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Vertessen K, Luman M, Bet P, Bergwerff CE, Bottelier M, Stoffelsen R, Swanson JM, Wisse A, Twisk J, Oosterlaan J. Improving Methylphenidate Titration in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): A Randomized Controlled Trial Using Placebo-Controlled Titration Implemented in Clinical Practice. Paediatr Drugs 2024; 26:319-330. [PMID: 38280943 DOI: 10.1007/s40272-023-00604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND AND OBJECTIVES Concerns exist regarding the rising use of methylphenidate. A double-blind, placebo-controlled methylphenidate titration (PCT) for children with attention-deficit/hyperactivity disorder (ADHD) has shown potential to improve titration (i.e., detection of placebo responders and larger ADHD symptom improvement) in experimental settings. This study aims to determine if these advantages can be transferred to clinical settings. METHOD Children (aged 5-13 years) with an ADHD diagnosis and an indication to start methylphenidate (MPH) treatment were recruited. Participants were randomized to PCT or care as usual (CAU) in a 1:1 ratio followed by a 7-week randomized controlled trial (T1) and 6-month, naturalistic, open-label follow-up (T2). Parents, teachers, and physicians rated ADHD symptoms, ADHD medication use, MPH dosing, and treatment satisfaction using questionnaires. RESULTS A total of 100 children were enrolled and randomized to PCT (n = 49) or CAU (n = 51). In the PCT group, we found 8.2% placebo responders, 16.3% non-responders, and 65.3% responders to MPH. With PCT compared with CAU, a significantly larger number of children discontinued MPH (T1: 24.5 vs 5.9%, p = 0.009; T2: 41.7 vs 10.4%, p < 0.001) and refrained from using other pharmacological treatment (T1: 20.4 vs 3.9%, p = 0.013; T2: 20.83 vs 6.25%, p = 0.002). At both timepoints, there were no significant differences between the groups in the average dose of MPH, ADHD symptoms, or treatment satisfaction. CONCLUSIONS PCT can be used to improve detection of children who do not benefit from MPH, and may therefore potentially reduce overtreatment of ADHD with MPH.
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Affiliation(s)
- Karen Vertessen
- Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Marjolein Luman
- Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Levvel Specialists in Youth and Family Care, Amsterdam, The Netherlands
| | - Pierre Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
| | - Catharina E Bergwerff
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Marco Bottelier
- Child Study Center Accare, UMC Groningen, Groningen, The Netherlands
| | - Reino Stoffelsen
- Levvel Specialists in Youth and Family Care, Amsterdam, The Netherlands
| | - James M Swanson
- Department of Pediatrics, University of California, Irvine, USA
| | - Annemiek Wisse
- Youz, Center for Youth Mental Healthcare, Velsen-Noord, The Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Romano LGR, Schütte LM, van Hest RM, Meijer K, Laros-van Gorkom BAP, Nieuwenhuizen L, Eikenboom J, Heubel-Moenen FCJI, Uitslager N, Coppens M, Fijnvandraat K, Driessens MHE, Polinder S, Cnossen MH, Leebeek FWG, Mathôt RAA, Kruip MJHA. Peri-operative desmopressin combined with pharmacokinetic-guided factor VIII concentrate in non-severe haemophilia A patients. Haemophilia 2024; 30:355-366. [PMID: 38343113 DOI: 10.1111/hae.14946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/10/2023] [Accepted: 01/13/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Non-severe haemophilia A patient can be treated with desmopressin or factor VIII (FVIII) concentrate. Combining both may reduce factor consumption, but its feasibility and safety has never been investigated. AIM We assessed the feasibility and safety of combination treatment in nonsevere haemophilia A patients. METHODS Non-severe, desmopressin responsive, haemophilia A patients were included in one of two studies investigating peri-operative combination treatment. In the single-arm DAVID study intravenous desmopressin (0.3 μg/kg) once-a-day was, after sampling, immediately followed by PK-guided FVIII concentrate, for maximally three consecutive days. The Little DAVID study was a randomized trial in patients undergoing a minor medical procedure, whom received either PK-guided combination treatment (intervention arm) or PK-guided FVIII concentrate only (standard arm) up to 2 days. Dose predictions were considered accurate if the absolute difference between predicted and measured FVIII:C was ≤0.2 IU/mL. RESULTS In total 32 patients (33 procedures) were included. In the DAVID study (n = 21), of the FVIII:C trough levels 73.7% (14/19) were predicted accurately on day 1 (D1), 76.5% (13/17) on D2. On D0, 61.9% (13/21) of peak FVIII:C levels predictions were accurate. In the Little DAVID study (n = 12), on D0 83.3% (5/6) FVIII:C peak levels for both study arms were predicted accurately. Combination treatment reduced preoperative FVIII concentrate use by 47% versus FVIII monotherapy. Desmopressin side effects were mild and transient. Two bleeds occurred, both despite FVIII:C > 1.00 IU/mL. CONCLUSION Peri-operative combination treatment with desmopressin and PK-guided FVIII concentrate dosing in nonsevere haemophilia A is feasible, safe and reduces FVIII consumption.
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Affiliation(s)
- Lorenzo G R Romano
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lisette M Schütte
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Reinier M van Hest
- Department of Hospital Pharmacy and Clinical Pharmacology, Amsterdam University Medical Centers-University of Amsterdam, Amsterdam, The Netherlands
| | - Karina Meijer
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Nanda Uitslager
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Coppens
- Department of Hematology, Amsterdam University Medical Centers-University of Amsterdam, Amsterdam, The Netherlands
- Pulmonary Hypertension & Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Amsterdam University Medical Centers-University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, The Netherlands
| | | | - Suzanne Polinder
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology and Oncology, Erasmus MC, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ron A A Mathôt
- Department of Hospital Pharmacy and Clinical Pharmacology, Amsterdam University Medical Centers-University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
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Vertessen K, Luman M, Swanson JM, Bottelier M, Stoffelsen R, Bet P, Wisse A, Twisk JWR, Oosterlaan J. Methylphenidate dose-response in children with ADHD: evidence from a double-blind, randomized placebo-controlled titration trial. Eur Child Adolesc Psychiatry 2024; 33:495-504. [PMID: 36862163 PMCID: PMC10869379 DOI: 10.1007/s00787-023-02176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 02/17/2023] [Indexed: 03/03/2023]
Abstract
Methylphenidate (MPH) is highly efficacious in reducing symptoms of attention-deficit/hyperactivity disorder (ADHD) in children. Generally increased doses are found to result in better symptom control; however, it remains unclear whether this pattern can be observed at the individual level, given the large heterogeneity in individual dose-response relationships and observed placebo responses. A double-blind, randomized, placebo-controlled cross-over trial was used to compare weekly treatment with placebo and 5, 10, 15 and 20 mg of MPH twice daily on parent and teacher ratings of child ADHD symptoms and side effects. Participants were 5-13-year-old children with a DSM-5 diagnosis of ADHD (N = 45). MPH response was assessed at group and individual levels and predictors of individual dose-response curves were examined. Mixed model analysis showed positive linear dose-response curves at group level for parent and teacher rated ADHD symptoms and parent rated side effects, but not for teacher rated side effects. Teachers reported all dosages to improve ADHD symptoms compared to placebo, while parents only reported > 5 mg/dose as effective. At the individual level, most (73-88%) children, but not all, showed positive linear dose-response curves. Higher severity of hyperactive-impulsive symptoms and lower internalizing problems, lower weight, younger age and more positive opinions towards diagnosis and medication partly predicted steeper linear individual dose-response curves. Our study confirms that increased doses of MPH yield greater symptom control at a group level. However, large interindividual variation in the dose-response relationship was found and increased doses did not lead to greater symptom improvement for all children. This trial was registered in the Netherlands trial register (# NL8121).
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Affiliation(s)
- Karen Vertessen
- Clinical Neuropsychology Section, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Child and Adolescent Psychiatry, University Psychiatric Centre KU Leuven, Leuven, Belgium.
- Child Study Group, Clinical Neuropsychology Section, Vrije Universiteit Amsterdam, Van der Boechorststraat, 7-9, 1081 BT, Amsterdam, The Netherlands.
| | - Marjolein Luman
- Clinical Neuropsychology Section, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Levvel Specialists in Youth and Family Care, Amsterdam, The Netherlands
| | - James M Swanson
- Department of Pediatrics, University of California, Irvine, USA
| | - Marco Bottelier
- Child Study Center Accare, UMC Groningen, Groningen, The Netherlands
| | - Reino Stoffelsen
- Levvel Specialists in Youth and Family Care, Amsterdam, The Netherlands
| | - Pierre Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
| | - Annemiek Wisse
- Youz, Center for Youth Menthal Healthcare, Velsen-Noord, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Clinical Neuropsychology Section, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Emma Neuroscience Group, Department of Pediatrics, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Toorop AA, Noteboom S, Steenwijk MD, Gravendeel JW, Jasperse B, Barkhof F, Strijbis EMM, Rispens T, Schoonheim MM, van Kempen ZLE, Killestein J. Exploring the effects of extended interval dosing of natalizumab and drug concentrations on brain atrophy in multiple sclerosis. Mult Scler 2024; 30:266-271. [PMID: 38235514 PMCID: PMC10851624 DOI: 10.1177/13524585231225855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/01/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Extended interval dosing (EID) of natalizumab treatment is increasingly used in multiple sclerosis. Besides the clear anti-inflammatory effect, natalizumab is considered to have neuroprotective properties as well. OBJECTIVES This study aimed to study the longitudinal effects of EID compared to standard interval dosing (SID) and natalizumab drug concentrations on brain atrophy. METHODS Patients receiving EID or SID of natalizumab with a minimum radiological follow-up of 2 years were included. Changes in brain atrophy measures over time were derived from clinical routine 3D-Fluid Attenuated Inversion Recovery (FLAIR)-weighted magnetic resonance imaging (MRI) scans using SynthSeg. RESULTS We found no differences between EID (n = 32) and SID (n = 50) for whole brain (-0.21% vs -0.16%, p = 0.42), ventricular (1.84% vs 1.13%, p = 0.24), and thalamic (-0.32% vs -0.32%, p = 0.97) annualized volume change over a median follow-up of 3.2 years. No associations between natalizumab drug concentration and brain atrophy rate were found. CONCLUSION We found no clear evidence that EID compared to SID or lower natalizumab drug concentrations have a negative impact on the development of brain atrophy over time.
