Marco H. Blanker

The accessibility of primary care is under pressure, because more and more responsibilities and tasks are being shifted to general practitioners. Changes will have to take place to safeguard the core values of primary care: person-oriented, medical-generalistic and continuous. The increase in chronic diseases and multimorbidity forces general practitioners to delve deeper into complex care and maintain their management role in healthcare. Because of their guiding function, general practitioners must orientate themselves on problem areas that were previously discussed less prominently, such as questions related to gender identity and diversity. The time required for this may become available through the disposal and delegation of tasks and through further digitization. Digital interdisciplinary consultation in particular may improve the efficiency and quality of care. Finally, patients must be better informed about the nature of their complaints and the indications for an assessment by the GP.

Aim: We aimed to assess the mid-to long-term outcome of Polyacrylamide Hydrogel urethral injections as a treatment for women with stress urinary incontinence (SUI), who are not eligible for treatment with midurethral slings. Methods: We performed a single-arm, patient cohort study using the subjective improvement rate as primary outcome, defined as an answer “(very) much better” on the Patient Global Impression of Improvement. Secondary outcomes were the subjective cure rate (a negative answer to the Urogenital Distress Inventory stress subscale question 4), patient satisfaction (Visual Analogue Scale of≥ 8.0), complication rate, the amount of Hydrogel injected, the number of reinjections and to what extent patients would recommend this treatment. Results: A total of 357 women with pure SUI, or mixed urinary incontinence with predominant SUI were included. Adverse events were retrieved from their …

Background Adverse childhood events (ACEs) are prevalent and lead to well‐established adverse health sequelae in adulthood. Recent literature has claimed that exposure to trauma in early life may worsen lower urinary tract symptoms (LUTS) because emotion can alter the perception of bodily distress in the brain. Specifically, depressive symptoms might influence the association between ACEs and LUTS. We aimed to describe the associations between ACEs and LUTS among males and females and to determine whether depressive symptoms mediated these associations. Methods This study was a secondary analysis of the Coevorden observational cohort study (n = 1691, age ≥16 years). For this observational study participants filled in the male or female modules of the International Consultation on Incontinence Questionnaire for LUTS (ICIQ‐MLUTS and ICIQ‐FLUTS, respectively), the NEMESIS …

De menstruatiecup lijkt aan populariteit te winnen. In de afgelopen jaren rees de vraag of het gebruik van een menstruatiecup een verhoogd risico geeft op expulsie van een spiraal. Ondanks het beperkte onderzoek dat gedaan is en de lage bewijskracht van de beschikbare onderzoeken, lijkt voorzichtigheid geboden.

Objective:To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding after abdominal surgery.Background:The use of pharmacological thromboprophylaxis represents a trade-off that depends on VTE and bleeding risks that vary between procedures; their magnitude remains uncertain.Methods:We identified observational studies reporting procedure-specific risks of symptomatic VTE or major bleeding after abdominal surgery, adjusted the reported estimates for thromboprophylaxis and length of follow-up, and estimated cumulative incidence at 4 weeks postsurgery, stratified by VTE risk groups, and rated evidence certainty.Results:

BackgroundIn The Netherlands, health care is based on the principles of accessibility, solidarity and quality. 1 Accessibility is facilitated through a local general practitioner (GP) who not only acts as a gatekeeper for secondary care referrals but also manages a wide variety of acute and chronic health issues in primary care. Solidarity is ensured by health insurance that covers 99% of the Dutch population. 2 Quality is maintained by GPs using and creating evidence-based guidelines and by them structuring their electronic health records (EHRs) based on International Classification of Primary Care codes. This approach to health care ensures that patients receive consistent care and oversight in the long term.

The objective of this study was to examine sex differences in the association between sexual violence victimization and suicidal ideation and suicide attempt among adolescents. Data for this study came from the 2017 National Youth Risk Behavior Survey. An analytic sample of 10,475 adolescents aged 14–18 years (52.3% female) was analyzed. We used binary logistic regression to examine the association between sexual violence victimization and suicidal ideation and suicide attempt. We adjusted for the complexity of the sampling design and handled missing data using Multiple Imputation by Chained Equations. About 18% of adolescents experienced suicidal ideation and 7.5% attempted suicide during the past 12 months. About one in ten adolescents (15.5% of females versus 3.6% of males) experienced sexual violence. Controlling for other factors, the odds of reporting suicidal ideation were 1.86 times …

The absence of a consensus-based reference standard for urinary tract infection (UTI) research adversely affects the internal and external validity of diagnostic and therapeutic studies. This omission hinders the accumulation of evidence for a disease that imposes a substantial burden on patients and society, particularly in an era of increasing antimicrobial resistance. We did a three-round Delphi study involving an international, multidisciplinary panel of UTI experts (n=46) and achieved a high degree of consensus (94%) on the final reference standard. New-onset dysuria, urinary frequency, and urinary urgency were considered major symptoms, and non-specific symptoms in older patients were not deemed indicative of UTI. The reference standard distinguishes between UTI with and without systemic involvement, abandoning the term complicated UTI. Moreover, different levels of pyuria were incorporated in the …

