Leiden University Scholary Publications
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Development of quality indicators for hand osteoarthritis care: results from an European consensus study
Get PDFBackgroundPeople with hand osteoarthritis (OA) often have poor access to recommended treatments. To enhance care quality, quality indicators (QIs) based on clinical recommendations are essential. Current QI sets, like the Osteoarthritis Quality Indicator Questionnaire (OA-QI v.2), primarily address hip- and knee OA, and not hand OA.ObjectivesTo adapt the OA-QI v.2 for assessing patient-reported quality of hand OA care.DesignWe used the OA-QI v.2. set as a starting point and adapted it to reflect hand OA care. A literature search was performed to identify potential QIs for hand OA following the Rand/UCLA Appropriateness method. A European expert panel, comprising researchers, clinicians, and patient research partners, participated in online meetings to discuss adaptation and suggest new QIs based on treatment recommendations for hand OA, and anonymously rated each suggested QI regarding its importance, validity, usefulness, and feasibility. Consensus was defined by predefined rating cut-off scores. The adapted questionnaire was translated from English into Norwegian. Cognitive debriefing interviews with Norwegian and UK hand OA patients were conducted to ensure clarity.ResultsOur initial literature search provided 1670 articles, with none describing relevant QIs. After three voting rounds, sixteen QI items reached consensus, reflecting current hand OA care standards. Items were generally well understood, requiring only minor clarity amendments after patient interviews (N = 28).ConclusionThe OA-QI v.2 was successfully adapted into a 16-item Hand OA-QI set ensuring alignment with international care standards for hand OA through literature review, international expert panels and patient feedback on language and layout.Pathophysiology and treatment of rheumatic disease
Using machine learning analysis to describe patterns in tissue Doppler and speckle tracking echocardiography in patients with transposition of the great arteries after arterial switch operation☆
Get PDFBackgroundAdvanced echocardiographic techniques such as Tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) can detect more subtle changes in ventricular performance. We aimed to study the ventricular performance in patients with transposition of the great arteries (TGA) at mid-term follow-up after the arterial switch operation (ASO) with advanced echocardiographic techniques. In addition, we sought to discover new clinical phenotypes using unsupervised machine learning.MethodsConventional, TDI and STE echocardiographic parameters were prospectively obtained from 124 TGA patients (66.1 % male, age 10.8 ± 5.1 years, 24.2 % with ventricular septal defect) in this observational study. The data was analyzed with conventional statistics and new machine learning techniques.ResultsTGA patients had reduced biventricular systolic (septal s’ Z-score −2.28 ± 1.26; RV s’ Z-score −2.16 ± 0.71; mean left ventricular longitudinal strain Z-score of the LV -2.49 ± 1.68) and RV diastolic performance (RV E/e’ Z-score 2.35 ± 1.70) mid-term after ASO. Unsupervised clustering within the TGA population revealed 3 clusters. Interestingly, cluster 3 defined a group of patients with older age at ASO, the most reduced ventricular performance as well as the highest rates of reoperations and interventions.ConclusionsAssessment of ventricular performance with TDI and STE 10 years after ASO showed that TGA patients have decreased biventricular systolic and diastolic function, especially at the septal regions. Novel analytical methods such as unsupervised clustering may help identify new clinical phenotypes from multiple variables and may contribute to improved risk stratification.Thoracic Surger
Als ramp langer dan 72 uur duurt, heb je meer nodig dan een noodpakket
No full textSecurity and Global Affair
The irrelevance of the Oslo accords for ICC jurisdiction over (alleged) crimes committed against the Palestinian Bedouin community
Get PDFExploring the Frontiers of International La
Buddhist-confucian polemics in seventeenth-century Japan: the critics of Hayashi Razan
No full textAsian Studie
Introducing entrepreneurial resilience in small business failure prediction
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Surinamese maroon and indigenous knowledge in the creation of natural and ethnographic collections housed in The Netherlands
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Natural killer cell-mediated cytotoxicity shapes the clonal evolution of B-cell leukemia
Get PDFThe term cancer immunoediting describes the dual role by which the immune system can suppress and promote tumor growth and is divided into three phases: elimination, equilibrium, and escape. The role of NK cells has mainly been attributed to the elimination phase. Here, we show that NK cells play a role in all three phases of cancer immunoediting. Extended co-culturing of DNA-barcoded mouse BCR/ABLp185+ B-cell acute lymphoblastic leukemia (B-ALL) cells with NK cells allowed for a quantitative measure of NK cell–mediated immunoediting. Although most tumor cell clones were efficiently eliminated by NK cells, a certain fraction of tumor cells harbored an intrinsic primary resistance. Furthermore, DNA barcoding revealed tumor cell clones with secondary resistance, which stochastically acquired resistance to NK cells. NK cell–mediated cytotoxicity put a selective pressure on B-ALL cells, which led to an outgrowth of primary and secondary resistant tumor cell clones, which were characterized by an IFNγ signature. Besides well-known regulators of immune evasion, our analysis of NK cell–resistant tumor cells revealed the upregulation of genes, including lymphocyte antigen 6 complex, locus A (Ly6a), which we found to promote leukemic cell resistance to NK cells. Translation of our findings to the human system showed that high expression of LY6E on tumor cells impaired their physical interaction with NK cells and led to worse prognosis in patients with leukemia. Our results demonstrate that tumor cells are actively edited by NK cells during the equilibrium phase and use different avenues to escape NK cell–mediated eradication.Immunobiology of allogeneic stem cell transplantation, transfusion medicine and immunotherapy of hematological disease
"Lawyerization" of universities in the USA: Louis H. Guard and Joyce P. Jacobsen on the 'new era of higher education'
Get PDFThe progression of EU law: Accommodating change and upholding value