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Affiliation(s)
- Alyssa A Toorop
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Samantha Noteboom
- MS Center Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Martijn D Steenwijk
- MS Center Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Job W Gravendeel
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bas Jasperse
- MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frederik Barkhof
- MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Eva MM Strijbis
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Biologics Laboratory and Department of Immunopathology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Menno M Schoonheim
- MS Center Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Zoé LE van Kempen
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joep Killestein
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Veltkamp F, van Oers HA, Teela L, Mak-Nienhuis EM, Haverman L, Bouts AHM. Distress in parents of children with first-onset steroid-sensitive nephrotic syndrome. Pediatr Nephrol 2023; 38:4013-4022. [PMID: 37380933 PMCID: PMC10584702 DOI: 10.1007/s00467-023-06038-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Steroid-sensitive nephrotic syndrome (SSNS) is associated with a relapsing-remitting course that can be stressful for parents. As little is known of parental distress at the first onset of SSNS, this study aims to describe parental distress and everyday problems in mothers and fathers of a child with newly diagnosed SSNS participating in a randomized controlled trial of levamisole added to corticosteroids. METHODS To assess distress, the Distress Thermometer for Parents (DT-P) was used, which includes questions on distress (thermometer score 0-10, ≥ 4 "clinical distress") and presence of everyday problems in six domains: practical, social, emotional, physical, cognitive, and parenting. The DT-P was completed 4 weeks after the onset of SSNS. Total sum and individual items of everyday problems were compared with reference data from mothers and fathers of the Dutch general population. RESULTS There was no difference in clinically elevated parental distress between SSNS mothers (n = 37) and fathers (n = 25) and reference parents. Compared to reference fathers, fathers of a child with SSNS scored significantly higher on emotional problems (P = 0.030), while mothers experienced more parenting problems (P = 0.002). Regression analyses showed that lower parental age and having a girl with SSNS were significantly associated with more practical problems and higher distress thermometer scores, respectively. CONCLUSIONS Four weeks after onset, SSNS mothers and fathers experience equal distress as reference parents. However, both parents endorsed significantly more everyday problems. Therefore, monitoring parental distress, even in the first weeks of the disease, could contribute to timely interventions and prevent worsening of problems. CLINICAL TRIAL REGISTRY Dutch Trial Register ( https://onderzoekmetmensen.nl/en/trial/27331 ). A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Floor Veltkamp
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Child Development, Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Hedy A van Oers
- Child Development, Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Lorynn Teela
- Child Development, Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Elske M Mak-Nienhuis
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Lotte Haverman
- Child Development, Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Antonia H M Bouts
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Child Development, Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Post Box, 22660, 1100 DD, Amsterdam, The Netherlands.
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6
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Keij FM, Schouwenburg S, Kornelisse RF, Preijers T, Mir F, Degraeuwe P, Stolk LM, van Driel A, Kenter S, van der Sluijs J, Heidema J, den Butter PCP, Reiss IKM, Allegaert K, Tramper-Stranders GA, Koch BCP, Flint RB. Oral and Intravenous Amoxicillin Dosing Recommendations in Neonates: A Pooled Population Pharmacokinetic Study. Clin Infect Dis 2023; 77:1595-1603. [PMID: 37757471 PMCID: PMC10686957 DOI: 10.1093/cid/ciad432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND There is a lack of evidence on oral amoxicillin pharmacokinetics and exposure in neonates with possible serious bacterial infection (pSBI). We aimed to describe amoxicillin disposition following oral and intravenous administration and to provide dosing recommendations for preterm and term neonates treated for pSBI. METHODS In this pooled-population pharmacokinetic study, 3 datasets were combined for nonlinear mixed-effects modeling. In order to evaluate amoxicillin exposure following oral and intravenous administration, pharmacokinetic profiles for different dosing regimens were simulated with the developed population pharmacokinetic model. A target of 50% time of the free fraction above the minimal inhibitory concentration (MIC) with an MICECOFF of 8 mg/L (to cover gram-negative bacteria such as Escherichia coli) was used. RESULTS The cohort consisted of 261 (79 oral, 182 intravenous) neonates with a median (range) gestational age of 35.8 weeks (range, 24.9-42.4) and bodyweight of 2.6 kg (range, 0.5-5). A 1-compartment model with first-order absorption best described amoxicillin pharmacokinetics. Clearance (L/h/kg) in neonates born after 30 weeks' gestation increased with increasing postnatal age (PNA day 10, 1.25-fold; PNA day 20, 1.43-fold vs PNA day 3). Oral bioavailability was 87%. We found that a twice-daily regimen of 50 mg/kg/day is superior to a 3- or 4-times daily schedule in the first week of life for both oral and intravenous administration. CONCLUSIONS This pooled population pharmacokinetic description of intravenous and oral amoxicillin in neonates provides age-specific dosing recommendations. We conclude that neonates treated with oral amoxicillin in the first weeks of life reach adequate amoxicillin levels following a twice-daily dosing regimen. Oral amoxicillin therapy could therefore be an adequate, cost-effective, and more patient-friendly alternative for neonates worldwide.
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Affiliation(s)
- Fleur M Keij
- Department of Paediatrics, Division of Neonatology, Erasmus University Medical Centre–Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Paediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Stef Schouwenburg
- Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - René F Kornelisse
- Department of Paediatrics, Division of Neonatology, Erasmus University Medical Centre–Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Tim Preijers
- Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Fatima Mir
- Section of Paediatric Infectious Disease, Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Pieter Degraeuwe
- Department of Paediatrics, Division of Neonatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Leo M Stolk
- Department of Clinical Pharmacy, Maastricht University Medical Centre, The Netherlands
| | - Arianne van Driel
- Department of Paediatrics, IJsselland Hospital, Capelle a/d IJssel, The Netherlands
| | - Sandra Kenter
- Department of Paediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Jacqueline van der Sluijs
- Department of Paediatrics, Division of Neonatology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Jojanneke Heidema
- Department of Paediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Irwin K M Reiss
- Department of Paediatrics, Division of Neonatology, Erasmus University Medical Centre–Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Karel Allegaert
- Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Gerdien A Tramper-Stranders
- Department of Paediatrics, Division of Neonatology, Erasmus University Medical Centre–Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Paediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Robert B Flint
- Department of Paediatrics, Division of Neonatology, Erasmus University Medical Centre–Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
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7
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Andringa A, Veerkamp K, Roebroeck M, Ketelaar M, Klem M, Dekkers H, Voorman J, van Driel M, Buizer A. Combined surveillance and treatment register for children with cerebral palsy: the protocol of the Netherlands CP register. BMJ Open 2023; 13:e076619. [PMID: 37898490 PMCID: PMC10619026 DOI: 10.1136/bmjopen-2023-076619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/03/2023] [Indexed: 10/30/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is a childhood onset, lifelong, condition. Early detection and timely treatment of potential problems during the child's development are important to prevent secondary impairments and improve function. Clinical management of children with CP requires a spectrum of multidisciplinary interventions, which have an impact on short-term and long-term outcomes. However, there is a lack of knowledge about a personalised approach in this heterogeneous population. Various CP registers with different aims have been developed worldwide, which has made an important contribution to our understanding of CP. The purpose of this protocol is to describe the unique design of a combined multidisciplinary surveillance and treatment register for children with CP in the Netherlands, which aims to improve quality of care and to enhance an individual treatment approach. METHODS AND ANALYSIS The Netherlands CP Register combines a multidisciplinary surveillance programme with a standardised protocol for treatment registry. The register systematically collects real-life surveillance and treatment data of children with CP. The register contributes to daily care at the individual level by screening for potential secondary impairments using a decision-support tool, by visualising individual development using a dashboard, and by supporting goal setting and shared decision-making for interventions. The register provides a platform at the national level for quality of care improvement and a comprehensive database of real-life data allowing multicentre studies with a long-term follow-up. People with lived experience of CP, healthcare professionals from different disciplines and researchers collaborated in the development of the register. ETHICS AND DISSEMINATION The Netherlands CP register was submitted to the Medical Ethics Review Committee of VU University Medical Center (Amsterdam, the Netherlands), who judged the register not to be subject to the Medical Research Involving Human Subjects Act. A scientific board reviews requests for dissemination of data from the register for specific research questions.
