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1. Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19-A Prospective Cohort Study

Author

Stals, M.A.M., Kaptein, F.H.J., Bemelmans, R.H.H., Bemmel, T. van, Boukema, I.C., Braeken, D.C.W., Braken, S.J.E., Bresser, C., Cate, H.T., Deenstra, D.D., Dooren, Y., Faber, L.M., Grootenboers, M., Haan, L.R., Haazer, C., Sol, A.I.D., Kelliher, S., Koster, T., Kroft, L.J., Meijer, R.I., Pals, F., Thiel, E.R.E. van, Westerweel, P.E., Wolde, M.T., Klok, F.A., Huisman, M.V., Stals, M.A.M., Kaptein, F.H.J., Bemelmans, R.H.H., Bemmel, T. van, Boukema, I.C., Braeken, D.C.W., Braken, S.J.E., Bresser, C., Cate, H.T., Deenstra, D.D., Dooren, Y., Faber, L.M., Grootenboers, M., Haan, L.R., Haazer, C., Sol, A.I.D., Kelliher, S., Koster, T., Kroft, L.J., Meijer, R.I., Pals, F., Thiel, E.R.E. van, Westerweel, P.E., Wolde, M.T., Klok, F.A., and Huisman, M.V.

Abstract

Item does not contain fulltext, Background Diagnostic strategies for suspected pulmonary embolism (PE) have not been prospectively evaluated in COVID-19 patients. Methods Prospective, multicenter, outcome study in 707 patients with both (suspected) COVID-19 and suspected PE in 14 hospitals. Patients on chronic anticoagulant therapy were excluded. Informed consent was obtained by opt-out approach. Patients were managed by validated diagnostic strategies for suspected PE. We evaluated the safety (3-month failure rate) and efficiency (number of computed tomography pulmonary angiographies [CTPAs] avoided) of the applied strategies. Results Overall PE prevalence was 28%. YEARS was applied in 36%, Wells rule in 4.2%, and "CTPA only" in 52%; 7.4% was not tested because of hemodynamic or respiratory instability. Within YEARS, PE was considered excluded without CTPA in 29%, of which one patient developed nonfatal PE during follow-up (failure rate 1.4%, 95% CI 0.04-7.8). One-hundred seventeen patients (46%) managed according to YEARS had a negative CTPA, of whom 10 were diagnosed with nonfatal venous thromboembolism (VTE) during follow-up (failure rate 8.8%, 95% CI 4.3-16). In patients managed by CTPA only, 66% had an initial negative CTPA, of whom eight patients were diagnosed with a nonfatal VTE during follow-up (failure rate 3.6%, 95% CI 1.6-7.0). Conclusion Our results underline the applicability of YEARS in (suspected) COVID-19 patients with suspected PE. CTPA could be avoided in 29% of patients managed by YEARS, with a low failure rate. The failure rate after a negative CTPA, used as a sole test or within YEARS, was non-negligible and reflects the high thrombotic risk in these patients, warranting ongoing vigilance.

Published
2021

2. Factors associated with posttraumatic stress symptoms in a prospective cohort of patients after abdominal sepsis:A nomogram

Author

Boer, Kimberly R., Van Ruler, O., Van Emmerik, Arnold A.P., Sprangers, Mirjam A., De Rooij, Sophia E., Vroom, Margreeth B., De Borgie, C. A.J.M., Boermeester, M. A., Reitsma, Johannes B., Boer, K. R., Mahler, C. W., Reuland, E. A., Van Till, J. W.O., Opmeer, B. C., Bossuyt, P. M.M., Schultz, M. J., Sprangers, M. A., Obertop, H., Gouma, D. J., Steller, E. P., Tanis, P., Hart, H., Gerhards, M. F., Guijt, M., Oudemans, H. M., Bosscha, K., Ritchie, E., Vermeer, M., De Graaf, P. W., Van Etten, B., Haazer, C., Salm, E., Lamme, B., Hesselink, E. J., Rommes, H., Oostenbroek, R. J., Te Velde, L., Govaert, G., Ponssen, H. H., Gooszen, H. G., Dinkelman, M. K., Leenen, L. P.H., Pierik, E. G.J.M., Lansink, K. W.W., Bakker, J., Boer, Kimberly R., Van Ruler, O., Van Emmerik, Arnold A.P., Sprangers, Mirjam A., De Rooij, Sophia E., Vroom, Margreeth B., De Borgie, C. A.J.M., Boermeester, M. A., Reitsma, Johannes B., Boer, K. R., Mahler, C. W., Reuland, E. A., Van Till, J. W.O., Opmeer, B. C., Bossuyt, P. M.M., Schultz, M. J., Sprangers, M. A., Obertop, H., Gouma, D. J., Steller, E. P., Tanis, P., Hart, H., Gerhards, M. F., Guijt, M., Oudemans, H. M., Bosscha, K., Ritchie, E., Vermeer, M., De Graaf, P. W., Van Etten, B., Haazer, C., Salm, E., Lamme, B., Hesselink, E. J., Rommes, H., Oostenbroek, R. J., Te Velde, L., Govaert, G., Ponssen, H. H., Gooszen, H. G., Dinkelman, M. K., Leenen, L. P.H., Pierik, E. G.J.M., Lansink, K. W.W., and Bakker, J.

