Peter M M Spreeuwenberg

Nederlands Instituut voor onderzoek van de Gezondheidszorg, Utrecht, Utrecht, Netherlands

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Publications (27)62.41 Total impact

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    ABSTRACT: When studying the patient perspective on communication, some studies rely on analogue patients (patients and healthy subjects) who rate videotaped medical consultations while putting hemselves in the shoes of the video-patient. To describe the rationales, methodology, and outcomes of studies using videovignette designs in which videotaped medical consultations are watched and judged by analogue patients. Pubmed, Embase, Psychinfo and CINAHL databases were systematically searched up to February 2012. Data was extracted on: study characteristics and quality, design, rationales, internal and external validity, limitations and analogue patients’ perceptions of studied communication. A meta-analysis was conducted on the distribution of analogue patients’ evaluations of communication. Thirty-four studies were included, comprising both scripted and clinical studies, of average-to-superior quality. Studies provided unspecific, ethical as well as methodological rationales for conducting video-vignette studies with analogue patients. Scripted studies provided the most specific methodological rationales and tried the most to increase and test internal validity (e.g. by performing manipulation checks) and external validity (e.g. by determining identification with videopatient). Analogue patients’ perceptions of communication largely overlap with clinical patients’ perceptions. The meta-analysis revealed that analogue patients’ evaluations of practitioners’ communication are not subject to ceiling effects. Analogue patients’ evaluations of communication equaled clinical patients’ perceptions, while overcoming ceiling effects. This implies that analogue patients can be included as proxies for clinical patients in studies on communication, taken some described precautions into account. Insights from this review may ease decisions about including analogue patients in video-vignette studies, improve the quality of these studies and increase knowledge on communication from the patient perspective. (aut. ref.)
    Journal of General Internal Medicine 09/2012; 27(11):1570. · 3.28 Impact Factor
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    ABSTRACT: When studying the patient perspective on communication, some studies rely on analogue patients (patients and healthy subjects) who rate videotaped medical consultations while putting themselves in the shoes of the video-patient. To describe the rationales, methodology, and outcomes of studies using video-vignette designs in which videotaped medical consultations are watched and judged by analogue patients. Pubmed, Embase, Psychinfo and CINAHL databases were systematically searched up to February 2012. Data was extracted on: study characteristics and quality, design, rationales, internal and external validity, limitations and analogue patients' perceptions of studied communication. A meta-analysis was conducted on the distribution of analogue patients' evaluations of communication. Thirty-four studies were included, comprising both scripted and clinical studies, of average-to-superior quality. Studies provided unspecific, ethical as well as methodological rationales for conducting video-vignette studies with analogue patients. Scripted studies provided the most specific methodological rationales and tried the most to increase and test internal validity (e.g. by performing manipulation checks) and external validity (e.g. by determining identification with video-patient). Analogue patients' perceptions of communication largely overlap with clinical patients' perceptions. The meta-analysis revealed that analogue patients' evaluations of practitioners' communication are not subject to ceiling effects. Analogue patients' evaluations of communication equaled clinical patients' perceptions, while overcoming ceiling effects. This implies that analogue patients can be included as proxies for clinical patients in studies on communication, taken some described precautions into account. Insights from this review may ease decisions about including analogue patients in video-vignette studies, improve the quality of these studies and increase knowledge on communication from the patient perspective.