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Affiliation(s)
- Aukje Andringa
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Steering group of the Netherlands CP register, Amsterdam, Netherlands
| | - Kirsten Veerkamp
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marij Roebroeck
- Steering group of the Netherlands CP register, Amsterdam, Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre and Rijndam Rehabilitation, Rotterdam, Netherlands
| | - Marjolijn Ketelaar
- Steering group of the Netherlands CP register, Amsterdam, Netherlands
- De Hoogstraat Rehabilitation, Utrecht, Netherlands
- Department of Rehabilitation, University Medical Centre Utrecht, Brain Centre, Utrecht, Netherlands
- CP-Net, Utrecht, Netherlands
| | - Martijn Klem
- Steering group of the Netherlands CP register, Amsterdam, Netherlands
- CP-Net, Utrecht, Netherlands
- Revalidatie Nederland, Utrecht, Netherlands
| | - Hurnet Dekkers
- Steering group of the Netherlands CP register, Amsterdam, Netherlands
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands
- Netherlands Society of Rehabilitation Medicine, Utrecht, Netherlands
| | - Jeanine Voorman
- Steering group of the Netherlands CP register, Amsterdam, Netherlands
- Department of Rehabilitation, University Medical Centre Utrecht, Brain Centre, Utrecht, Netherlands
- CP-Net, Utrecht, Netherlands
- Netherlands Society of Rehabilitation Medicine, Utrecht, Netherlands
- Department of Rehabilitation, Physiotherapy Sciences and Sport, University Medical Centre Utrecht, location Wilhelmina Children's Hospital and Prinses Máxima Centre for Child Oncology, Utrecht, Netherlands
| | - Marieke van Driel
- Steering group of the Netherlands CP register, Amsterdam, Netherlands
- CP Nederland, Houten, Netherlands
| | - Annemieke Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Steering group of the Netherlands CP register, Amsterdam, Netherlands
- Netherlands Society of Rehabilitation Medicine, Utrecht, Netherlands
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands
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8
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Veltkamp F, Teela L, Luijten MAJ, van Oers HA, Mak-Nienhuis EM, Haverman L, Bouts AHM. Health-related quality of life of children with first onset steroid-sensitive nephrotic syndrome. Eur J Pediatr 2023; 182:4605-4614. [PMID: 37548700 PMCID: PMC10587200 DOI: 10.1007/s00431-023-05135-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
This study assessed HRQoL and emotional and behavioral difficulties (EBD) and associated variables in children with first onset SSNS. While relapsing steroid-sensitive nephrotic syndrome (SSNS) in children is associated with lower health-related quality of life (HRQoL), little is known about first onset. Four weeks after onset, children (2-16 years) and/or their parents who participated in a randomized placebo-controlled trial, completed the Pediatric Quality of Life Inventory 4.0 (PedsQL) and Strengths and Difficulties Questionnaire (SDQ) to measure HRQoL and EBD, respectively. Total and subscale scores and the proportion of children with impaired HRQoL (> 1 SD below the mean of the reference group) or SDQ clinical scores (< 10th and > 90th percentile) were compared to the Dutch general population (reference group). Regression analyses were used to identify associated variables. Compared to the reference group, children 8-18 years reported significantly lower total HRQoL, and physical and emotional functioning. A large proportion (> 45%) of these children had impaired HRQoL. There were no differences in HRQoL between children 2-7 years and the reference group, except for higher scores on social functioning (5-7 years). Similar proportions of SSNS and reference children scored within the clinical range of SDQ subscales. Age, sex, and steroid side-effects were negatively associated with HRQol and/or EBD. Conclusion: This study showed that HRQoL and EBD are affected in children of different ages with first onset SSNS. This calls for more awareness from healthcare providers and routinely monitoring of HRQoL and EBD in daily clinical care to prevent worsening of symptoms. Clinical trial registry: Netherlands Trial Register ( https://trialsearch.who.int/ ; NTR7013), date of registration: 02 June 2018. What is Known: • Health-related quality of life (HRQoL) is lower and emotional and behavioral difficulties (EBD) is more affected in children with frequently-relapsing and steroid-dependent nephrotic syndrome. What is New: • HRQoL and EBD are affected in children with first onset steroid-sensitive nephrotic syndrome compared to a reference group of the Dutch general population. • To what extent HRQoL and EBD are affected depends on the age of the patient.
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Affiliation(s)
- Floor Veltkamp
- Amsterdam University Medical Centers location University of Amsterdam, Emma Children's Hospital, Department of Pediatric Nephrology, Meibergdreef 9, Post box 22660, 1100 DD, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
| | - Lorynn Teela
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
- Amsterdam University Medical Centers, location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Michiel A J Luijten
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
- Amsterdam University Medical Centers, location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hedy A van Oers
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
- Amsterdam University Medical Centers, location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
| | - Elske M Mak-Nienhuis
- Amsterdam University Medical Centers location University of Amsterdam, Emma Children's Hospital, Department of Pediatric Nephrology, Meibergdreef 9, Post box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Lotte Haverman
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
- Amsterdam University Medical Centers, location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
| | - Antonia H M Bouts
- Amsterdam University Medical Centers location University of Amsterdam, Emma Children's Hospital, Department of Pediatric Nephrology, Meibergdreef 9, Post box 22660, 1100 DD, Amsterdam, the Netherlands.
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands.
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9
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Huijbers MJ, Wentink C, Lucassen PL, Kramers C, Akkermans R, Spijker J, Speckens AE. Supporting antidepressant discontinuation using mindfulness plus monitoring versus monitoring alone: A cluster randomized trial in general practice. PLoS One 2023; 18:e0290965. [PMID: 37669281 PMCID: PMC10479886 DOI: 10.1371/journal.pone.0290965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/17/2023] [Indexed: 09/07/2023] Open
Abstract
Discontinuing antidepressant medication (ADM) can be challenging for patients and clinicians. In the current study we investigated if Mindfulness-Based Cognitive Therapy (MBCT) added to supported protocolized discontinuation (SPD) is more effective than SPD alone to help patients discontinue ADM. This study describes a prospective, cluster-randomized controlled trial (completed). From 151 invited primary care practices in the Netherlands, 36 (24%) were willing to participate and randomly allocated to SPD+MBCT (k = 20) or SPD (k = 16). Adults using ADM > 9 months were invited by GPs to discuss tapering, followed by either MBCT+SPD, or SPD alone. Exclusion criteria included current psychiatric treatment; substance use disorder; non-psychiatric indication for ADM; attended MBCT within past 5 years; cognitive barriers. From the approximately 3000 invited patients, 276 responded, 119 participated in the interventions and 92 completed all assessments. All patients were offered a decision aid and a personalized tapering schedule (with GP). MBCT consisted of eight group sessions of 2.5 hours and one full day of practice. SPD was optional and consisted of consultations with a mental health assistant. Patients were assessed at baseline and 6, 9 and 12 months follow-up, non-blinded. In line with our protocol, primary outcome was full discontinuation of ADM within 6 months. Secondary outcomes were depression, anxiety, withdrawal symptoms, rumination, well-being, mindfulness skills, and self-compassion. Patients allocated to SPD + MBCT (n = 73) were not significantly more successful in discontinuing (44%) than those allocated to SPD (n = 46; 33%), OR 1.60, 95% CI 0.73 to 3.49, p = .24, number needed to treat = 9. Only 20/73 allocated to MBCT (27%) completed MBCT. No serious adverse events were reported. In conclusion, we were unable to demonstrate a significant benefit of adding MBCT to SPD to support discontinuation in general practice. Actual participation in patient-tailored interventions was low, both for practices and for patients. (Trial registration: ClinicalTrials.gov PRS ID: NCT03361514 registered December 2017).
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Affiliation(s)
- Marloes J. Huijbers
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carolien Wentink
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter L.B.J. Lucassen
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelis Kramers
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Spijker
- Expertise Centre for Depression, Pro Persona Nijmegen, Nijmegen, The Netherlands
| | - Anne E.M. Speckens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
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10
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Hassan D, Versmissen J, Hek K, van Dijk L, van den Bemt PMLA. Feasibility of a protocol for deprescribing antihypertensive medication in older patients in Dutch general practices. BMC Prim Care 2022; 23:280. [PMID: 36352363 PMCID: PMC9644553 DOI: 10.1186/s12875-022-01894-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Older patients using antihypertensive medication may experience Adverse Drug Events (ADEs), and thus benefit from deprescribing. The lack of a practical protocol may hamper deprescribing. Therefore, we aimed to develop a deprescribing protocol, based on a review of literature, combined with a feasibility test in a small number of patients. METHODS A deprescribing protocol for general practitioners was drafted and tested in older patients using multiple antihypertensive medication in a single arm intervention. Patients were included if they were 75 years or older, were using two or more antihypertensives, had at least one ADE linked to antihypertensive medication and deprescribing was considered to be safe by their general practitioner. The primary outcome was the percentage of patients for whom one or more antihypertensive drugs were stopped or reduced in dose after 12 months of follow up while maintaining safe blood pressures. Secondary outcomes were the proportion of patients reporting no ADEs after 12 months and the number of deprescribed antihypertensives. Patient's opinions on deprescribing and enablers and barriers for study participation were also collected. RESULTS Nine general practitioners included 14 patients to deprescribe antihypertensive medication using the deprescribing protocol. After 12 months antihypertensive drug use was lowered in 11 patients (79%). These patients had a mean systolic blood pressure increase of 16 mmHg and a mean diastolic blood pressure increase of 8 mmHg. Nine patients (64%) reported experiencing no ADEs anymore after twelve months. The mean number of deprescribed antihypertensives was 1.1 in all patients and 1.4 (range: 0.5 to 3.5) in patients who successfully lowered their medication. At baseline, being able to use less medication was the most frequently mentioned enabler to participate in this study. The most frequently mentioned positive experience at the end of the study was using less medication, which was in line with the most mentioned enabler to participate in this study. CONCLUSION A protocol for deprescribing antihypertensives in older patients was considered feasible, as it resulted in a substantial degree of safe deprescribing in this pilot study. Larger studies are needed to demonstrate the effect and safety of deprescribing antihypertensives in older patients.
