Search

Background: Decision-making whether older patients benefit from surgery can be a difficult task. This report investigates characteristics and outcomes of a large cohort of inpatients, aged 80 years and over, undergoing non-cardiac surgery. Methods: This observational study was performed at a tertiary university medical centre in the Netherlands. Patients of 80 years or older undergoing elective or urgent surgery from January 2004 to June 2017 were included. Outcomes were length of stay, discharge destination, 30-day and long-term mortality. Patients were divided into low-, intermediate and high-risk surgery subgroups. Univariable and multivariable logistic regression were used to evaluate the association of risk factors and outcomes. Secondary outcomes were time trends, assessed with Mantel–Haenszel chi-square test. Results: Data of 8251 patients, undergoing 19,027 surgical interventions were collected from the patients’ medical record. 7032 primary procedures were suitable for analyses. Median LOS was 3 days in the low-risk group, compared to six in the intermediate- and ten in the high-risk group. Median LOS of the total cohort decreased from 5.8 days (IQR 1.9–14.5) in 2004–2007 to 4.6 days (IQR 1.9–9.0) in 2016–2017. Three quarters of patients were discharged to their home. Postoperative 30-day mortality in the low-risk group was 2.3%. In the overall population 30-day mortality was high and constant during the study period (6.7%, ranging from 4.2 to 8.4%). Conclusion:Patients should not be withheld surgery solely based on their age. However, even for low-risk surgery, the mortality rate of more than 2% is substantial. Deciding whether older patients benefit from surgery should be based on the understanding of individual risks, patients’ wishes and a patient-centred plan.

09 januari 2023, Contains fulltext : 287548.pdf (Publisher’s version ) (Open Access), Motivation: Home range is a common measure of animal space use as it provides ecological information that is useful for conservation applications. In macroecological studies, values are typically aggregated to species means to examine general patterns of animal space use. However, this ignores the environmental context in which the home range was estimated and does not account for intraspecific variation in home range size. In addition, the focus of macroecological studies on home ranges has been historically biased toward terrestrial mammals. The use of aggregated numbers and terrestrial focus limits our ability to examine home range patterns across different environments, variation in time and between different levels of organisation. Here we introduce HomeRange, a global database with 75,611 home-range values across 960 different mammal species, including terrestrial, as well as aquatic and aerial species. Main types of variable contained: The dataset contains mammal home-range estimates, species names, methodological information on data collection, home-range estimation method, period of data collection, study coordinates and name of location, as well as species traits derived from the studies, such as body mass, life stage, reproductive status and locomotor habit. Spatial location and grain: The collected data is distributed globally. Across studies, the spatial accuracy varies, with the coarsest resolution being 1 degree. Time period and grain: The data represent information published between 1939 and 2022. Across studies, the temporal accuracy varies, some studies report start and end dates specific to the day. For other studies, only the month or year is reported. Major taxa and level of measurement: Mammal species from 24 of the 27 different taxonomic orders. Home-range estimates range from individual-level values to population-level averages. Methods Mammalian home range papers were compiled via an extensive literature search. All home range values were ex

Radboud University, 03 mei 2023, Promotor : Huijbregts, M.A.J. Co-promotores : Santini, L., Tucker, A., Contains fulltext : 292309.pdf (Publisher’s version ) (Open Access), Macroecological research has grown rapidly over the last few decades, investing most of its efforts on describing patterns of biodiversity and human-induced threats using correlative- based approaches. Although correlative studies have provided important insights, they are unable to discern correlations from causal relationships. This limits our ability to generate reliable projections outside the spatio-temporal and taxonomic domains of the input data. In contrast, process-based models attempt to replicate the dynamics of a system, modeling directly its underlying mechanisms. As such, process-based methods have the potential to provide more reliable predictions under novel conditions. Despite recent advancements in ecological theory, increases in data availability and the growth of computational power, it remains a significant challenge to construct and further develop process-based ecosystem models that are widely applicable to different questions and ecological contexts. The main aim of this thesis was to develop and apply processed-based ecological models to better understand and improve their functioning, expand current ecological theory as well as increase the support of process-based modeling. To increase the accessibility and reproducibility of the Madingley model, I developed a user-friendly and transparent R interface called MadingleyR. I also assessed the applicability of General Ecosystem Models (GEMs), in particular the Madingley model, for interpreting ecological hypotheses as well as exploring conservation scenarios. In this context, I investigated the roles large-bodied mammals in regulating the trophic structure and maintaining ecosystem functioning. Considering the limitations that follow from the global-scale scope of the Madingley model, I developed and validated a new GEM, focusing on landscape-level simulations, though the integration of species identity, species-specific interactions and animal movement.

