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Background: Developmental Dysplasia of the Hip (DDH) is one of the most common pediatric orthopedic disorders, affecting 1–3% of all newborns. The optimal treatment of centered DDH is currently under debate. This randomized controlled trial aims to study the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH. Methods: This is a multicenter, parallel-group, open-label, non-inferiority randomized controlled trial studying the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH in fourteen hospitals in the Netherlands. In total, 800 infants with centered DDH (Graf IIa-/IIb/IIc), aged 10–16 weeks, will be randomly allocated to the active monitoring or abduction treatment group. Infants will be followed up until the age of 24 months. The primary outcome is the rate of normal hips, defined as an acetabular index lower than 25 degrees on an antero-posterior radiograph, at the age of 12 months. Secondary outcomes are the rate of normal hips at the age of 24 months, complications, time to hip normalization, the relation between baseline patient characteristics and the rate of normal hips, compliance, costs, cost-effectiveness, budget impact, health-related quality of life (HRQoL) of the infant, HRQoL of the parents/caregivers, and parent/caregiver satisfaction with the treatment protocol. Discussion: The outcomes of this randomized controlled trial will contribute to improving current care-as-usual for infants with centered DDH. Trial registration: Dutch Trial Register, NL9714, registered September 6, 2021. https://clinicaltrialregister.nl/en/trial/29596.

Background: Subclinical depressive symptoms are highly prevalent among adolescents and are associated with negative consequences, which may pose an economic burden for society. We conducted a prevalence-based cost-of-illness study using a societal perspective to investigate the cost-of-illness of subclinical depressive symptoms among adolescents. Methods: Using a bottom-up approach, cost questionnaires were assessed to measure costs from 237 Dutch families with an adolescent aged 11–18 with subclinical depressive symptoms (of which 34 met the criteria of a depressive disorder). The study is registered in the Dutch Trial Register (Trial NL5584/NTR6176; www.trialregister.nl/trial/5584). Results: Our calculations show that adolescents with subclinical depressive symptoms cost the Dutch society more than €42 million annually, expressed in costs related to depressive symptoms. Secondary analyses were performed to test the reliability and stability of the costs. When costs related to psychological problems were considered, the annual costs amounted to €67 million. The total societal costs related to physical problems amounted to approximately €126 million. All costs combined (depressive, psychological, behavioural and physical problems and other reasons) amounted to a €243 million. Total costs were highest for physical-related problems of the adolescent (52% of the total costs), followed by psychological (28%), depressive (17%) and behavioural problems (1%). Using an international prevalence rate, societal costs related to depressive symptoms resulted in €54 million a year. Conclusions: Cost-effective prevention programmes seem warranted given the high societal costs and risk of future costs as subclinical depressive symptoms could be a precursor of clinical depression later in life.

PURPOSE: To evaluate current practice patterns of immediate sequential bilateral cataract surgery (ISBCS) in the Netherlands and assess ophthalmologists' attitudes towards performing ISBCS in future cataract care.SETTING: Dutch ophthalmic society members.DESIGN: Cross-sectional study (national survey).METHODS: An electronic survey on ISBCS was sent as part of an annual survey on cataract practice patterns to members of the Dutch ophthalmic society. Questions regarding current ISBCS practice patterns, willingness to perform ISBCS routinely in future care, reasons for performing ISBCS and reasons for not performing ISBCS were included. Data were analysed using descriptive statistics.RESULTS: In total, 237/520 survey recipients (45.6%) responded to the overall survey. Data on the ISBCS questions was available from 227 respondents. Sixty-two ophthalmologists (27.3%) currently performed ISBCS, predominantly in low patient-volumes (90.3% in one to five patients per month). However, 108/227 ophthalmologists (47.6%) considered performing ISBCS routinely in future practice. Procedures for which ISBCS was mainly considered included age-related cataract surgery using topical and general anaesthesia. Availability of separate products and instruments for both eyes and patient advantages were considered of high importance when performing ISBCS. Main reasons for not performing ISBCS included the risk of endophthalmitis and potential medico-legal aspects.CONCLUSIONS: Although ISBCS is currently no routine procedure in the Netherlands, it is considered by almost 50% of surgeons. In order to improve implementation on a national level, potential barriers identified in this survey (fear of bilateral endophthalmitis, potential medico-legal issues, a lack of availability of separate products for both eyes) should be addressed.

