Search

Your search keyword '"Steyerberg EW"' showing total 1,290 results
Start Over Author "Steyerberg EW"
1,290 results on '"Steyerberg EW"'

1. The Potential Value of Prehabilitation for Preventing Delirium in Elective Surgery for Aneurysms of the Abdominal Aorta

Author

Meulenbroek AL, Steyerberg EW, Janssen TL, van Mil SR, Faes MC, and van der Laan L

Subjects
aneurysm of the abdominal aorta, prehabilitation, preoperative rehabilitation, delirium, delirium/prevention and control, Geriatrics, RC952-954.6
Abstract

Anne Lise Meulenbroek,1 Ewout W Steyerberg,2 Ties L Janssen,1 Stefanie R van Mil,1 Miriam C Faes,3 Lijckle van der Laan1,4 1Department of Surgery, Amphia Hospital, Breda, the Netherlands; 2Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; 3Department of Geriatrics, Amphia Hospital, Breda, the Netherlands; 4Department of Cardiovascular Sciences, Research Group of Vascular Surgery, KU Leuven, Leuven, BelgiumCorrespondence: Anne Lise Meulenbroek, Department of Surgery, Amphia Hospital, Molengracht 21, Breda, 4818 CK, the Netherlands, Tel +31 76 595 3157, Fax +31 76 595 3818, Email AMeulenbroek1@amphia.nlObjective: Delirium is a common and serious postoperative complication in elderly patients undergoing abdominal aortic aneurysm (AAA) repair and is associated with a variety of adverse outcomes. Multimodal prehabilitation aims to identify and minimize potential risk factors for delirium and improve overall health. The aim of this study is to investigate the effect of multimodal prehabilitation on delirium incidence in elderly patients undergoing elective repair for AAA.Methods: A single-centre cohort analysis was performed in the Netherlands for patients aged ≥ 70 years, undergoing elective repair for AAA (open surgery and endovascular aortic repair). Prehabilitation was gradually introduced between 2016 and 2019 and offered as standard care from 2019. The program was constructed to optimize overall health and included delirium risk assessment, home-based tailor-made exercises by a physical therapist, nutritional optimization by a dietician, iron infusion in case of anaemia and a comprehensive geriatric assessment by a geriatrician in case of frailty. The primary outcome was incidence of delirium within 30 days after surgery.Results: A total of 81 control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (11.1% in the control group to 4.9% in the prehabilitation group), with too small numbers to reach statistical significance (p=0.09). Also, patients in the prehabilitation group had a small, non-significant decreased length of hospital stay (4 days) compared to the control group (5 days) (p=0.07).Conclusion: Although no significant differences were found, we carefully conclude that this study provides some support for implementing multimodal prehabilitation for delirium prevention in elderly patients undergoing AAA repair. Further research with larger cohorts is necessary to identify and select patients that would most benefit from prehabilitation.Plain Language Summary: Delirium is a common complication in elderly patients after undergoing abdominal aortic aneurysm (AAA) repair. Delirium is associated with a prolonged hospital-stay, decreased quality of life and increased mortality. To prevent delirium it is important to identify possible risk factors and assess the patients’ overall fitness. This is best done preoperatively, since the patient is not yet recovering from a major surgery. This is called “prehabilitation”.In this study, we investigated the effect of multimodal prehabilitation in patients undergoing surgery for an AAA. The program consists of:Individual delirium risk-assessment,Personalized home-based tailor-made exercises,Nutritional optimization,Iron infusion in case of anaemia, andA comprehensive geriatric assessment by a geriatrician in case of frailty.Eighty-one control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (11.1% control to 4.9% prehabilitation), with too small numbers to reach statistical significance (p=0.09). Also, patients in the prehabilitation group had a small, non-significant decreased length of stay (4 days) compared to the control group (5 days) (p=0.07).Prehabilitation may be effective in preventing delirium in elderly patients undergoing AAA repair. Further research is necessary to identify and select patients that would most benefit from prehabilitation.Keywords: aneurysm of the abdominal aorta, prehabilitation, preoperative rehabilitation, delirium, delirium/prevention and control

Published
2024

2. Multicomponent Prehabilitation as a Novel Strategy for Preventing Delirium in Older Chronic Limb Threatening Ischemia Patients: A Study Protocol

Author

Meulenbroek Anne L, Faes MC, van Mil SR, Buimer MG, de Groot HGW, Veen EJ, Ho GH, Boonman-de Winter LJM, de Vries J, van Gorkom R, Toonders F, van Alphen R, van Overveld K, Verbogt N, Steyerberg EW, and van der Laan L

Subjects
chronic limb threatening ischemia, vascular surgical procedures, delirium, delirium/prevention and control, prehabilitation., Geriatrics, RC952-954.6
Abstract

Anne L Meulenbroek,1 Miriam C Faes,2 Stefanie R van Mil,1 MG Buimer,1 Hans GW de Groot,1 Eelco J Veen,1 Gwan H Ho,1 Leandra JM Boonman-de Winter,3,4 Jolanda de Vries,5,6 Rebecca van Gorkom,1 Fleur Toonders,1 Rene van Alphen,7 Karolien van Overveld,8 Nathalie Verbogt,1 Ewout W Steyerberg,9 Lijckle van der Laan1,10 1Department of Surgery, Amphia Hospital, Breda, the Netherlands; 2Department of Geriatrics, Amphia Hospital, Breda, the Netherlands; 3Department of Scientific Research, Amphia Hospital, Breda, the Netherlands; 4Admiraal de Ruyter Ziekenhuis, Goes, the Netherlands; 5Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; 6Board, Admiraal de Ruyter Hospital, Goes, the Netherlands; 7Department of Physical Therapy, Amphia Hospital, Breda, the Netherlands; 8Department of Dieticians, Amphia Hospital, Breda, the Netherlands; 9Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands; 10Department of Cardiovascular Science, University Hospitals Leuven, Leuven, BelgiumCorrespondence: Anne L Meulenbroek, Department of Surgery, Amphia Hospital, Molengracht 21, Breda, 4818 CK, the Netherlands, Tel +31 76 595 3157, Fax +31 76 595 3818, Email AMeulenbroek1@amphia.nlObjective: Chronic limb threatening ischemia is the final stage of peripheral arterial disease. Current treatment is based on revascularization to preserve the leg. In the older, hospitalized chronic limb threatening ischemia patient, delirium is a frequent and severe complication after revascularization. Delirium leads to an increased length of hospital stay, a higher mortality rate and a decrease in quality of life. Currently, no specific guidelines to prevent delirium in chronic limb threatening ischemia patients exist. We aim to evaluate the effect of a multicomponent, multidisciplinary prehabilitation program on the incidence of delirium in chronic limb threatening ischemia patients ≥ 65 years.Design: A prospective observational cohort study to investigate the effects of the program on the incidence of delirium will be performed in a large teaching hospital in the Netherlands. This manuscript describes the design of the study and the content of this specific prehabilitation program.Methods: Chronic limb threatening ischemia patients ≥ 65 years that require revascularization will participate in the program. This program focuses on optimizing the patient’s overall health and includes delirium risk assessment, nutritional optimization, home-based physical therapy, iron infusion in case of anaemia and a comprehensive geriatric assessment in case of frailty. The primary outcome is the incidence of delirium. Secondary outcomes include quality of life, amputation-free survival, length of hospital stay and mortality. Exclusion criteria are the requirement of acute treatment or patients who are mentally incompetent to understand the procedures of the study or to complete questionnaires. A historical cohort from the same hospital is used as a control group.Discussion: This study will clarify the effect of a prehabilitation program on delirium incidence in chronic limb threatening ischemia patients. New insights will be obtained on optimizing a patient’s preoperative mental and physical condition to prevent postoperative complications, including delirium.Trial: This protocol is registered at the Netherlands National Trial Register (NTR) number: NL9380.Keywords: chronic limb threatening ischemia, vascular surgical procedures, delirium, delirium/prevention and control, prehabilitation

Published
2022

3. Adjusting for confounding by indication in observational studies: a case study in traumatic brain injury

Author

Cnossen MC, van Essen TA, Ceyisakar IE, Polinder S, Andriessen TM, van der Naalt J, Haitsma I, Horn J, Franschman G, Vos PE, Peul WC, Menon DK, Maas AIR, Steyerberg EW, and Lingsma HF

Subjects
Confounding, observational studies, traumatic brain injury, instrumental variable analysis, comparative effectiveness research, Infectious and parasitic diseases, RC109-216
Abstract

