The impact of textual elements on the comprehensibility of drug label instructions (DLIs):A systematic review

IntroductionCorrect interpretation of drug labels instructions (DLIs) is needed for safe use and better adherence to prescribed drugs. DLIs are often too difficult for patients, especially for those with limited health literacy. What is yet unknown, is how specific textual elements in DLIs (e.g., the presentation of numbers, or use of medical jargon) and patients' health literacy skills are related to the comprehension of DLIs. In order to provide concrete directions for health professionals on how to optimize drug prescriptions, we performed a systematic review to summarize the available research findings on which textual elements facilitate or hinder the correct interpretation of DLIs in relation to patients' health literacy.MethodA systematic search was performed in PubMed, EMBASE, PsychINFO, and Smartcat (until April 2019) to identify studies investigating textual elements that facilitate or hinder the correct interpretation of DLIs in relation to patients' health literacy.ResultsA total of 434 studies were identified of which 28 studies met our inclusion criteria. We found that textual elements contributing to the correct interpretation of DLIs were: using explicit time periods in dosage instructions, using plain language, presenting numbers in a numerical format, and providing DLIs in patients' native language. Multistep instructions per instruction line, using abbreviations and medical jargon seem to hinder the correct interpretation of DLIs. Although health literacy was taken into account in a majority of the studies, none of them assessed the effectiveness of specific textual elements on patients' comprehensibility of DLIs.ConclusionBased on our findings, we provide an overview of textual elements that contribute to the correct interpretation of DLIs. Optimizing the textual instruction on drug labels may increase the safety and adherence to prescribed drugs, taking into account that a significant proportion of patients has low health literacy

Radiotherapy Late Effects and Osteogenesis Imperfecta: Dos and Don’ts in Clinical Practice

In radiation oncology, little is known about possible difficulties in patients with Osteogenesis Imperfecta (OI). Because radiotherapy can cause various side-effects including bone, soft tissue and cardiovascular toxicities, we foresee that patients with OI may experience even more acute and late side-effects due to pre-existing problems. We present two cases of radiotherapy in patients with OI, measured the effects of radiation on their bone mineral density and provide clinical recommendations for patient tailored radiotherapy strategies in patients with OI

Pots, people and prehistoric mobility: Peter van den Broeke's contributions to the study of Later Prehistoric communities

