Routine follow-up after pacemaker implantation: frequency, pacemaker programming and professionals in charge.

Aims: To describe current evidence of the frequency, contents, and involved professionals of the routine follow-up visits in patients who have received a pacemaker (PM).

Methods And Results: The multicentre FOLLOWPACE study prospectively collected data during implantation and follow-up of 1526 patients who received a PM for the first time. A total of 4914 follow-up visits were studied.

Implementation of outpatient preoperative evaluation clinics: facilitating and limiting factors.

Background: Several studies have shown that outpatient preoperative evaluation by anaesthetists increases quality of care and is cost-effective. The aim of this study was to gain insight into the factors that positively or negatively influence the implementation of outpatient preoperative evaluation clinics (OPE clinics).

Methods: After an extensive literature study and pilot interviews, we constructed written questionnaires that were sent to all Dutch hospitals.

Poor health-related quality of life of patients with indication for chronic cardiac pacemaker therapy.

Background: Studies on health-related quality of life (HRQoL) of patients awaiting pacemaker (PM) implantation are scarce, or executed in specific patient subgroups (regarding age or specific cardiac rhythm disorders). The purpose of this study was to systematically assess the HRQoL in a large unselected cohort of patients with a conventional indication for PM therapy.

Methods: Pre-PM implantation HRQoL (measured with the SF-36 questionnaire, completed at hospital admission) of 818 consecutive Dutch patients included in the FOLLOWPACE study was compared with the HRQoL in a sample of the general Dutch population, and with several cohorts of patients with other conditions.

Bias in sensitivity and specificity caused by data-driven selection of optimal cutoff values: mechanisms, magnitude, and solutions.

Background: Optimal cutoff values for tests results involving continuous variables are often derived in a data-driven way. This approach, however, may lead to overly optimistic measures of diagnostic accuracy. We evaluated the magnitude of the bias in sensitivity and specificity associated with data-driven selection of cutoff values and examined potential solutions to reduce this bias.

A new diagnostic rule for deep vein thrombosis: safety and efficiency in clinically relevant subgroups.

Background: Recently, a new, simple diagnostic rule was introduced to enable GPs to safely refrain from referring a considerable proportion of the patients suspected of having deep vein thrombosis (DVT). The rule (which includes seven patient history and physical examination items plus the result of a D-dimer test) discriminates 'very low' risk patients (not to be referred) from patients with an increased risk of DVT (to be referred). However, the rule's 'efficiency' (proportion of patients designated by the rule as very low risk) and safety (DVT prevalence among these very low risk patients) may change according to patient characteristics.

Polytomous regression did not outperform dichotomous logistic regression in diagnosing serious bacterial infections in febrile children.

Objective: To compare polytomous and dichotomous logistic regression analyses in diagnosing serious bacterial infections (SBIs) in children with fever without apparent source (FWS).

Study Design And Setting: We analyzed data of 595 children aged 1-36 months, who attended the emergency department with fever without source. Outcome categories were SBI, subdivided in pneumonia and other-SBI (OSBI), and non-SBI.

Polytomous logistic regression analysis could be applied more often in diagnostic research.

Objective: Physicians commonly consider the presence of all differential diagnoses simultaneously. Polytomous logistic regression modeling allows for simultaneous estimation of the probability of multiple diagnoses. We discuss and (empirically) illustrate the value of this method for diagnostic research.

Decision-making in temporal lobe epilepsy surgery: the contribution of basic non-invasive tests.

Purpose: We studied the extent to which the widely used diagnostic tests contribute to the decision whether or not to perform temporal lobe epilepsy (TLE) surgery in The Netherlands.

Methods: This nation-wide, retrospective study included 201 consecutive patients referred for TLE surgery screening. The individual and combined contribution of nine index tests to the consensus decision to perform surgery was investigated.

Cognitive outcomes five years after not undergoing coronary artery bypass graft surgery.

Background: Patients with coronary artery disease who underwent coronary artery bypass graft surgery have a high risk of cognitive decline 5 years after the procedure. It is conceivable that this is not caused by the operation, but by natural aging.

Methods: Psychologists repeatedly administered a battery of seven neuropsychological tests with eight main variables to 112 subjects without known coronary artery disease, with a time interval of 5 years.

Updating methods improved the performance of a clinical prediction model in new patients.

Objective: Ideally, clinical prediction models are generalizable to other patient groups. Unfortunately, they perform regularly worse when validated in new patients and are then often redeveloped. While the original prediction model usually has been developed on a large data set, redevelopment then often occurs on the smaller validation set.

Meta-analysis of MR imaging in the diagnosis of breast lesions.

Purpose: To determine, in a meta-analysis, the diagnostic performance of contrast material-enhanced magnetic resonance (MR) imaging in patients with breast lesions.

Materials And Methods: Studies to assess the diagnostic performance of MR imaging in patients suspected of having breast cancer who underwent MR imaging and biopsy from January 1985 through March 2005 were reviewed for inclusion. A summary receiver operating characteristic curve was constructed, and pooled weighted estimates of sensitivity and specificity were calculated by using the recently developed bivariate approach for diagnostic meta-analysis.

