To provide insight into professionals' perceptions of and experiences with shared decision-making (SDM) in the treatment of symptomatic patients with severe aortic stenosis (AS).
A semistructured ...interview study was performed in the heart centres of academic and large teaching hospitals in the Netherlands between June and December 2020. Cardiothoracic surgeons, interventional cardiologists, nurse practitioners and physician assistants (n=21) involved in the decision-making process for treatment of severe AS were interviewed. An inductive thematic analysis was used to identify, analyse and report patterns in the data.
Four primary themes were generated: (1) the concept of SDM, (2) knowledge, (3) communication and interaction, and (4) implementation of SDM. Not all respondents considered patient participation as an element of SDM. They experienced a discrepancy between patients' wishes and treatment options. Respondents explained that not knowing patient preferences for health improvement hinders SDM and complicating patient characteristics for patient participation were perceived. A shared responsibility for improving SDM was suggested for patients and all professionals involved in the decision-making process for severe AS.
Professionals struggle to make highly complex treatment decisions part of SDM and to embed patients' expectations of treatment and patients' preferences. Additionally, organisational constraints complicate the SDM process. To ensure sustainable high-quality care, professionals should increase their awareness of patient participation in SDM, and collaboration in the pathway for decision-making in severe AS is required to support the documentation and availability of information according to the principles of SDM.
The polymer polydimethylsiloxane (PDMS) is widely used to build microfluidic devices compatible with cell culture. Whilst convenient in manufacture, PDMS has the disadvantage that it can absorb small ...molecules such as drugs. In microfluidic devices like “Organs-on-Chip”, designed to examine cell behavior and test the effects of drugs, this might impact drug bioavailability. Here we developed an assay to compare the absorption of a test set of four cardiac drugs by PDMS based on measuring the residual non-absorbed compound by High Pressure Liquid Chromatography (HPLC). We showed that absorption was variable and time dependent and not determined exclusively by hydrophobicity as claimed previously. We demonstrated that two commercially available lipophilic coatings and the presence of cells affected absorption. The use of lipophilic coatings may be useful in preventing small molecule absorption by PDMS.
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•Binding of different compounds to PDMS varies greatly.•Previous reported correlations of absorption and LogP values could not be repeated.•Topological polar surface area possibly related to compound absorption.•A lipid based coating partially obviates compound absorption.•Presence of cultured cells affects free drug concentration, but less than substrate.
Objective
This study aimed at estimating the cumulative incidence of antiepileptic drug (AED) treatment failure of first‐line monotherapy levetiracetam vs valproic acid in glioma patients with ...epilepsy.
Methods
In this retrospective observational study, a competing risks model was used to estimate the cumulative incidence of treatment failure, from AED treatment initiation, for the two AEDs with death as a competing event. Patients were matched on baseline covariates potentially related to treatment assignment and outcomes of interest according to the nearest neighbor propensity score matching technique. Maximum duration of follow‐up was 36 months.
Results
In total, 776 patients using levetiracetam and 659 using valproic acid were identified. Matching resulted in two equal groups of 429 patients, with similar covariate distribution. The cumulative incidence of treatment failure for any reason was significantly lower for levetiracetam compared to valproic acid (12 months: 33% 95% confidence interval (CI) 29%–38% vs 50% 95% CI 45%–55%; P < .001). When looking at specific reasons of treatment failure, treatment failure due to uncontrolled seizures was significantly lower for levetiracetam compared to valproic acid (12 months: 16% 95% CI 12%–19% vs 28% 95% CI 23%–32%; P < 0.001), but no differences were found for treatment failure due to adverse effects (12 months: 14% 95% CI 11%–18% vs 15% 95% CI 11%–18%; P = .636).
Significance
Our results suggest that levetiracetam may have favorable efficacy compared to valproic acid, whereas level of toxicity seems similar. Therefore, levetiracetam seems to be the preferred choice for first‐line AED treatment in patients with glioma.