Additional file 1: Appendix A. Overview personality traits. Appendix B. PubMed Search Strategy. Appendix C. Risk of bias assessment. Appendix D. PRISMA 2020 checklist.

Background Cognitive behavioral therapy (CBT) is an effective intervention to treat depressive disorders in youth. However, 50% of adolescents still have depressive symptoms after treatment, and 57% drop out during treatment. Online CBT interventions have proven to be effective in reducing depressive symptoms and seem promising as a treatment for depressed adolescents. However, combining online programs with face-to-face sessions seems necessary to increase their effectiveness and monitor for suicide risk. Objective In this study, we examine the effectiveness and cost-effectiveness of a blended CBT treatment protocol, a mixture of online and face-to-face CBT, as a treatment for clinically depressed adolescents. Methods A pragmatic quasi-experimental controlled trial will be conducted to study the effectiveness of a blended CBT treatment protocol, in which blended CBT is compared with face-to-face CBT (n=44) and treatment as usual (n=44); the latter two were collected in a previous randomized controlled trial. The same inclusion and exclusion criteria will be used: adolescents aged between 12 and 21 years, with a clinical diagnosis of a depressive disorder, and referred to one of the participating mental health institutions. Assessments will be conducted at the same time points: before the start of the intervention, during the intervention (after 5 and 10 weeks), postintervention, and at 6- and 12-month follow-ups. Results The primary outcome is the presence of a depression diagnosis at 12-month follow-up. Several secondary outcomes will be measured, such as depressive symptoms, quality of life, and suicide risk. Costs and effects in both conditions will be compared to analyze cost-effectiveness. Further, moderating (age, gender, alcohol and drug use, parental depression, and other psychopathology) and mediating effects (negative automatic thoughts, cognitive emotion regulation, attributional style) will be analyzed. Also, treatment characteristics will be studied, such as characteristics of the therapists, treatment expectancy, and therapeutic alliance. Dropout rates and treatment characteristics will be measured to study the feasibility of blended CBT. Conclusions This study will examine the effectiveness and cost-effectiveness of a blended CBT program in which depressed adolescents are treated in mental health care. Results of blended CBT will be compared with face-to-face CBT and treatment as usual, and implications for implementation will be reviewed. Trial Registration Dutch Trial Register (NTR6759); http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6759 International Registered Report Identifier (IRRID) DERR1-10.2196/13434 RR1-10.2196/12654

