MR CLEAN Investigators, Clinical Neurophysiology, Faculty of Science and Technology, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Radiology and Nuclear Medicine, Graduate School, Neurology, Biomedical Engineering and Physics, Other Research, Other departments, Radiology and nuclear medicine, NCA - neurodegeneration, Public Health, Radiology & Nuclear Medicine, RS: CARIM - R3 - Vascular biology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA AIOS Neurologie (9), Interne Geneeskunde, Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: MA Arts Assistenten Obstetrie Gynaecologie (9), Huisartsgeneeskunde, NUTRIM, and MUMC+: DA BV Medisch Specialisten Radiologie (9)
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medicine.medical_specialty ,Solitaire Cryptographic Algorithm ,Randomization ,RECANALIZATION ,THERAPY ,law.invention ,Randomized controlled trial ,Modified Rankin Scale ,law ,SCORE ,medicine ,OCCLUSIONS ,IR-98132 ,Intracerebral hemorrhage ,business.industry ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,General Medicine ,Odds ratio ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,medicine.disease ,Confidence interval ,Surgery ,Clinical trial ,Anesthesia ,ENDOVASCULAR TREATMENT ,METIS-313119 ,CEREBRAL INFARCT ,business - Abstract
Contains fulltext : 153000.pdf (Publisher’s version ) (Open Access) BACKGROUND: In patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, intraarterial treatment is highly effective for emergency revascularization. However, proof of a beneficial effect on functional outcome is lacking. METHODS: We randomly assigned eligible patients to either intraarterial treatment plus usual care or usual care alone. Eligible patients had a proximal arterial occlusion in the anterior cerebral circulation that was confirmed on vessel imaging and that could be treated intraarterially within 6 hours after symptom onset. The primary outcome was the modified Rankin scale score at 90 days; this categorical scale measures functional outcome, with scores ranging from 0 (no symptoms) to 6 (death). The treatment effect was estimated with ordinal logistic regression as a common odds ratio, adjusted for prespecified prognostic factors. The adjusted common odds ratio measured the likelihood that intraarterial treatment would lead to lower modified Rankin scores, as compared with usual care alone (shift analysis). RESULTS: We enrolled 500 patients at 16 medical centers in The Netherlands (233 assigned to intraarterial treatment and 267 to usual care alone). The mean age was 65 years (range, 23 to 96), and 445 patients (89.0%) were treated with intravenous alteplase before randomization. Retrievable stents were used in 190 of the 233 patients (81.5%) assigned to intraarterial treatment. The adjusted common odds ratio was 1.67 (95% confidence interval [CI], 1.21 to 2.30). There was an absolute difference of 13.5 percentage points (95% CI, 5.9 to 21.2) in the rate of functional independence (modified Rankin score, 0 to 2) in favor of the intervention (32.6% vs. 19.1%). There were no significant differences in mortality or the occurrence of symptomatic intracerebral hemorrhage. CONCLUSIONS: In patients with acute ischemic stroke caused by a proximal intracranial occlusion of the anterior circulation, intraarterial treatment administered within 6 hours after stroke onset was effective and safe. (Funded by the Dutch Heart Foundation and others; MR CLEAN Netherlands Trial Registry number, NTR1804, and Current Controlled Trials number, ISRCTN10888758.).
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- 2015
7. Cognitive functioning in patients with carotid artery occlusion; a systematic review
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Oudeman, E.A., Kappelle, L.J., Berg-Vos, R.M. van den, Weinstein, H.C., Berg, E. van den, Klijn, C.J.M., Oudeman, E.A., Kappelle, L.J., Berg-Vos, R.M. van den, Weinstein, H.C., Berg, E. van den, and Klijn, C.J.M.
