Research on the prevalence, diagnostic and prognostic value for treatment of personality pathology – i.e., both personality disorders and problematic personality characteristics – was... Show more Research on the prevalence, diagnostic and prognostic value for treatment of personality pathology – i.e., both personality disorders and problematic personality characteristics – was carried out within a mainly Dutch forensic mental health setting. Issues such as (dis)simulation and unintentional self-deception limit the utility of self-report instruments within a pre-trial setting. Personality disorders and psychopathic traits in suspected offenders in the Netherlands often lead to court rulings of enforced psychiatric treatment – an internationally unique situation. A prospective study on the predictive value of personality disorder isolated factors that can affect enforced treatment length, such as crime type and comorbidity, that can be a focus for policy makers and forensic mental health experts. Caution is advised when using self-report instruments within the forensic context, especially in the absence of response bias scales and in the case of (legal) incentives for certain outcomes. There is urgent need for international standardization of instruments and terminology and a test battery that is specifically designed for and validated within forensic populations. An increase in (detail of) digital registration of patient, treatment and risk characteristics is necessary for meaningful scientific research, a better assessment of personality and risks, fewer incidents, lower recidivism and shorter treatment. Show less
This thesis consists of a number of studies revolving around the leading research theme, i.e., the derivation of new vectorcardiographic diagnostic & prognostic information from the 12-lead... Show moreThis thesis consists of a number of studies revolving around the leading research theme, i.e., the derivation of new vectorcardiographic diagnostic & prognostic information from the 12-lead electrocardiogram (ECG). Various research questions have been addressed, but most studies use a similar data processing approach, consisting of initial mathematical synthesis of a vectorcardiogram (VCG) from a standard 12-lead ECG, followed by the measurement of general VCG characteristics like maximal QRS- and T vectors, QRS- and T integrals, the spatial QRS-T angle (SA) and the ventricular gradient (VG). Studies focus on methodological as well as on clinical issues, and are discussed in the thesis. Show less
Distale radius fracturen komen veel voor. Bij ongeveer de helft van de distale radius fracturen komt een processus styloideus ulnae (PSU, distale ulna fractuur) voor. Een PSU fractuur is een... Show moreDistale radius fracturen komen veel voor. Bij ongeveer de helft van de distale radius fracturen komt een processus styloideus ulnae (PSU, distale ulna fractuur) voor. Een PSU fractuur is een indicator voor toegenomen instabiliteit. In een meta-analyse wordt geen verschil aangetoond in uitkomst van een distale radius fracturen met of zonder PSU fractuur. Hetzelfde geldt voor het al dan niet vastgroeien van het PSU. In ongeveer 33% van de distale radius fracturen komt distale radioulnaire (DRU) instabiliteit voor. Klinische testen en radiologische onderzoeken om dit te diagnosticeren zijn weinig betrouwbaar. Een CT-scan additioneel aan een r_ntgenfoto zorgt niet voor toename in overeenstemming over de uitslag. De overeenstemming tussen beoordelaars van CT-scans valt tegen, naast een grote normale spreiding. Wanneer DRU instabiliteit gediagnostiseerd is, zal de ossale anatomie genormaliseerd moeten worden. In dit proefschrift worden operatie-technieken beschreven die veilig en effectief zijn voor het oplossen van DRU instabiliteit. De auteur concludeert dat DRU instabiliteit een diagnostisch dilemma is. Onderzoek zal zich moeten richten op individuele normaalwaarden, zodat de diagnose makkelijker te stellen is. De aanbeveling wordt gedaan dat distale radius fracturen behandeld dienen te worden door gespecialiseerde teams zodat de complicaties beperkt blijven en indien nodig herkend en optimaal behandeld worden. Show less
Exter, P.L. den; Hulle, T. van der; Hartmann, I.J.C.; Jimenez, D.; Klok, F.A.; Huisman, M.V.; Kroft, L.J.M. 2015
Venous thromboembolism is a common disease that can lead to potential fatal complications. The diagnosis and treatment of a first venous thromboembolism has been well studied, however the... Show moreVenous thromboembolism is a common disease that can lead to potential fatal complications. The diagnosis and treatment of a first venous thromboembolism has been well studied, however the diagnostic management and therapy of recurrent venous thromboembolism still have limitations. This thesis discusses a new imaging technique for recurrent deep venous thrombosis and the duration of treatment after a recurrent venous thromboembolism. It shows that Magnetic Resonance Direct Thrombus Imaging might be a potential diagnostic tool for the diagnostic management of recurrent venous thromboembolism. Furthermore the prognosis after a first deep vein thrombosis is discussed by means of recurrence and bleeding risks. Show less
Spondyloarthritis (SpA) is a heterogeneous group of rheumatic diseases, characterized by sacroiliac-joint inflammation (sacroiliitis), peripheral and extra-articular complaints. The lack of... Show moreSpondyloarthritis (SpA) is a heterogeneous group of rheumatic diseases, characterized by sacroiliac-joint inflammation (sacroiliitis), peripheral and extra-articular complaints. The lack of diagnostic criteria makes diagnosing SpA challenging, yet, classification criteria are available. We tested the performance (sensitivity, specificity) of various classification criteria; the recently developed Assessment of SpondyloArthritis international Society (ASAS) criteria outperformed all other criteria. We investigated the discrepancies in interpretation MRIs and conventional radiographs on the presence of sacroiliitis; agreement on radiographic sacroiliitis between different readers is only moderate, but agreement regarding sacroiliitis on MRI is substantial. Rheumatologists take into account all clinical and laboratory results in addition to the imaging results in the diagnostic process. The diagnostic Berlin algorithm - in which all relevant results are taken into account __ can assist rheumatologists. We proposed a modification of this algorithm, which is accepted by ASAS and also included in the recently published guidelines for the diagnosis and treatment of SpA by the Dutch Society for Rheumatology. Besides, we performed systematic literature reviews, forming the base for the update of the ASAS management recommendations. With these results, SpA-patients can be recognized earlier, offering better treatment options and better outcomes. However, further improvements of care for SpA-patients are necessary. Show less
