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Our objective was to test a theoretical model that explains quality of life as a function of the intrusiveness of illness encroaching on the different domains of one’s life. The intrusiveness of illness is explained not only by disease and treatment related factors, but also by one’s psychological and social resources (Devins, 1994). To investigate this issue, a sample of 336 women aged 50 and under, recently diagnosed with breast cancer were interviewed in their homes. Consistent with Devins’ model, intrusiveness of illness mediated the effect of disease and treatment factors on quality of life. Contrary to his model, some treatment factors also had direct effects while social and psychological factors had only direct effects on quality of life. Neither time post-diagnosis nor type of treatment affected the psychological component of quality of life. © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Subjective well‐being (SWB) and quality of life (QOL) are intricately related constructs. Recent research shows both constructs share some facets, but are distinct entities. It is unclear, both internationally and in the Netherlands, if and how SLTs address SWB in clinical practice. The current study was set up to explore Dutch SLTs' perceptions of SWB in relation to the management of people with aphasia. Aims: To describe how Dutch SLTs, working with people with aphasia in a private practice or a healthcare setting, address patient's SWB during diagnosis and treatment, and to identify barriers and facilitators they experience when addressing SWB. Methods & Procedures: A qualitative research design with a phenomenological approach was used. SLTs from private practices and healthcare settings were invited to participate in individual interviews and a focus group. The data were analysed thematically using a combination of inductive and deductive methods. Outcomes & Results: Eight SLTs participated in the study. The SLTs' experiences were captured in four themes that emerged from the data: (1) SWB is a multifaceted concept and depends on patient‐specific factors: premorbid factors, life priorities and time post‐stroke; (2) SLTs experience more responsibility for patients' SWB than their profession allows; (3) collaboration between SLTs and patients, patients' network and other healthcare professionals is required to address SWB during diagnosis and treatment; and (4) misinterpretations are inevitable when SLTs or the patients' network address patients' SWB. Conclusions & Implications: The results showed that SLTs feel responsible for addressing SWB in the management of people with aphasia. Their perception of the concept of SWB is similar to the definition used in the literature and is multifaceted. They feel responsible for the part of SWB that is related to communicative functioning, but less so for the more heuristic aspects of SWB. This is related to their experienced limitation of influence on SWB, which for some leaves them feeling out of depth and uncertain about boundaries between professionals. Addressing SWB in a multidisciplinary team is therefore considered important in order to adequately and fully capture someone's SWB and reduce to clinicians' experienced burden and responsibility. What this paper addsWhat is already known on this subjectRecent studies suggest that quality of life measures may lack facets related to subjective well‐being (SWB). Aphasia is likely to impact on SWB of a stroke survivor, but it is unclear if and how SWB is addressed by speech and language therapists in diagnosis, and treatment of Dutch PWA.What this study addsThis study provides insight into the operationalization of SWB in Dutch clinical practice, including barriers SLTs experience when addressing SWB.Clinical implications of this studyMonitoring and influencing SWB of people with aphasia is a complex process, that SLTs consider only possible in multi‐disciplinary teams. Clear guidelines on roles and responsibilities between various disciplines involved are necessary to improve care for people with aphasia. [ABSTRACT FROM AUTHOR]

Introduction: There is growing acknowledgement of the benefits of incorporating a bio-psychosocial model of understanding pain within physical therapist practice1. Consequently this has led to an increasing interest in interventions such Pain neuroscience education (PNE). However, pain management strategies developed by clinicians in one culture may not necessarily be understood, appropriate, or effective in another culture2 Methods: This study is part of a broader research in the development of culturally sensitive pain neuroscience education for the Lebanese population. Therefore, the purpose of this paper is to first gain an in-depth understanding of the Lebanese physiotherapists' perceptions towards the management of chronic low back pain as well as the knowledge regarding PNE. A qualitative one-to-one semi-structured interviews with 10 practicing physical therapists were conducted. The transcribed text from the interviews was analyzed using inductive thematic analysis. Results: Several themes were generated, identified, and constructed by the researchers: (1) physiotherapists use of a biomechanical approach. (2) Poor knowledge about the bio-psychosocial approach or PNE. (3) Barrier and facilitation for the implementation of PNE. Discussion: The preliminary results showed a limited knowledge of the bio-psychosocial approach, or PNE, and that the Lebanese physical therapist use more a biomechanical approach in the treatment and assessment of people with chronic low back pain. Process evaluation: The results showed that training is needed for physiotherapists to deliver a broader model of care, and that future research should focus on developing a culturally sensitive PNE material. [ABSTRACT FROM AUTHOR]

Individuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF) and mental health problems or challenging behavior are difficult to reach by mainstream healthcare facilities and support organizations and frequently avoid the care they need. To improve the care for this client group in the Netherlands, the (Flexible) Assertive Community Treatment (ACT) model—originally developed for people with severe mental illness—was adapted and implemented by five organizations specialized in the care for people with MID/BIF and mental health problems or challenging behavior. After an introduction of the original ACT model and a description of the international state of the art of ACT for people with (M)ID/BIF, this paper describes the (Flexible) ACT‐MID/BIF model as developed and implemented in the Netherlands. Professionals' and clients' experiences with this new type of care are reported as well. Implications for clinical practice, policy and research are discussed. [ABSTRACT FROM AUTHOR]

Background: Despite growing (inter)national awareness and appreciation, age‐specific care is still not always self‐evident and accepted as standard of care for adolescent and young adult (AYA) cancer patients. It is unknown whether long‐term AYA cancer survivors have missed age‐specific care, and if so, which survivors missed it and regarding which topics. Methods: The Netherlands Cancer Registry (NCR) identified all long‐term AYA cancer survivors (aged 18–39 years at initial cancer diagnosis, 5–20 years past diagnosis) in the Netherlands, who were invited to participate in a population‐based, observational, cross‐sectional questionnaire study (SURVAYA study), including questions on care needs. Results: In total, 3.989 AYAs participated (35.3% response rate). One‐third of them had a need for age‐specific care (33.5%), 41.2% had no need and 25.3% did not know whether they had a need. Those who had a need for age‐specific care were significantly more often female, higher educated, diagnosed at a younger age, and treated with chemotherapy, radiotherapy or hormone therapy. Most frequent topics were disease and treatment (29.7%), emotions (24.1%), friends (22.6%), family and children (15.6%), fertility and pregnancy (14.8%), work and reintegration (10.5%), care not tailored (13.8%), and overarching care and life (27.7%). Palliative care (0.0%), spirituality (0.2%), death (0.7%), complementary care (0.7%), and late effects (1.3%) were mentioned least. Conclusions: A substantial proportion of long‐term AYA cancer survivors showed a need for age‐specific care, varying by sociodemographic and clinical factors, on a wide variety of topics, which could be targeted to improve current AYA care services. [ABSTRACT FROM AUTHOR]

