100 research outputs found
Waardering en verkoop van overtollig incourant rijksvastgoed:een onderzoek naar de discrepantie tussen het Rijk en marktpartijen bij de waardering en verkoop van overtollig incourant rijksvastgoed
Understanding Outstanding: quality assurance in colonoscopy
Since a couple of years, quality assurance (QA) stands at the core of the attention in the
healthcare sector. Especially after the publication in 2000 of the Institute of Medicine’s report
‘To err is human’ the interest in QA has taken a quantum leap and many quality initiatives have
been developed. This report revealed that every year in the United States approximately
98,000 patients died because of medical errors. Following this report, within the healthcare
sector the awareness arose that the quality of the service had to improve, with special attention
to safety and patient experiences. Since then the healthcare sector has learned some
important lessons in QA from other industries such as the airline industry and energy sector,
which are generally classified as ultra-safe organizations.
Gastrointestinal endoscopy has been one of the medicine specialties which enrolled
important quality initiatives. Especially since the introduction of colorectal cancer (CRC)
screening programs, many efforts have been undertaken to better understand the concept
of high quality endoscopy. CRC screening has been proven to decrease the incidence of CRC,
and CRC related mortality. Therefore many institutions and societies recommend to screen
asymptomatic individuals by fecal occult blood tests, flexible sigmoidoscopy, or colonoscopy.
As these screening programs involve healthy individuals, the cost-effectiveness of such
programmatic screening approaches is highly dependent on the quality of the procedure,
but also on pre- and post-procedure quality aspects to improve screenee experiences and
thereby the uptake of and adherence to screening modalities.
In the Netherlands, CRC screening is about to start in 2013 by means of biennial fecal immunochemical
testing. To attain the highest effect a comprehensive QA program should be
enrolled with major focus on endoscopy as secondary screening method, as is recommended
now by the European Union. The other diagnostic and therapeutic service
Overheidsinvesteringen in Nederland:Een schets van de ontwikkeling van de investeringen van de Nederlandse overheid
Predicting trajectories of behavioral adjustment in children diagnosed with acute lymphoblastic leukemia
Purpose
Previous research showed that children with cancer are at risk for developing behavioral adjustment problems after successful treatment; however, the course of adjustment remains unclear. This study focuses on adjustment trajectories of children during treatment for acute lymphoblastic leukemia (ALL) and aims to distinguish subgroups of patients showing different trajectories during active treatment, and to identify sociodemographic, medical, and psychosocial predictors of the distinct adjustment trajectories.
Methods
In a multicenter longitudinal study, 108 parents of a child (response rate 80 %) diagnosed with ALL were assessed during induction treatment (T0), after induction/consolidation treatment (T1), and after end of treatment (T2). Trajectories of child behavioral adjustment (Child Behavior Checklist; CBCL) were tested with latent class growth modeling (LCGM) analyses.
Results
For internalizing behavior, a three-trajectory model was found: a group that experienced no problems (60 %), a group that experienced only initial problems (30 %), and a group that experienced chronic problems (10 %). For externalizing behavior, a three-trajectory model was also found: a group that experienced no problems (83 %), a group that experienced chronic problems (12 %), and a group that experienced increasing problems (5 %). Only parenting stress and baseline QoL (cancer related) were found to contribute uniquely to adjustment trajectories.
Conclusions
The majority of the children (77 %) showed no or transient behavioral problems during the entire treatment as reported by parents. A substantial group (23 %) shows maladaptive trajectories of internalizing behavioral problems and/or externalizing behavioral problems. Screening for risk factors for developing problems might be helpful in early identification of these children
Molecular stool testing as an alternative for surveillance colonoscopy: a cross-sectional cohort study
Resilience in pediatric oncology. Family risk and resilience factors and child behavioral adjustment
Contains fulltext :
183420.pdf (publisher's version ) (Open Access)Radboud University, 21 maart 2018Promotores : Prins, J.B., Grootenhuis, M.A., Hoogerbrugge, P.M.
Co-promotor : Verhaak, C.M.147 p
- …