effectiviteit en werkzame mechanismen

This report reviews empirical evidence for the effectiveness of four police strategies as well as the conditions under which these strategies reach their effect.In deze researchsynthese is gezocht naar resultaten uit empirisch onderzoek over de effectiviteit van vier verschillende politiestrategieën, alsmede de omstandigheden waaronder deze strategieën effectief zijn. De volgende onderzoeksvragen komen in deze studie aan de orde: Wat is de actuele stand van de kennis over de effectiviteit van Comunity Policing? Wat is de actuele stand van de kennis over de effectiviteit van Third Party Policing? Wat is de actuele stand van de kennis over de effectiviteit van Hotspot policing? Wat is de actuele stand van de kennis over de effectiviteit van Problem Oriented Policing? Onder welke omstandigheden (of in welke context) worden de resultaten van effectieve politiestrategieën bereikt? Onder welke omstandigheden (of in welke context) blijft het effect van effectieve politiestrategieën uit? INHOUD: 1. Inleiding 2. Methode 3. Evidente politiestrategieën 4. Omstandigheden 5. Conclusies en suggesties voor vervolgonderzoe

Procesevaluatie van de gedragsinterventie Stay-a-way

Stay-a-way is a Dutch cognitive-behavioural intervention designed to help young offenders who have substance use problems. Before it can be determined whether the intended behavioural changes are achieved in Stay-a-way, a process evaluation is necessary to ensure that the intervention was delivered as intended.Stay-a-way richt zich op het motiveren tot vermindering van het middelengebruik, vergroten van het inzicht ten aanzien van middelengebruik en delictgedrag, en het voorkomen van middelenafhankelijkheid bij jongeren met een verhoogd risico daartoe. Het uiteindelijke doel is het verkleinen van de kans op recidive. Het programma is in juni 2011 erkend door de Erkenningscommissie Gedragsinterventies Justitie. Stay-a-way is bedoeld voor delinquenten van 12 tot en met 18 jaar, met een midden of hoog dynamisch risicoprofiel (DRP), en bij wie sprake is van (risico op) middelenmisbruik of -afhankelijkheid. In deze procesevaluatie wordt onderzocht of het programma Stay-a-way wordt uitgevoerd zoals beoogd in de programmahandleidingen. Daarnaast wordt nagegaan wat achterliggende oorzaken zijn van eventuele problemen in de uitvoering en welke verbeteringen in de implementatie dan wel interventie zelf gewenst zijn. Tot slot wordt op basis van het behalen van de procesevaluatie nagegaan in hoeverre een doeltreffendheidstudie - in termen van het behalen van programmadoelen - uitvoerbaar zal zijn

The effects of integrative reminiscence on depressive symptomatology and mastery of older adults.

A quasi-experimental (non-randomized) study was conducted to study the effects of a new intervention The story of your life that combines integrative reminiscence with narrative therapy. The program consists of seven sessions of two hours and one follow-up session after 8 weeks. It is directed at community-dwelling people of 55 years and older with mild to moderate depressive symptoms. After the intervention the participants showed significantly less depressive symptoms and higher mastery, also in comparison with a waiting-list control group. Demographic factors and initial levels of depressive symptomatology and mastery were not found to moderate the effects. The effects were maintained at 3 months after completion of the intervention. Although the new program was positively evaluated by the majority of the participants there is room for improvement. Adaptations should be made, and evaluated in a randomised controlled trial

Cost-utility of a visiting service for older widowed individuals: Randomised trial

Background. Despite a growing understanding of the effectiveness of bereavement interventions and the groups that benefit most from them, we know little about the cost-effectiveness of bereavement interventions. Methods. We conducted a cost-utility analysis alongside a randomized clinical trial on a visiting service for older widowed individuals (n = 110) versus care as usual (CAU; n = 106). The visiting service is a selective bereavement intervention that offers social support to lonely widows and widowers by a trained volunteer. Participants were contacted 6-9 months post-loss. Eleven percent of all contacted persons responded and eight percent participated in the trial. The primary outcome measure was quality adjusted life years (QALYs) gained (assessed with the EQ-5D), which is a generic measure of health status. Costs were calculated from a societal perspective excluding costs arising from productivity losses. Using the bootstrap method, we obtained the incremental cost utility ratio (ICUR), projected these on a cost-utility plane and presented as an acceptability curve. Results. Overall, the experimental group demonstrated slightly better results against slightly higher costs. Whether the visiting service is acceptable depends on the willingness to pay: at a willingness to pay equal to zero per QALY gained, the visiting service has a probability of 31% of being acceptable; beyond €20,000, the visiting service has a probability of 70% of being more acceptable than CAU. Conclusion. Selective bereavement interventions like the visiting service will not produce large benefits from the health economic point of view, when targeted towards the entire population of all widowed individuals. We recommend that in depth analyses are conducted to identify who benefits most from this kind of interventions, and in what subgroups the incremental cost-utility is best. In the future bereavement interventions are then best directed to these groups. Trial registration. Controlled trials ISRCTN17508307. © 2008 Onrust et al; licensee BioMed Central Ltd

