Sturen met ZZP's?!

Inleiding. De ouderenzorg in Nederland is aan verandering onderhevig. Kleinschalig wonen, vraaggericht werken, de normen verantwoorde zorg en certificering om kwaliteit van zorg aan te tonen zijn steeds terugkerende onderwerpen. Naast deze aspecten die vooral gaan over de kwaliteit van zorg, is de financiering van de zorg een belangrijk onderwerp. De geleidelijke invoering en bekostiging middels zorgzwaartepakketten is namelijk vanaf 1 januari 2009 begonnen. Om zowel efficiënter werken als verbetering van de kwaliteit van zorg in de ouderenzorg mogelijk te maken, lijkt personeel het sleutelwoord. De personeelskosten van een zorginstelling bepalen gemiddeld tachtig procent van de totale kosten. Bovendien is het personeel de spil van de zorgverlening en is het de belangrijkste factor bij het leveren van kwalitatief hoogwaardige zorg. Door een goede personeelsplanning kan een zorginstelling efficiënter werken en kan zij haar beschikbare middelen zo doelmatig mogelijk inzetten (Eveborn et al., 2005). De invoering van de zorgzwaartepakketten kan voor zorginstellingen daarom een goede aanleiding vormen om de personeelsplanning onder de loep te nemen en waar mogelijk verbeteringen toe te passen. In dit artikel wordt bekeken op welke manier de personeelsplanning in de ouderenzorg het beste vormgegeven kan worden op basis van de ZZP-financiering

Utilisation of cardiac pacemakers over a 20-year period: Results from a nationwide pacemaker registry

The implantation of cardiac pacemakers has become a well-established therapy for conduction disorders and sinus node dysfunction. In many countries pacemaker registries have been initiated in order to collect information on patient characteristics, trends in numbers and the types of pacemakers used, to identify problematic devices, and for safety monitoring. For this utilisation study the Central Pacemaker Patients Registration (CPPR) from the Netherlands Pacemaker Registry Foundation (CPPR-SPRN) containing data collected for more than 20 years was used. During this period nearly 97,000 first pacemakers were implanted. Analyses show an increase in the rate of implanted devices. The change in pacemaker type from VVI to DDD, followed by biventricular stimulation, is reflected by the number of simultaneously implanted leads, which is partly a consequence of cardiac resynchronisation therapy. Our data demonstrate that indications for implantation and type of pacemaker are comparable with other European countries

3D-DART: a DNA structure modelling server

There is a growing interest in structural studies of DNA by both experimental and computational approaches. Often, 3D-structural models of DNA are required, for instance, to serve as templates for homology modeling, as starting structures for macro-molecular docking or as scaffold for NMR structure calculations. The conformational adaptability of DNA when binding to a protein is often an important factor and at the same time a limitation in such studies. As a response to the demand for 3D-structural models reflecting the intrinsic plasticity of DNA we present the 3D-DART server (3DNA-Driven DNA Analysis and Rebuilding Tool). The server provides an easy interface to a powerful collection of tools for the generation of DNA-structural models in custom conformations. The computational engine beyond the server makes use of the 3DNA software suite together with a collection of home-written python scripts. The server is freely available at http://haddock.chem.uu.nl/dna without any login requirement

COMPTEL observations of the inner galaxy

This paper presents a first global study of COMPTEL observations of the inner Galaxy in the energy range 0.75–10 MeV. Preliminary findings demonstrate COMPTEL’s capabilities for mapping the observed gamma radiation and disentangling the contributions from point sources and diffuse emission

Determinants of delay in the head and neck oncology care pathway:The next step in value-based health care

Objective Head and neck squamous cell carcinomas (HNSCC) are relatively fast-growing tumours, and delay of treatment is associated with tumour progression and adverse outcomes. The aim of this study is to identify determinants of delay in a head and neck oncology centre. Methods This cohort study with prospectively collected data investigated associations between patient (including geriatric assessment at first consultation), tumour and treatment characteristics and treatment delay. Two quality indicator intervals assessing value-based healthcare were studied: care pathway interval (CPI, interval between first visit in an HNOC and treatment initiation) and time-to-treatment initiation (TTI, interval between histopathological confirmation of HNSCC and treatment initiation), using regression analyses. Results Stage-IV tumours and initial radiotherapy were independent predictors of delay in CPI. Initial radiotherapy was associated with delay in TTI. Overall, 37% of the patients started treatment within 30 days after first consultation (67% in case of initial surgical treatment and 11.5% if treated with (chemo)radiation, p <0.001). Geriatric assessment outcomes were not associated with delay. Indicators for delay in initial surgery patients were stage-IV tumours (CPI). Conclusion The majority of HNSCC patients encounter delay in treatment initiation, specifically in patients with advanced-stage tumours or when radiotherapy is indicated

