General practice registration networks in the Netherlands: a brief report

In the Netherlands, several general practice registrations exist. Groups of general practitioners register elements of patient care according to agreed-upon criteria, and these data are collected in a central database. By means of a questionnaire the authors interviewed the managers of all nine computerized registration networks extensively about the possibilities and limitations of their registration. In addition, respondents answered some questions with data from the central database of their network. Various items are collected by nearly all the registration networks, while other items are collected by only one network. Answering questions with data from the central database turned out to be difficult. Organization and manpower are the main obstacles

Green Care kuntoutumisen tukena mielenterveyskuntoutujien palvelukodissa

Tämän opinnäytetyön tavoitteena oli suunnitella ja toteuttaa Green Care-menetelmillä toiminnallisia ryhmiä. Ryhmien tavoitteena oli selvittää mielenterveyskuntoutujien kokemuksia eräässä mielenterveys- ja päihdekuntoutujien palvelukodissa. Opinnäytetyön tavoitteena oli myös tarkastella Green Care-menetelmien merkitystä palvelukodin asiakkaiden kuntoutumiseen. Opinnäytetyön tarkoituksena oli myös lisätä mielenterveys- ja päihdekuntoutujien palvelukodin palvelutarjontaa ja toimintatapoja Green Care-menetelmien avulla. Palvelukoti tarjoaa asumis-, kuntoutus- ja tukipalveluja 30:lle päihde- ja mielenterveyskuntoutujalle ja siellä noudatetaan yhteisöllisyyden periaatteita. Opinnäytetyön viitekehyksessä kuvaan erilaisia Green Care-menetelmiä ja niiden hyvinvointivaikutuksia sekä Green Caren etiikkaa. Kerron myös Green Care-käsitteestä, sen historiasta sekä esiintymisestä Suomessa. Green Care-toimintaa pidetään sateenvarjokäsitteenä erilaisille luontolähtöisille ja eläinavusteisille menetelmille, joilla pyritään edistämään ihmisten sosiaalista, fyysistä, psyykkistä ja koulutuksellista hyvinvointia. Green Care-toiminnan keskeisimmät elementit ovat luonto, luonnossa tapahtuva ja luontoelementtejä käyttävä toiminta sekä yhteisö, jossa toiminta tapahtuu. Teoriaosuudessa kerron myös mielenterveyskuntouksesta, sen käsitteistä ja kuntoutuksen prosessista. Kuvaan myös kuntoutusvalmiutta ja toimintakyvyn arviointia sekä mielenterveystyön etiikkaa. Mielenterveys on hyvinvoinnin tila, jossa ihminen näkee omat kykynsä selviytyä elämän haasteista ja työstä ja ottaa osaa yhteisönsä toimintaan. Opinnäytetyö on toiminnallinen opinnäytetyö, jonka tutkimuksellisessa osuudessa on käytetty osallistuvaa havainnointia ja avointa haastattelua. Haastattelut olivat ryhmähaastatteluja ja kolmelle asiakkaalle tehtiin myös yksilöhaastattelut. Tutkimuksen tulokset on analysoitu teemoittelun avulla. Sekä havaintojen että haastattelujen perusteella palvelukodin asiakkaat kokivat Green Care-menetelmät positiivisina, aktivoivina ja erilaisia hyvinvointivaikutuksia tuottavina. Yleisimmin koettu hyvinvointivaikutus oli menetelmien rauhoittava vaikutus. Green Care-toiminnan merkitystä palvelukodin mielenterveyskuntoutujille oli vaikea arvioida neljän toimintakerran avulla, mutta viitteitä antavana tuloksena voidaan pitää kahden asiakkaan toimintakyvyn lisääntymistä toiminnan aikana. Palvelukodin asiakkaat osallistuivat Green Care-menetelmillä toteutettuihin toimintaryhmiin aktiivisemmin kuin koskaan aikaisemmin ulkopuolisen tahon järjestämään toimintaan. Näiden kokemusten vuoksi palvelukoti aikoo hyödyntää jatkossa luontolähtöisiä menetelmiä enemmän palveluissaan. Opinnäytetyön tulokset ovat hyvin saman suuntaiset kuin Green Care-toiminnasta tehdyissä tutkimuksissa Suomessa ja ulkomailla. Menetelmien hyvinvointivaikutuksista on olemassa paljon näyttöä erilaisille asiakasryhmille. Mielenterveys- ja päihdekuntoutujien palvelukodissa, jossa opinnäytetyö tehtiin, ei ollut aikaisemmin juurikaan hyödynnetty luontoa asiakkaiden kuntoutumisen tukena. Neljä toimintakertaa oli melko lyhyt aika arvioida, miten Green Care-toiminnat tukevat asiakkaiden kuntoutumista palvelukodissa, joten toivon, että asiaa tutkitaan lisää, kun palvelukodissa on käytetty Green Care-toimintoja vähintään vuoden ajan.Using Green Care methods to support rehabilitation of mental health rehabilitees in a service flat. This thesis goal was to plan and help groups with certain functions and “Green Care” methods. The main goal of the groups was to find out about the experiences of mental health rehabilitees in one mental health and drug addict institution. The idea of