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The Link between False Confessions, Suggestibility, and Compliance:A Review Using Experimental and Field Studies
No full textThe Economic and societal burden associated with drug-resistant epilepsy in the Netherlands: an AIM@ EPILEPSY burden-of-disease study protocol
No full textAbstractBackground Living with epilepsy, especially drug-resistant epilepsy (DRE), imposes several challenges for people diagnosed with the condition. These challenges include the physical and mental implications of epilepsy on both caregivers and patients with epilepsy. For the more than 120 000 individuals living with this neurological disorder in the Netherlands, along with their families, daily activities become hazardous, limited and costly, significantly affecting their health-related quality of life (HRQoL). As data on the burden of epilepsy in the Netherlands are lacking, studies attempting to capture the impact of epilepsy on individuals, caregivers and society are needed to enhance understanding and help address the burden of epileptic seizures.Methods and analysis The study is part of the AIM@EPILEPSY project. The project aims to develop a planning suite enabling cost-saving, minimally invasive treatment for epilepsy. By surveying 330 people with epilepsy and an anticipated sample of 150–200 informal caregivers across the Netherlands, using standardised questionnaires focusing on associated societal costs and the impact on HRQoL, this bottom-up, prevalence-based prospective study aims to understand the societal burden of DRE in the Netherlands. The data will be collected at 0, 3, 6 and 12 months of follow-up. The study results will describe the economic impact of epilepsy, focusing on cost-of-illness (€) and HRQoL (utilities) in the Netherlands.Ethics and dissemination The proposed study was approved by the Maastricht University Medical Ethics Review Committee (Approval reference: FHML-REC/2024/067/Amendment/2024_16). The result of the study is planned to be published in a peer-reviewed journal and presented at international and local scientific conferences
Postoperative changes in CPAK-classification do not significantly influence patient-reported outcome measures following conventional or robotic-assisted total knee arthroplasty:A randomised controlled trial
No full textPurposeThe purpose of this study was to investigate the impact of pre- and postoperative changes in Coronal Plane Alignment of the Knee (CPAK) classification on patient-reported outcome measures (PROMs) and to determine the rate of CPAK classification change in patients undergoing either conventionally aligned total knee arthroplasty (CTKA) or imageless robotic-assisted total knee arthroplasty (RATKA). We hypothesised that PROM improvements would be comparable regardless of whether postoperative CPAK classification was preserved ("In-the-box") or altered ("Out-of-the-box") in both surgical techniques.MethodsIn this prospective randomised controlled trial, 180 patients were assigned to either CTKA or RATKA. CPAK classification was assessed pre- and postoperatively. PROMs were collected at baseline, 3, and 12 months postoperatively, including the Knee Society Score, Oxford Knee Score, visual analog scale (VAS) for daytime and night time pain, EuroQol-5D (index and VAS), and patient satisfaction.ResultsBaseline characteristics were similar between groups. Native CPAK classification was preserved in 31% of CTKA and 41% of RATKA patients. Postoperatively, CPAK II was most common (40% CTKA and 49% RATKA), followed by CPAK V. Both groups showed significant improvements in all PROMs at 3- and 12-months, regardless of CPAK classification change, and operative technique.ConclusionsShort-term functional outcomes following TKA were not significantly influenced by In-the-box or Out-of-the box CPAK classification. Both CTKA and RATKA yielded comparable PROM improvements. Although altered CPAK often required greater soft-tissue release, especially in CTKA, this did not affect outcomes, suggesting alignment strategy should prioritise individual anatomy and soft-tissue balance over strict CPAK matching.Level of EvidenceLevel I
Evaluation of echocardiography monitoring in myotonic dystrophy type 1 patients
No full textIntroduction: Myotonic Dystrophy type 1 (DM1) is the most prevalent genetic neuromuscular disorder. The potential cardiac involvement, including arrhythmia and left ventricular dysfunction, demands routine follow-up with ECG and echocardiography, however recommendations on the interval of echocardiographic follow-up varies substantially. The aim of this study is to evaluate the long-term prevalence of LV dysfunction during echocardiographic follow-up of patients with DM1. Secondly, we aim to assess the association between structural abnormalities on echocardiography, ECG and clinical parameters. Methods: This retrospective cohort study with DM1 patients was conducted in Maastricht University Medical Center (MUMC+) and Radboud University Medical Center. All patients above 18 years old were included through the Dutch DM1 patient registry (MYODRAFT study). Patients were evaluated between January 2010 and December 2023. A total of 273 patients were included, in whom echocardiographic data was collected and correlated with clinical data, neuromuscular status and ECG parameters. Results: At baseline 20/273 (7.3%) patients had LV dysfunction (LVEF < 50% and/or LV dilatation). When newly detected LVEF <50% alone is considered then the yield of routine