[Teleradiology in a family practice on the Dutch island of Ameland: a cost-benefit analysis].
Ned Tijdschr Geneeskd. 2013;156(51):A5428
Authors: Jacobs JJ, Jacobs JP, Wiersma D, Sanderman R
OBJECTIVE: To calculate the costs and benefits of the introduction of teleradiology at a general practice on the Dutch island of Ameland from the perspectives of three different entities: (a) the family doctor (investor); (b) patients; and (c) health insurance companies.
DESIGN: Descriptive, cost-benefit analysis.
METHOD: For the year 2009, one and a half years after the introduction of a teleradiology facility at a general practice in Ameland, the operational and financing costs, the patient’s saved travel time and expenses and the teleradiology costs for health insurance companies were compared with the costs that would have been made without teleradiology.
RESULTS: In 2009, 426 X-rays had been taken at the general practice of which 241 for trauma and 185 for non-traumatic cases. With a reimbursement of € 100 per X-ray taken during normal working hours and € 200 for those taken during evenings and weekends, benefits for the family doctor (investor) were € 46,698 and the costs amounted to € 45,710, or a positive balance of € 980. Patients’ savings in travel time and expenses were calculated at € 111,068. Health insurance companies reimbursed a minimum of € 89,265 less on diagnosis and treatment.
CONCLUSION: The introduction of teleradiology a general practice in Ameland resulted in a considerable cost reduction for patients as well as for health insurance companies. In the future, diagnosing in this manner could be expanded in particular to regions in which the distances to hospitals are greater: a part of secondary healthcare could be conducted at a reduced cost.
PMID: 24472309 [PubMed - indexed for MEDLINE]
Development of a brief questionnaire (ICQ-S) to monitor inhaled corticosteroid side-effects in clinical practice.
Allergy. 2014 Mar;69(3):372-9
Authors: Foster JM, Schokker S, Sanderman R, Postma DS, van der Molen T
BACKGROUND: Side-effect concerns impede adherence with inhaled corticosteroids (ICS) and often underlie poor asthma control. We developed a brief version (ICQ-S) of the 57-item Inhaled Corticosteroids side-effect Questionnaire (ICQ) to facilitate side-effect monitoring in busy clinics.
METHODS: Part 1: After completion by 482 patients with doctor-diagnosed asthma, each ICQ item underwent item reduction analysis. Part 2: Patients prescribed ICS for asthma completed the ICQ at baseline (BL), ICQ-S at day 14 (D14) and day 28 (D28), and 6-item Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (MiniAQLQ) at BL, D14 and D28. 14-day test-retest reliability was assessed by intraclass correlation coefficient (ICC) between ICQ-S scores and internal consistency by Cronbach’s alpha (α) coefficient and item-total correlations of ICQ-S. Criterion validity was assessed by correlations (Spearman’s rho) between ICQ and ICQ-S total score. Patients reported duration and difficulty of ICQ-S completion at D28.
RESULTS: Part 1: The ICQ-S consists of fifteen local/systemic ICS side-effects of similar range to the full ICQ. Part 2: 62 asthma patients (mean ACQ score 0.79 ± SD 0.83) prescribed daily ICS [BDP-equivalent median dose 1000 μg (IQR: 500, 1000)] participated. ICC between ICQ-S scores was 0.90. All item-total correlations were rho ≥ 0.20. The ICQ-S demonstrated criterion validity, for example, ICQ and ICQ-S were strongly associated (rho = 0.86). 81% of patients completed the ICQ-S within 5 minutes and 97% found completion ‘not difficult’.
CONCLUSION: The ICQ-S is a brief, patient-friendly tool with good reliability and validity, which may be useful for monitoring ICS side-effects in clinical practice.
PMID: 24444382 [PubMed - indexed for MEDLINE]
Mindfulness, acceptance and catastrophizing in chronic pain.
PLoS One. 2014;9(1):e87445
Authors: de Boer MJ, Steinhagen HE, Versteegen GJ, Struys MM, Sanderman R
OBJECTIVES: Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT) suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to examine the influence of mindfulness and general psychological acceptance on pain-related catastrophizing in patients with chronic pain.
METHODS: A cross-sectional survey was conducted, including 87 chronic pain patients from an academic outpatient pain center.
RESULTS: The results show that general psychological acceptance (measured with the AAQ-II) is a strong predictor of pain-related catastrophizing, independent of gender, age and pain intensity. Mindfulness (measured with the MAAS) did not predict levels of pain-related catastrophizing.
DISCUSSION: Acceptance of psychological experiences outside of pain itself is related to catastrophizing. Thus, acceptance seems to play a role in the pain experience and should be part of the treatment of chronic pain. The focus of the ACT treatment of chronic pain does not necessarily have to be on acceptance of pain per se, but may be aimed at acceptance of unwanted experiences in general. Mindfulness in the sense of “acting with awareness” is however not related to catastrophizing. Based on our research findings in comparisons with those of other authors, we recommend a broader conceptualization of mindfulness and the use of a multifaceted questionnaire for mindfulness instead of the unidimensional MAAS.
