Purpose Evaluation of survival of meniscal allograft transplantation (MAT) and postoperative patient-reported outcome (PRO), and their association with prior interventions of the knee. Methods A... Show morePurpose Evaluation of survival of meniscal allograft transplantation (MAT) and postoperative patient-reported outcome (PRO), and their association with prior interventions of the knee. Methods A prospective consecutive study of 109 consecutive patients who had an arthroscopic meniscal allograft transplantation (MAT) between 1999 and 2017 by a single surgeon. Patients were assessed with KOOS scores, preoperative and after a minimal follow-up of 2 years. Furthermore, two anchor questions (whether expectations were met and overall satisfaction, on a five-point Likert scale) were asked. Additionally, prior interventions to MAT were evaluated. Results Prior to MAT, patients had undergone an average of 2.8 (range 1-14) of surgical procedures of the knee. Overall, mean allograft survival was 16.1 years (95% CI 14.8-17.5 years). Higher age at surgery was associated with lower MAT survival: hazard ratio for MAT failure was 1.19 per year increase (95% CI 1.04 to 1.36,p = 0.009). At 4.5 years (IQR, 2-9) of follow-up, all KOOS score were still improved compared to baseline. Age below 35 years, simultaneous anterior cruciate ligament reconstruction and number of knee surgeries before MAT were associated with lower KOOS scores. Overall patient expectations and overall satisfaction after MAT were not associated with preoperative patient characteristics nor with the number or kind of preoperative interventions. Conclusion Meniscal allograft transplantation has a good overall survival with a clinically relevant improvement. Both meniscal allograft survival and PRO were associated with age. PRO was lower in patients younger than 35 years at time of MAT and meniscal allograft survival was worse in patients older than 50 years. PRO was associated with preoperative patient characteristics and number of surgical procedures prior to MAT. All patients reported improved postoperative satisfaction and met expectations after MAT, both independent of the preoperative history of knee interventions. Show less
Objectives: Tailoring medical information to cancer patients' needs is recommended, but there is little guidance on how to tailor, and limited research exists about its effects. Tailoring to the... Show moreObjectives: Tailoring medical information to cancer patients' needs is recommended, but there is little guidance on how to tailor, and limited research exists about its effects. Tailoring to the amount of preferred information may be easily implementable in clinic and is tested here.Methods: A video-vignette experiment was used to systematically vary video patients' information preferences (limited/extensive) and amount of provided information (additional/no additional). N= 253 cancer patients/survivors evaluated these video-recorded consultations, serving as analogue patients (APs), and completed outcome measures.Results: Tailoring information to video patients' preferences had no effect on APs' evaluation of the consultation (satisfaction, trust). Yet, there was a main effect of APs' own information preferences: Those preferring extensive information recalled (M Delta = 5.8%) and recognized (M Delta = 3.5%) more information than those preferring limited information. Moreover, information provision mattered among APs who preferred limited information: They recognized even less if provided with extensive information.Conclusions: Tailoring to the amount of video patient's information preferences did not affect APs' evaluation of the consultation (satisfaction, trust), while APs' personal information preferences determined their recall and recognition of medical information.Practice implications: Information preferences should be assessed and tailored to in clinical practice. Overwhelming patients/survivors, who prefer limited information, should be prevented. (C) 2019 Elsevier B.V. All rights reserved. Show less
Increased patient involvement has been show to result in better clinical outcomes and increased autonomy and to offer a way to control volume and costs of chronic healthcare. The main research... Show moreIncreased patient involvement has been show to result in better clinical outcomes and increased autonomy and to offer a way to control volume and costs of chronic healthcare. The main research question of this thesis was whether part of the kidney transplant aftercare can be delegated to patients without loss of quality of care. The results of the studies described show that self-monitoring kidney function after transplantation is an attractive option to kidney transplant patients and can lead to a significant decrease in number of outpatient visits without compromising on quality of care. Further, self-monitoring could offer a relatively cheap way to increase monitoring frequency, which could lead to earlier detection and treatment of complications and, consequently, improved clinical outcomes. To unravel the full potential of self-monitoring kidney function after transplantation, it is recommended to use accurate measurement devices that both patients and healthcare professionals have confidence in, design a protocol with the involvement of a multidisciplinary group that is truly representative of all stakeholders (including patients and physicians that are more critical of self-monitoring) and choose a study design that includes formative evaluations instead of summative evaluations alone. Show less
Epidural analgesia provided superior analgesia to remifentanil PCA. Women randomised to epidural analgesia with a request for pain relief are more satisfied with their analgesia than women... Show more Epidural analgesia provided superior analgesia to remifentanil PCA. Women randomised to epidural analgesia with a request for pain relief are more satisfied with their analgesia than women randomised to remifentanil PCA. Costs of epidural analgesia and remifentanil PCA are not significantly different. From an economic perspective, there is no preferential pain treatment in labouring women. Epidural analgesia is associated with a greater incidence of fever and significantly higher temperature overall. Patient controlled remifentanil has an effect on maternal SpO2 with significantly lower mean SpO2 during the labour period. This shows that respiratory complications are a serious problem associated with remifentanil and that continuous monitoring by trained personnel is obligatory. Persistent postpartum pain affects many women. Of surveyed women, 6.1% complained of significant pain related to delivery. Since this was a retrospective follow up study this results might be explained by the study design and these findings have to be evaluated by further research. Show less
The aim of this thesis was to investigate the limitations in daily life, outcome measures, clinical outcomes with the emphasis on patient satisfaction, and economic aspects of the treatment of hand... Show moreThe aim of this thesis was to investigate the limitations in daily life, outcome measures, clinical outcomes with the emphasis on patient satisfaction, and economic aspects of the treatment of hand osteoarthritis (OA). Patients with hand OA report severe restrictions in daily life, in particular in opening food packaging. We defined guidelines for the industry on the production of easy-to-open food packaging to make life easier for patients in the future. For evaluating the outcome of an intervention, numerous patient-reported outcome measures are used at present with questionable measurement properties. We could show that the Michigan Hand Outcomes Questionnaire demonstrates good measurement properties in patients with trapeziometacarpal (TMC) OA. Many variables determine patient satisfaction with treatment; expectations being fulfilled, relief of pain or symptoms, and the restoration of hand function are the most important determinants. Evaluation of the outcomes of conservative and surgical management in patients with TMC OA showed that surgery leads to significantly improved hand function after one year, while conservative treatment is most effective in the first 6 months. From an economic point of view, surgery is associated with considerably higher costs than conservative treatment, with respect to both healthcare costs and loss of productivity. Show less
Voorn, V.M.A.; Vermeulen, H.M.; Nelissen, R.G.H.H.; Kloppenburg, M.; Huizinga, T.W.J.; Leijerzapf, N.A.C.; ... ; Linden, H.M.J. van der 2013
