Destination unknown: Parents and healthcare professionals' perspectives on transition from paediatric to adult care in Down syndrome.

BACKGROUND: Transitioning from paediatric medical care to adult care is a challenging process for children, parents and healthcare professionals. The aim of this study was to explore the experiences, concerns and needs of parents of children with Down syndrome and of professionals regarding this transition. METHOD: A qualitative study was performed using semi-structured interviews with 20 parents of children with Down syndrome and six healthcare professionals. RESULTS: We showed that parents and professionals have concerns during each of the three distinct phases of transition (preparation, transfer and integration). Data disclose specific concerns regarding communication, continuity of care and rebuilding trust. We propose a framework for the transition to adult care. CONCLUSIONS: The transition in medical care for children with Down syndrome should be flexible, patient-centred and coordinated together with patients and parents. Only in ensuring continuity of care will individuals with Down syndrome not get lost in transition.

Is the Site of Back Pain Related to the Location of Magnetic Resonance Imaging Lesions in Patients With Chronic Back Pain? Results From the Spondyloarthritis Caught Early Cohort.

OBJECTIVE: To determine associations between magnetic resonance imaging (MRI) lesions originating from either axial spondyloarthritis (SpA) or from degeneration and pain in patients with chronic back pain of <2 years duration. METHODS: Patients from the Spondyloarthritis Caught Early (SPACE) cohort identified the sites of pain (thoracic, lumbar, buttock). The average MRI scores from 2 readers for axial SpA lesions and from 2 different readers for degenerative lesions were used. Associations between sacroiliac (SI) joint lesions and buttock pain were investigated by logistic regression analysis, and associations between axial SpA or degenerative lesions and pain in the spine (thoracic and lumbar) were investigated using generalized estimating equations. Interactions with sex, age, HLA-B27, and fulfillment of Assessment of SpondyloArthritis international Society (ASAS) criteria were tested. RESULTS: In 348 patients (126 males, 127 fulfilling ASAS criteria, mean age 29.4 years), spinal MRI (and SI joint images in 342) were available. Pain was localized in the thoracic spine (35.9%), the lumbar spine (82.5%), or in the buttock(s) (57.8%). Inflammatory lesions of the SI joint (odds ratio [OR] 1.06; P = 0.04) and erosions of the SI joint in patients <25 years (OR 1.16; P = 0.04) were associated with buttock pain. Axial SpA spinal lesions were not associated with pain. Modic type 1 lesions in patients >35 years (OR 5.19; P = 0.001), high-intensity zone lesions in females not fulfilling ASAS criteria (OR 5.09; P = 0.001), and herniation in various subgroups (OR range 2.07-4.66) were associated with pain. CONCLUSION: Specific degenerative lesions, but not typical axial SpA lesions, of the spine are associated with pain at the same location in some subgroups. Inflammatory lesions in the SI joint are associated with buttock pain.

[A man with progressive neck and shoulder pain]. / Een man met progressieve pijn in nek en schouder.

A 66-year-old man was referred to the hospital with progressive neck and right shoulder pain. Conventional radiographs and a thoracic CT-scan demonstrated destruction of the first rib on the right side due to a tumour invading the apical chest wall. The patient was diagnosed with a Pancoast tumour (i.e. superior sulcus tumour).

Comparison of four nasal sampling methods for the detection of viral pathogens by RT-PCR-A GA(2)LEN project.

The aim of this study was to compare the efficacy and patient discomfort between four techniques for obtaining nasal secretions. Nasal secretions from 58 patients with symptoms of a common cold, from three clinical centers (Amsterdam, Lodz, Oslo), were obtained by four different methods: swab, aspirate, brush, and wash. In each patient all four sampling procedures were performed and patient discomfort was evaluated by a visual discomfort scale (scale 1-5) after each procedure. Single pathogen RT-PCRs for Rhinovirus (RV), Influenza virus and Adenovirus, and multiplex real-time PCR for RV, Enterovirus, Influenza virus, Adenovirus, Respiratory Syncytial Virus (RSV), Parainfluenza virus, Coronavirus, Metapneumovirus, Bocavirus and Parechovirus were performed in all samples. A specific viral cause of respiratory tract infection was determined in 48 patients (83%). In these, the detection rate for any virus was 88% (wash), 79% (aspirate), 77% (swab) and 74% (brush). The degree of discomfort reported was 2.54 for swabs, 2.63 for washes, 2.68 for aspirates and 3.61 for brushings. Nasal washes yielded the highest rate of viral detection without excessive patient discomfort. In contrast, nasal brushes produced the lowest detection rates and demonstrated the highest level of discomfort.

Intratympanic gentamicin therapy for intractable Ménière's disease.

CONCLUSIONS: Intratympanic gentamicin treatment using a low dose of gentamicin (approximately 21-24 mg per injection) applied at intervals of a minimum of 27 days, has been shown to be a successful treatment of vertigo. OBJECTIVES: The objective of this analysis was to evaluate the efficacy and side effects of intratympanic injections of gentamicin as treatment of intractable unilateral Ménière's disease. PATIENTS AND METHODS: This was a retrospective study in which 57 patients treated with intratympanic gentamicin for Ménière's disease were analysed. Patients received between 1 and 10 intratympanic injections of gentamicin in an outpatient setting. RESULTS: Six months after treatment, overall complete or substantial vertigo control was reported by 80.7% of our patients (VCC class A, 61.4%; class B, 19.3%). Unilateral caloric weakness increased from 50.1% to 79.8% after treatment, and complete caloric areflexia (30 degrees C and 44 degrees C) was induced in 38.6%. In this study hearing worsened (> 10 dB = SNHL) in only 15.8% of our patients (range 10-29 dB) and loss of word recognition (WR) scores worsened (>15%) in 31% of the patients. Only 1 injection was necessary in 49.1% of the patients, the remaining 50.9% needed 2, 3, 4, 6 or 10 injections, always with a time interval of a minimum of 27 days.