Maryse C Cnossen,1 Thomas A van Essen,2,3 Iris E Ceyisakar,1 Suzanne Polinder,1 Teuntje M Andriessen,4 Joukje van der Naalt,5 Iain Haitsma,6 Janneke Horn,7 Gaby Franschman,8 Pieter E Vos,9 Wilco C Peul,2,3 David K Menon,10 Andrew IR Maas,11 Ewout W Steyerberg,1,12 Hester F Lingsma1 1Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; 2Neurosurgical Cooperative Holland, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands; 3Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands; 4Department of Psychology, RIVAS Healthcare Group, Gorinchem, the Netherlands; 5Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands; 6Department of Neurosurgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; 7Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 8Department of Anesthesiology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands; 9Department of Neurology, Slingeland Hospital, Doetinchem, the Netherlands; 10Division of Anaesthesia, University of Cambridge/Addenbrooke’s Hospital, Cambridge, UK; 11Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium; 12Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands Introduction: Observational studies of interventions are at risk for confounding by indication. The objective of the current study was to define the circumstances for the validity of methods to adjust for confounding by indication in observational studies. Patients and methods: We performed post hoc analyses of data prospectively collected from three European and North American traumatic brain injury studies including 1,725 patients. The effects of three interventions (intracranial pressure [ICP] monitoring, intracranial operation and primary referral) were estimated in a proportional odds regression model with the Glasgow Outcome Scale as ordinal outcome variable. Three analytical methods were compared: classical covariate adjustment, propensity score matching and instrumental variable (IV) analysis in which the percentage exposed to an intervention in each hospital was added as an independent variable, together with a random intercept for each hospital. In addition, a simulation study was performed in which the effect of a hypothetical beneficial intervention (OR 1.65) was simulated for scenarios with and without unmeasured confounders. Results: For all three interventions, covariate adjustment and propensity score matching resulted in negative estimates of the treatment effect (OR ranging from 0.80 to 0.92), whereas the IV approach indicated that both ICP monitoring and intracranial operation might be beneficial (OR per 10% change 1.17, 95% CI 1.01–1.42 and 1.42, 95% CI 0.95–1.97). In our simulation study, we found that covariate adjustment and propensity score matching resulted in an invalid estimate of the treatment effect in case of unmeasured confounders (OR ranging from 0.90 to 1.03). The IV approach provided an estimate in the similar direction as the simulated effect (OR per 10% change 1.04–1.05) but was statistically inefficient. Conclusion: The effect estimation of interventions in observational studies strongly depends on the analytical method used. When unobserved confounding and practice variation are expected in observational multicenter studies, IV analysis should be considered. Keywords: confounding, observational studies, traumatic brain injury, instrumental variable analysis, comparative effectiveness research

Published
2018

4. Evaluation of the Prevention and Reactivation Care Program (PReCaP) for the hospitalized elderly: a prospective nonrandomized controlled trial

Author

Asmus-Szepesi KJ, Flinterman LE, Koopmanschap MA, Nieboer AP, Bakker TJ, Mackenbach JP, and Steyerberg EW

Subjects
functional decline, hospitalized elderly, geriatric rehabilitation, Geriatrics, RC952-954.6
Abstract

Kirsten J Asmus-Szepesi,1 Linda E Flinterman,1 Marc A Koopmanschap,2 Anna P Nieboer,2 Ton J Bakker,3 Johan P Mackenbach,1 Ewout W Steyerberg1 1Department of Public Health, Erasmus University Medical Center, 2Institute of Health Policy and Management, Erasmus University, 3Stichting Wetenschap Balans, Rotterdam, the Netherlands Background: The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly.Methods: The prospective nonrandomized controlled trial reported here was performed in three hospitals in the Netherlands. One hospital implemented the Prevention and Reactivation Care Program (PReCaP), while two other hospitals providing usual care served as control settings. Within the PReCaP hospital we compared patients pre-implementation with patients post-implementation of the PReCaP (“within-hospital analysis”), while our nonrandomized controlled trial compared patients of the PReCaP hospital post-implementation with patients from the two control hospitals providing usual care (“between-hospital analysis”). Hospitalized patients 65 years or older and at risk of functional decline were interviewed at baseline and at 3 and 12 months using validated questionnaires to score functioning, depression, and health-related quality of life (HRQoL). We estimated costs per unit of care from hospital information systems and national data sources. We used adjusted general linear mixed models to analyze functioning and HRQoL.Results: Between-hospital analysis showed no difference in activities of daily living (ADL) or instrumental activities of daily living (IADL) between PReCaP patients and control groups. PReCaP patients did have slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI) 0.2–0.6]), lower depression (Geriatric Depression Scale 15; -0.9 [95% -1.1 to -0.6]) and higher perceived health (Short-Form 20; 5.6 [95% CI 2.8–8.4]) than control patients. Analyses within the PReCaP hospital comparing patients pre- and post-implementation of the PReCaP showed no improvement over time in functioning, depression, and HRQoL. One-year health care costs were higher for PReCaP patients, both for the within-hospital analysis (+€7,000) and the between-hospital analysis (+€2,500).Conclusion: We did not find any effect of the PReCaP on ADL and IADL. The PReCaP may possibly provide some benefits to hospitalized patients at risk of functional decline with respect to cognitive functioning, depression, and perceived health. Further evaluations of integrated intervention programs to limit functional decline are therefore required. Keywords: functional decline, geriatric rehabilitation, health-related quality of life, activities of daily living

Published
2015

5. Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age

Author

Raats JW, Flu HC, Ho GH, Veen EJ, Vos LD, Steyerberg EW, and van der Laan L

Subjects
Ruptured AAA, treatment outcome, elderly, clinical disicion making, Geriatrics, RC952-954.6
Abstract

Jelle W Raats,1 Hans C Flu,1 Gwan H Ho,1 Eelco J Veen,1 Louwerens D Vos,2 Ewout W Steyerberg,3 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Radiology, Amphia Hospital, Breda, 3Department of Public Health, Erasmus MC, Rotterdam, the Netherlands Background: Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR), conventional open repair (OPEN), and conservative treatment in elderly patients with rAAA.Methods: We conducted a retrospective study of all rAAA patients treated with OPEN or eEVAR between January 2005 and December 2011 in the vascular surgery department at Amphia Hospital, the Netherlands. The outcome in patients treated for rAAA by eEVAR or OPEN repair was investigated. Special attention was paid to patients who were admitted and did not receive operative intervention due to serious comorbidity, extremely advanced age, or poor physical condition. We calculated the 30-day rAAA-related mortality for all rAAA patients admitted to our hospital.Results: Twelve patients did not receive operative emergency repair due to extreme fragility (mean age 87 years, median time to mortality 27 hours). Twenty-three patients had eEVAR and 82 had OPEN surgery. The 30-day mortality rate in operated patients was 30% (7/23) in the eEVAR group versus 26% (21/82) in the OPEN group (P=0.64). No difference in mortality was noted between eEVAR and OPEN over 5 years of follow-up. There were more cardiac adverse events in the OPEN group (n=25, 31%) than in the eEVAR group (n=2, 9%; P=0.035). Reintervention after discharge was more frequent in patients who received eEVAR (35%) than in patients who had OPEN (6%, P

Published
2014

6. Neoadjuvant chemoradiation followed by surgery versus surgery alone for patients with adenocarcinoma or squamous cell carcinoma of the esophagus (CROSS)

Author

Richel DJ, Tilanus HW, Wijnhoven BPL, van Dekken H, Steyerberg EW, Muller K, van Berge Henegouwen MI, Koppert LB, van Lanschot JJB, van Heijl M, Busch ORC, Bartelsman JF, Koning CCE, Offerhaus GJ, and van der Gaast A

