The Impact of Breast Cancer Screening on Population Health

Breast cancer is an important public health problem with an estimated number of 1.38 million breast cancer cases and 458,000 deaths from the disease yearly worldwide. Randomized trials have shown that mammography screening significantly reduces breast cancer mortality. Besides the benefits in terms of lives saved, mammography screening is, however, also associated with harms, such as false-positive test results and overdiagnosis. This thesis describes the impact of breast cancer screening in the population and compares the effects to the effects of other interventions. We found that mammography screening has had a substantial impact on breast cancer mortality in the U.S. and is projected to continue to do so in the future. Screening women biennially from age 50 to 74 years leads to a favorable balance between benefits and harms. More intensive screening (either extending the age ranges or increasing the screenin

Method for Business Process Management System Selection

In recent years business process management (BPM) and specifically information systems that support the analysis, design and execution of processes (also called business process management systems (BPMS)) are getting more attention. This has lead to an increase in research on BPM and BPMS. However the research on BPMS is mostly focused on the architecture of the system and how to implement such systems. How to select a BPM system that fits the strategy and goals of a specific organization is largely ignored. In this paper we present a BPMS selection method, which is based on research into the criteria that are important for organizations, which are going to implement a BPMS

Business Customer eXperience Alignment Framework: Improving Customer Satisfaction

Globalization and technological innovation has led to an increasing competition between telecommunication service providers and has eroded traditional product- and service-based differentiation. One way to gain a competitive advantage is to create distinctiveness by improving customer experience in such a manner that it leads to higher customer satisfaction and loyalty. One of the drivers to improve the customer experience is the service interface. To improve this service interface, organizations must get insight into their customer interaction process. The amount of data about customers and the service provider processes is increasing and becoming more readily available for analysis. Process mining is a technique to provide insight into these processes. In this paper, a framework is presented to improve the customer satisfaction by alignment of the business service delivery process and the customer experience by applying process mining

Treatment and impact of mental disorders during pregnancy

Mental disorders are a major cause of disability among women during the perinatal period and have consequences for her unborn child as well. There is a lack of evidence-based treatment algorithms due to the complicated risk-benefit analysis for both mother and her unborn child. This thesis extends existing knowledge on the treatment and impact of mental disorders during pregnancy. It includes a meta-analysis on all pharmacological and non-pharmacological interventions to treat antepartum mental disorders. It evaluates the efficacy of a new group-based multicomponent therapy for pregnant women with a mental disorder. Subsequently, it explores the impact of a mental disorder on sleep quality by measuring objective and subjective sleep quality during pregnancy. Different phenotypes of mood fluctuations across pregnancy and associations with pregnancy outcomes are described. At last, the prevalence of suicidal ideation and deliberate self-harm is investigated in pregnant women with a severe mental disorder

What makes IS Implementation Successful? A Study on Implementation Effectiveness

It has been noted that implementation climate is positively associated with implementation effectiveness. However, the recipe for a successful implementation of IS/IT systems still doesn’t exist. Specifically, it is unclear what a good implementation climate requires, what it should be, and to what extent the acceptance and success of the implementation of a new IS/IT system is affected. Despite success and opportunities for organizations that innovate with information systems (IS) and information technology (IT) in general there are also many failures of IS/IT implementations caused by both technical and non-technical problems. This study, based on the Klein-Sorra model of implementation effectiveness, shows that skills and innovation-values fit do significantly influence intention to use in the context of our questionnaire-based survey, the implementation of a new document management system (DMS) at the Dutch Police. Survey data was collected from 41 end-users. For practitioners, this research offers practices to be considered during implementation of a new system

Think twice before starting a new trial; what is the impact of recommendations to stop doing new trials?

ObjectivesIn evidence-based medicine, we base our conclusions on the effectiveness of interventions on the results of high-quality meta-analysis. If a new randomized controlled trial (RCT) is unlikely to change the pooled effect estimate, conducting the new trial is a waste of resources. We evaluated whether recommendations not to conduct further RCTs reduced the number of trials registered for two scenarios.MethodsAnalysis of registered trials on the World Health Organisation (WHO) International Clinical Trials Registry Platform (ICTRP). We regarded trial protocols relevant if they evaluated the effectiveness of (1) exercise for chronic low back pain (LBP) and (2) cognitive behavioural therapy (CBT) for chronic pain. We calculated absolute and relative numbers and change of registered trials in a pre-set time window before and after publication of the recommendations, both published in 2012.ResultsWe found 1,574 trials registered in the WHO trial registry for exercise in LBP (459 before 2012; 1,115 after) and 5,037 trials on chronic pain (1,564 before 2012; 3,473 after). Before 2012, 13 trials on exercise for LBP (out of 459) fit the selection criteria, compared to 42 trials (out of 1,115) after, which represents a relative increase of 33%. Twelve trials (out of 1,564) regarding CBT for chronic pain, fit the selection criteria before 2012 and 18 trials (out of 3,473) after, representing a relative decrease of 32%. We found that visibility, media exposure and strength of the recommendation were related to a decrease in registered trials.ConclusionsRecommendations not to conduct further RCTs might reduce the number of trials registered if these recommendations are strongly worded and combined with social media attention

BPM Maturity and Digital Leadership: An exploratory study

When organizations start to digitize, this often means that processes will be changed. The management paradigm that is centered on the continues review and improvement of organizational processes is Business Process Management (BPM). To digitize processes, an organization should have the right competences to deal with both technological and process changes. However, currently, it is not known which competences are needed by leaders to guide an organization with digital process transformation initiatives. Hence, this paper consists of an explorative study based on interviews with five experts to find out if and how the competences related to digital leadership can guide such initiatives. The experts are employees within five different organizations. The interviews showed some interesting results. First of all, several competences of digital leadership were mentioned by various experts. Many of these competences corresponded with each other. In the interviews, the following competences of digital leadership were mentioned most often: Collaboration, Self-direction, Lifelong learning, and Flexibility. Secondly, there are many approaches to gain insight into processes within organizations. The use of models is necessary to create added value, to help coordinate information provision between the processes and the people who work for the organization. One such approach is the use of Business Process Management Maturity models, which provide insight into the process maturity level of an organization. According to the respondents, there is a relationship between BPM maturity and digital leadership

Transforming Clinical Practice Guideline Usage Through the Use of a Clinical Decision Support System: An Explorative Study at the University Medical Centre Utrecht

Medical treatments require a lot of knowledge and skills. To safeguard the quality of healthcare in general, Clinical Practice Guidelines (CPG) are written. Different studies show that the quality of healthcare improves by using CPGs. Based on the advancements in IT, a CPG could best be supported through the use of a Clinical Decision Support System (CDSS). In this paper, we seek to transform the use of several CPGs with regards to anti-clotting medicine and treatments through the utilization of a CDSS at the University Medical Centre Utrecht (UMCU) in the Netherlands. Data analysis shows that many of the included CPGs overlap and that the utilization of a CDSS for the determination of anti-clotting medicine and treatments could result in more effective and efficient decision making. Additionally, during the validation of the CDSS, we derived the attitude of the stakeholders towards the use of a CPG in a pilot study comprising a CDSS and identified several success factors that should be taken into account when designing, validating, and implementing CPGs into CDSS