293 research outputs found
Minimally invasive vessel-preservation spleen preserving distal pancreatectomy-how I do it, tips and tricks and clinical results
No full textBackground: Minimally invasive spleen-preserving distal pancreatectomy (SPDP) has emerged as a parenchyma-preserving approach and has become the standard treatment for pancreatic benign and low-grade malignant lesions. Nevertheless, minimally invasive SPDP is still technically challenging, especially when vessel preservation is intended. This study aims to describe the technique and outcomes of laparoscopic (LSPDP) and robot-assisted spleen-preserving distal pancreatectomy (RSPDP) with intended vessel preservation, highlighting the important tips and tricks to overcome technical obstacles and optimize surgical outcomes. Methods: A retrospective observational study of consecutive patients undergoing LSPDP and RSPDP with intended vessel preservation by a single surgeon in two different centers. A video demonstrating both surgical techniques is attached. Results: A total of 50 patients who underwent minimally invasive SPDP were included of which 88% underwent LSPDP and 12% RSPDP. Splenic vessels were preserved in 37 patients (74%) while a salvage vessel-resecting technique was performed in 13 patients (26%). The average surgery time was 178 ± 74 min for the vessel-preserving and 188 ± 57 for the vessel-resecting technique (p = 0.706) with an estimated blood loss of 100 mL in both groups (p = 0.663). The overall complication rate was 46% (n = 23) with major complications (Clavien Dindo ≥ III) observed in 14% (n = 7) of the patients. No conversions occurred. The median length of hospital stay was 4 days. Conclusion: This study presented the results after minimally invasive SPDP with intended vessel preservation by a highly experienced pancreatic surgeon. It provided tips and tricks to successfully accomplish a minimally invasive SPDP, which can contribute to quick patient rehabilitation and optimal postoperative results. Graphical Abstract: [Figure not available: see fulltext.]
Economic evaluation of pressure ulcer care: a cost minimization analysis of preventive strategies.
No full textContains fulltext :
80890.pdf (Publisher’s version ) (Closed access)The purpose of this study was to determine the cost for prevention and treatment of pressure ulcers from a hospital perspective and to identify the least resource-intensive pressure ulcer prevention strategy. Cost analyses were examined from a hospital perspective using direct costs. The study was carried out alongside a prospective cohort study on the incidence and risk factors for pressure ulcers. Two large teaching hospitals in the Netherlands with (partly) opposing approaches in prevention, a technological versus a human approach, were analyzed. The main outcome measures were resource use, costs of preventive measures and treatment, and pressure ulcer incidence in both hospitals. Pressure ulcer prevention through a predominantly technical approach resulted in a similar incidence rate as prevention through a predominantly human approach. However, the technical approach was considerably less expensive
Vijf keer archeologie in Reusel-De Mierden. Vijf kleine proefsleuvenonderzoeken in Reusel, Hulsel en Lage Mierde, gemeente Reusel-De Mierden (Noord-Brabant)
No full textIn opdracht van de gemeente Reusel-De Mierden heeft het AAC/Projectenbureau in de week van 22 tot en met 26 oktober 2007 een vijftal inventariserende veldonderzoeken uitgevoerd in Reusel (Reeneik), Hulsel (Willibrordlaan en Kerkweg) en Lage Mierde (Ganzepoen en 't Laar), alle in de gemeente Reusel-De Mierden. De resultaten van deze proefsleuvenonderzoeken zijn in één publicatie gerapporteerd (AAC-48).
Elk van deze veldonderzoeken is apart met een eigen dataset (GIS-tekeningen en veldfoto's) in het e-depot gepubliceerd.
Hulsel Willibrordlaan:
Alle drie de sleuven bleken veel meer in de zone van het beekdal te liggen dan vooraf werd aangenomen. Onder de oude akkerlaag is op sommige locaties nog een donkerbruine tot zwarte, zeer humeuze, zandige leemlaag aanwezig. Ook vandaag de dag is het grondwaterpeil hier nog vrij hoog.
