Reinier P. Akkermans

Purpose: To investigate the responsiveness of the patient-reported outcome measure pediatric physical therapy (PROM-ppt), a questionnaire used to also stimulate shared decision making in Dutch pediatric physical therapy practices. Methods: Children completed the PROM-ppt at intake and 3 months after intervention or post-intervention. Reported problems were categorized as motor or pain related goals for intervention. Responsiveness was examined to test the a priori hypotheses and area under the curve (AUC). The Global Perceived Effect scale was used for comparison. Results: Overall, the hypotheses were confirmed in 60% of the cases with adequate AUCs. In children with motor problems, 80% of the hypotheses were matched, with adequate AUCs. In children with pain related problems, 40% of the hypotheses were matched, with inadequate AUCs. Conclusion: The PROM-ppt had moderate responsiveness in the pediatric population, good responsiveness in children with interventions for motor problems, and poor responsiveness to pain related problems.

Background/Objectives: Follow-up studies in very preterm infants are common, but fewer studies are situated in low- or middle-income countries. In a prospective cohort study, we explored longitudinal motor performance trajectories and influencing factors, including an early motor intervention program. Very preterm infants (gestational age < 32 weeks and/or very-low-birth-weight < 1500 g) in the middle-income country of Suriname were included. Methods: We assessed 149 (49.7% boys) infants (mean gestational age 29⁺⁶, mean birth weight 1271 g) at 3, 12, and 24 months with the Bayley Scales of Infant and Toddler Development for fine motor (FM), gross motor (GM), and composite scores (CSs). Influencing perinatal and environmental factors were explored. Delayed-scoring infants were referred to a motor intervention program. Data were analyzed using mixed-model linear regression. Results: The Bayley mean FM and GM scores decreased between 3 and 12 months and stabilized at 24 months. The mean CS at 3, 12, and 24 months was 102.3, 92.7, and 92.2, respectively. The latter two were significantly below the reference values (100, SD 15, p < 0.01). Birth weight z-scores significantly influenced FM (p = 0.013) and CS (p = 0.009); a lower birth weight was associated with initially lower scores and a smaller decline over time than a higher birth weight. The motor intervention program (n = 54) showed no significant interaction effects at all time points after correction for frequency of interventions (no; 1–5; >5 interventions). Conclusions: Motor performance was normal at 3 months and delayed at 12 and 24 months. Birth weight, but not the early intervention program, influenced longitudinal motor trajectories. We recommend follow-up of motor performance and suggest adding the Prechtl General Movement assessment at 3 months of age. The clinical implementation of the early motor invention program needs additional studies to reach an adequate training level.

Background: Bacterial vaginosis (BV) is a common problem in primary care. BV symptoms often have a negative impact on patients’ quality of life and may predispose to gynaecological problems. Some patients experience recurring episodes of BV. This study’s objective is to identify possible factors that may be associated with BV recurrence and describe the characteristics of these patients and interventions performed by general practitioners. Methods: In this retrospective cohort study, we used data from a primary care registration network in the Netherlands in the period 2015–2020. We analysed differences between patients with recurrent BV and patients with a single episode of BV in terms of characteristics and interventions performed by general practitioners. Results: We found that patients with recently prescribed antibiotics, and a medical history of sexually transmitted infections and/or Candidiasis significantly more often presented with recurrent BV. Patients with recurrent BV had more remote consultations and less in-person consultations than single-episode patients. The reason for encounter was more often a request for medication. Regarding GPs’ diagnostic and therapeutic interventions, microbiological tests were more frequently performed in recurrent BV patients. Moreover, most patients in both groups were prescribed oral metronidazole most frequently. Conclusions: Our findings might help GPs to better recognise patients at risk of recurrence. GPs could re-evaluate their approach to the diagnosis and treatment of recurrent BV, opting for in-person consultation and using standardised diagnostic criteria and microbiological testing in patients with recurrent complaints. Antibiotic use for other conditions in these patients may lead to new BV episodes.

