Minimally invasive repair of pectus excavatum in a 17-year-old boy with a history of congenital diaphragmatic hernia and lack of pericardium

AbstractWe reported a 17-year-old boy with very deep asymmetric pectus excavatum and with a history of congenital diaphragmatic hernia repair and hypoplastic left lung. We performed a minimally invasive repair of pectus excavatum as described by Nuss et al., in 1998. We performed a left-sided thoracoscopy, instead of the right-sided according our normal routine, to provide a safe route. We created a substernal tunnel to have a clear definition of the deviant anatomy after congenital diaphragmatic hernia repair. However, we noticed an absence of the pericardium, which, by itself, can increase the risk of cardiac injury in both bar insertion and removal. Instead of the usual right-sided thoracoscopy, we recommend providing a safe view by left-sided thoracoscopy in comparable cases (e.g. congenital diaphragmatic hernia, other cardiac or vascular malformations) to reduce the risk of rupture or perforation of cardiac structures

Huntington's disease: Psychological aspects of predictive testing

Predictive testing for Huntington's disease appears to have long lasting psychological effects. The predictive test for Huntington's disease (HD), a hereditary disease of the nervous system, was introduced in the Netherlands in the late eighties. As adverse consequences of the test were anticipated, the effects of testing were studied conscientiously. The general conclusions of these studies were that the negative effects of testing were limited and temporary. The positive consequences of testing seemed to outweigh the negative ones. Knowing if one carried the gene put an end to the unbearable uncertainty of becoming diseased in the future. Testing made it possible to make important decisions, such as concerning having children, pursuing further studies or buying a house. However, long-term investigation at the Leiden University Medical Centre (LUMC) now demonstrates that ten years after the test, when the first symptoms are likely to occur in the near future, the distress of carriers increases again. Strikingly, the current findings are based on a selection of psychologically more stable participants. Individuals who withdrew from the study directly after receiving an unfavourable test result reported (pre-test) considerably less well-being, a worse view of the future, and more evasive behaviour. It is expected that the psychological distress of these dropouts is even greater than that of the retained individuals. It is worrisome that these dropouts stay out of reach of further psychological counselling. Reinier Timman LUMC Centre for Human and Clinical Genetics, and dept. of NeurologyDe Open Ankh, Dtichting Dienstverlening GezondheidszorgUBL - phd migration 201

Myotonic dystrophy: The burden for patients and their partners

Objective: Dystrophia myotonica is characterized by progressive muscular weakness, myotonia, mental slowness and lack of initiative, which causes problems in daily life both for patients and for their spouses. Some couples seem to deal with these problems satisfactorily, while for others they are quite burdensome. The aim of this study was to describe the relationship of severity of dystrophia myotonica and psychological wellbeing in patients and partners. Methods: Sixty-nine couples, in whom one partner had dystrophia myotonica, completed questionnaires on severity of dystrophia myotonica, marital satisfaction, anxiety and depression (Hospital Anxiety and Depression Scale), hopelessness (Beck Hopelessness Scale) and general psychological health (General Health Questionnaire-12). Results: For patients, a worse view of the future, worse general wellbeing, more anxiety and more depression was associated with a greater need for help. For partners, worse general wellbeing and more anxiety was associated with a lack of initiative of the patient and less marital satisfaction. It is noteworthy that 40% of patients and particularly female partners had Beck Hopelessness Scale scores suggestive of clinically relevant depression. Conclusion: Dystrophia myotonica places a heavy burden on patients, and especially on female partners. The need for help and dependency has more influence on the wellbeing of patients than the symptoms of dystrophia myotonica themselves. Marital satisfaction is a strong predictor of better wellbeing, both for patients and, even more so, for partners

Adaptation and validation of the Dutch version of the nasal obstruction symptom evaluation (NOSE) scale

The nasal obstruction symptom evaluation (NOSE) scale is a validated disease-specific, self-completed questionnaire for the assessment of quality of life related to nasal obstruction. The aim of this study was to validate the Dutch (NL-NOSE) questionnaire. A prospective instrument validation study was performed in a tertiary academic referral center. Guidelines for the cross-cultural adaptation process from the original English language scale into a Dutch language version were followed. Patients undergoing functional septoplasty or septorhinoplasty and asymptomatic controls completed the questionnaire both before and 3 months after surgery to test reliability and validity. Additionally, we explored the possibility to reduce the NOSE scale even further using graded response models. 129 patients and 50 controls were included. Internal consistency (Cronbach’s alpha 0.82) and test–retest reliability (intraclass correlation coefficient 0.89) were good. The instrument showed excellent between-group discrimination (Mann–Whitney U = 85, p < 0.001) and high response sensitivity to change (Wilcoxon rank p < 0.001). The NL-NOSE correlated well with the score on a visual analog scale measuring the subjective sensation of nasal obstruction, with exception of item 4 (trouble sleeping). Item 4 provided the least information to the total sc

