De Kinderkliniek

ABSTRACT Background Ultrasonography is increasingly being used in primary care settings, facilitated by technological advancements, reduced device‐related costs, and improved access to training and support. It holds particular promise for underserved communities, where barriers such as co‐pays or long waiting lists can limit access to diagnostic services. This study evaluates the impact of a primary care ultrasonography service in an underserved urban community. Methods We conducted a retrospective cohort study of consecutive patients who underwent ultrasonography between 2019 and 2024 at a large primary care center ( n = 7877) in Amsterdam, the Netherlands. The primary outcomes included the frequency, indications, and diagnostic outcomes. Secondary outcomes included diagnostic accuracy, changes in clinical decision‐making and referral rates, which were compared with three large primary care centers in adjacent neighborhoods ( n = 23,189). Results A total of 394 patients were included in our primary care ultrasonography service, which involved 40.9% of all diagnostic ultrasounds ordered by our GPs; of whom 62.4% underwent abdominal ultrasonography, 31.7% gynecological ultrasonography, and 5.8% other types of ultrasounds. Ultrasonography yielded conclusive results in 83.5% of cases. The sensitivity and specificity of these ultrasounds for relevant abnormalities were 97.9% (95% CI: 92.5%–99.7%) and 89.8% (95% CI: 85.3%–93.4%), respectively. Conclusion Primary care ultrasonography enhances diagnostic efficiency and reduces the number of direct referrals for ultrasound. Its use in underserved communities can improve healthcare access and help address system‐related diagnostic health disparities. Further research is needed to assess its cost‐effectiveness and scalability.

This study aims to assess the peri- and postoperative outcomes of the vNOTES hysterectomy in the Netherlands during implementation. Nationwide cohort study. vNOTES hysterectomies performed in the Netherlands by 15 hospitals since the implementation of the technique, from August 2019 to September 2024. 673 patients undergoing vNOTES hysterectomy. Descriptive data are presented as frequencies with percentage or mean with range. Logistic regression was used to assess the risk of conversions/complications per BMI group. Peri- and postoperative outcomes such as operating time, conversions, and complications. The mean operating time was 67.4 min (range 24-210). There were 37 (5.5%) conversions and 94 (15.5%) complications. Nineteen (2.8%) complications were perioperative, and 75 (12.7%) postoperative. Ten (1.5%) of the perioperative complications were classified as Clavien-Dindo (CD) 1, and nine (1.3%) as CD3. Postoperatively, 18 patients (3.1%) had a reintervention (N = 17 CD3, N = 1 CD4), and two (0.3%) patients were admitted to the intensive care unit (CD4). The mean blood loss was 127 mL (range 50-2000), and 220 (37%) of patients were discharged the same day. This large nationwide cohort study during implementation of the vNOTES hysterectomy demonstrates the safety and feasibility of this upcoming technique, reporting on a short surgery duration and a similar complication percentage compared to other methods of hysterectomy.

Introduction: During the first COVID-19 outbreak in 2020 in the Netherlands, the incidence of pulmonary embolism (PE) appeared to be high in COVID-19 patients admitted to the intensive care unit (ICU). This study was performed to evaluate the incidence of PE during hospital stay in COVID-19 patients not admitted to the ICU. Methods: Data were retrospectively collected from 8 hospitals in the Netherlands. Patients admitted between February 27, 2020, and July 31, 2020, were included. Data extracted comprised clinical characteristics, medication use, first onset of COVID-19-related symptoms, admission date due to COVID-19, and date of PE diagnosis. Only polymerase chain reaction (PCR)-positive patients were included. All PEs were diagnosed with computed tomography pulmonary angiography (CTPA). Results: Data from 1,852 patients who were admitted to the hospital ward were collected. Forty patients (2.2%) were diagnosed with PE within 28 days following hospital admission. The median time to PE since admission was 4.5 days (IQR 0.0–9.0). In all 40 patients, PE was diagnosed within the first 2 weeks after hospital admission and for 22 (55%) patients within 2 weeks after onset of symptoms. Patient characteristics, pre-existing comorbidities, anticoagulant use, and laboratory parameters at admission were not related to the development of PE. Conclusion: In this retrospective multicenter cohort study of 1,852 COVID-19 patients only admitted to the non-ICU wards, the incidence of CTPA-confirmed PE was 2.2% during the first 4 weeks after onset of symptoms and occurred exclusively within 2 weeks after hospital admission.

