scholarly journals Improving care for victims: a study protocol of the evaluation of a centre for sexual and family violence

BMJ Open ◽  
2016 ◽  
Vol 6 (9) ◽  
pp. e011545 ◽  
Author(s):  
E Zijlstra ◽  
S LoFoWong ◽  
G Hutschemaekers ◽  
A Lagro-Janssen
Keyword(s):  
The Netherlands ◽  
Family Violence ◽  
Study Protocol ◽  
Medical Center ◽  
Implementation Process ◽  
Multidisciplinary Care ◽  
Patient Characteristics ◽  
Analysis Data ◽  
Group Discussions ◽  
Data Collection And Analysis

IntroductionWorldwide, sexual and family violence are highly prevalent problems. Victims of sexual and family violence often do not seek formal help in the acute phase. When they do seek help, they encounter a system of scattered care. For this reason, a centre for sexual and family violence was launched in Nijmegen, the Netherlands. The centre provides multidisciplinary care for victims of acute sexual and/or family violence. With the study described in this study protocol, we want to evaluate the implementation process and the reach of the Center for Sexual and Family Violence Nijmegen (CSFVN).Methods and analysisWe will conduct a mixed-methods study including quantitative and qualitative methods of data collection and analysis. Data about the implementation process will be obtained via semistructured interviews and focus group discussions. Content analysis will be done in software program Atlas.ti. Analysis of file data will be undertaken to assess the reach of the CSFVN (patient characteristics and characteristics of the care they received). The data will be analysed in SPSS.Ethics and disseminationThe Medical Ethics Committee of the Radboud University Nijmegen Medical Center approved the study protocol under file number 2012–1218. Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will present the results at relevant international, national and local conferences and meetings. We will send press releases to relevant media. We will share the results with the network of assault centres in the Netherlands.

scholarly journals Barriers and facilitators to the timely diagnosis of endometriosis in primary care in the Netherlands

2019 ◽  
Vol 37 (1) ◽  
pp. 131-136 ◽  
Author(s):  
Moniek van der Zanden ◽  
Doreth A M Teunissen ◽  
Inger W van der Woord ◽  
Didi D M Braat ◽  
Willianne L D M Nelen ◽  
...  
Keyword(s):  
The Netherlands ◽  
Interdisciplinary Collaboration ◽  
Diagnostic Delay ◽  
Signs And Symptoms ◽  
Daily Practice ◽  
Patient Characteristics ◽  
Barriers And Facilitators ◽  
Reproductive Age ◽  
Group Discussions ◽  
Timely Diagnosis

Abstract Background Endometriosis is an invalidating gynaecological condition in women of reproductive age, and a frequent cause of infertility. Unfortunately, the condition is characterized by a long interval between onset of symptoms and diagnosis. GPs in the Netherlands are educated to provide basic gynaecological care and serve as gatekeepers for specialist medical care. Therefore, it is of great importance that they recognize signs and symptoms possibly caused by endometriosis to initiate adequate actions. Objective The main objective of this study was to identify barriers and facilitators to the timely diagnosis of endometriosis from the GPs’ perspective. Methods Semi-structured focus group discussions with GPs were organized throughout the Netherlands. The participants were encouraged to brainstorm about their perspective on daily practice regarding endometriosis and suggestions for interventions to enable early diagnosis and treatment. Analysis was based on grounded theory methodology. Results Forty-three GPs participated in six focus groups. Analysis of the transcripts revealed relevant determinants of practice in four main themes: professionals’ experience and competence, patient characteristics, guideline factors and professional collaboration. A lack of knowledge and awareness appeared to result in a low priority for establishing the diagnosis of endometriosis, especially in young women. Infertility, patient engagement and a recent serious case or training facilitated referral. Conclusion Several factors in daily primary health care contribute to the diagnostic delay in endometriosis. Future interventions to reduce this delay may be aimed at increasing awareness by means of education, incorporating the subject into national clinical guidelines and improvements in interdisciplinary collaboration.

