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Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, Pulcini C, Kahlmeter G, Kluytmans J, Carmeli Y, Ouellette M, Outterson K, Patel J, Cavaleri M, Cox EM, Houchens CR, Grayson ML, Hansen P, Singh N, Theuretzbacher U, Magrini N, Aboderin AO, Al-Abri SS, Awang Jalil N, Benzonana N, Bhattacharya S, Brink AJ, Burkert FR, Cars O, Cornaglia G, Dyar OJ, Friedrich AW, Gales AC, Gandra S, Giske CG, Goff DA, Goossens H, Gottlieb T, Guzman Blanco M, Hryniewicz W, Kattula D, Jinks T, Kanj SS, Kerr L, Kieny MP, Kim YS, Kozlov RS, Labarca J, Laxminarayan R, Leder K, Leibovici L, Levy-Hara G, Littman J, Malhotra-Kumar S, Manchanda V, Moja L, Ndoye B, Pan A, Paterson DL, Paul M, Qiu H, Ramon-Pardo P, Rodríguez-Baño J, Sanguinetti M, Sengupta S, Sharland M, Si-Mehand M, Silver LL, Song W, Steinbakk M, Thomsen J, Thwaites GE, van der Meer JWM, Van Kinh N, Vega S, Villegas MV, Wechsler-Fördös A, Wertheim HFL, Wesangula E, Woodford N, Yilmaz FO, Zorzet A. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. The Lancet Infectious Diseases 2018; 18:318-327. [DOI: 10.1016/s1473-3099(17)30753-3] [Citation(s) in RCA: 2242] [Impact Index Per Article: 373.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/13/2017] [Accepted: 11/01/2017] [Indexed: 12/12/2022]
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van Der Schaaf ME, Schmits IC, Roerink M, Geurts DEM, Toni I, Roelofs K, De Lange FP, Nater UM, van der Meer JWM, Knoop H. Investigating neural mechanisms of change of cognitive behavioural therapy for chronic fatigue syndrome: a randomized controlled trial. BMC Psychiatry 2015; 15:144. [PMID: 26138726 PMCID: PMC4489043 DOI: 10.1186/s12888-015-0515-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is characterized by profound and disabling fatigue with no known somatic explanation. Cognitive behavioral therapy (CBT) has proven to be a successful intervention leading to a reduction in fatigue and disability. Based on previous neuroimaging findings, it has been suggested that central neural mechanisms may underlie CFS symptoms and play a role in the change brought on by CBT. In this randomized controlled trial we aim to further investigate the neural mechanisms that underlie fatigue in CFS and their change by CBT. METHODS/DESIGN We will conduct a randomized controlled trial in which we collect anatomical and functional magnetic resonance imaging (MRI) measures from female CFS patients before and after CBT (N = 60) or waiting list (N = 30) and compare these with measures from age and education matched healthy controls (N = 30). By including a large treatment group we will also be able to compare patients that benefit from CBT with those that do not. In addition, to further investigate the role of endocrine and immune biomarkers in CFS, we will determine cortisol and cytokine concentrations in blood, hair and/or saliva. DISCUSSION This project creates an unique opportunity to enhance our understanding of CFS symptoms and its change by CBT in terms of neuroanatomical, neurofunctional, endocrinological and immunological mechanisms and can help to further improve future treatments strategies. TRIAL REGISTRATION Dutch Trial Register #15852. Registered 9 December 2013 ( http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4311 ).
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Affiliation(s)
- Marieke E van Der Schaaf
- Radboud University Medical Center, Expert Centre for Chronic Fatigue, Nijmegen, The Netherlands. .,Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands. .,Donders Institute, Centre for neuroimaging, Kapittelweg 29, P.O. Box 9101, NL-6500 HB, Nijmegen, The Netherlands.
| | - Iris C Schmits
- Radboud University Medical Center, Expert Centre for Chronic Fatigue, Nijmegen, The Netherlands.
| | - Megan Roerink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Dirk EM Geurts
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Karin Roelofs
- Behavioral Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Floris P De Lange
- Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Urs M Nater
- Department of Psychology, University of Marburg, Marburg, Germany.
| | - Jos WM van der Meer
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Knoop
- Radboud University Medical Center, Expert Centre for Chronic Fatigue, Nijmegen, The Netherlands.