    Journal of General Internal Medicine 06/2012; 27(11):1528-43. · 3.28 Impact Factor
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    ABSTRACT: To study the effects of introducing a nursing guideline on depression in residents with dementia of psychogeriatric nursing home wards. A multi-center controlled clinical trial with randomization at ward level was used to study the effects of the guideline introduction. Nursing teams were trained in applying the guideline to their own residents diagnosed with depression in dementia. Key elements of the nursing guideline are increasing individualized pleasant activities and decreasing unpleasant events. Participating residents were 97 residents diagnosed with dementia and comorbid depression, from 18 psychogeriatric nursing home wards, in 9 Dutch nursing homes. Measurements took place at pre-test, post-test and follow-up. Primary outcome was severity of depression measured with the MDS/RAI-Depression Rating Scale (DRS) and the Cornell Scale for Depression in Dementia. Secondary outcome is mood as measured by the FACE-observation scale. Compliance with the nursing guideline was moderate. Despite this, residents on the experimental wards showed a significant reduction in depression on the DRS. With the Cornell scale a reduction of depression was found as well, although not significantly different from that in the control group. No effects on observed mood were found. This study shows significant reductions in depression severity by introducing a nursing guideline on psychogeriatric nursing home wards. Better compliance with the guideline could probably enlarge the effects. Some ways to achieve enhanced compliance are: (1) additionally train non-certified nurse assistants, and (2) emphasize necessary conditions for successful introduction of the guideline to nursing team managers.
    International Journal of Geriatric Psychiatry 07/2011; 26(7):723-32. · 2.98 Impact Factor
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    ABSTRACT: To improve care for residents with depression in dementia, an evidence based nursing guideline was developed. Using the guideline has already shown positive effects on depression in psychogeriatric nursing home residents. To study the effects of the introduction of the nursing guideline 'depression in dementia' on perceived professional autonomy, workload and feelings of powerlessness and confidence in Certified Nurse Assistants. A multi-center controlled intervention study with randomization at ward level, using pre-test, post-test and follow-up measurements. 18 psychogeriatric wards in 9 Dutch nursing homes. 193 Certified Nurse Assistants working on psychogeriatric nursing home wards for at least 20 h per week. An evidence based guideline for nursing teams of psychogeriatric nursing home wards was introduced on nine experimental wards to reduce depression in residents diagnosed with depression in dementia. The guideline introduction consisted of team training and the installation of a promotion group. The nine control wards continued providing usual care. Primary outcomes are: (1) perceived professional autonomy and (2) experienced workload in Certified Nurse Assistants measured with the VBBA subscales 'autonomy' and 'pace and amount of work'. Secondary outcomes are perceived powerlessness and confidence in caring for depressed and demented residents, using two self-developed scales. The guideline introduction had a small, significant, positive effect on generally perceived professional autonomy in the Certified Nurse Assistants of the experimental wards. No short-term effects were found on generally experienced workload, or on confidence and powerlessness in caring for depressed residents with dementia. The introduction of the nursing guideline 'depression in dementia' has small, positive effects on perceived professional autonomy among the Certified Nurse Assistants. Long-term effects on experienced workload should be studied.
    International journal of nursing studies 06/2011; 48(6):710-9. · 1.91 Impact Factor
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    International journal of nursing studies 06/2011; 48(6):782-3. · 1.91 Impact Factor
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    ABSTRACT: Objectives: Previous studies into the effects of guided imagery in patients with fibromyalgia show varying results. The current study gives more insight into the effects on pain, self-efficacy and functional status. Design: A randomized clinical trial with pre-test, post-test and follow-up measurements. Subjects: 65 patients (32 experimental; 33 control) with a fibromyalgia diagnosis shorter than 6 years, recruited from a patient organisation and calls in local newspapers in the Netherlands. Intervention: The intervention group received two 1,5 hour group sessions, including group conversation, instruction about Guided Imagery and the distribution of a cd with Guided Imagery exercises. The intervention group was asked to do one or two Guided Imagery exercises per day during 4 weeks. The control group received two 1,5 hour group sessions, including group conversation only. Outcome measures: Daily pain was assessed during 26 days with a pain diary using a 10 cmVisual Analogue Scale. Functional status and selfefficacy were measured at pre-test, post-test ( 4 weeks after pre-test) and at follow-up (10 weeks after pre-test), using the Fibromyalgia Impact Questionnaire and the subscale self-efficacy in dealing with pain of the Chronic Pain Self-efficacy Scale. Results: No effects of guided imagery were established on daily pain, functional status or self-efficacy in dealing with pain. Discussion: Possible explanations for the diverging results between studies might be found in the specific content of the exercises (pleasant imagery versus pleasant imagery + focus on pain in the current study), the length of the intervention period and the background of participants (recruitment via physicians versus recruitment via patient organisations in the current study). Additionally, the study concludes that the focus of interventions for patients with fibromyalgia should not only be on chronic pain, but also on other symptoms, like fatigue and sleep disturbances. (aut. ref.)
