39 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. Gaining insight into the views of outpatients with Huntington’s disease regarding their future and the way they deal with their poor prognosis: a qualitative 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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Advance care planning ,Huntington’s disease ,Qualitative research ,Neurodegenerative disease ,Patients’ perspectives ,Special situations and conditions ,RC952-1245 - Abstract
Abstract Background Huntington’s disease (HD) has a poor prognosis. Decision-making capacity and communication ability may become lost as the disease progresses. Therefore, HD patients are encouraged to engage in advance care planning (ACP). To improve ACP for HD patients, there is a need to better understand how these patients face their poor prognosis. Aim To gain insight into the views of HD patients who receive outpatient care regarding their future and the way they deal with the poor prognosis of their disease. Methods A qualitative study using semi-structured interviews with 12 patients with HD (7 outpatient clinic, 3 day care, 2 assisted living facility). Audio-recorded interviews were transcribed verbatim. Through reading and re-reading interviews, writing memos and discussions in the research team, strategies were identified. Results Three strategies emerged for facing a future with HD. Participants saw the future: 1) as a period that you have to prepare for; 2) as a period that you would rather not think about; 3) as a period that you do not have to worry about yet. Participants could adopt more than one strategy at a time. Even though participants realized that they would deteriorate and would need more care in the future, they tried to keep this knowledge ‘at a distance’, with the motivation of keeping daily life as manageable as possible. Conclusions Official ACP guidelines recommend discussing goals and preferences for future treatment and care, but patients tend to want to live in the present. Further research is needed to elucidate the best approach to deal with this discrepancy.
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- 2021
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9. Antibiotic prescribing and non-prescribing in nursing home residents with signs and symptoms ascribed to urinary tract infection (ANNA): study protocol for a cluster randomized controlled trial
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Jeanine J. S. Rutten, Laura W. van Buul, Martin Smalbrugge, Suzanne E. Geerlings, Debby L. Gerritsen, Stephanie Natsch, Philip D. Sloane, Ruth B. Veenhuizen, Johannes C. van der Wouden, and Cees M. P. M. Hertogh
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Urinary tract infection ,Nursing homes ,Antibiotic prescribing ,Antibiotic stewardship ,Decision support ,Randomized controlled trial ,Geriatrics ,RC952-954.6 - Abstract
Abstract Background Antibiotic overprescribing for suspected urinary tract infection (UTI) in nursing homes (NHs) is common. Typical clinical scenarios in which antibiotics are inappropriately prescribed include response to nonspecific signs and symptoms and/or a positive urine test in the absence of symptoms referable to the urinary tract. These and other scenarios for inappropriate antibiotic prescribing were addressed in a recent international Delphi study which resulted in the development of a decision tool for the empiric treatment of UTI in frail older adults. The aim of the current study is to implement this decision tool, by integrating it into the electronic health record (EHR) and providing education on its content and use, and to evaluate its effect on appropriate antibiotic prescribing. An additional aim is to evaluate the quality of the intervention and the implementation process. Methods A cluster Randomized Controlled Trial (cRCT) is conducted in sixteen NHs and aims to include 897 residents diagnosed with suspected UTI. NHs in the intervention group use the EHR-integrated decision tool, and receive education for physicians and nursing staff; in the control group care as usual is provided. Data is collected through case report forms within the EHR at the day of diagnosis and at 3, 7, and 21 days thereafter. The primary outcome is appropriate antibiotic prescribing for suspected UTI at the day of diagnosis. Secondary outcomes include the course of symptoms, alternative diagnoses, treatment changes, complications, hospitalization, and mortality. Data on total antibiotic prescribing are additionally collected in the participating NHs 12 months before and during the study. Finally, the process evaluation combines cRCT data with questionnaires and qualitative interviews with NH professionals. Discussion This is the first cRCT to evaluate the recently developed, international decision tool for empiric treatment of suspected UTI in NH residents. Study findings will elucidate the effect of the intervention on appropriate antibiotic prescribing for suspected UTI, and provide insight into the applicability of the decision tool in NHs in general and in specific subgroups of NH residents. With this study we aim to contribute to antibiotic stewardship efforts in long-term care. Trial registration The ANNA study was registered at the Netherlands Trial Register on 26 February 2019, with identification number NTR NL7555 .
