A 12-month follow-up study of treating overweight schizophrenic patients with aripiprazole

Objective: To investigate the feasibility of switching overweight schizophrenic patients to aripiprazole and to assess the impact of 12 months of aripiprazole treatment on weight in routine practice. Method: This was a non-controlled cohort study in overweight schizophrenic patients. Data were collected before treatment with aripiprazole was started and at 12-month follow-up. Results: A total of 53 patients were included; of these 55% continued using aripiprazole for 12 months. Aripiprazole treatment for 12 months (P = 0.027) and stopping clozapine or olanzapine treatment (P = 0.038) predicted weight loss (>= 3 kg). Patients receiving aripiprazole monotherapy (n = 16, mean -3.0 kg) had similar weight loss than patients receiving aripiprazole in addition to another antipsychotic drug (n = 13, mean -4.4 kg). Conclusion: In routine practice once aripiprazole treatment was started, more than half of the patients remained on aripiprazole and most of them lost weight. Adding aripiprazole to clozapine gave similar weight loss as monotherapy with aripiprazole

[Basisdocument Radon.]

Betreft de engelse editie van 710401014<br>This document on the subject of radon contains data on sources, emissions, dispersion and risks. Risks are based on a comparison of exposure levels and detrimental effects. The main risk to humans from radon is the induction of lung cancer. Possible techniques to reduce these risks, as well as the costs involved, are discussed. A number of potential policy scenarios for radon are also examined. The mean Rn-222 concentration in Dutch living rooms is 29 Bq m-3 (range 8-140 Bq m-3), which falls within the range of 20-90 Bq m-3 observed in other European countries. The soil (averaging about 70%) and the building materials used (about 30%) are the principal contributors to the Rn-222 concentrations in indoor air. The mean outdoor atmospheric concentrations in the Netherlands is about 3 Bq m-3 (1-10 Bq m-3, depending on the geographical location). The average exposure to radon daughters in the Netherlands corresponds to a lung cancer mortality of 60 (uncertainty interval: 30-120) per million persons per year (80% resulting from Rn-222 and 20% from Rn-220). Knowledge of radon in the Netherlands is still incomplete. Research into Rn-222 exposures in office buildings, factories, schools and day nurseries, and additional field test of the effectiveness of radon control measures are recommended. As knowledge of Rn-220 exposures is virtually non-existent, exploratory research is also recommended.DGM/SV

The human environmental balance

A future policy instrument for assessing the consequences of changes (already made) to the physical environment can be found in the instrument known as the human environmental balance. By taking all relevant aspects into account when using this instrument, present and future serious defects along with necessary areas of focus will become clear. In this way, the balance will fulfil an important evaluative and indicative function, serving as an integral conceptual framework to find out what investments to make and where they should be made. This report describes a survey, representing an initial step on the road to a balanced physical environment, charting further work along the way. It is also meant to stimulate a broad debate on how to audit this physical environment and what to study. The concept of the physical environment is defined as consisting of (stocks of) various objects in a certain (spatial) arrangement. These objects are evaluated from three perspectives: ecological, economic and social/psychological. The first two perspectives focus on long-term issues on sustainability. In the third perspective the central theme is the perception of the environment by humans themselves; here, we are concerned about short-term issues on the sub-national (local) level. The 1970-1995 draft balance also saw its first elaboration in this report.De leefomgevingsbalans is een door VROM voorgesteld toekomstig beleidsinstrument om gedane ingrepen in het fysieke milieu op hun integrale gevolgen voor de leefomgeving te beoordelen. De leefomgevingsbalans zou hiermee een belangrijke evaluerende en signalerende functie hebben: door beschouwing van alle relevante aspecten maakt de balans zichtbaar waar tekorten zijn of dreigen te ontstaan en waar extra inspanningen nodig zijn. Hiermee vormt de leefomgevingsbalans een integratief raamwerk dat richtinggevend kan zijn voor de aard en locatie van gewenste investeringen. Dit rapport is een verkenning van een mogelijk invulling van een dergelijke leefomgevingsbalans en dient uitsluitend als basis voor discussie. Het beschouwt de fysieke leefomgeving als een verzameling van (voorraden) van allerlei objecten in een bepaalde ruimtelijke configuratie. Deze objecten worden vanuit verschillende invalshoeken verschillend gewaardeerd. Hierbij is onderscheid gemaakt in een ecologisch, economisch en sociaal-psychologisch perspectief. De eerste twee perspectieven zijn vooral gericht op lange termijn-vraagstukken waarbij duurzaamheid voorop staat. Bij het laatste perspectief gaat om de individuele leefbaarheid van de burger, veelal handelend over korte termijn-vraagstukken op vooral lokaal niveau. Op deze wijze wordt het 'leefomgevingskapitaal' gepresenteerd als een drieluik van economische, ecologische en sociaal-psychologische waarden. In het rapport is ook een eerste uitwerking van dit concept voor de periode 1970-1995 gegeven

