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Objective: Vestibular schwannoma management aims to maintain optimal quality of life (QoL) while preventing severe sequelae of the tumor or its treatment. This study assessed long-term QoL of patients with vestibular schwannoma in relation to treatment modality and decisional regret. Study Design: A longitudinal study, in which clinical and QoL data were used that were cross-sectionally acquired in 2014 and again in 2020 from the same patient group. Setting: A tertiary expert center for vestibular schwannoma care in the Netherlands. Methods: QoL was measured by the Penn Acoustic Quality of Life (PANQOL) scale. Changes in time were assed using a linear mixed model. In addition, the Decision Regret Scale was analyzed. Results: Of 867 patients, 536 responded (62%), with a median follow-up of 11 years. All PANQOL subdomain scores remained stable over time and did not exceed minimal clinically important difference (MCID) levels. Time since treatment did not affect QoL. Patients had comparable average QoL scores and proportions of patients with changing QoL scores (ie, exceeding the MCID) over time, irrespective of the received initial treatment. Female patients and those who required salvage therapy (either by radiotherapy or surgery) reported a lower QoL. The latter patient group reported the highest decisional regret. Conclusion: On average, the long-term QoL of patients with vestibular schwannoma is comparable for patients under active surveillance and those who have received active treatment, and it remains stable over time. This suggests that, on average, preservation of QoL of patients with vestibular schwannoma is feasible when adequately managed.

Contains fulltext : 215194.pdf (Publisher’s version ) (Open Access) Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical treatment in adults for such complaints. Unfortunately, tonsillectomy is an invasive treatment associated with a high complication rate and a long recovery time. Complications and a long recovery time are mostly related to removing the vascular and densely innervated capsule of the tonsils. Recently, CO2-lasertonsillotomy under local anesthesia has been demonstrated to be a viable alternative treatment for tonsil-related disease with a significantly shorter and less painful recovery period. The milder side-effect profile of CO2-lasertonsillotomy is likely related to leaving the tonsil capsule intact. The aim of the current report is to present a concise protocol detailing the execution of CO2-lasertonsillotomy under local anesthesia. This intervention has been performed successfully in our hospital in more than 1,000 patients and has been found to be safe and to be associated with a steep learning curve.

Demographic, social contact determinants and sexual risk determinants for HSV-1 and HSV-2 seropositivity among children, adults, and adults who ever had sexual intercourse, with equivocal samples classified as positive. (DOC 144 kb)

The effect of converting the number of partners in the past year to the number of partners in the past 6Â months. (DOC 50 kb)

Sexual risk determinants for HSV-1 seropositivity among native Dutch adults who ever had sexual intercourse. (DOC 51 kb)

Demographic, social contact determinants and sexual risk determinants for HSV-1 and HSV-2 seropositivity among children, adults, and adults who ever had sexual intercourse, stratified by Pienter study. (DOC 141 kb)

Item does not contain fulltext OBJECTIVE: In an evaluation of our patients with parotid gland neoplasms, we noticed that patients with a Warthin's tumour were heavy smokers. The aim of this study was to confirm earlier findings in the literature concerning a possible association between smoking and the development of a Warthin's tumour. METHODS: A case control study was performed using the clinical records and discharge letters of all consecutive patients with a Warthin's tumour in the pathology database of our hospital covering the last 15 years. Patients with a pleomorphic adenoma and a group of patients visiting our audiology department were used as controls. RESULTS: A smoking history was found in 97.5% of the patients with a Warthin's tumour. Of the patients with a pleomorphic adenoma, 59% had a smoking history; 56.5% of the audiology group had a smoking history. Mean age at the time of the operation was 60.1 years of age in the Warthin's tumour group and 48.6 for the pleomorphic adenoma group. CONCLUSION: The mean age for the development of a Warthin's tumour is ten years older than for a pleomorphic adenoma. Furthermore, the development seems to be closely related to smoking habits.

