Structural and magneto-transport characterization of Co_2Cr_xFe_(1-x)Al Heusler alloy films

We investigate the structure and magneto-transport properties of thin films of the Co_2Cr_xFe_(1-x)Al full-Heusler compound, which is predicted to be a half-metal by first-principles theoretical calculations. Thin films are deposited by magnetron sputtering at room temperature on various substrates in order to tune the growth from polycrystalline on thermally oxidized Si substrates to highly textured and even epitaxial on MgO(001) substrates, respectively. Our Heusler films are magnetically very soft and ferromagnetic with Curie temperatures up to 630 K. The total magnetic moment is reduced compared to the theoretical bulk value, but still comparable to values reported for films grown at elevated temperature. Polycrystalline Heusler films combined with MgO barriers are incorporated into magnetic tunnel junctions and yield 37% magnetoresistance at room temperature

Better experiences with quality of care predict well-being of patients with chronic obstructive pulmonary disease in the Netherlands

Objective:This study was conducted to (1) identify improvements in care quality and well-being of patients with chronic obstructivepulmonary disease in the Netherlands and (2) investigate the longitudinal relationship between these factors. Methods:This longitudinal study was conducted among patients diagnosed with chronic obstructive pulmonary disease enrolled in the Ken-nemer Lucht care programme in the Netherlands. Biomarker data (lung capacity) were collected at patients’health care practices in 2012.Complete case analysis was conducted, and the multiple imputation technique allowed us to report pooled results from imputed datasets. Results:Surveys were filled out by 548/1303 (42%) patients at T0 (2012) and 569/996 (57%) remaining participants at T1. Quality of care improved significantly (p< 0.05). Analyses adjusted for well-being at T0, age, educational level, marital status, gender, lung functionand health behaviours showed that patients’assessments of the quality of chronic care delivery at T0 (p< 0.01) and changes therein(p < 0.001) predicted patients’well-being at T1. Conclusion:These results clearly show that the quality of care and changes therein are important for the well-being of patients withchronic obstructive pulmonary disease in the primary care setting. Practice implications:To improve quality of care for chronically ill patients, multicomponent interventions may be neede

Better experiences with quality of care predict well-being of patients with chronic obstructive pulmonary disease in the Netherlands

Objective:This study was conducted to (1) identify improvements in care quality and well-being of patients with chronic obstructivepulmonary disease in the Netherlands and (2) investigate the longitudinal relationship between these factors. Methods:This longitudinal study was conducted among patients diagnosed with chronic obstructive pulmonary disease enrolled in the Ken-nemer Lucht care programme in the Netherlands. Biomarker data (lung capacity) were collected at patients’health care practices in 2012.Complete case analysis was conducted, and the multiple imputation technique allowed us to report pooled results from imputed datasets. Results:Surveys were filled out by 548/1303 (42%) patients at T0 (2012) and 569/996 (57%) remaining participants at T1. Quality of care improved significantly (p< 0.05). Analyses adjusted for well-being at T0, age, educational level, marital status, gender, lung functionand health behaviours showed that patients’assessments of the quality of chronic care delivery at T0 (p< 0.01) and changes therein(p < 0.001) predicted patients’well-being at T1. Conclusion:These results clearly show that the quality of care and changes therein are important for the well-being of patients withchronic obstructive pulmonary disease in the primary care setting. Practice implications:To improve quality of care for chronically ill patients, multicomponent interventions may be neede

Is “disease management” the answer to our problems? No! Population health management and (disease) prevention require “management of overall well-being”