Text-mining in electronic healthcare records can be used as efficient tool for screening and data collection in cardiovascular trials: a multicenter validation study

Objective: This study aimed to validate trial patient eligibility screening and baseline data collection using text-mining in electronic healthcare records (EHRs), comparing the results to those of an international trial. Study Design and Setting: In three medical centers with different EHR vendors, EHR-based text-mining was used to automatically screen patients for trial eligibility and extract baseline data on nineteen characteristics. First, the yield of screening with automated EHR text-mining search was compared with manual screening by research personnel. Second, the accuracy of extracted baseline data by EHR text mining was compared to manual data entry by research personnel. Results: Of the 92,466 patients visiting the out-patient cardiology departments, 568 (0.6%) were enrolled in the trial during its recruitment period using manual screening methods. Automated EHR data screening of all patients showed that the number of patients needed to screen could be reduced by 73,863 (79.9%). The remaining 18,603 (20.1%) contained 458 of the actual participants (82.4% of participants). In trial participants, automated EHR text-mining missed a median of 2.8% (Interquartile range [IQR] across all variables 0.4e8.5%) of all data points compared to manually collected data. The overall accuracy of automatically extracted data was 88.0% (IQR 84.7e92.8%). Conclusion: Automatically extracting data from EHRs using text-mining can be used to identify trial participants and to collect baseline informatio

Нейросекреторная активность супраоптического ядра переднего гипоталамуса кроликов под действием транскутанной электростимуляции зрительного анализатора

На 8 кролях породи Метелик вивчали вплив непрямої черезшкірної електростимуляції зорового аналізатора на нейросекреторну активність магноцелюлярних клітин супраоптичного ядра переднього гіпоталамусу. На мікропрепаратах інтактних тварин переважали нейрони II морфофункціонального типу, що перебувають у стадії синтезу нейросекрету. Показано, що за дії электростимуляції спостерігається перерозподіл головних морфо-функціональних типів нейронів. Відзначено збільшення змісту клітин I й III типів, відповідно у стадіях спокою після виведення секрету й накопичення, що вказує на активацію процесів звільнення нейросекрету і його акумуляції. Виразність реакції нервової тканини однакова при силі стимулюючого струму 100 мкА й 300 мкА.The influence of indirect through-skin electrostimulation (different doses) of the optical analyser on neurosecretory activity of anterior hypothalamus magnocellular nucleus was stading during chronic experiment. The stady was carried out on rabbits. Five morphological types of neurons was exposed in the supraoptical nucleus of control animal groop: I type- phase of rest after neurosecrets leading, II- phase of synthesis, III- phase of accumulation, IV - leading phase, V - phase of degerneration, but neurons of II types was prevalenced (51%). The indirect electrostimulation of the optical analyser provokes quantitative changes of keeping same neurons types. The number of I and III types neurons increases (on 20% and 7%) . The kind of changes is indicative of electrostimulation activation influense on neurosecrets leading and accumulation. Expression of nervous tissue reaction was identical under different doses (100 mkA and 300 mkA) of afferent electrostimulation

The Prebiotic Inulin Aggravates Accelerated Atherosclerosis in Hypercholesterolemic APOE*3-Leiden Mice

Vascular Surger

Occupational exposure to gases/fumes and mineral dust affect DNA methylation levels of genes regulating expression

Many workers are daily exposed to occupational agents like gases/fumes, mineral dust or biological dust, which could induce adverse health effects. Epigenetic mechanisms, such as DNA methylation, have been suggested to play a role. We therefore aimed to identify differentially methylated regions (DMRs) upon occupational exposures in never-smokers and investigated if these DMRs associated with gene expression levels. To determine the effects of occupational exposures independent of smoking, 903 never-smokers of the LifeLines cohort study were included. We performed three genome-wide methylation analyses (Illumina 450 K), one per occupational exposure being gases/fumes, mineral dust and biological dust, using robust linear regression adjusted for appropriate confounders. DMRs were identified using comb-p in Python. Results were validated in the Rotterdam Study (233 never-smokers) and methylation-expression associations were assessed using Biobank-based Integrative Omics Study data (n = 2802). Of the total 21 significant DMRs, 14 DMRs were associated with gases/fumes and 7 with mineral dust. Three of these DMRs were associated with both exposures (RPLP1 and LINC02169 (2x)) and 11 DMRs were located within transcript start sites of gene expression regulating genes. We replicated two DMRs with gases/fumes (VTRNA2-1 and GNAS) and one with mineral dust (CCDC144NL). In addition, nine gases/fumes DMRs and six mineral dust DMRs significantly associated with gene expression levels. Our data suggest that occupational exposures may induce differential methylation of gene expression regulating genes and thereby may induce adverse health effects. Given the millions of workers that are exposed daily to occupational exposures, further studies on this epigenetic mechanism and health outcomes are warranted