Effect of an interactive, educational app about venous thromboembolism and anticoagulation on patient satisfaction: A randomized controlled trial.

BACKGROUND: Adequate patient education is essential for patients to engage in shared decision-making when deciding to stop or continue anticoagulation after 3 months for venous thromboembolism (VTE). Our objectives were to evaluate the effect of an interactive, educational app on patients' level of satisfaction with information, perceived level of knowledge, decisional conflict and extent of shared decision-making when deciding on treatment duration of VTE. MATERIALS AND METHODS: This randomized controlled trial in 1 academic and 3 general Dutch hospitals included adult patients diagnosed with VTE without malignancy or prolonged anticoagulation for other indications. Patients were randomized in 1:1 ratio to receive the app (intervention group) in addition to hospital-specific standard of care. The app, created for this study, contains information on VTE and anticoagulation on an interactive timeline. In the week preceding the consultation when treatment duration is decided, patients were provided with daily videos using push notifications. Outcomes were assessed through self-reported questionnaires at baseline, 1-2 days before and 1 day after consultation. Data were analyzed using t-tests and linear mixed models for repeated measurements. RESULTS: Data of 56 patients were analyzed (mean age 57 ± 13; 27% female). On a numeric rating scale from 0 to 10, patients who received the app were 0.9 points (95%CI 0.0-1.7; p 0.04) more satisfied with the provided information. Patients who received the app experienced significantly less decisional conflict. No differences in other outcomes were observed. CONCLUSIONS: An educational app about VTE and anticoagulation increases patients' satisfaction and reduces decisional conflict when deciding on treatment duration of VTE. This study was registered in the Netherlands Trial Register (NL7037).

Dalteparin and anti-Xa: a complex interplay of therapeutic drug monitoring.

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.

Rationale for catheter-based therapies in acute pulmonary embolism.

Pulmonary embolism (PE) is a common disease resulting in significant morbidity and mortality. High-risk features of PE are hypotension or shock, and early reperfusion is warranted to unload the strained right ventricle and improve clinical outcomes. Currently, systemic thrombolysis (ST) is the standard of care but is associated with bleeding complications. Catheter-based therapies (CDT) have emerged as a promising alternative having demonstrated to be equally effective while having a lower risk of bleeding. Several CDT are currently available, some combining mechanical properties with low-dose thrombolytics. Recent guidelines suggest that CDT may be considered in patients with high-risk PE who have high bleeding risk, after failed ST, or in patients with rapid haemodynamic deterioration as bail-out before ST can be effective, depending on local availability and expertise. In haemodynamically stable patients with right ventricular (RV) dysfunction (intermediate-risk PE), CDT may be considered if clinical deterioration occurs after starting anticoagulation and relative contraindications for ST due to bleeding risk exist. Decision on treatment modality should follow a risk-benefit analysis on a case by case base, weighing the risk of PE-related complications; i.e. haemodynamic deterioration vs. bleeding. As timely initiation of treatment is warranted to prevent early mortality, bleeding risk factors should be assessed at an early stage in all patients with acute PE and signs of RV dysfunction. To ensure optimal management of complex cases of PE and assess a potential CDT strategy, a multidisciplinary approach is recommended. A dedicated Pulmonary Embolism Response Team may optimize this process.

Antigen quantification as in vitro alternative for potency testing of inactivated viral poultry vaccines.

Routine batch control of licensed inactivated viral vaccines for poultry usually includes a potency assay as a measure of vaccine efficacy. Potency assays often consist of vaccination-challenge experiments in the target species or in laboratory animals. Instead of measuring the protection of vaccinated animals against virulent pathogens, the serological response after vaccination can be quantified for some vaccines. In vitro antigen quantification assays would be attractive alternatives for the current potency assays because the time and costs involved could be greatly reduced and animal use could be avoided. Such in vitro assays will only be acceptable when the correlation between results and efficacy or potency has been demonstrated convincingly. The results of our studies on antigen quantification assays indicate that, in principle, quantification of viral antigens from inactivated oil-adjuvanted vaccines is feasible and reproducible using specially developed antigen capture ELISAs in combination with specific software for statistical analysis of the ELISA data. We have developed methods to quantify the haemagglutination-neuraminidase (HN) and fusion (F) proteins of Newcastle disease virus (NDV), the viral protein 3 (VP3) of the infectious bursal disease virus (IBDV), and the spike-1 (S1) protein of the infectious bronchitis virus (IBV). Vaccination experiments with inactivated ND vaccines indicate that the in vitro quantified HN- or F-proteins of NDV are reliable indicators of the serological response after vaccination.

Efficiency of light utilization of Chlamydomonas reinhardtii under medium-duration light/dark cycles.

