The Netherlands journal of medicine
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Randomized Controlled Trial
Fendrix® compared to Engerix® in HIV-infected patients nonresponding to initial- and re-vaccination schedule.
In HIV-infected patients, the immunogenicity of hepatitis B vaccines is impaired. In this randomised controlled study (RCT), we investigated the effect of Fendrix® versus double-dose Engerix® vaccination in previously non-responsive HIV-infected subjects. ⋯ These results together, suggest that continuing HBV vaccination in non-responders to a first course of single-dose vaccine and a double-dose revaccination scheme is worth the effort. No superiority of one of the investigated hepatitis B vaccines was shown in this cohort but an appropriate number of patients needed to achieve reliable answers was not achieved.
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Length of stay (LOS) in the Emergency Department (ED) is correlated with an extended in-hospital LOS and may even increase 30-day mortality. Older patients represent a growing population in the ED and they are especially at risk of adverse outcomes. Screening tools that adequately predict admission could help reduce waiting times in the ED and reduce time to treatment. We aimed to develop and validate a clinical prediction tool for admission, applicable to the aged patient population in the ED. ⋯ The developed CLEARED tool reliably predicts admission in elderly patients visiting the ED. It is a promising prompt, although further research is needed to implement the tool and to investigate the benefits in terms of reduction of crowding and LOS in the ED.
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The Choosing Wisely campaign aims to reduce low-value care to improve quality and lower healthcare costs. Our objective was to determine the current implementation of the Choosing Wisely Netherlands campaign and the 10 recommendations (released in 2014) for internal medicine. ⋯ Four years after the introduction, only one-third of physicians and residents of internal medicine were aware of the Choosing Wisely Netherlands campaign. Nevertheless, most Choosing Wisely recommendations were implemented sufficiently in clinical practice. There is room for improvement, mainly in recommendations that need a multidisciplinary approach.
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Case Reports
Hypokalaemia and peripheral oedema in a Cushingoid patient with metastatic prostate cancer.
We report on a 75-year-old man with a history of metastatic prostate cancer who presented with haematuria, peripheral oedema, metabolic alkalosis, hypokalaemia, and hypertension. Laboratory evaluation was compatible with the diagnosis of adrenocorticotropic hormone (ACTH)-dependent cushing's syndrome and suggestive of ectopic ACTH production. Pathology of a prostate biopsy specimen showed a large cell neuroendocrine carcinoma (LCNEC) of the prostate. This report describes a case of Cushing's syndrome that was probably caused by ectopic ACTH secretion by a LCNEC of the prostate.
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Combined administration of intravenous (iv) and intraperitoneal (ip) (iv/ip) chemotherapy is an effective adjuvant treatment option after primary debulking surgery (PDS) for advanced ovarian cancer (OC). Increased toxicityand patient burden limit its use in daily practice. ⋯ In daily practice, 54% of patients with advanced OC could complete all scheduled cycles of iv/ ip chemotherapy with acceptable morbidity and toxicity, leading to outcomes comparable with the results of published trials on iv/ip chemotherapy.