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Purpose: To assess the feasibility of using freehand Single Photon Emission Computed Tomography (free-handSPECT) for the identification of technetium-99m-hydroxydiphosphonate (Tc-99m-HDP) positive bone lesions and to evaluate the possibility of using these imaging data-sets for augmented- and virtual-reality based navigation approaches.Material and methods: In 20 consecutive patients referred for scintigraphy with Tc-99m-HDP, 21 three-dimensional freehandSPECT-images were generated using a handheld gamma camera. Concordance of the two different data sets was ranked. Furthermore, feasibility of segmenting the hotspot of tracer accumulation for navigation purposes was assessed.Results: In 86% of the cases freehandSPECT images showed good concordance with the corresponding part of the scintigraphic images. In lesions with a signal to background ratio (SBR) > 1.36, freehandSPECT provided an automatically segmented reference point for navigation purposes. In 14% of the cases (average SBR 1.82, range 1.0-3.4) freehandSPECT images showed intermediate concordance due to difficult anatomical area or negative bone scintigraphy and could not be used as navigation targets.Conclusion: In this pilot study, in 86% of the cases freehandSPECT demonstrated good concordance with traditional scintigraphy. A lesion with a SBR of 1.36 or more was suitable for navigation. These high quality freehandSPECT images supported the future exploration navigation strategies, e.g. guided needle biopsies. (C) 2019 Sociedad Espaiiola de Medicina Nuclear e Imagen Molecular. Published by Elsevier Espatia, S.L.U. All rights reserved.

Als alle kosten en baten van alcohol worden opgeteld, waren de kosten in 2013 ongeveer 2,3 tot 4,2 miljard euro. Kosten kunnen bijvoorbeeld ontstaan door een lagere arbeidsproductiviteit, door inzet van politie en justitie, en door verkeersongevallen. De baten van alcoholgebruik zijn bijvoorbeeld de accijnsinkomsten voor de overheid. Als we ook private kosten meenemen in de berekening, zoals de kosten van voortijdige sterfte en verlies aan kwaliteit van leven, dan waren de kosten in 2013 4,2 tot 6,1 miljard euro. In deze kostenschattingen is het welzijn dat mensen bij het drinken van alcohol kunnen ervaren niet meegenomen, omdat het moeilijk is om dit in maat en getal uit te drukken. Dit blijkt uit onderzoek van het RIVM en drie andere organisaties. Maatregelen zijn mogelijk om mensen minder alcohol te laten drinken, zoals een accijnsverhoging, een beperking van het aantal verkooppunten en een totaalverbod op alcoholreclame en -sponsoring. Zulke maatregelen kunnen de samenleving forse besparingen opleveren en hebben daarmee netto een positief effect op de Nederlandse samenleving. Voorbeelden van die positieve effecten zijn minder sterfte en betere kwaliteit van leven doordat ziekten die met alcoholgebruik samenhangen worden voorkomen. Ook wordt de arbeidsproductiviteit hoger, zijn er minder verkeersongevallen en is minder inzet van politie en justitie nodig. Op de lange termijn, over een periode van 50 jaar, levert een accijnsverhoging van 50 procent tussen de 4,5 en 10,7 miljard euro op. Bij een accijnsverhoging van 200 procent is dat 12,2 tot 35,8 miljard euro. Het saldo van kosten en baten na 50 jaar is 1,8 tot 4,3 miljard euro wanneer 10 procent van de verkooppunten worden gesloten. Dit bedrag loopt op tot 4,6 tot 10,7 miljard euro als 25 procent van de verkooppunten sluit. Een mediaban levert de samenleving circa 3,5 tot 7,8 miljard euro op na 50 jaar, maar hierover bestaat meer onzekerheid. Dit is een herziene versie van een onderzoek uit 2016. Nieuwe inzichten en nieuwe cijfers waren de aanleiding voor deze herziening. Voor beide rapporten is een zogeheten maatschappelijke kosten-batenanalyse (MKBA) uitgevoerd waarbij de drie genoemde beleidsmaatregelen zijn doorgerekend. MKBA's zijn een hulpmiddel om de welvaartseffecten van maatregelen in kaart te brengen en kunnen beleidsmakers ondersteunen bij hun beslissingen over toekomstig overheidsbeleid.