The light regime inside a photobioreactor is characterized by a light gradient with full (sun)light at the light-exposed surface and darkness in the interior of the bioreactor. Consequently, depending on the mixing characteristics, algae will be exposed to certain light/dark cycles. In this study the green alga Chlamydomonas reinhardtii was cultivated under five different light regimes: (1) continuous illumination; (2) a square-wave light/dark cycle with a light fraction (epsilon) of 0.5 and a duration (t(c)) of 6.1 s; (3) epsilon=0.5, t(c)=14.5 s; (4) epsilon=0.5, t(c)=24.3 s and (5) epsilon=0.8, t(c)=15.2 s. The biomass yield on light energy, protein per photons, decreased under light/dark cycles (epsilon=0. 5) in comparison to continuous light (CL), from 0.207 (CL) to 0.117-0.153 g mol(-1) (epsilon=0.5). Concomitantly, the maximal specific photosynthetic activity, oxygen production per protein, decreased from 0.94 (CL) to 0.64-0.66 g g(-1) h(-1) (epsilon=0.5). Also the quantum yield of photochemistry, yield of the conversion of light energy into chemical energy, decreased from 0.47 (CL) to 0. 23 (epsilon=0.5, t(c)=24.3 s). Apparently, C. reinhardtii is not able to maintain a high photosynthetic capacity under medium-duration light/dark cycles and since specific light absorption did not change, light utilization efficiency decreased in comparison to continuous illumination.

Enabling children: participation as a new perspective on child-health promotion.

As fellow citizens, all children need a stimulating social environment that helps them develop self-respect and social competence. Developmental research, however, shows, that many children do not or cannot fulfil the social, moral or cognitive developmental tasks which are necessary for healthy development. A lack of opportunities for gaining meaningful social experiences can be seen as a major source of psychosocial and behavioural problems in children. On the contrary, active commitment in educational environments such as the school and the neighbourhood, helps them to get an increasingly better grip on their own lives and health. Moreover, such 'children's participation' appears to have a protective and preventive effect for health-related problems. Therefore, it is argued, that 'enablement', a key-element of both the Ottawa Charter on Health Promotion and the International Convention on the Rights of the Child, should be at the core of every child-health promotion programme.

Arxula adeninivorans, a yeast assimilating many nitrogenous and aromatic compounds.

A detailed description of the yeast species Arxula adeninivorans (syn. Trichosporon adeninovorans) was given. The yeast assimilated all the sugars, polyalcohols and organic acids used in the conventional carbon compound assimilation test rapidly, except for L-rhamnose, inulin, lactose, lactate and methanol. As nitrogen sources served all conventionally used compounds except creatine and creatinine. Several nitrogenous compounds, e.g. amino acids, purine derivatives, served as sole source of carbon, nitrogen and energy. This was also true of many primary n-alkylamines and terminal diamines, but of nitrogen-less analogous compounds such as alcohols, dialcohols, carboxylic acids and dicarboxylic acids only intermediates of general metabolism were assimilated. For observing growth at the expense of potentially toxic compounds the slant culture method was developed. In this test lactate was readily assimilated but proved to be toxic at the same time. Several aliphatic organic acids and their esters supported growth in this test, as was the case with several benzene compounds such as hydroquinone, 3- and 4-hydroxybenzoic acid, protocatechuic, gentisic, gallic and ferulic acids, 4-hydroxyacetophenone and 1-phenyl-n-dodecane.

Yeasts and fungi occurring in ensiled whole-crop maize and other ensiled vegetable crops.

The yeast flora of whole-crop maize ensiled for two weeks was predominated by Candida holmii, C. lambica, C. milleri, Hansenula anomala and Saccharomyces dairensis. Inoculation with other yeast species reported in the literature to prevail in maize or wheat silages did not alter the yeast flora. At 25 or 30 degrees C the ascomycetous fermentative species found at 20 degrees C were accompanied with ascomycetous non-fermentative fungi, i.c. Exophiala jeanselmei and Verticillium psalliotae, by the non-fermentative imperfect basidiomycetous yeast Rhodotorula mucilaginosa and by the weakly fermentative imperfect ascomycetous yeast Trichosporon adeninovorans. The yeast flora of other vegetable crops, ensiled at 20 degrees C for two weeks, was predominated by the same species that prevailed in ensiled maize, provided the crop did not contain mustard oils or menthol. If these compounds occurred in the crops, the yeast flora was predominated by nonfermentative species like Candida famata, Stephanoascus ciferrii, Rhodotorula minuta, Rh. rubra and Trichosporon cutaneum.

[Early detection of developmental disorders: the need for a new perspective]. / Vroegtijdige onderkenning van ontwikkelingsstoornissen: de noodzaak van een nieuw perspectief.

Early detection of abnormality in young children (aged 0-7) in the Netherlands is to be organized on two levels. First, regional cooperation between child-health professionals and institutions will be stimulated in order to form a nationwide network of 'multidisciplinary teams', with the task of coordinating early detection in a specific area. These teams are to advise parents and professionals in those cases where a child's development is suspected of being 'at risk'. The second part of the program is a campaign to promote the idea of early detection among the population. The aim is to develop the 'signalizing' and diagnostic abilities of parents, teachers and child-health professionals through education and training. The subject of early detection seemed and still seems to be a focus of different interests, and of conflicts of competence between different groups and schools of professionals and different institutions. In this article some of the main conflicting issues are discussed. One of the important problems concerning early detection is the question of defining normality and abnormality. It is concluded that in the case of early detection of both somatic and psychosomatic disorder there can be no such thing as an absolute scientific rationality, as is often suggested. Theoretical frameworks underlying methods of early detection are influenced by social, cultural and historical factors, and thus form a social construction. Finally a protocol-approach is being suggested, a method that might clear some of the problems concerning the content and organizational procedures of the Dutch system for early detection.

