المؤلفون: Elske L. van den Burg, Marjolein P. Schoonakker, Bregje Korpershoek, Lara E. Sommeling, Carlijn A. Sturm, Hildo J. Lamb, Hanno Pijl, Mattijs E. Numans, Marieke A. Adriaanse, Petra G. van Peet

المصدر: BMC Primary Care, Vol 25, Iss 1, Pp 1-13 (2024)

مصطلحات موضوعية: Type 2 diabetes, Fasting-mimicking diet, Intermittent energy restriction, Periodic fasting, Diet, Dietary behaviour, Medicine (General), R5-920

الوصف: Abstract Background Lifestyle changes, especially regarding diet quality and physical activity, are important in the management of type 2 diabetes (T2D). This mixed-methods study explores self-initiated lifestyle changes in patients with T2D who followed a periodic fasting-mimicking diet (FMD). Methods Quantitative data were obtained from the Fasting In diabetes Treatment trial (November 2018 to August 2021) in which 100 participants with T2D, using metformin only or no medication, were randomised to receive a monthly 5-day FMD for twelve months next to usual care, or usual care only. Diet quality and physical activity questionnaires were completed at baseline, six and twelve months. Changes over time were analysed using linear mixed models. Focus groups were organized with FMD participants to explore experiences regarding self-initiated lifestyle changes. The qualitative data was analysed using the Theoretical Domains Framework. Results Questionnaires were available from 49 FMD participants and 43 controls. No differences in diet quality were found. Total physical activity in the FMD participants changed from 34.6 to 38.5 h per week (h/wk) from baseline to twelve months, while in controls it changed from 34.9 to 29.0 h/wk (between group difference, p = 0.03). In six focus groups with FMD participants (n = 20), individual participants perceived the FMD as an encouragement for (minor) lifestyle changes. There were no barriers to behaviour change related to the FMD. Important facilitators of healthy behaviour were an increase in awareness of the impact of lifestyle on health (knowledge), better physical fitness (physical) and health improvement (reinforcement). Facilitators unrelated to the FMD included family support (social influences) and opportunities in the neighbourhood (environmental context and resources), while barriers unrelated to the FMD were experiencing health problems (physical) and social events (social influences). Conclusions Using an FMD for five consecutive days per month did not affect diet quality in between FMD periods in quantitative analysis, but increased the number of hours per week spent on physical activity. Qualitative analysis revealed self-initiated improvements in both diet quality and physical activity in individual participants using an FMD. Healthcare professionals could use an FMD programme as a ‘teachable moment’ to stimulate additional lifestyle changes. Trial registration ClinicalTrials.gov; NCT03811587. Registered 22 January 2019.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2731-4553Test

الوصول الحر: https://doaj.org/article/acf87987958e48b091d479dd4d64e3beTest

المؤلفون: Thomas H.G. Bongaerts, Frederike L. Büchner, Vera Nierkens, Matty R. Crone, Onno R. Guicherit, Mattijs E. Numans

المصدر: BMC Primary Care, Vol 25, Iss 1, Pp 1-9 (2024)

مصطلحات موضوعية: Cancer screening, Participation, General practitioner, Primary care, Netherlands, Medicine (General), R5-920

الوصف: Abstract Background In the Netherlands, population-based cancer screening programmes (CSPs) are organized aiming at cervical, breast and colorectal cancer. For a CSP to be effective, high participation rates are essential; however, there is an alarming downward trend, including wide regional variation in screening uptake. General practitioner (GP) involvement can have a stimulating effect on screening participation. Current GP involvement is however, limited, varies between the programmes and has changed over time. Unexplored is what GPs think of their role(s) in the CSPs. The aim of this study was therefore to map the perceptions and beliefs of GPs regarding their current and future role in the Dutch CSPs. Methods A mixed-methods sequential explanatory study was conducted in the Leiden/The Hague area of the Netherlands, between the end of 2021 and 2022. A questionnaire was developed and distributed among 110 GPs. The aggregated results obtained from the questionnaires served as starting points for conducting semi-structured interviews, with purposefully selected GPs. With this sequential approach we aimed to further enhance the understanding of the questionnaire data, and delved into the topics that emerged from the questionnaire responses. Results In total, 46 GPs completed the online questionnaire (response rate 42%). Subsequent five semi-structured comprehensive interviews were conducted. GPs indicated that they frequently encounter the CSP in their daily practice and consider it important. They also emphasised it is important that GPs remain closely involved with the CSPs in the future. Nevertheless, GPs also repeatedly mentioned that they are not eager to take on more logistical/organizational tasks. They are however willing to empower CSPs in a positive manner. Conclusion GPs were generally positive about the CSPs and their current role within these programmes. Nevertheless, several options have been proposed to improve the CSPs, especially to increase screening uptake for populations in a socioeconomically disadvantaged position. Since it is of utmost importance to screen those who are most at risk of developing the screening-specific tumours, efforts should be made to achieve this goal.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2731-4553Test

