Elisabeth-TweeSteden Ziekenhuis

People with HIV (PWH) using antiretroviral therapy are at increased risk to develop cardiovascular diseases (CVD). We hypothesized that residual viremia (RV; unquantifiable low, but detectable viral load) increases CVD risk. We enrolled 1895 virally suppressed PWH and compared CVD incidence in participants with and without RV. Extensive multi-omics characterization was performed. Incident CVD was registered after 2-year follow-up and adjusted odds ratios (aOR) calculated accounting for classical CVD risk factors. The numbers of expected and actual CVD events were compared using CVD risk scores. RV, detected in one-third of participants, strongly increased the risk of developing a first cardiovascular event (3.1% vs 1.2%, aOR 2.8,p=0.004). Participants with RV experienced twice the number of events predicted by the SCORE2 riskmodel. The association between RV and CVD was not driven by inflammation, immune activation, gut barrier dysfunction, or lipometabolic perturbations. Residual viremia independently associated with CVD development, highlighting the need for tailored prevention and examination of novel intervention strategies.

ObjectiveTo compare the effects of percutaneous nephrostomy (PCN) and JJ ureteric stent (JJ) for urinary tract decompression in patients with obstructive urolithiasis on health‐related quality of life (HRQoL), pain scores, urinary symptoms, and patient satisfaction.Patients and MethodsIn 11 hospitals, 204 patients with obstructive urolithiasis were randomised to JJ or PCN placement. Patient‐reported outcome measures (PROMs) were assessed until stone passage, surgical removal, or at 3 months.ResultsBoth PCN and JJ effectively improved HRQoL index scores (PCN: pre‐decompression 0.70, 1 day post‐decompression 0.82, P = 0.003; JJ: pre 0.59, post 0.85, P < 0.001), pain scores (PCN: pre 4.9, post 1.3, P < 0.001; JJ: pre 5.5, post 1.3, P < 0.001), and achieved patient satisfaction (score at discharge PCN: 7.9; JJ: 8.2), with no significant differences between interventions in overall HRQoL (generalised estimating equation [GEE] P = 0.7) or mean daily pain scores (GEE P = 0.4). PCN led to more self‐care difficulties (patients reporting no problems: PCN 74%, JJ 91%, P = 0.023), while JJ recipients reported more urinary symptoms and higher peak pain intensity (pain score PCN: 2.3, JJ: 3.7, between groups P = 0.018). Despite symptoms, more JJ recipients preferred the same intervention in future (60%), than PCN recipients (31%) (P < 0.001). Survey‐based data collection may introduce response bias (response rate 59%).ConclusionIn patients with obstructive urolithiasis, urinary decompression with PCN and JJ improved HRQoL and pain comparably. JJ causes more urinary symptoms and peak pain but allows better self‐care. Baseline self‐care and urinary symptoms should guide shared decision‐making. Drainage duration should be minimised.

Introduction: Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for depression of which the acute and short-term effects have been studied extensively.However, much J o u r n a l P r e -p r o o f less is known about the long-term effectiveness of rTMS.This paper aims to investigate the long-term effects of rTMS and antidepressant medication in patients with moderate treatment-resistant depression (2 treatment trials).Methods: Naturalistic follow-up data was collected for twelve months as part of a clinical trial comparing rTMS and antidepressant medication.Response and remission based on the Hamilton Depression Rating Scale (HDRS-17) were calculated for both groups at end of treatment, as well as at four-, six-, nine-and twelve-months follow-up.Furthermore, the sustained effects of both treatments on anxiety, anhedonia, and rumination were investigated.Results: At the end of treatment, response and remission rates were higher in the rTMS group (40.9% and 29.5%) than in the medication group (18.8% and 6.3%).69% of the patients in the medication group received treatment with rTMS at some point during the follow-up period.Response and remission remained relatively stable over 12 months in both groups.Sustained response was observed in the majority of rTMS and medication responders for whom data was available for the full follow-up period.Conclusion: Our findings provide insights into the naturalistic long-term effects of rTMS and antidepressant medication in patients with moderate treatment-resistant depression.

<h3>Background and Importance</h3> Electronic personal health records (ePHRs) increasingly allow patients to manage their own medical data. Integration of a digital assistant (DA; ie, a conversational agent) into ePHRs may be of added value as a supportive tool to help better engage patients and improve patients’ experience of entering (complex) data. Previously, the use of a DA for self-reporting of medication history (ChaRM) showed positive results. Consequently, an additional prototype was developed that supports patients in documenting their medication <i>allergy</i> history (ChaRM-A). <h3>Aim and Objectives</h3> To evaluate the accuracy of self-reported medication allergy histories guided by ChaRM-A compared to pharmacy technicians. <h3>Material and Methods</h3> A prospective, observational study was conducted from February-May 2025. Outpatients ≥18 years, scheduled for a visit to the outpatient medication reconciliation department, were randomly selected for participation. Patients performed medication allergy history taking in an online standalone environment with ChaRM-A support. Subsequently, a pharmacy technician conducted medication reconciliation including medication allergy history taking (usual care). The primary outcome was the proportion of patients with a discrepancy between the two composed medication allergy lists. Secondary outcomes were the nature and prevalence of the discrepancies, their clinical relevance and potential risk factors. Data were analysed through descriptive statistics and regression analysis. <h3>Results</h3> Forty-five patients (median age 66 years (IQR 57-76), range 19-88 years) documented their medication allergy history with support of ChaRM-A. The median time they needed was 2 minutes and 27 seconds (IQR 01:33-04:39). Sixteen (35.6%) patients did not have any allergies. The other 29 patients documented ≥1 allergy and 28 (96.6%) of them had ≥1 discrepancy (median 1 discrepancy per patient (IQR 1-4), range 1-10). In total, 70 discrepancies were found: 37.1% documentation deviations, 35.7% omissions and 27.1% additions. Most discrepancies (n=61, 87.1%) were classified as unharmful. The number of discrepancies per patient was significantly associated with the number of allergies per patient (p=0.03 (95% CI: 1.03-1.94)). <h3>Conclusion and Relevance</h3> Although numerous discrepancies were found between medication allergy histories self-reported by patients with a DA and pharmacy technicians, their clinical relevance was low, indicating that a DA may safely support patients. Optimisation of the DA and additional research is needed to fully support patients in self-reporting medication allergies. <h3>Conflict of Interest</h3> No conflict of interest

