Evaluating positive experiences of very severe dementia patients

We developed a Snoezelen application to promote the wellbeing of people with severe dementia. During a Snoezelen session, patients are provided with positive and pleasurable experiences, through a combination of visual, auditory, olfactory, and haptic stimuli. Because no measure to evaluate appreciation or enjoyment by this target group themselves could be found, a new observation measure was created and compared to existing proxy measures in a visual stimulation study based on the Snoezelen philosophy. This measure contains three domain scales, Attention, Arousal, and Valence; two (Attention and Arousal) were sensitive enough to capture an effect, or at least a trend towards an effect, of stimulus condition. This finding is seen as promising for the further development of these kinds of observational measures for testing designs for and with this target group

Long-Term Outcome of Sustained Endocrine Monotherapy for Elderly Breast Cancer Patients

Background: Among elderly breast cancer patients, endocrine therapy may be chosen as definitive treatment by patients or physicians. This study investigated the efficacy of endocrine monotherapy (ET) in terms of avoidance of invasive local treatment. Methods: Elderly patients (≥70 years) with a diagnosis of estrogen receptor-positive breast cancer who underwent ET between 2008 and 2015 were identified through the Netherlands Cancer Registry. The primary outcome was the cumulative risk of undergoing invasive local treatment (radiotherapy or surgery) for the primary tumor. The secondary outcomes were development of uncontrolled local disease and overall survival (OS). Results: Of the 105 patients (median age, 86 years) enrolled in this study, 91 (78 %) received ET as definitive treatment, whereas 14 received ET as a “bridge to surgery.” For the 91 patients who used ET as intended definitive treatment, the 5-year cumulative risk of undergoing invasive local treatment and experiencing uncontrolled disease were respectively 28 % and 16 %. The 5-year cumulative OS was 42 %. Whereas 11 patients had metastatic or locally progressive breast cancer at the time of death, cardiovascular disease, infectious diseases, and old age or dementia were reported as contributing to the death of 39 patients. Conclusions: For a select group of elderly breast cancer patients who received sustained ET, the risk of undergoing invasive local treatment was surpassed by a twofold higher risk of dying. As an alternative to invasive local treatment, ET can be discussed as a safe and effective option for patients unwilling or unfit to undergo surgery.</p

Interpretatie en discussie

The Unification of the Mediterranean World (400 BC - 400 AD

Ecologische effecten van metaalverontreiniging in het overstromingsgebied van de Dommel. Triade onderzoek, ecologische risico's en mogelijkheden voor inrichting en beheer

De rivier de Dommel is sterk verontreinigd met cadmium en zink als gevolg van historische activiteiten van de zinkindustrie. Bij overstroming worden deze metalen, gebonden aan organisch stof en kleideeltjes, afgezet op de bodem in het overstromingsgebied. Als gevolg hiervan is ook het overstromingsgebied van de Dommel plaatselijk sterk verontreinigd. De overheid heeft voor een belangrijk deel van het Dommeldal natuurdoelstellingen opgesteld, waaronder het realiseren van de Ecologische Hoofd Structuur. Onduidelijkheid over de invloed van de metaalverontreiniging op de ecologie en natuurontwikkeling heeft geleid tot stagnatie van grondaankopen om deze EHS te kunnen realiseren. Om deze stagnatie op te heffen heeft het projectbureau Actief Bodembeheer de Kempen nader onderzoek laten uitvoeren. Het onderzoek heeft zich gericht op de vraag wat de locatiespecifieke ecologische risico’s zijn van de cadmium- en zinkverontreinigingen bij verschillende natuur(doel)typen die in het Dommeldal aanwezig zijn of ontwikkeld gaan worden. Het betreft hier de natuur(doel)typen die zich in een gebied bevinden dat gemiddeld één of meerdere keren per tien jaar overstroomd wordt. Deze natuur(doel)typen zijn voornamelijk bloemrijk grasland, nat schraalgrasland, moeras en elzenbroekbos. Het onderzoek is stapsgewijs uitgevoerd en wordt TRIADE genoemd vanwege de drie componenten waaruit het is opgebouwd te weten chemie, toxicologie en veldmetinge

Propofol in neonates causes a dose-dependent profound and protracted decrease in blood pressure

Aim: To analyse the effects of different propofol starting doses as premedication for endotracheal intubation on blood pressure in neonates. Methods: Neonates who received propofol starting doses of 1.0 mg/kg (n = 30), 1.5 mg/kg (n = 23) or 2.0 mg/kg (n = 26) as part of a previously published dose-finding study were included in this analysis. Blood pressure in the 3 dosing groups was analysed in the first 60 minutes after start of propofol. Results: Blood pressure declined after the start of propofol in all 3 dosing groups and was not restored 60 minutes after the start of propofol. The decline in b

Clomiphene citrate: A potential alternative for testosterone therapy in hypogonadal males

BACKGROUND: Hypogonadism is a worldwide problem among men causing sexual, physical and mental problems. Testosterone therapy is the first-choice treatment for male hypogonadism, with several side effects, that is, subfertility. Clomiphene citrate (CC) is an alternative off-label therapy for a certain group of hypogonadal males, especially for those with an active or future child wish. There is scarce literature in usage of CC for men with hypogonadism. The aim of this retrospective study was to evaluate the effectiveness and safety of CC for hypogonadal males. METHODS: In this single-centre study, men treated with CC for hypogonadism were evaluated retrospectively. Primary outcome was hormonal evaluation including total testosterone (TT), free testosterone (FT), luteinizing hormone (LH) and follicle stimulating hormone (FSH). Secondary outcomes were hypogonadal symptoms, metabolic and lipid parameters, haemoglobin (Hb), haematocrit (Ht), prostate specific antigen (PSA), side effects, the effect of a trial without medication and potential predictors for biochemical and clinical response. RESULTS: In total, 153 hypogonadal men were treated with CC. Mean TT, FT, LH and FSH increased during treatment. TT increased from 9 to 16 nmol/L, with a biochemical increase in 89% of the patients. In patients who continued CC treatment, an increased level of TT persisted after 8 years of treatment. With CC treatment, 74% of the patients experienced hypogonadal symptom improvement. LH at the lower normal range before CC treatment was predictive for better TT response. During CC therapy, few side effects were reported and no clinical important changes in PSA, Hb and Ht were found. CONCLUSION: Clomiphene citrate is an effective therapy on short and long term, improving both clinical symptoms and biochemical markers of male hypogonadism with few side effects and good safety aspects