Turning green: the impact of changing to more eco-friendly respiratory healthcare - a carbon and cost analysis of Dutch prescription data.

Objectives: Dry powder inhalers (DPIs) and soft mist inhalers have a substantially lower global warming potential than pressurised metered-dose inhalers (pMDIs). To help mitigate climate change, we assessed the potential emission reduction in CO equivalents when replacing pMDIs by non-propellant inhalers (NPIs) in Dutch respiratory healthcare and estimated the associated cost.

Design: We performed a descriptive analysis of prescription data from two national databases of two independent governmental bodies.

Non-ST-elevation myocardial infarction in the Netherlands: room for improvement!

Aim: To analyse non-ST-elevation myocardial infarction (NSTEMI) care in the Netherlands and to identify modifiable factors to improve NSTEMI healthcare.

Methods: This retrospective cohort study analysed hospital and pharmacy claims data of all NSTEMI patients in the Netherlands in 2015. The effect of percutaneous coronary intervention (PCI) during hospitalisation on 1‑year mortality was investigated in the subcohort alive 4 days after NSTEMI.

Are CAR-T therapies living up to their hype? A study using real-world data in two cohorts to determine how well they are actually working in practice compared with bone marrow transplants.

With the increasing use of new regulatory tools, like the Food and Drug Administration's breakthrough designation, there are increasing challenges for European health technology assessors (HTAs) to make an accurate assessment of the long-term value and performance of chimeric antigen receptor T-cell (CAR-T) therapies, particularly for orphan conditions, such as acute lymphoblastic leukaemia. The aim of this study was to demonstrate a novel methodology harnessing longitudinal real-world data, extracted from the electronic health records of a medical centre functioning as a clinical trial site, to develop an accurate analysis of the performance of CAR-T compared with the next-best treatment option, namely allogeneic haematopoietic cell transplant (HCT). The study population comprised 43 subjects in two cohorts: 29 who had undergone HCT treatment and 14 who had undergone CAR-T therapy.

Defining output-based standards to achieve and maintain tuberculosis freedom in farmed deer, with reference to member states of the European Union.

Within the European Union (EU), detailed legislation has been developed for cattle, but not deer, to minimise disease risks associated with trade in animals and animal products. This legislation is expressed as input-based standards, providing a detailed outline of the activity required (for example, testing of animals and application of defined control measures), on the expectation that an adequate output (for example, confidence in freedom) will be achieved. Input-based standards are at odds with the increasing shift towards output-based standards, particularly in OIE rules governing international trade.

Risk of rabies introduction by non-commercial movement of pets.

In response to a Commission request, EFSA has carried out a quantitative assessment of the risk of rabies introduction into the UK, Ireland, Sweden, and Malta due to the movement of pets incubating rabies at the time of movement. The risk that a pet is incubating rabies at the time of first vaccination is equal to the prevalence of rabies-incubating pets in the population of origin. Following induction of protective immunity by vaccination, animals already incubating rabies will still develop clinical disease as a function of time after vaccination (termed type A risk).

Introduction of diabetes passports involving both patients and professionals to improve hospital outpatient diabetes care.

Aim: To investigate whether a comprehensive strategy involving both patients and professionals, with the introduction of a diabetes passport as a key component, improves diabetes care.

Methods: The first 150 consecutive patients who visited their internist for a diabetes check up at the internal medicine outpatient departments at each of nine Dutch general hospitals were included in this 1 year clustered, randomised, controlled trial. Health care professionals attended an educational meeting about the use and dissemination of the diabetes passport which is a patient held record.

A fast multipole method for Maxwell equations stable at all frequencies.

The solution of Helmholtz and Maxwell equations by integral formulations (kernel in exp(i kr)/r) leads to large dense linear systems. Using direct solvers requires large computational costs in O(N(3)). Using iterative solvers, the computational cost is reduced to large matrix-vector products.

