Behavior of leadless atrioventricular synchronous pacing during exercise.

Background: The leadless Micra AV pacemaker is designed to provide atrioventricular (AV) synchronous tracking by detecting atrial contraction. Detection of the mechanical atrial signals can become challenging at a fast sinus rate.

Objective: The purpose of the study was to evaluate the AV synchronous performance during exercise in outpatients implanted with a Micra AV pacemaker.

Evolution of ventricular and valve function in patients with right ventricular pacing - A randomized controlled trial comparing leadless and conventional pacing.

Background: Leadless pacemakers (PMs) were recently introduced to overcome lead-related complications. They showed high safety and efficacy profiles. Prospective studies assessing long-term safety on cardiac structures are still missing.

Is it feasible to outsource the remote monitoring of implantable cardiac defibrillators in a large tertiary hospital?

Aim: To provide a detailed description of the workflow at our telecardiology centre and to analyse the workload of real-world remote monitoring with the aim to assess the feasibility to outsource this service.

Methods: analysis was conducted on the telecardiology service provided at the University Hospitals of Leuven by extracting patient demographic data, general time usage and detailed information about the type of remote contacts. 10,869 contacts in 948 patients have been included.

Leadless pacemaker for patients following cardiac valve intervention.

Background: Permanent pacing is common after valve intervention. The presence of a conventional pacemaker in this population is recognized as a risk factor for infectious events. Therefore, a leadless pacing system could be the preferred strategy when permanent pacing is required after valve intervention.

Bacteraemia after leadless pacemaker implantation.

Background: Transvenous 3 permanent pacemaker-related infection is a severe condition associated with significant morbidity and mortality. Leadless pacemakers may be more resistant to bacterial seeding during bloodstream infection because of its small surface area and encapsulation in the right ventricle. This study reports the incidence and outcomes of bacteraemia in patients implanted with a Micra leadless pacemaker.

Determinants of the difficulty of leadless pacemaker implantation.

Background: The Micra Transcatheter Pacing System is implanted directly in the right ventricle (RV) through the femoral vein using a steerable transcatheter delivery system. The present study was done to identify determinants of difficult leadless pacemaker implant procedures including operator, patient, and RV anatomical characteristics.

Methods: All patients who underwent a Micra implant from July 2015 to December 2018 at our center were analyzed.

Point of care microspirometry to facilitate the COPD diagnostic process in primary care: a clustered randomised trial.

We studied if pre-bronchodilator FEV/FEV determinations with microspirometers by GPs improve the diagnostic process for COPD in a 6-8 month clustered randomised controlled trial in Dutch general practices ( http://www.trialregister.nl : NTR4041).

Applause sign in advanced Parkinson's disease.

Background: The 'applause sign' a tendency to continue applauding in response to instructions to clap three times was described in 1995 and was considered specific to degenerative disease, especially to atypical parkinsonian disorders. In early phase Parkinson's disease (PD) the sign has been reported positive as well. In late stage PD it is unknown whether and to what extent the sign may be elicited and it remains unknown if and to what degree the sign correlates to cognitive impairment and PD related dementia.

Diagnostic accuracy of pre-bronchodilator FEV1/FEV6 from microspirometry to detect airflow obstruction in primary care: a randomised cross-sectional study.

Background: Forced expiratory volume in 1s/forced expiratory volume in 6 s ( FEV1/FEV6) assessment with a microspirometer may be useful in the diagnostic work up of subjects who are suspected of having COPD in primary care.

Aim: To determine the diagnostic accuracy of a negative pre-bronchodilator (BD) microspirometry test relative to a full diagnostic spirometry test in subjects in whom general practitioners (GPs) suspect airflow obstruction.

Methods: Cross-sectional study in which the order of microspirometry and diagnostic spirometry tests was randomised.

Perspectives on Parkinson disease care in Dutch nursing homes.

Introduction: Parkinson's disease (PD) is a complex and disabling disorder. Ultimately, 20% to 40% of patients are admitted to a nursing home, and neurologists often lose track of these patients. Care and treatment of these institutionalized patients have not been addressed comprehensively, but anecdotal reports suggest it is suboptimal.

