's-Hertogenbosch, Netherlands
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Prins J.B.,Medical Psychology | Uitterhoeve R.,Radboud University Nijmegen | Merkx M.A.W.,Oral and Maxillofacial Surgery | Achterberg T.V.,IQ Healthcare
Cancer Nursing | Year: 2014

Adequate provider-patient communication is viewed as an important aspect of good quality (cancer) care, supports patients' stress control, and can positively influence health outcomes. OBJECTIVE:: The objective of this study was to describe nurse-patient communication in 2 consecutive follow-up consultations after head and neck cancer, with or without a partner present. METHODS:: This was a descriptive observational study of 17 video-recorded, coded, and analyzed consultations of 10 head and neck cancer patients and 6 partners. RESULTS:: Nurses adequately responded to about 25% of patients' and partners' emotional cues. In almost 75%, nurses responded to cues using distancing behaviors. The majority of informational questions of both patients and partners were adequately answered. Comparison of consecutive visits showed small differences for patients' and partners' cue-emission and for nurses' responsive behaviors between visits 1 and 2. CONCLUSION:: Nurses adequately responded to informational questions from patients and partners. However, they seemed to be less observant of and able to address emotional cues. Communication on nurse-patient-partner interaction deserves further research in a much larger sample and over a longer time period. IMPLICATION FOR PRACTICE:: Nurses' awareness of the importance of adequate cue responding is vital, as is the choice to "unlearn" the predominant distancing behaviors. The needs and the role of the patients' partner in consultations and managing consultations require further attention in training and professional practice.Copyright © 2014 Wolters Kluwer Health Lippincott Williams & Wilkins.


Scholte M.,Radboud University Nijmegen | Scholte M.,IQ Healthcare | Neeleman-Van Der Steen C.W.M.,Caransscoop | Hendriks E.J.M.,Maastricht University | And 4 more authors.
International Journal for Quality in Health Care | Year: 2014

Objective: To evaluate measurement properties of a set of public quality indicators on physical therapy. Design. An observational study with web-based collected survey data (2009 and 2010). Setting: Dutch primary care physical therapy practices. Participants. In 3743 physical therapy practices, 11 274 physical therapists reporting on 30 patients each. Main Outcome Measure(s). Eight quality indicators were constructed: screening and diagnostics (n = 2), setting target aim and subsequent of intervention (n = 2), administrating results (n = 1), global outcome measures (n = 2) and patient's treatment agreement (n = 1). Measurement properties on content and construct validity, reproducibility, floor and ceiling effects and interpretability of the indicators were assessed using comparative statistics and multilevel modeling. Results. Content validity was acceptable. Construct validity (using known group techniques) of two outcome indicators was acceptable; hypotheses on age, gender and chronic vs. acute care were confirmed. For the whole set of indicators reproducibility was approximated by correlation of 2009 and 2010 data and rated moderately positive (Spearman's ? between 0.3 and 0.42 at practice level) and interpretability as acceptable, as distinguishing between patient groups was possible. Ceiling effects were assessed negative as they were high to extremely high (30% for outcome indicator 6-95% for administrating results). Conclusion. Weaknesses in data collection should be dealt with to reduce bias and to reduce ceiling effects by randomly extracting data from electronic medical records. More specificity of the indicators seems to be needed, and can be reached by focusing on most prevalent conditions, thus increasing usability of the indicators to improve quality of care. © The Author 2014.


van der Vorm A.,IQ Healthcare | van der Laan A.L.,IQ Healthcare | Borm G.,Biostatistics and Health Technology Assessment | Vernooij-Dassen M.,Healthcare Alzheimer Center Nijmegen | And 3 more authors.
Clinical Genetics | Year: 2010