- Abstract
Item does not contain fulltext, INTRODUCTION: Patients with complete occlusion of the internal carotid artery (CAO) are vulnerable to cerebral hypoperfusion. Since cerebral hypoperfusion is associated with accelerated cognitive decline, patients with CAO may have an increased risk of cognitive impairment. We aimed to assess the prevalence and profile of cognitive impairment in patients with CAO and to explore the relation between hemodynamic impairment and cognitive functioning. METHODS: We systematically searched Medline and EMBASE for studies including patients with symptomatic or asymptomatic CAO subjected to cognitive testing that were published between 1980 and 2017. We did not include patients with carotid stenosis. We obtained data on type of study, patient characteristics, cerebral imaging and neuropsychological testing. In addition, we extracted data on potential causes of systemic hemodynamic impairment and the presence and stage of cerebral hemodynamic impairment. We assessed methodological quality of included studies with the Newcastle-Ottawa Scale. RESULTS: We found eight studies comprising 244 patients (mean age 61years, 76% male, 93% symptomatic CAO). The proportion of patients with cognitive impairment ranged from 54 to 71% in four studies; in the other four studies patients with CAO performed worse on cognitive testing than controls, but results were not quantified. Impairment was reported in all cognitive domains. We found no data on the association between systemic hemodynamic impairment and cognitive functioning. Studies that assessed whether cerebral hemodynamic impairment was associated with cognitive functioning showed conflicting results. CONCLUSION: In patients with CAO, cognitive impairment is present in about half to two-thirds of patients and is not restricted to specific cognitive domains. The effect of systemic and cerebral hemodynamic impairment on cognitive functioning in patients with CAO deserves further study.
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- 2018
8. The Dutch Acute Stroke Audit: Benchmarking acute stroke care in the Netherlands
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Kuhrij, L.S., Wouters, Michel W.J.M., Berg-Vos, R.M. van den, Leeuw, F.E. de, Nederkoorn, P.J., Kuhrij, L.S., Wouters, Michel W.J.M., Berg-Vos, R.M. van den, Leeuw, F.E. de, and Nederkoorn, P.J.
- Abstract
Contains fulltext : 199529.pdf (Publisher’s version ) (Open Access)
- Published
- 2018
9. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke A Randomized Clinical Trial
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Fransen, P.S.S., Berkhemer, O.A., Lingsma, H.F., Beumer, D., Berg, L.A. van den, Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Oostayen, J.A. van, Nijeholt, G.J.L.A., Boiten, J., Brouwer, P.A., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., R.H. lo, Dijk, E.J. van, Vries, J. de, Kort, P.L.M. de, Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Visser, M.C., Bot, J.C.J., Vroomen, P.C., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Steyerberg, E.W., Flach, H.Z., Marquering, H.A., Sprengers, M.E.S., Jenniskens, S.F.M., Beenen, L.F.M., Berg, R. van den, Koudstaal, P.J., Zwam, W.H. van, Roos, Y.B.W.E.M., Oostenbrugge, R.J. van, Majoie, C.B.L.M., Lugt, A. van der, Dippel, D.W.J., Multictr Randomized Clin Trial End, Other departments, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, ANS - Neurovascular Disorders, Graduate School, Neurology, Biomedical Engineering and Physics, Other Research, MUMC+: MA AIOS Neurologie (9), RS: CARIM - R3.03 - Cerebral small vessel disease, Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), RS: CARIM - R3.11 - Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Clinical Neurophysiology, Faculty of Science and Technology, Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, Radiology & Nuclear Medicine, and Public Health
