Diagnostic reference level curves for paediatric fluoroscopic imaging in the Netherlands.

Objectives: Establishing paediatric DRLs is challenging due to sparse data availability. The objective was to assess paediatric fluoroscopic dose levels in Dutch clinical practice, as current diagnostic reference levels (DRLs) need updating following the European Guidelines on DRLs for Paediatric Imaging (PiDRL).

Material And Methods: Air Kerma-area Product (KAP) values were retrospectively collected from paediatric patients (0-18 years) who underwent fluoroscopic procedures in nine Dutch hospitals between 01-01-2017 and 01-06-2021.

Total tumor volume predicts overall survival and response to induction chemotherapy in patients with colorectal cancer liver metastases: An ancillary study of the phase 3 CAIRO5 trial.

Introduction: This study aimed to assess whether total tumor volume (TTV) outperforms RECIST1.1 for treatment response assessment in patients with colorectal liver metastases (CRLM), and to investigate TTV as a predictive biomarker for the optimal systemic treatment regimen for individual patients with initially unresectable CRLM.

Methods: Patients with initially unresectable liver-only CRLM from the phase 3 CAIRO5 trial (NCT02162563) were included.

Most patients with tibial plateau fractures regain function for daily activities but do not return to their pre-injury level of sport: comparison of multicenter cohort of 1101 patients and age-related peers.

Purpose: The aim was to evaluate patient-reported outcomes - symptoms, pain, activities of daily living (ADL), sports, and quality of life (QoL) - in patients with tibial plateau fractures. Outcomes were compared with those of age-matched peers from the general population to support patient counseling.

Methods: A multicenter cross-sectional study was performed including 1101 patients with tibial plateau fractures between 2003 and 2019.

Intraoperative renal and cerebral tissue oxygen saturation measurements to predict postoperative acute kidney injury in pediatric cardiac surgery: a prospective observational study.

Purpose: Pediatric patients undergoing cardiac surgery are at risk of developing postoperative acute kidney injury (AKI). We hypothesized that a reduction in intraoperative renal (SrO) or cerebral (ScO) tissue oxygen saturation is associated with postoperative AKI.

Methods: We conducted a prospective observational study including fifty pediatric patients with non-cyanotic heart disease undergoing elective surgical repair with cardiopulmonary bypass.

Trends in Term-Equivalent Age Brain Volumes in Infants Born Across the Gestational Age Spectrum.

Purpose: Our understanding of the influence of preterm birth and related perinatal exposures on early brain development is limited, hampering personalized optimization of neuroprotective strategies. This study assesses the effect of gestational age (GA) at birth on brain volumes at term-equivalent age (TEA) in infants without overt brain injury born across the GA spectrum.

Methods: A cohort of infants born across the GA spectrum (25-40 weeks' gestation) underwent 3T brain MRI around TEA (40-46 weeks postmenstrual age).

Hypertensive retinopathy in Dutch emergency departments: a multicenter retrospective cohort analysis.

Suspected hypertensive emergencies account for approximately one in every 200 emergency department (ED) visits in the Netherlands. One manifestation of hypertensive-mediated organ damage (HMOD) is hypertensive retinopathy. A rapid and aggressive reduction in blood pressure in these patients can result in severe cerebral complications, however a clear clinical definition is lacking, resulting in a heterogeneous patient population and ongoing debate regarding the necessity of intravenous therapy in these cases.

Extemporaneous Compounding, Pharmacy Preparations and Related Product Care in the Netherlands.

: In many parts of the world, pharmacists hold the primary responsibility for providing safe and effective pharmacotherapy. A key aspect is the availability of appropriate medicines for each individual patient. When industrially manufactured medicines are unsuitable or unavailable, pharmacists can prepare tailor-made medicines.

Predicting peripheral venous catheter related phlebitis using machine learning (PPML): development and prospective validation of PPML for cardiology inpatients.

Background: Peripheral venous catheter use is a common healthcare practice and carries risk for peripheral venous catheter-related phlebitis (PVCP). The aims of this study were to develop a machine learning model using inpatient hospital data to accurately predict the risk of PVCP and apply this model for early identification to reduce the risk of PVCP in the department of Cardiology.