الوصول الحر: https://doaj.org/article/a8fa5d47c41f4c44b7bd9f6aefb15d7aTest

المؤلفون: Anna G. Kaal, Rick Roos, Pieter de Jong, Rianne M. C. Pepping, Johanna M. W. van den Berg, Maarten O. van Aken, Ewout W. Steyerberg, Mattijs E. Numans, Cees van Nieuwkoop

المصدر: Scientific Reports, Vol 14, Iss 1, Pp 1-9 (2024)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract Community-acquired Pneumonia (CAP) guidelines generally recommend to admit patients with moderate-to-severe CAP and start treatment with intravenous antibiotics. This study aims to explore the clinical outcomes of oral antibiotics in patients with moderate-to-severe CAP. We performed a nested cohort study of an observational study including all adult patients presenting to the emergency department of the Haga Teaching Hospital, the Netherlands, between April 2019 and May 2020, who had a blood culture drawn. We conducted propensity score matching with logistic and linear regression analysis to compare patients with moderate-to-severe CAP (Pneumonia Severity Index class III–V) treated with oral antibiotics to patients treated with intravenous antibiotics. Outcomes were 30-day mortality, intensive care unit admission, readmission, length of stay (LOS) and length of antibiotic treatment. Of the original 314 patients, 71 orally treated patients were matched with 102 intravenously treated patients. The mean age was 73 years and 58% were male. We found no significant differences in outcomes between the oral and intravenous group, except for an increased LOS of + 2.6 days (95% confidence interval 1.2–4.0, p value

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/475b7201c58941e198a96c2b869f9488Test

المؤلفون: Roeland M. Watjer, Tobias N. Bonten, Koen D. Quint, Mohammad M. Hasani, Mattijs E. Numans, Just A.H. Eekhof

المصدر: BMC Primary Care, Vol 24, Iss 1, Pp 1-7 (2023)

مصطلحات موضوعية: Molluscum contagiosum, Treatment, Survey, General practice, Medicine (General), R5-920

الوصف: Abstract Background Molluscum contagiosum (MC) can cause significant burden in children. So far, pharmacological treatment has not been proven beneficial. More rigorous interventions have not been well studied. Current guidelines advise a “wait and see” policy. However, children and their parents frequently visit their GP requesting intervention. Therefore, the aim of this study was to gain insight into the approach to MC by GPs and parents’ expectations and to investigate willingness to participate in an interventional study. Methods A survey study was carried out among GPs and parents using a questionnaire for each group inquiring about MC and potential study participation. Descriptive statistics were used to analyze results and logistical regression to investigate factors influencing participation. Results The majority of GPs (88%) preferred an expectative approach; only 21% were willing to participate in a trial as proposed. GPs estimating ≥ 50% of parents would request treatment, were more likely to participate. Most responding parents did or would visit their GP requesting treatment. In contrast to GPs, 58% were willing to participate. Parents preferring cryotherapy or curettage were more likely to participate. Conclusion Our study demonstrated that the majority of GPs preferred a conservative approach, adhering to current guidelines. However, most parents preferred treatment to resolve MC and symptoms. Parents’ willingness to participate was much higher than GP’s, reflecting parents’ desire for treatment. These findings underscore the need for continued therapeutic research. Careful preparation and selection of GPs and patients will be essential to ensure the feasibility of such an endeavor. Trial registration This survey study was not part of a clinical trial.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2731-4553Test