    01/2011;
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    ABSTRACT: A randomized pre- and post-test control group design was conducted in 12 oncology wards to investigate the effectiveness of an intervention, existing of a communication skills training with web-enabled video feedback and a Question Prompt Sheet (QPS), which aimed to improve patient education to older cancer patients (≥65 years). The effects were studied by analyzing questionnaires and video recordings of patient education sessions preceding chemotherapy with 210 different patients. Patients' recall of information was the primary outcome of the study. Recall was checked against the actual communication in the video-recordings. Moreover, communication skills were assessed by observing the extent to which nurses implemented 67 communication aspects, categorized in seven dimensions, using the QUOTE(chemo). Experimental nurses demonstrated a significant intervention effect on communicating realistic expectations. Within-group improvements were measured in the experimental group for tailored communication, affective communication and interpersonal communication. Although the use of a QPS significantly increased question asking, only limited results were found on older patients' recall scores. The overall proportion recall of recommendations showed a marginally significant pre-/post-change in proportion recall in favour of the experimental group and there was a significant pre-/post-change in two out of six sub-categories. The results indicate that nurses' communication skills can be improved by communication skills training. More research is needed to understand the difficult relationship between patient-provider communication and recall of information.
    Critical reviews in oncology/hematology 11/2010; 80(1):145-59. · 5.27 Impact Factor
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    ABSTRACT: To examine the characteristics of patients participating in a shared medical appointment (SMA); to what extent SMAs fulfil patients' needs; to evaluate if patients are better informed after an SMA and how they evaluate meeting other patients at an SMA, and how health professionals experience SMAs. Descriptive. Fourteen multidisciplinary teams participated in the study. The Dutch Institute for Healthcare Improvement (CBO) trained them in how to conduct an SMA. The experiences of patients participating in an SMA were compared with the experiences of patients who visited the doctor individually. Patients completed questionnaires before and after the SMA (n = 83) or the individual visit (n = 158). Patients who participated in an SMA did not differ significantly from the regular patient population in either demographic characteristics or in their experience of health and care uptake. Patients participated in an SMA primarily to share experiences with fellow patients, to learn from others and to obtain more information. Both patients and health professionals (n = 53) reported that patients received more information during an SMA. Patients valued the contact with their fellow patients. SMA offered care givers a different experience and opportunities to learn. For patients and health professionals, SMAs seem indeed to have added value. More research is needed to understand the working mechanism and the long-term effects of participation in SMAs.
    Nederlands tijdschrift voor geneeskunde 01/2009; 153:A828.
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    ABSTRACT: The literature on adult trauma survivors demonstrates that those exposed to traumatic stress have a poorer physical health status than nonexposed individuals. Studies on physical health effects in adolescent trauma survivors, in contrast, are scarce. In the current study, it was hypothesized that adolescents who have been involved in a mass burn incident (N = 124) will demonstrate more physical and mental health problems than an unaffected cohort from the same community (N = 1,487). Health data were extracted from electronic medical records, covering 1-year prefire and 4-years postfire. When compared to the prefire baseline, survivors showed significantly larger increases in mental, respiratory, and musculoskeletal problems than community controls during the first year after the fire, but not during the later years.
    Journal of Traumatic Stress 05/2008; 21(2):239-42. · 2.72 Impact Factor
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    ABSTRACT: "Eating profiles" can be defined as types of clients distinguished by combinations of food preferences, consumption patterns, and preferences for ambiance. The purpose of this article is to describe the development and initial testing of an instrument to establish eating profiles of residents of nursing homes or elderly homes. We constructed a 35-item, 4-subscale questionnaire. This self-administered, usable instrument derived five eating profiles from clients' perspectives. Insight in eating profiles is important for facility managers to ascertain that the food, dinner service, and ambiance are adequately tailored to the residents' preferences.
