103 results on '"TenVergert EM"'
Search Results
2. Withholding antibiotics from patients with febrile neutropenia - Reply
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De Bont, ESJM, Nijhuis, CO, Gietema, JA, Van der Graaf, WTA, Daenen, SMGJ, Vellenga, E, TenVergert, EM, Vermeulen, KM, Groen, HJM, Kamps, WA, Faculteit Medische Wetenschappen/UMCG, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Methods in Medicines evaluation & Outcomes research (M2O), Guided Treatment in Optimal Selected Cancer Patients (GUTS), and Stem Cell Aging Leukemia and Lymphoma (SALL)
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BACTERIAL-INFECTION ,FEVER ,CHILDREN ,CHEMOTHERAPY ,LOW-RISK ,CANCER - Published
- 2006
3. Improved quality of life after lung transplantation in individuals with cystic fibrosis
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Vermeulen, KM, van der Bij, W, Erasmus, ME, Duiverman, EJ, Koeter, GH, TenVergert, EM, Faculteit Medische Wetenschappen/UMCG, Methods in Medicines evaluation & Outcomes research (M2O), Cardiovascular Centre (CVC), and Groningen Institute for Organ Transplantation (GIOT)
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health-related quality of life ,cystic fibrosis ,FUTURE ,lung transplantation ,SURVIVAL ,CHILDREN ,humanities - Abstract
The aim of the present study was to assess the effect of lung transplantation (LgTX) on health-related quality of life (HRQL) in a group of patients with cystic fibrosis (CF), compared to patients with other diagnoses (non-CF). HRQL was assessed before transplantation in a group of 32 CIF patients and 183 non-CF patients. After LgTX, we conducted a prospective longitudinal study among 10 CF patients and 35 non-CIF patients who survived at least 31 months after LgTX. Measures were the Nottingham Health Profile (NHP), the State-Trait Anxiety Inventory (STAI), the Self-Rating Depression Scale (ZUNG), the Index of Well-Being (IWB), and the Karnofsky Performance Index. Patients in the CIF group were younger, spent more days on the waiting list, and were more likely to be working or going to school than patients with other indications. Before transplantation, CIF patients and non-CF patients experienced restrictions on almost all HRQL measures, compared to the general population. On the NHP dimensions of mobility and energy, CF patients had significantly better scores than non-CF patients. Between 1-4 months after transplantation, scores on the NHP, ZUNG, and Karnofsky performance indices improved, and STAI and IWB scores even occurred within the reference value in both groups. Significantly better scores in the CIF group compared to the non-CIF group were found on the NHP dimension of mobility 4 months after transplantation, and on the dimension of sleep 7 and 13 months after transplantation. Scores remained more or less stable overtime in both groups. It may be concluded that patients in both groups experience major restrictions in HRQL before transplantation. However, pretransplant non-CF patients experience more restrictions than CIF patients. After LgTX, both groups of patients showed substantial improvement in HRQL, and this improvement was maintained until 31 months after LgTX. (C) 2004 Wiley-Liss, Inc.
- Published
- 2004
4. Reliability and validity of the (modified) Amsterdam inventory for auditory disability and handicap
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Meijer, AGW, Wit, HP, TenVergert, EM, Albers, FWJ, Kobold, JPM, and Faculteit Medische Wetenschappen/UMCG
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AIAD ,hearing quality ,HEARING DISABILITY ,ADULTS ,self-assessment ,psychometric analysis - Abstract
This study investigated the psychometric adequacy of the (modified) Amsterdam Inventory for Auditory Disability and Handicap ((m)AIAD). The original version of the AIAD was developed by Kramer et al in 1995. Special emphasis was placed on the statistical aspects of the scores, because these properties place limits on the clinical utility of the instrument. The AIAD is a self-assessment questionnaire that consists of 30 questions covering all the relevant factors of disability in individual hearing functioning in daily life. This paper reports data from 94 subjects, aged 17-65 years, with different hearing abilities, who completed a modified version of the AIAD and the Hearing Disability Questionnaire (HDQ), on two occasions 1 month apart. The psychometric adequacy of the AIAD was determined by measuring its reliability and validity. Factor analysis was performed, and the reliability was tested by measuring, internal consistency, split-half correlation, and test-retest reproducibility. The validity was tested by measuring construct and criterion validity. The results showed that the reliability of the (m)AIAD was highly satisfactory, with good internal consistency, high split-half correlations, and high test-retest correlations. Construct validity showed a high correlation between scores on the (m)AIAD and scores on the HDQ. Criterion validity showed a moderate but significant correlation between scores on the (m)AIAD and hearing thresholds in dB HL.
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- 2003
5. Cost-effectiveness of the HIT programme in patients with schizophrenia and persistent auditory hallucinations
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Stant, AD, TenVergert, EM, Groen, H, Jenner, JA, Nienhuis, FJ, van de Willige, G, Wiersma, D, and Faculteit Medische Wetenschappen/UMCG
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therapy ,TREATING SCHIZOPHRENIA ,COGNITIVE THERAPY ,ILLNESS ,costs and cost analysis ,schizophrenia ,CONTROLLED TRIAL ,PSYCHOSIS ,MANAGEMENT ,PATTERNS ,cost-benefit analysis (cost-effectiveness) ,MENTAL-HEALTH-CARE ,hallucinations ,FOLLOW-UP ,health care economics and organizations ,INTEGRATIVE TREATMENT - Abstract
Objective: To examine the cost-effectiveness of Hallucination focused Integrative Treatment (HIT) in patients with schizophrenia and a history of persistent auditory hallucinations. Method: Costs, in and outside the health care sector, and outcomes were registered prospectively during a period of 18 months for patients who received the HIT programme and for patients in the care as usual (CAU) condition. The Positive and Negative Syndrome Scale (PANSS) was used as main outcome measure in the cost-effectiveness analysis. Bootstrap analyses provided additional information on the skewly distributed costs. Results: Mean costs per patient in the HIT group ($18 237) were lower than the mean costs per patient in the CAU group ($21 436). Results of the PANSS were slightly in favour of the HIT group. Conclusion: There appears to be no significant cost-effectiveness advantage of the HIT programme over CAU. Additional analyses indicated that future application of the HIT programme will, in most cases, lead to a reduction of (non) medical costs.
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- 2003
6. The cost effectiveness of lung transplantation compared with that of heart and liver transplantation in the Netherlands
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Ouwens, JP, van Enckevort, PJ, TenVergert, EM, Bonsel, GJ, van der Bij, W, Haagsma, EB, Rutten, FFH, Slooff, MJH, Koeter, GH, Other departments, Faculteit Medische Wetenschappen/UMCG, and Groningen Institute for Organ Transplantation (GIOT)
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LIFE ,Transplantation ,surgical procedures, operative ,liver transplantation ,cost-benefit analysis ,lung transplantation ,PROGRAM ,heart transplantation - Abstract
This study was performed to assess the main reasons for the unfavorable cost effectiveness of lung transplantation compared with that of heart and liver transplantation. Costs, effects, and cost-effectiveness ratios of Dutch lung, heart, and liver transplantation programs were compared. The data are based on three Dutch technology assessments of transplantation, with minor adjustments for time and methods. In result, mainly follow-up costs of lung transplantation are higher than costs of heart and liver transplantation - US $150,300, US $121,500, and US $95,300, respectively - in the first 3 years after transplantation. The survival gain realized by lung transplantation is small (4.4 years) compared with heart (8.8 years) and liver (14.7years) transplantation. Costs per life-year gained were US $77,000, US $38,000, and US $26,000 for lung, heart, and liver transplantation, respectively. The unfavorable cost effectiveness of lung transplantation is largely related to a relatively small survival gain and high follow-up costs.
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- 2003
7. Long-term quality of life in patients surviving at least 55 months after lung transplantation
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Vermeulen, KM, Ouwens, JP, van der Bij, W, Koeter, GH, TenVergert, EM, Faculteit Medische Wetenschappen/UMCG, Methods in Medicines evaluation & Outcomes research (M2O), and Groningen Institute for Organ Transplantation (GIOT)
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comorbidity ,RECIPIENTS ,LIVER ,quality of life ,longitudinal ,Bronchiolitis Obliterans Syndrome (BOS) ,PSYCHIATRIC ASPECTS ,BRONCHIOLITIS OBLITERANS ,REGISTRY ,OF-LIFE ,lung transplantation ,HEART ,CANDIDATES - Abstract
The aim of this study was to examine the long-term effect of lung transplantation on Health Related Quality of Life by studying 28 patients who survived at least 55 months after lung transplantation. Measures included the Nottingham Health Profile, questions concerning lung-specific problems, the State-Trait Anxiety Inventory, the Self-rating Depression Scale, the Index of Well-Being, the Karnofsky performance index, and questions concerning activities of daily life. Furthermore, comorbid conditions were measured. Before transplantation patients reported restrictions on almost all quality of life measures. Until approximately 43 months after transplantation there were significant improvements on most dimensions of the Nottingham Health Profile and more patients could walk without dyspnea. Significant improvements occurred with regard to the levels of anxiety, depression, and well being, and the scores on the Karnofsky performance index improved. Activities of daily life could be performed without help by most patients. After approximately 43 months patients experienced more dyspnea, anxiety, depression, and a lower level of well being. The number of patients suffering from a decrease of kidney function, drug treated hyperlipidemia, insulin dependent diabetes mellitus and bronchiolitis obliterans syndrome increased. It may be concluded that patients experience a stable and better overall quality of life after transplantation. Long-term after lung transplantation patients experience a decline on several dimensions of quality of life, which may be explained by an increase of comorbid conditions and Bronchiolitis Obliterans Syndrome. 2003 Elsevier Science Inc. All rights reserved.