Abstract

Objective: To determine to what extent patients who have survived abdominal sepsis suffer from symptoms of posttraumatic stress disorder (PTSD) and depression, and to identify potential risk factors for PTSD symptoms. Design and setting: PTSD and depression symptoms were measured using the Impact of Events Scale-Revised (IES-R), the Post-Traumatic Symptom Scale 10 (PTSS-10) and the Beck Depression Inventory II (BDI-II). Patients and participants: A total of 135 peritonitis patients were eligible for this study, of whom 107 (80%) patients completed the questionnaire. The median APACHE-II score was 14 (range 12-16), and 89% were admitted to the ICU.Measurements and results: The proportion of patients with "moderate" PTSD symptom scores was 28% (95% CI 20-37), whilst 10% (95% CI 6-17) of patients had "high" PTSD symptom scores. Only 5% (95% CI 2-12) of the patients expressed severe depression symptoms. Factors associated with increased PTSD symptoms in a multivariate ordinal regression model were younger age (0.74 per 10 years older, p = 0.082), length of ICU stay (OR = 1.4 per doubling of duration, p = 0.003) and having some (OR = 4.9, p = 0.06) or many (OR = 55.5, p < 0.001) traumatic memories of the ICU or hospital stay. Conclusion: As many as 38% of patients after abdominal sepsis report elevated levels of PTSD symptoms on at least one of the questionnaires. Our nomogram may assist in identifying patients at increased risk for developing symptoms of PTSD.

Published
2008

3. Health related quality of life six months following surgical treatment for secondary peritonitis - Using the EQ-5D questionnaire

Author

Boer, Kimberly R., van Ruler, Oddeke, Reitsma, Johannes B., Mahler, Cecilia W., Opmeer, Brent C., Reuland, E. Ascelijn, Gooszen, Hein G., de Graaf, Peter W., Hesselink, Eric J., Gerhards, Michael F., Steller, E. P.H., Sprangers, Mirjam A., Boermeester, Marja A., De Borgie, Corianne A., Van Till, J. W.O., Bossuyt, P. M.M., Schultz, M. J., Obertop, H., Gouma, D. J., Tanis, P., Hart, H., Guijt, M., Oudemans, H. M., Bosscha, K., Ritchie, E., Vermeer, M., Van Etten, B., Haazer, C., Salm, E., Rommes, H., Oostenbroek, R. J., te Velde, L., Govaert, G., Ponssen, H. H., Dinkelman, M. K., Leenen, L. P.H., Pierik, E. G.J.M., Lansink, K. W.W., Bakker, K., Boer, Kimberly R., van Ruler, Oddeke, Reitsma, Johannes B., Mahler, Cecilia W., Opmeer, Brent C., Reuland, E. Ascelijn, Gooszen, Hein G., de Graaf, Peter W., Hesselink, Eric J., Gerhards, Michael F., Steller, E. P.H., Sprangers, Mirjam A., Boermeester, Marja A., De Borgie, Corianne A., Van Till, J. W.O., Bossuyt, P. M.M., Schultz, M. J., Obertop, H., Gouma, D. J., Tanis, P., Hart, H., Guijt, M., Oudemans, H. M., Bosscha, K., Ritchie, E., Vermeer, M., Van Etten, B., Haazer, C., Salm, E., Rommes, H., Oostenbroek, R. J., te Velde, L., Govaert, G., Ponssen, H. H., Dinkelman, M. K., Leenen, L. P.H., Pierik, E. G.J.M., Lansink, K. W.W., and Bakker, K.

Abstract

Background: To compare health related quality of life (HR-QoL) in patients surgically treated for secondary peritonitis to that of a healthy population. And to prospectively identify factors associated with poorer (lower) HR-QoL. Design: A prospective cohort of secondary peritonitis patients was mailed the EQ-5D and EQ-VAS 6-months following initial laparotomy. Setting: Multicenter study in two academic and seven regional teaching hospitals. Patients: 130 of the 155 eligible patients (84%) responded to the HR-QoL questionnaires. Results: HR-QoL was significantly worse on all dimensions in peritonitis patients than in a healthy reference population. Peritonitis characteristics at initial presentation were not associated with HR-QoL at six months. A more complicated course of the disease leading to longer hospitalization times and patients with an enterostomy had a negative impact on the mobility (p = 0.02), self-care (p < 0.001) and daily activities: (p = 0.01). In a multivariate analysis for the EQ-VAS every doubling of hospital stay decreases the EQ-VAS by 3.8 points (p = 0.015). Morbidity during the six-month follow-up was not found to be predictive for the EQ-5D or EQ-VAS. Conclusion: Six months following initial surgery, patients with secondary peritonitis report more problems in HR-QoL than a healthy reference population. Unfavorable disease characteristics at initial presentation were not predictive for poorer HR-QoL, but a more complicated course of the disease was most predictive of HR-QoL at 6 months.

