| 1. |
- de Vries, Arjen E., et al.
(författare)
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Perceived barriers of heart failure nurses and cardiologists in using clinical decision support systems in the treatment of heart failure patients
- 2013
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Ingår i: BMC Medical Informatics and Decision Making. - : BioMed Central. - 1472-6947. ; 13:54
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundClinical Decision Support Systems (CDSSs) can support guideline adherence in heart failure (HF) patients. However, the use of CDSSs is limited and barriers in working with CDSSs have been described as a major obstacle. It is unknown if barriers to CDSSs are present and differ between HF nurses and cardiologists. Therefore the aims of this study are; 1. Explore the type and number of perceived barriers of HF nurses and cardiologists to use a CDSS in the treatment of HF patients. 2. Explore possible differences in perceived barriers between two groups. 3. Assess the relevance and influence of knowledge management (KM) on Responsibility/Trust (R&T) and Barriers/Threats (B&T).MethodsA questionnaire was developed including; B&T, R&T, and KM. For analyses, descriptive techniques, 2-tailed Pearson correlation tests, and multiple regression analyses were performed.ResultsThe response- rate of 220 questionnaires was 74%. Barriers were found for cardiologists and HF nurses in all the constructs. Sixty-five percent did not want to be dependent on a CDSS. Nevertheless thirty-six percent of HF nurses and 50% of cardiologists stated that a CDSS can optimize HF medication. No relationship between constructs and age; gender; years of work experience; general computer experience and email/internet were observed. In the group of HF nurses a positive correlation (r .33, P<.01) between years of using the internet and R&T was found. In both groups KM was associated with the constructs B&T (B=.55, P=<.01) and R&T (B=.50, P=<.01).ConclusionsBoth cardiologists and HF-nurses perceived barriers in working with a CDSS in all of the examined constructs. KM has a strong positive correlation with perceived barriers, indicating that increasing knowledge about CDSSs can decrease their barriers.
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| 2. |
- Kraai, Imke, et al.
(författare)
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The value of telemonitoring and ICT-guided disease management in heart failure: Results from the IN TOUCH study
- 2016
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Ingår i: International Journal of Medical Informatics. - : ELSEVIER IRELAND LTD. - 1386-5056 .- 1872-8243. ; 85:1, s. 53-60
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Tidskriftsartikel (refereegranskat)abstract
- Aim: It is still unclear whether telemonitoring reduces hospitalization and mortality in heart failure (HF) patients and whether adding an Information and Computing Technology-guided-disease-management-system (ICT-guided-DMS) improves clinical and patient reported outcomes or reduces healthcare costs. Methods: A multicenter randomized controlled trial was performed testing the effects of INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) with in total 179 patients (mean age 69 years; 72% male; 77% in New York Heart Association Classification (NYHA) III-IV; mean left ventricular ejection fraction was 28%). Patients were randomized to ICT-guided-DMS or to ICT-guided-DMS + telemonitoring with a follow-up of nine months. The composite endpoint included mortality, HF-readmission and change in health-related quality of life (HR-QoL). Results: In total 177 patients were eligible for analyses. The mean score of the primary composite endpoint was -0.63 in ICT-guided-DMS vs. -0.73 in ICT-guided-DMS + telemonitoring (mean difference 0.1,95% CI: -0.67 +0.82, p = 0.39). All-cause mortality in ICT-guided-DMS was 12% versus 15% in ICT-guided-DMS + telemonitoring (p = 0.27); HF-readmission 28% vs. 27% p = 0.87; all-cause readmission was 49% vs. 51% (p = 0.78). HR-QoL improved in most patients and was equal in both groups. Incremental costs were 1360 in favor of ICT-guided-DMS. ICT-guided-DMS + telemonitoring had significantly fewer HF-outpatient-clinic visits (p < 0.01). Conclusion: ICT-guided-DMS + telemonitoring for the management of HF patients did not affect the primary and secondary endpoints. However, we did find a reduction in visits to the HF-outpatient clinic in this group suggesting that telemonitoring might be safe to use in reorganizing HF-care with relatively low costs. (C) 2015 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://cleativecommons.org/licenses/by-nc-nd/4.0/).
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| 3. |
- Blunden, Jessica, et al.
