Smits M.,Radboud Institute for Health science |
Hanssen S.,Radboud Institute for Health science |
Huibers L.,Radboud Institute for Health science |
Giesen P.,University of Aarhus
Nederlands Tijdschrift voor Geneeskunde | Year: 2016
Objective To assess the organisation and appropriateness of telephone triage in general practices in the Netherlands. Design Cross-sectional observational study. Methods Via email we invited all members of the Dutch Association of practice assistants to complete an online survey. The questionnaire included questions about practice assistants' background characteristics and the practices' triage organisation. Furthermore, they were asked to assess the indicated type of care for a number of fictive case scenarios involving a variety of health problems and levels of urgency. To determine the appropriateness of the respondents' assessments, each was compared to a reference standard agreed by experts. In addition, the association between practice assistants' background characteristics and organizational setup of the triage organisation with the appropriateness of triage was examined. Results The response rate was 41.1% (N=973). The required care was assessed appropriately in 63.6% of the cases, overestimated in 19.3% and underestimated in 17.1% of cases. The sensitivity of identifying patients with a highly urgent problem was 76.7%, whereas the specificity was 94.0%. The appropriateness of the assessments of the required care was higher for more experienced assistants and assistants with regular daily work meetings with the GP. Triage training, use of a triage tool and authorization of advice provision were not associated with appropriateness of triage. Conclusion Triage by practice assistants in general practices is efficient, but potentially unsafe in highly urgent cases. It is therefore important to train practice assistants in the identification of highly urgent cases.
PubMed | Radboud Institute for Molecular Life science, Montpellier University, Grupo de Investigacion en Biomedicina Molecular, Donders Institute for Brain and 2 more.
Type: | Journal: Molecular therapy. Nucleic acids | Year: 2017
Usher syndrome (USH) is the most common cause of combined deaf-blindness in man. The hearing loss can be partly compensated by providing patients with hearing aids or cochlear implants, but the loss of vision is currently untreatable. In general, mutations in the USH2A gene are the most frequent cause of USH explaining up to 50% of all patients worldwide. The first deep-intronic mutation in the USH2A gene (c.7595-2144A>G) was reported in 2012, leading to the insertion of a pseudoexon (PE40) into the mature USH2A transcript. When translated, this PE40-containing transcript is predicted to result in a truncated non-functional USH2A protein. In this study, we explored the potential of antisense oligonucleotides (AONs) to prevent aberrant splicing of USH2A pre-mRNA as a consequence of the c.7595-2144A>G mutation. Engineered 2-O-methylphosphorothioate AONs targeting the PE40 splice acceptor site and/or exonic splice enhancer regions displayed significant splice correction potential in both patient derived fibroblasts and a minigene splice assay for USH2A c.7595-2144A>G, whereas a non-binding sense oligonucleotide had no effect on splicing. Altogether, AON-based splice correction could be a promising approach for the development of a future treatment for USH2A-associated retinitis pigmentosa caused by the deep-intronic c.7595-2144A>G mutation.
Clinical, biophysical, immunohistochemical, and in vivo reflectance confocal microscopy evaluation of the response of subjects with sensitive skin to home-use fractional non-ablative photothermolysis device
PubMed | Philips, Radboud Institute for Molecular Life science and Radboud Institute for Health science
Type: Journal Article | Journal: Lasers in surgery and medicine | Year: 2016
Fractional photothermolysis using professional devices is a well-accepted and a widely used technique for skin rejuvenation. Recently, the technology has also been implemented in devices for home-use. Yet, a subpopulation of consumers exists that reacts excessively to this stimulation and reports sensitive skin (SS).The goal of this study was to evaluate the response of subjects with SS and NSS to fractional non-ablative photothermolysis to provide additional insights in the pathophysiology of SS.Subjects with SS and non-sensitive skin (NSS), selected using a proprietary questionnaire were stimulated by applying a home-use fractional non-ablative photothermolysis device. Self-reported perceptions and objective effects were evaluated after 0.5, 8, 24, and 72 hours by clinical, biophysical and immunohistochemical assessment, and in vivo reflectance confocal microscopy (RCM).Significantly fewer mast cells were found in SS compared to NSS subjects, 0.5 and 72 hours after stimulus based on tryptase staining, and SS subjects report discomfort more frequently. Immunohistochemical biomarkers revealed new insights in the effects of fractional non-ablative photothermolysis, which were supported by RCM: peri- and interlesional epidermal proliferation, and changes in keratinocyte differentiation.Previously, we have already reported that SS could be elicited by mechanical and chemical stimuli. Thus, mild yet excessive self-reported perceptions described here supports the hypothesis about existence of generalized skin sensitivity. Furthermore, it supports a view point suggesting involvement of TRPV1 receptors in this phenomenon. While histological evaluation, in line with our previous results points to the role of mast cells in SS, overall, however, fractional non-ablative photothermolysis causes only mild damage, nearly equal in SS and NSS and could be used as an in vivo model for skin regeneration without manipulating the skin barrier. Lasers Surg. Med. 48:474-482, 2016. 2016 Wiley Periodicals, Inc.