Parkinson disease in long term care facilities: a review of the literature.

Parkinson disease (PD) is common in long term care (LTC) facilities. The number of institutionalized patients with PD will rise sharply in the coming decades because of 2 concurrent phenomena: aging of the population leads to an increased PD prevalence and improved quality of care has led to a prolonged survival in advanced disease stages. Only a few studies have investigated the prevalence and clinical characteristics of patients with PD in LTC facilities.

Nonmotor symptoms in nursing home residents with Parkinson's disease: prevalence and effect on quality of life.

Objectives: To determine the prevalence of nonmotor symptoms (NMS) in nursing home (NH) residents with Parkinson's disease (PD) and to establish the association with quality of life.

Design: Cross-sectional.

Setting: Nursing homes in the southeast of the Netherlands.

Accuracy and precision of desktop spirometers in general practices.

Background: Spirometry has become an essential tool for general practices to diagnose and monitor chronic airways diseases, but very little is known about the performance of the spirometry equipment that is being used in general practice settings. The use of invalid spirometry equipment may have consequences on disease diagnosis and management of patients.

Objectives: To establish the accuracy and precision of desktop spirometers that are routinely used in general practices.

Glycopyrrolate for sialorrhea in Parkinson disease: a randomized, double-blind, crossover trial.

Background: Sialorrhea affects approximately 75% of patients with Parkinson disease (PD). Sialorrhea is often treated with anticholinergics, but central side effects limit their usefulness. Glycopyrrolate (glycopyrronium bromide) is an anticholinergic drug with a quaternary ammonium structure not able to cross the blood-brain barrier in considerable amounts.

Quality of routine spirometry tests in Dutch general practices.

Background: Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care.

Aim: To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics.

Design Of Study: Analysis of routine spirometry test records.

Clinical and pharmacogenetic determinants for the discontinuation of non-ergoline dopamine agonists in Parkinson's disease.

Objective: To identify determinants for the discontinuation of non-ergoline dopamine agonist (DA) treatment in patients with Parkinson’s disease (PD) and to identify genetic determinants in genes encoding dopamine receptor (DR)D2 and DRD3 in a exploratory analysis.

Methods: Patients included were first-time users of the non-ergoline DA ropinirole or pramipexole who had been diagnosed with PD before 2005. Treatment discontinuation was defined as a gap of 180 days or more between two refills of the DA.

Spirometry expert support in family practice: a cluster-randomised trial.

Aim: To assess the impact of two modes of spirometry expert support on Family physicians' (FPs') diagnoses and planned management in patients with apparent respiratory disease.

Method: A cluster-randomised trial was performed with family practices as the unit of randomisation. FPs from 44 family practices recorded their diagnosis and planned management before and after spirometry for 868 patients.

Clinical identification of dysarthria types among neurologists, residents in neurology and speech therapists.

Background: Classification of dysarthria types comprises flaccid, spastic, ataxic, hypo- and hyperkinetic and mixed dysarthria. This study focussed on the ability of neurologists to clinically identify the correct type of dysarthria in neurological patients.

Methods: Eighteen patients with dysarthria and 4 healthy controls were enrolled in the study.

Discontinuation of ropinirole and pramipexole in patients with Parkinson's disease: clinical practice versus clinical trials.

Objective: To compare characteristics and incidence of discontinuation of Parkinson's disease (PD) patients starting ropinirole or pramipexole in clinical practice with data from randomised controlled clinical trials (RCTs).

Methods: Included in the retrospective clinical-practice cohort were first-time users of ropinirole or pramipexole diagnosed with PD before 2005. Baseline characteristics and incidence of discontinuation were compared between the clinical-practice cohort and RCTs.

Combining vocational and research training.

Background: The gap between research and clinical practice can be bridged by strengthening the position of the clinician-researcher with appropriate research training and protected time for research.

Methods: A Dutch program combines vocational training in family medicine with research training. This article describes the scientific output of registrars following this combined program.