Effectiviteit en welzijnsaspecten van kastvallen (verdrinkingsvallen) voor de bestrijding van schadelijke wilde knaagdieren

This report examines the effectiveness and animal welfare aspects of drowning traps for the control of harmful wild rodents, with special attention to the Ekomille or EKO1000 trap. The conclusion is that such systems can be effective in certain situations, but that the welfare impact of the Ekomille is estimated to be severe to extreme. This is because animals in the Ekomille drown consciously. When redesigning, manufacturers could pay attention to direct stunning of animals and/or shortening the time to loss of consciousness and/or death

DEUCE: A Methodology for Detecting Unauthorized Access of Electronic Health Records Using Process Mining

Hospitals have a keen interest to root out unauthorized access of Electronic Health Records (EHRs). The retrospective analysis of suspicious EHR views may help to take preventive measures against such access. However, investigating EHR access manually is labor-intensive and only allows for checking a small sample of cases. We explore how process mining techniques can be used to support the detection of unauthorized views. In the context of EHR access, it is easier to define authorized views with certainty than to detect unauthorized views. Therefore, we propose DEUCE: a methodology that focuses on identifying authorized behavior, such that unauthorized views are distinguished, and can be investigated more in-depth. We evaluate the methodology in the form of a case study at a Dutch hospital. As a result of this study, the hospital has adopted the approach in favor of their traditional approach and unauthorized EHR access is now more efficiently detected

Effectiviteit en welzijnsaspecten van kastvallen (verdrinkingsvallen) voor de bestrijding van schadelijke wilde knaagdieren

This report examines the effectiveness and animal welfare aspects of drowning traps for the control of harmful wild rodents, with special attention to the Ekomille or EKO1000 trap. The conclusion is that such systems can be effective in certain situations, but that the welfare impact of the Ekomille is estimated to be severe to extreme. This is because animals in the Ekomille drown consciously. When redesigning, manufacturers could pay attention to direct stunning of animals and/or shortening the time to loss of consciousness and/or death

DEUCE - A Methodology for Detecting Unauthorized Access of Electronic Health Records Using Process Mining.

Hospitals have a keen interest to root out unauthorized access of Electronic Health Records (EHRs). The retrospective analysis of suspicious EHR views may help to take preventive measures against such access. However, investigating EHR access manually is labor-intensive and only allows for checking a small sample of cases. We explore how process mining techniques can be used to support the detection of unauthorized views. In the context of EHR access, it is easier to define authorized views with certainty than to detect unauthorized views. Therefore, we propose DEUCE: a methodology that focuses on identifying authorized behavior, such that unauthorized views are distinguished, and can be investigated more in-depth. We evaluate the methodology in the form of a case study at a Dutch hospital. As a result of this study, the hospital has adopted the approach in favor of their traditional approach and unauthorized EHR access is now more efficiently detected

Effectiviteit en welzijnsaspecten van kastvallen (verdrinkingsvallen) voor de bestrijding van schadelijke wilde knaagdieren

This report examines the effectiveness and animal welfare aspects of drowning traps for the control of harmful wild rodents, with special attention to the Ekomille or EKO1000 trap. The conclusion is that such systems can be effective in certain situations, but that the welfare impact of the Ekomille is estimated to be severe to extreme. This is because animals in the Ekomille drown consciously. When redesigning, manufacturers could pay attention to direct stunning of animals and/or shortening the time to loss of consciousness and/or death

Immediate treatment vs. active-surveillance in very-low-risk prostate cancer: the role of patient-, tumour-, and hospital-related factors

Background: To provide insight in the treatment variation of very-low-risk prostate cancer patients and to assess the role of hospital-related factors. Methods: All patients diagnosed with very-low-risk prostate cancer (cT1c-cT2a, PSA < 10 ng/ml, Gleason score <7 and <3 positive cores) in 2015 and 2016 were identified through the population-based Netherlands Cancer Registry. Multilevel logistic regression analyses were performed to examine the crude and case-mix adjusted probability of immediate treatment vs. active-surveillance (AS) according to hospital of diagnosis and to evaluate the effect of patient-, tumour-, and hospital-related factors. Results: In all, 2047 (85.4%) of the 2396 patients with very-low-risk prostate cancer were managed with AS. The crude proportion of patients with AS varied from 33.3 to 100% between hospitals. Case-mix adjusted probability varied from 71 to 97%. Tumour stage cT2a vs. cT1c (OR 2.0, 95%CI 1.1−3.6), two vs. one positive core (OR 2.8, 95%CI 1.6−4.7), diagnostic MRI (OR 2.8, 95%CI 1.5−5.2), discussion of a patient in a multi-disciplinary team (OR 2.2, 95%CI 1.1−4.5), discussion of treatment options with the patient (OR 3.3, 95%CI 1.5−7.4) and type of hospital (non-university referral hospital vs. community hospital: OR 0.5, 95%CI 0.2−0.9) were associated with immediate treatment. Conclusion: The majority of Dutch very-low-risk prostate cancer patients is managed with AS but variation between hospitals exists. Part of the variation is explained by patient- and tumour characteristics but also hospital-related factors play a role. This implies that clinical practice could be improved

Variation in the Prescription of Androgen Deprivation Therapy in Intermediate- and High-risk Prostate Cancer Patients Treated with Radiotherapy in the Netherlands, and Adherence to European Association of Urology Guidelines: A Population-based Study

Background: According to (inter-)national guidelines, (neo-)adjuvant and concurrent androgen deprivation therapy (ADT) in combination with external beam radiotherapy (EBRT) is optional for intermediate-risk prostate cancer (PCa) patients and is the recommended standard treatment for high-risk PCa patients. Objective: The aim of this study is to provide insight into the prescription of ADT in intermediate- and high-risk PCa patients treated with EBRT in the Netherlands, and to evaluate adherence to European Association of Urology guidelines and factors affecting prescription. Design, setting, and participants: All intermediate- and high-risk PCa patients between October 2015 and April 2016 were identified through the population-based Netherlands Cancer Registry. Variation in the prescription of ADT in patients with EBRT was evaluated. Multivariable multilevel logistic regression analyses were performed to determine the probability of ADT and to examine the role of patient-, tumour-, and hospital-related factors. Results and limitations: Overall, 29% of patients with intermediate-risk PCa received ADT varying from 3% to 73% between institutions. From the multivariable regression analysis, higher Gleason grade, magnetic resonance imaging, and computed tomography (CT)-positron-emission tomography/CT prior to radiotherapy appeared to be associated with increased prescription of ADT. Among high-risk patients, 83% received ADT, varying from 57% to 100% between departments. A higher prostate-specific antigen level, more advanced tumour stage, and a higher Gleason grade were associated with increased prescription. Conclusions: Less than one-third of intermediate-risk PCa patients treated with EBRT receive ADT. The variation in the prescription of ADT between different institutions is substantial. This suggests that the prescription is largely dependent on different institutional policies. The guideline adherence in high-risk PCa is fairly good, as the vast majority of patients received ADT as recommended. However, given the clear recommendations in the guidelines, adherence could be improved. Patient summary: In this review, we looked at the variation of hormonal treatment in intermediate- and high-risk prostate cancer patients. We found substantial variation between institutions