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- 2020
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10. Underlying goals of advance care planning (ACP): a qualitative analysis of the literature
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Nienke Fleuren, Marja F. I. A. Depla, Daisy J. A. Janssen, Martijn Huisman, and Cees M. P. M. Hertogh
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Advance care planning ,Goals of care ,End-of-life ,Quality of care ,Autonomy ,Relationships ,Special situations and conditions ,RC952-1245 - Abstract
Abstract Background Since the introduction of the concept of advance care planning (ACP), many studies have been conducted exploring beneficial effects. These studies show a heterogeneity in clinical endpoints, which reflects diversity of goals connected to ACP. This study aims to get insight in the range of underlying goals that comprise the legitimacy of ACP. Methods Systematic literature search in PubMed, EMBASE, PsychInfo, CINAHL and Cochrane Library. Articles on normative aspects of ACP were included, based on title and abstract. Due to the quantity of inclusions, of which many had similar content, purposive sampling was used to select articles for full text document analysis. Analysis stopped once saturation was reached. Results In total, 6497 unique articles were found of which 183 were included. Saturation was reached after document analysis of 55 articles (30%); this yielded 141 codes concerning goals of ACP and also 70 codes about objections against ACP, which shed light on the underlying goals of ACP as well. We identified five underlying goals: respecting individual patient autonomy, improving quality of care, strengthening relationships, preparing for end-of-life, reducing overtreatment. Conclusions Five distinctive underlying goals of ACP were identified, each with corresponding objections that need to be considered. Specifying underlying goals of ACP may direct the debate on definitions, methods and preferred outcomes of ACP. This study was funded by the Netherlands Organisation for Health Research and Development, grant 839120002.
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- 2020
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11. Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial
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Tjarda M. Boere, Laura W. van Buul, Rogier M. Hopstaken, Ruth B. Veenhuizen, Maurits W. van Tulder, Jochen W. L. Cals, Theo J. M. Verheij, and Cees M. P. M. Hertogh
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Respiratory tract infection ,Nursing home ,Antibiotic prescribing ,CRP ,Point-of-care testing ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Antibiotics are over-prescribed for lower respiratory tract infections (LRTI) in nursing home residents due to diagnostic uncertainty. Inappropriate antibiotic use is undesirable both on patient level, considering their exposure to side effects and drug interactions, and on societal level, given the development of antibiotic resistance. C-reactive protein (CRP) point-of-care testing (POCT) may be a promising diagnostic tool to reduce antibiotic prescribing for LRTI in nursing homes. The UPCARE study will evaluate whether the use of CRP POCT for suspected LRTI is (cost-) effective in reducing antibiotic prescribing in the nursing home setting. Methods/design A cluster randomized controlled trial will be conducted in eleven nursing homes in the Netherlands, with the nursing home as the unit of randomization. Residents with suspected LRTI who reside at a psychogeriatric, somatic, or geriatric rehabilitation ward are eligible for study participation. Nursing homes in the intervention group will provide care as usual with the possibility to use CRP POCT, and the control group will provide care as usual without CRP POCT for residents with (suspected) LRTI. Data will be collected from September 2018 for approximately 1.5 year, using case report forms that are integrated in the electronic patient record system. The primary study outcome is antibiotic prescribing for suspected LRTI at index consultation (yes/no). Discussion This is the first randomised trial to evaluate the effect of nursing home access to and training in the use of CRP POCT on antibiotic prescribing for LRTI, yielding high-level evidence and contributing to antibiotic stewardship in the nursing home setting. The relatively broad inclusion criteria and the pragmatic study design add to the applicability and generalizability of the study results. Trial registration Netherlands Trial Register, Trial NL5054. Registered 29 August 2018.