Design and management of an orthopaedic bone bank in the Netherlands

The design and management of an orthopaedic bone bank is a complex process in which medical organisation and legislation intertwine. Neither in the Netherlands, nor in any other European country, there are official guidelines for the organisation and management of an orthopaedic bone bank. In the Netherlands, the recently modified ‘law of security and quality for using human materials’ (WVKL) dictates requirements for technical and organisational aspects for the use of human tissue and cells. The bone bank procedures include a thorough questionnaire for donor selection, extensive serological, bacteriological and histopathological examination, as well as standard procedures for registration, processing, preservation, storage and distribution of bone allografts. This article describes the organisation of an accredited bone bank and can be used as a proposition for an official guideline or can be useful as an example for other orthopaedic bone banks in Europe

Impaction bone grafting of the acetabulum at hip revision using a mix of bone chips and a biphasic porous ceramic bone graft substitute: Good outcome in 43 patients followed for a mean of 2 years

Background and purpose One of the greatest problems of revision hip arthroplasty is dealing with lost bone stock. Good results have been obtained with impaction grafting of allograft bone. However, there have been problems of infection, reproducibility, antigenicity, stability, availability of bone, and cost. Thus, alternatives to allograft have been sought. BoneSave is a biphasic porous ceramic specifically designed for use in impaction grafting. BoneSave is 80% tricalcium phosphate and 20% hydroxyapatite. Previous in vitro and in vivo studies have yielded good results using mixtures of allograft and BoneSave, when compared with allograft alone. This study is the first reported human clinical trial of BoneSave in impaction grafting

B-cell lymphoma in retrieved femoral heads: a long term follow up

<p>Abstract</p> <p>Background</p> <p>A relatively high incidence of pathological conditions in retrieved femoral heads, including a group of patients having low grade B-cell lymphoma, has been described before. At short term follow up none of these patients with low-grade B-cell lymphoma showed evidence of systemic disease. However, the long term follow up of these patients is not known.</p> <p>Methods</p> <p>From November 1994 up to and including December 2005 we screened all femoral heads removed at the time of primary total hip replacement histopathologically and included them in the bone banking protocol according to the guidelines of the American Associations of Tissue Banks (AATB) and the European Association of Musculo-Skeletal Transplantation (EAMST). We determined the percentage of B-cell lymphoma in all femoral heads and in the group that fulfilled all criteria of the bone banking protocol and report on the long-term follow-up.</p> <p>Results</p> <p>Of 852 femoral heads fourteen (1.6%) were highly suspicious for low-grade B-cell lymphoma. Of these 852 femoral heads, 504 were eligible for bone transplantation according to the guidelines of the AATB and the EAMST. Six femoral heads of this group of 504 were highly suspicious for low-grade B-cell lymphoma (1.2%). At long term follow up two (0.2%) of all patients developed systemic malignant disease and one of them needed medical treatment for her condition.</p> <p>Conclusion</p> <p>In routine histopathological screening we found variable numbers of low-grade B-cell lymphoma throughout the years, even in a group of femoral heads that were eligible for bone transplantation. Allogenic transmission of malignancy has not yet been reported on, but surviving viruses are proven to be transmissible. Therefore, we recommend the routine histopathological evaluation of all femoral heads removed at primary total hip arthroplasty as a tool for quality control, whether the femoral head is used for bone banking or not.</p

Cervical intramedullary schwannoma: a case report and review of the literature

Intramedullary schwannomas unrelated with neurofibromatosis are uncommon tumors, but if correctly diagnosed and properly treated they may have a good prognosis

Functional remission of people with serious mental illness (SMI):Psychometric properties of a new ROM-instrument

BACKGROUND: Instruments are used for routine outcome monitoring of patients with severe mental illness in order to measure psychiatric symptoms, care needs and quality of life. By adding an instrument for measuring functional remission a more complete picture can be given of the complaints, the symptoms and general functioning, which can give direction to providing care for patients with severe mental illness. AIM: To describe the development and testing of a new instrument of functional remission (FR) among people with a psychotic disorder or another serious mental disorder (SMI) as an addition to the symptomatic remission (SR), according to international criteria. METHOD: The FR-assessment involves assessment by a mental health professional who conducts a semi-structured interview with the patient and his or her family and/or uses patient files relating to the three areas of functioning: daily living and self-care; work, study and housekeeping; and social contacts. These areas are rated on a three-point scale of o: independent; 1: partially independent; 2: dependent. The assessment covers a period of six months, in accordance with the measurement of symptomatic remission and should be part of regular routine outcome monitoring (ROM) procedures. The FR-instrument was used in 2012 with 840 patients from eight Dutch mental care institutions and included a one-year follow-up among 523 patients (response 62%). RESULTS: The results showed that the instrument is relatively easily to complete. It was also relevant for clinical practice, although further research is needed because of the raters' low response. Intra- and inter-rater reliability, discriminating and convergent validity, and sensitivity to change were rated sufficient to good. CONCLUSION: If the FR-instrument becomes part of regular ROM-procedures and is used as a measure of societal participation, it could be a useful addition to current measures of symptomatic remission.</p