Feasibility and validity of low-budget telephonic follow-up interviews in routine outcome monitoring of substance abuse treatment

Aims   Routine outcome monitoring (ROM) is receiving growing attention. However, follow-up interviews are time-consuming and costly. This study examines the feasibility and validity of low-budget telephonic follow-up interviews for ROM in a substance abuse treatment centre (SATC).
Design   Observational study using data collected for routine outcome monitoring.
Setting   The study was performed in a SATC in an urban area in the Netherlands.
Participants   Feasibility and validity were assessed on data of 2325 patients.
Measurements   Data on pre-treatment socio-demographic and clinical characteristics were collected using electronic patient records (EPRs) and the European version of the Addiction Severity Index (EuropASI). Data on intensity of treatment were also collected through the EPRs. Telephonic follow-up interviews were conducted between 9 and 10 months after intake.
Findings   A 53% follow-up rate was achieved; 35% of the patients could not be contacted, 3% explicitly refused and in 8% other reasons accounted for non-participation. About 50% of the interviews took place in the intended time-frame. Costs were €40 ($57) per completed interview. There were indications of selection bias, because patients with cocaine as their primary problem and patients with polysubstance abuse were under-represented in the follow-up sample; the presence of these disorders is associated with negative treatment outcome.
Conclusions   Implementing telephonic low-budget follow-up interviews for ROM is feasible, but selection bias threatens internal validity of data, limiting generalization to the total treatment population. Increased efforts to track patients for follow-up may improve generalization.     

Pandemic influenza and hospital resources

Using estimates from the Centers for Disease Control and Prevention, the World Health Organization, and published models of the expected evolution of pandemic influenza, we modeled the surge capacity of healthcare facility and intensive care unit (ICU) requirements over time in northern Netherlands (approximately 1.7 million population). We compared the demands of various scenarios with estimates of maximum ICU capacity, factoring in healthcare worker absenteeism as well as reported and realistic estimates derived from semistructured telephone interviews with key management in ICUs in the study area. We show that even during the peak of the pandemic, most patients requiring ICU admission may be served, even those who have non-influenza-related conditions, provided that strong indications and decision-making rules are maintained for admission as well as for continuation (or discontinuation) of life support. Such a model should be integral to a preparedness plan for a pandemic with a new human-transmissible agent.     

Null effect of dietary restriction on prostate carcinogenesis in the Wistar-Unilever rat

Chronic dietary restriction inhibits carcinogenesis in several sites in laboratory animals. To determine the effects of dietary restriction on prostate carcinogenesis, prostate cancers were induced in male Wistar-Unilever rats by a sequential regimen of cyproterone acetate (50 mg/day; 21 days); testosterone propionate (100 mg/kg/day; 3 days); N-methyl-N-nitrosourea [MNU; 30 mg/kg; single dose]; and testosterone (subcutaneous implants of 2 pellets containing 40 mg each). Dietary restriction (0% [ad libitum control], 15%, or 30%) was initiated 2 wk post-MNU, and continued until study termination at 12 mo. Dietary restriction induced a rapid suppression of body weight gain but conferred no protection against prostate carcinogenesis. 74% of carcinogen-treated ad libitum controls developed accessory sex gland cancers, versus cancer incidences of 64% and 72% in groups restricted by 15% and 30%, respectively. Similarly, 44% of dietary controls developed cancers limited to the dorsolateral/prostate, versus incidences of 45% and 53% in groups restricted by 15% and 30%. The results of the present study do not support the hypothesis that prostate carcinogenesis can be prevented by reducing caloric intake. Reducing mean body weight by up to 25% through chronic dietary restriction has no effect on the induction of prostate cancers in the Wistar-Unilever rat model.     

WHO-EORTC classification for cutaneous lymphomas

Primary cutaneous lymphomas are currently classified by the European Organization for Research and Treatment of Cancer (EORTC) classification or the World Health Organization (WHO) classification, but both systems have shortcomings. In particular, differences in the classification of cutaneous T-cell lymphomas other than mycosis fungoides, Sezary syndrome, and the group of primary cutaneous CD30+ lymphoproliferative disorders and the classification and terminology of different types of cutaneous B-cell lymphomas have resulted in considerable debate and confusion. During recent consensus meetings representatives of both systems reached agreement on a new classification, which is now called the WHO-EORTC classification. In this paper we describe the characteristic features of the different primary cutaneous lymphomas and other hematologic neoplasms frequently presenting in the skin, and discuss differences with the previous classification schemes. In addition, the relative frequency and survival data of 1905 patients with primary cutaneous lymphomas derived from Dutch and Austrian registries for primary cutaneous lymphomas are presented to illustrate the clinical significance of this new classification.     