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Affiliation(s)
- Dimokrat Hassan
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Jorie Versmissen
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Karin Hek
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
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11
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de Looff P, Duursma R, Noordzij M, Taylor S, Jaques N, Scheepers F, de Schepper K, Koldijk S. Wearables: An R Package With Accompanying Shiny Application for Signal Analysis of a Wearable Device Targeted at Clinicians and Researchers. Front Behav Neurosci 2022; 16:856544. [PMID: 35813597 PMCID: PMC9262092 DOI: 10.3389/fnbeh.2022.856544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
Abstract
Physiological signals (e.g., heart rate, skin conductance) that were traditionally studied in neuroscientific laboratory research are currently being used in numerous real-life studies using wearable technology. Physiological signals obtained with wearables seem to offer great potential for continuous monitoring and providing biofeedback in clinical practice and healthcare research. The physiological data obtained from these signals has utility for both clinicians and researchers. Clinicians are typically interested in the day-to-day and moment-to-moment physiological reactivity of patients to real-life stressors, events, and situations or interested in the physiological reactivity to stimuli in therapy. Researchers typically apply signal analysis methods to the data by pre-processing the physiological signals, detecting artifacts, and extracting features, which can be a challenge considering the amount of data that needs to be processed. This paper describes the creation of a “Wearables” R package and a Shiny “E4 dashboard” application for an often-studied wearable, the Empatica E4. The package and Shiny application can be used to visualize the relationship between physiological signals and real-life stressors or stimuli, but can also be used to pre-process physiological data, detect artifacts, and extract relevant features for further analysis. In addition, the application has a batch process option to analyze large amounts of physiological data into ready-to-use data files. The software accommodates users with a downloadable report that provides opportunities for a careful investigation of physiological reactions in daily life. The application is freely available, thought to be easy to use, and thought to be easily extendible to other wearable devices. Future research should focus on the usability of the application and the validation of the algorithms.
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Affiliation(s)
- Peter de Looff
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- De Borg, Den Dolder, Netherlands
- Fivoor Science and Treatment Innovation, Den Dolder, Netherlands
- *Correspondence: Peter de Looff,
| | | | - Matthijs Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Sara Taylor
- Affective Computing Group, Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Natasha Jaques
- Affective Computing Group, Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Floortje Scheepers
- PsyData Group, Department of Psychiatry, UMC Utrecht, Utrecht, Netherlands
| | - Kees de Schepper
- PsyData Group, Department of Psychiatry, UMC Utrecht, Utrecht, Netherlands
| | - Saskia Koldijk
- PsyData Group, Department of Psychiatry, UMC Utrecht, Utrecht, Netherlands
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12
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Schröder MAM, van Herwaarden AE, Span PN, van den Akker ELT, Bocca G, Hannema SE, van der Kamp HJ, de Kort SWK, Mooij CF, Schott DA, Straetemans S, van Tellingen V, van der Velden JA, Sweep FCGJ, Claahsen-van der Grinten HL. Optimizing the Timing of Highest Hydrocortisone Dose in Children and Adolescents With 21-Hydroxylase Deficiency. J Clin Endocrinol Metab 2022; 107:e1661-e1672. [PMID: 34788830 PMCID: PMC8947312 DOI: 10.1210/clinem/dgab826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT Hydrocortisone treatment of young patients with 21-hydroxylase deficiency (21OHD) is given thrice daily, but there is debate about the optimal timing of the highest hydrocortisone dose, either mimicking the physiological diurnal rhythm (morning), or optimally suppressing androgen activity (evening). OBJECTIVE We aimed to compare 2 standard hydrocortisone timing strategies, either highest dosage in the morning or evening, with respect to hormonal status throughout the day, nocturnal blood pressure (BP), and sleep and activity scores. METHODS This 6-week crossover study included 39 patients (aged 4-19 years) with 21OHD. Patients were treated for 3 weeks with the highest hydrocortisone dose in the morning, followed by 3 weeks with the highest dose in the evening (n = 21), or vice versa (n = 18). Androstenedione (A4) and 17-hydroxyprogesterone (17OHP) levels were quantified in saliva collected at 5 am; 7 am; 3 pm; and 11 pm during the last 2 days of each treatment period. The main outcome measure was comparison of saliva 17OHP and A4 levels between the 2 treatment strategies. RESULTS Administration of the highest dose in the evening resulted in significantly lower 17OHP levels at 5 am, whereas the highest dose in the morning resulted in significantly lower 17OHP and A4 levels in the afternoon. The 2 treatment dose regimens were comparable with respect to averaged daily hormone levels, nocturnal BP, and activity and sleep scores. CONCLUSION No clear benefit for either treatment schedule was established. Given the variation in individual responses, we recommend individually optimizing dose distribution and monitoring disease control at multiple time points.
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Affiliation(s)
- Mariska A M Schröder
- Amalia Children’s Hospital, Department of Pediatrics, Radboud University Medical Center, HB Nijmegen, the Netherlands
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, HB Nijmegen, the Netherlands
| | - Antonius E van Herwaarden
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, HB Nijmegen, the Netherlands
| | - Paul N Span
- Radiotherapy & OncoImmunology Laboratory, Department of Radiation Oncology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, HB Nijmegen, the Netherlands
| | - Erica L T van den Akker
- Department of Pediatrics, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, DR Rotterdam, the Netherlands
| | - Gianni Bocca
- Beatrix Children’s Hospital, Department of Pediatrics, University Medical Center Groningen, RB Groningen, the Netherlands
| | - Sabine E Hannema
- Department of Pediatrics, Leiden University Medical Centre, RC Leiden, the Netherlands
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, MB Amsterdam, the Netherlands
| | - Hetty J van der Kamp
- Wilhelmina Children’s Hospital, Utrecht University Medical Center, EA Utrecht, the Netherlands
| | - Sandra W K de Kort
- Department of Pediatrics, Haga Teaching Hospital/Juliana Children’s Hospital, AA The Hague, the Netherlands
| | - Christiaan F Mooij
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, AZ Amsterdam, the Netherlands
| | - Dina A Schott
- Department of Pediatrics Endocrinology, Zuyderland medical center, PC Heerlen, the Netherlands
| | - Saartje Straetemans
- Department of Pediatric Endocrinology, Maastricht university medical center, HX Maastricht, the Netherlands
| | - Vera van Tellingen
- Department of Pediatrics, Catharina Hospital, EJ Eindhoven, the Netherlands
| | - Janiëlle A van der Velden
- Amalia Children’s Hospital, Department of Pediatrics, Radboud University Medical Center, HB Nijmegen, the Netherlands
| | - Fred C G J Sweep
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, HB Nijmegen, the Netherlands
| | - Hedi L Claahsen-van der Grinten
- Amalia Children’s Hospital, Department of Pediatrics, Radboud University Medical Center, HB Nijmegen, the Netherlands
- Correspondence: Hedi L. Claahsen-van der Grinten, MD, PhD, Amalia Children’s Hospital, Radboud University Medical Center, Department of Pediatrics, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands.
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13
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Heijdra JM, Al Arashi W, de Jager NCB, Cloesmeijer ME, Bukkems LH, Zwaan CM, Leebeek FWG, Mathôt RAA, Cnossen MH. Is pharmacokinetic-guided dosing of desmopressin and von Willebrand factor-containing concentrates in individuals with von Willebrand disease or low von Willebrand factor reliable and feasible? A protocol for a multicentre, non-randomised, open label cohort trial, the OPTI-CLOT: to WiN study. BMJ Open 2022; 12:e049493. [PMID: 35168962 PMCID: PMC8852670 DOI: 10.1136/bmjopen-2021-049493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Von Willebrand disease (VWD) is a bleeding disorder, caused by a deficiency or defect of von Willebrand factor (VWF). In case of medical procedures or bleeding, patients are treated with desmopressin and/or VWF-containing concentrates to increase plasma VWF and factor VIII (FVIII). However, in many cases these factor levels are outside the targeted range. Therefore, population pharmacokinetic (PK) models have been developed, which aim to quantify and explain intraindividual and interindividual differences in treatment response. These models enable calculation of individual PK parameters by Bayesian analysis, based on an individual desmopressin test or PK profile with a VWF-containing concentrate. Subsequently, the dose necessary for an individual to achieve coagulation factor target levels can be calculated. METHODS AND ANALYSIS Primary aim of this study is to assess the predictive performance (the difference between predicted and measured von VWF activity and FVIII levels) of Bayesian forecasting using the developed population PK models in four different situations: (A) desmopressin testing (n≥30); (B) medical procedures (n=70; 30 receiving desmopressin, 30 receiving VWF-containing concentrate and 10 receiving a combination of both); (C) bleeding episodes (n=20; 10 receiving desmopressin and 10 receiving VWF-containing concentrate) and (D) prophylaxis with a VWF-containing concentrate (n=3 to 5). Individuals with all types of VWD and individuals with low VWF (VWF 0.30-0.60 IU/mL) will be included. Reliability and feasibility of PK-guided dosing will be tested by assessing predictive performance, treatment duration, haemostasis, patient satisfaction and physician satisfaction. ETHICS AND DISSEMINATION The OPTI-CLOT:to WiN study was approved by the medical ethics committee of the Erasmus MC, University Medical Centre Rotterdam, the Netherlands. Results of the study will be communicated through publication in international scientific journals and presentation at (inter)national conferences. TRIAL REGISTRATION NUMBER NL7212 (NTR7411); Pre-results, EudraCT 2018-001631-46.
