Margriet De Haan - Academia.edu (original) (raw)

Papers by Margriet De Haan

Endoscopy, Sep 30, 2014

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and th... more This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ES-GAR), published in Endoscopy and European Radiology simultaneously. It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

Background: Colorectal cancer (CRC) is the second most prevalent type of cancer in Europe. Early ... more Background: Colorectal cancer (CRC) is the second most prevalent type of cancer in Europe. Early detection and removal of CRC or its precursor lesions by population screening can reduce mortality. Colonoscopy and computed tomography colonography (CT colonography) are highly accurate exams and screening options that examine the entire colon. The success of screening depends on the participation rate. We designed a randomized trial to compare the uptake, yield and costs of direct colonoscopy population screening, using either a telephone consultation or a consultation at the outpatient clinic, versus CT colonography first, with colonoscopy in CT colonography positives. Methods and design: 7,500 persons between 50 and 75 years will be randomly selected from the electronic database of the municipal administration registration and will receive an invitation to participate in either CT colonography (2,500 persons) or colonoscopy (5,000 persons) screening. Those invited for colonoscopy scr...

In een proefbevolkingsonderzoek naar dikkedarmkanker vergeleek Margriet de Haan coloscopie (onder... more In een proefbevolkingsonderzoek naar dikkedarmkanker vergeleek Margriet de Haan coloscopie (onderzoek met een dunne flexibele slang met camera om de darm van binnenuit te bekijken) met CT-colografie (onderzoek waarbij de darmen worden onderzocht zonder slang) wat betreft opkomst, opbrengst, belasting en reden voor deelname. De opkomst voor CT-colografie was hoger dan voor coloscopie, maar de opbrengst per deelnemer was lager,

European Radiology, 2014

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and th... more This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), published in Endoscopy and European Radiology simultaneously. It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

European Journal of Radiology, 2012

Objective: Compare colonic distension and perceived burden of CT colonography between participant... more Objective: Compare colonic distension and perceived burden of CT colonography between participants receiving hyoscine butylbromide and glucagon hydrochloride as bowel relaxant. Materials and methods: Data were collected within a screening trial. Participants received 20 mg hyoscine butylbromide intravenously or 1 mg of glucagon hydrochloride intravenously (if hyoscine butylbromide contra-indicated). Colon distension per segment was assessed using a 4-point scale (prone and supine). Data on perceived burden of CT colonography were collected using a questionnaire two weeks after the examination. Outcome measures between groups were compared using propensity score matching. We used a stratified Wilcoxon-Mann-Whitney test statistic for quantitative and Cochran-Mantel-Haenszel statistics for categorical variables. Results: 541 participants were included: 336 (62%) received hyoscine butylbromide and 205 received glucagon hydrochloride. All hyoscine butylbromide recipients had an adequately distended colon, compared to 96% in the glucagon hydrochloride group (RR 7.31, 95% CI: 1.61-33.28). More glucagon hydrochloride recipients scored the insufflation as rather or extremely burdensome (25% vs. 16%; overall mean score 2.7 vs. 2.4; P < 0.001) and more found the entire CT colonography rather or extremely burdensome (14% vs. 7%; 2.2 vs. 1.9; P = 0.001). Most frequently reported side effects were a dry mouth in the hyoscine butylbromide group (15%) and nausea in the glucagon hydrochloride group (13%). Conclusion: Compared to glucagon hydrochloride, premedication with hyoscine butylbromide results in significantly more adequately distended colons and a less burdensome procedure. When hyoscine butylbromide can be used, it is the preferred bowel relaxant. Colon distension, perceived burden and side effects of CT colonography for screening using hyoscine butylbromide or glucagon hydrochloride as bowel relaxant 127 7

Does CT colonography have a role for population-based colorectal cancer screening?

Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening popul... more Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening population: a meta-analysis

Endoscopy

Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiol... more Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia.Strong recommendation, high quality evidence.ESGE/ESGAR do not recommend barium enema in this setting.Strong recommendation, high quality evidence. 2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors.Strong recommendation, low quality evidence.ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete.Weak recommendation, low quality evidence. 3 When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms.Strong recommendation, high quality evidence.Bec...