BACKGROUND: Disease management programs based on the chronic care model have achieved successful and long-term improvement in the quality of chronic care delivery and patients’ health behaviors and physical quality of life. However, such programs have not been able to maintain or improve broader self-management abilities or social well-being, which decline over time in chronically ill patients. Disease management efforts, population health management initiatives and innovative primary care solutions are still mainly focused on clinical and functional outcomes and health behaviors (e.g., smoking cessation, exercise, and diet) failing to address individuals’ overall quality of life and well-being. Individuals’ ability to achieve well-being can be assessed with great specificity through the application of social production function (SPF) theory. This theory asserts that people produce their own well-being by trying to optimize the achievement of instrumental goals (stimulation, comfort, status, behavioral confirmation, affection) that provide the means to achieve the larger, universal goals of physical and social well-being. DISCUSSION: A shift in focus from the management of physical function, disease limitations, and lifestyle behaviors alone to an approach that fosters self-management abilities such as self-efficacy and resource investment as well as overall quality of life, is urgently needed. Disease management interventions should be aimed at adequately addressing all difficulties chronically ill patients face in life, such as the effects of pain and fatigue on the ability to maintain a job and social life and to participate in activities promoting physical and social well-being. Patients’ ability to maintain engagement in stimulating work and social activities with the people who are important to them may be even more important than aspects of disease self-management such as blood pressure or glycemic control. Interventions should aim to make chronically ill patients capable of managing their own well-being and adequately addressing their needs in a broader sense. SUMMARY: So, is disease management the answer to our problems in the time of aging populations and increased prevalence of unhealthy lifestyles, chronic illnesses, and comorbidity? No! Effective (disease) prevention, disease management, patient-centered care, and high-quality chronic care and/or population health management calls for management of overall well-being

The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting.

Background: Patients with multi-morbidity have complex care needs that often make healthcare delivery difficult and costly to manage. Current healthcare delivery is not tailored to the needs of patients with multi-morbidity, although multi-morbidity poses a heavy burden on patients and is related to adverse outcomes. Patient-centered care and co-creation of care are expected to improve outcomes, but the relationships among patient-centered care, co-creation of care, physical well-

Situational awareness, relational coordination and integrated care delivery to hospitalized elderly in the Netherlands: A comparison between hospitals

__Abstract__ Background: It is known that interprofessional collaboration is crucial for integrated care delivery, yet we are still unclear about the underlying mechanisms explaining effectiveness of integrated care delivery to older patients. In addition, we lack research comparing integrated care delivery between hospitals. Therefore, this study aims to (i) provide insight into the underlying components 'relational coordination' and 'situational awareness' of integrated care delivery and the role of team and organizational context in integrated care delivery; and (ii) compare situational awareness, relational coordination, and integrated care delivery of different hospitals in the Netherlands. Methods. This cross-sectional study took place in 2012 among professionals from three different hospitals involved in the delivery of care to older patients. A total of 215 professionals filled in the questionnaire (42% response rate).Descriptive statistics and paired-sample t-tests were used to investigate the level of situational awareness, relational coordination, and integrated care delivery in the three different hospitals. Correlation and multilevel analyses were used to investigate the relationship between background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery. Results: No differences in background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery were found among the three hospitals. Correlational analysis revealed that situational awareness (r = 0.30; p < 0.01), relational coordination (r = 0.17; p < 0.05), team climate (r = 0.29; p < 0.01), formal internal communication (r = 0.46; p < 0.01), and informal internal communication (r = 0.36; p < 0.01) were positively associated with integrated care delivery. Stepwise multilevel analyses showed that formal internal communication (p < 0.001) and situational awareness (p < 0.01) were associated with integrated care delivery. Team climate was not significantly associated with integrated care delivery when situational awareness and relational coordination were included in the equation. Thus situational awareness acted as mediator between team climate and integrated care delivery among professionals delivering care to older hospitalized patients. Conclusions: The results of this study show the importance of formal internal communication and situational awareness for quality of care delivery to hospitalized older patients

To vaccinate or not to vaccinate? Perspectives on HPV vaccination among girls, boys, and parents in the Netherlands: A Q-methodological study