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- 2020
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12. 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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13. 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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14. Raising enthusiasm for the medical care of elderly patients: a concept mapping study to find elements for an elderly friendly medical curriculum
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Ariadne A. Meiboom, Henk de Vries, Fedde Scheele, and Cees M. P. M. Hertogh
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Medical students ,Geriatrics ,Curriculum development ,Concept mapping ,Special aspects of education ,LC8-6691 ,Medicine - Abstract
Abstract Background To deliver high quality of care for the growing population of older patients more geriatricians are needed. However, the interest of medical students for a career in geriatrics is lagging behind due to a lack of exposure, the nature of the work, and the low status and financial rewards. So far, only isolated interventions aimed at enhancing interest and/or attitudes with regard to geriatrics have been studied, pointing to the need for a broader-based strategy. The goal of this research is to find elements for a curriculum framework that can raise medical students’ enthusiasm for the medical care of elderly patients. Methods We used the concept mapping method developed by Trochim. This computer-assisted procedure consists of five steps: brainstorming, prioritizing and clustering with several experts, followed by processing by the computer and analysis. Results The views that were generated were grouped into the following clusters: a patient-centered medical curriculum, a curriculum representative of patient population, geriatrics presented as intellectually challenging and emotionally appealing, senior-friendly role models, a clear professional perspective. The results are presented in the form of a graphic chart. Conclusions An agenda to discuss the necessary actions for drastic curricular reforms in medical schools is set. This may give some guidance to this urgent, but highly complicated issue how to make medical student enthusiastic for the medical care for elderly patients.
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- 2018
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15. 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
16. Asymptomatic Cases and Limited Transmission of SARS-CoV-2 in Residents and Healthcare Workers in Three Dutch Nursing Homes
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Laura W. van Buul, Judith H. van den Besselaar, Fleur M. H. P. H. Koene, Bianca M. Buurman, and Cees M. P. M. Hertogh
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Geriatrics ,RC952-954.6 - Abstract
We aimed to assess the contribution of a- and presymptomatic residents and healthcare workers in transmission of SARS-CoV-2 in nursing homes. We conducted two serial point-prevalence surveys, including standardized symptom assessment and nasopharyngeal and oropharyngeal testing for SARS-CoV-2, among 297 residents and 542 healthcare workers of three Dutch nursing homes (NHs) with recent SARS-CoV-2 introduction. At the first point-prevalence survey, 15 residents tested positive of which one was presymptomatic and three remained asymptomatic. At the second point-prevalence survey one resident and one healthcare worker tested SARS-CoV-2 positive and both remained asymptomatic. Although a limited number of SARS-CoV-2 positive cases were identified, this study confirms a- and presymptomatic occurrence of Covid-19. We additionally describe factors that may contribute to the prevention of transmission. Taken together, our study complements the discussion on effective SARS-CoV-2 screening in NHs.
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- 2020
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17. 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
18. 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
19. High prevalence of multidrug resistant Enterobacteriaceae among residents of long term care facilities in Amsterdam, the Netherlands.
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Eline van Dulm, Aletta T R Tholen, Annika Pettersson, Martijn S van Rooijen, Ina Willemsen, Peter Molenaar, Marjolein Damen, Paul Gruteke, Paul Oostvogel, Ed J Kuijper, Cees M P M Hertogh, Christina M J E Vandenbroucke-Grauls, and Maarten Scholing
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Medicine ,Science - Abstract
IntroductionThe aim of this study was to determine the rate of asymptomatic carriage and spread of multidrug-resistant micro-organisms (MDRO) and to identify risk factors for extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriage in 12 long term care facilities (LTCFs) in Amsterdam, the Netherlands.Materials and methodsFrom November 2014 to august 2015, feces and nasal swabs from residents from LTCFs in Amsterdam, the Netherlands were collected and analyzed for presence of multidrug-resistant Gram-negative bacteria (MDRGN), including ESBL-E, carbapenemase-producing Enterobacteriaceae (CPE), colistin-resistant Enterobacteriaceae and methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Logistic regression analysis was performed to assess associations between variables and ESBL-carriage.ResultsIn total, 385 residents from 12 LTCFs (range 15-48 residents per LTCF) were enrolled. The prevalence of carriage of MDRGN was 18.2% (range among LTCFs 0-47%) and the prevalence of ESBL-E alone was 14.5% (range among LTCFs: 0-34%). Of 63 MDRGN positive residents, 50 (79%) were ESBL-E positive of which 43 (86%) produced CTX-M. Among 44 residents with ESBL-E positive fecal samples of whom data on contact precautions were available at the time of sampling, only 9 (20%) were already known as ESBL-E carriers. The prevalence for carriage of MRSA was 0.8% (range per LTCF: 0-7%) and VRE 0%. One CPE colonized resident was found. All fecal samples tested negative for presence of plasmid mediated resistance for colistin (MCR-1). Typing of isolates by Amplified Fragment Length Polymorphism (AFLP) showed five MDRGN clusters, of which one was found in multiple LTCFs and four were found in single LTCFs, suggesting transmission within and between LTCFs. In multivariate analysis only the presence of MDRO in the preceding year remained a risk factor for ESBL-E carriage.ConclusionsThe ESBL-carriage rate of residents in LTCFs is nearly two times higher than in the general population but varies considerably among LTCFs in Amsterdam, whereas carriage of MRSA and VRE is low. The majority (80%) of ESBL-E positive residents had not been detected by routine culture of clinical specimens at time of sampling. Current infection control practices in LTCFs in Amsterdam do not prevent transmission. Both improvement of basic hygiene, and funding for laboratory screening, should allow LTCFs in Amsterdam to develop standards of care to prevent transmission of ESBL-E.
