[The use of the Brøset Violence Checklist within forensic psychiatry]. / Het gebruik van de Brøset Violence Checklist binnen de forensische psychiatrie.

BACKGROUND: It is well known that structured short-term risk assessment tools contribute to predicting physically aggressive behavior in patients in acute psychiatry. AIM: To research whether the Brøset-Violence-Checklist (BVC), an instrument for short-term prediction of violence of psychiatric inpatients, can be used in forensic psychiatry and how the use of the BVC is experienced. METHOD: Twice every 24 hours at more or less fixed times, a BVC score was registered for all patients who stayed in a crisis department within a Forensic Psychiatric Center in 2019. The BVC total scores were then related to physically aggressive incidents. In addition, focus groups and interviews were conducted with sociotherapists to examine experiences with the use of the BVC. RESULTS: The analysis showed a significant predictive value of the BVC total score (AUC = 0.69; p < 0.01). Moreover, the sociotherapists experienced the BVC as user-friendly and efficient. CONCLUSION: The BVC has good predictive value to forensic psychiatry. This is especially true for those patients for whom personality disorder is not part of the primary classification.

Longitudinal humoral response after SARS-CoV-2 vaccination in ocrelizumab treated MS patients: To wait and repopulate?

OBJECTIVE: The objective of this study was to measure humoral responses after SARS-CoV-2 vaccination in MS patients treated with ocrelizumab (OCR) compared to MS patients without disease modifying therapies (DMTs) in relation to timing of vaccination and B-cell count. METHODS: OCR treated patients were divided into an early and a late group (cut-off time 12 weeks between infusion and first vaccination). Patients were vaccinated with mRNA-1273 (Moderna). B-cells were measured at baseline (time of first vaccination) and SARS-CoV-2 antibodies were measured at baseline, day 28, 42, 52 and 70. RESULTS: 87 patients were included (62 OCR patients, 29 patients without DMTs). At day 70, seroconversion occurred in 39.3% of OCR patients compared to 100% of MS patients without DMTs. In OCR patients, seroconversion varied between 26% (early group) to 50% (late group) and between 27% (low B-cells) to 56% (at least 1 detectable B-cell/µL). CONCLUSIONS: Low B-cell counts prior to vaccination and shorter time between OCR infusion and vaccination may negatively influence humoral response but does not preclude seroconversion. We advise OCR treated patients to get their first vaccination as soon as possible. In case of an additional booster vaccination, timing of vaccination based on B-cell count and time after last infusion may be considered.

[Self-harming behavior by patients admitted to forensic psychiatry]. / Zelfbeschadigend gedrag door patiënten in de forensische psychiatrie.

BACKGROUND: Incidents of self-harm by forensic psychiatric patients usually have a large impact on all those involved and self-harming behavior is an important predictor for violence towards others during treatment. AIM: To describe incidents of self-harm during the treatment of patients admitted to forensic psychiatry. METHOD: All incidents of self-harm during treatment in a forensic psychiatric center that were registered between 2008 and 2019 were analyzed and coded with respect to severity with the MOAS+. RESULTS: Between 2008 and 2019 299 incidents of self-harm were registered committed by 106 patients. Most of these incidents (87,6%) were classified as non-suicidal. Methods most often used were cutting themselves with glass, broken plates or mugs, a razor or knife and swallowing dangerous objects or liquids. There were ten cases of suicide, almost all by suffocation with a rope or belt. The majority of the incidents were coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. CONCLUSION: Incidents of self-harm happen regularly in forensic psychiatry and are usually severe. More research is needed into the impact on all those involved, motivations and triggers for self-harming behavior and effective treatment of it.

Stage I-II non-small-cell lung cancer treated using either stereotactic ablative radiotherapy (SABR) or lobectomy by video-assisted thoracoscopic surgery (VATS): outcomes of a propensity score-matched analysis.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) lobectomy and stereotactic ablative radiotherapy (SABR) are both used for early-stage non-small-cell lung cancer. We carried out a propensity score-matched analysis to compare locoregional control (LRC). PATIENTS AND METHODS: VATS lobectomy data from six hospitals were retrospectively accessed; SABR data were obtained from a single institution database. Patients were matched using propensity scores based on cTNM stage, age, gender, Charlson comorbidity score, lung function and performance score. Eighty-six VATS and 527 SABR patients were matched blinded to outcome (1:1 ratio, caliper distance 0.025). Locoregional failure was defined as recurrence in/adjacent to the planning target volume/surgical margins, ipsilateral hilum or mediastinum. Recurrences were either biopsy-confirmed or had to be PET-positive and reviewed by a tumor board. RESULTS: The matched cohort consisted of 64 SABR and 64 VATS patients with the median follow-up of 30 and 16 months, respectively. Post-SABR LRC rates were superior at 1 and 3 years (96.8% and 93.3% versus 86.9% and 82.6%, respectively, P = 0.04). Distant recurrences and overall survival (OS) were not significantly different. CONCLUSION: This retrospective analysis found a superior LRC after SABR compared with VATS lobectomy, but OS did not differ. Our findings support the need to compare both treatments in a randomized, controlled trial.

Developments in early-stage NSCLC: advances in radiotherapy.

An increase in the number of predominantly elderly patients with early-stage non-small-cell lung cancer is anticipated in many Western populations. Patients often have major co-morbidities and are at increased risk for surgical morbidity and mortality. In the past decade, the use of stereotactic ablative radiotherapy (SABR) has achieved excellent results, with only mild toxicity in such vulnerable patient groups, leading to SABR becoming accepted as a standard of care for unfit patients in several countries. The planning and delivery of SABR has rapidly improved in recent years, particularly with the use of 'on-board' imaging at treatment units, and shortened treatment delivery times. Increasingly, more central tumors are being treated using lower doses per fraction (so-called risk-adapted schemes). It is also becoming clear that long-term follow-up should take place at specialist centers in order to distinguish the evolving fibrosis that is frequently observed from the relatively infrequent local recurrences. Given the high local control rates and limited toxicity, increasing attention is being paid to the use of SABR in the subgroup of so-called borderline operable patients, and clinical trials comparing surgery and SABR in these patients are ongoing.