De geprotocolleerde Interapy-behandeling van depressie via het internet; resultaten van een gerandomiseerde trial

Psychologische behandelingen via internet bieden een nieuwe mogelijkheid voor de geestelijke gezondheidszorg. In samenwerking met de Stichting Mentrum ggz Amsterdam heeft Interapy een behandeling voor depressie via internet opgezet. De behandeling bestaat uit cognitief-gedragstherapeutische interventies, zoals psycho-educatie, schrijfopdrachten, registratie, activatie, het uitdagen van negatieve automatische gedachten en terugvalpreventie. Dit artikel beschrijft de procedure, de behandeling en de resultaten van een vergelijkende studie onder cliënten die matig tot ernstig depressief waren. De cliënten die direct actief werden behandeld (N = 32) verbeterden significant meer dan de cliënten in de psycho-educatieconditie (N = 14). Deze tweede groep kreeg de actieve behandeling ongeveer twaalf weken later. De effecten waren groot. In de actief behandelde groep liet 75 procent van de cliënten klinisch relevante verbetering zien, in de psycho-educatieconditie was dat percentage 36. Uit de follow-up na zes weken bleek dat de verbeteringen standhielden

Does trust in health care influence the use of complementary and alternative medicine by chronically ill people?

BACKGROUND: People's trust in health care and health care professionals is essential for the effectiveness of health care, especially for chronically ill people, since chronic diseases are by definition (partly) incurable. Therefore, it may be understandable that chronically ill people turn to complementary and alternative medicine (CAM), often in addition to regular care. Chronically ill people use CAM two to five times more often than non-chronically ill people. The trust of chronically ill people in health care and health care professionals and the relationship of this with CAM use have not been reported until now. In this study, we examine the influence of chronically ill people's trust in health care and health care professionals on CAM use. METHODS: The present sample comprises respondents of the 'Panel of Patients with Chronic Diseases' (PPCD). Patients (≥25 years) were selected by GPs. A total of 1,625 chronically ill people were included. Trust and CAM use was measured by a written questionnaire. Statistical analyses were t tests for independent samples, Chi-square and one-way analysis of variance, and logistic regression analysis. RESULTS: Chronically ill people have a relatively low level of trust in future health care. They trust certified alternative practitioners less than regular health care professionals, and non-certified alternative practitioners less still. The less trust patients have in future health care, the more they will be inclined to use CAM, when controlling for socio-demographic and disease characteristics. CONCLUSION: Trust in future health care is a significant predictor of CAM use. Chronically ill people's use of CAM may increase in the near future. Health policy makers should, therefore, be alert to the quality of practising alternative practitioners, for example by insisting on professional certification. Equally, good quality may increase people's trust in public health care

Pregnancy-related pelvic girdle pain: an update

A large number of scientists from a wide range of medical and surgical disciplines have reported on the existence and characteristics of the clinical syndrome of pelvic girdle pain during or after pregnancy. This syndrome refers to a musculoskeletal type of persistent pain localised at the anterior and/or posterior aspect of the pelvic ring. The pain may radiate across the hip joint and the thigh bones. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period. The physiological processes characterising this clinical entity remain obscure. In this review, the definition and epidemiology, as well as a proposed diagnostic algorithm and treatment options, are presented. Ongoing research is desirable to establish clear management strategies that are based on the pathophysiologic mechanisms responsible for the escalation of the syndrome's symptoms to a fraction of the population of pregnant women

Assisted reproductive technology nursing positioning Australian research in the global context /