Most publications on the ethical aspects of genetic research into Alzheimer's Disease (AD) concentrate on the differences between the opinions of professionals and non-professionals. Differences in rating of morally relevant issues between groups of professionals have not yet been described. A modified Delphi study in two rounds was held to identify differences between groups of experts (i.e. clinicians, representatives of patient organisations, ethicists and persons with a commercial background). The strongest correlation was found between the opinions of ethicists and representatives of patient organisations (0.67) and between clinicians and ethicists (0.62). Moderate correlation (0.55) was found between the opinions of clinicians and representatives of patient organisations. Persons with a commercial background showed a weak correlation with clinicians (0.41), ethicists (0.35) and representatives of patient organisations (0.30). These differences in rating of morally relevant issues between various professional groups are relevant for clinical practice and dementia care, particularly the different rating of prenatal diagnosis found between clinicians and representatives of patient organisations. Interdisciplinary consultations between various professional groups -including at least researchers, clinicians and ethicists -are recommended to guarantee that all considerations will be incorporated into the debate on ethical issues of genetic research into AD. © 2009 John Wiley & Sons A/S.


Tacken M.A.J.B.,Radboud University Nijmegen | Jansen B.,Radboud University Nijmegen | Jansen B.,IQ healthcare | Mulder J.,Radboud University Nijmegen | And 7 more authors.
Vaccine | Year: 2013

Background: In 2009 the pandemic influenza virus A(H1N1)pdm09 emerged with guidance that people at risk should be vaccinated. It is unclear how this event affected the underlying seasonal vaccination rate in subsequent years. Purpose: To investigate the association of pandemic influenza A(H1N1)pdm09 and seasonal flu vaccination status in 2009 with vaccination rates in 2010 and 2011. Methods: Data were collected in 40 Dutch family practices on patients at risk for influenza during 2009-2011; data analysis was conducted in 2012. Results: A multilevel logistic regression model (. n=. 41,843 patients) adjusted for practice and patient characteristics (age and gender, as well as those patient groups at risk), showed that people who were vaccinated against A(H1N1)pdm09 in 2009 were more likely to have been vaccinated in 2010 (OR 6.02; 95%CI 5.62-6.45, p<. .0001). This likelihood was even more for people who were vaccinated against seasonal flu in 2009 (OR 13.83; 95%CI 12.93-14.78, p<. .0001). A second analysis on the uptake rate in 2011 (. n=. 39,468 patients) showed that the influence of the vaccination state in 2009 declined after two years, but the diminishing effect was smaller for people vaccinated against A(H1N1)pdm09 than for seasonal flu (OR 5.50; 95%CI 5.13-5.90, p<. .0001; OR 10.98; 95%CI 10.26-11.75, p<. .0001, respectively). Conclusion: Being vaccinated against A(H1N1)pdm09 and seasonal influenza in the pandemic year 2009 enhanced the probability of vaccination in the next year and this was still effective in 2011. This suggests that peoples' vaccination routines were not changed by the rumor around the outbreak of A(H1N1)pdm09, but rather confirmed underlying behavior. © 2012 Elsevier Ltd.


Eppenga W.L.,IQ healthcare | Eppenga W.L.,Radboud University Nijmegen | Derijks H.J.,IQ healthcare | Derijks H.J.,University Utrecht | And 4 more authors.
Journal of the American Medical Informatics Association | Year: 2012

Objective: To compare the clinical relevance of medication alerts in a basic and in an advanced clinical decision support system (CDSS). Design: A prospective observational study. Materials and methods: We collected 4023 medication orders in a hospital for independent evaluation in two pharmacotherapy-related decision support systems. Only the more advanced system considered patient characteristics and laboratory test results in its algorithms. Two pharmacists assessed the clinical relevance of the medication alerts produced. The alert was considered relevant if the pharmacist would undertake action (eg, contact the physician or the nurse). The primary analysis concerned the positive predictive value (PPV) for clinically relevant medication alerts in both systems. Results: The PPV was significantly higher in the advanced system (5.8% vs 17.0%; p<0.05). Significant differences were found in the alert categories: druge (drug) interaction (9.9% vs 14.8%; p<0.05), drugeage interaction (2.9% vs 73.3%; p<0.05), and dosing guidance (5.6% vs 16.9%; p<0.05). Including laboratory values and other patient characteristics resulted in a significantly higher PPV for the advanced CDSS compared to the basic medication alerts (12.2% vs 23.3%; p<0.05). Conclusion: The advanced CDSS produced a higher proportion of clinically relevant medication alerts, but the number of irrelevant alerts remained high. To improve the PPV of the advanced CDSS, the algorithms should be optimized by identifying additional risk modifiers and more data should be made electronically available to improve the performance of the algorithms. Our study illustrates and corroborates the need for cyclic testing of technical improvements in information technology in circumstances representative of daily clinical practice.


