Nannan Panday RS, Wang S, Schermer EH
… +3 more, Cooksley T, Alam N, Nanayakkara PWB
Neth J Med
· 2020 Feb · PMID 32043473
BACKGROUND: Sepsis in patients with cancer is increasingly common and associated with high mortality. To date, no studies have examined the effectiveness of prehospital antibiotics in septic patients with cancer. This st...BACKGROUND: Sepsis in patients with cancer is increasingly common and associated with high mortality. To date, no studies have examined the effectiveness of prehospital antibiotics in septic patients with cancer. This study aimed without and to evaluate the effect of prehospital antibiotics in septic patients with cancer. METHODS: We conducted a post-hoc sub-analysis of the PHANTASi (PreHospital ANTibioitcs Against Sepsis) trial database: a randomised controlled trial which enrolled patients with suspected sepsis who were transported to the emergency department by ambulance. Patients in the intervention group were administered prehospital intravenous antibiotics while those in the control group received usual care. We compared patients who had cancer to those who did not. Primary outcome was 28-day mortality; among the secondary outcomes, we included in-hospital mortality and 90-day mortality. RESULTS: 357(13.4%) of the 2658 included patients had cancer in the past five years, of which, 209 (58.5%) were included in the intervention and 148 (41.5%) usual care groups; 28-day mortality was significantly higher in patients who were diagnosed with cancer in the past five years than those without cancer in the past five years: 15.2% vs. 7.1%, respectively (p < 0.001). Prehospital antibiotics in the group of patients with cancer in the last five years yielded no significant effect on survival. There were however, significantly fewer 30-day readmissions (p = 0.031) in the intervention group of cancer patients (12.2% vs 5.7%). CONCLUSION: Prehospital antibiotics did not improve overall survival. However, there was a significant reduction in 30-day readmissions.
de Graaf MA, Hazelbag HM, Tim J
… +2 more, van Rossum AP, Vlasveld LT
Neth J Med
· 2019 Dec · PMID 31880274
Pure red cell aplasia (PRCA) is a rare disease characterised by anaemia and low reticulocyte count, caused by absence of erythropoiesis in the bone marrow. This report describes a case of a ring-calcified thymoma that le...Pure red cell aplasia (PRCA) is a rare disease characterised by anaemia and low reticulocyte count, caused by absence of erythropoiesis in the bone marrow. This report describes a case of a ring-calcified thymoma that led to the development of PRCA. Moreover, we provide an overview on the classification of thymoma and the pathophysiology and treatment of PRCA.
de Haes I, Versluis J, Lam KH
… +3 more, Jongen JLM, Doorduijn JK, Kuipers S
Neth J Med
· 2019 Dec · PMID 31880273
Infectious mononucleosis may mimic lymphoma, both clinically and histopathologically. We present a patient with neurological symptoms and lymphadenopathy, initially diagnosed as Epstein-Barr virus (EBV)-positive angioimm...Infectious mononucleosis may mimic lymphoma, both clinically and histopathologically. We present a patient with neurological symptoms and lymphadenopathy, initially diagnosed as Epstein-Barr virus (EBV)-positive angioimmunoblastic T-cell lymphoma (AITL) with cerebrospinal fluid (CSF) localisation based on lymph node pathology and a 30-fold higher EBV load in the CSF compared with serum. However, the patient fully recovered spontaneously and EBV became negative in both CSF and serum, suggestive of a dramatic presentation of EBV meningoencephalitis.
BACKGROUND: To review the procedural diagnosis of male breast cancer. METHODS: Medline and Google Scholar searches using the terms (male breast cancer) and (diagnosis); and (triple assessment). RESULTS: Most of the searc...BACKGROUND: To review the procedural diagnosis of male breast cancer. METHODS: Medline and Google Scholar searches using the terms (male breast cancer) and (diagnosis); and (triple assessment). RESULTS: Most of the search-specific items are incorporated in more comprehensive reviews about male breast cancer in general. Relevant data was extracted in accordance with the aim of this review. RESULTS: Most of the diagnosed cases are advanced stage ductal invasive carcinomas, express hormone receptors in the great majority, and are less likely to over-express HER2-neu. They present usually as a painless retroareolar mass that requires triple assessment. The diagnosis needs a high index of suspicion primarily due to the unawareness of such a cancer in males.
Hypertension is a major risk factor for ischaemic heart disease and stroke. Despite the availability of numerous pharmacological treatment options, blood pressure (BP) targets are often not achieved. The inability to rea...Hypertension is a major risk factor for ischaemic heart disease and stroke. Despite the availability of numerous pharmacological treatment options, blood pressure (BP) targets are often not achieved. The inability to reach BP levels below 140/90 mmHg despite the use of three or more antihypertensive drugs is defined as resistant hypertension (RH). The etiology for RH is multifactorial. First, BP should be appropriately measured. In order to improve BP control, lifestyle modification should be recommended, adherence should be carefully assessed to exclude pseudo-resistance, and efforts should be made to exclude secondary causes of hypertension before initiating new drugs or considering device-based treatment strategies. This short review will highlight several aspects of RH management along with a focus on several new treatment options. act available.
