Archeologe Hayley (31) is lyrisch over lijken

Leiden. Op een veld in Texas worden elke dag honderd lijken bestudeerd voor politieonderzoek en de wetenschap. Het klinkt als een macabere werkplek, maar de Leidse archeologe Hayley Mickleburgh (31) mikt op een beurs om hier nog jaren onderzoek te verrichten. ‘Er is niks griezeligs aan.’NexusArchaeology of indigenous Americ

Prevalence of von Hippel-Lindau gene mutations in sporadic renal cell carcinoma: results from the Netherlands cohort study

BACKGROUND: Biallelic von Hippel-Lindau (VHL) gene defects, a rate-limiting event in the carcinogenesis, occur in approximately 75% of sporadic clear-cell Renal Cell Carcinoma (RCC). We studied the VHL mutation status in a large population-based case group. METHODS: Cases were identified within the Netherlands cohort study on diet and cancer, which includes 120,852 men and women. After 11.3 years of follow-up, 337 incident cases with histologically confirmed epithelial cancers were identified. DNA was isolated from paraffin material collected from 51 pathology laboratories and revised by one pathologist, leaving material from 235 cases. VHL mutational status was assessed by SSCP followed by direct sequencing, after testing SSCP as a screening tool in a subsample. RESULTS: The number of mutations was significantly higher for clear-cell RCC compared to other histological types. We observed 131 mutations in 114 out of 187 patients (61%) with clear-cell RCC. The majority of mutations were truncating mutations (47%). The mean tumor size was 72.7 mm for mutated tumors compared to 65.3 mm for wildtype tumors (p = 0.06). No statistically significant differences were observed for nuclear grade, TNM distribution or stage. In other histological types, we observed 8 mutations in 7 out of 48 patients (15%), 1 mutation in 1 of 6 oncocytoma, 3 mutations in 2 of 7 chromophobe RCC, 2 mutations in 2 of 30 papillary RCC, no mutations in 1 collecting duct carcinoma and 2 mutations in 2 of 4 unclassified RCC. CONCLUSION: VHL mutations were detected in 61% of sporadic clear-cell RCC. VHL mutated and wildtype clear-cell RCC did not differ with respect to most parameters

Prehospital paths and hospital arrival time of patients with acute coronary syndrome or stroke, a prospective observational study

Background: Patients with a presumed diagnosis of acute coronary syndrome (ACS) or stroke may have had contact with several healthcare providers prior to hospital arrival. The aim of this study was to describe the various prehospital paths and the effect on time delays of patients with ACS or stroke. Methods: This prospective observational study included patients with presumed ACS or stroke who may choose to contact four different types of health care providers. Questionnaires were completed by patients, general practitioners (GP), GP cooperatives, ambulance services and emergency departments (ED). Additional data were retrieved from hospital registries. Results: Two hundred two ACS patients arrived at the hospital by 15 different paths and 243 stroke patients by ten different paths. Often several healthcare providers were involved (60.8 % ACS, 95.1 % stroke). Almost half of all patients first contacted their GP (47.5 % ACS, 49.4 % stroke). Some prehospital paths were more frequently used, e.g. GP (cooperative) and ambulance in ACS, and GP or ambulance and ED in stroke. In 65 % of all events an ambulance was involved. Median time between start of symptoms and hospital arrival for ACS patients was over 6 h and for stroke patients 4 h. Of ACS patients 47.7 % waited more than 4 h before seeking medical advice compared to 31.6 % of stroke patients. Median time between seeking medical advice to arrival at hospital was shortest in paths involving the ambulance only (60 min ACS, 54 min stroke) or in combination with another healthcare provider (80 to 100 min ACS, 99 to 106 min stroke). Conclusions: Prehospital paths through which patients arrived in hospital are numerous and often complex, and various time delays occurred. Delays depend on the entry point of the health care system, and dialing the emergency number seems to be the best choice. Since reducing patient delay is difficult and noticeable differences exist between various prehospital paths, further research into reasons for these different entry choices may yield possibilities to optimize paths and reduce overall time delay

Denial and physical outcomes in lung cancer patients, a longitudinal study

Although denial in cancer patients is often seen in clinical practice, studies relating denial to physical outcomes are lacking. The present study aims to investigate patterns of denial among lung cancer patients and connect these to their physical outcomes. Denial was measured longitudinally in 195 consecutive newly diagnosed lung cancer patients. Four assessments were conducted over an 8-month period. Patient-reported physical outcomes were measured with a generic and disease-specific quality of life measure. Medical data were provided by the patients' chest physicians. Three patterns of denial over time were identified in lung cancer patients: patients displayed either low, moderate or increasing denial. Male lung cancer patients were found to deny at a moderate level more often. A moderate or increasing level of denial was consistently related to improved patient-rated physical outcomes. Lung cancer patients displaying more denial reported a better overall perception of health and better physical functioning. They complained less about fatigue, nausea and vomiting, appetite loss, dysphagia and pain in arm and shoulder than low deniers. Other symptoms did not differ among denial classes. Denial in lung cancer patients may well be an adaptive mechanism and have to be respected in clinical practice. (C) 2009 Elsevier Ireland Ltd. All rights reserve

Denial and social and emotional outcomes in lung cancer patients: The protective effect of denial

