www.catharinaziekenhuis.nl Wetenschappelijk Jaaroverzicht 2015 Onder redactie van: JMAH Jansen E Looije J Verhallen ATM Dierick-van Daele L van Coppenolle Een uitgave van het Catharina Ziekenhuis Eindhoven, 2016 © niets van deze uitgave mag worden gekopieerd zonder toestemming van de uitgever. 2 Inhoudsopgave Algemeen Klinisch Laboratorium 5 Anesthesiologie 11 Apotheek 19 Cardiologie 23 Cardiothoracale Chirurgie 54 Chirurgie 65 Dermatologie 163 Fysiotherapie 171 Gynaecologie 173 ICMT 187 Intensive Care 189 Inwendige geneeskunde 192 Kindergeneeskunde 206 Klinische Fysica 212 Kwaliteit 219 Longgeneeskunde 222 Maag, darm, leverziekten 231 Medische Psychologie 241 Mondziekten, kaak en aangezichtschirurgie 244 Neurologie 246 Nucleaire Geneeskunde 251 Onderwijs & Onderzoek 254 Operatiekamers 258 Orthopedie 260 Pamm 264 Plastische Chirurgie 270 Radiologie 273 Radiotherapie 283 Spoedeisende hulp 291 Urologie 293 Boeken 298 Promoties 301 Wetenschapsavond 2015 Catharina Ziekenhuis 305 Tabellen 330 Auteursindex 337 3 Scientific advancement should aim to affirm and to improve human life Nathan Deal (1942) Nathan Deal. (n.d.). BrainyQuote.com. Retrieved April 6, 2016, from BrainyQuote.com Web site: http://www.brainyquote.com/quotes/quotes/n/nathandeal342936.html 4 Algemeen Klinisch Laboratorium 5 Berkel M van Beslisondersteuning is meer dan een algoritme: heparinepomp-protocol op de Intensive Care Boer AK*, Kreeftenberg H*, Bindels A*, Roos A*, Houterman S*, Korsten E*, van Dijk- van Berkel M* Ned Tijdschr Klin Chem Labgeneesk 2015; 40(3): 211-2 geen abstract beschikbaar impactfactor: -- Boer AK Beslisondersteuning is meer dan een algoritme: heparinepomp-protocol op de Intensive Care Boer AK*, Kreeftenberg H*, Bindels A*, Roos A*, Houterman S*, Korsten E*, van Dijk- van Berkel M* Ned Tijdschr Klin Chem Labgeneesk 2015; 40(3): 211-2 geen abstract beschikbaar impactfactor: -- Boer AK Cut-off values to rule out urinary tract infection should be gender-specific Geerts N*, Boonen KJ, Boer AK*, Scharnhorst V* Clin Chim Acta. 2015 Nov 23;452:173-176 Voor abstract zie: AKL - Geerts N impactfactor: 2.824 Boer AK Subclinical hypothyroidism: a 'laboratory-induced' condition Coene KL*, Demir A, Broeren MA, Verschuure P, Lentjes EG, Boer AK* Eur J Endocrinol. 2015 Oct;173(4):499-505. Epub 2015 Jul 28 Voor abstract zie: AKL - Coene KL impactfactor: 4.069 Boer AK Urine flow cytometry can rule out urinary tract infection, but cannot identify bacterial morphologies correctly Geerts N*, Jansz AR*, Boonen KJ*, Wijn RP*, Koldewijn EL*, Boer AK*, Scharnhorst V* Clin Chim Acta. 2015 Jun 26;448:86-90 Voor abstract zie: AKL - Geerts N impactfactor: 2.824 Boonen KJ Urine flow cytometry can rule out urinary tract infection, but cannot identify bacterial morphologies correctly Geerts N*, Jansz AR*, Boonen KJ*, Wijn RP*, Koldewijn EL*, Boer AK*, Scharnhorst V* Clin Chim Acta. 2015 Jun 26;448:86-90 Voor abstract zie: AKL - Geerts N impactfactor: 2.824 6 Coene KL Iatrogenic anemia/Twenty-five million liters of blood into the sewer: comment Coene KL*, Roos AN*, Scharnhorst V* J Thromb Haemost. 2015 Jun;13(6):1160-1 geen abstract beschikbaar impactfactor: 5.720 Coene KL Subclinical hypothyroidism: a 'laboratory-induced' condition Coene KL*, Demir A, Broeren MA, Verschuure P, Lentjes EG, Boer AK* Eur J Endocrinol. 2015 Oct;173(4):499-505. Epub 2015 Jul 28 OBJECTIVE: In current literature and guidelines there is a tendency to define absolute thyroid stimulating hormone (TSH) concentrations at which patient follow-up or even pharmaceutical intervention should be initiated. As TSH concentrations depend on the analytical method/platform used for TSH quantification, absolute cut-off values may pose threats for uniform clinical decision making. In this study we therefore set out to clarify to what extent the method/platform and the reference values applied for TSH influence the clinical interpretation of thyroid parameters. DESIGN AND METHODS: We retrospectively analyzed anonymous TSH results from the Dutch external quality assessment program in relation to reference values advised by different manufacturers. We also examined TSH/free thyroxin (fT4) reference ranges and prevalence of thyroid pathology among different Dutch laboratories, including four cases in which a switch in measuring platform was made. RESULTS: Our data show that interpretation of thyroid parameters is not only influenced by between-method/platform variation, but is also substantially affected by the variation in TSH/fT4 reference intervals applied in individual laboratories. Additionally, we show that the transition to a novel analytical method/platform can result in a shift in the prevalence of thyroid pathology, especially for subclinical hypothyroidism. CONCLUSIONS: Subclinical hypothyroidism can be a 'laboratory-induced' condition. This