Multi-Disciplinary Skull Base Conference and its Effects on Patient Management

2021 ◽  
pp. 000348942110212
Author(s):  
Nathan Kemper ◽  
Scott B. Shapiro ◽  
Allie Mains ◽  
Noga Lipschitz ◽  
Joseph Breen ◽  
...  
Keyword(s):  
Skull Base ◽  
Medical Center ◽  
Academic Medical Center ◽  
Significant Proportion ◽  
Internal Auditory Canal ◽  
Patient Characteristics ◽  
Management Plan ◽  
Case Review ◽  
Retrospective Case ◽  
Lateral Skull Base

Objective: Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic. Methods: Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized. Results: A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered. Conclusions: For a significant proportion of patients with pathology of the lateral skull base, the management plan changed as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes.

scholarly journals Prediction of Behavioral T/C Levels in Cochlear Implant Patients Based Upon Analysis of Electrode Impedances

2021 ◽  
Author(s):  
A. Molisz ◽  
A. Zarowski ◽  
E. Cardinael ◽  
A. Vermeiren ◽  
T. Theunen ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Cochlear Implants ◽  
Objective Measure ◽  
Analysis Data ◽  
Case Review ◽  
Data Collection And Analysis ◽  
Compound Action Potentials ◽  
Subjective Threshold ◽  
Electrode Contact ◽  
Maximum Comfort

Abstract Background Fitting cochlear implants in babies and noncooperative patients is cumbersome and time consuming. Therefore, objective parameters have been sought in order to predict the subjective threshold (T) and maximum comfort (C) levels. Measurements of the electrically evoked compound action potentials (ECAPs) have been widely used for this purpose, yet the correlation between these objective measures and the subjective T/C levels is weak to moderate. Purpose This article aims (1) to evaluate correlations between the subjective parameters of the fitting maps such as thresholds (T level) and maximum comfort levels (C level), the impedance of the electrode contacts, and the ECAP thresholds, and (2) to compare the value of the electrode impedances and the ECAP measures for prediction of the T/C levels. Research Design Case review study in a quaternary otologic referral center. Study Sample Ninety-eight consecutive CI patients were enrolled. The average age of the patients was 49 years. All patients were users of the Nucleus 24RECA (Freedom, Contour Advance-of-Stylet electrode) cochlear implant. Data Collection and Analysis Data on impedance of the electrode contacts and the behavioral T/C levels at the first fitting session (2–5 weeks after surgery) and at the 5th fitting session (4–6 months after surgery) have been retrospectively collected in 98 consecutive CI patients. Additionally, the intraoperative impedance values and the ECAP thresholds (tNRT) have been recorded. Results Impedances of electrode contacts show significant strong negative correlations with the stabilized T/C levels at 4 to 6 months after implantation and are an important predictor for the behavioral T/C levels. They can explain R 2 = 28 to 41% of the variability of the behavioral T/C levels. In multiple regression analysis electrode contact impedances can explain twice as much of the variability of the stabilized T/C levels than the tNRT values. The electrode impedances together with the tNRT values are able to explain R 2 = 37 to 40% of the global variability of the T/C levels while the tNRT thresholds solely are able to explain only R 2 = 5 to 14% of the T/C levels variability. Conclusion Impedances of electrode contacts correlate strongly with the stabilized behavioral T/C levels and may be used as an objective measure for fitting of cochlear implants.