الوصول الحر: https://doaj.org/article/84c744a758774aeaa5bba8bcac2f8cd7Test

المؤلفون: Simone van den Bulk, Wouter A. Spoelman, Paul R. M. van Dijkman, Mattijs E. Numans, Tobias N. Bonten, Leiden University Medical Center(LUMC)

المصدر: BMC Primary Care, Vol 23, Iss 1, Pp 1-10 (2022)

مصطلحات موضوعية: Chest pain, Primary care, Coronary artery disease, Communication, Referral rate, Guideline adherence, Medicine (General), R5-920

الوصف: Abstract Background The prevalence of coronary artery disease is increasing due to the aging population and increasing prevalence of cardiovascular risk factors. Non-acute chest pain often is the first symptom of stable coronary artery disease. To optimise care for patients with non-acute chest pain and make efficient use of available resources, we need to know more about the current incidence, referral rate and management of these patients. Methods We used routinely collected health data from the STIZON data warehouse in the Netherlands between 2010 and 2016. Patients > 18 years, with no history of cardiovascular disease, seen by the general practitioner (GP) for non-acute chest pain with a suspected cardiac origin were included. Outcomes were (i) incidence of new non-acute chest pain in primary care, (ii) referral rates to the cardiologist, (iii) correspondence from the cardiologist to the GP, (iv) registration by GPs of received correspondence and; (v) pharmacological guideline adherence after newly diagnosed stable angina pectoris. Results In total 9029 patients were included during the study period, resulting in an incidence of new non-acute chest pain of 1.01/1000 patient-years. 2166 (24%) patients were referred to the cardiologist. In 857/2114 (41%) referred patients, correspondence from the cardiologist was not available in the GP’s electronic medical record. In 753/1257 (60%) patients with available correspondence, the GP did not code the conclusion in the electronic medical record. Despite guideline recommendations, 37/255 (15%) patients with angina pectoris were not prescribed antiplatelet therapy nor anticoagulation, 69/255 (27%) no statin and 67/255 (26%) no beta-blocker. Conclusion After referral, both communication from cardiologists and registration of the final diagnosis by GPs were suboptimal. Both cardiologists and GPs should make adequate communication and registration a priority, as it improves health outcomes. Secondary pharmacological prevention in patients with angina pectoris was below guideline standards. So, proactive attention needs to be given to optimise secondary prevention in this high-risk group in primary care.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2731-4553Test

الوصول الحر: https://doaj.org/article/e44382981bd94307899686967f65c00cTest

المؤلفون: Willemijn Tros, Jenny T. van der Steen, Janine Liefers, Reinier Akkermans, Henk Schers, Mattijs E. Numans, Petra G. van Peet, A. Stef Groenewoud

المصدر: BMC Primary Care, Vol 23, Iss 1, Pp 1-9 (2022)

مصطلحات موضوعية: Advance care planning, Cancer, Organ failure, Multimorbidity, General practice, Electronic health record, Medicine (General), R5-920

الوصف: Abstract Background Timely initiation of advance care planning (ACP) in general practice is challenging, especially in patients with non-malignant conditions. Our aim was to investigate how perceived optimal timing of ACP initiation and its triggers relate to recorded actual timing in patients with cancer, organ failure, or multimorbidity. Methods In this mixed-methods study in the Netherlands, we analysed health records selected from a database with primary care routine data and with a recorded ACP conversation in the last two years before death of patients who died with cancer, organ failure, or multimorbidity. We compared actual timing of ACP initiation as recorded in health records of 51 patients with the perceived optimal timing as determined by 83 independent GPs who studied these records. Further, to identify and compare triggers for GPs to initiate ACP, we analysed the health record documentation around the moments of the recorded actual timing of ACP initiation and the perceived optimal timing of ACP initiation. We combined quantitative descriptive statistics with qualitative content analysis. Results The recorded actual timing of ACP initiation was significantly closer to death than the perceived optimal timing in patients with cancer (median 88 vs. 111 days before death (p = 0.049)), organ failure (227 vs. 306 days before death (p = 0.02)) and multimorbidity (113 vs. 338 days before death (p = 0.006)). Triggers for recorded actual versus perceived optimal timing were similar across the three groups, the most frequent being ‘expressions of patients’ reflections or wishes’ (14% and 14% respectively) and ‘appropriate setting’ (10% and 13% respectively). Conclusion ACP in general practice was initiated and recorded later in the illness trajectory than considered optimal, especially in patients with organ failure or multimorbidity. As triggers were similar for recorded actual and perceived optimal timing, we recommend that GPs initiate ACP shortly after a trigger is noticed the first time, rather than wait for additional or more evident triggers when the illness is in an advanced stage.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2731-4553Test

