A nationwide survey on the perceptions of general surgeons on artificial intelligence

Aim: Artificial intelligence (AI) has the potential to improve perioperative diagnosis and decision making. Despite promising study results, the majority of AI platforms in surgery currently remain in the research setting. Understanding the current knowledge and general attitude of surgeons toward AI applications in their surgical practice is essential and can contribute to the future development and uptake of AI in surgery. Methods: In March 2021, a web-based survey was conducted among members of the Dutch Association of Surgery. The survey measured opinions on the existing knowledge, expectations, and concerns on AI among surgical residents and surgeons. Results: A total of 313 respondents completed the survey. Overall, 85% of the respondents agreed that AI could be of value in the surgical field and 61% expected AI to improve their diagnostic ability. The outpatient clinic (35.8%) and operating room (39.6%) were stated as area of interest for the use of AI. Statistically, surgeons working in an academic hospital were more likely to be aware of the possibilities of AI (P = 0.01). The surgeons in this survey were not worried about job replacement, however they raised the greatest concerns on accountability issues (50.5%), loss of autonomy (46.6%), and risk of bias (43.5%). Conclusion: This survey demonstrates that the majority of the surgeons show a positive and open attitude towards AI. Although various ethical issues and concerns arise, the expectations regarding the implementation of future surgical AI applications are high.

A sector-wide response to national policy on client-centred care and support: a document analysis of the development of a range of instruments to assess clients’ experiences in the care and support for people with (intellectual) disabilities

Background Client-centred care serves as the foundation for healthcare policy. Indeed, various instruments for assessing clients’ experiences of care and support are increasingly used to provide insights into the quality, and client-centred nature, of the care and support provided, which, in turn, aids the development of subsequent improvements. The unique characteristics of care and support for people with intellectual disabilities (ID), such as the need for both lifelong and life-wide care and support across all aspects of clients’ lives, led to an initiative within Dutch ID care to jointly develop a range of instruments to assess the experiences of clients receiving ID care and support. Individual clients’ experiences and suggestions for improvement, which are embedded in clients’ care plan cycles, constitute the foundation of this Range of Instruments. This paper provides a unique, bottom-up, exhaustive account of the process of developing the Range of instruments used to assess the experiences of clients in the field of Dutch ID care. Methods Relevant documents at three levels (i.e. 1) national documents, such as policy papers and governmental reports, 2) documents and reports from the Dutch Association of Healthcare Providers for People with Disabilities (VGN) along with minutes from the meetings of the expert Committee who assessed the instruments, and 3) correspondence between the Committee and developers as well as the forms used in the assessment process for each instrument) were qualitatively analysed by two researchers who had no affiliation with the development of the Range of instruments used to assess clients’ experiences in ID care and support. All of the documents were inductively coded using a thematic analytical approach. Informants who were either currently or previously involved in the development of these instruments were asked to provide clarification over the documents themselves and to explain the context in which they were produced. Results The development of the range of instruments can be classified into four phases, namely: 1) supporting the bottom-up development of initiatives to assess clients’ experiences, 2) focusing on learning and further development, 3) stimulating exchange between the developers and users of the instruments and the Committee responsible for assessing them, and 4) further development in response to the changing times and new landscape. Conclusions The range of instruments were found to be appropriate for a variety of clients in ID care and support, specifically in terms of assessing their individual experiences and gaining insight into their suggestions for improvement, and effective in terms of collaboratively improving the quality of ID care and support. In so doing, these instruments potentially provide an avenue through which clients’ experiences can be embedded in the process of ID care and support. Other specific features in the development of these instruments, namely their incremental adoption, ongoing evaluation and strong practice orientation, were also found to be suitable for other care contexts’ attempts to respond to the top-down policy objectives of client-centeredness and translating outcomes into direct care practice.

