Training specialists to write appropriate reply letters to general practitioners about patients with medically unexplained physical symptoms; A cluster-randomized trial.

Objective: To evaluate effects of a communication training for specialists on the quality of their reply letters to general practitioners (GPs) about patients with medically unexplained physical symptoms (MUPS). Methods: Before randomization, specialists included ≤3 MUPS patients in a multi-center cluster-randomized trial. In 14 h of MUPS-specific communication training, 2.5 h focused on reply letters. Letters were discussed with regard to reporting and answering GPs' referral questions and patients' questions, and to reporting findings, explaining MUPS with perpetuating factors and giving advice. After the training, all doctors again included ≤3 MUPS patients. Reply letters to GPs were assessed for quality and blindly rated on a digital scale. Results: We recruited 478 MUPS patients and 123 specialists; 80% of the doctors wrote ≥1 reply letters, 285 letters were assessed. Trained doctors reported (61% versus 37%, OR=2.55, F(1281)=6.60, pgroup*time=.01) and answered (63% versus 33%, OR=3.31, F(1281)=5.36, pgroup*time=.02) patients' questions more frequently than untrained doctors. Conclusion: Training improves reply letters with regard to patients' questions, but not with regard to the following: GPs' referral questions, somatic findings, additional testing, explaining, and advice. Practice implications: Training specialists to write appropriate reply letters needs more focus on explanation and advice

A core outcome domain set for clinical research on capillary malformations (the COSCAM project):an e-Delphi process and consensus meeting

BACKGROUND: There is limited evidence on the best available treatment options for capillary malformations (CMs), mainly due to the absence of uniform outcome measures in trials on therapies. A core outcome set (COS) enables standard reporting of trial outcomes, which facilitates comparison of treatment results. OBJECTIVES: To develop a core outcome domain set (CDS), as part of a core outcome set (COS), for clinical research on CMs. METHODS: Sixty‐seven potentially relevant outcome subdomains were recognized based on the literature, focus group sessions, and input from the COSCAM working group. These outcome subdomains were presented in an online Delphi study to CM experts (medical specialists and authors of relevant literature) and (parents of) patients with CM (international patient associations). During three e‐Delphi study rounds, the participants repeatedly scored the importance of these outcome subdomains on a seven‐point Likert scale. Participants could also propose other relevant outcome subdomains. Consensus was defined as ≥ 80% agreement as to the importance of an outcome subdomain among both stakeholder groups. The CDS was finalized during an online consensus meeting. RESULTS: In total 269 participants from 45 countries participated in the first e‐Delphi study round. Of these, 106 were CM experts from 32 countries, made up predominantly of dermatologists (59%) and plastic surgeons (18%). Moreover, 163 (parents of) patients with CM from 28 countries participated, of whom 58% had Sturge–Weber syndrome. During the two subsequent e‐Delphi study rounds, 189 and 148 participants participated, respectively. After the entire consensus process, consensus was reached on 11 outcome subdomains: colour/redness, thickness, noticeability, distortion of anatomical structures, glaucoma, overall health‐related quality of life, emotional functioning, social functioning, tolerability of intervention, patient satisfaction with treatment results, and recurrence. CONCLUSIONS: We recommend the CDS to be used as a minimum reporting standard in all future trials of CM therapy. Our next step will be to select suitable outcome measurement instruments to score the core outcome subdomains. What is already known about this topic? Besides physical and functional sequelae, capillary malformations (CMs) often cause emotional and social burden. The lack of uniform outcome measures obstructs proper evaluation and comparison of treatment strategies. As a result, there is limited evidence on the best available treatment options. The development of a core outcome set (COS) may improve standardized reporting of trial outcomes. What does this study add? A core outcome domain set (CDS), as part of a COS, was developed for clinical research on CMs. International consensus was reached on the recommended core outcome subdomains to be measured in CM trials: colour/redness, thickness, noticeability, distortion of anatomical structures, glaucoma, overall health‐related quality of life, emotional functioning, social functioning, tolerability of intervention, patient satisfaction with treatment results, and recurrence. This CDS enables the next step in the development of a COS, namely to reach consensus on the core outcome measurement instruments to score the core outcome subdomains. What are the clinical implications of this work? The obtained CDS will facilitate standardized reporting of treatment outcomes, thereby enabling proper comparison of treatment results. This comparison is likely to provide more reliable information for patients about the best available treatment options

Schiedam Demos-terrein : een archeologisch vooronderzoek op de toekomstige parkeerlocatie van het Vlietlandziekenhuis

Met lit. op

Spijkenisse verpleeginrichting : een archeologisch vooronderzoek

Met lit. op

BOOR 101

onderzoeksrappor

BOOR 102

onderzoeksrappor

Ombudsprudentie

ix,405 hal,;28 c

Trees and ladders: A critique of the theory of human cognitive and behavioural evolution in Palaeolithic archaeology

The modern biological model of (human) evolution is that of a branching tree. By contrast, prevailing models for human cognitive evolution remain unilinear in character, representing a ladder. The linear ladder model is the result of the opposition of an ethnographic and a primate reference frame for cognition, representing the two ends of what by definition becomes a linear line of evolution. It forces all types of behaviour that are not considered fully " modern" to assume a position at a lower level of cognition. The linear model is in addition pushed by the (flawed) perception of a linear encephalization trend over time. The structure of this linear model is not fundamentally based in either modern evolutionary theory or the archaeological record. The model itself is even structurally immune to constraints from pertinent data. Adopting a branching tree model instead has serious implications for views on hominin cognition and particularly the meaning of being " behaviourally modern" . In a branching model, " modern behaviour" no longer has a unique status as being . by necessity the most sophisticated level of cognition, turning many of the traditional implications derived from the possession of " modern behaviour" moot. The challenge that adoption of a branching tree model creates is that ways have to be devised to account for unique cognitive expressions that are not covered by the existing framework of ethnography and primatology. In addition, notions about the " superiority" of " modern behaviour" over other forms of cognitive expression have to be abandoned. The advantage is that the model is structured to pertinent archaeological data and actually testable with archaeological data. Two case studies from the Lower and Middle Palaeolithic of Europe probe the construction of unique models for mobility strategies " bottom up" from archaeological data, providing a unique alternative to mobility models and their cognitive implications as derived from " bottom down" application of an ethno-primatological framework. © 2011 Elsevier Ltd and INQUA