Worldwide, the application of a (gas/liquid) two-phase flow in membrane processes has received ample scientific deliberation because of its potential to reduce concentration polarization and membrane ...fouling, and therefore enhance membrane flux. Gas/liquid flows are now used to promote turbulence and instabilities inside membrane modules in various membrane processes such as microfiltration, ultrafiltration, nanofiltration, reverse osmosis, membrane distillation, electrodialysis, and membrane bio-reactors. This paper provides a comprehensive and critical literature review of the state of the art in this research area. A total of 205 scientific papers published in peer-reviewed journals from 1989 to 2013 were collected. The data in 195 of these papers (published up to 2011) were compiled and analyzed. These data were analyzed and normalized based on gas and liquid superficial velocities, gas/liquid ratio and feed types, trans-membrane pressure and membrane module type in order to make a fair comparison and identify general characteristics. The objective was to identify key factors in the application of two-phase flows in aqueous separation and purification processes, deliver new insights in how to optimize operations for implementation of this technology in the industry, discuss the importance of energy saving, provide a brief overview of current commercial applications and suggest future directions for research.
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•A critical review on the use of two-phase flow in membrane processes is presented.•Two-phase flow cleaning can effectively improve membrane process performance.•Optimal conditions for using gas-liquid flow are derived from the analysis of literature data.•Technical and economical analyses show that two-phase flow is competitive.•Future research directions are suggested.
Water bodies are increasingly contaminated with a diversity of organic micropollutants (OMPs). This impacts the quality of ecosystems due to their recalcitrant nature. In this study, we assessed the ...removal of OMPs by spent mushroom substrate (SMS) of the white button mushroom (
Agaricus bisporus
) and by its aqueous tea extract. Removal of acesulfame K, antipyrine, bentazon, caffeine, carbamazepine, chloridazon, clofibric acid, and
N, N
-diethyl-
meta
-toluamide (DEET) by SMS and its tea was between 10 and 90% and 0–26%, respectively, in a 7-day period. Sorption to SMS particles was between 0 and 29%, which can thus not explain the removal difference between SMS and its tea, the latter lacking these particles. Carbamazepine was removed most efficiently by both SMS and its tea. Removal of OMPs (except caffeine) by SMS tea was not affected by heat treatment. By contrast, heat-treatment of SMS reduced OMP removal to < 10% except for carbamazepine with a removal of 90%. These results indicate that OMP removal by SMS and its tea is mediated by both enzymatic and non-enzymatic activities. The presence of copper, manganese, and iron (0.03, 0.88, and 0.33 µg L
-1
, respectively) as well as H
2
O
2
(1.5 µM) in SMS tea indicated that the Fenton reaction represents (part of) the non-enzymatic activity. Indeed, the in vitro reconstituted Fenton reaction removed OMPs > 50% better than the teas. From these data it is concluded that spent mushroom substrate of the white button mushroom, which is widely available as a waste-stream, can be used to purify water from OMPs.
Key points
•
A. bisporus SMS effectively removes OMPs from water, outperforming its tea.
•
A. bisporus SMS utilizes enzymatic and non-enzymatic activities for OMP removal.
•
A. bisporus SMS is a promising bioremediation substrate for OMP removal.
Aim
To provide insight into the basic characteristics of decision making in the treatment of symptomatic severe aortic stenosis (SSAS) in Dutch heart centres with specific emphasis on the evaluation ...of frailty, cognition, nutritional status and physical functioning/functionality in (instrumental) activities of daily living (I)ADL.
Methods
A questionnaire was used that is based on the European and American guidelines for SSAS treatment. The survey was administered to physicians and non-physicians in Dutch heart centres involved in the decision-making pathway for SSAS treatment.