Gastroenterology, 2011

Screening for colorectal cancer (CRC) is widely recommended, but the preferred strategy remains t... more Screening for colorectal cancer (CRC) is widely recommended, but the preferred strategy remains to be determined. We conducted a randomized controlled trial comparing the participation rate and diagnostic yield of colonoscopy versus CT-colonography (CTC) screening. A random ...

European Radiology, 2016

Purpose We assessed the burden of waiting for surveillance CT colonography (CTC) performed in pat... more Purpose We assessed the burden of waiting for surveillance CT colonography (CTC) performed in patients having 6-9 mm colorectal polyps on primary screening CTC. Additionally, we compared the burden of primary and surveillance CTC. Materials and methods In an invitational population-based CTC screening trial, 101 persons were diagnosed with <3 polyps 6-9 mm, for which surveillance CTC after 3 years was advised. Validated questionnaires regarding expected and perceived burden (5-point Likert scales) were completed before and after index and surveillance CTC, also including items on burden of waiting for surveillance CTC. McNemar's test was used for comparison after dichotomization. Results Seventy-eight (77 %) of 101 invitees underwent surveillance CTC, of which 66 (85 %) completed the expected and 62 (79 %) the perceived burden questionnaire. The majority of participants (73 %) reported the experience of waiting for surveillance CTC as 'never' or 'only sometimes' burdensome. There was almost no difference in expected and perceived burden between surveillance and index CTC. Waiting for the results after the procedure was significantly more burdensome for surveillance CTC than for index CTC (23 vs. 8 %; p = 0.012). Conclusion Waiting for surveillance CTC after primary CTC screening caused little or no burden for surveillance participants. In general, the burden of surveillance and index CTC were comparable. Key points • Waiting for surveillance CTC within a CRC screening caused little burden • The vast majority never or only sometimes thought about their polyp(s) • In general, the burden of index and surveillance CTC were comparable • Awaiting results was more burdensome for surveillance than for index CTC

European radiology, Jan 11, 2015

Surveillance CT colonography (CTC) is a viable option for 6-9 mm polyps at CTC screening for colo... more Surveillance CT colonography (CTC) is a viable option for 6-9 mm polyps at CTC screening for colorectal cancer. We established participation and diagnostic yield of surveillance and determined overall yield of CTC screening. In an invitational CTC screening trial 82 of 982 participants harboured 6-9 mm polyps as the largest lesion(s) for which surveillance CTC was advised. Only participants with one or more lesion(s) ≥6 mm at surveillance CTC were offered colonoscopy (OC); 13 had undergone preliminary OC. The surveillance CTC yield was defined as the number of participants with advanced neoplasia in the 82 surveillance participants, and was added to the primary screening yield. Sixty-five of 82 participants were eligible for surveillance CTC of which 56 (86.2 %) participated. Advanced neoplasia was diagnosed in 15/56 participants (26.8 %) and 9/13 (69.2 %) with preliminary OC. Total surveillance yield was 24/82 (29.3 %). No carcinomas were detected. Adding surveillance results to in...

The American journal of gastroenterology, Jan 20, 2015

Volumetric growth assessment has been proposed for predicting advanced histology at surveillance ... more Volumetric growth assessment has been proposed for predicting advanced histology at surveillance computed tomography (CT) colonography (CTC). We examined whether is it possible to predict which small (6-9 mm) polyps are likely to become advanced adenomas at surveillance by assessing volumetric growth. In an invitational population-based CTC screening trial, 93 participants were diagnosed with one or two 6-9 mm polyps as the largest lesion(s). They were offered a 3-year surveillance CTC. Participants in whom surveillance CTC showed lesion(s) of ≥6 mm were offered colonoscopy. Volumetric measurements were performed on index and surveillance CTC, and polyps were classified into growth categories according to ±30% volumetric change (>30% growth as progression, 30% growth to 30% decrease as stable, and >30% decrease as regression). Polyp growth was related to histopathology. Between July 2012 and May 2014, 70 patients underwent surveillance CTC after a mean surveillance interval of...