Methods: A prediction model was developed to estimate the risk of developing PVCP within 3–24 h after introduction during a clinical admission in the department of Cardiology.

Cefiderocol-resistant pathogens in German hospital wastewater: a reservoir for multidrug resistance.

Cefiderocol-resistant bacteria pose a growing concern in both clinical and environmental settings. This study investigates cefiderocol-resistant bacteria in wastewater from six German tertiary care hospitals. A total of 36 samples were analysed using a culture-dependent approach involving cefiderocol pre-enrichment, yielding 97 cefiderocol-resistant isolates-primarily Enterobacter roggenkampii, Klebsiella oxytoca, Serratia marcescens, and Citrobacter farmeri.

Comparative 30-day Echocardiographic Outcomes of Myval versus Sapien and Evolut THVs: Insights from LANDMARK Trial.

Introduction: Several factors, including device design, annulus size, and sizing strategies, influence transcatheter heart valve (THV) hemodynamic outcomes in patients with aortic stenosis(AS). This substudy evaluates early (30-day) echocardiographic outcomes of the Myval, Sapien, and Evolut THV series, focusing on hemodynamic performance and valve durability.

Methodology: The LANDMARK trial is a prospective, randomised, multicentre, open-label, non-inferiority trial comparing 384 patients implanted with Myval THV series to 384 receiving Sapien and Evolut THV series.

Optimizing chemotherapy practices: The impact of dose banding on reissuing and waste reduction.

ObjectivesDose banding has been introduced to prevent waste caused by cancellation of the chemotherapeutic agents paclitaxel, carboplatin, docetaxel, gemcitabine, irinotecan and oxaliplatin. This could enhance the interchangeability of reconstituted chemotherapy, improving sustainability and cost-efficiency in healthcare. The aim of this project is to evaluate the impact of dose banding on the increase of reissuing admixtures and reduction of medication waste.

Gradually Increasing Pacing Impedances with Normal Sensing Values in Pacemaker and Defibrillation Leads: A Watchful Waiting Strategy.

Background: The increasing prevalence of cardiac implantable electronic devices (CIEDs) has led to greater data collection, including pacing impedance, a key measure of lead integrity and electrical function. While acute impedance changes may signal lead fractures or insulation defects, gradual increases are often linked to tissue-interface calcification. The optimal management of patients with progressively rising impedance remains uncertain.

Cost-Effectiveness of Ultra-Early Tranexamic Acid as Add-On to Standard Care After Subarachnoid Hemorrhage (ULTRA Trial).

Objective: To evaluate the cost-effectiveness and cost-utility of adding ultra-early and short-term administration of tranexamic acid (TXA) to standard care in patients with subarachnoid hemorrhage (SAH).

Materials And Methods: An economic evaluation was performed alongside the ultra-early tranexamic acid after subarachnoid hemorrhage (ULTRA) trial. The main outcomes were the incremental cost-effectiveness ratio (ICER), expressed as costs per one-point increase in modified Rankin scale (mRS) score, and the incremental cost-utility ratio (ICUR), expressed as costs per quality-adjusted life-year (QALY).

Fear of suffocation in patients hospitalized with chronic respiratory disease: Results from a flashmob trial.

Background: In patients suffering from chronic respiratory diseases, the prevalence of comorbid anxiety disorder is higher compared to controls. A specific form of anxiety in respiratory patients is fear of suffocation. This fear has been explored in qualitative studies on the experience of dyspnea in chronic obstructive pulmonary disease (COPD) and interstitial lung disease.

Performance of shotgun metagenomics on whole blood from patients with suspected bloodstream infection: Challenges remain.

Bloodstream infections (BSI) are common, and identifying the causative organism is crucial for effective patient management. Shotgun metagenomics (SMg) has emerged as a promising diagnostic tool; however, standardized protocols are lacking. This study aimed to evaluate the use of SMg for diagnosing BSI in patients with confirmed or suspected infections, using stored samples collected at the time of blood culture (BC).

