High and Intensive Care in Psychiatry: Validating the HIC Monitor as a Tool for Assessing the Quality of Psychiatric Intensive Care Units.

This study aims to validate the HIC monitor as a model-fidelity scale to the High and Intensive Care (HIC) model, a recently developed model for acute psychiatric wards. To assess the psychometric properties of the HIC monitor, 37 audits were held on closed inpatient wards at 20 psychiatric hospitals in the Netherlands. Interrater reliability, construct validity and content validity were examined. Our results suggest that the HIC monitor has good psychometric properties. It can be used as a tool for assessing the implementation of the HIC model on acute psychiatric wards in the Netherlands, and for quality assessment and improvement.

A case of late-onset systemic sclerosis with ruptured silicone breast implants.

BACKGROUND: It is still unresolved whether there is a relationship between silicone breast implants (SBIs) and late-onset systemic sclerosis (SSc). CASE DESCRIPTION: A 83-year-old female was diagnosed with limited cutaneous SSc. During follow-up the presence of ruptured SBIs was confirmed. We provide a literature review concerning SBIs and development of SSc, particularly in relation to age of onset. CONCLUSION: Data about age of onset are incomplete and no details on the rupture of SBIs are reported; however, an association between SSc and SBIs possibly exists.

'Welzijn op Recept' (Social Prescribing): a helping hand in re-establishing social contacts - an explorative qualitative study.

'Welzijn op Recept' is an intervention in which primary care providers refer patients with psychosocial problems to a community well-being organisation. Welzijn op Recept has been helping participants in the town of Nieuwegein, the Netherlands for more than three years. An impact study was carried out from September to December 2014. The qualitative study aimed to determine what happens in the chain of the social prescription and what changes the participant experiences in terms of social participation. The participants in this study were selected by the well-being coaches. A total of 10 semi-structured in-depth interviews were conducted. This study has shown that the participants had confidence in their referral to the community well-being organisation. The well-being coaches constitute a link between primary care providers, patients and the community well-being organisation. Participants have explicitly indicated that they experienced an increase in their own strength, self-confidence, self-reliance and the number of social contacts, and stated that they are experiencing better health. A point of special interest in the current programme is the planning of structured follow-up interviews after starting up an activity.

Translation, cross-cultural adaptation, and validation of the UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument (SCTC GIT) 2.0 into Dutch.

OBJECTIVES: To translate and adapt the University of California, Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument 2.0 (UCLA SCTC GIT 2.0) into Dutch and validate it among Dutch systemic sclerosis (SSc) patients. METHODS: First, the UCLA SCTC GIT 2.0 questionnaire was translated and adapted according to international guidelines. The resulting Dutch GIT 2.0 was, in combination with the SSc Health Assessment Questionnaire (SHAQ) and Short Form-36 (SF-36) administered to SSc patients participating in a standardised medical assessment. Moreover, all previous clinical examinations and confirmed medical diagnoses related to GIT were extracted from the medical records. Internal consistency was determined by calculating Cronbach's alpha. To determine the reliability, the questionnaire was re-administered with an interval of two weeks to a subgroup of patients and the intraclass-correlation coefficient (ICC) was computed. Spearman correlation coefficients between GIT scores, SF-36 and SHAQ were computed. GIT scores were compared among patients with and without previous gastrointestinal examinations and/or diagnoses. RESULTS: Eighty-nine patients with a mean age of 53.6 (SD 12) years, and predominantly female (76%) were included. The median total GIT score was 0.17 (Cronbach's alpha 0.921). The test-retest reliability of the total GIT score was good (n=27; ICC 0.749). Overall, the GIT total scores correlated significantly with the SHAQ visual analogue scale intestinal complaints and the SF-36. Significant differences between GIT total and subscale scores of patients with and without previous gastrointestinal examinations and diagnoses were present. CONCLUSIONS: The Dutch GIT 2.0 questionnaire showed good internal consistency, construct validity and test-retest reliability.

Contaminants and microorganisms in Dutch organic food products: a comparison with conventional products.

Organic products were analysed for the presence of contaminants, microorganisms and antibiotic resistance and compared with those from conventional products. No differences were observed in the Fusarium toxins deoxynivalenol and zearalenone in organic and conventional wheat, during both a dry period and a very wet period which promoted the production of these toxins. Nitrate levels in head lettuce produced organically in the open field were much lower than those in conventional products. In iceberg lettuce and head lettuce from the greenhouse, no differences were detected. Organically produced carrots contained higher nitrate levels than conventional products. Both organic and conventional products contained no residues of non-polar pesticides above the legal limits, although some were detected in conventional lettuce. Organic products contained no elevated levels of heavy metals. Salmonella was detected in 30% of pig faeces samples obtained from 30 organic farms, similar to the incidence at conventional farms. At farms that switched to organic production more then 6 years ago no Salmonella was detected, with the exception of one stable with young pigs recently purchased from another farm. No Salmonella was detected in faeces at the nine farms with organic broilers, and at one out of ten farms with laying hens. This is comparable with conventional farms where the incidence for Salmonella lies around 10%. Campylobacter was detected in faeces at all organic broiler farms, being much higher than at conventional farms. One of the most remarkable results was the fact that faeces from organic pigs and broilers showed a much lower incidence of antibiotic resistant bacteria, except for Campylobacter in broilers. It is concluded that the organic products investigated scored as equally well as conventional products with regard to food safety and at the same time show some promising features with respect to antibiotic resistance.

[Cardiomyopathy during clozapine therapy]. / Cardiomyopathie tijdens clozapinegebruik.

