Osteoarthrosis in the general population : a follow-up study of osteoarthrosis of the hip

Describing the prevalence and the radiological and clinial abnormalities as they occur in the Zoetermeer population survey and fixing the position of the EPOZ data regarding OA amidst other population surveys on rheumatic diseases was the first aim of this study. This will be, together with the study of determinants that play an initiating, promoting or protecting role, the major subject of this thesis. This very large random population survey containing data about several chronic diseases was held between 1975 and 1978 in Zoetermeer. The first part of this investigation is the result of an analysis of the existing data arid contains publications on radiological OA of hands, feet, spine, pelvis, knees and shoulders and the relationship with several anthropometric variables and life style habits. All radiographs were initially read by Prof.Dr. H.A. Valkenburg and were coded for osteoarthrosis, rheumatoid arthritis and chondrocalcinosis. Dr. H. Haanen who was the second reader of most of the radiographs presented a thorough description of the design and construction of the EPOZ study in his thesis on epidemiological aspects of low back pain [5]. Dr. L.K.J. van Romunde started an analysis of the pattern of OA by means of homogeneity analysis. The conclusions from this method were that a coherent pattern existed of degenerative joint disease. Disc degeneration of the cervical and lumbar spine from the age of 45 and OA of some small joints of hand and feet from the age of 55 can be considered 'normal aging' in this pattern. OA of the hips and to a lesser extent OA of the knees seemed to be exceptional within this pattern. Evidence of a divergent pattern of the hips was also mentioned by R.M. Acheson [3]. He considered the diviating relation between osteoarthrosis and body mass to be an argument for an the exceptional place of the hip in the pattern of OA. This special place that OA of the hip seems to occupy was reason for a special investigation, the result of which constitute the second part of this thesis

Consistency in diagnostic suggestions does not influence the tendency to accept them

Background: Studies suggest that residents tend to accept diagnostic suggestions, which could lead to diagnostic errors if the suggestion is incorrect. Those studies did not take into account that physicians in clinical practice will mainly encounter correct suggestions. The present study investigated residents’ diagnostic performance if they would first encounter a number of correct suggestions followed by a number of incorrect suggestions, and vice versa. It was hypothesized that more incorrect suggestions would be accepted if participants had first evaluated a series of correct suggestions. Method: Residents (n = 38) evaluated suggested diagnoses on eight written clinical cases. Half of the participants first evaluated four correct suggestions and then evaluated four incorrect suggestions (C/I-condition). The other half started with the four incorrect suggestions followed by the correct suggestions (I/C-condition). Results: Our findings show that the evaluation score in the C/I condition (M = 2.87, MSE = 0.14) equaled that in the I/C condition (M = 2.66, MSE = 0.14), F(1,36) = 1.09, p = 0.30, ns, meaning that consistency in preceding suggested diagnoses did not influence the tendency to accept subsequent diagnostic suggestions. There was, however, a significant interaction effect between case order and phase, F(1,36) = 11.82, p = 0.001, ηp2 = 0.25, demonstrating that the score on cases with correct suggestions was higher than the score on cases with incorrect suggestions. Conclusion: These findings indicate that consistency in preceding correct or incorrect diagnostic suggestions did not influence the tendency to accept or reject subsequent suggestions. However, overall residents still showed a tendency to accept diagnostic suggestions, which may lead to diagnostic errors if the suggestion is incorrect

The role of seaports in green supply chain management : initiatives, attitudes, and perspectives in Rotterdam, Antwerp, North Sea Port, and Zeebrugge