Denial is a well-known phenomenon in clinical oncology practice. Yet whether the impact of denial on patient well-being is beneficial or harmful remains unknown. The purpose of the current study is to investigate the relationship between denial and social and emotional outcomes in a large sample of lung cancer patients over an extended time period. Denial and social and emotional outcomes were measured in 195 newly diagnosed lung cancer patients. Four assessments were conducted over 8 months. The level of denial was measured using the Denial of Cancer Interview. Patient-reported social and emotional outcomes were measured using the EORTC-QLQ-30 and the HADS. Patients with a moderate or increasing level of denial over time reported better social outcomes (role functioning: p = 0.0036, social functioning: p = 0.027) and less anxiety (p = 0.0001) and depression (p = 0.0019) than patients with a low level of denial. The overall quality of life was better among lung cancer patients who displayed either moderate or increasing levels of denial compared with those who displayed low levels of denial (p <0.0001). A certain level of denial in lung cancer patients can have a protective effect on social and emotional outcomes. Clinicians should take this into account when providing information about the illness and its prognosis. (C) 2010 Elsevier Ireland Ltd. All rights reserve

Needs, barriers and facilitators of older adults towards eHealth in general practice: a qualitative study

BACKGROUND: The strain on health care services is increasing due to an ageing population and the increasing prevalence of chronic health conditions. eHealth could contribute to optimise effective and efficient care to older adults with one or more chronic health conditions in the general practice. AIM: The aim of this study was to identify the needs, barriers and facilitators amongst community-dwelling older adults (60+) suffering from one or more chronic health conditions, in using online eHealth applications to support general practice services. METHODS: A qualitative study, using semi-structured followed by think-aloud interviews, was conducted in the Netherlands. The semi-structured interviews, supported by an interview guide were conducted and analysed thematically. The think-aloud method was used to collect data about the cognitive process while the participant was completing a task within online eHealth applications. Verbal analysis according to the Chi approach was conducted to analyse the think-aloud interviews. FINDINGS: A total of n = 19 older adults with a mean age of 73 years participated. The ability to have immediate contact with the GP on important health issues was identified as an important need. Identified barriers were non-familiarity with the online eHealth applications and a mismatch of user health needs. The low computer experience resulted in non-familiarity with the online eHealth applications. Faltering applications resulted in participants refusing to participate in the use of online eHealth applications. Convenience, efficiency and the instant availability of eHealth via applications were identified as important facilitators. CONCLUSION: To improve the use and acceptability of eHealth applications amongst older adults in the general practice, the applications should be tailored to meet individual needs. More attention should be given to improving the user-friendliness of these applications and to the promotion of the benefits such as facilitating older adults independent living for longer

Prehospital paths and hospital arrival time of patients with acute coronary syndrome or stroke, a prospective observational study

Background: Patients with a presumed diagnosis of acute coronary syndrome (ACS) or stroke may have had contact with several healthcare providers prior to hospital arrival. The aim of this study was to describe the various prehospital paths and the effect on time delays of patients with ACS or stroke. Methods: This prospective observational study included patients with presumed ACS or stroke who may choose to contact four different types of health care providers. Questionnaires were completed by patients, general practitioners (GP), GP cooperatives, ambulance services and emergency departments (ED). Additional data were retrieved from hospital registries. Results: Two hundred two ACS patients arrived at the hospital by 15 different paths and 243 stroke patients by ten different paths. Often several healthcare providers were involved (60.8 % ACS, 95.1 % stroke). Almost half of all patients first contacted their GP (47.5 % ACS, 49.4 % stroke). Some prehospital paths were more frequently used, e.g. GP (cooperative) and ambulance in ACS, and GP or ambulance and ED in stroke. In 65 % of all events an ambulance was involved. Median time between start of symptoms and hospital arrival for ACS patients was over 6 h and for stroke patients 4 h. Of ACS patients 47.7 % waited more than 4 h before seeking medical advice compared to 31.6 % of stroke patients. Median time between seeking medical advice to arrival at hospital was shortest in paths involving the ambulance only (60 min ACS, 54 min stroke) or in combination with another healthcare provider (80 to 100 min ACS, 99 to 106 min stroke). Conclusions: Prehospital paths through which patients arrived in hospital are numerous and often complex, and various time delays occurred. Delays depend on the entry point of the health care system, and dialing the emergency number seems to be the best choice. Since reducing patient delay is difficult and noticeable differences exist between various prehospital paths, further research into reasons for these different entry choices may yield possibilities to optimize paths and reduce overall time delay

The denial of cancer interview: development and first assessment of psychometric properties in lung cancer patients

Based on Weissman and Hackett's comprehensive definition of denial, a semi-structured interview was developed to measure denial in cancer patients. The denial in cancer interview (DCI) covers both the patients' recount of their illness experience and the expert's impression of the level of denial in the patient story. This paper describes the development and first psychometric analyses of the instrument. The development of the DCI was based on clinical observation, the expert opinion of eight specialised psychiatrist as well as three small pilot studies to assess feasibility. The DCI is composed of two parts: a semi-structured interview consisting of nine specific items to be answered by the patient and two items covering the interviewer's clinical impression of the patient's type and level of denial. Follow-up interviews were held at 8, 16 and 32 weeks after the baseline assessment (T2-4). To measure the inter-rater reliability, interviews were recorded and rated independently by one interviewer and one of the study's co-workers. One hundred and ninety-five consecutive newly diagnosed lung cancer patients were interviewed. The internal consistency of the DCI (Cronbach's alpha) was 0.84 at first interview and 0.85, 0.82 and 0.83 at T2-4, respectively. The inter-rater agreement was good for the DCI overall and the patient's assessment scale, and satisfactory for the clinical impression items. Content validity was supported by clinical observation, in depth open interviewing and expert opinion. The DCI proved to be a feasible and reliable instrument for measuring denial in lung cancer patients. Further testing in other oncology settings will provide insight in wider applicability. The DCI can be used in future studies concerning denial in cancer patients. Insight in denial and its background will help us to adequately address denial in patients and communicate with the