BACKGROUND: The seasonal influenza epidemic poses a significant burden on hospitals, both in terms of capacity and costs. Beds that are occupied by isolated influenza patients result in hospitals temporary being closed t...BACKGROUND: The seasonal influenza epidemic poses a significant burden on hospitals, both in terms of capacity and costs. Beds that are occupied by isolated influenza patients result in hospitals temporary being closed to admissions and elective operations being cancelled. Improving hospital and emergency department (ED) patient flow during the influenza season could solve these problems. Microbiological point-of-care-testing (POCT) could reduce unnecessary patient isolation by providing a positive/negative result before admission, but has not yet broadly been implemented. METHODS: A clinical pathway for patients with acute respiratory tract infection presenting at the ED was implemented, including a PCR-based POCT for influenza, operated by nurses and receptionists. In parallel, a temporary ward equipped with 15 beds for influenza-positive patients was established. In this retrospective observational study, we describe the results of implementing this pathway by comparison with the previous epidemic. RESULTS: Clinical performance of the POCT within the clinical pathway was good with strongly decreased time from ED presentation to sample collection (194 vs 47 min) and time from sample collection to result (1094 vs 62 min). Hospital patient flow was improved by a decreased percentage of admitted influenza-positive patients (91% vs 73%) and shorter length of subsequent stay (median 5.86 vs 4.61 days) compared to the previous influenza epidemic. In addition, 430 patient-days of unnecessary isolation have been prevented within a time span of 18 weeks. Roughly estimated savings were almost 400,000 euros. CONCLUSION: We recommend that hospitals explore possibilities for improving patient flow during an influenza epidemic.
Limper M, de Leeuw K, Lely AT
… +13 more, Westerink J, Teng YKO, Eikenboom J, Otter S, Jansen AJG, V D Ree M, Spierings J, Kruyt ND, van der Molen R, Middeldorp S, Leebeek FWG, Bijl M, Urbanus RT
Neth J Med
· 2019 Apr · PMID 31012427
INTRODUCTION: The antiphospholipid syndrome (APS) is defined by the occurrence of venous and/or arterial thrombosis and/or pregnancy-related morbidity, combined with the presence of antiphospholipid antibodies (aPL) and/...INTRODUCTION: The antiphospholipid syndrome (APS) is defined by the occurrence of venous and/or arterial thrombosis and/or pregnancy-related morbidity, combined with the presence of antiphospholipid antibodies (aPL) and/or a lupus anticoagulant (LAC). Large, controlled, intervention trials in APS are limited. This paper aims to provide clinicians with an expert consensus on the management of APS. METHODS: Relevant papers were identified by literature search. Statements on diagnostics and treatment were extracted. During two consensus meetings, statements were discussed, followed by a Delphi procedure. Subsequently, a final paper was written. RESULTS: Diagnosis of APS includes the combination of thrombotic events and presence of aPL. Risk stratification on an individual base remains challenging. 'Triple positive' patients have highest risk of recurrent thrombosis. aPL titres > 99th percentile should be considered positive. No gold standard exists for aPL testing; guidance on assay characteristics as formulated by the International Society on Thrombosis and Haemostasis should be followed. Treatment with vitamin K-antagonists (VKA) with INR 2.0-3.0 is first-line treatment for a first or recurrent APS-related venous thrombotic event. Patients with first arterial thrombosis should be treated with clopidogrel or VKA with target INR 2.0-3.0. Treatment with direct oral anticoagulants is not recommended. Patients with catastrophic APS, recurrent thrombotic events or recurrent pregnancy morbidity should be referred to an expert centre. CONCLUSION: This consensus paper fills the gap between evidence-based medicine and daily clinical practice for the care of APS patients.
BACKGROUND: The International Committee of Medical Journal Editors (ICMJE) has expressed its concerns about predatory journals using the list of ICMJE Recommendations (ICMJE-R) followers to "gain the appearance of legiti...BACKGROUND: The International Committee of Medical Journal Editors (ICMJE) has expressed its concerns about predatory journals using the list of ICMJE Recommendations (ICMJE-R) followers to "gain the appearance of legitimacy." We assessed the presence of potential predatory journals on the ICMJE-R list and their adherence to ICMJE recommendations. METHODS: A random sample of 350 journals from the estimated 3,100-3,200 biomedical journals listed as ICMJE-R followers was chosen. Data collected from the ICMJE and journal webpages in English were: adherence to six ICMJE-R policies/requirements, year of journal's listing as ICMJE-R follower, discipline covered, publisher and its country of origin and existence of article processing charge. Potential predatory journal was considered as one open access journal not being a member of a recognized listing in COPE, DOAJ, OASPA, AJOL and/or INASP. RESULTS: Thirty-one percent of journals were considered to be potentially predatory; 94% of them were included in the ICMJE-R list in 2014-2018. Half were published in the United States and 62% were devoted to medicine. Adherence to five of the six policies/requirements was infrequent, ranging from 51% (plagiarism) to 7% (trial registration). Seventy-two percent of journals mentioned a policy on authors' conflicts of interest. Information on article processing charge was available for 76% journals and could not be found for 22%. Authorship policy/ instructions were significantly more present in journals with publishers from India than from the USA (53% vs 30%; p = 0.047), with no differences in the other five policies. CONCLUSION: Predatory journals should be deleted from the ICMJE-R list of followers to prevent misleading authors. ICMJE-R following journals need to be reevaluated with pre-defined published criteria.