Results
All 16 Dutch heart centres participated. Before a patient case is discussed by the heart team, heart centres rarely request data from the referring hospital regarding patients’ functionality (
n
= 5), frailty scores (
n
= 0) and geriatric consultation (
n
= 1) as a standard procedure. Most heart centres ‘often to always’ do their own screening for frailty (
n
= 10), cognition/mood (
n
= 9), nutritional status (
n
= 10) and physical functioning/functionality in (I)ADL (
n
= 10). During heart team meetings data are ‘sometimes to regularly’ available regarding frailty (
n
= 5), cognition/mood (
n
= 11), nutritional status (
n
= 8) and physical functioning/functionality in (I)ADL (
n
= 10). After assessment in the outpatient clinic patient cases are re-discussed ‘sometimes to regularly’ in heart team meetings (
n
= 10).
Conclusions
Dutch heart centres make an effort to evaluate frailty, cognition, nutritional status and physical functioning/functionality in (I)ADL for decision making regarding SSAS treatment. However, these patient data are not routinely requested from the referring hospital and are not always available for heart team meetings. Incorporation of these important data in a structured manner early in the decision-making process may provide additional useful information for decision making in the heart team meeting.
Aim
To investigate the anti‐biofilm efficacy of irrigation using a simulated root canal model, the chemical effect of irrigants against biofilms grown on dentine discs and their impact on biofilm ...viscoelasticity, the efficacy of the irrigants in decontaminating infected dentinal tubules and the capacity of bacteria to regrow.
Methodology
Biofilm removal, viscoelastic analysis of remaining biofilms and bacterial viability were evaluated using a simulated root canal model with lateral morphological features, dentine discs and a dentinal tubule model, respectively. Experiments were conducted using a two‐phase irrigation protocol. Phase 1: a modified salt solution (RISA) and sodium hypochlorite (NaOCl) were used at a low flow rate to evaluate the chemical action of the irrigants. Ultrasonic activation (US) of a chemically inert solution (buffer) was used to evaluate the mechanical efficacy of irrigation. Phase 2: a final irrigation with buffer at a high flow rate was performed for all groups. Optical coherence tomography (OCT), low load compression testing (LLCT) and confocal scanning laser microscopy analysis were used in the different models. One‐way analysis of variance (anova) was performed for the OCT and LLCT analysis, whilst Kruskal–Wallis and Wilcoxon ranked tests for the dentinal tubule model.
Results
US and high flow rate removed significantly more biofilm from the artificial lateral canal. For biofilm removal from the artificial isthmus, no significant differences were found between the groups. Within‐group analysis revealed significant differences between the steps of the experiment, with the exception of NaOCl. For the dentine discs, no significant differences regarding biofilm removal and viscoelasticity were detected. In the dentinal tubule model, NaOCl exhibited the greatest anti‐biofilm efficacy.
Conclusions
The mechanical effect of irrigation is important for biofilm removal. An extra high flow irrigation rate resulted in greater biofilm removal than US in the artificial isthmus. The mechanical effect of US seemed to be more effective when the surface contact biofilm–irrigant was small. After the irrigation procedures, the remaining biofilm could survive after a 5‐day period. RISA and NaOCl seemed to alter post‐treatment remaining biofilms.
Evidence on physical and psychological well-being of in-hospital cardiac arrest (IHCA) survivors is scarce. The aim of this study is to describe long-term health-related quality of life (HRQoL), ...functional independence and psychological distress 3 and 12 months post-IHCA.
A multicenter prospective cohort study in 25 hospitals between January 2017 – May 2018. Adult IHCA survivors were included. HRQoL (EQ-5D-5L, SF-12), psychological distress (HADS, CSI) and functional independence (mRS) were assessed at 3 and 12 months post-IHCA.
At 3-month follow-up 136 of 212 survivors responded to the questionnaire and at 12 months 110 of 198 responded. The median (IQR) EQ-utility Index score was 0.77 (0.65–0.87) at 3 months and 0.81 (0.70–0.91) at 12 months. At 3 months, patients reported a median SF-12 (IQR) physical component scale (PCS) of 38.9 (32.8–46.5) and mental component scale (MCS) of 43.5 (34.0–39.7) and at 12 months a PCS of 43.1 (34.6–52.3) and MCS 46.9 (38.5–54.5).
