22 results on '"Cees M P M, Hertogh"'
Search Results
2. Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU)
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Cees M P M Hertogh, Anna Kowalczyk, Maciek Godycki-Cwirko, Morten Lindbaek, Ronny Gunnarsson, Pär-Daniel Sundvall, Theo J M Verheij, Nils Grude, Wim G Groen, Silje Rebekka Heltveit-Olsen, Sigurd Hoye, Egill Snaebjörnsson Arnljots, Tamara N Platteel, Hilde A M Koning, and Christina Åhrén
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Medicine - Abstract
Introduction Methenamine hippurate is a urinary antiseptic used as preventive treatment for recurrent urinary tract infections (UTIs) in some Scandinavian countries. However, the scientific evidence for the preventive effect and safety for longer-term use is limited. The aim of this study is to assess whether methenamine hippurate can reduce the incidence of UTIs in older women with recurrent UTIs.Methods and analysis The ImpresU consortium is a collaboration between Norway, Sweden, Poland and the Netherlands. The study is a randomised, controlled, triple-blind phase IV clinical trial. Women ≥70 years with recurrent UTIs are screened for eligibility in a general practice setting. We aim to include 400 women in total, with 100 recruited from each collaborating country. The participants are randomised to treatment with methenamine hippurate 1 g or placebo tablets two times per day for a treatment period of 6 months, followed by a drug-free follow-up period of 6 months. The primary outcome is number of antibiotic treatments for UTIs during the treatment period. The secondary outcomes include number of antibiotic treatments for UTIs during the follow-up period and self-reported symptom of severity and duration of UTI episodes. Differences in complications between the treatment groups are measured as safety outcomes. We also aim to investigate whether strain characteristics or phylogenetic subgroups of Escherichia coli present in the urine culture at inclusion have a modifying effect on the outcomes.Ethics and dissemination Ethical approvals are obtained in all participating countries. The results will be communicated in peer-reviewed journals and at scientific conferences.Trial registration number ClinicalTrials.gov Registry (NCT04077580); EudraCT: 2018-002235-15.
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- 2022
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3. Cost-effectiveness and return-on-investment of C-reactive protein point-of-care testing in comparison with usual care to reduce antibiotic prescribing for lower respiratory tract infections in nursing homes: a cluster randomised trial
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Maurits W van Tulder, Cees M P M Hertogh, Judith E Bosmans, Theo J M Verheij, Rogier M Hopstaken, Mohamed El Alili, Tjarda M Boere, and Laura W van Buul
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Medicine - Abstract
Objectives C-reactive protein point-of-care testing (CRP POCT) is a promising diagnostic tool to guide antibiotic prescribing for lower respiratory tract infections (LRTI) in nursing home residents. This study aimed to evaluate cost-effectiveness and return-on-investment (ROI) of CRP POCT compared with usual care for nursing home residents with suspected LRTI from a healthcare perspective.Design Economic evaluation alongside a cluster randomised, controlled trial.Setting 11 Dutch nursing homes.Participants 241 nursing home residents with a newly suspected LRTI.Intervention Nursing home access to CRP POCT (POCT-guided care) was compared with usual care without CRP POCT (usual care).Main outcome measures The primary outcome measure for the cost-effectiveness analysis was antibiotic prescribing at initial consultation, and the secondary outcome was full recovery at 3 weeks. ROI analyses included intervention costs, and benefits related to antibiotic prescribing. Three ROI metrics were calculated: Net Benefits, Benefit-Cost-Ratio and Return-On-Investment.Results In POCT-guided care, total costs were on average €32 higher per patient, the proportion of avoided antibiotic prescribing was higher (0.47 vs 0.18; 0.30, 95% CI 0.17 to 0.42) and the proportion of fully recovered patients statistically non-significantly lower (0.86 vs 0.91; −0.05, 95% CI −0.14 to 0.05) compared with usual care. On average, an avoided antibiotic prescription was associated with an investment of €137 in POCT-guided care compared with usual care. Sensitivity analyses showed that results were relatively robust. Taking the ROI metrics together, the probability of financial return was 0.65.Conclusion POCT-guided care effectively reduces antibiotic prescribing compared with usual care without significant effects on recovery rates, but requires an investment. Future studies should take into account potential beneficial effects of POCT-guided care on costs and health outcomes related to antibiotic resistance.Trial registration number NL5054.
