A Dutch paediatric palliative care guideline: a systematic review and evidence-based recommendations for symptom treatment

Background: Children with life-threatening and life-limiting conditions can experience high levels of suffering due to multiple distressing symptoms that result in poor quality of life and increase risk of long-term distress in their family members. High quality symptom treatment is needed for all these children and their families, even more so at the end-of-life. In this paper, we provide evidence-based recommendations for symptom treatment in paediatric palliative patients to optimize care. Methods: A multidisciplinary panel of 56 experts in paediatric palliative care and nine (bereaved) parents was established to develop recommendations on symptom treatment in paediatric palliative care including anxiety and depression, delirium, dyspnoea, haematological symptoms, coughing, skin complaints, nausea and vomiting, neurological symptoms, pain, death rattle, fatigue, paediatric palliative sedation and forgoing hydration and nutrition. Recommendations were based on evidence from a systematic literature search, additional literature sources (such as guidelines), clinical expertise, and patient and family values. We used the GRADE methodology for appraisal of evidence. Parents were included in the guideline panel to ensure the representation of patient and family values. Results: We included a total of 18 studies that reported on the effects of specific (non) pharmacological interventions to treat symptoms in paediatric palliative care. A few of these interventions showed significant improvement in symptom relief. This evidence could only (partly) answer eight out of 27 clinical questions. We included 29 guidelines and two textbooks as additional literature to deal with lack of evidence. In total, we formulated 221 recommendations on symptom treatment in paediatric palliative care based on evidence, additional literature, clinical expertise, and patient and family values. Conclusion: Even though available evidence on symptom-related paediatric palliative care interventions has increased, there still is a paucity of evidence in paediatric palliative care. We urge for international multidisciplinary multi-institutional collaboration to perform high-quality research and contribute to the optimization of symptom relief in palliative care for all children worldwide

Ligament reconstruction in thumb carpometacarpal joint instability: A systematic review

Summary: In thumb carpometacarpal (CMC) instability, laxity of the ligaments surrounding the joint leads to pain and weakness in grip and pinch strength, which predisposes the patient to developing CMC joint arthritis. Recent advancements in joint anatomy and kinematics have led to the development of various surgical reconstructive procedures. This systematic review outlines the available ligament reconstruction techniques and their efficacy in treating nontraumatic and nonarthritic CMC instability. Additionally, we aimed to provide evidence which specific ligament reconstruction technique demonstrates the best results. Four databases (Embase, MEDLINE, Web of Science, and Cochrane Central) were searched for studies that reported on surgical techniques and their clinical outcomes in patients with nontraumatic and nonarthritic CMC instability. Twelve studies were analyzed for qualitative review, including nine different surgical ligament reconstruction techniques involving two hundred and thirty thumbs. All but one of the reported techniques improved postoperative pain scores and showed substantial improvement in pinch and grip strength. Complication rates varied between 0% and 25%. The included studies showed that ligament reconstruction effectively alleviated the patients’ complaints regarding pain and instability, resulting in overall high patient satisfaction. Nevertheless, drawing definitive conclusions regarding the superiority of any ligament reconstruction technique remains challenging owing to the limited availability of homogeneous data in the current literature

A Dutch paediatric palliative care guideline:a systematic review and evidence-based recommendations for symptom treatment

Background: Children with life-threatening and life-limiting conditions can experience high levels of suffering due to multiple distressing symptoms that result in poor quality of life and increase risk of long-term distress in their family members. High quality symptom treatment is needed for all these children and their families, even more so at the end-of-life. In this paper, we provide evidence-based recommendations for symptom treatment in paediatric palliative patients to optimize care. Methods: A multidisciplinary panel of 56 experts in paediatric palliative care and nine (bereaved) parents was established to develop recommendations on symptom treatment in paediatric palliative care including anxiety and depression, delirium, dyspnoea, haematological symptoms, coughing, skin complaints, nausea and vomiting, neurological symptoms, pain, death rattle, fatigue, paediatric palliative sedation and forgoing hydration and nutrition. Recommendations were based on evidence from a systematic literature search, additional literature sources (such as guidelines), clinical expertise, and patient and family values. We used the GRADE methodology for appraisal of evidence. Parents were included in the guideline panel to ensure the representation of patient and family values. Results: We included a total of 18 studies that reported on the effects of specific (non) pharmacological interventions to treat symptoms in paediatric palliative care. A few of these interventions showed significant improvement in symptom relief. This evidence could only (partly) answer eight out of 27 clinical questions. We included 29 guidelines and two textbooks as additional literature to deal with lack of evidence. In total, we formulated 221 recommendations on symptom treatment in paediatric palliative care based on evidence, additional literature, clinical expertise, and patient and family values. Conclusion: Even though available evidence on symptom-related paediatric palliative care interventions has increased, there still is a paucity of evidence in paediatric palliative care. We urge for international multidisciplinary multi-institutional collaboration to perform high-quality research and contribute to the optimization of symptom relief in palliative care for all children worldwide.</p

Proteomic markers with prognostic impact on outcome of chronic lymphocytic leukemia patients under chemo-immunotherapy: results from the HOVON 109 study