Green supply chain management (GSCM) can be defined as the integration of environmental concerns into the inter-organizational practices of supply chain management (SCM). This paper analyzes the role of seaports in the greening of supply chains in two ways. First, the fields of action to pursue GSCM objectives in ports are identified and grouped. The proposed typology includes five groups of actions, i.e., green shipping; green port development and operations; green inland logistics; seaports and the circular economy; and, actions in the field of knowledge development and information sharing. In the empirical part of the paper, this typology is used to analyze green actions and initiatives developed by market players and port authorities in the Rhine-Scheldt Delta, the leading European port region in cargo throughput terms. This structured overview of green actions and initiatives shows that these ports are hotbeds for GSCM initiatives, but progress in some areas remains slows. The second part of the analysis focuses on the attitudes and perceptions of port-related actors towards the greening of port-related supply chains. A large-scale survey conducted in the Belgian and Dutch logistics and port industry reveals that greening has been put massively on the agenda by the firms between 2010 and now. The results give a clear view on the diverse drivers and impediments towards the greening of supply chains. In addition, one can still see a gap between words and actions. The survey further points to the role of governments as catalysts or soft enforcers for change, and calls for continuity and coherence in government policy. This paper is the first study providing a comprehensive analysis on initiatives, approaches, and perspectives of port-related actors in a specific multi-port region

An experimental study on the effects of a simulation game on students’ clinical cognitive skills and motivation

Simulation games are becoming increasingly popular in education, but more insight in their critical design features is needed. This study investigated the effects of fidelity of open patient cases in adjunct to an instructional e-module on students’ cognitive skills and motivation. We set up a three-group randomized post-test-only design: a control group working on an e-module; a cases group, combining the e-module with low-fidelity text-based patient cases, and a game group, combining the e-module with a high-fidelity simulation game with the same cases. Participants completed questionnaires on cognitive load and motivation. After a 4-week study period, blinded assessors rated students’ cognitive emergency care skills in two mannequin-based scenarios. In total 61 students participated and were assessed; 16 control group students, 20 cases students and 25 game students. Learning time was 2 h longer for the cases and game groups than for the control group. Acquired cognitive skills did not differ between groups. The game group experienced higher intrinsic and germane cognitive load than the cases group (p = 0.03 and 0.01) and felt more engaged (p < 0.001). Students did not profit from working on open cases (in adjunct to an e-module), which nonetheless challenged them to study longer. The e-module appeared to be very effective, while the high-fidelity game, although engaging, probably distracted students and impeded learning. Medical educators designing motivating and effective skills training for novices should align case complexity and fidelity with students’ proficiency level. The relation between case-fidelity, motivation and skills development is an important field for further study

An experimental study on the effects of a simulation game on students’ clinical cognitive skills and motivation

textabstractSimulation games are becoming increasingly popular in education, but more insight in their critical design features is needed. This study investigated the effects of fidelity of open patient cases in adjunct to an instructional e-module on students’ cognitive skills and motivation. We set up a three-group randomized post-test-only design: a control group working on an e-module; a cases group, combining the e-module with low-fidelity text-based patient cases, and a game group, combining the e-module with a high-fidelity simulation game with the same cases. Participants completed questionnaires on cognitive load and motivation. After a 4-week study period, blinded assessors rated students’ cognitive emergency care skills in two mannequin-based scenarios. In total 61 students participated and were assessed; 16 control group students, 20 cases students and 25 game students. Learning time was 2 h longer for the cases and game groups than for the control group. Acquired cognitive skills did not differ between groups. The game group experienced higher intrinsic and germane cognitive load than the cases group (p = 0.03 and 0.01) and felt more engaged (p < 0.001). Students did not profit from working on open cases (in adjunct to an e-module), which nonetheless challenged them to study longer. The e-module appeared to be very effective, while the high-fidelity game, although engaging, probably distracted students and impeded learning. Medical educators designing motivating and effective skills training for novices should align case complexity and fidelity with students’ proficiency level. The relation between case-fidelity, motivation and skills development is an important field for further study

Training medical specialists to communicate better with patients with medically unexplained physical symptoms (MUPS). A randomized, controlled trial

Background Patients with medically unexplained physical symptoms (MUPS) are prevalent 25-50% in general and specialist care. Medical specialists and residents often find patients without underlying pathology difficult to deal with, whereas patients sometimes don't feel understood. We developed an evidence-based communication training, aimed to improve specialists' interviewing, information-giving and planning skills in MUPS consultations, and tested its effectiveness. Methods The intervention group in this multi-center randomized controlled trial received a 14-hour training program to which experiential learning and feedback were essential. Using techniques from Cognitive Behavioral Therapy, they were stimulated to seek interrelating factors (symptoms, cognitions, emotions, behavior, and social environment) that reinforced a patient's symptoms. They were taught to