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Affiliation(s)
- Jessica M Heijdra
- Department of Pediatric Hematology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wala Al Arashi
- Department of Pediatric Hematology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nico C B de Jager
- Hospital Pharmacy - Clinical Pharmacology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael E Cloesmeijer
- Hospital Pharmacy - Clinical Pharmacology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Laura H Bukkems
- Hospital Pharmacy - Clinical Pharmacology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Christian M Zwaan
- Department of Pediatric Oncology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ron A A Mathôt
- Hospital Pharmacy - Clinical Pharmacology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Ten Hoorn S, Sommeijer DW, Elliott F, Fisher D, de Back TR, Trinh A, Koens L, Maughan T, Seligmann J, Seymour MT, Quirke P, Adams R, Richman SD, Punt CJA, Vermeulen L. Molecular subtype-specific efficacy of anti-EGFR therapy in colorectal cancer is dependent on the chemotherapy backbone. Br J Cancer 2021; 125:1080-1088. [PMID: 34253874 PMCID: PMC8505637 DOI: 10.1038/s41416-021-01477-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/08/2021] [Accepted: 06/30/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Patient selection for addition of anti-EGFR therapy to chemotherapy for patients with RAS and BRAF wildtype metastatic colorectal cancer can still be optimised. Here we investigate the effect of anti-EGFR therapy on survival in different consensus molecular subtypes (CMSs) and stratified by primary tumour location. METHODS Retrospective analyses, using the immunohistochemistry-based CMS classifier, were performed in the COIN (first-line oxaliplatin backbone with or without cetuximab) and PICCOLO trial (second-line irinotecan with or without panitumumab). Tumour tissue was available for 323 patients (20%) and 349 (41%), respectively. RESULTS When using an irinotecan backbone, anti-EGFR therapy is effective in both CMS2/3 and CMS4 in left-sided primary tumours (progression-free survival (PFS): HR 0.44, 95% CI 0.26-0.75, P = 0.003 and HR 0.12, 95% CI 0.04-0.36, P < 0.001, respectively) and in CMS4 right-sided tumours (PFS HR 0.17, 95% CI 0.04-0.71, P = 0.02). Efficacy using an oxaliplatin backbone was restricted to left-sided CMS2/3 tumours (HR 0.57, 95% CI 0.36-0.96, P = 0.034). CONCLUSIONS The subtype-specific efficacy of anti-EGFR therapy is dependent on the chemotherapy backbone. This may provide the possibility of subtype-specific treatment strategies for a more optimal use of anti-EGFR therapy.
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Affiliation(s)
- Sanne Ten Hoorn
- Amsterdam UMC, University of Amsterdam, LEXOR, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Dirkje W Sommeijer
- Amsterdam UMC, University of Amsterdam, LEXOR, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Flevohospital, Department of Internal Medicine, Almere, The Netherlands
| | - Faye Elliott
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - David Fisher
- MRC Clinical Trials Unit, University College London, London, UK
| | - Tim R de Back
- Amsterdam UMC, University of Amsterdam, LEXOR, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anne Trinh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lianne Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tim Maughan
- Department of Oncology, University of Oxford, Oxford, UK
| | - Jenny Seligmann
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - Matthew T Seymour
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - Phil Quirke
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - Richard Adams
- Centre for Trials Research Cardiff University and Velindre Hospital, Cardiff, Wales, UK
| | - Susan D Richman
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - Cornelis J A Punt
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Louis Vermeulen
- Amsterdam UMC, University of Amsterdam, LEXOR, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands.
- Oncode Institute, Amsterdam UMC, Amsterdam, The Netherlands.
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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van Dalen M, Pasmans SGMA, Aendekerk ML, Mathijssen I, Koudstaal M, Timman R, Williamson H, Hillegers M, Utens EMWJ, Okkerse J. Investigating online psychological treatment for adolescents with a visible difference in the Dutch YP Face IT study: protocol of a randomised controlled trial. BMJ Open 2021; 11:e041449. [PMID: 33483443 PMCID: PMC7831738 DOI: 10.1136/bmjopen-2020-041449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This paper outlines the study protocol for the Dutch Young People (YP) Face IT Study. Adolescents with a visible difference (ie, disfigurement) often experience challenging social situations such as being stared at, receiving unwanted questions or being teased. As a consequence, some of these adolescents experience adverse psychosocial outcomes and appearance-related distress. To address this appearance-related distress, an online psychotherapeutic intervention, YP Face IT, has been developed. YP Face IT uses social interaction skills training and cognitive-behavioural therapy. The Dutch YP Face IT Study tests whether this intervention is effective in reducing social anxiety and improving body esteem. METHODS AND ANALYSIS Participants are adolescents aged 12-18 with a visible difference and experiencing appearance-related distress. In this two-armed randomised controlled trial, 224 adolescents will be randomised to care as usual or YP Face IT. Adolescents will complete questionnaires at baseline, at 13 weeks and at 25 weeks. Primary outcomes are differences in social anxiety and body esteem between YP Face IT and care as usual. Secondary outcomes are differences in aspects of self-worth, perceived stigmatisation, health-related quality of life, life engagement, appearance-related distress and depressive symptoms between the two groups. ETHICS AND DISSEMINATION Research ethics approval was obtained from the medical ethics review committee in Rotterdam (reference number MEC-2018-052/NL63955.078.18). Findings will be disseminated through academic peer-reviewed publications, conferences and newsletters to patient associations and participants of the study. TRIAL REGISTRATION NUMBER The Netherlands Trial Register (NL7626).
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Affiliation(s)
- Marije van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Centre of Pediatric Dermatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Marie-Louise Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Irene Mathijssen
- Department of Plastic and Reconstructive and Hand Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia-Children's Hospital, Rotterdam, Netherlands
| | - Maarten Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Reinier Timman
- Department of Psychiatry, unit of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, Netherlands
| | - Heidi Williamson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Child Psychiatry Levvel/Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jolanda Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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Rutten GEHM, Van Vugt H, de Koning E. Person-centered diabetes care and patient activation in people with type 2 diabetes. BMJ Open Diabetes Res Care 2020; 8:8/2/e001926. [PMID: 33323460 PMCID: PMC7745339 DOI: 10.1136/bmjdrc-2020-001926] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The American Diabetes Association and the European Association for the Study of Diabetes advocate a person-centered approach to enhance patient engagement in self-care activities. To that purpose, people with diabetes need adequate diabetes knowledge, motivation, skills and confidence. These prerequisites are captured by the concept 'patient activation'. The Dutch Diabetes Federation implemented a person-centered consultation model for the annual diabetes review. To assess its relationship with patient activation, we measured the change in patient activation, and in person and disease-related factors in people with type 2 diabetes after their second person-centered annual review. RESEARCH DESIGN AND METHODS Observational study in 47 primary care practices and six outpatient hospital clinics. FOLLOW-UP 1 year. From 2.617 people with diabetes and capable of completing questionnaires (no additional exclusion criteria) 1.487 (56.8%) participated, 1366 with type 2 diabetes. MAIN OUTCOME patient activation (13-item Patient Activation Measure, score 0-100). Before the first and after the second review, participants completed questionnaires. Medical data were retrieved from electronic records. We performed a repeated measure analysis using a linear mixed model in 1299 participants, who completed the first set of questionnaires. RESULTS In 1299 participants (41.6% female, mean age 66 years, median diabetes duration 10 years, median glycated hemoglobin (HbA1c) 6.8%/51 mmol/mol), the mean baseline activation level was 58.9 (SD 11.7). Independent of actual diabetes care, activation levels increased 1.53 units (95% CI 0.67 to 2.39, p=0.001). Several diabetes perceptions improved significantly; diabetes distress level decreased significantly. Body mass index (-0.22, 95% CI -0.33 to -0.10, p<0.001) and low-density lipoprotein cholesterol (-2.71 mg/dL, 95% CI -4.64 to -0.77, p=0.004) decreased, HbA1c increased 0.08% (95% CI 0.03 to 0.12) (p=0.001). CONCLUSIONS Person-centered diabetes care was associated with a slightly higher patient activation level, improved diabetes perception and small improvements in clinical outcomes. Person-centered care may enhance patient engagement, but one should not expect substantial improvement in patient outcomes in the short term.
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Affiliation(s)
- Guy E H M Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heidi Van Vugt
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Eelco de Koning
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
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Petit-Steeghs V, Mogami-Asselin GIK, Nijenkamp MD, Spoel M, Broerse JEW, Pittens CACM. Empowering Patients and Health Professionals to Address Sexual Health in the Context of Anorectal Malformations and Hirschsprung's Disease. Qual Health Res 2020; 30:2033-2048. [PMID: 32762414 PMCID: PMC7549282 DOI: 10.1177/1049732320944653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study is to develop a tool that is aligned with patients' and health professionals' needs to address sexual health in the context of anorectal malformations and Hirschsprung's disease. A multiphased participatory action-research was conducted. First, an inventory of needs was made through interviews (11 patients, 11 professionals), three online focus groups (4 patients, 20 professionals), and a questionnaire (38 patients). Subsequently, four cocreation sessions with in total four patients and nine professionals were organized to translate the needs into a tool (in the form of a website). The websites' functionality was assessed via a questionnaire (n = 34). The website, directed to patients, their parents, and professionals, stimulates awareness, fills knowledge gaps, and shows possibilities for support. The website is expected to change restrictive attitudes toward sexual health and improve the legitimization of the topic needed for the allocation of resources and sexologists' involvement in current care pathways.