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- 2003
8. Simulated waiting list prioritization for equitable allocation of donor lungs
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Ouwens, JP, Groen, H, TenVergert, EM, Koeter, GH, van der Bij, W, Faculteit Medische Wetenschappen/UMCG, and Groningen Institute for Organ Transplantation (GIOT)
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TRANSPLANTATION PROGRAM ,DISEASE - Abstract
Background: In lung transplantation (LTx), allocation of donor lungs is usually based on blood group, height and waiting time. Long waiting times favor patients with a slowly progressive end-stage lung disease and make the current allocation system the subject of discussion. In an attempt to equalize the chances for transplantation for every patient, irrespective of diagnosis, we investigated the effect of diagnosis-dependent prioritization on the waiting list, using a simulation model. Methods: For the main disease categories on the waiting list, the relative risks of dying while on the waiting list were calculated using empirical data from the Dutch LTx program gathered over a period of 10 years. In a microsimulation model of the Dutch LTx program based on data from the actual situation, patients with diagnoses associated with a statistically significant increased risk of death while on the waiting list were prioritized by multiplying the time on the waiting list by the relative risk. Results: Relative risks of death on the waiting list were increased significantly in patients with cystic fibrosis, primary pulmonary hypertension and pulmonary fibrosis. Prioritization resulted in an increased chance of transplantation for the prioritized diagnoses and a decreased chance for the non-prioritized diagnoses. The distribution of diagnoses after LTx was almost equal to the distribution of diagnoses on the waiting list. Conclusion: The simulated method of prioritization on the waiting list is a step forward to a more equitable allocation of donor lungs. Moreover, this method is clinically feasible, as long as the waiting list is updated frequently.
- Published
- 2002
9. Selective decontamination of the digestive tract to prevent postoperative infection: A randomized placebo-controlled trial in liver transplant patients
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Zwaveling, JH, Maring, JK, Klompmaker, IJ, Haagsma, EB, Bottema, JT, Winter, Heinrich L.J., van Enckevort, PJ, TenVergert, EM, Metselaar, HJ, Bruining, HA, Slooff, MJH, Faculteit Medische Wetenschappen/UMCG, and Groningen Research Institute of Pharmacy
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BACTERIAL ,liver transplantation ,cost effectiveness ,Gram-positive bacterial infection ,fungal infection ,MORTALITY ,costs ,BOWEL DECONTAMINATION ,colonization ,infection ,INTENSIVE-CARE UNIT ,selective decontamination ,postoperative complications ,FAILURE ,Gram-negative bacterial infection ,sepsls - Abstract
Objective., To determine the efficacy of selective decontamination of the digestive tract (SDD) in patients undergoing elective transplantation of the liver. Design: Randomized, double-blind, placebo-controlled study. Setting. Two academic teaching hospitals. Patients. Adult patients undergoing elective liver transplantation: 26 patients receiving SDD and 29 patients receiving a placebo. Interventions: Patients undergoing SDD were administered 400 mg of norfloxacin once daily as soon as they were accepted for transplantation, Postoperative treatment for this group consisted of 2 mg of colistin, 1.8 mg of tobramycin, and 10 mg of amphotericin B, four times daily, combined with an oral paste containing a 2% solution of the same drugs until postoperative day 30. Prophylactic Intravenous administration of antibiotics was not part of the SDD regimen in this study. Control patients were given a similar regimen with placebo drugs. Measurements: The mean number of postoperative bacterial and fungal infections in the first 30 days after transplantation was the primary efficacy end point. Days on a ventilator, days spent in the intensive care unit, and medical costs were registered as secondary outcome variables. Main Results. Of the 26 patients undergoing SOD, 22 (84.5%) developed an infection in the postoperative study period; In the placebo group (n = 29), these numbers were not significantly different (25 patients, 86%). The mean number of postoperative infectious episodes per patient was also not significantly different: 1.77 (SDD) vs. 1.93 (placebo), Infections Involving Gram-negative aerobic bacteria and Candida species were significantly less frequent in patients receiving SOD (p Conclusions. Selective decontamination of the digestive tract does not prevent Infection in patients undergoing elective liver transplantation and increases the cost of their care. It does, however, affect the type of infection. Infections with Gram-negative bacilli and with Candida species are replaced by infections with Gram-positive cocci.
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- 2002
10. Graft loss after pediatric liver transplantation
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Sieders, E, Peeters, PMJG, TenVergert, EM, de Jong, KP, Porte, RJ, Zwaveling, JH, Bijleveld, CMA, Gouw, ASH, Slooff, MJH, Groningen Institute for Organ Transplantation (GIOT), and Guided Treatment in Optimal Selected Cancer Patients (GUTS)
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RECIPIENTS ,MORBIDITY ,surgical procedures, operative ,DONOR LIVER ,SIZE ,FULMINANT HEPATIC-FAILURE ,TACROLIMUS FK506 ,INFECTION ,RISK-FACTORS ,SURVIVAL ,CHILDREN - Abstract
Objective To describe the epidemiology and causes of graft loss after pediatric liver transplantation and to identify risk factors. Summary Background Data Graft failure after transplantation remains an important problem. It results in patient death or retransplantation, resulting in lower survival rates. Methods A series of 157 transplantations in 120 children was analyzed. Graft loss was categorized as early (within 1 month) and late (after 1 month). Risk factors were identified by analyzing recipient, donor, and transplantation variables. Results Kaplan-Meier 1-month and 1 -, 3-, and 5-year patient survival rates were 85%, 82%, 77%, and 71%, respectively, Graft survival rates were 71%, 64%, 59%, and 53%, respectively. Seventy-one of 157 grafts (45%) were lost 18 (25%) by death of patients with functioning grafts and 53 (75%) by graft-related complications. Forty-five grafts (63%) were lost early after transplantation. Main causes of early loss were vascular complications, primary nonfunction, and patient death. Main cause of late graft loss was fibrosis/cirrhosis, mainly as a result of biliary complications or unknown causes, Child-Pugh score, anhepatic phase, and urgent transplantation were risk factors for early loss, Donor age, clonor/recipient weight ratio, blood loss, and technical-variant liver grafts were risk factors for late loss, Conclusions To prevent graft loss after pediatric liver transplantation, potential recipients should be referred early so they can be transplanted in an earlier phase of their disease, Technical-variant liver grafts are risk factors for graft survival. The logistics of the operation need to be optimized to minimize the length of the anhepatic phase.
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- 2002
11. Quality of life before and after lung transplantation in patients with emphysema versus other indications
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TenVergert, EM, Vermeulen, KM, van Enckevort, PJ, Faculteit Medische Wetenschappen/UMCG, and Methods in Medicines evaluation & Outcomes research (M2O)
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OF-LIFE ,PROGRAM ,SURVIVAL ,respiratory system ,LIVER-TRANSPLANTATION ,respiratory tract diseases - Abstract
Whether lung transplantation improves Health-related Quality of Life in patients with emphysema and other end-stage lung diseases before and after lung transplantation was examined. Between 1992 and 1999, 23 patients with emphysema and 19 patients with other indications completed self-administered questionnaires before lung transplantation, and at 4, 7, 13, and 25 mo. after transplantation. The questionnaire included the Nottingham Health Profile, the State-Trait Anxiety Inventory, the Self-rating Depression Scale, the Index of Well-being, the Self-report Karnofsky Index, and four respiratory-specific questions. Neither before nor after transplantation were significant differences found on most dimensions of Health-related Quality of Life between patients with emphysema and other indications. Before transplantation, both groups report major restrictions on the dimensions Energy and Mobility of the Nottingham Health Profile, low experienced well-being, depressive symptoms, and high dyspnea, About 4 mo. after transplantation, most Health-related Quality of Life measures improved significantly in both groups. These improvements were maintained in the following 21 mo.
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- 2001
12. Cost effectiveness of selective decontamination of the digestive tract in liver transplant patients
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van Enckevort, PJ, Zwaveling, JH, Bottema, JT, Maring, JK, Klompmaker, IJ, Slooff, MJH, TenVergert, EM, and Faculteit Medische Wetenschappen/UMCG
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musculoskeletal diseases ,CONTROLLED TRIAL ,DOUBLE-BLIND ,BACTERIAL ,INTENSIVE-CARE UNIT ,INFECTIONS ,MULTIPLE TRAUMA PATIENTS ,health care economics and organizations ,COLONIZATION - Abstract
Objective: To assess the cost effectiveness of selective decontamination of the digestive tract (SDD) in liver transplant patients. Design: Randomised, placebo-controlled, double-blind trial with an integrated economic evaluation. Setting: Two university hospitals in The Netherlands. Cost effectiveness was assessed from a societal perspective. Patients and participants: 58 patients who underwent liver transplantation and received SDD (n = 29) or placebo (n = 29) pre- and postoperatively. Interventions: SDD medication and placebo. Main outcome measures: Infection episodes, days of infection, costs of SDD and routine cultures, mean other direct medical costs per patient and additional costs of severe infection. Results: Costs of SDD medicine and routine cultures were on average 3100 US dollars ($US; 1997 values) per patient who underwent SDD. Both preoperatively and postoperatively, costs other than SDD and cultures did not significantly differ between the SDD and the placebo groups (preoperative, $US2370 vs $US2590; postoperative, $US25 455 vs $US24 915). Additional postoperative costs of severe infections were $US250 per day per patient. There were no significant differences in the mean number of infection episodes between groups. Conclusions: SDD leads to the additional costs of SDD medication and routine cultures, whereas no savings in other costs and no improvement in infection episodes are realised. Consequently, SDD may be considered as a nonefficient approach in patients undergoing liver transplantation. The additional costs of severe infection are considerable.
