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The Dutch Parelsnoer Institute-Cerebrovascular accident (CVA) Study is part of the Parelsnoer Institute (PSI), initiated in 2007 by the Netherlands Federation of University Medical Centers (NFU). PSI is a cooperation of all eight Dutch University Medical Centers (UMCs) and aims at building large prospectively collected datasets with uniformly and standardized storage of biomaterials for complex diseases. Currently, PSI covers 18 disease-specific cohorts called 'Pearls', and this number is still growing. One of these cohorts is the Stroke or CVA Pearl. For each of the cohorts, PSI offers the UMCs an infrastructure and standard procedures for storing the specific biomaterials in their certified biobanks. Clinical data are stored in a central database after being pseudonymized to ensure patient privacy. For the Parelsnoer Institute-CVA Study, blood for genetic analysis, serum and plasma are collected according to nationally agreed standards. Currently (November 2017) the Stroke Pearl has stored blood samples with prospectively obtained clinical data of around 6000 patients in all UMCs combined. Blood samples and data are available for all researchers with a methodologically valid research proposal.

Contains fulltext : 208145.pdf (publisher's version ) (Open Access), BACKGROUND: Quality of Life (QoL) is an important outcome measure in dementia, particularly in the context of interventions. Research investigating longitudinal QoL in dementia with Lewy bodies (DLB) is currently lacking. OBJECTIVE: To investigate determinants and trajectories of QoL in DLB compared to Alzheimer's disease (AD) and controls. METHODS: QoL was assessed annually in 138 individuals, using the EQ5D-utility-score (0-100) and the health-related Visual Analogue Scale (VAS, 0-100). Twenty-nine DLB patients (age 69+/-6), 68 AD patients (age 70+/-6), and 41 controls (age 70+/-5) were selected from the Dutch Parelsnoer Institute-Neurodegenerative diseases and Amsterdam Dementia Cohort. We examined clinical work-up over time as determinants of QoL, including cognitive tests, neuropsychiatric inventory, Geriatric Depression Scale (GDS), and disability assessment of dementia (DAD). RESULTS: Mixed models showed lower baseline VAS-scores in DLB compared to AD and controls (AD: beta+/-SE = -7.6+/-2.8, controls: beta+/-SE = -7.9+/-3.0, p < 0.05). An interaction between diagnosis and time since diagnosis indicated steeper decline on VAS-scores for AD patients compared to DLB patients (beta+/-SE = 2.9+/-1.5, p < 0.1). EQ5D-utility-scores over time did not differ between groups. Higher GDS and lower DAD-scores were independently associated with lower QoL in dementia patients (GDS: VAS beta+/-SE = -1.8+/-0.3, EQ5D-utility beta+/-SE = -3.7+/-0.4; DAD: VAS = 0.1+/-0.0, EQ5D-utility beta+/-SE = 0.1+/-0.1, p < 0.05). No associations between cognitive tests and QoL remained in the multivariate model. CONCLUSION: QoL is lower in DLB, while in AD QoL shows steeper decline as the disease advances. Our results indicate that non-cognitive symptoms, more than cognitive symptoms, are highly relevant as they impact QoL.

Background: Quality of Life (QoL) is an important outcome measure in dementia, particularly in the context of interventions. Research investigating longitudinal QoL in dementia with Lewy bodies (DLB) is currently lacking. Objective: To investigate determinants and trajectories of QoL in DLB compared to Alzheimer’s disease (AD) and controls. Methods: QoL was assessed annually in 138 individuals, using the EQ5D-utility-score (0–100) and the health-related Visual Analogue Scale (VAS, 0–100). Twenty-nine DLB patients (age 69 ± 6), 68 AD patients (age 70 ± 6), and 41 controls (age 70 ± 5) were selected from the Dutch Parelsnoer Institute-Neurodegenerative diseases and Amsterdam Dementia Cohort. We examined clinical work-up over time as determinants of QoL, including cognitive tests, neuropsychiatric inventory, Geriatric Depression Scale (GDS), and disability assessment of dementia (DAD). Results: Mixed models showed lower baseline VAS-scores in DLB compared to AD and controls (AD: ±SE = -7.6 ± 2.8, controls: ±SE = -7.9 ± 3.0, p < 0.05). An interaction between diagnosis and time since diagnosis indicated steeper decline on VAS-scores for AD patients compared to DLB patients (±SE = 2.9 ± 1.5, p < 0.1). EQ5D-utility-scores over time did not differ between groups. Higher GDS and lower DAD-scores were independently associated with lower QoL in dementia patients (GDS: VAS ±SE = -1.8 ± 0.3, EQ5D-utility ±SE = -3.7 ± 0.4; DAD: VAS = 0.1 ± 0.0, EQ5D-utility ±SE = 0.1 ± 0.1, p < 0.05). No associations between cognitive tests and QoL remained in the multivariate model. Conclusion: QoL is lower in DLB, while in AD QoL shows steeper