A systematic comparison of software dedicated to meta-analysis of causal studies.

Background: Our objective was to systematically assess the differences in features, results, and usability of currently available meta-analysis programs.

Methods: Systematic review of software. We did an extensive search on the internet (Google, Yahoo, Altavista, and MSN) for specialized meta-analysis software.

Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection.

Background: Intraoperative hypotension (IOH) is a common side effect of general anesthesia and has been reported to be associated with adverse perioperative outcomes. These associations were found using different definitions for IOH. It is unknown whether the incidences of IOH found with those different definitions are comparable.

Clinical diagnosis of herpes zoster in family practice.

Purpose: Family physicians usually diagnose herpes zoster on clinical grounds only, possibly resulting in false-positive diagnoses and unnecessary treatment. We wanted to determine the positive predictive value of the physicians' judgment in diagnosing herpes zoster and to assess the applicability of dried blood spot analysis for diagnosis of herpes zoster in family practice.

Methods: Our study population consisted of 272 patients older than 50 years with herpes zoster (rash for less than 7 days).

A randomised clinical trial on cardiotocography plus fetal blood sampling versus cardiotocography plus ST-analysis of the fetal electrocardiogram (STAN) for intrapartum monitoring.

Background: Cardiotocography (CTG) is worldwide the method for fetal surveillance during labour. However, CTG alone shows many false positive test results and without fetal blood sampling (FBS), it results in an increase in operative deliveries without improvement of fetal outcome. FBS requires additional expertise, is invasive and has often to be repeated during labour.

The added value of [18F]-fluoro-D-deoxyglucose positron emission tomography in screening for temporal lobe epilepsy surgery.

Purpose: [18F]-Fluoro-d-deoxyglucose positron emission tomography (FDG-PET) is an expensive, invasive, and not widely available technique used in the presurgical evaluation of temporal lobe epilepsy. We assessed its added value to the decision-making process in relation to other commonly used tests.

Methods: In a retrospective study of a large series of consecutive patients referred to the national Dutch epilepsy surgery program between 1996 and 2002, the contribution of FDG-PET, magnetic resonance imaging (MRI), and video-electroencephalogram (video-EEG) monitoring findings, alone or in combination, to the decision whether to perform surgery was investigated.

Incidence and predictors of in-hospital events after first implantation of pacemakers.

Aims: Despite an annual rise in the numbers of patients receiving their first pacemaker (PM), the risks of the implantation procedure remains unclear. The purpose of this prospective study is to estimate the incidence of in-hospital events after first PM implantation and to determine the predictors of these events.

Methods And Results: Patients with conventional pacing diagnosis were included in the Dutch multicentre FOLLOWPACE PM registry that prospectively documented patients' prognosis and quality of life, and PM events after first implantation.

A simple diagnostic model for ruling out pneumoconiosis among construction workers.

Background: Construction workers exposed to silica-containing dust are at risk of developing silicosis even at low exposure levels. Health surveillance among these workers is commonly advised but the exact diagnostic work-up is not specified and therefore may result in unnecessary chest x ray investigations.

Aim: To develop a simple diagnostic model to estimate the probability of an individual worker having pneumoconiosis from questionnaire and spirometry results, in order to accurately rule out workers without pneumoconiosis.

Predicting postherpetic neuralgia in elderly primary care patients with herpes zoster: prospective prognostic study.

Postherpetic neuralgia (PHN) is the most frequent complication of herpes zoster (HZ) and difficult to treat. Timely identification of high-risk HZ-patients enables physicians to focus on PHN prevention. To assess which simple to measure factors are independent predictors of PHN, and whether psychosocial and serological/virological parameters have additional predictive value, a prospective cohort study in primary care was conducted.

Resolving the blind spot of transoesophageal echocardiography: a new diagnostic device for visualizing the ascending aorta in cardiac surgery.

Background: Atherosclerosis of the ascending aorta (AA) and stroke after cardiac surgery are related. Knowledge of the location of AA-atherosclerosis pre-sternotomy allows changes in surgical strategy to avoid manipulation of the AA. The gold-standard for assessment of AA-atherosclerosis is intraoperative epiaortic ultrasound scanning (EUS).

[Treatment of patients with herpes zoster by epidural injection of steroids and local anaesthetics: less pain after 1 month, but no effect on long-term postherpetic neuralgia--a randomised trial].

Objective: To assess the effectiveness of a single epidural injection of steroids and local anaesthetics, as a supplement to the standard treatment, for the prevention ofpostherpetic neuralgia in older patients with herpes zoster.

Design: Open randomised trial.

Method: In the period September 2001-February 2004, 598 patients, aged > 50 years, with acute herpes zoster (rash for < 7 days) below dermatome C6, were randomly assigned to receive either standard therapy (oral antiviral agents and analgesics) alone or standard therapy plus an additional single epidural injection of 80 mg methylprednisolone and 10 mg bupivacaine.

Validating and updating a prediction rule for serious bacterial infection in patients with fever without source.

Aim: To externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source.

Methods: Patients, 1-36 mo, presenting with fever without source, were prospectively enrolled. Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis/ethmoiditis.