Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial)

Background: Syndesmotic injuries are common and their incidence is rising. In case of surgical fixation of the syndesmosis a metal syndesmotic screw is used most often. It is however unclear whether this screw needs to be removed routinely after the syndesmosis has healed. Traditionally the screw is removed after six to 12 weeks as it is thought to hamper ankle functional and to be a source of pain. Some studies however suggest this is only the case in a minority of patients. We therefore aim to investigate the effect of retaining the syndesmotic screw on functional outcome. Design: This is a pragmatic international multicentre randomised controlled trial in patients with an acute syndesmotic injury for which a metallic syndesmotic screw was placed. Patients will be randomised to either routine removal of the syndesmotic screw or removal on demand. Primary outcome is functional recovery at 12 months measured with the Olerud-Molander Score. Secondary outcomes are quality of life, pain and costs. In total 194 patients will be needed to demonstrate non-inferiority between the two interventions at 80% power and a significance level of 0.025 including 15% loss to follow-up. Discussion: If removal on demand of the syndesmotic screw is non-inferior to routine removal in terms of functional outcome, this will offer a strong argument to adopt this as standard practice of care. This means that patients will not have to undergo a secondary procedure, leading to less complications and subsequent lower costs.Peer reviewe

Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial) (vol 19, 35, 2018)

Peer reviewe

Natuurverkenning 2010-2040 : visies op de ontwikkeling van natuur en landschap

De Natuurverkenning verschijnt in een turbulente tijd waarin natuur en landschap sterk gepolitiseerd zijn. Met de verkenning wil het PBL een bijdrage leveren aan het structureren van het debat over de vernieuwing van het langetermijnbeleid en een impuls geven aan de politieke afwegingen. Nieuw is het gebruik van normatieve toekomstscenario’s als hulpmiddel om de achterliggende drijfveren voor natuurbeleid te verhelderen

From postpartum haemorrhage guideline to local protocol: a study of protocol quality

Objective: Postpartum hemorrhage (PPH) has a continuously rising incidence worldwide, suggesting suboptimal care. An important step in optimizing care is the translation of evidence-based guidelines into comprehensive hospital protocols. However, knowledge about the quality of these protocols is lacking. The objective of this study was to evaluate the quality of PPH-protocols on structure and content in the Netherlands. Methods: We performed an observational multicenter study. Eighteen PPH-protocols from 3 University Hospitals (UH), 8 Teaching Hospitals (TH) and 7 Non-Teaching hospitals (NTH) throughout the Netherlands were acquired. The structure of the PPH-protocols was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) Instrument. The content was appraised using previously developed quality indicators, based on international guidelines and Advance-Trauma-Life-Support (ATLS)-based course instructions. Results: The quality of the protocols for postpartum hemorrhage for both structure and content varied widely between different hospitals, but all of them showed room for improvement. The protocols scored mainly below average on the different items of the AGREE-II instrument (8 of the 10 items scored <4 on a 1-7 scale). Regarding the content, adoption of guideline recommendations in protocols was 46 %. In addition, a timely indication of 'when to perform' a recommendation was lacking in three-fourths of the items. Conclusion: This study shows that the quality of the PPH-protocols for both structure and content in the Netherlands is suboptimal. This makes adherence to the guideline and ATLS-based course instructions difficult.Mallory D. Woiski, Helena C. van Vugt, Anneke Dijkman, Richard P. Grol, Abraham Marcus, Johanna M. Middeldorp, Ben W. Mol, Femke Mols, Martijn A. Oudijk, Martina Porath, Hubertina J. Scheepers, Rosella P. Hermen

Enhancing modeling and change support for process families through change patterns