Summary: Paediatric non‐Hodgkin lymphomas (pNHL) are a diverse group of malignancies characterised by nodal and/or extranodal involvement. Less common pNHL forms include those derived from mature T‐ and natural killer (NK) cells. Much of our current understanding of paediatric mature (non‐anaplastic) T/NK‐cell lymphomas with respect to pathogenesis, diagnosis and treatment is extrapolated from adult literature. At the Sixth International Symposium on Childhood, Adolescent and Young Adult Non‐Hodgkin Lymphoma, convened September 26–29, 2018 in Rotterdam, The Netherlands, some important aspects on diagnosis and outcomes of mature (non‐anaplastic) T/NK‐cell lymphoma in children and adolescents were discussed and will be reviewed in here. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to describe trends in the diagnosis and treatment of women referred from the national screening program with cervical intraepithelial neoplasia (CIN) in the Netherlands, and to compare these trends with national guidelines and identify potential areas for improvement for the new primary high-risk HPV screening program.Material and Methods: We conducted a population-based cohort study using data from the Dutch pathology archive. Women aged 29-63 years who took part in the Dutch cervical screening program between 1 January 2005 and 31 December 2014 were selected. Three referral groups were identified: direct referrals and those referred after either one (first indirect referrals) or two (second indirect referrals) repeat cytology tests, totaling 85 239 referrals for colposcopy. The most invasive management technique and the most severe diagnosis of each screening episode was identified. Rates of management techniques were calculated separately by referral type, highest CIN diagnosis and age group.Results: In all, 85.1% of CIN 3 lesions were treated with excision (either large excision or hysterectomy) and 26.4% of CIN 1 lesions were treated with large excision. Rates of overtreatment (CIN 1 or less) in see-and-treat management were higher for indirect referrals than for direct referrals and increased with age. Large excision rates increased with CIN diagnosis severity.Conclusions: Despite guideline recommendations not to treat, CIN 1 lesions were treated in just over 25% of cases and approximately 15% of CIN 3 lesions were possibly undertreated. Given the expected increase in CIN detection in the new primary high-risk HPV screening program, reduction in CIN 1 treatment and CIN 2 treatment in younger women is needed to avoid an increase in potential harm. [ABSTRACT FROM AUTHOR]

Background: This study examined the psychometric properties of the Group Climate Instrument (GCI) in a sample of N = 189 adults (79% men) with mild intellectual disability or borderline intellectual functioning who were residents of a treatment facility in the Netherlands. Method: Construct validity of the GCI was examined by means of confirmatory factor analysis. Also, reliability and convergent validity of the GCI were examined. We also examined the variability in perception of the living group climate between and within living groups by computing intraclass correlation coefficients. Results: The model contained four first‐order factors (support, growth, group atmosphere and repression) and a second‐order factor overall climate, providing preliminary support for construct validity of the GCI. Reliability coefficients were good for all factors. Preliminary evidence for convergent validity was found in significant moderate associations between subscales and single item ratings for the factors of group climate. The intraclass correlation coefficients indicated that a considerate proportion of variance can be attributed to between‐group differences. Conclusions: The GCI might be used to assess perception of the living group climate for individuals with mild intellectual disability or borderline intellectual functioning in psychiatric and forensic care settings, although further development of the GCI and replication of our findings seem necessary. [ABSTRACT FROM AUTHOR]

Abstract: Background: Recent reports show increasing incidence of achalasia in some populations. The aim of this study was to estimate incidence, prevalence, and healthcare costs of achalasia in a large cohort in The Netherlands. Methods: Data were obtained from the largest Dutch healthcare insurance company (±4.4 million insured). Adult achalasia patients were identified between 2006 and 2014 when having an achalasia diagnosis code registered. A total of 907 achalasia patients were identified and included in our database, along with 9068 control patients (non‐achalasia patients), matched by age and gender. Key Results: The mean incidence over the 9‐year period was 2.2 per 100 000 persons and the mean prevalence was 15.3 per 100 000 persons. Mean age of achalasia patients was 54 (range 18‐98) years. Male to female ratio was 1:1. Socio‐economic status distribution was similar in achalasia patients and controls. Prior to the diagnosis, 74% of achalasia patients received proton pump inhibitors and 26% received anti‐emetic medication. The first year after diagnosis median total direct medical costs of achalasia patients were €2283 (IQR 969‐3044) per year. Patients above the 90th percentile of €4717 were significantly older than other patients below the 90th percentile (mean age 63 vs 57); P = .005. Conclusion & Inferences: In this large study that used a database comprising about 25% of all inhabitants of The Netherlands, it is confirmed that achalasia affects individuals of both genders and all ages. The costs associated with diagnosis and treatment of new cases of achalasia increase with increasing age. [ABSTRACT FROM AUTHOR]

Aims To study the effectiveness of intensive counselling by a practice nurse (PN) versus brief advice by a general practitioner (GP), each combined with pharmacotherapy, for 6 months' tobacco abstinence (primary outcome). Secondary outcomes included 12-month abstinence, medication adherence and incremental costs per life-year gained. Design A multi-site ( n = 10), two-group, parallel, pragmatic randomized controlled trial. Setting A network of primary health-care centres in the Netherlands. Participants A total of 295 adult daily smokers (mean age = 48 years; mean cigarettes/day = 19). Intervention and comparator Patients were randomized to receive individual counselling by a practice nurse (PN) ( n = 149) or brief advice by a general practitioner (GP) (146). All patients received 12 weeks of open-label varenicline. Measurements The primary outcome was prolonged biochemically validated abstinence from weeks 9 to 26 after treatment initiation. Secondary outcomes included abstinence from weeks 9 to 52, good dosing adherence (> 80% days taken) and incremental costs per life-year gained. Findings Abstinence rates in the PN versus GP groups were 32.2% ( n = 48) versus 39.0% [ n = 57; odds ratio (OR) = 0.71; 95% confidence interval (CI) = 0.44-1.16] from weeks 9 to 26 and 25.5% ( n = 38) versus 28.8% ( n = 42; OR = 0.84, 95% CI = 0.50-1.43) from weeks 9 to 52, respectively. Values of the Bayes factor indicated that the PN and GP were equally effective. Good dosing adherence was significantly lower in the PN (45.5%, n = 56/123) than in the GP group (62.0%, n = 75/121; OR = 0.45, 95% CI = 0.26-0.77), and the incremental costs per life-year gained were -€416.10. Conclusions Among people seeking help to stop smoking from their general practice, one-off brief advice from a general practitioner appears to be as effective as several sessions of behavioural support from a practice nurse when smoking cessation medication is provided. [ABSTRACT FROM AUTHOR]