Ezinga M.,Radboud University Nijmegen |
Ezinga M.,Radboud Institute for Health science |
Wetzels J.F.M.,Radboud University Nijmegen |
Bosch M.E.W.,Radboud University Nijmegen |
And 4 more authors.
Antiviral Therapy | Year: 2014
Background: Monitoring of side effects of long-term HIV treatment has become increasingly important. Tenofovir disoproxil fumarate (TDF), a first-line treatment option, is associated with kidney tubular dysfunction (KTD). Our objective was to further investigate the prevalence and risk factors of KTD, in particular its association with TDF plasma concentration in HIV-infected patients treated with TDF for at least one year. Methods: An observational cross-sectional single-centre study was conducted. KTD was defined as the presence of at least two of the following criteria: urinary α1-microglobulin/creatinine ratio >15 mg/10 mmol; fractional excretion (FE) of phosphate >20% in the presence of hypophosphataemia; FE of uric acid >10% in the presence of hypouricaemia and glucosuria. Multivariate logistic regression was used to study which variable was associated with KTD. Results: A total of 161 HIV patients were included. Abnormalities in tubular function were observed in 101 patients (62.7%), while 17 patients (10.6%) fulfilled the definition of KTD. Urinary α1-microglobulin/creatinine ratio was the most sensitive parameter to detect KTD. Multivariate logistic regression showed TDF plasma concentration to be the only variable associated with KTD. Post hoc analysis showed a stronger association between the product of TDF plasma concentration and TDF exposure and KTD. Conclusions: Parameters of KTD are frequently observed in patients on long-term TDF-containing combination antiretroviral therapy. KTD is associated with higher TDF plasma concentrations. A stronger association between the product of TDF plasma concentration and TDF exposure and KTD could suggest cumulative toxicity. A causative role for elevated TDF plasma concentration in development of KTD cannot be demonstrated in this cross-sectional analysis. Longitudinal research is needed to investigate the development and clinical relevance of KTD. ©2014 International Medical Press
Van Kempen J.A.L.,Radboud University Nijmegen |
Melis R.J.F.,Radboud University Nijmegen |
Perry M.,Radboud University Nijmegen |
Schers H.J.,Radboud Institute for Health science |
Olde Rikkert M.G.M.,Radboud University Nijmegen
Journal of the American Board of Family Medicine | Year: 2015
Background: To compare the outcomes of Comprehensive Geriatric Assessments by family physicians and geriatricians. Methods: An explorative observational study was conducted in six family practices (12 ambulatory family practitioners) and 1 geriatric department (4 hospital-based geriatricians) from a university medical center in Nijmegen (the Netherlands). As participants, we included 587 patients aged 70 years and older and registered in the six family practices. The main outcome measures were the judgment on the following: 1) absence or presence of frailty and 2) the state (good-fair-poor) on 8 underlying domains (physical, medication, cognition, sensory, instrumental activities of daily living scale, mobility, mental, and social) according to family practitioners and geriatricians based on a Comprehensive Geriatric Assessment. Results: Family physicians and geriatricians agreed on frailty absence/presence in 76% of cases. Geriatricians considered elderly more often frail than family physicians did (n = 294, 50% vs n = 213, 36%). Disagreement on frailty status was notably found in the patients who had less distinct, either poor or good, health states. Discordant frailty judgments, in which the geriatrician rated a person as frail and the family physicians did not, were related to geriatricians more often rating physical health as impaired. Further, geriatricians' judgments of frailty were more strongly related to impaired scores on the domains cognition, sensory, mobility, and mental compared with family physicians judgments: odds ratios 79.3 versus 9.3, 7.6 versus 2.0, 25.0 versus 3.0, and 18.0 versus 2.2, respectively. Impaired physical health and problematic medication use had equally strong associations with frailty in geriatricians and family physicians: odds ratios of 11.5 versus 10.4 and 2.4 versus 2.5, respectively. Conclusions: Geriatricians more often judge patients as frail compared with family physicians and seem to evaluate the available information differently. With increasing collaboration between primary and secondary care, understanding these differences becomes increasingly relevant. © 2015, American Board of Family Medicine. All rights reserved.