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Affiliation(s)
- V. Petit-Steeghs
- Athena Institute, Faculty of
Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Erasmus School of Health Policy
and Management, Erasmus University Rotterdam, Rotterdam, the
Netherlands
| | - G. I. K. Mogami-Asselin
- Athena Institute, Faculty of
Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M. D. Nijenkamp
- Athena Institute, Faculty of
Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M. Spoel
- Erasmus University Medical
Center—Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - J. E. W. Broerse
- Athena Institute, Faculty of
Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - C. A. C. M. Pittens
- Athena Institute, Faculty of
Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Schuurmans AAT, de Looff P, Nijhof KS, Rosada C, Scholte RHJ, Popma A, Otten R. Validity of the Empatica E4 Wristband to Measure Heart Rate Variability (HRV) Parameters: a Comparison to Electrocardiography (ECG). J Med Syst 2020; 44:190. [PMID: 32965570 PMCID: PMC7511462 DOI: 10.1007/s10916-020-01648-w] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/25/2020] [Indexed: 01/07/2023]
Abstract
Wearable monitoring devices are an innovative way to measure heart rate (HR) and heart rate variability (HRV), however, there is still debate about the validity of these wearables. This study aimed to validate the accuracy and predictive value of the Empatica E4 wristband against the VU University Ambulatory Monitoring System (VU-AMS) in a clinical population of traumatized adolescents in residential care. A sample of 345 recordings of both the Empatica E4 wristband and the VU-AMS was derived from a feasibility study that included fifteen participants. They wore both devices during two experimental testing and twelve intervention sessions. We used correlations, cross-correlations, Mann-Whitney tests, difference factors, Bland-Altman plots, and Limits of Agreement to evaluate differences in outcomes between devices. Significant correlations were found between Empatica E4 and VU-AMS recordings for HR, SDNN, RMSSD, and HF recordings. There was a significant difference between the devices for all parameters but HR, although effect sizes were small for SDNN, LF, and HF. For all parameters but RMSSD, testing outcomes of the two devices led to the same conclusions regarding significance. The Empatica E4 wristband provides a new opportunity to measure HRV in an unobtrusive way. Results of this study indicate the potential of the Empatica E4 as a practical and valid tool for research on HR and HRV under non-movement conditions. While more research needs to be conducted, this study could be considered as a first step to support the use of HRV recordings provided by wearables.
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Affiliation(s)
- Angela A T Schuurmans
- Department of Research and Development, Pluryn, P.O. Box 53, 6500, AB, Nijmegen, The Netherlands.
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands.
| | - Peter de Looff
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
- Wier, Specialized and Forensic Care Fivoor, Den Dolder, Netherlands
| | - Karin S Nijhof
- Department of Research and Development, Pluryn, P.O. Box 53, 6500, AB, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
| | - Catarina Rosada
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
| | - Ron H J Scholte
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
- Praktikon, P.O. Box 6909, 6503, GK, Nijmegen, The Netherlands
- Tranzo, Tilburg University, P. O. Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry, VUmc/De Bascule, P.O. Box 303, 1115 ZG, Duivendrecht, Amsterdam, The Netherlands
| | - Roy Otten
- Department of Research and Development, Pluryn, P.O. Box 53, 6500, AB, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
- ASU REACH Institute, Department of Psychology, Arizona State University, P.O. Box 876005, Tempe, AZ, 85287-6005, USA
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19
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Stol DM, Hollander M, Badenbroek IF, Nielen MMJ, Schellevis FG, de Wit NJ. Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care-a cohort study. Eur J Public Health 2020; 30:479-484. [PMID: 31722402 PMCID: PMC7292350 DOI: 10.1093/eurpub/ckz201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Early detection and treatment of cardiometabolic diseases (CMD) in high-risk patients is a promising preventive strategy to anticipate the increasing burden of CMD. The Dutch guideline ‘the prevention consultation’ provides a framework for stepwise CMD risk assessment and detection in primary care. The aim of this study was to assess the outcome of this program in terms of newly diagnosed CMD. Methods A cohort study among 30 934 patients, aged 45–70 years without known CMD or CMD risk factors, who were invited for the CMD detection program within 37 general practices. Patients filled out a CMD risk score (step 1), were referred for additional risk profiling in case of high risk (step 2) and received lifestyle advice and (pharmacological) treatment if indicated (step 3). During 1-year follow-up newly diagnosed CMD, prescriptions and abnormal diagnostic tests were assessed. Results Twelve thousand seven hundred and thirty-eight patients filled out the risk score of which 865, 6665 and 5208 had a low, intermediate and high CMD risk, respectively. One thousand seven hundred and fifty-five high-risk patients consulted the general practitioner, in 346 of whom a new CMD was diagnosed. In an additional 422 patients a new prescription and/or abnormal diagnostic test were found. Conclusions Implementation of the CMD detection program resulted in a new CMD diagnosis in one-fifth of high-risk patients who attended the practice for completion of their risk profile. However, the potential yield of the program could be higher given the considerable number of additional risk factors—such as elevated glucose, blood pressure and cholesterol levels—found, requiring active follow-up and presumably treatment in the future.
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Affiliation(s)
- Daphne M Stol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Correspondence: Daphne M. Stol, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands, Tel: +31 887568181, e-mail:
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ilse F Badenbroek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Mark M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - François G Schellevis
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (Location VUmc), Amsterdam, The Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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20
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Bosch A, Bierens M, de Wit AG, Ly V, van der Velde J, de Boer H, van Beek G, Appelman D, Visser S, Bos L, van der Meer J, Kamphuis N, Draaisma JMT, Donders R, van de Loo-Neus GHH, Hoekstra PJ, Bottelier M, Arias-Vasquez A, Klip H, Buitelaar JK, van den Berg SW, Rommelse NN. A two arm randomized controlled trial comparing the short and long term effects of an elimination diet and a healthy diet in children with ADHD (TRACE study). Rationale, study design and methods. BMC Psychiatry 2020; 20:262. [PMID: 32460725 PMCID: PMC7251686 DOI: 10.1186/s12888-020-02576-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/30/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Food may trigger Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms. Therefore, an elimination diet (ED) might be an effective treatment for children with ADHD. However, earlier studies were criticized for the nature of the control group, potential confounders explaining the observed effects, unsatisfactory blinding, potential risks of nutritional deficiencies and unknown long term and cost-effectiveness. To address these issues, this paper describes the rationale, study design and methods of an ongoing two arm randomized controlled trial (RCT) comparing the short (5 week) and long term (1 year) effects of an elimination diet and a healthy diet compared with care as usual (CAU) in children with ADHD. METHODS A total of N = 162 children (5-12 years) with ADHD will be randomized to either an ED or a healthy diet. A comparator arm including N = 60 children being solely treated with CAU (e.g. medication) is used to compare the effects found in both dietary groups. The two armed RCT is performed in two youth psychiatry centers in the Netherlands, with randomization within each participating center. The primary outcome measure is response to treatment defined as a ≥ 30% reduction on an ADHD DSM-5 rating scale (SWAN) and/or on an emotion dysregulation rating scale (SDQ: dysregulation profile). This is assessed after 5 weeks of dietary treatment, after which participants continue the diet or not. Secondary outcome measures include the Disruptive Behavior Diagnostic Observational Schedule (DB-DOS), parent and teacher ratings of comorbid symptoms, cognitive assessment (e.g. executive functions), school functioning, physical measurements (e.g. weight), motor activity, sleep pattern, food consumption, nutritional quality of the diet, adherence, parental wellbeing, use of health care resources and cost-effectiveness. Assessments take place at the start of the study (T0), after five weeks (T1), four months (T2), eight months (T3) and 12 months of treatment (T4). T0, T1 and T4 assessments take place at one of the psychiatric centers. T2 and T3 assessments consist of filling out online questionnaires by the parents only. DISCUSSION This RCT will likely contribute significantly to clinical practice for ADHD by offering insight into the feasibility, nutritional quality, (cost-)effectiveness and long term effects of dietary treatments for ADHD. TRIAL REGISTRATION www.trialregister.nl, NTR5434. Registered at October 11th, 2015.
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Affiliation(s)
- Annick Bosch
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands.