Contains fulltext : 291983.pdf (Publisher’s version ) (Open Access) OBJECTIVE: To study the impact of a standardized postoperative anesthesia visit on 30-day mortality in medium to high-risk elective surgical patients. BACKGROUND: Postoperative complications are the leading cause of perioperative morbidity and mortality. Although modified early warning scores (MEWS) were instituted to monitor vital functions and improve postoperative outcome, we hypothesized that complementary anesthesia expertise is needed to adequately identify early deterioration. METHODS: In a prospective, multicenter, stepped-wedge cluster randomized interventional study in 9 academic and nonacademic hospitals in the Netherlands, we studied the impact of adding standardized postoperative anesthesia visits on day 1 and 3 to routine use of MEWS in 5473 patients undergoing elective noncardiac surgery. Primary outcome was 30-day mortality. Secondary outcomes included: incidence of postoperative complications, length of hospital stay, and intensive care unit admission. RESULTS: Patients were enrolled between October 2016 and August 2018. Informed consent was obtained from 5473 patients of which 5190 were eligible for statistical analyses, 2490 in the control and 2700 in the intervention group. Thirty-day mortality was 0.56% (n = 14) in the control and 0.44% (n = 12) in the intervention group (odds ratio 0.74, 95% Confidence interval 0.34-1.62). Incidence of postoperative complications did not differ between groups except for renal complications which was higher in the control group (1.7% (n = 41) vs 1.0% (n = 27), P = 0.014). Median length of hospital stay did not differ significantly between groups. During the postanesthesia visits, for 16% (n = 437) and 11% (n = 293) of patients recommendations were given on day 1 and 3, respectively, of which 67% (n = 293) and 69% (n = 202) were followed up. CONCLUSIONS: The combination of MEWS and a postoperative anesthesia visit did not reduce 30-day mortality. Whether a postoperative anesthesia visit with strong adherence to the recommendations provided and in a high-risk population might have a stronger impact on postoperative mortality remains to be determined. TRIAL REGISTRATION: Netherlands Trial Registration, NTR5506/ NL5249, https://www.trialregister.nl/trial/5249.

Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT Checklist. (DOCX 139 kb)

Interview guide. Description of the framework of the interviews. (DOC 42Â kb)

To compare perinatal singleton and multiple outcomes in a large Dutch in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) population and within risk subgroups. Newborns were assigned to a risk category based on gestational age, birthweight, Apgar score and congenital malformation. Register-based retrospective cohort study. Netherlands Perinatal Registry data. 3041 singletons and 1788 multiple children born from IVF/ICSI in 2003-2005. Student's t-test or Mann-Whitney U-test was used to analyze continuous data, χ²-analyses were used for categorical data. Multivariate logistic and linear regression analysis was performed to analyze whether the risk stratification criteria were associated with neonatal hospital admission and length of stay. Start of labor, mode of delivery, gestational age, birthweight, Apgar score, congenital malformation, neonatal hospital admission, neonatal intensive care unit admission and mortality. IVF/ICSI conceived multiples had considerably poorer outcomes than singletons in terms of cesarean section rate, preterm birth, birthweight, being small-for-gestational age, Apgar score, neonatal hospital admission, neonatal intensive care unit admission and neonatal mortality. As opposed to the results found in the total study population and the low- and moderate-risk population, high-risk multiples showed better outcomes than high-risk singletons regarding cesarean section rate, birthweight and Apgar score. All risk stratification variables were associated with being hospitalized after birth. Length of stay was associated with all risk stratification criteria except Apgar score. Perinatal outcomes in IVF/ICSI conceived multiples are considerably poorer than in singletons. This finding mainly pertains to low-risk children. High-risk multiples had significantly better perinatal outcomes than high-risk singletons. This article is protected by copyright. All rights reserved

Background: A quality improvement collaborative is an intensive project involving a combination of implementation strategies applied in a limited “breakthrough” time window. After an implementation project, it is generally difficult to sustain its success. In the current study, sustainability was described as maintaining an implemented innovation and its benefits over a longer period of time after the implementation project has ended. The aim of the study was to explore potentially promising strategies for sustaining the Enhanced Recovery After Surgery (ERAS) programme in colonic surgery as perceived by professionals, three to six years after the hospital had successfully finished a quality improvement collaborative. Methods: A qualitative case study was performed to identify promising strategies to sustain key outcome variables related to the ERAS programme in terms of adherence, time needed for functional recovery and hospital length of stay (LOS), as achieved immediately after implementation. Ten hospitals were selected which had successfully implemented the ERAS programme in colonic surgery (2006–2009), with success defined as a median LOS of 6 days or less and protocol adherence rates above 70%. Fourteen semi-structured interviews were held with eighteen key participants of the care process three to six years after implementation, starting with the project leader in every hospital. The interviews started by confronting them with the level of sustained implementation results. A direct content analysis with an inductive coding approach was used to identify promising strategies. The mean duration of the interviews was 37 minutes (min 26 minutes – max 51 minutes). Results: The current study revealed strategies targeting professionals and the organisation. They comprised internal audit and feedback on outcomes, small-scale educational booster meetings, reminders, changing the physical structure of the organisation, changing the care process, making work agreements and delegating responsibility, and involving a coordinator. A multifaceted self-driven promising strategy was applied in most hospitals, and in most hospitals promising strategies were suggested to sustain the ERAS programme. Conclusions: Joining a quality improvement collaborative may not be enough to achieve long-term normalisation of transformed care, and additional investments may be needed. The findings suggest that certain post-implementation strategies are valuable in sustaining implementation successes achieved after joining a quality improvement collaborative.