Subjects
Surgery, RD1-811
Abstract

Abstract Background A surgical resection is currently the preferred treatment for esophageal cancer if the tumor is considered to be resectable without evidence of distant metastases (cT1-3 N0-1 M0). A high percentage of irradical resections is reported in studies using neoadjuvant chemotherapy followed by surgery versus surgery alone and in trials in which patients are treated with surgery alone. Improvement of locoregional control by using neoadjuvant chemoradiotherapy might therefore improve the prognosis in these patients. We previously reported that after neoadjuvant chemoradiotherapy with weekly administrations of Carboplatin and Paclitaxel combined with concurrent radiotherapy nearly always a complete R0-resection could be performed. The concept that this neoadjuvant chemoradiotherapy regimen improves overall survival has, however, to be proven in a randomized phase III trial. Methods/design The CROSS trial is a multicenter, randomized phase III, clinical trial. The study compares neoadjuvant chemoradiotherapy followed by surgery with surgery alone in patients with potentially curable esophageal cancer, with inclusion of 175 patients per arm. The objectives of the CROSS trial are to compare median survival rates and quality of life (before, during and after treatment), pathological responses, progression free survival, the number of R0 resections, treatment toxicity and costs between patients treated with neoadjuvant chemoradiotherapy followed by surgery with surgery alone for surgically resectable esophageal adenocarcinoma or squamous cell carcinoma. Over a 5 week period concurrent chemoradiotherapy will be applied on an outpatient basis. Paclitaxel (50 mg/m2) and Carboplatin (Area-Under-Curve = 2) are administered by i.v. infusion on days 1, 8, 15, 22, and 29. External beam radiation with a total dose of 41.4 Gy is given in 23 fractions of 1.8 Gy, 5 fractions a week. After completion of the protocol, patients will be followed up every 3 months for the first year, every 6 months for the second year, and then at the end of each year until 5 years after treatment. Quality of life questionnaires will be filled out during the first year of follow-up. Discussion This study will contribute to the evidence on any benefits of neoadjuvant treatment in esophageal cancer patients using a promising chemoradiotherapy regimen. Trial registration ISRCTN80832026

Published
2008
Full Text
View/download PDF

7. Predictive value of updating framingham risk scores with novel risk markers in the U.S. general population

Author

Max, Wendy, Fleischmann, Kirsten, Ferket, BS, Van, BJH, Hunink, MGM, Agarwal, I, Kavousi, M, Franco, OH, Steyerberg, EW, and Fleischmann, KE

Abstract

Background: According to population-based cohort studies CT coronary calcium score (CTCS), carotid intima-media thickness (cIMT), high-sensitivity C- reactive protein (CRP), and ankle-brachial index (ABI) are promising novel risk markers for improving card

Published
2014

8. Personalized Prediction of Lifetime Benefits with Statin Therapy for Asymptomatic Individuals: A Modeling Study

Author

Fleischmann, Kirsten, Ferket, BS, van, BJH, Heeringa, J, Spronk, S, Fleischmann, KE, Nijhuis, RLG, Hofman, A, Steyerberg, EW, and Hunink, MGM

Abstract

Background: Physicians need to inform asymptomatic individuals about personalized outcomes of statin therapy for primary prevention of cardiovascular disease (CVD). However, current prediction models focus on short-term outcomes and ignore the competing ri

Published
2012

9. Vibrational spectroscopy for the triage of traumatic brain injury computed tomography priority and hospital admissions

Author

Theakstone, AG, Brennan, PM, Ashton, K, Czeiter, E, Jenkinson, MD, Syed, K, Reed, MJ, Baker, MJ, Åkerlund, C, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, ML, Bartels, R, Barzó, P, Beauvais, R, Beer, R, Bellander, B-M, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, MR, Cameron, P, Lozano, GC, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Citerio, G, Clusmann, H, Coburn, M, Coles, J, Cooper, JD, Correia, M, Amra Čović, A, Curry, N, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, Dawes, H, Keyser, VD, Degos, V, Corte, FD, Boogert, HD, Depreitere, B, Đilvesi, Đ, Dixit, A, Donoghue, E, Dreier, J, Dulière, G-L, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, VL, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, PA, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, RL, Gupta, D, Haagsma, JA, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, PJ, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J-Y, Johnson, F, Jones, K, Karan, M, Kolias, AG, Kompanje, E, Kondziella, D, Kornaropoulos, E, Koskinen, L-O, Kovács, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledoux, D, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, AIR, Castaño-León, AM, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Maréchal, H, Mattern, J, McMahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyirádi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, PM, Payen, J-F, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Pisica, D, Ples, H, Polinder, S, Pomposo, I, Posti, JP, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Helmrich, IR, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, JV, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnák, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schäfer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, RF, Schwendenwein, E, Sewalt, C, Singh, RD, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevens, R, Stewart, W, Steyerberg, EW, Stocchetti, N, Sundström, N, Takala, R, Tamás, V, Tamosuitis, T, Taylor, MS, Ao, BT, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, CM, Unterberg, A, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, Jagt, MVD, Steen, GVD, Naalt, JVD, van Dijck, JTJM, van Erp, IA, van Essen, TA, Van Hecke, W, van Heugten, C, Van Praag, D, van Veen, E, Vyvere, TV, van Wijk, RPJ, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, PM, Vik, A, Vilcinis, R, Volovici, V, Steinbüchel, NV, Voormolen, D, Vulekovic, P, Wang, KKW, Whitehouse, D, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylén, P, Younsi, A, Zeiler, FA, Zelinkova, V, Ziverte, A, and Zoerle, T

Abstract

Computed tomography (CT) brain imaging is routinely used to support clinical decision-making in patients with traumatic brain injury (TBI). Only 7% of scans, however, demonstrate evidence of TBI. The other 93% of scans contribute a significant cost to the healthcare system and a radiation risk to patients. There may be better strategies to identify which patients, particularly those with mild TBI, are at risk of deterioration and require hospital admission. We introduce a blood serum liquid biopsy that utilizes attenuated total reflectance (ATR)-Fourier transform infrared (FTIR) spectroscopy with machine learning algorithms as a decision-making tool to identify which patients with mild TBI will most likely present with a positive CT scan. Serum samples were obtained from patients (n = 298) patients who had acquired a TBI and were enrolled in CENTER-TBI and from asymptomatic control patients (n = 87). Injury patients (all severities) were stratified against non-injury controls. The cohort with mild TBI was further examined by stratifying those who had at least one CT abnormality against those who had no CT abnormalities. The test performed exceptionally well in classifications of patients with mild injury versus non-injury controls (sensitivity = 96.4% and specificity = 98.0%) and also provided a sensitivity of 80.2% when stratifying mild patients with at least one CT abnormality against those without. The results provided illustrate the test ability to identify four of every five CT abnormalities and show great promise to be introduced as a triage tool for CT priority in patients with mild TBI.

Published
2022

10. A new approach to evidence synthesis in traumatic brain injury: Living systematic reviews

Author

Synnot, Anneliese, Gruen, RL, Menon, D, Steyerberg, EW, Buki, A, Peul, W, Elliott, JH, and Maas, A

Subjects
Uncategorized
Abstract

Living systematic reviews (LSRs) are online summaries of health care research that are updated as new research becomes available. This new development in evidence synthesis is being trialled as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) project. We will develop and sustain an international TBI knowledge community that maintains up-to-date, high quality LSRs of the current state of knowledge in the most important questions in TBI. Automatic search updates will be run three-monthly, and newly identified studies incorporated into the review. Review teams will seek to publish journal updates at regular intervals, with abridged updates available more frequently online. Future project stages include the integration of LSR and other study findings into "living"clinical practice guidance. It is hoped these efforts will go some way to bridging current temporal disconnects between evidence, guidelines, and practice in TBI.

Published
2022
Full Text
View/download PDF

11. Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients : a CENTER-TBI study

Author

van Veen, E, van der Jagt, M, Citerio, G, Stocchetti, N, Gommers, D, Burdorf, A, Menon, DK, Maas, AIR, Kompanje, EJO, Lingsma, HF, Åkerlund, C, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, ML, Bartels, R, Barzó, P, Beauvais, R, Beer, R, Bellander, B-M, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, MR, Cameron, P, Lozano, GC, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Clusmann, H, Coburn, M, Coles, J, Cooper, JD, Correia, M, Čović, A, Curry, N, Czeiter, E, Czosnyka, M, Fizelier, CD, Dark, P, Dawes, H, De Keyser, V, Degos, V, Corte, FD, den Boogert, H, Depreitere, B, Đilvesi, Đ, Dixit, A, Donoghue, E, Dreier, J, Dulière, GL, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, VL, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, PA, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, RL, Gupta, D, Haagsma, JA, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, PJ, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, JY, Johnson, F, Jones, K, Karan, M, Kolias, AG, Kompanje, E, Kondziella, D, Kornaropoulos, E, Koskinen, LO, Kovács, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledoux, D, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Castaño, AML, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Maréchal, H, Mattern, J, McMahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyirádi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, PM, Payen, JF, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Pisica, D, Ples, H, Polinder, S, Pomposo, I, Posti, JP, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Helmrich, IR, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, JV, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnák, M, Sahuquillo, J, Sakowitz, O, Porras, RS, Sandor, J, Schäfer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, RF, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevens, R, Stewart, W, Steyerberg, EW, Sundström, N, Takala, R, Tamás, V, Tamosuitis, T, Taylo, MS, Ao, BT, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, CM, Unterberg, A, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, Van der Steen, G, van der Naalt, J, van Dijck, JTJM, van Essen, TA, Van Hecke, W, van Heugten, C, Van Praag, D, Vyvere, TV, van Wijk, RPJ, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, PM, Vik, A, Vilcinis, R, Volovici, V, von Steinbüchel, N, Voormolen, D, Vulekovic, P, Wang, KKW, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylén, P, Younsi, A, Zeiler, FA, Zelinkova, V, Ziverte, A, Zoerle, T, van Veen, Ernest [0000-0002-5495-3996], and Apollo - University of Cambridge Repository

