| 1. |
- Dorlo, T P C, et al.
(författare)
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[Miltefosine : a new remedy for leishmaniasis].
- 2006
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Ingår i: Nederlandsch tijdschrift voor geneeskunde. - 0028-2162 .- 1876-8784. ; 150:49, s. 2697-701
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Tidskriftsartikel (refereegranskat)abstract
- There is a need for a safe and effective oral treatment for cutaneous and visceral leishmaniasis. Miltefosine is the first oral drug that is efficacious against different forms ofleishmaniasis, however it is not equally effective against all Leishmania species. Miltefosine is an alkylphosphocholine, originally developed for the treatment of cancer. The mechanism of action is probably based on interference with the synthesis and degradation of parasitic membrane lipids. Little is known about the pharmacokinetics ofmiltefosine; an important characteristic is its long elimination half-life of seven days or longer. The most frequent adverse effects are of gastrointestinal origin. Miltefosine should not be used during pregnancy. Over thirty leishmaniasis patients have already been treated with miltefosine in the Netherlands.
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| 2. |
- Jaarsma, T, et al.
(författare)
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[Value of basic and intensive management of patients with heart failure; results of a randomised controlled clinical trial]
- 2008
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Ingår i: Nederlandsch tijdschrift voor geneeskunde. - 0028-2162 .- 1876-8784. ; 152:37, s. 2016-21
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the efficacy of 2 nurse-directed programmes of different intensity for the counselling and follow-up of patients hospitalised for heart failure, compared with standard care by a cardiologist. DESIGN: Multicentre randomised clinical trial (www.trialregister.nl: NCT 98675639). METHOD: A total of 1023 patients were randomized after hospitalisation for heart failure to 1 of 3 treatment strategies: standard care provided by a cardiologist, follow-up care from a cardiologist with basic counselling and support by a nurse specialising in heart failure, or follow-up care from a cardiologist with intensive counselling and support by a nurse specialising in heart failure. Primary end points were the time to rehospitalisation due to heart failure or death and the number of days lost to rehospitalisation or death during the 18-month study period. Data were analysed on an intent-to-treat basis. RESULTS: Mean patient age was 71 years, 38% were women, 50% had mild heart failure and 50% had severe heart failure. During the study, 411 patients (40%) were rehospitalised due to heart failure or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (differences not significant). The time to rehospitalisation or death was similar in the 3 groups: hazard ratios for the basic and intensive support groups versus the control group were 0.96 (95% CI: 0.76-1.21; p = 0.73) and 0.93 (95% CI: 0.73-1.17; p = 0.53), respectively. The number of days lost to rehospitalisation or death was 39,960 in the control group; this number was 15% less in the intervention groups, but the difference was not significant. However, there was a trend toward lower mortality in the intervention groups. In all 3 groups, more visits occurred than planned, which may have had a considerable effect on care, notably in the control group. CONCLUSION: The results of this study indicated that the provision of additional counselling and support by a nurse specialising in heart failure as an adjuvant to intensive follow-up care provided by a cardiologist does not always lead to a reduction in rehospitalisation frequency.
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| 3. |
- van Veldhuisen, D J, et al.
(författare)
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[The nurse practitioner in the treatment of cardiac patients : successful job reallocation within health care]
- 2006
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Ingår i: Nederlandsch tijdschrift voor geneeskunde. - 0028-2162 .- 1876-8784. ; 150:46, s. 2528-9
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Tidskriftsartikel (refereegranskat)abstract
- There is an ever-growing need for medical staff to provide health care, and several tasks that have traditionally been carried out by physicians are increasingly being undertaken by specialized nurses. Both nurse practitioners and physician's assistants now commonly work in-hospital. In The Netherlands, there have been relatively few studies which have examined the potential role of specialized nurses. A study from Alkmaar shows that the care of patients who have recently had a myocardial infarction, which is normally done by a resident/physician-in-training, can also be carried out by a nurse practitioner, when working within the limits of well-defined protocol, and under the supervision of a staff cardiologist. Although no difference in clinical endpoints was found during the follow-up period, the study shows that patients who were under the care of the nurse practitioner were overall more satisfied with the information that was provided to them, than those under the care of the resident. These findings are important and need confirmation in larger studies and in other patient populations.
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