Chronic post-surgical pain is known to be a common complication of thoracic surgery and has been associated with a lower quality of life, increased healthcare utilisation, substantial direct and indirect costs, and increased long-term use of opioids. This systematic review with meta-analysis aimed to identify and summarise the evidence of all prognostic factors for chronic post-surgical pain after lung and pleural surgery. Electronic databases were searched for retrospective and prospective observational studies as well as randomised controlled trials that included patients undergoing lung or pleural surgery and reported on prognostic factors for chronic post-surgical pain. We included 56 studies resulting in 45 identified prognostic factors, of which 16 were pooled with a meta-analysis. Prognostic factors that increased chronic post-surgical pain risk were as follows: higher postoperative pain intensity (day 1, 0-10 score), mean difference (95%CI) 1.29 (0.62-1.95), p < 0.001; pre-operative pain, odds ratio (95%CI) 2.86 (1.94-4.21), p < 0.001; and longer surgery duration (in minutes), mean difference (95%CI) 12.07 (4.99-19.16), p < 0.001. Prognostic factors that decreased chronic post-surgical pain risk were as follows: intercostal nerve block, odds ratio (95%CI) 0.76 (0.61-0.95) p = 0.018 and video-assisted thoracic surgery, 0.54 (0.43-0.66) p < 0.001. Trial sequential analysis was used to adjust for type 1 and type 2 errors of statistical analysis and confirmed adequate power for these prognostic factors. In contrast to other studies, we found that age had no significant effect on chronic post-surgical pain and there was not enough evidence to conclude on sex. Meta-regression did not reveal significant effects of any of the study covariates on the prognostic factors with a significant effect on chronic post-surgical pain. Expressed as grading of recommendations, assessment, development and evaluations criteria, the certainty of evidence was high for

Item does not contain fulltext

Contains fulltext : 287845.pdf (Publisher’s version ) (Closed access)

Objective: According to current guidelines, supervised exercise therapy (SET) is the treatment of choice for intermittent claudication (IC). Little is known about the potential consequences of psychological factors on the effectiveness of treatment. The aim of this study was to determine possible associations between a set of psychological constructs and treatment outcomes, and to investigate whether self efficacy increased after SET. Methods: This was a substudy of the ELECT Registry, a multicentre Dutch prospective cohort study in patients with IC receiving primary SET. A complete set of validated questionnaires scoring extraversion, neuroticism, conscientiousness, anxiety, depression, self control, optimism, and self efficacy was obtained in 237 patients (median age 69 years, 40% female). Anxiety and depression were dichotomised using established cutoff scores, whereas other scores were analysed as continuous measures. Multiple linear regression analyses determined possible associations between these independent variables and maximum and functional walking distances (MWD and FWD, respectively), Six Minute Walk Test (6MWT), and VascuQol-6 (dependent variables). Self efficacy during 12 months of SET was analysed using a linear mixed model. Results: Neuroticism and anxiety were associated with lower overall VascuQol-6 scores (estimate –1.35 points [standard error (SE) 0.57; p = .018] and –1.98 points [SE 0.87, p = .023], respectively). Optimism and self efficacy demonstrated higher overall 6MWT (5.92 m [SE 2.34; p = .012] and 1.35 m [SE 0.42; p = .001], respectively). Self control was associated with lower overall log MWD (–0.02 [SE 0.01; p = .038] and log FWD (–0.02 [SE 0.01; p = .080), whereas self efficacy had a higher overall log MWD (0.01 [SE 0.003; p = .009]) and log FWD (0.01 [SE 0.003; p = .011]). Depressive patients with IC demonstrated a greater improvement in 6MWT during follow up (17.56 m [SE 8.67; p = .044]), but this small effect was not confirmed i