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- 2001
13. Analysis of survival and morbidity after pediatric liver transplantation with full-size and technical-variant grafts
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Sieders, E, Peeters, PMJG, TenVergert, EM, Bijleveld, CMA, De Jong, KP, Zwaveling, JH, Boersma, GA, Slooff, MJH, Faculteit Medische Wetenschappen/UMCG, Groningen Institute for Organ Transplantation (GIOT), and Guided Treatment in Optimal Selected Cancer Patients (GUTS)
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SHORTAGE ,DONOR LIVER ,INFANTS ,CHILDREN ,WAITING-LIST ,HEPATIC TRANSPLANTATION - Abstract
Background To alleviate the shortage of size-matched whole-donor organs, too-large-for-size cadaveric donor grafts are modified by liver resection techniques. These modifications result in technical-variant liver transplantation (TVLTx). Patient and graft survival rates after TVLTx are considered comparable to those after full-size liver transplantation (FSLTx). However, morbidity after TVLTx is often underexposed. The aim of this study was to analyze the results of FSLTk and TVLTx in terms of patient and graft survival rates and morbidity. Methods. A consecutive series of 97 primary and elective pediatric liver transplantations performed in a single center was retrospectively analyzed. Forty-seven children had a FSLTx and 50 a TVLTx (38 reduced-size liver grafts and 12 split-liver grafts). The overall median follow-up period was 3.5 years. Results. There were no differences in patient and graft survival rates between FSLTx and TVLTx. However, after TVLTx there was a significantly higher complication rate (1.42 vs. 0.81 after FSLTx). TVLTx is more hampered by biliary complications (30% vs. 17%), expressed by a higher incidence of cholangitis and leakage of bile. These complications led to a significantly higher incidence of sepsis (44% vs. 19%) and a significantly higher intervention rate (0.40 vs. 1.28) after TVLTx, There was no difference in the incidence of retransplantations between FSLTx and TVLTx. Conclusions. Both FSLTx and TVLTx offer the same prognosis in terms of patient and graft survival rates for children after a primary and elective liver transplantation. However, TVLTx has a higher morbidity.
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- 1999
14. Prospective cost-utility analysis of lung transplantation in the Netherlands: A comment on the pilot study by Gartner et al
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van Enckevort, PJ, TenVergert, EM, van der Bij, W, Rutten, FFH, Faculteit Medische Wetenschappen/UMCG, and Groningen Institute for Organ Transplantation (GIOT)
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- 1999
15. Does lung transplantation prolong life? A comparison of survival with and without transplantation
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TenVergert, EM, Bonsel, GJ, van der Bij, W, Faculteit Medische Wetenschappen/UMCG, and Groningen Institute for Organ Transplantation (GIOT)
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CYSTIC-FIBROSIS ,PROGNOSIS ,OXYGEN-THERAPY ,HEART ,OBSTRUCTIVE PULMONARY-DISEASE - Abstract
Background: Because of the assumed beneficial effect of lung transplantation on survival, controlled trials to assess the therapeutic benefit of lung transplantation are considered to be unethical. Therefore other methods must be used to provide control data. In this study the effect of lung transplantation on survival for patients with end-stage pulmonary disease was analyzed, with waiting list survival rates used as control data. Methods: The analysis was based on 157 consecutive patients who were put on the waiting list of the Dutch lung transplantation program during the period November 1990 to January 31, 1996, of whom 76 underwent transplantation. Following the principles of control group estimation as set out in the context of heart transplantation, a stepwise approach was used to arrive at a multivariate time-dependent Cox regression model. The following prognostic variables were included in the analyses: age, forced expiratory volume in 1 second, partial pressure of carbon dioxide, partial pressure of oxygen, and diagnosis. Results: The 1- and 2-year waiting list survival rates were 78% and 58%, respectively. The 1- and 2-year transplantation survival rates (i.e., survival from placement on the waiting list, including posttransplantation survival) were 79% and 64%, respectively. The multivariate time-dependent Cox analysis showed that lung transplantation reduced the risk of dying by 55% (95% confidence interval, 3% to 79%). For patients with emphysema the risk of dying was estimated to be 77% lower than for patients with other diagnoses (96% confidence interval, 50% to 89%). Conclusions: With COX regression, adjusting for age, forced expiratory volume in 1 second, partial pressure of carbon dioxide, partial pressure of oxygen, and diagnosis, lung transplantation showed a statistically significant effect on survival in selected patients with end-stage pulmonary disease.
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- 1998
16. Cost-effectiveness of lung transplantation in the Netherlands - A scenario analysis
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Al, MJ, Koopmanschap, MA, van Enckevort, PJ, van der Bij, W, TenVergert, EM, Faculteit Medische Wetenschappen/UMCG, and Groningen Institute for Organ Transplantation (GIOT)
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scenario-analysis ,lung transplantation ,microsimulation ,cost utility ,HEART ,cost-effectiveness - Abstract
Study objectives: To calculate cost-effectiveness of scenarios concerning lung transplantation in the Netherlands. Design: Microsimulation model predicting survival, quality of life, and costs with and without transplantation program, based on data of the Dutch lung transplantation program of 1990 to 1995. Setting: Netherlands, University Hospital Groningen. Patients: Included were 425 patients referred for lung transplantation, of whom 57 underwent transplantation. Intervention: Lung transplantation. Results: For the baseline scenario, the costs per life-year gained are G 194,000 (G=Netherlands guilders) and the costs per quality-adjusted life-year (QALY) gained are G 167,000. Restricting patient inflow ("policy scenario") lowers the costs per life-year gained: G 172,000 (costs per QALY gained: G 144,000). The supply of more donor lungs could reduce the costs per life-year gained to G 159,000 (G 135,000 per QALY gained; G1=US$0.6, based on exchange rate at the time of the study). Conclusions: Lung transplantation is an expensive but effective intervention: survival and quality of life improve substantially after transplantation, The costs per life-year gained are relatively high, compared with other interventions and other types of transplantation. Restricting the patient inflow and/or raising donor supply improves cast-effectiveness to some degree. Limiting the extent of inpatient screening or lower future costs of immunosuppressives may slightly improve the cost-effectiveness of the program.
- Published
- 1998
17. Evaluatie van het Groningse longtransplantatieprogramma: overleving, kwaliteit van leven en kosteneffectiviteit
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TenVergert, EM, van Enckevort, PJ, Geertsma, A, Koopmanschap, Marc, van der Bij, W, Boer, WJ, and Erasmus School of Health Policy & Management
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- 1998
18. Technology assessment of the Dutch Lung Transplantation program
- Author
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van Enckevort, PJ, TenVergert, EM, Bonsel, GJ, van der Bij, W, Koopmanschap, MA, Al, MJ, Rutten, FFH, Faculteit Medische Wetenschappen/UMCG, and Groningen Institute for Organ Transplantation (GIOT)
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COST-EFFECTIVENESS ,QUALITY-OF-LIFE ,HEART ,LIVER-TRANSPLANTATION ,health care economics and organizations - Abstract
The costs, effects, and cost-effectiveness of the Dutch Lung Transplantation program were assessed. The results show that lung transplantation is a very costly intervention that improves survival and quality of life. Costs per life-year and per QALY gained were, respectively, US $90,000 and US $71,000.
- Published
- 1998
19. Poor initial graft function after orthotopic liver transplantation: can it be predicted and does it affect outcome? An analysis of 125 adult primary transplantations
- Author
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Maring, JK, Klompmaker, IJ, Zwaveling, JH, Kranenburg, K, TenVergert, EM, Slooff, MJH, and University of Groningen
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liver transplantation ,primary dysfunction ,ORGAN-TRANSPLANTATION ,graft function ,MARGINAL DONORS ,RISK-FACTORS ,risk factors ,VENOUS BYPASS ,CRITERIA - Abstract
Donor liver shortage is a persistent problem in liver transplantation. A more liberal donor acceptance policy may be a possible solution. However, this might put recipients at risk for initial poor function or even non-function of the graft. Therefore risk factors for initial graft dysfunction should be identified, preferably by using an uniform definition of primary graft dysfunction or non-function. We retrospectively analysed 125 adult liver transplantations in order to identify risk factors for initial poor function and primary non-function. Donor, recipient pretransplant and surgical parameters were evaluated. Since there is no consensus on the criteria of dysfunction we used two definitions known from literature. No risk factors for postoperative dysfunction could be identified for either of the two definition sets. Furthermore, the definition set that included ALAT, prothrombin time and bile production in the first 72 h to identify poor graft function showed no relation with graft or recipient outcome. The other set, using ASAT and prothrombin time, determined from day 2 to day 7, showed that patients with a primary dysfunction had significantly higher morbidity and mortality compared to patients with a well functioning graft. We conclude that initial poor function after liver transplantation remains unpredictable, irrespective of the way it is defined. Moreover, our analysis shows that initial poor function can also develop in recipients that receive 'non-marginal' grafts without prolonged ischemia times. These results may support a more liberal selection of donor livers.