Individual participant–data meta-analysis (IPDMA) uses data at the participant level to synthesize evidence on clinical decision-making. We discuss the differences from aggregate-data meta-analysis and the advantages and challenges of IPDMA. IPDMA provides an opportunity to study effect modifiers at the participant level and can reduce bias in comparison to aggregate-data meta-analysis. A challenge with IPDMA is that it often requires considerable effort to obtain all the data, and an inability to obtain data for all the studies can lead to availability bias.Patient summarySystematic reviews of the literature are performed to summarize available evidence regarding clinical decisions. Here we explain the differences between reviews that use aggregated data from published studies and reviews that use the participant-level data from those studies.

Vatsaelinkirurgisten leikkausten laskimotukos- ja verenvuotoriskit vaihtelevat huomattavasti eri toimenpiteiden välillä — University of Helsinki Skip to main navigation Skip to search Skip to main content University of Helsinki Home University of Helsinki Logo English Svenska Suomi Home Persons Publications Projects Research Infrastructures Research Units Datasets Activities Prizes Press/Media Search by expertise, name or affiliation Vatsaelinkirurgisten leikkausten laskimotukos- ja verenvuotoriskit vaihtelevat huomattavasti eri toimenpiteiden välillä Lauri I. Lavikainen, Gordon H. Guyatt, Ville J. Sallinen, Paul J. Karanicolas, Rachel J. Couban, Tino Singh, Yung Lee, Jaana Elberkennou, Riikka Aaltonen, Kaisa Ahopelto, Ines Beilmann-Lehtonen, Marco H. Blanker, Jovita L. Cárdenas, Rufus Cartwright, Samantha Craigie, PJ Devereaux, Herney A. Garcia-Perdomo, Fang Zhou Ge, Huda A. Gomaa, Alex LE HalmeJari …

OBJECTIVES: To compare the recurrence of non-muscle invasive bladder carcinoma (NMIBC) after transurethral resection employing cystoscopy with hexaminolevulinate-based photodynamic diagnosis (PDD) or with standard white light.PATIENTS AND METHODS: We included patients with newly suspected NMIBC in this retrospective cohort study and compared those undergoing transurethral resection by white light cystoscopy (WLC)(2008-2010) and PDD (2010-2012). All patients were treated following established criteria for good quality resection. The primary outcome was the difference in the recurrence rate after 60 months' follow-up, but we also stratified recurrence by risk groups, as set by the European Organization for Research and Treatment of Cancer. The mean recurrence-free survival was compared between the cohorts. Odds ratios or hazard ratios are reported with their 95% confidence intervals.RESULTS: The WLC and PDD cohorts comprised 124 and 91 subjects, respectively. There were no significant differences in recurrence rates between the cohorts at 6 months (recurrence rate 9/123; 7.3%), 12 months (17/118; 14.4%) or 60 months (39/102; 38.2%), with odds ratios of 1.23 (CI 0.48-3.25), 1.32 (CI 0.67-2.62) and 1.12 (CI 0.70-1.79), in favour of WLC, respectively. Further analysis showed no significant effect of PDD on either recurrence by risk group or on mean recurrence-free survival (hazard ratio, 1.12 [CI 0.70-1.79]).CONCLUSION: We found no relevant differences in the recurrence of NMIBC after the introduction of PDD with hexaminolevulinate compared to standard WLC when used for transurethral resection in our …

Evaluation of teleconsultations on the Prisma platform revealed differences in the type of questions posted by Dutch general practitioners and advice received from dermatologists regarding people with skin of colour (SOC) and those with white skin. A survey of users of this interdisciplinary platform confirmed low competence in recognizing and treating problems in people with SOC, and a need for additional education to provide care for people with SOC identified.

BackgroundVestibular rehabilitation is a safe and effective exercise-based treatment for patients with chronic vestibular symptoms. However, it is underused in general practice. Internet-based vestibular rehabilitation (Vertigo Training), which has proven to be effective as well, was developed to increase uptake. We now aim to improve the quality of care for patients with vestibular symptoms by carrying out a nationwide implementation of Vertigo Training. We will evaluate the effect of this implementation on primary care.MethodsOur implementation study consists of three successive phases:1) We will perform a retrospective observational cohort study and a qualitative interview study to evaluate the current management of patients with vestibular symptoms in primary care, in particular anti-vertigo drug prescriptions, and identify areas for improvement. We will use the results of this phase to tailor our implementation …

ObjectiveTo explore the views and preferences of care providers on app use for the treatment of UI and to identify the anticipated barriers to, and facilitators of, implementation.Patients and MethodsWe performed an exploratory, two-phase, sequential mixed-methods study. In phase 1, the views of care providers were explored through five focus group sessions with care providers involved in UI: general practitioners (GPs), practice assistants (PAs), pelvic physical therapists (PPTs), and urologists and (uro)gynecologists (UGs). In phase 2, the identified themes and subthemes were quantified in an online survey distributed among different care providers matching these groups.ResultsIn the focus group sessions, 30 female and two male care providers participated. Survey participants included 351 PAs and 76 PPTs (all females) next to 124 GPs and 183 UGs (70% females). Caregivers generally considered UI …

