Building an information product for cycle time analysis

Introduction
Regulations for medical organizations are becoming stricter. Inspection services and foundations like SONCOS will be checking hospitals regularly and ask for specific data cornering the cycle times of certain clinical pathways. A Large Teaching Hospital in the Netherlands wants to change towards an information infrastructure which can provide these insights.

Method
After the stakeholders and goals are formulated, the second step towards such an data infrastructure is an information product blueprint of the system to-be.

Results & conclusion
Generating this blueprint is the specific aim of this thesis research by means of translating Business Process Modelling Notation to ORM-diagrams to eventually generate information product blueprints to serve as a foundation for cycle time analysis.

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Contractbeheer als privacy instrument

Inleiding
De aanleiding van dit onderzoek is een rapport van de Privacy-werkorganisatie. Dit rapport geeft namelijk een uiteenzetting van conclusies en aanbevelingen om het UMCG te laten voldoen aan de toekomstige Europese Privacy Verordening (in het vervolg EPV). De EPV gaat namelijk mogelijk van kracht in 2015 en wordt mogelijk per 2017 gehandhaafd. Dit onderzoek richt zich op het contractbeheer van het UMCG. Bij de implementatie van de EPV gaan werkprocessen veranderen en dat heeft gevolgen voor het handelen van de medewerkers van het UMCG, alsook het contractbeheer. Het contractbeheer binnen de centrale organisatieonderdelen van het UMCG voldoet namelijk op het moment niet aan de EPV. Bij de sectoren/ afdelingen van het UMCG is daarom nog onduidelijk op welke wijze het contractbeheer per sector/ afdeling wordt vormgegeven. Het UMCG wil daarom de huidige situatie binnen de sectoren/ afdelingen graag weten, gezien het UMCG wil voldoen aan de EPV.

Methode
Voor het theoretische deel van het onderzoek is een juridische inhoudsanalyse gemaakt door alle relevante rechtsbronnen en (juridische) literatuur te bestuderen. Voor het praktijkgedeelte is beperkt deskresearch gedaan en is een kwalitatief onderzoek uitgevoerd met behulp van halfgestructureerde interviews, bestaande uit open en gesloten vragen.

Resultaten
Europese Privacy Verordening (EPV)
Op het moment is de EPV binnen de sectoren/ afdelingen erg onderbelicht. Er wordt geen prioriteit aangegeven en slecht over gecommuniceerd binnen de sectoren. Er is echter wel behoefte aan informatie over de EPV, mensen zijn nieuwsgierig en werken graag mee om EPV-compliant te worden.

Contracteren
De derden binnen de sectoren zijn in kaart gebracht, dit zijn met name andere ziekenhuizen, zorgverzekeraars en leveranciers. Binnen de sectoren worden zowel mondelinge en schriftelijke overeenkomsten gesloten voornamelijk in het kader van samenwerkingen, onderzoek, zorgverzekeraars en arbeidsovereenkomsten.

Huidige infrastructuur contractbeheer.
Het UMCG begint in toenemende mate behoefte te krijgen aan een gestructureerde wijze van contractbeheer. Tot op heden heeft het contractbeheer nog niet prioriteit nummer één gehad en is het een onderontwikkeld aandachtsgebied. De wijze waarop het contractbeheer binnen de sectoren/ afdelingen van het UMCG plaatsvindt verschillen sterk. Bij sommige afdelingen liggen contracten her en der verborgen in mailboxen, bureaulades en kasten. Vaak is het ook zo dat er geen weet meer is van het contract, wat betekent dat de status van het contract niet duidelijk is. Binnen de sectoren/ afdelingen is het niet duidelijk wie er wel en niet bevoegd is om contracten te mogen tekenen. Daarnaast is het niet duidelijk wie eigenaar is van het contract.

Conclusie
De resultaten hebben geleid tot aanbevelingen voor het opnieuw inrichten van het contractbeheer om compliant te worden aan de Europese Privacy Verordening. De meeste aanbevelingen zijn ook nuttig als de Europese Privacy Verordening niet doorgaat, dit om professioneel contractbeheer in te richten.