Using various tools most IHCA survivors report an acceptable HRQoL and a substantial part experiences lower HRQoL compared to population norms. Our data suggest that younger (male) patients and those with poor functional status prior to admission are at highest risk of impaired HRQoL.
•The majority of IHCA survivors reports an acceptable health-related quality of life (HRQoL).•HRQoL is still diminished in a substantial part of survivors compared to population norms.•Diminished HRQoL seems to be associated with young age, male sex and impaired functional independence.•Screening and risk stratification for physical and psychological issues should be implemented in post-cardiac arrest care.
Early detection of bacterial transmission and outbreaks in hospitals is important because nosocomial infections can result in health complications and longer hospitalization. Current practice to ...detect outbreaks uses genotyping methods amplified fragment length polymorphism (AFLP) and whole genome sequencing (WGS), which are not suitable methods for real-time transmission screening of both susceptible and resistant bacteria. The aim was to assess the typing technique Fourier transform infrared (FTIR) spectroscopy as real-time screening method to discriminate large amounts of susceptible and resistant bacteria at strain level when there is no evident outbreak in comparison with the WGS reference. Isolates of past hospital outbreak strains of
Acinetobacter baumannii/calcoaceticus complex
(
n
= 25),
Escherichia coli
(
n
= 31),
Enterococcus faecium
(
n
= 22),
Staphylococcus aureus
(
n
= 37) and
Pseudomonas aeruginosa
(
n
= 30) were used for validation of FTIR. Subsequently,
Enterococcus faecalis
(
n
= 106) and
Enterococcus faecium
(
n
= 104) isolates from weekly routine screening samples when no potential outbreak was present were analysed. FTIR showed reproducibility and congruence of cluster composition with WGS for
A. baumannii/calcoaceticus complex
and
E. faecium
outbreak isolates. The FTIR results of
E. faecalis
and
E. faecium
isolates from routine samples showed reproducibility, but the congruence of cluster composition with WGS was low. For
A. baumannii/calcoaceticus complex
and
E. faecium
outbreak isolates, FTIR appears to be a discriminatory typing tool. However, our study shows the discriminatory power is too low to screen real-time for transmission of
E. faecium
and
E. faecalis
at patient wards based on isolates acquired in routine surveillance cultures when there is no clear suspicion of an ongoing outbreak.
Summary
Vitamin D status of nonwestern immigrants in Europe was poor. Vitamin D status of nonwestern populations in their countries of origin varied, being either similar to the immigrant populations ...in Europe or higher than in European indigenous populations. Vitamin D concentrations in nonwestern immigrant populations should be improved.
Purpose
The higher the latitude, the less vitamin D is produced in the skin. Most European countries are located at higher latitudes than the countries of origin of their nonwestern immigrants. Our aim was to compare the serum 25-hydroxyvitamin D (25(OH)D) concentration of nonwestern immigrant populations with those of the population in their country of origin, and the indigenous population of the country they migrated to.
Methods
We performed literature searches in the “PubMed” and “Embase” databases, restricted to 1990 and later. The search profile consisted of terms referring to vitamin D or vitamin D deficiency, prevalence or cross-sectional studies, and countries or ethnicity. Titles and abstracts were reviewed to identify studies on population-based mean serum 25(OH)D concentrations among Turkish, Moroccan, Indian, and sub-Sahara African populations in Europe, Turkey, Morocco, India, and sub-Sahara Africa.
Results
The vitamin D status of immigrant populations in Europe was poor compared to the indigenous European populations. The vitamin D status of studied populations in Turkey and India varied and was either similar to the immigrant populations in Europe (low) or similar to or even higher than the indigenous European populations (high).
Conclusions
In addition to observed negative consequences of low serum 25(OH)D concentrations among nonwestern populations, this overview indicates that vitamin D status in nonwestern immigrant populations should be improved. The most efficacious strategy should be the subject of further study.
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