Development of the Treatment Inventory of Costs in Psychiatric Patients: TIC-P Mini and Midi

AbstractBackgroundMedical costs of (psychiatric) illness can be validly measured with patient report questionnaires. These questionnaires comprise many detailed items resulting in lengthy administrations.ObjectivesWe set out to find the minimal number of items needed to retrieve 80% and 90% of the costs as measured by the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P).MethodsThe TIC-P is a validated patient-reported outcome measure concerning the utilization of medical care and productivity losses. The present study focused on direct medical costs. We applied data of 7756 TIC-P administrations from three studies in patients with mental health care issues. Items that contribute least to the total cost were eliminated, providing that 80% and 90% of the total cost was retained.ResultsAverage medical costs per patient were €658 over the last 4 weeks. The distribution of cost was highly skewed, and 5 of the 14 items of the TIC-P accounted for less than 10% of the total costs. The 80% Mini version of the TIC-P required five items: ambulatory services, private practice, day care, general hospital, and psychiatric clinic. The TIC-P Midi 90% inventory required eight items. Both had variance between the three samples in the optimal choice of the items.ConclusionsThe number of items of the TIC-P can be reduced considerably while maintaining 80% and 90% of the medical costs estimated by the complete TIC-P. The reduced length makes the questionnaire more suitable for routine outcome monitoring

Influence of Polyethylene Soil Mulch and Foliar Application of Urea , Complete Fertilizers, Seaweed in Alleviating Salt Stress of Broccoli (Brassica Oleracea Var.Italica)

This experiment was carried out to study the effect of soil mulch (with black polyethylene) and foliar application of  urea, complete fertilizer and seaweed as well as control) and their interaction in alleviation of salt stress on broccoli which cultivated in salty soil(11.3 dS.m-1) under drip irrigation , by estimating of leaf area, SOD and Catalase activity , MDA and Glutathione concentration in both of leaves and flowers.  In broccoli leaves, soil mulch gave a significant effect in each of leaf area, SOD activity and non- significant effect in catalase activity, Glutathione  and MDA concentration , while in flowers it caused a significant effects on all studied parameters except catalase activity compared to no mulch treatment . Complete fertilizer treatment caused higher effect in all studied parameters than urea and seaweed compared to control treatment . In all studied parameters , the interaction between soil mulch and foliar treatments had high significant effect . complete fertilizer + mulch treatment was the  best, which caused increase in leaf area , SOD and Catalase activity in addition of Glutathione concentration compared to control treatment in both leaves and flowers , while it caused the biggest significant decrease in MDA concentration in both of leaves and flowers. Keywords: Broccoli, Foliar fertilizer, seaweed , soil mulch, Urea, complete fertilize

STEP II Standaard Evaluatie Project 2000-2008

Deze uitgave is de afsluitende rapportage van acht jaar STEP II. Bij de start van STEP II was er sprake van de unieke situatie dat een aantal vergelijkbare afdelingen systematisch informatie verzamelden over de effecten van het behandelmodel dat wij klinische psychotherapie zijn gaan noemen, om dat met elkaar te vergelijken met als doel de verbetering van de kwaliteit van de geboden behandelingen. Ook werden er aarzelende stappen gezet in het omvormen van het effectonderzoek naar een meer wetenschappelijke standaard. Inmiddels is routine outcome monitoring gemeengoed aan het worden en zijn de eerste resultaten gepresenteerd van een groot wetenschappelijk onderzoek naar de (kosten)effectiviteit van diverse behandeldoseringen, waaronder de (deeltijd)klinische psychotherapie. Nieuwe tijden vragen nieuwe plannen, vragen om afronding van het oude en bezinning op de toekomst. Binnenkort zal STEP III het licht zien: een mean and lean design dat snelle terugkoppeling mogelijk maakt zodat deelnemende instellingen een benchmark kunnen opzetten gericht op verbetering van de kwaliteit van hun behandelingen