Publications by authors named "Laura W Van Buul"
Objectives: To explore the influenza and COVID-19 vaccination status among Dutch nursing home (NH) health care workers (HCWs), factors associated with vaccination including the influence of the pandemic, and the facilitators and barriers to vaccination willingness.
Design: An explanatory sequential mixed methods study.
Setting And Participants: HCWs providing direct care to residents in Dutch NHs.
Article Synopsis
- The study is about asymptomatic bacteriuria (ASB) in older people, where bacteria are present in urine but don't cause symptoms of a urinary tract infection (UTI).
- Researchers believe that having non-dangerous bacteria might actually help protect the bladder from harmful bacteria that can cause UTIs.
- They will collect urine samples and health information from nursing home residents over 18 months to see how ASB relates to UTIs and if it helps prevent them.
Objectives: To investigate guideline adherence 3 years after the introduction of a national guideline on urinary tract infections (UTIs) in frail older adults. Appropriate use of urine dipstick tests, treatment decisions, and antibiotic drug choices in residents with (suspected) UTIs without a catheter were examined.
Design: Observational prospective study.
Objectives: To assess the internal and external validity of a cluster randomized controlled trial (cRCT) evaluating a decision tool with supportive interventions for the empirical treatment of urinary tract infections (UTIs) in nursing homes (NHs), and to identify facilitators and barriers in implementing this antibiotic stewardship intervention.
Design: Mixed-methods process evaluation study.
Setting And Participants: Physicians, nursing staff, client council members, and residents of Dutch NHs.
Article Synopsis
- Antibiotics are often given out too much to nursing home residents for urinary tract infections (UTIs), even when they might not need them.
- It can be hard to tell if residents have UTI symptoms, especially if they have dementia or can't communicate well.
- The study helped find better ways for nursing staff to notice UTI symptoms in these residents and created helpful tools to assist them in this job.
[Which frail older adult really has a urinary tract infection?].
Ned Tijdschr Geneeskd
December 2022
In frail older adults, antibiotics are often inappropriately prescribed for suspected urinary tract infections (UTIs). We describe three cases in the general practice, nursing home, and emergency department setting to illustrate how to improve diagnosing UTIs in frail older patients. Nonspecific symptoms, e.
View Article and Find Full Text PDFArticle Synopsis
- C-reactive protein point-of-care testing (CRP POCT) is being studied for its effectiveness and cost-efficiency in guiding antibiotic prescriptions for nursing home residents diagnosed with lower respiratory tract infections (LRTI).
- The study was conducted in 11 nursing homes in the Netherlands, involving 241 residents, comparing POCT-guided care to standard care without the use of CRP testing.
- Findings indicated that while POCT-guided care led to a higher cost per patient, it significantly reduced antibiotic prescribing; however, it did not notably affect recovery rates, suggesting a need for careful consideration of its investment versus benefits.
Objective: To investigate whether an electronic health record (EHR)-integrated decision tool, combined with supportive interventions, results in more appropriate antibiotic prescribing in nursing home (NH) residents with suspected urinary tract infection (UTI), without negative consequences for residents.
Design: Cluster randomized controlled trial with NHs as the randomization unit; intervention group NHs received the EHR-integrated decision tool and supportive interventions, and control group NHs provided care as usual.
Setting And Participants: 212 residents with suspected UTI, from 16 NHs in the Netherlands.
Purpose: To assess whether one swab can be used to perform both the antigen-detection rapid diagnostic test (Ag-RDT) and reverse transcriptase polymerase chain reaction (RT-PCR) for COVID-19 detection during an outbreak in the nursing home (NH) setting.
Methods: The single-swab method (SSM), where the Ag-RDT is performed with the transport medium used for RT-PCR, was evaluated in three Dutch NHs and compared to the laboratory setting. We collected Ag-RDT and RT-PCR results, NH resident characteristics and symptomatology.
Objectives: This study evaluated logistics, process data, and barriers/facilitators for the implementation and use of C-reactive protein point-of-care testing (CRP POCT) for suspected lower respiratory tract infections (LRTIs) in nursing home (NH) residents.
Design: This process evaluation was performed alongside a cluster randomized, controlled trial (UPCARE study) to evaluate the effect of CRP POCT on antibiotic prescribing for suspected LRTIs in NH residents.
Setting And Participants: Eleven NHs in the Netherlands.
Article Synopsis
- The study aimed to see if using C reactive protein point-of-care testing (CRP POCT) could safely decrease antibiotic prescriptions for residents with lower respiratory tract infections in nursing homes.
- Conducted in the Netherlands, the trial involved 84 physicians treating 241 patients across 11 nursing homes, comparing those using CRP POCT with those receiving standard care.