Roken veroorzaakt veel vermijdbare ziekten en sterfte. Een manier om succesvol te stoppen met roken, is het gebruik van een bewezen effectieve stopmethode. Een online keuzehulp kan helpen een geschikte stopmethode te kiezen. Onderzoekers uit Maastricht en Amsterdam analyseren gebruik en effectiviteit van de online keuzehulp.

This dissertation had two main goals. The first goal was to learn more about so-called decision aids that are used to help users make decisions related to improving their own health. It was found that, while these tools can help people, we still need to learn more about what really helps in decision making. The dissertation makes a first contribution to this. The second goal was to develop a digital decision aid to help smokers decide how they want to quit smoking. This decision aid was developed together with smokers and other experts. Furthermore, it was examined who finds such a decision aid interesting and from which part of the decision aid users benefit the most. It was found that, although many people are interested in such a digital decision aid, more research needs to be done into what ensures that users continue to use the decision aid and do not stop halfway through.

Endometriosis is a common and benign gynaecological disease. Common symptoms include menstrual pain, pain during intercourse, chronic pain and impaired fertility. This dissertation presents and describes three aspects of endometriosis: genetic and molecular aspects, imaging and quality of life. The B lymphocyte stimulator and the paired-box 2 gene were studied and both appear to play a role in the pathogenesis of endometriosis. This study also investigated the extent to which certain MRI characteristics are associated with the histological infiltration depth in the intestinal wall of patients with colorectal endometriosis. The last chapter of this dissertation explains that symptoms such as chronic pelvic pain and dyspareunia tend to persist in women with endometriosis, despite the patients having been treated in a tertiary hospital. This has a significant impact on their quality of life.

With the continuous evolution of different treatments for the care of hemorrhoids, it is important that the effectiveness of (surgical) treatments is analysed in a systematic way. Clinical studies on the effectiveness of hemorrhoid interventions have used a wide range of outcomes and outcome measures. Different guidelines indicate the lack of uniformity in the definition, measurement and reporting of outcomes. As a result, optimal evidence synthesis is hampered and high quality guidelines are lacking. A solution to improve the homogeneity of result reporting on hemorrhoids is the development and use of a core outcome set. With this dissertation, we have taken an important step towards improving hemorrhoid research by developing a core outcome set for such research. Furthermore, over the past ten years several national guidelines for the treatment of hemorrhoids have been published. The most recently updated guideline is from the American colorectal surgeons. The methodological quality of these guidelines can be improved by being much more specific about the methods used to formulate their recommendations. Therefore, we have developed an international, multidisciplinary, high-quality guideline in collaboration with the European Society of Coloproctology (ESCP) that addresses both diagnostic and therapeutic modalities for the management of hemorrhoids.

