The effect and process evaluations of the national quality improvement programme for palliative care : the study protocol

Background: The nationwide integration of palliative care best practices into general care settings is challenging but important in improving the quality of palliative care. This is why the Dutch National Quality Improvement Programme for Palliative Care has recently been launched. This four-year programme consists of about 70 implementation trajectories of best practices. A large evaluation study has been set up to evaluate this national programme and separate implementation trajectories. Methods/Design: This paper presents the protocol of the evaluation study consisting of a quantitative effect evaluation and a qualitative process evaluation. The effect evaluation has a pre-test post-test design, with measurements before implementation (month 0) and after implementation (month 9) of a best practice. Patients are eligible if they have a life expectancy of less than six months and/or if they are undergoing palliative treatment and provided they are physically and mentally capable of responding to questionnaires. Bereaved relatives are eligible if they have been involved in the care of a deceased patient who died after a sickbed between six weeks and six months ago. Three types of measurement instruments are used: (1) numerical rating scales for six symptoms (pain, fatigue, breathlessness, obstipation, sadness and anxiety), (2) the Consumer Quality Index Palliative Care - patient version and (3) the version for bereaved relatives. The process evaluation consists of analysing implementation plans and reports of the implementation, and individual and group interviews with healthcare professionals. This will be done nine to eleven months after the start of the implementation of a best practice. Discussion: This mixed-method evaluation study gives more insight into the effects of the total programme and the separate implementation trajectories. However, evaluation of large quality improvement programmes is complicated due to changing, non-controlled environments. Therefore, it is important that an effect evaluation is combined with a process evaluation

A comparison and accuracy analysis of impedance-based temperature estimation methods for Li-ion batteries

In order to guarantee safe and proper use of Lithium-ion batteries during operation, an accurate estimate of the battery temperature is of paramount importance. Electrochemical Impedance Spectroscopy (EIS) can be used to estimate the battery temperature and several EIS-based temperature estimation methods have been proposed in the literature. In this paper, we argue that all existing EIS-based methods implicitly distinguish two steps: experiment design and parameter estimation. The former step consists of choosing the excitation frequency and the latter step consists of estimating the battery temperature based on the measured impedance resulting from the chosen excitation. By distinguishing these steps and by performing Monte-Carlo simulations, all existing methods are compared in terms of accuracy (i.e., mean-square error) of the temperature estimate. The results of the comparison show that, due to different choices in the two steps, significant differences in accuracy of the estimate exist. More importantly, by jointly selecting the parameters of the experiment-design and parameter-estimation step, a more-accurate temperature estimate can be obtained. In case of an unknown State-of-Charge, this novel method estimates the temperature with an average absolute bias of View the MathML sourceC and an average standard deviation of View the MathML sourceC using a single impedance measurement for the battery under consideration

Social consequences of advanced cancer in patients and their informal caregivers:A qualitative study

Purpose Cancer threatens the social well-being of patients and their informal caregivers. Social life is even more profoundly affected in advanced diseases, but research on social consequences of advanced cancer is scarce. This study aims to explore social consequences of advanced cancer as experienced by patients and their informal caregivers. Methods Seven focus groups and seven in-depth semi-structured interviews with patients (n = 18) suffering from advanced cancer and their informal caregivers (n = 15) were conducted. Audiotapes were transcribed verbatim and open coded using a thematic analysis approach. Results Social consequences were categorized in three themes: "social engagement," "social identity," and "social network." Regarding social engagement, patients and informal caregivers said that they strive for normality by continuing their life as prior to the diagnosis, but experienced barriers in doing so. Regarding social identity, patients and informal caregivers reported feelings of social isolation. The social network became more transparent, and the value of social relations had increased since the diagnosis. Many experienced positive and negative shifts in the quantity and quality of their social relations. Conclusion Social consequences of advanced cancer are substantial. There appears to be a great risk of social isolation in which responses from social relations play an important role. Empowering patients and informal caregivers to discuss their experienced social consequences is beneficial. Creating awareness among healthcare professionals is essential as they provide social support and anticipate on social problems. Finally, educating social relations regarding the impact of advanced cancer and effective support methods may empower social support systems and reduce feelings of isolation

Pre-verbal infants perceive emotional facial expressions categorically

Adults perceive emotional expressions categorically, with discrimination being faster and more accurate between expressions from different emotion categories (i.e. blends with two different predominant emotions) than between two stimuli from the same category (i.e. blends with the same predominant emotion). The current study sought to test whether facial expressions of happiness and fear are perceived categorically by pre-verbal infants, using a new stimulus set that was shown to yield categorical perception in adult observers (Experiments 1 and 2). These stimuli were then used with 7-month-old infants (N  =  34) using a habituation and visual preference paradigm (Experiment 3). Infants were first habituated to an expression of one emotion, then presented with the same expression paired with a novel expression either from the same emotion category or from a different emotion category. After habituation to fear, infants displayed a novelty preference for pairs of between-category expressions, but not within-category ones, showing categorical perception. However, infants showed no novelty preference when they were habituated to happiness. Our findings provide evidence for categorical perception of emotional expressions in pre-verbal infants, while the asymmetrical effect challenges the notion of a bias towards negative information in this age group

