Versterven bij een psychiatrische patiënt: hindernissen voor patiënt, familie en behandelteam

In deze klinische les beschrijven we een patiënt met een uitgebreide psychiatrische voorgeschiedenis van een chronische depressie die na een jarenlange ambivalente houding besluit te stoppen met eten en drinken, omdat hij – zoals de KNMG het noemt – ‘lijdt aan het leven’. Patiënt had geen verzoek tot euthanasie of hulp bij zelfdoding. Zijn eerste poging, die zes weken duurde, resulteerde niet in het door hem gewenste overlijden. Een tweede poging, vier maanden later, was wel succesvol. In de les komen de hindernissen aan de orde die de patiënt, de familie en het behandelteam tegenkwamen. Met name de psychiatrische voorgeschiedenis, de als gevolg daarvan bestaande polyfarmacie met diverse psychofarmaca, de overmatige dorst, de rol van de echtgenote en de dilemma’s van het behandelend team, maakten deze casus extra gecompliceerd. Daarmee worden dergelijke casus een grote uitdaging voor behandelaars die immers de plicht hebben in zo’n geval goede palliatieve zorg te verlenen

Genome-wide monitoring expression changes of wild Emmer wheat exposed to shock-drought stress

BACKGROUND: Neuropsychiatric symptoms (NPS) frequently occur in patients with dementia. To date, prospective studies on the course of NPS have been conducted in patients with dementia in clinical centers or psychiatric services. The primary goal of this study is to investigate the course of NPS in patients with dementia and caregiver distress in primary care. We also aim to detect determinants of both the course of NPS in patients with dementia and informal caregiver distress in primary care. METHODS/DESIGN: This is a prospective observational study on the course of NPS in patients with dementia in primary care. Thirty-seven general practitioners (GPs) in 18 general practices were selected based on their interest in participating in this study. We will retrieve electronic medical files of patients with dementia from these general practices. Patients and caregivers will be followed for 18 months during the period January 2012 to December 2013. Patient characteristics will be collected at baseline. Time to death or institutionalization will be measured. Co-morbidity will be assessed using the Charlson index. Psychotropic drug use and primary and secondary outcome measures will be measured at 3 assessments, baseline, 9 and 18 months. The primary outcome measures are the Neuropsychiatric Inventory score for patients with dementia and the Sense of Competence score for informal caregivers. In addition to descriptive analyses frequency parameters will be computed. Univariate analysis will be performed to identify determinants of the course of NPS and informal caregiver distress. All determinants will then be tested in a multivariate regression analysis to determine their unique contribution to the course of NPS and caregiver distress. DISCUSSION: The results of this study will provide data on the course of NPS, which is clinically important for prognosis. The data will help GPs and other professionals in planning follow-up visits and in the timing for offering psycho-education, psychosocial interventions and the provision of care. In addition, these data will enlarge health professionals' awareness of NPS in their patients with dementia

Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia

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Practitioners' perceptions of acceptability of a question prompt list about palliative care for advance care planning with people living with dementia and their family caregivers: a mixed-methods evaluation study

Objectives In oncology and palliative care, patient question prompt lists (QPLs) with sample questions for patient and family increased patients' involvement in decision-making and improved outcomes if physicians actively endorsed asking questions. Therefore, we aim to evaluate practitioners' perceptions of acceptability and possible use of a QPL about palliative and end-of-life care in dementia. Design Mixed-methods evaluation study of a QPL developed with family caregivers and experts comprising a survey and interviews with practitioners. Setting Two academic medical training centres for primary and long-term care in the Netherlands. Participants Practitioners (n=66; 73% woman; mean of 21 (SD 11) years of experience) who were mostly general practitioners and elderly care physicians. Outcomes The main survey outcome was acceptability measured with a 15-75 acceptability scale with >= 45 meaning 'acceptable'. Results The survey response rate was 21% (66 of 320 participated). The QPL was regarded as acceptable (mean 51, SD 10) but 64% felt it was too long. Thirty-five per cent would want training to be able to answer the questions. Those who felt unable to answer (31%) found the QPL less acceptable (mean 46 vs 54 for others; p=0.015). We identified three themes from nine interviews: (1) enhancing conversations through discussing difficult topics, (2) proactively engaging in end-of-life conversations and (3) possible implementation. Conclusion Acceptability of the QPL was adequate, but physicians feeling confident to be able to address questions about end-of-life care is crucial when implementing it in practice, and may require training. To facilitate discussions of advance care planning and palliative care, families and persons with dementia should also be empowered to access the QPL themselves.Geriatrics in primary carePublic Health and primary car

Nieuwe tijd, nieuw specialisme: kwetsbare oudere is gebaat bij visionair denkende mensen.

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[Are psychotropic drugs too frequently prescribed in Dutch nursing homes?]

In 1993 Ribbe en Hertogh published a paper in which they expressed their concern about the high prevalence of psychotropic drug use in Dutch nursing homes. Since then, this situation does not seem to have been changed significantly. Recent figures from psychotropic drug use in patients with dementia show prevalence rates of over 60%. The Dutch government decided to choose the prevalence of psychotropic drug use as an indicator of the quality of care and invested in a specific improvement project that aims to reduce psychotropic drug use among nursing home patients. There is a small body of evidence from international research that antipsychotics safely can be reduced without a rise in problem behaviours. In combination with the limited effectiveness and the risk of stroke and increased mortality, the question raises whether these agents should be prescribed at all at least for patients with dementia. A recent study from the UK however, found a significant decrease of antipsychotic drug use by heavily investing in all kinds of person-centered care skills of the nursing staff. These findings underscore the necessity of investing in the caregivers of nursing homes to be able to cope with the complex problems they are faced with

Memantine bij de behandeling van 5 dementerende verpleeghuispatiënten: een systematische meting van de effecten.

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[Dementia: the importance of psychosocial interventions],Dementie: het belang van psychosociale interventies.

Contains fulltext : 51229.pdf (publisher's version ) (Closed access)The number of people suffering from dementia in The Netherlands is expected to rise from 175,000 in 2006 to 400,000 by the year 2050. Stella Braam recently wrote a book in which she described the experiences of her father, a former psychologist with the attitudes and knowledge of professionals concerning communication and coping with dementia, when he became dement himself. She reports that hardly anyone actually listened to the emotions and wishes of her father. Coping with dementia constitutes a major challenge to society. A working-group of the Dutch Institute for Healthcare Improvement CBO recently advised psychological approaches as the first-line treatment for the neuropsychiatric symptoms of dementia; however, they decided not to give concrete guidelines because of the lack of evidence. A study of the literature reveals that the effects of psychosocial interventions are certainly promising even though the evidence is weak. Investment in more research in this field and immediate implementation of the existing knowledge by caregivers and professional workers are recommended

Bespreking van proefschrift: Smalbrugge M. Anxiety and depression in nursing home patients: prevalence, risk indicators and consequences (Vrije Universiteit Amsterdam 2006).

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Het leven, ziek zijn en sterven van dementerende verpleeghuispatiënten: een onderzoek naar morbiditeit, functionele status en mortaliteit

Contains fulltext : mmubn000001_178973866.pdf (publisher's version ) (Open Access)Promotores : C. van Weel, P. Froeling en Y. Hekster118 p