A 47-year old man was admitted for macroscopic hematuria and spontaneous hematomas. Laboratory results showed a prolonged partial thromboplastin time (PTT), a prolonged activated partial thromboplastin time (APTT) and a...A 47-year old man was admitted for macroscopic hematuria and spontaneous hematomas. Laboratory results showed a prolonged partial thromboplastin time (PTT), a prolonged activated partial thromboplastin time (APTT) and a severe vitamin K deficiency. The underlying cause proved to be vitamin K malabsorption due to previously undiagnosed celiac disease, possibly provoked by oral antibiotic administration.
de Kruijff E, van Gammeren AJ, Porcelijn L
… +1 more, van Esser JWJ
Neth J Med
· 2019 Feb · PMID 30895931
Post-transfusion purpura (PTP) is a rare, but severe transfusion reaction in which both donor and autologous platelets are sequestered due to immunization against HPA-1a antigens in HPA-1a negative recipients (HPA: human...Post-transfusion purpura (PTP) is a rare, but severe transfusion reaction in which both donor and autologous platelets are sequestered due to immunization against HPA-1a antigens in HPA-1a negative recipients (HPA: human platelet antigens). We describe a patient who developed PTP during induction therapy for acute myeloid leukaemia. The pitfalls, delays in diagnosing and therapy options of this serious transfusion reaction are discussed.
Allegra A, Innao V, Allegra AG
… +4 more, Ettari R, Pugliese M, Pulvirenti N, Musolino C
Neth J Med
· 2019 Feb · PMID 30895929
Human beings are inhabited by innumerable microorganisms that interrelate with the host in a reciprocal way, establishing a combined and efficient ecosystem - the microbiota - that can affect healthiness as well as disea...Human beings are inhabited by innumerable microorganisms that interrelate with the host in a reciprocal way, establishing a combined and efficient ecosystem - the microbiota - that can affect healthiness as well as disease. There is evidence that the conformation of the microbiota may influence, and is controlled by, the human immune system. Microbes existing in human tissues offer a multiplicity of advantages that participate in functional actions in the host through the adjustment of essential processes such as immunity, signal transduction, and metabolism. The imbalance of this microbial structure has been connected with the pathogenesis and progression of cancer. We reviewed the present knowledge of the diverse microbial ecosystems and we investigated their potential link to carcinogenesis, and the possibility of using advantageous microbes in controlling and preventing hematologic malignancies.
Karim AF, Westenberg LEH, Eurelings LEM
… +2 more, Otten R, Gerth van Wijk R
Neth J Med
· 2019 Feb · PMID 30895928
INTRODUCTION: Atopic syndrome (allergic rhinitis, asthma and eczema) and food allergies are frequently reported, especially in developed countries. Studies have previously suggested an inverse association between allergi...INTRODUCTION: Atopic syndrome (allergic rhinitis, asthma and eczema) and food allergies are frequently reported, especially in developed countries. Studies have previously suggested an inverse association between allergic diseases and cancer. The aim of this study was to investigate the association between allergic diseases and different types of cancers by performing a systematic review of the literature. METHODS: A systematic literature search of Ovid Medline, Embase, Web of Science, Cochrane Library and Google Scholar was performed for studies on the association between allergic diseases and cancers. RESULTS: We identified a total of 5868 articles through our search, with 145 articles describing an association between allergic diseases and cancers. Allergies were associated with reduced risk of brain cancer, pancreatic cancer and melanoma and with possibly reduced risk of lymphatic and hematopoietic cancer, colorectal cancer, urogenital cancers of women and cancers in general. Asthma, but not atopy without asthma, was however associated with increased risk of lung cancer. There is possibly no association between allergic diseases and the risk of breast cancer and prostate cancer. CONCLUSION: Overall, allergic diseases are inversely associated with the risk of cancers.