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Search Results: 1 - 10 of 671 matches for " Augustinus JP Schrijvers "
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The effect of acute kidney injury on long-term health-related quality of life: a prospective follow-up study
José GM Hofhuis, Henk F van Stel, Augustinus JP Schrijvers, Johannes H Rommes, Peter E Spronk
Critical Care , 2013, DOI: 10.1186/cc12491
Abstract: The pre-admission HRQOL (by proxy) of AKI survivors was significant lower in two dimensions compared with the age matched general population. Six months after ICU discharge survivors with and without AKI showed an almost similar HRQOL. However, compared with the general population with a similar age, HRQOL was poorer in both groups.
Quality of life before intensive care unit admission is a predictor of survival
José GM Hofhuis, Peter E Spronk, Henk F van Stel, Augustinus JP Schrijvers, Jan Bakker
Critical Care , 2007, DOI: 10.1186/cc5970
Abstract: We conducted a prospective cohort study in a university-affiliated teaching hospital. Patients admitted to the ICU for longer than 48 hours were included. Close relatives completed the Short-form 36 (SF-36) within the first 48 hours of admission to assess pre-admission HRQOL of the patient. Mortality was evaluated from ICU admittance until 6 months after ICU discharge. Logistic regression and receiver operating characteristic analyses were used to assess the predictive value for mortality using five models: the first question of the SF-36 on general health (model A); HRQOL measured using the physical component score (PCS) and mental component score (MCS) of the SF-36 (model B); the Acute Physiology and Chronic Health Evaluation (APACHE) II score (an accepted mortality prediction model in ICU patients; model C); general health and APACHE II score (model D); and PCS, MCS and APACHE II score (model E). Classification tables were used to assess the sensitivity, specificity, positive and negative predictive values, and likelihood ratios.A total of 451 patients were included within 48 hours of admission to the ICU. At 6 months of follow up, 159 patients had died and 40 patients were lost to follow up. When the general health item was used as an estimate of HRQOL, area under the curve for model A (0.719) was comparable to that of model C (0.721) and slightly better than that of model D (0.760). When PCS and MCS were used, the area under the curve for model B (0.736) was comparable to that of model C (0.721) and slightly better than that of model E (0.768). When using the general health item, the sensitivity and specificity in model D (sensitivity 0.52 and specificity 0.81) were similar to those in model A (0.45 and 0.80). Similar results were found when using the MCS and PCS.This study shows that the pre-admission HRQOL measured with either the one-item general health question or the complete SF-36 is as good at predicting survival/mortality in ICU patients as the APACHE I
The consumer quality index (CQ-index) in an accident and emergency department: development and first evaluation
Bos Nanne,Sturms Leontien M,Schrijvers Augustinus JP,van Stel Henk F
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-284
Abstract: Background Assessment of patients’ views are essential to provide a patient-centred health service and to evaluating quality of care. As no standardized and validated system for measuring patients’ experiences in accident and emergency departments existed, we have developed the Consumer Quality index for the accident and emergency department (CQI A&E). Methods Qualitative research has been undertaken to determine the content validity of the CQI A&E. In order to assess psychometric characteristics an 84-item questionnaire was sent to 653 patients who had attended a large A&E in the Netherlands. Also, fifty importance questions were added to determine relevance of the questions and for future calculations of improvement scores. Exploratory factor analysis was applied to detect the domains of the questionnaire. Results Survey data of 304 (47%) patients were used for the analysis. The first exploratory factor analysis resulted in three domains based on 13 items: ‘Attitude of the healthcare professionals’, ‘Environment and impression of the A&E’ and ‘Respect for and explanation to the patient’. The first two had an acceptable internal consistency. The second analysis, included 24 items grouped into 5 domains: ‘Attitude of the healthcare professionals’, ‘Information and explanation’, ‘Environment of the A&E’,’Leaving the A&E’ and ‘General information and rapidity of care’. All factors were internal consistent. According to the patients, the three most important aspects in healthcare performance in the A&E were: trust in the competence of the healthcare professionals, hygiene in the A&E and patients’ health care expectations. In general, the highest improvement scores concerned patient information. Conclusions The Consumer Quality index for the accident and emergency department measures patients’ experiences of A&E healthcare performance. Preliminary psychometric characteristics are sufficient to justify further research into reliability and validity.