Objective: Maternal alloimmunization to fetal red-blood-cell antigens is a major cause of fetal anemia, which can lead to hydrops and perinatal death if untreated. The cornerstone of management during pregnancy is intrauterine intravascular blood transfusion (IUT). Although this procedure is considered relatively safe, complications continue to occur. The aim of this study was to evaluate rates of procedure-related complications and perinatal loss following IUT, and their change over time, in order to identify factors leading to improved outcome.Methods: This was a retrospective analysis of all IUTs for red-cell alloimmunization performed at the national referral center for fetal therapy in The Netherlands, from 1988 to 2015. Differences in complication rates and their associations with alterations in transfusion technique after 2001 were assessed.Results: Between 1988 and 2015, 1678 IUTs were performed in 589 fetuses. For IUTs performed in 2001 and onwards, there was significant improvement in survival (88.6% vs 97.0%, P < 0.001) and a decline in procedure-related complications per fetus (9.8% vs 3.3%, P = 0.001) and per procedure (3.4% vs 1.2%, P = 0.003) compared with those performed before 2001. Procedure-related perinatal loss declined from 4.7% to 1.8% per fetus (P = 0.053). Beneficial changes in transfusion technique were routine use of fetal paralysis, increased use of intrahepatic transfusion and avoidance of arterial puncture.Conclusions: IUT has become an increasingly safe procedure in recent years when performed by experienced hands. The chosen technique should be fine-tuned according to the patient's individual situation. The declining complication rates are most likely related to center volume: this rare procedure is best performed in experienced fetal therapy centers. © 2016 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Delirium is a common form of vital organ dysfunction in intensive care unit (ICU) patients and is associated with poor outcomes. Adherence to guideline recommendations pertaining to delirium is still suboptimal. Aims We performed a survey aimed at identifying barriers for implementation that should be addressed in a tailored implementation intervention targeted at improved ICU delirium guideline adherence. Design The survey was conducted among ICU professionals. Methods An online survey was conducted among 360 ICU health care professionals (nurses, physicians and delirium consultants) from six ICUs in the southwest of the Netherlands as part of a multicentre prospective implementation project [response rate: 64% of 565 invited; 283 (79%) were nurses]. Results Although the majority (83%) of respondents considered delirium a common and major problem in the ICU, we identified several barriers for implementation of a delirium guideline. The most important barriers were knowledge deficit, low delirium screening rate, lack of trust in the reliability of delirium screening tools, belief that delirium is not preventable, low familiarity with delirium guidelines, low satisfaction with physician-described delirium management, poor collaboration between nurses and physicians, reluctance to change delirium care practices, lack of time, disbelief that patients would receive optimal care when adhering to the guideline and the perception that the delirium guideline is cumbersome or inconvenient in daily practice. Conclusion Although ICU professionals consider delirium a serious problem, several important barriers to adhere to guidelines on delirium management are still present today. Relevance to clinical practice Identification of implementation barriers for adherence to guidelines pertaining to delirium is feasible with a survey. Results of this study may help to design-targeted implementation strategies for ICU delirium management. [ABSTRACT FROM AUTHOR]

Objective: The introduction of bundled payment for diabetes care in the Netherlands led to the origination of care groups. This study explored to what extent variation in health care costs per patient can be attributed to the performance of care groups. Furthermore, the commonly applied simple mean aggregation was compared with the more advanced generalized linear mixed model (GLMM) to benchmark health care costs per patient between care groups.Data Source: Dutch 2009 nationwide insurance claims data of diabetes type 2 patients (104,544 patients, 50 care groups).Study Design: Both a simple mean aggregation and a GLMM approach was applied to rank care groups, using two different health care costs variables: total treatment health care costs and diabetes-specific specialist care costs per diabetes patient.Principal Findings: Care groups varied slightly in the first and mainly in the second indicator. Care group variation was not explained by composition. Although the ranking methods were correlated, some care groups' rank positions differed, with consequences on the top-10 and the low-10 positions.Conclusions: Differences between care groups exist when an appropriate indicator and a sophisticated aggregation technique is used. Currently applied benchmarking may have unfair consequences for some care groups. [ABSTRACT FROM AUTHOR]

Objective: To examine the accuracy and timing of diagnosis of fetal cleft lip with or without cleft palate (CL ± P) in the years following the introduction of a national screening program, and to assess the completeness and accuracy of information in The Netherlands Perinatal Registry.Methods: A list was obtained of cases with a prenatal or postnatal diagnosis of CL ± P from two fetal medicine units between 2008 and 2012. All cases of CL ± P were included irrespective of the presence or absence of additional anomalies. Cases were included if the estimated date of delivery was between 1 January 2008 and 31 December 2012.Results: During the study period, 330 cases of CL ± P were identified, with a prevalence of 15 per 10 000 pregnancies. The number of cases that were detected before 24 weeks' gestation increased during the study period, while the rate of termination of pregnancy did not change significantly (P = 0.511). CL ± P was isolated in 217 (66%) cases and karyotype was abnormal in 69 (21%) cases. In 5% of the cases in which CL ± P seemed to be isolated during the 18-23-week anomaly scan, postnatal array comparative genomic hybridization (array-CGH) revealed an abnormal karyotype and 50% of these cases had major additional anomalies. Examination of data from The Netherlands Perinatal Registry demonstrated that in 37% of cases CL±P was not recorded in the pregnancy records.Conclusion: CL ± P is increasingly being diagnosed prenatally, without a significant effect on the rate of pregnancy termination. Further improvement in the diagnostic accuracy may be achieved by advocating prenatal array-CGH to reduce the frequency of unexpected anomalies being diagnosed after birth. It is important that healthcare providers register accurately the presence or absence of anomalies in the birth records to ensure that, in the future, data from The Netherlands Perinatal Registry can be relied upon to monitor prevalence. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Aim To investigate the clinical and microbiological effects of local disinfection with 0.5% sodium hypochlorite (NaOCl) with or without systemic antimicrobials (amoxicillin and metronidazole, AM) during basic periodontal therapy (BPT). Material and Methods In a randomized clinical trial (four groups), 110 chronic periodontitis patients received BPT plus local irrigation with saline (BPT + S), local disinfection with NaOCl (BPT + DIS), BPT + DIS + AM or BPT + S + AM. The outcome was analysed at baseline, 3, 6 and 12 months. Results There was no difference in clinical attachment level gain at 12 months between the four groups. BPT + DIS showed no additional improvement compared to BPT + S; BPT + DIS + AM showed fewer sites with probing pocket depth (PPD) ≥7 mm versus BPT + S only up to 6 months ( p = 0.037). In factorial analyses, additional clinical reduction for PPD ( p = 0.023) and number of sites with PPD ≥5 ( p = 0.007), ≥6 ( p = 0.002) and ≥7 mm ( p < 0.001) were found when AM was added to BPT, but not when DIS was applied. In all groups, a comparable decrease in targeted bacteria was found. AM caused adverse events in 22% of the patients. Conclusion Local disinfection with NaOCl, also in combination with AM, showed, after 1-year follow-up, no additional clinical and microbiological effects compared to BPT alone. [ABSTRACT FROM AUTHOR]