Developing a national continuous quality improvement system for neuromodulation treatment in The Netherlands.

Background: Because neuromodulation was not included in the national health insurance system, the Dutch Neuromodulation Group (DNG) developed national standards and a continuous quality improvement (CQI) system for consistency in application of neuromodulation techniques and in the quality of outcomes.

Developing The National Quality Improvement System: A stepwise approach was used in which the following ten steps were taken: (1) selected participating medical specialists and their centers, (2) described the treatment protocol, (3) collected data in a national database, (4) organized feedback sessions for the DNG, (5) formulated quality indicators, (6) adjusted the process of treatment, (7) formalized the structure of the DNG, (8) defined responsibilities, (9) established procedures for future development, and (10) made agreements with payers.

Discussion: Making reimbursement for expensive health care interventions contingent on a national CQI system created a powerful financial incentive to continuously provide effective care in an efficient manner.

Patients and nurses determine variation in adherence to guidelines at Dutch hospitals more than internists or settings.

Aims: To measure adherence to recently developed diabetes guidelines at Dutch hospital outpatient clinics and distinguish determinants for variations in care on hospital, internist and patient levels.

Methods: Thirteen general hospitals with 58 internists recruited 1950 diabetic patients. Data were extracted from medical files (n = 1915) and from patient questionnaires (n = 1465).

Improving quality of vascular access care for hemodialysis patients.

Background: Because quality of care for patients with end-stage renal disease (ESRD) has improved, they require long-term vascular access for hemodialysis. Construction of a native vein arteriovenous fistula (AVF) on the arm is considered best practice; a prosthetic graft (PG) AVF on the arm is a good alternative, although insertion of a central venous catheter (CVC), the third choice, is sometimes necessary. A quality improvement project was initiated at the dialysis unit of Rijnland Hospital (The Netherlands) to improve quality of vascular access care.

Blocking ELISA's for the distinction between antibodies against European and American strains of porcine reproductive and respiratory syndrome virus.

A double blocking ELISA was developed in order to satisfy the need for large scale serological screening for PRRS and simultaneous distinction between infection with European and American strains of PRRSV in pig herds. The Immunoperoxidase monolayer assay (IPMA) and the double blocking ELISA enabled distinction on serological basis between infection with European and American strains of PRRSV. The distinction was possible from about day 7 after infection of pigs with PRRSV.

Examination of virus shedding in semen from vaccinated and from previously infected boars after experimental challenge with porcine reproductive and respiratory syndrome virus.

Danish artificial insemination (AI) centres house several boars antibody positive to porcine reproductive and respiratory syndrome virus as well as PRRSV-naive boars which may become acutely infected. The risk of transmission of PRRSV by semen may therefore constitute a serious problem to the Danish pig industry. The use of a vaccination-program may be a way to avoid or reduce the problem.

Detection of antibodies against porcine parvovirus nonstructural protein NS1 may distinguish between vaccinated and infected pigs.

The humoral antibody response against the nonstructural protein NS1 and the structural protein VP2 of porcine parvovirus (PPV) was evaluated by immuno-peroxidase test (IPT) and enzyme linked immuno sorbent assay (ELISA) using recombinant PPV antigens. The coding sequence for NS1 and VP2 was inserted into the baculovirus. Autographa californica nuclear polyhedrosis virus (AcNPV) genome resulting in two recombinant baculoviruses AcNPV-NS1 and AcNPV-VP2, respectively.

Inactivation of virus during anaerobic digestion of manure in laboratory scale biogas reactors.

Reduction of porcine parvovirus, bovine enterovirus and faecal enterococci were measured in biogas reactors continuously run on manure and manure supplemented with household waste at 35 degrees C and 55 degrees C and in batch test run at 70 degrees C. The aim of the experiments was to study the sanitation effect of anaerobic digestion and to evaluate the use of faecal enterococci as an indicator of sanitation. Parallel studies on the reduction of virus and faecal enterococci were done in physiological saline solution.