Conceptual issues specifically related to health-related quality of life in critically ill patients
José GM Hofhuis, Henk F van Stel, Augustinus JP Schrijvers, Johannes H Rommes, Jan Bakker, Peter E Spronk
Critical Care , 2009, DOI: 10.1186/cc7699
Abstract: Traditionally, assessment of critical care has focused largely on survival. However, during recent years attention has increasingly been paid to the quality of that survival – an important issue for patients and their families [1]. Patients recovering from critical illness may exhibit impaired functional status, with associated reduced health-related quality of life (HRQOL). Recent studies conducted in critically ill patients have measured HRQOL, but an evaluation of conceptual issues is usually missing from such reports [2]. Here we discuss specifically these conceptual issues.Development of intensive care unit (ICU) technology has grown rapidly during the past few years, enabling ICU staff to sustain and restore the lives of critically ill patients who otherwise would have died. In the past, survival alone was enough to justify any intervention, but the current climate of budgetary constraint and the high costs of many interventions have made ICU staff increasingly aware of the importance of HRQOL measurement [3]. An important issue is how ICU patients feel and function. This information seems essential for making decisions at the bedside, but it is also important in the evaluation of the efficacy and efficiency of ICU interventions [4]. HRQOL investigation in critically ill patients can help to address these issues of long-term prognosis [4].In HRQOL studies in general, as well as those specifically in critically ill patients, there is a lack of a clear framework for defining and describing HRQOL. Measuring HRQOL is in essence evaluating the health status of individuals, both mental and physical, together with their own sense of well being [5]. The World Health Organization defines health not only as the absence of infirmity and disease, but also as a state of physical, mental and social well being [6]. By using this definition we can define HRQOL.It is rarely possible to assess the effects of critical illness or ICU treatment on HRQOL because the patient's condi
How do COPD patients respond to exacerbations?
Jaap CA Trappenburg, David Schaap, Evelyn M Monninkhof, Jean Bourbeau, Gerdien H de Weert-van Oene, Theo JM Verheij, Jan-Willem J Lammers, Augustinus JP Schrijvers
BMC Pulmonary Medicine , 2011, DOI: 10.1186/1471-2466-11-43
Abstract: In a multicentre observational study, 121 patients (age 67 ± 11 years, FEV1pred. 48 ± 19) were followed for 6 weeks by daily diary symptom recording. Three types of action were assessed daily: planning periods of rest, breathing techniques and/or sputum clearing (type-A), increased bronchodilator use (type-B) and contacting a healthcare provider (type-C).Type-A action was taken in 70.7%, type-B in 62.7% and type C in 17.3% of exacerbations (n = 75). Smokers were less likely to take type-A and B actions. Type-C actions were associated with more severe airflow limitation and increased number of hospital admissions in the last year.Our study shows that most patients are willing to take timely self-management actions during exacerbations. Future research is needed to determine whether the low incidence of contacting a healthcare provider is due to a lack of self-management or healthcare accessibility.Chronic obstructive pulmonary disease (COPD) is characterised by a progressive decline in respiratory function, exercise capacity and health status [1]. This underlying disease state is interrupted by episodes of acute worsening in respiratory symptoms. If these deteriorations are beyond individual day-to-day variability, these are defined as exacerbations [2]. It is widely recognized that acute exacerbations play a central role in COPD-related morbidity and mortality [1]. Exacerbations are associated with marked physiologic deterioration that may affect disease progression by accelerating reductions in forced expiratory volume in 1 s (FEV1) [3,4], have a significant negative effect on the individual's health-related quality of life (HRQoL) [5,6] and generate an increasing burden on health services and economic costs [7]. Several studies have shown that almost 50% of exacerbations remain unreported and subsequently do not receive adequate treatment [8-10]. Although unreported exacerbations are often considered to be mild, recent studies have shown that these exacerbations m
Detecting exacerbations using the Clinical COPD Questionnaire
Jaap CA Trappenburg, Irene Touwen, Gerdien H de Weert-van Oene, Jean Bourbeau, Evelyn M Monninkhof, Theo JM Verheij, Jan-Willem J Lammers, Augustinus JP Schrijvers
Health and Quality of Life Outcomes , 2010, DOI: 10.1186/1477-7525-8-102