Background: Despite the introduction of Human papillomavirus (HPV) vaccination in national immunization programs (NIPs), vaccination rates in most countries remain relatively low. An understanding of the reasons underlying decisions about whether to vaccinate is essential in order to promote wider spread of HPV vaccination. This is particularly important in relation to policies seeking to address shortfalls in current HPV campaigns. The aim of this study was to explore prevailing perspectives concerning HPV vaccination among girls, boys, and parents, and so to identify potential determinants of HPV vaccination decisions in these groups. Method: Perspectives were explored using Q-methodology. Forty-seven girls, 39 boys, and 107 parents in the Netherlands were asked to rank a comprehensive set of 35 statements, assembled based on the health belief model (HBM), according to their agreement with them. By-person factor analysis was used to identify common patterns in these rankings, which were interpreted as perspectives on HPV vaccination. These perspectives were further interpreted and described using data collected with interviews and open-ended questions. Results: The analysis revealed four perspectives: "prevention is better than cure," "fear of unknown side effects," "lack of information and awareness," and "my body, my choice." The first two perspectives and corresponding determinants of HPV vaccination decisions were coherent and distinct; the third and fourth perspectives were more ambiguous and, to some extent, incoherent, involving doubt and lack of awareness and information (perspective 3), and overconfidence (perspective 4). Conclusions: Given the aim of publically funded vaccination programs to minimize the spread of HPV infection and HPV-related disease and the concerns about current uptake levels, our results indicate that focus should be placed on increasing awareness and knowledge, in particular among those in a modifiable phase

Satisfaction with care as a quality-of-life predictor for stroke patients and their caregivers

Purpose: We sought to identify indicators associated with the quality of life (QoL) of stroke patients and caregivers. Methods: The cross-sectional study was conducted at nine Dutch stroke service facilities involving 251 stroke patients and their caregivers. We used the EuroQol (EQ-5D) and Satisfaction with Stroke Care questionnaires, and included the variables (1) disability at hospital admission, (2) length of hospital stay, (3) demographic data, and (4) caregivers' relationship with stroke patients. The Actor-Partner (patient-caregiver) Interdependence Model (APIM) was used to examine dependence between patients' and caregivers' QoL scores through dyad membership. Results: Patients' age was significantly related to their QoL, and caregivers' age and educational level were significantly related to their QoL. Patients' disability on hospital admission and length of stay were associated with patients' QoL, and their disability on admission was related to caregivers' QoL. No relationship was found between length of stay and caregivers' QoL. Satisfaction with care was associated with both patients' and caregivers' QoL. Conclusions: The APIM distinguished the different roles of patients and caregivers while acknowledging the interdependence of their QoL scores. Satisfaction with care was identified as important indicator of stroke patients' and caregivers' QoL

Evaluating an integrated neighbourhood approach to improve well-being of frail elderly in a Dutch community: a study protocol

<p>Abstract</p> <p>Background</p> <p>An important condition for independent living is having a well-functioning social network to provide support. An Integrated Neighbourhood Approach (INA) creates a supportive environment for the frail elderly, offering them tailored care in their local context that allows them to improve self-management abilities and well-being. The purpose of our research is to investigate how an INA can contribute to outcomes of frail elderly and the cost-effectiveness of such a program. The first central study question is: To what extent does INA contribute to (a) continuous, demand-driven, coordinated care and support for the independently- living frail elderly; (b) improvement of their well-being and self-management abilities; and (c) reinforcement of their neighbourhood networks. The second central research question is: is the INA a cost-effective method to support the frail, independently- living elderly?</p> <p>Methods</p> <p>We investigate a Dutch INA. This transition experiment aims to facilitate the independently-living frail elderly (70+) to live the life they wish to live and improve their well-being. The study population consists of independently-living frail elderly persons in Rotterdam. The transition experiment starts in two Rotterdam districts and is later extended to two other districts. We propose a concurrent mixed methods design, that is, a combination of qualitative and quantitative research methods to evaluate processes, effects and costs of INA. Such a design will provide insight into an on-going INA and demonstrate which of its elements are potentially (cost)-effective for the frail elderly.</p> <p>Discussion</p> <p>We embrace a wide range of scientific methodologies to evaluate the INA project and obtain information on mechanisms and contexts that will be valuable for decision making on local and national levels. The study will lead to a better understanding of how to provide support via social networks for the frail elderly and add to the knowledge on the feasibility and cost-effectiveness of the program in maintaining or improving their well-being. Last, the study will highlight the factors that determine the program's success or failure.</p