BACKGROUND: The Press Ganey survey is widely used to evaluate physician and institution quality and performance, with some institutions making their survey results publicly available. However, given its subjective nature...BACKGROUND: The Press Ganey survey is widely used to evaluate physician and institution quality and performance, with some institutions making their survey results publicly available. However, given its subjective nature, the survey results may be subject to bias regarding physician characteristics, such as race, sex, and specialty, that are unrelated to competence. The goal of this study was to determine if and what physician characteristics influence Press Ganey results. METHODS: In this study, publicly-available information on sex, race, specialty, and Press Ganey results for all physicians with a photograph and a Press Ganey rating at two institutions was collected in June 2018 and compared for difference. RESULTS: The average Press Ganey rating for the 678 physicians included in the study was 4.73 out of 5. Female physicians had fewer negative comments (0.49 female vs. 0.67 male, p = 0.04) and there was no difference in positive comments or ratings. White physicians had higher ratings (4.74 white vs. 4.71 non-white, p = 0.01), greater number of positive comments (12.3 vs. 10.0, p = 0.008), and fewer negative comments (0.55 vs. 0.80, p = 0.03). Paediatric physicians had lower ratings (4.66 paediatric vs. 4.75 adult, p < 0.001) and fewer positive comments (9.07 paediatric vs. 12.21 adult, p = 0.004). CONCLUSIONS: These results suggest that physician race and specialty choice impact Press Ganey results. Given that neither race nor specialty influence physician competence, this data suggests that the Press Ganey survey is a biased measure of physician quality and should not be used to evaluate physician skill or ability.
van Bergen EDP, Huisman A, Welsing PMJ
… +4 more, de Winter MA, Rookmaaker MB, Kaasjager HAH, Nijkeuter M
Neth J Med
· 2019 Dec · PMID 31880268
BACKGROUND: Monitoring low-molecular-weight heparins is generally not required. However, guidelines advise to monitor anti-Xa levels in patients with renal insufficiency or a BMI above 50, and in pregnancy. Measuring ant...BACKGROUND: Monitoring low-molecular-weight heparins is generally not required. However, guidelines advise to monitor anti-Xa levels in patients with renal insufficiency or a BMI above 50, and in pregnancy. Measuring anti-Xa levels is a complex challenge since sampling should be performed three to five hours after subcutaneous injection and after steady state concentrations have been reached. Strict compliance is pivotal for justified dose adjustments. OBJECTIVES: We questioned compliance to our protocol and performed this study to explore that. METHODS: This retrospective cohort study included patients ≥ 18 years receiving therapeutic dalteparin in a Dutch academic medical centre. Patients with a first anti-Xa level measured between February 23rd and December 30th, 2017 were selected. According to our local guideline, monitoring anti-Xa activity is indicated in patients on therapeutic doses of dalteparin who are pregnant, morbidly obese (BMI > 50), or have renal insufficiency (clearance < 60 ml/min). Accurate sampling was defined as measuring levels after at least three injections (after which a patient may reach steady state) and then four hours after the injection with dalteparin. The frequency of compliance to our protocol was assessed. RESULTS: We included 158 patients with 396 anti-Xa levels, of which 41% (65/158) of all first anti-Xa levels were drawn without appropriate indication. Almost half, 48% (211/396), were sampled incorrectly and 25% of these (53/211) were followed by a dose adjustment. In total, 74% (293/396) of the samples were not indicated or were taken at the wrong time. CONCLUSIONS: Monitoring anti-Xa levels is a complex clinical challenge. This study showed that non-compliance with recommendations for anti-Xa monitoring was high, often resulting in unjustified dose adjustments.
The use of digital tools is indispensable in our daily lives. The medical world keeps up with this progress by implementing digital tools to facilitate and improve patient care, such as eConsults and self-care apps. Seri...The use of digital tools is indispensable in our daily lives. The medical world keeps up with this progress by implementing digital tools to facilitate and improve patient care, such as eConsults and self-care apps. Serious games are also becoming increasingly popular in healthcare education, particularly in surgical residency training and nursing education. However, gaming and digitisation of education have not been widely integrated in internal medicine residency education yet. Therefore, these programs are not yet modernised to meet the demands of the 21th century physician. In this article, we will explicate our view on digitisation of the internal medical education programme with special attention to serious gaming. We will discuss pros and cons of digitisation, describe challenges of development and implementation of games, and offer some examples of digital educational tools for practical use.
Peeters LEJ, den Uil CA, Feyz L
… +3 more, van den Bemt PMLA, Daemen J, Versmissen J
Neth J Med
· 2019 Dec · PMID 31814590
Acute withdrawal of calcium channel blockers can lead to the so-called calcium channel blocker withdrawal phenomenon, in particular, when high dosages are used. In the case presented, inadequate drug substitution led to...Acute withdrawal of calcium channel blockers can lead to the so-called calcium channel blocker withdrawal phenomenon, in particular, when high dosages are used. In the case presented, inadequate drug substitution led to this phenomenon which resulted in a serious course of events. Careful monitoring the process of drug substitution with respect to equal therapeutic dosages is therefore a necessity, especially in vulnerable patients.
de Jong WK, Mulders ACM, Westendorp W
… +1 more, Becker A
Neth J Med
· 2019 Dec · PMID 31814589
In this manuscript, we describe a patient with an exceptional response of brain metastases from lung cancer to short course nivolumab while on high-dose steroids. This case shows that immunotherapy can cause delayed and...In this manuscript, we describe a patient with an exceptional response of brain metastases from lung cancer to short course nivolumab while on high-dose steroids. This case shows that immunotherapy can cause delayed and enduring responses even in patients with poor predictive parameters for treatment success, such as low programmed death ligand-1 (PDL1) expression and long-term treatment with high-dose corticosteroids. Secondly, it underscores the importance of follow up after the administration of immunotherapy, even in cases with a deemed poor prognosis and few received cycles of immunotherapy.