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Objectives: Timely detection and diagnosis of dementia are beneficial for providing appropriate, anticipatory care and preventing acute situations. However, initiating diagnostic testing is a complex and dynamic process that requires general practitioners (GPs) to balance competing priorities. Previously identified barriers, such as a lack of time, knowledge, and resources, may not fully represent the challenges involved in this process. Therefore, this study aimed to examine GPs' more implicit considerations on starting the diagnostic trajectory for dementia. Methods: A qualitative study was conducted using semi‐structured interviews with 14 Dutch GPs who were purposively selected through maximum variation sampling. The interview transcripts were inductively analyzed in multiple rounds by a multidisciplinary research team using thematic analysis. Results: GPs' considerations on starting the diagnostic trajectory for dementia can be summarized in three main themes that are interconnected: (1) 'the presumed patient's willingness', that is, facing a dilemma of wanting to respect patient autonomy in cases of denial or an absence of a diagnostic request, while at the same time identifying a problem and feeling the urgency to act; (2) 'the GP's attempt not to harm', that is, balancing between not wanting to harm the patient and/or relatives with the burdensome label of dementia and with the possible negative consequences of a late diagnosis; and (3) 'time, trust, and interprofessional collaboration influence timeliness of diagnostic work‐up', that is, time available for consultations, time as a diagnostic factor, GP's diagnostic confidence, and trustful physician–patient relationship. Conclusions: This study revealed that important ethical dilemmas regarding patient autonomy and the principle of doing no harm lie behind practical GP barriers to initiating diagnostic testing for dementia. Time, trust, and interprofessional collaboration were found to facilitate GPs in determining the right decision and timing with each individual patient and their relatives. Future research could explore the value of diagnostic decision aids that explicitly involve patients and their relatives in this balancing act. [ABSTRACT FROM AUTHOR]

The effect of cold-rolling on the microstructure and molten salt corrosion behaviour of 316L alloy was investigated. Corrosion tests were performed in FLiNaK salt at 600 °C for 300 h. The present results indicate that cold-rolling leads to enhanced corrosion in molten salt despite its beneficial effect on the alloys mechanical properties. It is shown that the corrosion resistance of cold-rolled 316L alloy is largely governed by the presence of high-angle grain boundaries (HAGBs) and geometrically-necessary dislocations (GNDs). Exacerbated corrosion is thus directly related to the increased prevalence of grain boundaries and dislocations within the microstructure.

The characteristics of pneumococcal carriage vary between infants and adults. Host immune factors have been shown to contribute to these age-specific differences, but the role of pathogen sequence variation is currently less well-known. Identification of age-associated pathogen genetic factors could leadto improved vaccine formulations. We therefore performed genome sequencing in a large carriage cohort of children and adults and combined this with data from an existing age-stratified carriage study. We compiled a dictionary of pathogen genetic variation, including serotype, strain, sequence elements, single-nucleotide polymorphisms (SNPs), and clusters of orthologous genes (COGs) for each cohort – all of which were used in a genome-wide association with host age. Age-dependent colonization showed weak evidence of being heritable in the first cohort (h2 = 0.10, 95% CI 0.00–0.69) and stronger evidence in the second cohort (h2 = 0.56, 95% CI 0.23–0.87). We found that serotypes and genetic background (strain) explained a proportion of the heritability in the first cohort (h2serotype = 0.07, 95% CI 0.04–0.14 and h2GPSC = 0.06, 95% CI 0.03–0.13) and the second cohort (h2serotype = 0.11, 95% CI 0.05–0.21 and h2GPSC = 0.20, 95% CI 0.12–0.31). In a meta-analysis of these cohorts, we found one candidate association (p=1.2 × 10-9) upstream of an accessory Sec-dependent serine-rich glycoprotein adhesin. Overall, while we did find a small effect of pathogen genome variation on pneumococcal carriage between child and adult hosts, this was variable between populations and does not appear to be caused by strong effects of individual genes. This supports proposals for adaptive future vaccination strategies that are primarily targeted at dominant circulating serotypes and tailored to the composition of the pathogen populations.

Streptococcus suis is a Gram-positive bacterium and zoonotic pathogen that causes meningitis and sepsis in pigs and humans. The aim of this study was to identify genes required for S. suis infection. We created Tn-Seq libraries in a virulent S. suis strain 10, which was used to inoculate pigs in an intrathecal experimental infection. Comparative analysis of the relative abundance of mutants recovered from different sites of infection (blood, cerebrospinal fluid, and meninges of the brain) identified 361 conditionally essential genes, i.e. required for infection, which is about 18% of the genome. The conditionally essential genes were primarily involved in metabolic and transport processes, regulation, ribosomal structure and biogenesis, transcription, and cell wall membrane and envelope biogenesis, stress defenses, and immune evasion. Directed mutants were created in a set of 10 genes of different genetic ontologies and their role was determined in ex vivo models. Mutants showed different levels of sensitivity to survival in whole blood, serum, cerebrospinal fluid, thermic shock, and stress conditions, as compared to the wild type. Additionally, the role of three selected mutants was validated in co-infection experiments in which pigs were infected with both wild type and isogenic mutant strains. The genetic determinants of infection identified in this work contribute to novel insights in S. suis pathogenesis and could serve as targets for novel vaccines or antimicrobial drugs.