Gastroenterology, 2011

ABSTRACT

Gut, 2015

Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-r... more Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. The introduction of CRC screening programmes using stool tests and flexible sigmoidoscopy, have been shown to reduce CRC-related mortality substantially. In several European countries, population-based CRC screening programmes are ongoing or being rolled out. Stool tests like faecal occult blood testing are non-invasive and simple to perform, but are primarily designed to detect early invasive cancer. More invasive tests like colonoscopy and CT colonography (CTC) aim at accurately detecting both CRC and cancer precursors, thus providing for cancer prevention. This review focuses on the accuracy, acceptance and safety of CTC as a CRC screening technique and on the current position of CTC in organised population screening. Based on the detection characteristics and acceptability of CTC screening, it might be a viable screening test. The potential disadvantage of ra...

Radiology, 2012

To compare the diagnostic yields of a radiologist and trained technologists in the detection of a... more To compare the diagnostic yields of a radiologist and trained technologists in the detection of advanced neoplasia within a population-based computed tomographic (CT) colonography screening program. Ethical approval was obtained from the Dutch Health Council, and written informed consent was obtained from all participants. Nine hundred eighty-two participants (507 men, 475 women) underwent low-dose CT colonography after noncathartic bowel preparation (iodine tagging) between July 13, 2009, and January 21, 2011. Each scan was evaluated by one of three experienced radiologists (≥800 examinations) by using primary two-dimensional (2D) reading followed by secondary computer-aided detection (CAD) and by two of four trained technologists (≥200 examinations, with colonoscopic verification) by using primary 2D reading followed by three-dimensional analysis and CAD. Immediate colonoscopy was recommended for participants with lesions measuring at least 10 mm, and surveillance was recommended ...

British journal of cancer, Jan 27, 2010

On theoretical grounds, the age of the grandmother and the age of the mother at delivery of her d... more On theoretical grounds, the age of the grandmother and the age of the mother at delivery of her daughter may affect the breast cancer risk of the granddaughter. We used the data relating to the Diagnostic Research Mamma-carcinoma cohort (DOM (Diagnostisch Onderzoek Mammacarcinoom) 3), which comprises a population-based sample of 12 178 women aged 41-63 years at enrolment in 1982-85 and followed up until 2000. During follow-up 340 postmenopausal breast cancer cases were identified. To these we applied a case-cohort design together with a random sample from the baseline cohort (n=1826). Of these study participants, we were able to retrieve the birth dates of 998 mothers (309 cases, 689 controls), and for 547 of these we also retrieved the birth dates of the grandmothers (197 cases, 350 controls). A weighted Cox proportional hazards model was used to estimate the hazard ratios (HRs) for the effect of the age of the grandmother and the age of the mother on the breast cancer risk of the ...

International Journal of Medical Education, 2010

Objectives: There is growing evidence for the value of several forms of peer teaching in medical ... more Objectives: There is growing evidence for the value of several forms of peer teaching in medical education. Little is known about the feasibility of such an approach in courses of clinical reasoning. The University Medical Center Utrecht offers a clinical reasoning course for first and second year students which previously had been occasionally led by sixth year, i.e. near-peer students. We evaluated a version of this course, fully delivered by final year students. Methods: In 2008-2009 this highly structured mandatory clinical reasoning course for second year medical students was fully tutored by final year medical students, as part of a teacher training course in their core curriculum. Routine evaluations before and after introducing near-peers as tutors were compared, a focused questionnaire survey was conducted, as well as an interview with a group of students to evaluate the new format. Results: There was no difference in the ratings of the course before and after the introduction of the new format. In general, second year students are satisfied with the nearpeer teachers. Strong points mentioned are their high motivation, involvement, enthusiasm, adjustment of cognitive level of teaching to the recipient students and stimulating skills. Conclusions: Although our study cannot provide evidence for differential learning effects, the evaluation of our final year student led clinical reasoning course shows encouraging results.