Background: Specialized outpatient psychotherapy for patients with borderline personality disorder (BPD) is expected to reduce their use of other health care resources. It is currently unknown to what extent the costs of providing these interventions can be expected to be offset by a reduction in other health care costs in the Netherlands. To establish the cost-effectiveness and budget impact of specialized outpatient psychotherapy, the estimated incremental costs are synthesized with the estimated incremental effects. We have developed a method for the synthesis of all relevant evidence on clinical effectiveness as well as health care resource use. Aim of the Study: The aim of this article is to present a method for the synthesis of evidence for cost-effectiveness and budget impact analysis with a specific application to specialized outpatient psychotherapy for borderline personality disorder in the Netherlands. Methods: A systematic search of the English-language literature is performed to retrieve evidence on the clinical effectiveness and the health care resource use following 12 months of specialized outpatient psychotherapy for borderline personality disorder. The available evidence is used as an input for a model-based economic evaluation. Simulated patient-level data are used to provide overall estimates of the incremental costs and incremental effects, which serve to assess the cost-effectiveness and budget impact of specialized outpatient psychotherapy for borderline personality disorder in the Netherlands. Results: The results indicate that specialized outpatient psychotherapy for BPD can be considered cost-effective and that its scaling up to Dutch national level would require an investment of E 2.367 million (95% C.I.: E 1,717,000 - E 3,272,000) per 1,000 additional patients with BPD. Sensitivity analyses demonstrated the robustness of our findings in light of several uncertain components and assumptions in our calculations, but also their sensitivity to the choice of included studies based on the comparator condition and the assumption of high intervention costs. Discussion: We present a method for the synthesis of evidence from different types of studies in a way that respects the uncertainty surrounding those findings. Limitations of the study pertain to the inclusion of findings from studies with suboptimal designs, the transferability of research findings, and uncertainty regarding the time horizon considered. More research is needed on the sensitivity of our findings to the choice of included studies based on the comparator condition. Implications for Health Care Provision and Use: The results suggest that the provision of specialized outpatient psychotherapy for BPD leads to a reduction in other health care resource use. Overall, the results are promising and encourage future studies on aspects that are currently still uncertain. Implications for Health Policies: The results may support policy makers in deciding whether or not to allocate health care budget for the provision of specialized outpatient psychotherapy for patients with BPD in the Netherlands. Implications for Further Research: The results provide important directions for future research. This includes the need for future studies to make a comparison between specialized outpatient psychotherapy and treatment as usual and to have longer follow-up time.

BACKGROUND: Major depression is probably best seen as a chronically recurrent disorder, with patients experiencing another depressive episode after remission. Therefore, attention to reduce the risk of relapse or recurrence after remission is warranted. The aim of this review is to meta-analytically examine the effectiveness of psychological interventions to reduce relapse or recurrence rates of depressive disorder.METHODS: We systematically reviewed the pertinent trial literature until May 2014. The random-effects model was used to compute the pooled relative risk of relapse or recurrence (RR). A distinction was made between two comparator conditions: (1) treatment-as-usual and (2) the use of antidepressants. Other sources of heterogeneity in the data were explored using meta-regression.RESULTS: Twenty-five randomised trials met inclusion criteria. Preventive psychological interventions were significantly better than treatment-as-usual in reducing the risk of relapse or recurrence (RR=0.64, 95% CI=0.53-0.76, z=4.89, pLIMITATIONS: Differences between the primary studies in methodological design, composition of the patient groups and type of intervention may have caused heterogeneity in the data, but could not be evaluated in a meta-regression owing to poor reporting.CONCLUSIONS: We conclude that there is supporting evidence that preventive psychological interventions reduce the risk of relapse or recurrence in major depression.

Contains fulltext : 152854.pdf (Publisher’s version ) (Closed access) BACKGROUND: Homeobox (HOX) genes, which are involved in organ development and homeostasis, have been shown to be involved in normal prostate- and PCa development. In this study, we investigate the expression levels of the HOX A-D genes in PCa. The functional relevance and potential of HOX gene as biomarkers are explored. METHODS: We evaluated HOX gene expression in prostate tissues of different grade and stage and related the outcome to clinical parameters. We analyzed AR regulation and function of HOXC6 in PCa cell lines. We developed a urine-based HOXC6 mRNA assay for diagnostic purposes. RESULTS: HOXC6 was one of the most upregulated HOX genes in all primary, metastasized, and castration-resistant PCa. HOXC6 upregulation was specific to the epithelial component of PCa, and HOXC6 was shown to be involved in epithelial cell proliferation. HOXC6 expression was not influenced by androgens nor by treatments targeting the AR signaling pathway. HOXC6 expression was not related to a prognosis after radical prostatectomy, that is, biochemical or local recurrence. We successfully developed an assay for HOXC6 mRNA detection in urine and confirmed that HOXC6 levels are higher in PCa patients. CONCLUSIONS: HOXC6 has a role in all PCa stages, particularly in PCa cell proliferation. Due to its stable expression, HOXC6 is a novel candidate biomarker for PCa not only in early detection but also for monitoring of progression or response to therapy. Prostate 75:1868-1876, 2015. (c) 2015 Wiley Periodicals, Inc.

Background: Internet-based cognitive therapy with monitoring via text messages (mobile CT), in addition to treatment as usual (TAU), might offer a cost-effective way to treat recurrent depression. Method: Remitted patients with at least 2 previous episodes of depression were randomized to mobile CT in addition to TAU (n = 126) or TAU only (n = 113). A linear mixed model was used to examine the effect of the treatment condition on a 3-month course of depressive symptoms after remission. Both an intention-to-treat analysis (n = 239) and a completer analysis (n = 193) were used. Depressive symptoms were assessed using the Inventory of Depressive Symptomatology (IDS-SR30) at baseline and 1.5 and 3 months after randomization. Results: Residual depressive symptoms showed a small but statistically significant decrease in the intention-to-treat group over 3 months in the mobile CT group relative to the TAU group (difference: -1.60 points on the IDS-SR30 per month, 95% CI = -2.64 to -0.56, p = 0.003). The effect of the treatment condition on the depressive symptomatology at the 3-month follow-up was small to moderate (Cohen's d = 0.44). All analyses among completers (≥5 modules) showed more pronounced treatment effects. Adjustment for unequally distributed variables did not markedly affect the results. Conclusions: Residual depressive symptoms after remission showed a more favorable course over 3 months in the mobile CT group compared to the TAU group. These results are a first indication that mobile CT in addition to TAU is effective in treating recurrently depressed patients in remission. However, demonstration of its long-term effectiveness and replication remains necessary.