Introduction: Retrospective studies suggest that a rapid initiation of treatment results in a better prognosis for patients in the emergency department. There could be a difference between the actual medication administration time and the documented time in the electronic health record. In this study, the difference between the observed medication administration time and documentation time was investigated. Patient and nurse characteristics were also tested for associations with observed time differences. Methods: In this prospective study, emergency nurses were followed by observers for a total of 3 months. Patient inclusion was divided over 2 time periods. The difference in the observed medication administration time and the corresponding electronic health record documentation time was measured. The association between patient/nurse characteristics and the difference in medication administration and documentation time was tested with a Spearman correlation or biserial correlation test. Results: In 34 observed patients, the median difference in administration and documentation time was 6.0 minutes (interquartile range 2.0-16.0). In 9 (26.5%) patients, the actual time of medication administration differed more than 15 minutes with the electronic health record documentation time. High temperature, lower saturation, oxygen-dependency, and high Modified Early Warning Score were all correlated with an increasing difference between administration and documentation times. Discussion: A difference between administration and documentation times of medication in the emergency department may be common, especially for more acute patients. This could bias, in part, previously reported time-to-treatment measurements from retrospective research designs, which should be kept in mind when outcomes of retrospective time-to-treatment studies are evaluated.
DOCUMENT
Objectives: Improving foot orthoses (FOs) in patients with rheumatoid arthritis (RA) by using in-shoe plantar pressure measurements seems promising. The objectives of this study were to evaluate (1) the outcome on plantar pressure distribution of FOs that were adapted using in-shoe plantar pressure measurements according to a protocol and (2) the protocol feasibility. Methods: Forty-five RA patients with foot problems were included in this observational proof-of concept study. FOs were custom-made by a podiatrist according to usual care. Regions of Interest (ROIs) for plantar pressure reduction were selected. According to a protocol, usual care FOs were evaluated using in-shoe plantar pressure measurements and, if necessary, adapted. Plantar pressure–time integrals at the ROIs were compared between the following conditions: (1) no-FO versus usual care FO and (2) usual care FO versus adapted FO. Semi-structured interviews were held with patients and podiatrists to evaluate the feasibility of the protocol. Results: Adapted FOs were developed in 70% of the patients. In these patients, usual care FOs showed a mean 9% reduction in pressure–time integral at forefoot ROIs compared to no-FOs (p = 0.01). FO adaptation led to an additional mean 3% reduction in pressure–time integral (p = 0.05). The protocol was considered feasible by patients. Podiatrists considered the protocol more useful to achieve individual rather than general treatment goals. A final protocol was proposed. Conclusions: Using in-shoe plantar pressure measurements for adapting foot orthoses for patients with RA leads to a small additional plantar pressure reduction in the forefoot. Further research on the clinical relevance of this outcome is required.
DOCUMENT
Tussenstand van het onderzoek, uitgevoerd door de HvA en UvA, naar het Amsterdams Experiment met de Bijstand (2018-2022), waarin wordt geschreven over de methode, uitkomsten en het belang van kwantitatief in combinatie met kwalitatief onderzoek.--Samenvatting (English)In the period 2018-2021 the municipality of Amsterdam conducted an experiment with beneficiaries of social assistance. Benefit recipients could voluntarily participate in the experiment. They were randomly assigned to three experimental conditions, viz. ‘extra attention’ (in which they received more frequent counseling and support), ‘self-direction’ (which offered the participants the freedom to make their own choices), and the ‘comparison group’ (the control group which received the customary treatment). Under all three conditions, participants who worked part-time could earn up to €200 a month on top of their social assistance benefit. A little over 800 participants (of the 5,000 in total) were followed closely by researchers of the Amsterdam University of Applied Science (HvA) and the University of Amsterdam (UvA). Although the participants who got ‘extra attention’ did not significantly flow out more frequently from the social assistance system than participants in the other two conditions, they did more often have a part-time job at the end of the experiment. There were no significant differences between the conditions with respect to participation in other non-paid activities, such as voluntary work and informal care. In-depth interviews with a selection of the participants showed, among other outcomes, that they considered the financial uncertainty as a main hindrance for doing (more) part-time work.