- Results showed a significant reduction in initial antibiotic prescriptions (53.5% vs 82.3%) in the CRP group, with similar recovery rates and low mortality differences, suggesting CRP POCT may help reduce unnecessary antibiotic use without compromising patient outcomes.*
Background: The COVID-19 pandemic has led to high mortality rates in nursing homes (NHs) in Europe. For adequate risk management and good prognostications, it is essential to identify mortality risk factors.
Objective: This study aimed to determine whether previously identified risk factors for 30-day mortality in Dutch NH residents with COVID-19 are unique to COVID-19.
Background: Sars-CoV-2 outbreaks resulted in a high case fatality rate in nursing homes (NH) worldwide. It is unknown to which extent presymptomatic residents and staff contribute to the spread of the virus.
Aims: To assess the contribution of asymptomatic and presymptomatic residents and staff in SARS-CoV-2 transmission during a large outbreak in a Dutch NH.
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.
View Article and Find Full Text PDFObjectives: To describe the symptomatology, mortality, and risk factors for mortality in a large group of Dutch nursing home (NH) residents with clinically suspected COVID-19 who were tested with a reverse transcription-polymerase chain reaction (RT-PCR) test.
Design: Prospective cohort study.
Setting And Participants: Residents of Dutch NHs with clinically suspected COVID-19 and who received RT-PCR test.
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.
View Article and Find Full Text PDFBackground: 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.
View Article and Find Full Text PDFThe diagnosis and management of urinary tract infections (UTIs) among residents of post-acute and long-term care (PALTC) settings remains challenging. Nonspecific symptoms, complex medical conditions, insufficient awareness of diagnostic criteria, and unnecessary urine studies all contribute to the inappropriate diagnosis and treatment of UTIs in PALTC residents. In 2017, the Infection Advisory Subcommittee at AMDA-The Society for Post-Acute and Long-Term Care Medicine convened a workgroup comprised of experts in geriatrics and infectious diseases to review recent literature regarding UTIs in the PALTC population.
View Article and Find Full Text PDFAntibiotics are among the most widely prescribed drugs in long-term care facilities, which highlights the importance of antibiotic stewardship (ABS) in this setting. In this article, we describe the experiences with ABS in nursing homes (NHs) from the perspective of 4 European countries: the Netherlands, Norway, Poland, and Sweden. In these countries, a large variety of initiatives to develop and implement ABS in NHs have been introduced in recent years.
View Article and Find Full Text PDFObjectives: Nonspecific signs and symptoms combined with positive urinalysis results frequently trigger antibiotic therapy in frail older adults. However, there is limited evidence about which signs and symptoms indicate urinary tract infection (UTI) in this population. We aimed to find consensus among an international expert panel on which signs and symptoms, commonly attributed to UTI, should and should not lead to antibiotic prescribing in frail older adults, and to integrate these findings into a decision tool for the empiric treatment of suspected UTI in this population.
View Article and Find Full Text PDFObjectives: To evaluate the effect of tailored interventions on the appropriateness of decisions to prescribe or withhold antibiotics, antibiotic use and guideline-adherent antibiotic selection in nursing homes (NHs).
Methods: We conducted a quasi-experimental study in 10 NHs in the Netherlands. A participatory action research (PAR) approach was applied, with local stakeholders in charge of selecting tailored interventions based on opportunities for improved antibiotic prescribing that they derived from provided baseline data.
Background: Insight into factors that influence antibiotic prescribing is crucial when developing interventions aimed at a more rational use of antibiotics. We examined factors that influence antibiotic prescribing in long-term care facilities, and present a conceptual model that integrates these factors.
Methods: Semi-structured qualitative interviews were conducted with physicians (n = 13) and nursing staff (n = 13) in five nursing homes and two residential care homes in the central-west region of the Netherlands.
Objective: To investigate the appropriateness of decisions to prescribe or withhold antibiotics for nursing home (NH) residents with infections of the urinary tract (UTI), respiratory tract (RTI), and skin (SI).
Design: Prospective study.
Setting: Ten NHs in the central-west region of the Netherlands.
It is challenging to change physicians' antimicrobial prescribing behaviour. Although antimicrobial prescribing is determined by contextual (e.g.
View Article and Find Full Text PDFIntroduction: The common occurrence of infectious diseases in nursing homes and residential care facilities may result in substantial antibiotic use, and consequently antibiotic resistance. Focusing on these settings, this article aims to provide a comprehensive overview of the literature available on antibiotic use, antibiotic resistance, and strategies to reduce antibiotic resistance.
Methods: Relevant literature was identified by conducting a systematic search in the MEDLINE and EMBASE databases.