Endoscopy, Sep 30, 2014

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and th... more This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ES-GAR), published in Endoscopy and European Radiology simultaneously. It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

Background: Colorectal cancer (CRC) is the second most prevalent type of cancer in Europe. Early ... more Background: Colorectal cancer (CRC) is the second most prevalent type of cancer in Europe. Early detection and removal of CRC or its precursor lesions by population screening can reduce mortality. Colonoscopy and computed tomography colonography (CT colonography) are highly accurate exams and screening options that examine the entire colon. The success of screening depends on the participation rate. We designed a randomized trial to compare the uptake, yield and costs of direct colonoscopy population screening, using either a telephone consultation or a consultation at the outpatient clinic, versus CT colonography first, with colonoscopy in CT colonography positives. Methods and design: 7,500 persons between 50 and 75 years will be randomly selected from the electronic database of the municipal administration registration and will receive an invitation to participate in either CT colonography (2,500 persons) or colonoscopy (5,000 persons) screening. Those invited for colonoscopy scr...

In een proefbevolkingsonderzoek naar dikkedarmkanker vergeleek Margriet de Haan coloscopie (onder... more In een proefbevolkingsonderzoek naar dikkedarmkanker vergeleek Margriet de Haan coloscopie (onderzoek met een dunne flexibele slang met camera om de darm van binnenuit te bekijken) met CT-colografie (onderzoek waarbij de darmen worden onderzocht zonder slang) wat betreft opkomst, opbrengst, belasting en reden voor deelname. De opkomst voor CT-colografie was hoger dan voor coloscopie, maar de opbrengst per deelnemer was lager,

European Radiology, 2014

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and th... more This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), published in Endoscopy and European Radiology simultaneously. It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

European Journal of Radiology, 2012

Objective: Compare colonic distension and perceived burden of CT colonography between participant... more Objective: Compare colonic distension and perceived burden of CT colonography between participants receiving hyoscine butylbromide and glucagon hydrochloride as bowel relaxant. Materials and methods: Data were collected within a screening trial. Participants received 20 mg hyoscine butylbromide intravenously or 1 mg of glucagon hydrochloride intravenously (if hyoscine butylbromide contra-indicated). Colon distension per segment was assessed using a 4-point scale (prone and supine). Data on perceived burden of CT colonography were collected using a questionnaire two weeks after the examination. Outcome measures between groups were compared using propensity score matching. We used a stratified Wilcoxon-Mann-Whitney test statistic for quantitative and Cochran-Mantel-Haenszel statistics for categorical variables. Results: 541 participants were included: 336 (62%) received hyoscine butylbromide and 205 received glucagon hydrochloride. All hyoscine butylbromide recipients had an adequately distended colon, compared to 96% in the glucagon hydrochloride group (RR 7.31, 95% CI: 1.61-33.28). More glucagon hydrochloride recipients scored the insufflation as rather or extremely burdensome (25% vs. 16%; overall mean score 2.7 vs. 2.4; P < 0.001) and more found the entire CT colonography rather or extremely burdensome (14% vs. 7%; 2.2 vs. 1.9; P = 0.001). Most frequently reported side effects were a dry mouth in the hyoscine butylbromide group (15%) and nausea in the glucagon hydrochloride group (13%). Conclusion: Compared to glucagon hydrochloride, premedication with hyoscine butylbromide results in significantly more adequately distended colons and a less burdensome procedure. When hyoscine butylbromide can be used, it is the preferred bowel relaxant. Colon distension, perceived burden and side effects of CT colonography for screening using hyoscine butylbromide or glucagon hydrochloride as bowel relaxant 127 7

Does CT colonography have a role for population-based colorectal cancer screening?

Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening popul... more Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening population: a meta-analysis

Endoscopy

Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiol... more Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia.Strong recommendation, high quality evidence.ESGE/ESGAR do not recommend barium enema in this setting.Strong recommendation, high quality evidence. 2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors.Strong recommendation, low quality evidence.ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete.Weak recommendation, low quality evidence. 3 When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms.Strong recommendation, high quality evidence.Bec...

