Ontwikkelingsmaatschappij Oost Nederland

Dit hoofdstuk behandelt de effectiviteit van cognitieve gedragstherapie (CGT) voor kinderen en jongeren met angststoornissen. Er wordt vervolgens ingegaan op de effectiviteit van individuele versus groeps-CGT, face-to-face versus online CGT, en CGT met en zonder ouderlijke betrokkenheid.

Een kind groeit op in een omgeving waar het voortdurend in interactie met anderen is. Angst kan hierin voor sommige kinderen een belemmering zijn. Denk bijvoorbeeld aan de angst om anderen om hulp te vragen. Vandaar dat we in dit hoofdstuk stilstaan bij de belangrijke anderen voor het kind. Bij wie kan het kind sociale steun zoeken, en hoe kan het dat doen? En hoe kan het kind op een goede manier diens grenzen aangeven? We behandelen de theorie en onderzoek over sociale steun en sociale vaardigheden, en presenteren een aantal oefeningen die binnen het Denken + Doen = Durven programma kunnen worden ingezet om met sociale situaties, en interacties met anderen te oefenen.

The health care sector sensed already for several years a shift in primary care to more complex situations and support questions. Tackling these challenges requires an integrated collaboration between health, wellbeing and social care. There was an urge to bring in a different approach of care. In order to fulfill that need Flanders was defined into 60 geographical areas in 2020: ‘The primary care zones’. Capturing local needs and working bottom-up became the foundation of the organization. The focus on goal-oriented, customized and integrated care made it possible to fill out the gap created by more complex situations. Representatives from health providers, welfare workers, local authorities and the person in need of care are brought together. The primary care zone promotes collaboration between these different partners. This extensive network ensures that primary care regions can as well pick up and unroll local needs as charges unrolled by the government. Person-centered care is the key to success of this new approach. Care and support goals from the people itself, depending on their quality of life, are the starting point. This in combination with more recognition for informal care, makes sure that socially vulnerable people are able to take control of their own life and the necessary care to sustain this. In order to realize a care policy in function of person-centered care, we need to listen to the people who live in our primary care zone. There’s continually increased attention and effort to cocreate and build our organization with socially vulnerable people. Self-determination and autonomy are ever highly valuated. As organization there’s the expectation of building bridges between professionals, but also between the professional and the client. The focus in the relationship between clients and professionals shifted the past years. There’s more attention for participation and democratic decision making and for the perspective of the people itself. Clients are not to be seen as passive recipients anymore. They say: ‘nothing about us, without us.’ and who are we to protest? In order to do so we established a group of 15 experts. From October 22 until November 23 we will meet up monthly to exchange ideas. The group has experience in different domains: informal care, chronic illnesses, poverty, addiction, psychic vulnerability, elderly care and disabilities. The experts hope to dive deeper into our participation process to show and explain to you how to co-design a care journey that responds to people’s needs. Taking their experience in account, will help our board to pick up local needs and to adjust primary care to them. Focus on strength and possibilities of the people in the group are hereby necessary to accomplish our goal. Together with the group we strive to share the ownership on our plan of action We want them to have an impact on the policy and to cocreate an organization not only for them, but with them.

BackgroundVery little data is available about the involvement of lifeboat crews in medical emergencies at sea. The aim of this study is to analyze the medical operations at sea performed by the Royal Netherlands Sea Rescue Institution (KNRM).MethodsThis is a retrospective descriptive analysis of all medical operations at sea performed by the KNRM between January 2017 and January 2020. The operations were divided in three groups: with ambulance crew aboard the lifeboat, ambulance crew on land waiting for the arrival of the lifeboat, and autonomous operations (without ambulance crew involvement). The main outcome measures were circumstances, encountered medical problems, follow-up and crew departure time.ResultsThe KNRM performed 282 medical operations, involving 361 persons. Operations with ambulance crew aboard the lifeboat (n = 39; 42 persons) consisted mainly of persons with serious trauma or injuries; 32 persons (76.2%) were transported to a hospital. Operations with ambulance crew on land (n = 153; 188 persons) mainly consisted of situations where time was essential, such as persons who were still in the water, with risk of drowning (n = 45, 23.9%), on-going resuscitations (n = 9, 4.8%) or suicide attempts (n = 7, 3.7%). 101 persons (53,7%) were transported to a hospital. All persons involved in the autonomous operations (n = 90; 131 persons) had minor injuries. 38 persons (29%) needed additional medical care, mainly for (suspected) fractures or stitches. In 115 (40.8%) of all operations lifeboat crews did not know that there was a medical problem at the time of departure. Crew departure time in operations with ambulance crew aboard the lifeboat (13.7 min, min. 0, max. 25, SD 5.74 min.) was significantly longer than in operations with ambulance crew on land (7.7 min, min. 0, max 21, SD 4.82 min., p < 0.001).ConclusionThis study provides new information about the large variety of medical emergencies at sea and the way that lifeboat and ambulance crews are involved. Crew departure time in operations with ambulance crew aboard the lifeboat was significantly longer than in operations with ambulance crew on land. This study may provide useful indications for improvement of future medical operations at sea, such as triage, because in 40.8% of operations, it was not known at the time of departure that there was a medical problem.

