Introduction: There are two surgical approaches to reconstruct a pressure ulcer (PU): one-stage reconstruction or two-stage reconstruction. One stage reconstruction consists of surgical debridement and flap reconstruction during one operation. Two-stage surgery consist of a surgical debridement and a final reconstruction in two different sessions, with approximately six weeks between both sessions. Objective: The aim of this study was to compare the results of single stage surgery and two-stage surgery on the PU recurrence rate and other important post operative complications. Method: A retrospective, comparative study in Spinal Cord Injured (SCI) individuals with a single- or two stage surgical reconstruction between 2005 and 2016 was designed. A total of 81 records were included for analysis. Results: The primary outcome, the difference in occurrence of a recurrent PU in the reconstructed area (33.3% versus 31.6%), is not statistically significant between one-and two-stages reconstruction. Also, the mean duration to develop a recurrent PU between both surgical reconstructions is not statistically significant. Other surgical complications in the reconstructed area like wound hematoma, hemorrhage, seroma or (partial) flap failure did not differ significantly between both groups, apart and in total. We calculated the additional costs in case of a two-stage approach compared with a single-stage reconstruction at EUR 16,362. Conclusions: There are no statistical significant differences in PU recurrence rate or other post operative complications between SCI patients who have undergone one- or two stage PU reconstructive surgery. The most obvious choice for a one-stage approach in case of PU reconstructive surgery has great positive implications for the patient, family, health care providers and the health care system.
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Background: A patient decision aid (PtDA) can support shared decision making (SDM) in preference-sensitive care, with more than one clinically applicable treatment option. The development of a PtDA is a complex process, involving several steps, such as designing, developing and testing the draft with all the stakeholders, known as alpha testing. This is followed by testing in ‘real life’ situations, known as beta testing, and then finalising the definite version. Our aim was developing and alpha testing a PtDA for primary treatment of early stage breast cancer, ensuring that the tool is considered relevant, valid and feasible by patients and professionals. Methods: Our qualitative descriptive study applied various methods including face-to-face think-aloud interviews, a focus group and semi-structured telephone interviews. The study population consisted of breast cancer patients facing the choice between breast-conserving therapy with or without preceding neo-adjuvant chemotherapy and mastectomy, and professionals involved in breast cancer care in dedicated multidisciplinary breast cancer teams. Results: A PtDA was developed in four iterative test rounds, taking nearly 2 years, involving 26 patients and 26 professionals. While the research group initially opted for simplicity for the sake of implementation, the clinicians objected that the complexity of the decision could not be ignored. Other topics of concern were the conflicting views of professionals and patients regarding side effects, the amount of information and how to present it. Conclusion: The development was an extensive process, because the professionals rejected the simplifications proposed by the research group. This resulted in the development of a completely new draft PtDA, which took double the expected time and resources. The final version of the PtDA appeared to be well-appreciated by professionals and patients, although its acceptability will only be proven in actual practice (beta testing)
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Breast cancer is the most prevalent form of cancer that affects women worldwide, posing a significant burden on public health. While advancements in early detection and improved treatments have led to a remarkable 90% five-year survival rate and an 83% ten-year survival rate, this has also resulted in more prophylactic mastectomies being performed. Despite advancements in breast-conserving techniques, immunotherapy, and hormone therapy, many women still undergo mastectomies as part of their cancer treatment. In all cases, this results in scarring, and additional side effects from treatment modalities may arise. The loss of a breast can profoundly impact health-related quality of life (HRQoL). Although HRQoL has improved greatly during the recent years, systematic and local therapy having side effects is not uncommon, and this needs more attention.