Using a Co-design Approach to Create Tools to Facilitate Physical Activity in Children With Physical Disabilities

Introduction: There is a lack of effective interventions available for Pediatric Physical Therapists (PPTs) to promote a physically active lifestyle in children with physical disabilities. Participatory design methods (co-design) may be helpful in generating insights and developing intervention prototypes for facilitating a physically active lifestyle in children with physical disabilities (6–12 years).Materials and methods: A multidisciplinary development team of designers, developers, and researchers engaged in a co-design process–together with parents, PPTs, and other relevant stakeholders (such as the Dutch Association of PPTs and care sports connectors). In this design process, the team developed prototypes for interventions during three co-creation sessions, four one-week design sprint, living-lab testing and two triangulation sessions. All available co-design data was structured and analyzed by three researchers independently resulting in themes for facilitating physical activity.Results: The data rendered two specific outcomes, (1) knowledge cards containing the insights collected during the co-design process, and (2) eleven intervention prototypes. Based on the generated insights, the following factors seem important when facilitating a physically active lifestyle: a) stimulating self-efficacy; b) stimulating autonomy; c) focusing on possibilities; d) focusing on the needs of the individual child; e) collaborating with stakeholders; f) connecting with a child's environment; and g) meaningful goal setting.Conclusion: This study shows how a co-design process can be successfully applied to generate insights and develop interventions in pediatric rehabilitation. The designed prototypes facilitate the incorporation of behavioral change techniques into pediatric rehabilitation and offer new opportunities to facilitate a physically active lifestyle in children with physical disabilities by PPTs. While promising, further studies should examine the feasibility and effectivity of these prototypes.

Development of the Dutch Structure for Integrated Children’s Palliative Care

Children’s palliative care (CPC) is gaining attention worldwide, facilitated by the exchange of knowledge during regular specialised congresses. This article describes the developments in the Netherlands over the past 15 years. The Foundation for Children’s Palliative Expertise (PAL) was established as a nationwide initiative committed to improving palliative care for children countrywide. This led to the development of the first hospital-based CPC team in 2012, which expanded to a total of seven teams adjacent to children’s university hospitals. Regional networks for CPC were developed in parallel to these teams from 2014 onwards. The networks are a collaboration of professionals from different disciplines and organisations, from hospital to homecare, and have covered the aspects of CPC nationally from 2019 onwards. They are connected through the Dutch Knowledge Centre for CPC. This centre was established in 2018 by the PAL Foundation in collaboration with the Dutch Association for Pediatrics. In 2013, the first evidence-based guideline, ‘palliative care for children’, provided access to knowledge for parents and healthcare providers, and in 2017, a format for an individual palliative care plan was established. Within the Knowledge Centre for CPC, a physician’s support centre for dilemma’s regarding the end of life of children was set up. The efforts to have children’s palliative care embedded in the regular Dutch health care insurance are ongoing.

Comparison of the CO-RADS and the RSNA chest CT classification system concerning sensitivity and reliability for the diagnosis of COVID-19 pneumonia

Background The Radiological Society of North America (RSNA) recently published a chest CT classification system and Dutch Association for Radiology has announced Coronavirus disease 2019 (COVID-19) reporting and data system (CO-RADS) to provide guidelines to radiologists who interpret chest CT images of patients with suspected COVID-19 pneumonia. This study aimed to compare CO-RADS and RSNA classification with respect to their sensitivity and reliability for diagnosis of COVID-19 pneumonia. Results A retrospective study assessed consecutive CT chest imaging of 359 COVID-19-positive patients. Three experienced radiologists who were aware of the final diagnosis of all patients, independently categorized each patient according to CO-RADS and RSNA classification. RT-PCR test performed within one week of chest CT scan was used as a reference standard for calculating sensitivity of each system. Kappa statistics and intraclass correlation coefficient were used to assess reliability of each system. The study group included 359 patients (180 men, 179 women; mean age, 45 ± 16.9 years). Considering combination of CO-RADS 3, 4 and 5 and combination of typical and indeterminate RSNA categories as positive predictors for COVID-19 diagnosis, the overall sensitivity was the same for both classification systems (72.7%). Applying both systems in moderate and severe/critically ill patients resulted in a significant increase in sensitivity (94.7% and 97.8%, respectively). The overall inter-reviewer agreement was excellent for CO-RADS (κ = 0.801), and good for RSNA classification (κ = 0.781). Conclusion CO-RADS and RSNA chest CT classification systems are comparable in diagnosis of COVID-19 pneumonia with similar sensitivity and reliability.