الوصول الحر: https://doaj.org/article/c4115ebad8a948fcb0787cdb26cfdd09Test

المؤلفون: Zoë T. M. Scheefhals, Eline F. de Vries, Joyce M. Molenaar, Mattijs E. Numans, Jeroen N. Struijs

المصدر: International Journal of Integrated Care, Vol 23, Pp 20-20 (2023)

مصطلحات موضوعية: observational data, routinely collected data, health policy, integrated care, integrated maternity care, data-infrastructure, Medicine (General), R5-920

الوصف: Introduction: Observational data are increasingly seen as a valuable source for integrated care research. Especially since the growing availability of routinely collected data and quasi-experimental methods. The aim of this paper is to describe the potentials and challenges when using observational data for integrated maternity care research, based on our experience from developing and working with the Data-InfrAstructure for ParEnts and childRen (DIAPER). Methods and Results: We provide a description of DIAPER, which is a linked data-infrastructure on the individual level based on maternity care claims data, quality and utilization of maternity care and data from municipal registries, covering the life course from preconception to adulthood. We then discuss potentials and practical applications of DIAPER such as to evaluate alternative payment models for integrated maternity care, to set the policy agenda regarding postpartum care, to provide insights into value of care and into provider variation, and to evaluate (policy) interventions designed to promote and support integrated maternity care. This is relevant for several stakeholders: policy makers, payers, providers and clients/patients. Based on experiences with DIAPER, we identify remaining challenges: missing data sources (especially self-reported outcomes), suboptimal quality of data, privacy concerns and potential biases introduced during data linkage, and describe how these challenges were tackled within the applications of DIAPER. Conclusions: With DIAPER we demonstrated that using observational data can be of added value for integrated care research, but also that challenges remain. It is essential to keep exploring and developing the possibilities of observational data and continue the discussions in the scientific community. Learning from each other’s successes and failures will be critical.

وصف الملف: electronic resource

العلاقة: https://account.ijic.org/index.php/up-j-ijic/article/view/7012Test; https://doaj.org/toc/1568-4156Test

الوصول الحر: https://doaj.org/article/fb6920eed4c445a28333c07eab5d9059Test

المؤلفون: Thomas H. G. Bongaerts, Frederike L. Büchner, Matty R. Crone, Job van Exel, Onno R. Guicherit, Mattijs E. Numans, Vera Nierkens

المصدر: BMC Public Health, Vol 22, Iss 1, Pp 1-12 (2022)

مصطلحات موضوعية: Cancer screening, Participation, Uptake, Perspectives, Q-methodology, I-Change model, Public aspects of medicine, RA1-1270