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Haring CM, Cools BM, van der Meer JWM, Postma CT. Student performance of the general physical examination in internal medicine: an observational study. BMC Med Educ 2014; 14:73. [PMID: 24712683 PMCID: PMC4233641 DOI: 10.1186/1472-6920-14-73] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/03/2014] [Indexed: 05/06/2023]
Abstract
BACKGROUND Many practicing physicians lack skills in physical examination. It is not known whether physical examination skills already show deficiencies after an early phase of clinical training. At the end of the internal medicine clerkship students are expected to be able to perform a general physical examination in every new patient encounter. In a previous study, the basic physical examination items that should standardly be performed were set by consensus. The aim of the current observational study was to assess whether medical students were able to correctly perform a general physical examination regarding completeness as well as technique at the end of the clerkship internal medicine. METHODS One hundred students who had just finished their clerkship internal medicine were asked to perform a general physical examination on a standardized patient as they had learned during the clerkship. They were recorded on camera. Frequency of performance of each component of the physical examination was counted. Adequacy of performance was determined as either correct or incorrect or not assessable using a checklist of short descriptions of each physical examination component. A reliability analysis was performed by calculation of the intra class correlation coefficient for total scores of five physical examinations rated by three trained physicians and for their agreement on performance of all items. RESULTS Approximately 40% of the agreed standard physical examination items were not performed by the students. Students put the most emphasis on examination of general parameters, heart, lungs and abdomen. Many components of the physical examination were not performed as was taught during precourses. Intra-class correlation was high for total scores of the physical examinations 0.91 (p <0.001) and for agreement on performance of the five physical examinations (0.79-0.92 p <0.001). CONCLUSIONS In conclusion, performance of the general physical examination was already below expectation at the end of the internal medicine clerkship. Possible causes and suggestions for improvement are discussed.
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Affiliation(s)
- Catharina M Haring
- Department of Internal Medicine (463), Radboud university medical center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Bernadette M Cools
- Department of Internal Medicine (463), Radboud university medical center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jos WM van der Meer
- Department of Internal Medicine (463), Radboud university medical center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Cornelis T Postma
- Department of Internal Medicine (463), Radboud university medical center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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van der Meer JWM, Vandenbroucke-Grauls CMJE. Resistance to selective decontamination: the jury is still out. The Lancet Infectious Diseases 2013; 13:282-3. [DOI: 10.1016/s1473-3099(13)70014-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Keijmel SP, Delsing CE, Sprong T, Bleijenberg G, van der Meer JWM, Knoop H, Bleeker-Rovers CP. The Qure study: Q fever fatigue syndrome--response to treatment; a randomized placebo-controlled trial. BMC Infect Dis 2013; 13:157. [PMID: 23536997 PMCID: PMC3620935 DOI: 10.1186/1471-2334-13-157] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/21/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Q fever is a zoonosis that is present in many countries. Q fever fatigue syndrome (QFS) is one of the most frequent sequelae after an acute Q fever infection. QFS is characterized by persistent fatigue following an acute Q fever infection, leading to substantial morbidity and a high socio-economic burden. The occurrence of QFS is well-documented, and has been described in many countries over the past decades. However, a treatment with proven efficacy is not available. Only a few uncontrolled studies have tested the efficacy of treatment with antibiotics on QFS. These studies suggest a positive effect of long-term treatment with a tetracycline on performance state; however, no randomized controlled trials have been performed. Cognitive behavioral therapy (CBT) has been proven to be an effective treatment modality for chronic fatigue in other diseases, but has not yet been tested in QFS. Therefore, we designed a trial to assess the efficacy of long-term treatment with the tetracycline doxycycline and CBT in patients with QFS. METHODS/DESIGN A randomized placebo-controlled trial will be conducted. One-hundred-eighty adult patients diagnosed with QFS will be recruited and randomized between one of three groups: CBT, long-term doxycycline or placebo. First, participants will be randomized between CBT and medication (ratio 1:2). A second double-blinded randomization between doxycycline and placebo (ratio 1:1) will be performed in the medication condition. Each group will be treated for six months. Outcome measures will be assessed at baseline and post intervention. The primary outcome measure is fatigue severity. Secondary outcome measures are functional impairment, level of psychological distress, and Coxiella burnetii PCR and serology. DISCUSSION The Qure study is the first randomized placebo-controlled trial, which evaluates the efficacy of long-term doxycycline and of cognitive behavioral therapy in patients with QFS. The results of this study will provide knowledge about evidence-based treatment options for adult patients with QFS. TRIAL REGISTRATION ClinicalTrials.gov: NCT01318356, and Netherlands Trial Register: NTR2797.
