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Search Results: 1 - 10 of 35220 matches for " Nelleke van der Graaf "
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Outcome of HIV-exposed uninfected children undergoing surgery
Jonathan S Karpelowsky, Alastair JW Millar, Nelleke van der Graaf, Guido van Bogerijen, Heather J Zar
BMC Pediatrics , 2011, DOI: 10.1186/1471-2431-11-69
Abstract: A prospective study of children less than 60 months of age undergoing general surgery at a paediatric referral hospital from July 2004 to July 2008 inclusive. Children underwent age-definitive HIV testing and were followed up post operatively for the development of complications, length of stay and mortality.Three hundred and eighty children were enrolled; 4 died and 11 were lost to follow up prior to HIV testing, thus 365 children were included. Of these, 38(10.4%) were HIVe, 245(67.1%) were HIVn and 82(22.5%) were HIVi children.The overall mortality was low, with 2(5.2%) deaths in the HIVe group, 0 in the HIVn group and 6(7.3%) in the HIVi group (p = 0.0003). HIVe had a longer stay than HIVn children (3 (2-7) vs. 2 (1-4) days p = 0.02). There was no significant difference in length of stay between the HIVe and HIVi groups. HIVe children had a higher rate of complications compared to HIVn children, (9 (23.7%) vs. 14(5.7%) (RR 3.8(2.1-7) p < 0.0001) but a similar rate of complications compared to HIVi children 34 (41.5%) (RR = 0.6 (0.3-1.1) p = 0.06).HIVe children have a higher risk of developing complications and mortality after surgery compared to HIVn children. However, the risk of complications is lower than that of HIVi children.HIV-exposed uninfected (HIVe) children are a rapidly growing population. Programs for the prevention of mother to child transmission (PMTCT) have reduced the transmission rate of perinatal HIV infection to approximately 2% to 5% [1-3]. Such programs have therefore effectively reduced the number of HIV infected (HIVi)children but identified an increasing population of HIVe children [4].HIVe children have been overlooked as a group of children who may be at an increased risk of illness compared to HIV-unexposed (HIVn) children. Recently, increased morbidity and mortality in HIVe children compared to HIVn children has been reported [4-10]. Many factors may account for this including innate deficiencies in immunity [11-13], feeding practice
Branding: Wijkidentiteit als aangrijpingspunt voor stedelijke vernieuwing
Freek de Meere,Peter van der Graaf,Kees Fortuin
Journal of Social Intervention : Theory and Practice , 2008,
Abstract: In this article the authors explore the potential of the popular concept of identity branding for urban renewal and urban development. They describe the case of a neighbourhood in Ede, where branding was thought to have been very successful by all those involved. However, a more in depth analysis shows that the assigned identity of the neighbourhood did not play any role in this success. In an effort to explain this discrepancy, the authors argue that branding was not directed at the symbolic space of the neighbourhood, but merely at the social and physical space. Drawing on theoretical literature on identity construction, the authors end with some suggestions to enhance a more fruitful use of the symbolic space in urban renewal and urban development.
Protocol for Physiotherapy OR Tvt Randomised Efficacy Trial (PORTRET): a multicentre randomised controlled trial to assess the cost-effectiveness of the tension free vaginal tape versus pelvic floor muscle training in women with symptomatic moderate to severe stress urinary incontinence
Julien Labrie, Yolanda van der Graaf, Eric Buskens, Stella ESM Tiersma, Huub CH van der Vaart
BMC Women's Health , 2009, DOI: 10.1186/1472-6874-9-24
Abstract: A multi-centre randomised controlled trial will be performed for women between 35 - 80 years old with moderate to severe, predominantly stress, urinary incontinence, who have not received specialised PFMT or previous anti-incontinence surgery. Women will be assigned to either PFMT by a specialised physiotherapist for a standard of 9-18 session in a period of 6 months, or TVT(O) surgery. The main endpoint of the study is the subjective improvement of urinary incontinence. As secondary outcome the objective cure will be assessed from history and clinical parameters. Subjective improvement in quality of life will be measured by generic (EQ-5D) and disease-specific (Urinary Distress Inventory and Incontinence Impact Questionnaire) quality of life instruments. The economical endpoint is short term (1 year) incremental cost-effectiveness in terms of costs per additional year free of urinary incontinence and costs per Quality Adjusted Life Years (QALY) gained. Finally, treatment strategy and patient characteristics will be combined in a prediction model, to allow for individual treatment decisions in future patients. Four hundred female patients will be recruited from over 30 hospitals in the NetherlandsNederlands trial register: NTR 1248Urinary incontinence is a common problem among adult women, with an estimated overall prevalence of 40% and between 6-10% of women with severe incontinence.[1] Stress urinary incontinence is the predominant type of incontinence affecting approximately 50% of incontinent women. Thus, 20% of adult women will experience stress urinary incontinence. The severity of urinary incontinence is often expressed in the number of incontinence episodes/week, where 7-14 episodes/week is considered as moderate and more than 14 episodes/week as severe incontinence.[1]In addition, urinary incontinence is known to have a negative impact on quality of life and the economical costs related to it are substantial. These patient-centred and economical outcomes ar