echocardiography follow-up was: 9/273 at baseline (3%), 2/84 at 36 months (2%), 9/184 at 72 months (5%) and 10/117 at the interval beyond 72 months (8%). The only clear correlation between ECG and echocardiography abnormalities was a widened QRS interval 125 +/- 31 ms vs. 103 +/- 19 ms (p = 0.007). This was also demonstrated in the multivariable analysis. Of the DM1 patients developing LV dysfunction, the median interval between the diagnosis of DM1 and the first echocardiogram detecting LV dysfunction was 181 months (15.1 years) with an interquartile range of 85-301 months (7.0-25.1 years). Discussion: Based on the data of this large retrospective study, the occurrence of LV dysfunction in DM1 patients is rather low (7.4%) at baseline and increases with 6.5% at 72 months follow-up. There is a significant correlation between LV dysfunction and a widened QRS interval. Which could prompt earlier echocardiographic follow up in this patient group. Routine echocardiography is useful in DM1 however the interval of echocardiography could be shifted more towards 5 years in asymptomatic patients because of the slow progressive nature of the disease
The Heartbeat of Global Health Advancing Cardiovascular Care Through International Nursing Research
No full textA cost-effectiveness analysis of the effect of hospital variation in the probability of providing treatment with curative intent in potentially curable esophageal and gastric cancer patients
No full textFor potentially curable esophageal cancer (EC) and gastric cancer (GC) patients, the probability of treatment with curative intent varies between hospitals and is associated with survival. This study examines the effect of this variation on health economics outcomes and cost-effectiveness. We performed a cost-effectiveness analysis from a societal perspective in potentially curable EC or GC patients selected from the Netherlands Cancer Registry. Resource use and costs were estimated for each treatment strategy from diagnosis until five years follow-up using a top-down costing method. Hospitals were divided into tertiles of low, medium, or high probability of treatment with curative intent using multilevel multivariable logistic regression. The primary outcome was the incremental cost-effectiveness ratio (ICER). Mean total costs per patient was not significantly different between low, medium, and high probability hospitals for EC (n = 9468) (<euro>47,532 vs. <euro>47,384 vs. <euro>47,825), while for GC (n = 3085) costs were significantly lower in low compared to medium and high probability hospitals (<euro>27,759 vs. <euro>30,183 vs. <euro>29,589, both P < 0.001). Costs per quality adjusted life year (QALY) were slightly lower in high probability hospitals for both EC and GC (EC: <euro>29,181 vs. <euro>28,646 vs. <euro>27,659, GC: <euro>25,003 vs. <euro>22,505 vs. <euro>20,495). ICERs were highest for high vs. medium probability hospitals for EC (<euro>4900/QALY) and for medium vs. low probability hospitals for GC (<euro>10,539/QALY). Variation in treatment with curative intent between hospitals affects health economics outcomes to a limited extent. Although all hospital comparisons were cost-effective, for the highest QALY gain, it is recommended to treat potentially curable patients as in high probability hospitals
Extracellular Vesicles Derived From Streptococcus anginosus Aggravate Lupus Nephritis by Triggering TLR2-MyD88-NF-κB Signalling in NK Cells
No full textSystemic lupus erythematosus (SLE) has been linked to gut microbiome dysbiosis, notably an overabundance of Streptococcus anginosus; however, the impact of this microbial imbalance on disease pathogenesis remains unclear. Here, we investigated the contribution of S. anginosus-derived extracellular vesicles (SA-EVs) to SLE progression, with an emphasis on lupus nephritis (LN). Fifty-four SLE patients and 43 healthy controls (HC) were recruited. The faecal, blood and serum samples from participants were collected. SLE disease activity (SLEDA) was evaluated by the SLEDA Index (SLEDAI). Stool S. anginosus abundance was quantified by quantitative PCR, NK cell activation by flow cytometry and serum proinflammatory cytokines profile by ELISA. Lupus-prone MRL/lpr mice were orally administered SA-EVs to evaluate in vivo inflammatory responses, renal NK cell activation and renal histopathological changes. S. anginosus levels were significantly elevated in SLE patients relative to HC, positively correlated with SLEDAI scores and NK cell cytotoxicity. In vitro, SA-EVs stimulation of patient NK cells significantly heightened proinflammatory mediator production (granzyme B, TNF-α), increased cytotoxicity and downregulated inhibitory receptors (TIM-3, NKG2A, TIGIT) compared to control EVs from S. Salivarius (SS-EVs). Mechanistically, lipoteichoic acid (LTA) within SA-EVs engaged Toll-like receptor 2 (TLR2) on NK cells, activating MyD88/NF-κB signalling pathway. In MRL/lpr mice, SA-EVs treatment increased renal immune complex deposition, upregulated renal NK cell activation markers (NKp44, NKp46), and exacerbated LN pathology with greater immune cell infiltration and inflammatory cytokine levels. Furthermore, NK cell depletion with anti-NK1.1 antibodies significantly prolonged survival in SA-EVs administered mice. Thus, SA-EVs exacerbate SLE by hyperactivating NK cells via the TLR2-MyD88-NF-κB pathway, leading to amplified systemic inflammation and aggravated LN. These findings underscore the potential of targeting SA-EVs for therapeutic intervention in SLE.</p