| | - Margreet Bierens
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Ardine G de Wit
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Verena Ly
- Leiden University, Institute of Psychology and Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Jessica van der Velde
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Heleen de Boer
- Accare, Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Gerry van Beek
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Danielle Appelman
- Triversum - GGZ-NHN, Child and Adolescent Psychiatry, Alkmaar, the Netherlands
| | | | - Lisa Bos
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Jolanda van der Meer
- De Bascule, Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Niki Kamphuis
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud University Medical Center Amalia Children's hospital, Nijmegen, the Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gigi H H van de Loo-Neus
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marco Bottelier
- Triversum - GGZ-NHN, Child and Adolescent Psychiatry, Alkmaar, the Netherlands
| | - Alejandro Arias-Vasquez
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helen Klip
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Jan K Buitelaar
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia W van den Berg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Nanda N Rommelse
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
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de Jonge SW, Wolfhagen N, Boldingh QJ, Bom WJ, Posthuma LM, Scheijmans JC, van der Leeuw BM, van der Hoeven JA, Hering JP, Sonneveld DJ, van Geffen OE, Hendriks ER, Kluyver EB, Demirkiran A, van Lonkhuijzen LR, Slotema T, Draaisma WA, Koopman SJ, van Rossem CC, Over LM, van Duijvendijk P, Dijkgraaf MG, Hollmann MW, Boermeester MA. Enhanced PeriOperative Care and Health protection programme for the prevention of surgical site infections after elective abdominal surgery (EPOCH): study protocol of a randomised controlled, multicentre, superiority trial. BMJ Open 2020; 10:e038196. [PMID: 32457082 PMCID: PMC7252990 DOI: 10.1136/bmjopen-2020-038196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Surgical site infections (SSI) are a common postoperative complication. During the development of the new WHO guidelines on SSI prevention, also in the Netherlands was concluded that perioperative care could be optimised beyond the current standard practice. We selected a limited set of readily available, cheap and evidence-based interventions from these new guidelines that are not part of standard practice in the Netherlands and formulated an Enhanced PeriOperative Care and Health bundle (EPOCH). Here, we describe the protocol for an open-label, randomised controlled, parallel-group, superiority trial to test the effect of the EPOCH bundle added to (national) standard care in comparison to standard care alone on the incidence of SSI. METHODS AND ANALYSIS EPOCH consists of intraoperative high fractional inspired oxygen (0.80); goal-directed fluid therapy; active preoperative, intraoperative and postoperative warming; perioperative glucose control and treatment of severe hyperglycaemia (>10 mmoll-1) and standardised surgical site handling. Patients scheduled for elective abdominal surgery with an incision larger than 5 cm are eligible for inclusion. Participants are randomised daily, 1:1 according to variable block sizes, and stratified per participating centre to either EPOCH added to standard care or standard care only. The primary endpoint will be SSI incidence according to the Centers for Disease Control and Prevention (CDC) definition within 30 days as part of routine clinical follow-up. Four additional questionnaires will be sent out over the course of 90 days to capture disability and costs. Other secondary endpoints include anastomotic leakage, incidence of incisional hernia, serious adverse events, hospital readmissions, length of stay and cost effectiveness. Analysis of the primary endpoint will be on an intention-to-treat basis. ETHICS AND DISSEMINATION Ethics approval is granted by the Amsterdam UMC Medical Ethics Committee (reference 2015_121). Results will be disseminated through peer-reviewed journals and summaries shared with stakeholders. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER Registered in the Dutch Trial Register: NL5572.
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Affiliation(s)
- Stijn W de Jonge
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Niels Wolfhagen
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Quirine Jj Boldingh
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Wouter J Bom
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Linda M Posthuma
- Department of Anesthesiology, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Jochem Cg Scheijmans
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Bart Mf van der Leeuw
- Department of Anesthesiology, Albert Schweitzer Hospital, Dordrecht, Noord-Holland, Netherlands
| | | | - Jens Peter Hering
- Anesthesiology, Dijklander Ziekenhuis, Hoorn, Noord-Holland, Netherlands
| | - Dirk Ja Sonneveld
- Department of Surgery, Dijklander Ziekenhuis, Hoorn, Noord-Holland, Netherlands
| | - Otto E van Geffen
- Department of Anesthesiology, Tergooiziekenhuizen, Hilversum, Noord-Holland, Netherlands
| | - Eduard R Hendriks
- Department of Surgery, Tergooiziekenhuizen, Hilversum, Noord-Holland, Netherlands
| | - Ewoud B Kluyver
- Department of Anesthesiology, Rode Kruis Ziekenhuis, Beverwijk, Noord-Holland, Netherlands
| | - Ahmet Demirkiran
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, Noord-Holland, Netherlands
| | - Luc Rcw van Lonkhuijzen
- Department of Gynaecologic Oncology, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Thomas Slotema
- Department of Anesthesiology, Jeroen Bosch Hospital, 's-Hertogenbosch, Noord-Brabant, Netherlands
| | - Werner A Draaisma
- Department of Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, Noord-Brabant, Netherlands
| | - Seppe Jsha Koopman
- Department of Anesthesiology, Maasstad Ziekenhuis, Rotterdam, Zuid-Holland, Netherlands
| | - Charles C van Rossem
- Department of Surgery, Maasstad Ziekenhuis, Rotterdam, Zuid-Holland, Netherlands
| | - Linda M Over
- Department of Anesthesiology, Gelre Ziekenhuizen, Apeldoorn, Gelderland, Netherlands
| | | | - Marcel Gw Dijkgraaf
- Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, Noord-Holland, Netherlands
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van de Maat JS, Peeters D, Nieboer D, van Wermeskerken AM, Smit FJ, Noordzij JG, Tramper-Stranders G, Driessen GJA, Obihara CC, Punt J, van der Lei J, Polinder S, Moll HA, Oostenbrink R. Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in The Netherlands: A stepped-wedge cluster randomised trial. PLoS Med 2020; 17:e1003034. [PMID: 32004317 PMCID: PMC6993966 DOI: 10.1371/journal.pmed.1003034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/06/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Optimising the use of antibiotics is a key component of antibiotic stewardship. Respiratory tract infections (RTIs) are the most common reason for antibiotic prescription in children, even though most of these infections in children under 5 years are viral. This study aims to safely reduce antibiotic prescriptions in children under 5 years with suspected lower RTI at the emergency department (ED), by implementing a clinical decision rule. METHODS AND FINDINGS In a stepped-wedge cluster randomised trial, we included children aged 1-60 months presenting with fever and cough or dyspnoea to 8 EDs in The Netherlands. The EDs were of varying sizes, from diverse geographic and demographic regions, and of different hospital types (tertiary versus general). In the pre-intervention phase, children received usual care, according to the Dutch and NICE guidelines for febrile children. During the intervention phase, a validated clinical prediction model (Feverkidstool) including clinical characteristics and C-reactive protein (CRP) was implemented as a decision rule guiding antibiotic prescription. The intervention was that antibiotics were withheld in children with a low or intermediate predicted risk of bacterial pneumonia (≤10%, based on Feverkidstool). Co-primary outcomes were antibiotic prescription rate and strategy failure. Strategy failure was defined as secondary antibiotic prescriptions or hospitalisations, persistence of fever or oxygen dependency up to day 7, or complications. Hospitals were randomly allocated to 1 sequence of treatment each, using computer randomisation. The trial could not be blinded. We used multilevel logistic regression to estimate the effect of the intervention, clustered by hospital and adjusted for time period, age, sex, season, ill appearance, and fever duration; predicted risk was included in exploratory analysis. We included 999 children (61% male, median age 17 months [IQR 9 to 30]) between 1 January 2016 and 30 September 2018: 597 during the pre-intervention phase and 402 during the intervention phase. Most children (77%) were referred by a general practitioner, and half of children were hospitalised. Intention-to-treat analyses showed that overall antibiotic prescription was not reduced (30% to 25%, adjusted odds ratio [aOR] 1.07 [95% CI 0.57 to 2.01, p = 0.75]); strategy failure reduced from 23% to 16% (aOR 0.53 [95% CI 0.32 to 0.88, p = 0.01]). Exploratory analyses showed that the intervention influenced risk groups differently (p < 0.01), resulting in a reduction in antibiotic prescriptions in low/intermediate-risk children (17% to 6%; aOR 0.31 [95% CI 0.12 to 0.81, p = 0.02]) and a non-significant increase in the high-risk group (47% to 59%; aOR 2.28 [95% CI 0.84 to 6.17, p = 0.09]). Two complications occurred during the trial: 1 admission to the intensive care unit during follow-up and 1 pleural empyema at day 10 (both unrelated to the study intervention). Main limitations of the study were missing CRP values in the pre-intervention phase and a prolonged baseline period due to logistical issues, potentially affecting the power of our study. CONCLUSIONS In this multicentre ED study, we observed that a clinical decision rule for childhood pneumonia did not reduce overall antibiotic prescription, but that it was non-inferior to usual care. Exploratory analyses showed fewer strategy failures and that fewer antibiotics were prescribed in low/intermediate-risk children, suggesting improved targeting of antibiotics by the decision rule. TRIAL REGISTRATION Netherlands Trial Register NTR5326.
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Affiliation(s)
- Josephine S. van de Maat
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
- * E-mail:
| | - Daphne Peeters
- Department of Paediatrics, HAGA–Juliana Children’s Hospital, Den Haag, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Frank J. Smit
- Department of Paediatrics, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Jeroen G. Noordzij
- Department of Paediatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | | | - Charlie C. Obihara
- Department of Paediatrics, Elisabeth–TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Jeanine Punt
- Department of Paediatrics, LangeLand Ziekenhuis, Zoetermeer, The Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Henriette A. Moll
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
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van den Berg J, Hamel CC, Snijders MP, Coppus SF, Vandenbussche FP. Mifepristone and misoprostol versus misoprostol alone for uterine evacuation after early pregnancy failure: study protocol for a randomized double blinded placebo-controlled comparison (Triple M Trial). BMC Pregnancy Childbirth 2019; 19:443. [PMID: 31775677 PMCID: PMC6880504 DOI: 10.1186/s12884-019-2497-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/09/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early pregnancy failure (EPF) is a common complication of pregnancy. If women do not abort spontaneously, they will undergo medical or surgical treatment in order to remove the products of conception from the uterus. Curettage, although highly effective, is associated with a risk of complications; medical treatment with misoprostol is a safe and less expensive alternative. Unfortunately, after 1 week of expectant management in case of EPF, medical treatment with misoprostol has a complete evacuation rate of approximately 50%. Misoprostol treatment results may be improved by pre-treatment with mifepristone; its effectiveness has already been proven for other indications of pregnancy termination. This study will test the hypothesis that, in EPF, the sequential combination of mifepristone with misoprostol is superior to the use of misoprostol alone in terms of complete evacuation (primary outcome), patient satisfaction, complications, side effects and costs (secondary outcomes). METHODS The trial will be performed multi-centred, prospectively, two-armed, randomised, double-blinded and placebo-controlled. Women with confirmed EPF by ultrasonography (6-14 weeks), managed expectantly for at least 1 week, can be included and randomised to pre-treatment with oral mifepristone (600 mg) or oral placebo (identical in appearance). Randomisation will take place after receiving written consent to participate. In both arms pre-treatment will be followed by oral misoprostol, which will start 36-48 h later consisting of two doses 400 μg (4 hrs apart), repeated after 24 h if no tissue is lost. Four hundred sixty-four women will be randomised in a 1:1 ratio, stratified by centre. Ultrasonography 2 weeks after treatment will determine short term treatment effect. When the gestational sac is expulsed, expectant management is advised until 6 weeks after treatment when the definitive primary endpoint, complete or incomplete evacuation, will be determined. A sonographic endometrial thickness < 15 mm using only the allocated therapy by randomisation is considered as successful treatment. Secondary outcome measures (patient satisfaction, complications, side effects and costs) will be registered using a case report form, patient diary and validated questionnaires (Short Form 36, EuroQol-VAS, Client Satisfaction Questionnaire, iMTA Productivity Cost Questionnaire). DISCUSSION This trial will answer the question if, in case of EPF, after at least 1 week of expectant management, sequential treatment with mifepristone and misoprostol is more effective than misoprostol alone to achieve complete evacuation of the products of conception. TRIAL REGISTRATION Clinicaltrials.gov (d.d. 02-07-2017): NCT03212352. Trialregister.nl (d.d. 03-07-2017): NTR6550. EudraCT number (d.d. 07-08-2017): 2017-002694-19. File number Commisie Mensgebonden Onderzoek (d.d. 07-08-2017): NL 62449.091.17.
