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Unlocking value in healthcare:barriers and success factors in the introduction of value-based payment models in the Dutch healthcare system
No full textThis dissertation explores the barriers and success factors of VBP models that influence their design, implementation, and application within the context of NOC and transmural care in the Netherlands. In doing so, this dissertation is expected to further aid the VBHC reform in the country. This dissertation identifies elements that enhance or inhibit the design, implementation, and application/evaluation of VBP models. It also analyzes the impact of different types of models on outcomes and reviews what facilitating and inhibiting factors are associated to each model type. These facilitating and inhibiting elements are also studied considering stakeholders’ insights in a Dutch network. Furthermore, this dissertation explores the introduction of a VBP model monitoring method and shares the results of its application in the Netherlands. Lastly, this dissertation takes a step back from the VBP models and analyzes the complex elements that shape the contractual negotiations between hospitals and health insurers in the Netherlands, examining why VBHC, despite its advantages, has not received more attention in this negotiation process
Developing the Mental Effort and Load-Translingual Scale (MEL-TS) as a Foundation for Translingual Research in Self-Regulated Learning
No full textAssessing cognitive demand is crucial for research on self-regulated learning; however, discrepancies in translating essential concepts across languages can hinder the comparison of research findings. Different languages often emphasize various components and interpret certain constructs differently. This paper aims to develop a translingual set of items distinguishing between intentionally invested mental effort and passively perceived mental load as key differentiations of cognitive demand in a broad range of learning situations, as they occur in self-regulated learning. Using a mixed-methods approach, we evaluated the content, criterion, convergent, and incremental validity of this scale in different languages. To establish content validity, we conducted qualitative interviews with bilingual participants who discussed their understanding of mental effort and load. These participants translated and back-translated established and new items from the cognitive-demand literature into English, Dutch, Spanish, German, Chinese, and French. To establish criterion validity, we conducted preregistered experiments using the English, Chinese, and German versions of the scale. Within those experiments, we validated the translated items using established demand manipulations from the cognitive load literature with first-language participants. In a within-subjects design with eight measurements (N = 131), we demonstrated the scale's criterion validity by showing sensitivity to differences in task complexity, extraneous load manipulation, and motivation for complex tasks. We found evidence for convergent and incremental validity shown by medium-size correlations with established cognitive load measures. We offer a set of translated and validated items as a common foundation for translingual research. As best practice, we recommend four items within a reference point evaluation
Systematic optimization and evaluation of a Dutch sexual health intervention:Role model stories for chlamydia prevention, testing, and treatment
No full textBackground The rapidly evolving nature of eHealth necessitates regular optimization and subsequent evaluation. Within the Dutch sexual health intervention Sense.info, we utilized a mixed-methods cyclic evaluation process to assess and optimize the potential impact of the chlamydia page. This paper reports on the page's optimization through the development of role model stories for chlamydia prevention and the subsequent evaluation of these stories.Method The experiences of 10 young individuals served as the basis of role model stories using the behavior change principle modeling based on social cognitive theory. These stories aimed to motivate young individuals to undergo sexually transmitted infection testing, use condoms, and notify sexual partners. Once the stories were posted online, we tracked use data between July and September 2022 and investigated end-user perspectives through a think-aloud study combined with semistructured interviews (N = 20, Mage = 19.7, SDage = 2.65). Template analyses were used for the analysis of the think-aloud study.Results Use data revealed that all stories were accessed by website visitors, yet other page elements on the chlamydia page interacted with more. The exploration of end-user perspectives indicated a positive impact of the personal stories on normalization, self-efficacy, and skills related to chlamydia preventive behaviors. Mixed results were found regarding some conditions for the effectiveness of the behavior change principle modeling.Discussion and conclusion This study provided valuable insights into the cyclic evaluation process for evaluating and optimizing web-based public health interventions, as well as the potential impact of role model stories on sexual health prevention. Also, aspects of the stories that could be optimized in future optimization rounds were identified. Overall, this research contributes to enhancing the impact of eHealth interventions through iterative evaluation and optimization processes
An exploration of governance in teaching hospitals in the Netherlands focused on educational objectives