Studies on manifestations of canine distemper virus infection in an urban dog population.

An upsurge of canine distemper was recognized at the beginning of 1991 in the urban dog population of the Copenhagen area. The outbreak had the characteristics of a virulent morbillivirus introduction in a partly immune population, where the disease primarily was manifested in young individuals. Testing of single serum samples for the presence of canine distemper virus (CDV) IgM antibodies using an IgM ELISA confirmed current and recent CDV infections in an urban dog population, where the use of attenuated CDV vaccines was widespread.

Infection studies with canine distemper virus in harbour seals.

Infection studies in harbour seal (Phoca vitulina) were conducted with the Snyder-Hill strain of canine distemper virus (CDV) that is virulent for dog and mink. The inoculated seals showed clinical symptoms which were to some degree similar to those observed in CDV infections of sensitive species of carnivores. Viral replication in lymphoid cells was followed by an extended period of immunosuppression.

Neonatal herpes policy in The Netherlands. Five years after a consensus conference.

In order to establish whether the recommendations of an in 1987 organized consensus conference about neonatal herpes policy in the Netherlands had been followed, an inquiry was held in January 1992 among gynecologists, pediatricians and microbiologists. Compared with the results of an inquiry that was held five years before, it was found that the incidence of neonatal herpes had not increased in the last ten years (approximately five cases annually or one per 35,000 neonates) despite the lower frequency of caesarean sections (more than 50 sections a year before 1987 and less than 10 sections a year after 1987). It is concluded that the consensus statements not only have been followed, but that they also proved to be sound.

Round table on morbilliviruses in marine mammals.

Since 1988 morbilliviruses have been increasingly recognized and held responsible for mass mortality amongst harbour seals (Phoca vitulina) and other seal species. Virus isolations and characterization proved that morbilliviruses from seals in Northwest Europe were genetically distinct from other known members of this group including canine distemper virus (CDV), rinderpest virus, peste des petits ruminants virus and measles virus. An epidemic in Baikal seals in 1987 was apparently caused by a morbillivirus closely related to CDV so that two morbilliviruses have now been identified in two geographically distant seal populations, with only the group of isolates from Northwest Europe forming a new member of the genus morbillivirus: phocid distemper virus (PDV).

Coronavirus infection in mink (Mustela vison). Serological evidence of infection with a coronavirus related to transmissible gastroenteritis virus and porcine epidemic diarrhea virus.

Antibodies to a transmissible gastroenteritis virus (TGEV)-related coronavirus have been demonstrated in mink sera by indirect immunofluorescence, peroxidase-linked antibody assays and immunoblotting. This is the first serological evidence of a specific coronavirus infection in mink. The putative mink coronavirus (MCV) seems to be widespread in the Danish mink population with a prevalence approaching 100%.

Antigenic relationships between field isolates of morbilliviruses from different carnivores.

The antigenic relationships between PDV and isolates of morbilliviruses from carnivores suffering from distemper were investigated. Fourteen isolates, originating from terrestrial carnivores and harbour seals from 1985-1991 from Denmark, Norway, Greenland, and the U.S.

Demonstration of antibodies against bovine leukemia virus (BLV) by blocking ELISA using bovine polyclonal anti-BLV immunoglobulin.

A blocking enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies against bovine leukemia virus (BLV) is described. The test is based on the biotin-streptavidin system using unlabelled polyclonal bovine IgG against BLV as catching antibody and biotinylated bovine anti-BLV IgG as detecting antibody. The sensitivity was found to be 50-100 times higher than the agar gel immunodiffusion test, with a specificity of practically 100%.

The seal death in Danish waters 1988. 2. Virological studies.

Mass abortions and high mortality were observed in harbour seals in Danish waters during 1988. Severe pneumonia and emphysema were typical clinical and post-mortem findings. Virological studies were carried out to identify the cause of the epidemic.