Abstract: The Clinical COPD Questionnaire (CCQ) is a short questionnaire with great evaluative properties in measuring health status. The current explorative study evaluates the discriminative properties of weekly CCQ assessment in detecting exacerbations.In a multicentre prospective cohort study, 121 patients, age 67.4 ± 10.5 years, FEV1 47.7 ± 18.5% pred were followed for 6 weeks by daily diary card recording and weekly CCQ assessment. Weeks were retrospectively labeled as stable or exacerbation (onset) weeks using the Anthonisen symptom diary-card algorithm. Change in CCQ total scores are significantly higher in exacerbation-onset weeks, 0.35 ± 0.69 compared to -0.04 ± 0.37 in stable weeks (p < 0.001). Performance of the Δ CCQ total score discriminating between stable and exacerbation onset weeks was sufficient (area under the ROC curve 0.75). At a cut off point of 0.2, sensitivity was 62.5 (50.3-73.4), specificity 82.0 (79.3-84.4), and a positive and negative predictive value of 43.5 (35.0-51.0) and 90.8 (87.8-93.5), respectively. Using this cut off point, 22 (out of 38) unreported exacerbations were detected while 39 stable patients would have been false positively 'contacted'.Weekly CCQ assessment is a promising, low burden method to detect unreported exacerbations. Further research is needed to validate discriminative performance and practical implications of the CCQ in detecting exacerbations in daily care.Chronic Obstructive Pulmonary Disease (COPD) is a progressive chronic disease, characterized by an irreversible decline in lung function, exercise capacity and health status. The natural history of COPD is interrupted by exacerbations: episodes of worsening symptoms and signs, accelerating lung function decline [1,2] and responsible for decreased health related quality of life (HRQoL)[3,4], increased mortality [5,6] and health-care costs[7,8].Irrespective of the definition of exacerbation used, the clinical diagnosis points to an acute clinical worsening that may ne
Action Plan to enhance self-management and early detection of exacerbations in COPD patients; a multicenter RCT
Jaap CA Trappenburg, Lieselotte Koevoets, Gerdien H de Weert-van Oene, Evelyn M Monninkhof, Jean Bourbeau, Thierry Troosters, Theo JM Verheij, Jan-Willem J Lammers, Augustinus JP Schrijvers
BMC Pulmonary Medicine , 2009, DOI: 10.1186/1471-2466-9-52
Abstract: The current multicenter, single-blind RCT with a follow-up period of 6 months, evaluates the hypothesis that individualized AP's reduce exacerbation recovery time. Patients are included from regular respiratory nurse clinics and allocated to either usual care or the AP intervention. The AP provides individualized treatment prescriptions (pharmaceutical and non-pharmaceutical) related to a color coded symptom status (reinforcement at 1 and 4 months). Although usually not possible in self-management trials, we ensured blinding of patients, using a modified informed consent procedure in which patients give consent to postponed information. Exacerbations in both study arms are defined using the Anthonisen symptom diary-card algorithm. The Clinical COPD Questionnaire (CCQ) is assessed every 3-days. CCQ-recovery time of an exacerbation is the primary study outcome. Additionally, healthcare utilization, anxiety, depression, treatment delay, and self-efficacy are assessed at baseline and 6 months. We aim at including 245 COPD patients from 7 hospitals and 5 general practices to capture the a-priori sample size of at least 73 exacerbations per study arm.This RCT identifies if an AP is an effective component of self-management in patients with COPD and clearly differentiates from existing studies in its design, outcome measures and generalizability of the results considering that the study is carried out in multiple sites including general practices.NCT00879281Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. This airflow limitation is usually progressive and associated with an abnormal response to noxious particles or gases [1]. COPD is a major cause of morbidity and mortality throughout the world[2]. Its stable state is interrupted by periods of worsening symptoms which vary in severity and frequency both during the course of a patient's illness and between patients. Depending on aetiology and severity, these p
Study Protocol- An exploratory trial on health promoting schools at Dutch secondary schools
Vincent Busch,Rob Johannes De Leeuw,Augustinus Jacobus Schrijvers
International Journal of Integrated Care , 2012,
Abstract: Background: Recent studies show adolescent health-related behaviours to co-occur synergistically. This paper describes the study design for an exploratory trial on the effects of a comprehensive, whole-school health promoting school intervention. This intervention tackles seven different behavioural domains simultaneously via a combination of education, creating a healthy environment and introducing healthy behavioural policies. Additionally, extensive partnerships are formed between schools, parents, neighbourhoods and youth health authorities to coordinate health promotion efforts. Study design and data collection methods: The intervention will be implemented at two secondary schools. Results will be compared with two control schools (n≈1500). The intervention's effectiveness in changing student behaviours as well as physical and psychosocial health status along with qualitative lessons learned on the integration of youth health care services and school health education practices are the main aimed outcomes of this study. Data are collected via a mixed methods design combining an annual youth health (behaviour) monitor with a qualitative process evaluation via interviews with key stakeholders. Data analysis: A multilevel analysis is performed combined with a systematic analysis of qualitative interview data. Conclusions: This study will produce an evaluation of a comprehensive health promoting school intervention that combines an integrated approach of schools, neighbourhoods, families and youth health services to improve adolescent health.
