The effect of thyroid hormone on haemostasis and thrombosis

In this thesis the relation between thyroid hormones and the coagulation system will be examined. As an introduction, the hypothalamic-pituitary-thyroid axis, the coagulation system and their interactions will be discussed. A short overview of the literature preceding the research reported in this thesis is about the relation between thyroid hormones, the coagulation system, and risk of bleeding and venous thrombosis. In conclusion, in the studies in this thesis we found strong evidence that higher than average levels of FT4 increase the risk of venous thrombosis. Weak evidence is provided that lower than average levels of FT4 give an increased risk of bleeding in patients using vitamin K antagonists. A hypothyroid state possesses probably both pro- and anti-coagulant properties. The effect of FT4 on venous thrombosis is mediated at least by coagulation factors factor VIII and von Willebrand factor.UBL - phd migration 201

Positive health during the COVID-19 pandemic: a survey among community-dwelling older individuals in the Netherlands

Abstract Background Coronavirus Disease 2019 (COVID-19) reached the Netherlands in February 2020. To minimize the spread of the virus, the Dutch government announced an “intelligent lockdown”. Older individuals were urged to socially isolate completely, because they are at risk of a severe disease course. Although isolation reduces the medical impact of the virus, the non-medical impact should also be considered. Aim To investigate the impact of COVID-19 pandemic and associated restrictive measures on the six dimensions of Positive Health in community-dwelling older individuals living in the Netherlands, and to identify differences within subgroups. Methods In May/June 2020, community-dwelling older individuals aged ≥ 65 years completed an online survey based on Huber’s model of Positive Health. Positive Health was measured regarding the appreciation of the six dimensions (categorized as poor/satisfactory/excellent) and a comparison with a year before (categorized as decreased/unchanged/increased) using frequencies (%) and a chi-square test. Results 834 older individuals participated (51% women, 38% aged ≥ 76 years, 35% living alone, 16% self-rated poor health). Most respondents assessed their bodily functions, mental well-being and daily functioning as satisfactory, their meaningfulness and quality of life (QoL) as excellent, and their social participation as poor. 12% of the respondents reported a deterioration of 4–6 dimensions and 73% in 1–3 dimensions, compared to the past year. Deterioration was most frequently experienced in the dimension social participation (73%), the dimension mental well-being was most frequently improved (37%) and quality of life was in 71% rated as unchanged. Women more often observed a deterioration of 4–6 dimensions than men (15% vs. 8%, p = 0.001), and individuals with self-rated poor health more often than individuals with self-rated good health (22% vs. 10%, p < 0.001). Older individuals living alone experienced more frequently a decrease in meaningfulness compared to older individuals living together. Conclusion The COVID-19 pandemic and associated restrictive measures had a substantial impact on all six dimensions of Positive Health in community-dwelling older individuals, especially in women, respondents living alone and respondents with self-rated poor general health.Development and application of statistical models for medical scientific researc

Preoperative Indicators of the Effectiveness of Surgical Release in Patients with de Quervain Disease:A Prospective Cohort Study

Background: A significant proportion of patients report persistent pain after surgical release for de Quervain disease (DQ). This study aimed to investigate the effectiveness of a surgical release for DQ and to identify the preoperative factors associated with pain after a surgical release for DQ. Methods: This prospective cohort study included 707 patients who underwent surgical release and completed a visual analogue scale questionnaire (VAS; range 0 to 100). We used a paired t test to analyze the effectiveness of the surgical release on pain at 3 months postoperatively compared with the preoperative measure. A hierarchical multivariable linear regression model was created to investigate the contribution of patient-related and disease-related characteristics to postoperative pain. Results: All VAS domains showed improvement after surgical release. On average, the mean VAS pain decreased by 44 points (95% CI, 42, 46). Smoking (B = 6.37; P &lt; 0.01), younger age (B = -0.35; P &lt; 0.01), longer duration of complaints (B = 0.13; P &lt; 0.01), concomitant surgery (B = 14.40; P &lt; 0.01), and higher VAS pain scores at intake (B = 0.15; P &lt; 0.01) were associated with worse VAS pain scores postoperatively. Together, the variables explained 11% of the variance in mean VAS pain score at 3 months follow-up. Conclusions: This study confirms that surgical treatment for DQ significantly reduces patient-reported pain. Smoking, younger age, concomitant surgery, duration of complaints, and higher VAS pain scores at intake are associated with worse patient-reported pain 3 months after surgical release. However, the small effects suggest that these factors should not be considered the only important factors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.</p

