This thesis aimed to identify possible risks associated with erythropoiesis-simulating agent (ESA) use. First, trends in anemia management are described, showing less ESA use in Swedish patients... Show moreThis thesis aimed to identify possible risks associated with erythropoiesis-simulating agent (ESA) use. First, trends in anemia management are described, showing less ESA use in Swedish patients with chronic kidney disease (CKD) and less ESA-treated patients had a hemoglobin above 12 g/dL. Furthermore it is shown that ESA- treated pre-dialysis patients in the Netherlands received more antihypertensive agents than patients without ESA, confirming the hypertensive effect of ESA. However, no relevant difference in routinely measured blood pressure was observed between patients with and without ESA treatment, thus the hypertensive effect of ESAs could be controlled in clinical practice. In addition, no excess of thrombotic events was shown in ESA-treated dialysis patients compared to patients without ESA treatment. In contrast, a higher risk of cardiovascular events with ESA use was indicated in Danish patients with multiple myeloma and myelodyslastic syndrome. Also, with two analytical approaches, a harmful effect of high ESA doses on mortality was indicated in Dutch dialysis patients. Last, it was shown that ESA resistance was associated with mortality in both hemodialysis and peritoneal dialysis patients. To conclude, treatment with high ESA doses was associated with a higher risk of mortality, but the mechanism is largely unknown. Show less
Currently, 35-45% of newly diagnosed breast cancer patients in developed countries is aged 65 years and older. Older women with breast cancer comprise a heterogeneous group due to large differences... Show moreCurrently, 35-45% of newly diagnosed breast cancer patients in developed countries is aged 65 years and older. Older women with breast cancer comprise a heterogeneous group due to large differences with regard to concomitant diseases, physiological reserve and functional status. Current guidelines for breast cancer are based on studies that were mostly performed in younger patients. Therefore, treatment of older women with breast cancer is not evidence-based, and it cannot be expected that clinical trials will fill this gap of knowledge in the near future. The aim of this thesis was to investigate several aspects of breast cancer treatment in older women. In Part I, several aspects of treatment in older breast cancer patients were assessed. Part II assessed methodological aspects of studying breast cancer in older patients. This thesis has shown that older patients are at increased risk for overdiagnosis of breast cancer due to population screening, with potential harmful effects due to the increased risk of complications of treatment. Despite changing treatment strategies, breast cancer prognosis of older women has not improved. Current treatment strategies and decisions tools are insufficient. Observational studies will become increasingly important in this patient population, the use of accurate methods will be essential. Show less
Glas, N.A. de; Kiderlen, M.; Craen, A.J.M. de; Hamaker, M.E.; Portielje, J.E.A.; Velde, C.J.H. van de; ... ; Bastiaannet, E. 2015
The Subacromial Impingement Syndrome (SIS) is the most prevalent disorder of the shoulder in primary health care. Acromionplasty, as the main surgical treatment of SIS, is one of the most performed... Show moreThe Subacromial Impingement Syndrome (SIS) is the most prevalent disorder of the shoulder in primary health care. Acromionplasty, as the main surgical treatment of SIS, is one of the most performed orthopedic surgeries. However, its results are highly variable. Possibly, there are different etiologic subgroups of patients, that might need specific treatment approaches. Several etiologic mechanisms have been described for subacromial narrowing or __impingement__: i.e. 1) structural causes, including acromion shape, subacromial bony spurs, osteophytes; 2) narrowing of the subacromial space due to humerus cranialisation in patients with (micro)instability, or scapular dyskinesia; 3) intrinsic mechanisms such as primary degenerative tendinopathy of the rotator cuff. The aim of this thesis is to unravel the clinical entity __Subacromial Impingement Syndrome__ and to develop methods for identifying distinct etiological patient subgroups that need specific diagnostics and treatment strategies. To this end, we explore the terminological problems and opinions on the main characteristics of SIS amongst international health practitioners, study the prevalence of previously reported etiologic mechanisms in patients with SIS symptoms, develop clinical and biomechanical methods to evaluate and categorize patients with SIS symptoms in diagnostic subgroups, and compare treatment outcomes in trials and follow-up studies. Show less