(författare)
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State of the Climate in 2012
- 2013
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Ingår i: Bulletin of The American Meteorological Society - (BAMS). - 0003-0007 .- 1520-0477. ; 94:8, s. S1-S258
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Tidskriftsartikel (refereegranskat)abstract
- For the first time in serveral years, the El Nino-Southern Oscillation did not dominate regional climate conditions around the globe. A weak La Ni a dissipated to ENSOneutral conditions by spring, and while El Nino appeared to be emerging during summer, this phase never fully developed as sea surface temperatures in the eastern conditions. Nevertheless, other large-scale climate patterns and extreme weather events impacted various regions during the year. A negative phase of the Arctic Oscillation from mid-January to early February contributed to frigid conditions in parts of northern Africa, eastern Europe, and western Asia. A lack of rain during the 2012 wet season led to the worst drought in at least the past three decades for northeastern Brazil. Central North America also experienced one of its most severe droughts on record. The Caribbean observed a very wet dry season and it was the Sahel's wettest rainy season in 50 years. Overall, the 2012 average temperature across global land and ocean surfaces ranked among the 10 warmest years on record. The global land surface temperature alone was also among the 10 warmest on record. In the upper atmosphere, the average stratospheric temperature was record or near-record cold, depending on the dataset. After a 30-year warming trend from 1970 to 1999 for global sea surface temperatures, the period 2000-12 had little further trend. This may be linked to the prevalence of La Ni a-like conditions during the 21st century. Heat content in the upper 700 m of the ocean remained near record high levels in 2012. Net increases from 2011 to 2012 were observed at 700-m to 2000-m depth and even in the abyssal ocean below. Following sharp decreases in to the effects of La Ni a, sea levels rebounded to reach records highs in 2012. The increased hydrological cycle seen in recent years continued, with more evaporation in drier locations and more precipitation in rainy areas. In a pattern that has held since 2004, salty areas of the ocean surfaces and subsurfaces were anomalously salty on average, while fresher areas were anomalously fresh. Global tropical cyclone activity during 2012 was near average, with a total of 84 storms compared with the 1981-2010 average of 89. Similar to 2010 and 2011, the North Atlantic was the only hurricane basin that experienced above-normal activity. In this basin, Sandy brought devastation to Cuba and parts of the eastern North American seaboard. All other basins experienced either near-or below-normal tropical cyclone activity. Only three tropical cyclones reached Category 5 intensity-all in Bopha became the only storm in the historical record to produce winds greater than 130 kt south of 7 N. It was also the costliest storm to affect the Philippines and killed more than 1000 residents. Minimum Arctic sea ice extent in September and Northern Hemisphere snow cover extent in June both reached new record lows. June snow cover extent is now declining at a faster rate (-17.6% per decade) than September sea ice extent (-13.0% per decade). Permafrost temperatures reached record high values in northernmost Alaska. A new melt extent record occurred on 11-12 July on the Greenland ice sheet; 97% of the ice sheet showed some form of melt, four times greater than the average melt for this time of year. The climate in Antarctica was relatively stable overall. The largest maximum sea ice extent since records begain in 1978 was observed in September 2012. In the stratosphere, warm air led to the second smallest ozone hole in the past two decades. Even so, the springtime ozone layer above Antarctica likely will not return to its early 1980s state until about 2060. Following a slight decline associated with the global 2 emissions from fossil fuel combustion and cement production reached a record 9.5 +/- 0.5 Pg C in 2011 and a new record of 9.7 +/- 0.5 Pg C is estimated for 2012. Atmospheric CO2 concentrations increased by 2.1 ppm in 2012, to 392.6 ppm. In spring 2012, 2 concentration exceeded 400 ppm at 7 of the 13 Arctic observation sites. Globally, other greenhouse gases including methane and nitrous oxide also continued to rise in concentration and the combined effect now represents a 32% increase in radiative forcing over a 1990 baseline. Concentrations of most ozone depleting substances continued to fall.
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| 4. |
- de Vries, Arjen E, et al.
