Ultrasound scanning of bladder volume is used for prevention of postoperative urinary retention (POUR). Accurate assessment of bladder volume is needed to allow clinical decision-making regarding the need for postoperative catheterization. Two commonly used ultrasound devices, the BladderScan® BVI 9400 and the newly released Prime® (Verathon Medical®, Bothell, WA, USA), with or without the ‘pre-scan’ option, have not been validated in clinical practice. The aim of this study was to assess the performance of these devices in daily clinical practice. Between June and September 2016 a prospective observational study was conducted in 318 surgical patients (18 years or older) who needed a urinary catheter perioperatively for clinical reasons. For acceptable performance, we required that the volume as estimated by the BladderScan® differs by no more than 5% from the actual urine volume after catheterization. The Schuirmann’s two one-sided test was performed to assess equivalence between the BladderScan® estimate and catheterization. The BVI 9400® overestimated the actual bladder volume by + 17.5% (95% CI + 8.8 to + 26.3%). The Prime® without pre-scan underestimated by − 4.1% (95% CI − 8.8 to + 0.5%) and the Prime® with pre-scan underestimated by − 6.3% (95% CI − 11.6 to − 1.1%). This study shows that while both ultrasound devices were able to approximate current bladder volume, both BVI 9400® and Prime®—with and without pre-scan—were not able to measure the actual bladder volume within our predefined limit of ± 5%. Using the pre-scan feature of the Prime® did not further improve accuracy.

Purpose Bariatric procedures are technically complex and skill demanding. In order to standardize the procedures for research and training, a Delphi analysis was performed to reach consensus on the practice of the laparoscopic gastric bypass and sleeve gastrectomy in the Netherlands. Methods After a pre-round identifying all possible steps from literature and expert opinion within our study group, questionnaires were send to 68 registered Dutch bariatric surgeons, with 73 steps for bypass surgery and 51 steps for sleeve gastrectomy. Statistical analysis was performed to identify steps with and without consensus. This process was repeated to reach consensus of all necessary steps. Results Thirty-eight participants (56%) responded in the first round and 32 participants (47%) in the second round. After the first Delphi round, 19 steps for gastric bypass (26%) and 14 for sleeve gastrectomy (27%) gained full consensus. After the second round, an additional amount of 10 and 12 sub-steps was confirmed as key steps, respectively. Thirteen steps in the gastric bypass and seven in the gastric sleeve were deemed advisable. Our expert panel showed a high level of consensus expressed in a Cronbach’s alpha of 0.82 for the gastric bypass and 0.87 for the sleeve gastrectomy. Conclusions The Delphi consensus defined 29 steps for gastric bypass and 26 for sleeve gastrectomy as being crucial for correct performance of these procedures to the standards of our expert panel. These results offer a clear framework for the technical execution of these procedures.

To investigate the efficacy of preventive and antitachycardia pacing (ATP) in patients with symptomatic paroxysmal atrial fibrillation (AF) without bradyarrhythmias. In this randomized cross-over pilot study, we randomized 38 symptomatic paroxysmal AF patients ‘without' bradyarrhythmias to atrial pacing lower rate 70 ppm and prevention and ATP therapies ON or to atrial pacing lower rate 34 ppm and prevention and ATP therapies OFF during 12 weeks with a 4 week washout period in between. The atrial lead was preferably placed in the inter-atrial septum. Antiarrhythmic drugs were continued during the study. Primary endpoint was AF burden. Mean age was 62 ± 9 years and 27 (71%) patients had lone AF. Septal lead placement was accomplished in 26 (68%) patients. During the treatment ON, there was a trend for AF burden reduction [from median 3.3% (1.0–15.2) to 2.4% (0.2–12.2), P = 0.06, reduction 27%]. If septal lead placement was accomplished, AF burden reduction was statistically significant [44% reduction, from median 2.5% (1.0–8.0) to 1.4% (0.2–8.4), P = 0.03]. Quality of life and symptoms did not change, also not in the septal group. A hybrid therapy of preventive and ATP pacing and antiarrhythmic drugs may significantly reduce but not abolish AF burden if septal pacing is realized.

Multiple myeloma (MM) is associated with increased venous thromboembolism (VTE) risk. Current guidelines recommend aspirin or low-molecular-weight heparin for thromboprophylaxis depending on VTE risk. Nevertheless, VTE risks remain high: a recent meta-analysis reported an incidence of 6.2% during the entire MM course. Direct oral anticoagulants (DOACs) showed promising results in other malignancies. This systematic review provides an overview of evidence on DOAC thromboprophylaxis in MM. PubMed and Embase were searched up to November 21, 2023, for studies evaluating MM and DOAC thromboprophylaxis (PROSPERO: CRD42022376152). Two authors independently screened titles, abstracts, and texts, assessed bias using a modified version of the Newcastle Ottawa Scale and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation approach, and performed data extraction and analysis. Seven articles comprising 416 patients with DOAC thromboprophylaxis were included, primarily involving newly diagnosed patients with MM (56.3%) receiving lenalidomide-based regimens (69.1%). Overall Newcastle Ottawa Scale study quality was moderate. Four studies reported follow-up duration ranging from 90 days after induction to 7 months. VTE proportions ranged from 0% to 23.5%, with 4 studies reporting 0%. The proportions of minor, clinically relevant nonmajor, and major bleeding ranged from 0% to 18.2%, 0% to 7.7%, and 0% to 4.5%, respectively. Arterial thrombosis proportions ranged from 0% to 2.9%. Only 2 studies reported on mortality (2% and 7.1%). Overall Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was very low for all outcomes. Current evidence regarding routine DOACs in MM is insufficient, warranting further research to establish the DOAC thromboprophylaxis risk-to-benefit ratio in MM.

Treatment with vitamin K antagonists (VKA) requires a high proportion of time in the therapeutic range (TTR) and a low international normalised ratio (INR) variability to be maximally safe and effective. Switching from short-acting acenocoumarol to long-acting phenprocoumon could improve VKA control. We assessed whether switching from acenocoumarol to phenprocoumon improves the time in the therapeutic range (TTR) and INR variability. In a retrospective cohort with data on 236,957 patients-years of VKA management from two first-line anticoagulation clinics in the Netherlands, we identified 124 patients in target range 2–3, 269 patients in target range 2–3.5 and 98 patients in target range 2.5–3.5 who switched from acenocoumarol to phenprocoumon. They were matched in a 1:2 ratio to non-switching controls using propensity score matching. Over the first 180 days after a switch, switchers’ TTR declined 5 (95% CI 1 to 10), 10 (95% CI 7 to 13) and 5 (95% CI 0 to 11) percentage points relative to non-switchers, in target ranges 2–3, 2–3.5 and 2.5–3.5. Anticoagulation was more often supra-therapeutic in switchers, and switchers had a higher INR variability. In the following 180 days, TTR in switchers became 1 (95% CI -4 to 6), 4 (95% CI 0 to 7) and 6 (95% CI 1 to 12) percentage points better than in non-switchers. Switchers’ INRs were much more stable than non-switchers’. Eventually, a switch from acenocoumarol to phenprocoumon leads to a higher TTR and a lower INR variability. However, this is preceded by a transition period with opposite effects. An improved conversion algorithm could possibly shorten the transition period. Until then, physicians and patients should decide whether switching is worth the increased risk during the transition phase.