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- 2022
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4. Prevalences and Indications of Psychotropic Drug Prescriptions in Nursing Home Residents with Korsakoff Syndrome
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Ineke J. Gerridzen, Els Doejaaren, Ruth B. Veenhuizen, Cees M. P. M. Hertogh, and Karlijn J. Joling
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Korsakoff syndrome ,nursing home ,psychotropic drugs ,behavioral symptoms ,Medicine - Abstract
Psychotropic drugs (PD) are often prescribed to nursing home residents with Korsakoff syndrome (KS). It is unknown whether these drugs are prescribed correctly or whether they are prescribed off-label, for example, to treat behavioral symptoms. To get more insight into PD prescriptions, a descriptive study was performed. The type, category and indications of PD prescriptions of 285 participants were analyzed using medication charts and questionnaires. Behavioral symptoms were investigated with the Neuropsychiatric Inventory-Questionnaire. The results showed that atypical antipsychotics (57.1%) were prescribed more frequently than typical antipsychotics (49.3%). Of the antidepressants, selective serotonin/norepinephrine reuptake inhibitors (63.1%) were most frequently prescribed, followed by tricyclic antidepressants (23.4%). Of the benzodiazepines, anxiolytics (85.7%) were more prescribed than hypnotics (24.5%). Besides psychiatric disorders, PD were also prescribed to treat behavioral symptoms varying from 29.9% (antipsycho-tics) to 26.3% (benzodiazepines) and 9.3% (antidepressants). Furthermore, prescriptions were high if behavioral symptoms were present. To conclude, PD are often prescribed to residents with KS for an unapproved indication, namely behavioral symptoms. Additional research is needed to obtain further insight into the current prescribing culture and the effectiveness of PD. The insights thus obtained may, ultimately, contribute to the appropriate prescription of PD for people with KS.
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- 2023
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5. Impaired Awareness in People with Severe Alcohol-Related Cognitive Deficits Including Korskoff’s Syndrome: A Network Analysis
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Hester Fidder, Ruth B. Veenhuizen, Ineke J. Gerridzen, Wessel N. van Wieringen, Martin Smalbrugge, Cees M. P. M. Hertogh, and Anouk M. van Loon
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Korsakoff’s syndrome ,nursing homes ,network analysis ,anosognosia ,neuropsychiatric symptoms ,Medicine - Abstract
Background: Impaired awareness of one’s own functioning is highly common in people with Korsakoff’s syndrome (KS). However, it is currently unclear how awareness relates to impairments in daily functioning and quality of life (QoL). Methods: We assessed how impaired awareness relates to cognitive, behavioral, physical, and social functioning and QoL by applying a network analysis. We used cross-sectional data from 215 patients with KS or other severe alcohol-related cognitive deficits living in Dutch long-term care facilities (LTCFs). Results: Apathy has the most central position in the network. Higher apathy scores relate positively to reduced cognition and to a greater decline in activities of daily living and negatively to social participation and the use of antipsychotic drugs. Impaired awareness is also a central node. It is positively related to a higher perceived QoL, reduced cognition and apathy, and negatively to social participation and length of stay in the LTCF. Mediated through apathy and social participation, impaired awareness is indirectly related to other neuropsychiatric symptoms. Conclusions: Impaired awareness is closely related to other domains of daily functioning and QoL of people with KS or other severe alcohol-related cognitive deficits living in LTCFs. Apathy plays a central role. Network analysis offers interesting insights to evaluate the interconnection of different symptoms and impairments in brain disorders such as KS.
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- 2023
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6. Effectiveness and characteristics of physical fitness training on aerobic fitness in vulnerable older adults: an umbrella review of systematic reviews
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Cees M P M Hertogh, Johannes C van der Wouden, Elise P Jansma, Dennis Visser, Elizabeth M Wattel, Karin H L Gerrits, Franka J M Meiland, Aafke J de Groot, and Ewout B Smit
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Medicine - Abstract
Objectives To present an overview of effectiveness and training characteristics of physical training on aerobic fitness, compared with alternative or no training, in adults aged over 65 years with various health statuses, providing a basis for guidelines for aerobic training of vulnerable older adults that can be used in geriatric rehabilitation.Design An umbrella review of systematic reviews that included both randomised controlled trials and other types of trials.Data sources MEDLINE, Embase, CINAHL and the Cochrane Library were searched on 9 September 2019.Eligibility criteria for selecting studies We included systematic reviews reporting on physical training interventions that are expected to improve aerobic fitness, presenting results for adults aged 65 years and older, describing at least one of the FITT-characteristics: Frequency, Intensity, Time or Type of exercise, and measuring aerobic fitness at least before and after the intervention.Data extraction and synthesis Two independent reviewers extracted the data and assessed the risk of bias. A narrative synthesis was performed.Results We included 51 papers on 49 reviews. Positive effect of training on aerobic fitness was reported by 33 reviews, 11 reviews remained inconclusive and 5 reviews reported no effect. Training characteristics varied largely. Frequency: 1–35 sessions/week, Intensity: light–vigorous, Time:
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- 2022
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7. The Association Between Possible Stressors and Mood Outcomes in Older Residents of Long-Term Care Facilities
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Milou J. Angevaare, Hein P. J. van Hout, Martin Smalbrugge, Annette H. Blankenstein, Cees M. P. M. Hertogh, Jos W. R. Twisk, and Karlijn J. Joling
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resilience ,mood outcome ,self-report ,stressor ,conflict ,major life stressor ,Psychiatry ,RC435-571 - Abstract
IntroductionResilience incorporates the presence of a positive response to some type of stressor. To properly explore resilience, it is important to systematically identify relevant stressors. We aimed to identify (combinations of) stressors with the strongest relationship with observer-reported and self-reported mood outcomes in older residents of long-term care facilities (LTCFs) in The Netherlands.Materials and MethodsWe included 4,499 older (≥60) residents of 40 LTCFs who participated in the Dutch InterRAI-LTCF cohort between 2005 and 2018. The association of possible stressors (single stressors, number of stressors, and combinations of two stressors) in this population with observer-reported (Depression Rating Scale) and self-reported mood outcomes was analyzed using multilevel tobit models and logistic regressions.ResultsMajor life stressor [“experiences that (threatened to) disrupt(ed) a person's daily routine and imposed some degree of readjustment”] and conflict with other care recipients and/or staff were most strongly associated with both mood outcomes. Furthermore, conflict was a particularly prevalent stressor (24%). Falls, fractures, and hospital visits were more weakly or not associated at all. Overall, the associations were similar for the mood outcomes based on observer-report and self-report, although there were some differences. Multiple stressors were more strongly associated with both mood outcomes than one stressor.ConclusionMajor life stressor and conflict emerged as important stressors for resilience research within the psychological domain in LTCF residents. Further (longitudinal) research is necessary to determine the directionality and relevance of the strong association of conflict with mood for LTCF practice.