(författare)
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Follow-up and treatment of an instable patient with heart failure using telemonitoring and a computerised disease management system : A case report
- 2012
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Ingår i: European Journal of Cardiovascular Nursing. - London, UK : Sage Publications. - 1474-5151 .- 1873-1953. ; 11:4, s. 432-438
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Tidskriftsartikel (refereegranskat)abstract
- In the last decades, the introduction of information and communication technology (ICT) in healthcare promised an improved quality of care while reducing workload and improving cost-effectiveness. This might be realised by the use of computer guided decision support systems and telemonitoring. This case study describes the process of care of a patient with chronic heart failure, who was treated with a computerised disease management system in combination with telemonitoring. With the help of these appliances, we think we were probably able to prevent at least two readmissions for heart failure in a period of 10months. We also gained more insight into patient's behaviour with regards to compliance with the heart failure regimen at home. Frequent contact at distance and the online availability of physiological measurements at home facilitated patient tailored education and helped the patient to react adequately to symptoms of deterioration. Additionally, up-titration of heart failure medication was performed without contacting the patient at the outpatient clinic.
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| 5. |
- de Vries, Arjen E., et al.
(författare)
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Health Professionals Expectations Versus Experiences of Internet-Based Telemonitoring: Survey Among Heart Failure Clinics
- 2013
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Ingår i: Journal of Medical Internet Research. - : Journal of Medical Internet Research / Gunther Eysenbach. - 1438-8871. ; 15:1, s. 73-83
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although telemonitoring is increasingly used in heart failure care, data on expectations, experiences, and organizational implications concerning telemonitoring are rarely addressed, and the optimal profile of patients who can benefit from telemonitoring has yet to be defined. less thanbrgreater than less thanbrgreater thanObjective: To assess the actual status of use of telemonitoring and to describe the expectations, experiences, and organizational aspects involved in working with telemonitoring in heart failure in the Netherlands. less thanbrgreater than less thanbrgreater thanMethods: In collaboration with the Netherlands Organization for Applied Scientific Research (TNO), a 19-item survey was sent to all outpatient heart failure clinics in the Netherlands, addressed to cardiologists and heart failure nurses working in the clinics. less thanbrgreater than less thanbrgreater thanResults: Of the 109 heart failure clinics who received a survey, 86 clinics responded (79%). In total, 31 out of 86 (36%) heart failure clinics were using telemonitoring and 12 heart failure clinics (14%) planned to use telemonitoring within one year. The number of heart failure patients receiving telemonitoring generally varied between 10 and 50; although in two clinics more than 75 patients used telemonitoring. The main goals for using telemonitoring are "monitoring physical condition", "monitoring signs of deterioration" (n=39, 91%), "monitoring treatment" (n=32, 74%), "adjusting medication" (n=24, 56%), and "educating patients" (n=33, 77%). Most patients using telemonitoring were in the New York Heart Association (NYHA) functional classes II (n=19, 61%) and III (n=27, 87%) and were offered the use of the telemonitoring system "as long as needed" or without a time limit. However, the expectations of the use of telemonitoring were not met after implementation. Eight of the 11 items about expectations versus experiences were significantly decreased (Pandlt;.001). Health care professionals experienced the most changes related to the use of telemonitoring in their work, in particular with respect to "keeping up with current development" (before 7.2, after 6.8, P=.15), "being innovative" (before 7.0, after 6.1, P=.003), and "better guideline adherence" (before 6.3, after 5.3, P=.005). Strikingly, 20 out of 31 heart failure clinics stated that they were considering using a different telemonitoring system than the system used at the time. less thanbrgreater than less thanbrgreater thanConclusions: One third of all heart failure clinics surveyed were using telemonitoring as part of their care without any transparent, predefined criteria of user requirements. Prior expectations of telemonitoring were not reflected in actual experiences, possibly leading to disappointment. (J Med Internet Res 2013;15(1):e4) doi:10.2196/jmir.2161
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| 6. |
- de Vries, Arjen E, et al.
(författare)
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The value of INnovative ICT guided disease management combined with Telemonitoring in OUtpatient clinics for Chronic Heart failure patients. Design and methodology of the IN TOUCH study : a multicenter randomised trial
- 2011
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Ingår i: BMC health services research. - : Springer Science and Business Media LLC. - 1472-6963. ; 11, s. 167-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although the value of telemonitoring in heart failure patients is increasingly studied, little is known about the value of the separate components of telehealth: ICT guided disease management and telemonitoring. The aim of this study is to investigate the value of telemonitoring added to ICT guided disease management (DM) on the quality and efficiency of care in patients with chronic heart failure (CHF) after a hospitalisation.METHODS/DESIGN: The study is divided in two arms; a control arm (DM) and an intervention arm (DM+TM) in 10 hospitals in the Netherlands. In total 220 patients will be included after worsening of CHF (DM: N = 90, DM+TM: N = 130). Total follow-up will be 9 months. Data will be collected at inclusion and then after 2 weeks, 4.5 and 9 months. The primary endpoint of this study is a composite score of: 1: death from any cause during the follow-up of the study, 2: first readmission for HF and 3: change in quality of life compared to baseline, assessed by the Minnesota Living with Heart failure Questionnaire. The study has started in December 2009 and results are expected in 2012.CONCLUSIONS: The IN TOUCH study is the first to investigate the effect of telemonitoring on top of ICT guided DM on the quality and efficiency of care in patients with worsening HF and will use a composite score as its primary endpoint.TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR1898.