The reimbursement for expensive medicines: stakeholder perspectives on the SMA medicine nusinersen and the Dutch Coverage Lock policy

Background: The reimbursement for expensive medicines poses a growing challenge to healthcare worldwide. In order to increase its control over the costs of medicines, the Dutch government introduced the Coverage Lock (CL) policy in 2015. The CL postpones decisions regarding reimbursement of expensive medicines until detailed advice on i.e., cost-effectiveness has been given. The CL has been in place for six years, has raised many questions and concerns, but currently, no evaluation is known to the authors. A better understanding of the effects of the CL on all stakeholders involved may contribute to reflections on the CL process and help find ways to improve it. An evaluation of Dutch policy will also be relevant for other countries that aim to optimize reimbursement procedures for expensive treatments. To perform this evaluation, we focused on the CL procedure for the medicine nusinersen. Nusinersen is the first treatment for spinal muscular atrophy (SMA). Following EMA approval in May 2017, it was placed in the CL. The analysis of cost-effectiveness and added therapeutic value resulted in an advice for reimbursement limited to children younger than 9.5 years at the start of treatment; this was implemented from August 2018 onwards. Methods: Qualitative stakeholder perspective analysis of the CL procedure focusing on nusinersen with 15 stakeholders. Results: Stakeholders raised key issues of the CL based on their experience with nusinersen: emotional impact of the CL, duration of the CL procedure, appropriateness of the CL procedure for different types of medicines, transparency of the CL, a wish for patient-centred decision-making and the lack of uniformity of access to expensive treatments. Discussion: Stakeholders supported measures to control healthcare expenses and to ensure reasonable pricing. They considered the delay in access to therapies and lack of procedural transparency to be the main challenges to the CL. Stakeholders also agreed that the interests of patients deserve more attention in the practical implementation of the reimbursement decision. Stakeholders suggested a number of adjustments to improve the CL, such as a faster start with conditional reimbursement programs to ensure access and intensify European collaboration to speed up the assessment of the medicine

Family group decision-making for children at risk of abuse or neglect:A systematic review

Background: Capturing the scale of child maltreatment is difficult, but few wouldargue that it is anything less than a global problem which can affect victims’ healthand wellbeing throughout their life. Systems of detection, investigation and inter-vention for maltreated children are the subject of continued review and debate.Objectives: To assess the effectiveness of the formal use of family group decisionmaking (FGDM) in terms of child safety, permanence (of child's living situation), child and family wellbeing, and client satisfaction with the decisionmaking process. Search Methods: Both published and unpublished manuscripts were considered eligible for this review. Library staff from Scholarly Information (Brownless Biomedical Library)University of Melbourne, conducted 14 systematic bibliographic searches. Reviewers also checked the reference lists of all relevant articles obtained, and reference lists from previously published reviews. Researchers also handsearched 10 relevant journals. Selection Criteria: Study samples of children and young people, aged 0–18 years, who have been the subject of a child maltreatment investigation, were eligible for this review. Studies had to have used random assignment to create treatment and control groups; or,parallel cohorts in which groups were assessed at the same point in time. Any form ofFGDM, used in the course of a child maltreatment investigation or service, was considered an eligible intervention if it involved: a concerted effort to convene family, extended family, and community members; and professionals; and involved a planned meeting with the intention of working collaboratively to develop a plan for the safetywellbeing of children; with a focus on familycentred decisionmaking.Data Collection and Analysis: Two review authors independently extracted the necessary data from each study report, using the software application Covidence. Covi-dence highlighted discrepancies between data extracted by separate reviewers, further analysis was conducted until a consensus was reached on what data were to be included in the review. Two authors also independently conducted analyses of study bias. Main Results: Eighteen eligible study reports were found, providing findings from15 studies, involving 18 study samples. Four were randomised controlled trials(RCTs; N = 941) the remainder employed quasiexperimental designs with parallel cohorts. Three of the quasiexperimental studies used prospective evaluations of non-randomly assigned comparison groups (N = 4,368); the rest analysed preexisting survey data, child protection case files or court data (N = 91,786). The total number of children studied was 97,095. The longest postintervention followup period w as 3 years. Only four studies were conducted outside the United States; two in Canada and one in Sweden and one in the Netherlands. The review authors judged there to be a moderate or high risk of bias, in most of the bias categories considered. Only one study referenced a study protocol. Eleven of the fifteen studies were found to have a high likelihood of selection bias (73%). Baseline imbalance bias was deemed to be unlikely in just two studies, and highly likely in nine (60%). Confounding variables were judged to be highly likely in four studies (27%), and contamination bias was judged highly likely in five studies (33%). Researcher allegiance was rated as a high risk in three studies (20%)where the authors argued for the benefits of FGDM within the article, but without supporting references to an appropriate evidence base. Bias from differential diagnostic activity, and funding source bias, were less evident across the evidence reviewed. This review combines findings for eight FGDM outcome measures. Findings from RCTs were available for four outcomes, but none of these, combined in metaanalysis or otherwise, were statistically significant. Combining findings from the quasiexperiment al studies provided one statistically significant finding, for the reunification of families, favouring FGDM. Ten effect sizes, from nine quasiexperimental studies, were synthesised to examine effects on the reunification of children with their family or the effect on maintaining inhome care; in short, the effect FGDM has on keeping families together. There was a high level of heterogeneity between the studies (I2=92%). The overall effect, based on the combination of these studies was positive, small, but statistically significant: odds ratio (OR), 1.69 (confidence interval [CI], 1.03, 2.78). Holinshead's(2017) RCT also measured the maintenance on inhomecareandreportedasimilarresult: OR, 1.54 (CI, −0.19, 0.66) not statistically significant. The overall effect for continued maltreatment from metaanalysis of five quasiexperimental studies, favoured the FGDM group, but was not statistically significant: OR, 0.73 (CI, 0.48, 1.11).The overall combined effect for continued maltreatment, reported in RCTs, favoured the control group. But it was not statistically significant: OR, 1.29 (CI, 0.85, 1.98). Five effect sizes, from nonrandomised studies, were synthesised to examine the effect of FGDM on the number of kinship placements. The overall positive effect based on the combination of these studies was negligible: OR, 1.31 (CI, 0.94, 1.82). Metaanalysis was not possible with other outcomes. FGDM's role in expediting case processing and case closures was investigated in six studies, three of which reported findings favouring FGDM, and three which favoured the comparison group. Children's placement stability was reported in two studies: an RCT's findings favoured the control, while a quasiexperimental study's findings favoured FGDM. Three studies reported findings for service user satisfaction: one had only 30 participants, one reported a statistically significant positive effect for FGDM, the other found no difference between FGDM and a control. Engagement with support services was reported in two studies; neither reported statistically significant finding