Introduction: Australian healthcare statistics indicate that 39,362 stimulated in-vitro fertilisation (IVF) cycles were initiated in Australia in 2009 and these cycles were co-ordinated by almost 300 ART nurses working across the country at 70 accredited primary, associate and satellite IVF units. There is currently no distinct model or theory that informs ART nursing practice in the Australian context. Additionally, there is limited published research that comprehensively examines the unique nature of the ART nursing practice domain internationally. The purpose of this study was to examine ART nursing practice in Australia from the nurses’ perspective. Outcomes of this research have the potential to translate into the global ART nursing community. Method: Grounded Theory (GT) methodology was used to explore Australian ART Nurses’ understanding regarding their specialised clinical practice. Purposive and later theoretical sampling facilitated recruitment of Registered Nurse (RN) participants who were best positioned to inform this research by exploring their perceptions in relation to their clinical practice and to acquire comprehensive data. Fifteen in-depth, semi-structured interviews were undertaken with RNs who were members of the Fertility Nurses of Australasia (FNA) professional group practicing in metropolitan and regional areas around the country. The data collected contributed to a deep understanding of clinical practice from the nursing perspective. NVivo 8™ was used to manage the significant volume of data and to facilitate analysis based on the Grounded Theory constant comparative approach. Results: The principal themes that emerged from this study were two-fold. Firstly it was identified that context specific elements such as personal and professional attributes, knowledge, and patient care activities impact on practice. In addition, a series of factors, both positive and negative, including elements such as communication, support, patient issues, and teamwork were identified by the participants as influencing how the ART nurse practices. The ART Nurse plays a pivotal role, balancing all aspects of the ART process to facilitate effective and efficient patient care and cycle management to optimise patient care and clinical and psychosocial outcomes. This research highlights the complexity of the role and how ART nurses balance these influences as they endeavour to maintain equilibrium for patients and for the ART practice. Conclusion: The ART patient journey is often likened to a roller coaster ride. Outcomes of this research indicate that ART nurses accompany patients on this journey and they play a pivotal and balancing role as they co-ordinate treatment cycles. This research, firmly grounded in comprehensive data collected directly from ART registered nurse participants, identifies themes of particular importance to this journey from the nursing practice perspective. The identified substantive theory contributes to the emerging global body of knowledge with regard to ART nursing practice. Importantly findings will inform practice development, quality assurance, education and curriculum development for ART nurses and the outcomes of this translational research are considered relevant to the global ART nursing context

Long-term outcome in couples with unexplained subfertility and an intermediate prognosis initially randomized between expectant management and immediate treatment

BACKGROUND We recently reported that treatment with intrauterine insemination and controlled ovarian stimulation (IUI-COS) did not increase ongoing pregnancy rates compared with expectant management (EM) in couples with unexplained subfertility and intermediate prognosis of natural conception. Long-term cost-effectiveness of a policy of initial EM is unknown. We investigated whether the recommendation not to treat during the first 6 months is valid, regarding the long-term effectiveness and cumulative costs. METHODS Couples with unexplained subfertility and intermediate prognosis of natural conception (n=253, at 26 public clinics, the Netherlands) were randomly allocated to 6 months EM or immediate start with IUI-COS. The couples were then treated according to local protocol, usually IUI-COS followed by IVF. We followed couples until 3 years after randomization and registered pregnancies and resources used. Primary outcome was time to ongoing pregnancy. Secondary outcome was treatment costs. Analysis was by intention-to-treat. Economic evaluation was performed from the perspective of the health care institution. RESULTS Time to ongoing pregnancy did not differ between groups (log-rank test P=0.98). Cumulative ongoing pregnancy rates were 72–73% for EM and IUI-COS groups, respectively [relative risk 0.99 (95% confidence interval (CI) 0.85–1.1)]. Estimated mean costs per couple were €3424 (95% CI €880–€5968) in the EM group and €6040 (95% CI €4055–€8125) in the IUI-COS group resulting in an estimated saving of €2616 per couple (95% CI €385–€4847) in favour of EM. CONCLUSIONS In couples with unexplained subfertility and an intermediate prognosis of natural conception, initial EM for 6 months results in a considerable cost-saving with no delay in achieving pregnancy or jeopardizing the chance of pregnancy. Further comparisons between aggressive and milder forms of ovarian stimulation should be performed.Inge M. Custers, Minouche M.E. van Rumste, Jan Willem van der Steeg, Madelon van Wely, Peter G.A. Hompes, Patrick Bossuyt, Frank J. Broekmans, Cees N.M. Renckens, Marinus J.C. Eijkemans, Thierry J.H.M. van Dessel, Fulco van der Veen, Ben W.J. Mol, Pieternel Steures, and CECER