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- 2019
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20. Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): A randomized controlled trial.
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Judith D M Vloothuis, Marijn Mulder, Rinske H M Nijland, Quirine S Goedhart, Manin Konijnenbelt, Henry Mulder, Cees M P M Hertogh, Maurits van Tulder, Erwin E H van Wegen, and Gert Kwakkel
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Medicine ,Science - Abstract
Background and purposeWe designed an 8-week caregiver-mediated exercise program with e-health support after stroke (CARE4STROKE) in addition to usual care with the aim to improve functional outcome and to facilitate early supported discharge by increasing the intensity of task specific training.MethodsAn observer-blinded randomized controlled trial in which 66 stroke patient-caregiver couples were included during inpatient rehabilitation. Patients allocated to the CARE4STROKE program trained an additional amount of 150 minutes a week with a caregiver and were compared to a control group that received usual care alone. Primary outcomes: self-reported mobility domain of the Stroke Impact Scale 3.0 (SIS) and length of stay (LOS). Secondary outcomes: motor impairment, strength, walking ability, balance, mobility and (Extended) Activities of Daily Living of patients, caregiver strain of caregivers, and mood, self-efficacy, fatigue and quality of life of both patients and caregivers. Outcomes were assessed at baseline, 8 and 12 weeks after randomization.ResultsNo significant between-group differences were found regarding SIS-mobility after 8 (β 6.21, SD 5.16; P = 0.229) and 12 weeks (β 0.14, SD 2.87; P = 0.961), and LOS (P = 0.818). Significant effects in favor of the intervention group were found for patient's anxiety (β 2.01, SD 0.88; P = 0.023) and caregiver's depression (β 2.33, SD 0.77; P = 0.003) post intervention. Decreased anxiety in patients remained significant at the 12-week follow-up (β 1.01, SD 0.40; P = 0.009).ConclusionsThis proof-of concept trial did not find significant effects on both primary outcomes mobility and LOS as well as the secondary functional outcomes. Treatment contrast in terms of total exercise time may have been insufficient to achieve these effects. However, caregiver-mediated exercises showed a favorable impact on secondary outcome measures of mood for both patient and caregiver.Clinical trial registrationNTR4300, URL- http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4300.
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- 2019
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21. 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
