JointCalc: A web-based personalised patient decision support tool for joint replacement

Background and purpose Health information systems (HIS) are expected to be effective and efficient in improving healthcare services, but empirical observation of HIS reveals that most perform poorly in terms of these metrics. Theoretical factors of HIS performance are widely studied, and solutions to mitigate poor performance have been proposed. In this paper we implement effective methods to eliminate some common drawbacks of HIS design and demonstrate the synergy between the methods. JointCalc, the first comprehensive patient-facing web-based decision support tool for joint replacement, is used as a case study for this purpose. Methods and results User-centred design and thorough end-user involvement are employed throughout the design and development of JointCalc. This is supported by modern software production paradigms, including continuous integration/continuous development, agile and service-oriented architecture. The adopted methods result in a user-approved application delivered well within the scope of project. Conclusion This work supports the claims of high potential efficiency of HIS. The methods identified are shown to be applicable in the production of an effective HIS whilst aiding development efficiency

Mast cells, eosinophils and IgE-positive cells in the nasal mucose of patients with vasomotor rhinitis - An immunohistochemical study

Vasomotor rhinitis (VMR) is a disorder of unknown pathogenesis. Forty patients with VMR were carefully selected on the basis of inclusion and exclusion criteria proposed by Mygind and Weeke. Nasal biopsy specimens were taken in the patient group as well as in a group of ten controls. Brush cytology was also taken in the VMR group. Inflammatory cells were identified and counted in the nasal mucosa, with the use of immunohistochemical techniques and a panel of monoclonal antibodies. Eosinophils were studied with the use of BMK13, EG2, and Giemsa. Mast cells were studied with anti-chymase (B7), anti-tryptase (G3) and toluidine blue. Sections were stained with IgE as well. There was no significant difference in the number of eosinophils, mast cells and IgE-positive cells between the two groups. Additionally, in contrast with other reports, in sections that were double-stained with anti-chymase and anti-tryptase, single chymase-positive cells were found

Nonequilibrium Josephson effect in mesoscopic ballistic multiterminal SNS junctions

We present a detailed study of nonequilibrium Josephson currents and conductance in ballistic multiterminal SNS-devices. Nonequilibrium is created by means of quasiparticle injection from a normal reservoir connected to the normal part of the junction. By applying a voltage at the normal reservoir the Josephson current can be suppressed or the direction of the current can be reversed. For a junction longer than the thermal length, $L\gg\xi_T$, the nonequilibrium current increases linearly with applied voltage, saturating at a value equal to the equilibrium current of a short junction. The conductance exhibits a finite bias anomaly around $eV \sim \hbar v_F/L$. For symmetric injection, the conductance oscillates $2\pi$-periodically with the phase difference $\phi$ between the superconductors, with position of the minimum ($\phi=0$ or $\pi$) dependent on applied voltage and temperature. For asymmetric injection, both the nonequilibrium Josephson current and the conductance becomes $\pi$-periodic in phase difference. Inclusion of barriers at the NS-interfaces gives rise to a resonant behavior of the total Josephson current with respect to junction length with a period $\sim \lambda_F$. Both three and four terminal junctions are studied.Comment: 21 pages, 19 figures, submitted to Phys. Rev.

Towards optimal use of antithrombotic therapy of people with cancer at the end of life: a research protocol for the development and implementation of the SERENITY shared decision support tool Thrombosis Research

Background: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs. Methods: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe.Results: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life. Conclusions: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers

A theory of personalisation of appearance: quantitative evaluation of qualitatively derived data

Using qualitative data, Blom and Monk (2003) derived a theory of why people choose to personalise the appearance of their PCs and mobile phones. This paper describes some quantitative data that provide some support for, and some modifications to, the theory. Individuals having personal home pages were recruited to fill in a questionnaire that assesses dispositions to personalise and its effects. In addition the 82 home pages were inspected to assess the extent of personalisation. This correlated significantly with the dispositions 'Frequency of Use' and 'Knowledge of Personalisation'. The questionnaire items corresponding to effects were factor analysed. A four-factor solution suggested item groupings similar, but not identical, to those used in the theory. There are significant positive correlations between the extent of personalisation and cognitive effects and enduring emotional effects. The value of quantitative data for confirming and refining a qualitative theory is discussed

Heeft de biologische glastuinbouw toekomst

Biologische glastuinbouw moet nog verder verbeteren. Onderzoekers, adviseurs en ondernemers hebben samengewerkt in het project 'de biologische kringloopkas'. De concepten die zijn ontwikkeld moeten nu door ondernemers verder worden opgepakt en uitgewerkt

Acceptance of preventive treatment in migraine patients: results of a survey

Item does not contain fulltextBACKGROUND: The number of migraine patients eligible for preventive treatment is considerably higher than the number of patients actually using it. This study explores reasons for this discrepancy. METHODS: An explorative survey among patients and their general practitioners (GPs) participating in a trial on preventive medication. Migraine patients who were eligible for preventive treatment (n = 75) attended an evaluation consultation with their GP to optimize migraine treatment. GPs and patients who did not start preventive treatment were asked if they had discussed the possibility of preventive treatment and, if so, why they decided not to start it. RESULTS: Of the 32 GPs, 8 (25%) did not discuss the possibility of preventive treatment with their patients; in 4 because of perceived lack of effectiveness. Patients who did not start preventive treatment (n = 43) used less triptans and had less psychological distress compared to those who did start (n = 32). Main reasons for patients not starting were negative attitudes towards medication in general, fear of medication side-effects, previous unsuccessful attempts, attacks not being severe enough, and impact of migraine on daily life acceptable. CONCLUSION: The decision of the individual patient and their GP to start preventive treatment is not only determined by attack frequency, but also depends on the impact of the headache attacks on their daily life and their negative attitude towards medication

Law as rules of behavioural choice : an exploration of jurisprudential systems

OBJECTIVE: To interpret questionnaire scores, clinicians and researchers need to know what change in score reflects a meaningful change in the condition of an individual patient, and what difference reflects a meaningful difference between groups. These values differ between different populations. We determined the within-person minimally important change (MIC) and the between-group minimally important difference (MID) of the Headache Impact Test-6 (HIT-6) questionnaire in a primary-care population of migraine patients. METHODS: We included 490 patients who participated in a clinical trial on the treatment of migraine in primary care. We compared their change scores on the HIT-6 questionnaire between baseline and at three-months follow-up with the answers to two anchor questions according to the 'mean change approach' and the 'ROC curve approach'. RESULTS: The within-person MIC was estimated to be between -2.5 points (mean change approach) and -6 points (ROC curve approach). The choice for the within-person MIC value depends on the consequences of false positives and false negatives in a particular setting. The between-group MID was estimated at -1.5 points. CONCLUSIONS: We determined the within-person MIC and between-group MID for the HIT-6 in a primary-care population of migraine patients. We recommend the use of these values for clinical care and for research