Search PubMed⌕ Search

Biomedical subjects

Erik Buskens

Publications and source records attributed to Erik Buskens.

46 records · Page 3Linked to original sources
PubMed2003

Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability.

OBJECTIVE: Although quantitative microbiological cultures of samples obtained by bronchoscopy are considered the most specific tool for diagnosing ventilator-associated pneumonia, this labor-intensive invasive technique is not widely used. The Clinical Pulmonary Infection Score (CPIS), a diagnostic algorithm that relies on easily available clinical, radiographic, and microbiological criteria, could be an attractive alternative for diagnosing ventilator-associated pneumonia. Initially, the CPIS scoring system was validated upon 40 quantitative cultures of bronchoalveolar lavage fluid from 28 patients, and only few other studies have evaluated this scoring system since then. Therefore, little is known about the accuracy of this score. DESIGN: We compared the scores of a slightly adjusted CPIS with results from quantitative cultures of bronchoalveolar lavage fluid in 99 consecutive patients with suspicion of ventilator-associated pneumonia, using growth of > or =10(4) cfu/ml in bronchoalveolar lavage fluid as a cut-off for diagnosing ventilator-associated pneumonia. In addition, the CPIS were calculated for 52 patients by two different intensivists to determine the inter-observer variability. RESULTS: Ventilator-associated pneumonia was diagnosed in 69 (69.6%) patients. When using a CPIS >5 as diagnostic cutoff, the sensitivity of the score was 83% and its specificity was 17%. The area under the Receiver Operating Characteristic curve was 0.55. The level of agreement for prospectively measured Clinical Pulmonary Infection Score (< or =6 and >6) was poor (kappa =0.16). CONCLUSIONS: When compared to quantitative cultures of bronchoalveolar lavage fluid, the CPIS has a low sensitivity and specificity for diagnosing ventilator-associated pneumonia with considerable inter-observer variability.

Adult↗
PubMed2003

A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients.

BACKGROUND: The performance of coronary bypass surgery without cardiopulmonary bypass ("off pump") may reduce perioperative morbidity and costs, but it is uncertain whether the outcome is similar to that involving the use of cardiopulmonary bypass ("on pump"). METHODS: In a multicenter, randomized trial, we randomly assigned 139 patients with predominantly single- or double-vessel coronary disease to on-pump surgery and 142 to off-pump surgery. Cardiac outcome and cost effectiveness were determined one year after surgery. The uncertainty surrounding the cost-effectiveness ratio (cost differences per quality-adjusted year of life gained) was addressed by bootstrapping. RESULTS: At one year, the rate of freedom from death, stroke, myocardial infarction, and coronary reintervention was 90.6 percent after on-pump surgery and 88.0 percent after off-pump surgery (absolute difference, 2.6 percent; 95 percent confidence interval, - 4.6 to 9.8). Graft patency in a randomized subgroup of patients was 93 percent after on-pump surgery and 91 percent after off-pump surgery (absolute difference, 2.0 percent; 95 percent confidence interval, - 6.5 to 10.4). On-pump surgery was associated with $1,839 in additional direct costs per patient ($14,908 vs. $13,069--a difference of 14.1 percent) and an increase in quality-adjusted years of life of 0.83 as compared with 0.82 (difference, 0.01 year; 95 percent confidence interval, - 0.03 to 0.04). Off-pump surgery was more cost effective than on-pump surgery in 95 percent of bootstrap estimates. CONCLUSIONS: In low-risk patients, there was no difference in cardiac outcome at one year between those who underwent on-pump bypass surgery and those who underwent off-pump surgery. Off-pump surgery was more cost effective.

Cardiopulmonary Bypass↗
PubMed2003

Radiofrequency lesioning of dorsal root ganglia for chronic lumbosacral radicular pain: a randomised, double-blind, controlled trial.

BACKGROUND: Results of observational studies have shown pain reduction with percutaneous radiofrequency lesioning of dorsal root ganglia for lumbosacral radicular pain, but there are few randomised controlled trials. We aimed to assess the efficacy of radiofrequency lesioning of dorsal root ganglia for lumbosacral radicular pain. METHODS: We screened 1001 patients, who were mostly referred by their family doctor, in four hospitals for a double-blind randomised trial. 83 patients met inclusion criteria and thus were randomly assigned to receive a radiofrequency lesion or control treatment of the involved dorsal root ganglion. Control treatment was done in the same way as radiofrequency lesioning, but without radiofrequency current. Preoperatively and during 3-month follow-up, patients reported visual analogue leg-pain and back-pain scores, physical impairment, and use of analgesics in a diary. Primary outcome was success or failure of treatment, defined by a multidimensional decision rule, which included median outcome variables from the diary. Post-hoc analysis for possible covariate interference with outcome variables was done. Primary outcome data were analysed on an intention-to-treat basis. FINDINGS: 45 patients were assigned radiofrequency lesioning and 38 control treatment. Three patients dropped out before 3 months. After 3 months, seven (16%) of 44 patients treated with radiofrequency lesioning and nine (25%) of 36 in the control group had successful treatment (difference -9.1% [95% CI -33.0 to 12.0], p=0.43). No differences between groups in side-effects were seen. INTERPRETATION: Lumbosacral radiofrequency lesioning of dorsal root ganglia failed to show advantage over control treatment with local anaesthetics. Thus, its use as routine treatment in lumbosacral radicular pain should not be advocated.