22. 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
23. Een carrière als specialist ouderengeneeskunde; iets voor de huidige geneeskundestudent?
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Ariadne A. Meiboom, Henk de Vries, Marc B. M. Soethout, Cees M. P. M. Hertogh, and Fedde Scheele
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carrière keuze ,geneeskundestudent ,specialisme ouderengeneeskunde ,Medicine - Abstract
Achtergrond Vanwege de toename van het aantal oudere patiënten met multimorbiditeit zijn er meer specialisten ouderengeneeskunde nodig. Het aantal beschikbare opleidingsplaatsen is echter de laatste jaren niet volledig benut geweest. Om een indruk te krijgen van de mate van belangstelling voor een carrière in het specialisme ouderengeneeskunde van geneeskundestudenten en de mogelijke factoren die daarbij een rol spelen, hebben wij deze belangstelling geëxploreerd, evenals het beroepsbeeld dat geneeskundestudenten hebben van dit specialisme. Dit hebben we gedaan in een ‘oud’ en ‘nieuw’ curriculum. Deze laatste kent een verplicht coschap ouderengeneeskunde en meer competentiegebonden leren. Methode In het VUmc is in 2014 aan 120 geneeskundestudenten en in 2009 aan 150 geneeskundestudenten aan het einde van hun laatste jaar een vragenlijst voorgelegd over beroepsvoorkeuren en beroepskenmerken. Resultaten Het responspercentage bedroeg 100 % respectievelijk 85 %. Van het nieuwe curriculum overwoog 16,7 % van de studenten het specialisme ouderengeneeskunde als beroep. Van het oude curriculum was dat 9,4 % p( = 0,087). De beroepskenmerken die studenten vooral aantrekkelijk vonden, maar niet van toepassing achtten op het specialisme ouderengeneeskunde waren: diagnostiek, acute aandoeningen, zichtbare resultaten. De beroepskenmerken die studenten zeer van toepassing vonden op dit specialisme, doch minder aantrekkelijk vonden voor hun latere beroep, waren: psychosociale-, chronische- en terminale aandoeningen. Discussie Er is een trend dat studenten van het nieuwe curriculum meer belangstelling hebben voor het beroep van specialist ouderengeneeskunde, al blijft deze belangstelling laag. Het verdient aanbeveling om in de basisartsopleiding, zowel in de bachelor als in een verplicht coschap ouderengeneeskunde, te laten zien dat aantrekkelijk gevonden kenmerken van het artsenberoep wel degelijk voorkomen in dit specialisme. Tevens zou in de basisopleiding meer aandacht besteed moeten worden aan de begeleiding en behandeling van patiënten met chronische en terminale aandoeningen.
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- 2018
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24. 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
25. National point prevalence study on carriage of multidrug-resistant microorganisms in Dutch long-term care facilities in 2018
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Esther, van Kleef, Cornelia C H, Wielders, Leo M, Schouls, Sabiena G, Feenstra, Cees M P M, Hertogh, Marc J M, Bonten, Yolanda, van Weert, Alma, Tostmann, Mariken, van der Lubben, Sabine C, de Greeff, Elma, Smeets, and Microbes in Health and Disease (MHD)
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0301 basic medicine ,Microbiology (medical) ,Klebsiella pneumoniae ,030106 microbiology ,Population ,Prevalence ,beta-Lactamases/genetics ,beta-Lactamases ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,0302 clinical medicine ,Antibiotic resistance ,Environmental health ,Escherichia coli ,Medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,education ,Escherichia coli Infections ,Pharmacology ,education.field_of_study ,Molecular epidemiology ,biology ,business.industry ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,bacterial infections and mycoses ,Long-Term Care ,Long-term care ,Escherichia coli/genetics ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Infectious Diseases ,Carriage ,Multilocus sequence typing ,business ,Multilocus Sequence Typing - Abstract
Objectives Long-term care facilities (LTCFs) may act as a reservoir of ESBL-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) for hospitals and the general population. In this study, we estimated the prevalence and molecular epidemiology of rectal carriage with ESBL-E and CPE in residents of Dutch LTCFs between March 2018 and December 2018. Methods LTCFs were geographically selected across the country. For each LTCF, a random sample of residents were tested for ESBL-E and CPE in 2018. To identify risk factors for high carriage prevalence and/or individual carriage, characteristics of LTCFs and of a subset of the tested residents were collected. WGS was conducted on isolates from LTCFs with an ESBL-E prevalence of >10% and all CPE isolates to identify institutional clonal transmission. Results A total of 4420 residents of 159 LTCFs were included. The weighted mean ESBL-E prevalence was 8.3% (95% CI: 6.8–10.0) and no CPE were found. In 53 LTCFs (33%), where ESBL-E prevalence was >10%, MLST using WGS (wgMLST) was performed. This included 264 isolates, the majority being Escherichia coli (n = 224) followed by Klebsiella pneumoniae (n = 30). Genetic clusters were identified in more than half (30/53; 57%) of high ESBL-positive LTCFs. Among the E. coli isolates, blaCTX-M-15 (92/224; 41%) and blaCTX-M-27 (40/224; 18%) were the most prevalent ESBL-encoding genes. For K. pneumoniae isolates, the most common was blaCTX-M-15 (23/30; 80%). Conclusions The estimated prevalence of ESBL-E rectal carriage in Dutch LTCFs is 8.3% and resistance is observed mainly in E. coli with predominance of blaCTX-M-15 and blaCTX-M-27. ESBL-E prevalence in LTCFs seems comparable to previously reported prevalence in hospitals and the general population.