Subjects
Critical care, Traumatic brain injury, WLSM, Original, Intensive care unit
Abstract

Background\ud \ud In patients with severe brain injury, withdrawal of life-sustaining measures (WLSM) is common in intensive care units (ICU). WLSM constitutes a dilemma: instituting WLSM too early could result in death despite the possibility of an acceptable functional outcome, whereas delaying WLSM could unnecessarily burden patients, families, clinicians, and hospital resources. We aimed to describe the occurrence and timing of WLSM, and factors associated with timing of WLSM in European ICUs in patients with traumatic brain injury (TBI).\ud \ud \ud \ud Methods\ud \ud The CENTER-TBI Study is a prospective multi-center cohort study. For the current study, patients with traumatic brain injury (TBI) admitted to the ICU and aged 16 or older were included. Occurrence and timing of WLSM were documented. For the analyses, we dichotomized timing of WLSM in early (

Published
2021

12. Comparison of methods for predicting COVID-19-related death in the general population using the OpenSAFELY platform

Author

Williamson, EJ, Tazare, J, Bhaskaran, K, McDonald, HI, Walker, AJ, Tomlinson, L, Wing, K, Bacon, S, Bates, C, Curtis, HJ, Forbes, HJ, Minassian, C, Morton, CE, Nightingale, E, Mehrkar, A, Evans, D, Nicholson, BD, Leon, DA, Inglesby, P, MacKenna, B, Davies, NG, DeVito, NJ, Drysdale, H, Cockburn, J, Hulme, WJ, Morley, J, Douglas, I, Rentsch, CT, Mathur, R, Wong, A, Schultze, A, Croker, R, Parry, J, Hester, F, Harper, S, Grieve, R, Harrison, DA, Steyerberg, EW, Eggo, RM, Diaz-Ordaz, K, Keogh, R, Evans, SJW, Smeeth, L, Goldacre, B, and Collaborative, OpenSAFELY

Abstract

Background Obtaining accurate estimates of the risk of COVID-19-related death in the general population is challenging in the context of changing levels of circulating infection. Methods We propose a modelling approach to predict 28-day COVID-19-related death which explicitly accounts for COVID-19 infection prevalence using a series of sub-studies from new landmark times incorporating time-updating proxy measures of COVID-19 infection prevalence. This was compared with an approach ignoring infection prevalence. The target population was adults registered at a general practice in England in March 2020. The outcome was 28-day COVID-19-related death. Predictors included demographic characteristics and comorbidities. Three proxies of local infection prevalence were used: model-based estimates, rate of COVID-19-related attendances in emergency care, and rate of suspected COVID-19 cases in primary care. We used data within the TPP SystmOne electronic health record system linked to Office for National Statistics mortality data, using the OpenSAFELY platform, working on behalf of NHS England. Prediction models were developed in case-cohort samples with a 100-day follow-up. Validation was undertaken in 28-day cohorts from the target population. We considered predictive performance (discrimination and calibration) in geographical and temporal subsets of data not used in developing the risk prediction models. Simple models were contrasted to models including a full range of predictors. Results Prediction models were developed on 11,972,947 individuals, of whom 7999 experienced COVID-19-related death. All models discriminated well between individuals who did and did not experience the outcome, including simple models adjusting only for basic demographics and number of comorbidities: C-statistics 0.92–0.94. However, absolute risk estimates were substantially miscalibrated when infection prevalence was not explicitly modelled. Conclusions Our proposed models allow absolute risk estimation in the context of changing infection prevalence but predictive performance is sensitive to the proxy for infection prevalence. Simple models can provide excellent discrimination and may simplify implementation of risk prediction tools.

Published
2021

13. Health-related quality of life after traumatic brain injury : deriving value sets for the QOLIBRI-OS for Italy, The Netherlands and The United Kingdom

