A national antimicrobial guide with local, customizable versions:how is it used? A two-year analysis

OBJECTIVES: Guideline adherence is one of the most important objectives for antibiotic stewardship. The Dutch Working Party on Antibiotic Policy (SWAB) developed an online national guide (SWAB-ID) in 2006. Every Dutch hospital is offered the opportunity to customize the national version to their local context and distribute it through an independent website. We studied user data to see how often the guidelines on therapy, prophylaxis and medication are used.METHODS: Data on usage between 19 June 2020 and 30 June 2022 were extracted through Google Analytics for the national site and the 53 hospitals using a customized version of the national guide. User data were divided into three main groups: users of the national guide SWAB-ID, and users of the sites of general hospitals and university hospitals.RESULTS: A total of 1 837 126 searches were analysed, of which 1 393 681 (75.9%) concerned therapy, 111 774 (6.1%) prophylaxis and 331 671 (18%) medication. Of these searches, 456 854 (24.9%) were performed on the national site, 950 887 (51.8%) by general hospitals and 429 385 (23.4%) by university hospitals. The most commonly searched tracts among all user groups were lower respiratory tract (21.8%), kidney and urinary tract (16.6%) and skin and soft tissues (11.8%). The most commonly searched conditions were community-acquired pneumonia (15.3%), cystitis (13.5%) and sepsis (11.3%). The top ranked pages on medication differed for the three categories of users.CONCLUSIONS: The SWAB-ID antimicrobial guide is used extensively by both general and university hospitals. The online guide can help in prescribing therapy according to the guideline.</p

Stroke Mechanics of Swimmers with Permanent Physical Disabilities

Abstract The physical properties of water provide a unique environment for facilitating movement, particularly if the constraints imposed by gravity preclude carrying out the activities of daily living within reasonable limits of convenience. Consequently, aquatic exercises have been used extensively as a rehabilitative and recreational medium for persons with permanent physical disabilities. Although programs have been designed specifically for swimmers with physical disabilities, the methods used for instruction continue to be based primarily on techniques used for teaching swimming to non-disabled persons. To this end, the purpose of this paper was to discuss the propulsive and compensatory swimming stroke mechanics used by swimmers with physical disabilities. The discussion will include the manner in which the inherent physical limitations may hinder efficient propulsive movements in the water. The expectation is that with increased information on the underwater movement mechanics of persons with permanent physical disabilities, it will be possible to improve methods of instruction

High Current CD4+ T cell count predicts suboptimal adherence to antiretroviral therapy

Date of Acceptance: 30/09/2015 Funding: A.O.P. is financially supported by the Dutch AIDS Fonds (http://www.aidsfonds.nl/), grant nrs. 2011020 and 2012025. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Discovery of a ~7 Hz Quasi-Periodic Oscillation in the low-luminosity low-mass X-ray binary 4U 1820-30

We have discovered a 7.06+-0.08 Hz quasi-periodic oscillation (QPO) in the X-ray flux of the low-luminosity low-mass X-ray binary (LMXB) and atoll source 4U 1820-30. This QPO was only observable at the highest observed mass accretion rate, when the source was in the uppermost part of the banana branch, at a 2-25 keV luminosity of 5.4x10^37 erg/s (for a distance of 6.4 kpc). The QPO had a FWHM of only 0.5+-0.2 Hz during small time intervals (32-s of data), and showed erratic shifts in the centroid frequency between 5.5 and 8 Hz. The rms amplitude over the energy range 2-60 keV was 5.6%+-0.2%. The amplitude increased with photon energy from 3.7%+-0.5% between 2.8 and 5.3 keV to 7.3%+-0.6% between 6.8 and 9.3 keV, above which it remained approximately constant at ~7%. The time lag of the QPO between 2.8-6.8 and 6.8-18.2 keV was consistent with being zero (-1.2+-3.4 ms). The properties of the QPO (i.e., its frequency and its presence only at the highest observed mass accretion rate) are similar to those of the 5-20 Hz QPO observed in the highest luminosity LMXBs (the Z sources) when they are accreting near the Eddington mass accretion limit. If this is indeed the same phenomenon, then models explaining the 5-20 Hz QPO in the Z sources, which require the near-Eddington accretion rates, will not hold. Assuming isotropic emission, the 2-25 keV luminosity of 4U 1820-30 at the time of the 7 Hz QPOs is at maximum only 40% (for a companion star with cosmic abundances), but most likely ~20% (for a helium companion star) of the Eddington accretion limit.Comment: Accepted for publication in ApJ Letters (6 pages, including 3 figures