Catheter Ablation↗
PubMed2002

Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers.

OBJECTIVE: To evaluate whether risk assessment scales can be used to identify patients who are likely to get pressure ulcers. DESIGN: Prospective cohort study. SETTING: Two large hospitals in the Netherlands. PARTICIPANTS: 1229 patients admitted to the surgical, internal, neurological, or geriatric wards between January 1999 and June 2000. MAIN OUTCOME MEASURE: Occurrence of a pressure ulcer of grade 2 or worse while in hospital. RESULTS: 135 patients developed pressure ulcers during four weeks after admission. The weekly incidence of patients with pressure ulcers was 6.2% (95% confidence interval 5.2% to 7.2%). The area under the receiver operating characteristic curve was 0.56 (0.51 to 0.61) for the Norton scale, 0.55 (0.49 to 0.60) for the Braden scale, and 0.61 (0.56 to 0.66) for the Waterlow scale; the areas for the subpopulation, excluding patients who received preventive measures without developing pressure ulcers and excluding surgical patients, were 0.71 (0.65 to 0.77), 0.71 (0.64 to 0.78), and 0.68 (0.61 to 0.74), respectively. In this subpopulation, using the recommended cut-off points, the positive predictive value was 7.0% for the Norton, 7.8% for the Braden, and 5.3% for the Waterlow scale. CONCLUSION: Although risk assessment scales predict the occurrence of pressure ulcers to some extent, routine use of these scales leads to inefficient use of preventive measures. An accurate risk assessment scale based on prospectively gathered data should be developed.

Adult↗
PubMed2002

Risk indicators for pressure ulcers during surgery.

Patients undergoing surgery are prone to develop pressure ulcers during surgery. The aim of this study was to identify pressure ulcer risk indicators in patients undergoing surgery which lasted more than four hours. A prospective follow-up study was conducted in 208 patients. Data on presence or absence of pressure ulcers and risk indicators were collected preoperatively, during surgery, and postoperatively. The results show that of the many indicators recorded, the only predictor of pressure ulcers was length of surgery. Because it is not possible to influence the length of the surgery, prevention should primarily be aimed at decreasing pressure and shearing forces during surgery.

Adolescent↗
PubMed2002

Percutaneous thrombolysis of thrombosed haemodialysis access grafts: comparison of three mechanical devices.

BACKGROUND: Percutaneous thrombolysis has become an accepted treatment of thrombosed haemodialysis grafts. Several devices have been developed for mechanical thrombolysis, which macerate the clot using different mechanisms such as aspiration and fragmentation. The aim of our study was to compare the efficacy of three devices for mechanical thrombolysis in removing the thrombus from thrombosed haemodialysis access grafts and to determine the initial technical and clinical success, complication rates of each device, and graft patency after the procedure. METHODS: Thrombolysis (i.e. clot removal followed by percutaneous transluminal angioplasty (PTA)) was performed in 68 thrombosed haemodialysis grafts using the Cragg brush catheter combined with urokinase in 13, the Hydrolyser in 18 and the Arrow-Trerotola Percutaneous Thrombolytic Device (PTD) in 37. Clot removal scores (CRS, the ability to thoroughly remove clot from the access), initial technical success, clinical success, patency at 30, 60, and 90 days, and complication rates were evaluated. RESULTS: CRS for the Cragg brush, Hydrolyser and PTD were good in 92, 44, and 95% of cases, respectively. Initial technical (85, 83, and 95%) and clinical success (62, 67, and 86%), mean patency rates at 30 (73, 60, and 55%), 60 (61, 53, and 49%), and 90 (49, 40, and 43%) days, stenosis after PTA (33, 46, and 21%) and complication rates (8, 6, and 0%) were not different for the three devices. Success rates and graft patency depended on the effect of PTA, irrespective of the device used. CONCLUSIONS: The rotational devices removed clots more effectively than the Hydrolyser, with the PTD having the advantage of not requiring urokinase. However, the result of PTA in the treatment of underlying stenoses was the only predictive value for graft patency.

Angioplasty, Balloon↗
PubMed2002

Preoperative diagnosis of carotid artery stenosis: accuracy of noninvasive testing.