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Affiliation(s)
- Stephan P Keijmel
- Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Department of Internal Medicine and division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
| | - Corine E Delsing
- Department of Internal Medicine, Medical Spectrum Twente, P.O. Box 50000, 7500, Enschede, KA, the Netherlands
| | - Tom Sprong
- Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Department of Internal Medicine and division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Department of Internal Medicine and division of Infectious Diseases, Canisius Wilhelmina Hospital, P.O. Box 9015, 6500, Nijmegen, GS, the Netherlands
| | - Gijs Bleijenberg
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
| | - Jos WM van der Meer
- Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Department of Internal Medicine and division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
| | - Hans Knoop
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
| | - Chantal P Bleeker-Rovers
- Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Department of Internal Medicine and division of Infectious Diseases, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
- Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
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Ioana M, Ferwerda B, Farjadian S, Ioana L, Ghaderi A, Oosting M, Joosten LAB, van der Meer JWM, Romeo G, Luiselli D, Dediu D, Netea MG. High variability of TLR4 gene in different ethnic groups in Iran. Innate Immun 2011; 18:492-502. [DOI: 10.1177/1753425911423043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Infectious diseases exert a constant evolutionary pressure on the innate immunity genes. TLR4, an important member of the TLR family, specifically recognizes conserved structures of various infectious pathogens. Two functional TLR4 polymorphisms, Asp299Gly and Thr399Ile, modulate innate host defense against infections, and their prevalence between various populations has been proposed to be influenced by local infectious pressures. If this assumption is true, strong local infectious pressures would lead to a homogeneous pattern of these ancient TLR4 polymorphisms in geographically-close populations, while a weak selection or genetic drift may result in a diverse pattern. We evaluated TLR4 polymorphisms in 15 ethnic groups in Iran, to assess whether infections exerted selective pressures on different haplotypes containing these variants. The Iranian subpopulations displayed a heterogeneous pattern of TLR4 polymorphisms, comprising various percentages of Asp299Gly and Thr399Ile, alone or in combination. The Iranian sample, as a whole, showed an intermediate mixed pattern when compared with commonly-found patterns in Africa, Europe, Eastern Asia and the Americas. These findings suggest a weak, or absent, selection pressure on TLR4 polymorphisms in the Middle-East that does not support the assumption of an important role of these polymorphisms in the host defense against local pathogens.
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Affiliation(s)
- Mihai Ioana
- Radboud University Nijmegen Medical Centre, and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Department of Medicine, Nijmegen, The Netherlands
- Department of Molecular and Cellular Biology, University of Medicine and Pharmacy of Craiova, Romania
- University of Medicine and Pharmacy ‘Carol Davila’ Bucharest, Romania
| | - Bart Ferwerda
- Radboud University Nijmegen Medical Centre, and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Department of Medicine, Nijmegen, The Netherlands
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Shirin Farjadian
- Department of Immunology, Shiraz University of Medical Sciences, Shiraz, Iran
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Luiza Ioana
- Radboud University Nijmegen Medical Centre, and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Department of Medicine, Nijmegen, The Netherlands
| | - Abbas Ghaderi
- Shiraz Institute for Cancer Research, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marije Oosting
- Radboud University Nijmegen Medical Centre, and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Department of Medicine, Nijmegen, The Netherlands
| | - Leo AB Joosten
- Radboud University Nijmegen Medical Centre, and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Department of Medicine, Nijmegen, The Netherlands
| | - Jos WM van der Meer
- Radboud University Nijmegen Medical Centre, and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Department of Medicine, Nijmegen, The Netherlands
| | - Giovanni Romeo
- Unità di Genetica Medica, Policlinico Universitario S. Orsola-Malpighi, Bologna, Italy
| | - Donata Luiselli
- Dipartimento di Biologia Evoluzionistica Sperimentale, Fisiche e Naturali, Università di Bologna, Italy
| | - Dan Dediu
- Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
| | - Mihai G Netea
- Radboud University Nijmegen Medical Centre, and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Department of Medicine, Nijmegen, The Netherlands
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