A randomized controlled trial of an implantable 2-channel peroneal nerve stimulator on walking speed and activity in poststroke hemiplegia

OBJECTIVE: To determine the effect of a new implantable 2-channel peroneal nerve stimulator on walking speed and daily activities, in comparison with the usual treatment in chronic stroke survivors with a drop foot. DESIGN: Randomized controlled trial. SETTING: All subjects were measured 5 times in the gait laboratory. PARTICIPANTS: Twenty-nine stroke survivors with chronic hemiplegia with drop foot who fulfill the predefined inclusion and exclusion criteria were included in the study. INTERVENTION: The intervention group received an implantable 2-channel peroneal nerve stimulator for correction of their drop foot. The control group continued using their conventional walking device, consisting of an ankle-foot orthosis, orthopedic shoes, or no device. MAIN OUTCOME MEASURES: Walking speed, assessed both by a six-minute walk test (6MWT) and by using a 10-m walkway, was selected as primary outcome measure and activity monitoring data, consisting of percentage time spent on stepping, standing, and sitting/lying were selected as secondary outcome measure. RESULTS: Functional electric stimulation (FES) resulted in a 23% improvement of walking speed measured with the 6MWT, whereas the improvement in the control group was only 3% (P=.010). Comfortable walking speed measured on a 10-m walkway was also significantly improved in favor of FES (P=.038). The percentage time spent on stepping deteriorated with 3% in the intervention and 0.8% in control group, which was not statistically significant between both groups (P=.13). CONCLUSIONS: The present study shows a clinically relevant effect of the implantable 2-channel peroneal nerve stimulator on walking speed in the sample of stroke survivors included in our study.     

Measuring whole-body actin/myosin protein breakdown in mice using a primed constant stable isotope-infusion protocol

To measure actin/myosin protein breakdown, the 24 h excretion of N (tau)-methylhistidine (3MH) is used. However, in mice, this method is invalid. Therefore we have developed a liquid chromatography-MS technique to measure the tracer/tracee ratio and concentration of 3MH in plasma, enabling an in vivo primed constant infusion protocol with a deuterated stable isotope of 3MH. We tested this model by giving a primed constant infusion of L-[3-methyl-(2)H(3)]histidine, L-[phenyl-(2)H(5)]phenylalanine and L-[phenyl-(2)H(2)]tyrosine to three anaesthetized experimental groups: mice receiving saline intraperitoneally (i.p.) (CON), mice receiving saline i.p. and starved for 9 h (STA), and mice receiving lipopolysaccharide i.p. and starved for 9 h (STA+LPS). The contribution of myofibrillar to total protein breakdown was significantly lower in the STA group than the CON group (30+/-4% and 54+/-14% respectively; P <0.05), and was significantly higher in the STA+LPS group than the STA group (52+/-7% and 30+/-4% respectively; P <0.05). Whole-body myofibrillar protein breakdown, total protein breakdown, protein synthesis and net protein breakdown were not different between the groups. We conclude that this in vivo primed constant stable isotope-infusion protocol can give valuable information about the role of actin/myosin protein breakdown in mice.     

Laboratory Study of the Impact of Repetitive Electrical and Mechanical Stimulation on Brown Shrimp Crangon crangon