is an undesirable situation, regarding the clinical implications such a diagnosis can have for patients. impactfactor: 4.069 Geerts N Cut-off values to rule out urinary tract infection should be gender-specific Geerts N*, Boonen KJ, Boer AK*, Scharnhorst V* Clin Chim Acta. 2015 Nov 23;452:173-176 The diagnosis of urinary tract infection (UTI) by urine culture is an expensive and time- consuming procedure. Using a screening method, to identify negative samples, would improve the procedure and reduce costs. In this study, urine flow cytometry, of over 7000 urine samples, was assessed by retrospective analysis. With a cut-off value of >200bacteria/µl, we obtained a sensitivity of 93.0%, a specificity of 63.5%, and a negative predictive value (NPV) of 96.2%. As a result the culturing of 49% of all samples could be avoided. In addition, the data was retrospectively analyzed to determine if the introduction of gender-specific cut-off values could improve screening results. The obtained receiver operator curves are indeed significantly different when gender specific cut-offs were used. When a NPV of 95% is considered acceptable the unisex cut-off value of >200bacteria/µl can be used for women (NPV 94.9%), but the cut-off value for men could be raised to >400bacteria/µl without diminishing the NPV (NPV 95.0%). impactfactor: 2.824 7 Geerts N Urine flow cytometry can rule out urinary tract infection, but cannot identify bacterial morphologies correctly Geerts N*, Jansz AR*, Boonen KJ*, Wijn RP*, Koldewijn EL*, Boer AK*, Scharnhorst V* Clin Chim Acta. 2015 Jun 26;448:86-90 The diagnosis of urinary tract infection (UTI) by urine culture is a time-consuming and costly procedure. Usage of a screening method, to identify negative samples, would therefore affect time-to-diagnosis and laboratory cost positively. Urine flow cytometers are able to identify particles in urine. Together with the introduction of a cut-off value, which determines if a urine sample is subsequently cultured or not, the number of cultures can be reduced, while maintaining a low level of false negatives and a high negative predictive value. Recently, Sysmex developed additional software for their urine flow cytometers. Besides measuring the number of bacteria present in urine, information is given on bacterial morphology, which may guide the physician in the choice of antibiotic. In this study, we evaluated this software update. The UF1000i classifies bacteria into two categories: 'rods' and 'cocci/mixed'. Compared to the actual morphology of the bacterial pathogen found, the 'rods' category scores reasonably well with 91% chance of classifying rod-shaped bacteria correctly. The 'cocci/mixed' category underperforms, with only 29% of spherical-shaped bacteria (cocci) classified as such. In its current version, the bacterial morphology software does not classify bacteria, according to their morphology, well enough to be of clinical use in this study population. impactfactor: 2.824 Kerkhof D van de Charcot-Leyden crystals in acute myeloid leukemia van de Kerkhof D*, Scharnhorst V*, Huysentruyt CJ, Brands-Nijenhuis AV, Ermens AA Int J Lab Hematol. 2015 Aug;37(4):e100-2 Geen abstract beschikbaar impactfactor: 1.819 Kerkhof D van de Reducing the immediate availability of red blood cells in cardiac surgery, a single- centre experience Haanschoten MC*, van Straten AH*, Verstappen F*, van de Kerkhof D*, van Zundert AA*, Soliman Hamad MA* Neth Heart J. 2015 Jan;23(1):28-32. Epub 2014 Oct 18 Voor abstract zie: Anesthesiologie - Haanschoten MC impactfactor: 1.837 Scharnhorst V Charcot-Leyden crystals in acute myeloid leukemia van de Kerkhof D*, Scharnhorst V*, Huysentruyt CJ*, Brands-Nijenhuis AV*, Ermens AA Int J Lab Hematol. 2015 Aug;37(4):e100-2 Geen abstract beschikbaar impactfactor: 1.819 8 Scharnhorst V Cholesterol in the ICU: a cheap and reliable marker for illness severity? Kreeftenberg HG*, Roos AN*, Bindels AJ*, Scharnhorst V* Neth J Crit Care 2015;20(2):17-20 Voor abstract zie: Inwendige geneeskunde - Kreeftenberg HG impactfactor: -- Scharnhorst V Cut-off values to rule out urinary tract infection should be gender-specific Geerts N*, Boonen KJ, Boer AK*, Scharnhorst V* Clin Chim Acta. 2015 Nov 23;452:173-176 Voor abstract zie: AKL - Geerts N impactfactor: 2.824 Scharnhorst V Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study Mocroft A, Lundgren JD, Ross M, Law M, Reiss P, Kirk O, Smith C, Wentworth D, Neuhaus J, Fux CA, Moranne O, Morlat P, Johnson MA, Ryom L; D:A:D study group; Royal Free Hospital Clinic Cohort; INSIGHT study group; SMART study group; ESPRIT study group; collaborator: Scharnhorst V* PLoS Med. 2015 Mar 31;12(3):e1001809. eCollection 2015 BACKGROUND: Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV- positive individuals that can guide decision making in clinical practice.