A 45-year-old woman of Moroccan origin developed a dilated cardiomyopathy during clozapine treatment for a psychosis that did not respond to conventional antipsychotics. The onset of her illness was acute with chest pain. She subsequently developed shortness of breath and oedema of the face and legs. The cardiomyopathy appeared to be partially reversible after the clozapine was halted. Cardiomyopathy during the use of clozapine is rarely described in the literature, although myocarditis is a known complication. The cause of cardiomyopathy during the use of clozapine is not known. Myocarditis might evolve into cardiomyopathy. There are indications that myocarditis is caused by an allergic reaction to clozapine. It is advised that clozapine treatment should only be initiated under the close supervision of a psychiatrist, and that during the use of clozapine one should be alert to the risk of cardiac complications.

[Delirium due to increase in clozapine level during an inflammatory reaction]. / Delirium door stijging van clozapinespiegels tijdens ontstekingsreactie.

Between January 1999 and May 2000, the Netherlands Pharmacovigilance Foundation LAREB received five reports of patients with clozapine intoxication attributed to inflammation. The reports all concerned men with schizophrenia, aged 63, 54, 41, 45 en 42 years. The occurrence of increased clozapine levels during inflammation, and normalisation after recovery, strongly suggest a causal relationship. No other possible explanations were found. A three to five-fold increase occurred in most instances, but one patient experienced a ten-fold increase compared with the basal levels of clozapine. Three of the patients developed a delirium as an intoxication symptom, probably due to anticholinergic effects on the central nervous system. In case of an inflammatory reaction in patients on clozapine treatment, the physician should be aware of the possibility of clozapine intoxication and delirium. Measuring clozapine levels during infection and dosing based on these levels can minimise the adverse effects of clozapine intoxication.

Towards an understanding of non-compliance. An assessment of risk factors for defaulting from leprosy treatment.

Within the Eastern Leprosy Control Project of Nepal, a retrospective case control study looked for simple factors that might be used operationally to predict non-compliant behaviour in patients. Patients with these factors would then become the targets of measures such as intensified health education messages and home visits in order to reduce the risk of defaulting. A study of 1442 patient cards (half defaulters, half treatment completed) revealed occasional small but significant demographic and clinical differences, but none was of a sufficient magnitude to be operationally useful. Review of the attendance of patients in the first few months of treatment suggested that eventual defaulting was strongly associated with irregularity from the commencement of treatment. It is possible that an early indicator based on attendance over the first months can be used to target patients who are in danger of non-completion of treatment.

On the numerical accuracy of the boundary element method.

The numerical accuracy of the boundary element (BE) method used to solve the volume conduction problem of nested compartments, each having a homogeneous conductivity, is studied. The following techniques for improving this accuracy are discussed: the handling of the auto solid angle element omega ii, the overall refinement of the level of discreteness, the use of a locally refined discrete grid, the isolated problem approach, and an adaptive refined computation of the discrete surface integrals involved in the BE method. The effects of these techniques on the numerical accuracy of the computed electrical potentials are illustrated by taking a volume conductor consisting of four concentric spheres representing the head since for this model an analytical (exact) solution is available. The techniques are of importance for numerically computed electroencephalograms (EEG's) since the numerically computed surface EEG's are severely affected by the relatively low conductivity of the compartment representing the skull.

On the magnetic field distribution generated by a dipolar current source situated in a realistically shaped compartment model of the head.

The magnetic field distribution around the head is simulated using a realistically shaped compartment model of the head. The model is based on magnetic resonance images. The 3 compartments describe the brain, the skull and the scalp. The source is represented by a current dipole situated in the visual cortex. The magnetic field distribution due to the source and that due to the volume currents are calculated separately. The simulations are carried out in order to ascertain which matrix of grid points is suitable as a measuring grid. The possibilities studied are grid points situated in a plane, in a surface which follows the contours of the head and in a sphere. This sphere is taken concentric to the sphere which is the best possible fit for the head. Taking into account the relative contribution of the volume currents and the possible accuracy in the positioning of the magnetic field detector, it can be concluded that the best choice is to measure the normal component of the magnetic field at points which are situated in the spherical surface. The results of this study also show that the magnetic field distribution based on a realistically shaped compartment model differs from that based on a compartment model consisting of concentric spheres. In the spherical model of the head no contribution of the volume currents to the component of the field normal to the sphere can be expected. The difference between the results obtained with these two volume conductor models increases with source depth.

Inverse solutions based on MEG and EEG applied to volume conductor analysis.

An inverse solution computer program, using a single current dipole in a selected volume conductor, calculates an equivalent dipole from a magneto- or electroencephalographic distribution. The program is used to evaluate several volume conductor models of the head by using one model when generating the distribution and another when calculating the equivalent dipole. Sources of errors in the equivalent dipole, namely uncertainties in the model parameters (e.g. conductivities) and noise in the MEG or EEG distribution, are investigated in the same way. A realistically shaped model of the head is introduced to investigate the extent to which sphere-shaped models can be used.

Model evaluation using electroencephalography and magnetoencephalography.

The source of both the measured visual evoked potentials and the measured visual evoked magnetic fields was estimated by means of an inverse procedure. The model used consisted of a single current dipole positioned in a volume conductor consisting of four concentric spheres. Comparison of the results showed that the estimations did not always match. In order to reveal a possible cause of this mismatch a realistically shaped multicompartment model of the head was constructed. From forward simulations it followed that the influence of the realistic shape was apparent, especially when the dipole was positioned deep within the brains.