LINH-cijfers: taakopvatting van huisartsen omtrent psychosociale zorgverlening versmald.

De taakopvatting van huisartsen ten aanzien van psychosociale zorgverlening is aanzienlijk versmald. Vergeleken met 1987 vinden minder huisartsen dat ze zich bezig zouden moeten houden met het bespreken van bijvoorbeeld de relatieproblemen van hun patiënten, hun opvoedingsmoeilijkheden of de langdurige problemen op hun werk. Psychosociale zorgverlening maakt een wezenlijk onderdeel uit van de door Nederlandse huisartsen verleende zorg. Toch is bijvoorbeeld het percentage huisartsen dat het bespreken van langdurige problemen op het werk volledig of grotendeels tot het eigen takenpakket rekent, afgenomen van 70% tot iets minder dan de helft (46%). De verschuiving in taakopvatting is minder groot bij psychiatrische problemen, zoals het behandelen van wanen. Juist méér huisartsen dan vroeger geven aan dat zij het bieden van hulp bij het bedwingen van suïcidale neigingen wél tot hun taak rekenen. Hoe dat komt is onbekend. De veranderingen in taakopvatting gaan hand in hand met het minder vaak door huisartsen zelf behandelen van psychosociale problemen in de dagelijkse praktijk.Dit blijkt uit een schriftelijke enquête onder Nederlandse huisartsen in 1987 en 2001 (in het kader van respectievelijk de Eerste en Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk)

Spasticity Deciphered: The effects of intrathecal baclofen treatment determined by electromyography in spasticity

BackgroundSpasticity is a condition that affects patients who have sustained an upper motor neuron lesion. Such lesions include for example cerebral palsy (CP), of which 35% is affected by spasticity, and stroke, of which 90% is affected by spasticity. Pharmacological therapy often involves the prescription of oral baclofen. However, due to the difficulty of medication in crossing the blood-brain barrier, high dosages of oral baclofen are required to achieve the desired therapeutic effect, which in turn leads to an increase of the incidence of negative side-effects. For patients with severe spasticity, the intrathecal baclofen (ITB) pump is indicated for more effective drug delivery. To monitor the efficacy of the treatment and quantify the level of spasticity, the Modified Ashworth Scale (MAS) is employed. Nevertheless, the moderate inter- and intra-rater reliability indicates that the subjectivity of the approach represents a potential limitation. Therefore, a more objective approach is required. Surface electromyography (sEMG) can measure direct muscle activity and is an objective and non-invasive approach. Yet, there is no research available on sEMG measurements to assess the change in muscle activity as a result of ITB treatment. ObjectiveThe primary objective of this exploratory study is to assess the effect of intrathecal baclofen on lower limb muscle activity using sEMG. The secondary objectives are assessing the correlation between the sEMG feature values and MAS scores, and between the sEMG feature values and Patient's Global Impression of Change (PGIC) scores.MethodsEMG measurements were performed during standard assessment of the MAS on patients receiving an ITB single shot trial (SS) and/or pump implantation. The following features were analyzed: (1) Root Mean Square (RMS), (2) Peak Amplitude Value (PAV), (3) Median Frequency, and (4) Co-Contraction (CCR). A comparative analysis was conducted to assess the change in mean feature value of each individual muscle between pre- and post-treatment for the purpose of study aim 1. The Spearman's rank correlation coefficient was calculated in order to assess the relationship between changes in feature values and changes in MAS scores. Furthermore, the Spearman's rank correlation coefficient was calculated to assess the relationship between the changes in most effective feature and the PGIC scores. ResultsA total of twelve patients were included in the study, diagnosed with a variety of conditions including spinal cord injury (SCI), multiple sclerosis (MS), traumatic brain injury (TBI) and CP. Following ITB treatment, the RMS demonstrated a statistically significant decrease for three out of eight muscles: the left semitendinosus (p = 0.020), the right rectus femoris (p = 0.025) and the right tibialis anterior (p = 0.002). The PAV presented a decrease in 3-8 out of 10 patients following SS baclofen treatment. The changes in median frequency exhibited considerable variability between patients following ITB treatment. The CCR decreased in six out of ten patients for the left leg following SS baclofen treatment. A significant correlation was observed between the change in MAS scores and change in RMS in the medial gastrocnemius (p = 0.027) and the change in median frequency in the semitendinosus (p = 0.002). A low correlation was observed between the change in RMS and the PGIC score.ConclusionIn conclusion, this study demonstrates the potential of sEMG features, such as RMS, in assessing the impact of ITB treatment on muscle activity. Future work could validate these findings by increasing the sample size and improving certain methodological aspects.TM30004; 35 ECTSTechnical Medicine | Sensing and Stimulatio