Analysing group contract design using a threshold public goods experiment

This paper presents the results of a threshold public goods game experiment with heterogeneous players. The experiment is designed in close collaboration with the Dutch association of agri-environmental farmer collectives. Subjects are recruited at a university (study 1) and a farm management training centre (study 2), the subjects of the second study most resembling the subjects in the field. The experiment consists of several treatments and each treatment has two different distribution rules, which are varied in a within-subjects manner. After subjects have experienced both, they can vote for one of the two rules: either a differentiated bonus that results in equal payoff for all, or an undifferentiated, equal share of the group bonus. In a between-subjects manner, subjects can vote for a (minimum or average) threshold or are faced with an exogenous threshold. The results indicate that exogenous thresholds perform better, possibly because the focal point they provide facilitates coordination. With regard to the two distribution rules, the results are mixed: in study 1, average contributions and payoffs are higher under the ‘equal-payoff’ rule, but there is no significant difference between the two in study 2. Overall, our results suggest that environmental payment schemes should consider cost heterogeneity in the design of group contracts, and pay explicit attention to coordination problems too.

Antibiotic prophylaxis prescribing habits in oral implant surgery in the Netherlands: a cross-sectional survey

Background There seems to be no consensus on the prescription of prophylactic antibiotics in oral implant surgery. The Dutch Association of Oral Implantology (NVOI) guidelines do not include a clear policy on prophylactic antibiotic prescriptions for oral implant surgery among healthy patients. The purpose of the study was to determine whether antibiotic prophylaxis is commonly prescribed in the Netherlands by general dentists, maxillofacial surgeons and oral implantologists in conjunction with oral implant surgery among healthy patients and to assess the type and amount of prophylactic antibiotic prescribed. Methods This observational cross-sectional study is based on a web survey. A questionnaire developed in the United States of America was translated and slightly adjusted for use in the Netherlands. It contained predominantly close-ended questions relating to demographics, qualifications, antibiotic type, prescription duration and dosage. An email including an introduction to the study and an individual link to the questionnaire was sent in February 2018 to a sample of 600 general dental practitioners and all 302 specialized dentists (oral implantologists, periodontists and maxillofacial surgeons) recognized by the NVOI. Overall, 902 questionnaires were anonymously sent. Finally, 874 potential participants were reached. Collected data were analyzed through descriptive statistics. Results In total, 218 (24.9%) participants responded to the questionnaire, including 45 females (20.8%) and 171 males (79.2%). Overall, 151 (69.9%) regularly placed oral implants. Of them, 79 (52.7%) prescribe antibiotics only in specific situations, 66 (43.7%) regularly, and 5 (3.3%) did not prescribe antibiotics at all. Overall, 83 participants who prescribe antibiotics did so both pre- and postoperatively (57.2%), 47 only preoperatively (32.4%) and 12 exclusively postoperatively (8.3%). A single dose of 2000 mg of amoxicillin orally one hour prior to surgery was the most prescribed preoperative regimen. The most frequently prescribed postoperative regimen was 500 mg of amoxicillin three times daily for five days after surgery. On average, participants prescribe a total of 7018 mg of antibiotics before, during or after oral implant surgery. Conclusions Antibiotic prophylaxis in conjunction with oral implant surgery is prescribed in the Netherlands on a large scale, and recommendations based on the last published evidence are frequently not followed.

Positive health as a new concept for physiotherapy in the Netherlands?

