Improving low back pain management in primary care

Contains fulltext : 58866.pdf (Publisher’s version ) (Open Access)KUN Katholieke Universiteit Nijmegen, 23 november 2004Promotores : Grol, R.P.T.M., Koes, B.W. Co-promotores : Wensing, M.J.P., Tulder, M.W. van176 p

The Politics of Shark Attacks: Explaining policy responses following shark bites in Florida, Cape Town, and New South Wales

This dissertation investigates the policymaking process during emotionally charged periods by comparing responses to shark bites in three locations. It examines the factors that explain policies which followed incidents in the American state of Florida, the South African City of Cape Town, and the Australian state of New South Wales. Each location reacted differently to these events, with Florida banning eco-tourism shark feeding, Cape Town adopting a Shark Spotter program, and New South Wales funding aerial patrols. Shark bite policy responses are emblematic of other emotion-laden and seemingly knee-jerk policy responses, yet explaining why one issue or event produces a reaction while another does not remains an elusive question. This study constructs a theoretical framework to analyze the policy process based on the roles of affect, salience, policy entrepreneurship, and causal stories. A high affect-low threshold (HALT) framework is utilized to analyze shark bite policy responses in three ways. First, the HALT framework illustrates the way negative high affect-high salient events can be aggregated into a representative dreaded outcome. Secondly, it demonstrates the way aggregate dreaded outcomes place pressures on key actors to lower policy thresholds. Thirdly, it shows how the pressures from these aversive problem conditions encourage entrepreneurs to select quickly adoptable measures that provide positive affective relief. This framework was utilized in each case study and showed how the speed and direction of policy responses was influenced. In Florida, the governor opened the policy process when faced with the dread of tourism losses and encouraged adoption of a regulatory ban. In Cape Town, community stakeholders lowered the threshold in fear of political involvement and guided the adoption of the Shark Spotter program. In New South Wales, a minister used his office to announce a plan for aerial patrols to interrupt a series of political controversies

Implementation of the Dutch low back pain guideline for general practitioners: a cluster randomized controlled trial.

Contains fulltext : 47629.pdf (publisher's version ) (Closed access)STUDY DESIGN: Cluster randomized controlled trial for a multifaceted implementation strategy. OBJECTIVES: To assess the effectiveness of tailored interventions (multifaceted implementation strategy) to implement the Dutch low back pain guideline for general practitioners with regard to adherence to guideline recommendations. SUMMARY OF BACKGROUND DATA: Guidelines for the management of low back pain in primary care have been developed in various countries, but little is known about the optimal implementation strategy. A multifaceted implementation strategy was developed to overcome identified barriers to the implementation of the Dutch low back pain guideline for general practitioners. METHODS: General practitioners were randomized to an intervention or a control group. The general practitioners in the intervention group (n = 21) received tailored interventions consisting of the Dutch low back pain guideline for general practitioners, a 2-hour educational and clinical practice workshop; two scientific articles on low back pain management; the guideline for occupational physicians; a tool for patient education; and a tool for reaching agreement on low back care with physical, exercise, and manual therapists. The control group (n = 20) received no intervention. The participating general practitioners were asked to recruit consecutive patients with a new episode of low back pain as the main reason for consultation. General practitioners completed registration forms of each individual consultation with regard to the main outcome measures: advice and information, referral to other health-care providers, and prescription of medication. RESULTS: Forty-one of the 67 randomized general practitioners reported on a total of 616 consultations for 531 patients with nonspecific low back pain. The advice and explanation provided by the general practitioners, the prescription of paracetamol or nonsteroidal anti-inflammatory drugs, and prescription of pain medication on atime contingent or a pain contingent basis showed no statistically significant differences between the intervention and control groups. There were also no differences in overall referral rate. However, in follow-up consultations fewer patients were referred to a physical or exercise therapist by the general practitioners in the intervention group than in the control group. CONCLUSIONS: The multifaceted intervention strategy modestly improved implementation (for parts of the recommendations in) the Dutch low back pain guideline by general practitioners and produced small concomitant changes in patient management. The implementation strategy produced fewer referrals to therapists during follow-up consultations

Gegevensuitwisseling door toezichthouders

This research aims at defining the interests to be taken into account in the exchange of supervisory data among supervisors, and between supervisors on the one hand and the Ministry of Justice, the police and special investigating officers on the other. In addition, it examines the desirability and juridical possibility to insert a general regulation on data exchange in the General Administrative Law Act (Awb) and/or in other laws. In order to make an inventory of the interests involved in data exchange between the public agencies mentioned above, and to evaluate their respective importance, we examined the relevant literature and jurisprudence, executed a quickscan, studied specific cases, held discussions with experts in the field, organised a round table meeting with experts and, for the sake of a multicriteria analysis (MCA), conducted an internet inquiry among qualified people on the work floor