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De lerende organisatie

Introduction
The research that has been fulfilled at the Wenckebach Instituut of the UMCG, focuses on the optimization of the co-operation between employees. The main research question is: In extent to wich the organization meets different characteristics of a learning organization and what does the organization need to become a learning organization. This question is formulated from the management team. The current organization has a columnwise organizational structure and consists of four departments who barely co-operate with each other. To guarantee the quality of the services, the management team want to optimize the co-operation between the departments, by using the concept of ‘the learning organization’.
Method
To answer this main research question, a qualitative research is conducted. Ten interviews have been held with employees and managers from the two departments Postgraduate School of Medicine and the Expertise Center. In advance, a desk research about learning organizations and the characteristics, is performed. The interviews are based on three important characteristics found in the literature: psychological safety, horizontal communication & knowledge sharing and coaching leadership. Besides discussing these topics, there is also asked how to increase the characteristics.
Results
The results show that the Wenckebach Instituut at some points meets the characteristics of a learning organization. The psychological safety within the teams is high and this is also a negotiable topic within the teams. Besides that, the horizontal communication should be improved. Within the teams, the horizontal communication is good, but between the teams there is a lack of communication. The lack of communication and co-operation between the teams is because the employees don’t have knowledge about each others activities and expertises. The results also show that the managers already have different characteristics of a coaching leader. They give the employees much responsibility and freedom. Something the managers can improve is involve the employees more within organizational decisions and by clearly communicate the mission, vision and goal of the organization. The results also show some barriers in the organization who hinder in becoming a learning organization. These barriers are: a lack of presence of the employees in the organization, wich means that the employees often work outside the organization, the split in groups (docters and nurses) which the departments serve, a low intrinsic motivation concerns co-operation and the functioning of organizational systems.
Conclusion
There can be concluded that the employees have the intention to create a learning organization. But the intrinsic motivation to actually do it, can be improved. The role of the management team is to stimulate this and to make clear what they expect from their employees. The management teams should also communicate the mission and vision of the organization. There also can be concluded that there is a tension between the expectations of the employees and the management team about each others role. The employees expect a stimulating and steering role of the management team, while the management team discribes their own role only as facilitating. Besides that, the lack of knowledge about each others activities is the main reason why colleagues from different departments don’t co-operate. To map these activities is a first stap to better co-operation.

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Samenwerken in een netwerkorganisatie

Introduction
The research focuses on working together as network-based organization within the Wenckebach Institute (WI), part of the University Medical Centre Groningen (UMCG). The work of different sections of the Wenckebach Institute overlap in content and target audience. By profiting more of each other’s knowledge and qualities, services can be further improved. A network-based organization is well suited for collaboration between separate sections of the organization.
Methods
Since 2014, the separate sections of the WI are housed in one building. This research describes what possibilities there are for collaboration as network-based organization within the WI. Specifically, two sections are examined; PGSoM and CLAS.
Results
The most notable finding of the research is that employees are insufficiently aware of each other’s existence and tasks. At this moment, employees of the WI do not experience the organization as network-based. Existing networks are based on previous collaborations, but these are not extensive networks. Employees know that they are allowed to initiate networking, but do not know that this is expected of them. Employees expect a more facilitating role of the MT concerning the organization of networking meetings. In addition, they expect more communication concerning the expectations.
Conclusion
Collaborations in the current form derive from coordination meetings, or when employees that are already familiar reach out to each other for a possible assignment. Within both sections there are possibilities for (more) collaboration. The MT aims to increase collaboration and provides coworkers with the space to do this. Among coworkers there seems little resistance for increased collaboration. Despite the fact that the will exists to get to know coworkers, not all coworkers initiate contact themselves. Moreover, almost all coworkers believe that the structure of the building is inconvenient and not pleasant, and feel that this structure is not suited for accidental encounters. Coworkers want to get to know other colleagues in the organization, and want to be informed on each other’s occupations.

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The evolvement of stakeholders’ focus of attention in the context of a failing project

Introduction
Currently, Electronic Health Records (EHRs) are becoming the standard within healthcare institutions. However, although these systems provide many benefits, hospitals are struggling with the implementation of EHRs.

Method
In order to provide some insight in the difficulties related to these implementations, the central aim of this paper is to study how the issues voiced by stakeholders have evolved over time during a failed EHR project within a large teaching hospital. By combining theories about stakeholder and issue management and using Pettigrew’s (1987) classification of process, context and content related issues, seventeen issue sub-categories were identified.

Results & conclusion
The majority of them were perceived as threats during the project, yet two of the sub-categories evolved from being perceived as an opportunity towards becoming a threat over time. Also, it turned out that stakeholders raised different issues at different moments during the failed project, meaning that some of the voiced issues were only mentioned at the start of the project, while others surfaced later on. Moreover, the results show interdependencies exist between some of the issue sub-categories.

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Hypoactive medial prefrontal cortex functioning in adults reporting childhood emotional maltreatment.

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Hypoactive medial prefrontal cortex functioning in adults reporting childhood emotional maltreatment.