Turner syndrome (TS) is accompanied with premature ovarian insufficiency. Oocyte vitrification is an established method to preserve fertility. However, data on the oocyte yield in women with TS who vitrify their oocytes and the return rate to utilize the oocytes are scarce. Retrospective multicenter cohort study. Data was collected from medical records of women with TS who started oocyte vitrification between 2010 and 2021. Thirty-three women were included. The median cumulative number of vitrified oocytes was 20 per woman. Complications occurred in 4% of the cycles. Significant correlations were found between the cumulative number of vitrified oocytes and AMH (r = 0.54 and p < 0.01), AFC (r = 0.49 and p < 0.01), percentage of 46,XX cells (r = 0.49 and p < 0.01), and FSH (r = -0.65 and p < 0.01). Spontaneous (n = 8) and IVF (n = 2) pregnancies occurred in 10 women ± three years after vitrification. So far, none of the women have returned to utilize their vitrified oocytes. Oocyte vitrification is a feasible fertility preservation option for women with TS, particularly in those with 46,XX cell lines or sufficient ovarian reserve. Multiple stimulation cycles are recommended to reach an adequate number of vitrified oocytes for pregnancy. It is too early to draw conclusions about the utilization of vitrified oocytes in women with TS.

BackgroundSyncope management is fraught with unnecessary tests and frequent failure to establish a diagnosis. We evaluated the potential of implementing the 2018 European Society of Cardiology (ESC) Syncope Guidelines regarding diagnostic yield, accuracy and costs.MethodsA multicentre pre-post study in five Dutch hospitals comparing two groups of syncope patients visiting the emergency department: one before intervention (usual care; from March 2017 to February 2019) and one afterwards (from October 2017 to September 2019). The intervention consisted of the simultaneous implementation of the ESC Syncope Guidelines with quick referral routes to a syncope unit when indicated. The primary objective was to compare diagnostic accuracy using logistic regression analysis accounting for the study site. Secondary outcome measures included diagnostic yield, syncope-related healthcare and societal costs. One-year follow-up data were used to define a gold standard reference diagnosis by applying ESC criteria or, if not possible, evaluation by an expert committee. We determined the accuracy by comparing the treating physician’s diagnosis with the reference diagnosis.ResultsWe included 521 patients (usual care, n = 275; syncope guidelines intervention, n = 246). The syncope guidelines intervention resulted in a higher diagnostic accuracy in the syncope guidelines group than in the usual care group (86% vs.69%; risk ratio 1.15; 95% CI 1.07 to 1.23) and a higher diagnostic yield (89% vs. 76%, 95% CI of the difference 6 to 19%). Syncope-related healthcare costs did not differ between the groups, yet the syncope guideline implementation resulted in lower total syncope-related societal costs compared to usual care (saving €908 per patient; 95% CI €34 to €1782).ConclusionsESC Syncope Guidelines implementation in the emergency department with quick referral routes to a syncope unit improved diagnostic yield and accuracy and lowered societal costs.Trial registrationNetherlands Trial Register, NTR6268