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- 2022
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8. Symptom- and Prevention-Based Testing of COVID-19 in Nursing Home Residents: A Retrospective Cohort Study
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Kelly C. Paap, Anouk M. van Loon, Sarian M. van Rijs, Esther Helmich, Bianca M. Buurman, Martin Smalbrugge, and Cees M. P. M. Hertogh
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Geriatrics ,RC952-954.6 - Abstract
Nursing homes (NH) residents with COVID-19 can either be tested because of presence of core symptoms (S-based) or because of transmission prevention (TP-based). The investigated study sample included all NH residents who underwent SARS-CoV-2 RT-PCR testing between March 16, 2020 and May 31, 2020 ( n = 380). Clinical symptoms, temperature, and oxygen saturation were extracted from medical records, 7 days before to 14 days after testing. COVID-19 was confirmed in 81 (21%) residents; 36 (44%) S-based and 45 (56%) TP-based: 45. Cycle threshold (CT) values did not differ between the groups. In the 7 days prior to the test falling (32%), somnolence (25%) and fatigue (21%) occurred in both groups. Two days before the test, we observed a stronger decrease in oxygen saturation and an increase in temperature for the S-based group compared to the T-based group that remained up to 10 days after testing. Residents within the S-based group were 2.5 times more likely to increased mortality within 30 days than residents in the TP-based group (HR, 2.56; 95% 1.3–5.2). Although, 73% of the T-based group did eventually develop core symptoms. Thus, attention to falling and daily measures of temperature and oxygen saturation can contribute to earlier detection.
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- 2021
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9. Multifaceted antibiotic stewardship intervention using a participatory-action-research approach to improve antibiotic prescribing for urinary tract infections in frail elderly (ImpresU): study protocol for a European qualitative study followed by a pragmatic cluster randomised controlled trial
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Cees M P M Hertogh, Anna Kowalczyk, Morten Lindbaek, Ronny Gunnarsson, Pär-Daniel Sundvall, Nicolaas P A Zuithoff, Theo J M Verheij, Esther A R Hartman, Wim G Groen, Silje Rebekka Heltveit-Olsen, Sigurd Hoye, Ingmarie Skoglund, Egill Snaebjörnsson Arnljots, Maciej Godycki-Cwirko, Tamara N Platteel, Annelie A Monnier, and Alma C van de Pol
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Medicine - Published
- 2021
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10. The quality of geriatric rehabilitation from the patients’ perspective: a scoping review
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Anne L Lubbe, Marjon van Rijn, Wim G Groen, Sophie Hilhorst, George L Burchell, Cees M P M Hertogh, Margriet C Pol, Urban Vitality, Lectoraat Integratie van Psychiatrische en Somatische Zorg, Faculteit Gezondheid, and Lectoraat Ergotherapie - Participatie en Omgeving
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Aging ,General Medicine ,Geriatrics and Gerontology - Abstract
Background the efficacy and outcomes of geriatric rehabilitation (GR) have previously been investigated. However, a systematic synthesis of the aspects that are important to patients regarding the quality of GR does not exist. Objective the aim of this scoping review was to systematically synthesise the patients’ perspective on the quality of GR. Methods we followed the Scoping Review framework and gathered literature including a qualitative study design from multiple databases. The inclusion criteria were: a qualitative study design; a geriatric population; that patients had participated in a geriatric rehabilitation programme and that geriatric rehabilitation was assessed by the patient. The results sections of the included studies were analysed using a thematic analysis approach. Results twenty articles were included in this review. The main themes identified were: (i) the need for information about the rehabilitation process, (ii) the need for telling one’s story, (iii) the need for support (physical, psychological, social and how to cope with limitations), (iv) the need for shared decision-making and autonomy, (v) the need for a stimulating rehabilitation environment and (vi) the need for rehabilitation at home. Conclusion in this study, we identified the aspects that determine the quality of rehabilitation from the patient’s perspective, which may lead to a more holistic perspective on the quality of GR.