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- 1997
20. Survival with and without hung transplantation
- Author
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vanderBij, W, TenVergert, EM, and Groningen Institute for Organ Transplantation (GIOT)
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HEART - Published
- 1997
21. Lifetime costs of lung transplantation of incremental costs
- Author
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van Enckevort, PJ, Koopmanschap, Marc, TenVergert, EM, Geertsma, A, van der Bij, W, Boer, WJ, Rutten, FFH, and Erasmus School of Health Policy & Management
- Published
- 1997
22. Lifetime costs of lung transplantation: Estimation of incremental costs
- Author
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VanEnckevort, PJ, Koopmanschap, MA, Tenvergert, EM, VanderBij, W, Rutten, FFH, and Groningen Institute for Organ Transplantation (GIOT)
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NETHERLANDS ,lung transplantation ,incremental costs ,health care economics and organizations - Abstract
Despite an expanding number of centres which provide lung transplantation, information about the incremental costs of lung transplantation is scarce. From 1991 until 1995, in The Netherlands a technology assessment was performed which provided information about the incremental costs of lung transplantation. Costs in the situation with and without a transplantation programme were compared from a Lifetime perspective. Because randomization was ethically inadmissible, only costs in the situation with the programme were observed. Both conventional treatment costs and costs of the transplantation programme were registered. Costs in the situation without the programme were based on the conventional treatment costs in the situation with the programme. Due to the study period of four years, long term follow-up costs were estimated. The total incremental costs per transplanted patient were estimated at Dfl 466 767 (5% discounted costs). The main part of these costs was caused by the high costs during the Lifetime follow-up of the patients. (C) 1997 by John Wiley & Sons, Ltd.
- Published
- 1997
23. LONG-TERM BENEFITS OF REHABILITATION AT HOME ON QUALITY-OF-LIFE AND EXERCISE TOLERANCE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
- Author
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WIJKSTRA, PJ, TENVERGERT, EM, VANALTENA, R, OTTEN, [No Value], KRAAN, J, POSTMA, DS, KOETER, GH, Faculteit Medische Wetenschappen/UMCG, and Groningen Research Institute for Asthma and COPD (GRIAC)
- Subjects
HEALTH-STATUS ,QUALITY OF LIFE ,CHRONIC LUNG-DISEASE ,CHRONIC OBSTRUCTIVE PULMONARY DISEASE ,EXERCISE TOLERANCE ,HOME REHABILITATION ,RANDOMIZED CONTROL TRIAL ,AIR-FLOW LIMITATION - Abstract
Background - Pulmonary rehabilitation has been shown to have short term subjective and objective benefits for patients with chronic obstructive pulmonary disease (COPD). However, appropriately controlled studies have not previously been performed, nor have the benefits of different types of continuation programme for rehabilitation been investigated. Both these problems have been addressed in a single study of the long term effects of once monthly physiotherapy versus once weekly physiotherapy at home after a comprehensive home rehabilitation programme on quality of life and exercise tolerance in patients with COPD. Methods - Thirty six patients with severe airways obstruction (mean (SD) forced expiratory volume in one second (FEV(1)) 1.3(0.4)1, FEV(1)/inspiratory vital capacity (IVC) 37.2(7.9)%) were studied. Twenty three patients followed a rehabilitation programme at home for 18 months consisting of physiotherapy and supervision by a nurse and general practitioner. During the first three months all 23 patients visited the physiotherapist twice a week for a 0.5 hour session, Thereafter, 11 patients (group A) received a session of physiotherapy once weekly while 12 patients (group B) received a session of physiotherapy once a month. The control group C (13 patients) received no rehabilitation at all. Quality of life was assessed by the Chronic Respiratory Questionnaire, exercise tolerance by the six minute walking distance, and lung function by FEV(1) and IVC. Outcome measures were assessed at baseline and at three, six, 12, and 18 months. Results - Long term improvements in quality of life were found in patients in groups A and B, but not in those in group C compared with baseline, but these only reached significance in group B at all time points. Patients in group B had a higher quality of life than those in group C only at three and 12 months. There was a decrease in both six minute walking distance (at 12 and 18 months) and IVC (at three, 12, and 18 months) in patients in group C compared with the baseline measurement. Between groups analysis showed no differences for six minute walking distance, FEV(1), and IVC. Conclusions - This study is the first to show that rehabilitation at home for three months followed by once monthly physiotherapy sessions improves quality of life over 18 months. The change in quality of life was not associated with a change in exercise tolerance.
- Published
- 1995
24. Assessment of the quality of life before and after lung transplantation: First results
- Author
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TenVergert, EM, EssinkBot, ML, Bonsel, GJ, vanderBij, W, deBoer, W, Korner, MM, Korfer, R, Faculteit Medische Wetenschappen/UMCG, and Groningen Institute for Organ Transplantation (GIOT)
- Subjects
longitudinal study ,health status ,medical technology assessment - Published
- 1995
25. RELATION OF LUNG-FUNCTION, MAXIMAL INSPIRATORY PRESSURE, DYSPNEA, AND QUALITY-OF-LIFE WITH EXERCISE CAPACITY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
- Author
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WIJKSTRA, PJ, TENVERGERT, EM, VANDERMARK, TW, POSTMA, DS, VANALTENA, R, KRAAN, J, KOETER, GH, Faculteit Medische Wetenschappen/UMCG, and Groningen Research Institute for Asthma and COPD (GRIAC)
- Subjects
VENTILATION ,CHRONIC-BRONCHITIS ,DISABILITY ,DISTANCE ,WALKING TEST ,respiratory system ,PERFORMANCE ,RESPIRATORY-DISEASE ,human activities ,ARTERIAL OXYGEN DESATURATION ,respiratory tract diseases - Abstract
Background - Several studies have shown that both objective and subjective measurements are related to exercise capacity in patients with chronic obstructive pulmonary disease (COPD). In this study the relative contribution of lung function, maximal inspiratory pressure, dyspnoea, and quality of life to the performance in a walking distance test and a bicycle ergometer test was investigated. Methods - Static lung volumes, forced expiratory volume in one second (FEV(1)), inspiratory slow vital capacity (IVC), transfer factor for carbon monoxide (TLCO) divided by the alveolar volume (TLCO/VA), static compliance (Cst), and maximal inspiratory peak pressure (PImaxPOES) were measured in 40 patients with COPD with severe airways obstruction (mean FEV(1) 44% predicted, mean FEV(1)/IVC 37% predicted). Quality of life was assessed by the Chronic Respiratory Questionnaire (CRQ) and dyspnoea by the Borg category scale. Exercise capacity was measured by both a six minute walking distance (test) and a maximal work load of the bicycle ergometer test (Wmax). Results - Spirometric values and maximal inspiratory pressure were modestly correlated with both the six minute walking test and Wmax, r values ranging from 0.50 to 0.58. The TLCO was strongly correlated with the six minute walking test (r = 0.62) and with Wmax (r = 0.78). Quality of Life showed no correlation with exercise capacity, while there was a correlation between dyspnoea and the six minute walking test (r = -0.41). Backward linear regression analysis selected TLCO and PImaxPOES as the most significant determinants for exercise performance. They explained 54% and 69% of the variance in the six minute walking test and Wmax, respectively. Conclusions - The results show that exercise capacity in patients with COPD with severe airways obstruction is more strongly related to inspiratory muscle strength and lung function than to dyspnoea and quality of life. The significant correlation between dyspnoea and the six minute walking test suggests that subjective variables are more strongly related to walking tests than to bicycle ergometer tests.
- Published
- 1994
26. TRAINING IN MEASUREMENT
- Author
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TOMIC, W, KINGMA, J, TENVERGERT, EM, and Faculteit Medische Wetenschappen/UMCG
- Subjects
DEVELOPMENTAL SCALE ,TRADITIONAL INTELLIGENCE ,SERIATION ,education ,CONSERVATION ,PIAGETIAN TASKS - Abstract
The study investigated the effects of Obuchova's (1966, 1972) method of teaching children how to measure. The subjects were 30 kindergarten children who showed no pretest knowledge of either conservation or seriation. Children from the training condition (n = 15) received 3 1/2 weeks of training. Training appeared to be highly effective. A broad near-far transfer was observed; that is, skills were transferred to conservation tasks not taught in training. Far-far transfer (i.e., transfer to concepts not included in training) was also observed, because the children were able to solve a broad range of seriation tasks for which they had received no training. This is a noteworthy result, because far-far transfer has rarely been reported in training research. These effects persisted for 4 months. The educational importance of this result is that by means of a broadly designed course of training, strong and long-lasting near-far and far-far transfer effects may be induced. Training did not, however, evoke sleeper effects, because trained and untrained children performed at the same level 2 years after training.