Soc Cogn Affect Neurosci. 2014 Dec;9(12):2026-33

Authors: van Harmelen AL, van Tol MJ, Dalgleish T, van der Wee NJ, Veltman DJ, Aleman A, Spinhoven P, Penninx BW, Elzinga BM

Abstract

Childhood emotional maltreatment (CEM) has adverse effects on medial prefrontal cortex (mPFC) morphology, a structure that is crucial for cognitive functioning and (emotional) memory and which modulates the limbic system. In addition, CEM has been linked to amygdala hyperactivity during emotional face processing. However, no study has yet investigated the functional neural correlates of neutral and emotional memory in adults reporting CEM. Using functional magnetic resonance imaging, we investigated CEM-related differential activations in mPFC during the encoding and recognition of positive, negative and neutral words. The sample (N = 194) consisted of patients with depression and/or anxiety disorders and healthy controls (HC) reporting CEM (n = 96) and patients and HC reporting no abuse (n = 98). We found a consistent pattern of mPFC hypoactivation during encoding and recognition of positive, negative and neutral words in individuals reporting CEM. These results were not explained by psychopathology or severity of depression or anxiety symptoms, or by gender, level of neuroticism, parental psychopathology, negative life events, antidepressant use or decreased mPFC volume in the CEM group. These findings indicate mPFC hypoactivity in individuals reporting CEM during emotional and neutral memory encoding and recognition. Our findings suggest that CEM may increase individuals’ risk to the development of psychopathology on differential levels of processing in the brain; blunted mPFC activation during higher order processing and enhanced amygdala activation during automatic/lower order emotion processing. These findings are vital in understanding the long-term consequences of CEM.

PMID: 24493840 [PubMed – indexed for MEDLINE]

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Enduring effects of Preventive Cognitive Therapy in adults remitted from recurrent depression: A 10 year follow-up of a randomized controlled trial.

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Enduring effects of Preventive Cognitive Therapy in adults remitted from recurrent depression: A 10 year follow-up of a randomized controlled trial.

J Affect Disord. 2015 Jul 11;185:188-194

Authors: Bockting CL, Smid NH, Koeter MW, Spinhoven P, Beck AT, Schene AH

Abstract

BACKGROUND: Prevention of recurrence is a challenge in the management of major depressive disorder (MDD). The long-term effects of Preventive Cognitive Therapy (PCT) in preventing recurrence in MDD are not known.

METHODS: A RCT comparing the addition of PCT to Treatment As Usual (TAU), versus TAU including patients with recurrent depression who were in remission at entry (N=172). PCT consisted of eight weekly group sessions. TAU involved standard treatment. Primary outcome is time to first recurrence of a depressive episode as assessed by blinded interviewers over 10 years based on DSM-IV-TR criteria.

RESULTS: Also over 10 years, the protective effect of PCT was dependent on the number of previous episodes a patient experienced. The protective effect intensified with the number of previous depressive episodes (Cox regression; p=.004, Hazard ratio=.576, 95% CI=.396-.837) and is mainly established within the first half of the 10 year follow-up period. For patients with more than three previous episodes (52% of the sample), PCT significantly increased the median survival time (713.0 days) versus patients that received TAU (205.0 days). No enduring effects were found on secondary outcomes.

LIMITATIONS: Dropout rates were relatively high for secondary outcomes, but relatively low for the primary outcome. Results were comparable after multiple imputation.

CONCLUSIONS: PCT in remitted patients with multiple prior episodes has long-term preventive effects on time to recurrence. To reduce recurrence rates, booster sessions might be necessary. A personalized medicine approach might be necessary to reduce recurrence rates even further.

PMID: 26188380 [PubMed – as supplied by publisher]

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Urine Albumin-Creatinine Ratio Versus Albumin Excretion for Albuminuria Staging: A Prospective Longitudinal Cohort Study.

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Urine Albumin-Creatinine Ratio Versus Albumin Excretion for Albuminuria Staging: A Prospective Longitudinal Cohort Study.

Am J Kidney Dis. 2015 Jul 15;

Authors: Vart P, Scheven L, Lambers Heerspink HJ, de Jong PE, de Zeeuw D, Gansevoort RT, PREVEND Study Group and the RENAAL Investigators

Abstract

BACKGROUND: New guidelines advocate the use of albumin-creatinine ratio (ACR) in a urine sample instead of 24-hour urinary albumin excretion (UAE) for staging albuminuria. Concern has been expressed that this may result in misclassification for reasons including interindividual differences in urinary creatinine excretion.

STUDY DESIGN: Prospective longitudinal cohort study.

SETTING & PARTICIPANTS: We examined 7,623 participants of the PREVEND and RENAAL studies for reclassified when using ACR instead of 24-hour UAE, the characteristics of reclassified participants, and their outcomes. Albuminuria was categorized into 3 ACR and UAE categories: <30, 30 to 300, and >300mg/g or mg/24 h, respectively.

PREDICTORS: Baseline ACR and 24-hour UAE.

