Qualitative evaluation of a form for standardized information exchange between orthopedic surgeons and occupational physicians

BACKGROUND: Both occupational physicians and orthopedic surgeons can be involved in the management of work relevant musculoskeletal disorders. These physicians hardly communicate with each other and this might lead to different advices to the patient. Therefore, we evaluated a standardized information exchange form for the exchange of relevant information between the orthopedic surgeon and the occupational physician. The main goals of this qualitative study are to evaluate whether the form improved information exchange, whether the form gave relevant information, and to generate ideas to further improve this information exchange. METHODS: The information exchange form was developed in two consensus meetings with five orthopedic surgeons and five occupational physicians. To evaluate the information exchange form, a qualitative evaluation was set up. Structured telephone interviews were undertaken with the patients, interviews with the physicians were face-to-face and semi-structured, based on a topic list. These interviews were recorded and literally transcribed. Each interview was analyzed separately in Atlas-Ti. RESULTS: The form was used for 8 patients, 7 patients agreed to participate in the qualitative evaluation. All three orthopedic surgeons involved and three of the six involved occupational physicians agreed to be interviewed. The form was transferred to 4 occupational physicians, the other 3 patients recovered before they visited the occupational physician. The information on the form was regarded to be useful. All orthopedic surgeons agreed that the occupational physician should take the initiative. Most physicians felt that the form should not be filled out for each patient visiting an orthopedic surgeon, but only for those patients who do not recover as expected. Orthopedic surgeons suggested that a copy of the medical information provided to the general practitioner could also be provided to occupational physicians. CONCLUSION: The information exchange form was regarded to be useful and could be used in practice. The occupational physician should take the initiative for using this form and most physicians felt the information should only be exchanged for patients who do not recover as expected. That means that the advantage of giving information early in the treatment is lost

Effectiveness of a multidisciplinary care program on recovery and return to work of patients after gynaecological surgery; design of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Return to work after gynaecological surgery takes much longer than expected, irrespective of the level of invasiveness. In order to empower patients in recovery and return to work, a multidisciplinary care program consisting of an e-health intervention and integrated care management including participatory workplace intervention was developed.</p> <p>Methods/Design</p> <p>We designed a randomized controlled trial to assess the effect of the multidisciplinary care program on full sustainable return to work in patients after gynaecological surgery, compared to usual clinical care. Two hundred twelve women (18-65 years old) undergoing hysterectomy and/or laparoscopic adnexal surgery on benign indication in one of the 7 participating (university) hospitals in the Netherlands are expected to take part in this study at baseline. The primary outcome measure is sick leave duration until full sustainable return to work and is measured by a monthly calendar of sickness absence during 26 weeks after surgery. Secondary outcome measures are the effect of the care program on general recovery, quality of life, pain intensity and complications, and are assessed using questionnaires at baseline, 2, 6, 12 and 26 weeks after surgery.</p> <p>Discussion</p> <p>The discrepancy between expected physical recovery and actual return to work after gynaecological surgery contributes to the relevance of this study. There is strong evidence that long periods of sick leave can result in work disability, poorer general health and increased risk of mental health problems. We expect that this multidisciplinary care program will improve peri-operative care, contribute to a faster return to work of patients after gynaecological surgery and, as a consequence, will reduce societal costs considerably.</p> <p>Trial registration</p> <p>Netherlands Trial Register (NTR): <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2087">NTR2087</a></p

A theoretical framework to describe communication processes during medical disability assessment interviews

