The interactive web-based program MSmonitor for self-management and multidisciplinary care in multiple sclerosis:utilization and valuation by patients

Background: MSmonitor is an interactive web-based program for self-management and integrated, multidisciplinary care in multiple sclerosis. Methods: To assess the utilization and valuation by persons with multiple sclerosis, we held an online survey among those who had used the program for at least 1 year. We evaluated the utilization and meaningfulness of the program's elements, perceived use of data by neurologists and nurses, and appreciation of care, self-management, and satisfaction. Results: Fifty-five persons completed the questionnaire (estimated response rate 40%). The Multiple Sclerosis Impact Profile (MSIP), Medication and Adherence Inventory, Activities Diary, and electronic consultation (e-consult) were used by 40%, 55%, 47%, and 44% of respondents and were considered meaningful by 83%, 81%, 54%, and 88%, respectively. During out-patient consultations, nurses reportedly used the MSmonitor data three to six times more frequently than neurologists. As to nursing care, more symptoms were dealt with (according to 54% of respondents), symptoms were better discussed (69%), and the overall quality of care had improved (60%) since the use of the program. As to neurological care, these figures were 24%, 31%, and 27%, respectively. In 46% of the respondents, the insight into their symptoms and disabilities had increased since the use of the program; the MSIP, Activities Diary, and e-consult had contributed most to this improvement. The overall satisfaction with the program was 3.5 out of 5, and 73% of the respondents would recommend the program to other persons with multiple sclerosis. Conclusion: A survey among persons with multiple sclerosis using the MSmonitor program showed that the MSIP, Medication and Adherence Inventory, Activities Diary, and e-consult were frequently used and that the MSIP, Medication and Adherence Inventory, and e-consult were appreciated the most. Moreover, the quality of nursing care, but not so neurological care, had improved, which may relate to nurses making more frequent use of the MSmonitor data than neurologists

Opschalen van sociale ondernemingen: groei in impact. Belangrijkste onderzoeksresultaten

Dit beknopte onderzoeksverslag presenteert de belangrijkste resultaten van het tweejarig onderzoeksproject naar de kansen en uitdagingen voor het opschalen van sociale ondernemingen gericht op arbeidsparticipatie van mensen met een grote afstand tot de arbeidsmarkt. In de afgelopen jaren is het aantal sociale ondernemingen wereldwijd sterk gegroeid. Sociale ondernemingen zoeken naar nieuwe economisch duurzame manieren om structurele maatschappelijke problemen aan te pakken die vaak buiten de directe aandacht en doelstellingen van de publieke en private sector vallen. Sociale ondernemingen zijn in de eerste plaats missiegedreven, waarbij winst geen doel op zich is maar een middel om sociale impact te creëren met betrekking tot een specifiek maatschappelijk probleem. De aanleiding voor dit onderzoek vormde het feit dat veel sociale ondernemingen, ondanks hun groeiambities, er nog onvoldoende in slagen om wat betreft hun maatschappelijke impact het lokale niveau te overstijgen. Het effectief realiseren van meervoudige waarde —sociaal en economisch— is niet eenvoudig. Zo hebben sociale ondernemingen over het algemeen te maken met een grotere verscheidenheid aan belanghebbenden, waardoor de activiteiten niet altijd even consistent zijn en doelstellingen soms zelfs met elkaar in strijd lijken

Nieuwe banen Lelystad : eindrapportage

Een aantal jaren terug verwachtte de gemeente Lelystad banengroei op de Flevolandse arbeidsmarkt. Bekend was dat kwetsbare groepen op de arbeidsmarkt zonder extra inspanning niet automatisch van die nieuwe banengroei zouden profiteren. De vraag rees hoe deze verwachte groei van de werkgelegenheid kon worden verbonden aan de inclusie van mensen met een afstand tot de arbeidsmarkt. Dit leidde tot het concept voor de Nieuwe Banen methodiek

Nieuwe Banen Methodiek : verbinden van economische groei aan inclusie. Samenvatting

