100 research outputs found
The effect of cognitive impairment on the predictive value of multimorbidity for the increase in disability in the oldest old: the Leiden 85-plus Study
Background: prevention of disability is an important aim of healthcare for older persons. Selection of persons at risk is a first crucial step in this process
Cost-effectiveness of a multicomponent primary care program targeting frail elderly people
Contains fulltext :
191679.pdf (publisher's version ) (Open Access
Continuous quantification of transcription factor dynamics in individual hematopoietic stem and progenitor cells
STUDY DESIGN: Systematic review of clinical guidelines. OBJECTIVES: To assess the methodologic quality of existing guidelines for the management of acute low back pain. SUMMARY OF BACKGROUND DATA: Guidelines are playing an increasingly important role in evidence-based practice. After publication of the Quebec Task Force in Canada in 1987 and the Agency for Health Care Policy and Research guidelines in the United States in 1994, guidelines for acute low back pain were developed in many other countries. However, little is known about the methodologic quality of these guidelines. METHODS: Guidelines were selected by electronically searching MEDLINE and the Internet and through personal communication with experts in the field of low back pain research in primary care. The methodologic quality of the guidelines was assessed by two authors independently using the AGREE instrument. RESULTS: A total of 17 guidelines were included. Overall, the quality of reporting of guidelines was disappointing. Most guidelines clearly described the aim of the guideline and its target population, and most guideline development committees were multiprofessional. However, many other methodologic flaws were identified. More than half of the guidelines did not take patients' preferences into account, did not perform a pilot test among target users, did not clearly describe the methods of study identification and selection, did not include an external review, did not provide a procedure for updating, were not supported with tools for application, did not consider potential organizational barriers and cost implications, did not provide criteria for monitoring and audit, did not include recommendations for implementation strategies, and did not adequately record editorial independence and conflict of interest of the members. The diagnostic and therapeutic recommendations of the guidelines were largely similar. CONCLUSIONS: The quality and transparency of the development process and the consistency in the reporting of primary care guidelines for low back pain need to be improved
Cochrane corner: Is integrated disease management for patients with COPD effective?
Patients with COPD experience respiratory
symptoms, impairments of daily living and recurrent
exacerbations. The aim of integrated disease
management (IDM) is to establish a programme of
different components of care (ie, self-management,
exercise, nutrition) in which several healthcare providers
(ie, nurses, general practitioners, physiotherapists,
pulmonologists) collaborate to provide efficient and good
quality of care. The aim of this Cochrane systematic
review was to evaluate the effectiveness of IDM on
quality of life, exercise tolerance and exacerbation related
outcomes. Searches for all available evidence were
carried out in various databases. Included randomised
controlled trials (RCTs) consisted of interventions with
multidisciplinary (≥2 healthcare providers) and
multitreatment (≥2 components) IDM interventions with
duration of at least 3 months. Two reviewers
independently searched, assessed and extracted data of
all RCTs. A total of 26 RCTs were included, involving
2997 patients from 11 different countries with a followup
varying from 3 to 24 months. In all 68% of the
patients were men, with a mean age of 68 years and a
mean forced expiratory volume in 1 s (FEV1) predicted
value of 44.3%. Patients treated with an IDM
programme improved significantly on quality of life
scores and reported a clinically relevant improvement of
44 m on 6 min walking distance, compared to controls.
Furthermore, the number of patients with ≥1 respiratory
related hospital admission reduced from 27 to 20 per
100 patients. Duration of hospitalisation decreased
significantly by nearly 4 days
Asthma control cost-utility randomized trial evaluation (ACCURATE): the goals of asthma treatment
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97659.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Despite the availability of effective therapies, asthma
remains a source of significant morbidity and use of health care resources. The
central research question of the ACCURATE trial is whether maximal doses of
(combination) therapy should be used for long periods in an attempt to achieve
complete control of all features of asthma. An additional question is whether
patients and society value the potential incremental benefit, if any,
sufficiently to concur with such a treatment approach. We assessed patient
preferences and cost-effectiveness of three treatment strategies aimed at
achieving different levels of clinical control: 1. sufficiently controlled asthma
2. strictly controlled asthma 3. strictly controlled asthma based on exhaled
nitric oxide as an additional disease marker DESIGN: 720 Patients with mild to
moderate persistent asthma from general practices with a practice nurse, age
18-50 yr, daily treatment with inhaled corticosteroids (more then 3 months usage
of inhaled corticosteroids in the previous year), will be identified via patient
registries of general practices in the Leiden, Nijmegen, and Amsterdam areas in
The Netherlands. The design is a 12-month cluster-randomised parallel trial with
40 general practices in each of the three arms. The patients will visit the
general practice at baseline, 3, 6, 9, and 12 months. At each planned and
unplanned visit to the general practice treatment will be adjusted with support
of an internet-based asthma monitoring system supervised by a central
coordinating specialist nurse. Patient preferences and utilities will be assessed
by questionnaire and interview. Data on asthma control, treatment step, adherence
to treatment, utilities and costs will be obtained every 3 months and at each
unplanned visit. Differences in societal costs (medication, other (health) care
and productivity) will be compared to differences in the number of limited
activity days and in quality adjusted life years (Dutch EQ5D, SF6D, e-TTO, VAS).