    Journal of Nutrition for the Elderly 02/2008; 27(1-2):47-64.
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    ABSTRACT: Mental health problems associated with benzodiazepine treatment are often highly prevalent in the aftermath of disasters. Nevertheless, not much is known about benzodiazepine use after disasters. Considering the negative effects associated with prolonged use and the adverse effects of benzodiazepines on recovery of patients with acute stress, the aim of the present study was to explore benzodiazepine use in the context of the Enschede fireworks disaster of 13 May 2000. A longitudinal study using electronic medical records of general practitioners. Subjects were patients aged 16 years and older, registered at one of the practices between 1999 and 2003 (1541 victims and 5370 references). Pre- and post-disaster data were available on benzodiazepine prescriptions, healthcare utilization and sociodemographic characteristics. Benzodiazepine use was defined using different criteria (e.g. any use, daily use, chronic use). Data were analysed using multivariate multilevel logistic regression analyses. Compared with patients from a reference group, disaster victims were at increased risk of becoming an incident benzodiazepine user after the disaster. Benzodiazepine use also had a different time course among victims compared with references. However, daily or prolonged use of benzodiazepines was not often observed and did not show dramatic deviations among disaster victims compared with references. There is no convincing evidence that general practitioners systematically deviated from clinical guidelines for benzodiazepines, which generally advocate their short time application.
    The European Journal of Public Health 01/2008; 17(6):612-7. · 2.52 Impact Factor
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    ABSTRACT: This study aims to examine the impact of women's characteristics (demographics, risk behaviour, and beliefs) on the uptake of cervical cancer screening, taking practice characteristics (demographic and organizational) into account. Routinely collected data of screening status were sampled from electronic medical records of 32 Dutch general practices. Additionally, a questionnaire was sent to a sample of 2224 listed women-1204 screened, 1020 unscreened. We used a step-by-step, logistic, multilevel approach to examine determinants of the screening uptake. Analyses of data for 1392 women (968 screened and 424 unscreened) showed that women's beliefs about cervical screening and attendance are the best predictors of screening uptake, even when demographic and organizational aspects are taken into account. Women aged 40-50 years who felt high personal moral obligation, who had only one sexual partner ever, and who were invited and reminded by their own general practice had the greatest likelihood of screening uptake. A non-response study was performed; the non-responders to the questionnaire (mainly unscreened) thought they had less risk of cervical cancer, were less motivated, less often intended to get future screening, and were more convinced that cervical cancer cannot be cured. To improve the uptake rate, we should focus on the personal moral obligation of eligible women, beliefs about the risks of cervical cancer, and available cures. Invitations and reminders within general practices enhance the uptake rate.
    The European Journal of Public Health 05/2007; 17(2):178-85. · 2.52 Impact Factor
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    ABSTRACT: De meeste bewoners in verpleeg- en verzorgingshuizen oordelen positief over hun kwaliteit van leven. Verzorgenden spelen hierbij een belangrijke rol. In instellingen waar verzorgenden af en toe zomaar een praatje met de bewoners maken, waarderen bewoners de kwaliteit van leven hoger. 'Sociale contacten zijn veel wezenlijker en belangrijker voor de kwaliteit van leven in verpleeg- en verzorgingshuizen dan tot nu toe wordt gedacht', verklaart NIVEL-onderzoeker Sandra van Beek. Ouderen die vaker deelnemen aan groepsactiviteiten én ouderen die vaker een praatje maken met het verzorgend personeel, ervaren een hogere kwaliteit van leven. Het gaat dus niet om gesprekken tijdens de zorg, maar juist om zomaar een praatje tussendoor. 