Objective To evaluate the perceived quality of follow-up telephone consultations (TCs) from the perspective of patients and healthcare professionals (HCPs) of multiple medical disciplines during the COVID-19 pandemic.Design A qualitative study using semi-structured interviews and reflexive thematic analysis.Setting Seven medical disciplines (general dermatology, dermato-oncology, head and neck oncology, internal medicine, medical oncology, gynaecological oncology and surgical oncology) at a large university hospital in the Netherlands.Participants Patients who received and HCPs who provided TCs as a substitute for outpatient follow-up appointments during the COVID-19 pandemic.Results Eighty-two patients and 58 HCPs were interviewed. Predominantly, patients and HCPs were satisfied with the quality of care by TCs. They regarded TCs as efficient, accessible and of acceptable quality, provided there was an established patient-HCP relationship, medical complaints were absent and physical examination was not indicated. However, most patients were worried about the accuracy of their health assessment in the absence of physical examination and non-verbal communication. Both patients and HCPs wish to use TCs in the future alternatively with face-to-face consultations.Conclusion This study concludes that TCs seem a valuable contribution to the context of follow-up care and could partially replace face-to-face consultations. TCs can be performed in stable, chronic patients with whom a doctor-patient relationship has already been established. Face-to-face consultations are considered more appropriate in the case of new patients, challenging or emotionally charged consultations and when clinically relevant physical examination is indicated. Due to the context-dependent nature of experiences of patients and HCPs, TCs should be used with an individually customised approach based on patient and disease specifics, in which shared decision-making plays an extensive role. Before major implementation is considered, sufficient data on the safety regarding missed diagnoses or cancer recurrences should be assembled first.

BackgroundAs the number of cancer survivors is increasing, it is important to be able to offer exercise and physical activity (PA)–promoting interventions that are both effective and reasonably accessible. Internet-based interventions are typically less expensive and more accessible alternatives to on-site supervised interventions. Currently, little is known about the characteristics of nonparticipants in PA promotion trials in the cancer survivorship setting, both in general and specifically in trials using internet-supported interventions. ObjectiveThis study aims to gain insight into the characteristics associated with nonparticipation in a blended internet-based supported intervention trial to promote PA. MethodsBreast and prostate cancer survivors, 3-36 months after primary curative treatment, were invited to participate in the PABLO trial; this trial compared an internet-based intervention to enhance PA levels, with or without additional support from a physical therapist, to usual care. Participants and nonparticipants were asked to complete a comprehensive questionnaire assessing sociodemographics, fatigue, and health-related quality of life. Baseline data for participants and nonparticipants were compared using the independent Student t test and chi-square test. ResultsThe inclusion rate in the trial was 11.03% (137/1242). Of the nonparticipants, 13.95% (154/1104) completed the questionnaire. Participants were more highly educated (P=.04), had a paid job less often (P=.03), and were on sick leave more often (P=.03). They reported less PA per week, both moderate (P=.03) and vigorous (P

Background: Osteoarthritis of the hand can lead to pain, stiffness, and deformation, and thus to functional disability. The purpose of this study was to compare short-term clinical outcomes of 2 silicone proximal interphalangeal (PIP) joint implants, NeuFlex and Integra, in patients with primary osteoarthritis. Methods: We included 72 PIP joints, of which 40 were replaced by a NeuFlex implant and 32 by an Integra implant. The average follow-up was 12 months for the Integra group and 16 months for the NeuFlex group. Results: There was no change in active flexion preoperatively and postoperatively. Extension lag and Disabilities of the Arm, Shoulder, and Hand score decreased substantially in both groups, whereas grip strength and Patient-Specific Functional Scale (PSFS) score increased. All patients were satisfied. Between groups, there was a significant difference in the PSFS score, in favor of the Integra group. Conclusions: Both implants have excellent results, but more research is needed with more patients to prevent bias and to determine the long-term outcome of these implants. [ABSTRACT FROM AUTHOR]

Streptococcus pneumoniae is a causative agent of meningitis and bacteremia. In a combined pathogen and host GWAS, Lees et al. find that host genetic variation is associated with both susceptibility and severity of pneumococcal meningitis, and specific bacterial genetic variation associated with susceptibility.

Objectives:. The surprise question, “Would I be surprised if this patient died in the next 12 months?” is a tool to identify patients at high risk of death in the next year. Especially in the situation of an ICU admission, it is important to recognize patients who could and could not have the benefits of an intensive treatment in the ICU department. Design and Setting:. A single-center, prospective, observational cohort study was conducted between April 2013 and April 2018, in ICU Gelre hospitals, location Apeldoorn. Patients:. A total of 3,140 patients were included (57% male) with a mean age of 63.5 years. Seven-hundred thirteen patients (23%) died within 1 year. Interventions:. The physician answered three different surprise question’s with either “yes” or “no”: “I expect that the patient is going to survive the ICU admission” (surprise question 1), “I expect that the patient is going to survive the hospital stay” (surprise question 2), and “I expect that the patient is going to survive one year after ICU admission” (surprise question 3). We tested positive and negative predicted values of the surprise questions, the mean accuracy of the surprise questions, and kappa statistics. Measurements and Main Results:. The positive and negative predictive values of the surprise questions for ICU admission, hospital admission, and 1-year survival were, respectively, 64%/94%, 59%/92%, and 60%/86%. Accordingly, the mean accuracy and kappa statistics were 93% (95% CI, 92–94%), κ equals to 0.43, 89% (95% CI, 88–90%), κ equals to 0.40, and 81% (95% CI, 80–82%), κ equals to 0.43. Conclusions:. The frequently overlooked simple and cheap surprise question is probably an useful tool to evaluate the prognosis of acutely admitted critically ill patients.