Patient-Reported Outcomes and Function after Surgical Repair of the Ulnar Collateral Ligament of the Thumb

Purpose: The purpose of this study was to report prospectively collected patient-reported outcomes of patients who underwent open thumb ulnar collateral ligament (UCL) repair and to find risk factors associated with poor patient-reported outcomes. Methods: Patients undergoing open surgical repair for a complete thumb UCL rupture were included between December 2011 and February 2021. Michigan Hand Outcomes Questionnaire (MHQ) total scores at baseline were compared to MHQ total scores at three and 12 months after surgery. Associations between the 12-month MHQ total score and several variables (i.e., sex, injury to surgery time, K-wire immobilization) were analyzed. Results: Seventy-six patients were included. From baseline to three and 12 months after surgery, patients improved significantly with a mean MHQ total score of 65 (standard deviation [SD] 15) to 78 (SD 14) and 87 (SD 12), respectively. We did not find any differences in outcomes between patients who underwent surgery in the acute (&lt;3 weeks) setting compared to a delayed setting (&lt;6 months). Conclusions: We found that patient-reported outcomes improve significantly at three and 12 months after open surgical repair of the thumb UCL compared to baseline. We did not find an association between injury to surgery time and lower MHQ total scores. This suggests that acute repair for full-thickness UCL tears might not always be necessary. Type of study/level of evidence: Therapeutic II.</p

SENSITIVITY ANALYSIS FOR AN APPARENT DIRECT EFFECT AFTER CONDITIONING ON AN INTERMEDIATE VARIABLE

Development and application of statistical models for medical scientific researc

Systematic review and meta-analysis of antibiotic prophylaxis to prevent infections from chest drains in blunt and penetrating thoracic injuries

BACKGROUND: No consensus exists as to whether antibiotic prophylaxis in tube thoracostomy as primary treatment for traumatic chest injuries reduces the incidence of surgical-site and pleural cavity infections. METHODS: A systematic literature search was performed according to PRISMA guidelines to identify randomized clinical trials on antibiotic prophylaxis in tube thoracostomy for traumatic chest injuries. Data were extracted by two reviewers using piloted forms. Mantel-Haenszel pooled odds ratios (ORs) were calculated with 95 per cent confidence intervals (c.i.). RESULTS: Eleven articles were included, encompassing 1241 chest drains in 1234 patients. Most patients (84·7 per cent) were men, and a penetrating injury mechanism was most common (856, 69·4 per cent). A favourable effect of antibiotic prophylaxis on the incidence of pulmonary infection was found, with an OR for the overall infectious complication rate of 0·24 (95 per cent c.i. 0·12 to 0·49). Patients who received antibiotic prophylaxis had an almost three times lower risk of empyema than those who did not receive antibiotic treatment (OR 0·32, 0·17 to 0·61). A subgroup analysis in patients with penetrating chest injuries showed that antibiotic prophylaxis in these patients reduced the risk of infection after tube thoracostomy (OR 0·28, 0·14 to 0·57), whereas in a relatively small blunt trauma subgroup no effect of antibiotic prophylaxis after blunt thoracic injury was found. CONCLUSION: Infectious complications are less likely to develop when antibiotic prophylaxis is administered to patients with thoracic injuries requiring chest drains after penetrating injury. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.Infectious Disease

Quantification of Bias in Direct Effects Estimates Due to Different Types of Measurement Error in the Mediator

Clinical epidemiolog

Lower leg cast immobilisation and risk of venous thrombosis: results from the MEGA study

Clinical epidemiolog