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- 2023
11. Supporting older patients in working on rehabilitation goals:A scoping review of nursing interventions
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Anne Marie Vaalburg, Petra Boersma, Elizabeth M. Wattel, Johannes C. F. Ket, Cees M. P. M. Hertogh, and Robbert J. J. Gobbens
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goal setting ,geriatric rehabilitation ,nursing interventions ,review ,Human medicine ,nursing role, scoping ,Gerontology ,goal achieving - Abstract
Background: Nurses are consistently present throughout the rehabilitation of older patients but are apprehensive about performing goal-centred care in the multidisci plinary team. Objectives: The aim of this review was to explore working interventions on setting goals and working with goals designed for nurses in geriatric rehabilitation, and to describe their distinctive features. Methods: We performed a scoping review. We searched MEDLINE and CINAHL through August 4, 2021. Search terms related to the following themes: nurses, reha bilitation, geriatric, goal and method. We used snowballing to find additional. From the selected studies, we systematically extracted data on means, materials and the nursing role and summarized them in a narrative synthesis, using intervention com ponent analysis. Results: The study includes 13 articles, describing 11 interventions which were devel oped for six different aims: improving multidisciplinary team care; increasing patient centredness; improving disease management by patients; improving the psychological, and emotional rehabilitation; increasing the nursing involvement in rehabilitation; or helping patients to achieve goals. The interventions appeal to four aspects of the nurs ing profession: assessing self-care skills incorporating patient's preferences; setting goals with patients, taking into account personal needs and what is medically advis able; linking the needs of the patient with multidisciplinary professional treatment and vice versa; and thus, playing an intermediate role and supporting goal achievement. Conclusions: The interventions show that in goal-centred care, the nurse might play an important unifying role between patients and the multidisciplinary team. With the support of nurses, the patient may become more aware of the rehabilitation process and transfer of ownership of treatment goals from the multidisciplinary team to the patient might be achieved. Not many interventions were found meant to support thenursing role. This may indicate a blind spot in the rehabilitation community to the ad ditional value of its contribution.
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- 2023
12. Impaired Awareness in People with Severe Alcohol-Related Cognitive Deficits Including Korskoff’s Syndrome:A Network Analysis
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Hester Fidder, Ruth B. Veenhuizen, Ineke J. Gerridzen, Wessel N. van Wieringen, Martin Smalbrugge, Cees M. P. M. Hertogh, Anouk M. van Loon, Elderly care medicine, APH - Aging & Later Life, APH - Quality of Care, Epidemiology and Data Science, and APH - Methodology
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General Medicine ,Korsakoff’s syndrome ,nursing homes ,network analysis ,anosognosia ,neuropsychiatric symptoms - Abstract
Background: Impaired awareness of one’s own functioning is highly common in people with Korsakoff’s syndrome (KS). However, it is currently unclear how awareness relates to impairments in daily functioning and quality of life (QoL). Methods: We assessed how impaired awareness relates to cognitive, behavioral, physical, and social functioning and QoL by applying a network analysis. We used cross-sectional data from 215 patients with KS or other severe alcohol-related cognitive deficits living in Dutch long-term care facilities (LTCFs). Results: Apathy has the most central position in the network. Higher apathy scores relate positively to reduced cognition and to a greater decline in activities of daily living and negatively to social participation and the use of antipsychotic drugs. Impaired awareness is also a central node. It is positively related to a higher perceived QoL, reduced cognition and apathy, and negatively to social participation and length of stay in the LTCF. Mediated through apathy and social participation, impaired awareness is indirectly related to other neuropsychiatric symptoms. Conclusions: Impaired awareness is closely related to other domains of daily functioning and QoL of people with KS or other severe alcohol-related cognitive deficits living in LTCFs. Apathy plays a central role. Network analysis offers interesting insights to evaluate the interconnection of different symptoms and impairments in brain disorders such as KS.
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- 2023
13. Dealing with requests for euthanasia in incompetent patients with dementia. Qualitative research revealing underexposed aspects of the societal debate
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Djura O Coers, Marike E de Boer, Eefje M Sizoo, Martin Smalbrugge, Carlo J W Leget, Cees M P M Hertogh, Elderly care medicine, APH - Aging & Later Life, and APH - Quality of Care
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Aging ,General Medicine ,Geriatrics and Gerontology - Abstract
Objectives In the Netherlands, a case of euthanasia of an incompetent patient with dementia and an advance euthanasia directive (AED) caused great societal unrest and led to a petition signed by more than 450 physicians. In this paper, we investigate these physicians’ reasons and underlying motives for supporting the ‘no sneaky euthanasia’ petition, with the aim of gaining insight into the dilemmas experienced and to map out topics in need of further guidance. Methods Twelve in-depth interviews were conducted with physicians recruited via the webpage ‘no sneaky euthanasia’. General topics discussed were: reasons for signing the petition, the possibilities of euthanasia in incompetent patients and views on good end-of-life care. Data were interpreted using thematic content analysis and the framework method. Results Reasons for supporting the petition are dilemmas concerning ‘sneaky euthanasia’, the over-simplified societal debate, physicians’ personal moral boundaries and the growing pressure on physicians. Analysis revealed three underlying motives: aspects of handling a euthanasia request based on an AED, good end-of-life care and the doctor as a human being. Conclusions Although one of the main reasons for participants to support the petition was the opposition to ‘sneaky euthanasia’, our results show a broader scope of reasons. This includes their experience of growing pressure to comply with AEDs, forcing them to cross personal boundaries. The underlying motives are related to moral dilemmas around patient autonomy emerging in cases of decision-making disabilities in advanced dementia. To avoid uncertainty regarding patients’ wishes, physicians express their need for reciprocal communication.