Published
2007

4. Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19-A Prospective Cohort Study.

Author

Stals MAM, Kaptein FHJ, Bemelmans RHH, van Bemmel T, Boukema IC, Braeken DCW, Braken SJE, Bresser C, Cate HT, Deenstra DD, Dooren YPAV, Faber LM, Grootenboers MJJH, Haan LR, Haazer C, Sol AID, Kelliher S, Koster T, Kroft LJM, Meijer RI, Pals F, van Thiel ERE, Westerweel PE, Wolde MT, Klok FA, and Huisman MV

Abstract

Background  Diagnostic strategies for suspected pulmonary embolism (PE) have not been prospectively evaluated in COVID-19 patients. Methods  Prospective, multicenter, outcome study in 707 patients with both (suspected) COVID-19 and suspected PE in 14 hospitals. Patients on chronic anticoagulant therapy were excluded. Informed consent was obtained by opt-out approach. Patients were managed by validated diagnostic strategies for suspected PE. We evaluated the safety (3-month failure rate) and efficiency (number of computed tomography pulmonary angiographies [CTPAs] avoided) of the applied strategies. Results  Overall PE prevalence was 28%. YEARS was applied in 36%, Wells rule in 4.2%, and "CTPA only" in 52%; 7.4% was not tested because of hemodynamic or respiratory instability. Within YEARS, PE was considered excluded without CTPA in 29%, of which one patient developed nonfatal PE during follow-up (failure rate 1.4%, 95% CI 0.04-7.8). One-hundred seventeen patients (46%) managed according to YEARS had a negative CTPA, of whom 10 were diagnosed with nonfatal venous thromboembolism (VTE) during follow-up (failure rate 8.8%, 95% CI 4.3-16). In patients managed by CTPA only, 66% had an initial negative CTPA, of whom eight patients were diagnosed with a nonfatal VTE during follow-up (failure rate 3.6%, 95% CI 1.6-7.0). Conclusion  Our results underline the applicability of YEARS in (suspected) COVID-19 patients with suspected PE. CTPA could be avoided in 29% of patients managed by YEARS, with a low failure rate. The failure rate after a negative CTPA, used as a sole test or within YEARS, was non-negligible and reflects the high thrombotic risk in these patients, warranting ongoing vigilance., Competing Interests: Conflict of Interest Frederikus Klok reports research grants from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, MSD, Daiichi-Sankyo, Actelion, the Dutch thrombosis association, The Netherlands Organization for Health Research and Development and the Dutch Heart foundation. Menno Huisman reports receiving research grants from ZonMW, Boehringer Ingelheim, Bayer Health Care and Pfizer-Bristol-Myers Squibb. He has received consultancy and lecture fees from Pfizer-Bristol-Myers Squibb, Boehringer Ingelheim, Bayer Health Care and Aspen. The other authors have nothing to disclose., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

Published
2021
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5. Bereaved relatives' experiences during the incurable phase of cancer: a qualitative interview study.

Author

Wijnhoven MN, Terpstra WE, van Rossem R, Haazer C, Gunnink-Boonstra N, Sonke GS, and Buiting HM

Subjects
Female, Humans, Interviews as Topic, Male, Middle Aged, Qualitative Research, Bereavement, Caregivers psychology, Family psychology, Neoplasms drug therapy, Terminal Care psychology
Abstract

Objective: To examine bereaved relatives' experiences from time of diagnosis of incurable cancer until death with specific emphasis on their role in the (end-of-life) decision-making concerning chemotherapy., Design: Qualitative interview study., Setting: Hospital-based., Participants and Methods: In-depth interviews with 15 close relatives of patients who died from non-small cell lung cancer or pancreatic cancer, using a thematic content analysis., Results: All relatives reported that patients' main reason to request chemotherapy was the possibility to prolong life. Relatives reported that patients receiving chemotherapy had more difficulty to accept the incurable nature of their disease than patients who did not. They mostly followed the patients' treatment wish and only infrequently suggested ceasing chemotherapy (because of side effects) despite sometimes believing that this would be a better option. Relatives continuously tried to support the patient in either approaching the death or in attaining hope to continue life satisfactorily. Most relatives considered the chemotherapy period meaningful, since it sparked patients' hope and was what patients wanted. Cessation of chemotherapy caused a relief but coincided with physical deterioration and an increased caregivers' role; many relatives recalled this latter period as more burdensome., Conclusions: Relatives tend to follow patients' wish to continue or cease chemotherapy, without expressing their own feelings, although they were more inclined to opt cessation. They experience a greater caregiver role after cessation and their feelings of responsibility associated with the disease can be exhausting. More attention is needed to reduce relatives' distress at the end of life, also to fully profit from this crucial form of (informal) healthcare., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Published
2015
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