Gemeenten in Nederland zetten verschillende strategieën in om mensen met een afstand tot de arbeidsmarkt naar werk te begeleiden. De strategieën kunnen grofweg worden ingedeeld in twee type aanpakken: Het versterken van het individu om de afstand te verkleinen (bijv. door trainingen) en het stimuleren van werkgevers om meer mensen met een afstand op te nemen (bijv. SROI verplichting). Ondanks alle inspanningen blijft het aantal bedrijven dat werkzoekenden uit kwetsbare groepen duurzaam plaatst nog onvoldoende. Daarnaast is weinig bekend over effectieve aanpakken om meer werkgevers te betrekken bij de inclusieve arbeidsmarktgedachte. Een aantal jaren terug verwachtte de gemeente Lelystad banengroei op de Flevolandse arbeidsmarkt. Bekend was dat kwetsbare groepen op de arbeidsmarkt zonder extra inspanning niet automatisch van die nieuwe banengroei zouden profiteren. De vraag rees hoe deze verwachte groei van de werkgelegenheid kon worden verbonden aan de inclusie van mensen met een afstand tot de arbeidsmarkt. Dit leidde tot het concept voor de Nieuwe Banen methodiek. Url van brondocument: https://www.inclusiefwerkt.nl/wp content/uploads/2019/12/20190913_Nieuwe Banen-methodiek_samenvatting_def.pd

Labour flexibility practices in Dutch SMEs

Purpose: The purpose of this paper is to understand how small and medium enterprises (SMEs) cope with the need for labour flexibility. Most previous studies ignore the labour flexibility practices of SMEs, especially in times of economic growth and tight labour markets. Design/methodology/approach: A multiple case study approach is applied, with ten Dutch SMEs located in one small province with a similar labour market. A survey was executed as an intake, followed by 48 interviews with the entrepreneurs, HR and other managers and employees, and two focus groups in each company. The findings are based on an analysis of the approved case descriptions. Findings: SMEs, like big companies, do not rely on one flexibility practice. Volume fluctuations are countered with all flexibility strategies, the mix fluctuations and the product innovations are mostly countered with flexible functions and flexible production technology. In general, the data suggest that flexibility strategies of SMEs can be characterised as ad hoc, reactive and with a short-term orientation. Research limitations/implications: Future research should include other sectors and regions enabling to generalise the findings. Future research should have a longitudinal design to include the pathway dependencies of flexibility practices. Practical implications: This study identifies the need to analyse flexibility demands; reduce flexibility demands before investments in flexibility practices; create production process flexibility; invest in labour flexibility practices only after the first three steps are taken; and develop basic and more advanced levels of flexible contracts, flexible functions and flexible working times. Originality/value: This study contributes to the authors’ knowledge on the use of labour flexibility practices in SMEs. In addition, it brings empirical data on how these labour flexibility practices relate to the needs for flexibility and how they relate to other sources of organisational flexibility, such as a flexible market approach and flexible production technologies. Dynamic capabilities should include the suggested operationalisation of the flexibility practices

Persistence and adherence in multiple sclerosis patients starting glatiramer acetate treatment: assessment of relationship with care received from multiple disciplines

Background: In multiple sclerosis patients, the persistence of, and adherence to, disease-modifying treatment are often insufficient. The degree of persistence and adherence may relate to the care received from various disciplines. Methods: In an observational study of 203 patients treated with glatiramer acetate 20 mg subcutaneous daily, we assess the persistence and adherence in relation to the amount of care received in various disciplines. The frequencies and durations of care per discipline were reported by patients online, as were missed doses and eventual treatment discontinuation. The associations between the care provided by neurologists, nurses, psychologists, pharmacists, and rehabilitative doctors and persistence and adherence were the primary outcomes; the associations between care received from general practitioners, occupational therapists, physiotherapists, social workers, dieticians, home caregivers, informal caregivers, other medical specialists, and other caregivers and persistence and adherence were secondary outcomes. Results: It was found that the 12-month persistence rate was 62% and that 85% of the persistent patients were 95% adherent (missed Conclusion: We obtained no evidence that, in multiple sclerosis patients, persistence of and adherence to disease-modifying treatment are associated with the amount of neurological, nursing, pharmaceutical, or rehabilitative care. However, findings suggest that the treatment of psychological problems in Q3 may relate to persistence and that home care and informal care may relate to adherence