The increasing adoption of process-aware information systems (PAISs), together with the variability of business processes (BPs), has resulted in large collections of related process model variants (i.e., process families). To effectively deal with process families, several proposals (e.g., C-EPC, Provop) exist that extend BP modeling languages with variability-specific constructs. While fostering reuse and reducing modeling efforts, respective constructs imply additional complexity and demand proper support for process designers when creating and modifying process families. Recently, generic and language independent adaptation patterns were successfully introduced for creating and evolving single BP models. However, they are not sufficient to cope with the specific needs for modeling and evolving process families. This paper suggests a complementary set of generic and language-independent change patterns specifically tailored to the needs of process families. When used in combination with existing adaptation patterns, change patterns for process families will enable the modeling and evolution of process families at a high-level of abstraction. Further, they will serve as reference for implementing tools or comparing proposals managing process families. © 2013 Springer-Verlag.This work has been developed with the support of MICINN under the Project EVERYWARE TIN2010-18011.Ayora Esteras, C.; Torres Bosch, MV.; Weber, B.; Reichert, M.; Pelechano Ferragud, V. (2013). Enhancing modeling and change support for process families through change patterns. En Enterprise, Business-Process and Information Systems Modeling, BPMDS 2013. Springer Verlag. 246-260. https://doi.org/10.1007/978-3-642-38484-4_18S246260van der Aalst, W.M.P., ter Hofstede, A.H.M., Barros, B.: Workflow Patterns. Distributed and Parallel Databases 14(1), 5–51 (2003)Aghakasiri, Z., Mirian-Hosseinabadi, S.H.: Workflow change patterns: Opportunities for extension and reuse. In: Proc. SERA 2009, pp. 265–275 (2009)Ayora, C., Torres, V., Reichert, M., Weber, B., Pelechano, V.: Towards run-time flexibility for process families: Open issues and research challenges. In: La Rosa, M., Soffer, P. (eds.) BPM 2012 Workshops. LNBIP, vol. 132, pp. 477–488. Springer, Heidelberg (2013)Ayora, C., Torres, V., Weber, B., Reichert, M., Pelechano, V.: Change patterns for process families. Technical Report, PROS-TR-2012-06, http://www.pros.upv.es/technicalreports/PROS-TR-2012-06.pdfDadam, P., Reichert, M.: The ADEPT project: a decade of research and development for robust and flexible process support. Com. Sci. - R&D 23, 81–97 (2009)Dijkman, R., La Rosa, M., Reijers, H.A.: Managing large collections of business process models - Current techniques and challenges. Comp. in Ind. 63(2), 91–97 (2012)Döhring, M., Zimmermann, B., Karg, L.: Flexible workflows at design- and runtime using BPMN2 adaptation patterns. In: Abramowicz, W. (ed.) BIS 2011. LNBIP, vol. 87, pp. 25–36. Springer, Heidelberg (2011)Gottschalk, F.: Configurable process models. Ph.D. thesis, Eindhoven University of Technology, The Netherlands (2009)Grambow, G., Oberhauser, R., Reichert, M.: Contextual injection of quality measures into software engineering processes. Intl. J. Adv. in Software 4, 76–99 (2011)Gschwind, T., Koehler, J., Wong, J.: Applying patterns during business process modeling. In: Dumas, M., Reichert, M., Shan, M.-C. (eds.) BPM 2008. LNCS, vol. 5240, pp. 4–19. Springer, Heidelberg (2008)Günther, C.W., Rinderle, S., Reichert, M., van der Aalst, W.M.P.: Change mining in adaptive process management systems. In: Meersman, R., Tari, Z. (eds.) OTM 2006. LNCS, vol. 4275, pp. 309–326. Springer, Heidelberg (2006)Hallerbach, A., Bauer, T., Reichert, M.: Context-based configuration of process variants. In: Proc. TCoB 2008, pp. 31–40 (2008)Hallerbach, A., Bauer, T., Reichert, M.: Capturing variability in business process models: the Provop approach. J. of Software Maintenance 22(6-7), 519–546 (2010)Kitchenham, B., Charters, S.: Guidelines for performing Systematic Literature Reviews in Software Engineering, Technical Report EBSE/EPIC–2007–01 (2007)Kulkarni, V., Barat, S., Roychoudhury, S.: Towards business application product lines. In: France, R.B., Kazmeier, J., Breu, R., Atkinson, C. (eds.) MODELS 2012. LNCS, vol. 7590, pp. 285–301. Springer, Heidelberg (2012)Küster, J.M., Gerth, C., Förster, A., Engels, G.: Detecting and resolving process model differences in the absence of a change log. In: Dumas, M., Reichert, M., Shan, M.-C. (eds.) BPM 2008. LNCS, vol. 5240, pp. 244–260. Springer, Heidelberg (2008)Küster, J.M., Gerth, C., Engels, G.: Dynamic computation of change operations in version management of business process models. In: Kühne, T., Selic, B., Gervais, M.-P., Terrier, F. (eds.) ECMFA 2010. LNCS, vol. 6138, pp. 201–216. Springer, Heidelberg (2010)Lanz, A., Weber, B., Reichert, M.: Time patterns for process-aware information systems. Requirements Engineering, 1–29 (2012)La Rosa, M., van der Aalst, W.M.P., Dumas, M., ter Hofstede, A.H.M.: Questionnaire-based variability modeling for system configuration. Software and System Modeling 8(2), 251–274 (2009)Lerner, B.S., Christov, S., Osterweil, L.J., Bendraou, R., Kannengiesser, U., Wise, A.: Exception Handling Patterns for Process Modeling. IEEE Transactions on Software Engineering 36(2), 162–183 (2010)Li, C., Reichert, M., Wombacher, A.: Mining business process variants: Challenges, scenarios, algorithms. Data Knowledge & Engineering 70(5), 409–434 (2011)Marrella, A., Mecella, M., Russo, A.: Featuring automatic adaptivity through workflow enactment and planning. In: Proc. CollaborateCom 2011, pp. 372–381 (2011)Müller, D., Herbst, J., Hammori, M., Reichert, M.: IT support for release management processes in the automotive industry. In: Dustdar, S., Fiadeiro, J.L., Sheth, A.P. (eds.) BPM 2006. LNCS, vol. 4102, pp. 368–377. Springer, Heidelberg (2006)Reichert, M., Weber, B.: Enabling flexibility in process-aware information systems: challenges, methods, technologies. Springer (2012)Reinhartz-Berger, I., Soffer, P., Sturm, A.: Organizational reference models: supporting an adequate design of local business processes. IBPIM 4(2), 134–149 (2009)Rosemann, M., van der Aalst, W.M.P.: A configurable reference modeling language. Information Systems 32(1), 1–23 (2007)Russell, N., ter Hofstede, A.H.M., Edmond, D., van der Aalst, W.M.P.: Workflow data patterns. Technical Report FIT-TR-2004-01, Queensland Univ. of Technology (2004)Russell, N., ter Hofstede, A.H.M., Edmond, D., van der Aalst, W.M.P.: Workflow resource patterns. Technical Report WP 127, Eindhoven Univ. of Technology (2004)Russell, N., van der Aalst, W.M.P., ter Hofstede, A.H.M.: Workflow Exception Patterns. In: Martinez, F.H., Pohl, K. (eds.) CAiSE 2006. 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Livestock production: recent trends, future prospects

