Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
In this thesis several studies are presented that have targeted decision making about case management plans in probation. In a case management plan probation officers describe the goals and interventions that should help offenders stop reoffending, and the specific measures necessary to reduce acute risks of recidivism and harm. Such a plan is embedded in a judicial framework, a sanction or advice about the sanction in which these interventions and measures should be executed. The topic of this thesis is the use of structured decision support, and the question is if this can improve decision making about case management plans in probation and subsequently improve the effectiveness of offender supervision. In this chapter we first sketch why structured decision making was introduced in the Dutch probation services. Next we describe the instrument for risk and needs assessment as well as the procedure to develop case management plans that are used by the Dutch probation services and that are investigated in this thesis. Then we describe the setting of the studies and the research questions, and we conclude with an overview of this thesis.
Energiebeheer gericht aanpakken, Het analyseren van doelstellingen, resultaten en impacts van energie- en broeikasgasbeheersprogramma’s in bedrijven (met een samenvatting in het Nederlands): De wereldwijde uitstoot van broeikasgassen moet drastisch worden teruggebracht om de mondiale stijging van de temperatuur tot het relatief veilige niveau van maximaal 2 graden Celsius te beperken. In de komende decennia zal de verbetering van de energie-efficiëntie de belangrijkste strategie zijn voor het verminderen van de energiegerelateerde uitstoot van broeikasgassen. Hoewel er een enorm potentieel is voor verbetering van de energie-efficiëntie, wordt een groot deel daarvan nog niet benut. Dit wordt veroorzaakt door diverse investeringsbarrières die de invoering van maatregelen voor energie-efficiëntie verbetering verhinderen. De invoering van energiemanagement wordt vaak beschouwd als een manier om dergelijke barrières voor energiebesparing te overwinnen. De invoering van energiemanagement in bedrijven kan worden gestimuleerd door de introductie van programma's voor energie-efficiëntie verbetering en vermindering van de uitstoot van broeikasgassen. Deze programma's zijn vaak een combinatie van verschillende elementen zoals verplichtingen voor energiemanagement; (ambitieuze) doelstellingen voor energiebesparing of beperking van de uitstoot van broeikasgassen; de beschikbaarheid van regelingen voor stimulering, ondersteuning en naleving; en andere verplichtingen, zoals openbare rapportages, certificering en verificatie. Tot nu toe is er echter beperkt inzicht in het proces van het formuleren van ambitieuze doelstellingen voor energie-efficiëntie verbetering of het terugdringen van de uitstoot van broeikasgassen binnen deze programma's, in de gevolgen van de invoering van dergelijke programma's op de verbetering van het energiemanagement, en in de impact van deze programma's op energiebesparing of de vermindering van de uitstoot van broeikasgassen. De centrale onderzoeksvraag van dit proefschrift is als volgt geformuleerd: "Wat is de impact van energie- en broeikasgasmanagement programma’s op het verbeteren van het energiemanagement in de praktijk, het versnellen van de energieefficiëntie verbetering en het beperken van de uitstoot van broeikasgassen in bedrijven?".