Background: Plasma transfusion is often used prophylactically in patients with coagulopathy. However, the doses transfused may not be adequate to normalize hemostatic tests, which are commonly used as surrogate markers in practice. Currently, there is no reliable way to predict the posttransfusion international normalized ratio (INR) after plasma transfusion. Therefore, our aim was to develop and validate a formula that can reliably estimate post-plasma transfusion INR.Study Design and Methods: A compartmental model was developed using demographic (sex, height, weight) and laboratory variables (hematocrit [Hct], INRinitial , and plasma volume transfused). The formula was validated using a data set from a multicenter trial conducted between May 2010 and June 2013 in critically ill, nonbleeding patients with coagulopathy, receiving prophylactic plasma transfusions. INR was measured just before and immediately after plasma transfusion.Results: Initial plasma volume is calculated using the patient's Hct and blood volume (derived from Nadler's formula). The estimated immediate posttransfusion INR is then calculated as [Formula: see text] There was a significant agreement between the model predictions and the actual INR measurements after transfusion. A total of 83% of the predictions were within the acceptable range of variation. Furthermore, there was no proportional difference or systemic bias between the predictions and the actual INR measurements.Conclusion: This mathematical formula estimates posttransfusion INR after a certain volume of plasma transfusion with a good predictive ability. This formula, which only requires basic demographic and laboratory variables, may help the physicians to determine the volume of plasma required for a specific target INR in stable, nonbleeding patients. [ABSTRACT FROM AUTHOR]

Background: A developmental improvement of symptoms in attention-deficit/hyperactivity disorder (ADHD) is frequently reported, but the underlying neurobiological substrate has not been identified. The aim of this study was to determine whether white matter microstructure is related to developmental improvement of ADHD symptoms. Methods: A cross-sectional magnetic resonance imaging (MRI) analysis was embedded in a prospective follow-up of an adolescent cohort of ADHD and control subjects (NeuroIMAGE). Mean age at baseline was 11.9 years, mean interval of follow-up was 5.9 years. About 75.3% of the original cohort was retained successfully. Data of 101 participants with ADHD combined type at baseline and 40 healthy controls were analysed. ADHD symptoms were measured with semistructured, investigator-based interviews and Conners' questionnaires, on the basis of DSM-IV criteria. Fractional anisotropy (FA) and mean diffusivity (MD) indices of white matter microstructure were measured using whole brain diffusion tensor imaging at follow-up only. In a dimensional analysis FA and MD were related to change in ADHD symptoms. To link this analysis to DSM-IV diagnoses, a post hoc categorical group analysis was conducted comparing participants with persistent (n = 59) versus remittent (n = 42) ADHD and controls. Results: Over time, participants with ADHD showed improvement mainly in hyperactive/impulsive symptoms. This improvement was associated with lower FA and higher MD values in the left corticospinal tract at follow-up. Findings of the dimensional and the categorical analysis strongly converged. Changes in inattentive symptoms over time were minimal and not related to white matter microstructure. Conclusions: The corticospinal tract is important in the control of voluntary movements, suggesting the importance of the motor system in the persistence of hyperactive/impulsive symptoms. [ABSTRACT FROM AUTHOR]

Objective: To describe influences on decision-making and prognostic variables in the prenatal management of fetal lower urinary tract obstruction (LUTO).Methods: This was a prospective registry study of pregnant women with a male fetus with LUTO from centers within the British Isles and The Netherlands. Women and/or their clinicians were given the treatment option of either conservative management or vesicoamniotic shunting (VAS). Baseline characteristics of women in the registry, reasons for entry to the registry and pregnancy outcomes were assessed. The main study outcomes were survival to 28 days after delivery, further survival to 2 years and renal function. Logistic regression analysis was used to examine prognostic variables that affected outcome. Results were compared with those of women in a randomized controlled trial (RCT) who were allocated randomly to a treatment option.Results: Forty-five women were registered, of whom 78% (35/45) underwent conservative management. Twenty-seven women entered the registry owing to their clinician's preference for management and 18 because of their own preference. Compared to the conservative-management group of the RCT, a higher proportion of women in the registry opting for conservative management had a normal amniotic fluid volume at diagnosis (P = 0.05) and a diagnosis of LUTO ≥ 24 weeks' gestation (P = 0.003). On multivariable logistic regression analysis, these variables showed a significant association with perinatal survival (P < 0.001). Survival to 28 days after delivery was higher in the conservative-management group, at 69% (24/35), compared to 40% (4/10) in the VAS group (P = 0.02) but this difference had limited statistical significance owing to small study size (relative risk, 0.58 (95% CI, 0.26-1.29); P = 0.14).Conclusion: In our prospective registry, the majority of fetuses with LUTO received conservative management, which was associated with better short- and long-term outcomes. A significant proportion of these pregnancies had normal amniotic fluid volume and a gestational age at diagnosis of ≥ 24 weeks, characteristics shown to be associated with improved survival. [ABSTRACT FROM AUTHOR]

Initiating prophylactic treatment at an early age is considered to be the optimal form of therapy for a child with haemophilia A or B. The pioneering long term experiences of prophylactic treatment from Sweden and The Netherlands demonstrated the benefit of prophylaxis in retrospective and observational studies. Decades later, these benefits were confirmed in a randomized controlled study in USA. We review the current status of prophylactic replacement therapy of haemophilia in children, adolescents, adults and the elderly. Prophylaxis should begin at an early age and there are arguments for continuing it into adulthood. The dose of prophylaxis is dependent on the goal of treatment, economic resources and venous access and should be tailored individually. Starting the first exposures to clotting factor concentrates as prophylactic treatment, instead of on-demand in response to a bleed, may decrease the frequency of inhibitors in patients with haemophilia A. Novel longer-acting products are being introduced that could be helpful for patients with difficult venous access and enable higher trough levels. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to provide an overview of foetal/neonatal alloimmune neutropenia (FNAIN), together with advice on the clinical management. Methods: Neutrophil serology in the Netherlands is centralised at Sanquin Diagnostic Services. We examined FNAIN cases between January 1, 1991, and July 1, 2013, to determine the number of cases diagnosed, the relationship with human neutrophil antigen (HNA) antibody, the clinical presentation and therapeutic interventions. Results: We identified 35 FNAIN cases. The detected HNA antibodies were as follows: anti-HNA-1a (n = 7), anti-HNA-1b (n = 12), anti-HNA-1c (n = 2), anti-HNA-2 (n = 8), anti-HNA-3a (n = 1), anti-HNA-5a (n = 1) and anti-FccRIIIb (n = 4). No infections were diagnosed in 14 neonates, and the other 21 neonates suffered from omphalitis (n = 6), urinary tract infection (n = 1), candida mucositis (n = 1), fever of unknown origin (n = 6) and sepsis (n = 7, 20%). Parity, gestational age, birthweight, neutrophil counts and antibody specificity were not significantly different for cases with, and without, infections. All the infected children were treated with antibiotics. No children died. Conclusion: More than half (21) of the 35 cases of FNAIN presented with infections and most implicated were HNA-1a, HNA-1b and HNA-2. Treatment with antibiotics seemed adequate. A neonatal neutropenia workflow model for use in neonatal intensive care units is presented. [ABSTRACT FROM AUTHOR]