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- 2023
14. Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries
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Esther A R Hartman, Alma C van de Pol, Silje Rebekka Heltveit-Olsen, Morten Lindbæk, Sigurd Høye, Sara Sofia Lithén, Pär-Daniel Sundvall, Sofia Sundvall, Egill Snaebjörnsson Arnljots, Ronny Gunnarsson, Anna Kowalczyk, Maciek Godycki-Cwirko, Tamara N Platteel, Wim G Groen, Annelie A Monnier, Nicolaas P Zuithoff, Theo J M Verheij, and Cees M P M Hertogh
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General Medicine - Abstract
Objective To evaluate whether antibiotic prescribing for suspected urinary tract infections in frail older adults can be reduced through a multifaceted antibiotic stewardship intervention. Design Pragmatic, parallel, cluster randomised controlled trial, with a five month baseline period and a seven month follow-up period. Setting 38 clusters consisting of one or more general practices (n=43) and older adult care organisations (n=43) in Poland, the Netherlands, Norway, and Sweden, from September 2019 to June 2021. Participants 1041 frail older adults aged 70 or older (Poland 325, the Netherlands 233, Norway 276, Sweden 207), contributing 411 person years to the follow-up period. Intervention Healthcare professionals received a multifaceted antibiotic stewardship intervention consisting of a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. A participatory-action-research approach was used for implementation, with sessions for education, evaluation, and local tailoring of the intervention. The control group provided care as usual. Main outcome measures The primary outcome was the number of antibiotic prescriptions for suspected urinary tract infections per person year. Secondary outcomes included the incidence of complications, all cause hospital referrals, all cause hospital admissions, all cause mortality within 21 days after suspected urinary tract infections, and all cause mortality. Results The numbers of antibiotic prescriptions for suspected urinary tract infections in the follow-up period were 54 prescriptions in 202 person years (0.27 per person year) in the intervention group and 121 prescriptions in 209 person years (0.58 per person year) in the usual care group. Participants in the intervention group had a lower rate of receiving an antibiotic prescription for a suspected urinary tract infection compared with participants in the usual care group, with a rate ratio of 0.42 (95% confidence interval 0.26 to 0.68). No differences between intervention and control group were observed in the incidence of complications (v 0.05 per person year), hospital referrals (v 0.05), admissions to hospital (0.01 v 0.05), and mortality (0 v 0.01) within 21 days after suspected urinary tract infections, nor in all cause mortality (0.26 v 0.26). Conclusions Implementation of a multifaceted antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infections in frail older adults. Trial registration ClinicalTrials.gov NCT03970356 .
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- 2023
15. Cost-effectiveness and return-on-investment of C-reactive protein point-of-care testing in comparison with usual care to reduce antibiotic prescribing for lower respiratory tract infections in nursing homes
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Tjarda M Boere, Mohamed El Alili, Laura W van Buul, Rogier M Hopstaken, Theo J M Verheij, Cees M P M Hertogh, Maurits W van Tulder, Judith E Bosmans, Elderly care medicine, APH - Aging & Later Life, Psychiatry, APH - Mental Health, VUmc - School of Medical Sciences, Health Economics and Health Technology Assessment, Faculty of Behavioural and Movement Sciences, AMS - Musculoskeletal Health, APH - Methodology, APH - Societal Participation & Health, Family Medicine, and RS: CAPHRI - R5 - Optimising Patient Care
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Respiratory Tract Infections/diagnosis ,Physicians' ,Cost-Benefit Analysis ,General Medicine ,Practice Patterns ,Anti-Bacterial Agents ,Nursing Homes ,Anti-Bacterial Agents/therapeutic use ,C-Reactive Protein ,SDG 3 - Good Health and Well-being ,Point-of-Care Testing ,Humans ,Practice Patterns, Physicians' ,Respiratory Tract Infections - Abstract
ObjectivesC-reactive protein point-of-care testing (CRP POCT) is a promising diagnostic tool to guide antibiotic prescribing for lower respiratory tract infections (LRTI) in nursing home residents. This study aimed to evaluate cost-effectiveness and return-on-investment (ROI) of CRP POCT compared with usual care for nursing home residents with suspected LRTI from a healthcare perspective.DesignEconomic evaluation alongside a cluster randomised, controlled trial.Setting11 Dutch nursing homes.Participants241 nursing home residents with a newly suspected LRTI.InterventionNursing home access to CRP POCT (POCT-guided care) was compared with usual care without CRP POCT (usual care).Main outcome measuresThe primary outcome measure for the cost-effectiveness analysis was antibiotic prescribing at initial consultation, and the secondary outcome was full recovery at 3 weeks. ROI analyses included intervention costs, and benefits related to antibiotic prescribing. Three ROI metrics were calculated: Net Benefits, Benefit-Cost-Ratio and Return-On-Investment.ResultsIn POCT-guided care, total costs were on average €32 higher per patient, the proportion of avoided antibiotic prescribing was higher (0.47 vs 0.18; 0.30, 95% CI 0.17 to 0.42) and the proportion of fully recovered patients statistically non-significantly lower (0.86 vs 0.91; −0.05, 95% CI −0.14 to 0.05) compared with usual care. On average, an avoided antibiotic prescription was associated with an investment of €137 in POCT-guided care compared with usual care. Sensitivity analyses showed that results were relatively robust. Taking the ROI metrics together, the probability of financial return was 0.65.ConclusionPOCT-guided care effectively reduces antibiotic prescribing compared with usual care without significant effects on recovery rates, but requires an investment. Future studies should take into account potential beneficial effects of POCT-guided care on costs and health outcomes related to antibiotic resistance.Trial registration numberNL5054.