Gastroenterology, 2011

Screening for colorectal cancer (CRC) is widely recommended, but the preferred strategy remains t... more Screening for colorectal cancer (CRC) is widely recommended, but the preferred strategy remains to be determined. We conducted a randomized controlled trial comparing the participation rate and diagnostic yield of colonoscopy versus CT-colonography (CTC) screening. A random ...

European Radiology, 2016

Purpose We assessed the burden of waiting for surveillance CT colonography (CTC) performed in pat... more Purpose We assessed the burden of waiting for surveillance CT colonography (CTC) performed in patients having 6-9 mm colorectal polyps on primary screening CTC. Additionally, we compared the burden of primary and surveillance CTC. Materials and methods In an invitational population-based CTC screening trial, 101 persons were diagnosed with <3 polyps 6-9 mm, for which surveillance CTC after 3 years was advised. Validated questionnaires regarding expected and perceived burden (5-point Likert scales) were completed before and after index and surveillance CTC, also including items on burden of waiting for surveillance CTC. McNemar's test was used for comparison after dichotomization. Results Seventy-eight (77 %) of 101 invitees underwent surveillance CTC, of which 66 (85 %) completed the expected and 62 (79 %) the perceived burden questionnaire. The majority of participants (73 %) reported the experience of waiting for surveillance CTC as 'never' or 'only sometimes' burdensome. There was almost no difference in expected and perceived burden between surveillance and index CTC. Waiting for the results after the procedure was significantly more burdensome for surveillance CTC than for index CTC (23 vs. 8 %; p = 0.012). Conclusion Waiting for surveillance CTC after primary CTC screening caused little or no burden for surveillance participants. In general, the burden of surveillance and index CTC were comparable. Key points • Waiting for surveillance CTC within a CRC screening caused little burden • The vast majority never or only sometimes thought about their polyp(s) • In general, the burden of index and surveillance CTC were comparable • Awaiting results was more burdensome for surveillance than for index CTC

European radiology, Jan 11, 2015

Surveillance CT colonography (CTC) is a viable option for 6-9 mm polyps at CTC screening for colo... more Surveillance CT colonography (CTC) is a viable option for 6-9 mm polyps at CTC screening for colorectal cancer. We established participation and diagnostic yield of surveillance and determined overall yield of CTC screening. In an invitational CTC screening trial 82 of 982 participants harboured 6-9 mm polyps as the largest lesion(s) for which surveillance CTC was advised. Only participants with one or more lesion(s) ≥6 mm at surveillance CTC were offered colonoscopy (OC); 13 had undergone preliminary OC. The surveillance CTC yield was defined as the number of participants with advanced neoplasia in the 82 surveillance participants, and was added to the primary screening yield. Sixty-five of 82 participants were eligible for surveillance CTC of which 56 (86.2 %) participated. Advanced neoplasia was diagnosed in 15/56 participants (26.8 %) and 9/13 (69.2 %) with preliminary OC. Total surveillance yield was 24/82 (29.3 %). No carcinomas were detected. Adding surveillance results to in...

The American journal of gastroenterology, Jan 20, 2015

Volumetric growth assessment has been proposed for predicting advanced histology at surveillance ... more Volumetric growth assessment has been proposed for predicting advanced histology at surveillance computed tomography (CT) colonography (CTC). We examined whether is it possible to predict which small (6-9 mm) polyps are likely to become advanced adenomas at surveillance by assessing volumetric growth. In an invitational population-based CTC screening trial, 93 participants were diagnosed with one or two 6-9 mm polyps as the largest lesion(s). They were offered a 3-year surveillance CTC. Participants in whom surveillance CTC showed lesion(s) of ≥6 mm were offered colonoscopy. Volumetric measurements were performed on index and surveillance CTC, and polyps were classified into growth categories according to ±30% volumetric change (>30% growth as progression, 30% growth to 30% decrease as stable, and >30% decrease as regression). Polyp growth was related to histopathology. Between July 2012 and May 2014, 70 patients underwent surveillance CTC after a mean surveillance interval of...