Bruggemann R.J.M.,Radboud University Nijmegen |
Bruggemann R.J.M.,Radboud Institute for Health science |
Aarnoutse R.E.,Radboud University Nijmegen |
Aarnoutse R.E.,Radboud Institute for Health science
Current Fungal Infection Reports | Year: 2015
Therapeutic drug monitoring (TDM) involves the measurement of plasma or serum drug concentration to adapt dosages to achieve predefined target concentrations that are associated with optimal clinical response while minimizing the chance of encountering toxicity. Many papers in the field of antifungal drugs have focused on the evidence that supports the use of TDMthereby emphasizing the breakpoints or target concentrations in general literature. This review focuses on the process of TDM to inform health care workers on the fundaments and prerequisites that safeguard the good application of TDM. Knowledge on the complete process of TDMincluding pharmacokinetics (and relevant covariates), pharmacodynamic aspects, trials that are necessary to provide uswith evidence, translation of knowledge to other populations and pathogens, and implications for the pre-analytical, analytical, and postanalytical phases (the process of TDM) are discussed in relevant detail. For each individual step, recommendations are made for the readers. We believe this will be a valuable resource and to be of added value to the many papers that focus on relations between exposure and efficacy or toxicity. It will help to achieve greater benefit of TDM. © The Author(s) 2015.
Lempers V.J.,Radboud University Nijmegen |
Lempers V.J.,Radboud Institute for Health science |
Bruggemann R.J.,Radboud University Nijmegen |
Bruggemann R.J.,Radboud Institute for Health science
Journal of Antimicrobial Chemotherapy | Year: 2016
The Information Age has revolutionized the ability of healthcare professionals (HCPs) to oversee a substantial body of clinically relevant information literally at one's fingertips. In the field of clinical pharmacology, this may be particularly useful for managing drug-drug interactions (DDIs). A thorough understanding of the underlying mechanisms of DDIs allows the HCP to predict such interactions and avoid those of greatest clinical significance. Specifically, successful treatment with antifungal agents is complicated by the high potential to interact with other concomitant medications. We describe here the development of a real-time knowledge base of DDIs with antifungal agents, providing expert recommendations to HCPs on how to handle DDIs with these drugs. This new resource will facilitate rapid identification, quantification and classification of these DDIs by clinicians with varying levels of experience and resources worldwide, ultimately improving patient safety and strengthening health systems. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
PubMed | University Utrecht, Canisius Wilhelmina Hospital, Uppsala University, Radboud University Nijmegen and 3 more.