Update and external validation of a multivariable prediction model for tube feeding dependency for at least four weeks during chemoradiotherapy for head and neck cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6040-6040
Author(s):  
Anna C. H. Willemsen ◽  
Annemieke Kok ◽  
Laura W.J. Baijens ◽  
J. P. De Boer ◽  
Remco de Bree ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Radiation Dose ◽  
The Netherlands ◽  
Prediction Model ◽  
Head And Neck ◽  
Neck Cancer ◽  
Predictive Value ◽  
Medical Center ◽  
External Validation ◽  
Tube Feeding

6040 Background: Patients who receive chemoradiation or bioradiation (CRT/BRT) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) often experience high toxicity rates, which may interfere with oral intake, leading to (temporary) tube feeding (TF) dependency. International guidelines recommend gastrostomy insertion when the expected use of TF exceeds four weeks. In this study we aimed to update and externally validate a prediction model to identify patients in need for TF for at least four weeks, meeting the international criteria for prophylactic gastrostomy insertion. Methods: This retrospective multicenter cohort study was performed in four tertiary referral head and neck cancer centers in the Netherlands. The prediction model was developed using data from the University Medical Center Utrecht and the Netherlands Cancer Institute. The model was externally validated in patients from the Maastricht University Medical Center and Radboud University Medical Center. The primary endpoint was TF, initiated during or within 30 days after completion of CRT/BRT, and administered for at least four weeks. Potential predictors were retrieved from patient medical records and radiotherapy dose-volume parameters were calculated. Results: The developmental and validation cohort included 409 and 334 patients respectively. Multivariable analysis showed significant predictive value (p < 0.05) for adjusted diet at start of CRT/BRT, percentage weight change prior to treatment initiation, WHO performance status, tumor-site, nodal stage, mean radiation dose to the contralateral parotid gland, and mean radiation dose to the oral cavity. The area under the receiver operating characteristics curve for the updated model was 0.73 and after external validation 0.64. Positive and negative predictive value at 90% cut off were 80.0% and 48.2% respectively. Conclusions: This externally validated prediction model to estimate TF-dependency for at least four weeks in LAHNSCC patients performs well. This model, which will be presented, can be used in clinical practice to guide personalized decision making on prophylactic gastrostomy insertion.

scholarly journals P127: Paramedics perception of working in Nova Scotia’s collaborative emergency centres

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S121
Author(s):  
S. Whalen ◽  
J. Goldstein ◽  
R. Urquhart ◽  
A. Carter
Keyword(s):  
Health Care ◽  
Nova Scotia ◽  
Care Delivery ◽  
Analysis Data ◽  
Team Work ◽  
Healthcare Team ◽  
Telephone Interviews ◽  
Leadership Support ◽  
Data Collection And Analysis ◽  
Constant Comparative Analysis

Introduction: The Collaborative Emergency Centre (CEC) model of health care delivery was implemented in rural Nova Scotia in July 2011 without an identifiable, directly comparable precedent. It features interprofessional teams working under one roof with the goal of providing improved access to timely primary health care, and appropriate access to 24/7 emergency care. One important component of the CEC model is overnight staffing by a paramedic/registered nurse team consulting with an offsite physician via telephone. Our objective was to ascertain the attitudes, feelings and experiences of paramedics working within the CEC construct. Methods: We conducted a qualitative study, guided by the principles of grounded theory. Semi-structured telephone interviews were carried out by the principal investigator with paramedics with experience working in a CEC in the province of Nova Scotia. Interviews were recorded, transcribed and analyzed. Analysis involved an inductive and deductive grounded approach using constant comparative analysis. Data collection and analysis continued until thematic saturation was reached. Results: Fourteen paramedics participated in the study. The majority were male (n=10, 71%), with a mean age of 44 years (STD=8.8) and mean experience as a paramedic of 14 years (STD=9.7). Four major themes were identified from the data: 1) leadership support, encompassing support from Emergency Health Services and Government prior to and after implementation of the model, 2) team work and collaboration, including interprofessional relationships among members of the healthcare team, 3) value to patients and the communities, and 4) professional and personal benefits of working in CECs. Conclusion: Paramedics have found working in CECs to be both professionally and personally rewarding. They perceive the CEC model to be of great value to the patients and communities it serves. Key lessons that might help future expansion of the model in Nova Scotia and other jurisdictions across the country include the importance of building and strengthening relationships between paramedics and nurses, and the need for greater feedback and support from leadership.