OUTCOMES: Cardiovascular (CV) morbidity and mortality and all-cause mortality.

RESULTS: When using ACR in the early morning void instead of 24-hour UAE, 88% of participants were classified in corresponding albuminuria categories. 307 (4.0%) participants were reclassified to a higher, and 603 (7.9%), to a lower category. Participants who were reclassified to a higher ACR category in general had a worse CV risk profile compared with nonreclassified participants, whereas the reverse was true for participants reclassified to a lower ACR category. Similarly, Cox proportional hazards regression analyses showed that reclassification to a higher ACR category was associated with a tendency for increased risk for CV morbidity and mortality and all-cause mortality, whereas reclassification to a lower ACR category was associated with a tendency for lower risk. Net reclassification improvement, adjusted for age, sex, and duration of follow-up, was 0.107 (P=0.002) for CV events and 0.089 (P<0.001) for all-cause mortality.

LIMITATIONS: Early morning void urine collection instead of spot urine collection.

CONCLUSIONS: Our results indicate that there is high agreement between early morning void ACR and 24-hour UAE categories. Reclassification is therefore limited, but when present, is generally indicative of the presence of CV risk factors and prognosis.

PMID: 26188433 [PubMed – as supplied by publisher]

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Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70% ethanol locks: A randomised controlled multi-centre trial.

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Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70% ethanol locks: A randomised controlled multi-centre trial.

Eur J Cancer. 2015 Jul 15;

Authors: Schoot RA, van Ommen CH, Stijnen T, Tissing WJ, Michiels E, Abbink FC, Raphael MF, Heij HA, Lieverst JA, Spanjaard L, Zwaan CM, Caron HN, van de Wetering MD

Abstract

BACKGROUND: The prevention of central venous catheter (CVC) associated bloodstream infections (CABSIs) in paediatric oncology patients is essential. Ethanol locks can eliminate pathogens colonising CVCs and microbial resistance is rare. Aim of this study was to determine whether two hour 70% ethanol locks can reduce CABSI in paediatric oncology patients.

METHODS: We conducted a randomised, double blind, multi-centre trial in paediatric oncology patients (1-18years) with newly inserted CVCs. Patients were randomly assigned to receive two hour ethanol locks (1.5 or 3ml 70%) or heparin locks (1.5 or 3ml 100IU/ml), whenever it was needed to use the CVC, maximum frequency once weekly. Primary outcomes were time to CABSI or death due to CABSI.

RESULTS: We recruited 307 patients (ethanol, n=153; heparin, n=154). In the ethanol group, 16/153 (10%) patients developed a CABSI versus 29/154 (19%) in the heparin group. The incidence of CABSI was 0.77/1000 and 1.46/1000 catheter days respectively (p=0.039). The number-needed-to-treat was 13. No patients died of CABSI. In particular, Gram-positive CABSIs were reduced (ethanol, n=8; heparin, n=21; p=0.012). Fewer CVCs were removed because of CABSI in the ethanol group (p=0.077). The ethanol lock patients experienced significantly more transient symptoms compared to the heparin lock patients (maximum grade 2) (nausea, p=0.030; taste alteration, p<0.001; dizziness, p=0.001; blushing, p<0.001), no suspected unexpected serious adverse reactions (SUSAR) occurred.

CONCLUSIONS: This is the first randomised controlled trial to show that ethanol locks can prevent CABSI in paediatric oncology patients, in particular CABSI caused by Gram-positive bacteria. Implementation of ethanol locks in clinical practice should be considered.

PMID: 26188849 [PubMed – as supplied by publisher]

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Supraphysiological hormonal status, anxiety disorders, and COMT Val/Val genotype are associated with reduced sensorimotor gating in women.

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Supraphysiological hormonal status, anxiety disorders, and COMT Val/Val genotype are associated with reduced sensorimotor gating in women.

Psychoneuroendocrinology. 2015 Jul 2;60:217-223

Authors: Comasco E, Hellgren C, Olivier J, Skalkidou A, Sundström Poromaa I

Abstract

Pregnancy is a period characterized by a supraphysiological hormonal status, and greater anxiety proneness, which can lead to peripartum affective symptoms with dramatic consequences not only for the woman but also for the child. Clinical psychiatry is heavily hampered by the paucity of objective and biology-based intermediate phenotypes. Prepulse inhibition (PPI) of the startle response, a neurophysiological measure of sensorimotor gating, has been poorly investigated in relation to anxiety and in pregnant women. In the present study, the PPI of healthy non-pregnant women (n=82) and late pregnant women (n=217) was investigated. Age, BMI, depression and anxiety symptoms, tobacco use, and antidepressant medication were considered. We investigated and provided evidence of lower PPI: (i) in healthy pregnant women compared to healthy non-pregnant controls, (ii) in pregnant women with anxiety disorders compared to healthy pregnant women, (iii) in pregnant women with anxiety disorders using SSRI compared to un-medicated pregnant women with anxiety disorders, and (iv) in healthy pregnant women carrying the COMT Val158Met Val/Val genotype compared to Met carriers. Altogether, a reduced sensorimotor gating as an effect of supraphysiological hormonal status, anxiety disorders, SSRIs, and catecholaminergic genotype, implicate the putative relevance of lower PPI as an objective biological correlate of anxiety proneness in pregnant women. These findings call for prospective studies to dissect the multifactorial influences on PPI in relation to mental health of pregnant women.