Type: Journal Article | Journal: Clinical pharmacokinetics | Year: 2016
Caspofungin is an echinocandin antifungal agent used as first-line therapy for the treatment of invasive candidiasis. The maintenance dose is adapted to body weight (BW) or liver function (Child-Pugh score B or C). We aimed to study the pharmacokinetics of caspofungin and assess pharmacokinetic target attainment for various dosing strategies.Caspofungin pharmacokinetic data from 21 intensive care unit (ICU) patients was available. A population pharmacokinetic model was developed. Various dosing regimens (loading dose/maintenance dose) were simulated: licensed regimens (I) 70/50mg (for BW <80kg) or 70/70mg (for BW >80kg); and (II) 70/35mg (for Child-Pugh score B); and adapted regimens (III) 100/50mg (for Child-Pugh score B); (IV) 100/70mg; and (V) 100/100mg. Target attainment based on a preclinical pharmacokinetic target for Candida albicans was assessed for relevant minimal inhibitory concentrations (MICs).A two-compartment model best fitted the data. Clearance was 0.55L/h and the apparent volumes of distribution in the central and peripheral compartments were 8.9 and 5.0L, respectively. The median area under the plasma concentration-time curve from time zero to 24h on day14 for regimens I-V were 105, 65, 93, 130, and 186mgh/L, respectively. Pharmacokinetic target attainment was 100% (MIC 0.03g/mL) irrespective of dosing regimen but decreased to (I) 47%, (II) 14%, (III) 36%, (IV) 69%, and (V) 94% for MIC 0.125g/mL.The caspofungin maintenance dose should not be reduced in non-cirrhotic ICU patients based on the Child-Pugh score if this classification is driven by hypoalbuminemia as it results in significantly lower exposure. A higher maintenance dose of 70mg in ICU patients results in target attainment of>90% of the ICU patients with species with an MIC of up to 0.125g/mL.
Van De Loo K.F.E.,Radboudumc Amalia Childrens Hospital |
Van Gelder M.H.J.,Radboud Institute for Health science |
Roukema J.,Radboudumc Amalia Childrens Hospital |
Roeleveld N.,Radboud Institute for Health science |
And 3 more authors.
European Respiratory Journal | Year: 2016
The aim of this study was to systematically review and meta-analyse observational studies on prenatal maternal psychological stress and the subsequent development of asthma and wheezing in early childhood. All available published literature from 1960 until November 2013 was systematically searched through electronic databases (PubMed, Embase, PsycInfo and Web of Science). All observational studies assessing associations between any form of prenatal maternal psychological stress and respiratory morbidity in the child were included. Data extraction, quality assessment and meta-analyses were performed. The overall meta-analysis included 10 studies and showed that the prevalence of wheezing, asthma and other respiratory symptoms is higher in children of mothers who were exposed to or experienced some form of psychological stress during pregnancy than in mothers who did not (pooled OR 1.56 (95% CI 1.36-1.80)). Comparable results were observed in subgroup analyses of stress exposure, perceived stress, asthma and wheezing. This study demonstrates that prenatal maternal psychological stress is associated with respiratory morbidity, including asthma and wheezing in the child. Future studies examining the early origins of asthma and wheezing need to account for the impact of prenatal maternal stress. © ERS 2016.
PubMed | Radboud University Nijmegen, Radboud Institute for Health science and Radboudumc Amalia Childrens Hospital
Type: Journal Article | Journal: The European respiratory journal | Year: 2016
The aim of this study was to systematically review and meta-analyse observational studies on prenatal maternal psychological stress and the subsequent development of asthma and wheezing in early childhood.All available published literature from 1960 until November 2013 was systematically searched through electronic databases (PubMed, Embase, PsycInfo and Web of Science). All observational studies assessing associations between any form of prenatal maternal psychological stress and respiratory morbidity in the child were included. Data extraction, quality assessment and meta-analyses were performed.The overall meta-analysis included 10 studies and showed that the prevalence of wheezing, asthma and other respiratory symptoms is higher in children of mothers who were exposed to or experienced some form of psychological stress during pregnancy than in mothers who did not (pooled OR 1.56 (95% CI 1.36-1.80)). Comparable results were observed in subgroup analyses of stress exposure, perceived stress, asthma and wheezing.This study demonstrates that prenatal maternal psychological stress is associated with respiratory morbidity, including asthma and wheezing in the child. Future studies examining the early origins of asthma and wheezing need to account for the impact of prenatal maternal stress.