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Purpose: This research aimed to explore factors associated with patient-reported breast and abdominal scar quality after deep inferior epigastric perforator (DIEP) flap breast reconstruction (BR). Material and Methods: This study was designed as a descriptive cross-sectional survey in which women after DIEP flap BR were invited to complete an online survey on breast and abdominal scarring. The online survey was distributed in the Netherlands in several ways in order to reach a diverse population of women. Outcomes were assessed with the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS). Additional items were assessed with a numeric rating scale (NRS). Results: A total of 248 women completed the survey. There was a statistically significant worse POSAS scar appraisal for the abdominal scar compared with the breast scar. The vast majority of women reported high scores on at least one scar characteristic of their breast scar or ab- dominal scar. Overall, color, stiffness, thickness, and irregularity scored higher than pain and itching. Women were only moderately positive about the size, noticeability, location, and the information provided regarding scarring. Conclusion: It is crucial to address the inevitability of scars in patient education before a DIEP flap BR, with a particular focus on the abdominal scar, as women experience abdominal scars significantly worse than their breast scars. Providing more information on the experience of other women and the expected appearance will contribute to having realistic expectations while allowing them to make well-informed decisions.
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Purpose: The aim of this study was to assess physiotherapists’ clinical use and acceptance of a novel telemonitoring platform to facilitate the recording of measurements during rehabilitation of patients following anterior cruciate ligament reconstruction. Additionally, suggestions for platform improvement were explored. Methods: Physiotherapists from seven Dutch private physiotherapy practices participated in the study. Data were collected through log files, a technology acceptance questionnaire and focus group meetings using the “buy a feature” method. Data regarding platform use and acceptance (7-point/11-point numeric rating scale) were descriptively analysed. Total scores were calculated for the features suggested to improve the platform, based on the priority rating (1 = nice to have, 2 = should have, 3 = must have). Results: Participating physiotherapists (N = 15, mean [SD] age 33.1 [9.1] years) together treated 52 patients during the study period. Platform use by the therapists was generally limited, with the number of log-ins per patient varying from 3 to 73. Overall, therapists’ acceptance of the platform was low to moderate, with average (SD) scores ranging from 2.5 (1.1) to 4.9 (1.5) on the 7-point Likert scale. The three most important suggestions for platform improvement were: (1) development of a native app, (2) system interoperability, and (3) flexibility regarding type and frequency of measurements. Conclusions: Even though health care professionals were involved in the design of the telemonitoring platform, use in routine care was limited. Physiotherapists recognized the relevance of using health technology, but there are still barriers to overcome in order to successfully implement eHealth in routine care.
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Background: The majority of patients diagnosed with early-stage breast cancer are in a position to choose between having a mastectomy or lumpectomy with radiation therapy (breast-conserving therapy). Since the long-term survival rates for mastectomy and for lumpectomy with radiation therapy are comparable, patients’ informed preferences are important for decision-making. Although most clinicians believe that they do include patients in the decision-making process, the information that women with breast cancer receive regarding the surgical options is often rather subjective, and does not invite patients to express their preferences. Shared decision-making (SDM) is meant to help patients clarify their preferences, resulting in greater satisfaction with their final choice. Patient decision aids can be very supportive in SDM. We present the protocol of a study to β test a patient decision aid and optimise strategies for the implementation of SDM regarding the treatment of early-stage breast cancer in the actual clinical setting. Methods/design: This paper concerns a preimplementation and post-implementation study, lasting from October 2014 to June 2015. The intervention consists of implementing SDM using a patient decision aid. The intervention will be evaluated using qualitative and quantitative measures, acquired prior to, during and after the implementation of SDM. Outcome measures are knowledge about treatment, perceived SDM and decisional conflict. We will also conduct face-to-face interviews with a sample of these patients and their care providers, to assess their experiences with the implementation of SDM and the patient decision aid.