PMID: 26189199 [PubMed – as supplied by publisher]

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Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial.

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Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial.

J Shoulder Elbow Surg. 2015 Aug;24(8):1274-81

Authors: Lambers Heerspink FO, van Raay JJ, Koorevaar RC, van Eerden PJ, Westerbeek RE, van ‘t Riet E, van den Akker-Scheek I, Diercks RL

Abstract

BACKGROUND: Good clinical results have been reported for both surgical and conservative treatment of rotator cuff tears. The primary aim of this randomized controlled trial was to compare functional and radiologic improvement after surgical and conservative treatment of degenerative rotator cuff tears.

METHODS: We conducted a randomized controlled trial that included 56 patients with a degenerative full-thickness rotator cuff tear between January 2009 and December 2012; 31 patients were treated conservatively, and rotator cuff repair was performed in 25 patients. Outcome measures, including the Constant-Murley score (CMS), visual analog scale (VAS) pain and VAS disability scores, were assessed preoperatively and after 6 weeks and 3, 6, and 12 months. Magnetic resonance imaging was performed preoperatively and at 12 months postoperatively.

RESULTS: At 12 months postoperatively, the mean CMS was 81.9 (standard deviation [SD], 15.6) in the surgery group vs 73.7 (SD, 18.4) in the conservative group (P = .08). VAS pain (P = .04) and VAS disability (P = .02) were significantly lower in the surgery group at the 12-month follow-up. A subgroup analysis showed postoperative CMS results were significantly better in surgically treated patients without a retear compared with conservatively treated patients (88.5 [SD, 6.2] vs 73.7 [SD, 18.4]).

CONCLUSION: In our population of patients with degenerative rotator cuff tears who were randomly treated by surgery or conservative protocol, we did not observe differences in functional outcome as measured with the CMS 1 year after treatment. However, significant differences in pain and disabilities were observed in favor of surgical treatment. The best outcomes in function and pain were seen in patients with an intact rotator cuff postoperatively.

PMID: 26189808 [PubMed – in process]

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Regulation of protein homeostasis in neurodegenerative diseases: the role of coding and non-coding genes.

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Regulation of protein homeostasis in neurodegenerative diseases: the role of coding and non-coding genes.

Cell Mol Life Sci. 2015 Jul 21;

Authors: Sin O, Nollen EA

Abstract

Protein homeostasis is fundamental for cell function and survival, because proteins are involved in all aspects of cellular function, ranging from cell metabolism and cell division to the cell’s response to environmental challenges. Protein homeostasis is tightly regulated by the synthesis, folding, trafficking and clearance of proteins, all of which act in an orchestrated manner to ensure proteome stability. The protein quality control system is enhanced by stress response pathways, which take action whenever the proteome is challenged by environmental or physiological stress. Aging, however, damages the proteome, and such proteome damage is thought to be associated with aging-related diseases. In this review, we discuss the different cellular processes that define the protein quality control system and focus on their role in protein conformational diseases. We highlight the power of using small organisms to model neurodegenerative diseases and how these models can be exploited to discover genetic modulators of protein aggregation and toxicity. We also link findings from small model organisms to the situation in higher organisms and describe how some of the genetic modifiers discovered in organisms such as worms are functionally conserved throughout evolution. Finally, we demonstrate that the non-coding genome also plays a role in maintaining protein homeostasis. In all, this review highlights the importance of protein and RNA homeostasis in neurodegenerative diseases.

PMID: 26190021 [PubMed – as supplied by publisher]

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Dynamic Ligand Reactivity in a Rhodium Pincer Complex.

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Dynamic Ligand Reactivity in a Rhodium Pincer Complex.

Chemistry. 2015 Jul 17;

Authors: Tang Z, Otten E, Reek JN, van der Vlugt JI, de Bruin B

Abstract

Invited for the cover of this issue is the group of Bas de Bruin and Jarl Ivar van der Vlugt at the University of Amsterdam. The image depicts the complementary nucleophilic and electrophilic ligand arms of a new cooperative PNN pincer ligand. Read the full text of the article at 10.1002/chem.201501453.