Contains fulltext : 174452.pdf (publisher's version ) (Open Access)

Contains fulltext : 153952.pdf (publisher's version ) (Open Access), OBJECTIVE: To test the hypothesis that it is possible to select a group of low risk women who can start labour in midwife-led care without having increased rates of severe adverse maternal outcomes compared to women who start labour in secondary care. DESIGN AND METHODS: We conducted a nationwide cohort study in the Netherlands, using data from 223 739 women with a singleton pregnancy between 37 and 42 weeks gestation without a previous caesarean section, with spontaneous onset of labour and a child in cephalic presentation. Information on all cases of severe acute maternal morbidity collected by the national study into ethnic determinants of maternal morbidity in the Netherlands (LEMMoN study), 1 August 2004 to 1 August 2006, was merged with data from the Netherlands Perinatal Registry of all births occurring during the same period. Our primary outcome was severe acute maternal morbidity (SAMM, i.e. admission to an intensive care unit, uterine rupture, eclampsia or severe HELLP, major obstetric haemorrhage, and other serious events). Secondary outcomes were postpartum haemorrhage and manual removal of placenta. RESULTS: Nulliparous and parous women who started labour in midwife-led care had lower rates of SAMM, postpartum haemorrhage and manual removal of placenta compared to women who started labour in secondary care. For SAMM the adjusted odds ratio's and 95% confidence intervals were for nulliparous women: 0.57 (0.45 to 0.71) and for parous women 0.47 (0.36 to 0.62). CONCLUSIONS: Our results suggest that it is possible to identify a group of women at low risk of obstetric complications who may benefit from midwife-led care. Women can be reassured that we found no evidence that midwife-led care at the onset of labour is unsafe for women in a maternity care system with a well developed risk selection and referral system.

Contains fulltext : 137200.pdf (publisher's version ) (Closed access), OBJECTIVE: to investigate factors important to women receiving midwife-led care with regard to their expectations for management of labour pain. DESIGN: semi-structured ante partum interviews and analyses using constant comparison method. PARTICIPANTS: fifteen pregnant women between 36 and 40 weeks gestation receiving midwife-led care. SETTING: five midwifery practices across the Netherlands between June 2009 and July 2010. MAIN OUTCOME: women's expectations regarding management of labour pain. RESULTS: we found three major themes to be important in women's expectations for management of labour pain: preparation, support and control and decision-making. In regards to all these themes, three distinct approaches towards women's planning for pain management in labour were identified: the 'pragmatic natural', the 'deliberately uninformed' and the 'planned pain relief' approach. CONCLUSION: midwives need to recognise that women take different approaches to pain management in labour in order to adapt care to the individual woman.

Background: Chlamydia trachomatis infections in pregnancy can cause maternal disease, adverse pregnancy outcomes and neonatal disease, which is why chlamydia screening during pregnancy has been advocated. The effectiveness of a screening program depends on the knowledge of health care professionals, women and partners and the acceptability for screening of the target population. We assessed the knowledge of chlamydia infection among pregnant women and their partners in the Netherlands, their attitudes towards testing, and their experiences of being offered a chlamydia test. In addition, we evaluated the association between participants' background characteristics and knowledge of chlamydia. Methods: Pregnant women aged <= 30 years and their partners (regardless of their age) attending one of the participating primary midwifery care practices in the Netherlands were invited to participate. All participants completed a questionnaire, pregnant women provided a vaginal swab and partners provided a urine sample to test for C. trachomatis. Results: In total, 383 pregnant women and 282 partners participated in the study of whom 1.9% women and 2.6% partners tested chlamydia positive. Participants had high levels of awareness (92.8%) of chlamydial infection. They were knowledgeable about the risk of chlamydia infection; median knowledge score was 9.0 out of 12.0. Lower knowledge scores were found among partners (p-value <0.001), younger aged (p-value 0.02), non-western origin (p-value <0.001), low educational level (p-value <0.001), and no history of sexually transmitted infections (p-value <0.001). In total, 78% of respondents indicated that when pregnant women are tested for chlamydia, their partners should also be tested; 54% believed that all women should routinely be tested. Pregnant women more often indicated than partners that testing partners for chlamydial infection was not necessary (p-value <0.001). The majority of pregnant women (56.2%) and