Gastroenterology, 2011

ABSTRACT

Gut, 2015

Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-r... more Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. The introduction of CRC screening programmes using stool tests and flexible sigmoidoscopy, have been shown to reduce CRC-related mortality substantially. In several European countries, population-based CRC screening programmes are ongoing or being rolled out. Stool tests like faecal occult blood testing are non-invasive and simple to perform, but are primarily designed to detect early invasive cancer. More invasive tests like colonoscopy and CT colonography (CTC) aim at accurately detecting both CRC and cancer precursors, thus providing for cancer prevention. This review focuses on the accuracy, acceptance and safety of CTC as a CRC screening technique and on the current position of CTC in organised population screening. Based on the detection characteristics and acceptability of CTC screening, it might be a viable screening test. The potential disadvantage of ra...

Radiology, 2012

To compare the diagnostic yields of a radiologist and trained technologists in the detection of a... more To compare the diagnostic yields of a radiologist and trained technologists in the detection of advanced neoplasia within a population-based computed tomographic (CT) colonography screening program. Ethical approval was obtained from the Dutch Health Council, and written informed consent was obtained from all participants. Nine hundred eighty-two participants (507 men, 475 women) underwent low-dose CT colonography after noncathartic bowel preparation (iodine tagging) between July 13, 2009, and January 21, 2011. Each scan was evaluated by one of three experienced radiologists (≥800 examinations) by using primary two-dimensional (2D) reading followed by secondary computer-aided detection (CAD) and by two of four trained technologists (≥200 examinations, with colonoscopic verification) by using primary 2D reading followed by three-dimensional analysis and CAD. Immediate colonoscopy was recommended for participants with lesions measuring at least 10 mm, and surveillance was recommended ...

British journal of cancer, Jan 27, 2010

On theoretical grounds, the age of the grandmother and the age of the mother at delivery of her d... more On theoretical grounds, the age of the grandmother and the age of the mother at delivery of her daughter may affect the breast cancer risk of the granddaughter. We used the data relating to the Diagnostic Research Mamma-carcinoma cohort (DOM (Diagnostisch Onderzoek Mammacarcinoom) 3), which comprises a population-based sample of 12 178 women aged 41-63 years at enrolment in 1982-85 and followed up until 2000. During follow-up 340 postmenopausal breast cancer cases were identified. To these we applied a case-cohort design together with a random sample from the baseline cohort (n=1826). Of these study participants, we were able to retrieve the birth dates of 998 mothers (309 cases, 689 controls), and for 547 of these we also retrieved the birth dates of the grandmothers (197 cases, 350 controls). A weighted Cox proportional hazards model was used to estimate the hazard ratios (HRs) for the effect of the age of the grandmother and the age of the mother on the breast cancer risk of the ...

International Journal of Medical Education, 2010

Objectives: There is growing evidence for the value of several forms of peer teaching in medical ... more Objectives: There is growing evidence for the value of several forms of peer teaching in medical education. Little is known about the feasibility of such an approach in courses of clinical reasoning. The University Medical Center Utrecht offers a clinical reasoning course for first and second year students which previously had been occasionally led by sixth year, i.e. near-peer students. We evaluated a version of this course, fully delivered by final year students. Methods: In 2008-2009 this highly structured mandatory clinical reasoning course for second year medical students was fully tutored by final year medical students, as part of a teacher training course in their core curriculum. Routine evaluations before and after introducing near-peers as tutors were compared, a focused questionnaire survey was conducted, as well as an interview with a group of students to evaluate the new format. Results: There was no difference in the ratings of the course before and after the introduction of the new format. In general, second year students are satisfied with the nearpeer teachers. Strong points mentioned are their high motivation, involvement, enthusiasm, adjustment of cognitive level of teaching to the recipient students and stimulating skills. Conclusions: Although our study cannot provide evidence for differential learning effects, the evaluation of our final year student led clinical reasoning course shows encouraging results.