Background: GPs frequently use 10-year-risk estimations of cardiovascular disease (CVD) to identify high- risk patients.Aim: To assess the performance of four models for predicting the 10-year risk of CVD in Dutch general practice.Design and setting: Prospective cohort study. Routine data (2009– 2019) was used from 46 Dutch general practices linked to cause of death statistics.Method: The outcome measures were fatal CVD for SCORE and first diagnosis of fatal or non- fatal CVD for SCORE fatal and non-fatal (SCORE- FNF), Globorisk-laboratory, and Globorisk-office. Model performance was assessed by examining discrimination and calibration.Results: The final number of patients for risk prediction was 1981 for SCORE and SCORE-FNF, 3588 for Globorisk-laboratory, and 4399 for Globorisk- office. The observed percentage of events was 18.6% (n= 353) for SCORE- FNF, 6.9% (n= 230) for Globorisk-laboratory, 7.9% (n= 323) for Globorisk-office, and 0.3% (n= 5) for SCORE. The models showed poor discrimination and calibration. The performance of SCORE could not be examined because of the limited number of fatal CVD events. SCORE-FNF, the model that is currently used for risk prediction of fatal plus non-fatal CVD in Dutch general practice, was found to underestimate the risk in all deciles of predicted risks.Conclusion: Wide eligibility criteria and a broad outcome measure contribute to the model applicability in daily practice. The restriction to fatal CVD outcomes of SCORE renders it less usable in routine Dutch general practice. The models seriously underestimate the 10-year risk of fatal plus non-fatal CVD in Dutch general practice. The poor model performance is possibly because of differences between patients that are eligible for risk prediction and the population that was used for model development. In addition, selection of higher-risk patients for CVD risk assessment by GPs may also contribute to the poor model performance.

Background: Heyde syndrome is the co-occurrence of aortic stenosis and gastrointestinal bleeding secondary to angiodysplasias. Surgical aortic valve replacement effectively reduces bleeding, but the effects of transcatheter aortic valve implantation (TAVI) are largely unknown. This study aimed to describe the reduction of gastrointestinal bleeding in patients with Heyde syndrome after TAVI and to identify the factors associated with rebleeding. Methods: We enrolled patients with Heyde syndrome from a prospective TAVI registry. Gastrointestinal bleeding episodes were assessed by the Bleeding Academic Research Consortium classification, and cumulative incidence functions were used to calculate cessation rates. Factors potentially associated with rebleeding were analyzed using logistic regression. Differences between Heyde and non-Heyde patients were assessed through a case-cohort study. Results: Between December 2008 and June 2020, 1111 patients underwent TAVI. There were 70 patients with Heyde syndrome (6.3%). In the first year following TAVI, gastrointestinal bleeding ceased in 46 of 70 patients (62% [95% CI, 50%–74%]). Bleeding episodes decreased from 3.2 (95% CI, 2.5–4.2) to 1.6 ([95% CI, 1.2–2.2] P =0.001) and hemoglobin levels increased from 10.3 (95% CI, 10.0–10.8) to 11.3 (95% CI, 10.8–11.6) g/dL ( P =0.007). Between 1 and 5 years after TAVI (35 [interquartile range, 21–51] months), 53 of 62 patients (83% [95% CI, 72%–92%]) no longer experienced gastrointestinal bleeding. Paravalvular leakage (≥mild) was associated with rebleeding risk (odds ratio, 3.65 [95% CI, 1.36–9.80]; P =0.010). Periprocedural bleeding was more common in Heyde than in control patients (adjusted odds ratio, 2.55 [95% CI, 1.37–4.73]; P =0.003). Conclusions: Patients with Heyde syndrome are at increased risk for periprocedural bleeding. Post-TAVI, gastrointestinal bleeding disappears in the majority of patients. Paravalvular leakage may curtail these clinical benefits.

Previous studies show an association between a history of abuse and higher care demand. However, studies in general practice regarding help-seeking behaviour by patients (mainly male patients) with...