Effects of Exogenous Recombinant APC in Mouse Models of Ischemia Reperfusion Injury and of Atherosclerosis

<div><p>Activated protein C (APC) is a serine protease that has both anticoagulant and cytoprotective properties. The cytoprotective effects are protease activated receptor 1 (PAR-1) and endothelial protein C receptor (EPCR) dependent and likely underlie protective effects of APC in animal models of sepsis, myocardial infarction and ischemic stroke. S360A-(A)PC, a variant (A)PC that has no catalytic activity, binds EPCR and shifts pro-inflammatory signaling of the thrombin-PAR-1 complex to anti-inflammatory signaling. In this study we investigated effects of human (h)wt-PC, hS360A-PC, hwt-APC and hS360A-APC in acute (mouse model of acute myocardial ischemia/reperfusion (I/R) injury) and chronic inflammation (apoE^−/− mouse model of atherosclerosis). All h(A)PC variants significantly reduced myocardial infarct area (p<0.05) following I/R injury. IL-6 levels in heart homogenates did not differ significantly between sham, placebo and treatment groups in I/R injury. None of the h(A)PC variants decreased number and size of atherosclerotic plaques in apoE^−/− mice. Only hS360A-APC slightly affected phenotype of plaques. IL-6 levels in plasma were significantly (p<0.001) decreased in hwt-APC and hS360A-PC treated mice. In the last group levels of monocyte chemotactic protein 1 (MCP-1) were significantly increased (p<0.05). In this study we show that both hwt and hS360A-(A)PC protect against acute myocardial I/R injury, which implies that protection from I/R injury is independent of the proteolytic activity of APC. However, in the chronic atherosclerosis model hwt and hS360-(A)PC had only minor effects. When the dose, species and mode of (A)PC administration will be adjusted, we believe that (A)PC will have potential to influence development of chronic inflammation as occurring during atherosclerosis as well.</p></div

Treatment with wt- or S360A-(A)PC does not alter plaque area or # of plaques.

<p>ApoE^−/− mice were injected with saline or 0.2 mg/kg of wt-PC, S360A-PC, wt-APC or S360A-APC. Images of an initial (<b>A</b>) and an advanced (<b>B</b>) plaque after hematoxylin and eosin (H&E) staining. <b>C)</b> Atherosclerotic lesions were classified as initial (black bars) or advanced (white bars) and numbers of both type of plaques per mouse were determined. <b>D)</b> Total plaque area in the aortic arch as determined by H&E staining. <b>E)</b> Surface area of individual initial plaques. <b>F)</b> Surface area of individual advanced plaques. All graphs show mean +/− SEM, statistical significance was tested using one-way analysis of variance with Dunnett post hoc test, *P<0.05.</p

Only S360A-APC treatment influences plaque phenotype.

<p>Images of plaques stained for collagen (<b>A</b>), macrophages (<b>B</b>), leukocytes (<b>C</b>), and T cells (<b>D</b>). <b>E)</b> After sirius red staining, the percentage of collagen was determined by dividing the area of collagen by the total plaque area. <b>F)</b> After Mac-3 staining, the percentage of macrophages as a percentage of the total number of cells per plaque was calculated. <b>G)</b> After CD45 staining, the percentage of leukocytes as a percentage of the total number of cells per plaque was calculated. <b>H)</b> After CD3 staining, the percentage of T cells of the total number of cells per plaque was calculated. All graphs show mean +/− SEM, statistical significance was tested using one-way analysis of variance with Dunnett post hoc test, *P<0.05, **P<0.01.</p