This is the first study to assess patient preferences and cost-effectiveness of
asthma treatment strategies driven by different target levels of asthma control.
Trial registration: Netherlands Trial Registration NTR1756
Public transport policy in the Netherlands
Dutch public transport as a part of transport policy.Institute of Transport and Logistics Studies. Faculty of Economics and Business. The University of Sydne
Exploring the variation in implementation of a COPD disease management programma and its impact on health outcomes
This study aims to (1) examine the variation in implementation of a 2-year chronic obstructive pulmonary disease (COPD) management programme called RECODE, (2) analyse the facilitators and barriers to implementation and (3) investigate the influence of this variation on health outcomes. Implementation variation among the 20 primary-care teams was measured directly using a self-developed scale and indirectly through the level of care integration as measured with the Patient Assessment of Chronic Illness Care (PACIC) and the Assessment of Chronic Illness Care (ACIC). Interviews were held to obtain detailed information regarding the facilitators and barriers to implementation. Multilevel models were used to investigate the association between variation in implementation and change in outcomes. The teams implemented, on average, eight of the 19 interventions, and the specific package of interventions varied widely. Important barriers and facilitators of implementation were (in)sufficient motivation of healthcare provider and patient, the h
Effectiveness of integrated disease management for primary care chronic obstructive pulmonary disease patients: results of cluster randomised trial.
__Objective__ To investigate the long term effectiveness of integrated disease management delivered in primary care on quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with usual care.
__Design__ 24 month, multicentre, pragmatic cluster randomised controlled trial
__Setting__ 40 general practices in the western part of the Netherlands
__Participants__ Patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse, and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team.
__Intervention__ General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating integrated disease management in practice, including early recognition of exacerbations and self management, smoking cessation, physiotherapeutic reactivation, optimal diagnosis, and drug adherence. Additionally, the course served as a network platform and collaborating healthcare providers designed an individual practice plan to integrate integrated disease management into daily practice. The control group continued usual care (based on
Parents' underestimation of their child's weight status. Moderating factors and change over time: A cross-sectional study
BACKGROUND: Parents' underestimation of their child's weight status can hinder active participation in overweight prevention programs. We examined the level of agreement between the parents' perception of their child's weight status and the child's actual weight status, moderating factors, and change over time. METHODS: This cross-sectional study used data collected in 2009 (n = 8105), 2013 (n = 8844) and 2017 (n = 11,022) from a community-based survey conducted among parents of children age 2-12 years in the Netherlands. Parents classified their perception of their child's weight status on a 5-point Likert scale. In 2009 and 2013, the child's BMI was calculated from self-reported data by parents. The level of agreement between the parent's perception of the weight status and the actual weight status was examined using Cohen's kappa. The role of demographic factors on parents' perception were examined using logistic regression. RESULTS: In 2009, 2013 and 2017, 6%, 6% and 5% of the parents, respectively, classified their child as heavy/extremely heavy. In 2009 and 2013, 64.7% and 61.0% of parents, respectively, underestimated the weight status of their overweight child. This was even higher among parents of obese children. Overall, the agreement between the parents' perception and the actual weight status improved from 2009 (kappa = 0.38) to 2013 (kappa = 0.43) (p<0.05), but remained unsatisfactory. The parents' underestimation of their child's overweight/obesity status was associated with the child's age in 2009 and 2013 (2-7 years; OR: 0.18), the child's gender in 2009 (male; OR: 0.55), and the parents' education level in 2009 (middle and high education; OR: 0.56 and 0.44 respectively). CONCLUSIONS: Parents' underestimation of their child's weight status remains alarmingly high, particularly among parents of young, obese children. This underestimation is a barrier to preventing childhood overweight/obesity. Healthcare professionals should take this underestimation into consideration and should actively encourage parents to take steps to prevent overweight/obesity in their children
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