Bartels R.H.M.A.,Radboud University Nijmegen | Boogaarts H.,Radboud University Nijmegen | Westert G.,IQ Healthcare
Acta Neurochirurgica | Year: 2013

Background: Regularly, patients are not involved in development of evaluative tools. Investigators define outcomes according to their interests. These can be different with those of the patients. Therefore, it may be difficult for patients to choose between treatment options, because the outcomes' measurements may not reflect their problems in daily life. Most ideally, patients are involved from the beginning in the development of an outcome measurement tool. In this study, a new concept was demonstrated in which a questionnaire was developed in collaboration with patients to evaluate the quality of surgical care of a frequently encountered entity (carpal tunnel syndrome) that is meaningful for and understandable by patients. Methods: Through a patient participatory research in an academic hospital, 50 consecutive patients who recently underwent surgical decompression of carpal tunnel syndrome were asked to optimize a questionnaire. An existing questionnaire was sent to the patients with the request to grade the relevance of each question. They were also offered the possibility to add questions from their point of view. Results: All questions were found relevant. Finally, the questionnaire was modified by adding one question proposed by the patients. They wanted to include a question that would evaluate the effect of the treatment. Therefore, a question was introduced to evaluate the effect of the surgery on the symptoms and signs with a six-item Likert scale varying from severely worsened to free of signs and symptoms. Finally, the EQ-5D-5 L was added as a measure of quality of life. Conclusions: The participation of patients is essential but until now not usual when a tool for evaluating the success of a treatment is developed. Information that is meaningful for patients but not obligate for researchers can easily be missed in the classical development of outcome measurement tools. This information will be crucial when future patients try to understand the findings of research in order to make an appropriate decision between eventual treatment options. © 2013 Springer-Verlag Wien.


Van Doorn A.,IQ Healthcare | Kirschner K.,IQ Healthcare | Bouma M.,Nederlands Huisartsen Genootschap | Burgers J.,IQ Healthcare | And 2 more authors.
Huisarts en Wetenschap | Year: 2010

Aim: To describe four reliability and validity issues regarding the clinical indicators from the Visitation Instrument Accreditation (VIA). Based on this information practices needed to start improvement projects in order to get accreditation. Method: An observational study based on the medical records of 82 practices. Results: The indicators that covered chronic disease management (diabetes, COPD, asthma and cardiovascular risk management), prevention activities (influenza vaccination, cervical cancer screening) and antibiotics policy were correlated weakly, suggesting that the instrument provided a rather broad scope of the practice when it comes to chronic disease management and prevention. Furthermore, the different topics were each measured by indicators that had a sufficient coherence, which suggested that they measured a clear underlying concept. To achieve a reliable indicator score, data from at least 96 patients were necessary when 10% error is allowed. VIA allows to take a sample of 40 patients, but in that case the error margin increases to 15%. To establish a reliable benchmark we needed 233 practices when 5% error is allowed. Conclusion: The clinical indicators from VIA are reliable and valid and can be used by a general practice to gain insight into their own performance compared to others. For practice policy on quality improvement an error margin of 10-15% around the indicator score on practice level seems to be acceptable. In case of accountability or a pay-for-performance program we would be more comfortable with a smaller error margin. A sample of 40 patients wouldn't do. However, it is again and again a search to find the balance between feasibility and justice.