Author

Voormolen, DC, Polinder, S, von Steinbuechel, N, Feng, Y, Wilson, L, Oppe, M, Haagsma, JA, Åkerlund, C, Adams, H, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, ML, Bartels, R, Barzó, P, Beauvais, R, Beer, R, Bellander, B-M, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, MR, Cameron, P, Lozano, GC, Carbonara, M, Castaño-León, AM, Chevallard, G, Chieregato, A, Citerio, G, Cnossen, M, Coburn, M, Coles, J, Cooper, JD, Correia, M, Čović, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dawes, H, De Keyser, V, Degos, V, Corte, FD, Boogert, HD, Depreitere, B, Đilvesi, Đ, Dixit, A, Donoghue, E, Dreier, J, Dulière, G-L, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, VL, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, PA, Gratz, J, Gravesteijn, B, Grossi, F, L.Gruen, R, Gupta, D, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, PJ, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J-Y, Jones, K, Karan–, M, Kolias, AG, Kompanje, E, Kondziella, D, Koskinen, L-O, Kovács, N, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, AIR, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Maréchal, H, Mattern, J, McFadyen, C, McMahon, C, Melegh, B, Menon, D, Menovsky, T, Mulazzi, D, Muraleedharan, V, Murray, L, Nair, N, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Noirhomme, Q, Nyirádi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, PM, Payen, J-F, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Ples, H, Pomposo, I, Posti, JP, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Real, R, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, JV, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnák, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schäfer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, RF, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevanovic, A, Stevens, R, Stewart, W, Steyerberg, EW, Stocchetti, N, Sundström, N, Synnot, A, Takala, R, Tamás, V, Tamosuitis, T, Taylor, MS, Ao, BT, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, CM, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, Van der Steen, G, van der Naalt, J, van Dijck, JTJM, van Essen, T, Van Hecke, W, van Heugten, C, Van Praag, D, Vyvere, TV, Vanhaudenhuyse, A, van Wijk, RPJ, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, PM, Vik, A, Vilcinis, R, Volovici, V, von Steinbüchel, N, Voormolen, D, Vulekovic, P, Wang, KKW, Wiegers, E, Williams, G, Wolf, S, Yang, Z, Ylén, P, Younsi, A, Zeiler, FA, Zelinkova, V, Ziverte, A, Zoerle, T, Voormolen, D. C., Polinder, S., von Steinbuechel, N., Feng, Y., Wilson, L., Oppe, M., Haagsma, J. A., Akerlund, C., Adams, H., Amrein, K., Andelic, N., Andreassen, L., Anke, A., Antoni, A., Audibert, G., Azouvi, P., Azzolini, M. L., Bartels, R., Barzo, P., Beauvais, R., Beer, R., Bellander, B. -M., Belli, A., Benali, H., Berardino, M., Beretta, L., Blaabjerg, M., Bragge, P., Brazinova, A., Brinck, V., Brooker, J., Brorsson, C., Buki, A., Bullinger, M., Cabeleira, M., Caccioppola, A., Calappi, E., Calvi, M. R., Cameron, P., Lozano, G. C., Carbonara, M., Castano-Leon, A. M., Chevallard, G., Chieregato, A., Citerio, G., Cnossen, M., Coburn, M., Coles, J., Cooper, J. D., Correia, M., Covic, A., Curry, N., Czeiter, E., Czosnyka, M., Dahyot-Fizelier, C., Dawes, H., De Keyser, V., Degos, V., Corte, F. D., Boogert, H., Depreitere, B., Dilvesi, D., Dixit, A., Donoghue, E., Dreier, J., Duliere, G. -L., Ercole, A., Esser, P., Ezer, E., Fabricius, M., Feigin, V. L., Foks, K., Frisvold, S., Furmanov, A., Gagliardo, P., Galanaud, D., Gantner, D., Gao, G., George, P., Ghuysen, A., Giga, L., Glocker, B., Golubovic, J., Gomez, P. A., Gratz, J., Gravesteijn, B., Grossi, F., L. Gruen, R., Gupta, D., Haitsma, I., Helbok, R., Helseth, E., Horton, L., Huijben, J., Hutchinson, P. J., Jacobs, B., Jankowski, S., Jarrett, M., Jiang, J. -Y., Jones, K., Karan-, M., Kolias, A. G., Kompanje, E., Kondziella, D., Koskinen, L. -O., Kovacs, N., Lagares, A., Lanyon, L., Laureys, S., Lecky, F., Lefering, R., Legrand, V., Lejeune, A., Levi, L., Lightfoot, R., Lingsma, H., Maas, A. I. R., Maegele, M., Majdan, M., Manara, A., Manley, G., Martino, C., Marechal, H., Mattern, J., Mcfadyen, C., Mcmahon, C., Melegh, B., Menon, D., Menovsky, T., Mulazzi, D., Muraleedharan, V., Murray, L., Nair, N., Negru, A., Nelson, D., Newcombe, V., Nieboer, D., Noirhomme, Q., Nyiradi, J., Olubukola, O., Oresic, M., Ortolano, F., Palotie, A., Parizel, P. M., Payen, J. -F., Perera, N., Perlbarg, V., Persona, P., Peul, W., Piippo-Karjalainen, A., Pirinen, M., Ples, H., Pomposo, I., Posti, J. P., Puybasset, L., Radoi, A., Ragauskas, A., Raj, R., Rambadagalla, M., Real, R., Rhodes, J., Richardson, S., Richter, S., Ripatti, S., Rocka, S., Roe, C., Roise, O., Rosand, J., Rosenfeld, J. V., Rosenlund, C., Rosenthal, G., Rossaint, R., Rossi, S., Rueckert, D., Rusnak, M., Sahuquillo, J., Sakowitz, O., Sanchez-Porras, R., Sandor, J., Schafer, N., Schmidt, S., Schoechl, H., Schoonman, G., Schou, R. F., Schwendenwein, E., Sewalt, C., Skandsen, T., Smielewski, P., Sorinola, A., Stamatakis, E., Stanworth, S., Stevanovic, A., Stevens, R., Stewart, W., Steyerberg, E. W., Stocchetti, N., Sundstrom, N., Synnot, A., Takala, R., Tamas, V., Tamosuitis, T., Taylor, M. S., Ao, B. T., Tenovuo, O., Theadom, A., Thomas, M., Tibboel, D., Timmers, M., Tolias, C., Trapani, T., Tudora, C. M., Vajkoczy, P., Vallance, S., Valeinis, E., Vamos, Z., Van der Steen, G., van der Naalt, J., van Dijck, J. T. J. M., van Essen, T., Van Hecke, W., van Heugten, C., Van Praag, D., Vyvere, T. V., Vanhaudenhuyse, A., van Wijk, R. P. J., Vargiolu, A., Vega, E., Velt, K., Verheyden, J., Vespa, P. M., Vik, A., Vilcinis, R., Volovici, V., von Steinbuchel, N., Voormolen, D., Vulekovic, P., Wang, K. K. W., Wiegers, E., Williams, G., Wolf, S., Yang, Z., Ylen, P., Younsi, A., Zeiler, F. A., Zelinkova, V., Ziverte, A., Zoerle, T., Centre of Excellence in Complex Disease Genetics, Research Programs Unit, Aarno Palotie / Principal Investigator, Institute for Molecular Medicine Finland, Genomics of Neurological and Neuropsychiatric Disorders, HUS Neurocenter, Neurokirurgian yksikkö, Helsinki Institute for Information Technology, Statistical and population genetics, Department of Mathematics and Statistics, Biostatistics Helsinki, Clinicum, Helsinki University Hospital Area, Department of Public Health, Samuli Olli Ripatti / Principal Investigator, Complex Disease Genetics, Section Neuropsychology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: FPN NPPP I, Psychiatrie & Neuropsychologie, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Rocka, Saulius, Tamosuitis, Tomas, „Springer' grupė, Molecular Neuroscience and Ageing Research (MOLAR), Public Health, Voormolen, Daphne C [0000-0003-0449-0708], Apollo - University of Cambridge Repository, Voormolen, D, Polinder, S, von Steinbuechel, N, Feng, Y, Wilson, L, Oppe, M, Haagsma, J, Akerlund, C, Adams, H, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Barzo, P, Beauvais, R, Beer, R, Bellander, B, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Lozano, G, Carbonara, M, Castano-Leon, A, Chevallard, G, Chieregato, A, Citerio, G, Cnossen, M, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dawes, H, De Keyser, V, Degos, V, Corte, F, Boogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, P, Gratz, J, Gravesteijn, B, Grossi, F, L. Gruen, R, Gupta, D, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, P, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J, Jones, K, Karan-, M, Kolias, A, Kompanje, E, Kondziella, D, Koskinen, L, Kovacs, N, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, A, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Marechal, H, Mattern, J, Mcfadyen, C, Mcmahon, C, Melegh, B, Menon, D, Menovsky, T, Mulazzi, D, Muraleedharan, V, Murray, L, Nair, N, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Noirhomme, Q, Nyiradi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Ples, H, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Real, R, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnak, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schafer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevanovic, A, Stevens, R, Stewart, W, Steyerberg, E, Stocchetti, N, Sundstrom, N, Synnot, A, Takala, R, Tamas, V, Tamosuitis, T, Taylor, M, Ao, B, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, C, Vajkoczy, P, Vallance, S, Valeinis, E, Vamos, Z, Van der Steen, G, van der Naalt, J, van Dijck, J, van Essen, T, Van Hecke, W, van Heugten, C, Van Praag, D, Vyvere, T, Vanhaudenhuyse, A, van Wijk, R, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Volovici, V, von Steinbuchel, N, Vulekovic, P, Wang, K, Wiegers, E, Williams, G, Wolf, S, Yang, Z, Ylen, P, Younsi, A, Zeiler, F, Zelinkova, V, Ziverte, A, and Zoerle, T

Subjects
Male, CONJOINT-ANALYSIS, Neurologi, VALUATION, Health-related quality of life, Discrete choice experiment, 0302 clinical medicine, Traumatic brain injury, Surveys and Questionnaires, Brain Injuries, Traumatic, SCALE, media_common, Netherlands, 030503 health policy & services, Health utilities, Health-related quality of life, Quality of life after brain injury overall scale (QOLIBRI-OS), Traumatic brain injury, Value set, Art, Middle Aged, STATE, 3142 Public health care science, environmental and occupational health, 3. Good health, Neurology, Italy, Female, 0305 other medical science, Quality of life after brain injury overall scale (QOLIBRI-OS), Adult, Value set, Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi, DISCRETE-CHOICE EXPERIMENTS, Adolescent, media_common.quotation_subject, Article, 03 medical and health sciences, Kingdom, Young Adult, SDG 3 - Good Health and Well-being, Inigo, Humans, Quality of Life Research, Aged, Health related quality of life, Public Health, Environmental and Occupational Health, Health Care Service and Management, Health Policy and Services and Health Economy, EUROQOL, United Kingdom, 3141 Health care science, health utilities, health-related quality of life, quality of life after brain injury overall scale (QOLIBRI-OS), traumatic brain injury, value set, Health utilities, PREFERENCE-BASED MEASURES, Quality of Life, Humanities, 030217 neurology & neurosurgery
Abstract

PURPOSE: The Quality of Life after Brain Injury overall scale (QOLIBRI-OS) measures health-related quality of life (HRQoL) after traumatic brain injury (TBI). The aim of this study was to derive value sets for the QOLIBRI-OS in three European countries, which will allow calculation of utility scores for TBI health states. METHODS: A QOLIBRI-OS value set was derived by using discrete choice experiments (DCEs) and visual analogue scales (VAS) in general population samples from the Netherlands, United Kingdom and Italy. A three-stage procedure was used: (1) A selection of health states, covering the entire spectrum of severity, was defined; (2) General population samples performed the health state valuation task using a web-based survey with three VAS questions and an at random selection of sixteen DCEs; (3) DCEs were analysed using a conditional logistic regression and were then anchored on the VAS data. Utility scores for QOLIBRI-OS health states were generated resulting in estimates for all potential health states. RESULTS: The questionnaire was completed by 13,623 respondents. The biggest weight increase for all attributes is seen from "slightly" to "not at all satisfied", resulting in the largest impact on HRQoL. "Not at all satisfied with how brain is working" should receive the greatest weight in utility calculations in all three countries. CONCLUSION: By transforming the QOLIBRI-OS into utility scores, we enabled the application in economic evaluations and in summary measures of population health, which may be used to inform decision-makers on the best interventions and strategies for TBI patients., Hannelore Kohl Stiftung (Germany) OneMind (USA) Integra LifeSciences Corporation (USA)