Predictors of adverse events after endovascular abdominal aortic aneurysm repair: A meta-analysis of case reports
Felix JV Schl?sser, Geert JMG van der Heijden, Yolanda van der Graaf, Frans L Moll, Hence JM Verhagen
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-317
Abstract: We selected case reports from PubMed reporting original data on adverse events after endovascular abdominal aortic aneurysm repair. Extracted risk factors were: age, sex, aneurysm diameter, comorbidities, re-interventions, at least one follow-up visit being missed or refusal of a re-intervention by the patient. Extracted outcomes were: death, rupture and (non-)device-related complications.In total 113 relevant articles were selected. These reported on 173 patients. A fatal outcome was reported in 15% (N = 26) of which 50% came after an aneurysm rupture (N = 13). Non-fatal aneurysm rupture occurred in 15% (N = 25). Endoleaks were reported in 52% of the patients (N = 90). In half of the patients with a rupture no prior endoleak was discovered during follow-up. In 83% of the patients one or more re-interventions were performed (N = 143). Mortality was higher among women (risk ratio 2.9; 95% confidence interval 1.4 to 6.0), while the presence of comorbidities was strongly associated with both ruptures (risk ratio 1.6; 95% confidence interval 0.9 to 2.9) and mortality (risk ratio 2.1; 95% confidence interval 1.0 to 4.7). Missing one or more follow-up visits (≥1) or refusal of a re-intervention by the patient was strongly related to both ruptures (risk ratio 4.7; 95% confidence interval 3.1 to 7.0) and mortality (risk ratio 3.8; 95% confidence interval 1.7 to 8.3).Female gender, the presence of comorbidities and at least one follow-up visit being missed or refusal of a re-intervention by the patient appear to increase the risk for mortality after endovascular abdominal aortic aneurysm repair. Larger aneurysm diameter, higher age and multimorbidity at the time of surgery appear to increase the risk for rupture and other complications after endovascular abdominal aortic aneurysm repair. These risk factors deserve further attention in future studies.Up to the last decade of the last century, open surgery was the procedure of choice for abdominal aortic aneurysm (AAA) repair.
Direct short-term effects of EBP teaching: change in knowledge, not in attitude; a cross-cultural comparison among students from European and Asian medical schools
Indah S. Widyahening,Geert J.M.G. van der Heijden,Foong Ming Moy,Yolanda van der Graaf
Medical Education Online , 2012, DOI: 10.3402/meo.v17i0.19623
Abstract: Introduction: We report about the direct short-term effects of a Clinical Epidemiology and Evidence-based Medicine (CE-EBM) module on the knowledge, attitude, and behavior of students in the University Medical Center Utrecht (UMCU), Universitas Indonesia (UI), and University of Malaya (UM). Methods: We used an adapted version of a 26-item validated questionnaire, including four subscales: knowledge, attitude, behavior, and future use of evidence-based practice (EBP). The four components were compared among the students in the three medical schools before the module using one-way ANOVA. At the end of the module, we measured only knowledge and attitudes. We computed Cronbach's α to assess the reliability of the responses in our population. To assess the change in knowledge and attitudes, we used the paired t-test in the comparison of scores before and after the module. Results: In total, 526 students (224 UI, 202 UM, and 100 UMCU) completed the questionnaires. In the three medical schools, Cronbach's α for the pre-module total score and the four subscale scores always exceeded 0.62. UMCU students achieved the highest pre-module scores in all subscales compared to UI and UM with the comparison of average (SD) score as the following: knowledge 5.04 (0.4) vs. 4.73 (0.69) and 4.24 (0.74), p<0.001; attitude 4.52 (0.64) vs. 3.85 (0.68) and 3.55 (0.63), p<0.001; behavior 2.62 (0.55) vs. 2.35 (0.71) and 2.39 (0.92), p=0.016; and future use of EBP 4.32 (0.59) vs. 4.08 (0.62) and 3.7 (0.71), p<0.01. The CE-EBM module increased the knowledge of the UMCU (from average 5.04±0.4 to 5.35±0.51; p<0.001) and UM students (from average 4.24±0.74 to 4.53±0.72; p<0.001) but not UI. The post-module scores for attitude did not change in the three medical schools. Conclusion: EBP teaching had direct short-term effects on knowledge, not on attitude. Differences in pre-module scores are most likely related to differences in the system and infrastructure of both medical schools and their curriculum.
