Monique Caljouw | Universiteit Leiden (original) (raw)

Papers by Monique Caljouw

BMC Geriatrics, 2014

Background: Although dementia at the end of life is increasingly being studied, we lack prospecti... more Background: Although dementia at the end of life is increasingly being studied, we lack prospective observational data on dying patients. In this study symptoms were observed in patients with dementia in the last days of life.

Journal of the American Geriatrics Society, 2014

Objective: To identify factors that explain differences in patients with high and low levels of f... more Objective: To identify factors that explain differences in patients with high and low levels of fear of falling after a hip fracture. Design: Cross-sectional study in 10 skilled nursing facilities in the Netherlands. Patients: A total of 100 patients aged ≥ 65 years admitted to a skilled nursing facility after a hip fracture. Methods: Participants were divided into 2 groups; low and high level of fear of falling, based on median Falls Efficacy Score -International. Data relating to factors that might explain fear of falling were collected, including demographic variables, aspects of functioning, psychological factors, and comorbidities. For every factor a univariate logistic regression was conducted. For the multivariate regression model a backward procedure was used in which variables with p < 0.05 were included. Results: Walking ability and activities of daily living before fracture, number of complications, activities of daily living after fracture, anxiety and self-efficacy were significantly associated univariately with fear of falling. Multivariate analysis showed that walking ability before fracture (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.14-0.83), activities of daily living after fracture (OR 0.89, 95% CI 0.80-0.99), and anxiety (OR 1.22, 95% CI 1.05-1.42) were independently associated with fear of falling. Conclusion: Impaired walking ability before fracture, impaired activities of daily living after fracture, and increased anxiety help distinguish between older persons with high and low levels of fear of falling after hip fracture. Because the last 2 factors are modifiable, this information enables the development of specific interventions for older persons with a high level of fear of falling.

European Geriatric Medicine, 2013

Disability and rehabilitation, Jan 14, 2015

Purpose: To assess the measurement properties of the Falls Efficacy Scale-International (FES-I) i... more Purpose: To assess the measurement properties of the Falls Efficacy Scale-International (FES-I) in patients after a hip fracture aged ≥ 65 years. Methods: In a sample of 100 patients, we examined the structural validity, internal consistency and construct validity. For the structural validity a confirmatory factor analysis was carried out. For construct validity predetermined hypotheses were tested. In a second sample of 21 older patients the inter-rater reliability was evaluated. Results: The factor analysis yielded strong evidence that the FES-I is uni-dimensional in patients with a hip fracture; the Cronbach's alpha was 0.94. When testing the reliability, the intra-class correlation coefficient was 0.72, while the Standard Error of Measurement was 6.4 and the Smallest Detectable Change was 17.7 (on a scale from 16 to 64). The Spearman correlation of the FES-I with the one-item fear of falling instrument was high (r = 0.68). The correlation was moderate with instruments measur...

Transfusion Medicine, 2004

Red-cell transfusions are required for symptomatic treatment of severe anaemia caused by intensiv... more Red-cell transfusions are required for symptomatic treatment of severe anaemia caused by intensive chemotherapy. Concerns about the transfusion-related complications, such as infections (e.g. the very low risk of human immunodeficiency virus (HIV)/hepatitis C virus (HCV) transmission and the risk of postoperative infections), haemolytic transfusion reaction, immunological effects and the costs, prompt a reevaluation of the transfusion practice. Retrospective analysis of prospectively collected data on 84 patients with acute myeloid leukaemia (AML), who were treated with combination chemotherapy between June 1, 1997 and December 7, 2001, was performed. The use of red-cell transfusions with a restrictive transfusion policy (haemoglobin ¼ 7Á2-8Á8 g dL À1 , dependent on age and symptoms, n ¼ 38) was compared with a more liberal transfusion trigger (haemoglobin ¼ 9Á6 g dL À1 , n ¼ 46). The number of units transfused was recorded. Signs and symptoms of anaemia, chemotherapy-related effects and complications were investigated for both transfusion policies. The more restrictive transfusion policy led to a significant decrease of 11% of red blood cell (RBC) transfusions in patients with AML. No significant differences were found in the incidence of infections, number of platelet units transfused, bleeding complications, cardiac symptoms or response to chemotherapy. The more restrictive transfusion policy was feasible in this clinical setting, and it might be concluded that a restrictive transfusion policy is safe in supporting clinical patients treated with intensive chemotherapy for AML.