[Psychogeriatrics in Great Britain--report of the Nottingham course 1984]. / Psychogeriatrie in Groot-Brittannië--verslag van de Nottingham-cursus 1984.

The British Council's Course 'Psychogeriatrics' at the University of Nottingham reflects the state and development of the internationally acknowledged psychiatry of old age in Britain. This article describes the contents of the course in terms of epidemiology, organization, diagnosis and treatment, with special attention to aspects of education and research. It concludes with a remark on the identity of the subject, stating that psycho-geriatrics has its emphasis in training and research rather than being a medical subspecialty.

[Application of the BOP (an evaluation scale for older patients) in a psychiatric hospital. A clinical study]. / Het gebruik van de BOP in een psychiatrische kliniek. Een praktijkonderzoek.

In this study we examined the relationship between BOP rating scores and psychiatric diagnoses at discharge of 74 psychogeriatric patients admitted to the AZUA psychiatric clinic. The BOP is the Dutch rating scale modelled after the Stockton Geriatric Rating Scale. The BOP was administered two weeks after admittance, and a second time four weeks later. These results were compared with results from an earlier study. The usefulness of the BOP as viewed by the treatment and nursing staff was evaluated. Treatment team evaluation of the BOP revealed some shortcomings. Members found the information too global und redundant. Reflecting their training and own point of view, the nursing staff too gave critical assessments of the BOP. Analysis of the first BOP rating scores showed a positive correlation between three BOP subscale scores and the discharge diagnosis of dementia. Closer inspection revealed that this relation was limited to male patients suggesting that both the patient sex and the nature of the dementia may be factors influencing BOP rating scores.

A cross-cultural study of the reliability and factorial dimensions of the Nurses' Observation Scale for Inpatient Evaluation (NOSIE).

Investigated the reliability and factor structure of the Nurses' Observation Scale for Inpatient Evaluation (NOSIE) in a group of short-stay psychiatric patients (N = 247) of a Dutch psychiatric university clinic. It was found that the NOSIE has good interrater reliability. With the exception of the Social Competence and Personal Neatness subscales five of the original seven scales could be replicated when compared with American and British studies.

[Comparison between 2 behavior observation scales in psychogeriatrics. A closer look at the NOSIE and the BOP]. / Een vergelijking tussen twee gedragsobservatieschalen in de psychogeriatrie. De NOSIE en de BOP nader onderzocht.

The relation between the NOSIE (Nurses' Observation Scale for Inpatient Evaluation) and the BOP (Dutch version of the Stockton Geriatric Rating Scale) was studied in a psycho-geriatric sample. The results supported the hypothesis of a trans-cultural difference in the use of the NOSIE. Dutch nurses subsume personal neatness under social competence. Anglo-Saxons do not. The factor solution of the NOSIE, with the exception of the depression factor, was comparable with earlier Dutch research, and was interpreted as support for the notion, that the NOSIE is a reliable observation scale. The correlation between factor scales of the NOSIE and the BOP were significant, but of moderate range. This was taken to mean that there is limited convergent validity between the NOSIE and the BOP. A high correlation was found between the infirmity scale and other subscales of the BOP. The BOP as well as the NOSIE were able to purposefully distinguish diagnostic groups when an external criterium or mixed criteria were used. It was concluded that both the BOP and the NOSIE may supplement each other in psycho-geriatric research practice.

Org 4333, a potent, irreversibly binding estrogen agonist.

Two synthetic routes to 11 beta-chloromethylestra-1,3,5(10)-trien-3,17 beta-diol (Org 4333) are described. In biological tests this compound was found to be a potent irreversibly binding estrogen agonist.

A cross-cultural study of the reliability and factorial dimensions of the Brief Psychiatric Rating Scale (BPRS).

The factor-structure and the reliability of the Brief Psychiatric Rating Scale (BPRS) was investigated in a group of short stay psychiatric patients in a Dutch university clinic. It was found that the BPRS has a good inter-rater reliability. With the exception of a new Disorientation subscale all original five subscales could be replicated when compared with an American study.

The principle of separate responsibility in clinical psychiatric practice. 6 years' experience.

An experiment lasting 6 years with an organizational principle called 'separate responsibility' is described. Its aim was to promote open two-way communication in an acute psychiatric admission clinic, by dividing power, i.e. responsibility for individual patients and patients as a group, over two multidisciplinary treatment teams. Multidisciplinarity, however, turned out to be impossible to maintain for different reasons. Instead, a splitting occurred of medical and nursing disciplines through identification of the former with individual treatment and of the latter with the patient groups. An unproductive loss of common treatment goals was the result leading to a near closing down of the clinic. Putting medical and nursing personnel into one team, responsible for the entire treatment of the unit, restored productivity and improved treatment and the working climate.