Pulse trawling is currently the best available alternative to beam trawling in the brown shrimp Crangon crangon and Sole Solea solea (also known as Solea vulgaris) fisheries. To evaluate the effect of repetitive exposure to electrical fields, brown shrimp were exposed to the commercial electrodes and pulse settings used to catch brown shrimp (shrimp startle pulse) or Sole (Sole cramp pulse) 20 times in 4 d and monitored for up to 14 d after the first exposure. Survival, egg loss, molting, and the degree of intranuclear bacilliform virus (IBV) infection were evaluated and compared with those in stressed but not electrically exposed (procedural control) and nonstressed, nonexposed (control) brown shrimp as well as brown shrimp exposed to mechanical stimuli. The lowest survival at 14 d (57.3%) occurred in the Sole cramp pulse treatment, and this was significantly lower than in the group with the highest survival, the procedural control (70.3%). No effect of electrical stimulation on the severity of IBV infection was found. The lowest percentage of molts occurred in the repetitive mechanical stimulation treatment (14.0%), and this was significantly lower than in the group with the highest percentage of molts, the procedural control (21.7%). Additionally, the mechanically stimulated brown shrimp that died during the experiment had a significantly larger size than the surviving individuals. Finally, no effect of the shrimp startle pulse was found. Therefore, it can be concluded that repetitive exposure to a cramp stimulus and mechanical stimulation may have negative effects on the growth and/or survival of brown shrimp. However, there is no evidence that electrical stimulation during electrotrawls would have a larger negative impact on brown shrimp stocks than mechanical stimulation during conventional beam trawling.

Received November 15, 2015; accepted May 16, 2016     

Sinus node function after cardiac surgery: is impairment specific for the maze procedure?

BACKGROUND: Maze surgery is a final solution for intractable atrial fibrillation (AF), but an adverse effect on postoperative sinus node function has been reported. Whether this also applies to other types of cardiac surgery is unclear. METHODS: We assessed postoperative rhythm by means of repeated exercise tolerance testing, ambulatory electrocardiography, and non-invasive testing of autonomic function between 1 and 12 months after four types of cardiac surgery. Fourteen patients without structural cardiac disease and medically refractory AF underwent the maze III procedure, 11 patients with mitral valve disease and preoperative AF underwent valvar surgery combined with a (simplified) maze III procedure, and 8 patients with mitral valve disease in sinus rhythm (SR) underwent isolated valvar surgery. The control group consisted of eight patients with sinus rhythm who underwent coronary artery bypass surgery (CABG). RESULTS: One month after surgery, the chronotropic response to exercise was depressed, mean heart rate was high, and heart rate variability (HRV) was low, especially after maze III, combined surgery, and isolated valvar surgery. Twelve months after surgery, moderate improvements were observed. After CABG, considerably fewer abnormalities were observed, and HRV parameters recovered to a large extent. Non-invasive testing of autonomic function indicated disturbed vagal modulation of heart rate in all three groups with atrial incision. CONCLUSION: Thus, attenuation of HRV and vagal modulation of sinus node function are not confined to maze surgery but also apply to isolated mitral valve surgery. Atrial incision therefore appears to be crucial and presumably produces autonomic nervous damage followed by partial reinnervation. Nevertheless, cardiac surgery in general seems initially to impair sinus node function with partial recovery in the consecutive 12 months.     

Survival of HIV-1 and HIV-2 perinatally infected children in The Gambia

BACKGROUND: The risk of mother-to-child transmission (MTCT) of HIV-2 is much lower than that of HIV-1, but the long-term prognosis of perinatally infected HIV-2 children is unknown. We re-visited children who were part of a large MTCT study in The Gambia (conducted during 1993-1997), in order to compare the long-term survival of children perinatally infected with HIV-2 with that of seronegative and of HIV-1 infected children. METHODS: Five to eight years' follow-up of a cohort of children born to HIV-negative, HIV-1 positive, and HIV-2 positive mothers. RESULTS: Seven hundred and seventy-four children were followed up for a median of 6.6 years. Of 17 perinatally HIV-1 infected children, three were still alive on 1 July 2001, two had been lost to follow-up, and 12 had died. The median survival was 2.5 years. Of eight HIV-2 infected children five were still alive, none were lost to follow-up and three had died. The mortality hazards ratio of both HIV-1 [9.9; 95% confidence interval (CI), 5.2-19], and of HIV-2 infected children (3.9; CI, 1.2-12) was significantly increased compared with children of seronegative mothers. The mortality hazards ratio of HIV uninfected children of HIV-1 or HIV-2 infected mothers was not significantly increased compared to that of children of seronegative mothers (P = 0.17 and P = 0.5 respectively). CONCLUSIONS: Children with perinatally acquired HIV-2 infection have a higher mortality than children of seronegative mothers. Guidelines for treatment of HIV-1 infected children should be used for treatment of HIV-2 infected children.