Introduction: Evidence on physical and psychological well-being of in-hospital cardiac arrest (IHCA) survivors is scarce. The aim of this study is to describe long-term health-related quality of life (HRQoL), functional independence and psychological distress 3 and 12 months post-IHCA. Methods: A multicenter prospective cohort study in 25 hospitals between January 2017 – May 2018. Adult IHCA survivors were included. HRQoL (EQ-5D-5L, SF-12), psychological distress (HADS, CSI) and functional independence (mRS) were assessed at 3 and 12 months post-IHCA. Results: At 3-month follow-up 136 of 212 survivors responded to the questionnaire and at 12 months 110 of 198 responded. The median (IQR) EQ-utility Index score was 0.77 (0.65–0.87) at 3 months and 0.81 (0.70–0.91) at 12 months. At 3 months, patients reported a median SF-12 (IQR) physical component scale (PCS) of 38.9 (32.8–46.5) and mental component scale (MCS) of 43.5 (34.0–39.7) and at 12 months a PCS of 43.1 (34.6–52.3) and MCS 46.9 (38.5–54.5). Discussion: Using various tools most IHCA survivors report an acceptable HRQoL and a substantial part experiences lower HRQoL compared to population norms. Our data suggest that younger (male) patients and those with poor functional status prior to admission are at highest risk of impaired HRQoL.

Contains fulltext : 241652.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 229536.pdf (publisher's version ) (Open Access)

20 april 2021, Contains fulltext : 235958.pdf (Publisher’s version ) (Open Access)

In biogeomorphic landscapes, plant traits can steer landscape development through plant-mediated feedback interactions. Interspecific differences in clonal expansion strategy can therefore lead to the emergence of different landscape organisations. Yet, whether landscape-forming plants adopt different clonal expansion strategies depending on their physical environment remains to be tested. Here, we use a field survey and a complementary mesocosm approach to investigate whether sediment deposition affects the clonal expansion strategy employed by dune-building marram grass individuals. Our results reveal a consistent shift in expansion pattern from more clumped, Brownian-like, movement in sediment-poor conditions, to patchier, Levy-like, movement under high sediment supply rates. Additional model simulations illustrate that the sediment-dependent shift in movement strategies induces a shift in optimisation of the cost-benefit relation between landscape engineering (i.e. dune formation) and expansion. Plasticity in expansion strategy may therefore allow landscape-forming plants to optimise their engineering ability depending on their physical landscape.

Background: Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. Methods: A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. Results: After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). Conclusion: In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.

Contains fulltext : 225060.pdf (publisher's version ) (Open Access)

Contains fulltext : 212331pub.pdf (publisher's version ) (Open Access)

Contains fulltext : 225710.pdf (publisher's version ) (Open Access)

Lifeforms ranging from bacteria to humans employ specialized random movement patterns. Although effective as optimization strategies in many scientific fields, random walk application in biology has remained focused on search optimization by mobile organisms. Here, we report on the discovery that heavy-tailed random walks underlie the ability of clonally expanding plants to self-organize and dictate the formation of biogeomorphic landscapes. Using cross-Atlantic surveys, we show that congeneric beach grasses adopt distinct heavy-tailed clonal expansion strategies. Next, we demonstrate with a spatially explicit model and a field experiment that the Lévy-type strategy of the species building the highest dunes worldwide generates a clonal network with a patchy shoot organization that optimizes sand trapping efficiency. Our findings demonstrate Lévy-like movement in plants, and emphasize the role of species-specific expansion strategies in landscape formation. This mechanistic understanding paves the way for tailor-made planting designs to successfully construct and restore biogeomorphic landscapes and their services.