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Onrust J, Hobma S, Piersma T. Determining the availability of earthworms for visually hunting predators. WILDLIFE SOC B 2019. [DOI: 10.1002/wsb.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jeroen Onrust
- Conservation Ecology Group, Groningen Institute for Evolutionary Life Sciences (GELIFES)University of Groningen P.O. Box 11103 9700 CC Groningen The Netherlands
| | - Sjoerd Hobma
- Conservation Ecology Group, Groningen Institute for Evolutionary Life Sciences (GELIFES)University of Groningen P.O. Box 11103 9700 CC Groningen The Netherlands
| | - Theunis Piersma
- Conservation Ecology Group, Groningen Institute for Evolutionary Life Sciences (GELIFES)University of Groningen P.O. Box 11103 9700 CC Groningen The Netherlands
- NIOZ Royal Netherlands Institute for Sea ResearchDepartment of Coastal Systems and Utrecht University P.O. Box 59 1790 AB Den Burg (Texel) The Netherlands
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Trietsch J, van Steenkiste B, Hobma S, Frericks A, Grol R, Metsemakers J, van der Weijden T. The challenge of transferring an implementation strategy from academia to the field: a process evaluation of local quality improvement collaboratives in Dutch primary care using the normalization process theory. J Eval Clin Pract 2014; 20:1162-71. [PMID: 25410767 DOI: 10.1111/jep.12287] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES A quality improvement strategy consisting of comparative feedback and peer review embedded in available local quality improvement collaboratives proved to be effective in changing the test-ordering behaviour of general practitioners. However, implementing this strategy was problematic. We aimed for large-scale implementation of an adapted strategy covering both test ordering and prescribing performance. Because we failed to achieve large-scale implementation, the aim of this study was to describe and analyse the challenges of the transferring process. METHODS In a qualitative study 19 regional health officers, pharmacists, laboratory specialists and general practitioners were interviewed within 6 months after the transfer period. The interviews were audiotaped, transcribed and independently coded by two of the authors. The codes were matched to the dimensions of the normalization process theory. RESULTS The general idea of the strategy was widely supported, but generating the feedback was more complex than expected and the need for external support after transfer of the strategy remained high because participants did not assume responsibility for the work and the distribution of resources that came with it. CONCLUSION Evidence on effectiveness, a national infrastructure for these collaboratives and a general positive attitude were not sufficient for normalization. Thinking about managing large databases, responsibility for tasks and distribution of resources should start as early as possible when planning complex quality improvement strategies. Merely exploring the barriers and facilitators experienced in a preceding trial is not sufficient. Although multifaceted implementation strategies to change professional behaviour are attractive, their inherent complexity is also a pitfall for large-scale implementation.
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Affiliation(s)
- Jasper Trietsch
- School for Public Health and Primary Care (CAPHRI), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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Daniels R, van Rossum E, Metzelthin S, Sipers W, Habets H, Hobma S, van den Heuvel W, de Witte L. A disability prevention programme for community-dwelling frail older persons. Clin Rehabil 2011; 25:963-74. [DOI: 10.1177/0269215511410728] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is ‘The trainee consistent demonstrates a knowledge of how evidence based methods and strategies can be incorporated in an integral and multidisciplinary programme for community-dwelling frail elderly.’ Abstract Objective: To describe and justify a primary care interdisciplinary programme for community-dwelling frail older people aimed to prevent disability. Background: Disability is a negative outcome of frailty among older persons. Policy reports and research studies emphasize the need for programmes to reduce disability progression. Between 2008 and 2010 we developed such a programme. Development: Following the Intervention Mapping protocol, a research team and a multidisciplinary professional developed the programme. Literature reviews and an expert meeting led to identification of basic elements, theory-based methods and practical tools. The programme: The general practitioner and the practice nurse comprise the core team that can be extended by other professionals such as occupational and physical therapist. The programme includes six steps: (1) screening, (2) assessment, (3) analysis and preliminary action plan, (4) agreement on an action plan, (5) execution of the action plan (toolbox parts) and (6) evaluation and follow-up. The main features are: identifying risks for developing disability and targeting risk factors using professional standards and the 5A Behavioural Change Model to support self management, and identifying problems in performing activities and enhancing meaningful activities based on the Model of Human Occupation. Screening, individual assessment, tailor-made and client-centred care, self-management support, case management and interdisciplinary cooperation are important principles in delivering the programme. Discussion: The disability-prevention programme seems promising for addressing the needs of frail older people for independent living and for targeting risk factors. Its feasibility and effects are currently being tested in a randomized controlled trial.
