Beeldcommunicatie in de GGZ:onderzoeksrapport over Fase 1 en 2

De geestelijke gezondheidszorg (GGZ) staat, net zoals andere sectoren in de zorg, voor een grote maatschappelijke opgave: er moet fors bezuinigd worden terwijl de kwaliteit van de zorg gehandhaafd moet blijven. Verwacht wordt dat de inzet van beeldcommunicatie in de zorg hieraan een bijdrage kan leveren. Beeldcommunicatie is echter iets dat de zorgverleners “overkomt”: ze zijn er vanuit de genoten opleidingen niet of nauwelijks op toegerust, terwijl ze juist geoefend zijn om subtiele signalen te interpreteren die via beeldcommunicatie niet of veel moeilijker waarneembaar zijn. GGZ-zorgverleners zitten dus klem tussen de maatschappelijke opgave van bezuinigen enerzijds, en de verantwoordelijkheid die ze voelen voor hun cliënten anderzijds

Technologies to support community-dwelling persons with dementia: a position paper on issues regarding development, usability, effectiveness and cost-effectiveness, deployment, and ethics

Background: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them

Postoperative serum proteomic profiles may predict recurrence-free survival in high-risk primary breast cancer

Item does not contain fulltextPURPOSE: Better breast cancer prognostication may improve selection of patients for adjuvant therapy. We conducted a retrospective longitudinal study in which we investigated sera of high-risk primary breast cancer patients, to search for proteins predictive of recurrence-free survival. METHODS: Sera of 82 breast cancer patients obtained after surgery, but prior to the administration of adjuvant therapy, were fractionated using anion-exchange chromatography, to facilitate the detection of the low-abundant serum peptides. Selected fractions were subsequently analysed by surface-enhanced laser desorption/ionisation time-of-flight mass spectrometry (SELDI-TOF MS), and the resulting protein profiles were searched for prognostic markers by appropriate bioinformatics tools. RESULTS: Four peak clusters (i.e. m/z 3073, m/z 3274, m/z 4405 and m/z 7973) were found to bear significant prognostic value (P </= 0.01). The m/z 3274 candidate marker was structurally identified as inter-alpha-trypsin inhibitor heavy chain 4 fragment(658-688) in serum. Except for the m/z 7973 peak cluster, these peaks remained independently associated with recurrence-free survival upon multivariate Cox regression analysis, including clinical parameters of known prognostic value in this study population. CONCLUSION: Investigation of the postoperative serum proteome by, e.g., anion-exchange fractionation followed by SELDI-TOF MS analysis is promising for the detection of novel prognostic factors. However, regarding the rather limited study population, validation of these results by analysis of independent study populations is warranted to assess the true clinical applicability of discovered prognostic markers. In addition, structural identification of the other markers will aid in elucidation of their role in breast cancer prognosis, as well as enable development of absolute quantitative assays

Haptoglobin phenotype is not a predictor of recurrence free survival in high-risk primary breast cancer patients

Contains fulltext : 70104tjan-heijnen.pdf (publisher's version ) (Open Access)BACKGROUND: Better breast cancer prognostication may improve selection of patients for adjuvant therapy. We conducted a retrospective follow-up study in which we investigated sera of high-risk primary breast cancer patients, to search for proteins predictive of recurrence free survival. METHODS: Two sample sets of high-risk primary breast cancer patients participating in a randomised national trial investigating the effectiveness of high-dose chemotherapy were analysed. Sera in set I (n = 63) were analysed by surface enhanced laser desorption ionisation time-of-flight mass spectrometry (SELDI-TOF MS) for biomarker finding. Initial results were validated by analysis of sample set II (n = 371), using one-dimensional gel-electrophoresis. RESULTS: In sample set I, the expression of a peak at mass-to-charge ratio 9198 (relative intensity 20), identified as haptoglobin (Hp) alpha-1 chain, was strongly associated with recurrence free survival (global Log-rank test; p = 0.0014). Haptoglobin is present in three distinct phenotypes (Hp 1-1, Hp 2-1, and Hp 2-2), of which only individuals with phenotype Hp 1-1 or Hp 2-1 express the haptoglobin alpha-1 chain. As the expression of the haptoglobin alpha-1 chain, determined by SELDI-TOF MS, corresponds to the phenotype, initial results were validated by haptoglobin phenotyping of the independent sample set II by native one-dimensional gel-electrophoresis. With the Hp 1-1 phenotype as the reference category, the univariate hazard ratio for recurrence was 0.87 (95% CI: 0.56 - 1.34, p = 0.5221) and 1.03 (95% CI: 0.65 - 1.64, p = 0.8966) for the Hp 2-1 and Hp 2-2 phenotypes, respectively, in sample set II. CONCLUSION: In contrast to our initial results, the haptoglobin phenotype was not identified as a predictor of recurrence free survival in high-risk primary breast cancer in our validation set. Our initial observation in the discovery set was probably the result of a type I error (i.e. false positive). This study illustrates the importance of validation in obtaining the true clinical applicability of a potential biomarker