Recognizing and Handling Negations in Machine Learning

In several machine learning problems, a relatively small subproblem is present in which combinations of (negating) objects or structures result in a negation or otherwise other classification compared to when these (negating) objects are not present. To be more specific, a variant of the XOR problem is present in a small amount of objects in these classification problems. Examples of this could be negating words in textual sentiment classification or the presence of sarcasm when one wants to determine seriousness in speech. As negations are usually present in a small part of much larger datasets, it is important to recognize these relatively rare negation structures within objects' data. Correctly recognizion and handling negations could improve overall classification performance in machine learning problems that inhibit negations in some of their dataset objects. To lay the groundwork for solving these problems, the subproblem of recognizing negation words in sentiment classification is solved by employing a word embedding neural network to recognize text structure and to correctly classify these negations while at the same time this neural network is used to classify complete sentences in the problem of sentiment classification

De absolute priority rule in de WHOA: achtergrond, uitwerking en knelpunten

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3D Printing Metal Spare Parts On-board: The Implementation of Additive Manufacturing on-board Heerema Vessels

In this Master Thesis the potential of Additive Manufacturing on-board vessels of Heerema Marine Contractors is looked into, with the goal to design a recommendation for implementing this technology. Heerema is an offshore construction company that is intrinsically motivated to improve their sustainability. They transport, install and remove all types of offshore facilities. All Heerema vessels have a warehouse on-board, containing spare parts. Spare parts are parts in-stock that will be used to maintain the vessel or execute projects. In total the warehouse contains 300.000 parts, with an average value of 13.000.000 US$. The total weight of the stored material is 1.400.000 kg. If a needed spare part is not in-stock, it is ordered and brought to the vessel. Both actions take up a lot of time and could risk a project being stopped, which influences the economic pillar of the Triple Bottom Line consisting of people, planet and profit. Having this many parts on-board, and always ordering a ‘new part’ when something breaks, is not seen as a sustainable project execution. Especially taking into account the possibility of repairing. Next to that, extra transports or air freights are needed to get parts on-board, which influences the sustainable pillar of the Triple Bottom Line. In some cases, parts used to be produced by suppliers that do not exist anymore, which makes it hard to order new ones or obligated to purchase packages. The preferred situation for Heerema would be to use Additive Manufacturing as an additional production method for spare parts. For the implementation of this technology, a sufficient quality of the printed parts is desired. Sufficiency for critical parts has to be qualified by external certification organizations. Sufficiency for non-critical parts is reached once it functions within the used application. Next to the quality of the prints, the time it takes to print a part is important. Both quality and time depend on the performance of the 3D printer, which will influence the adoption of the crew. The preferred situation can be seen as the goal Heerema if aiming for. To reach this goal, a Roadmap is recommended. This Roadmap is designed as being the most suitable way of implementing and using 3D printing on-board of their vessels. The Roadmap is based on three different phases: The Research phase, The Printing phase and The Opportunities phase. Within these phases, the printing phase exists of two sub-phases: a plastic and a metal print phase. Each printing phase exists of a testing phase, a limited use phase and an expansion phase. The transition from one phase to another is based on a stepwise approach to lower the risks that could occur while implementing a complex innovation. The stepwise approach is based on the level of trust among the vessel crew towards the level of complexity of the implemented innovation. The conducted research supports the proposed solution that leads to the preferred situation. The solution is assessed according the three aspects of the Industrial Design Engineering domain: Technology, Human Values and Business.The solution is shown to be feasible due to the chosen hardware, the study on printable spare parts, 3D print studies and mechanical tests at the TU Delft.Additionally, the solution is shown to be viable due to relative low investment costs, a decrease in man-hours and transports and a waste reduction based on Value Stream Mapping. Also, the solution is shown to be desirable due to the collaboration with current users, a promising partnership with Layertec and the fit with the sustainability aims of Heerema. The thesis is enclosed by mentioning the research limitations, reflections, recommendations and further research for Heerema.Integrated Product Desig

