Excess of health care use in general practice and of comorbid chronic conditions in cancer patients compared to controls

<p>Abstract</p> <p>Background</p> <p>The number of cancer patients and the number of patients surviving initial treatments is expected to rise. Traditionally, follow-up monitoring takes place in secondary care. The contribution of general practice is less visible and not clearly defined.</p> <p>This study aimed to compare healthcare use in general practice of patients with cancer during the follow-up phase compared with patients without cancer. We also examined the influence of comorbid conditions on healthcare utilisation by these patients in general practice.</p> <p>Methods</p> <p>We compared health care use of N=8,703 cancer patients with an age and gender-matched control group of patients without cancer from the same practice. Data originate from the Netherlands Information Network of General Practice (LINH), a representative network consisting of 92 general practices with 350,000 enlisted patients. Health care utilisation was assessed using data on contacts with general practice, prescription and referral rates recorded between 1/1/2001 and 31/12/2007. The existence of additional comorbid chronic conditions (ICPC coded) was taken into account.</p> <p>Results</p> <p>Compared to matched controls, cancer patients had more contacts with their GP-practice (19.5 vs. 11.9, p<.01), more consultations with the GP (3.5 vs. 2.7, p<.01), more home visits (1.6 vs. 0.4, p<.01) and they got more medicines prescribed (18.7 vs. 11.6, p<.01) during the follow-up phase. Cancer patients more often had a chronic condition than their matched controls (52% vs. 44%, p<.01). Having a chronic condition increased health care use for both patients with and without cancer. Cancer patients with a comorbid condition had the highest health care use.</p> <p>Conclusion</p> <p>We found that cancer patients in the follow-up phase consulted general practice more often and suffered more often from comorbid chronic conditions, compared to patients without cancer. It is expected that the number of cancer patients will rise in the years to come and that primary health care professionals will be more involved in follow-up care. Care for comorbid chronic conditions, communication between specialists and GPs, and coordination of tasks then need special attention.</p

Effects of a partially supervised conditioning programme in cystic fibrosis: an international multi-centre randomised controlled trial (ACTIVATE-CF): study protocol

Physical activity (PA) and exercise have become an accepted and valued component of cystic fibrosis (CF) care. Regular PA and exercise can positively impact pulmonary function, improve physical fitness, and enhance health-related quality of life (HRQoL). However, motivating people to be more active is challenging. Supervised exercise programs are expensive and labour intensive, and adherence falls off significantly once supervision ends. Unsupervised or partially supervised programs are less costly and more flexible, but compliance can be more problematic. The primary objective of this study is to evaluate the effects of a partially supervised exercise intervention along with regular motivation on forced expiratory volume in 1 s (FEV1) at 6 months in a large international group of CF patients. Secondary endpoints include patient reported HRQoL, as well as levels of anxiety and depression, and control of blood sugar.; It is planned that a total of 292 patients with CF 12 years and older with a FEV1 ≥ 35% predicted shall be randomised. Following baseline assessments (2 visits) patients are randomised into an intervention and a control group. Thereafter, they will be seen every 3 months for assessments in their centre for one year (4 follow-up visits). Along with individual counselling to increase vigorous PA by at least 3 h per week on each clinic visit, the intervention group documents daily PA and inactivity time and receives a step counter to record their progress within a web-based diary. They also receive monthly phone calls from the study staff during the first 6 months of the study. After 6 months, they continue with the step counter and web-based programme for a further 6 months. The control group receives standard care and keeps their PA level constant during the study period. Thereafter, they receive the intervention as well.; This is the first large, international multi-centre study to investigate the effects of a PA intervention in CF with motivational feedback on several health outcomes using modern technology. Should this relatively simple programme prove successful, it will be made available on a wider scale internationally.; ClinicalTrials.gov Identifier: NCT01744561 ; Registration date: December 6, 2012

Centralized and decentralized energy mangement system for a multi commodity smart grid