Local and Regional Anesthesia, 2010

Journal of the American Medical Directors Association, 2013

Geriatric rehabilitation postacute care length of stay discharge destination a b s t r a c t Obje... more Geriatric rehabilitation postacute care length of stay discharge destination a b s t r a c t Objective: Although geriatric rehabilitation (GR) is beneficial for restoration of activities and participation after hospitalization of vulnerable older persons, little is known about the optimal organization of care of these postacute facilities. This study examines the relationship of patient volume and service concentration with successful GR (short length of stay and discharge home) in skilled nursing facilities (SNFs). Design: A national multicenter retrospective cohort study. Setting and participants: All patients indicated for GR in a Dutch SNF. Measurements: Nurses filled out digital registration forms from patient records. Patients were studied in 3 predefined diagnostic groups: total joint replacement, traumatic injuries, and stroke. Facility characteristics were obtained by structured telephone interviews with facility managers. Volume was based on the number of discharges in a 3-month period and categorized in low-, medium-, and high-volume facilities. Concentration was defined at the organizational level in which the population consists of 80% or more of 1 or 2 diagnostic groups, with the prerequisite of having a minimum of 10 rehabilitation beds. Results: From 88 facilities, 2269 GR patients (mean age 78.2 years [SD 9.7]; 68.2% female) were included. The median length of stay in the SNF was 45 days (interquartile range 23e81), 57% of the patients were discharged home, and 9.8% died during GR. Of patients with total joint replacement (n ¼ 501), concentration was related to successful rehabilitation (odds ratio 5.7; 95% confidence interval 1.3e24.3; P ¼ .020, adjusted for age and gender); this relationship was not found for patients with traumatic injuries or stroke. Volume showed no relation with successful rehabilitation in any of the 3 diagnostic groups.

Journal of the American Geriatrics Society, 2014

OBJECTIVES: To determine whether cranberry capsules prevent urinary tract infection (UTI) in long... more OBJECTIVES: To determine whether cranberry capsules prevent urinary tract infection (UTI) in long-term care facility (LTCF) residents. DESIGN: Double-blind randomized placebo-controlled multicenter trial. SETTING: Long-term care facilities (LTCFs). PARTICIPANTS: LTCF residents (N = 928; 703 women, median age 84). MEASUREMENTS: Cranberry and placebo capsules were taken twice daily for 12 months. Participants were stratified according to UTI risk (risk factors included long-term catheterization, diabetes mellitus, ≥1 UTI in preceding year). Main outcomes were incidence of UTI according to a clinical definition and a strict definition. RESULTS: In participants with high UTI risk at baseline (n = 516), the incidence of clinically defined UTI was lower with cranberry capsules than with placebo (62.8 vs 84.8 per 100 person-years at risk, P = .04); the treatment effect was 0.74 (95% confidence interval (CI) = 0.57-0.97). For the strict definition, the treatment effect was 1.02 (95% CI = 0.68-1.55). No difference in UTI incidence between cranberry and placebo was found in participants with low UTI risk (n = 412). CONCLUSION: In LTCF residents with high UTI risk at baseline, taking cranberry capsules twice daily reduces the incidence of clinically defined UTI, although it does not reduce the incidence of strictly defined UTI. No difference in incidence of UTI was found in residents with low UTI risk. J Am Geriatr Soc 62:103-110, 2014.

Journal of Neonatal Nursing, 2007

The aim of our study was to test the reliability and validity of the adapted COMFORT scale in pre... more The aim of our study was to test the reliability and validity of the adapted COMFORT scale in premature infants with a gestational age between 28 to 37 weeks using the VAS as comparison. Two nurses made paired observations before and after the heel puncture for routine neonatal metabolic screening. They completed the adapted COMFORT scale and VAS for 57 premature infants, divided into five gestational age groups. The interrater reliability for the COMFORT scale, given by a linearly weighted kappa ranged from 0.62 to 0.84. The intraclass coefficient for the total COMFORT score was 0.85 (95% CI 0.76e0.91) in the pre-test and 0.93 (95% CI 0.89e0.96) in the post-test. The items of the COMFORT scale had a high internal consistency. No significant differences in distress and pain in the various gestational age subgroups were observed. The adapted COMFORT scale is a valid and reliable instrument to measure distress and pain in premature infants.