De Vries M.C.,Leiden University | Houtlosser M.,Leiden University | Wit J.M.,Leiden University | Engberts D.P.,Leiden University | And 3 more authors.
BMC Medical Ethics | Year: 2011

Background: Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. Methodology. An empirical ethical approach, combining (1) a narrative review of (primarily) qualitative studies on parents' and physicians' experiences of the pediatric oncology research practice, and (2) comparison of these experiences with existing theoretical ethical concepts about (pediatric) research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Results: Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist). True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the existence of a therapeutic misconception between them and parents. Conclusion: Due to the integration of research and care, their different ethical perspectives become intertwined in the daily practice of pediatric oncology. Increasing awareness of what this means for the communication between parents and physicians is essential. Future research should focus on efforts that overcome the problems that the synchronicity of research and care evokes. © 2011 de Vries et al; licensee BioMed Central Ltd.


Braspenning J.,IQ Healthcare | Van Doorn-Klomberg A.,IQ Healthcare | Bouma M.,IQ Healthcare | Westert G.,IQ Healthcare
Huisarts en Wetenschap | Year: 2012

Braspenning JCC, Van Doorn-Klomberg AL, Bouma M, Westert GP. General practice working hours. Huisarts Wet 2012;55(12):542-7. Background: Little is known about how many hours general practice staff work a week and how many hours are spent on hands-on patient care. Aim: To determine how many hours general practice staff work a week. Methods: Secondary analysis of data collected with the NHG Praktijkaccreditering® (NPA) surveys carried out in 2009-2011 (867 practices) and 2007-2008 (890 practices), and of data retrieved from patient records from 53-123 practices of the Netherlands general practice information network LINH in 2006-2010. Results: The NPA data for 2009-2011 showed that the average practice worked a mean of 52.0 hours per 1000 patients per week (n=328 practices), with the hours being worked in a 4:3:1 ratio by general practitioners, practice nurses, and practice assistants, respectively. GPs spent a mean of 14.9 hours per 1000 patients per week on direct, hands-on patient care in 2007-2008, which is about two-thirds of the total number of hours GPs worked a week (NPA 2007-2008, n=714 GPs). In 2010 GPs spent 16.4 hours on hands-on patient care, an increase of 10.1%. In 2010, GPs and practice assistants together spent an estimated 20.1 hours per 1000 patients per week on direct, hands-on patient care. On the basis of LINH data, the estimated number of contact hours in 2010 was 16.1 hours per 1000 patients per week. Conclusion: While estimation of general practice working hours is fraught with uncertainty, it would seem that general practitioners, practice nurses, and practice assistants together work 112.1 hours per week for an average practice of 2350 patients, excluding out-of-hours services. GPs and practice assistants spend about two-thirds of their working hours on direct, hands-on patient care. © 2012 Bohn, Stafleu van Loghum. Literatuur:.


PubMed | IQ Healthcare
Type: Journal Article | Journal: European journal of preventive cardiology | Year: 2014

To prevent cardiovascular complications, sometimes double and triple therapy with a vitamin K antagonist (VKA), clopidogrel and/or acetylsalicylic acid (ASA) are indicated. These combinations increase the patients risk of serious bleeding events. Therefore, adherence to clinical guidelines is of the utmost importance when these high-risk therapies are prescribed.We performed a retrospective cohort study of 238 cases in a community pharmacy that were treated with a combination of VKA, clopidogrel and/or ASA between January 2006 and December 2009. Hospital records and community pharmacy records were used to obtain the indication(s), the duration of combination therapy, the presence of risk-increasing and risk-decreasing co-medications and any relevant co-morbidities. The cardiologists attitudes towards the prescribing of antithrombotic combinations and their self-reported adherence to guidelines were assessed by a brief questionnaire.We found there was no guideline-based indication for 22 of the 146 cases (14%) on ASA plus clopidogrel and 19 of the 82 cases (23%) on VKA plus ASA. Of the 238 cases given antithrombotic combination therapies, 77 (32%) were placed at an additional increased risk of serious gastrointestinal events, yet 43 (56%) of these did not receive adequate gastric protection. Out of the 19 of 60 cardiologists (32%) who responded to our questionnaire; 17 (90%) and 13 (68%) stated that a strict indication is very important when initiating therapy with ASA plus clopidogrel or ASA plus VKA, respectively.There is room to further develop adherence to guideline-based prescribing of antithrombotic combination therapies and to improve prescription of gastric protection for patients receiving these high-risk combinations.

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