Published
2020

14. Variation in the practice of tracheal intubation in Europe after traumatic brain injury : a prospective cohort study

Author

Gravesteijn, BY, Sewalt, CA, Ercole, A, Lecky, F, Menon, D, Steyerberg, EW, Maas, AIR, Lingsma, HF, Klimek, M, Åkerlund, C, Adams, H, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Beer, R, Bellander, B, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Borgen, L, Brorsson, C, Buki, A, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Carbayo, L, Carbonara, M, León, A, Chevallard, G, Chieregato, A, Citerio, G, Coburn, M, Coles, J, Cooper, J, Correia, M, Cnossen, M, Czeiter, E, Czosnyka, M, Fizelier, C, De Keyser, V, Degos, V, Della Corte, F, Boogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Donoghue, E, Dreier, J, Dulière, G, Ercole Ari, A, Ezer, E, Fabricius, M, Foks, K, Frisvold, S, Furmanov, A, Galanaud, D, Gantner, D, Ghuysen, A, Giga, L, Golubovic, J, Gomez, P, Grossi, F, Gupta, D, Haitsma, I, Helbok, R, Helseth, E, Hutchinson, P, Jankowski, S, Karan, M, Kolias, A, Kondziella, D, Koskinen, L, Kovács, N, Lagares, A, Laureys, S, Lightfoot, R, Lingsma, H, Maas, A, Manara, A, Martino, C, Maréchal, H, Mattern, J, McFadyen, C, McMahon, C, Menovsky, T, Mulazzi, D, Muraleedharan, V, Murray, L, Nair, N, Negru, A, Nelson, D, Newcombe, V, Noirhomme, Q, Nyirádi, J, Ortolano, F, Payen, J, Perlbarg, V, Persona, P, Peul, W, Piippo‐Karjalainen, A, Ples, H, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Richter, S, Rocka, S, Roe, C, Roise, O, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Sahuquillo, J, Sandro, O, Sakowitz, O, Porras, R, Schirmer‐Mikalsen, K, Schou Rico, F, Smielewski, P, Sorinola, A, Stamatakis, E, Kowalk, A, Steyerberg, E, Stocchetti, N, Sundström, N, Takala, R, Tamás, V, Tamosuitis, T, Tenovuo, O, Thomas, M, Tibboel, D, Tolias, C, Trapani, T, Tudora, C, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, Van der Steen, G, van Dijck, J, Essen, T, Vanhaudenhuyse, A, Wijk, R, Vargiolu, A, Vega, E, Vik, A, Vilcinis, R, Volovici, V, Voormolen, D, Vulekovic, P, Williams, G, Wolf, S, Younsi, A, Zeiler, F, Ziverte, A, and Zoerle, T

Abstract

Traumatic brain injury patients frequently undergo tracheal intubation. We aimed to assess current intubationpractice in Europe and identify variation in practice. We analysed data from patients with traumatic brain injuryincluded in the prospective cohort study collaborative European neurotrauma effectiveness research intraumatic brain injury (CENTER-TBI) in 45 centres in 16 European countries. We included patients who weretransported to hospital by emergency medical services. We used mixed-effects multinomial regression toquantify the effects on pre-hospital or in-hospital tracheal intubation of the following: patient characteristics;injury characteristics; centre; and trauma system characteristics. A total of 3843 patients were included. Ofthese, 1322 (34%) had their tracheas intubated; 839 (22%) pre-hospital and 483 (13%) in-hospital. Thefit of themodel with only patient characteristics predicting intubation was good (Nagelkerke R2 64%). The probability oftracheal intubation increased with the following: younger age; lower pre-hospital or emergency departmentGCS; higher abbreviated injury scale scores (head and neck, thorax and chest, face or abdomen abbreviatedinjury score); and one or more unreactive pupils. The adjusted median odds ratio for intubation between tworandomly chosen centres was 3.1 (95%CI 2.1–4.3) for pre-hospital intubation, and 2.7 (95%CI 1.9–3.5) for in-hospital intubation. Furthermore, the presence of an anaesthetist was independently associated with more pre-hospital intubation (OR 2.9, 95%CI 1.3–6.6), in contrast to the presence of ambulance personnel who areallowed to intubate (OR 0.5, 95%CI 0.3–0.8). In conclusion, patient and injury characteristics are key drivers oftracheal intubation. Between-centre differences were also substantial. Further studies are needed to improvethe evidence base supporting recommendations for tracheal intubation.

Published
2019

18. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI

Author

Cnossen, MC, Huijben, JA, van der Jagt, M, Volovici, V, van Essen, T, Polinder, S, Nelson, D, Ercole, A, Stocchetti, N, Citerio, G, Peul, WC, Maas, AIR, Menon, D, Steyerberg, EW, Ligsma, HF, Ercole, Ari [0000-0001-8350-8093], Menon, David [0000-0002-3228-9692], and Apollo - University of Cambridge Repository

Subjects
ICP, Intracranial hypertension, Europe, Traumatic brain injury, Clinical Protocols, Trauma Centers, Surveys and Questionnaires, ICU, Brain Injuries, Traumatic, Humans, Longitudinal Studies, Prospective Studies, Comparative effectiveness research, Survey, Monitoring, Physiologic
Abstract

Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed based on literature and expert opinion, and pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n = 60, 91%) and designated level I trauma centers (n = 44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately ninety percent of the participants (n = 58) indicated placing an ICP monitor in patients with severe TBI and computed tomography abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as having a relatively aggressive approach to ICP monitoring and treatment (n = 32, 48%), whereas the others were considered more conservative (n = 34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with traumatic brain injury and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research.