الوصف: Abstract Background The Netherlands hosts, as many other European countries, three population-based cancer screening programmes (CSPs). The overall uptake among these CSPs is high, but has decreased over recent years. Especially in highly urbanized regions the uptake rates tend to fall below the minimal effective rate of 70% set by the World Health Organization. Understanding the reasons underlying the decision of citizens to partake in a CPS are essential in order to optimize the current screening participation rates. The aim of this study was to explore the various perspectives concerning cancer screening among inhabitants of The Hague, a highly urbanized region of the Netherlands. Methods A Q-methodology study was conducted to provide insight in the prevailing perspectives on partaking in CSPs. All respondents were inhabitants of the city of The Hague, the Netherlands. In an online application they ranked a set of 31 statements, based on the current available literature and clustered by the Integrated Change model, into a 9-column forced ranking grid according to level of agreement, followed by a short survey. Respondents were asked to participate in a subsequent interview to explain their ranking. By-person factor analysis was used to identify distinct perspectives, which were interpreted using data from the rankings and interviews. Results Three distinct perspectives were identified: 1). “Positive about participation”, 2). “Thoughtful about participation”, and 3). “Fear drives participation”. These perspectives provide insight into how potential respondents, living in an urbanized region in the Netherlands, decide upon partaking in CSPs. Conclusions Since CSPs will only be effective when participation rates are sufficiently high, it is essential to have insight into the different perspectives among potential respondents concerning partaking in a CSP. This study adds new insights concerning these perspectives and suggests several ideas for future optimization of the CSPs.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2458Test

الوصول الحر: https://doaj.org/article/c6bc23d7848f4510a774c15b99cd11deTest

المؤلفون: Rosa Naomi Minderhout, Mattijs E. Numans, Hedwig M. M. Vos, Marc A. Bruijnzeels

المصدر: BMC Research Notes, Vol 15, Iss 1, Pp 1-6 (2022)

مصطلحات موضوعية: Triple aim, Population health management, Acute care services, Integrated care, Evaluate, Crowding, Medicine, Biology (General), QH301-705.5, Science (General), Q1-390

الوصف: Abstract Objective The accessibility of acute care services is currently under pressure, and one way to improve services is better integration. Adequate methodology will be required to provide for a clear and accessible evaluation of the various intervention initiatives. The aim of this paper is to develop and propose a Population Health Management(PHM) methodology framework for evaluation of transitions in acute care services. Results Our methodological framework is developed from several concepts found in literature, including Triple Aim, integrated care and PHM, and includes continuous monitoring of results at both project and population levels. It is based on a broad view of health rather than focusing on a specific illness and facilitates the evaluation of various intervention initiatives in acute care services in the Netherlands and distinctly explains every step of the evaluation process and can be applied to a heterogeneous group of patients.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1756-0500Test

الوصول الحر: https://doaj.org/article/20b36bc72e0543738680d6dd3f24e488Test

المؤلفون: Hendrikus J. A. van Os, Jos P. Kanning, Tobias N. Bonten, Margot M. Rakers, Hein Putter, Mattijs E. Numans, Ynte M. Ruigrok, Rolf H. H. Groenwold, Marieke J. H. Wermer

المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 12, Iss 7 (2023)

مصطلحات موضوعية: cardiovascular risk, prediction, sex differences, young adults, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background Prediction models for risk of cardiovascular events generally do not include young adults, and cardiovascular risk factors differ between women and men. Therefore, this study aimed to develop prediction models for first‐ever cardiovascular event risk in men and women aged 30 to 49 years. Methods and Results We included patients aged 30 to 49 years without cardiovascular disease from a Dutch routine care database. Outcome was defined as first‐ever cardiovascular event. Our reference models were sex‐specific Cox proportional hazards models based on traditional cardiovascular predictors, which we compared with models using 2 predictor subsets with the 20 or 50 most important predictors based on the Cox elastic net model regularization coefficients. We assessed the C‐index and calibration curve slopes at 10 years of follow‐up. We stratified our analyses based on 30‐ to 39‐year and 40‐ to 49‐year age groups at baseline. We included 542 141 patients (mean age 39.7, 51% women). During follow‐up, 10 767 cardiovascular events occurred. Discrimination of reference models including traditional cardiovascular predictors was moderate (women: C‐index, 0.648 [95% CI, 0.645–0.652]; men: C‐index, 0.661 [95%CI, 0.658–0.664]). In women and men, the Cox proportional hazard models including 50 most important predictors resulted in an increase in C‐index (0.030 and 0.012, respectively), and a net correct reclassification of 3.7% of the events in women and 1.2% in men compared with the reference model. Conclusions Sex‐specific electronic health record‐derived prediction models for first‐ever cardiovascular events in the general population aged

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2047-9980Test

الوصول الحر: https://doaj.org/article/6b0ad05b002e4f5ab805d27ebcee86dfTest