Background: The treatment landscape has completely changed for advanced melanoma. We report survival outcomes and the differential impact of prognostic factors over time in daily clinical practice... Show moreBackground: The treatment landscape has completely changed for advanced melanoma. We report survival outcomes and the differential impact of prognostic factors over time in daily clinical practice.Methods: From a Dutch nationwide population-based registry, patients with advanced melanoma diagnosed from 2013 to 2017 were analysed (n = 3616). Because the proportional hazards assumption was violated, a multivariable Cox model restricted to the first 6 months and a multivariable landmark Cox model from 6 to 48 months were used to assess overall survival (OS) of cases without missing values. The 2017 cohort was excluded from this analysis because of the short follow-up time.Results: Median OS of the 2013 and 2016 cohort was 11.7 months (95% confidence interval [CI]: 10.4-13.5) and 17.7 months (95% CI: 14.9-19.8), respectively. Compared with the 2013 cohort, the 2016 cohort had superior survival in the Cox model from 0 to 6 months (hazard ratio [HR] = 0.55 [95% CI: 0.43-0.72]) and in the Cox model from 6 to 48 months (HR = 0.68 [95% CI: 0.57-0.83]). Elevated lactate dehydrogenase levels, distant metastases in >= 3 organ sites, brain and liver metastasis and Eastern Cooperative Oncology Group performance score of >= 1 had stronger association with inferior survival from 0 to 6 months than from 6 to 48 months. BRAF-mutated melanoma had superior survival in the first 6 months (HR = 0.50 [95% CI: 0.42-0.59]).Conclusion(s): Prognosis for advanced melanoma in the Netherlands has improved from 2013 to 2016. Prognostic importance of most evaluated factors was higher in the first 6 months after diagnosis. BRAF-mutated melanoma was only associated with superior survival in the first 6 months. (C) 2020 Elsevier Ltd. All rights reserved. Show less
Bij veel te vroeg geboren kinderen blijft prematurenretinopathie (ROP) een belangrijke oorzaak van blind- en slechtziendheid. Dit ondanks uitgebreid onderzoek. De oorzaak hiervan is, dat de... Show moreBij veel te vroeg geboren kinderen blijft prematurenretinopathie (ROP) een belangrijke oorzaak van blind- en slechtziendheid. Dit ondanks uitgebreid onderzoek. De oorzaak hiervan is, dat de leeftijd, waarop deze kinderen geboren en in leven gehouden kunnen worden daalt door een betere neonatologische behandeling. Het aantal kinderen, dat ernstige ROP kan oplopen neemt hierdoor toe. Een vroege opsporing en behandeling van ROP kan de kans op het ontwikkelen van een visuele beperking en de ernst daarvan verminderen. Een evidence-based richtlijn is een belangrijk hulpmiddel om de zorg voor deze hoog-risico prematuren te optimaliseren. Er is echter geen universeel screeningsprotocol op te stellen, omdat het niveau van de neonatologische zorg per land erg kan verschillen. Door middel van de NEDROP studie werden op nationaal niveau het screeningsproces, de invloed van overplaatsingen, de incidentie van ROP, de risicofactoren alsmede de behandelcriteria en de behandeling van ROP ge_nventariseerd. Dit heeft mede geresulteerd in een nieuwe richtlijn geschikt voor allen die betrokken zijn bij de screening (oogartsen, neonatologen, kinderartsen, verpleegkundigen en de ouders) en een uniforme, landelijke ouder-informatie folder. Het uiteindelijke doel van de NEDROP studie is om blind- en slechtziendheid door ROP te doen afnemen in Nederland. Show less
This thesis describes the results of the LEMMoN study, a nationwide prospective cohort study into severe maternal morbidity in the Netherlands in which all hospitals in the Netherlands participated... Show moreThis thesis describes the results of the LEMMoN study, a nationwide prospective cohort study into severe maternal morbidity in the Netherlands in which all hospitals in the Netherlands participated. The main objectives of the study were to assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Cases of severe maternal morbidity were collected during a two-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n=371,021). Special attention was paid to the ethnic background. Substandard care was assessed in selected cases during audit meetings. Severe maternal morbidity was reported in 2552 cases, overall incidence being 7.1 per 1000 deliveries. Incidences of ICU admission, uterine rupture, eclampsia and major obstetric haemorrhage were 0.24%, 0.06%, 0.06% and 0.45% per 1000, respectively. Non-Western immigrant women had a 1.3 fold increased risk of severe maternal morbidity as compared with Western women. Jehovah__s witnesses had a 3.1-fold increased risk. Overall case fatality rate was 1 in 53. Substandard care was found in 80% of assessed cases during clinical audit. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge. Show less