Background The current WHO definition of health seems to no longer meet the changes in the current Dutch health system. An alternative approach which puts emphasis on health, not disease, is Positive Health. This focus shifts the emphasis on improving resilience and well-being rather than the perspective on what is lacking in health. In 2014, this new definition of Positive health was included in the professional profile ’physiotherapist’ of the Royal Dutch Association for Physiotherapy. This study examines the attitude of physiotherapists to Positive Health and to what extent they experience this concept in their current working practice. Methods A mixed method study was used, with a quantitative and qualitative method. A survey was completed by 276 physiotherapists and 7 semi-structured interviews were conducted among physiotherapists. Results Positive health was considered positive by 68% of the physiotherapists that health is seen as a dynamic concept rather than static, and 60.5% consider it important that the emphasis is on self-regulation. However, physiotherapists wonder if all patients have the ability to self-manage skills. The qualitative analysis shows that all therapists find the new definition positive and that it covers all aspects of health. Conclusions In general, physiotherapists are positive about the definition of positive health. Positive health can help physiotherapists in their work with clients and other professionals because of the multidisciplinary approach. Key messages Positive health can help physiotherapists to promote health in their clients. Positive health can stimulate cooperation between physiotherapists and client to increase self-management.

Optimum control of TB in the EU by addressing migrant health effectively in an interconnected world

Worldwide, tuberculosis is one of the top 10 causes of death. Although most EU/EEA countries are low-incidence, TB remains a public health issue. In this region, TB predominantly affects vulnerable populations, including migrants (ECDC/WHO, 2019). Since migration has been increasing over the last several decades, the health needs are considerable and merit great attention for several reasons. First, migrants have a right to health. Second, health promotion and disease prevention among migrants contributes to overall public health. Last, healthy migrants contribute to positive development outcomes (WHO, 2016) (IOM, 2017). In order to meet the health needs of migrants, prevention is an important step. Part of preventive care is detecting illness at an early stage (for example by screening), so that treatment can be introduced when it works best (WHO Europe, 2018). However, screening of a population is only beneficial if a positive result leads to effective actions independent of geographic location (Jackson, 2017). So, how does one facilitate a fluid care pathway for TB-elimination? In the Netherlands, the Community Health Services (GGDs) carry out TB-control non-geographically. All 25 GGDs use iTBC, a nationwide, integrated platform that supports and connects all TB processes, independent of place and time. The appropriate TB screening pathway is selected, based on prevalence in country of birth, for all migrants resulting in optimized screening, treatment and control. In a PPP between Topicus, the Dutch Association of GGDs (GGD GHOR Nederland) and the Central Agency for the Reception of Asylum Seekers, this process has been automated for asylum seekers. By safely sharing relevant data, migrants can be screened and treated effectively. Resulting in health needs of migrants being met and optimum control of TB in low-incidence countries. The aim is to screen, treat, control and end tuberculosis whilst scaling the Dutch blueprint across the EU/EEA region. Key messages TB-screening contributes to EU public health if follow-up actions are facilitated non-geographically. The Dutch blueprint for TB-control shows how migrant health needs are met in an interconnected world.

Inside Outsourcing: Experiences of Outsourced Physical Therapy Services in Dutch Hospitals

Over the past years, it has become more common in Dutch hospitals to outsource allied healthcare services to the private sector. This development has affected hospital-based physical therapy significantly. And as a result, there is an increasing need for guidance in this new situation. In response to this, the Dutch Association of Physical Therapy in Hospitals (NVZF) conducted a comprehensive study into the process of outsourcing with the objective to inform and advise physical therapy services in hospitals about outsourcing developments. Eight Dutch hospitals where physical therapy services had been outsourced or where this option was explored, were interviewed. The EFQM-Model (European Foundation for Quality Management – Excellence Model) was used to examine the outsourcing process. This provided the following insights into the outsourcing process of physical therapy in Dutch hospitals: (a) three motives of the board of a hospital to outsource the department of physical therapy and three factors influencing whether outsourcing will occur, (b) four different organizational structures of physical therapy services, two of which reflect outsourced services and (c) nine critical factors to be considered by hospital-based physical therapy services when outsourcing occurs. The results of the research were summarized in a Dutch guideline consisting of three parts named “Identifying Motives for Outsourcing and the Probability of Outsourcing”, “Organizing according to the Right to Exist”, and “Development Goals for the Future using the Critical Factors from the Research Results”.