Effects of structured involvement of the primary care team versus standard care after a cancer diagnosis on patient satisfaction and healthcare use: the GRIP randomised controlled trial

Background: The growing number of cancer survivors and treatment possibilities call for more personalised and integrated cancer care. Primary care seems well positioned to support this. We aimed to assess the effects of structured follow-up of a primary care team after a cancer diagnosis. Methods: We performed a multicentre randomised controlled trial enrolling patients curatively treated for breast, lung, colorectal, gynaecologic cancer or melanoma. In addition to usual cancer care in the control group, patients randomized to intervention were offered a “Time Out consultation” (TOC) with the general practitioner (GP) after diagnosis, and subsequent follow-up during and after treatment by a home care oncology nurse (HON). Primary outcomes were patient satisfaction with care (questionnaire: EORTC-INPATSAT-32) and healthcare utilisation. Intention-to-treat linear mixed regression analyses were used for satisfaction with care and other continuous outcome variables. The difference in healthcare utilisation for categorical data was calculated with a Pearson Chi-Square or a Fisher exact test and count data (none versus any) with a log-binomial regression. Results: We included 154 patients (control n = 77, intervention n = 77) who were mostly female (75%), mainly diagnosed with breast cancer (51%), and had a mean age of 61 (SD ± 11.9) years. 81% of the intervention patients had a TOC and 68% had HON contact. Satisfaction with care was high (8 out of 10) in both study groups. At 3 months after treatment, GP satisfaction was significantly lower in the intervention group on 3 of 6 subscales, i.e., quality (− 14.2 (95%CI -27.0;-1.3)), availability (− 15,9 (− 29.1;-2.6)) and information provision (− 15.2 (− 29.1;-1.4)). Patients in the intervention group visited the GP practice and the emergency department more often ((RR 1.3 (1.0;1.7) and 1.70 (1.0;2.8)), respectively). Conclusions: In conclusion, the GRIP intervention, which was designed to involve the primary care team during and after cancer treatment, increased the number of primary healthcare contacts. However, it did not improve patient satisfaction with care and it increased emergency department visits. As the high uptake of the intervention suggests a need of patients, future research should focus on optimizing the design and implementation of the intervention. Trial registration: GRIP is retrospectively (21/06/2016) registered in the ‘Netherlands Trial Register’ (NTR5909)

Carotid Artery Intima-Media Thickness, Carotid Plaque and Coronary Heart Disease and Stroke in Chinese

Background: Our aim was to prospectively investigate the association between carotid artery intima-media thickness (IMT) as well as carotid plaque and incidence of coronary heart disease (CHD) and stroke in Chinese, among whom data are limited. Methods and Findings: We conducted a community-based cohort study composed of 2190 participants free of cardiovascular disease at baseline in one community. During a median 10.5-year follow up, we documented 68 new cases of coronary heart disease and 94 cases of stroke. The multivariate relative risks (RRs) associated with a change of 1 standard deviation of maximal common carotid IMT were 1.38 (95% confidence interval [CI], 1.12–1.70) for CHD and 1.47 (95% CI, 1.28–1.69) for stroke. The corresponding RRs with internal carotid IMT were 1.47 (95% CI, 1.21–1.79) for CHD and 1.52 (95% CI, 1.31–1.76) for stroke. Carotid plaque measured by the degree of diameter stenosis was also significantly associated with increased risk of CHD (p for trend<0.0001) and stroke (p for trend<0.0001). However, these associations were largely attenuated when adjusting for IMT measurements. Conclusions: This prospective study indicates a significant association between carotid IMT and incidence of CHD and stroke in Chinese adults. These measurements may be useful for cardiovascular risk assessment and stratification in Chinese

Natuursteen

Item does not contain fulltex

Keramisch bouwmateriaal

Item does not contain fulltex

Achter de Johanneskerk te Lichtenvoorde, Rentenierstraat 5 en 9 : een inventariserend veldonderzoek in de vorm van proefsleuven

Lit.opg

Multi-agent control for integrated heat and electricity management in residential districts

For the built environment it is envisaged that in the next decades the total annual energy demand, both thermal and electric, could be covered by renewable sources generated within the built environment. More and more thermoelectric elements, such as heat pumps and thermal storage, will enable conversion from heat to electricity and vice versa. Control in this environment therefore requires an integral management of both heat network and the electricity network. In this paper we present of a market-based multi-commodity algorithm for integrated coordination of electricity and heat flows at the residential district level. The algorithm is an enhancement of the PowerMatcher concept for electricity alone and inherits its advantages such as scalability and user autonomy. Some examples are given to demonstrate the usability of algorithm in residential areas to unleash a large flexibility potential of heat and electricity flows in support of the integration of renewable energy

Brielle Nobelstraat, gemeente Brielle : een archeologische begeleiding

Lit.opg

Facilitating DER energy services for grid management via OS4ES : Aggregated flexibility, class model and matching algorithms

The European electricity infrastructure is challenged by the deployment of large numbers of DER systems in the grid. The massive deployment complicates the network management done by System Operators: DSOs, TSOs and BRPs. To cope with these adverse effects, the use of smart strategies using the flexibility potential of DER systems has been advocated. The Open System for Energy Services (OS4ES) framework, with a distributed registry for DER Systems is designed to exploit flexibility and to close the current gaps of information, communication and cooperation between DERs, DSOs and BRPs. This enables a new process for identifying, aggregating and creating value out of flexibility. In this paper relevant parts for emerging the OS4ES process are outlined. One part presents the OS4ES defined energy services for flexibility involving DERs. Based on this and on the information that needs to be exchanged between DERs and other parts of the system in order for such services to be executed, will introduce the vital and interesting elements of the semantic class model of DERs. OS4ES is strongly based on standardized and interoperable communication interfaces, as well as generic interfaces among components producing, consuming or storing electrical energy. Also the general context and the scope of the matching algorithms that are needed to support OS4ES registry-related functionalities will be sketched, presenting the DER system services searching functionalities to be dealt with.Peer reviewe