BACKGROUND: Research in different fields of medicine suggests that communication is important in physician-patient encounters and influences satisfaction with these encounters. It is argued that this also applies to the non-curative tasks that physicians perform, such as sickness certification and medical disability assessments. However, there is no conceptualised theoretical framework that can be used to describe intentions with regard to communication behaviour, communication behaviour itself, and satisfaction with communication behaviour in a medical disability assessment context. OBJECTIVE: The objective of this paper is to describe the conceptualization of a model for the communication behaviour of physicians performing medical disability assessments in a social insurance context and of their claimants, in face-to-face encounters during medical disability assessment interviews and the preparation thereof. CONCEPTUALIzATION: The behavioural model, based on the Theory of Planned Behaviour (TPB), is conceptualised for the communication behaviour of social insurance physicians and claimants separately, but also combined during the assessment interview. Other important concepts in the model are the evaluation of communication behaviour (satisfaction), intentions, attitudes, skills, and barriers for communication. CONCLUSION: The conceptualization of the TPB-based behavioural model will help to provide insight into the communication behaviour of social insurance physicians and claimants during disability assessment interviews. After empirical testing of the relationships in the model, it can be used in other studies to obtain more insight into communication behaviour in non-curative medicine, and it could help social insurance physicians to adapt their communication behaviour to their task when performing disability assessment

Claw and limb disorders in 12 Norwegian beef-cow herds

<p>Abstract</p> <p>Background</p> <p>The main aim of the study was to assess the prevalence of claw and limb disorders in Norwegian beef-cow herds.</p> <p>Methods</p> <p>Twenty-six herds with ≥15 cow-years were selected by computerized systematic assignment from the three most beef cattle-dense regions of Norway. The study population consisted of 12 herds with 28 heifers and 334 cows. The animals were trimmed and examined once by claw trimmers during the late winter and spring of 2003. The seven claw trimmers had been taught diagnosing and recording of claw lesions. Environment, feeding and management routines, age and breed, culling and carcass characteristics were also recorded.</p> <p>Results</p> <p>Lameness was recorded in 1.1% of the animals, and only in hind claws. Pericarpal swellings were recorded in one animal and peritarsal lesions in none. In total, claw and limb disorders including lameness were recorded in 29.6% of the animals, 4.1% with front and 28.2% with hind limb disorders, respectively. Most lesions were mild. Laminitis-related claw lesions were recorded in 18.0% of the animals and infectious lesions in 16.6%. The average claw length was 84 mm in front claws and 89 mm in hind claw. Both laminitis-related and infectious claw lesions were more prevalent with increasing age. Carcasses from animals with claw and limb disorders were on average 34 kg heavier than carcasses from animals without such disorders (p = 0.02). Our results also indicate association between some management factors and claw lesions.</p> <p>Conclusion</p> <p>The study shows that the prevalence of lameness was low in 12 Norwegian beef-cow herds compared to beef-cattle herds in other countries and also that there were less claw and limb disorders in these herds compared to foreign dairy-cattle herds. The prevalence of lameness and white-line fissures was approximately the same as in Norwegian dairy herds whereas less dermatitis, heel-horn erosions, haemorrhages of the sole and the white line and sole ulcers were recorded.</p

