Depression and comorbidity : general practice-based studies on occurence and health care consequences

Schellevis, F.G. [Promotor]Bos, G.A.M. van den [Promotor]Groenewegen, P.P. [Promotor

A study of cost-effectiveness of treating serious mental illness:challenges and solutions

BACKGROUND People with serious mental illness (SMI) often suffer high healthcare costs and enduring loss of quality of life. Increasing our understanding of the cost-effectiveness of people with SMI is important when striving for optimal health at affordable costs. AIM To describe aspects that can be important for cost-effectiveness research targeting people with SMI. METHOD These aspects are demonstrated by considering pro-active care, rehabilitation and involuntary treatment RESULTS The possible involvement of a large number of stakeholders outside of healthcare requires cost-effectiveness research to also map the costs and benefits outside of healthcare, preferably for each stakeholder specifically. Availability of data, the possibility to combine datasets, and ways to deal with dropouts require extra attention. CONCLUSION Cost-effectiveness research targeting people with SMI could be enhanced when solutions are found for the availability of data inside and outside of healthcare and when dropout can be compensated for by other sources of data, such that costs and benefits for each stakeholder can be estimated more reliably.</p

Basics of advanced therapy medicinal product development in academic pharma and the role of a GMP simulation unit

Following successes of authorized chimeric antigen receptor T-cell products being commercially marketed in the United States and European Union, product development of T-cell-based cancer immunotherapy consisting of cell-based advanced therapy medicinal products (ATMPs) has gained further momentum. Due to their complex characteristics, pharmacological properties of living cell products are, in contrast to classical biological drugs such as small molecules, more difficult to define. Despite the availability of many new advanced technologies that facilitate ATMP manufacturing, translation from research-grade to clinical-grade manufacturing in accordance with Good Manufacturing Practices (cGMP) needs a thorough product development process in order to maintain the same product characteristics and activity of the therapeutic product after full-scale clinical GMP production as originally developed within a research setting. The same holds true for transferring a fully developed GMP-grade production process between different GMP facilities. Such product development from the research to GMP-grade manufacturing and technology transfer processes of established GMP-compliant procedures between facilities are challenging. In this review, we highlight some of the main obstacles related to the product development, manufacturing process, and product analysis, as well as how these hinder rapid access to ATMPs. We elaborate on the role of academia, also referred to as ‘academic pharma’, and the added value of GMP production and GMP simulation facilities to keep innovation moving by reducing the development time and to keep final production costs reasonable

Monitor multidisciplinaire samenwerkingsverbanden in de eerste lijn.

Bij de helft van de Nederlandse huisartsenpraktijken is inmiddels een fysiotherapeut, apotheker, sociaal psychiatrisch verpleegkundige of andere zorgverlener gevestigd. Leidt vestiging op één adres ook tot meer samenwerking? Eén adres Eenderde van alle huisartsenpraktijken heeft een formeel samenwerkingsverband. Het merendeel daarvan is ook met andere zorgverleners op hetzelfde adres gevestigd. Daarbij blijkt dat praktijken met meerdere huisartsen vaker samenwerken met andere zorgverleners dan solopraktijken. De regionale verschillen binnen Nederland zijn klein. Centrale rol Het lijkt aannemelijk dat door de gezamenlijke vestiging op één adres de samenwerking ook toeneemt. Het ministerie van VWS wil de eerste lijn versterken zodat die zijn centrale rol in het Nederlandse zorgsysteem kan behouden. De achterliggende gedachte is dat samenwerking goed is voor de samenhang van de zorg en afstemming. Samenwerkingscontract Met subsidie van het ministerie van VWS is voor het eerst op landelijk niveau voor een groot aantal eerstelijns disciplines de samenwerking met de huisarts in kaart gebracht. Het NIVEL keek naar verschillende eerstelijns hulpverleners op één adres, naar formele samenwerking die is vastgelegd in een contract, de presentatie van huisarts en andere zorgverleners naar buiten, en of samenwerkingsverbanden worden gefinancierd door zorgverzekeraars. Voor het onderzoek werden alle Nederlandse huisartsenpraktijken aangeschreven. Ruim driekwart reageerde. Het NIVEL wil deze ontwikkeling in de toekomst blijven volgen

Diagnosing major depression in elderly primary care patients: nuances and determinants.

The researchers studied how general practitioners (GPs) diagnosed elderly patients with depressive symptoms. Sociodemographic factors such as younger age, female sex and more education, clinical characteristics such as severe depression and comorbidity of anxiety disorders are suggested to improve the diagnostic rate of depression. It may be decreased by comorbidity of somatic diseases. The role of these determinants was investigated in old age. (aut.ref.