Different patient subgroup, different ranking? Which quality indicators do patients find important when choosing a hospital for hip- or knee arthroplasty?

<p>Abstract</p> <p>Background</p> <p>Patients are increasingly expected to become active, critical consumers in healthcare. They can use comparative healthcare information presented on websites to make informed choices for healthcare providers. However, the use of this information has been limited so far. An obstacle can be that the information is not perceived as relevant by patients. Presenting only the most important quality indicators might improve the usefulness of this information. The aim of this study was to explore which quality indicators different subgroups of patients find important when choosing a hospital for total hip arthroplasty (THA) or total knee arthroplasty (TKA).</p> <p>Methods</p> <p>In this explorative, cross-sectional study, questionnaires were distributed to 265 patients who underwent or had to undergo THA/TKA. Participants were asked to rank the importance of three types of quality indicators: patient experience indicators, clinical performance indicators, and indicators about hospital services. We used random effects regression analyses to assess the relative importance of the indicators in different subgroups of patients.</p> <p>Results</p> <p>110 patients (response rate 41.5%) who underwent or had to undergo THA/TKA participated. Conduct of doctors, the presence of procedures to prevent adverse effects of thrombosis and information about the specialist area of orthopaedists were the most important patient experience indicator, clinical performance indicator and indicator about hospital services, respectively. We found a few differences between patient subgroups in the importance attached to the quality indicators.</p> <p>Conclusions</p> <p>This study provides a first insight into which quality indicators patients find important when choosing a hospital for THA/TKA, and shows that subgroups of patients differ in the value they attach to these indicators. More extended research is needed to establish the indicators that should at least be presented in succinct overviews of comparative healthcare information for patients choosing a hospital for THA/TKA.</p

Measurement results from fires. Analysis of Environmental Incident Service measurement data from 2008–2021

Bij branden ontstaan veel stoffen die schadelijk zijn als mensen ze inademen of ermee in contact komen. Deze stoffen kunnen zich verspreiden in de omgeving. Het hangt af van de materialen die verbranden, de weersomstandigheden en hoe de brand zich ontwikkelt, welke stoffen ontstaan, hoeveel en hoe ze zich verspreiden. Sommige schadelijke stoffen ontstaan bij elke brand, zoals roet en fijnstof. Andere stoffen ontstaan uit de verbranding van bepaalde materialen. Voorbeelden zijn dioxinen (uit bepaalde kunststoffen) en metalen (onder andere bij schrootbranden). De Milieuongevallen Dienst (MOD(Milieu Ongevallen Dienst)) van het RIVM mat tussen 2008 en 2021 bij 132 branden of er schadelijke stoffen in de lucht zaten. Dat is vooral het geval op minder dan 300 meter van de brand. Op meer dan 1 kilometer van de brand meet het RIVM ze bijna nooit. Dat komt omdat de stoffen zich in de lucht verspreiden en verdunnen. De gezondheidsrisico’s zijn hierbij heel klein. Het is dan genoeg dat bewoners het advies krijgen om thuis te blijven, ramen en deuren dicht te doen en uit de rook te blijven. Extra metingen van het RIVM zijn niet altijd nodig. Deze conclusies zijn in 2007 getrokken en worden nu bevestigd in een uitgebreide analyse van de metingen. Het RIVM wil in bepaalde situaties de schadelijke stoffen blijven onderzoeken. Het gaat om branden die lang duren, waarbij lang moet worden nageblust, met veel rookontwikkeling, of waarbij de rook blijft ‘hangen’ en weinig opstijgt. Dit geldt vooral voor branden bij bedrijven in de afvalverwerking, sloop en recycling en in opslagloodsen en grote gebouwen. Meten kan ook nuttig zijn bij maatschappelijke onrust of als hulpdiensten of bevoegd gezag erom vragen. Verder is het wenselijk dat de MOD stoffen gaat meten in de rook die nu nog niet bij branden worden gemeten.Fires produce many substances that are harmful if people inhale them or come into contact with them. These substances can spread in the surrounding area. The type and amount of substances that are produced and how they spread depends on the materials that burn, the weather conditions and how the fire develops. Some substances that are harmful to health, such as soot and fine particles, are produced by all fires. Other substances are only produced when certain materials burn. Examples include dioxins (from certain plastics) and metals (from sources like scrap fires). Between 2008 and 2021, RIVM’s Environmental Incident Service measured whether harmful substances were released into the air during 132 fires. This mainly occurs within 300 metres of a fire. RIVM has rarely detected harmful substances more than a kilometre away from a fire. This is because substances dissipate as they spread through the air. The health risks in this case are very small. It is enough to advise residents to stay at home, close all windows and doors and keep out of the smoke. Additional measurements by RIVM are therefore not always necessary. These conclusions, drawn in 2007, have now been confirmed by an extensive analysis of the measurements. In certain situations, RIVM would like to continue examining the harmful substances. This concerns fires that last for a long time, take a long time to extinguish, produce a great deal of smoke, or produce smoke that lingers and does not rise much. This is especially true for fires at industrial sites used for waste processing, demolition and recycling, and fires in warehouses and large buildings. Measurements can also be useful in the event of social unrest or if requested by emergency response teams or a relevant competent authority. Furthermore, the Environmental Incident Service should start measuring substances in smoke that are not yet measured during and after fires