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| 7. |
- van Zeeburg, Hester J. T., et al.
(författare)
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Clinical and Molecular Characteristics of Squamous Cell Carcinomas From Fanconi Anemia Patients
- 2008
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Ingår i: Journal of the National Cancer Institute. - : Oxford University Press (OUP). - 1460-2105 .- 0027-8874. ; 100:22, s. 1649-1653
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Tidskriftsartikel (refereegranskat)abstract
- Fanconi anemia is a recessively inherited disease that is characterized by congenital abnormalities, bone marrow failure, and a predisposition to develop cancer, particularly squamous cell carcinomas (SCCs) in the head and neck and anogenital regions. Previous studies of Fanconi anemia SCCs, mainly from US patients, revealed the presence of high-risk human papillomavirus (HPV) DNA in 21 (84%) of 25 tumors analyzed. We examined a panel of 21 SCCs mainly from European Fanconi anemia patients (n = 19 FA patients; 16 head and neck squamous cell carcinomas [HNSCCs], 2 esophageal SCCs, and 3 anogenital SCCs) for their clinical and molecular characteristics, including patterns of allelic loss, TP53 mutations, and the presence of HPV DNA by GP5+/6+ polymerase chain reaction. HPV DNA was detected in only two (10%) of 21 tumors (both anogenital SCCs) but in none of the 16 HNSCCs. Of the 18 tumors analyzed, 10 contained a TP53 mutation. The patterns of allelic loss were comparable to those generally found in sporadic SCCs. Our data show that HPV does not play a major role in squamous cell carcinogenesis in this cohort of Fanconi anemia patients and that the Fanconi anemia SCCs are genetically similar to sporadic SCCs despite having a different etiology.
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| 8. |
- de La Peña Aguilera, Pablo, et al.
(författare)
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Consistent imprints of elevation, soil temperature and moisture on plant and arthropod communities across two subarctic landscapes
- 2023
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Ingår i: Insect Conservation and Diversity. - 1752-458X .- 1752-4598. ; 16, s. 684-700
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Tidskriftsartikel (refereegranskat)abstract
- 1. Factors shaping arthropod and plant community structure at fine spatial scales are poorly understood. This includes microclimate, which likely plays a large role in shaping local community patterns, especially in heterogeneous landscapes characterised by high microclimatic variability in space and in time.2. We explored differences in local microclimatic conditions and regional species pools in two subarctic regions: Kilpisj & auml;rvi in north-west Finland and Varanger in north-east Norway. We then investigated the relationship between fine-scale climatic variation and local community characteristics (species richness and abundance) among plants and arthropods, differentiating the latter into two groups: flying and ground-dwelling arthropods collected by Malaise and pitfall traps, respectively. Arthropod taxa were identified through DNA metabarcoding. Finally, we examined if plant richness can be used to predict patterns in arthropod communities.3. Variation in soil temperature, moisture and snow depth proved similar between regions, despite differences in absolute elevation. For each group of organisms, we found that about half of the species were shared between Kilpisj & auml;rvi and Varanger, with a quarter unique to each region.4. Plants and arthropods responded largely to the same drivers. The richness and abun-dance of both groups decreased as elevation increased and were positively correlated with higher soil moisture and temperature values. Plant species richness was a poor predictor of local arthropod richness, in particular for ground-dwelling arthropods.5. Our results reveal how microclimatic variation within each region carves pro-nounced, yet consistent patterns in local community richness and abundance out of a joint species pool.