Idiopathic combined, autoantibody-mediated ADAMTS-13/factor H deficiency in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome in a 17-year-old woman: a case report

Introduction Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome is a life-threatening condition with various etiopathogeneses. Without therapy approximately 90% of all patients die from the disease. Case presentation We report the case of a 17-year-old Caucasian woman with widespread hematomas and headache. Due to hemolytic anemia, thrombocytopenia, and schistocytosis, thrombotic thrombocytopenic purpura-hemolytic uremic syndrome was suspected and plasma exchange therapy was initiated immediately. Since her thrombocyte level did not increase during the first week of therapy, plasma treatment had to be intensified to a twice-daily schedule. Further diagnostics showed markedly reduced activities of both ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 - also known as von Willebrand factor-cleaving protease) and factor H. Test results for antibodies against both proteins were positive. While plasma exchange therapy was continued, rituximab was given once weekly for four consecutive weeks. After the last dose, thrombocytes and activities of ADAMTS-13 and factor H increased into the normal range. Our patient improved and was discharged from the hospital. Conclusions Since no clinical symptoms/laboratory findings indicated a malignant or specific autoimmune-mediated disorder, the diagnosis made was thrombotic thrombocytopenic purpura-hemolytic uremic syndrome due to idiopathic combined, autoantibody-mediated ADAMTS-13/factor H deficiency

(Cost)effectiveness of life review for Older Adults: Design of a randomized controlled trial

Background Depression in older adults is a serious health problem with a poor prognosis. There is a need for indicated preventive psychological interventions for older adults, that show to be promising in preventing depressive disorders. Methods/design This manuscript describes the design of a study evaluating 'Looking for Meaning', a newly developed prevention course for older adults with depressive symptoms, based on life-review. Both clinical and economic effectiveness are evaluated in a pragmatic randomized controlled trial. The control condition of this 12-session preventive intervention is a 20-minute video movie. The primary outcome is symptoms of depression at post-treatment and follow-up (6 months after post-treatment). Secondary outcomes are symptoms of anxiety, satisfaction with life, mastery, reminiscence styles, quality of life, and health care costs. An additional result of this study is the insight into the working elements of the course, provided by the qualitative study. The qualitative data, mainly based on 20 open-ended interviews with participants, are to be analyzed with an emphasis on newly emerging insight. Discussion This study will add to the existing scientific knowledge in several ways, especially by also including an economic evaluation and a qualitative study to gain insight into the working mechanisms of the course, both rather new in the field of life review. Positive results of this study will make an evidence-based intervention to improve public health among older people available