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- 2021
26. 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
27. 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
28. 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
29. 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
30. 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
31. 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
32. 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
- Subjects
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.
- Published
- 2022
33. Pressure in dealing with requests for euthanasia or assisted suicide
- Author
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Marike E, de Boer, Marja F I A, Depla, Marjolein, den Breejen, Pauline, Slottje, Bregje D, Onwuteaka-Philipsen, and Cees M P M, Hertogh
- Subjects
Interviews as Topic ,Euthanasia ,General Practitioners ,Professional-Family Relations ,Decision Making ,Humans ,Qualitative Research ,Stress, Psychological ,Netherlands ,Suicide, Assisted - Abstract
The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide (EAS). This study aimed to explore the content of this pressure as experienced by general practitioners (GP). We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: (1) emotional blackmail, (2) control and direction by others, (3) doubts about fulfilling the criteria, (4) counterpressure by patient's relatives, (5) time pressure around referred patients and (6) organisational pressure. We conclude that the pressure can be attributable to the patient-physician relationship and/or the relationship between the physician and the patient's relative(s), the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account.
- Published
- 2018
34. End-of-life treatment decisions in nursing home residents dying with dementia in the Netherlands
- Author
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Simone A, Hendriks, Martin, Smalbrugge, Luc, Deliens, Raymond T C M, Koopmans, Bregje D, Onwuteaka-Philipsen, Cees M P M, Hertogh, and Jenny T, van der Steen
- Subjects
Aged, 80 and over ,Male ,Terminal Care ,Palliative Care ,Anti-Bacterial Agents ,Nursing Homes ,Hospitalization ,Withholding Treatment ,Quality of Life ,Humans ,Dementia ,Female ,Practice Patterns, Physicians' ,Advance Directives ,Aged ,Netherlands - Abstract
The objective was to describe end-of-life treatment decisions for patients dying with dementia in various stages of dementia in long-term care facilities in the Netherlands with elderly care physicians responsible for treatment and care.We present data collected in the nationally representative Dutch End of Life in Dementia study (2007-2011). Within 2 weeks after death, 103 physicians completed questionnaires about the last phase of life in 330 residents with dementia who resided in 1 of 34 participating long-term care facilities. We used descriptive statistics.Advance directives were rare (4.9%). A minority was hospitalized (8.0%) in the last month (mainly for fractures) or received antibiotics (24.2%) in the last week (mainly for pneumonia). Four residents received tube feeding or rehydration therapy in the last week. In almost half of the residents (42.3%), decisions were made not to start potentially life-prolonging treatment such as hospital transfer and artificial nutrition and hydration. In more than half of the residents (53.7%), decisions were made to withdraw potentially life-prolonging treatment such as artificial nutrition and hydration and medication. Antibiotics were more frequently prescribed for residents with less advanced dementia, but otherwise there were no differences in treatment decisions between residents with advanced and less advanced dementia.Physicians often withhold potentially burdensome life-prolonging treatment in nursing home residents in all stages of dementia in the Netherlands. This suggests that the physicians feel that a palliative care approach is appropriate at the end of life in dementia in long-term care. Copyright © 2016 John WileySons, Ltd. StartCopTextCopyright © 2016 John WileySons, Ltd.
