Objective: International guidelines recommend supervised exercise therapy (SET) as primary treatment for all patients with intermittent claudication (IC), yet primary endovascular revascularisation (ER) might be more effective in patients with iliac artery obstruction. Methods: This was a multicentre RCT including patients with IC caused by iliac artery stenosis or occlusion (NCT01385774). Patients were allocated randomly to SET or ER stratified for maximum walking distance (MWD) and concomitant SFA disease. Primary endpoints were MWD on a treadmill (3.2 km/h, 10% incline) and disease specific quality of life (VascuQol) after one year. Additional interventions during a mean follow up of 5.5 years were recorded. Results: Between November 2010 and May 2015, 114 patients were allocated to SET, and 126 to ER. The trial was terminated prematurely after 240 patients were included. Compliance with SET was 57/114 (50%) after six months. Ten patients allocated to ER (8%) did not receive this intervention. One year follow up was complete for 90/114 (79%) SET patients and for 104/126 (83%) ER patients. The mean MWD improved from 187 to 561 m in SET patients and from 196 to 574 m in ER patients (p =.69). VascuQol sumscore improved from 4.24 to 5.58 in SET patients, and from 4.28 to 5.88 in ER patients (p =.048). Some 33/114 (29%) SET patients had an ER within one year, and 2/114 (2%) surgical revascularisation (SR). Some 10/126 (8%) ER patients had additional ER within one year and 10/126 (8%) SR. After a mean of 5.5 years, 49% of SET patients and 27% of ER patients underwent an additional intervention for IC. Conclusion: Taking into account the many limitations of the SUPER study, both a strategy of primary SET and primary ER improve MWD on a treadmill and disease specific Qol of patients with IC caused by an iliac artery obstruction. It seems reasonable to start with SET in these patients and accept a 30% failure rate, which, of course, must be discussed with the patient. Patients continue to have interventions beyond one year.
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‘Ik ben in 2019 afgestudeerd als maatschappelijk werker (MWD) aan de Hogeschool Utrecht. Vanaf toen was ik officieel een professional, maar dankzij mijn ervaringsdeskundigheid als jonge mantelzorger thuis, was ik al jaren als vrijwillig professional verbonden aan het sociaal werk. Na mijn hbo-studie ben ik de master Community Development aan de Hogeschool Utrecht gaan volgen. Eén van de opdrachten van deze master is om zelf een community op te zetten. Aangezien ik tijdens mijn studie MWD graag meer begrip en ruimte had willen krijgen van medestudenten en docenten om mijn studie te combineren met de zorgtaken thuis, besloot ik te gaan onderzoeken hoe ik andere studenten in deze situatie kan ondersteunen. Ik bouwde vervolgens aan een supportgroep voor studenten met zorgtaken en breng deze studenten zo bij elkaar. In deze supportgroep kunnen studenten die mantelzorgen van zich af praten en onderling ervaringen uitwisselen. Ondanks de positieve reacties, blijkt het moeilijk om de studenten die het betreft te bereiken en ze (blijvend) aan de supportgroep te verbinden. Ik buig me nu over de vraag hoe ik deze supportgroep duurzaam kan verbinden aan de Hogeschool Utrecht.
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At the end of January 2015 I was given a research assignment formulated and sponsored by two professors of professorships (hereafter lectoraten) associated with the Academy for Social Studies (SASS), and the manager of Professionals and Bedrijven (hereafter P&B). At a later stage, the research was expanded by the sponsorship of the educational managers of the bachelor and master studies of SPH and MWD. It is a complex assignment with several research perspectives and aims. The main goal was to find out how to make better use of the products of the lectoraten for educational purposes. This umbrella goal included many subordinate aims. One aim concerned identifying the products and prioritizing them according to the educational demands of clients in the field and of teachers of the SASS educational programmes. Another aim was to demonstrate which skills the teachers who develop educational materials need to have and to identify steps necessary to adapt the products. Yet another aim consisted of finding better ways for knowledge to circulate between the lectoraten and the teaching staff of SASS. Finally advising the staff of P & B on marketing and communications in relation to the products of the lectoraten was aimed at. Overview of the reportAs stated, there are multiple assignment-givers (hereafter sponsors). In the first section the general societal context which triggered the assignment has been sketched but contextual aspects related to each of the sponsors have also been identified (in Appendix 1). The individual contexts of sponsors were important because, although they agreed on the broad aims of the assignment, they naturally have specific expectations of the results based on their particular situations. After the background sketch, seven sub-tasks given by the sponsors have been turned into subordinate - research and consultation questions. The second section describes the methods used and measures taken to obtain findings. This includes an identification of the inventory structure, actors involved both intramurally and extramurally (the stakeholders). Next, a Delphi method for developing a profile of learner needs and a list of topics of products is described.In the third section, findings are set out in relation to the 7 sub-research and consultation questions. Some discussion and concluding remarks are given for most of the seven questions. The findings are written in English but most of the quotations from respondents have not been translated so they appear in Dutch. Section four summarises these findings in a compact manner since there were conclusions throughout the findings. Section five offers recommendations in Dutch. Attention is given to the different emphases of the sponsors in the details of recommendations. Please note that many end notes and appendices are offered for further reading since some of the approaches mentioned in the text may be unfamiliar to some readers. A word about terms Both Dutch and English employ a variety of terms to identify the provision (aanbod) of learning for adults in working environments and to identify the learning activities or programmes. This can be confusing but is, unfortunately, unavoidable. In Dutch, the terms ‘deskundigheidsbevordering, nascholing, bijscholing’ and ‘trainingsaanbod’ or occasionally ‘professionalisering’ are all used to indicate what in English is called ‘professional development’ (often abbreviated to PD) or ‘staff development’ or, recently, ‘professionalisation’ The typical Dutch use of the term ‘training’ for almost all stypes of learning activities has a somewhat more restricted meaning in English. Educational activities are often referred to as ‘learning trajectories’; ‘ learning opportunities’ or ‘interventions’ as well as, less commonly, ‘training sessions’ or ‘workshops’. All of the English terms are employed throughout this report. The most commonly used are ‘professionalisation’ or ‘PD’ for the provision and ‘interventions’ to indicate specific educational programmes or activities.
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