Emissie-inventarisaties en opties voor uitworpbeperking

Dit is het eindrapport van het project "Maatschappelijke oorzaken broeikaseffect: emissie-inventarisaties en opties voor uitworpbeperking", gefinancierd door het Nationaal Onderzoek Programma Mondiale Luchtverontreiniging en Klimaatverandering en het Directoraat Milieuhygiene van het Ministerie van Volkshuisvesting, Ruimtelijke Ordening en Milieubeheer. In 1990 was er weinig bekend over de nationale uitworp van de niet-CO2 broeikasgassen en de oorzaken ervan. De doelstellingen van het project waren tweeledig: het ondersteunen van de ontwikkeling van een Nederlands klimaatbeleid dat met alle broeikasgassen rekening zou houden en de identificering van lacunes in de kennis omtrent de bronnen van broeikasgassen teneinde de prioriteitstelling binnen het NOP te ondersteunen. Het eindrapport vat de vier fasen van het project samen. In de eerste fase werd een eerste voorlopige inventarisatie van de uitworp van broeikasgassen gemaakt, te weten koolstofdioxide (CO2), methaan (CH4), distikstofoxide of lachgas (N2O) en de ozon precursors koolstofmonoxide (CO), stikstofoxiden (NOx) en vluchtige organische stoffen (VOS). In de tweede fase werd de opgedane kennis gebruikt om de ontwikkeling van Richtlijnen voor Nationale Uitworpinventarisaties door het gezamenlijk OESO/IPCC programma te ondersteunen, onder meer via de organisatie van een internationale workshop en de deelname aan de planningsgroep van het programma. In de derde fase werd een gedetailleerde analyse uitgevoerd van de nationale bronnen van methaan, de huidige en toekomstige uitworp, en de mogelijkheden tot beheersing van de uitworp. Tenslotte werd een vergelijkbare analyse uitgevoerd voor distikstofoxide. In deze studies werd gevonden, dat maatregelen die niet speciaal gericht zijn op het beperken van klimaatverandering, zouden helpen de uitworp van de niet-CO2 broeikasgassen te beheersen. Terwijl voor methaan, de nationale uitworp even zouden afnemen door maatregelen in de veeteelt en afvalverwijdering, zouden voor distikstofoxide de reductie in de uitworp vanuit de landbouw meer dan gecompenseerd worden door een toename in speciaal de transportsector. Het project laat ook zien, dat de toepassing van meer gedetailleerde informatie leidt tot verschillen met de Richtlijnen, enerzijds omdat niet alle broncategorieen in de Richtlijnen zijn opgenomen en anderzijds vanwege andere locatie-specifieke emissiefactoren.This report is the final summary report of the project "Social causes of the greenhouse effect ; emissions inventories and options for control", funded by the National Research Programme on Global Air Pollution and Climate Change (NRP) and the Environment Directorate of the Ministry of Housing, Physical Planning and Environment. In 1990, little was known about national emissions of greenhouse gases other than carbon dioxide. Therefore, the project was started in that year to develop a national inventory of the emissions of all greenhouse gases and their causes. The objectives of the project were twofold: supporting the development of a comprehensive Dutch climate policy and the identification of gaps in knowledge about sources of greenhouse gases to support priority setting of the NRP. The report summarizes the four phases of the project. In the first phase, a first national inventory of greenhouse gas emissions was made, capturing carbon dioxide (CO2), chlorofluorocarbons (CFCs), methane (CH4), nitrous oxide (N2O) and the ozone precursors carbon monoxide (CO), nitrogen oxides (NOx) and volatile organic compounds (VOC). In the second phase, the acquired expertise was used to support the development of Guidelines for National Emissions Inventories by the joint OECD/IPCC programme through workshop organization and participation in the international planning group. In the third phase, a detailed analysis was performed of the sources of methane, its current and future emissions and the options for control. Finally, a similar analysis was performed for nitrous oxide. In these studies, it was found that policies not specifically aiming at mitigating climate change, would help to control the emissions of the non-CO2 greenhouse gases. While for methane, national emissions would even decrease because of measures in the livestock management and waste disposal sectors, for nitrous oxide the reductions in agricultural emissions would be outweighed by increases especially in the transportation sector. The project shows that the application of more detailed information leads to differences with the Guidelines, both because of the limited number of source categories in the Guidelines and because of different, locally specific emissions factors.DGM/LENO