Contains fulltext : 117640.pdf (publisher's version ) (Open Access), OBJECTIVES: To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. DESIGN: Cohort study using a linked dataset. SETTING: Information on all cases of severe acute maternal morbidity in the Netherlands collected by the national study into ethnic determinants of maternal morbidity in the netherlands (LEMMoN study), 1 August 2004 to 1 August 2006, merged with data from the Netherlands perinatal register of all births occurring during the same period. PARTICIPANTS: 146 752 low risk women in primary care at the onset of labour. MAIN OUTCOME MEASURES: Severe acute maternal morbidity (admission to an intensive care unit, eclampsia, blood transfusion of four or more packed cells, and other serious events), postpartum haemorrhage, and manual removal of placenta. RESULTS: Overall, 92 333 (62.9%) women had a planned home birth and 54 419 (37.1%) a planned hospital birth. The rate of severe acute maternal morbidity among planned primary care births was 2.0 per 1000 births. For nulliparous women the rate for planned home versus planned hospital birth was 2.3 versus 3.1 per 1000 births (adjusted odds ratio 0.77, 95% confidence interval 0.56 to 1.06), relative risk reduction 25.7% (95% confidence interval -0.1% to 53.5%), the rate of postpartum haemorrhage was 43.1 versus 43.3 (0.92, 0.85 to 1.00 and 0.5%, -6.8% to 7.9%), and the rate of manual removal of placenta was 29.0 versus 29.8 (0.91, 0.83 to 1.00 and 2.8%, -6.1% to 11.8%). For parous women the rate of severe acute maternal morbidity for planned home versus planned hospital birth was 1.0 versus 2.3 per 1000 births (0.43, 0.29 to 0.63 and 58.3%, 33.2% to 87.5%), the rate of postpartum haemorrhage was 19.6 versus 37.6 (0.50, 0.46 to 0.55 and 47.9%, 41.2% to 54.7%), and the rate of manual removal of placenta was 8.5 vers

Contains fulltext : 53050.pdf (publisher's version ) (Closed access)

Item does not contain fulltext, Objective. To compare the rate of surgical site infection (SSI) before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented. To demonstrate that a more prudent, restrictive policy would not have a detrimental effect on patient outcomes.Design. Before-after trial with prospective SSI surveillance in the Dutch nosocomial surveillance network (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), using the criteria of the Centers for Disease Control, including postdischarge surveillance for up to 1 year.Methods. During a preintervention period and a postintervention period (both 6-13 months), 12 Dutch hospitals collected data on antimicrobial prophylaxis and SSI rates. The study was limited to commonly performed surgical procedures in 4 specialties: vascular, intestinal, gynecological and orthopedic surgery. Selected risk factors for analysis were sex, age, American Society of Anesthesiologists classification, wound contamination class, duration of surgery, length of hospital stay before surgery, and urgency of surgery (elective or acute).Results. A total of 3,621 procedures were included in the study, of which 1,668 were performed before the intervention and 1,953 after. The overall SSI rate decreased from 5.4% to 4.5% (P=.22). Among the procedures included in the study, the largest proportion (55%) were total hip arthroplasty, and the smallest proportion (2%) were replacement of the head of the femur. SSI rates varied from 0% for vaginal hysterectomy to 21.1% for femoropopliteal or femorotibial bypass surgery. Crude and adjusted odds ratios showed that there were no significant changes in procedure-specific SSI rates after the intervention (P>.1).Conclusions. An optimized and restrictive antibiotic prophylaxis policy had no detrimental effect on the outcome of clean and clean contaminated surgery, as measured by SSI rate.