Auditory Temporal Gap Detection in Children with and without Auditory Processing Disorder

2010 ◽  
Vol 21 (06) ◽  
pp. 404-408 ◽  
Author(s):  
Dennis P. Phillips ◽  
Michel Comeau ◽  
Jessica N. Andrus
Keyword(s):  
Auditory Processing ◽  
Silent Period ◽  
Analysis Data ◽  
Auditory Processing Disorder ◽  
Gap Detection ◽  
Temporal Acuity ◽  
Normal Children ◽  
Modified Method ◽  
Simple Event ◽  
Data Collection And Analysis

Background: Auditory gap detection is a measure of temporal acuity. The paradigm comes in two forms, distinguished by whether the sounds bounding the silent period are the same (within channel [WC]) or different (between channel [BC]). Purpose: The purpose of this study was to test normal children and children referred for auditory processing disorder (APD) assessment, with both gap detection paradigms. Research Design: Best gap durations (i.e., shortest reliably detected gaps) were measured in a two-interval, two-alternative forced-choice design embedded within a modified method of limits, for both WC and BC paradigms, with stimuli presented at 55 dB HL. Study Sample: Sixteen control children and 20 children referred for APD assessment participated in the study. Of the 20 referred children, 9 were diagnostically positive for APD (APD+), and 11 were negative (APD−). The mean age of children in all three groups was 10–11 yr. Data Collection and Analysis: Data collected were best gap durations for each paradigm, for each child. Group differences were assessed using Kruskal-Wallis analyses of variance. Results: WC best gap durations were very similar across the three participant groups. BC best gap durations varied significantly between listener groups, with the greatest difference being between controls and APD+ samples. Conclusions: BC best gap durations differed among the listener groups while WC ones did not. This suggests that the relative timing perceptual operations required by the BC task are more susceptible to the perceptual disturbances in APD than is the simple event detection required by the WC task.

scholarly journals The Lifelines COVID-19 Cohort: a questionnaire-based study to investigate COVID-19 infection and its health and societal impacts in a Dutch population-based cohort

2020 ◽  
Author(s):  
Kate Mc Intyre ◽  
Pauline Lanting ◽  
Patrick Deelen ◽  
Henry Wiersma ◽  
Judith M. Vonk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Informed Consent ◽  
The Netherlands ◽  
Disease Susceptibility ◽  
Medical Center ◽  
Dutch Population ◽  
Physical And Mental Health ◽  
Weekly Basis ◽  
Wide Range ◽  
Societal Impacts

AbstractThe COVID-19 pandemic has affected billions of people around the world not only through the infection itself but also through its wider impact on public health and daily life. To assess the effects of the pandemic, a team of researchers across a wide range of disciplines developed and implemented the Lifelines COVID-19 questionnaire, leading to the development of the Lifelines COVID-19 cohort. This cohort is recruited from participants of the Lifelines prospective population cohort and the Lifelines NEXT birth cohort, and participants were asked to fill out detailed questionnaires about their physical and mental health and experiences on a weekly basis starting in late March of 2020 and on a bi-weekly basis staring in June 2020. The Lifelines region covers the three Northern provinces of the Netherlands— Drenthe, Groningen and Friesland—which together account for ∼10% of the Dutch population. To date, >70,000 people have responded to the questionnaires at least once, and the questionnaire program is still ongoing. Data collected by the questionnaires will be used to address four aspects of the outbreak: (1) how the COVID-19 pandemic developed in the three northern provinces of the Netherlands, (2) which environmental risk factors predict disease susceptibility and severity, (3) which genetic risk factors predict disease susceptibility and severity and (4) what are the psychological and societal impacts of the crisis.Informed consentAll Lifelines and Lifelines NEXT participants have provided informed consent that provide the opportunity for add-on research.Research involving human participantsBoth the Lifelines and the Lifelines NEXT studies were approved by the ethics committee of the University Medical Center Groningen.

