Challenges in the identification and quantification of an unknown impurity in chenodeoxycholic acid drug substance.

In 2018 the Amsterdam University Medical Centre decided to prepare chenodeoxycholic acid (CDCA) capsules (also known as pharmacy compounding) for patients with the genetic metabolic disease cerebrotendinous xanthomatosis (CTX) when the product with a marketing authorization was commercially unavailable for patients. However, after reanalysis, unknown impurities were identified in the CDCA active pharmaceutical ingredient (API) using thin-layer chromatography from the European Pharmacopoeia (Ph.Eur.

Tactile tastes: Testing the relation between tactile thresholds, liking of textures and pickiness in eating.

The texture of foods plays an important role in the liking of foods. Especially for picky eaters, texture can be a reason to reject foods. Previous studies showed that picky eaters in general dislike tactile stimulation more, which can include the feel of sand in their hands and specific food textures in their mouth.

Expanding Geographical Access to Cancer Care in Botswana: Current Status and Future Prospects.

Purpose: The growing cancer burden in Botswana has been linked to aging, lifestyle factors, and high HIV infection prevalence. The government has designated four geographically distributed hospitals as public oncology centers (POCs). A needs assessment was undertaken to ascertain the characteristics of cancer care at these centers.

Management of low back pain and lumbosacral radicular syndrome: the Guideline of the Royal Dutch Society for Physical Therapy (KNGF).

Background: Significant progress and new insights have been gained since the Dutch Physical Therapy guideline on low back pain (LBP) in 2013 and the Cesar en Mensendieck guideline in 2009, necessitating an update of these guidelines.

Aim: To update and develop an evidence-based guideline for the comprehensive management of LBP and lumbosacral radicular syndrome (LRS) without serious specific conditions (red flags) for Dutch physical therapists and Cesar and Mensendieck Therapists.

Design: Clinical practice guideline.

Relationship Between Quality of Life and Symptom Burden in Patients With Cancer With and Without HIV in Botswana.

Cancer is an emerging public health concern in sub-Saharan Africa. In Botswana, the most prevalent cancers are HIV related. The symptom burden that results from cancer and HIV infection is associated with poorer quality of li.

A cost-utility analysis of two Clostridioides difficile infection guideline treatment pathways.

Objectives: Treatment guidelines are key drivers of prescribing practice in the management of Clostridioides difficile infection (CDI), but recommendations on best practice can vary. We conducted a cost-utility analysis to compare the treatment pathway recommended by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline with the pathway proposed by the National Institute for Health and Care Excellence (NICE) guideline, from the perspective of the UK National Health Service.

Methods: A decision tree modelling approach was adopted to reflect the treatment pathway for CDI as outlined in ESCMID and NICE guidelines.

Predicting treatment response to vancomycin using bacterial DNA load as a pharmacodynamic marker in premature and very low birth weight neonates: A population PKPD study.

While positive blood cultures are the gold standard for late-onset sepsis (LOS) diagnosis in premature and very low birth weight (VLBW) newborns, these results can take days, and early markers of possible treatment efficacy are lacking. The objective of the present study was to investigate whether the response to vancomycin could be quantified using bacterial DNA loads (BDLs) determined by real-time quantitative polymerase chain reaction (RT-qPCR). VLBW and premature neonates with suspected LOS were included in a prospective observational study.

The Acceptability and Feasibility of Routine Use of Validated Cancer Symptom Assessment Instruments Among Patients and Nurses in the Oncology Ward at Princess Marina Hospital, in Gaborone, Botswana.

This cross-sectional study evaluated the acceptability and feasibility of oncology nurses using validated cancer symptom assessment instruments to assess symptom burden. A consecutive sample of cancer patients and oncology ward nurses at a hospital in Gaborone, Botswana, was used. Patients' symptom burden was assessed using the Memorial Symptom Assessment Scale-Short Form and the Visual Analog Scale-Pain, and patient- and nurse-acceptability data were assessed using the Client Satisfaction Questionnaire and the Intervention Rating Profile.

Effectiveness of Enhanced Performance Feedback on Appropriate Use of Blood Transfusions: A Comparison of 2 Cluster Randomized Trials.

Importance: Auditing and feedback are frequently used to improve patient care. However, it remains unclear how to optimize feedback effectiveness for the appropriate use of treatments such as blood transfusion, a common but costly procedure that is more often overused than underused.

Objective: To evaluate 2 theoretically informed feedback interventions to improve the appropriate use of blood transfusions.

On the Detection of COVID-Driven Changes in Atmospheric Carbon Dioxide.

We assess the detectability of COVID-like emissions reductions in global atmospheric CO concentrations using a suite of large ensembles conducted with an Earth system model. We find a unique fingerprint of COVID in the simulated growth rate of CO sampled at the locations of surface measurement sites. Negative anomalies in growth rates persist from January 2020 through December 2021, reaching a maximum in February 2021.

The Ocean Carbon Response to COVID-Related Emissions Reductions.

The decline in global emissions of carbon dioxide due to the COVID-19 pandemic provides a unique opportunity to investigate the sensitivity of the global carbon cycle and climate system to emissions reductions. Recent efforts to study the response to these emissions declines has not addressed their impact on the ocean, yet ocean carbon absorption is particularly susceptible to changing atmospheric carbon concentrations. Here, we use ensembles of simulations conducted with an Earth system model to explore the potential detection of COVID-related emissions reductions in the partial pressure difference in carbon dioxide between the surface ocean and overlying atmosphere (ΔpCO), a quantity that is regularly measured.