Pots, people and prehistoric mobility: Peter van den Broeke’s contributions to the study of Later Prehistoric communities Stijn Arnoldussen, Eugene Ball, Joyce van Dijk, Eric Norde & Nynke de Vries This sixth edition of the ‘Metaaltijden. Bijdragen in de studie van de metaaltijden’ contains more papers than usual. This is due to fact that – upon the retirement of Peter van den Broeke – we have seized the opportunity to get a wide range of colleagues to publish a paper to mark this festive occasion. Due to generous contributions by our sponsors, and this year by the municipality of Nijmegen in particular, we can offer you this broad range of papers that address various of the topics central to Peter’s research (Theunissen, this volume). In the contributions by Bloo, Arnoldussen & De Vries, Taayke and Hermsen & Scholte Lubberink, Later Prehistoric handmade pottery takes center stage. Papers focus on regional fabrics and forms (Hermsen & Scholte Lubberink, this volume; Taayke, this volume, cf. Van den Broeke 1987; 1991a; 2012; 2018), the importance of pottery fragmentation in recognizing depositions (De Vries, this volume, cf. Van den Broeke 2002a; 2015) and remarkable decorations on pottery (cf. Van den Broeke, this volume). Taayke (this volume) tries to determine what the earliest Iron Age pottery of the northeastern Netherlands looked like (cf. Van den Broeke 2012, 133‑136). Bloo (this volume) argues that local Neolithic pottery (cf. Ball & Van den Broeke 2007; Van den Broeke et al. 2010, 54‑55) may have inspired the decorative repertoire of Iron Age vessels, and Geerts (this volume) stresses the role of imitation in the production of handmade Roman wares (cf. Van den Broeke 2005a) to express social identities (cf. Van den Broeke 2000). Drenth & Schut (this volume) also note the importance of imitation in their discussion of a stone hammer-axe (cf. Van den Broeke 2005f, 666‑667) from Putten, whose decoration mimics that seen on antler axes (cf. Van den Broeke 2002b, 25). Other types of material culture (cf. Van den Broeke 2005b) are discussed as well. Verhart (this volume) presents a series of remarkable finds of bone and antler tools (cf. Van den Broeke 1983) from Peter’s place of birth Vlaardingen. Heeren (this volume) uses a previously unknown type of brooch from the Northern Netherlands to outline (supra-)regional contacts, affinities and/or mobility of people and material culture in Later Prehistory (cf. Van den Broeke 2001, 15; 22‑23; 28). Amkreutz, Fontijn & Pots , pe ople and prehistoric mobility 13 Gentile’s case of a Late Bronze Age sword from Limburg shows how wetland landscapes figured as arenas for the deposition of objects (cf. Van den Broeke 2001; 2003, 20‑21; 2004, 1‑3). Access to such wetland zones may have been formalised with infrastructure (cf. Van den Broeke 2017, 34‑40; 93‑94), much like the bog trackway of Valthe discussed by Van der Sanden (this volume). The contributions by Fontijn et al., Jas & Louwe Kooijmans and Eimermann & Zuyderwyk all discuss (material culture originating from) Later Prehistoric funerary landscapes (cf. Van den Broeke 1999; 2005c-d; 2006; 2011; Eimermann & Van den Broeke 2017). Jas and Louwe Kooijmans’ narrative (this volume) tells how urns from the Deelen urnfield travelled about and have only been preserved as a painting but could still – using Peter’s typological schemes – be dated to the Early Iron Age (Van den Broeke 2012, 36; 74; 87). Eimermann and Zuyderwyk (this volume) review the fabrication methods and depositional contexts for Iron Age Wendelringe neckrings (cf. Van den Broeke 2001, 132‑133; 142‑144; Eimermann & Van den Broeke 2016). Settlement research (cf. Van den Broeke & Van Londen 1995; Van den Broeke 1993; 2005; Van den Broeke et al. 2010) also figures amongst the papers presented here. Fokkens (this volume) argues for a more cautionary approach towards the dating of features based on finds recovered from their fills (cf. Van den Broeke 2012, 15‑23). A similarly critical stance is found in Koot’s paper (this volume) on the premises underlying our models of settlement dynamics for Iron Age settlements in the Western Netherlands (cf. Van den Broeke 1990; 1991b; 1993; 1995). From the Late Iron Age onwards, a few of the sites in the Western Netherlands appear to specialise in salt production (cf. Van den Broeke 1986; 2007; 2012, 167), as Van Heeringen (this volume) shows for the Vlaardingen – Claudis Civilislaan site. Daniëls and Van Enckevort (this volume) discuss the prehistoric settlements of both high- (Kops Plateau; cf. Van den Broeke 2014) and low-lying Nijmegen (Waalsprong; Van Den Broeke 2002b, 13; 21‑22; 26; 2017; Van den Broeke & Ball 2012). In Bakels’ paper (this volume), goldof- pleasure is presented as a component to the group of oil-rich plants (comprising also linseed and brassica seeds; Van den Broeke 2005h, 687) that were staples of Iron Age communities. Despite the vast array of topics covered, we consider this to be a far from complete reflection of the scope and extent of Peter’s publications – which we expect not to cease upon retirement. Moreover, many of the authors have fond memories of the ways in which Peter shares his vast knowledge with them: always modest, helpful and witty. His outstanding expertise on later prehistoric pottery, but also his broad and deep knowledge of Later Prehistoric communities in general, means that Peter has been – and will continue to be – a help or mentor to many in their careers. It is therefore fitting, that we in turn dedicate this sixth issue of “Metaaltijden. Bijdragen in de studie van de Metaaltijden” to Peter van den Broeke. We hope you enjoy reading it! On behalf of the editorial team, Stijn Arnoldussen, Eugene Ball, Joyce van Dijk, Eric Norde & Nynke de Vrie