El modelo de consenso sobre el Sistema de Certificación en Docencia en Educación Superior en Holanda: un fenómeno típicamente holandés

[EN] This article describes the process which led to the introduction of a University Teaching Qualification (UTQ) at research universities in the Netherlands. Until 2008, the only requirements to get appointed as a lecturer at most Dutch research universities pertained to research competences. This changed in 2008 when all Dutch research universities signed the Mutual Agreement of University Teaching Qualification. In 2005 staff developers of six universities initiated a working group to support the idea of a mutual agreement of the UTQ. Their initiative was taken over by two Vice Chancellors but at that time there was no consensus between all the research universities. This changed by political pressure of the Ministry of Education and student unions. The Dutch UTQ is mandatory, but not by law. The UTQ Agreement describes the scheme that concerns the embedding of the UTQ certification procedures in the participating universities. The mutual recognition of the UTQ is an example of a typical Dutch phenomenon called the Polder Model a strategy of consensus based policy making and a pragmatic recognition of pluriformity.[ES] El artículo describe el proceso que condujo a la introducción de un título de enseñanza universitaria (UTQ) en las universidades de investigación en los Países Bajos. Hasta 2008, los únicos requisitos para ser profesor en la mayoría de las universidades de investigación holandeses se remitían a competencias en investigación. Esto cambió en 2008, cuando todas las universidades de investigación holandeses firmaron el Acuerdo Mutuo de la Universidad de Cualificación Docente. En 2005 los formadores de seis universidades iniciaron un grupo de trabajo para apoyar la idea de un acuerdo mutuo sobre la UTQ. Su iniciativa fue asumida por dos Rectores, sin que hubiera consenso entre todas las universidades de investigación. Esto cambió por la presión política de la Consejería de Educación y los sindicatos de estudiantes. Ahora el UTQ es obligatorio, pero no por la ley. El Acuerdo UTQ describe el esquema que se refiere a la incorporación de los procedimientos de certificación UTQ en las universidades participantes. El reconocimiento mutuo de la UTQ es un ejemplo de un típico fenómeno holandés, el modelo pólder, una estrategia basada en el consenso en la formulación de políticas y un reconocimiento pragmático de la pluriformidad.De Jong, R.; Mulder, J.; Deneer, P.; Van Keulen, H. (2013). Poldering a teaching qualification system in Higher Education in the Netherlands: a typical Dutch phenomenon. REDU. Revista de Docencia Universitaria. 11(3):23-40. https://doi.org/10.4995/redu.2013.5517OJS2340113Association of Universities in the Netherlands/ VSNU (2008). Mutual agreement on a national framework of a University Teaching Qualification System (Overeenkomst Wederzijdse erkenning Basiskwalificatie Onderwijs: BKO). The Hague.Board of the University of Groningen (2013). University of Groningen Critical Reflection 2013. GroningenGerritsen, R.J., Jong, R. de, & Alst, J. M. T. van (2004). Toetsen van docentcompetenties: professionaliseringsbeleid voor docenten. TH&MA, 2004(5), 53-61.Gibbs, G. (2005). NTFS Report on Utrecht University. Oxford: NTFS.Jong, R. de (2012). Teaching competencies: qualification frameworks and external audits. The Dutch example: how to unite uniformity and flexibility. Lecture presented at the annual RED-U meeting, 02-02-1012 Bilbao, Spain.Jong, R. de, & Keulen, H. van. (2007) De lange weg naar competente én gekwalificeerde docenten, Onderzoek van Onderwijs, 36/3, 44-47.Jong, R. de, Alst, J. van, Andernach, T., Baume, D., Diez, A., Keulen, H. van, Petegem, P. van (2010). International agreement on a Qualification for University Teaching, Let's make a start as experts in staff development. Workshop at the ICED Conference 2010, Barcelona, Spain.Jong, R. de, Andernach, T., Barendsen, E. & Mulder, J. (2011). Externe kwaliteitsborging BasisKwalificatie Onderwijs in de Praktijk, Een onderzoek naar een bruikbaar auditsysteem'. The Hague: SoFoKles.Keesen, F., Wubbels, T., Tartwijk, J. van, & Bouhuijs, P. A. J. (1996). Preparing university teachers in The Netherlands: Issues and trends. International Journal for Academic Development, 1(2), 8-16.Keulen, J.van, Alst, J. van, Jong, R. de, & Halma, A. (2006). Towards a national system of teaching qualifications in higher education in the Netherlands. Paper presented at the ICED Conference 2006, Sheffield, EnglandKeulen, H. van, Jong, R de, Deneer, P. (2008). Characteristics of successful faculty development programs. Paper presented at the ICED Conference 2008, Salt Lake City, USA.Kranenburg, M. (1999), The political branch of the polder model, The economist (May 2002) ModelmakersMulder, J.A., Jong, R. A.H. de & Andernach, J.A. (2012). University Teaching Qualification: Quality assurance via external audits in the Netherlands. Paper presented at the 2012 ICED conference, Bangkok, Thailand