Shoulder arthroplasty effectively treats various degenerative and traumatic shoulder conditions, but outcomes can be compromised by complications, limited mobility, and persistent pain. The impact of previous nonarthroplasty surgery on functional outcomes remains unclear. Therefore, the purpose of this study is to determine if a history of prior nonarthroplasty shoulder surgery is associated with worse functional outcomes after primary shoulder arthroplasty. This registry study with data sourced from the Dutch Arthroplasty Register (LROI) includes adult patients who underwent primary arthroplasty between 2014 and 2022, with or without a history of prior nonarthroplasty shoulder surgery. Prior surgeries were divided into the following categories: osteosynthesis, stabilization, rotator cuff, subacromial decompression, and other shoulder surgeries. The outcomes of the study include revision rate, shoulder function, and shoulder pain. Twenty-five thousand one hundred eighty-eight shoulder arthroplasty procedures were recorded in the registry between 2014 and 2022. Of the procedures, 18,160 (72.1%) were reverse total shoulder arthroplasty, 4,772 (18.9%) anatomic total shoulder arthroplasty, and 2,256 (9.0%) hemishoulder arthroplasty. A total of 4,203 patients (16.7%) underwent prior shoulder surgery, while 20,985 (83.3%) did not. From 2017 onward, completion rates of patient-reported outcome measures ranged from 21.2% to 30.0%. Prior shoulder surgery was associated with higher chance of revision surgery (hazard ratio [HR] (95% confidence interval [CI]) = 1.48 (1.31 to 1.68), n = 25,188). Prior surgery was associated with less improvement in shoulder function (regression coefficient (95%CI) = -2.84 (-3.83 to -1.84), n = 3,206), less improvement in pain score at rest (regression coefficient (95%CI) = -0.57 (-0.77 to -0.37), n = 3,325) and less improvement in pain during activity (regression coefficient (95%CI) = -0.64 (-0.88 to -0.41), n = 3,318) after 12 months. Patients with a history of osteosynthesis (HR (95%CI) = 1.58 (1.31 to 1.91)) or rotator cuff repair (HR (95%CI) = 1.47 (1.18 to 1.83)) had lower prosthesis survival compared to those without such interventions. A history of nonarthroplasty shoulder surgery is associated with higher revision rates and poorer patient-reported outcomes after primary shoulder arthroplasty. These findings highlight the importance of surgical history in preoperative counseling and risk stratification.

An important aim of the new mental health act implemented in the Netherlands in 2020 was to shift the focus from hospitalization to treatment. The act provides an option for patients' compulsory treatment at home (CTH). Unlike compulsory community treatment (CCT), which allows mental health workers to hospitalize patients involuntarily if they do not comply with treatment. CTH is not provided elsewhere in the world. This case report concerns a patient who, to avoid hospitalization, received CTH in the form of compulsory medication and was able to recover at home. Retrospectively, she and the mental health team both positively evaluated this use of CTH. The parties involved all concluded that CTH restricted the patient's autonomy less than hospitalization, it did not influence the therapeutic relationship, and the CTH could be delivered in a way that it did not compromise participants' safety. This case report shows that, in some situations, CTH can avoid hospitalization. Care should nonetheless be taken to assess its appropriateness, to discuss any preconditions, and to evaluate the use of compulsory treatment in dialog with the patient and significant others.

Limited health literacy (LHL) can affect the ability to understand and apply health information. For patients with rotator cuff tears, following post-treatment guidelines is crucial for recovery. However, existing resources often don't meet the needs of those with LHL, potentially delaying recovery. This study investigates the prevalence of LHL in patients with rotator cuff tears, the challenges in managing health information, and possible strategies to improve care. The prevalence of LHL in patients with rotator cuff tears was assessed using the Single-Item Literacy Screener. To explore the challenges in managing health information and possible solutions, semistructured interviews based on the Health Literacy Questionnaire were conducted with twelve patients. Data were collected through audio recordings and field notes, which were transcribed and analyzed using thematic analysis. The prevalence of LHL in patients contacted by phone was 9.3% and 40.7% when contacted at the outpatient clinic. Patients experienced significant language barriers in health care communication, challenges in finding and evaluating relevant health information. These patients reported diverse and specific needs for tailored health information. They suggested using formats that cater to their preferences and sought support from their social networks to better manage their condition and treatment journey. This study adds to the evidence that LHL is common and associated with multiple challenges in health care engagement. Addressing these challenges through personalized, accessible communication strategies, in combination with support from their social environment, should be a priority for health care systems aiming to reduce inequalities and improve patient outcomes in patients with rotator cuff tears.