Clinical Practice Guideline for Physical Therapist Management of People With Rheumatoid Arthritis.

Objective: This guideline revises the 2008 Royal Dutch Society for Physical Therapy guideline for physical therapy for patients with rheumatoid arthritis (RA).

Method: This revised guideline was developed according to the Appraisal of Guidelines for Research and Evaluation tool and the Guidelines International Network standards. A multidisciplinary guideline panel formulated clinical questions based on perceived barriers in current care.

Quantifying the influence of short-term emission reductions on climate.

The COVID-19 (coronavirus disease 2019) pandemic has resulted in a marked slowdown in greenhouse gas and aerosol emissions. Although the resulting emission reductions will continue to evolve, this will presumably be temporary. Here, we provide estimates of the potential effect of such short-term emission reductions on global and regional temperature and precipitation by analyzing the response of an Earth System Model to a range of idealized near-term emission pathways not considered in available model intercomparison projects.

Building a national hernia registry in South Africa: initial ventral hernia repair results from a diverse healthcare sector.

Purpose: The purpose of this paper was to introduce a new registry in a developing country by describing the demographics, management and 30-day outcomes of patients undergoing ventral hernia repair in the public and private healthcare sectors of South Africa.

Methods: This study was a retrospective review of a prospectively maintained hernia registry from the 1st of February 2019 to 29th of February 2020.

Results: 353 ventral hernia repair cases were recorded of which 47% were incisional hernias and the remainder were primary hernias.

Economic value of clinical decision support allied to direct data feedback to clinicians: blood usage in haematology.

Background And Objectives: Responding to national and local pressures to reduce the amount of blood transfused, the haematology department of Oxford University Hospitals (OUH), UK implemented an electronic blood-ordering system with clinical decision support. This intervention targeted junior doctors, giving regular feedback on their transfusion practices with respect to clinical guidelines.

Methods: We evaluated the incremental costs of the intervention using interrupted time series methods to compare red blood cell and platelet usage before and after the intervention was implemented.

Chloroprocaine versus prilocaine for spinal anesthesia in ambulatory knee arthroscopy: a double-blind randomized trial.

Background: In ambulatory lower limb surgery, spinal anesthesia with rapid onset and a short duration of block is preferable. We hypothesized that the use of 2-chloroprocaine would be associated with a faster motor block recovery compared with prilocaine in knee arthroscopy. A difference of 15 min was considered clinically relevant.

Predicting no return to sports after three months in patients with traumatic knee complaints in general practice by combining patient characteristics, trauma characteristics and knee complaints.

It remains unclear to what extent patients with traumatic knee complaints aged 18-45 years seen in general practice experience difficulties with return to sports. This study aims to determine the proportion of patients with a knee trauma that return to sports at six weeks and three months follow-up. Also examined were associations between no return to sports and baseline patient/trauma characteristics, knee complaints and MR (magnetic resonance) findings, as well as the additive value of MR findings.

Faecal immunochemical tests versus colonoscopy for post-polypectomy surveillance: an accuracy, acceptability and economic study.

Background: In the UK, patients with one or two adenomas, of which at least one is ≥ 10 mm in size, or three or four small adenomas, are deemed to be at intermediate risk of colorectal cancer (CRC) and referred for surveillance colonoscopy 3 years post polypectomy. However, colonoscopy is costly, can cause discomfort and carries a small risk of complications.

Objectives: To determine whether or not annual faecal immunochemical tests (FITs) are effective, acceptable and cost saving compared with colonoscopy surveillance for detecting CRC and advanced adenomas (AAs).

Faecal immunochemical tests (FIT) versus colonoscopy for surveillance after screening and polypectomy: a diagnostic accuracy and cost-effectiveness study.

Objective: The English Bowel Cancer Screening Programme (BCSP) recommends 3 yearly colonoscopy surveillance for patients at intermediate risk of colorectal cancer (CRC) postpolypectomy (those with three to four small adenomas or one ≥10 mm). We investigated whether faecal immunochemical tests (FITs) could reduce surveillance burden on patients and endoscopy services.

Design: Intermediate-risk patients (60-72 years) recommended 3 yearly surveillance were recruited within the BCSP (January 2012-December 2013).

Mixed-methods evaluation of the Perioperative Medicine Service for High-Risk Patients Implementation Pilot (POMSHIP): a study protocol.

Introduction: Perioperative complications have a lasting effect on health-related quality of life and long-term survival. The Royal College of Anaesthetists has proposed the development of perioperative medicine (POM) services as an intervention aimed at improving postoperative outcome, by providing better coordinated care for high-risk patients. The Perioperative Medicine Service for High-risk Patients Implementation Pilot was developed to determine if a specialist POM service is able to reduce postoperative morbidity, failure to rescue, mortality and cost associated with hospital admission.

Does MRI add value in general practice for patients with traumatic knee complaints? A 1-year randomised controlled trial.

Objective: To determine whether referral to MRI by the general practitioner (GP) is non-inferior to usual care (no access to MRI by GPs) in patients with traumatic knee complaints regarding knee-related daily function.

Methods: This was a multicentre, non-inferiority randomised controlled trial with 1-year follow-up. GPs invited eligible patients during or after their consultation.