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Search Results: 1 - 10 of 607 matches for " Frans Verhey "
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Passive movement therapy in patients with moderate to severe paratonia; study protocol of a randomised clinical trial (ISRCTN43069940)
Johannes SM Hobbelen, Frans RJ Verhey, Jacobus HJ Bor, Rob A de Bie, Raymond TCM Koopmans
BMC Geriatrics , 2007, DOI: 10.1186/1471-2318-7-30
Abstract: Passive movement therapy (PMT) currently is the main physiotherapeutic intervention. General doubt about the beneficial effects of this widely used therapy necessitates a randomised clinical trial (RCT) to study the efficacy of PMT on the severity of paratonia and on the improvement of daily care.A RCT with a 4-week follow-up period. Patients with dementia (according to the DSM-IV-TR Criteria) and moderate to severe paratonia are included in the study after proxy consent. By means of computerised and concealed block randomisation (block-size of 4) patients are included in one of two groups. The first group receives PMT, the second group receives usual care without PMT. PMT is given according to a protocol by physical therapist three times a week for four weeks in a row. The severity of paratonia (Modified Ashworth scale), the severity of the dementia (Global Deterioration Scale), the clinical improvement (Clinical Global Impressions), the difficulty in daily care (Patient Specific Complaints) and the experienced pain in daily care of the participant (PACSLAC-D) is assessed by assessors blind to treatment allocation at baseline, after 6 and 12 treatments.Success of the intervention is defined as a significant increase of decline on the modified Ashworth scale. The 'proportion of change' in two and four weeks time on this scale will be analysed. Also a multiple logistic regression analysis using declined/not declined criteria as dependent variable with correction for relevant confounders (e.g. stage of dementia, medication, co-morbidity) will be used.This study is the first RCT of this size to gain further insight on the effect of passive movement therapy on the severity of paratonia.Current Controlled Trials ISRCTN43069940Paratonia is one of the motor problems seen in persons with dementia and was first described by Dupré in 1910 as the inability to relax muscles in combination with a mental disorder [1]. Paratonia is hypothesized to develop centrally but to exert an
Systematic care for caregivers of people with dementia in the ambulatory mental health service: designing a multicentre, cluster, randomized, controlled trial
Anouk Spijker, Frans Verhey, Maud Graff, Richard Grol, Eddy Adang, Hub Wollersheim, Myrra Vernooij-Dassen
BMC Geriatrics , 2009, DOI: 10.1186/1471-2318-9-21
Abstract: In our ongoing, cluster, randomized, single-blind, controlled trial, the participants in six mental health services in four regions of the Netherlands have been randomized per service. Professionals of the ambulatory mental health services (psychologists and social psychiatric nurses) have been randomly allocated to either the intervention group or the control group. The study population consists of community-dwelling people with dementia and their informal caregivers (patient-caregiver dyads) coming into the health service. The dyads have been clustered to the professionals. The primary outcome measure is the patient's admission to a nursing home or home for the elderly at 12 months of follow-up. This measure is the most important variable for estimating cost differences between the intervention group and the control group. The secondary outcome measure is the quality of the patient's and caregiver's lives.A novelty in the SCPD is the pro-active and systematic approach. The focus on the caregiver's sense of competence is relevant to economical healthcare, since this sense of competence is an important determinant of delay of institutionalization of people with dementia. The SCPD might be able to facilitate this with a relatively small cost investment for caregivers' support, which could result in a major decrease in costs in the management of dementia. Implementation on a national level will be started if the SCPD proves to be efficient.NCT00147693Estimates state that the rapidly aging western European population will peak at about 2040 [1]. An aging population demands more healthcare and challenges the healthcare budget. Two-thirds of the people with dementia (also referred to as "patients" in this study protocol) are cared for at home [2]. Care at home is often intensive and burdensome. Informal caregivers of these patients carry a greater burden than informal caregivers of other chronically ill people [3], and they are at a greater risk of depression [4-6]. The
Research protocol of the NeedYD-study (Needs in Young onset Dementia): a prospective cohort study on the needs and course of early onset dementia
Deliane van Vliet, Christian Bakker, Raymond TCM Koopmans, Myrra JFJ Vernooij-Dassen, Frans RJ Verhey, Marjolein E de Vugt
BMC Geriatrics , 2010, DOI: 10.1186/1471-2318-10-13