Clinical Rheumatology, 2011

This study aims to examine the needs and preferences regarding the delivery of health care servic... more This study aims to examine the needs and preferences regarding the delivery of health care services and information provision and their determinants in patients with systemic sclerosis (SSc). A questionnaire was sent to 77 SSc outpatients, comprising 27 items on health care needs within the domains physical, psychological, social support, employment/daily activities, or other health problems and 13 items on information needs. Moreover, the patients' preferences regarding the provision of health care services and information were listed. Additional assessments included sociodemographic characteristics, physical functioning (SSc Health Assessment Questionnaire), and quality of life (SF-36). Sixty-four patients (83%) returned the questionnaire. Twenty-six patients (41%) reported one or more unmet health care needs, with the highest proportions of patients with unmet needs seen in the physical (28%) and psychological (20%) domain. The highest percentages of patients with information needs were observed for medical subjects (20-28%). A lower mental component summary scale score and younger age were associated with the presence of at least one health care need in the psychological domain. Worse physical functioning, a diagnosis of diffuse SSc and having a partner were associated with higher information need score. A yearly, standardized multidisciplinary assessment program was most frequently mentioned as a preferred, but not yet existing health care model (59%) and the rheumatologist as a preferred source of information supply (75%). Unmet health care and information needs are common among SSc patients. To improve SSc health care, more attention should be paid to health care services for specific physical and psychological problems and medical information supply by the rheumatologist. In addition, the development of new models of care, such as a yearly, standardized multidisciplinary diagnostic program seems warranted.

British Journal of Anaesthesia, 2008

Background. Measuring patient satisfaction after anaesthesia care is complex. The existing patien... more Background. Measuring patient satisfaction after anaesthesia care is complex. The existing patient satisfaction questionnaires are limited and omit aspects of patient satisfaction, such as professional competence, information provision, service, and staff-patient relationship. The aim of our study was to develop a valid and reliable self-reported multidimensional questionnaire assessing patient satisfaction that included these issues.

BMC Medicine, 2011

Background: Urinary tract infections (UTI) are common among the oldest old and may lead to a few ... more Background: Urinary tract infections (UTI) are common among the oldest old and may lead to a few days of illness, delirium or even to death. We studied the incidence and predictive factors of UTI among the oldest old in the general population.

Aims and objectives. To investigate in surgical gynaecological patients the types of health probl... more Aims and objectives. To investigate in surgical gynaecological patients the types of health problems arising or persisting up to six weeks after discharge and the effectiveness of telephone advice. Background. The decreasing length of hospital stay has increased the need for specific instructions about the postdischarge period. Telephone advice could be a valuable tool to address this problem. To our knowledge, postdischarge health problems and the value of telephone advice have not been investigated among gynaecological patients. Design. Randomised controlled trial. Methods. Gynaecological patients expected to stay in the ward longer than 24 hour were invited to participate. A pilot study showed that wound healing, pain, mobility, urination, defecation and vaginal bleeding were the most common health problems postdischarge. Based on that information, guidelines were formulated that were used by trained nurses to give telephone advice to the intervention group (n = 235), in addition to the usual care. The control group of gynaecological patients (n = 233) received usual care only. Results. Of all 468 participants, about 50% were operated for general gynaecology. At discharge, wound pain (56%), mobility problems (54%) and constipation (27%) were the most frequently mentioned problems in both groups. Participants who completely followed the advice with regard to wound healing (p = 0AE02), pain (p = 0AE01), vaginal bleeding (p = 0AE03) and mobility (p = 0AE04) experienced greater improvement than participants who did not follow, or only partly followed, the advice. Conclusions. The telephone advice appears to make a significant contribution to help gynaecological surgical patients to solve or reduce their postdischarge health problems. Relevance to clinical practice. The positive effect of such advice can be interpreted as an improvement in the quality of life of the postoperative gynaecological patient.