No full textBackgroundMany countries are improving medical education in teaching hospitals through more focus on internal quality assurance, for example by creating new stakeholders like hospital-wide education committees. Adequate oversight is thought essential to ensure the quality of medical education. How teaching hospitals distribute roles and responsibilities for quality control across educational stakeholders to organize this oversight is rarely investigated. This study aims to answer the following exploratory question: Who are the primary stakeholders involved in educational governance, and what are their roles in safeguarding educational quality in teaching hospitals?MethodsWe conducted an exploratory qualitative study of educational governance structures in all teaching hospitals in the Netherlands with at least three training programs. We carried out document analysis of recent governance codes, documents drafted by Dutch teaching hospitals to describe their methods of internal governance for the national accreditor, and analyzed the data using a thematic analysis approach through the lens of organizational theories of Mintzberg and Freidson.ResultsThe study identified key stakeholders in quality management of medical education in all teaching hospitals of the Netherlands. An overview of their roles and responsibilities is given and a stakeholder map is drafted. Teaching hospitals gave the hospital-wide education committee three different roles: an advisory role, a quality controller role and a conflict mediation role.DiscussionHospitals have set up the assignment of decision-making power in different ways, creating different variants of hospital-wide education committees and potentially causing them to be less effective at quality management. Whether these different roles affect the quality management of medical education in practice requires practice-oriented research. The study reveals remarkable ambiguity regarding the assignment and exercise of decision-making power between actors. This study contributes to the literature by identifying key actors and their roles in the quality management of postgraduate medical education, providing a foundation for follow-up research
Still Lost in the Mall:False Memories Happen and That's What Matters
No full textFor more than 25 years, psychologists have explored how people can develop rich false memories. Murphy et al. (2023) replicated the original “lost in the mall” study (Loftus and Pickrell 1995), demonstrating that 35% of participants developed false beliefs or memories. Andrews and Brewin (in press) reanalyzed Murphy et al.'s data, concluding that participants who developed false memories reported 25% of the suggested details and 50% of their reports were potentially real memories. Based on this, Andrews and Brewin posited that only 4% of Murphy et al.'s participants developed false memories. We take issue with Andrews and Brewin's conclusions. Given human memory is reconstructive, we should expect participants' reports to contain remnants of accurate memories, self or schematic knowledge, or speculation. Moreover, even low false memory rates can be practically important. What matters is that suggestive influences can lead to substantial memory distortions and even plant new events that had not occurred
No proportional relationship between shape and size of the femoral canal and the external proximal femur morphology in elderly patients
No full textIntroduction: The proximal femur morphology changes with age, which may complicate the compatibility of contemporary cementless stem designs in very elderly patients. This study investigated the internal and external proximal femur morphology, correlated canal dimensions with external dimensions, and examined whether age-associated changes in the femoral canal and external morphology are related in subjects aged 80 years and older. Methods: Three-dimensional models of human femora were reconstructed from computed tomographic (CT) scans of 90 very elderly subjects (mean 84 years, range 80–105 years). Morphological parameters describing the location of the femoral head center (FHC) (i.e. neck-shaft angle [NSA], mediolateral offset [ML-offset], and distance between lesser trochanter (LT) and FHC [LT-FHC]) and parameters describing the canal morphology (i.e. the cortices, canal dimensions, and canal flare index [CFI]) were measured. Regression and correlation analyses were performed in order to assess the relation between internal and external morphology. Results: No significant associations regarding dimensions nor geometry between internal and external femur morphology could be detected. Canal dimensions were not able to predict the external dimensions more accurately than the deviation between the individual value and the mean value for the total cohort. Conclusions: Based on these findings, proportional sizing of the cementless femoral component is not necessarily endorsed in very elderly patients, and age-associated changes of the femoral canal and external morphology do not appear to be related. However, further research is needed to evaluate the ability of contemporary non-modular cementless stems to anatomically reconstruct the proximal femur in very elderly patients specifically
Efficient and reproducible differentiation protocol for pluripotent stem cells into functional endothelial cells:Unveiling the path to vascular regeneration
No full textIntroduction: Endothelial cells (ECs) play a crucial role in many treatments for cardiovascular diseases, such as blood vessel repair, tissue engineering, and drug delivery. The process of differentiating these cells is complex and involves various sources and numerous molecular and cellular events. Differentiating pluripotent stem cells (PSCs) into endothelial cells are one of the most effective sources for creating ECs in the lab and offers great potential for regenerative medicine. However, different cell types can appear during differentiation process. Objectives: This study presents a reliable and reproducible protocol for efficiently differentiating human pluripotent stem cells (hPSCs) into mature endothelial cells with high purity (>98%). Methods: FLK1+ cells were isolated from hPSCs using fluorescence-activated cell sorting (FACS). Then isolated FLK1+ cells differentiated into high-purity endothelial cells (ECs) by adding endothelial growth factors (VEGF, FGF, and EGM-2 medium). The differentiated ECs were extensively characterized by evaluating key endothelial markers and assessing their functional abilities, such as tube formation and response to angiogenic signals. Finally, the ECs were further purified using a second FACS step with a CD31 antibody. Results: The differentiated hPSC-derived endothelial cells (hPSC-ECs) expressed high levels of PECAM-1 (CD31), VE-cadherin (CD144), and von Willebrand factor (vWF), with more than 98% of the cells showing these markers. Additionally, the hPSC-ECs formed tubular structures and effectively took up acetylated fluorescently-labeled low-density lipoprotein (DiI-ac-LDL), demonstrating their functionality as endothelial cells. Conclusion: Our study clarifies the molecular mechanisms involved in the differentiation of hPSCs into endothelial cells, emphasizing key signaling pathways important for determining endothelial cell fate. These findings provide a framework for the scalable production of transplantable endothelial cells, representing a significant advancement in personalized therapies and tissue engineering for regenerative medicine