- Published
- 1993
27. Efficacy and Safety of Antifibrinolytic Drugs in Liver Transplantation: A Systematic Review and Meta-Analysis
- Author
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Molenaar, IQ, primary, Warnaar, N, additional, Groen, H, additional, TenVergert, EM, additional, Slooff, MJH, additional, and Porte, RJ, additional
- Published
- 2007
- Full Text
- View/download PDF
28. CELLULAR-DAMAGE AND EARLY METABOLIC FUNCTION OF TRANSPLANTED LIVERS STORED IN EUROCOLLINS OR UNIVERSITY-OF-WISCONSIN SOLUTION
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PRUIM, J, TENVERGERT, EM, KLOMPMAKER, IJ, SLOOFF, MJH, and Guided Treatment in Optimal Selected Cancer Patients (GUTS)
- Subjects
UNIVERSITY-OF-WISCONSIN SOLUTION ,UW SOLUTION ,LIVER ENZYMES ,EUROCOLLINS ,PROCUREMENT ,LIVER PRESERVATION ,ALLOGRAFT FUNCTION ,GRAFTS ,PRESERVATION ,BILE ACIDS ,AMINO ACID METABOLISM ,VIABILITY ,HEPATIC TRANSPLANTATION - Abstract
In a clinical setting, the effect of Eurocollins (EC) and University of Wisconsin solution (UW) on liver grafts were studied in the early reperfusion phase of liver transplantation. Blood samples were drawn before and after declamping of the portal vein in a group of 11 transplants with EC-perfused livers, and a group of 12 transplants with UW-perfused livers. Parenchymal damage was assessed by the LDH, AST, and ALT, and purine degradation by measuring the uric acid levels. Metabolic function was determined by the serum bile acids and the plasma amino acids, i.e. (valine + leucine + isoleucine)/(phenylalanine + tyrosine) ratio. Donor and pretransplant recipient parameters were almost identical. The cold ischemia time of both groups differed significantly. The results show the following: a significant difference between both the LDH and the uric acid levels in the two groups was revealed, with a smaller increase of the LDH levels and no increase of the uric acid levels in the UW group. Metabolic activity, as measured from the bile acids and the amino acid profile in the peripheral blood, was identical in both groups. We conclude that both EC-stored and UW-stored liver grafts show immediate metabolic function after reperfusion. The amount of metabolic function was equal in both groups, notwithstanding longer cold ischemia time in the UW group. In addition, more parenchymal damage occurred in the EC group.
- Published
- 1991
29. Actual non-estimated ten-year survival in adults after liver transplantation (LT)
- Author
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van der Hilst, CS, primary, IJtsma, AJC, additional, Boelstra, TJ, additional, Haagsma, EB, additional, van den Berg, AP, additional, TenVergert, EM, additional, and Slooff, MJH, additional
- Published
- 2006
- Full Text
- View/download PDF
30. PCN17 COST REDUCTION IN THE DIAGNOSTIC EVALUATION OF PATIENTS WITH NON-SMALL CELL LUNG CANCER USING ENDOSCOPIC ULTRASONOGRAPHY WITH FINE-NEEDLE ASPIRATION
- Author
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Groen, H, primary, Post, WJ, additional, Groen, HJM, additional, Kramer, H, additional, and TenVergert, EM, additional
- Published
- 2003
- Full Text
- View/download PDF
31. PP65. Economic evaluation of high dose chemotherapy for breast cancer patients
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van Enckevort, PJ, primary, TenVergert, EM, additional, de Vries, EGE, additional, and Rodenhuis, S, additional
- Published
- 1997
- Full Text
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32. Cost of liver transplantation: a systematic review and meta-analysis comparing the United States with other OECD countries.
- Author
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van der Hilst CS, Ijtsma AJ, Slooff MJ, and Tenvergert EM
- Abstract
Large cost variations of liver transplantation are reported. The aim of this study was to assess cost differences of liver transplantation and clinical follow-up between the United States and other Organization for Economic Cooperation and Development (OECD) countries. Eight electronic databases were searched, and 2,000 citations published after 1990 with more than 10 transplantations, and with original cost data, were identified. A total of 30 articles included 5,975 liver transplantations. Meta-analysis was used to derive a combined mean using a random-effects model to test for heterogeneity between studies. Estimated mean cost of a U.S. liver transplantation was US$163,438 (US$145,277-181,598) compared to US$103,548 (US$85,514-121,582) for other OECD countries. Patient characteristics, disease characteristics, quality of the health care provider, and methodology could not explain this cost difference. Health system characteristics differed between the U.S. and other OECD countries. Cost differences in liver transplantation between these two groups may be largely explained by health system characteristics. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
33. Prospective study of long-term impact of adjuvant high-dose and conventional-dose chemotherapy on health-related quality of life.
- Author
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Buijs C, Rodenhuis S, Seynaeve CM, van Hoesel QG, van der Wall E, Smit WJ, Nooij MA, Voest E, Hupperets P, TenVergert EM, van Tinteren H, Willemse PH, Mourits MJ, Aaronson NK, Post WJ, and de Vries EG
- Published
- 2007
34. The effect of intra-articular injection of ultracain in the temporomandibular joint in patients with preauricular pain: a randomized prospective double-blind placebo-controlled crossover study.
- Author
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Tjakkes GE, TenVergert EM, de Bont LGM, and Stegenga B
- Published
- 2007
- Full Text
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35. Antiviral treatment of idiopathic sudden sensorineural hearing loss: a prospective, randomized, double-blind clinical trial.
- Author
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Stokroos RJ, Albers FWJ, and Tenvergert EM
- Abstract
A subclinical viral labyrinthitis has been postulated in the literature to elicit Idiopathic Sudden Sensorineural Hearing Loss. An etiological role for the herpes virus family is assumed. Corticosteroids possess a limited beneficial effect on hearing recovery in ISSHL. In this study, the therapeutic value of the antiherpetic drug aciclovir (Zovirax) on hearing recovery in 44 ISSHL patients receiving prednisolone is evaluated in a multicentre clinical trial. The study is designed prospectively, randomized, double-blind and placebo-controlled. Subjective parameters include hearing recovery, a pressure sensation on the affected ear, disequilibrium or vertigo and tinnitus. Audiometric parameters include pure tone and speech audiometry. A one-year follow up is obtained. Both the pressure sensation and disequilibrium or vertigo have a good prognosis, but tinnitus, occurring in most patients, has a poor prognosis. Hearing recovery prognosis depends on the severity of initial hearing loss, and not on vestibular involvement. No beneficial effect from combining aciclovir with prednisolone can be established in ISSHL. [ABSTRACT FROM AUTHOR]
- Published
- 1998
- Full Text
- View/download PDF
36. High-dose chemotherapy with hematopoietic stem-cell rescue for high-risk breast cancer.
- Author
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Rodenhuis S, Bontenbal M, Beex LVA, Wagstaff J, Richel DJ, Nooij MA, Voest EE, Hupperets P, van Tinteren H, Peterse HL, TenVergert EM, de Vries EGE, and Netherlands Working Party on Autologous Transplantation in Solid Tumors
- Published
- 2003
37. TMD pain: the effect on health related quality of life and the influence of pain duration.
- Author
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Tjakkes GH, Reinders JJ, Tenvergert EM, and Stegenga B
- Subjects
- Activities of Daily Living, Adolescent, Adult, Aged, Anxiety diagnosis, Anxiety etiology, Depression diagnosis, Depression etiology, Female, Health Status Indicators, Hospitalization, Humans, Male, Mental Health, Middle Aged, Netherlands, Pain Measurement, Psychometrics, Reference Values, Surveys and Questionnaires, Time Factors, Pain etiology, Pain psychology, Quality of Life, Temporomandibular Joint Disorders complications, Temporomandibular Joint Disorders physiopathology, Temporomandibular Joint Disorders psychology
- Abstract
Objectives: As impact of literature concerning this subject is scarce, the objectives of this study were to assess whether the Health Related Quality of Life (HRQoL) is decreased in patients with painful temporomandibular disorders as compared to the HRQoL in the general population, and to evaluate to what extent pain duration affects HRQoL., Methods: Data concerning physical and mental health were retrieved from patients with painful temporomandibular disorders. Assessment tools used were: the Mandibular Function Impairment Questionnaire (MFIQ), the Short-Form-36 (SF-36), the Hospital Anxiety and Depression Schedule (HADS), and the General Health Questionnaire (GHQ). In order to examine the influence of the duration of pain on HRQoL, the total sample was divided into three different subgroups. Subgroup 1 consisted of patients with complaints existing less than one year. Patients with complaints from 1 to 3 years were allocated to the second group. The 3rd subgroup included patients with complaints longer than 3 years., Results: The total sample consisted of 95 patients (90 females and 5 males). On most physical and social functioning items, groups 2 and 3 scored significantly worse than the general population. On the other hand, none of the groups differed from the general population when comparing the mental items. Duration of pain was significantly correlated with SF-36 subscale physical functioning and the mandibular impairment., Conclusion: Patients with TMD pain less than one year score better than compared to the population norm. With a longer duration of pain, mental health scores and role limitations due to emotional problems do not appear to be seriously affected by reduced physical health, while social functioning appears to be considerably affected.