BMC Geriatrics, 2014

Background: Although dementia at the end of life is increasingly being studied, we lack prospecti... more Background: Although dementia at the end of life is increasingly being studied, we lack prospective observational data on dying patients. In this study symptoms were observed in patients with dementia in the last days of life.

Journal of the American Geriatrics Society, 2014

Objective: To identify factors that explain differences in patients with high and low levels of f... more Objective: To identify factors that explain differences in patients with high and low levels of fear of falling after a hip fracture. Design: Cross-sectional study in 10 skilled nursing facilities in the Netherlands. Patients: A total of 100 patients aged ≥ 65 years admitted to a skilled nursing facility after a hip fracture. Methods: Participants were divided into 2 groups; low and high level of fear of falling, based on median Falls Efficacy Score -International. Data relating to factors that might explain fear of falling were collected, including demographic variables, aspects of functioning, psychological factors, and comorbidities. For every factor a univariate logistic regression was conducted. For the multivariate regression model a backward procedure was used in which variables with p < 0.05 were included. Results: Walking ability and activities of daily living before fracture, number of complications, activities of daily living after fracture, anxiety and self-efficacy were significantly associated univariately with fear of falling. Multivariate analysis showed that walking ability before fracture (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.14-0.83), activities of daily living after fracture (OR 0.89, 95% CI 0.80-0.99), and anxiety (OR 1.22, 95% CI 1.05-1.42) were independently associated with fear of falling. Conclusion: Impaired walking ability before fracture, impaired activities of daily living after fracture, and increased anxiety help distinguish between older persons with high and low levels of fear of falling after hip fracture. Because the last 2 factors are modifiable, this information enables the development of specific interventions for older persons with a high level of fear of falling.

European Geriatric Medicine, 2013

Disability and rehabilitation, Jan 14, 2015

Purpose: To assess the measurement properties of the Falls Efficacy Scale-International (FES-I) i... more Purpose: To assess the measurement properties of the Falls Efficacy Scale-International (FES-I) in patients after a hip fracture aged ≥ 65 years. Methods: In a sample of 100 patients, we examined the structural validity, internal consistency and construct validity. For the structural validity a confirmatory factor analysis was carried out. For construct validity predetermined hypotheses were tested. In a second sample of 21 older patients the inter-rater reliability was evaluated. Results: The factor analysis yielded strong evidence that the FES-I is uni-dimensional in patients with a hip fracture; the Cronbach's alpha was 0.94. When testing the reliability, the intra-class correlation coefficient was 0.72, while the Standard Error of Measurement was 6.4 and the Smallest Detectable Change was 17.7 (on a scale from 16 to 64). The Spearman correlation of the FES-I with the one-item fear of falling instrument was high (r = 0.68). The correlation was moderate with instruments measur...

Transfusion Medicine, 2004

Red-cell transfusions are required for symptomatic treatment of severe anaemia caused by intensiv... more Red-cell transfusions are required for symptomatic treatment of severe anaemia caused by intensive chemotherapy. Concerns about the transfusion-related complications, such as infections (e.g. the very low risk of human immunodeficiency virus (HIV)/hepatitis C virus (HCV) transmission and the risk of postoperative infections), haemolytic transfusion reaction, immunological effects and the costs, prompt a reevaluation of the transfusion practice. Retrospective analysis of prospectively collected data on 84 patients with acute myeloid leukaemia (AML), who were treated with combination chemotherapy between June 1, 1997 and December 7, 2001, was performed. The use of red-cell transfusions with a restrictive transfusion policy (haemoglobin ¼ 7Á2-8Á8 g dL À1 , dependent on age and symptoms, n ¼ 38) was compared with a more liberal transfusion trigger (haemoglobin ¼ 9Á6 g dL À1 , n ¼ 46). The number of units transfused was recorded. Signs and symptoms of anaemia, chemotherapy-related effects and complications were investigated for both transfusion policies. The more restrictive transfusion policy led to a significant decrease of 11% of red blood cell (RBC) transfusions in patients with AML. No significant differences were found in the incidence of infections, number of platelet units transfused, bleeding complications, cardiac symptoms or response to chemotherapy. The more restrictive transfusion policy was feasible in this clinical setting, and it might be concluded that a restrictive transfusion policy is safe in supporting clinical patients treated with intensive chemotherapy for AML.