Surgery versus endoscopy with digital single-operator cholangioscopy-guided therapy for Mirizzi syndrome:the SEIZE study
No full textBackground The management of Mirizzi syndrome has been primarily surgical, but there are no comparisons between surgical and digital single-operator cholangioscopy (dSOC)-guided treatment. The objective of this study was to compare the safety and other outcomes of the two approaches. Methods A large multicenter international retrospective analysis was conducted comparing dSOC and surgery in patients with type II-IV Mirizzi syndrome between January 2005 and June 2023. Patients with postsurgical anatomy, Mirizzi type I or V, or previous cholecystectomy were excluded. Results 290 patients were included (dSOC, n=176; surgery, n=114). At baseline, patients undergoing dSOC were older P =0.006) and exhibited more co-morbidities. While technical success was lower with dSOC (89.8% vs. 96.5%; P =0.04), the need for reintervention was comparable after a median follow-up duration of 741.5 days (interquartile range [IQR] 320-1781) vs. 346 days (IQR 67-1220; P =0.009). Overall adverse events (10.2% vs. 41.2%; P <0.001) and severe adverse events (1.7% vs. 15.8%; P <0.001) occurred less frequently with dSOC, findings that were confirmed with propensity score-matching. A lower need for hepaticojejunostomy (8.2% vs. 25.4%; P =0.006) and lower rate of conversion to open surgery (6.0% vs. 22.8%; P =0.009) were observed in patients undergoing elective cholecystectomy following dSOC compared with the primary surgery group. Conclusions Our study demonstrates that the use of dSOC for Mirizzi syndrome is effective, showing superior safety despite being used to treat patients with more underlying co-morbidities. dSOC seems valuable in downgrading the extent of subsequent surgery, by potentially reducing the need for hepaticojejunostomy and conversion to open surgery.</p
Interhemispheric effects of iTBS on the fronto-parietal network:Evidence from dual-site stimulation
No full textThis study investigated the neuromodulatory effects of Theta Burst Stimulation (TBS) on resting-state functional connectivity (FC) following psychosocial stress induced by the Trier Social Stress Test (TSST). Given its key role in cognitive control and emotion regulation - processes highly relevant for rumination - we focused on the frontoparietal network. Across two studies, intermittent (iTBS) and continuous (cTBS) protocols were applied to the left Dorsolateral Prefrontal Cortex (DLPFC; study 1) and right Ventrolateral Prefrontal Cortex (VLPFC; study 2) prior to stress induction. Functional Near-Infrared Spectroscopy (fNIRS) was used to assess neural changes. A total of 88 (study 1) and 89 (study 2) healthy participants were recruited, balanced for low and high trait rumination. Each participant received both active and sham TBS (iTBS or cTBS), in a randomized, counterbalanced design. Results indicated that iTBS elicited excitatory effects on prefrontal and fronto-parietal connectivity, whereas cTBS effects were more variable. Trait rumination emerged as a modulator of TBS effects: In study 1, significant interactions for FC between the right VLPFC and Somatosensory Association Cortex (SAC) when stimulating the left DLPFC emerged, while study 2 revealed similar interactions for FC between the left DLPFC and SAC and intra-SAC FC when stimulating the right VLPFC. Correlations between post-stress state rumination and FC changes further support these findings. These results underscore the importance of neural assessments in TBS research and highlight the complexity of individual differences in state and trait rumination. Understanding the interplay between TBS, fronto-parietal connectivity, and rumination may provide valuable insights into personalized neuromodulation strategies
Course directors' reflections on educational design choices for incorporating near-peer teaching into clinical skills teaching
No full textPurposeNear-peer teaching (NPT) is widely used to substitute faculty in undergraduate clinical skills training. However, little is known about which educational design choices are made when incorporating NPT, prompting the following research questions: What were course directors' design choices when incorporating near-peers into clinical skills courses? And, what were the reasons for these design choices?Materials and MethodsThis descriptive qualitative study carried out 25 semi-structured interviews with course directors from 12 countries who had recently published on NPT, complemented by other, recognized NPT experts. Reflexive thematic analysis of the transcribed interviews combined inductive and deductive approaches. Cognitive Apprenticeship informed the deductive analysis.ResultsCourse directors appointed near-peers to teach standardisable skills to small groups of beginners in courses without patients - complemented by faculty supervision. Some directors involved near-peers in co-designing education, co-assessments, or co-facilitating transition to clinical practice. Course directors justified their choices based on near-peers' limited content expertise, but also their adherence to teaching scripts, cognitive congruence with students, social proximity, digital/technical literacy and low costs.ConclusionsCourse directors' design choices were mainly inspired by working around near-peers' limitations. Some courses capitalised on near-peers' unique perspectives, extending near-peer roles to co-designing education and co-facilitating transitions to practice