Close to the border—Resilience in healthcare in a European border region:Findings of a needs analysis
No full textObjectives Promoting resilience, the ability to withstand and overcome challenging situations, is crucial for maintaining the performance of healthcare systems. Unique challenges faced by healthcare facilities in border regions render them particularly vulnerable during crises, emphasizing the need to promote resilience in these areas. The current study evaluated the state and needs of resilience in healthcare professionals in a representative European border region. Methods All hospitals and emergency medical care services in the Euregio Meuse-Rhine (Germany, Belgium, the Netherlands) were approached to participate via an online-survey. Behavioral data on psychological distress (Patient Health Questionnaire-4), work-related stressors, individual resilience (Brief Resilience Scale, Resilience at Work scale), and organizational resilience (Benchmark Resilience Tool-short) were collected. Results 2233 participants initiated the survey with 500 responses included in the analysis. 46% of the participants indicated clinically significant psychological distress. Most challenging stressors were staff availability, available time, and workload. On average, individual resilience was in the normal range, yet 15.6% showed below average resilience. At the organizational level, healthcare institutions can particularly enhance resilience in the domains of Internal resources, Situation Awareness, and Unity of purpose. Compared to their neighbor countries, German healthcare professionals indicated higher levels of depressive symptoms, were more burdened by work-related stressors, and reported lower levels of organizational resilience. Conclusion Findings highlight that healthcare institutions not only need to promote the resilience of the individual employee particularly in border regions, healthcare institutions, must also act to be better prepared for potential threats and crises while considering each country’s unique needs
Understanding the determinants and outcomes of education in pulmonary rehabilitation:Moving Toward Person-Centered Care
No full textTopic Importance: Education and psychosocial support are essential components of pulmonary rehabilitation (PR). However, the delivery of education often follows a one-size-fits-all approach, with individual factors that influence learning rarely considered. Moreover, education-related outcomes are frequently overlooked in PR assessments, and their inconsistent use has limited our understanding of education's impact on people with chronic respiratory diseases. There is a clear need for practical guidance to identify key learning determinants and to define targeted education outcomes, ultimately optmizing PR and establishing quality standards. Review Findings: Cognitive function, health literacy, psychological status, and social connection can influence an individual's ability to learn. Without proper consideration and assessment, these factors can otherwise become barriers to education and effective self-management. Education in PR should aim to: (1) improve individuals' knowledge to foster informed and active participants; (2) develop their skills to enable autonomy and competence; and (3) enhance their confidence to apply this knowledge and skills in daily life. This review emphasizes the importance of person-centered education in PR, provides a framework for understanding which education-related outcomes to target, and highlights the need for future research to enhance this essential component.</p
RADAR-AD:assessment of multiple remote monitoring technologies for early detection of Alzheimer's disease
No full textBACKGROUND: Alzheimer's disease (AD) is a progressive neurodegenerative disorder affecting millions worldwide, leading to cognitive and functional decline. Early detection and intervention are crucial for enhancing the quality of life of patients and their families. Remote Monitoring Technologies (RMTs) offer a promising solution for early detection by tracking changes in behavioral and cognitive functions, such as memory, language, and problem-solving skills. Timely detection of these symptoms can facilitate early intervention, potentially slowing disease progression and enabling appropriate treatment and care. METHODS: The RADAR-AD study was designed to evaluate the accuracy and validity of multiple RMTs in detecting functional decline across various stages of AD in a real-world setting, compared to standard clinical rating scales. Our approach involved a univariate analysis using Analysis of Covariance (ANCOVA) to analyze individual features of six RMTs while adjusting for variables such as age, sex, years of education, clinical site, BMI and season. Additionally, we employed four machine learning classifiers - Logistic Regression, Decision Tree, Random Forest, and XGBoost - using a nested cross-validation approach to assess the discriminatory capabilities of the RMTs. RESULTS: The ANCOVA results indicated significant differences between healthy and AD subjects regarding reduced physical activity, less REM sleep, altered gait patterns, and decreased cognitive functioning. The machine-learning-based analysis demonstrated that RMT-based models could identify subjects in the prodromal stage with an Area Under the ROC Curve of 73.0 %. In addition, our findings show that the Amsterdam iADL questionnaire has high discriminatory abilities. CONCLUSIONS: RMTs show promise in AD detection already in the prodromal stage. Using them could allow for earlier detection and intervention, thereby improving patients' quality of life. Furthermore, the Amsterdam iADL questionnaire holds high potential when employed remotely