Telemedicine follow-up for pre-malignant and malignant glottic lesions: a randomised controlled trial study protocol comparing care close to home versus standard of care.

Background And Purpose: In the Netherlands, care for head and neck cancer (HNC) is centralised in head and neck oncology centres (HNOCs). Follow-up after treatment requires frequent visits that can burden patients and providers. Telemedicine, through remote evaluation of laryngopharyngoscopy videos recorded at local hospitals, may offer a feasible alternative.

Non-targeted immunosuppressive and immunomodulatory therapies for idiopathic inflammatory myopathies.

Background: Idiopathic inflammatory myopathies (IIM) are autoimmune-mediated inflammatory disorders of skeletal muscles with non-muscle involvement in some people, which carry significant morbidity and mortality. Treatment of IIM represents an area of unmet need. This review is an update of a review previously published in 2012, as new and promising data on non-targeted treatments have emerged.

Beyond Infusion: Real-World Insights Into Infusion-Related Reactions in Monoclonal Antibody Therapy.

Purpose: The exact mechanism responsible for infusion-related reactions (IRRs) after monoclonal antibody (mAb) therapy is unclear. It is also unknown before treatment which patient will develop IRRs. The reported incidence of IRRs varies per and between mAbs, and real-world incidence data are scarce.

Flexor tendon repair in zone II of the hand: Evidence-based management.

Introduction: Flexor tendon injuries require precise surgical repair followed by rehabilitation to ensure optimal recovery and reduce the risk of complications such as tendon rupture, scarring and adhesions. Zone II flexor tendon injuries, which are located between the flexor digitorum superficialis insertion and the A1 pulley, are particularly challenging due to the complex anatomy and the high risk of complication, earning it the nickname "no man's land".

Material And Methods: This systematic review was conducted in accordance with the principles of evidence-based medicine (EBM), which involve formulating a clinical question, searching for relevant studies, and critically appraising the quality of the evidence.

Targeted immunosuppressive and immunomodulatory therapies for idiopathic inflammatory myopathies.

Background: Idiopathic inflammatory myopathies (IIM) are autoimmune-mediated inflammatory disorders of skeletal muscles with non-muscle involvement in some people. Treatment of IIM represents an area of unmet need; a previous Cochrane review (2012) found little or no evidence to guide treatment. Since then, potentially promising treatments targeting B and T cells and complement inhibitors have been investigated.

Antimicrobial treatment affects the microbiome and resistome of both treated and untreated rehabilitating harbour seals (Phoca vitulina).

Background: Antimicrobial use has contributed to the alarming rise of antimicrobial resistance (AMR), posing a significant global health threat. Effective AMR control requires a One Health approach. The presence of AMR in the environment can challenge wildlife conservation, as resistance may reduce treatment success.

Reliability of serum neurofilament light and glial fibrillary acidic protein for detecting disease activity upon discontinuation of first-line disease-modifying therapy in stable multiple sclerosis (DOT-MS).

Background: Neurofilament light(NfL) and glial fibrillary acidic protein(GFAP) are associated with disease activity in multiple sclerosis(MS), however use in monitoring remains limited. The ability of these biomarkers to detect disease activity upon treatment discontinuation was studied.

Methods: Long-term stable relapse-onset MS patients were to continue or discontinue their first-line disease-modifying therapy(DMT) to study the safety of DMT discontinuation(DOT-MS trial NCT04260711).

Activated Clotting Time Guided Heparinisation during Open Abdominal Aortic Aneurysm Repair (ACTION-1): A Randomised, Multicentre, Single Blind, Superiority Trial.

Objective: The optimal dosage of intravenous unfractionated heparin and the role of monitoring its effect using activated clotting time (ACT) to prevent thromboembolic complications (TECs) during open abdominal aortic aneurysm (AAA) repair are uncertain. This trial aimed to compare ACT guided heparinisation with a single dose of 5 000 international units (IU) of heparin.

Methods: This was a multicentre, randomised controlled, single blinded, superiority trial (NCT04061798).