Contains fulltext : 153671.pdf (Publisher’s version ) (Open Access)

Item does not contain fulltext BACKGROUND: Depression is highly prevalent in patients with chronic physical illnesses. A promising intervention for this group of patients is the collaborative care treatment as developed in the us. AIM: To demonstrate the prevalence of depression and the risk factors of depression in diabetes patients, to describe how the screening for depression can be carried out and to assess whether the collaborative care treatment in the Netherlands is effective. METHOD: A questionnaire was completed every three months in order to determine whether there was an improvement in patients' depression and physical symptoms. The outcomes were analysed by means of the multilevel logistic regression analyses. RESULTS: On the basis of the Patient Health Questionnaire, about 26% of the diabetes patients were found to have a depression. This questionnaire was validated for the measurement of depression in diabetes patients, the best results being found at a cut-off point of 12. In cases of fairly severe depression, collaborative care had no effect on depressive symptoms but did reduce severe physical complications. In cases of more severe depression, collaborative care only had an effect on depressive symptoms, but was not found to have any effect on physical complications. CONCLUSION: There is evidence that collaborative care can reduce depression and physical complications in chronically ill patients. However, more research is needed to find out whether collaborative care can become more effective if it is supplemented with digital methods and group therapy. 10 p.

Additional file 1: Univariable logistic regression for determinants of infectious syphilis, HIV and hepatitis B among female sex workers, 2006 to 2013. Additional file 1 shows the crude odds ratios for the association between determinants included in the study and the outcome of having infectious syphilis, HIV or hepatitis B. Results are presented for female sex workers who were tested by the STI clinic in the Netherlands in the study period 2006 to 2013.

This workshop reviewed the current science to inform and recommend the best evidence-based approaches on the use of germ cell genotoxicity tests. The workshop questions and key outcomes were as follows. (1) Do genotoxicity and mutagenicity assays in somatic cells predict germ cell effects? Limited data suggest that somatic cell tests detect most germ cell mutagens, but there are strong concerns that dictate caution in drawing conclusions. (2) Should germ cell tests be done, and when? If there is evidence that a chemical or its metabolite(s) will not reach target germ cells or gonadal tissue, it is not necessary to conduct germ cell tests, notwithstanding somatic outcomes. However, it was recommended that negative somatic cell mutagens with clear evidence for gonadal exposure and evidence of toxicity in germ cells could be considered for germ cell mutagenicity testing. For somatic mutagens that are known to reach the gonadal compartments and expose germ cells, the chemical could be assumed to be a germ cell mutagen without further testing. Nevertheless, germ cell mutagenicity testing would be needed for quantitative risk assessment. (3) What new assays should be implemented and how? There is an immediate need for research on the application of whole genome sequencing in heritable mutation analysis in humans and animals, and integration of germ cell assays with somatic cell genotoxicity tests. Focus should be on environmental exposures that can cause de novo mutations, particularly newly recognized types of genomic changes. Mutational events, which may occur by exposure of germ cells during embryonic development, should also be investigated. Finally, where there are indications of germ cell toxicity in repeat dose or reproductive toxicology tests, consideration should be given to leveraging those studies to inform of possible germ cell genotoxicity.