Geheel in het noorden van proefsleuf 1 is een greppel aangesneden, die mogelijk uit de Late-Middeleeuwen dateert; hierin is de voet van een steengoedkan gevonden, die aan de binnenkant wat spaarzaam geglazuurd is. De overige aangesneden greppels en kuilen lijken jonger te zijn; allemaal Nieuwe tijd A tot recent. De meeste greppels (bijvoorbeeld de sporen 27 en 19) lijken samen te hangen met de ontginning van het terrein tot akker; zij hangen direct onder de oude akkerlaag en lijken er soms nog in te hangen. Mogelijk waren het ontwateringsgeultjes. Eén greppel/sloot (spoor 11) leek in eerste instantie interessant te zijn. De greppel/sloot is 2 tot 3 m breed en maakt in het zuidelijke deel van proefsleuf 1 een haakse bocht. Verspreid over de greppel/sloot zijn oude bakstenen aangetroffen. Nader onderzoek toonde echter dat de greppel/sloot nog slechts enkele centimeters diep is en vrijwel geen materiaal bevat. Waarschijnlijk dateert hij in de Vroeg-Nieuwe tijd.
Buiten baksteenfragmenten is er slechts een tweetal scherven gevonden, beiden van roodbakkend aardewerk uit de Nieuwe tijd
Zuilense Vecht Lin(k)t Urban Sports
No full textHet doel van dit project was om samen met alle betrokkenen te komen tot een gedragen adviesprogrammering voor het urban sportpark Zuilense Vecht, dat ligt op de gemeentegrenzen van Utrecht en Stichtse Vecht.
Allereerst zijn geleerde lessen opgemaakt naar aanleiding van interviews met professionals die betrokken waren bij andere urban sportparken.
Deze lessen zijn meegenomen naar het vervolg van dit project, waarbij we hebben gewerkt aan een adviesprogrammering in co-design met alle betrokkenen (sport- en welzijnsprofessionals uit de wijken, professionals uit urban sports en de MBO sportacademie; én kinderen en jongeren zelf)
The impact of obesity on the pharmacokinetics of drugs in adolescents and adults
No full text
Despite the increasing number of obese patients, evidence-based dosing guidelines are scarce, particularly for obese children and morbidly obese adults (BMI > 40 kg/m2). For both these populations, pharmacokinetic studies are needed to provide a basis for evidence-based dosing guidelines.
In this thesis, we studied the pharmacokinetics of the CYP3A substrate midazolam, the renally excreted drug metformin and acetaminophen (metabolized by glucuronidation, sulphation and CYP2E1) in obese adolescents and/or morbidly obese adults. We address several currently unanswered questions; Can doses for obese adolescents be predicted on the basis of data obtained in morbidly obese adults? How to analyse pharmacokinetic data in obese adolescents, for whom body weight is influenced by growth, age and obesity? How to achieve safe and effective acetaminophen dosing for morbidly obese patients?
The studies described in this thesis contribute to the existing gaps in knowledge regarding the pharmacokinetics and evidence-based dosing of drugs in obese adolescents and morbidly obese adults.
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The impact of obesity on the pharmacokinetics of drugs in adolescents and adults
No full text
Despite the increasing number of obese patients, evidence-based dosing guidelines are scarce, particularly for obese children and morbidly obese adults (BMI > 40 kg/m2). For both these populations, pharmacokinetic studies are needed to provide a basis for evidence-based dosing guidelines.
In this thesis, we studied the pharmacokinetics of the CYP3A substrate midazolam, the renally excreted drug metformin and acetaminophen (metabolized by glucuronidation, sulphation and CYP2E1) in obese adolescents and/or morbidly obese adults. We address several currently unanswered questions; Can doses for obese adolescents be predicted on the basis of data obtained in morbidly obese adults? How to analyse pharmacokinetic data in obese adolescents, for whom body weight is influenced by growth, age and obesity? How to achieve safe and effective acetaminophen dosing for morbidly obese patients?
The studies described in this thesis contribute to the existing gaps in knowledge regarding the pharmacokinetics and evidence-based dosing of drugs in obese adolescents and morbidly obese adults.