PMID: 26190203 [PubMed – as supplied by publisher]

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Metacognitive training for schizophrenia spectrum patients: a meta-analysis on outcome studies.

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Metacognitive training for schizophrenia spectrum patients: a meta-analysis on outcome studies.

Psychol Med. 2015 Jul 20;:1-11

Authors: van Oosterhout B, Smit F, Krabbendam L, Castelein S, Staring AB, van der Gaag M

Abstract

BACKGROUND: Metacognitive training (MCT) for schizophrenia spectrum is widely implemented. It is timely to systematically review the literature and to conduct a meta-analysis.

METHOD: Eligible studies were selected from several sources (databases and expert suggestions). Criteria included comparative studies with a MCT condition measuring positive symptoms and/or delusions and/or data-gathering bias. Three meta-analyses were conducted on data gathering (three studies; 219 participants), delusions (seven studies; 500 participants) and positive symptoms (nine studies; 436 participants). Hedges’ g is reported as the effect size of interest. Statistical power was sufficient to detect small to moderate effects.

RESULTS: All analyses yielded small non-significant effect sizes (0.26 for positive symptoms; 0.22 for delusions; 0.31 for data-gathering bias). Corrections for publication bias further reduced the effect sizes to 0.21 for positive symptoms and to 0.03 for delusions. In blinded studies, the corrected effect sizes were 0.22 for positive symptoms and 0.03 for delusions. In studies using proper intention-to-treat statistics the effect sizes were 0.10 for positive symptoms and -0.02 for delusions. The moderate to high heterogeneity in most analyses suggests that processes other than MCT alone have an impact on the results.

CONCLUSIONS: The studies so far do not support a positive effect for MCT on positive symptoms, delusions and data gathering. The methodology of most studies was poor and sensitivity analyses to control for methodological flaws reduced the effect sizes considerably. More rigorous research would be helpful in order to create enough statistical power to detect small effect sizes and to reduce heterogeneity. Limitations and strengths are discussed.

PMID: 26190517 [PubMed – as supplied by publisher]

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Neural correlates of visuospatial working memory in attention-deficit/hyperactivity disorder and healthy controls.

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Neural correlates of visuospatial working memory in attention-deficit/hyperactivity disorder and healthy controls.

Psychiatry Res. 2015 Jul 3;

Authors: van Ewijk H, Weeda WD, Heslenfeld DJ, Luman M, Hartman CA, Hoekstra PJ, Faraone SV, Franke B, Buitelaar JK, Oosterlaan J

Abstract

Impaired visuospatial working memory (VSWM) is suggested to be a core neurocognitive deficit in attention-deficit/hyperactivity disorder (ADHD), yet the underlying neural activation patterns are poorly understood. Furthermore, it is unclear to what extent age and gender effects may play a role in VSWM-related brain abnormalities in ADHD. Functional magnetic resonance imaging (fMRI) data were collected from 109 individuals with ADHD (60% male) and 103 controls (53% male), aged 8-25 years, during a spatial span working memory task. VSWM-related brain activation was found in a widespread network, which was more widespread compared with N-back tasks used in the previous literature. Higher brain activation was associated with higher age and male gender. In comparison with controls, individuals with ADHD showed greater activation in the left inferior frontal gyrus (IFG) and the lateral frontal pole during memory load increase, effects explained by reduced activation on the low memory load in the IFG pars triangularis and increased activation during high load in the IFG pars opercularis. Age and gender effects did not differ between controls and individuals with ADHD. Results indicate that individuals with ADHD have difficulty in efficiently and sufficiently recruiting left inferior frontal brain regions with increasing task difficulty.

PMID: 26190554 [PubMed – as supplied by publisher]

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The efforts of direct support professionals to facilitate inclusion: the role of psychological determinants and work setting.

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The efforts of direct support professionals to facilitate inclusion: the role of psychological determinants and work setting.

J Intellect Disabil Res. 2015 Jul 20;

Authors: Venema E, Otten S, Vlaskamp C

Abstract

BACKGROUND: Various studies have found that direct support professionals (DSPs) play an important role in determining the degree to which people with intellectual disabilities (ID) are included in society. However, less research has been conducted on the psychological processes that may influence the behavioural intentions of DSPs to actually engage with and invest effort in supporting their clients’ inclusion. Five possible psychological variables are identified in the literature: attitudes, social norms, experienced competencies, identity and meta-evaluation. In our research, we tested whether these processes influence the (intended) efforts DSPs make to facilitate their clients’ inclusion.

METHOD: A structured questionnaire was sent to 927 DSPs working in one of three different locations (an ordinary non-segregated setting, a reversed non-segregated setting and a residential facility). Of these, 336 DSPs completed the questionnaire.