the thesis was also to study the meaning of “Green Care” methods in the rehabilitation of rehabilitees in the institution. The goal was to increase the services and methods in the mental health and drug addict institution using “Green Care” methods. The service flats provide housing, rehabilitation and other support services to 30 mental health and drug addict rehabilitees and they try to bring a community spirit within the service. In the framework of the thesis I give information about the different “Green Care” methods, the welfare effects and the ethics of “Green Care”. I also described the concept of “Green Care”, its history and its appearance in Finland. “Green Care” methods are known as a rainbow concept of different methods were nature and animals play a part in advancing humans` social, physical, metal and educational welfare. The main elements in “Green Care” methods are nature, activities in nature and the use of nature elements. Also the community were the actions take place is important. In the theory part I wrote about mental health rehabilitation, concepts and the process of rehabilitation. I described the willingness for rehabilitation, the ability to function and the ethics of mental work. Mental health is a state of welfare where you can see your ability to survive the challenges of life and work and you can take part in a community’s functions. The thesis is a functional thesis in which there was used an examinational part, participating observation and open interviews. The interviews were group interviews and three customers also participated in the individual interviews. The results of the examination were analysed using the theme method. When analysing the results of the examination it was discovered that the customers of the mental health and drug addict institution found “Green Care” methods positive, activating and providing welfare. The customers found that the methods had a calming effect. The meaning of “Green Care” methods to the institutions rehabilitees was hard to estimate based on four visits to the service flats. But some progress was seen on two rehabilitees ability to function during the time “Green Care” methods were used. The customers in the service flats participated more willingly to functioning groups using “Green Care” methods than to any other functioning groups that were organized by an outsider. Because of these experiences the institution will use more nature based methods in its services. The results of the thesis are very similar to other examinations made in Finland and other countries about “Green Care” methods. The welfare effects of the methods used show various evidence using different customer groups. Nature was hardly ever used as a method of rehabilitation for the customers in the mental health and drug addict institution in which the thesis was made. Four times using the methods was quite a short time to evaluate how “Creen Care” methods was quite a short time to evaluate how “Green Care” methods support the rehabilitation of the customers in the service flat so I hope that there is a possibility to study the rehabilitees more when the methods are used at least for a year

Coronavirus disease 2019 scenarios for a long-term strategy under fundamental uncertainty

Early on, scientists have pointed out that coronavirus disease 2019 is most likely here to stay, although its course and development are uncertain. This requires a long-term strategy of living with the virus. However, the urgency of new waves of infection and the emergence of new variants have invoked an approach of acute crisis management over and over, hindering the design of a structural approach for the long term. Exploratory scenarios can provide scientific strategic guidance to policy processes to be better prepared in this situation of fundamental uncertainty. We have therefore developed five scenarios, which describe the possible long-term development of the pandemic from an epidemiological, virological, and broader societal perspective. These scenarios are based on four driving forces that are both important and uncertain: immunity, vaccination, mutations, and human behavior. The scenarios are (1) return to normal, (2) flu+, (3) external threat, (4) continuous struggle, and (5) worst case. Working with scenarios is crucial for appropriate public communication and provides guidance for anticipating the various conceivable possibilities for the further course of the pandemic

Defining antimicrobial prescribing quality indicators: what is a new prescription?

