Effect of a multilevel implementation programme on shared decision-making in breast cancer care.

BACKGROUND: Women with newly diagnosed breast cancer face multiple treatment options. Involving them in a shared decision-making (SDM) process is essential. The aim of this study was to evaluate whether a multilevel implementation programme enhanced the level of SDM behaviour of clinicians observed in consultations. METHODS: This before-after study was conducted in six Dutch hospitals. Patients with breast cancer who were facing a decision on surgery or neoadjuvant systemic treatment between April 2016 and September 2017 were included, and provided informed consent. Audio recordings of consultations made before and after implementation were analysed using the five-item Observing Patient Involvement in Decision-Making (OPTION-5) instrument to assess whether clinicians adopted new behaviour needed for applying SDM. Patients scored their perceived level of SDM, using the nine-item Shared Decision-Making Questionnaire (SDM-Q-9). Hospital, duration of the consultation(s), age, and number of consultations per patient that might influence OPTION-5 scores were investigated using linear regression analysis. RESULTS: Consultations of 139 patients were audiotaped, including 80 before and 59 after implementation. Mean (s.d.) OPTION-5 scores, expressed on a 0-100 scale, increased from 38.3 (15.0) at baseline to 53.2 (14.8) 1 year after implementation (mean difference (MD) 14.9, 95 per cent c.i. 9.9 to 19.9). SDM-Q-9 scores of 105 patients (75.5 per cent) (72 before and 33 after implementation) were high and showed no significant changes (91.3 versus 87.6; MD -3.7, -9.3 to 1.9). The implementation programme had an association with OPTION-5 scores (ß = 14.2, P < 0.001), hospital (ß = 2.2, P = 0.002), and consultation time (ß = 0.2, P < 0.001). CONCLUSION: A multilevel implementation programme supporting SDM in breast cancer care increased the adoption of SDM behaviour of clinicians in consultations.

The Dutch neuromuscular database CRAMP (Computer Registry of All Myopathies and Polyneuropathies): development and preliminary data.

Each of the various neuromuscular diseases is rare. Consequently, solid epidemiological data are not available and it is often difficult to find sufficient patients for studies. For this reason, the Dutch neuromuscular database, CRAMP (Computer Registry of All Myopathies and Polyneuropathies), was developed in 2004 by the Dutch Neuromuscular Research Support Centre, to store information on patient characteristics and diagnoses (based on Rowland and McLeod's classification) in a uniform and easily retrievable manner. Care was taken to preserve data confidentiality. It is envisaged that CRAMP will prove particularly useful for studies in which multicentre collaboration is needed to recruit a sufficiently large number of patients. More than 10,000 patients with neuromuscular diseases (4,837 female, 5,476 male) have been registered since 2004, half of whom (n=5059) have peripheral nerve disorders.

[The practice guideline: 'Treatment of tobacco dependence']. / Richtlijn 'Behandeling van tabaksverslaving'.

The interdisciplinary guideline 'Treatment of tobacco dependence' discusses the approach to smoking patients. The point of departure is the concept that smoking is an addiction and that its treatment should be based on this fact. The effectiveness of treatment depends on the patient's motivation to stop smoking and on the intensity of the intervention. Pharmacotherapy may be of added value here, particularly for persistent smokers. The guideline aims at reaching as many smoking patients as possible, regardless of whether there is a relationship between their symptoms or ill health and smoking. Practitioners should ask about smoking habits regularly and smokers should be advised at least once to stop. Further treatment and guidance aims in particular to increase the motivation to quit and at those who are prepared to stop on the basis of the stages-of-change model. More intensive possibilities for treatment, by both general practitioners and specialists, are needed for persistent smokers. Such facilities are hardly available at all in The Netherlands at present, but will have to be developed to make the cost-effective treatment of tobacco addiction possible on a large scale.

Educational needs of stroke survivors and their family members, as perceived by themselves and by health professionals.

This study identified informational needs of stroke survivors and their family members as perceived by themselves and by health professionals. The source of information, and the desired source for future information were also explored. Green's Precede-Proceed model was used as a theoretical framework. In the study 35 stroke survivors, 39 family members and 43 health professionals participated. The results show that stroke survivors and family members indicated to desire the most information regarding reducing the chance of a new stroke. Stroke survivors rated as the major gaps of information: reducing the chance of a new stroke and coping with stress. Family members rated as the major gaps of information: sources to apply for help; strategies to perform activities of daily living, and reducing the chance of a new stroke. Stroke survivors and their family members expressed as the most desired source of information the doctor in the hospital. Health professionals expressed a high level of concern about the amount of information stroke survivors and family members receive; they expressed a substantial need for information about all topics for both groups, which should be provided by several sources. Some needs are recognized, but in most cases not met. Family members of stroke survivors who suffered more than one stroke seem to have received more information--and to desire less. Both highly educated stroke survivors and family members indicate to have received less information and desire more information than lower educated respondents.

Infrared emission spectra from a heterogeneous catalyst system in reaction conditions. 1: Description of the microreactor assembly.

The design and construction of a microreactor with an IR transmitting window are described. The microreactor can be used to study heterogeneously catalyzed gas phase reactions in the l00-600 degrees C temperature range by analyzing the emitted IR radiation with the aid of a Fourier transform infrared spectrometer. The reactor feed can be prepared so that the reaction conditions correspond to a practical, heterogeneously catalyzed, gas phase reaction system. Product stream monitoring can be carried out to determine whether the IR emission spectra obtained originate from a stationary state in the catalytic reaction. Some results obtained with the present microreactor are given.