Pneumonia Recovery; Discrepancies in Perspectives of the Radiologist, Physician and Patient

BACKGROUND: Chest radiographs are often used to diagnose community-acquired pneumonia (CAP), to monitor response to treatment and to ensure complete resolution of pneumonia. However, radiological exams may not reflect the actual clinical condition of the patient. OBJECTIVE: To compare the radiographic resolution of mild to moderately severe CAP to resolution of clinical symptoms as assessed by the physician or rated by the patient. DESIGN: Prospective cohort study. PARTICIPANTS: One hundred nineteen patients admitted because of mild to moderately severe CAP with new pulmonary opacities. MAIN MEASURES: Radiographic resolution and clinical cure of CAP were determined at day 10 and 28. Radiographic resolution was defined as the absence of infection-related abnormalities; clinical cure was rated by the physician and defined by improvement of signs and symptoms. In addition, the CAP score, a patient-based symptom score, was calculated. KEY RESULTS: Radiographic resolution, clinical cure and normalization of the CAP score were observed in 30.8%, 93% and 32% of patients at day 10, and in 68.4%, 88.9% and 41.7% at day 28, respectively. More severe CAP (PSI score >90) was independently associated with delayed radiographic resolution at day 28 (OR 4.7, 95% CI 1.3-16.9). All 12 patients with deterioration of radiographic findings during follow-up had clinical evidence of treatment failure. CONCLUSIONS: In mild to moderately severe CAP, resolution of radiographic abnormalities and resolution of symptoms scored by the patient lag behind clinical cure assessed by physicians. Monitoring a favorable disease process by routine follow-up chest radiographs seems to have no additional value above following a patient's clinical cours

Effectiveness and cost-effectiveness of a nurse-delivered intervention to improve adherence to treatment for HIV : a pragmatic, multicentre, open-label, randomised clinical trial

This trial was funded from public money by the Netherlands Organisation for Health Research and Development (ZonMW; grant number 171002208). Aardex provided support on the development of the study website. We thank all the HIV nurses and physicians from the seven HIV clinics involved in the AIMS study for their input and collaboration (Academic Medical Centre, Slotervaart hospital, and St. Lucas-Andreas hospital, all in Amsterdam; the Leiden University Medical Centre, Leiden; HAGA hospital, The Hague; Erasmus Medical Centre, Rotterdam; and Isala clinic, Zwolle), the study participants, and the Stichting HIV Monitoring (SHM) for their support in accessing the SHM database for identifying patient inclusion criteria and developing the Markov model. Finally, we thank and remember Herman Schaalma (deceased) for his contribution to the study design and grant application.Peer reviewedPostprin

Absence of seroreversion in 80 HAART-treated HIV-1 seropositive patients with at least five-years undetectable plasma HIV-1 viral load

Partial or complete seroreversion for HIV-1, or incomplete antibody evolution are relatively rare events that have so far only been described in patients treated with HAART early after virus infection. Whether seroreversion is seen in patients treated effectively with HAART years after their acute infection has not been investigated so far. Therefore we have investigated anti-HIV antibody levels in 80 patients treated with HAART during chronic HIV-1 infection, who had an undetectable HIV-1 plasma viral load for at least five years. In none of the patients we observed seroreversion, and there was also no significant decrease or increase in antibody levels in this group of patients. So, successful HAART treatment during chronic HIV-1 infection does not induce seroreversion

