Do routine outcome monitoring results translate to clinical practice? A cross-sectional study in patients with a psychotic disorder

Background: The use of Routine Outcome Monitoring (ROM) in mental health care has increased widely during the past decade. Little is known, however, on the implementation and applicability of ROM outcome in daily clinical practice. In the Netherlands, an extensive ROM-protocol for patients with psychotic disorders has been implemented over the last years (ROM-Phamous). The current study investigated to what extent ROM results translate to daily clinical practice. Therefore, we investigated whether clinical problems as identified with ROM were detected and used in the treatment of patients with psychotic disorders. Methods: Out of the ROM database of 2010 (n = 1040), a random sample of 100 patients diagnosed with a psychotic disorder was drawn. ROM-data used in this study included a physical examination, laboratory tests, interviews and self-report questionnaires. Based on these data, the prevalence of positive and negative symptoms, psychosocial problems and cardiovascular risk factors was determined. Next, we investigated whether these problems, as identified with ROM, were reflected in the treatment plans of patients, as an indication of the use of ROM in clinical practice. Results: The sample consisted of 63 males and 37 females. The mean age was 44 and the mean duration of illness was 17.7 years. The prevalence of positive and negative symptoms, psychosocial problems and cardiovascular risk factors ranged from 11 to 86 %. In the majority of cases, problems as identified with ROM were not reflected in the treatment plans of patients. Conclusions: We found a substantial discrepancy between the ROM measurements and the treatment plans, i.e. low rates of detection of symptoms, psychosocial problems and cardiovascular risk factors in the treatment plans, even though these problems were identified with ROM. The opposite occurred as well, where problems were reflected in the treatment plans but not identified with ROM. Thus, ROM and daily clinical practice appear to be two separate processes, whereas ideally they should be integrated. Strong efforts should be made to integrate ROM and consequent treatment activities. Such integration may help to provide patients with adequate and customized care and simultaneously minimize under-and over-treatment

Towards a harmonized European surveillance for dietary and physical activity indicators in young and adult populations

Background The Policy Evaluation Network proposes a consolidated approach to measure comparable health indicators across European health surveillance systems to evaluate effectiveness of policy action. Methods In a stepwise approach, questionnaire items used by the systems for measuring diet and physical activity data to describe health indicators were identified based on their validity, reliability, and suitability to monitor achievement of health recommendations. They were collated to unified questionnaire modules and discussed bilaterally with representatives of these systems to explore barriers and facilitators for implementation. Also, establishment of a methodological competence platform was proposed, in which the surveillance and monitoring systems agree on the priorities and common quality standards for the harmonization process and to coordinate the integration of questionnaire modules into existing systems. Results In total, seven questionnaire modules were developed, of which two diet and two physical activity modules were proposed for implementation. Each module allows measurement of data reflecting only partial aspects of national and WHO recommendations related to diet and physical activity. Main barriers were the requirements of systems to monitor temporal trends and to minimize costs. Main facilitator for implementation was the systems’ use of questionnaire items that were comparable to the unified modules. Representatives agreed to participate in a methodological competence platform. Conclusion We successfully took first steps in the realization of the roadmap towards a harmonization of European surveillance by introducing unified questionnaire modules allowing the collection of comparable health indicators and by initiating the establishment of a competence platform to guide this process

Do decision support systems influence variation in prescription?

<p>Abstract</p> <p>Background</p> <p>Translating scientific evidence into daily practice is problematic. All kinds of intervention strategies, using educational and/or directive strategies, aimed at modifying behavior, have evolved, but have been found only partially successful. In this article the focus is on (computerized) decision support systems (DSSs). DSSs intervene in physicians' daily routine, as opposed to interventions that aim at influencing knowledge in order to change behavior. We examined whether general practitioners (GPs) are prescribing in accordance with the advice given by the DSS and whether there is less variation in prescription when the DSS is used.</p> <p>Methods</p> <p>Data were used from the Second Dutch National Survey of General Practice (DNSGP2), collected in 2001. A total of 82 diagnoses, 749811 contacts, 133 physicians, and 85 practices was included in the analyses. GPs using the DSS daily were compared to GPs who do not use the DSS. Multilevel analyses were used to analyse the data. Two outcome measures were chosen: whether prescription was in accordance with the advice of the DSS or not, and a measure of concentration, the Herfindahl-Hirschman Index (HHI).</p> <p>Results</p> <p>GPs who use the DSS daily prescribe more according to the advice given in the DSS than GPs who do not use the DSS. Contradictory to our expectation there was no significant difference between the HHIs for both groups: variation in prescription was comparable.</p> <p>Conclusion</p> <p>We studied the use of a DSS for drug prescribing in general practice in the Netherlands. The DSS is based on guidelines developed by the Dutch College of General Practitioners and implemented in the Electronic Medical Systems of the GPs. GPs using the DSS more often prescribe in accordance with the advice given in the DSS compared to GPs not using the DSS. This finding, however, did not mean that variation is lower; variation is the same for GPs using and for GPs not using a DSS. Implications of the study are that DSSs can be used to implement guidelines, but that it should not be expected that variation is limited.</p

Exploring the natural variation for reproductive thermotolerance in wild tomato species

Contains fulltext : 190834.pdf (publisher's version ) (Open Access)12 p

Recovery of Gait After Stroke: What Changes?

