[Oral galantamine versus rivastigmine transdermal patch: a descriptive study at a memory clinic in The Netherlands]. / Galantamine of rivastigmine pleister. Een beschrijvend onderzoek op een geheugenpolikliniek in Nederland.

OBJECTIVES: Since January 2008 in The Netherlands, two cholinesterase inhibitors, oral galantamine and rivastigmine transdermal patch, are registered as a one-day symptomatic treatment for Alzheimer's disease. As no head to head study was performed yet, the objective of this study was to describe the daily practice of oral galantamine and rivastigmine transdermal patch in a real life population of a memory clinic of a suburban teaching hospital in The Netherlands. METHODS: A randomized open label study in 84 ambulant Alzheimer's patients with at least 6 months follow-up and treated either with oral galantamine (group G) or rivastigmine transdermal patch (group R). Data collection included patients' demographic and disease variables. Adverse events were collected and, in case of interruption of the primary treatment, the alternative treatment was registered. RESULTS: Serious adverse events did not occur. In group G respectively group R adverse events occurred in 20 patients (50%) and 18 patients (41%). No difference occurred in the frequency of nausea or vomiting. In group R more patients noted dermatological adverse events. In group G respectively group R medication was stopped in 12 patients (30%) and 14 patients (32%). However, compared to group G after stopping the treatment in group R more patients received a new anti-dementia medication (respectively 11 patients (79%) and 4 patients (33%)) (chi2(1) = 5.418, p = .026). CONCLUSION: Despite different forms, the use of oral galantamine and rivastigmine transdermal patch showed neither difference in the frequency of adverse events neither in the frequency of stopping primary treatment. However, compared to oral galantamine use, rivastigmine transdermal patch resulted in more dermatological adverse events and after stopping rivastigmine transdermal patch, new anti-dementia medication or form was more often started. More research is urgently needed.

[A triage system for non-urgent ambulant frail elderly]. / Triage in de niet acute ouderengeneeskunde: geriater, arts-assistent geriatrie of valpolikliniek. Een praktijkvoorbeeld.

PURPOSE: This study aimed to examine a triage system for non-urgent ambulant frail elderly. METHODS: Three months prospective evaluation of patients, admitted for an out-hospital evaluation on a geriatric ward of an non-academic teaching hospital and not suitable for a memory clinic or falls clinic. A maximum of four patients entered the triage system at the same moment and a nurse and a physiotherapist investigated these patients separately during 30 minutes in total. After these investigations, triage consensus was reached and immediately thereafter, 2 patients were admitted to a fall clinic, 1 patient was admitted to a consultant and 1 patient was admitted to a resident. For each admission, there were positive and negative reasons defined. RESULTS: During 22 moments of triage, 68 patients were admitted to the different out-hospital evaluations. In 90% positive reasons for triage were used. CONCLUSIONS: A triage system for non-urgent ambulant frail elderly seems to be effective. However, more research is needed.

[Fear of falling in a fall clinic for geriatric patients: a pilot study]. / Angst voor vallen op een valpolikliniek geriatrie: een pilotstudy.

OBJECTIVE: In this pilot study we want to determine how often fear of falling occurs in geriatric patients visiting a fall clinic and to study the characteristics of fear of falling and its consequences. DESIGN: Retrospective study of patient's records. METHOD: A random sample of 100 medical records of geriatric patients of the fall clinic of the Jeroen Bosch Ziekenhuis in Den Bosch was systematical examined. RESULTS: The mean age of the patients was 79.8 +/- 6 years. Before visiting the fall clinic, the patients had a history of falling during 34.6 months, and 62% of them visited a hospital due to the consequences of falling. In the fall clinic a mean number of 2.5 probable causes per fall was diagnosed. In this study 31% of the patients had fear of falling. The demographic characteristics and the causes of falling of the patients with or without fear of falling, were almost the same. Patients with fear of falling had a hip prothesis in 26%, whereas patients without fear of falling only in 7% had a hip prothesis (P < 0.05). In patients with fear of falling, in 90% extra diagnostic investigation was needed, whereas in patients without fear of falling extra diagnostic investigation only occurred in 53% (P < 0.01). Finally, patients with fear of falling needed 1.8 more times physical therapy compared to patients without fear of falling (P < 0.01). CONCLUSION: After a fall, fear of falling occurs often in geriatric patients. In this study, no causes for fear of falling could be determinated, although hip prothesis are associated with fear of falling. In patients with fear of falling more medical consumption occurs. In medical practice as in science fear of falling needs more attention.

Angst voor vallen op een valpolikliniek geriatrie: een pilotstudy.

Fear of falling in a fall clinic for geriatric patients: a pilot study Objective. In this pilot study we wantto determine how often fear of falling occurs in geriatric patients visiting a fall clinic and to study the characteristics of fear of falling and its consequences.Design. Retrospective study of patient's records.Method. A random sample of 100 medical records of geriatric patients of the fall clinic of the Jeroen Bosch Ziekenhuis in Den Bosch was systematical examined.Results. The mean age of the patients was 79.8 ± 6 years. Before visiting the fall clinic, the patients had a history of falling during 34.6 months, and 62% of them visited a hospital due to the consequences of falling. In the fall clinic a mean number of 2.5 probable causes per fall was diagnosed.In this study 31% of the patients had fear of falling. The demographic characteristics and the causes of falling of the patients with or without fear of falling, were almost the same. Patients with fear of falling had a hip prothesis in 26%, whereas patients without fear of falling only in 7% had a hip prothesis (P<0.05). In patients with fear of falling, in 90% extra diagnostic investigation was needed, whereas in patients without fear of falling extra diagnostic investigation only occurred in 53% (P<0.01). Finally, patients with fear of falling needed 1.8 more times physical therapy compared to patients without fear of falling (P<0.01).Conclusion. After a fall, fear of falling occurs often in geriatric patients. In this study, no causes for fear of falling could be determinated, although hip prothesis are associated with fear of falling. In patients with fear of falling more medical consumption occurs. In medical practice as in science fear of falling needs more attention.

Confirmation and differentiation of antibodies to human immunodeficiency virus 1 and 2 with a strip-based assay including recombinant antigens and synthetic peptides.

We evaluated the use of the INNO-LIA HIV-1/HIV-2 Ab test (LIA HIV; Innogenetics) for the confirmation of antibodies to human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2). The test includes three recombinant HIV-1 proteins: p24 (gag), p17 (gag), and endonuclease (p31; pol), in combination with two synthetic peptides derived from the env gene of HIV-1 and one synthetic peptide selected from the env gene of HIV-2. Analysis of 450 sera from blood donors, 220 sera from patients with non-HIV pathology, and 28 Western blot (WB) p24-only reactive sera revealed no false-positive results, and the rate of indeterminate results was substantially lower than that with WB. Testing of 334 WB-confirmed HIV antibody-positive sera (309 HIV-1; 25 HIV-2) revealed no false-negative results. In two of seven seroconversion panels tested, LIA HIV detected the presence of HIV antibodies before WB did. In the other five panels, LIA HIV and WB confirmed the presence of HIV antibodies in the same sample. The LIA HIV assay therefore appears well suited for routine confirmation of the presence of HIV-1 and HIV-2 antibodies.