Cellular Levels of HIV Unspliced RNA from Patients on Combination Antiretroviral Therapy with Undetectable Plasma Viremia Predict the Therapy Outcome

BACKGROUND:Combination antiretroviral therapy (cART), the standard of care for HIV-1 infection, is considered to be successful when plasma viremia remains below the detection limit of commercial assays. Yet, cART fails in a substantial proportion of patients after the apparent success. No laboratory markers are known that are predictive of cART outcome in initial responders during the period of undetectable plasma viremia. METHODOLOGY/PRINCIPAL FINDINGS:Here, we report the results of a retrospective longitudinal study of twenty-six HIV-infected individuals who initially responded to cART by having plasma viremia suppressed to <50 copies/ml. Eleven of these patients remained virologically suppressed, whereas fifteen experienced subsequent cART failure. Using sensitive methods based on seminested real-time PCR, we measured the levels of HIV-1 proviral (pr) DNA, unspliced (us) RNA, and multiply spliced RNA in the peripheral blood mononuclear cells (PBMC) of these patients at multiple time points during the period of undetectable plasma viremia on cART. Median under-therapy level of usRNA was significantly higher (0.43 log(10) difference, P = 0.0015) in patients who experienced subsequent cART failure than in successfully treated patients. In multivariate analysis, adjusted for baseline CD4(+) counts, prior ART experience, and particular cART regimens, the maximal usRNA level under therapy was the best independent predictor of subsequent therapy failure (adjusted odds ratio [95% CI], 24.4 [1.5-389.5], P = 0.024). The only other factor significantly associated with cART failure was prior ART experience (adjusted odds ratio [95% CI], 12.3 [1.1-138.4], P = 0.042). Levels of usRNA under cART inversely correlated with baseline CD4(+) counts (P = 0.0003), but did not correlate with either baseline usRNA levels or levels of prDNA under therapy. CONCLUSION:Our data demonstrate that the level of HIV-1 usRNA in PBMC, measured in cART-treated patients with undetectable plasma viremia, is a strong predictive marker for the outcome of therapy

Testing and healthcare seeking behavior preceding HIV diagnosis among migrant and non-migrant individuals living in the Netherlands: Directions for early-case finding

OBJECTIVES: To assess differences in socio-demographics, HIV testing and healthcare seeking behavior between individuals diagnosed late and those diagnosed early after HIV-acquisition. DESIGN: Cross-sectional study among recently HIV-diagnosed migrant and non-migrant individuals living in the Netherlands. METHODS: Participants self-completed a questionnaire on socio-demographics, HIV-testing and healthcare seeking behavior preceding HIV diagnosis between 2013-2015. Using multivariable logistic regression, socio-demographic determinants of late diagnosis were explored. Variables on HIV-infection, testing and access to care preceding HIV diagnosis were compared between those diagnosed early and those diagnosed late using descriptive statistics. RESULTS: We included 143 individuals with early and 101 with late diagnosis, of whom respectively 59/143 (41%) and 54/101 (53%) were migrants. Late diagnosis was significantly associated with older age and being heterosexual. Before HIV diagnosis, 89% of those with early and 62% of those with late diagnosis had ever been tested for HIV-infection (p<0.001), and respectively 99% and 97% reported healthcare usage in the Netherlands in the two years preceding HIV diagnosis (p = 0.79). Individuals diagnosed late most frequently visited a general practitioner (72%) or dentist (62%), and 20% had been hospitalized preceding diagnosis. In these settings, only in respectively 20%, 2%, and 6% HIV-testing was discussed. CONCLUSION: A large proportion of people diagnosed late had previously tested for HIV and had high levels of healthcare usage. For earlier-case finding of HIV it therefore seems feasible to successfully roll out interventions within the existing healthcare system. Simultaneously, efforts should be made to encourage future repeated or routine HIV testing among individuals whenever they undergo an HIV test