Huisartsenposten en werkbelasting: objectieve en ervaren werkbelasting door avond-, nacht- en weekenddiensten in waarneemgroepen en huisartsenposten.

In recent years, a major shift has taken place in the way out-of-hours service is provided by GPs. Small-scale groups of GPs with rota-systems have been replaced by large-scale co-operatives. This article describes the degree to which out-of-hours co-operatives affect the objective and subjective workload caused by out-of-hours shifts. Results have indicated that GPs working in out-of-hours co-operatives spend approximately 70% less time on out-of-hours shifts than others. Additionally, they experience their out-of-hours shifts as less onerous and they are more satisfied about the way out-of-hours work is organised than other GPs. However, the reduced number of hours spent on out-of-hours work cannot be the one and only explanation of this greater satisfaction. Participation in a co-operative explains more of the variance in experienced workload than the number of hours spent on out-of-hours work. (aut.ref.

Factors affecting GPs workload in the period 1987-2001.

Background: Like in other countries, Dutch general practitioners (GPs) perceive an increase in workload. Too much work pressure will affect the quality of care and threats the accessibility of health care provided by GPs. Factors on organisational-level, patient-level as well as on GP-level may affect the objective and subjective workload of GPs. Some factors are beyond control of GPs (like e.g. ageing of patients), whereas other factors can be used by GPs to regulate workload. Insight in factors that affect the objective and subjective workload of GPs is important to guarantee a high quality health care system in the future. Aim: To describe a change in objective and subjective workload in general practice in the Netherlands between 1987-2001. Furthermore to provide a comprehensive insight into the factors that cause this change in objective and subjective workload. Methods: Data used in this study originate from the second Dutch National Survey of General Practice (DNSGP-2). This survey was carried out in 2001 in 104 general practices, amongst 195 GPs and 400,000 listed patients. Objective workload measures were derived from consultation registration, video observations and diaries (kept by GPs and practice assistants); subjective workload measures from questionnaires filled out by GPs. Factors on the organisational-level were measured by questionnaires, on the GP-level by diaries and questionnaires and factors on the patient-level by consultation registration and registration of socio-demographic characteristics. Cross-sectional, longitudinal and multilevel analyses were carried out. Data from the DNSGP-1 (1987) were used for the longitudinal analyses. Results: Hours worked by GPs per listed patient decreased between 1987 and 2001 despite the fact that consultation rate rose with 8%, mostly due to changes in patient demand. Gains in efficiency were reached by organisational changes like substituting home visits by office consultations and telephone consultations and by delegating more tasks to practice assistants. Furthermore, changes in GP-attitude, like a stricter task definition with respect to psychosocial activities, reduced workload. The percentage of GPs (partly) dissatisfied with their work in general doubled however (12% to 26%). Although the introduction of large scale out of hours (ooh) services significantly reduced time spent in ooh shifts (with 75%) it did not affect the subjective workload. Conclusions: By introducing organisational interventions and a more strict task orientation GPs seem to manage rising patient demands. The price paid for this seems to be a decrease in job satisfaction. Future interventions should not be restricted to lowering objective workload but take subjective workload into account as well. (aut.ref.