- Published
- 2010
- Full Text
- View/download PDF
38. Cost-effectiveness of a psychoeducational relapse prevention program for depression in primary care.
- Author
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Stant AD, TenVergert EM, Kluiter H, Conradi HJ, Smit A, and Ormel J
- Subjects
- Antidepressive Agents economics, Antidepressive Agents therapeutic use, Cost-Benefit Analysis, Depressive Disorder, Major prevention & control, Humans, Patient Education as Topic methods, Quality-Adjusted Life Years, Recurrence, Self Care, Self Efficacy, Depressive Disorder, Major economics, Depressive Disorder, Major therapy, Patient Education as Topic economics, Primary Health Care economics, Psychiatry economics
- Abstract
Background: Major depression is a prevalent mental disorder with a high risk of relapses and recurrences, which are associated with considerable burden for patients and high costs for society. Despite these negative consequences, only few studies have focused on interventions aimed at the prevention of recurrences in primary care patients with depression., Aims of the Study: To assess the cost-effectiveness of a psychoeducational prevention program (PEP) aimed at improving the long-term outcome of depression in primary care., Methods: Recruitment took place in the northern part of the Netherlands, patients were referred by general practitioners. In total 267 patients were included in the study and randomly assigned to usual care (UC) or UC with one of three forms of PEP; PEP alone, psychiatric consultation followed by PEP (psychiatrist-enhanced PEP), and cognitive behavioral therapy followed by PEP (CBT-enhanced PEP). Costs and health outcomes were registered at three month intervals during the 36 months follow-up of the study. Primary outcome measure was the proportion of depression-free time., Results: Mean total costs during the 36 months of the study were 8200 euros in the UC group, 9816 euros in the PEP group, 9844 euros in the psychiatrist-enhanced PEP group, and 9254 euros in the CBT-enhanced PEP group. Costs of productivity losses, hospital admissions, contacts with regional institutions for mental healthcare, and medication use contributed substantially to the total costs in each group. Results of the primary outcome measure were less positive for PEP than for UC, but slightly better in the enhanced PEP groups. If decision-makers are willing to pay up to 300 euros for an additional proportion of depression-free time, UC is most likely to be the optimal intervention. For higher willingness to pay, CBT-enhanced PEP seems most efficient., Discussion: The basic PEP intervention was not cost-effective in comparison with UC. The economic impact of productivity losses associated with depression, and the importance of including these costs in economic studies, was illustrated by the findings of this study. Due to the drop-out of patients during the 36 months follow-up period, economic analyses had to account for missing data, which may complicate the interpretation of the results. Although Quality-Adjusted Life Years (QALYs) could not be assessed for all the patients, the results of analyses focusing on QALYs supported the overall conclusion that PEP is not cost-effective. IMPLICATIONS FOR HEALTH CARE PROVISION AND POLICIES: Results indicated that PEP should not be implemented in the Dutch healthcare system. Furthermore, is seems highly unlikely that PEP could be cost-effective in other (comparable) European healthcare systems., Implications for Further Research: The relatively positive economic results for CBT-enhanced PEP imply that UC enriched with CBT (but without PEP) might be cost-effective in preventing relapses in primary care patients with depression. The actual consequences of CBT for relapse prevention will have to be studied in further detail, both from a clinical and economic point of view.
- Published
- 2009
39. Pre-transplant quality of life does not predict survival after lung transplantation.
- Author
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Vermeulen KM, TenVergert EM, Verschuuren EA, Erasmus ME, and van der Bij W
- Subjects
- Adult, Aged, Female, Forecasting, Health Status Indicators, Humans, Male, Middle Aged, Surveys and Questionnaires, Survival Rate, Time Factors, Lung Transplantation mortality, Quality of Life
- Abstract
Background: Currently, the goal of lung transplantation is not only to improve survival but also includes improvement of health-related quality of life (HRQL). Limited knowledge is available about the value of HRQL before lung transplantation with regard to predicting survival after lung transplantation. To maximize the benefits of transplantation, it is essential to gain knowledge about variables that predict both length and quality of survival. In this study we sought to determine whether HRQL before transplantation predicts survival after lung transplantation., Methods: For each of the 200 lung transplant recipients included in this study, the HRQL questionnaire completed at the date closest to the transplant date was selected. Measures included were: the Nottingham Health Profile (NHP); State-Trait Anxiety Inventory (STAI); Self-Rating Depression Scale (SDS)-Zung; Karnofsky Performance Scale; and Index of Well-Being (IWB). Cox regression models were used to determine whether pre-transplant scores predicted post-transplant survival., Results: Survival rates at 1, 3 and 5 years were 85%, 73% and 69%, respectively. Mean scores on all pre-transplant HRQL measures were unfavorable compared with reference values for the general population. No significant predictors for survival after lung transplantation were found., Conclusions: Results suggest that scores on the various HRQL measures before transplantation did not predict survival after lung transplantation. The present results do not support the usefulness of pre-transplant HRQL measures for the selection of lung transplant candidates or their urgency for transplantation.
- Published
- 2008
- Full Text
- View/download PDF
40. The outcome of primary liver transplantation from deceased donors in children with body weight < or =10 kg.
- Author
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Polak WG, Peeters PM, Miyamoto S, Sieders E, de Jong KP, Porte RJ, Bijleveld CM, Hendriks HG, Tenvergert EM, and Slooff MJ
- Subjects
- Child, Preschool, Female, Humans, Infant, Liver Transplantation mortality, Male, Netherlands epidemiology, Proportional Hazards Models, Reoperation, Retrospective Studies, Survival Analysis, Tissue Donors, Transplantation, Homologous, Body Weight, Graft Survival, Liver Failure surgery, Liver Transplantation adverse effects
- Abstract
Between November 1982 and March 2006, 67 children with body weight < or =10 kg had a primary liver transplantation from deceased donors in our unit. The aim of this study was to analyze the outcome in terms of patient and graft survival and to search for factors affecting this outcome. Overall, one-, three-, five-, and 10-yr primary patient and graft survival rates were 73%, 71%, 66%, 63% and 59%, 56%, 53%, 48%, respectively. Twenty-four of 67 (36%) children died and in the remaining 22 (33%), the first grafts failed and they were retransplanted. Cox regression analysis revealed that a need for retransplantation and urgent transplantation were important predictors for patient survival (p = 0.04 and p = 0.001, respectively). To assess whether the need for retransplantation can be influenced, all study variables were compared between surviving grafts and failed grafts. Cox regression analysis showed that only donor/recipient (D/R) weight ratio proved to be independent predictor for graft survival (p = 0.004). After comparison of graft survival with the long rank test according to different D/R weight ratios (3.0-7.0), the cut-off point for significantly different graft survival approached 4.0. The one-, three-, five-, and 10-yr graft survival for technical variant grafts with a D/R weight ratio <4.0 was 85%, 68%, 68%, and 68% compared with a D/R weight ratio >4.0 was 44%, 38%, 38%, and 30%, respectively (p = 0.02). In summary, patient survival in children with body weight < or =10 kg is determined by urgent transplantation and the need for retransplantation. Graft loss and retransplantation in small children can be prevented by adequate size matching of donor and recipient whereby a D/R weight ratio <4.0 seems to offer the favorable outcome.
- Published
- 2008
- Full Text
- View/download PDF
41. Distinguishing benign and malignant pelvic masses: the value of different diagnostic methods in everyday clinical practice.
- Author
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Engelen MJ, Bongaerts AH, Sluiter WJ, de Haan HH, Bogchelman DH, Tenvergert EM, Willemse PH, and van der Zee AG
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, CA-125 Antigen blood, Diagnosis, Differential, Female, Genital Diseases, Female diagnosis, Humans, Middle Aged, Pelvis pathology, Predictive Value of Tests, Prospective Studies, ROC Curve, Risk, Ultrasonography, Doppler, Color, Magnetic Resonance Imaging, Ovarian Diseases diagnosis, Ovarian Neoplasms diagnosis
- Abstract
Objective: To optimize referral to specialized gynaecologists for surgical treatment of ovarian cancer by improving preoperative discrimination between benign and malignant pelvic tumours., Study Design: In a prospective multicentre study 143 patients with a pelvic mass were included. At several occasions during the diagnostic work-up the gynaecologist estimated the chance of malignancy (educated guess/expert opinion). MRI in the local setting was suggested for uncertain cases. All MRI images were reviewed by an expert radiologist. The datasheet designed for the study further allowed for determining the risk of malignancy index (RMI)., Results: The diagnostic accuracy of the gynaecologist's final estimation of the chance of malignancy and the calculated RMI were comparable (area under the ROC curve of 0.87 and 0.86). MRI did not improve the accuracy of the diagnostic work-up for the study population as a whole. Subgroup analysis did however show improved diagnostic accuracy in cases with an estimated chance of malignancy between 20 and 80% when the MRI was read by an expert radiologist., Conclusion: Patient selection for surgery of a pelvic mass should be based on the chance of malignancy as assigned by the referring gynaecologists. In case of uncertainty MRI improves diagnostic accuracy, when judged by an expert.
- Published
- 2008
- Full Text
- View/download PDF
42. Economic consequences of alternative medication strategies in first episode non-affective psychosis.
- Author
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Stant AD, TenVergert EM, Wunderink L, Nienhuis FJ, and Wiersma D
- Subjects
- Adult, Antipsychotic Agents adverse effects, Antipsychotic Agents therapeutic use, Cost Savings statistics & numerical data, Drug Administration Schedule, Female, Humans, Long-Term Care economics, Male, Netherlands, Practice Guidelines as Topic, Prospective Studies, Psychotic Disorders drug therapy, Quality-Adjusted Life Years, Recurrence, Schizophrenia drug therapy, Antipsychotic Agents economics, Drug Costs statistics & numerical data, National Health Programs economics, Psychotic Disorders economics, Schizophrenia economics
- Abstract
Background: Maintenance treatment appears to be successful in preventing relapses in first episode psychosis, but is also associated with side effects. Guided discontinuation strategy is a less intrusive intervention, but may lead to more relapses. In the current economic evaluation, costs and health outcomes of discontinuation strategy will be compared with the results of maintenance treatment in patients with remitted first episode psychosis., Method: The study was designed as a randomised clinical trial. In total 128 patients were prospectively followed for 18 months after six months of stable remission. The economic evaluation was conducted from a societal perspective. Quality-adjusted life years (QALYs) were used as primary health outcome in the economic evaluation. Relapse rates were assessed in addition to various other secondary outcomes., Results: There were no relevant differences in mean costs between groups during the study. Total costs were largely influenced by costs related to admissions to psychiatric hospitals. No differences between groups were found for QALY results., Conclusions: There were no indications that either of the examined interventions is superior to the other in terms of costs or QALY results. Additional results indicated that the relapse rate in discontinuation strategy was twice as high, but without an increase in hospital admissions or negative consequences on other clinical outcomes. For a minority of remitted first episode patients, guided discontinuation strategy may offer a feasible alternative to maintenance treatment.