The livestock sector globally is highly dynamic. In developing countries, it is evolving in response to rapidly increasing demand for livestock products. In developed countries, demand for livestock products is stagnating, while many production systems are increasing their efficiency and environmental sustainability. Historical changes in the demand for livestock products have been largely driven by human population growth, income growth and urbanization and the production response in different livestock systems has been associated with science and technology as well as increases in animal numbers. In the future, production will increasingly be affected by competition for natural resources, particularly land and water, competition between food and feed and by the need to operate in a carbon-constrained economy. Developments in breeding, nutrition and animal health will continue to contribute to increasing potential production and further efficiency and genetic gains. Livestock production is likely to be increasingly affected by carbon constraints and environmental and animal welfare legislation. Demand for livestock products in the future could be heavily moderated by socio-economic factors such as human health concerns and changing socio-cultural values. There is considerable uncertainty as to how these factors will play out in different regions of the world in the coming decades

Early treatment versus expectative management of patent ductus arteriosus in preterm infants

_Background:_ Much controversy exists about the optimal management of a patent ductus arteriosus (PDA) in preterm infants, especially in those born at a gestational age (GA) less than 28weeks. No causal relationship has been proven between a (haemodynamically significant) PDA and neonatal complications related to pulmonary hyperperfusion and/or systemic hypoperfusion. Although studies show conflicting results, a common understanding is that medical or surgical treatment of a PDA does not seem to reduce the risk of major neonatal morbidities and mortality. As the PDA might have closed spontaneously, treated children are potentially exposed to iatrogenic adverse effects. A conservative approach is gaining interest worldwide, although convincing evidence to support its use is lacking. _Methods:_ This multicentre, randomised, non-inferiority trial is conducted in neonatal intensive care units. The study population consists of preterm infants (GA1.5mm. Early treatment (between 24 and 72h postnatal age) with the cyclooxygenase inhibitor(COXi) ibuprofen (IBU) is compared with an expectative management (no intervention intended to close a PDA). The primary outcome is the composite of mortality, and/or necrotising enterocolitis (NEC) Bell stage ≥ IIa, and/or bronchopulmonary dysplasia (BPD) defined as the need for supplemental oxygen, all at a postmenstrual age (PMA) of 36weeks. Secondary outcome parameters are short term sequelae of cardiovascular failure, comorbidity and adverse events assessed during hospitalization and long-term neurodevelopmental outcome assessed at a corrected age of 2 years. Consequences regarding health economics are evaluated by cost effectiveness analysis and budget impact analysis. _Discussion:_ As a conservative approach is gaining interest, we investigate whether in preterm infants, born at a GA less than 28weeks, with a PDA an expectative management is non-inferior to early treatment with IBU regarding to the composite outcome of mortality and/or NEC and/or BPD at a PMA of 36weeks