Harpenden, United Kingdom
Harpenden, United Kingdom

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Otten M.H.,Sophia Office | Prince F.H.M.,Sophia Office | Ten Cate R.,Leiden University | Van Rossum M.A.J.,Jan Medical | And 11 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Objectives: To evaluate the effectiveness of tumour necrosis factor (TNF) blockers in juvenile psoriatic arthritis (JPsA). Methods: The study was a prospective ongoing multicentre, observational study of all Dutch juvenile idiopathic arthritis (JIA) patients using biologicals. The response of arthritis was assessed by American College of Rheumatology (ACR) paediatric response and Wallace inactive disease criteria. The response of psoriatic skin lesions was scored by a 5-point scale. Results: Eighteen JPsA patients (72% female, median age onset 11.1 (range 3.3-14.6) years, 50% psoriatic skin lesions, 39% nail pitting, 22% dactylitis) were studied. The median follow-up time since starting anti-TNFα was 26 (range 3-62) months. Seventeen patients started on etanercept and one started on adalimumab. After 3 months of treatment 83% of the patients achieved ACR30 response, increasing to 100% after 15 months. Inactive disease reached in 67% after 39 months. There was no discontinuation because of inefficacy. Six patients discontinued treatment after a good clinical response. However, five patients flared and restarted treatment, all with a good response. During treatment four patients (two JPsA and two JIA patients with other subtypes) developed de novo psoriasis. In four of the nine patients the pre-existing psoriatic skin lesions improved. Conclusion: Anti-TNFα therapy in JPsA seems effective in treating arthritis. However, in most patients the arthritis flared up after treatment discontinuation, emphasising the need to investigate optimal therapy duration. The psoriatic skin lesions did not respond well and four patients developed de novo psoriasis.


PubMed | University of Lausanne, University of Central Lancashire, Sophia Office and Emma Childrens Hospital Academic Medical Center
Type: Journal Article | Journal: Intensive care medicine | Year: 2016

This position statement provides clinical recommendations for the assessment of pain, level of sedation, iatrogenic withdrawal syndrome and delirium in critically ill infants and children. Admission to a neonatal or paediatric intensive care unit (NICU, PICU) exposes a child to a series of painful and stressful events. Accurate assessment of the presence of pain and non-pain-related distress (adequacy of sedation, iatrogenic withdrawal syndrome and delirium) is essential to good clinical management and to monitoring the effectiveness of interventions to relieve or prevent pain and distress in the individual patient.A multidisciplinary group of experts was recruited from the members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). The group formulated clinical questions regarding assessment of pain and non-pain-related distress in critically ill and nonverbal children, and searched the PubMed/Medline, CINAHL and Embase databases for studies describing the psychometric properties of assessment instruments. Furthermore, level of evidence of selected studies was assigned and recommendations were formulated, and grade or recommendations were added on the basis of the level of evidence.An ESPNIC position statement was drafted which provides clinical recommendations on assessment of pain (n=5), distress and/or level of sedation (n=4), iatrogenic withdrawal syndrome (n=3) and delirium (n=3). These recommendations were based on the available evidence and consensus amongst the experts and other members of ESPNIC.This multidisciplinary ESPNIC position statement guides professionals in the assessment and reassessment of the effectiveness of treatment interventions for pain, distress, inadequate sedation, withdrawal syndrome and delirium.


Hoefnagel D.,Sophia Office | Kwee L.E.,Sophia Office | Van Putten E.H.P.,Slotervaartziekenhuis | Kros J.M.,Erasmus University Rotterdam | And 2 more authors.
Clinical Neurology and Neurosurgery | Year: 2014