Local and Regional Anesthesia, 2010

Journal of the American Medical Directors Association, 2013

Geriatric rehabilitation postacute care length of stay discharge destination a b s t r a c t Obje... more Geriatric rehabilitation postacute care length of stay discharge destination a b s t r a c t Objective: Although geriatric rehabilitation (GR) is beneficial for restoration of activities and participation after hospitalization of vulnerable older persons, little is known about the optimal organization of care of these postacute facilities. This study examines the relationship of patient volume and service concentration with successful GR (short length of stay and discharge home) in skilled nursing facilities (SNFs). Design: A national multicenter retrospective cohort study. Setting and participants: All patients indicated for GR in a Dutch SNF. Measurements: Nurses filled out digital registration forms from patient records. Patients were studied in 3 predefined diagnostic groups: total joint replacement, traumatic injuries, and stroke. Facility characteristics were obtained by structured telephone interviews with facility managers. Volume was based on the number of discharges in a 3-month period and categorized in low-, medium-, and high-volume facilities. Concentration was defined at the organizational level in which the population consists of 80% or more of 1 or 2 diagnostic groups, with the prerequisite of having a minimum of 10 rehabilitation beds. Results: From 88 facilities, 2269 GR patients (mean age 78.2 years [SD 9.7]; 68.2% female) were included. The median length of stay in the SNF was 45 days (interquartile range 23e81), 57% of the patients were discharged home, and 9.8% died during GR. Of patients with total joint replacement (n ¼ 501), concentration was related to successful rehabilitation (odds ratio 5.7; 95% confidence interval 1.3e24.3; P ¼ .020, adjusted for age and gender); this relationship was not found for patients with traumatic injuries or stroke. Volume showed no relation with successful rehabilitation in any of the 3 diagnostic groups.

Journal of the American Geriatrics Society, 2014

OBJECTIVES: To determine whether cranberry capsules prevent urinary tract infection (UTI) in long... more OBJECTIVES: To determine whether cranberry capsules prevent urinary tract infection (UTI) in long-term care facility (LTCF) residents. DESIGN: Double-blind randomized placebo-controlled multicenter trial. SETTING: Long-term care facilities (LTCFs). PARTICIPANTS: LTCF residents (N = 928; 703 women, median age 84). MEASUREMENTS: Cranberry and placebo capsules were taken twice daily for 12 months. Participants were stratified according to UTI risk (risk factors included long-term catheterization, diabetes mellitus, ≥1 UTI in preceding year). Main outcomes were incidence of UTI according to a clinical definition and a strict definition. RESULTS: In participants with high UTI risk at baseline (n = 516), the incidence of clinically defined UTI was lower with cranberry capsules than with placebo (62.8 vs 84.8 per 100 person-years at risk, P = .04); the treatment effect was 0.74 (95% confidence interval (CI) = 0.57-0.97). For the strict definition, the treatment effect was 1.02 (95% CI = 0.68-1.55). No difference in UTI incidence between cranberry and placebo was found in participants with low UTI risk (n = 412). CONCLUSION: In LTCF residents with high UTI risk at baseline, taking cranberry capsules twice daily reduces the incidence of clinically defined UTI, although it does not reduce the incidence of strictly defined UTI. No difference in incidence of UTI was found in residents with low UTI risk. J Am Geriatr Soc 62:103-110, 2014.

Journal of Neonatal Nursing, 2007

The aim of our study was to test the reliability and validity of the adapted COMFORT scale in pre... more The aim of our study was to test the reliability and validity of the adapted COMFORT scale in premature infants with a gestational age between 28 to 37 weeks using the VAS as comparison. Two nurses made paired observations before and after the heel puncture for routine neonatal metabolic screening. They completed the adapted COMFORT scale and VAS for 57 premature infants, divided into five gestational age groups. The interrater reliability for the COMFORT scale, given by a linearly weighted kappa ranged from 0.62 to 0.84. The intraclass coefficient for the total COMFORT score was 0.85 (95% CI 0.76e0.91) in the pre-test and 0.93 (95% CI 0.89e0.96) in the post-test. The items of the COMFORT scale had a high internal consistency. No significant differences in distress and pain in the various gestational age subgroups were observed. The adapted COMFORT scale is a valid and reliable instrument to measure distress and pain in premature infants.