Department of Clinical Pharmacy, St. Antonius Hospital Department of Anaesthesiology and Intensive Care, St. Antonius HospitalPharmacolog
A preliminary phenomenological exploration of experiences of the empty pelvis syndrome derived from a modified-Delphi: the price of survival following pelvic exenteration for advanced pelvic cancer
No full textObjective: The empty pelvis syndrome (EPS) is common after pelvic exenteration (PE), causing fluid collections, bowel obstruction, perineal sinuses, and fistulas. The best approach to fill the pelvis to mitigate this remains controversial, and the impact of EPS on health-related quality of life (HrQoL) is unknown. This study is the first to begin to explore lived-experiences of EPS complications. Methods: Unstructured EPS virtual focus group meetings were conducted with a convenience sample of patients who underwent PE, as an extension of a modified-Delphi study. Interpretative phenomenological analysis was conducted on verbatim transcripts to generate group experiential themes. Results: Twelve patients (eight UK, one Dutch, and three Belgian) participated in four focus groups. Eight EPS complications were reported, (two pelvic collections, five chronic perineal sinuses, and one bowel obstruction). Group experiential themes were ‘Out of Options’, depicting patients forced to accept complications or limited survival; ‘The New Normal’, with EPS potentially delaying adaptation to post-PE HrQoL; ‘Information Influencing Adaptation,’ emphasising the significance of patients understanding EPS to cope with its effects; and ‘Symptoms,’ reporting manifestations of EPS, the resultant physical limitations, and an intangible feeling that patients lost part of themselves. Conclusions: EPS may influence patient decision-making, regret, adaptation, and information-seeking. It can cause a variety of unpleasant symptoms and physical limitations, which may include phantom phenomenon. This work supports ongoing purposeful HrQoL research to better define these themes.</p
Bone Marrow Stem Cell Treatment for Ischemic Heart Disease in Patients with No Option of Revascularization: A Systematic Review and Meta-Analysis
No full textPMCID: PMC3686792This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
The cholesterol-raising diterpenes from coffee beans increase serum lipid transfer protein activity levels in humans
No full textCafestol and kahweol–diterpenes present in unfiltered coffee— strongly raise serum VLDL and LDL cholesterol and slightly reduce HDL cholesterol in humans. The mechanism of action is unknown. We determined whether the coffee diterpenes may affect lipoprotein metabolism via effects on lipid transfer proteins and lecithin:cholesterol acyltransferase in a randomized, double-blind cross-over study with 10 healthy male volunteers. Either cafestol (61–64 mg/day) or a mixture of cafestol (60 mg/day) and kahweol (48–54 mg/day) was given for 28 days. Serum activity levels of cholesterylester transfer protein, phospholipid transfer protein and lecithin:cholesterol acyltransferase were measured using exogenous substrate assays. Relative to baseline values, cafestol raised the mean (±S.D.) activity of cholesterylester transfer protein by 18±12% and of phospholipid transfer protein by 21±14% (both P<0.001). Relative to cafestol alone, kahweol had no significant additional effects. Lecithin:cholesterol acyltransferase activity was reduced by 11±12% by cafestol plus kahweol (P=0.02). It is concluded that the effects of coffee diterpenes on plasma lipoproteins may be connected with changes in serum activity levels of lipid transfer proteins
International survey on opinions and use of robot-assisted and laparoscopic minimally invasive pancreatic surgery: 5-year follow up
No full textBackground: Evidence on the value of minimally invasive pancreatic surgery (MIPS) has been increasing but it is unclear how this has influenced the view of pancreatic surgeons on MIPS. Methods: An anonymous survey was sent to members of eight international Hepato-Pancreato-Biliary Associations. Outcomes were compared with the 2016 international survey. Results: Overall, 315 surgeons from 47 countries participated. The median volume of pancreatic resections per center was 70 (IQR 40–120). Most surgeons considered minimally invasive distal pancreatectomy (MIDP) superior to open (ODP) (94.6%) and open pancreatoduodenectomy (OPD) superior to minimally invasive (MIPD) (67.9%). Since 2016, there has been an increase in the number of surgeons performing both MIDP (79%–85.7%, p = 0.024) and MIPD (29%–45.7%, p < 0.001), and an increase in the use of the robot-assisted approach for both MIDP (16%–45.6%, p < 0.001) and MIPD (23%–47.9%, p < 0.001). The use of laparoscopy remained stable for MIDP (91% vs. 88.1%, p = 0.245) and decreased for MIPD (51%–36.8%, p = 0.024). Conclusion: This survey showed considerable changes of MIPS since 2016 with most surgeons considering MIDP superior to ODP and an increased use of robot-assisted MIPS. Surgeons prefer OPD and therefore the value of MIPD remains to be determined in randomized trials
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