- Published
- 2007
- Full Text
- View/download PDF
43. Cost-effectiveness of neonatal screening for medium chain acyl-CoA dehydrogenase deficiency: the homogeneous population of The Netherlands.
- Author
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van der Hilst CS, Derks TG, Reijngoud DJ, Smit GP, and TenVergert EM
- Subjects
- Case-Control Studies, Cost-Benefit Analysis, Female, Humans, Incidence, Infant, Newborn, Lipid Metabolism, Inborn Errors diagnosis, Lipid Metabolism, Inborn Errors epidemiology, Male, Neonatal Screening standards, Netherlands, Reference Values, Retrospective Studies, Risk Assessment, Acyl-CoA Dehydrogenase deficiency, Cost of Illness, Health Care Costs, Lipid Metabolism, Inborn Errors economics, Neonatal Screening economics
- Abstract
Objective: To assess the cost-effectiveness of neonatal screening on medium chain acyl-CoA dehydrogenase (MCAD) deficiency in a homogeneous population., Study Design: For the scenario without neonatal screening, medical chart review and interviews were performed with physicians and families of 116 Dutch patients born between 1985 and July 2003 with clinically ascertained MCAD deficiency. For the scenario with neonatal screening, 66,205 unaffected and 11 affected newborns identified by prospective neonatal screening for MCAD deficiency in the northern part of the Netherlands were evaluated. The incremental cost-effectiveness ratio (ICER) used life years (LYs) as the outcome measure by combining both scenarios in a decision model with second-order Monte Carlo simulation., Results: For the scenarios with and without neonatal screening for MCAD deficiency, costs were $6.10 and $4.22 per newborn, respectively. The main cost categories were institutionalization (64%), admissions (17%), special education (8%), laboratory testing (4%), and (para)medical contact (4%). The resulting ICER was $1653 per LY gained. Sensitivity analysis generated an ICER between $14,839 and $4345 per LY gained., Conclusions: Screening for MCAD deficiency in a well-defined population generates an ICER well within accepted boundaries for cost-effective interventions, even after sensitivity analysis.
- Published
- 2007
- Full Text
- View/download PDF
44. Cost-effectiveness analysis in severe mental illness: outcome measures selection.
- Author
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Stant AD, Buskens E, Jenner JA, Wiersma D, and TenVergert EM
- Subjects
- Antipsychotic Agents economics, Antipsychotic Agents therapeutic use, Cost-Benefit Analysis, Hallucinations, Humans, Psychotherapy economics, Quality of Life, Quality-Adjusted Life Years, Outcome Assessment, Health Care methods, Schizophrenia economics, Schizophrenia therapy
- Abstract
Background: Most economic evaluations conducted in mental healthcare did not include widely recommended preference-based health outcomes like the QALY (Quality-Adjusted Life Years). Instead, studies have mainly been designed as cost-effectiveness analyses that include single outcome measures aimed at a (disease) specific aspect of health., Aims of the Study: To raise awareness about the potential problems related to the selection of outcome measures for economic studies in patient populations with severe mental illness. Furthermore, to make suggestions that may prevent these problems in future economic evaluations., Methods: Data of a previously conducted economic evaluation assessing the cost-effectiveness of the HIT (Hallucination focused Integrative Treatment) intervention in patients with schizophrenia were used for the analyses presented in the current paper. Economic analyses based on the results of the selected primary health outcome (Positive and Negative Syndrome Scale: PANSS) were compared with results based on various other health outcomes assessed during the study, including QALYs., Results: No relevant differences between groups were found on the single primary health outcome initially included in the cost-effectiveness analysis. In contrast, relevant and significant differences were identified on three of the four additionally assessed health outcomes. Conclusions based on the results of multiple cost-effectiveness analyses and acceptability curves were strongly in favour of the experimental intervention when including these three additional instruments. QALY results did not show differences between groups., Discussion: Selecting between outcome measures for cost-effectiveness analysis in the field of mental healthcare appears to be a complicated process, which may have considerable consequences for the results of economic studies and subsequent policy decisions. It was argued that inconsistent results across the selected primary health outcome and additionally assessed health outcomes should explicitly be presented to decision-makers. Until there is consensus on a preference-based instrument suited for severe mental illness, QoL instruments could be applied instead of instruments aimed at specific aspects of health., Implications for Health Policies: Decision-makers in the field of mental healthcare should be careful when interpreting results of economic studies that included outcome measures aimed at a specific aspect of health. Such instruments may provide too narrow a view on relevant changes in health and findings may be difficult to generalise. Due to current reservations on the use of QALYs in mental healthcare, QALY outcomes should be considered in the context of the results of additionally assessed health outcomes.
- Published
- 2007
45. Long-term health-related quality of life after lung transplantation: different predictors for different dimensions.
- Author
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Vermuelen KM, van der Bij W, Erasmus ME, and TenVergert EM
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Prognosis, Surveys and Questionnaires, Time Factors, Lung Transplantation physiology, Lung Transplantation psychology, Quality of Life
- Abstract
Background: Lung transplantation has proven to be an effective treatment option for patients with end-stage lung disease with profound effects on both survival and health-related quality of life (HRQL). Generally, studies have reported improved HRQL after lung transplantation. When assessing HRQL, physical, psychologic or social dimensions are usually included. However, it is unclear what predicts outcome, to what extent, and whether there are differences in predictors between dimensions of HRQL. Knowledge about these predictors may be useful when making choices regarding therapy. The research question in the present study was: What are the predicting variables of physical and psychologic dimensions of HRQL, and do they differ?, Methods: Results from studies of the physical dimension (the Nottingham Health Profile's energy and mobility scales) and the psychologic dimension (Zung depression and STAI anxiety scores) from 140 transplanted patients with a maximum follow-up of almost 10 years were assessed using mixed-model analysis. For both dimensions, the following variables were tested for their predictive value: age; gender; diagnosis; year of transplantation; time on the waiting list; type of transplantation; bronchiolitis obliterans syndrome; and pre-transplant HRQL scores., Results: With regard to the physical dimension after lung transplantation, presence of bronchiolitis obliterans syndrome (BOS), age and pre-transplant scores on the measure under study were significant predictors for both energy and mobility. For mobility, gender appeared to be an additional predictor. With regard to the psychologic dimension after lung transplantation, BOS was a predictor for both anxiety and depression. Pre-transplant depression was an additional predictor for post-transplant depression, and age was an additional predictor for anxiety., Conclusions: Several variables were identified that predicted HRQL after lung transplantation. These variables differed between the physical and psychologic dimensions. The presence of BOS was a predictor for both dimensions. The present findings may be helpful when choosing or developing interventions aimed at improving HRQL after lung transplantation.
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- 2007
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46. RAte Control Efficacy in permanent atrial fibrillation: a comparison between lenient versus strict rate control in patients with and without heart failure. Background, aims, and design of RACE II.
- Author
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Van Gelder IC, Van Veldhuisen DJ, Crijns HJ, Tuininga YS, Tijssen JG, Alings AM, Bosker HA, Cornel JH, Kamp O, Veeger NJ, Volbeda M, Rienstra M, Ranchor AV, TenVergert EM, and Van den Berg MP
- Subjects
- Anti-Arrhythmia Agents therapeutic use, Atrial Fibrillation complications, Atrial Fibrillation epidemiology, Cardiac Pacing, Artificial methods, Cardiac Pacing, Artificial trends, Follow-Up Studies, Heart Failure complications, Heart Failure epidemiology, Humans, Multicenter Studies as Topic trends, Patient Selection, Prospective Studies, Randomized Controlled Trials as Topic trends, Atrial Fibrillation therapy, Heart Failure therapy, Multicenter Studies as Topic methods, Randomized Controlled Trials as Topic methods
- Abstract
Background: Recent studies demonstrated that rate control is an acceptable alternative for rhythm control in patients with persistent atrial fibrillation (AF). However, optimal heart rate during AF is still unknown., Objective: To show that in patients with permanent AF, lenient rate control is not inferior to strict rate control in terms of cardiovascular mortality, morbidity, neurohormonal activation, New York Heart Association class for heart failure, left ventricular function, left atrial size, quality of life, and costs., Methods: The RACE II study is a prospective multicenter trial in The Netherlands that will randomize 500 patients with permanent AF (< or = 12 months) to strict or lenient rate control. Strict rate control is defined as a mean resting heart rate < 80 beats per minute (bpm) and heart rate during minor exercise < 110 bpm. After reaching the target, a 24-hour Holter monitoring will be performed. If necessary, drug dose reduction and/or pacemaker implantation will be performed. Lenient rate control is defined as a resting heart rate < 110 bpm. Patients will be seen after 1, 2, and 3 months (for titration of rate control drugs) and yearly thereafter. We anticipate a 25% 2.5-year cardiovascular morbidity and mortality in both groups., Results: Enrollment started in January 2005 in 29 centers in The Netherlands and is expected to be concluded in June 2006. Follow-up will be at least 2 years with a maximum of 3 years., Conclusion: This study should provide data how to treat patients with permanent AF.