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| 9. |
- Egelkraut, Dagmar D., 1989-
(författare)
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Long-lasting ecological legacies of reindeer on tundra vegetation
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Reindeer can have strong effects on the plant species composition and functioning of tundra ecosystems, and often promote a transition towards a graminoid-dominated vegetation type. As a result, they influence many ecological processes, such as nutrient dynamics, soil biotic composition and functioning, and carbon storage. Several studies suggest that the effect of reindeer on vegetation may follow predictable patterns and could induce an alternative stable vegetation state. However, little empirical data on the long-term stability of reindeer effects on vegetation exist, as it is inherently challenging to study these ecological processes experimentally on a sufficiently long timescale. The main objective of this thesis was therefore to gain a better understanding of the long-term ecological processes following reindeer-induced vegetation shifts.In order to gain a more mechanistic insight in what initially drives this transition, I used a field-based grazing simulation experiment in which I separated defoliation, trampling, moss removal and the addition of feces. This allowed me to test the relative contribution of reindeer-related activities to initiating the shift from moss and heath- dominated tundra towards a graminoid-dominated vegetation state. Additionally, I studied the long-term ecological stability following such a vegetation shift. I did this by addressing historical milking grounds (HMGs): sites where high reindeer concentrations associated with historical traditional reindeer herding practices induced a vegetation transition from shrubs towards graminoids several centuries earlier, but which were abandoned a century ago. Studying HMGs allowed me to address: 1. The potential stability of reindeer-induced vegetation shifts; 2. The ecological mechanisms contributing to the long-term stability of these vegetation shifts; and 3. How such long-lasting vegetation changes influence soil carbon- and nutrient cycling.I found that trampling by reindeer is an important mechanism by which reindeer cause vegetation change. Addressing HMGs further revealed that this vegetation change can be hightly persistent, as the studied HMGs showed only a low encroachment at the surrounding borders in the last 50 years. The vegetation in the core areas of all studied HMGs had remained strikingly stable, and were hardly invaded by surrounding shrubs. Interestingly, soil nutrient concentrations and microbial activities were still different from the surrounding area as well, and even comparable to actively grazed areas. Even after many centuries of changed vegetation composition and soil processes, there was no difference in total carbon sequestration. This suggests that the environmental conditions for microbial decomposition were more important than vegetation composition for the soil carbon stocks, in our study site.After studying the contemporary habitat use of HMGs by reindeer and other herbivores, investigating the potential plant-soil feedbacks mechanisms and detailed soil analyses, I concluded that several ecological mechanisms contribute to the long-term stability of HMGs: first, the altered soil biotic and abiotic conditions appear to have a stronger advantage for HMG vegetation than for the surrounding tundra vegetation. Furthermore, I found a clear browsing preference of small rodents on single shrubs proliferating in HMGs, causing a strong limitation on shrub expansion. Moreover, the dense established sward of graminoids likely poses a strong direct competition for space and nutrients, hindering seedling establishment. Finally, I conclude that HMGs are highly stable on relevant ecological timescales, and propose how the concepts of historical contingency and ASS can be applied to understand stability of these reindeer-induced vegetation transitions.
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| 10. |
- Fischer, Anke, et al.
(författare)
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Communicating nature during lockdown - How conservation and outdoor organisations use social media to facilitate local nature experiences
- 2022
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Ingår i: People and Nature. - : Wiley. - 2575-8314. ; 4, s. 1292-1304
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Tidskriftsartikel (refereegranskat)abstract
- Social media impact not only our communication and social interactions but also our relationships to the natural environment. Social media can increase understanding of our environment by offering information and sharing calls to action, while at the same time, they might present a glamourised, standardised picture of nature and distract from actual outdoor interactions. The COVID-19 pandemic presents a unique opportunity to study the spaces created for interactions between the online and offline natural world, especially in countries where movement and thus outdoor activities were restricted during lockdowns. To understand these interactions, we investigated the social media communication of nature conservation and outdoor organisations by analysing Twitter posts of four prominent NGOs in Scotland. We found that during the first COVID-19-induced UK lockdown in spring 2020, Scottish nature conservation and outdoor organisations made distinctive efforts in supporting followers to connect with nature in the face of restrictions. Organisations showed signs of moving towards community-building through sharing experiences often related to nearby nature, while calls for environmental action, more prominent in the previous year, receded in relative importance. Emphasis was put on sensory engagement with, and finding solace in the rhythm of, nature. References to taking action to protect nature now became linked to a green recovery from the pandemic. We conclude that NGOs used social media not as a space separate from the outdoors, but as an augmented space where online and offline interactions were interwoven and a space in which during the COVID-19 pandemic, new avenues for engagement were being explored. Read the free Plain Language Summary for this article on the Journal blog.
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