PMID: 24489915 [PubMed - indexed for MEDLINE]
A prospective analysis on fatigue and experienced burden in informal caregivers of cancer patients during cancer treatment in the palliative phase.
Acta Oncol. 2014 Oct 7;:1-7
Authors: Peters ME, Goedendorp MM, Verhagen SA, Smilde TJ, Bleijenberg G, van der Graaf WT
Background. Although fatigue is the most frequently occurring symptom in patients with cancer, hardly anything is known about fatigue of their informal caregivers and the impact fatigue might have on perceived burden with providing care. We investigated the presence of fatigue in caregivers, its course and the relation of fatigue severity between caregivers and patients. Furthermore, we explored in caregivers whether fatigue severity was correlated to experienced burden. Material and methods. Informal caregivers and patients on cancer treatment in the palliative phase completed questionnaires at baseline and follow-up (6 months later). To measure fatigue severity, both groups completed the Checklist Individual Strength. Additionally, caregivers completed the Caregivers Strain Index to assess experienced burden with providing care. Descriptive analyses, paired t-tests, χ(2)-tests, Pearson’s correlations and regression analysis were performed. Results. At baseline 111 couples (patients and caregivers) participated, at follow-up 75 couples. At both time points 23% of caregivers were severely fatigued. There was no significant correlation between patients and caregivers on fatigue. Higher fatigue in both patients and caregivers was correlated with higher burden in caregivers and over 30% of burden could be explained by fatigue. Conclusion. Almost a quarter of caregivers of patients on active palliative treatment were severely fatigued, which figure remained stable over time. Fatigue in both patients and caregivers was related to caregivers’ burden. This observation should be taken into account with the growing demand on caregivers and the increase in cancer treatment options in the palliative setting.
PMID: 25291079 [PubMed - as supplied by publisher]
The mediating role of disability and social support in the association between low vision and depressive symptoms in older adults.
Qual Life Res. 2014 Apr;23(3):1039-43
Authors: Kempen GI, Ranchor AV, Ambergen T, Zijlstra GA
PURPOSE: Vision loss is highly prevalent in old age and has a substantial impact on different aspects of quality of life including depressive symptoms. Our objective was to examine the mediating role of disability and social support in the association between low vision and depressive symptoms.
METHODS: Differences in disability, social support, and depressive symptoms between 148 persons with low vision and a reference population (N = 4,792) all ≥57 years were compared. The association between low vision and depressive symptoms and the mediating role of disability and social support was examined by the means of regression.
RESULTS: A significant effect of low vision on depressive symptoms was identified even after the adjustment for disability and social support (standardized beta 0.053, P < 0.001). The association between low vision and symptoms of depression was partially mediated by disability, while social support was identified as a suppressor variable. Low vision, disability, and social support showed unique contributions to depressive symptoms.
CONCLUSIONS: Prevention of disability and the increase in social support may help to reduce symptoms of depression in older adults with low vision. By taking such information into account in their intervention work, health professionals working in this area may improve their care quality.
PMID: 24081872 [PubMed - indexed for MEDLINE]
The role of goal adjustment in symptoms of depression, anxiety and fatigue in cancer patients receiving psychosocial care: a longitudinal study.
Psychol Health. 2014 Sep 29;:1-35
Authors: Zhu L, Ranchor AV, van der Lee M, Garssen B, Sanderman R, Schroevers MJ
Abstract Objective: This study examined whether cancer patients reported increases in their goal adjustment capacities while receiving psychosocial care and whether these increases were related to changes in symptoms of depression, anxiety, and fatigue. Goal adjustment was conceptualized as two independent capacities: goal disengagement (i.e. disengage from unattainable goals) and goal reengagement (i.e. reengage into new goals). Design: This naturalistic, longitudinal study focused on 241 cancer patients receiving psychosocial care at one of the seven psycho-oncology institutions in the Netherlands. Data was collected before the start of psychosocial care (T1) and nine months thereafter (T2). Hierarchical regression analysis was used to examine the research questions. Main Outcome Measures: Goal adjustment, and symptoms of depression, anxiety and fatigue. Results: At group level, patients reported small increases in goal disengagement (d = 0.22) but no significant change in goal reengagement (d = 0.09). At an individual level, 34% of cancer patients reported an increase in goal disengagement and 30% an increase in goal reengagement. Increases in goal reengagement were significantly associated with decreases in both depressive and anxiety symptoms, but not to changes in fatigue. Conclusion: Findings indicate that particularly improvements in goal reengagement are beneficial for cancer patients’ psychological functioning.
PMID: 25264270 [PubMed - as supplied by publisher]
Receiving Instrumental Support in Late Parent-Child Relationships and Parental Depression.
J Gerontol B Psychol Sci Soc Sci. 2014 Sep 23;
Authors: Djundeva M, Mills M, Wittek R, Steverink N
OBJECTIVES: This study investigates the role of gender, functional limitations, and social interaction in the association between instrumental support from adult children and parental depression. We apply self-determination theory to hypothesize about the role of physical needs and social resources on parental depression in a European context.