Objectives: Midurethral slings are considered the gold standard for the surgical treatment of stress urinary incontinence (SUI), with an efficacy up to 80%. Another therapeutic option is the use of bulking agents, which create an artificial mass in the urethral submucosa, with an efficacy varying from 64% to 74%. Although bulking agents have a lower risk of complications than midurethral sling surgery, they are mainly used in case a midurethral sling is not an option or if midurethral sling surgery failed to cure stress urinary incontinence. In this study, we offer all patients with SUI in secondary care a choice between a single-incision midurethral sling procedure and treatment with a bulking agent. We want to examine patient preference and patient satisfaction for both procedures. We expect that offering both interventions in combination with standardized counselling will result in high patient …

BackgroundDe-implementation of low-value care can increase health care sustainability. We evaluated the reporting of direct costs of de-implementation and subsequent change (increase or decrease) in health care costs in randomized trials of de-implementation research.MethodsWe searched MEDLINE and Scopus databases without any language restrictions up to May 2021. We conducted study screening and data extraction independently and in duplicate. We extracted information related to study characteristics, types and characteristics of interventions, de-implementation costs, and impacts on health care costs. We assessed risk of bias using a modified Cochrane risk-of-bias tool.ResultsWe screened 10,733 articles, with 227 studies meeting the inclusion criteria, of which 50 included information on direct cost of de-implementation or impact of de-implementation on health care costs. Studies were mostly …

Het doel van de beoogde Mentale Gezondheidscentra in het Integraal Zorg Akkoord (hierna IZA) is passende en tijdige zorg of ondersteuning bieden aan mensen met mentale problemen die ook op andere levensgebieden problemen ervaren. Daarnaast wordt het doel gesteld om de instroom in de GGz te verminderen. Om dat te realiseren is een aantal, ingrijpende veranderingen nodig.Veranderingen in organisaties waarbij sprake is van een transitie en een transformatie zijn complexe opgaven. Bij het samen transformeren om tot een nieuwe organisatievorm te komen, gaat dit dubbelop. Het IZA getuigt dan ook van ambitie en moed om een aantal ingrijpende veranderingen voor te stellen. Het zijn veranderingen die de zorg moeten optimaliseren in termen van organisatie, kwaliteit en kostenbeheersing. De professionals, de individuele zorg-en welzijnsorganisaties en hun financiers, VWS, zorgverzekeraars en gemeenten kunnen dit niet afzonderlijk. De beoogde Mentale Gezondheidscentra brengen deze partijen bij elkaar, waardoor het geheel meer is dan de som der delen.

Introduction The rates of seeking consultation for urinary incontinence (UI) and the barriers against consultations vary among countries and study populations and are influenced by various factors such as embarrassment, perception of illness, resources and culture. Objectives To study healthcare‐seeking behaviours and barriers among Jordanian women. Methods Between 1 March 2020 and 15 April 2020, we conducted a cross‐sectional online survey among women 18 years of age or more who have UI and have access to the internet. We collected women's characteristics, UI types, severity, bother, seeking consultation behaviours and barriers. Logistic regression analyses were used to study the variables associated with seeking consultation. Results The data of 1454 women with a mean age (SD) of 41.5 (11.5) years were analysed. Mixed UI was the most common type (56.3%), while 43.8% of the …

Context There is insufficient evidence that antivertiginous drugs are effective in patients with vestibular symptoms. However, betahistine is one of the most frequently prescribed off-label drugs. The role of family physicians in these inappropriate drug prescriptions is still unclear.Objective This study aimed to evaluate the frequency of (long-term) antivertiginous drug prescriptions in primary care. We also aimed to identify factors associated with long-term prescriptions.Study design and Analysis We performed a retrospective observational cohort study. We used descriptive statistics to determine baseline characteristics and to calculate the prevalence and incidence of prescriptions. We performed a multivariable logistic regression analysis to identify factors associated with long-term prescriptions.Setting We used routine primary care data from more than 1.2 million patients registered at 269 primary care practices …

Huisartsen ervaren chronische duizeligheid vaak als een lastig probleem. De klacht kent veel verschillende oorzaken en er is geen effectieve medicamenteuze behandeling voorhanden. De NHG-Standaard Duizeligheid raadt behandeling met betahistine dan ook af. Toch schrijven huisartsen dit middel nog geregeld voor. Vestibulaire revalidatie, een bewezen effectieve oefentherapie, zetten ze daarentegen zelden in. In deze beschouwing beschrijven we de huidige literatuur over vestibulaire revalidatie en dragen we een stappenplan aan voor de behandeling van chronische duizeligheid.