PURPOSE: Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCTs) to investigate moderators of exercise intervention effects on cancer-related fatigue.METHODS: We used individual patient data from 31 exercise RCTs worldwide, representing 4,366 patients, of whom 3,846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z-score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with group allocation, using a likelihood ratio test.RESULTS: Exercise interventions had statistically significant beneficial effects on fatigue (β= -0.17 [95% confidence interval (CI) -0.22;-0.12]). There was no evidence of moderation by demographic or clinical characteristics. Supervised exercise interventions had significantly larger effects on fatigue than unsupervised exercise interventions (βdifference= -0.18 [95%CI -0.28;-0.08]). Supervised interventions with a duration ≤12 weeks showed larger effects on fatigue (β= -0.29 [95% CI -0.39;-0.20]) than supervised interventions with a longer duration. CONCLUSIONS: In this individual patient data meta-analysis, we found statistically significant beneficial effects of exercise interventions on fatigue, irrespective of demographic and clinical characteristics. These findings support a role for exercise, preferably supervised exercise interventions, in clinical practice. Reasons for differential effects in duration require further exploration.
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Hoe meer data er beschikbaar komt, des te meer de beslissing verbeterd kan worden. Hoe beter (slimmer) de beslissing wordt gemaakt, des te meer waarde de beslissing heeft voor uw organisatie. Dit wordt het data-netwerk-effect genoemd. Vaak wordt het data-netwerk-effect gerealiseerd door het gebruik van data van onbewuste data-donoren. In dit artikel wordt een ander soort data-donor belicht: de bewuste data-donor.
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Data is widely recognized as a potent catalyst for advancing healthcare effectiveness, increasing worker satisfaction, and mitigating healthcare costs. The ongoing digital transformation within the healthcare sector promises to usher in a new era of flexible patient care, seamless inter-provider communication, and data-informed healthcare practices through the application of data science. However, more often than not data lacks interoperability across different healthcare institutions and are not readily available for analysis. This inability to share data leads to a higher administrative burden for healthcare providers and introduces risks when data is missing or when delays occur. Moreover, medical researchers face similar challenges in accessing medical data due to thedifficulty of extracting data from applications, a lack of standardization, and the required data transformations before it can be used for analysis. To address these complexities, a paradigm shift towards a data-centric application landscape is essential, where data serves as the bedrock of the healthcare infrastructure and is application agnostic. In short, a modern way to think about data in general is to go from an application driven landscape to a data driven landscape, which will allow for better interoperability and innovative healthcare solutions.In the current project the research group Digital Transformation at Hanze University of Applied Sciences works together with industry partners to build an openEHR implementation for a Groningen-based mental healthcare provider.
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In dit artikel wordt het door Twigg et al. (2011) uitgevoerde onderzoek kritisch bekeken. In dit onderzoek is gekeken naar de relatie tussen de verpleegkundige bezetting en verbetering van verpleegkundig sensitieve uitkomsten. De onderzoekers constateren een positieve causale relatie maar onderbouwen dat niet door de gepresenteerde resultaten. Daarnaast wordt er geen aandacht geschonken aan andere contextuele factoren (zoals multidisciplinaire samenwerking) die van invloed zijn op de uitkomsten. Geconcludeerd kan worden dat de relatie tussen de verpleegkundige bezetting minder duidelijk is dan de onderzoekers concluderen.
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Background: Acquiring the theoretical and practical knowhow of conducting patient and public involvement (PPI) in research is not part of the traditional curriculum of researchers. Zuyd University of Applied Sciences and Huis voor de Zorg, a regional umbrella patient organization, therefore started a 1.5-year coaching programme. Objective: To establish a community of practice by developing a PPI coaching programme for senior and junior health services researchers of Zuyd University. The context consisted of research projects conducted by the participants. Methods: A participatory action research methodology. Data were collected from reports of thematic group meetings and individual sessions with participants, field notes and regular reflection meetings with the project team. Data were analysed by reflexive deliberation. Findings: The programme comprised a kick-off meeting (52 attendees), followed by 7 group meetings with 11 junior and 9 senior researchers. The project team constructed a serious game based on the concept of the participation ladder. Questions and concerns differed for junior and senior researchers, and separate tailored meetings were organized for both groups. Between group meetings, participants received individual assignments. Group meetings were accompanied by individual coaching sessions to provide tailor-made feedback. The programme concluded with a combined meeting with all stakeholders. Conclusion: Building a community of PPI practice through action research facilitates the development of a coaching programme that fosters social learning, empowerment and the development of a shared identity concerning PPI. The role and responsibilities of senior researchers should be distinguished from those of junior researchers.
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Data is widely recognized as a potent catalyst for advancing healthcare effectiveness, increasing worker satisfaction, and mitigating healthcarecosts. The ongoing digital transformation within the healthcare sector promises to usher in a new era of flexible patient care, seamless inter-provider communication, and data-informed healthcare practices through the application of data science. However, more often than not data lacks interoperability across different healthcare institutions andare not readily available for analysis. This inability to share data leads to a higher administrative burden for healthcare providers and introduces risks when data is missing or when delays occur. Moreover, medical researchers face similar challenges in accessing medical data due to thedifficulty of extracting data from applications, a lack of standardization, and the required data transformations before it can be used for analysis. To address these complexities, a paradigm shift towards a data-centricapplication landscape is essential, where data serves as the bedrock of the healthcare infrastructure and is application agnostic.In short, a modern way to think about data in general is to go from an application driven landscape to a data driven landscape, which willallow for better interoperability and innovative healthcare solutions.