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- 2022
16. Patient perspectives on advance euthanasia directives in Huntington's disease. A qualitative interview study
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Marina R, Ekkel, Marja F I A, Depla, Els M L, Verschuur, Ruth B, Veenhuizen, Cees M P M, Hertogh, and Bregje D, Onwuteaka-Philipsen
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Huntington Disease ,Attitude ,Euthanasia ,Humans ,Advance Directives ,Qualitative Research - Abstract
Huntington's disease (HD) has a poor prognosis. For HD patients in the Netherlands, one way of dealing with their poor prognosis is by drawing up an advance euthanasia directive (AED). Little is known about the perspectives of HD patients on their AED.To gain insight into patients' views on and attitudes towards their AED, and changes over time.A longitudinal qualitative interview study using 1 to 6 semi-structured interviews over a period of maximum three years. Nine HD patients (5 outpatient clinic, 3 day care, 1 assisted living facility) who either had an AED or were thinking about drawing it up participated in this study.We identified two themes that characterize patients' perspectives on their AEDs: (1) general character of the AED; (2) uncertainty around their AED. Ad (1) The conditions that the participants described in their AED were generally not very specific for the person. Mostly they were general notions of unbearable suffering. Familiarity with HD in the family could play a role in drawing up an AED. Ad (2) Participants generally were aware of the tentative character of their AED and could have doubts concerning their own willingness or the willingness of others in the future. Sometimes these doubts were so great, that it prevented them from drawing up an AED. However, patients did not alter their AED during the follow-up period or changed in their view or attitude on their AED.HD patients that draw up an AED usually describe general conditions for euthanasia and recognize that these conditions may change as the disease progresses. An AED or the wish to draw one up may be a good conversation starter for conversations about goals and preferences for future care.
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- 2022
17. Implementation of a national testing policy in Dutch nursing homes during SARS-CoV-2 outbreaks
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Judith H. Besselaar, Marije Spaargaren, Martin Smalbrugge, Fleur M. H. P. A. Koene, Loes Termeulen, Cees M. P. M. Hertogh, Bianca M. Buurman, Elderly care medicine, APH - Aging & Later Life, APH - Quality of Care, Graduate School, Geriatrics, and Nursing
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Policy ,SARS-CoV-2 ,Humans ,COVID-19 ,infection prevention and control ,skilled nursing facility ,Geriatrics and Gerontology ,Disease Outbreaks ,Nursing Homes - Abstract
Background: To evaluate how a national policy of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) regardless of symptoms was implemented during outbreaks in Dutch nursing homes in the second wave of the pandemic and to explore barriers and facilitators to serial testing. Methods: We conducted a mixed-method study of nursing homes in the Netherlands with a SARS-CoV-2 outbreak after 15 September 2020. Direct care staff and management from 355 healthcare organizations were invited to participate in a digital survey. A total of 74 out of 355 (20.9%) healthcare organizations participated and provided information about 117 nursing homes. We conducted 26 in-depth interviews on the outbreak and the testing strategy used. We also conducted four focus group meetings involving managers, physicians, nurses, and certified health assistants. Recordings were transcribed and data were thematically analyzed. Results: One hundred and four nursing homes (89%) tested residents regardless of their symptoms during the outbreak, and 85 nursing homes (73%) tested the staff regardless of their symptoms. However, interviews showed testing was sometimes implemented during later stages of the outbreak and was not always followed up with serial testing. Barriers to serial testing regardless of symptoms were lack of knowledge of local leaders with decisional making authority, lack of a cohort ward or skilled staff, and insufficient collaboration with laboratories or local public health services. Important facilitators to serial testing were staff willingness to undergo testing and the availability of polymerase chain reaction (PCR) tests. Conclusions: Serial testing regardless of symptoms was only partially implemented. The response rate of 21% of nursing home organizations gives a risk of selection bias. Barriers to testing need to be addressed. A national implementation policy that promotes collaboration between public health services and nursing homes and educates management and care staff is necessary.