'Door zo’n praatje oordelen bewoners positiever over hun woonomstandigheden. Ze voelen zich bijvoorbeeld meer thuis, voelen zich veilig en vervelen zich minder. Zo’n praatje werkt ook door in de contacten met anderen. Bewoners voelen zich bijvoorbeeld minder eenzaam en ervaren meer warmte en genegenheid.' Dat praatje tussendoor is bovendien belangrijk voor het lichamelijk welzijn van bewoners. Hoe dat komt is nog onduidelijk. 'De generatie die nu wordt verzorgd in verpleeg- en verzorgingshuizen klaagt niet snel', stelt Van Beek. 'Wellicht dat bewoners door regelmatige gesprekken met medewerkers eerder lichamelijke klachten durven aangeven, waardoor beter op hun situatie kan worden ingespeeld.' Door meer groepsactiviteiten te organiseren en contacten tussen verzorgend personeel en bewoners te stimuleren, kunnen instellingen de kwaliteit van leven van de bewoners op veel aspecten verbeteren. Met subsidie van zorgondernemersorganisatie ActiZ onderzocht het NIVEL (Nederlands instituut voor onderzoek van de gezondheidszorg) de kwaliteit van leven in verpleeg- en verzorgingshuizen. In het onderzoek is specifiek gekeken naar aspecten die bewoners met lichamelijke klachten belangrijk vinden. Over het algemeen ervaren de bewoners hun kwaliteit van leven als voldoende. Daarbij komen uit het onderzoek ook verschillende onderwerpen naar voren die verbetering behoeven, zo zou 34% van de bewoners zich gezonder willen voelen en is 29% eenzaam. Verder vormt het vervoer buitenshuis voor bijvoorbeeld familiebezoek een belangrijk knelpunt voor 32% van de bewoners. Ook geeft meer dan 20% van de bewoners aan niet zelf te kunnen bepalen wanneer ze lichamelijk verzorgd worden en kunnen eten en drinken. Van Beek: 'Dat bewoners zelf beslissingen kunnen nemen in het dagelijks leven, blijft een belangrijk aandachtspunt in de ouderenzorg.' In het NIVEL-onderzoek zijn 556 bewoners uit 22 zorginstellingen (6 verpleeghuizen en 16 verzorgingshuizen) geïnterviewd over kwaliteit van leven. Daarbij is gebruikgemaakt van de vragenlijst Zicht op eigen leven die vier domeinen van kwaliteit van leven onderscheidt: lichamelijk welbevinden, woon-/leefsituatie, participatie en mentaal welbevinden. Verder werden aan de bewoners enkele vragen voorgelegd over de gang van zaken binnen de instelling en werd gebruikgemaakt van Benchmarkgegevens van de instellingen. Bewoners met cognitieve beperkingen, door bijvoorbeeld dementie, zijn niet meegenomen in het onderzoek. 'Voor bewoners met cognitieve beperkingen is verder onderzoek wenselijk', oppert Van Beek, 'zodat de zorg ook voor hen kan worden verbeterd.'
    01/2007;
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    ABSTRACT: The impact of disasters on primary healthcare utilization is largely unknown. Moreover, it is often overlooked how disaster affects those closest to the primary victims, their family members. The objective of this study was to examine the long-term effects of a catastrophic fire on primary healthcare utilization. We conducted a prospective, population-based cohort study covering 1 year pre- and 3 years postfire. Utilization data were extracted from primary care records. Subjects consisted of 286 disaster victims, 802 family members of disaster victims, 3722 community control subjects, and 10,230 patients from a national reference population. As outcome measures, we studied 1) the annual number of contacts in primary care and 2) the annual number of contacts for problems related to mental health. Determinants are injury characteristics of victims and bereavement. All analyses control for age, gender, and insurance status. Being an uninjured victim who witnessed the disaster increases the number of contacts by a factor of 1.55 during the first year postfire (95% confidence interval [CI], 1.35-1.78). Uninjured victims contact the family practitioner more often for mental health-related problems than adolescent community control subjects (incidence rate ratio [IRR], 4.54; 95% CI, 1.69-12.20). In adult family members, the loss of a child predicts overall utilization (IRR, 1.88; 95% CI, 1.35-2.63) and utilization for mental health (IRR, 8.69; 95% CI, 2.10-35.92) during the first year postfire. Attention should be paid to the primary care needs of bereaved individuals and those who have witnessed the disaster.