Background Patients with meningiomas carry an increased risk for postoperative venous thromboembolic complications (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE). Objective In the present retrospective study we investigated the incidence of VTE and the risk factors involved, in a large cohort of patients surgically treated for an intracranial meningioma at our institution. Methods During the period from January 1997 to January 2009, 581 consecutive patients underwent craniotomy for intracranial meningioma. All patients received low-molecular weight heparins as thromboembolism prophylaxis. Patient demographics and tumor characteristics were gathered via retrospective chart review. Postoperative VTE and hemorrhages were noted. Backward stepwise logistic regression was used to determine the risk factors. Results 80.6% of meningiomas were WHO grade 1; 15.1% WHO grade 2; 4.3% WHO grade 3. Postoperative VTE were observed in 41 patients (7.2%). Of these, DVT was seen in 20 (3.5%) and PE in 26 patients (4.6%). The thromboembolic complication appeared on average 21.1 ± 29.2 days post surgery. The 90-day mortality rate after VTE was 11.2% (23.1% for PE and 5.0% for DVT). Postoperative hemorrhages requiring surgical treatment were found in 2.9% of patients. Risk factors for VTE were body mass index (p = 0.015) for DVT; weight (p = 0.001) and bedridden postoperatively (p = 0.001) for PE; and weight (p = 0.004) and bedridden postoperatively (p = 0.003) for VTE in general. There was no relation between tumor grade and thromboembolic complications. Conclusion The major risk factors for postoperative VTE found in our single center study are patient weight and a bedridden status postoperatively. Prophylactic intervention for this potentially fatal complication should be evaluated against the relative lower risk of postoperative hemorrhages. © 2014 Elsevier B.V.


PubMed | Sophia Office, University of Nottingham and a Center for Dairy Excellence
Type: Journal Article | Journal: New Zealand veterinary journal | Year: 2016

To assess the attitude of dairy farm consultants to the role of veterinarians on dairy farms and whether they viewed veterinary advice as impartial, free from commercial bias and central to farm productivity and profitability.A telephone survey was commissioned in September 2014 of 36 full-time farm consultants in the Canterbury and Otago region of New Zealand using a pre-prepared questionnaire to explore their attitudes towards the veterinary profession. Of those approached, 25 completed the survey.The consultants surveyed agreed or strongly agreed (21/23) that they were the custodians of animal health expenditure on farms, which was seen as an expense to be controlled (19/25 agreed or strongly agreed). This view was held more strongly (9/9 agreed or strongly agreed) by consultants with >5 years professional experience, compared to 10/16 consultants with 5 years experience. Most consultants (24/25) disagreed that they did not respect veterinary advice, but agreed (24/25) that veterinarians almost always had a vested interest in the advice that they gave. The role of veterinarians was seen by respondents to be mainly treatment of sick animals (22/25) and provision of animal health products (24/25), but not in maximising farm profitability (selected by 8/25 respondents). Consultants viewed their own roles as providing advice on the influence of animal health on farm profitability (21/25), nutrition (22/25) and reproduction (20/25). Most respondents (21/25) stated that reducing disease and animal health issues was important, but they (21/25) also identified a reduction in farm animal health expenditure as a measure of success. Only 7/25 consultants felt that they should work in partnership with veterinarians.This was a small scale study from one region of New Zealand but it indicates that consultants are ambivalent about the role and value of working more closely with veterinarians, and about the benefit that veterinary intervention may bring to a farms profitability.More successful veterinary involvement on dairy farms will follow from a better understanding of how other rural professionals are involved in the farms management and in meeting the individual farmers goals and motivations.


Driessen C.,Sophia Office | Eveleens J.,Erasmus MC Sophia Childrens Hospital | Bleyen I.,Erasmus MC Sophia Childrens Hospital | Van Veelen M.-L.,Erasmus MC Sophia Childrens Hospital | And 2 more authors.
Child's Nervous System | Year: 2014

Purpose: Our aim was to evaluate if optical coherence tomography (OCT) can be used as an alternative for fundoscopy to screen for increased intracranial pressure (ICP) in children with craniosynostosis Methods: We performed a prospective cohort study at the Dutch Craniofacial Centre. We included 38 patients with nonsyndromic scaphocephaly and Crouzon's syndrome aged 3-8 years old, in whom we scored complaints suggestive of increased ICP and performed fundoscopy and OCT. Main outcome measures total retinal thickness (TRT) which was measured on 58 OCT scans. Results: Forty-three percent of fundoscopies revealed pathologic changes of the papil in at least one eye. Retinal thickness was increased in patients with an abnormal fundoscopy as compared to patients with a normal papil (TRT p<0.001). Patients with Crouzon's syndrome had a significantly increased retinal thickness as compared to patients with scaphocephaly (TRT p<0.001). Conclusions: The current study demonstrates that OCT in children with craniosynostosis is feasible. It confirms that retinal thickness increases in case of papilledema. Given the quantitative character, OCT has a high potential as an alternative tool to screen for papilledema in craniosynostosis and other pediatric populations. © 2014 Springer-Verlag.


Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry. © 2011 The Author.


Van Rossum E.F.C.,Sophia Office | Van Den Akker E.L.T.,Sophia Office
Endocrine Development | Year: 2011

Changes in glucocorticoid (GC) receptor sensitivity can be categorized in three different types. First, generalized GC resistance syndrome is a hereditary disease. Patients present with signs and symptoms of increased androgen and/or mineralocorticoid action, combined with biochemical hypercortisolism, but lack of cushingoid features. Second, at a tissue level, transient changes in GC sensitivity are present during disease. Transient changes in GC sensitivity of leukocytes during infectious diseases like sepsis have been found, but also acquired forms or GC resistance occur, in particular in some types of neoplasms, major depression, AIDS, and several autoimmune diseases. Third, at the level of the general population, the diversity in GC sensitivity has a wide interindividual variation which in part can be explained by genetic variation of the GC receptor gene. Several single nucleotide polymorphisms of the gene have been associated with changes in GC sensitivity and its clinical phenotype. In this chapter, four genetic variants are described of which two (rs6198 and rs6189/6190) are associated with a relative GC resistance and two (rs1695 and rs41423247) are associated with a relative GC hypersensitivity. Copyright © 2011 S. Karger AG, Basel.


Fani L.,Sophia Office | Bak S.,Sophia Office | Delhanty P.,Erasmus University Rotterdam | Van Rossum E.F.C.,Erasmus University Rotterdam | Van Den Akker E.L.T.,Sophia Office
International Journal of Obesity | Year: 2014

Obesity is one of the greatest public health challenges of the 21st century. Obesity is currently responsible for ∼0.7-2.8% of a country's health costs worldwide. Treatment is often not effective because weight regulation is complex. Appetite and energy control are regulated in the brain. Melanocortin-4 receptor (MC4R) has a central role in this regulation. MC4R defects lead to a severe clinical phenotype with lack of satiety and early-onset severe obesity. Preclinical research has been carried out to understand the mechanism of MC4R regulation and possible effectors. The objective of this study is to systematically review the literature for emerging pharmacological obesity treatment options. A systematic literature search was performed in PubMed and Embase for articles published until June 2012. The search resulted in 664 papers matching the search terms, of which 15 papers remained after elimination, based on the specific inclusion and exclusion criteria. In these 15 papers, different MC4R agonists were studied in vivo in animal and human studies. Almost all studies are in the preclinical phase. There are currently no effective clinical treatments for MC4R-deficient obese patients, although MC4R agonists are being developed and are entering phase I and II trials. © 2014 Macmillan Publishers Limited.


PubMed | Sophia Office
Type: Journal Article | Journal: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery | Year: 2014

Our aim was to evaluate if optical coherence tomography (OCT) can be used as an alternative for fundoscopy to screen for increased intracranial pressure (ICP) in children with craniosynostosisWe performed a prospective cohort study at the Dutch Craniofacial Centre. We included 38 patients with nonsyndromic scaphocephaly and Crouzons syndrome aged 3-8 years old, in whom we scored complaints suggestive of increased ICP and performed fundoscopy and OCT. Main outcome measures total retinal thickness (TRT) which was measured on 58 OCT scans.Forty-three percent of fundoscopies revealed pathologic changes of the papil in at least one eye. Retinal thickness was increased in patients with an abnormal fundoscopy as compared to patients with a normal papil (TRT p < 0.001). Patients with Crouzons syndrome had a significantly increased retinal thickness as compared to patients with scaphocephaly (TRT p < 0.001).The current study demonstrates that OCT in children with craniosynostosis is feasible. It confirms that retinal thickness increases in case of papilledema. Given the quantitative character, OCT has a high potential as an alternative tool to screen for papilledema in craniosynostosis and other pediatric populations.

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