Clinical Rheumatology, 2011

This study aims to examine the needs and preferences regarding the delivery of health care servic... more This study aims to examine the needs and preferences regarding the delivery of health care services and information provision and their determinants in patients with systemic sclerosis (SSc). A questionnaire was sent to 77 SSc outpatients, comprising 27 items on health care needs within the domains physical, psychological, social support, employment/daily activities, or other health problems and 13 items on information needs. Moreover, the patients' preferences regarding the provision of health care services and information were listed. Additional assessments included sociodemographic characteristics, physical functioning (SSc Health Assessment Questionnaire), and quality of life (SF-36). Sixty-four patients (83%) returned the questionnaire. Twenty-six patients (41%) reported one or more unmet health care needs, with the highest proportions of patients with unmet needs seen in the physical (28%) and psychological (20%) domain. The highest percentages of patients with information needs were observed for medical subjects (20-28%). A lower mental component summary scale score and younger age were associated with the presence of at least one health care need in the psychological domain. Worse physical functioning, a diagnosis of diffuse SSc and having a partner were associated with higher information need score. A yearly, standardized multidisciplinary assessment program was most frequently mentioned as a preferred, but not yet existing health care model (59%) and the rheumatologist as a preferred source of information supply (75%). Unmet health care and information needs are common among SSc patients. To improve SSc health care, more attention should be paid to health care services for specific physical and psychological problems and medical information supply by the rheumatologist. In addition, the development of new models of care, such as a yearly, standardized multidisciplinary diagnostic program seems warranted.

British Journal of Anaesthesia, 2008

Background. Measuring patient satisfaction after anaesthesia care is complex. The existing patien... more Background. Measuring patient satisfaction after anaesthesia care is complex. The existing patient satisfaction questionnaires are limited and omit aspects of patient satisfaction, such as professional competence, information provision, service, and staff-patient relationship. The aim of our study was to develop a valid and reliable self-reported multidimensional questionnaire assessing patient satisfaction that included these issues.

BMC Medicine, 2011

Background: Urinary tract infections (UTI) are common among the oldest old and may lead to a few ... more Background: Urinary tract infections (UTI) are common among the oldest old and may lead to a few days of illness, delirium or even to death. We studied the incidence and predictive factors of UTI among the oldest old in the general population.

Aims and objectives. To investigate in surgical gynaecological patients the types of health probl... more Aims and objectives. To investigate in surgical gynaecological patients the types of health problems arising or persisting up to six weeks after discharge and the effectiveness of telephone advice. Background. The decreasing length of hospital stay has increased the need for specific instructions about the postdischarge period. Telephone advice could be a valuable tool to address this problem. To our knowledge, postdischarge health problems and the value of telephone advice have not been investigated among gynaecological patients. Design. Randomised controlled trial. Methods. Gynaecological patients expected to stay in the ward longer than 24 hour were invited to participate. A pilot study showed that wound healing, pain, mobility, urination, defecation and vaginal bleeding were the most common health problems postdischarge. Based on that information, guidelines were formulated that were used by trained nurses to give telephone advice to the intervention group (n = 235), in addition to the usual care. The control group of gynaecological patients (n = 233) received usual care only. Results. Of all 468 participants, about 50% were operated for general gynaecology. At discharge, wound pain (56%), mobility problems (54%) and constipation (27%) were the most frequently mentioned problems in both groups. Participants who completely followed the advice with regard to wound healing (p = 0AE02), pain (p = 0AE01), vaginal bleeding (p = 0AE03) and mobility (p = 0AE04) experienced greater improvement than participants who did not follow, or only partly followed, the advice. Conclusions. The telephone advice appears to make a significant contribution to help gynaecological surgical patients to solve or reduce their postdischarge health problems. Relevance to clinical practice. The positive effect of such advice can be interpreted as an improvement in the quality of life of the postoperative gynaecological patient.