Breast cancer is still one of the most common and difficult tumors to cure that impact women globally. Conventional treatment methods frequently result in inconsistent patient outcomes and serious side effects. By using integrative genomic and proteomic profiling to produce individualized oncological medicines, this study tackles the serious issue of the one-size-fits-all treatment paradigm. The study aimed to ascertain distinct genetic mutations and protein expression profiles in tumors pertaining to breast cancer, establish a connection between these molecular discoveries and clinical results, and customize treatments to optimize therapeutic effectiveness while reducing adverse effects. The most important contribution of this study is the comprehensive identification of both common and unique genetic mutations such as TP53, PIK3CA, BRCA1 and BRCA2 and the elucidation of their corresponding protein expression profiles. This molecular knowledge has helped develop individualized treatment protocols that have been shown to significantly improve treatment outcomes. Specifically, patients who received personalized treatment based on their molecular profiles experienced an average 60% reduction in tumor size compared to 35% with standard treatment. In addition, individualized treatments resulted in a lower mean adverse event score of 3 compared to conventional treatments of 7, highlighting a significant reduction in treatment-related adverse events. The results of this study highlight the potential of personalized medicine to optimize breast cancer treatment by matching treatment strategies to the unique molecular characteristics of each patient's tumor. These findings pave the way for future research aimed at improving individualized treatments, improving the availability and affordability of molecular profiling techniques, and expanding the application of these techniques to wider and more diverse patient populations. With continued innovation and clinical validation, integrated genomic and proteomic profiling promises to set new standards for personalized oncology care, ultimately improving patient outcomes and quality of life.

IntroductionSupplemental oxygen is the most important treatment for preterm born infants with established bronchopulmonary dysplasia (BPD). However, it is unknown what oxygen saturation levels are optimal to improve outcomes in infants with established BPD from 36 weeks postmenstrual age (PMA) onwards. The aim of this study is to compare the use of a higher oxygen saturation limit (≥95%) to a lower oxygen saturation limit (≥90%) after 36 weeks PMA in infants diagnosed with moderate or severe BPD.Methods and analysisThis non-blinded, multicentre, randomised controlled trial will recruit 198 preterm born infants with moderate or severe BPD between 36 and 38 weeks PMA. Infants will be randomised to either a lower oxygen saturation limit of 95% or to a lower limit of 90%; supplemental oxygen and/or respiratory support will be weaned based on the assigned lower oxygen saturation limit. Adherence to the oxygen saturation limit will be assessed by extracting oxygen saturation profiles from pulse oximeters regularly, until respiratory support is stopped. The primary outcome is the weight SD score at 6 months of corrected age. Secondary outcomes include anthropometrics collected at 6 and 12 months of corrected age, rehospitalisations, respiratory complaints, infant stress, parental quality of life and cost-effectiveness.Ethics and disseminationEthical approval for the trial was obtained from the Medical Ethics Review Committee of the Erasmus University Medical Centre, Rotterdam, the Netherlands (MEC-2018–1515). Local approval for conducting the trial in the participating hospitals has been or will be obtained from the local institutional review boards. Informed consent will be obtained from the parents or legal guardians of all study participants.Trial registration numberNL7149/NTR7347.

BackgroundThe aim of this study was to compare perineal wound healing between gluteal turnover flap and primary closure in patients undergoing abdominoperineal resection (APR) for rectal cancer.MethodsPatients who underwent APR for primary or recurrent rectal cancer with gluteal turnover flap in two university hospitals (2016–2021) were compared to a multicentre cohort of primary closure (2000–2017). The primary endpoint was uncomplicated perineal wound healing within 30 days. Secondary endpoints were long-term wound healing, related re-interventions, and perineal herniation. The perineal hernia rate was assessed using Kaplan Meier analysis.ResultsTwenty–five patients had a gluteal turnover flap and 194 had primary closure. The uncomplicated perineal wound-healing rate within 30 days was 68% (17/25) after gluteal turnover flap versus 64% (124/194) after primary closure, OR 2.246; 95% CI 0.734–6.876; p = 0.156 in multivariable analysis. No major wound complications requiring surgical re-intervention occurred after flap closure. Eighteen patients with gluteal turnover flap completed 12-month follow-up, and none of them had chronic perineal sinus, compared to 6% (11/173) after primary closure (p = 0.604). The symptomatic 18-month perineal hernia rate after flap closure was 0%, compared to 9% after primary closure (p = 0.184).ConclusionsThe uncomplicated perineal wound-healing rate after the gluteal turnover flap and primary closure after APR is similar, and no chronic perineal sinus or perineal hernia occurred after flap closure. Future studies have to confirm potential benefits of the gluteal turnover flap.

An amendment to this paper has been published and can be accessed via the original article.