- Published
- 2006
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47. Noninferiority testing in cost-minimization studies: Practical issues concerning power analysis.
- Author
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Span MM, TenVergert EM, van der Hilst CS, and Stolk RP
- Subjects
- Cost Control, Sensitivity and Specificity, Models, Econometric, Outcome Assessment, Health Care economics, Outcome Assessment, Health Care statistics & numerical data
- Abstract
Objectives: In cost-minimization studies, it is important to establish noninferiority in the clinical effect of the treatments under investigation. The relationship between the proportion of patients reaching the end point in a study, equivalence limit (delta), and power is investigated in the context of cost-minimization studies with dichotomous clinical end points. Two formulations of the null-hypothesis, absolute and relative formulations of delta, will be explored., Methods: Sensitivity analysis was performed, in which the effect of the predicted proportions and delta on the power in a noninferiority setting was investigated. The patterns found are discussed in terms of the practical relevance within the cost-minimization framework., Results: Sensitivity analyses show different patterns of results for both null-hypotheses. The differences in these results originate from the way delta is expressed. By expressing delta as absolute difference, power grows quite fast when sample proportions are smaller than expected. In the case of a proportional delta at small sample proportions, the power to establish noninferiority remains low., Conclusions: To obtain valid results from a cost-minimization study, care has to be taken to adapt the correct methodology for noninferiority testing in clinical outcomes. Defining delta in terms of absolute differences between treatments can lead to obscured results. Although conservative, the expression of delta as a proportion of the effectiveness of the treatment as usual is found to be closer to clinical practice. The inflated delta, resulting from smaller clinical effects than expected when absolute formulation is applied, thus can be avoided.
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- 2006
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48. The effect of HLA mismatches, shared cross-reactive antigen groups, and shared HLA-DR antigens on the outcome after pediatric liver transplantation.
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Sieders E, Hepkema BG, Peeters PM, TenVergert EM, de Jong KP, Porte RJ, Bijleveld CM, van den Berg AP, Lems SP, Gouw AS, and Slooff MJ
- Subjects
- Adolescent, Biopsy, Child, Child, Preschool, Cross Reactions immunology, Female, Follow-Up Studies, Graft Rejection epidemiology, Graft Rejection immunology, Graft Rejection pathology, Graft Survival, Humans, Incidence, Infant, Infant, Newborn, Liver Cirrhosis epidemiology, Liver Cirrhosis immunology, Liver Cirrhosis pathology, Male, Proportional Hazards Models, Retrospective Studies, Risk Factors, HLA-DR Antigens immunology, Histocompatibility Antigens Class I immunology, Histocompatibility Testing methods, Liver Transplantation immunology
- Abstract
The aim of this study was to analyze the effect of human leukocyte antigen (HLA) class I and HLA-DR mismatching, sharing cross-reactive antigen groups (CREGs), and sharing HLA-DR antigens on the outcome after pediatric liver transplantation. Outcome parameters were graft survival, acute rejection, and portal fibrosis. A distinction was made between full-size (FSLTx) and technical-variant liver transplantation (TVLTx). A total of 136 primary transplants were analyzed. The effect of HLA on the outcome parameters was analyzed by adjusted multivariate logistic and Cox regression analysis. HLA mismatches, shared CREGs, and shared HLA-DR antigens affected neither overall graft survival nor survival after FSLTx. Survival after TVLTx was superior in case of 2 mismatches at the HLA-DR locus compared to 0 or 1 mismatch (P = 0.01) and in case of no shared HLA-DR antigen compared to 1 shared HLA-DR antigen (P = 0.004). The incidence of acute rejection was not influenced by HLA. The incidence of portal fibrosis could be analyzed in 62 1-yr biopsies and was higher after TVLTx than FSLTx (P = 0.04). The incidence of portal fibrosis after TVLTx with 0 or 1 mismatch at the HLA-DR locus was 100% compared to 43% with 2 mismatches (P = 0.004). After multivariate analysis, matching for HLA-DR and matching for TVLTx were independent risk factors for portal fibrosis. In conclusion, an overall beneficial effect of HLA matching, sharing CREGs, or sharing HLA-DR antigens was not observed. A negative effect was present for HLA-DR matching and sharing HLA-DR antigens on survival after TVLTx. HLA-DR matching might be associated with portal fibrosis in these grafts.
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- 2005
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49. Fatigue and relating factors in high-risk breast cancer patients treated with adjuvant standard or high-dose chemotherapy: a longitudinal study.
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Nieboer P, Buijs C, Rodenhuis S, Seynaeve C, Beex LV, van der Wall E, Richel DJ, Nooij MA, Voest EE, Hupperets P, Mulder NH, van der Graaf WT, TenVergert EM, van Tinteren H, and de Vries EG
- Subjects
- Dose-Response Relationship, Drug, Female, Hemoglobins metabolism, Humans, Menopause, Mental Health, Middle Aged, Multivariate Analysis, Netherlands epidemiology, Pain, Prospective Studies, Regression Analysis, Risk Factors, Statistics, Nonparametric, Survivors, Antineoplastic Agents administration & dosage, Antineoplastic Agents adverse effects, Breast Neoplasms drug therapy, Fatigue epidemiology, Fatigue etiology, Quality of Life
- Abstract
Purpose: Determine whether standard or high-dose chemotherapy leads to changes in fatigue, hemoglobin (Hb), mental health, muscle and joint pain, and menopausal status from pre- to post-treatment and to evaluate whether fatigue is associated with these factors in disease-free breast cancer patients., Patients and Methods: Eight hundred eighty-five patients were randomly assigned between two chemotherapy regimens both followed by radiotherapy and tamoxifen. Fatigue was assessed using vitality scale (score < or = 46 defined as fatigue), poor mental health using mental health scale (score < or = 56 defined as poor mental health) both of Short-Form 36, muscle and joint pain with Rotterdam Symptom Checklist, and Hb levels were assessed before and 1, 2, and 3 years after chemotherapy., Results: Fatigue was reported in 20% of 430 assessable patients (202 standard-dose, 228 high-dose) with at least a 3-year follow-up, without change over time or difference between treatment arms. Mean Hb levels were lower following high-dose chemotherapy. Only 5% of patients experienced fatigue and anemia. Mental health score was the strongest fatigue predictor at all assessment moments. Menopausal status had no effect on fatigue. Linear mixed effect models showed that the higher the Hb level (P = .0006) and mental health score (P < .0001), the less fatigue was experienced. Joint (P < .0001) and muscle pain (P = .0283) were associated with more fatigue., Conclusion: In 3 years after treatment, no significant differences in fatigue were found between standard and high-dose chemotherapy. Fatigue did not change over time. The strongest fatigue predictor was poor mental health.
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- 2005
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50. Incomplete quality of life data in lung transplant research: comparing cross sectional, repeated measures ANOVA, and multi-level analysis.
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Vermeulen KM, Post WJ, Span MM, van der Bij W, Koëter GH, and TenVergert EM
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- Adult, Analysis of Variance, Artifacts, Bias, Cross-Sectional Studies, Epidemiologic Research Design, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Netherlands epidemiology, Reproducibility of Results, Sample Size, Sensitivity and Specificity, Data Interpretation, Statistical, Health Status Indicators, Lung Diseases epidemiology, Lung Diseases surgery, Lung Transplantation statistics & numerical data, Quality of Life, Research
- Abstract
Background: In longitudinal studies on Health Related Quality of Life (HRQL) it frequently occurs that patients have one or more missing forms, which may cause bias, and reduce the sample size. Aims of the present study were to address the problem of missing data in the field of lung transplantation (LgTX) and HRQL, to compare results obtained with different methods of analysis, and to show the value of each type of statistical method used to summarize data., Methods: Results from cross-sectional analysis, repeated measures on complete cases (ANOVA), and a multi-level analysis were compared. The scores on the dimension 'energy' of the Nottingham Health Profile (NHP) after transplantation were used to illustrate the differences between methods., Results: Compared to repeated measures ANOVA, the cross-sectional and multi-level analysis included more patients, and allowed for a longer period of follow-up. In contrast to the cross sectional analyses, in the complete case analysis, and the multi-level analysis, the correlation between different time points was taken into account. Patterns over time of the three methods were comparable. In general, results from repeated measures ANOVA showed the most favorable energy scores, and results from the multi-level analysis the least favorable. Due to the separate subgroups per time point in the cross-sectional analysis, and the relatively small number of patients in the repeated measures ANOVA, inclusion of predictors was only possible in the multi-level analysis., Conclusion: Results obtained with the various methods of analysis differed, indicating some reduction of bias took place. Multi-level analysis is a useful approach to study changes over time in a data set where missing data, to reduce bias, make efficient use of available data, and to include predictors, in studies concerning the effects of LgTX on HRQL.
- Published
- 2005
- Full Text
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