Objective: The purpose of this study was to explore differences in sedentary behavior, length of hospital stay, and discharge destination of patients before and after the Ban Bedcentricity implementation at ward level. Methods: The Ban Bedcentricity innovation and implementation procedure were implemented at the cardiothoracic surgery, cardiology, and orthopedics-traumatology wards. Sedentary behavior data were collected 2 weeks before and after the implementation using behavioral observations and analyzed with Pearson chi-square. Length of hospital stay and discharge destination data were collected from all admitted patients and analyzed with multiple and logistic regression analyses. Results: Behavioral observations showed that in 52% of the observations, patients were lying in bed before implementation and 40% after implementation at the cardiothoracic surgery, 64% and 46% at the cardiology, and 53% and 57% at the orthopedics-traumatology wards, respectively. The mean length of hospital stay after implementation (compared with implementation before) was 5.1 days at the cardiothoracic surgery (n = 1923; mean = +0.13 days, 95% CI = −0.32 to 0.60), 2.6 days at the cardiology (n = 2646; mean = −0.22 days, 95% CI = −0.29 to −0.14), and 2.4 days at the orthopedics-traumatology wards (n = 1598; mean = +0.28 days, 95% CI = 0.06 to 0.50). After the implementation, more patients were discharged home from the cardiothoracic surgery (odds ratio [OR = 1.23], 95% CI = 1.07 to 1.37) and cardiology wards (OR = 1.37, 95% CI = 1.22 to 1.49), and no statistically significant difference was found at the orthopedics-traumatology ward (OR = 1.09, 95% CI = 0.88 to 1.27). Conclusion: The results indicate beneficial outcomes after the implementation with less sedentary behavior and proportionately more patients being discharged home compared with before the implementation. However, little information is available about the adoption and fidelity of Ban Bedcentricity; therefore, outcomes should be interpreted with caution. Impact: This multifaceted innovation to reduce sedentary behavior of patients during the hospital stay seems to be promising, with outcomes indicating less sedentary behavior in patients and more patients being discharged home after the implementation. Lay Summary: We introduced Ban Bedcentricity, an intervention to reduce the amount of time patients lie in the hospital bed during their hospitalization. This study shows that after the introduction of Ban Bedcentricity, patients lie in bed less and are more often discharged home.

Aims and objectives: Translating and psychometrically assessing the Individualised Care Scale (ICS) for patients and nurses for the Flemish and Dutch healthcare context.Background: Individualised care interventions have positive effects on health outcomes. However, there are no valid and reliable instruments for evaluating individualised care for the Flemish and Dutch healthcare context.Design: Psychometric validation study.Setting and participants: In Flemish hospitals, data were collected between February and June 2016, and in Dutch hospitals, data were collected between December 2014 and May 2015. Nurses with direct patient contact and a working experience of minimum 6 months on the wards could participate. Patient inclusion criteria were being an adult, being mentally competent, having an expected hospital stay of minimum 1 day, and being able to speak and read the Dutch language. In total, 845 patients and 569 nurses were included.Methods: The ICS was translated into Dutch using a forward–backward translation process. Minimal linguistic adaptations to the Dutch ICS were made to use the scale as a Flemish equivalent. Omega, Cronbach’s Alpha, mean inter‐item correlations and standardised subscale correlations established the reliability and confirmatory factor analysis the construct validity of the ICS.Results: Internal consistency using Omega (Cronbach’s Alpha) ranged from 0.83 to 0.96 (0.82–0.95) for the ICS‐Nurse and from 0.88 to 0.96 (0.87–0.96) for the ICS‐Patient. Fit indices of the confirmatory factor analysis indicated a good model fit, except for the root mean square error of approximation, which indicated only moderate model fit.Conclusion: The Dutch version of the ICS showed acceptable psychometric performance, supporting its use for the Dutch and Flemish healthcare context.Relevance to clinical practice: Knowledge of nurses’ and patients’ perceptions on individualised care will aid to target areas in the Dutch and Flemish healthcare context in which work needs to be undertaken to provide individualised nursing care.