Intraoral scanning as an alternative to cone-beam computed tomographies to evaluate the accuracy of dental implant placement: a prospective clinical trial

开始日期2020-03-01

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Radboud Institute for Health Sciences

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381

项与 Radboud Institute for Health Sciences 相关的文献（医药）

2024-09-01·BMJ Open

Which actions contribute to the development of an interprofessional learning and working culture in nursing homes? A realist action study

Article

作者: Nouwens, Elvira S ; Fluit, Cornelia R M G ; Verbeek, Frank H O ; van Vught, Anneke J A H ; Lovink, Marleen Hermien ; Laurant, Miranda ; Huisman-de Waal, Getty

ObjectiveInsights about what actions contributed to the development of an interprofessional learning and working culture were lacking for nursing homes. This study aimed to provide insight into the context and actions that trigger mechanisms for the development of an interprofessional learning and working culture in nursing homes.Study designRealist evaluation action research was conducted from 2019 to 2023.Setting and participants11 teams in 6 Dutch nursing homes.Primary and secondary outcome measuresQuestionnaires, focus group interviews and observations were used to identify actions, context factors and mechanisms. We used retroductive analysis to discuss how actions were related to the development of the culture. Actions were evaluated in terms of context and manner in which they contribute to the development.Results21 actions were identified and clustered into two themes. Theme 1: improving person-centred care. Actions activated the mechanisms of critical reflective behaviour and collective ownership in a context of, among other things, clear roles and tasks, a stable and competent team, the presence of case managers and facilitating organisational factors such as time for reflection. Theme 2: getting to know and understand each other’s expertise. Actions activated respectful relationships, collective ownership of goals and feeling appreciated for your work in a context of, among other things, team members who meet regularly and management supporting interprofessional working.ConclusionsThis research sheds light on how and in what manner-specific actions contribute to the development of an interprofessional learning and working culture in nursing homes. Depending on the context, the actions triggered the following mechanisms: critical reflective behaviour, collective ownership of goals, respectful/caring relationships and feeling appreciated for your work. These mechanisms are the underlying drivers of an interprofessional learning and working culture. This study provides valuable guidance for fostering collaborative and effective interprofessional dynamics in nursing homes.

2024-08-24·British Journal of Cancer

Proactive monitoring of drug–drug interactions between direct oral anticoagulants and small-molecule inhibitors in patients with non-small cell lung cancer

Article

作者: Leentjens, Jenneke ; Otten, Leila-Sophie ; van Geel, Robin M J M ; Ter Heine, Rob ; Croes, Sander ; Winckers, Kristien ; van den Heuvel, Michel M ; Hendriks, Lizza E L ; Henskens, Yvonne ; Piet, Berber ; Gulikers, Judith L

AbstractBackgroundSmall-molecule inhibitors (SMIs) have revolutionised the treatment of non-small cell lung cancer (NSCLC). However, SMI-induced drug–drug interactions (DDIs) with frequently co-administered direct oral anticoagulants (DOACs), increase thromboembolic and bleeding risks. This study investigated and proactively managed the consequences of DOAC-SMI DDIs.MethodsThis prospective, observational study enrolled patients with NSCLC concomitantly using a DOAC and SMI. The primary outcome was the proportion of patients with DOAC plasma trough (Ctrough) and peak (Cpeak) concentrations outside expected ranges. Secondary outcomes included DOAC treatment modifications, incidence of bleeding and thromboembolic events and feasibility evaluation of pharmacokinetically guided DOAC dosing.ResultsThirty-three patients were analysed. Thirty-nine percent (13/33) had DOAC Ctrough and/or Cpeak were outside the expected ranges in 39% (13/33). In 71% (5/7) of patients with DOAC concentrations quantified before and during concurrent SMI use, DOAC Ctrough and/or Cpeak increased or decreased >50% upon SMI initiation. In all patients in whom treatment modifications were deemed necessary, DOAC concentrations were adjusted to within the expected ranges.ConclusionProactive monitoring showed that a substantial proportion of patients had DOAC concentrations outside the expected ranges. DOAC concentrations were successfully normalised after treatment modifications. These results highlight the importance of proactive monitoring of DOAC-SMI DDIs to improve treatment in patients with NSCLC.

2024-08-01·Journal of Antimicrobial Chemotherapy

Isavuconazole as prophylaxis and therapy for invasive fungal diseases: a real-life observational study

Article

作者: Schouten, Jeroen A ; de Kort, Elizabeth ; Ergün, Mehmet ; Jansen, Anouk M E ; Brüggemann, Roger J M ; Reijers, Monique H E ; Hilbrands, Luuk B ; Kunst, Henricus ; Verweij, Paul E

AbstractBackgroundIsavuconazole is a relatively new antifungal agent indicated for the management of various invasive fungal diseases (IFDs), including invasive aspergillosis. Information on real-world experience with isavuconazole is scarce. This retrospective observational study aimed to describe the usage of isavuconazole in clinical practice with an in-depth evaluation of individual isavuconazole exposure.MethodsPatients treated with isavuconazole were evaluated based on retrospective data, including therapeutic drug monitoring (TDM) data and efficacy and safety data. Additionally, we calculated the individual isavuconazole exposure described by the average AUC24 over the first 7 days of treatment by means of non-linear mixed-effects modelling and compared this with the currently desired lower target AUC of 60 mg·h/L.ResultsNinety-nine patients treated with isavuconazole were evaluated. In our real-life cohort, isavuconazole was often deployed off-label in patients with non-classical host factors and infections with non-Aspergillus and non-Mucorales species. Isavuconazole was most often chosen for its safety profile, even after prior triazole treatment with manifestations of toxicity. TDM and subsequent dosage adjustments were frequently performed. The individual average AUC24 over 7 days was above 60 mg·h/L in 29 out of 77 (37.7%) patients.ConclusionsThis overview provides practical insights that can aid clinicians in the management of their patients with IFD. Our study shows that isavuconazole was used in a diverse patient population and was well tolerated overall. Individual isavuconazole exposure reflected by the average AUC24 over the first 7 days of treatment was generally low and variable. Dosage adjustments following TDM were frequently performed. Our experience shows that isavuconazole is a feasible alternative after prior azole treatment.