PPAR-α genetic variants influence on-treatment platelet reactivity in patients treated with clopidogrel and lipid-lowering drugs and undergoing non-urgent percutaneous coronary intervention with stent implantation

Background: Response to clopidogrel varies between patients, due to many factors, like polymorphisms in genes encoding for metabolizing enzymes. The CYP3A4∗22 polymorphism has been proven to decrease the expression of CYP3A4, while the PPAR-α genetic variants G209A and A208G have been identified as determinants that affect CYP3A4. Statins and fibrates, which are the ligands of PPAR-α as well as being metabolized by CYP3A4, might also affect the response of clopidogrel through these two proteins. Objectives: To investigate the association between on-treatment platelet reactivity and the CYP3A4∗22 allele and genetic variations of the PPAR-α genes in clopidogrel-treated patients undergoing non-urgent percutaneous coronary intervention (PCI) with stenting and to evaluate the influence of statin/fibrate co-medication on these associations. Methods: A total of 1126 patients with non-urgent PCI and stenting pre-treated with clopidogrel and aspirin were genotyped for CYP3A4∗22 and PPAR-α (G209A and A208G). Platelet reactivity was measured using the VerifyNow® P2Y12-assay, expressed in PRU. Multivariate linear regression analysis was used to assess the association between the genetic variants and platelet reactivity, adjusted for confounders, including the CYP2C19 metabolizer status. A stratified analysis was conducted for patients with statin/fibrate co-medication. A recessive model was used for all associations. Results: The CYP3A4∗22/∗22 genotype was present in 0.4% of patients, 6.8% had the PPAR-α G209A AA genotype, and 7.0% had the PPAR-α A208G GG genotype. CYP3A4∗22 was not associated with platelet reactivity. PPAR-α genetic variants were significantly associated with platelet reactivity (PPAR-α G209A AA: -23.87 PRU [-43.54, -4.19]; PPAR-α A208G GG: -23.70 PRU [-43.13, -4.27]). In patients who were on statin/fibrate co-medication, these PPAR-α genetic variants were associated with an even lower platelet reactivity (-29.74 PRU [-50.94, -8.54], and -29.38 PRU [-50.26, -8.49], respectively), while those without statin/fibrate co-medication did not show a significant change in platelet reactivity (13.00 PRU [-39.79, 65.80]). Conclusions: Two genetic variants in PPAR-α (G209A and A208G) were associated with lower platelet reactivity in patients with non-urgent PCI and stenting co-treated with clopidogrel and lipid-lowering drugs

Cost Effectiveness of a CYP2C19 Genotype-Guided Strategy in Patients with Acute Myocardial Infarction:Results from the POPular Genetics Trial

INTRODUCTION: The POPular Genetics trial demonstrated that a CYP2C19 genotype-guided P2Y12 inhibitor strategy reduced bleeding rates compared with standard treatment with ticagrelor or prasugrel without increasing thrombotic event rates after primary percutaneous coronary intervention (PCI). OBJECTIVE: In this analysis, we aimed to evaluate the cost effectiveness of a genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel. METHODS: A 1-year decision tree based on the POPular Genetics trial in combination with a lifelong Markov model was developed to compare costs and quality-adjusted life-years (QALYs) between a genotype-guided and a standard P2Y12 inhibitor strategy in patients with myocardial infarction undergoing primary PCI. The cost-effectiveness analysis was conducted from a Dutch healthcare system perspective. Within-trial survival and utility data were combined with lifetime projections to evaluate lifetime cost effectiveness for a cohort of 1000 patients. Costs and utilities were discounted at 4 and 1.5%, respectively, according to Dutch guidelines for health economic studies. Besides deterministic and probabilistic sensitivity analyses, several scenario analyses were also conducted (different time horizons, different discount rates, equal prices for P2Y12 inhibitors, and equal distribution of thrombotic events between the two strategies). RESULTS: Base-case analysis with a hypothetical cohort of 1000 subjects demonstrated 8.98 QALYs gained and €725,550.69 in cost savings for the genotype-guided strategy (dominant). The deterministic and probabilistic sensitivity analysis confirmed the robustness of the model and the cost-effectiveness results. In scenario analyses, the genotype-guided strategy remained dominant. CONCLUSION: In patients undergoing primary PCI, a CYP2C19 genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel resulted in QALYs gained and cost savings. TRIAL REGISTRATION: Clinicaltrials.gov number: NCT01761786, Netherlands trial register number: NL2872