DOCUMENT
Background. Violent criminal offenders with personality disorders (PD’s) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs. Methods. We compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms. Results. Patients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*- time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*- time: t(1387) = −2.85, p = 0.005). Conclusions. These findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community
DOCUMENT
Purpose: Resuscitation quality and pace depend on effective team coordination, which can be facilitated by adequate leadership. Our primary aim was to assess the influence of trauma team leader experience on resuscitation pace. Second, we investigated the influence of injury severity on resuscitation pace. Methods: The trauma team leaders were identified (Staff trauma surgeon vs Fellow trauma surgeon) and classified from video analysis during a 1-week period. Resuscitations were assessed for time to the treatment plan, total resuscitation time, and procedure time. Furthermore, patient and resuscitation characteristics were assessed and compared: age, gender, Injury Severity Score, Glasgow Coma Scale < 9, and the number (and duration) of surgical procedures during initial resuscitation. Correlations between total resuscitation time, Injury Severity Score, and time to treatment plan were calculated. Results: After adjustment for the time needed for procedures, the time to treatment plan and total resuscitation time was significantly shorter in resuscitations led by a Staff trauma surgeon compared to a Fellow trauma surgeon (median 648 s (IQR 472-813) vs 852 s (IQR 694-1256); p 0.01 resp. median 1280 s (IQR 979-1494) vs 1535 s (IQR 1247-1864), p 0.04). Surgical procedures were only performed during resuscitations led by Staff trauma surgeons (4 thorax drains, 1 endotracheal intubation, 1 closed fracture reduction). Moreover, a significant negative correlation (r: - 0.698, p < 0.01) between Injury Severity Score and resuscitation time was found. Conclusion: Experienced trauma team leaders may positively influence the pace of the resuscitation. Moreover, we found that the resuscitation pace increases when the patient is more severely injured.
LINK
Na curatieve behandeling voor niet-gemetastaseerde borstkanker krijgen patiënten nacontrole (detectie van mogelijke terugkeer van borstkanker in het borstgebied) en nazorg ondersteuning bij mogelijke gevolgen van de ziekte en/of behandeling). Tot nu toe kregen alle patiënten vijf jaar lang een jaarlijks mammogram ongeacht hun risico op een recidief. Binnen de NABOR-studie worden in gedeelde besluitvorming nacontroleplannen gepersonaliseerd met behulp van de Borstkanker Nacontrolekeuzehulp, waarbij het individuele risico op recidief wordt berekend met het gevalideerde INFLUENCE-voorspellingsmodel. Gepersonaliseerde nazorgplannen worden ondersteund door de Nazorgkeuzehulp. Het doel van de studie is het bepalen van de (kosten)effectiviteit van gepersonaliseerde nacontrole en nazorg op zorgen van terugkeer van kanker en kwaliteit van leven. Het design is een ‘multiple interrupted time series’, waarbij ziekenhuizen via een transitiefase overstappen op het gebruik van beide keuzehulpen. De studie beoogt in 10 ziekenhuizen 1.040 patiënten te includeren die twee jaar worden gevolgd. Met toestemming overgenomen van NED TIJDSCHR ONCOL 2025;22:138-42. Summary: After curative treatment for non-metastatic breast cancer, patients receive surveillance (detection of possible recurrence of breast cancer in the breast area) and aftercare (support for possible consequences of the disease and/or treatment). Until now, all patients received an annual mammogram for five years, regardless of their risk of recurrence. Within the NABOR study, surveillance plans are personalized in shared decision-making using Breast Cancer Surveillance decision aid, in which the individual risk of recurrence is calculated using the validated INFLUENCE prediction model. Personal aftercare plans are supported by the Breast Cancer Aftercare decision aid. The aim of the study is to determine the (cost-)effectiveness of personalized surveillance and aftercare on patient-reported concerns about cancer recurrence and quality of life. The design is a multiple interrupted time series, in which hospitals switch to using both decision aids via a transition phase. The study aims to include in 10 hospitals 1,040 patients who will be followed for two years.