scholarly journals Acceptability of physician associate interns in primary care: results from a service evaluation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Elizabeth Cottrell ◽  
Victoria Silverwood ◽  
Alex Strivens-Joyce ◽  
Lucy Minshull ◽  
John J. Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
Analysis Data ◽  
Service Evaluation ◽  
Full Potential ◽  
Patient Acceptability ◽  
Practice Characteristics ◽  
Primary Care Workforce ◽  
Data Collection And Analysis ◽  
Or Practice ◽  
Five Practices

Abstract Background Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner (GP) recruitment and retention crisis. However, they are novel to the primary care workforce and have limitations, for example, they cannot prescribe. The novel 1 year Staffordshire PA Internship (SPAI) scheme, introduced in 2017, was established to support the integration of PAs into primary care. PA interns concurrently worked in primary and secondary care posts, with protected weekly primary care focussed education sessions. This evaluation established the acceptability of PA interns within primary care. Methods All ten PAs from the first two SPAI cohorts, the nine host practices (supervising GPs and practice managers) and host practice patients were invited to participate in the evaluation. A conceptual framework for implementing interventions in primary care informed data collection and analysis. Data were gathered at three time points over the internship from practices, through discussions with the supervising GP and/or practice manager, and from the PAs via discussion groups. To enrich discussion data, PA and practices were sent brief surveys requesting information on PA/practice characteristics and PA primary care roles. Patient acceptability data were collected by the host practices. Participation at every stage was optional. Results By evaluation end, eight PAs had completed the internship. Seven PAs and six practices provided data at every time point. Five practices provided patient acceptability data. Overall PA interns were acceptable to practices and patients, however ambiguity about the PA role and how best to communicate and operationalise PA roles was revealed. An expectation-preparedness gap resulted in PAs needing high levels of supervision early within the internship. SPAI facilitated closure of the expectation-preparedness gap and its funding arrangements made the high supervision requirements more acceptable to practices. Conclusions The test-of-concept SPAI successfully integrated new PAs into primary care. However, the identified challenges risk undermining PAs roles in primary care before they have attained their full potential. Nationally, workforce leaders should develop approaches to support new PAs into primary care, including commitments to longer-term, sustainable, cohesive and appropriately funded schemes, including structured and standardised education and supervision.

scholarly journals Proceedings of the International Forensic Radiology Research Summit May 10–11, 2016, Amsterdam, The Netherlands

2017 ◽  
Author(s):  
Nicole S. Jones ◽  
Jeri D. Ropero-Miller ◽  
Heather Waltke ◽  
Danielle McLeod-Henning ◽  
Danielle Weiss ◽  
...  
Keyword(s):  
The Netherlands ◽  
International Association ◽  
Medical Center ◽  
Academic Medical Center ◽  
Forensic Radiology ◽  
Professional Staff ◽  
Road Map ◽  
National Institute Of Justice ◽  
Operational Information ◽  
Radiology Research

On May 10–11, 2016, the US Department of Justice (DOJ) National Institute of Justice (NIJ), the Netherlands Forensic Institute (NFI; Dutch Ministry of Security and Justice of the Netherlands), the International Society for Forensic Radiology and Imaging (ISFRI), the International Association of Forensic Radiographers (IAFR), and NIJ’s Forensic Technology Center of Excellence (FTCoE) at RTI International organized and convened the International Forensic Radiology Research Summit (IFRRS) at the Academic Medical Center in Amsterdam. The summit assembled 40 international subject matter experts in forensic radiology, to include researchers, practitioners, government employees, and professional staff from 14 countries. The goal of this 2-day summit was to identify gaps, challenges, and research needs to produce a road map to success regarding the state of forensic radiology, including formulating a plan to address the obstacles to implementation of advanced imaging technologies in medicolegal investigations. These proceedings summarize the meeting’s important exchange of technical and operational information, ideas, and solutions for the community and other stakeholders of forensic radiology.

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