Validity and reliability of a structured interview for early detection and risk assessment of parenting and developmental problems in young children: a cross-sectional study
Henk F van Stel, Ingrid I E Staal, Jo M A Hermanns, Augustinus J P Schrijvers
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-71
Abstract: A cross-sectional study of 2012 18-month-old children, living in Zeeland, a province of the Netherlands. Inter-rater reliability was assessed in 67 children. Convergent validity was assessed by comparing SPARK-domains with domains in self-report questionnaires on child development and parenting stress. Discriminative validity was assessed by comparing different outcomes of the SPARK between groups with different levels of socio-economic status and by performing an extreme-groups comparison. The user experience of both parents and nurses was assessed with the aid of an online survey.The response rate was 92.1% for the SPARK. Self-report questionnaires were returned in the case of 66.9% of the remaining 1721 children. There was selective non-reporting: 33.1% of the questionnaires were not returned, covering 65.2% of the children with a high-risk label according to the SPARK (p?<?0.001). Inter-rater reliability was good to excellent with intraclass correlations between 0.85 and 1.0 for physical topics; between 0.61 and 0.8 for social-emotional topics and 0.92 for the overall risk assessment. Convergent validity was unexpectedly low (all correlations ≤0.3) although the pattern was as expected. Discriminative validity was good. Users were satisfied with the SPARK and identified some topics for improvement.The SPARK discriminates between children with a high, increased and low risk of parenting and developmental problems. It does so in a reliable way, but more research is needed on aspects of validity and in other populations.Early detection of parenting problems and problems in the psychosocial development of young children is important [1-7], as interventions are supposedly more effective when they are carried out earlier [6-12]. Evidence shows that this early detection is preferably done by using a validated instrument [7,13,14].In the Netherlands, the law requires preventive child health care (CHC) to detect parenting and developmental problems at an early stage. Howe
Economic evidence on integrated care for stroke patients; a systematic review
Johanneke F.M.M. Tummers,Augustinus J.P. Schrijvers,Anne J.M. Visser-Meily
International Journal of Integrated Care , 2012,
Abstract: Introduction: Given the high incidence of stroke worldwide and the large costs associated with the use of health care resources, it is important to define cost-effective and evidence-based services for stroke rehabilitation. The objective of this review was to assess the evidence on the relative cost or cost-effectiveness of all integrated care arrangements for stroke patients compared to usual care. Integrated care was defined as a multidisciplinary tool to improve the quality and efficiency of evidence based care and is used as a communication tool between professionals to manage and standardize the outcome-orientated care. Methods: A systematic literature review of cost analyses and economic evaluations was performed. Study characteristics, study quality and results were summarized. Results: Fifteen studies met the inclusion criteria; six on early-supported discharge services, four on home-based rehabilitation, two on stroke units and three on stroke services. The follow-up per patient was generally short; 1 year or less. The comparators and the scope of included costs varied between studies. Conclusions: Six out of six studies provided evidence that the costs of early-supported discharge are less than for conventional care, at similar health outcomes. Home-based rehabilitation is unlikely to lead to cost-savings, but achieves better health outcomes. Care in stroke units is more expensive than conventional care, but leads to improved health outcomes. The cost-effectiveness studies on integrated stroke services suggest that they can reduce costs. For future research we recommend to focus on the moderate and severely affected patients, include stroke severity as variable, adopt a societal costing perspective and include long-term costs and effects.
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