- Published
- 2016
35. Symptom relief in patients with pneumonia and dementia: implementation of a practice guideline
- Author
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Tessa, van der Maaden, Jenny T, van der Steen, Raymond T C M, Koopmans, Sarah M M M, Doncker, Johannes R, Anema, Cees M P M, Hertogh, and Henrica C W, de Vet
- Subjects
Adult ,Male ,Surveys and Questionnaires ,Practice Guidelines as Topic ,Humans ,Dementia ,Female ,Guideline Adherence ,Pneumonia ,Middle Aged ,Practice Patterns, Physicians' ,Netherlands ,Nursing Homes - Abstract
This study aimed to assess the degree of implementation and barriers encountered in the use of a practice guideline for optimal symptom relief for patients with dementia and pneumonia in Dutch nursing homes.A process evaluation included assessment of reach, fidelity, and dose delivered using researcher's observations, and dose received was addressed in a question "use of the practice guideline," which the physicians completed for each patient included in the study. Perceived barriers were assessed with a structured questionnaire (response 69%) and semi-structured interviews (n = 14), which were subject to qualitative content analysis.Of the 55 physicians involved in the intervention phase, 87% attended an implementation meeting; 20 physicians joined the study later (reach). The intervention was implemented as planned, and all intervention components were delivered by the researchers (fidelity and dose delivered). Thirty-six physicians included 109 patients. For 81% of the patients, the treating physician stated to have used the guideline (dose received). The guideline was perceived as providing a good overview of current practice, but some physicians had expected a more directive protocol or algorithm. Further, recommended regular observations of symptoms were rarely performed. Physician's often felt that "this is not different from what we usually do," and with the acute illness, there was not always enough time to (re)familiarize with the contents.The physicians used the practice guideline frequently despite important barriers. Future implementation may involve strategies such as multiple interactive meetings. Further, the greatest potential to alter usual practice should be emphasized, such as using observational instruments. Copyright © 2016 John WileySons, Ltd.
- Published
- 2016
36. Pain among institutionalized stroke patients and its relation to emotional distress and social engagement
- Author
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Suzanne, van Almenkerk, Marja F I A, Depla, Martin, Smalbrugge, Jan A, Eefsting, and Cees M P M, Hertogh
- Subjects
Aged, 80 and over ,Male ,Depressive Disorder ,Pain ,Middle Aged ,Long-Term Care ,Delusions ,Nursing Homes ,Aggression ,Stroke ,Cross-Sectional Studies ,Chronic Disease ,Odds Ratio ,Prevalence ,Humans ,Regression Analysis ,Female ,Social Behavior ,Psychomotor Agitation ,Stress, Psychological ,Aged ,Netherlands - Abstract
Pain is a frequent long-term consequence of stroke, but its relation to emotional and social well-being is poorly studied in stroke populations. We aimed to identify the prevalence of substantial pain among institutionalized stroke patients and to explore its relation to emotional distress (ED) and low social engagement (SE).In a cross-sectional design, we collected data of 274 chronic stroke patients in Dutch nursing homes. Observation lists were filled out in structured interviews with qualified nurse assistants who knew the residents well. Pain and SE were measured with the Resident Assessment Instrument for Long-term Care Facilities, and ED was measured with the Neuropsychiatric Inventory Questionnaire (NPIQ).Substantial pain was present in 28% of the residents, mostly located in the affected body side (68%). Multilevel regression analyses revealed that this pain was independently related to a 60% increase in NPIQ score (β 3.18 [1.84-4.53]) and to clinically relevant symptoms of delusions (odds ratio [OR] 8.45 [1.82-39.05]), agitation/aggression (OR 3.82 [1.76-8.29]), depression (OR 3.49 [1.75-6.98]), and anxiety (OR 2.32 [1.08-4.97]). Substantial pain was associated with low SE when adjusted for clinical covariates (OR 4.25 [1.72-10.53]), but only in residents with no/mild or severe cognitive impairment. This relation disappeared when additionally corrected for NPIQ score (OR 1.95 [0.71-5.39]).Pain is a serious and multidimensional problem among institutionalized stroke patients. It is related to increased ED, which in turn can be a pathway to low SE as an indicator of social vulnerability. Future research should reveal how pain management in nursing homes can be tailored to the needs of this patient group.