项与 Radboud Institute for Health Sciences 相关的新闻（医药）

2023-10-12

·PRNewswire

More Aggressive Treatment Doesn't Impact Quality of Life for Metastatic Colorectal Cancer Patients, According to New Study in JNCCN

Researchers found that removing as much tumor as possible in multiorgan metastatic colorectal cancer—via various methods—did not cause a decrease in quality of life despite an increase in adverse events; survival benefits remain unclear. PLYMOUTH MEETING, Pa., Oct. 12, 2023 /PRNewswire/ -- New research in the October 2023 issue of JNCCN—Journal of the National Comprehensive Cancer Network finds that intensive local-regional treatment to remove as much tumor as possible (known as "debulking"), in addition to standard systemic therapy, does not impact overall quality of life significantly for people with metastatic colorectal cancer. Continue Reading "These results should be taken into account in order to decide what the right treatment choice is for each individual." Tweet this October 2023 Edition of JNCCN now available at JNCCN.org. The researchers examined the ongoing ORCHESTRA trial (NCT01792934) to compare patients treated with standard palliative chemotherapy alone to those who received palliative chemotherapy plus either surgery, ablative therapy, and/or radiotherapy to reduce their tumor burden. 300 patients were randomized to receive standard care or additional intervention. Significant adverse events were reported in 21% of patients in the standard group and 43% of patients who also received tumor debulking. However, there were no statistical or clinically relevant differences according to patient-reported outcomes for overall health-related quality of life or fatigue. "This could mean that the negative impact of complications on quality of life is temporary and eventually balances out with a decrease in tumor-related symptoms after treatment. Patients might also adapt their HRQoL perceptions during the course of their disease and treatment." explained lead author Lotte Bakkerus, MD, Radboud Institute for Health Sciences, The Netherlands. "Given the considerable amount of complications from local treatment, we had expected to see a bigger impact on overall and persistent quality of life in the experimental group. The fact that local therapy associated serious side effects did not translate to a noticeable dip in the patients' perceived quality of life is quite intriguing and warrants further exploration. These results, including the risk of complications, should be taken into account in the consultation room in order to decide, together with the patient, what the right treatment choice is for each individual." The study focused on the results from a preplanned exploratory secondary endpoint of Health-Related Quality of Life (HRQoL) from the ORCHESTRA trial, which was measured using the EORTC Quality of Life Questionnaire-Core 30 and the Multidimensional Fatigue Inventory questionnaire at pre-specified time points during treatment. The intervention group included first-line FOLFOX or CAPOX +/- bevacizumab plus multi-organ debulking to reduce the tumor by at least 80%. That was compared to the control group of palliative systemic chemo-biologic therapy only. "Tumor debulking for patients with synchronous oligo-metastatic colorectal cancer is often utilized for curative intent and endorsed in the NCCN Guidelines, with surgical resection preferred over other acceptable treatment-modalities such as radiation therapy or thermal ablation. However, the potential survival benefits for such interventions have not been established for patients with multi-organ rather than single-organ colorectal-cancer metastases. That's a question that the ORCHESTRA trial is attempting to answer," commented Charles J. Schneider, MD, FACP, Professor of Clinical Medicine in the University of Pennsylvania Perelman School of Medicine and GI Medical Oncologist at Penn Medicine's Abramson Cancer Center. Dr. Schneider, is a member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Colon/Rectal/Anal Cancers, and was not involved in this study. He continued: "The outcome of no statistically significant or clinically relevant differences in HRQoL and fatigue after one year was surprising. More intriguing yet, is the fact that although the patients in the intervention group experienced local treatment related serious adverse events (SAEs) twice as often as patients in the standard group, there was a striking lack of association between the occurrence of SAEs and impact on HRQoL. Thus, this HRQoL 'equivalence,' even in the face of twice as many SAE's in the intervention group, should give guarded justification for multi-organ tumor debulking combined with palliative chemotherapy in select patients, if the survival data turns out to favor the intervention group as well." To read the entire study, visit JNCCN.org. Complimentary access to "Health-Related Quality of Life in Paitents with Metastatic Colorectal Cancer Undergoing Systemic Therapy With or Without Maximal Tumor Debulking" is available until January 10, 2024. About JNCCN—Journal of the National Comprehensive Cancer Network More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside/BroadcastMed. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit NCCN.org/jnccn/subscribe. Follow JNCCN on Twitter @JNCCN. About the National Comprehensive Cancer Network The National Comprehensive Cancer Network® ( NCCN ®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology ( NCCN Guidelines ®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit NCCN.org for more information. Media Contact: Rachel Darwin 267-622-6624 [email protected] SOURCE National Comprehensive Cancer Network