Aims To provide an overview of gambling in the Netherlands, focusing on historical background, policy, legislation, prevalence of problem gambling, availability of treatment options and research base. Methods Literature review. Results Contradictions between gambling policy and practice have been present in the past 15-20 years, and have led to an increasingly stricter gambling regulation to retain the government policy to restrict gambling within a national monopoly. Conversely, political efforts have been made to legalize internet gambling, but have not yet been approved. Compared to other European countries, slot machine gambling and casino gambling are relatively popular, whereas betting is relatively unpopular. Last-year problem gambling prevalence ( South Oaks Gambling Screen score > 5) is estimated at 0.22-0.15% (2005, 2011). Treatment for problem gambling is covered by health insurance under the same conditions as substance dependence, but only a small proportion of Dutch problem gamblers seeks help at addiction treatment centres. Conclusions Gambling policy in the Netherlands has become stricter during recent last years in order to maintain the Dutch gambling monopoly. Problem gambling in the Netherlands is relatively stable. Dutch research on problem gambling has a lack of longitudinal studies. Most of the epidemiological gambling studies are reported in non-peer-reviewed research reports, which diminishes control by independent peers on the methodology and interpretation of results. Recent efforts to enhance consistency in research methods between gambling studies over time could enhance knowledge on changes in (problem) gambling in the Netherlands. [ABSTRACT FROM AUTHOR]

Background and Objective Aggregatibacter actinomycetemcomitans is a pathogen in oral and nonoral infections. Detection and quantification of this pathogen can be performed using selective culture techniques. The aim of this study was to establish the efficacy of two known selective media in their ability to select and support the growth of A. actinomycetemcomitans. Material and Methods Trypticase soy bacitracin vancomycin ( TSBV) medium and brain-heart infusion agar with vancomycin ( Dentaid-1), as well as a modified Dentaid-1 medium (in which the brain-heart infusion agar was substituted with brain-heart infusion broth), were compared. Two-hundred and eighteen clinical samples were used to establish the recovery rate, the number of colony-forming units (CFUs) of A. actinomycetemcomitans as well as the total number of CFUs on the three different types of medium. In addition, the numbers of gram-negative aerobic rods and yeasts were determined. Results Both types of Dentaid-1 medium showed a higher recovery of A. actinomycetemcomitans compared with TSBV. However, these differences did not reach statistical significance. The total number of CFUs of A. actinomycetemcomitans recovered was significantly higher on Dentaid-1 compared with TSBV ( p = 0.029). The mean number of gram-negative aerobic rods recovered was statistically higher on both types of Dentaid-1 medium in comparison with TSBV. Low numbers of yeasts were recovered occasionally on all test plates. Conclusion Dentaid-1 is a low-cost effective alternative to TSBV for the isolation and growth of A. actinomycetemcomitans from clinical samples, such as dental plaque, which contain a complex microflora. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to compare peri-implant conditions between fully edentulous ( FES) and partially edentulous subjects ( PES). Material and methods A systematic review was conducted. The MEDLINE, EMBASE and COCHRANE databases were searched for publications up to January 1st 2012. Studies reporting on the bleeding tendency of the peri-implant mucosa and/or studies reporting on the prevalence of peri-implant mucositis and/or peri-implantitis were considered. Results Fifty-five publications describing 46 studies were selected. One study described both FES and PES, and all other studies described either FES or PES. Subgroup analyses were performed according to dental status (fully/partially edentulous), follow-up time (≥5 years and ≥ 10 years) and study design (prospective/cross-sectional). FES harboured more plaque at their implants than PES. Modified bleeding index scores were significantly higher in FES, but no differences in bleeding on probing, implant loss and probing pocket depth were observed between FES and PES. No meta-analysis could be performed on prevalence of peri-implant mucositis and peri-implantitis. Overall prevalence of peri-implantitis was 0-3.4% after 5 years and 5.8-16.9% after 10 years of implant evaluation. Conclusion FES and PES show comparable implant survival rates. However, no conclusion can be drawn regarding differences in prevalence of peri-implant mucositis and peri-implantitis between FES and PES. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Patients with atherothrombotic cardiovascular disease (ACD) should receive specific treatments, including lipid-lowering medication. In order to optimize treatment for patients with ACD in primary care, an efficient method to identify all these patients is needed. We aimed to assess which method serves best to identify all patients with ACD in Dutch primary care: morbidity records, antiplatelet prescribing records or a combination of these. Methods In a cross-sectional study in 45 Dutch general practices, computerized medical records of all patients with any cardiovascular disease, cardiovascular symptoms or cardiovascular medication were analysed. Results Of the 7280 patients with a recorded indisputable indication for antiplatelet therapy, 4715 (64.8%) could be identified by means of antiplatelet prescriptions. Of the patients with a recorded indisputable indication for antiplatelets but without any antiplatelet prescription, 28.9% received a vitamin K antagonist. Of the 8718 patients with antiplatelet therapy, 5697 (65.3%) could be identified by means of a recorded indisputable or possible indication for antiplatelet therapy. Female patients, patients younger than 60 years old and patients having a recorded diagnosis of angina pectoris or diabetes had a higher risk to be missed by antiplatelet prescribing records. Conclusion Morbidity records and prescribing records should be used both in order to identify all patients with ACD in primary care. Patients who use antiplatelet prescriptions but do not have a recorded ACD deserve extra attention, because they are either treated without a good indication for antiplatelet therapy (overtreatment) or need a correction of their morbidity records. [ABSTRACT FROM AUTHOR]