Background. Little is known about whether changes in coordination patterns of muscle activation after stroke are related to functional recovery of walking. Objective . The present study investigated the longitudinal relationship between changes in neuromuscular activation patterns of paretic muscles in hemiplegic gait and improvement in walking ability after stroke. Methods. Thirteen patients diagnosed with a first unilateral ischemic stroke had their recovery of walking measured by the Rivermead Mobility Index, Functional Ambulation Categories, Barthel Index, Trunk Control Test, Motricity Index, and comfortable walking speed. Surface electromyography (SEMG) of the erector spinae, gluteus maximus, gluteus medius, rectus femoris, vastus lateralis, semitendinosus, gastrocnemius, and tibialis anterior muscles of both legs was used to quantify coordination patterns in comfortable walking mode. All clinical and electromyography-related measurements were taken at 3, 6, 9, 12, and 24 weeks poststroke. Timing parameters of the SEMG patterns were calculated, using an objective burst detection algorithm, and analyzed with the measures of functional recovery. Results . All functional measures, except Trunk Control Test, showed statistically significant improvement over time, whereas SEMG patterns did not change significantly over time. Conclusion. The lack of significant change in SEMG patterns over time suggests that functional gait improvements may be more related to compensatory strategies in muscle activation of the unaffected leg and biomechanical changes than by restitution of muscle coordination patterns in the affected leg. \ud \u

IFAD Research Series 81: Food and water systems in semi-arid regions – case study: Egypt

Water is a major driver of food systems in arid and semi-arid countries. This paper explores the role of water in Egypt’s food system and the dilemma the country faces: raise food self-sufficiency by allocating freshwater resources from the Nile to food production, or rely on food imports from water-abundant regions worldwide. Using a food system analysis approach, the main drivers and outcomes in Egypt’s food system are described, followed by two examples of food system trade-offs where water plays an important role: wheat and chicken. The paper concludes with a reflection on the role of water in the food system and gives suggestions on how the role of water in the food system can be addressed systematically

Effects of Groundwater Nitrate and Sulphate Enrichment on Groundwater-Fed Mires: A Case Study

Mires and peatlands in general are heavily influenced by anthropogenic stressors like acidification, eutrophication, desiccation and fragmentation. Groundwater-fed mires are, in contrast to rainwater-fed mires, often well protected against desiccation due to constant groundwater discharge. Groundwater-fed mires can however be influenced by groundwater pollution such as groundwater nitrate enrichment, a threat which has received minor attention in literature. The present case study demonstrates how groundwater nitrate enrichment can affect the biogeochemical functioning and vegetation composition of groundwater-fed mires through direct nitrogen enrichment and indirect nitrate-induced sulphate mobilisation from geological deposits. Biogeochemical and ecohydrological analyses suggest that the Dutch groundwater-fed mire studied is influenced by different water sources (rainwater; groundwater of local and regional origin) with differing chemical compositions. The weakly buffered and nitrate-enriched groundwater leads, where it reaches the uppermost peat, to nitrogen enrichment, enhanced isotopic nitrogen signatures and altered the vegetation composition at the expense of characteristic species. Nitrate-induced sulphate mobilisation in the aquifer led to enhanced sulphate reduction, sulphide toxicity and elemental sulphur deposition in the mire. Despite sulphate reduction and nitrate enrichment, internal eutrophication did not play an important role, due to relatively low phosphorus concentrations and/or low iron-bound phosphorus of the peat soil. Future management of groundwater-fed mires in nitrate-polluted aquifers should include the reduction of nitrate leaching to the aquifer at the recharge areas by management and ecohydrological restoration measures on both a local and landscape scale

The effects of visual rhythms and optic flow on stride patterns of patients with Parkinson's disease

This study was aimed at determining the effects of rhythmic visual cueing under changing visual conditions on stride frequency in patients with Parkinson's disease (PD; n=21) and healthy age matched controls (n=7) while walking at different speeds on a treadmill. Stride frequency and stride length in patients with PD as well as controls were not rigidly coupled to walking speed and could be manipulated with walking speed as well as by using spatial and temporal rhythmic visual cues