OBJECTIVES: To describe the epidemiological, virologi-cal, and institutional characteristics of influenza-like illness(ILI) in nursing homes (NHs).DESIGN: Continuous clinical surveillance of ILI and viro-logical surveillance of ILI and other acute respiratoryinfections (ARIs) during four influenza seasons.SETTING: National sentinel NH surveillance network.PARTICIPANTS: National sentinel residents.MEASUREMENTS: Weekly registration of ILI cases(influenza seasons 2008/09–2009/10), influenza virusdetection (influenza seasons 2006/07–2009/10), and collec-tion of institutional characteristics of NHs at start ofparticipation.RESULTS: During the 2008/09 influenza season, ILI inci-dence started to rise in Week 49 of 2008, peaked in Week3 of 2009 (158 cases per 10,000 resident weeks), and flat-tened out by Week 16 of 2009 (mean ILI incidence duringepidemic: 73 cases per 10,000 resident weeks). During the2009/10 influenza pandemic, there was no epidemic peak.Influenza virus type and subtype varied throughout viro-logical surveillance but was limited to influenza A(H3N2)and B viruses. Higher staff vaccination coverage (>15%)was associated with lower ILI-incidence in the 2008/09influenza season in a univariate negative binomial regres-sion analysis (incidence rate ratio = 0.3, 95% confidenceinterval = 0.1–0.8)).CONCLUSION: Neither seasonal nor pandemic influenzaA(H1N1) viruses were detected in the network, despitewidespread community transmission of seasonal and influ-enza A(H1N1) virus. ILI incidence trends corresponded tovirological trends. Sentinel surveillance of ILI combiningclinical and virological data in NHs increases understand-ing of transmission risks in this specific vulnerablepopulation. J Am Geriatr Soc 59:2301–2305, 2011.

Item does not contain fulltext As in other countries, the growing resistance to antimicrobial drugs is also taking place in the Netherlands; the primary cause being the total consumption of antibiotics. Given the steady decline in the discovery of new antimicrobials, better use of agents currently available is warranted. Guidelines describing appropriate antimicrobial therapy play an important role; however, such guidelines are not optimally used in daily practice. Quality indicators can be used to assess the quality of antibiotic treatment and evaluate the impact of interventions aimed at improving care. Quality indicators used for evaluating treatment of infections of the respiratory and urinary tracts are developed previously. A comprehensive set of indicators that could be used to assess the quality of hospital antibiotic use for all bacterial infections has not yet been developed. A new project has recently been started in the Netherlands called 'The development of Reliable generic quality Indicators for the optimalisation of ANTibiotic use in the hospital' (RIANT study) for developing such a set of comprehensive indicators.

Item does not contain fulltext Workshop on the Philosophy of the Information and Computing Sciences, 8-12 February 2010, Leiden, Netherlands, 08 februari 2010

Contains fulltext : 56868.pdf (Publisher’s version ) (Closed access) 58 p.

Contains fulltext : 56678.pdf (Publisher’s version ) (Closed access) 48 p.

During recent decades, many studies have been performed in patients with early glottic cancer, which provide new insight into the two main treatment modalities, TOLMS and radiotherapy, and their outcomes. The aim of this thesis was: (i) What is the role of TOLMS in T2 glottic carcinoma in the Netherlands? (ii) Should more patients with T2 glottic carcinoma be treated with TOLMS? Within this thesis, we found that (i) the laryngeal preservation rate for T2 glottic carcinoma is higher after primary treatment with TOLMS than after primary treatment with radiotherapy; (ii) that the binary use (yes/no) for the involvement of the anterior commissure (AC) as a prognostic factor leads to inconsistent results, whereas studies with a more detailed classification of the AC show that there is a significant impact on oncological outcomes; (iii) that vertical involvement of the AC on imaging has a significant impact on local control not only in patients treated with TOLMS but also in patients receiving primary radiotherapy; and (iv) that patient with T2 glottic carcinoma treated with radiotherapy reported good long-term functional outcomes, although patients with tumors infiltrating the vocal fold muscle show a trend toward a higher degree of voice handicap than patients with tumor with only superficial spread.

In this thesis cochlear morphology and the intra-cochlear position of cochlear implant electrode arrays is being studied. Gaining insight in the variance of cochlear morphology allows to study the effect of morphological characteristics on surgical and speech perception outcomes following cochlear implantation. Furthermore, evaluating the intra-cochlear position of cochlear implant electrode arrays contributes to the search for the optimal position of the array in terms of speech perception outcomes.

Discourse representation in context is the attempt to capture certain aspects of the interpretation of natural language texts that are beyond the mere truth conditions of the text. Prime examples are interpretation of indefinites and pronouns in context, and interpretation of tenses.