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- 2022
18. Referral to geriatric rehabilitation:a scoping review of triage factors in acutely hospitalised older patients
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Aafke J, de Groot, Elizabeth M, Wattel, Carmen S, van Dam, Romke, van Balen, Johannes C, van der Wouden, and Cees M P M, Hertogh
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Aging ,Frailty ,Hip Fractures ,Humans ,General Medicine ,Triage ,Geriatrics and Gerontology ,Geriatric Assessment ,Referral and Consultation ,Aged - Abstract
Objective Old or frail acutely hospitalised patients can benefit from geriatric rehabilitation but criteria concerning referral decisions are unclear. This review presents an overview of clinical factors associated with referral to geriatric rehabilitation that may further consensus between hospital and rehabilitation professionals on triage. Design Scoping review. Methods A review was conducted following Arksey and O’Malley’s framework. The search included literature concerning a broad spectrum of acutely hospitalised patients and factors associated with their referral to geriatric rehabilitation. Results Selected abstracts were categorised into distinct geriatric rehabilitation care pathways such as stroke, hip fracture, amputation of lower limb, cardiac and oncologic rehabilitation. Abstracts on internal medical patients were further reviewed and 29 studies were included. A total of 13 studies focused on factors identifying rehabilitation needs and 16 on factors associated with outcome of geriatric rehabilitation. Triage factors were diverse and included frailty status, functional decline, cognitive symptoms and multimorbidity. Mood symptoms and living situation further specified post-acute care needs. In overview, triage factors could be characterised as demographic (n = 4), diagnosis-related (n = 8), mental (n = 6), functional (n = 10) or multi-domain (n = 12) and mapped in a transitional care pathway. Conclusions and implications Frailty and functional decline are characteristics frequently associated with referral to geriatric rehabilitation of acutely hospitalised internal medical patients. A comprehensive geriatric assessment or a simpler multi-domain set of tests reveals rehabilitation needs and approximates a functional prognosis. Professional consensus on factors and timing of triage in hospital is within reach.
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- 2022
19. Decisions on antibiotic prescribing for suspected urinary tract infections in frail older adults: a qualitative study in four European countries
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Esther A R Hartman, Wim G Groen, Silje Rebekka Heltveit-Olsen, Morten Lindbæk, Sigurd Høye, Pär-Daniel Sundvall, Ingmarie Skoglund, Egill Snaebjörnsson Arnljots, Ronny Gunnarsson, Anna Kowalczyk, Maciek Godycki-Cwirko, Katarzyna Kosiek, Tamara N Platteel, Alma C van de Pol, Theo J M Verheij, Annelie A Monnier, Cees M P M Hertogh, Elderly care medicine, and APH - Aging & Later Life
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Aging ,Antimicrobial Stewardship ,All institutes and research themes of the Radboud University Medical Center ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Frail Elderly ,Urinary Tract Infections ,Humans ,Inappropriate Prescribing ,General Medicine ,Geriatrics and Gerontology ,Qualitative Research ,Aged ,Anti-Bacterial Agents - Abstract
Background a suspected urinary tract infection (UTI) is the most common reason to prescribe antibiotics in a frail older patient. Frequently, antibiotics are prescribed unnecessarily. To increase appropriate antibiotic use for UTIs through antibiotic stewardship interventions, we need to thoroughly understand the factors that contribute to these prescribing decisions. Objectives (1) to obtain insight into factors contributing to antibiotic prescribing for suspected UTIs in frail older adults. (2) To develop an overarching model integrating these factors to guide the development of antibiotic stewardship interventions for UTIs in frail older adults. Methods we conducted an exploratory qualitative study with 61 semi-structured interviews in older adult care settings in Poland, the Netherlands, Norway and Sweden. We interviewed physicians, nursing staff, patients and informal caregivers. Results participants described a chain of decisions by patients, caregivers and/or nursing staff preceding the ultimate decision to prescribe antibiotics by the physician. We identified five themes of influence: (1) the clinical situation and its complexity within the frail older patient, (2) diagnostic factors, such as asymptomatic bacteriuria, (3) knowledge (gaps) and attitude, (4) communication: interprofessional, and with patients and relatives and (5) context and organisation of care, including factors such as availability of antibiotics (over the counter), antibiotic stewardship efforts and factors concerning out-of-hours care. Conclusions decision-making on suspected UTIs in frail older adults is a complex, multifactorial process. Due to the diverse international setting and stakeholder variety, we were able to provide a comprehensive overview of factors to guide the development of antibiotic stewardship interventions.