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Male ,Time Factors ,ANGIOGRAPHIC REPERFUSION ,030204 cardiovascular system & hematology ,THERAPY ,law.invention ,Brain Ischemia ,0302 clinical medicine ,Randomized controlled trial ,Modified Rankin Scale ,law ,Interquartile range ,Non-U.S. Gov't ,610 Medicine & health ,Stroke ,OUTCOMES ,Research Support, Non-U.S. Gov't ,Endovascular Procedures ,Atrial fibrillation ,Middle Aged ,THROMBECTOMY ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,Multicenter Study ,Treatment Outcome ,Anesthesia ,Tissue Plasminogen Activator ,Randomized Controlled Trial ,Female ,IMAGING SELECTION ,INTERVENTION ,medicine.medical_specialty ,Research Support ,METIS-320854 ,03 medical and health sciences ,Reperfusion therapy ,Fibrinolytic Agents ,SDG 3 - Good Health and Well-being ,medicine ,Journal Article ,Humans ,Aged ,Intention-to-treat analysis ,COMPLEXITY ,business.industry ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,medicine.disease ,Surgery ,INTRAVENOUS T-PA ,IR-103531 ,ENDOVASCULAR TREATMENT ,Reperfusion ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Fibrinolytic agent - Abstract
Item does not contain fulltext IMPORTANCE: Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusion leads to improved functional outcome in patients treated within 6 hours after onset. The influence of treatment delay on treatment effect is not yet known. OBJECTIVE: To evaluate the influence of time from stroke onset to the start of treatment and from stroke onset to reperfusion on the effect of IAT. DESIGN, SETTING, AND PARTICIPANTS: The Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) was a multicenter, randomized clinical open-label trial of IAT vs no IAT in 500 patients. The time to the start of treatment was defined as the time from onset of symptoms to groin puncture (TOG). The time from onset of treatment to reperfusion (TOR) was defined as the time to reopening the vessel occlusion or the end of the procedure in cases for which reperfusion was not achieved. Data were collected from December 3, 2010, to June 3, 2014, and analyzed (intention to treat) from July 1, 2014, to September 19, 2015. MAIN OUTCOMES AND MEASURES: Main outcome was the modified Rankin Scale (mRS) score for functional outcome (range, 0 [no symptoms] to 6 [death]). Multiple ordinal logistic regression analysis estimated the effect of treatment and tested for the interaction of time to randomization, TOG, and TOR with treatment. The effect of treatment as a risk difference on reaching independence (mRS score, 0-2) was computed as a function of TOG and TOR. Calculations were adjusted for age, National Institutes of Health Stroke Scale score, previous stroke, atrial fibrillation, diabetes mellitus, and intracranial arterial terminus occlusion. RESULTS: Among 500 patients (58% male; median age, 67 years), the median TOG was 260 (interquartile range [IQR], 210-311) minutes; median TOR, 340 (IQR, 274-395) minutes. An interaction between TOR and treatment (P = .04) existed, but not between TOG and treatment (P = .26). The adjusted risk difference (95% CI) was 25.9% (8.3%-44.4%) when reperfusion was reached at 3 hours, 18.8% (6.6%-32.6%) at 4 hours, and 6.7% (0.4%-14.5%) at 6 hours. CONCLUSION AND RELEVANCE: For every hour of reperfusion delay, the initially large benefit of IAT decreases; the absolute risk difference for a good outcome is reduced by 6% per hour of delay. Patients with acute ischemic stroke require immediate diagnostic workup and IAT in case of intracranial arterial vessel occlusion. TRIAL REGISTRATION: trialregister.nl Identifier: NTR1804.