Sixteen percent of the population in Europe suffers from chronic pain. The largest share of chronic pain is chronic low back pain. The extent of the problem for society, patients and pain treatment is the subject of this dissertation. Some results: If acute back pain has not disappeared within 3 months, chances are high (60%) that the back pain will not recover spontaneously. Chronic discogenic low back pain patients have moderate severe pain, a lot of physical restraints and a low quality of life. They cost society € 8000 per person per year. The methylene blue intradiscal injection is not cost-effective. Neuromodulation treatment reduces pain by 30% on average for at least eleven years. For many pain syndromes, the (cost) effectiveness of neuromodulation still has to be proven through research. When treating chronic pain, the practitioner should take into account the content and type of expectations of the patient. Expectations can be expressed as hope, norm, need or as an opportunity. Only the expectations expressed as probability calculations influence the treatment result.

In the past, more than one embryo was often replaced with IVF to increase the chance of a pregnancy. The flip side is that this also increases the chance of a multiple pregnancy. More and more often only one embryo is replaced because multiple pregnancies are associated with complications for mother and child. In this thesis, the long-term costs and outcomes of singles and multiple births born after IVF have been mapped and used to calculate the long-term cost-effectiveness of various embryo transfer strategies. The replacement of two embryos has the highest chance of success, but is also the most expensive. In terms of cost effectiveness, the preferred strategy depends on the analysis period. From an economic perspective, it is preferable to replace two embryos if the long-term costs and outcomes of the children are included

As from 2012, not only doctors but also nurse practitioners and physician assistants are allowed to independently indicate and perform some medical tasks (or have these performed). By order of the Ministry of Health, Welfare and Sport, the effectiveness and efficiency of this temporary task reallocation was studied. This dissertation shows that nurse practitioners and physician assistants perform catheterisations, surgical procedures, injections, punctures and medication prescriptions at a high level of independency. In addition, the care processes involved are more efficient, legal requirements are met and adverse side effects are absent. The minister has been advised to reallocate these tasks permanently. This has recently been realised.

This dissertation examines the sustainability of healthcare innovations following their active implementation in a hospital setting. Among other things, it evaluates the extent to which two surgical healthcare programmes that were successfully implemented in different Dutch hospitals are still part of the standard healthcare process years after the quality improvement project. It also presents factors that may influence the success of implementing sustainability. The insights in this dissertation are important for future quality improvement projects and research projects.Two innovations – a short-stay programme for bowel surgery (ERAS) and a short-stay programme for breast cancer surgery (SSP) – were evaluated three to six years after their successful implementation. Both programmes appear to have been reasonably well maintained.The respondents deemed the following aspects of relevance to the sustainability of the ERAS and SSP programmes: trust and faith in the innovation, application of the innovation in different contexts, the possibility to adapting the innovation to suit local needs, the possibility to modify the innovation, the institutionalisation of the innovation, and the short lines of communication within the multidisciplinary team.Grant: ZonMw efficiency research

In the Netherlands, annually almost 13.000 women get breast cancer. After completion of the treatments, the patient remains under observation for a long time, also called the follow-up. The guideline in the Netherlands is a three-monthly hospital check in the first year after the treatment, but there are doubts whether these frequent checks provide optimum care. Studies among 320 breast cancer patients from seven hospitals in the Netherlands show that a number of hospital checks in the first year can be replaced by telephone checks by the mammacare nurse, maintaining quality of life, high patient satisfaction and no increase of anxiety feelings. Moreover, the combination of telephone follow-up and an educational group programme appears to be a cost-effective strategy. Based on these results, it is advised to critically examine the guideline for follow-up for the first year after breast cancer and to implement telephone follow-up and the educational group programme in the guideline.

This dissertation investigates if short-stay breast cancer surgery (day or 24 hour case) is safe and efficient, studying the experiences of patients. A short stay programme was implemented in four Dutch hospitals. The proportion of patients who had short-stay treatment significantly increased after implementation from 45% to 82%, while the number of complications, rehospitalisation, reoperations or number of visits to the emergency department did not increase. The programme is less expensive than the usual care, even if the costs of implementation are taken into account. Research into the experiences of patients showed that especially the information provision needed to be improved. On the basis of these research results large-scale implementation of the programme is recommended.