Benchmarking promotion and deployment activities regarding intelligent vehicle safety systems in the EU

This paper presents the results of a Benchmarking study performed in the European Union on Awareness and Promotion & Deployment activities related to Intelligent Vehicle Safety (IVS) systems (1). The study, commissioned by the European Commission under the Intelligent Car Initiative (a i2010 flagship initiative), consisted of three phases: definition phase, data collection and analysis. The definition of the indicators and identification of the stakeholders made use of the translation of the AIDA-concept (Acceptance, Interest, Desire, Action) to the IVS systems context: the AUWE-concept (Awareness, Understanding, Willingness-to-buy, Equipment). It identified potential activities of different stakeholders to influence deployment of IVS systems. In the second phase data for the different stakeholder groups was collected by means of a web questionnaire in the 27 concerned countries. The data revealed that the different countries in the EU have different levels of awareness and are currently working on a wide range of promotion and deployment activities. In the analysis it was shown that promotion and deployment activities addressing the “willingness-to-buy” lacks attention. This resulted in recommendations for the commission in setting up a set of guidelines in order to assist the countries and stakeholders in these countries to raise awareness and to unfold promotion and deployment activities in a efficient manne

Transport through zeolite filled polymeric membranes

In this paper the effect of zeolite particles incorporated in rubbery polymers on the pervaporation properties of membranes made from these polymers is discussed. Pervaporation of methanol/toluene mixtures was carried out with membranes prepared from the toluene selective polymer EPDM and the methanol selective polymers Viton and Estane 5707. From the results of the pervaporation experiments it could be concluded that the addition of the hydrophilic zeolite NaX as well as the hydrophobic zeolite silicalite-1 leads to an increase in methanol flux and a decrease in toluene flux through the membranes. Pervaporation experiments with bi-layer membranes consisting of an unfilled polymer layer filled with zeolite particles demonstrated that the effect of addition of particles depends on their position in the membrane. Furthermore, the component flux through the membranes as a function of the volume fraction of zeolite is modelled with existing theories describing the permeability of heterogeneous materials. The results show that the apparent permeability of the dispersed phase is lower than the intrinsic permeability of the dispersed phase when the flux through the particle is restricted by the polymer phase. This phenomenon was confirmed by numerical simulation of the transport in the membrane through a plane parallel to the transport direction. The simulations are carried out for an unfilled membrane, a membrane filled with an impermeable particle, a rubber particle and with a particle which shows Langmuir sorption behaviour. The reason for the discrepancy between the apparent permeability and the intrinsic permeability is that the apparent permeability of the zeolite phase is calculated by dividing the flux with the driving force over the entire membrane which is larger than that over the particle. In case of numerical simulation the concentration in every position in the plane is known and therefore the intrinsic permeability of the filler can be calculated on basis of the actual driving force. This treatment results in a permeability which is correct over several orders of magnitude