Emissie-inventarisaties en opties voor uitworpbeperking

This report is the final summary report of the project "Social causes of the greenhouse effect ; emissions inventories and options for control", funded by the National Research Programme on Global Air Pollution and Climate Change (NRP) and the Environment Directorate of the Ministry of Housing, Physical Planning and Environment. In 1990, little was known about national emissions of greenhouse gases other than carbon dioxide. Therefore, the project was started in that year to develop a national inventory of the emissions of all greenhouse gases and their causes. The objectives of the project were twofold: supporting the development of a comprehensive Dutch climate policy and the identification of gaps in knowledge about sources of greenhouse gases to support priority setting of the NRP. The report summarizes the four phases of the project. In the first phase, a first national inventory of greenhouse gas emissions was made, capturing carbon dioxide (CO2), chlorofluorocarbons (CFCs), methane (CH4), nitrous oxide (N2O) and the ozone precursors carbon monoxide (CO), nitrogen oxides (NOx) and volatile organic compounds (VOC). In the second phase, the acquired expertise was used to support the development of Guidelines for National Emissions Inventories by the joint OECD/IPCC programme through workshop organization and participation in the international planning group. In the third phase, a detailed analysis was performed of the sources of methane, its current and future emissions and the options for control. Finally, a similar analysis was performed for nitrous oxide. In these studies, it was found that policies not specifically aiming at mitigating climate change, would help to control the emissions of the non-CO2 greenhouse gases. While for methane, national emissions would even decrease because of measures in the livestock management and waste disposal sectors, for nitrous oxide the reductions in agricultural emissions would be outweighed by increases especially in the transportation sector. The project shows that the application of more detailed information leads to differences with the Guidelines, both because of the limited number of source categories in the Guidelines and because of different, locally specific emissions factors.Dit is het eindrapport van het project "Maatschappelijke oorzaken broeikaseffect: emissie-inventarisaties en opties voor uitworpbeperking", gefinancierd door het Nationaal Onderzoek Programma Mondiale Luchtverontreiniging en Klimaatverandering en het Directoraat Milieuhygiene van het Ministerie van Volkshuisvesting, Ruimtelijke Ordening en Milieubeheer. In 1990 was er weinig bekend over de nationale uitworp van de niet-CO2 broeikasgassen en de oorzaken ervan. De doelstellingen van het project waren tweeledig: het ondersteunen van de ontwikkeling van een Nederlands klimaatbeleid dat met alle broeikasgassen rekening zou houden en de identificering van lacunes in de kennis omtrent de bronnen van broeikasgassen teneinde de prioriteitstelling binnen het NOP te ondersteunen. Het eindrapport vat de vier fasen van het project samen. In de eerste fase werd een eerste voorlopige inventarisatie van de uitworp van broeikasgassen gemaakt, te weten koolstofdioxide (CO2), methaan (CH4), distikstofoxide of lachgas (N2O) en de ozon precursors koolstofmonoxide (CO), stikstofoxiden (NOx) en vluchtige organische stoffen (VOS). In de tweede fase werd de opgedane kennis gebruikt om de ontwikkeling van Richtlijnen voor Nationale Uitworpinventarisaties door het gezamenlijk OESO/IPCC programma te ondersteunen, onder meer via de organisatie van een internationale workshop en de deelname aan de planningsgroep van het programma. In de derde fase werd een gedetailleerde analyse uitgevoerd van de nationale bronnen van methaan, de huidige en toekomstige uitworp, en de mogelijkheden tot beheersing van de uitworp. Tenslotte werd een vergelijkbare analyse uitgevoerd voor distikstofoxide. In deze studies werd gevonden, dat maatregelen die niet speciaal gericht zijn op het beperken van klimaatverandering, zouden helpen de uitworp van de niet-CO2 broeikasgassen te beheersen. Terwijl voor methaan, de nationale uitworp even zouden afnemen door maatregelen in de veeteelt en afvalverwijdering, zouden voor distikstofoxide de reductie in de uitworp vanuit de landbouw meer dan gecompenseerd worden door een toename in speciaal de transportsector. Het project laat ook zien, dat de toepassing van meer gedetailleerde informatie leidt tot verschillen met de Richtlijnen, enerzijds omdat niet alle broncategorieen in de Richtlijnen zijn opgenomen en anderzijds vanwege andere locatie-specifieke emissiefactoren

Methaan, het andere broeikasgas, onderzoek en beleid in Nederland

The increase of anthropogenic activities is the main reason for the increase of methane emissions in the Netherlands. Methane is an important greenhouse gas. The most important sources in the Netherlands are landfills, cattle, manure and the exploration, transport and distribution of oil and gas. In this report the emissions of methane are calculated for 1989-1992 using IPCC methodology. Developments in the emissions for the years until 2015 are estimated. Scenario's are used of the Third National Environmental Outlook. The government aim to reduce methane emissions with 10% by the year 2000 will only be effectuated if policies in the oil and gas sector, the livestock sector and the landfill sector are successful. Additional policy measures are feasible in landfill gas recovery and prevention of venting in the oil and gas sector. Cattle reduction are especially effective