    Medical Care 07/2006; 44(6):581-9. · 3.23 Impact Factor
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    ABSTRACT: This paper reports an investigation of the effects of the implementation of snoezelen, or multisensory stimulation, on the quality of nursing assistants' behaviour during morning care. Nursing assistants in long-term dementia care are often unaware of the impact of their behaviour on patient functioning. Snoezelen is a psychosocial intervention that might improve the quality of caregiver behaviour by combining a person-centred approach with the integration of sensory stimuli. A quasi-experimental pre- and post-test design was implemented in 12 wards for older mentally infirm patients at six nursing homes. The experimental group intervention was a 4-day in-house 'snoezelen' training, stimulus preference screening and supervision meetings. The control group received usual nursing home care. The effectiveness of the intervention was studied by analysing 250 video recordings, which were assessed by independent observers using a 4-point measurement scale developed for this study and based on Kitwood's Dialectical Framework. The results showed a statistically significant increase in 'Positive Person Work' and decrease in 'Malignant Social Psychology' (total scores) after the implementation of snoezelen. Nursing assistants in the experimental group also improved by statistically significant amounts on all subitems of 'Positive Person Work'. The mean number of sensory stimuli, offered explicitly, increased. The implementation of snoezelen succeeded in effecting a change to a more person-centred approach during morning care. The results indicate that nursing assistants' behaviour can be positively changed provided that the new care model has been successfully implemented.
    Journal of Advanced Nursing 04/2006; 53(6):656-68. · 1.53 Impact Factor
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    ABSTRACT: Dementia among nursing home residents is often accompanied by high care dependency and behavioral disturbances, resulting in an increased workload for the caregivers. Snoezelen, integrated into 24-hour dementia care, is an approach that might improve the quality of working life of dementia caregivers. This study aims to investigate the effectiveness of integrated snoezelen on work-related outcomes (workload and psychological outcomes) of caregivers in psychogeriatric nursing homes. A quasi-experimental pre- and post-test design was used, comparing six psychogeriatric wards that implemented snoezelen in 24-hour care to six control wards that continued giving usual care. One hundred and twenty-nine Certified Nursing Assistants (CNAs) were included in the pre-test and 127 CNAs in the post-test. The six intervention wards received a 4-day in-house training program. The intervention further consisted of implementation activities on the ward (e.g. stimulus preference screening, workgroup), three in-house follow-up meetings and two general meetings. Measurements on workload, perceived problems, stress reactions, job satisfaction and burnout were performed at baseline and after 18 months. A significant treatment effect in favor of the experimental group was found for time pressure, perceived problems, stress reactions and emotional exhaustion. CNAs of the experimental group also improved on their overall job satisfaction score. In particular, they were more satisfied with the quality of care and with their contact with residents. The implementation of snoezelen improved the quality of the working life of dementia caregivers.
    International Psychogeriatrics 10/2005; 17(3):407-27. · 2.19 Impact Factor
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    ABSTRACT: To investigate the effectiveness of snoezelen, integrated in 24-hour care, on the communication of Certified Nursing Assistants (CNAs) and demented nursing home residents during morning care. A quasi-experimental pre- and post-test design was conducted, comparing sic psychogeriatric wards, that implemented snoezelen, to six control wards, that continued in giving usual care. Measurements were performed at baseline and 18 months after a training 'snoezelen for caregivers'. Independent assessors analysed 250 video-recordings directly from the computer, using an adapted version of the Roter Interaction Analysis System (RIAS) and non-verbal measurements. Trained CNAs showed a significant increase of resident-directed gaze, affective touch and smiling. The total number of verbal utterances also increased (more social conversation, agreement, talking about sensory stimuli, information and autonomy). Regarding residents, a significant treatment effect was found for smiling, CNA-directed gaze, negative verbal behaviours (less disapproval and anger) and verbal expressed autonomy. The implementation of snoezelen improved the actual communication during morning care. Teaching CNAs to provide snoezelen has added value for the quality of care. Morning care by trained CNAs appeared to take more time. This suggests that (some) time investment might be required to achieve positive effects on CNA- resident communication.