Background: The number of reliable and valid instruments to measure the effects of therapy in apraxia of speech (AoS) is limited. Aims: To evaluate the newly developed Modified Diadochokinesis Test (MDT), which is a task to assess the effects of rate and rhythm therapies for AoS in a multiple baseline across behaviours design. Methods: The consistency, accuracy and fluency of speech of 24 adults with AoS and 12 unaffected speakers matched for age, gender and educational level were assessed using the MDT. The reliability and validity of the instrument were considered and outcomes compared with those obtained with existing tests. Results: The results revealed that MDT had a strong internal consistency. Scores were influenced by syllable structure complexity, while distinctive features of articulation had no measurable effect. The test-retest and intra- and inter-rater reliabilities were shown to be adequate, and the discriminant validity was good. For convergent validity different outcomes were found: apart from one correlation, the scores on tests assessing functional communication and AoS correlated significantly with the MDT outcome measures. The spontaneous speech phonology measure of the Aachen Aphasia Test (AAT) correlated significantly with the MDT outcome measures, but no correlations were found for the repetition subtest and the spontaneous speech articulation/prosody measure of the AAT. Conclusions & Implications: The study shows that the MDT has adequate psychometric properties, implying that it can be used to measure changes in speech motor control during treatment for apraxia of speech. The results demonstrate the validity and utility of the instrument as a supplement to speech tasks in assessing speech improvement aimed at the level of planning and programming of speech. [ABSTRACT FROM AUTHOR]

. Boden H, van der Hoeven BL, Karalis I, Schalij MJ, Jukema JW (Leiden University Medical Center, Leiden, The Netherlands). Management of acute coronary syndrome: achievements and goals still to pursue. Novel developments in diagnosis and treatment (Review). J Intern Med 2012; 271: 521-536. Acute coronary syndromes contribute a substantial part of the global disease burden. To realize a reduction in mortality and morbidity, the management of patients with these conditions involves the integration of several different approaches. Timely delivery of appropriate care is a key factor, as the beneficial effect of reperfusion is greatest when performed as soon as possible. Innovations in antithrombotic therapy have also contributed significantly to improvements in the prevention of ischaemic complications. However, with the use of such treatment, an increase in the risk of bleeding is inevitable. Therefore, the greatest challenge is now to obtain an optimal balance between the prevention of ischaemic complications and the risk of bleeding. In this regard, identification of patients at highest risk of either one is essential. [ABSTRACT FROM AUTHOR]

Objectives. Although the treatment of depressive illness aims to restore the imbalance between an excess of negative affect (NA) and a shortage of positive affect (PA), no study has examined how NA and PA may influence each other in depression. This study examines how NA and PA dynamically influence each other in depression and how this may impact on treatment response. Design. Depressed help-seeking individuals participated in the Experience Sampling Method (ESM), which enables visualization of subtle dynamic alterations of momentary affective states over time. Thereafter, participants received a combination of antidepressant treatment and psychotherapy, and were followed up each month. Methods. NA and PA were assessed during ESM at 10 random moments per day for 6 days. Depressive symptoms were assessed at baseline and at monthly intervals during treatment. Results. Future response to treatment was associated with altered baseline NA-PA dynamics in individuals with previous depressive episodes. Their daily life boosts of PA were followed by a stronger suppression of NA over subsequent hours than in other depressed groups or controls. Conclusions. Subtle individual differences in daily life emotional dynamics predict future treatment outcome in depression. [ABSTRACT FROM AUTHOR]

Overweight and obese people appear to be at greater risk of suboptimal vitamin and mineral status compared with people of a healthy weight. Nutrients most affected include vitamin D, vitamin B, carotenoids, folate, vitamin C and iron. The reasons are unknown but may be caused by poor diets, increased requirements or obesity-related changes to nutrient absorption, excretion or metabolism, or a combination of these. Sequestration of fat-soluble vitamins by adipose tissues is also a major factor. Although dietary assessment in obese populations is hampered by under-reporting, there is evidence that dietary patterns characterised by energy-dense, processed foods are more common in groups with a higher body mass index. Dieting practices, bariatric surgery and the use of anti-obesity drugs may compound the risk of nutrient inadequacy, although sustained weight loss helps to improve vitamin D status. A poor nutrient status could accentuate the risk of chronic diseases already experienced by overweight people on account of their excessive fat mass. There is evidence that the use of dietary supplements can improve nutrient status and have a favourable impact on disease risk markers such as lipid profiles and insulin resistance. Whether currently dieting or not, overweight people may benefit from safeguarding vitamin and mineral adequacy by taking a multi-nutrient supplement alongside an increased intake of nutrient-rich foods. [ABSTRACT FROM AUTHOR]

• Cough and cold medicines are frequently used in children to treat upper respiratory tract infections without solid proof of benefits. • Safety issues have been raised about the use of these drugs in young children. • In 2007 international warnings were issued advising against use of these drugs in young children. • Cough and cold medicines prescribing by primary care physicians has not really been influenced by international warnings in the Netherlands, where no additional national warnings were made and only partially in Italy. • A concerted action should be taken in Europe to advise strongly against the OTC use and prescription of cough and cold medicines in young children. The aim of the study was to assess the influence of national and international warnings on the prescription rates of cough and cold medicines (CCMs) in the youngest children (<2 years) in the Netherlands and Italy. Analysis of outpatient electronic medical records of children <2 years in Italy and the Netherlands was carried out. Age and country specific prescription prevalence rates were calculated for the period 2005-08. Comparisons of prescription rates in 2005 (pre) and 2008 (post) warnings were done by means of a chi-square test. The cohort consisted of 99 176 children <2 years of age. After international warnings, overall prescription rates for CCMs decreased slightly from 83 to 77/1000 person years ( P= 0.05) in Italy and increased in the Netherlands from 74 to 92/1000 children per year. Despite the international warnings, prescription rates for nasal sympathomimetics and opium alkaloids increased in the Netherlands ( P < 0.01). In Italy a significant decrease in the prescription rates of opium alkaloids and other cough suppressants ( P < 0.01) was observed, and also a significant reduction in use of combinations of nasal sympathomimetics. Despite the international safety warnings and negative benefit-risk profiles, prescription rates of cough and cold medicines remain substantial and were hardly affected by the warnings, especially in the Netherlands where no warning was issued. The hazards of use of these medicines in young children should be explicitly stipulated by the European Medicines Agency and all national agencies, in order to increase awareness amongst physicians and caretakers and reduce heterogeneity across the EU. [ABSTRACT FROM AUTHOR]

