Dit briefadvies maakt eerst kort de balans op van twee jaar oorlog. Vervolgens constateert de Raad dat de westerse consensus brozer wordt, dat er kantelpunten in zicht zijn en dat een langdurige... Show moreDit briefadvies maakt eerst kort de balans op van twee jaar oorlog. Vervolgens constateert de Raad dat de westerse consensus brozer wordt, dat er kantelpunten in zicht zijn en dat een langdurige patstelling dreigt. De vraag naar een adequate Nederlandse opstelling dient zich aan, ook voor de nieuw aan te treden regering. Het adviesrapport benadrukt de noodzaak van onverminderde Nederlandse en Europese steun aan Oekraïne en geeft aan dat Nederland zich proactiever moet voorbereiden op verschillende scenario’s voor de oorlog in Oekraïne en actief dient te streven naar de meest wenselijke uitkomsten, waaronder een overwinning voor Oekraïne of een sterke onderhandelingspositie voor het land.Het advies bespreekt daarna zes thema’s in meer detail: 1) de Europese veiligheidsarchitectuur; 2) de Europese defensie-industrie; 3) het perspectief op Oekraïens EU-lidmaatschap; 4) Oekraïne’s wederopbouw; 5) de gevolgen van de oorlog voor het mondiale Zuiden; en 6) weerbaarheid en draagvlak. Deze bespreking leidt tot een korte conclusie en een zestal aanbevelingen. Show less
Huberts-Bosch, A.; Bierens, M.; Ly V.; Velde, J. van der; Boer, H. de; Beek, G. van; ... ; Rommelse, N.N. 2023
The combination of chemotherapy and immune check-point inhibition (ICI) therapy is the current standard of care for most patients who are fit to undergo treatment for metastatic NSCLC. With this... Show moreThe combination of chemotherapy and immune check-point inhibition (ICI) therapy is the current standard of care for most patients who are fit to undergo treatment for metastatic NSCLC. With this combination, renal toxicity was slightly higher than with chemotherapy alone in initial clinical trials. However, in recent real-world data, loss of kidney function is reported to be more frequent. Both chemotherapy and ICI therapy can induce renal impairment, although the mechanism of renal damage is different. Renal injury from chemo-therapy is often ascribed to acute tubular injury and necrosis, whereas the main mechanism of injury caused by ICI therapy is acute tubulointerstitial nephritis. In cases of concomitant use of chemotherapy and ICI therapy, distinguishing the cause of renal failure is a challenge. Discriminating between these two causes is of utmost importance, as it would help assess which drug can be safely continued and which drug must be halted. This review aims to describe the underlying mecha-nisms of the renal adverse effects caused by chemo-therapy and ICI therapy, leading to a suggested diagnostic and treatment algorithm on the basis of clinical, laboratory, radiographic, and pathologic param-eters. This algorithm could serve as a supportive tool for clinicians to diagnose the underlying cause of acute kidney injury in patients treated with the combination of chemotherapy and immunotherapy. Show less
Bosch, A.; Bierens, M.; Wit. A.G. de; Ly, V.; Velde, J. van der; Boer, H. de; ... ; Rommelse, N.N. 2020
Background\methods\discussion\trial registrationFood may trigger Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms. Therefore, an elimination diet (ED) might be an effective treatment for... Show moreBackground\methods\discussion\trial registrationFood may trigger Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms. Therefore, an elimination diet (ED) might be an effective treatment for children with ADHD. However, earlier studies were criticized for the nature of the control group, potential confounders explaining the observed effects, unsatisfactory blinding, potential risks of nutritional deficiencies and unknown long term and cost-effectiveness. To address these issues, this paper describes the rationale, study design and methods of an ongoing two arm randomized controlled trial (RCT) comparing the short (5 week) and long term (1 year) effects of an elimination diet and a healthy diet compared with care as usual (CAU) in children with ADHD.\nA total of N = 162 children (5-12 years) with ADHD will be randomized to either an ED or a healthy diet. A comparator arm including N = 60 children being solely treated with CAU (e.g. medication) is used to compare the effects found in both dietary groups. The two armed RCT is performed in two youth psychiatry centers in the Netherlands, with randomization within each participating center. The primary outcome measure is response to treatment defined as a ≥ 30% reduction on an ADHD DSM-5 rating scale (SWAN) and/or on an emotion dysregulation rating scale (SDQ: dysregulation profile). This is assessed after 5 weeks of dietary treatment, after which participants continue the diet or not. Secondary outcome measures include the Disruptive Behavior Diagnostic Observational Schedule (DB-DOS), parent and teacher ratings of comorbid symptoms, cognitive assessment (e.g. executive functions), school functioning, physical measurements (e.g. weight), motor activity, sleep pattern, food consumption, nutritional quality of the diet, adherence, parental wellbeing, use of health care resources and cost-effectiveness. Assessments take place at the start of the study (T0), after five weeks (T1), four months (T2), eight months (T3) and 12 months of treatment (T4). T0, T1 and T4 assessments take place at one of the psychiatric centers. T2 and T3 assessments consist of filling out online questionnaires by the parents only.\nThis RCT will likely contribute significantly to clinical practice for ADHD by offering insight into the feasibility, nutritional quality, (cost-)effectiveness and long term effects of dietary treatments for ADHD.\nwww.trialregister.nl, NTR5434. Registered at October 11th, 2015. Show less
Valitalo, P.A.J.; Griffioen, K.; Rizk, M.; Visser, S.; Danhof, M.; Rao, M.; ... ; Hasselt, J.G.C. van 2015