Contains fulltext : 48238.pdf (publisher's version ) (Closed access), OBJECTIVES: Misuse of antibiotics in surgical prophylaxis is still quite common. The objectives of this study were to reduce the quantity and improve the quality of surgical prophylaxis and to reduce costs. METHODS: Prospective multi-site study of elective procedures in 13 Dutch hospitals. The quality of prophylaxis was audited before and after an intervention consisting of performance feedback and implementation of national clinical practice guidelines. Process outcome parameters were antibiotic choice, duration, timing, antibiotic volume and costs. Segmented regression analysis was used to estimate the effect size of the intervention. Patient outcome was documented by the incidence of surgical site infections (SSI). RESULTS: Before the intervention, 1763 procedures were recorded and 2050 thereafter. Antimicrobial use decreased from 121 to 79 DDD (defined daily doses)/100 procedures and costs reduced by 25% per procedure. After the intervention, antibiotic choice was inappropriate in only 37.5% of the cases instead of in 93.5% expected cases had the intervention not occurred. Prolonged prophylaxis was observed in 31.4% instead of 46.8% expected cases and inappropriate timing in 39.4% instead of the expected 51.8%. Time series analysis showed that all improvements were statistically significant (P < 0.01) and that they could be fully attributed to the intervention. The overall SSI rates before and after intervention were 5.4% (95% CI: 4.3-6.5) and 4.6% (95% CI: 3.6-5.4), respectively. CONCLUSIONS: The intervention led to improved quality of surgical prophylaxis and to reduced antibiotic use and costs without impairment of patient outcome.

RIVM rapport:In de periode van juli 1997 - december 2000 hebben 19 ziekenhuizen gegevens geregistreerd over 3.921 patienten op de Intensive Care (IC) met 41.744 verpleegdagen. Bij 1.065 patienten ontstonden 1.673 infecties, waarvan 684 pneumonieen, 354 gevallen van sepsis, 353 urineweginfecties en 282 overige infecties. Van alle patienten werd 63% beademd, had 88% een urinewegkatheter en 66% minstens een centrale lijn. Het aantal ventilatie-gerelateerde pneumonieen was 24 per 1000 ventilatiedagen, het aantal katheter-geassocieerde urineweginfecties tien per 1000 katheterdagen en het aantal gevallen van lijnsepsis was vier per 1000 centrale lijndagen. De surveillanceresultaten leidde in slechts twee ziekenhuizen tot interventiemaatregelen en in zeven ziekenhuizen tot ondersteuning van het beleid en/of de besluitvorming op het gebied van infectiepreventie op de IC., In the period from July 1997 to December 2000, 19 hospitals collected data on 3,921 patients in the Intensive Care Unit (ICU) for 41,744 ICU patient-days. Of these patients 1,065 had developed 1,673 infections, including 684 with pneumonia, 354 with sepsis, 353 with urinary tract infections and 282 with other infections. Of the total number of patients, 63% were mechanically ventilated, 88% had a urinary bladder catheter and 66% had at least one central vascular catheter. The number of ventilation-related pneumonias was 24 per 1000 ventilation-days, the number of catheter-related urinary tract infections was 10 per 1000 catheter-days, and the number of central catheter-related sepsis was 4 per 1000 central-venous catheter-days. The surveillance results led to interventions in only 2 hospitals, and 7 hosptials supported the policy and/or the decision-making process on infection prevention in the ICUs.

RIVM rapport:In the period from July 1997 to December 2000, 19 hospitals collected data on 3,921 patients in the Intensive Care Unit (ICU) for 41,744 ICU patient-days. Of these patients 1,065 had developed 1,673 infections, including 684 with pneumonia, 354 with sepsis, 353 with urinary tract infections and 282 with other infections. Of the total number of patients, 63% were mechanically ventilated, 88% had a urinary bladder catheter and 66% had at least one central vascular catheter. The number of ventilation-related pneumonias was 24 per 1000 ventilation-days, the number of catheter-related urinary tract infections was 10 per 1000 catheter-days, and the number of central catheter-related sepsis was 4 per 1000 central-venous catheter-days. The surveillance results led to interventions in only 2 hospitals, and 7 hosptials supported the policy and/or the decision-making process on infection prevention in the ICUs., In de periode van juli 1997 - december 2000 hebben 19 ziekenhuizen gegevens geregistreerd over 3.921 patienten op de Intensive Care (IC) met 41.744 verpleegdagen. Bij 1.065 patienten ontstonden 1.673 infecties, waarvan 684 pneumonieen, 354 gevallen van sepsis, 353 urineweginfecties en 282 overige infecties. Van alle patienten werd 63% beademd, had 88% een urinewegkatheter en 66% minstens een centrale lijn. Het aantal ventilatie-gerelateerde pneumonieen was 24 per 1000 ventilatiedagen, het aantal katheter-geassocieerde urineweginfecties tien per 1000 katheterdagen en het aantal gevallen van lijnsepsis was vier per 1000 centrale lijndagen. De surveillanceresultaten leidde in slechts twee ziekenhuizen tot interventiemaatregelen en in zeven ziekenhuizen tot ondersteuning van het beleid en/of de besluitvorming op het gebied van infectiepreventie op de IC.