Objective: To identify hand function problems and the reasons for choosing a specific finger splint in patients with rheumatoid arthritis (RA) and swan neck deformities. Methods: A qualitative study was performed alongside a randomized, controlled cross-over trial comparing the effectiveness of two types of finger splints (the silver ring splint [SRS] and the prefabricated thermoplastic splint [PTS]) in 50 patients with RA and swan neck deformities. Questions on the patients' main hand function problem and reasons for choosing a specific splint type were performed at baseline and after using each splint. The qualitative analyses included the identification of meaning units and (sub)concepts related to hand function problems and splint preferences. Results: RA patients with swan neck deformities experience problems with flexion initiation, painful proximal interphalangeal joint hyperextension, grip activities and comprehensive hand function activities. Reasons for preferring or not preferring a specific type of finger splint included: effect, ease of use, appearance, comfort and side effects. Apart from the splint slipping off and a negative attitude towards the appearance of the splint, which appeared to be more frequently mentioned in connection with the SRS, no clear pattern of positive or negative appreciation of either type of splint could be distinguished. Conclusion: RA patients with swan neck deformities experience a variety of problems, including impairments in functions and limitations in daily activities. With the prescription of finger splints, a substantial number of potentially positive and negative consequences of their use need to be taken into account. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Rationale In this study, information was gathered from five disciplines on their usual management methods for fibromyalgia (FM) in order to asses whether treatment regimens have changed in the Netherlands during a period of 6 years. In addition, insight was gained into the therapeutic motives of the professionals. Method A questionnaire was sent to a sample of 150 persons per discipline: general practitioners (GPs), rheumatologists (RMTs), rehabilitation specialists (RS), physical therapists and psychologists. Results The overall response rate was 40.4%. The referral behaviour changed (significantly), especially between GPs and RMTs. An increased choice for aerobic exercise (RS: P = 0.023) and multidisciplinary therapy (RMT: P = 0.046) was found. RMTs and RS showed decreased medication prescribing (RMT: P = 0.024). Preferences of treatment for FM differ per discipline. The choice is principally made on the basis of subjective, professional group-bound factors. Particularly for GPs, dynamic patient factors are an important motive in the management of FM. Conclusions Despite the fact that most changes found are in conformity with the literature, the absolute application percentages of recommended therapies are still very low. The differences in practice between the several disciplines seem explicable on the basis of the factors that have a prominent role in the choice of a therapy for FM. This study underlines the need for further research into methods and processes of the management of FM, and their clinical effectiveness. An effective way of dissemination, especially of guidelines, is essential. [ABSTRACT FROM AUTHOR]

The article reports the analysis of data on antidepressant prescription rates and youth suicide rates in the U.S. and the Netherlands has uncovered a decline in prescriptions of selective serotonin reuptake inhibitors (SSRIs) and an increase in youth suicides in the period following federal warnings on antidepressant safety for children. INSET: Evidence isn't there to condemn black box warning.

Aims To estimate the diffusion of new safety information concerning postmenopausal hormonal replacement therapy (HRT) into prescribing practice in the Netherlands and to assess the impact of revised guidelines on the long-term treatment of HRT. Design Cross-sectional study. Setting Community pharmacy dispensing data from a population of approximately 450 000 patients in the northern and eastern part of the Netherlands. Population Women aged 45–69 years to whom at least one HRT prescription was dispensed between 1 January 2000 and 1 January 2004. Main outcome measures Annual and quarter prevalences of HRT and the proportion of new HRT users, switchers and continuous HRT users per quarter. Results The prevalence of HRT prescribing decreased significantly from 107/1000 [95% confidence interval (CI) 104, 110] in 2000 to 87/1000 (95% CI 84, 89) in 2003. The decreasing prevalence was especially evident among the younger age groups and was most pronounced among users of oestrogen/progestagen combinations. The publication of the Women Health Initiative Study (WHI) was followed by a modest decrease in prescribing of HRT, whereas prescribing of HRT declined dramatically after publication of the Million Women Study (MWS) in August 2003. Among the continuous HRT users in the 4th quarter of 2002, 55% used HRT longer than 3 years. This percentage was 53 in the 4th quarter of 2003. Conclusions In contrast to the release of the WHI study results, publication of the MWS was followed by a dramatic fall in prescribing of HRT in the Netherlands. Despite the new recommendation that long-term HRT use should be discouraged, the proportion of long-term users did not change after the publication of the MWS. [ABSTRACT FROM AUTHOR]

To estimate the costs and effects of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early-onset group B streptococcal (GBS) disease in the Netherlands. The treatment strategies include a risk-based strategy, a screening-based strategy, a combined screening/risk-based strategy and the current Dutch guideline.Cost-effectiveness analysis based on decision model.Obstetric care system in the Netherlands.Hypothetical cohort of 200,000 neonates.A decision analysis model was used to compare the costs and effects of different treatment strategies with no treatment. Baseline estimates were derived from literature and a survey among parents of children affected by GBS disease. The analysis was performed from a societal perspective, and costs and effects were discounted at a percentage of 3%.Cost per quality adjusted of life-year (QALY).The risk-based strategy will prevent 352 cases of early-onset GBS for€5.0 million, indicating a cost-effectiveness ratio of€7600 per QALY gained. The combined screening risk-based strategy has comparable results. The current Dutch guideline resulted in lower effects for higher costs. The screening-based strategy shows the highest reduction in cases of early-onset GBS, however, at a cost-effectiveness ratio of€59,300 per QALY gained. Introducing the polymerase chain reaction (PCR) test may lead to a more favourable cost-effectiveness ratio.In the Dutch system, the combined screening/risk-based strategy and the risk-based strategy have reasonable cost-effectiveness ratios. If it becomes feasible to add the PCR test, the cost-effectiveness of the combined screening/risk-based strategy may even be more favourable. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the impact of medical conditions of children with profound intellectual and multiple disabilities on the professional support they receive in centres for special education.The medical files, the daily records and daily communication records between parents and professionals were reviewed for 48 children with profound intellectual and multiple disabilities in three centres for special education in the Netherlands. In addition, interviews were held with direct service professionals and medical doctors to complete the data collection.Not only do major medical conditions, such as hospital admissions, but also minor medical conditions, such as an increase in body temperature or the drowsy state a child is in as a result of a seizure, have an impact on performing activities and therapies in a child's educational centre.As a result of the prevalence of the medical conditions, professionals may decide not to carry on actions that were planned or do not offer an alternative programme. The risk of many‘empty’ hours despite the presence of highly specialized professional support is high. [ABSTRACT FROM AUTHOR]