Abstract: The NeedYD-study (Needs in Young Onset Dementia) is a longitudinal observational study investigating early onset dementia patients and their caregivers (n = 217). Assessments are performed every six months over two years and consist of interviews and questionnaires with patients and caregivers. The main outcomes are (1) the needs of patients and caregivers, as measured by the Camberwell Assessment of Needs for the Elderly (CANE) and (2) neuropsychiatric symptoms, as measured by the NeuroPsychiatric Inventory (NPI). Qualitative analyses will be performed in order to obtain more in-depth information on the experiences of EOD patients and their family members. The results of this study will be compared with comparable data on late onset dementia from a historical cohort.The study protocol of the NeedYD-study is presented here. To our knowledge, this study is the first prospective cohort study in this research area. Although some limitations exist, these do not outweigh the strong points of this study design.Dementia is often regarded as a disease of old age. However, there is also a group in which the symptoms of the disease develop before the age of 65. Prevalence rates of early onset dementia (EOD) have been reported to range between 54 and 260 cases per 100,000 in the 30-64 age group [1-3].EOD is recognized as an important psychosocial and medical health problem with serious consequences for patients and their families [4,5]. EOD is more difficult to recognize than late onset dementia (LOD) in the early stages of the disease because of the lower prevalence rate, the wider range of etiologies [6,7] and the use of other mental health services (e.g., community mental health teams). These factors cause an important delay before an accurate diagnosis can be established, commonly resulting in feelings of insecurity and frustration for both patients and their families [8]. A proper diagnosis is an important prerequisite for receiving adequate (in)formal support and health
Performance of the EQ-5D and the EQ-5D+C in elderly patients with cognitive impairments
Claire AG Wolfs, Carmen D Dirksen, Alfons Kessels, Dani?lle CM Willems, Frans RJ Verhey, Johan L Severens
Health and Quality of Life Outcomes , 2007, DOI: 10.1186/1477-7525-5-33
Abstract: Data from the MEDICIE study (n = 196) were used, in which all questionnaires were rated by proxies.Regarding construct validity, we found similar correlations between the EQ-5D and the Mini Mental State Examination (MMSE) and between the EQ-5D+C and the MMSE. Furthermore, both the EQ-5D and the EQ-5D+C were responsive to changes in the MMSE, with the EQ-5D performing slightly better.We conclude that the EQ-5D performs well for evaluating HRQoL in a population with cognitive impairments. Based on the results of this explorative study, it does not seem necessary to adjust the current classification system by adding a cognitive dimension. However, in order to compare both instruments regarding utility values, it is necessary to develop a new scoring algorithm for the EQ-5D+C by conducting a general population study. Considering the explorative nature of this study, it is recommended that more aspects of the validity of both the EQ-5D and the EQ-5D+C are explored in patients with cognitive impairments using a more tailored study design.The increasing number of older adults who are diagnosed with dementia has far-reaching implications for health service delivery and expenditures [1]. Economic evaluations are performed more often to assist decision-makers in setting priorities, especially with regard to resource allocation [2]. A central component of economic evaluations in health care is the use of preference-based instruments (also called value-based instruments) to measure changes in Health-Related Quality of Life (HRQoL). Preference-based measures, such as the EQ-5D [3,4], the SF-6D [5] and the HUI [6], are standardized multi-dimensional health state classifications [7]. For each of these instruments, health states have been valued using techniques such as standard gamble (SG) or time trade-off (TTO) [8]. These valuations were used for each instrument to generate a scoring algorithm of which a single utility score for each health state can be deduced.The EQ-5D is comm
Depression and Risk of Mortality in People with Diabetes Mellitus: A Systematic Review and Meta-Analysis
Fleur E. P. van Dooren, Giesje Nefs, Miranda T. Schram, Frans R. J. Verhey, Johan Denollet, Fran?ois Pouwer
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0057058
Abstract: Objective To examine the association between depression and all-cause and cardiovascular mortality in people with diabetes by systematically reviewing the literature and carrying out a meta-analysis of relevant longitudinal studies. Research Design and Methods PUBMED and PSYCINFO were searched for articles assessing mortality risk associated with depression in diabetes up until August 16, 2012. The pooled hazard ratios were calculated using random-effects models. Results Sixteen studies met the inclusion criteria, which were pooled in an overall all-cause mortality estimate, and five in a cardiovascular mortality estimate. After adjustment for demographic variables and micro- and macrovascular complications, depression was associated with an increased risk of all-cause mortality (HR = 1.46, 95% CI = 1.29–1.66), and cardiovascular mortality (HR = 1.39, 95% CI = 1.11–1.73). Heterogeneity across studies was high for all-cause mortality and relatively low for cardiovascular mortality, with an I-squared of respectively 78.6% and 39.6%. Subgroup analyses showed that the association between depression and mortality not significantly change when excluding three articles presenting odds ratios, yet this decreased heterogeneity substantially (HR = 1.49, 95% CI = 1.39–1.61, I-squared = 15.1%). A comparison between type 1 and type 2 diabetes could not be undertaken, as only one study reported on type 1 diabetes specifically. Conclusions Depression is associated with an almost 1.5-fold increased risk of mortality in people with diabetes. Research should focus on both cardiovascular and non-cardiovascular causes of death associated with depression, and determine the underlying behavioral and physiological mechanisms that may explain this association.