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Affiliation(s)
- Joyce van den Berg
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Postbus 9015, Nijmegen, GS 6500 The Netherlands
| | - Charlotte C. Hamel
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Postbus 9015, Nijmegen, GS 6500 The Netherlands
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, GA 6525 The Netherlands
| | - Marcus P. Snijders
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Postbus 9015, Nijmegen, GS 6500 The Netherlands
| | - Sjors F. Coppus
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, De Run 4600, Veldhoven, DB 5504 The Netherlands
| | - Frank P. Vandenbussche
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, GA 6525 The Netherlands
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Keij FM, Kornelisse RF, Hartwig NG, Mauff K, Poley MJ, Allegaert K, Reiss IKM, Tramper-Stranders GA. RAIN study: a protocol for a randomised controlled trial evaluating efficacy, safety and cost-effectiveness of intravenous-to-oral antibiotic switch therapy in neonates with a probable bacterial infection. BMJ Open 2019; 9:e026688. [PMID: 31289068 PMCID: PMC6615779 DOI: 10.1136/bmjopen-2018-026688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION High morbidity and mortality rates of proven bacterial infection are the main reason for substantial use of intravenous antibiotics in neonates during the first week of life. In older children, intravenous-to-oral switch after 48 hours of intravenous therapy has been shown to have many advantages and is nowadays commonly practised. We, therefore, aim to evaluate the effectiveness, safety and cost-effectiveness of an early intravenous-to-oral switch in neonates with a probable bacterial infection. METHODS AND ANALYSIS We present a protocol for a multicentre randomised controlled trial assessing the non-inferiority of an early intravenous-to-oral antibiotic switch compared with a full course of intravenous antibiotics in neonates (0-28 days of age) with a probable bacterial infection. Five hundred and fifty patients will be recruited in 17 hospitals in the Netherlands. After 48 hours of intravenous treatment, they will be assigned to either continue with intravenous therapy for another 5 days (control) or switch to amoxicillin/clavulanic acid suspension (intervention). Both groups will be treated for a total of 7 days. The primary outcome will be bacterial (re)infection within 28 days after treatment completion. Secondary outcomes are the pharmacokinetic profile of oral amoxicillin/clavulanic acid, the impact on quality of life, cost-effectiveness, impact on microbiome development and additional yield of molecular techniques in diagnosis of probable bacterial infection. ETHICS AND DISSEMINATION This study has been approved by the Medical Ethics Committee of the Erasmus Medical Centre. Results will be presented in peer-reviewed journals and at international conferences. TRIAL REGISTRATION NUMBER NCT03247920.
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Affiliation(s)
- Fleur M Keij
- Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Pediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - René F Kornelisse
- Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nico G Hartwig
- Pediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Katya Mauff
- Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marten J Poley
- Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Karel Allegaert
- Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Irwin K M Reiss
- Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Gerdien A Tramper-Stranders
- Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Pediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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Oprel DAC, Hoeboer CM, Schoorl M, De Kleine RA, Wigard IG, Cloitre M, Van Minnen A, Van der Does W. Improving treatment for patients with childhood abuse related posttraumatic stress disorder (IMPACT study): protocol for a multicenter randomized trial comparing prolonged exposure with intensified prolonged exposure and phase-based treatment. BMC Psychiatry 2018; 18:385. [PMID: 30541492 PMCID: PMC6291949 DOI: 10.1186/s12888-018-1967-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Childhood abuse related posttraumatic stress disorder (CA-PTSD) is associated with a high burden of disease and with treatment response rates that leave room for improvement. One of the treatments for PTSD, prolonged exposure (PE), is effective but has high drop-out rates and remission rates are relatively low. An intensified form of PE (iPE) was associated with good response and low drop-out rates in PTSD and has not yet been tested in a controlled trial in CA-PTSD. Phase-based treatment (PBT), in which PE is preceded by skills training may improve overall outcomes in this population. We will assess the effectiveness and cost-effectiveness of standard PE, iPE and PBT in patients with CA-PTSD. METHODS/DESIGN Multi-center randomized controlled trial. Treatment conditions are: prolonged exposure (PE; maximum of 16 sessions in 16 weeks); intensified PE (iPE; maximum of 12 sessions in four weeks and two booster sessions); phase-based treatment (PBT; maximum of eight sessions skills training followed by eight sessions PE in 16 weeks). PRIMARY OUTCOME Clinician-rated PTSD symptom severity. SECONDARY OUTCOMES loss of PTSD diagnosis, self-reported PTSD symptom severity, comorbid symptom severity and quality of life. Moreover, we will examine cost-effectiveness and moderators and mediators of treatment outcome. TARGET POPULATION adults with CA-PTSD (N = 150). Assessments in weeks 0, 4, 8, 16, 26 and 52. DISCUSSION Given that no consensus yet exists about the treatment guidelines for patients with CA-PTSD, the present study may have important implications for the treatment of CA-PTSD. TRAIL REGISTRATION Registered at C.C.M.O. on Sept 7, 2016 (NL57984.058.16); retrospectively registered at June 21, 2017 at clinicaltrials.gov identifier: NCT03194113 .
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Affiliation(s)
- D. A. C. Oprel
- Leiden University, Institute of Psychology, Wassenaarsweg 22, 3332 AK Leiden, The Netherlands
- Parnassiagroep, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
| | - C. M. Hoeboer
- Leiden University, Institute of Psychology, Wassenaarsweg 22, 3332 AK Leiden, The Netherlands
- Parnassiagroep, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
| | - M. Schoorl
- Leiden University, Institute of Psychology, Wassenaarsweg 22, 3332 AK Leiden, The Netherlands
- Parnassiagroep, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
| | - R. A. De Kleine
- Leiden University, Institute of Psychology, Wassenaarsweg 22, 3332 AK Leiden, The Netherlands
| | - I. G. Wigard
- Parnassiagroep, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
- Department of Clinical Psychology, University of Amsterdam, Overschiestraat 61, 1062 XD Amsterdam, The Netherlands
| | - M. Cloitre
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA USA
- National Center for PTSD Dissemination and Training Division, Palo Alto Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA USA
| | - A. Van Minnen
- PSYTREC, Prof. dr. Bronkhorststraat 2, 3723 MB Bilthoven, The Netherlands
- Radboud University, Behavioural Science Institute, Nijmegen, The Netherlands
| | - W. Van der Does
- Leiden University, Institute of Psychology, Wassenaarsweg 22, 3332 AK Leiden, The Netherlands
- Parnassiagroep, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Thijssen J, Albrecht G, Muris P, de Ruiter C. Treatment Fidelity during Therapist Initial Training is related to Subsequent Effectiveness of Parent Management Training-Oregon Model. J Child Fam Stud 2017; 26:1991-1999. [PMID: 28680261 PMCID: PMC5487755 DOI: 10.1007/s10826-017-0706-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The present study examined the association between treatment fidelity during therapist initial training and subsequent treatment outcome of Parent Management Training - Oregon model (PMTO) in The Netherlands. Clinically referred children (N = 86) aged 4 to 11 years and their parents received PMTO and were assessed at four time points: at baseline, and after 6, 12, and 18 months. Difference scores between baseline and follow-up assessments of externalizing behavior problems, parenting practices, and parental psychopathology and parents' overall ratings of working alliance, were correlated with treatment fidelity scores measured prior to the intervention. Furthermore, differences in therapists' fidelity scores between treatment completers and drop-outs were examined. Results showed that higher fidelity scores of PMTO therapists during initial training were associated with larger improvements in externalizing behavior, parenting practices, and parental psychopathology, especially after 18 months. In addition, parents who completed the treatment had a significantly more adherent therapist than families who dropped out. However, the correlations between treatment fidelity and working alliance were non-significant. These findings indicate that therapists' high adherence to the PMTO treatment principles during initial training decreases the chance of treatment drop-out and positively affects the longterm effectiveness of PMTO.
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Affiliation(s)
- Jill Thijssen
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | | | - Peter Muris
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Corine de Ruiter
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
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