APOE and the risk of PD with or without dementia in a population-based study.

OBJECTIVE: To study the association between APOE genotype and PD with or without dementia. METHODS: The study formed part of the Rotterdam Study, a prospective, population-based cohort study on the frequency, etiology, and prognosis of chronic diseases. The cohort examined for PD consisted of 6,969 independently living or institutionalized i

Prognostic factors and prediction models for hospitalisation and all-cause mortality in adults presenting to primary care with a lower respiratory tract infection: a systematic review

Objective To identify and synthesise relevant existing prognostic factors (PF) and prediction models (PM) for hospitalisation and all-cause mortality within 90 days in primary care patients with acute lower respiratory tract infections (LRTI). Design Systematic review. Methods Systematic searches of MEDLINE, Embase and the Cochrane Library were performed. All PF and PM studies on the risk of hospitalisation or all-cause mortality within 90 days in adult primary care LRTI patients were included. The risk of bias was assessed using the Quality in Prognostic Studies tool and Prediction Model Risk Of Bias Assessment Tool tools for PF and PM studies, respectively. The results of included PF and PM studies were descriptively summarised. Results Of 2799 unique records identified, 16 were included: 9 PF studies, 6 PM studies and 1 combination of both. The risk of bias was judged high for all studies, mainly due to limitations in the analysis domain. Based on reported multivariable associations in PF studies, increasing age, sex, current smoking, diabetes, a history of stroke, cancer or heart failure, previous hospitalisation, influenza vaccination (negative association), current use of systemic corticosteroids, recent antibiotic use, respiratory rate ≥25/min and diagnosis of pneumonia were identified as most promising candidate predictors. One newly developed PM was externally validated (c statistic 0.74, 95% CI 0.71 to 0.78) whereas the previously hospital-derived CRB-65 was externally validated in primary care in five studies (c statistic ranging from 0.72 (95% CI 0.63 to 0.81) to 0.79 (95% CI 0.65 to 0.92)). None of the PM studies reported measures of model calibration. Conclusions Implementation of existing models for individualised risk prediction of 90-day hospitalisation or mortality in primary care LRTI patients in everyday practice is hampered by incomplete assessment of model performance. The identified candidate predictors provide useful information for clinicians and warrant consideration when developing or updating PMs using state-of-the-art development and validation techniques

Prospective, blind study of the triple stimulation technique in the diagnosis of ALS

Contains fulltext : 89581.pdf (publisher's version ) (Closed access)OBJECTIVE: To evaluate the diagnostic yield of magnetic cortical stimulation with the triple stimulation technique (TST) to identify upper motor neuron (UMN) involvement in patients suspected of having ALS. METHODS: Fifty-nine patients were recruited to undergo TST in addition to the standard work-up for suspected motor neuron disease. TST combines transcranial magnetic stimulation of the motor cortex with collision studies, which results in a higher sensitivity in detecting UMN involvement. Primary outcome was the number of abnormal TST results in patients with possible ALS. The positivity rate was converted to the number needed to test with TST (NN-TST) for one extra diagnosis of ALS. RESULTS: Fifty patients underwent TST. In the total group (n=59), 18 patients had a motor neuron disorder but did not fulfil criteria for 'probable' or 'definite' ALS. In four of these patients TST was abnormal (NN-TST, 4.5). One TST was erroneously interpreted as abnormal. TST findings were normal in inclusion body myositis and peripheral nerve disorders. CONCLUSION: This prospective and blind study confirms open studies of TST in the evaluation of ALS. We suggest that TST can be used to arrive at a diagnosis of 'probable' or 'definite' ALS in patients lacking UMN signs in the upper extremities

68Ga-PSMA Uptake in Angiolipoma

Item does not contain fulltextGa-PSMA PET/CT is an imaging technique used in staging and detection of prostate cancer. However, enhanced uptake on Ga-PSMA PET/CT scan has also been ascribed to other malignant and benign lesions. We report on a case of a 56-year-old man with treated prostate carcinoma who had a Ga-PSMA PET/CT scan for restaging. Ga-PSMA uptakes in the prostatic bed and in multiple subcutaneous lesions were seen. Histopathology of a subcutaneous lesion revealed angiolipoma. It is important to be aware of the existence of the growing amount of reports on enhanced Ga-PSMA uptake unrelated to prostate cancer

Ontwikkeling van een serious game voor multidisciplinaire samenwerking in zorg en welzijn

Gemeenten en zorgorganisaties kijken steeds vaker over grenzen van sectoren heen vanwege de decentralisatie van ondersteuning aan langdurig zieken en ouderen. De samenwerking bij een dergelijke integrale aanpak kent verschillende uitdagingen, die in opleiding en training kunnen worden geoefend. Dit artikel beschrijft het proces om te komen tot een serious game voor het oefenen van de belangrijkste uitdagingen bij complexe multidisciplinaire samenwerking in zorg en welzijn. Op basis van literatuuronderzoek en interviews met professionals zijn vier leerdoelen opgesteld: het onderscheiden van de meerwaarde van de verschillende professionals, het communiceren met de verschillende professionals, het ontwikkelen van en het handelen naar een teamgerichte focus en het reflecteren op de samenwerking en de eigen rol hierin. In een prototype van de serious game combineerden we deze leerdoelen met gaming elementen, zoals tijdsdruk, het omgaan met tegenstrijdige belangen, het uitwisselen van unieke informatie, cross-training en stapsgewijze spelacties. De game is in drie pilotsessies gespeeld met professionals uit zorg en welzijn. Direct na het spelen werd met behulp van een evaluatieprotocol de game geëvalueerd en aangepast. De leerdoelen werden herkend en de spelvorm sluit aan bij de wensen van de praktijk. Deze studie biedt inzicht in de bouwstenen om multidisciplinaire samenwerking te optimaliseren en laat zien hoe een laagdrempelige, praktijkgerichte simulatietraining kan worden ontwikkeld

High detection rate of adenomas in familial colorectal cancer

Item does not contain fulltextBACKGROUND AND AIMS: Subjects with one first-degree relative (FDR) with colorectal cancer (CRC) 1) adenomas. Men were more often found to have an adenoma than women (24% vs 14.3%; p=0.01). Adenomas were more frequent in group B compared with group A (22.0% vs 15.6%; p=0.09). CONCLUSION: The yield of colonoscopic surveillance in familial CRC is substantially higher than the yield of screening reported for the general population