Haptoglobin Phenotype, Preeclampsia Risk and the Efficacy of Vitamin C and E Supplementation to Prevent Preeclampsia in a Racially Diverse Population

Haptoglobin's (Hp) antioxidant and pro-angiogenic properties differ between the 1-1, 2-1, and 2-2 phenotypes. Hp phenotype affects cardiovascular disease risk and treatment response to antioxidant vitamins in some non-pregnant populations. We previously demonstrated that preeclampsia risk was doubled in white Hp 2-1 women, compared to Hp 1-1 women. Our objectives were to determine whether we could reproduce this finding in a larger cohort, and to determine whether Hp phenotype influences lack of efficacy of antioxidant vitamins in preventing preeclampsia and serious complications of pregnancy-associated hypertension (PAH). This is a secondary analysis of a randomized controlled trial in which 10,154 low-risk women received daily vitamin C and E, or placebo, from 9-16 weeks gestation until delivery. Hp phenotype was determined in the study prediction cohort (n = 2,393) and a case-control cohort (703 cases, 1,406 controls). The primary outcome was severe PAH, or mild or severe PAH with elevated liver enzymes, elevated serum creatinine, thrombocytopenia, eclampsia, fetal growth restriction, medically indicated preterm birth or perinatal death. Preeclampsia was a secondary outcome. Odds ratios were estimated by logistic regression. Sampling weights were used to reduce bias from an overrepresentation of women with preeclampsia or the primary outcome. There was no relationship between Hp phenotype and the primary outcome or preeclampsia in Hispanic, white/other or black women. Vitamin supplementation did not reduce the risk of the primary outcome or preeclampsia in women of any phenotype. Supplementation increased preeclampsia risk (odds ratio 3.30; 95% confidence interval 1.61-6.82, p<0.01) in Hispanic Hp 2-2 women. Hp phenotype does not influence preeclampsia risk, or identify a subset of women who may benefit from vitamin C and E supplementation to prevent preeclampsia

Randomized controlled study of pain education in patients receiving radiotherapy for painful bone metastases

BACKGROUND: Although short-course radiotherapy is an effective treatment for patients with painful bone metastases, pain is not always sufficiently controlled. We therefore investigated the additional effect of a nurse-led pain education program on pain control and quality of life (QoL).PATIENTS AND METHODS: In this multicenter study, patients with solid tumor bone metastases and a worst pain intensity of ≥5 on a 0-10 numeric rating scale (NRS) were randomized between care as usual (control-group) and care as usual plus the Pain Education Program (PEP-group). PEP consisted of a structured interview and personalized education with follow-up phone calls. Patients completed the Brief Pain Inventory, EORTC QLQ-C15-PAL and BM22 at week 0, 1, 4, 8 and 12. The primary outcome was pain control, defined as the number of patients whose worst pain intensity was &lt;5 on a 0-10 NRS after 12 weeks. Secondary outcomes were time to reach control of pain (NRS &lt; 5), mean worst pain and average pain, and QoL at weeks 1, 4, 8 and 12.RESULTS: Of 308 included patients, 182 (92 PEP-group) completed 12 weeks follow-up. At 12 weeks, more patients in the PEP-group (71%) compared to the control-group (52%) reported pain control (P =.008). In the PEP-group, pain control was reached earlier than in the control-group (median 29 days versus 56 days; P =.003). Mean worst and average pain decreased in both groups but decreased more in the PEP-group. QoL did not differ between the groups.CONCLUSION: The addition of PEP to care as usual for patients treated with radiotherapy for painful bone metastases resulted in less pain and faster pain control.</p

Overpotential analysis of graphite-based Li-ion batteries seen from a porous electrode modeling perspective

The overpotential of Li-ion batteries is one of the most relevant characteristics influencing the power and energy densities of these battery systems. However, the intrinsic complexity and multi-influencing factors make it challenging to analyze the overpotential precisely. To decompose the total overpotential of a battery into various individual components, a pseudo-two-dimensional (P2D) model has been adopted and used for electrochemical simulations of a graphite-based porous electrode/Li battery. Analytical expressions for the total overpotential have been mathematically derived and split up into four terms, associated with the electrolyte concentration overpotential, the Li concentration overpotential in the solid, the kinetic overpotential, and the ohmic overpotential. All these four terms have been separately analyzed and are found to be strongly dependent on the physical/chemical battery parameters and the reaction-rate distribution inside the porous electrode. The reaction-rate distribution of the porous electrode is generally non-uniform and shows dynamic changes during (dis)charging, resulting in fluctuations in the four overpotential components. In addition, the disappearance of the phase-change information in the voltage curve of the graphite-based porous electrode/Li battery under moderate and high C-rates is ascribed to the Li concentration overpotential among solid particles, resulting from the non-uniform reaction-rate distribution