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Background: Patient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goal-setting process because patients can identify and rate their own problems. The aim of this study is to explore patients’ experiences with the feasibility of the PSC, in the physiotherapy goal setting. Method: We performed a qualitative study. Data were collected by observations of physiotherapy sessions (n=23) and through interviews with patients (n=23) with chronic conditions in physiotherapy practices. Data were analyzed using directed content analysis. Results: The PSC was used at different moments and in different ways. Two feasibility themes were analyzed. First was the perceived ambiguity with the process of administration: patients perceived a broad range of experiences, such as emotional and supportive, as well as feeling a type of uncomfortableness. The second was the perceived usefulness: patients found the PSC useful for themselves – to increase awareness and motivation and to inform the physiotherapist – as well as being useful for the physiotherapist – to determine appropriate treatment for their personal needs. Some patients did not perceive any usefulness and were not aware of any relation with their treatment. Patients with a more positive attitude toward questionnaires, patients with an active role, and health-literate patients appreciated the PSC and felt facilitated by it. Patients who lacked these attributes did not fully understand the PSC’s process or purpose and let the physiotherapist take the lead. Conclusion: The PSC is a feasible tool to support patient participation in the physiotherapy goal setting. However, in the daily use of the PSC, patients are not always fully involved and informed. Patients reported varied experiences related to their personal attributes and modes of administration. This means that the PSC cannot be used in the same way in every patient. It is perfectly suited to use in a dialogue manner, which makes it very suitable to improve goal setting within client-centered care.
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Background: Patient involvement in interprofessional education (IPE) is a new approach in fostering person-centeredness and collaborative competencies in undergraduate students. We developed the Patient As a Person (PAP-)module to facilitate students in learning from experts by experience (EBEs) living with chronic conditions, in an interprofessional setting. This study aimed to explore the experiences of undergraduate students, EBEs and facilitators with the PAP-module and formulate recommendations on the design and organization of patient involvement in IPE. Methods: We collected data from students, EBEs and facilitators, through eight semi-structured focus group interviews and two individual interviews (N = 51). The interviews took place at Maastricht University, Zuyd University of Applied Sciences and Regional Training Center Leeuwenborgh. Conventional content analysis revealed key themes. Results: Students reported that learning from EBEs in an interprofessional setting yielded a more comprehensive approach and made them empathize with EBEs. Facilitators found it challenging to address multiple demands from students from different backgrounds and diverse EBEs. EBEs were motivated to improve the personcentredness of health care and welcomed a renewed sense of purpose. Conclusions: This study yielded six recommendations: (a) students from various disciplines visit an EBE to foster a comprehensive approach, (b) groups of at least two students visit EBEs, (c) students may need aftercare for which facilitators should be receptive, (d) EBEs need clear instruction on their roles, (e) multiple EBEs in one session create diversity in perspectives and (f) training programmes and peer-to-peer sessions for facilitators help them to interact with diverse students and EBEs.
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Background: Limited information is available on the experiences of patients during rehabilitation after anterior cruciate ligament reconstruction (ACLR). Aim: The current study aimed to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. Method and Design: A survey-based study with an online platform was used to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. Seventy-two patients (age 27.8 [8.8] y) after ACLR participated. Data were analyzed and themes were identified by comparing categories and subcategories on similarity. Main Findings: Positive patient experiences were room for own input, supervision, attention, knowledge, honesty, and professionalism of the physiotherapist. Additionally, a varied and structured rehabilitation program, adequate facilities, and contact with other patients were identified as positive patient experiences. Negative experiences were a lack of attention, lack of professionalism of the physiotherapists, a lack of sport-specific field training, a lack of goal setting, a lack of adequate facilities, and health insurance costs. Conclusions: The current study identified factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. These findings can help physiotherapists in understanding the patient experiences during rehabilitation after ACLR.
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Vanuit Fontys Hogescholen wordt veel onderzoek gedaan, met name door onderzoekers van de verschillende lectoraten. Vanzelfsprekend worden er binnen deze onderzoeken veel data verzameld en verwerkt. Fontys onderschrijft het belang van zorgvuldige omgang met onderzoeksdata en vraagt daarom van onderzoekers dat zij hun Research Data Management (RDM) op orde hebben. Denk hierbij aan veilige opslag en duurzame toegankelijkheid van data. Maar ook (open access) publiceren en archiveren van onderzoeksdata maken onderdeel uit van RDM. Hoe je hier als onderzoeker invulling aan geeft kan soms best een zoektocht zijn, mede doordat nog niet iedereen even bekend is met het onderwerp RDM. Met dit boek hopen we onderzoekers binnen Fontys de belangrijkste informatie te bieden die nodig is om goed invulling te geven aan Research Data Management en daarbij ook te wijzen op de ondersteuning die op dit gebied voorhanden is.
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