Despite recent identification of several prognostic markers, there is still a need for new prognostic parameters able to predict clinical outcome in chronic lymphocytic leukemia (CLL) patients. Here, we aimed to validate the prognostic ability of known (proteomic) markers measured pretreatment and to search for new proteomic markers that might be related to treatment response in CLL. To this end, baseline serum samples of 51 CLL patients treated with chemo-immunotherapy were analyzed for 360 proteomic markers, using Olink technology. Median event-free survival (EFS) was 23 months (range: 1.25-60.9). Patients with high levels of sCD23 (>11.27, p= 0.026), sCD27 (>11.03, p= 0.04), SPINT1 (>1.6, p= 0.001), and LY9 (>8.22, p= 0.0003) had a shorter EFS than those with marker levels below the median. The effect of sCD23 on EFS differed between immunoglobulin heavy chain variable gene-mutated and unmutated patients, with the shortest EFS for unmutated CLL patients with sCD23 levels above the median. Taken together, our results validate the prognostic impact of sCD23 and highlight SPINT1 and LY9 as possible promising markers for treatment response in CLL patients. (C) 2020 ISEH - Society for Hematology and Stem Cells. Published by Elsevier Inc. All rights reserved.Immunobiology of allogeneic stem cell transplantation and immunotherapy of hematological disease

Measurements of hydrodynamics, sediment, morphology and benthos on Ameland ebb-tidal delta and lower shoreface

A large-scale field campaign was carried out on the ebb-tidal delta (ETD) of Ameland Inlet, a basin of the Wadden Sea in the Netherlands, as well as on three transects along the Dutch lower shoreface. The data have been obtained over the years 2017-2018. The most intensive campaign at the ETD of Ameland Inlet was in September 2017. With this campaign, as part of KustGenese2.0 (Coastal Genesis 2.0) and SEAWAD, we aim to gain new knowledge on the processes driving sediment transport and benthic species distribution in such a dynamic environment. These new insights will ultimately help the development of optimal strategies to nourish the Dutch coastal zone in order to prevent coastal erosion and keep up with sea level rise. The dataset obtained from the field campaign consists of (i) single-and multi-beam bathymetry; (ii) pressure, water velocity, wave statistics, turbidity, conductivity, temperature, and bedform morphology on the shoal; (iii) pressure and velocity at six back-barrier locations; (iv) bed composition and macrobenthic species from box cores and vibrocores; (v) discharge measurements through the inlet; (vi) depth and velocity from X-band radar; and (vii) meteorological data. The combination of all these measurements at the same time makes this dataset unique and enables us to investigate the interactions between sediment transport, hydrodynamics, morphology and the benthic ecosystem in more detail. The data provide opportunities to calibrate numerical models to a high level of detail. Furthermore, the open-source datasets can be used for system comparison studies. The data are publicly available at 4TU Centre for Research Data at https://doi.org/10.4121/collection:seawad (Delft University of Technology et al., 2019) and https://doi.org/10.4121/collection:kustgenese2 (Rijkswaterstaat and Deltares, 2019). The datasets are published in netCDF format and follow conventions for CF (Climate and Forecast) metadata. The http://data.4tu.nl (last access: 11 November 2020) site provides keyword searching options and maps with the geographical position of the data

Measurements of hydrodynamics, sediment, morphology and benthos on Ameland ebb-tidal delta and lower shoreface

A large-scale field campaign was carried out on the ebb-tidal delta (ETD) of Ameland Inlet, a basin of the Wadden Sea in the Netherlands, as well as on three transects along the Dutch lower shoreface. The data have been obtained over the years 2017-2018. The most intensive campaign at the ETD of Ameland Inlet was in September 2017. With this campaign, as part of KustGenese2.0 (Coastal Genesis 2.0) and SEAWAD, we aim to gain new knowledge on the processes driving sediment transport and benthic species distribution in such a dynamic environment. These new insights will ultimately help the development of optimal strategies to nourish the Dutch coastal zone in order to prevent coastal erosion and keep up with sea level rise. The dataset obtained from the field campaign consists of (i) single-and multi-beam bathymetry; (ii) pressure, water velocity, wave statistics, turbidity, conductivity, temperature, and bedform morphology on the shoal; (iii) pressure and velocity at six back-barrier locations; (iv) bed composition and macrobenthic species from box cores and vibrocores; (v) discharge measurements through the inlet; (vi) depth and velocity from X-band radar; and (vii) meteorological data. The combination of all these measurements at the same time makes this dataset unique and enables us to investigate the interactions between sediment transport, hydrodynamics, morphology and the benthic ecosystem in more detail. The data provide opportunities to calibrate numerical models to a high level of detail. Furthermore, the open-source datasets can be used for system comparison studies. The data are publicly available at 4TU Centre for Research Data at https://doi.org/10.4121/collection:seawad (Delft University of Technology et al., 2019) and https://doi.org/10.4121/collection:kustgenese2 (Rijkswaterstaat and Deltares, 2019). The datasets are published in netCDF format and follow conventions for CF (Climate and Forecast) metadata. The http://data.4tu.nl (last access: 11 November 2020) site provides keyword searching options and maps with the geographical position of the data

Atrial fibrillation history impact on catheter ablation outcome. Findings from the ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry

Background Atrial fibrillation (AF) promotes atrial remodeling that in turn promotes AF perpetuation. The aim of our study is to investigate the impact of AF history length on 1-year outcome of AF catheter ablation in a cohort of patients enrolled in the Atrial Fibrillation Ablation Registry. Methods We described the real-life clinical epidemiology, therapeutic strategies, and the short- and mid-term outcomes of 1948 patients (71.9% with paroxysmal AF) undergoing AF ablation procedures, stratified according to AF history duration (= 2 years). Results The mean AF history duration was 46.2 +/- 57.4 months, 592 patients had an AF history duration = 2 years (mean 75.5 +/- 63.5 months) (P = 2 years (34.0%) (P = 0.037). AF history duration >= 2 years, overall ablation procedure duration, hypertension, and chronic kidney disease were all predictors of recurrences after the blanking period. Conclusions In this multicenter registry, performing catheter ablation in patients with an AF history >= 2 years was associated with higher rates of AF recurrences at 1 year. Since cumulative time in AF in not necessarily equivalent to AF history, its role remains to be clarified.Cardiolog