Beeldbellen in de GGZ: inzichten uit de praktijk en instrumenten voor zorgverleners

Beeldbellen wordt gezien als één van de oplossingen om de kosten van de geestelijke gezondheidszorg in de hand te houden en kwalitatief goede zorg te blijven leveren. Beeldbellen (ook wel bekend als beeldschermzorg of telezorg) is een vorm van zorg op afstand waarbij zorgverlener en cliënt met elkaar communiceren via een beeldscherm. Effectievere behandeling, doelmatiger werken en afname van reistijd worden gezien als enkele grote voordelen van zorg op afstand (GGZ Nederland, 2013). Overheden, zorgverzekeraars en GGZ-instellingen hebben beeldbellen en andere vormen van zorg op afstand vanwege deze voordelen tot een speerpunt van hun beleid gemaakt (Schippers & van Rijn, 2014). Hierdoor aangemoedigd, worden er veel pilots met beeldbellen uitgevoerd. Echte doorbraken blijven vooralsnog echter uit (Krijgsman et al., 2016)

Beeldbellen in de GGZ:inzichten uit de praktijk en instrumenten voor zorgverleners

Beeldbellen wordt gezien als één van de oplossingen om de kosten van de geestelijke gezondheidszorg in de hand te houden en kwalitatief goede zorg te blijven leveren. Beeldbellen (ook wel bekend als beeldschermzorg of telezorg) is een vorm van zorg op afstand waarbij zorgverlener en cliënt met elkaar communiceren via een beeldscherm. Effectievere behandeling, doelmatiger werken en afname van reistijd worden gezien als enkele grote voordelen van zorg op afstand (GGZ Nederland, 2013). Overheden, zorgverzekeraars en GGZ-instellingen hebben beeldbellen en andere vormen van zorg op afstand vanwege deze voordelen tot een speerpunt van hun beleid gemaakt (Schippers & van Rijn, 2014). Hierdoor aangemoedigd, worden er veel pilots met beeldbellen uitgevoerd. Echte doorbraken blijven vooralsnog echter uit (Krijgsman et al., 2016)

Glimlachjes bij dementie

Wilt u uw glimlach met ons delen? Met dit verzoek vroeg ProMemo in de week van Wereld Alzheimerdag, aandacht voor ervaringen of situaties rondom dementie die humorvol, gek, lief of grappig zijn. Kortom, situaties die een glimlach oproepen. Dementie heeft een grote impact op de persoon zelf, betrokken naasten en professionals. Dementie kent daarbij vele gezichten en emoties. Naast de traan is er ook de glimlach. En die glimlach is er gelukkig ruimschoots, getuige de prachtige glimlachen die professionals, mensen met dementie en hun naasten met ons wilden delen. Deze glimlachjes zijn gebundeld in een boekje dat u hier kunt downloaden. Met dank aan alle mensen die hun glimlach wilden delen

CeHRes Roadmap to Improve Dementia Care

Dementia and technology, how do they go together? Technology might be a solution to support health and well-being for patients. Although promising, a lot of technologies are not used due to higher cost than expected, ineffective implementation, and technologies that do not work or help people in a positive way. To improve the adoption and use of technologies for health and well-being, we created a roadmap to guide the process of development, evaluation, and implementation (van Gemert- Pijnen et al. 2011). The roadmap is based on reviews of existing frameworks for eHealth and prior research about development, design, and implementation and applied in several research and development projects (van Gemert-Pijnen et al. 2013). In this chapter we elaborate on the use of the CeHRes roadmap for dementia care. First, we will describe the CeHRes roadmap and its principles for development, then we present a case study to demonstrate how the roadmap was used in practice, and finally we will reflect upon the case study by means of lessons learne