The impact of patient-reported frailty on cardiovascular outcomes in elderly patients after non-ST-acute coronary syndrome

Background: As life expectancy increases, the population of older individuals with coronary artery disease and frailty is growing. We aimed to assess the impact of patient-reported frailty on the treatment and prognosis of elderly early survivors of non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods: Frailty data were obtained from two prospective trials, POPular Age and the POPular Age Registry, which both assessed elderly NSTE-ACS patients. Frailty was assessed one month after admission with the Groningen Frailty Indicator (GFI) and was defined as a GFI-score of 4 or higher. In these early survivors of NSTE-ACS, we assessed differences in treatment and 1-year outcomes between frail and non-frail patients, considering major adverse cardiovascular events (MACE, including cardiovascular mortality, myocardial infarction, and stroke) and major bleeding. Results: The total study population consisted of 2192 NSTE-ACS patients, aged ≥70 years. The GFI-score was available in 1320 patients (79 ± 5 years, 37% women), of whom 712 (54%) were considered frail. Frail patients were at higher risk for MACE than non-frail patients (9.7% vs. 5.1%, adjusted hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.01–2.43, p = 0.04), but not for major bleeding (3.7% vs. 2.8%, adjusted HR 1.23, 95% CI 0.65–2.32, p = 0.53). Cubic spline analysis showed a gradual increase of the risk for clinical outcomes with higher GFI-scores. Conclusions: In elderly NSTE-ACS patients who survived 1-month follow-up, patient-reported frailty was independently associated with a higher risk for 1-year MACE, but not with major bleeding. These findings emphasize the importance of frailty screening for risk stratification in elderly NSTE-ACS patients.</p

Prior outpatient antibiotic use as predictor for microbial aetiology of community-acquired pneumonia: hospital-based study

Objective: The causative micro-organism in community-acquired pneumonia (CAP) is often difficult to predict. Different studies have examined chronic morbidity and clinical symptoms as predictors for microbial aetiology of pneumonia. The aim of our study was to assess whether prior outpatient antimicrobial treatment is predictive for determining the microbial aetiology of CAP. Methods: This was a hospital-based prospective observational study including all patients admitted with CAP between 1 October 2004 and 1 August 2006. Microbial investigations included sputum, blood culture, sputum PCR, antigen testing and serology. Exposure to antimicrobial drugs prior to hospital admission was ascertained through community pharmacy dispensing records. Multivariate logistic regression analysis was conducted to assess whether prior outpatient antimicrobial treatment is a predictor of microbial aetiology. Patient demographics, co-morbidities and pneumonia severity were considered to be other potential predictors. Results: Overall, 201 patients were included in the study. The microbial aetiology was determined in 64% of the patients. The five most prevalent pathogens were Streptococcus pneumoniae, Heamophilus influenzae, Legionella spp., Mycoplasma pneumoniae and Influenza virus A+B. Forty-seven of the patients (23%) had received initial antimicrobial treatment as outpatients. Multivariate analyses revealed that initial outpatient beta-lactam treatment was associated with a threefold increased chance of finding atypical pathogens and a threefold decreased probability of pneumococcal infection; the corresponding odds ratios were 3.51 (95% CI 1.25-9.99) and 0.30 (95% CI 0.10-0.90), respectively. Patients who received macrolides prior to hospitalisation had an increased probability of viral pneumonia. Conclusion: Prior outpatient antimicrobial therapy has a predictive value in the diagnostic workup aimed at identifying the causative pathogen and planning corresponding antimicrobial treatment in patients hospitalised for pneumonia

Effect of Adding Ticagrelor to Standard Aspirin on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting (POPular CABG) A Randomized, Double-Blind, Placebo-Controlled Trial