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Affiliation(s)
- Ramon Daniels
- Faculty of Health and Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Centre of Research on Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Centre of Research on Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Erik van Rossum
- Centre of Research on Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Centre of Research on Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Silke Metzelthin
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | | | - Herbert Habets
- Faculty of Health and Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Centre of Research on Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Orbis Medical Centre, Sittard-Geleen, The Netherlands
| | - Sjoerd Hobma
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Wim van den Heuvel
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Luc de Witte
- Centre of Research on Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Stolper E, van Leeuwen Y, van Royen P, van de Wiel M, van Bokhoven M, Houben P, Hobma S, van der Weijden T, Dinant GJ. Establishing a European research agenda on ‘gut feelings’ in general practice. A qualitative study using the nominal group technique. Eur J Gen Pract 2010; 16:75-9. [DOI: 10.3109/13814781003653416] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hobma S, Ram P, Muijtjens A, van der Vleuten C, Grol R. Effective improvement of doctor-patient communication: a randomised controlled trial. Br J Gen Pract 2006; 56:580-6. [PMID: 16882375 PMCID: PMC1874521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Doctor-patient communication is an essential component of general practice. Improvement of GPs' communication patterns is an important target of training programmes. Available studies have so far failed to provide conclusive evidence of the effectiveness of educational interventions to improve doctor-patient communication. AIM To examine the effectiveness of a learner-centred approach that focuses on actual needs, to improve GPs' communication with patients. DESIGN OF STUDY Randomised controlled trial. SETTING One hundred volunteer GPs in the Netherlands. METHOD The intervention identified individual GPs' deficiencies in communication skills by observing authentic consultations in their own surgery. This performance assessment was followed by structured activities in small group meetings, aimed at remedying the identified shortcomings. Outcomes were measured using videotaped consultations in the GPs' own surgery before and after the intervention. Communication skills were rated using the MAAS-Global, a validated checklist. RESULTS The scores in the intervention group demonstrated a significant improvement compared with those of the control group (95% confidence interval = 0.04 to 0.75). The effect size was moderate to large (d-value = 0.66). The level of participation significantly contributed to the effectiveness. Largest improvement was found on patient-centred communication skills. CONCLUSION The approach of structured individual improvement activities based on performance assessment is more effective in improving communication skills than current educational activities.
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Affiliation(s)
- Sjoerd Hobma
- Department of General practice, Centre for Quality of Care Research, University of Maastricht, Maastricht, The Netherlands.
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Ram P, van der Vleuten C, Rethans JJ, Schouten B, Hobma S, Grol R. Assessment in general practice: the predictive value of written-knowledge tests and a multiple-station examination for actual medical performance in daily practice. Med Educ 1999; 33:197-203. [PMID: 10211240 DOI: 10.1046/j.1365-2923.1999.00280.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study compares the predictive values of written-knowledge tests and a standardized multiple-station examination for the actual medical performance of general practitioners (GPs) in order to select effective assessment methods to be used in quality-improvement activities. A comprehensive assessment was performed in four phases. First, 100 GPs from the southern part of the Netherlands were assessed by a general medical knowledge test and by a knowledge test on technical skills. Second, in order to check for time-order effects, participants were randomly divided into two groups of 50 each, comparable on scores of both knowledge tests and on professional characteristics. Finally, both groups went through a multiple station examination using standardized patients and a practice video assessment of real surgery, but in opposite orders. Consultations were videotaped and assessed by well-trained peer observers. The drop-out rate was 10%. In both groups the predictive value of medical knowledge tests, ranging from 0.43 to 0.56 (Pearson correlation disattenuated), proved to be comparable with the predictive value of the multiple-station examination for actual performance (0.33-0.59). The overall explained variance of scores of the practice video assessment, measured by multiple regression analysis with performance scores as dependent variables and scores on the knowledge tests and the multiple-station examination as independent variables was moderate (19%). A time-order effect showed in only one direction: from practice video assessment to the multiple-station examination. The GP's professional characteristics did not contribute to the explanation of variation in performance. Medical knowledge tests can predict actual clinical performance to the same extent as a multiple-station examination. Compared with a station examination, a knowledge test may be a good alternative method for assessment the procedures of a large number of practising GPs.
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Affiliation(s)
- P Ram
- Centre for Quality Research, Universities of Maastricht, The Netherlands
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Hobma S, Hermus A, Pieters G, Smals A, Kloppenborg P. Concurrent hypercortisolism and hyperaldosteronism due to an adrenal adenoma. Klin Wochenschr 1990; 68:981-3. [PMID: 2232630 DOI: 10.1007/bf01646658] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The case of a 39-year-old woman with Cushing's syndrome, hypertension and severe hypokalemia, caused by a unilateral adrenal adenoma composed of cells of the zona fasciculata histological type, is described. Plasma renin activity, plasma levels of mineralocorticoids and the aldosterone secretion rate were determined before and after surgical removal of the adenoma. The tumor appeared to produce autonomously cortisol as well as corticosterone, 18-hydroxycorticosterone and aldosterone. This condition has not previously been described in the literature and might be explained by strong expression of the full spectrum of activities of the mitochondrial enzyme P450 C11 by the tumor cells. Interestingly, despite hyperaldosteronism, plasma renin activity was not suppressed.
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Affiliation(s)
- S Hobma
- Department of Medicine, St. Radboud Hospital, University of Nijmegen, The Netherlands
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Hermus A, Hobma S, Pieters G, Benraad T, Smals A, Kloppenborg P. Do weak mineralocorticoids affect the pathogenesis of hypertension in Cushing's disease? J Hypertens Suppl 1989; 7:S208-9. [PMID: 2698926 DOI: 10.1097/00004872-198900076-00100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Few studies have examined the effect of the weak mineralocorticoids corticosterone, 18-hydroxycorticosterone and 18-hydroxydeoxycorticosterone on the pathogenesis of hypertension in Cushing's disease. Therefore we measured plasma levels of these mineralocorticoids together with plasma aldosterone, plasma renin activity and the aldosterone secretion rate in 12 patients with Cushing's disease and in seven patients with essential hypertension. Plasma levels of aldosterone, corticosterone, 18-hydroxycorticosterone and 18-hydroxydeoxycorticosterone and the aldosterone secretion rate were similar in both groups of patients. Plasma renin activity, determined after 4 h of ambulation, was significantly higher in Cushing's disease than in essential hypertension. We conclude that it is unlikely that either aldosterone or the weak mineralocorticoids corticosterone, 18-hydroxycorticosterone and 18-hydroxydeoxycorticosterone play a specific role in the pathogenesis of hypertension in Cushing's disease.
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Affiliation(s)
- A Hermus
- Department of Medicine, St Radboud University Hospital, Nijmegen, The Netherlands
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