- Published
- 2016
10. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial
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Fransen, P.S., Berkhemer, O.A., Lingsma, H.F., Beumer, D., Berg, L.A. van den, Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, M.J., Walderveen, M.A. van, Staals, J., Hofmeijer, J., Oostayen, J.A., Lycklama, A.N.G.J., Boiten, J., Brouwer, P.A., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., Lo, R.H., Dijk, E.J. van, Vries, J. de, Kort, P.L. de, Berg, J.S., Hasselt, B.A. van, Aerden, L.A., Dallinga, R.J., Visser, M.C, Bot, J.C., Vroomen, P.C., Eshghi, O., Schreuder, T.H., Heijboer, R.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Steyerberg, E.W., Flach, H.Z., Marquering, H.A., Sprengers, M.E., Jenniskens, S.F., Beenen, L.F., Berg, R. van den, Koudstaal, P.J., Zwam, W.H. van, Roos, Y.B., Oostenbrugge, R.J. van, Majoie, C.B., Lugt, A. van der, Dippel, D.W., Fransen, P.S., Berkhemer, O.A., Lingsma, H.F., Beumer, D., Berg, L.A. van den, Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, M.J., Walderveen, M.A. van, Staals, J., Hofmeijer, J., Oostayen, J.A., Lycklama, A.N.G.J., Boiten, J., Brouwer, P.A., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., Lo, R.H., Dijk, E.J. van, Vries, J. de, Kort, P.L. de, Berg, J.S., Hasselt, B.A. van, Aerden, L.A., Dallinga, R.J., Visser, M.C, Bot, J.C., Vroomen, P.C., Eshghi, O., Schreuder, T.H., Heijboer, R.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Steyerberg, E.W., Flach, H.Z., Marquering, H.A., Sprengers, M.E., Jenniskens, S.F., Beenen, L.F., Berg, R. van den, Koudstaal, P.J., Zwam, W.H. van, Roos, Y.B., Oostenbrugge, R.J. van, Majoie, C.B., Lugt, A. van der, and Dippel, D.W.
- Abstract
Item does not contain fulltext, IMPORTANCE: Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusion leads to improved functional outcome in patients treated within 6 hours after onset. The influence of treatment delay on treatment effect is not yet known. OBJECTIVE: To evaluate the influence of time from stroke onset to the start of treatment and from stroke onset to reperfusion on the effect of IAT. DESIGN, SETTING, AND PARTICIPANTS: The Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) was a multicenter, randomized clinical open-label trial of IAT vs no IAT in 500 patients. The time to the start of treatment was defined as the time from onset of symptoms to groin puncture (TOG). The time from onset of treatment to reperfusion (TOR) was defined as the time to reopening the vessel occlusion or the end of the procedure in cases for which reperfusion was not achieved. Data were collected from December 3, 2010, to June 3, 2014, and analyzed (intention to treat) from July 1, 2014, to September 19, 2015. MAIN OUTCOMES AND MEASURES: Main outcome was the modified Rankin Scale (mRS) score for functional outcome (range, 0 [no symptoms] to 6 [death]). Multiple ordinal logistic regression analysis estimated the effect of treatment and tested for the interaction of time to randomization, TOG, and TOR with treatment. The effect of treatment as a risk difference on reaching independence (mRS score, 0-2) was computed as a function of TOG and TOR. Calculations were adjusted for age, National Institutes of Health Stroke Scale score, previous stroke, atrial fibrillation, diabetes mellitus, and intracranial arterial terminus occlusion. RESULTS: Among 500 patients (58% male; median age, 67 years), the median TOG was 260 (interquartile range [IQR], 210-311) minutes; median TOR, 340 (IQR, 274-395) minutes. An interaction between TOR and treatment (P = .04) existed, but not between TOG and treatment (P = .26).