Variability of CSF Alzheimer’s Disease Biomarkers: Implications for Clinical Practice
Stephanie J. B. Vos, Pieter Jelle Visser, Frans Verhey, Pauline Aalten, Dirk Knol, Inez Ramakers, Philip Scheltens, Marcel G. M. Olde. Rikkert, Marcel M. Verbeek, Charlotte E. Teunissen
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0100784
Abstract: Background Cerebrospinal fluid (CSF) biomarkers are increasingly being used for diagnosis of Alzheimer’s disease (AD). Objective We investigated the influence of CSF intralaboratory and interlaboratory variability on diagnostic CSF-based AD classification of subjects and identified causes of this variation. Methods We measured CSF amyloid-β (Aβ) 1-42, total tau (t-tau), and phosphorylated tau (p-tau) by INNOTEST enzyme-linked-immunosorbent assays (ELISA) in a memory clinic population (n = 126). Samples were measured twice in a single or two laboratories that served as reference labs for CSF analyses in the Netherlands. Predefined cut-offs were used to classify CSF biomarkers as normal or abnormal/AD pattern. Results CSF intralaboratory variability was higher for Aβ1-42 than for t-tau and p-tau. Reanalysis led to a change in biomarker classification (normal vs. abnormal) of 26% of the subjects based on Aβ1-42, 10% based on t-tau, and 29% based on p-tau. The changes in absolute biomarker concentrations were paralleled by a similar change in levels of internal control samples between different assay lots. CSF interlaboratory variability was higher for p-tau than for Aβ1-42 and t-tau, and reanalysis led to a change in biomarker classification of 12% of the subjects based on Aβ1-42, 1% based on t-tau, and 22% based on p-tau. Conclusions Intralaboratory and interlaboratory CSF variability frequently led to change in diagnostic CSF-based AD classification for Aβ1-42 and p-tau. Lot-to-lot variation was a major cause of intralaboratory variability. This will have implications for the use of these biomarkers in clinical practice.
Cost-Effectiveness of One Year Dementia Follow-Up Care by Memory Clinics or General Practitioners: Economic Evaluation of a Randomised Controlled Trial
Els Meeuwsen, René Melis, Geert van der Aa, Gertie Golüke-Willemse, Benoit de Leest, Frank van Raak, Carla Sch?lzel-Dorenbos, Desiree Verheijen, Frans Verhey, Marieke Visser, Claire Wolfs, Eddy Adang, Marcel Olde Rikkert
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079797
Abstract: Objective To evaluate the cost-effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared to general practitioners’ care. Methods A multicentre randomised trial with 175 community dwelling patients newly diagnosed with mild to moderate dementia, and their informal caregivers, with twelve months’ follow-up. Cost-effectiveness was evaluated from a societal point of view and presented as incremental cost per quality adjusted life year. To establish cost-effectiveness, a cost-utility analysis was conducted using utilities based on the EQ-5D. Uncertainty surrounding the incremental cost-effectiveness ratio (difference in costs divided by difference in effects) was calculated by bootstrapping from the original data. Results Compared to general practitioners’ care, treatment by the memory clinics was on average €1024 (95% CI: ?€7723 to €5674) cheaper, and showed a non-significant decrease of 0.025 (95% CI: ?0.114 to 0.064) quality adjusted life years. The incremental cost-effectiveness point estimate from the bootstrap simulation was € 41 442 per QALY lost if one would use memory clinic care instead of general practitioner care. Conclusion No evidence was found that memory clinics were more cost-effective compared to general practitioners with regard to post-diagnosis treatment and coordination of care of patients with dementia in the first year after diagnosis. Trial Registration ClinicalTrials.gov NCT00554047
Influence on fluid dynamics of coronary artery outlet angle variation in artificial aortic root prosthesis
Janko F Verhey, Christoph Bara
BioMedical Engineering OnLine , 2008, DOI: 10.1186/1475-925x-7-9