Over 60% of patients aged over 70 years, diagnosed with non-Hodgkin's lymphoma (NHL) in the Netherlands have serious comorbidity. We studied the independent influence of comorbidity on choice of treatment, dose reductions, treatment-related toxicity and prognosis, using data from a random sample of 381 patients from the population-based Eindhoven Cancer Registry. About 45% of patients over 60 years of age with NHL had high impact comorbidity at the time of cancer diagnosis. The proportion of patients with aggressive NHL who received chemotherapy decreased from 85% in patients aged 40–60 years to 70% in those over 60 years. About 65% of systematically treated patients with aggressive NHL suffered from treatment-related toxicity. Toxicity appeared to be more common among females and those with high-intermediate or high International Prognostic Index (IPI) risk. Among patients with aggressive NHL, the chance of dying for those with high impact comorbidity was twice as high compared with those without comorbidity. This was independent of the IPI risk. Dose reductions are frequently unavoidable for patients with severe comorbidity, poor performance status or chemotherapy-related toxicity. Whether the less frequent prescription of (full dose) chemotherapy for patients with advanced age and/or with comorbidity is justified remains a question for debate. [ABSTRACT FROM AUTHOR]

Cortical hyperexcitability is thought to explain the more enhanced contingent negative variation (CNV) amplitudes and impaired CNV habituation that have been found during the interictal period in migraine without aura. These CNV characteristics have been shown to normalize to the level of healthy controls during an attack. This study aimed to replicate the interictal findings, and additionally examine whether migraineurs show reduced CNV amplitudes during the postattack period. Of 12 patients with migraine without aura and their sex- and age-matched healthy controls, CNV characteristics were recorded once in an interictal period, once during the postattack period within 30 hours after an attack that was treated with sumatriptan, and once after an attack that was treated with habitual nonvasoactive medication (counterbalanced). The present results did not confirm the enhanced CNV early and late wave amplitudes or impaired habituation, and cortical hyperexcitability that have previously been reported in the interictal period in patients with migraine without aura. During the postattack period, a decrease in CNV early and late amplitudes was found but only after sumatriptan use. This reduction in CNV amplitudes was most prominent over the frontal cortex and could reflect cortical hypoexcitability, possibly related to a suppression of central catecholaminergic activity by sumatriptan. [ABSTRACT FROM AUTHOR]

In hospital Z, a Dutch university hospital, a new protocol for the diagnosis of vascular patients has been introduced. It requires vascular surgeons to rely sometimes on a non-invasive diagnostic technique, called duplex, in place of a previously used invasive one, called angiography. This article is a multivocai account of the protocol's introduction. It focuses on the intricate ways in which two aspects of diagnosis, the detection of disease and the design of treatment, relate. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with thrombolysis with intravenous alteplase for acute ischemic stroke in older adults.

The article focuses on the guidelines being practiced at Sanquin Blood Foundation in Amsterdam, Netherlands on the preparation and use granulocyte concentrates to cure neutropenic patients with severe infections. It says that granulocytes are collected only from a patient's relatives, and granulocyte colony-stimulating factors (G-CSF) are given only to non-related donor for human progenitor cells (HPC) collection. A chart on patient-donor compatibility determination is also discussed.

Background: After the Q fever outbreak in the Netherlands between 2007 and 2010, more than 300 patients with chronic Q fever have been identified. Some patients were also diagnosed with systemic sclerosis, a rare immune‐mediated disease. We aimed to increase awareness of concomitant chronic Q fever infection and systemic sclerosis and to give insight into the course of systemic sclerosis during persistent Q fever infection. Materials and methods: Chronic Q fever patients were identified after the Dutch Q fever outbreak in 2007‐2010. Systemic sclerosis was diagnosed by a scleroderma expert and patients fulfilled the 2013 Classification Criteria for Systemic Sclerosis. Results: Four cases presented with chronic Q fever, persistent Coxiella burnetii infection, shortly preceded or followed by the diagnosis of limited cutaneous systemic sclerosis. The three male patients of 60 years or older developed a relatively mild systemic sclerosis, which did not require immunosuppressive therapy during adequate treatment of the chronic Q fever infection. The 58‐year‐old female patient used immunosuppressives for her newly diagnosed systemic sclerosis at the time she likely developed a chronic Q fever infection. Conclusions: In this case series, chronic Q fever preceding systemic sclerosis was associated with a mild course of systemic sclerosis without the necessity of immunosuppressive drugs, while chronic Q fever development due to immunocompromised state was associated with a more deteriorating course of systemic sclerosis. [ABSTRACT FROM AUTHOR]

Purpose: All forms of past and current high-dose-rate brachytherapy utilize immobile applicators during treatment delivery. The only moving part is the source itself. This paradigm misses an important degree of freedom that, if explored, can in some instances produce previously unachievable dose conformality; that is, the dynamic motion of the applicator itself during treatment delivery. Monte Carlo and treatment planning simulations were used to illustrate the potential benefits of moving applicators for rectal cancer applications in particular. This concept is termed dynamic modulated brachytherapy (DMBT). Methods: The DMBT system uses a high-density, 18.0 g/cm3, 45 mm long tungsten alloy shield, cylindrical in shape, with a small window on one side to encapsulate a 192Ir source, to create collimation that results in a highly directional beam profile. This shield can be dynamically translated and rotated, using an attached robotic arm, during treatment to create a volumetric modulated arc therapy-type delivery, but from inside the rectal cavity. Monte Carlo simulations and planning optimization algorithms were developed inhouse to evaluate the effectiveness of this new approach using 36 clinical treatment plans comprised of 13 patients each treated using the intracavitary mold applicator (ICMA, Nucletron, The Netherlands) to quantify the potential clinical benefit. The prescription dose was 10 Gy/fx and the group had an average clinical target volume of 9.0 ± 3.5 cm3. Ideal phantom geometries were used to evaluate the impact of various shield dimensions and designs on the resulting plan quality. Results: Simulations of ideal phantom geometries found that shields as small as 10 mm in diameter can produce high quality plans. For the clinical patient cases, compared to the ICMA, for equal prescription tumor coverage, the DMBT plans provided >30% decrease in D5 (high dose volume) resulting in a ∼40% decrease in dose heterogeneity index. In addition, mean dose and D98 showed a reduction (typically 40%-60%) on all critical structures evaluated. However, for a 10 Gy prescribed dose there was an increase in total treatment time on average from 7.6 to 20.8 min for a source with an air-kerma strength of 40.25 kU (10 Ci). Conclusions: Dosimetric properties of a novel DMBT system have been described and evaluated. Comparison with the ICMA commercial applicator has shown it to be a prospective step forward in high-dose-rate brachytherapy 192Ir technology. Dynamic motion of an applicator during treatment, for any applicator and site in general, can provide additional degrees of freedom that, if properly considered, can potentially increase the plan quality significantly. [ABSTRACT FROM AUTHOR]

The article reports on the vaccination of all sheeps and goats on dairy farms and other premises in the Netherlands that have public access. It cites the Coxiella burnetii which has been a part of the enhanced measures to control outbreaks of Q fever that have affected the country. It notes on the voluntary campaign against Q fever in sheep and goats that has started 2008 despite the limited availability of the vaccines.