RESULTS: Several variables revealed differences between the three locations, specifically in efforts to facilitate inclusion, attitudes, social norms, experienced competencies and professional identity. Looking at the overall means, we found (relatively) high scores for the experienced competencies, role identity and meta-evaluation. In contrast, the means were relatively negative regarding the DSPs’ attitudes to inclusion and their assumed social norms.

CONCLUSIONS: Direct support professionals’ efforts to facilitate inclusion depend on their attitude towards inclusion, the experienced competencies, their role identity, the DSPs’ meta-evaluation and, indirectly through attitudes, also on the assumed social norms of the relevant stakeholders. Organizations responsible for supporting people with ID and which may want their DSPs to make greater efforts to facilitate inclusion should pay attention to these psychological variables.

PMID: 26190561 [PubMed – as supplied by publisher]

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De prevalentie van zowel urine incontinentie bij vrouwen met chronische hoestklachten, als de prevalentie van hoestklachten bij vrouwen met urine incontinentie

Doel van de studie. Het vaststellen van zowel de prevalentie van urine incontinentie bij vrouwen die op de hoestpoli gezien worden met chronische hoest, als de prevalentie van chronische hoest onder vrouwen die op de poli gynaecologie gezien worden met (stress) incontinentie en het onderzoeken van de impact van incontinentie op de kwaliteit van leven van vrouwen met chronische hoest.
Achtergrond. Bij hoesten neemt de abdominale druk toe, waarbij urineverlies kan optreden bij vrouwen met stress-incontinentie. Stress incontinentie kan de kwaliteit van leven nadelig beïnvloeden. Wanneer de prevalentie van urine incontinentie bij vrouwen met hoestklachten hoger is dan die in de algemene populatie, kan men hierop anticiperen door actief te gaan vragen naar urineverlies en gepaste hulp bieden. Dit zal bijdragen aan de kwaliteit van leven van deze vrouwen.
Studiedesign. Cross-sectioneel epidemiologisch onderzoek.
Methode. 53 nieuwe en 43 controle patiënten van de hoestpoli, 85 nieuwe patienten van de bekkenbodempoli en 2 vrouwen die bij beide poli’s bekend waren vulden allen een vragenlijst in bestaande uit de UDI, IIQ en LCQ.
Resultaten. De prevalentie van urine-incontinentie bij vrouwen die op de hoestpoli gezien worden met chronische hoest is 65.5%. De prevalentie van hoestklachten onder vrouwen die op de bekkenbodempoli gezien worden met (stress) incontinentie is 23%. Meer klachten van urineverlies gaan gepaard met een grotere impact op de kwaliteit van leven. Lichamelijke activiteiten en het gevoel van frustratie hebben het meest te lijden onder de klachten. Roken en leeftijd hebben geen invloed op hoest en incontinentieklachten. Vrouwen met kinderen hebben meer urogenitale klachten, echter niet meer urine incontinentie. Overgewicht beïnvloedt klachten van urineverlies in negatieve zin.
Conclusie. De prevalentie van urine-incontinentie bij vrouwen die op de hoestpoli gezien worden met chronische hoest is hoger dan de prevalentie in de algemene bevolking. Actief vragen naar klachten van urineverlies op de hoestpoli kan deze vrouwen aan het licht brengen. Zij kunnen doorgestuurd worden naar de bekkenbodempoli zodat ook het ongewenste urineverlies behandeld kan worden. Hiermee zal de kwaliteit van leven ten gevolge van het urineverlies verbeterd kunnen worden.

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Accumulation of Advanced Glycation Endproducts is Associated with Macrovascular Complications and Mortality, and Glycaemic Control with Microvascular Complications in Type 2 Diabetes Mellitus