Abstract: Two simplified base geometries are used for simulating the blood flow in order to determine velocity and pressure distributions. One model uses a straight cylindrical tube to approximate the aortic root geometry; the other uses a sinus design with pseudosinuses of Valsalva. The coronary outlet angle of the right coronary artery was discretely modified in both models in the range from 60° to 120°. The pressure and velocity distributions of both models are compared in the ascending aorta as well as in the right and the left coronary artery.The potentially allowed and anatomic limited variation of the outlet angle influences the pressure only a little bit and shows a very slight relative maximum between 70° and 90°. The sinus design and variations of the outlet angle of the coronary arteries were able to minimally optimize the perfusion pressure and the velocities in the coronary circulation, although the degree of such changes is rather low and would probably not achieve any clinical influence.Our results show that surgeons should feel relatively free to vary the outlet angle within the anatomic structural conditions when employing the technique of coronary reinsertion.The first surgical technique of valve-sparing aortic root reconstruction was described by [1,2]. Since then aortic surgery has developed rapidly, for the most part without changing the bases of the technique [3]. Valve-sparing aortic root replacement has provided very good results and has gained increasing acceptance over time [4,5]. The main limitation of this operation, however, is the need for an intact structure of the aortic valve to successfully complete the reconstruction. The gold standard for root replacement in all other cases is still the composite replacement by a Dacron tube carrying a mechanical or biological valve [6,7].The excellent results of aortic surgery as well as the increasing amount of degenerative aortic disease due to the rising number of elderly patients in the last years has
A finite element method model to simulate laser interstitial thermo therapy in anatomical inhomogeneous regions
Yassene Mohammed, Janko F Verhey
BioMedical Engineering OnLine , 2005, DOI: 10.1186/1475-925x-4-2
Abstract: In contrast to previous simulation attempts, our model is based on finite element method (FEM). We propose the use of LITT, in sensitive areas such as the neck region to treat tumours in lymph node with dimensions of 0.5 cm – 2 cm in diameter near the carotid artery. Our model is based on calculations describing the light distribution using the diffusion approximation of the transport theory; the temperature rise using the bioheat equation, including the effect of microperfusion in tissue to determine the extent of thermal damage; and the dependency of thermal and optical properties on the temperature and the injury. Injury is estimated using a damage integral. To check our model we performed a first in vitro experiment on porcine muscle tissue.We performed the derivation of the geometry from 3D ultrasound data and show for this proposed geometry the energy distribution, the heat elevation, and the damage zone. Further on, we perform a comparison with the in-vitro experiment. The calculation shows an error of 5% in the x-axis parallel to the blood vessel.The FEM technique proposed can overcome limitations of other methods and enables an efficient simulation for predicting the damage zone induced using LITT. Our calculations show clearly that major vessels would not be damaged. The area/volume of the damaged zone calculated from both simulation and in-vitro experiment fits well and the deviation is small. One of the main reasons for the deviation is the lack of accurate values of the tissue optical properties. In further experiments this needs to be validated.Laser radiation is now used routinely in surgery to incise, coagulate, or vaporize tissues. The laser light power is converted into heat in the target volume with ensuing coagulative necrosis, secondary degeneration and atrophy, and tumour shrinkage with minimal damage to surrounding structures [1]. The use of lasers in surgery introduces some desirable features over normal surgical methods such as increased pre
“Biological Nitrogen Fixation” Book Summary  [PDF]
Frans J. de Bruijn
Advances in Microbiology (AiM) , 2016, DOI: 10.4236/aim.2016.66040
Abstract: Biological nitrogen fixation is a very valuable alternative to nitrogen fertilizer. This process will be discussed in the “Biological Nitrogen Fixation” book. A wide array of free-living and associative nitrogen fixing organisms (diazotrophs) will be covered. The most extensively studied and applied example of biological nitrogen fixation is the symbiotic interaction between nitrogen fixing “rhizobia” and legume plants. While legumes are important as major food and feed crops, cereals such as wheat, maize and rice are the primary food crops, but do not have this symbiotic nitrogen fixing interaction with rhizobia. It has thus been a “holy grail” to transfer the ability to fix nitrogen to the cereals and this topic will be also addressed in these books.
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