Assessing the information desire of patients with advanced cancer by providing information with a decision aid, which is evaluated in a randomized trial: a study protocol
Linda JM Oostendorp, Petronella B Ottevanger, Winette TA van der Graaf, Peep FM Stalmeier
BMC Medical Informatics and Decision Making , 2011, DOI: 10.1186/1472-6947-11-9
Abstract: This study is a randomized controlled trial of patients with advanced colorectal, breast, or ovarian cancer who have started treatment with first-line palliative chemotherapy. The trial will consist of 100 patients in the decision aid group and 70 patients in the usual care group. To collect complete data of 170 patients, 246 patients will be approached for the study. Patients will complete a baseline questionnaire on sociodemographic data, well-being measures, and psychological measures, believed to predict information desire. The medical oncologist will judge the patient's information desire. After disease progression is diagnosed, the medical oncologist offers the choice between second-line palliative chemotherapy plus best supportive care (BSC) and BSC alone. Randomization will take place to determine whether patients will receive usual care (n = 70) or usual care and the decision aid (n = 100). The aid offers information about the potential risks and benefits of both treatment options, in terms of adverse events, tumour response, and survival. Patients decide for each item whether they desire the information or not. Two follow-up questionnaires will evaluate the effect of the decision aid.This study attempts to settle the debate on the desirability of informing patients with cancer. In contrast to several earlier studies, we will actually deliver information on treatment options to patients at the point of decision making.Netherlands Trial Register (NTR): NTR1113Good clinical practice encompasses optimal providing of information to patients. However, as yet the debate about the desirability of informing patients with cancer and thereby involving them in their own care process has not been resolved. On the one hand, it has been shown that patients with more severe disease may become emotionally unstable and tend to leave decision making to their physician [1-3]. Furthermore, patients with cancer may sometimes deny their illness [4]. In short, patients may wish '
Notes on rumen contents of Cape Buffalo Syncerus Caffer in the Addo Elephant National Park
G. de Graaf,K.C.A. Schultz,P.T. van der Waet
Koedoe : African Protected Area Conservation and Science , 1973, DOI: 10.4102/koedoe.v16i1.884
Abstract: The oesophagus and rumen contents of 18 Capebuffalo that died during the 1969/70 drought in the Addo Elephant National Park near Port Elizabeth were analysedand are discussed as regards a description, based on quantitativedata, of the main vegetation types in the Park. Notes on plantspecies that were observed being utilised by buffalo are also given.
Clinical outcome of implant removal after fracture healing. Design of a prospective multicentre clinical cohort study
Vos Dagmar I,Verhofstad Michael HJ,Hanson Beate,van der Graaf Yolanda
BMC Musculoskeletal Disorders , 2012, DOI: 10.1186/1471-2474-13-147
Abstract: Background The clinical results of removal of metal implants after fracture healing are unknown and the question whether to remove or to leave them in is part of discussion worldwide. We present the design of a prospective clinical multicentre cohort study to determine the main indications for and expectations of implant removal, the influence on complaints, the incidence of surgery related complications and the socio-economic consequences of implant removal. Methods/Design In a prospective multicentre clinical cohort study at least 200 patients with a healed fracture after osteosynthesis with a metal implant are included for analyzing the outcome after removal. Six hospitals in the Netherlands are participating. Special questionnaires are designed. The follow up after surgery will be at least six months. The primary endpoint is the incidence of surgery related complications. Secondary endpoints are the influence of removal on preoperative symptoms and complaints and the socio-economic consequences. Discussion By performing this study we hope to find profound arguments to remove or not to remove metal implants after fracture healing that can help to develop clear guidelines for daily practice. Trial registration NTR1297, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1297
Quest for a Nuclear Georeactor
R. J. de Meijer,E. R. van der Graaf,K. P. Jungmann
Physics , 2004, DOI: 10.1016/j.radphyschem.2004.04.128
Abstract: Knowledge about the interior of our planet is mainly based on the interpretation of seismic data from earthquakes and nuclear explosions, and of composition of meteorites. Additional observations have led to a wide range of hypotheses on the heat flow from the interior to the crust, the abundance of certain noble gases in gasses vented from volcanoes and the possibility of a nuclear georeactor at the centre of the Earth. This paper focuses on a proposal for an underground laboratory to further develop antineutrinos as a tool to map the distribution of radiogenic heat sources, such as the natural radionuclides and the hypothetical nuclear georeactor.
Quest for the Nuclear Georeactor
R. J. de Meijer,E. R. van der Graaf,K. P. Jungmann
Physics , 2004,
Abstract: The paper focuses on a proposal for an underground antineutrino antenna to further develop the dectection of these particles as a tool to map the distribution of radiogenic heat sources, such as the natural radionuclides and a hypothetical nuclear georeactor.
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