Background The UK Prospective Diabetes Study (UKPDS) showed in the nineties that glycaemic control (HbA1c) can predict vascular complications in type 2 diabetes mellitus (T2DM). More recently, the role of Advanced Glycation Endproducts (AGEs) accumulation in the development of cardiovascular complications in T2DM is increasingly acknowledged. The DCCT Trial showed that accumulation of AGEs from skin biopsies can predict vascular complications in type 1 diabetes mellitus. Nowadays, tissue AGEs can be measured non-invasively with the use of Skin Auto Fluorescence (SAF) properties and the AGE-Reader. The primary aim of this study was to evaluate the associations between SAF and the development of both macrovascular complications and microvascular complications in secondary care patients with T2DM. Our secondary aim was to compare these results with the UKPDS risk score calculations.
Methods and results A prospective cohort study of 514 T2DM patients (mean age 69±11 years, T2DM duration 18 years) from five Dutch hospitals was performed. Clinical status was assessed from April 2007 till January 2015. After a median follow-up of 5.1 (IQR 4.3-5.9) years, 79 (15%) patients died and 49 (9%) were lost to follow-up. 189 (37%) patients developed a macrovascular complication and 133 (26%) patients a microvascular complication. Tertiles of SAF were significantly associated with the development of macrovascular complications in Kaplan-Meier analysis (logrank p=0.003) but not for microvascular complications. However, tertiles of HbA1c were not associated with macrovascular complications, but only for the development of microvascular complications (logrank p=0.022). Cox regression analysis for SAF gave a hazard ratio (HR) of 1.53 (95%CI 1.24-1.89), p=0.0007 per unit (SAF) increase in the development of macrovascular complications. After correction for the UKPDS risk score the HR stayed significant: HR 1.28 (1.03-1.60), p=0.026. For HbA1c and microvascular complications a crude HR 1.20 (1.06-1.36), p=0.004 was found. The HR did not change after correction for the UKPDS score: HR 1.20 (1.06-1.36), p=0.004.
Conclusion This study shows after 5-years of follow-up that accumulation of AGEs is associated with the development of macrovascular complications in patients with T2DM. Furthermore, glycaemic control (HbA1c) is associated with the development of microvascular complications.

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Incremental value of rest myocardial perfusion using CT coronary angiography

Introduction The combination of rest and stress computed tomography (CT) has shown the
potential to assess myocardial perfusion. Limited data is available on the diagnostic
performance of rest CT perfusion (CTP) only. We hypothesize that rest CTP can have
incremental diagnostic value due to use of coronary dilators in CT image acquisition.
Objective (1) To establish the diagnostic accuracy of rest CTP compared to single photon
emission CT (SPECT) perfusion and coronary angiography (ICA) and (2) to create a semi
quantitative measurement of CT myocardial perfusion using custom made software.
Methods Patients who underwent coronary CT, SPECT and ICA were included. Multiple
readers assessed CT and SPECT perfusion using a 17-segment model on a 0-4 scale. ICA
results were used for discordant outcomes. Custom made software using a similar algorithm
as Kachenoura et al. was created to measure the regional CT myocardial to blood pool
perfusion ratio (PR). Results were compared to visual CTP analysis.
Results Data from 158 patients was analysed. Compared to rest SPECT, CTP sensitivity (SE)
and specificity (SP) on a per patient basis were 77.6% and 59.3%, respectively. Compared to
stress, SE was 77.9% and SP was 69.4%. CTP had a 63.0% SE and a 76.2% SP compared to
rest SPECT per vascular territory. For stress, a 64.5% SE and an 80.4% SP were found. Semi
quantitative analysis of CTP showed a SE of 28.6% and a SP of 83.3% compared to CTP
visual analysis on a per patient basis.
Conclusion (1) Visual analysis of MPI using rest CTP shows a good diagnostic accuracy
compared to SPECT MPI. Overall diagnostic performance of rest CTP has a higher
agreement with stress SPECT than rest SPECT. (2) Semi quantitative PR assessment had a
poor diagnostic accuracy due to a lack of sensitivity.

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Print tuning bij kinderen met en zonder een familiair risico op dyslexie : een fMRI studie

During reading acquisition, the brain gets tuned for recognizing letters in contrast to symbol. This is called ‘print tuning’ and results in brain activation in the visual word form area (VWVA) in the fusiform gyrus. The absence of brain activity in the left occipito-temporal cortex, including the visual word form area, is one of the most consistent findings in functional magnetic resonance imaging (fMRI) studies with dyslexia. However, little to nothing is known about children with a familiar risk at reading problems, who have nevertheless normal reading skills. The aim of this research is to investigate if and how brain activity, measured by fMRI, differs in children with a familiar risk at dyslexia with ((FRD), n = 2) and without ((FRND), n = 6) reading problems and a control group ((C), n = 13) during a visual repetition detection task focused on print tuning. This way we can determine if there is normalization of compensation at the brain level of the FRND-group. Normalization means that there will be no difference in brain activity between the control group and de FRND-group, compensation means that the FRND-group uses different brain areas during the task. During the repetition detection task, children watched words, pseudowords, nonwords and symbols and they had to respond if they saw a direct repetition of a stimulus. Accuracy was in all groups significantly different between symbols and the other stimulus types. Response time was comparable for all stimulus types. There was no significant difference between the FRND- and the control group. Contrary to our expectations and without a good explanation, only symbols gave significant brain activation in the control group. Except from extra brain activation in the control group in the left and right lingual gyrus in response to symbols compared to nonwords and letters, the FRND- and the control group did not significantly differ in brain activation patterns. Comparison with the FRD-group was not possible, because of the small group size.

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