How to integrate individual patient values and preferences in clinical practice guidelines? A research protocol

Background Clinical practice guidelines are largely conceived as tools that will inform health professionals' decisions rather than foster patient involvement in decision making. The time now seems right to adapt clinical practice guidelines in such a way that both the professional's perspective as care provider and the patients' preferences and characteristics are being weighed equally in the decision-making process. We hypothesise that clinical practice guidelines can be adapted to facilitate the integration of individual patients' preferences in clinical decision making. This research protocol asks two questions: How should clinical practice guidelines be adapted to elicit patient preferences and to support shared decision making? What type of clinical decisions are perceived as most requiring consideration of individual patients' preferences rather than promoting a single best choice? Methods Stakeholders' opinions and ideas will be explored through an 18-month qualitative study. Data will be collected from in-depth individual interviews. A purposive sample of 20 to 25 key-informants will be selected among three groups of stakeholders: health professionals using guidelines (e.g., physicians, nurses); experts at the macro- and meso-level, including guideline and decision aids developers, policy makers, and researchers; and patient representatives. Ideas and recommendations expressed by stakeholders will be prioritized by nominal group technique in expert meetings. Discussion One-for-all guidelines do not account for differences in patients' characteristics and for their preferences for medical interventions and health outcomes, suggesting a need for flexible guidelines that facilitate patient involvement in clinical decision making. The question is how this can be achieved. This study is not about patient participation in guideline development, a closely related and important issue that does not however substitute for, or guarantee individual patient involvement in clinical decisions. The study results will provide the needed background for recommendations about potential effective and feasible strategies to ensure greater responsiveness of clinical practice guidelines to individual patient's preferences in clinical decision-making

Deltaplan Erwinia. Deel C - Pootaardappelen. Eindrapport van het onderzoek 2009 - 2012

Het Deltaplan Erwinia (Deel C – Pootaardappelen) is een vervolg op het project 'Bacterievrije pootgoedteelt - een uitdaging!'. Het doel was om meer inzicht te krijgen in de Erwinia-problemen in de pootgoedteelt en uiteindelijk te komen tot een reductie van de economische schade met 50%. Uit het onderzoek (2009-2012) blijkt dat er bij vrijwel elk onderdeel van de teeltcyclus van pootaardappelen risicovolle handelingen vallen aan te wijzen die tot verergering van het probleem leiden. Na vier jaar onderzoek is de conclusie dat er, om de ten doel gestelde reductie van 50% reductie te realiseren, een samenhangend pakket aan maatregelen nodig is. Daarvoor wordt een aantal aanbevelingen gedaa

Deltaplan Erwinia. Deel C - Pootaardappelen. Eindrapport van het onderzoek 2009 - 2012

Het Deltaplan Erwinia (Deel C – Pootaardappelen) is een vervolg op het project 'Bacterievrije pootgoedteelt - een uitdaging!'. Het doel was om meer inzicht te krijgen in de Erwinia-problemen in de pootgoedteelt en uiteindelijk te komen tot een reductie van de economische schade met 50%. Uit het onderzoek (2009-2012) blijkt dat er bij vrijwel elk onderdeel van de teeltcyclus van pootaardappelen risicovolle handelingen vallen aan te wijzen die tot verergering van het probleem leiden. Na vier jaar onderzoek is de conclusie dat er, om de ten doel gestelde reductie van 50% reductie te realiseren, een samenhangend pakket aan maatregelen nodig is. Daarvoor wordt een aantal aanbevelingen gedaa

Mucin-bacterial interactions in the human oral cavity and digestive tract

Mucins are a family of heavily glycosylated proteins that are the major organic components of the mucus layer, the protective layer covering the epithelial cells in many human and animal organs, including the entire gastro-intestinal tract. Microbes that can associate with mucins benefit from this interaction since they can get available nutrients, experience physico-chemical protection and adhere, resulting in increased residence time. Mucin-degrading microorganisms, which often are found in consortia, have not been extensively characterized as mucins are high molecular weight glycoproteins that are hard to study because of their size, complexity and heterogeneity. The purpose of this review is to discuss how advances in mucus and mucin research, and insight in the microbial ecology promoted our understanding of mucin degradation. Recent insight is presented in mucin structure and organization, the microorganisms known to use mucin as growth substrate, with a specific attention on Akkermansia muciniphila, and the molecular basis of microbial mucin degradation owing to availability of genome sequences