Published
2017
Full Text
View/download PDF

19. Erratum to:Methods for evaluating medical tests and biomarkers

Author

Gopalakrishna, G, Langendam, M, Scholten, R, Bossuyt, P, Leeflang, M, Noel-Storr, A, Thomas, J, Marshall, I, Wallace, B, Whiting, P, Davenport, C, GopalaKrishna, G, De Salis, I, Mallett, S, Wolff, R, Riley, R, Westwood, M, Kleinen, J, Collins, G, Reitsma, H, Moons, K, Zapf, A, Hoyer, A, Kramer, K, Kuss, O, Ensor, J, Deeks, JJ, Martin, EC, Riley, RD, Rücker, G, Steinhauser, S, Schumacher, M, Snell, K, Willis, B, Debray, T, Deeks, J, Di Ruffano, LF, Taylor-Phillips, S, Hyde, C, Taylor, SA, Batnagar, G, STREAMLINE COLON Investigators, STREAMLINE LUNG Investigators, METRIC Investigators, Seedat, F, Clarke, A, Byron, S, Nixon, F, Albrow, R, Walker, T, Deakin, C, Zhelev, Z, Hunt, H, Yang, Y, Abel, L, Buchanan, J, Fanshawe, T, Shinkins, B, Wynants, L, Verbakel, J, Van Huffel, S, Timmerman, D, Van Calster, B, Zwinderman, A, Oke, J, O'Sullivan, J, Perera, R, Nicholson, B, Bromley, HL, Roberts, TE, Francis, A, Petrie, D, Mann, GB, Malottki, K, Smith, H, Billingham, L, Sitch, A, Gerke, O, Holm-Vilstrup, M, Segtnan, EA, Halekoh, U, Høilund-Carlsen, PF, Francq, BG, Dinnes, J, Parkes, J, Gregory, W, Hewison, J, Altman, D, Rosenberg, W, Selby, P, Asselineau, J, Perez, P, Paye, A, Bessede, E, Proust-Lima, C, Naaktgeboren, C, De Groot, J, Rutjes, A, Reitsma, J, Ogundimu, E, Cook, J, Le Manach, Y, Vergouwe, Y, Pajouheshnia, R, Groenwold, R, Peelen, L, Nieboer, D, De Cock, B, Pencina, MJ, Steyerberg, EW, Cooper, J, Parsons, N, Stinton, C, Smith, S, Dickens, A, Jordan, R, Enocson, A, Fitzmaurice, D, Adab, P, Boachie, C, Vidmar, G, Freeman, K, Connock, M, Court, R, Moons, C, Harris, J, Mumford, A, Plummer, Z, Lee, K, Reeves, B, Rogers, C, Verheyden, V, Angelini, GD, Murphy, GJ, Huddy, J, Ni, M, Good, K, Cooke, G, Hanna, G, Ma, J, Moons, KGMC, De Groot, JAH, Altman, DG, Reitsma, JB, Collins, GS, Moons, KGM, Kamarudin, AN, Kolamunnage-Dona, R, Cox, T, Borsci, S, Pérez, T, Pardo, MC, Candela-Toha, A, Muriel, A, Zamora, J, Sanghera, S, Mohiuddin, S, Martin, R, Donovan, J, Coast, J, Seo, MK, Cairns, J, Mitchell, E, Smith, A, Wright, J, Hall, P, Messenger, M, Calder, N, Wickramasekera, N, Vinall-Collier, K, Lewington, A, Damen, J, Cairns, D, Hutchinson, M, Sturgeon, C, Mitchel, L, Kift, R, Christakoudi, S, Rungall, M, Mobillo, P, Montero, R, Tsui, T-L, Kon, SP, Tucker, B, Sacks, S, Farmer, C, Strom, T, Chowdhury, P, Rebollo-Mesa, I, Hernandez-Fuentes, M, Damen, JAAG, Debray, TPA, Heus, P, Hooft, L, Scholten, RJPM, Schuit, E, Tzoulaki, I, Lassale, CM, Siontis, GCM, Chiocchia, V, Roberts, C, Schlüssel, MM, Gerry, S, Black, JA, Van der Schouw, YT, Peelen, LM, Spence, G, McCartney, D, Van den Bruel, A, Lasserson, D, Hayward, G, Vach, W, De Jong, A, Burggraaff, C, Hoekstra, O, Zijlstra, J, De Vet, H, Graziadio, S, Allen, J, Johnston, L, O'Leary, R, Power, M, Johnson, L, Waters, R, Simpson, J, Fanshawe, TR, Phillips, P, Plumb, A, Helbren, E, Halligan, S, Gale, A, Sekula, P, Sauerbrei, W, Forman, JR, Dutton, SJ, Takwoingi, Y, Hensor, EM, Nichols, TE, Kempf, E, Porcher, R, De Beyer, J, Hopewell, S, Dennis, J, Shields, B, Jones, A, Henley, W, Pearson, E, Hattersley, A, MASTERMIND consortium, Scheibler, F, Rummer, A, Sturtz, S, Großelfinger, R, Banister, K, Ramsay, C, Azuara-Blanco, A, Burr, J, Kumarasamy, M, Bourne, R, Uchegbu, I, Murphy, J, Carter, A, Marti, J, Eatock, J, Robotham, J, Dudareva, M, Gilchrist, M, Holmes, A, Monaghan, P, Lord, S, StJohn, A, Sandberg, S, Cobbaert, C, Lennartz, L, Verhagen-Kamerbeek, W, Ebert, C, Horvath, A, Test Evaluation Working Group of the European Federation of Clinical Chemistry and Laboratory Medicine, Jenniskens, K, Peters, J, Grigore, B, Ukoumunne, O, Levis, B, Benedetti, A, Levis, AW, Ioannidis, JPA, Shrier, I, Cuijpers, P, Gilbody, S, Kloda, LA, McMillan, D, Patten, SB, Steele, RJ, Ziegelstein, RC, Bombardier, CH, Osório, FDL, Fann, JR, Gjerdingen, D, Lamers, F, Lotrakul, M, Loureiro, SR, Löwe, B, Shaaban, J, Stafford, L, Van Weert, HCPM, Whooley, MA, Williams, LS, Wittkampf, KA, Yeung, AS, Thombs, BD, Cooper, C, Nieto, T, Smith, C, Tucker, O, Dretzke, J, Beggs, A, Rai, N, Bayliss, S, Stevens, S, Mallet, S, Sundar, S, Hall, E, Porta, N, Estelles, DL, De Bono, J, CTC-STOP protocol development group, and National Institute for Health Research

Subjects
medicine.medical_specialty, Astrophysics::High Energy Astrophysical Phenomena, MEDLINE, 030204 cardiovascular system & hematology, BTC (Bristol Trials Centre), MASTERMIND consortium, 03 medical and health sciences, 0302 clinical medicine, medicine, 030212 general & internal medicine, Intensive care medicine, CTC-STOP protocol development group, lcsh:R5-920, business.industry, Test Evaluation Working Group of the European Federation of Clinical Chemistry and Laboratory Medicine, Published Erratum, STREAMLINE COLON Investigators, 3. Good health, STREAMLINE LUNG Investigators, Centre for Surgical Research, Family medicine, METRIC Investigators, High Energy Physics::Experiment, Erratum, business, lcsh:Medicine (General)
Abstract

[This corrects the article DOI: 10.1186/s41512-016-0001-y.].

Published
2017

25. Simple dichotomous updating methods improved the validity of polytomous models

Author

Van Hoorde, Kirsten, Vergouwe, Y, Timmerman, Dirk, Van Huffel, Sabine, Steyerberg, EW, and Van Calster, Ben

Abstract

OBJECTIVES: Prediction models may perform poorly in a new setting. We aimed to determine which model updating methods should be applied for models predicting polytomous outcomes, which often suffer from one or more categories with low prevalence. STUDY DESIGN AND SETTING: We used case studies on testicular and ovarian tumors. The original regression models were based on 502 and 2,037 patients and validated on 273 and 1,107 patients, respectively. The polytomous models combined dichotomous models for category A vs. B + C and B vs. C (sequential dichotomous modeling). Simple recalibration, revision, and redevelopment methods were considered. To assess discrimination (using dichotomous and polytomous c-statistics) and calibration (by comparing observed and expected prevalences) of these methods, the validation data were divided into updating and test parts. Five hundred such divisions were randomly generated, and the average test set results reported. RESULTS: None of the updating methods could improve discrimination of the original models, but recalibration, revision, and redevelopment strongly improved calibration. Redevelopment was unstable with respect to overfitting and performance. CONCLUSION: Simple dichotomous updating methods behaved well when applied to polytomous models. Our results suggest that recalibration is preferred, but larger validation sets may make revision or redevelopment a sensible alternative. ispartof: Journal of Clinical Epidemiology vol:66 issue:10 pages:1158-1165 ispartof: location:United States status: published

Published
2013

28. O-094 Diagnostic Usefulness Of Biomarkers In The Management Of Children With Fever At Risk Of Serious Bacterial Infections At The Emergency Department: Prospective Diagnostic Study

Author

Nijman, RG, primary, Vergouwe, Y, additional, Moll, HA, additional, Dik, WA, additional, Smit, FJ, additional, van Veen, M, additional, Weerkamp, F, additional, Steyerberg, EW, additional, van der Lei, J, additional, de Rijke, YB, additional, and Oostenbrink, R, additional

Published
2014
Full Text
View/download PDF

29. Morphology of testicular parenchyma adjacent to germ cell tumours. An interim report

Author

Kersemaekers, AMF, Jacobsen, GK, Timmer, A, Steyerberg, EW, Molier, M, Van Weeren, PC, Stoop, H, Looijenga, LHJ, Faculteit Medische Wetenschappen/UMCG, and Reproductive Origins of Adult Health and Disease (ROAHD)

Subjects
SEMINOMAS, testicular neoplasm, microlithiasis, CARCINOMA, TESTIS, intratubular tumour, tubular atrophy, testicular parenchyma, angiopathy, TUMORS, ANTIGENS
Abstract