METHOD: A sample of 6,268 parents older than 65 who have nonresident children from the first wave of Survey of Health, Ageing and Retirement in Europe (2004) is analyzed. We estimate logistic regression models to test for the association between instrumental support and depression. Physical needs, gender, and social interaction are used as moderators.
RESULTS: Net of core factors that contribute to depression, including previous history of depression, there is a U-shaped pattern between receiving instrumental support and depression that persists across country regimes. For respondents with medium physical limitations, too little or too frequent support from children is associated with higher depression. For respondents with severe limitations, receiving at least some support is better than receiving none at all. The receipt of too frequent support from children increases the level of depression more for women than men. All interaction effects are comparable across country regimes.
DISCUSSION: Heterogeneity in physical needs and resources of older individuals must be taken into account when assessing the effects of instrumental support on mental health.
PMID: 25253024 [PubMed - as supplied by publisher]
Trajectories of personal control in cancer patients receiving psychological care.
Psychooncology. 2014 Sep 23;
Authors: Zhu L, Schroevers MJ, van der Lee M, Garssen B, Stewart RE, Sanderman R, Ranchor AV
OBJECTIVE: This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential patterns of psychological symptoms between trajectories.
METHODS: This naturalistic study focused on 241 cancer patients receiving psychological care at psycho-oncology institutions. Data were collected before the initiation of psychological care, and 3 and 9 months thereafter. Latent class growth analysis was applied to identify personal control trajectories.
RESULTS: Three personal control trajectories were identified: enduring improvement (41%), temporary improvement (50%), and deterioration (9%). Education and baseline physical symptoms distinguished these trajectories. In the whole group, improvements in personal control were associated with improvements in psychological symptoms. Patients at distinct trajectories reported different levels of psychological symptoms, but did not differ in their courses of psychological symptoms. Patients in the enduring and temporary control improvement groups experienced significant psychological symptoms reductions over time, whereas patients in the control deterioration group maintained high psychological symptoms.
CONCLUSIONS: Improvements in personal control seem to depend on initial control level: those who start with the highest control levels show subsequent improvements, whereas those with the lowest control levels show subsequent deterioration. Copyright © 2014 John Wiley & Sons, Ltd.
PMID: 25251894 [PubMed - as supplied by publisher]
[Ill after drinking untreated milk; 'die Amelander Krankheit'].
Ned Tijdschr Geneeskd. 2013;157(51):A7078
Authors: Jacobs JJ, Sanderman R
In 2012 three patients consulted their general practitioner with symptoms of gastro-enteritis with bloody stools. This was caused by drinking untreated milk infected with Campylobacter jejuni. Another patient developed reactive arthritis. He too had drunk untreated milk that had probably been infected with Yersinia enterocolitica. Between 1958 and 1995 many German children living in the region of Cologne developed gastro-enteritis after holidaying on Ameland, one of the Dutch islands. This condition was known as ‘die Amelander Krankheit’, and was caused by drinking untreated milk that had been infected with Campylobacter jejuni. After instructions to boil the milk before drinking were followed, the illness disappeared. These cases show that consumption of untreated milk can have negative consequences for health. Hence, if patients develop gastroenteritis symptoms after visiting a farm we recommend that the possibility that they may have drunk untreated milk is taken into account.
PMID: 24345367 [PubMed - indexed for MEDLINE]
Opinions of Dutch Liver Transplant Recipients on Anonymity of Organ Donation and Direct Contact With the Donor’s Family.
Transplantation. 2014 Sep 10;
Authors: Annema C, Op den Dries S, van den Berg AP, Ranchor AV, Porte RJ
BACKGROUND: In the Netherlands, anonymity of organ donation, which is currently protected by legislation, has come under discussion. In the Dutch society, a tendency to allow direct contact between transplant recipients and their donor’s family is noticeable. As little is known about the opinion of Dutch liver transplant recipients on anonymity of organ donation and direct contact with the donor’s family, this study examines their opinions.
METHODS: A cross-sectional study was conducted in 244 liver transplant recipients. Their opinions were examined in relation to demographic, transplant-related and emotional variables. Data were collected by questionnaire. Transplant-related variables were retrieved from the hospital’s liver transplant database.
RESULTS: Fifty-three percent of the respondents (n=177) agreed with anonymity of organ donation, mainly out of respect for the donor. Living situation, age, and level of positive affect influenced this opinion. The majority of the respondents (65%) indicated that they would like to receive some information about their donor, like age, sex, and health status. Only 19% of the respondents favored direct contact with the donor’s family, mainly to express their gratitude personally. Respondents transplanted for alcoholic cirrhosis were less in favor of direct contact. Respondents with feelings of guilt doubted more about direct contact.
CONCLUSION: There is no need to change the current legislation on anonymity of organ donation. However, most liver transplant recipients would like to receive some general information about their donor. Therefore, clear guidelines on the sharing of donor data with recipients need to be established.
PMID: 25211521 [PubMed - as supplied by publisher]