- Published
- 2014
37. Development of a practice guideline for optimal symptom relief for patients with pneumonia and dementia in nursing homes using a Delphi study
- Author
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Tessa, van der Maaden, Jenny T, van der Steen, Henrica C W, de Vet, Wilco P, Achterberg, Froukje, Boersma, Jos M G A, Schols, Jos F J M, van Berkel, David R, Mehr, Marcel, Arcand, Andy I M, Hoepelman, Raymond T C M, Koopmans, and Cees M P M, Hertogh
- Subjects
Male ,Consensus ,Delphi Technique ,Palliative Care ,Comorbidity ,Pneumonia ,Nursing Homes ,Dyspnea ,Cough ,Practice Guidelines as Topic ,Humans ,Dementia ,Female ,Aged - Abstract
This study aimed to develop a practice guideline for a structured and consensus-based approach to relieve symptoms of pneumonia in patients with dementia in nursing homes.A five-round Delphi study involving a panel consisting of 24 experts was conducted. An initial version of the practice guideline was developed with leading representatives of Dutch University Medical Centers with a department for elderly care medicine, based on existing guidelines for palliative care. The experts evaluated the initial version, after which we identified topics that reflected the main divergences. The experts rated their agreement with statements that addressed the main divergences on a 5-point Likert scale. Consensus was determined according to pre-defined criteria. The practice guideline was then revised according to the final decisions made by the project group and the representatives.The response rate for the expert panel was 67%. Main divergences included the applicability of guidelines for palliative care to patients with dementia and pneumonia in long-term care and the appropriateness of specific pharmacological treatment of dyspnea and coughing. Moderate consensus was reached for 80% of the statements. Major revisions included adding pharmacological treatment for coughing and recommending opioid rotation in the case of opioid-induced delirium. Two areas of divergent opinion remained: the usefulness of oxygen administration and treatment of rattling breath. The project group made the final decision in these areas.We developed a mostly consensus-based practice guideline for patients with dementia and pneumonia and mapped controversial issues for future investigation.
- Published
- 2013
38. Unbearable Suffering and Advanced Dementia
- Author
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Cees M. P. M. Hertogh
- Subjects
medicine.medical_specialty ,Palliative care ,business.industry ,Perspective (graphical) ,medicine.disease ,Palliative sedation ,Competence (law) ,Advanced dementia ,medicine ,Dementia ,Assisted suicide ,Psychiatry ,business ,Depression (differential diagnoses) - Published
- 2012
39. Advance directives for euthanasia in dementia: how do they affect resident care in Dutch nursing homes? Experiences of physicians and relatives
- Author
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Marike E, de Boer, Rose-Marie, Dröes, Cees, Jonker, Jan A, Eefsting, and Cees M P M, Hertogh
- Subjects
Aged, 80 and over ,Male ,Advance Directive Adherence ,Attitude of Health Personnel ,Euthanasia ,Decision Making ,Nursing Homes ,Suicide, Assisted ,Caregivers ,Surveys and Questionnaires ,Interview, Psychological ,Homes for the Aged ,Humans ,Dementia ,Female ,Mental Competency ,Health Services Research ,Advance Directives ,Medical Futility ,Aged ,Netherlands - Abstract
To gain insight into how advance directives for euthanasia affect resident care in Dutch nursing homes.Survey of elderly care physicians and additional qualitative interviews with a selection of elderly care physicians and relatives of people with dementia who had an advance directive for euthanasia.Dutch nursing home practice.Four hundred thirty-four elderly care physicians completed the general part of the questionnaire; 110 physicians provided case histories. Interviews were conducted with 11 physicians and eight relatives.The questionnaire contained general questions about the incidence of advance directives for euthanasia in people with dementia. A second part involved questions about the most recent case of a person with dementia and an advance directive for euthanasia who had died. The interviews with elderly care physicians and relatives focused on further exploration of the decision-making process regarding adherence to the advance directive for euthanasia.Despite law-based possibilities, advance directives for euthanasia of people with dementia were rarely adhered to, although they seem to have a supportive role in setting limitations on life-sustaining treatments. Elderly care physicians and relatives were found to be reluctant to adhere to advance directives for euthanasia. Not being able to engage in meaningful communication played a crucial role in this reluctance.Advance directives for euthanasia are never adhered to in the Netherlands in the case of people with advanced dementia, and their role in advance care planning and end-of-life care of people with advanced dementia is limited. Communication with the patient is essential for elderly care physicians to consider adherence to an advance directive for euthanasia of a person with dementia.
- Published
- 2011
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