A comparative morphological analysis of parenchyma adjacent to testicular germ cell tumours (TGCT) was performed in a series of 181 orchidectomy specimens: 86 with seminomas (Se), 72 with nonseminomatous germ cell tumours (NS) and 23 with combined tumours (CT, which have a Se and a NS component). The following morphological features were semiquantitatively scored: spermatogenesis (modified Johnsen score); amount of tubular atrophy; amount of carcinoma in situ (CIS); amount of intertubular tissue. Absence and presence was scored for the following features: lymphocytic infiltrate surrounding and invading CIS; intratubular seminoma (ISe); intratubular nonseminoma (INS); microlithiasis; diffuse and nodular hyperplasia of Leydig cells; angioinvasiveness; testicular angiopathy. Using non-parametric statistics these features were correlated with each other and with tumour type, tumour size and age of the patient. Se-patients presented at significantly higher age than NS-patients (36 vs 29 years, p=0.001). The age of patients with CT (32 years) was in between that of Se- and NS-patients. No correlation was found between patient age and tumour size. Parenchyma adjacent to Se, compared to parenchyma adjacent to NS had the following significant differences: a lower Johnsen score (5.6 vs 7.2, p=0.005); less frequent (85% vs 97% of specimens, p=0.016) and a lesser amount of CIS (26% vs 32% of tubules, p=0.015); more frequent peri- (80% vs 60% of specimens, p=0.001) and intratubular (68% vs 30% of specimens, p=0.001) lymphocytic infiltrates; more extensive tubular atrophy (36% vs 15% of tubules, p=0.001); and a larger area of intertubular tissue (42% vs 34% of parenchyma area, p=0.016). The pooled Se and CT had a significantly higher frequency of ISe than the NS (31% vs 17% of specimens, p=0.036). With one exception INS was only found adjacent to NS or CT, with a frequency of 16%, and 20% of the specimens, respectively. It was significantly associated with angio-invasiveness. In specimens lacking angio-invasion the frequency of INS was 6%. The correlation of INS with tumour size and patient age was studied in a series of 145 NS and CT (95 from the original series supplemented by 50 newer cases). In this series INS was significantly associated with smaller tumours and younger patients. Extensive tubular atrophy was significantly correlated with higher age, the diagnosis of Se, a low Johnsen score, and the presence of angiopathy. The more tubular atrophy, the less CIS (both in incidence and amount). Inversely, a higher Johnsen score is associated with smaller tumours, the diagnosis of NS or CT, a higher incidence and a larger amount of CIS, and little tubular atrophy. Tubules with mature spermatogenesis were found in 42% of the specimens regardless of tumour type. We conclude that ISe and INS are probably frequent intermediate stages between CIS and Se and NS, respectively. The features of parenchyma adjacent to Se are probably due to the host response elicited by the invasive Se, which secondarily also affects CIS. The long time to clinical presentation allows the host to eradicate most of the CIS by the time the tumour is surgically removed. The much less extensive morphological features of a host response in parenchyma adjacent to NS support the contention that NS originates as INS, behind the blood/testis barrier, without exposure of the host to tumour cells with a seminomatous phenotype (CIS- or Se cells). Microlithiasis and testicular angiopathy are frequent, but not specific findings in parenchyma next to TGCT. Their relationship with the development with TGCT is unexplained.

Published
2003

32. PREDICTION OF RESIDUAL RETROPERITONEAL MASS HISTOLOGY AFTER CHEMOTHERAPY FOR METASTATIC NONSEMINOMATOUS GERM-CELL TUMOR - MULTIVARIATE-ANALYSIS OF INDIVIDUAL PATIENT DATA FROM 6 STUDY-GROUPS

Author

STEYERBERG, EW, KEIZER, HJ, FOSSA, SD, SLEIJFER, DT, TONER, GC, KOOPS, HS, MULDERS, PFA, MESSEMER, JE, NEY, K, DONOHUE, JP, BAJORIN, D, STOTER, G, BOSL, GJ, HABBEMA, JDF, and Faculteit Medische Wetenschappen/UMCG

Subjects
TESTICULAR CANCER, CISPLATIN, TERATOMA, STAGE-III, SURGERY, PROGNOSTIC FACTORS, COMBINATION CHEMOTHERAPY, VINBLASTINE, BLEOMYCIN, LYMPHADENECTOMY
Abstract

Purpose: To develop a statistical model that predicts the histology (necrosis, mature teratoma, or cancer) after chemotherapy for metastatic nonseminomatous germ cell tumor (NSGCT). Patients and Methods: An international data was collected comprising individual patient data from six study groups. Logistic regression analysis was used to estimate the probability of necrosis and the ratio of cancer and mature teratoma. Results: Of 556 patients, 250 (45%) had necrosis at resection, 236 (42%) had mature teratoma, and 70 (13%) had cancer. Predictors of necrosis were the absence fo teratoma elements in the primary tumor, prechemotherapy normal alfa-fetoprotein (AFP), normal human chorionic gonadotropin (HCG), and elevated lactate dehydrogenase (LDH) levels, a small prechemotherapy or postchemotherapy mass, and a large shrinkage of the mass during chemotherapy. Multivariate combination of predictors yielded reliable models (goodness-of-fit tests, P > .20), which discriminated necrosis well from other histologies (area under the receiver operating characteristics (ROC) curve, .84), but which discriminated cancer only reasonably from mature teratoma (area, .66). Internal and external validation confirmed these findings. Conclusion: The validated models estimated with high accuracy the histology at resection, especially necrosis, based on well-known and readily available predictors. The predicted probabilities may help to chose between immediate resection of a residual mass or follow-up, taking into account the expected benefits and risks of resection, feasibility of frequent follow-up, the follow-up, the financial costs, and the patient's individual preferences.

Published
1995

33. Neoadjuvant chemoradiation followed by surgery versus surgery alone for patients with adenocarcinoma or squamous cell carcinoma of the esophagus (CROSS)

Author

van Heijl, M, primary, van Lanschot, JJB, additional, Koppert, LB, additional, van Berge Henegouwen, MI, additional, Muller, K, additional, Steyerberg, EW, additional, van Dekken, H, additional, Wijnhoven, BPL, additional, Tilanus, HW, additional, Richel, DJ, additional, Busch, ORC, additional, Bartelsman, JF, additional, Koning, CCE, additional, Offerhaus, GJ, additional, and van der Gaast, A, additional

Published
2008
Full Text
View/download PDF

48. Barriers to translating diagnostic research in febrilechildren to clinical practice: a systematic review.

Author

Oostenbrink R, Thompson M, Steyerberg EW, and ERNIE members

Abstract

BACKGROUND: Although the topic of identifying febrile children at risk of serious infections has been addressed by numerous research groups, identified predictors remain diverse and implementation of results in routine practice has been limited. The aim of this paper is to discuss the problems and challenges in advancing diagnostic research in febrile children. METHODS: The characteristics and results of 35 studies identified from a systematic review on predictors for febrile children were evaluated. RESULTS: Current diagnostic research is mainly performed in subpopulations, defined by age and temperature limits and in paediatric emergency settings, ignoring the role of primary care. It is characterised by a dichotomous approach of outcomes and a wide variability of potential predictors. Validation of results to other settings and impact studies of prediction rules on patient outcomes are scarce. In designing diagnostic studies on children suspected of serious infections focus is needed on all clinically relevant populations within the spectrum of primary care and emergency department settings. Consensus is also needed on the definition of fever, the concept of serious infection and the set of predictors to focus on. The heterogeneity of patients in different settings and countries stress the need for continuous updating of prediction rules in routine practice. Broad validation in different clinical settings and countries and impact analysis in routine care is essential. CONCLUSIONS: Scientists in the field of diagnosis of serious infection in children must agree on core design features to be incorporated in all studies in the area of diagnostic research in febrile children. This will improve evidence from future studies, and their generalisability and implementation in routine practice. [ABSTRACT FROM AUTHOR]

Published
2012

49. Competing risks and the clinical community: irrelevance or ignorance?

Author

Koller MT, Raatz H, Steyerberg EW, Wolbers M, Koller, Michael T, Raatz, Heike, Steyerberg, Ewout W, and Wolbers, Marcel

Abstract

Life expectancy has dramatically increased in industrialized nations over the last 200 hundred years. The aging of populations carries over to clinical research and leads to an increasing representation of elderly and multimorbid individuals in study populations. Clinical research in these populations is complicated by the fact that individuals are likely to experience several potential disease endpoints that prevent some disease-specific endpoint of interest from occurrence. Large developments in competing risks methodology have been achieved over the last decades, but we assume that recognition of competing risks in the clinical community is still marginal. It is the aim of this article to address translational aspects of competing risks to the clinical community. We describe clinical populations where competing risks issues may arise. We then discuss the importance of agreement between the competing risks methodology and the study aim, in particular the distinction between etiologic and prognostic research questions. In a review of 50 clinical studies performed in individuals susceptible to competing risks published in high-impact clinical journals, we found competing risks issues in 70% of all articles. Better recognition of issues related to competing risks and of statistical methods that deal with competing risks in accordance with the aim of the study is needed. [ABSTRACT FROM AUTHOR]

Published
2012
Full Text
View/download PDF

50. Prediction of outcome after moderate and severe traumatic brain injury: external validation of the International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models.

Author

Roozenbeek B, Lingsma HF, Lecky FE, Lu J, Weir J, Butcher I, McHugh GS, Murray GD, Perel P, Maas AI, Steyerberg EW, International Mission on Prognosis Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) Study Group, Roozenbeek, Bob, Lingsma, Hester F, Lecky, Fiona E, Lu, Juan, Weir, James, Butcher, Isabella, McHugh, Gillian S, and Murray, Gordon D

Published
2012
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results