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- 2016
11. Correlates of outcome and response to IVIg in 88 patients with multifocal motor neuropathy.
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Cats, E.A., Pol, W.L. van der, Piepers, S., Franssen, H., Jacobs, B.C., Berg-Vos, R.M. van den, Kuks, J.B.M., Doorn, P.A. van, Engelen, B.G.M. van, Verschuuren, J.J., Wokke, J.H.J., Veldink, J.H., Berg, L.H. van den, Cats, E.A., Pol, W.L. van der, Piepers, S., Franssen, H., Jacobs, B.C., Berg-Vos, R.M. van den, Kuks, J.B.M., Doorn, P.A. van, Engelen, B.G.M. van, Verschuuren, J.J., Wokke, J.H.J., Veldink, J.H., and Berg, L.H. van den
- Abstract
Contains fulltext : 87685.pdf (publisher's version ) (Closed access), OBJECTIVE: Identification and examination of all patients with multifocal motor neuropathy (MMN) in the Netherlands to document the clinical spectrum and response to IV immunoglobulin (IVIg) and to determine correlates of outcome. METHODS: A national cross-sectional descriptive study was performed. Ninety-seven patients were identified; 88 participated. Logistic regression analysis was used to study determinants of outcome. RESULTS: Age at onset was younger in men than in women (38 vs 45 years, p = 0.05). Onset of weakness was in distal arm (61%) or distal leg (34%), and occasionally in the upper arm (5%). Initial diagnosis was motor neuron disease in one-third of patients. Brisk, but not pathologic, reflexes in weakened muscles were found in 8%. Conduction blocks were most frequently detected in the ulnar (80%) and median (77%) nerves, but occasionally only between Erb and axilla (6%), or in the musculocutaneous nerve (1%). Ninety-four percent responded to IVIg therapy: nonresponders had longer disease duration before the first treatment (p = 0.03). Seventy-six percent received IVIg maintenance treatment at the time of this study (median duration 6 years; range 0-17): the median dose increased over the years from 12 to 17 g per week (p < 0.01). Independent determinants of more severe weakness and disability were axon loss (p < 0.001; p < 0.0001) and longer disease duration without IVIg (p = 0.03; p = 0.07). CONCLUSION: The results of this study may help aid recognition the clinical picture of MMN. Early IVIg treatment may help to postpone axonal degeneration and permanent deficits. Classification of evidence: This study provides Class IV evidence that IVIg improves muscle strength of patients with MMN and disability (defined as an increase of >or=1 Medical Research Council grade in at least 2 muscle groups without decrease in other muscle groups) in 94% (95% confidence interval, 86.8%-97.4%) of patients.
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- 2010
12. Diagnosis of multifocal motor neuropathy. Authors’ reply.
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Asseldonk, J.T.H. van, Franssen, H., Berg-Vos, R.M. van den, Wokke, J.H.J., Berg, L.H. van den, Asseldonk, J.T.H. van, Franssen, H., Berg-Vos, R.M. van den, Wokke, J.H.J., and Berg, L.H. van den
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- 2005
13. The spectrum of lower motor neuron syndromes : classification, natural course and treatment
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Berg-Vos, R.M. van den and Berg-Vos, R.M. van den
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- 2002
14. Triage of stroke patients in the chain of acute stroke care
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Nguyen, T.T.M., Wermer, M.J.H., Kruyt, N.D., Hertog, H.M. den, Quax, P.H.A., Chavannes, N.H., Groot, B. de, Berg-Vos, R.M. van den, Laat, K.F. de, and Leiden University
- Subjects
Prediction scales ,Large anterior vessel occlusion ,Stroke biomarker ,Hyperglycemia ,Prehospital triage ,Acute stroke ,Intracranial hemorrhage ,Endovascular treatment ,cardiovascular diseases ,Diagnostic accuracy ,Intravenous thrombolysis - Abstract
By advancing existing stroke triage systems, diagnosis and timely access of stroke patients to specialized care can be improved, which in turn can have a tremendous impact on current clinical practice. The overall aim of this thesis was to assess various ways to improve stroke triage in the chain of acute stroke. To begin with patient triage by assessing the patient’s entrance into the chain of acute stroke care (Part I). To improve patient triage, the focus should be to directly involve the ambulance once stroke is suspected. In Part II, prehospital triage tools to improve patient selection in the ambulance are identified en validated. Prehospital triage tools that can help identify patients who are more likely to have large anterior vessel occlusion or can differentiate between patients with acute ischemic stroke and intracerebral hemorrhage, will improve patient selection in the ambulance and thereby result in earlier initiation of endovascular treatment, thereby improving patient outcomes. In the last part (Part III), in-hospital factors are investigated that are known to have an adverse effect on patient outcome in the final part of the chain of acute stroke care, as continued efforts need to be made to further reduce in-hospital delays.
- Published
- 2022
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