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- 2022
20. Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU)
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Silje Rebekka Heltveit-Olsen, Pär-Daniel Sundvall, Ronny Gunnarsson, Egill Snaebjörnsson Arnljots, Anna Kowalczyk, Maciek Godycki-Cwirko, Tamara N Platteel, Hilde A M Koning, Wim G Groen, Christina Åhrén, Nils Grude, Theo J M Verheij, Cees M P M Hertogh, Morten Lindbaek, Sigurd Hoye, Elderly care medicine, and APH - Aging & Later Life
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Urinary Tract Infections ,Escherichia coli ,Humans ,Female ,Clinical Trials, Phase IV as Topic ,General Medicine ,Methenamine ,Phylogeny ,Aged ,Anti-Bacterial Agents ,Randomized Controlled Trials as Topic - Abstract
IntroductionMethenamine hippurate is a urinary antiseptic used as preventive treatment for recurrent urinary tract infections (UTIs) in some Scandinavian countries. However, the scientific evidence for the preventive effect and safety for longer-term use is limited. The aim of this study is to assess whether methenamine hippurate can reduce the incidence of UTIs in older women with recurrent UTIs.Methods and analysisThe ImpresU consortium is a collaboration between Norway, Sweden, Poland and the Netherlands. The study is a randomised, controlled, triple-blind phase IV clinical trial. Women ≥70 years with recurrent UTIs are screened for eligibility in a general practice setting. We aim to include 400 women in total, with 100 recruited from each collaborating country. The participants are randomised to treatment with methenamine hippurate 1 g or placebo tablets two times per day for a treatment period of 6 months, followed by a drug-free follow-up period of 6 months. The primary outcome is number of antibiotic treatments for UTIs during the treatment period. The secondary outcomes include number of antibiotic treatments for UTIs during the follow-up period and self-reported symptom of severity and duration of UTI episodes. Differences in complications between the treatment groups are measured as safety outcomes. We also aim to investigate whether strain characteristics or phylogenetic subgroups ofEscherichia colipresent in the urine culture at inclusion have a modifying effect on the outcomes.Ethics and disseminationEthical approvals are obtained in all participating countries. The results will be communicated in peer-reviewed journals and at scientific conferences.Trial registration numberClinicalTrials.gov Registry (NCT04077580); EudraCT: 2018-002235-15.
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- 2022
21. The Disability Paradox? Trajectories of Well-Being in Older Adults With Functional Decline
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Anouk M. van Loon, Marja F. I. A. Depla, Cees M. P. M. Hertogh, Martijn Huisman, Almar A. L. Kok, Elderly care medicine, APH - Aging & Later Life, Epidemiology and Data Science, APH - Societal Participation & Health, Psychiatry, APH - Mental Health, Cognitive Psychology, Sociology, and The Social Context of Aging (SoCA)
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Community and Home Care ,Male ,Aging ,Latent Class Analysis ,Humans ,Female ,Longitudinal Studies ,Personal Satisfaction ,Geriatrics and Gerontology ,Gerontology ,Aged - Abstract
Objectives: The ‘disability paradox’ (DP) suggests that most older adults maintain subjective well-being (SWB) despite functional decline. However, this may depend the SWB component: positive affect (PA), negative/depressed affect (NA/DA) or life satisfaction (LS). We assessed trajectories of these components in older adults with substantial functional decline. Methods: Data originated from the Longitudinal Aging Study Amsterdam ( N = 2545) observed during 1992–2008. Using latent class growth analysis, we distinguished a group with substantial functional decline and examined their SWB trajectories and individual characteristics. Results: The DP occurred more frequently for DA (Men:73%, Women:77%) and LS (Men:14%, Women:83%) than for PA (Men:26%, Women:17%). Higher perceived control (mastery) emerged as the most consistent factor associated with higher odds of the DP. Discussion: We provide a nuanced view of the DP, shifting the question from whether it exists to for which dimension of SWB and for whom it is more or less apparent.
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- 2022
22. Effectiveness and characteristics of physical fitness training on aerobic fitness in vulnerable older adults: an umbrella review of systematic reviews
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Dennis Visser, Elizabeth M Wattel, Karin H L Gerrits, Johannes C van der Wouden, Franka J M Meiland, Aafke J de Groot, Elise P Jansma, Cees M P M Hertogh, and Ewout B Smit
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SDG 3 - Good Health and Well-being ,geriatric medicine ,Physical Fitness ,Health Status ,rehabilitation medicine ,Humans ,General Medicine ,Exercise ,clinical physiology ,Aged ,Systematic Reviews as Topic - Abstract
ObjectivesTo present an overview of effectiveness and training characteristics of physical training on aerobic fitness, compared with alternative or no training, in adults aged over 65 years with various health statuses, providing a basis for guidelines for aerobic training of vulnerable older adults that can be used in geriatric rehabilitation.DesignAn umbrella review of systematic reviews that included both randomised controlled trials and other types of trials.Data sourcesMEDLINE, Embase, CINAHL and the Cochrane Library were searched on 9 September 2019.Eligibility criteria for selecting studiesWe included systematic reviews reporting on physical training interventions that are expected to improve aerobic fitness, presenting results for adults aged 65 years and older, describing at least one of the FITT-characteristics: Frequency, Intensity, Time or Type of exercise, and measuring aerobic fitness at least before and after the intervention.Data extraction and synthesisTwo independent reviewers extracted the data and assessed the risk of bias. A narrative synthesis was performed.ResultsWe included 51 papers on 49 reviews. Positive effect of training on aerobic fitness was reported by 33 reviews, 11 reviews remained inconclusive and 5 reviews reported no effect. Training characteristics varied largely. Frequency: 1–35 sessions/week, Intensity: light–vigorous, Time: ConclusionPhysical fitness training can be effective for vulnerable older adults. Exercise characteristics from current existing guidelines are widely applicable, although lower frequencies and intensities are also beneficial. For some conditions, adjustments are advised.PROSPERO registration numberCRD42020140575.
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- 2022
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