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Emotions are a key component of tourism experiences, as emotions make experiences more valued and more memorable. Peak-and-end-theory states that overall experience evaluations are best predicted by the emotions at the most intense and final moments of an experience. Peak-and-end-theory has mostly been studied for relatively simple experiences. Recent insights suggest that peak-and-end-theory does not necessarily hold for tourism experiences, which tend to be more heterogeneous and multi-episodic in nature. Through the novel approach of using electrophysiological measures in combination with experience reconstruction, the applicability of the peak-and-end-theory to the field of tourism is addressed by studying a musical theatre show in a theme park resort. Findings indicate that for a multi-episodic tourism experience, hypotheses from the peak-and-end-theory are rejected for the experience as a whole, but supported for individual episodes within the experience. Furthermore, it is shown that electrophysiology sheds a new light on the temporal dynamics of experience
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This article provides a description of the emergence of the Spanish ‘Occupy’ movement, Democracia real ya. The aim is to analyse the innovative discursive features of this movement and to connect this analysis to what we consider the innovative potential of the critical sciences. The movement is the result of a spontaneous uprising that appeared on the main squares of Madrid and Barcelona on 15 May 2011 and then spread to other Spanish cities. This date gave it its name: 15M. While the struggle for democracy in Spain is certainly not new, the 15M group shows a series of innovative features. These include the emphasis on peaceful struggle and the imaginary of a new democracy or worldview, transmitted through innovative placards and slogans designed by Spanish citizens. We consider these innovative not only due to their creativity, but also because of their use as a form of civil action. Our argument is that these placards both functioned as a sign of protest and, in combination with the demonstrations and the general dynamics of 15M, helped to reframe the population’s understanding of the crisis and rearticulate the identity of the citizens from victims to agents. In order to analyse the multimodal character of this struggle, we developed an interdisciplinary methodology, which combines socio-cognitive approaches that consider ideological proposals as socio-cognitive constructs (i.e. the notion of narrative or cognitive frame), and Critical Discourse Analysis (CDA) in the analysis of discourses related to processes of social imagination and transformation. The socio-constructivist perspective is used to consider these discourses in relation to their actors, particular contexts and actions. The use of CDA, which included a careful rhetoric analysis, helped to analyse the process of deconstruction, transformation and reconstruction that 15M uses to maintain its struggle. The narrative analysis and the discursive theoretical concept of articulation helped to methodologically show aspects of the process of change alluded to above. This change was both in terms of cognition and in the modification of identity that turned a large part of the Spanish population from victims to indignados and to the neologism indignadanos, which is a composition of indignado and ciudadano (citizen).
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Supply chain partnerships within housing refurbishment have not been given much specific attention which may be found surprising because the refurbishment market is becoming of increasing importance compared to new construction and has specific characteristics that require adapted approaches to supply chain integration. In this paper approaches, expected benefits and challenges of supply chain partnerships within housing renovation are explored. From general literature on building process innovation, dimensions of supply chain integration and potential advantages and challenges of have been derived and employed in a preliminary inquiry among Dutch housing associations and their partners that are experimenting with supply chain partnering in housing refurbishment projects. The results indicate that approaches are in a relatively early stage of development towards ‘mature’ supply chain partnerships. Furthermore, many of the general expectations also apply to the Dutch housing refurbishment sector, but at a more detailed level, refurbishment may require specific attention for the division of tasks and risks between the partners, particularly regarding communication with tenants.
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Uit de Managementsamenvatting: "In dit rapport beschrijven we de opzet en de uitkomsten van de evaluatie van het project Online Stagebegeleiding dat is uitgevoerd vanuit de Stimuleringsregeling Open en Online Onderwijs (projectcode O019-03). Het project had als doel om kennis te ontwikkelen over hoe online stagebegeleiding kan worden ingezet ter verrijking van werkplekleren in het hoger onderwijs. De conclusies en de daarop gebaseerde aanbevelingen presenteren wij in dit rapport met als doel de opgedane inzichten beschikbaar en inzichtelijk te maken voor geïnteresseerden in online onderwijs, stagebegeleiding of onderwijsinnovatie in het algemeen. Uit onderzoek blijkt dat goede begeleiding cruciaal is voor het succes van werkplekleren. Docenten zijn echter grotendeels niet op de werkplek aanwezig en hebben vaak (zeer) beperkte tijd om hun stagiairs te begeleiden. Daarbij is het voor studenten vaak moeilijk om hun leerproces op de stage te reguleren. In het project hebben wij de reeds bestaande Stage-App uitgebreid met functionaliteit voor docenten ter ondersteuning van de stagebegeleiding en hebben we deze ingezet in drie pilots."
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