Abstract BackgroundRisk-assessment of endometrial cancer (EC) is based on clinicopathological factors and molecular subgroup. It is unclear whether adding hormone receptor expression, L1CAM expression or CTNNB1 status yields prognostic refinement.MethodsParaffin-embedded tumour samples of women with high-risk EC (HR-EC) from the PORTEC-3 trial (n=424), and a Dutch prospective clinical cohort called MST (n=256), were used. All cases were molecularly classified. Expression of L1CAM, ER and PR were analysed by whole-slide immunohistochemistry and CTNNB1 mutations were assessed with a next-generation sequencing. Kaplan-Meier method, log-rank tests and Cox’s proportional hazard models were used for survival analysis.ResultsIn total, 649 HR-EC were included. No independent prognostic value of ER, PR, L1CAM and CTNNB1 was found, while age, stage, and adjuvant chemotherapy had an independent impact on risk of recurrence. Subgroup-analysis showed that only in NSMP HR-EC, ER-positivity was independently associated with a reduced risk of recurrence (HR 0.33, 95%CI 0.15-0.75).ConclusionsER-positivity is a strong favourable prognostic factor in NSMP HR-EC and identifies a homogeneous subgroup of NSMP tumours. ER-positive NSMP EC may be regarded as a novel fifth molecular subgroup. Assessment of ER status in high-risk NSMP EC is feasible in clinical practice and could improve risk stratification and treatment.

In deze stap wil je het obsessieve verhaal in geuren en kleuren in beeld krijgen en bereiken dat de patiënt herkent dat hij in dat verhaal opgaat en zich erop baseert. Ook wil je bereiken dat de patiënt herkent dat hij in vergelijkbare situaties waarover hij geen obsessie heeft zich automatisch baseert op waarneming, zelfkennis of gezond verstand. Hij proeft dan hoezeer dit zekerheid geeft en hoe buitengewoon goed dat waarnemingsapparaat functioneert. Je wilt graag dat je patiënt uiteindelijk vol overtuiging kan beleven: ‘als het (de gevreesde toestand) aan de hand is, dan merk ik het wel!’ Het alternatieve verhaal legt daarvoor het fundament.

Abstract Background: The SARS-CoV-2 pandemic has a huge impact on healthcare provided. The nationwide pathology registry of the Netherlands, PALGA, offers an outstanding opportunity to measure this impact for diseases in which pathology examinations are involved. Methods: Pathology specimen numbers in 2020 were compared with specimen numbers in 2019 for 5 periods of 4 weeks, representing two lockdowns and the periods in between, taking into account localization, procedure and dignity of diagnosis.Results: The largest decrease was seen during the first lockdown (spring 2020), when numbers of pathology reports declined up to 88% and almost all specimen types were affected. Afterwards each specimen type showed its own dynamics with a decrease during the second lockdown for some, while for others numbers remained relatively low during the whole year. Generally, for most tissue types resections, cytology and malignant diagnoses showed less decrease than biopsies and benign diagnoses. A significant but small catch-up (up to 17%) was only seen for benign resections of the lower gastro-intestinal tract, malignant skin resections and gallbladder resections.Conclusion: The corona pandemic has a significant effect on pathology diagnostics. This effect was most pronounced during the first lockdown, diverse for different sites of origin and for cytology compared with histology. The data presented here can help to assess the consequences on (public) health and provide a starting point in the discussion on how to make the best choices in times of scarce healthcare resources, considering the impact of both benign and malignant disease on quality of life.