BACKGROUND AND PURPOSE: Carotid endarterectomy has been shown to be beneficial in symptomatic patients with a severe stenosis (70% to 99%) of the internal carotid artery (ICA). Digital subtraction angiography (DSA) is the standard of reference in the diagnosis of carotid artery stenosis but has a relatively high complication rate. In a diagnostic study we investigated the accuracy of noninvasive testing compared with DSA. METHODS: In a prospective diagnostic study we performed duplex ultrasound (DUS), magnetic resonance angiography (MRA), and DSA on 350 consecutive symptomatic patients. Stenoses were measured with the observers blinded for clinical information and other test results. Separate and combined test results of DUS and MRA were compared with the reference standard DSA. Only the stenosis measurements of the arteries on the symptomatic side were included in the analyses. RESULTS: DUS analyzed with previously defined criteria resulted in a sensitivity of 87.5% (95% CI, 82.1% to 92.9%) and a specificity of 75.7% (95% CI, 69.3% to 82.2%) in identifying severe ICA stenosis (70% to 99%). Stenosis measurements on MRA yielded a sensitivity of 92.2% (95% CI, 86.2% to 96.2%) and a specificity of 75.7% (95% CI, 68.6% to 82.5%). When we combined MRA and DUS results, agreement between these 2 modalities (84% of patients) gave a sensitivity of 96.3% (95% CI, 90.8% to 99.0%) and a specificity of 80.2% (95% CI, 73.1% to 87.3%) for identifying severe stenosis. CONCLUSIONS: MRA showed a slightly better accuracy than DUS in the diagnosis of carotid artery stenosis. To achieve the best accuracy, however, both tests should be performed subsequently.

Adult↗
PubMedDate not supplied

Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-controlled trial.

OBJECTIVES: Radiofrequency facet joint denervation procedures have been common practice for 2 decades in treatment of chronic low back pain. We designed this multicenter, randomized, double-blind, sham treatment controlled trial to determine the efficacy of radiofrequency facet joint denervation, as it is routinely performed. METHODS: Inclusion criteria were low back pain, duration more than 6 months, and >or=50% Visual Analog Scale (VAS) reduction on diagnostic block. Exclusion criteria were prior radiofrequency treatment, radicular syndrome, coagulopathies, specific allergies, cancer, and pregnancy. A total of 81 out of 462 patients were randomized to undergo radiofrequency facet joint denervation or sham treatment. The first evaluation was carried out 3 months after treatment. Primary outcome was determined with a combined outcome measure comprising VAS, physical activities, and analgesic intake, from a twice-weekly recorded diary. Secondary outcome measures were the separate diary parameters, global perceived effect (complete relief, >50% relief, no effect, pain increase), and SF-36 Quality of Life Questionnaire. RESULTS: There were no dropouts before the first evaluation. The combined outcome measure showed no differences between radio- frequency facet joint denervation (n=40; success 27.5%) and sham (n=41; success 29.3%) (P=0.86). The VAS in both groups improved (P<0.001). Global perceived effect improved after radiofrequency facet joint denervation (P<0.05). The other secondary outcome parameters showed no significant differences. Relevant costs were evaluated. DISCUSSION: The combined outcome measure and VAS showed no difference between radiofrequency and sham, though in both groups, significant VAS improvement occurred. The global perceived effect was in favor of radiofrequency. In selected patients, radiofrequency facet joint denervation appears to be more effective than sham treatment.

Adolescent↗
PubMedDate not supplied

The benefit of STent placement and blood pressure and lipid-lowering for the prevention of progression of renal dysfunction caused by Atherosclerotic ostial stenosis of the Renal artery. The STAR-study: rationale and study design.

BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) is associated with progressive loss of renal function and is one of the most important causes of renal failure in the elderly. Current treatment includes restoration of the renal arterial lumen by endovascular stent placement. However, this treatment only affects damage caused by ARAS due to the stenosis and ensuing post-stenotic ischemia. ARAS patients have severe general vascular disease. Atherosclerosis and hypertension can also damage the kidney parenchyma causing renal failure. Medical treatment focuses on the latter. Lipid-lowering drugs (statins) could reduce renal failure progression and could reduce the overall high cardiovascular risk. The additional effect on preserving renal function of stent placement as compared to medical therapy alone is unknown. Therefore, the STAR-study aims to compare the effects of renal artery stent placement together with medication vs. medication alone on renal function in ARAS patients. METHOD: Patients with an ARAS of > or = 50% and renal failure (creatinine (Cr) clearance < 80 mL/min/1.73 m2) are randomly assigned to stent placement with medication or to medication alone. Medication consists of statins, anti-hypertensive drugs and antiplatelet therapy. Patients are followed for 2 yrs with extended follow-up to 5 yrs. The primary outcome of this study is a reduction in Cr clearance > 20% compared to baseline. This trial will include 140 patients.

Angioplasty, Balloon↗