Contains fulltext : 95791.pdf (publisher's version ) (Open Access): Since guidelines on antibiotic drug treatment often focus on appropriate first choice drugs, assessment of guideline adherence should only concentrate on the first drug prescribed, and not on subsequent antibiotics prescribed after failure of the first one. PURPOSE: To determine a valid cut-off point for a definition of "first" or "new" prescription in indicators for the assessment of the quality of antibiotic drug treatment on the basis of pharmaceutical data. METHODS: Three possible definitions for the term "new prescription" were compared, based on three different periods of time, viz. more than 35, 28, or 21 days after starting a previous antibiotic. In an observational study, 1,225 antimicrobial prescriptions from the medical files of five family practices were audited ("clinical classification") and compared with a classification based on the three definitions ("technical classification"). Agreement between these clinical and technical classifications was determined by calculating Cohen's kappa. The technical classification was analyzed as a diagnostic test, using the clinical classification as the gold standard, and sensitivity, specificity, likelihood ratios, and post-test probabilities were calculated. RESULTS: Defining "new prescription" as "more than 35 days after a previous prescription was issued" resulted in a Cohen's kappa of 0.93 (95% CI 0.92-0.98). The diagnostic value of this definition was extremely high, with a sensitivity of 0.976, specificity of 0.987, positive likelihood ratio of 77.7, and negative likelihood ratio of 0.02. CONCLUSION: We recommend using a cut-off value of 35 days since the last antimicrobial prescription as the definition of a "new prescription" when no diagnostic information is available, i.e., when using pharmaceutical data to assess the quality of antibiotic prescribing behavior.01 januari 201

Comparative Effectiveness Research: Challenges for Medical Journals

Editors from a number of medical journals lay out principles for journals considering publication of Comparative Effectiveness Research (CER). In order to encourage dissemination of this editorial, this article is freely available in PLoS Medicine and will be also published in Medical Decision Making, Croatian Medical Journal, The Cochrane Library, Trials, The American Journal of Managed Care, and Journal of Clinical Epidemiology

Chronic non-specific abdominal complaints in general practice: a prospective study on management, patient health status and course of complaints

BACKGROUND: While in general practice chronic non-specific abdominal complaints are common, there is insufficient data on the clinical course and the management of these complaints. Aim of this study was to present a primary care based profile of these chronic complaints including health care involvement, health status and clinical course. METHODS: Thirty general practitioners (GPs) and patients from their practices participated in a prospective follow-up study. All patients and GPs were asked to complete questionnaires at baseline and at 6, 12 and 18 months of follow-up. The GPs provided information on diagnostic and therapeutic management and on referral concerning 619 patients with chronic non-specific abdominal complaints, while 291 patients provided information about health status and clinical course of the complaints. RESULTS: When asked after 18 months of follow-up, 51,7% of the patients reported an equal or worsened severity of complaints. General health perception was impaired and patients had high scores on SCL-anxiety and SCL-depression scales. Diagnostic tests other than physical examination and laboratory tests were not frequently used. Medication was the most frequent type of treatment. The persistence of chronic non-specific abdominal complaints was quite stable. CONCLUSION: Once non-specific chronic abdominal complaints have become labelled as chronic by the attending physician, little improvement can be expected. The impact on patients' physiological and psychological well-being is large. GPs use a variety of diagnostic and therapeutic strategies. Research into the evidence base of currently applied management strategies is recommended