Due to the expected growth in district heatingsystems, as well as the development of hybrid energy appliancescombining electrical and thermal energy such as heat pumps andmicro-combined heat and power installations, new opportunitiesarise for the management of thermal energy systems as well aselectrical power systems. The possibility to &apos;convert&apos; forms ofenergy using these hybrid energy appliances in combination withother appliances that offer flexibility in their energy productionand consumption, can result in high energy efficiencyimprovements. In order to enable a prototype multi commoditysmart grid environment incorporating both heat and electricity,this paper presents a demand side management system forintelligent decisions across the commodities. The goal of thedemand side management system is to perform supply anddemand matching of the local resources and flexible appliances, aswell as to flatten out the net remaining supply or demand. Toaccomplish this, both a centralized and decentralized managementapproach are presented, incorporating various types of flexibleappliances as well as hybrid energy appliances. The managementapproaches are applied to a test case, where simulation resultsconfirm that the proposed approaches form a suitable solution forthe management of the multi commodity smart grid environment. Due to the expected growth in district heatingsystems, as well as the development of hybrid energy appliancescombining electrical and thermal energy such as heat pumps andmicro-combined heat and power installations, new opportunitiesarise for the management of thermal energy systems as well aselectrical power systems. The possibility to &apos;convert&apos; forms ofenergy using these hybrid energy appliances in combination withother appliances that offer flexibility in their energy productionand consumption, can result in high energy efficiencyimprovements. In order to enable a prototype multi commoditysmart grid environment incorporating both heat and electricity,this paper presents a demand side management system forintelligent decisions across the commodities. The goal of thedemand side management system is to perform supply anddemand matching of the local resources and flexible appliances, aswell as to flatten out the net remaining supply or demand. Toaccomplish this, both a centralized and decentralized managementapproach are presented, incorporating various types of flexibleappliances as well as hybrid energy appliances. The managementapproaches are applied to a test case, where simulation resultsconfirm that the proposed approaches form a suitable solution forthe management of the multi commodity smart grid environment

Conceptual framework and simulation platform for reliable distribution grid monitoring and control with market interaction

In order to maintain reliability and reduce uncertainties in the operation of the distribution network caused by a large penetration of distributed generation and energy intensive appliances, monitoring capabilities of distribution networks need to be improved for the deployment of proper control actions. This paper proposes a conceptual framework for securing network operation by enhanced monitoring and control applications by taking market aspect into account. A simulation platform is proposed for the performance assessment of the monitoring and control applications, which will reveal how their accuracy is affected by the reliability of the measurement equipment and the communication system, as well as the interaction with the energy markets

Applying demand side management using a generalised three phase grid supportive approach

Demand side management is often seen as a promising tool for distribution network operators to mitigate network operation limit violations. Many demand side management applications have been proposed, each with their own objectives and methodology. Quite often, these demand side management applications do not have a direct interface with the network monitoring applications of the network operator, and therefore are not always capable of resolving operation limit violations effectively. Besides, for network operators it can be difficult to deal with the various types of demand side management applications run by different aggregators or energy suppliers. Therefore, this paper proposes a generalised three phase grid supportive demand side management approach for distribution networks, establishing a new interface between the monitoring and network analysis tools of the network operator and the demand side management application. Using the network sensitivity, independently of what objective de demand side management application pursues, the demand side management application will be able to resolve network operation limit violations as specified by the network operator. A case study based on fair power sharing shows the applicability of the proposed approach for mitigating over and under voltages as well as over currents simultaneously, followed by recommendations for future work and conclusions

Interfacing solutions for power hardware-inthe- loop simulations of distribution feeders for testing monitoring and control applications

The need for advanced monitoring and control applications (MCAs) in future distribution networks calls for highly accurate and fully integrated simulation solutions for the purpose of performance assessment of these MCAs. Offline simulation using models of the power system, measurement equipment, local controllers and the information and communication infrastructure do not always resemble reality accurate enough. Therefore, power hardware-in-the-loop (PHIL) simulations are considered a cost-effective approach to overcome these challenges. This study presents the design of a PHIL-interface that allows to integrate a physical low-voltage feeder within a larger real-time simulated distribution network. Using the combination of the physical network and the larger simulated network, MCAs can be tested for scalability as well as accuracy. A data acquisition and processing system is presented that acquires all the true system states of both the physical feeder and the real-time simulated network, such that the MCAs can be verified in real-time. The functioning of the PHIL-interface is validated using practical results and illustrated using a test case for the performance assessment of a branch current state estimation algorithm