DOCUMENT
Background: To facilitate adherence to adaptive pain management behaviors after interdisciplinary multimodal pain treatment, we developed a mobile health app (AGRIPPA app) that contains two behavior regulation strategies. Objective: The aims of this project are (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app users. Methods: We will perform a multicenter randomized controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the 6 participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months posttreatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and health care expenses. Results: The study was approved by the local Medical Research Ethics Committee in October 2019. As of March 20, 2020, we have recruited 88 patients. Conclusions: This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After 3 years of development and feasibility testing, this formal evaluation will help determine to what extent the app will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice.
LINK
Purpose/Objective: Most dose-escalation trials in glioblastoma patients integrate the escalated dose throughout the standard course by targeting a specific subvolume. We hypothesize that anatomical changes during irradiation may affect the dose coverage of this subvolume for both proton- and photon-based radiotherapy. Material and Methods: For 24 glioblastoma patients a photon- and proton-based dose escalation treatment plan (of 75 Gy/30 fr) was simulated on the dedicated radiotherapy planning MRI obtained before treatment. The escalated dose was planned to cover the resection cavity and/or contrast enhancing lesion on the T1w post-gadolinium MRI sequence. To analyze the effect of anatomical changes during treatment, we evaluated on an additional MRI that was obtained during treatment the changes of the dose distribution on this specific high dose region. Results: The median time between the planning MRI and additional MRI was 26 days (range 16–37 days). The median time between the planning MRI and start of radiotherapy was relatively short (7 days, range 3–11 days). In 3 patients (12.5%) changes were observed which resulted in a substantial deterioration of both the photon and proton treatment plans. All these patients underwent a subtotal resection, and a decrease in dose coverage of more than 5% and 10% was observed for the photon- and proton-based treatment plans, respectively. Conclusion: Our study showed that only for a limited number of patients anatomical changes during photon or proton based radiotherapy resulted in a potentially clinically relevant underdosage in the subvolume. Therefore, volume changes during treatment are unlikely to be responsible for the negative outcome of dose-escalation studies.
DOCUMENT
The background and purpose of this paper is to investigate adherence, exercise performance levels and associated factors in head and neck cancer (HNC) patients participating in a guided home-based prophylactic exercise program during and after treatment [swallowing sparing intensity modulated radiation therapy (SW-IMRT)]. Fifty patients were included in the study. Adherence was defined as the percentage of patients who kept up exercising; exercise performance level was categorized as low: ≤1, moderate: 1–2, and high: ≥2 time(s) per day, on average. Associations between 6- and 12-week exercise performance levels and age, gender, tumour site and stage, treatment, intervention format (online or booklet), number of coaching sessions, and baseline HNC symptoms (EORTC-QLQ-H&N35) were investigated. Adherence rate at 6 weeks was 70% and decreased to 38% at 12 weeks. In addition, exercise performance levels decreased over time (during 6 weeks: 34% moderate and 26% high; during 12 weeks: 28% moderate and 18% high). The addition of chemotherapy to SW-IMRT [(C)SW-IMRT] significantly deteriorated exercise performance level. Adherence to a guided home-based prophylactic exercise program was high during (C)SW-IMRT, but dropped afterwards. Exercise performance level was negatively affected by chemotherapy in combination with SW-IMRT.
DOCUMENT
Pupils with problem behaviours are challenging teachers as well as they are a challenge to teachers to find a way to teach them what curricula prescribe. Especially middle school teachers and those working in schools for special education are con-fronted with pupils with behavioural problems. There, teachers experience hard classes and find it difficult to fit classroom management with the pupils needs. In this paper we focus on two questions: is pullout an effective treatment to handle problem behaviour? do special classes have advantages for pupils who were pulled out or not? First we present a theoretical framework about pullout and we explicit our expectations. Then we describe the methods of our research in schools for special educa-tion during two months for students (N=759) when pulled out. We examined the reason of pulling out and the interactions during the process outside the classroom and the return. Because teachers noticed date and time of the removal, it was possible to use survival analysis to show the effects of the treatment. We found that pullout occurs under quite different circumstances, so the treatment integrity is a problem because deficiency of the intervention leads to repeated pullout. The data also showed that special classes for pupils who are pulled out seem to trigger and/or in-tensify the process itself. So, we conclude that these classes have a contra-productive effect.
DOCUMENT