    Patient Education and Counseling 10/2005; 58(3):312-26. · 2.60 Impact Factor
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    ABSTRACT: To investigate the effectiveness of snoezelen, integrated in 24-hour daily care, on the behavior and mood of demented nursing home residents. Quasiexperimental pre- and posttest design. Twelve psychogeriatric wards of six nursing homes, spread over different parts of the Netherlands. One hundred twenty-five patients with moderate to severe dementia and care dependency were included in the pretest and 128 in the posttest; 61 were completers (included in both pre- and posttest). Experimental subjects received an individual 24-hour snoezel program, based on family history taking and stimulus preference screening. Caregivers were trained, and (organizational) adaptations were made to fulfill the conditions for resident-oriented snoezel care. The control group received usual nursing home care. Observations were made on the wards using subscales of the Dutch Behavior Observation Scale for Psychogeriatric Inpatients, the Dutch version of the Cohen-Mansfield Agitation Inventory, and the Cornell Scale for Depression in Dementia. Independent assessors observed video recordings of morning care and rated residents' behavior and mood using INTERACT and FACE, respectively. Residents receiving snoezel care demonstrated a significant treatment effect with respect to their level of apathetic behavior, loss of decorum, rebellious behavior, aggressive behavior, and depression. During morning care, the experimental subjects showed significant changes in well-being (mood, happiness, enjoyment, sadness) and adaptive behavior (responding to speaking, relating to caregiver, normal-length sentences). Snoezel care particularly seems to have a positive effect on disturbing and withdrawn behavior. The results suggest that a 24-hour integrated snoezel program has a generalizing effect on the mood and behavior of demented residents.
    Journal of the American Geriatrics Society 02/2005; 53(1):24-33. · 3.98 Impact Factor
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    ABSTRACT: A persistent finding in health services research is that health care delivery and hospital utilisation in the Western world varies widely between areas, both within and between countries. Most studies have concentrated on cross-sectional variations in medical practice. The aim of this article is to investigate whether or not small area variation changed through time. We used hospital discharge rates in the Netherlands for 12 diagnostic or surgical categories to indicate medical practice patterns. The data cover a time span of almost two decades: 1980-1997. First, it was found that in most cases regions are consistently above or below the national trend in the study period. Second, the analysis revealed a statistically significant decline of regional variation in hospital discharges in general during the 1980s and the 1990s. In all but one medical category the results of the separate analyses point towards a downward trend. In one-third of the medical categories this downward trend was statistically significant. Potential parallel changes in regional disparities in need for care, e.g. morbidity or age composition of regional populations or changes in regional differences in care supply are discussed.
    Health & Place 10/2004; 10(3):215-20. · 2.42 Impact Factor
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    ABSTRACT: To explore the sociodemographic and clinical characteristics of cancer patients seeking a second-opinion consultation and to analyze their second opinion-related motives, needs, and expectations. In 212 consecutive patients seeking a second opinion at the Surgical Oncology Outpatient Clinic, satisfaction with the first specialist, motivation for the second opinion, need for information, preference for decision participation, and hope for and expectation of a different second opinion were assessed with a questionnaire. The mean age was 53 years. Most patients were women (82%), of whom 76% were diagnosed with breast cancer. Half of the patients (51%) had a low educational level. The majority of patients (62%) only had internal motives for second-opinion seeking associated with the need for reassurance and more certainty, whereas a substantial minority of patients (38%) also had external motives related to negative experiences or unfulfilled needs. The externally motivated patients had a higher anxiety disposition, were less satisfied with their first specialist, preferred a more active role in medical decision making, and more often hoped for and expected a different second opinion. Motives for second-opinion consultations differ greatly. Understanding the difference between internal and external motivation is necessary to develop strategies to prevent unnecessary second-opinion seeking. Additional studies are warranted to evaluate the objective and subjective outcomes of second-opinion consultations.
    Journal of Clinical Oncology 05/2003; 21(8):1492-7. · 18.04 Impact Factor