BACKGROUND: Approximately 15% of saphenous vein grafts (SVGs) occlude during the first year after coronary artery bypass graft surgery (CABG) despite aspirin use. The POPular CABG trial (The Effect of Ticagrelor on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting Surgery) investigated whether ticagrelor added to standard aspirin improves SVG patency at 1 year after CABG. METHODS: In this investigator-initiated, randomized, double-blind, placebo-controlled, multicenter trial, patients with ≥1 SVGs were randomly assigned (1:1) after CABG to ticagrelor or placebo added to standard aspirin (80 mg or 100 mg). The primary outcome was SVG occlusion at 1 year, assessed with coronary computed tomography angiography, in all patients that had primary outcome imaging available. A generalized estimating equation model was used to perform the primary analysis per SVG. The secondary outcome was 1-year SVG failure, which was a composite of SVG occlusion, SVG revascularization, myocardial infarction in myocardial territory supplied by a SVG, or sudden death. RESULTS: Among 499 randomly assigned patients, the mean age was 67.9±8.3 years, 87.1% were male, the indication for CABG was acute coronary syndrome in 31.3%, and 95.2% of procedures used cardiopulmonary bypass. Primary outcome imaging was available in 220 patients in the ticagrelor group and 223 patients in the placebo group. The SVG occlusion rate in the ticagrelor group was 10.5% (51 of 484 SVGs) versus 9.1% in the placebo group (43 of 470 SVGs), odds ratio, 1.29 [95% CI, 0.73-2.30]; P=0.38. SVG failure occurred in 35 (14.2%) patients in the ticagrelor group versus 29 (11.6%) patients in the placebo group (odds ratio, 1.22 [95% CI, 0.72-2.05]). CONCLUSIONS: In this randomized, placebo-controlled trial, the addition of ticagrelor to standard aspirin did not reduce SVG occlusion at 1 year after CABG. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02352402

The chronic toxicity of emamectin benzoate to three marine benthic species using microcosms

The commercial farming of Atlantic salmon, Salmo salar, may require the periodic application of emamectin benzoate (EB) treatments to reduce the effects of biological pests, such as sea lice. As a result, EB is detected in sediments beneath these fish farms at considerable levels. Literature sediment toxicity data for EB for marine benthic species is only available for 10-day sediment toxicity tests, which might be too short to assess field effects. Here, we present a sediment toxicity test to determine 28-day mortality and growth effect concentrations for the non-target polychaete worm Arenicola marina, the crustacean Corophium volutator and the mollusk Cerastoderma edule using a marine microcosm setup. Results indicate that no concentration-dependent increase of mortality and growth rate was apparent to A. marina and C. edule. But for C. volutator, a concentration-dependent increase in mortality was observed, resulting in a calculated 28-d LC50 of 316 μg/kg dry sediment (95% confidence interval: 267–373 μg/kg dry sediment). There were significant effects on C. volutator growth rate at concentrations of 100 μg/kg dry sediment and above (NOEC = 30 μg/kg dry sediment). These observations show that C. volutator is more sensitive to EB than A. marina, which differs from results reported in previous studies. Comparison to the most sensitive NOEC (30 μg/kg dry sediment) found for C. volutator (organisms of 8–11 mm length), shows that the Environmental Quality Standard, derived by the Scottish Environment Protection Agency in 2017 which based on freshwater species data (NOEC = 1.175 μg/kg dry sediment), are relatively strict and is sufficiently protective for the marine species tested in this paper.</p

Tailored P2Y12 inhibitor treatment in patients undergoing non-urgent PCI—the POPular Risk Score study

PURPOSE: The POPular Risk Score was developed for the selective intensification of P2Y 12 inhibitor treatment with prasugrel instead of clopidogrel in patients undergoing non-urgent percutaneous coronary intervention (PCI) with stent implantation. This score is based on platelet reactivity (VerifyNow P2Y 12 assay), CYP2C19 genotyping, and clinical risk factors. Our aim was to determine if the use of this score in clinical practice is associated with a reduction in thrombotic events without increasing bleeding events. METHODS: In a single-center prospective cohort study, patients with a high risk score were treated with prasugrel and patients with a low risk score with clopidogrel. The risk score-guided cohort was compared with a historic cohort of clopidogrel-treated patients. The endpoint consisted of all-cause death, myocardial infarction, stroke, or stent thrombosis during 1 year of follow-up. TIMI major and minor bleeding events were also analyzed. RESULTS: The guided cohort contained 1127 patients, 26.9% of whom were switched to prasugrel according to the POPular Risk Score. The historic cohort contained 893 patients. The incidence of the combined thrombotic endpoint was significantly lower in the guided cohort as compared with the historic cohort (8.4% versus 3.7%, p < 0.001). This strategy was safe with respect to bleeding (4.0% versus 1.3%, p < 0.001, for TIMI major or minor bleeding). Results were comparable after multivariate and propensity score matched and weighted analysis. CONCLUSION: Selective intensification of P2Y 12 inhibitor treatment after non-urgent PCI based on the POPular Risk Score is associated with a reduction in thrombotic events without an increase in bleeding events