34 research outputs found
The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder
Objective: To investigate the effects of a brief, intensive, direct trauma-focused treatment programme for individuals with PTSD on BPD symptom severity. Methods: Individuals (n = 72) with severe PTSD (87.5% had one or more comorbidities; 52.8% fulfilled the criteria for the dissociative subtype of PTSD) due to multiple traumas (e.g. 90.3% sexual abuse) participated in an intensive eight-day trauma-focused treatment programme consisting of eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE) therapy, physical activity, and psychoeducation. Treatment did not include any form of stabilization (e.g. emotion regulation training) prior to trauma-focused therapy. Assessments took place at pre- and post-treatment (Borderline Symptom List, BSL-23; PTSD symptom severity, Clinician Administered PTSD Scale for DSM-5, CAPS-5), and across the eight treatment days (PTSD Checklist, PCL-5). Results: Treatment resulted in significant decreases of BPD symptoms (Cohen’s d = 0.70). Of the 35 patients with a positive screen for BPD at pre-treatment, 32.7% lost their positive screen at post-treatment. No adverse events nor dropouts occurred during the study time frame, and none of the patients experienced symptom deterioration in response to treatment. Conclusion: The results suggest that an intensive trauma-focused treatment is a feasible and safe treatment for PTSD patients with clinically elevated symptoms of BPD, and that BPD symptoms decrease along with the PTSD symptoms
Coeliac disease in The Netherlands: demographic data of a patient survey among the members of the Dutch Coeliac Society
Aprotinin in orthotopic liver transplantation: Evidence for a prohemostatic, but not a prothrombotic, effect
Aprotinin reduces blood transfusion requirements in
orthotopic liver transplantation (OLT). Concern has been
voiced about the potential risk for thrombotic complications
when aprotinin is used. The aim of this study is to
evaluate the effects of aprotinin on the two components of
the hemostatic system (coagulation and fibrinolysis) in
patients undergoing OLT. As part of a larger, randomized,
double-blind, placebo-controlled study, we compared
coagulation (fibrinogen level, activated partial thromboplastin
time [aPTT], prothrombin time, and platelet
count) and fibrinolytic variables (tissue-type plasminogen
activator [tPA] antigen and activity, plasminogen activator
inhibitor activity, and D-dimer), as well as thromboelastography
(reaction time [r], clot formation time,
and maximum amplitude) in 27 patients administered
either high-dose aprotinin (2 ! 106 kallikrein inhibitor
units [KIU] at induction, continuous infusion of 1 ! 106
KIU/h, and 1 ! 106 KIU before reperfusion; n " 10),
regular-dose aprotinin (2 ! 106 KIU at induction and
continuous infusion of 0.5 ! 106 KIU/h; n " 8), or
placebo (n " 9) during OLT. Blood samples were drawn
at seven standardized intraoperative times. Baseline characteristics
were similar for the three groups. During the
anhepatic and postreperfusion periods, fibrinolytic activity
(plasma D-dimer and tPA antigen levels) was significantly
lower in aprotinin-treated patients compared with
the placebo group. Interestingly, coagulation times (aPTT
and r) were significantly more prolonged in aprotinintreated
patients than the placebo group. No difference was
seen in the incidence of perioperative thrombotic complications
in the entire study population (n " 137). Aprotinin
has an anticoagulant rather than a procoagulant
effect. Its blood-sparing (prohemostatic) effect appears
to be the overall result of a strong antifibrinolytic and a
weaker anticoagulant effect. These findings argue against
a prothrombotic effect of aprotinin in patients undergoing
OLT. (Liver Transpl 2001;7:896-903.
Therapeutic drug monitoring of oral anticancer drugs - preliminary results of a prospective study
Therapeutic drug monitoring of oral anticancer drugs - preliminary results of a prospective study
Emergency Department to ICU Time Is Associated With Hospital Mortality : A Registry Analysis of 14,788 Patients From Six University Hospitals in the Netherlands
OBJECTIVES: Prolonged emergency department to ICU waiting time may delay intensive care treatment, which could negatively affect patient outcomes. The aim of this study was to investigate whether emergency department to ICU time is associated with hospital mortality. DESIGN, SETTING, AND PATIENTS: We conducted a retrospective observational cohort study using data from the Dutch quality registry National Intensive Care Evaluation. Adult patients admitted to the ICU directly from the emergency department in six university hospitals, between 2009 and 2016, were included. Using a logistic regression model, we investigated the crude and adjusted (for disease severity; Acute Physiology and Chronic Health Evaluation IV probability) odds ratios of emergency department to ICU time on mortality. In addition, we assessed whether the Acute Physiology and Chronic Health Evaluation IV probability modified the effect of emergency department to ICU time on mortality. Secondary outcomes were ICU, 30-day, and 90-day mortality. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 14,788 patients were included. The median emergency department to ICU time was 2.0 hours (interquartile range, 1.3-3.3 hr). Emergency department to ICU time was correlated to adjusted hospital mortality (p 3.7 hr), both compared with the reference category ( 2.4 hr) is associated with increased hospital mortality after ICU admission, mainly driven by patients who had a higher Acute Physiology and Chronic Health Evaluation IV probability. We hereby provide evidence that rapid admission of the most critically ill patients to the ICU might reduce hospital mortality
Emergency Department to ICU Time Is Associated With Hospital Mortality : A Registry Analysis of 14,788 Patients From Six University Hospitals in the Netherlands
OBJECTIVES: Prolonged emergency department to ICU waiting time may delay intensive care treatment, which could negatively affect patient outcomes. The aim of this study was to investigate whether emergency department to ICU time is associated with hospital mortality. DESIGN, SETTING, AND PATIENTS: We conducted a retrospective observational cohort study using data from the Dutch quality registry National Intensive Care Evaluation. Adult patients admitted to the ICU directly from the emergency department in six university hospitals, between 2009 and 2016, were included. Using a logistic regression model, we investigated the crude and adjusted (for disease severity; Acute Physiology and Chronic Health Evaluation IV probability) odds ratios of emergency department to ICU time on mortality. In addition, we assessed whether the Acute Physiology and Chronic Health Evaluation IV probability modified the effect of emergency department to ICU time on mortality. Secondary outcomes were ICU, 30-day, and 90-day mortality. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 14,788 patients were included. The median emergency department to ICU time was 2.0 hours (interquartile range, 1.3-3.3 hr). Emergency department to ICU time was correlated to adjusted hospital mortality (p 3.7 hr), both compared with the reference category ( 2.4 hr) is associated with increased hospital mortality after ICU admission, mainly driven by patients who had a higher Acute Physiology and Chronic Health Evaluation IV probability. We hereby provide evidence that rapid admission of the most critically ill patients to the ICU might reduce hospital mortality