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Background: Web-based patient education is increasingly offered to improve patients’ ability to learn, remember, and apply health information. Efficient organization, display, and structural design, that is, information architecture (IA), can support patients’ ability to independently use web-based patient education. However, the role of IA in the context of web-based patient education has not been examined systematically. Objective: To support intervention designers in making informed choices that enhance patients’ learning, this paper describes a randomized experiment on the effects of IA on the effectiveness, use, and user experience of a patient education website and examines the theoretical mechanisms that explain these effects. Methods: Middle-aged and older adults with self-reported hip or knee joint complaints were recruited to use and evaluate 1 of 3 patient education websites containing information on total joint replacement surgery. Each website contained the same textual content based on an existing leaflet but differed in the employed IA design (tunnel, hierarchical, or matrix design). Participants rated the websites on satisfaction, engagement, control, relevance, trust, and novelty and completed an objective knowledge test. Analyses of variance and structural equation modeling were used to examine the effects of IA and construct a theoretical model. Results: We included 215 participants in our analysis. IA did not affect knowledge gain (P=.36) or overall satisfaction (P=.07) directly. However, tunnel (mean 3.22, SD 0.67) and matrix (mean 3.17, SD 0.69) architectures were found to provide more emotional support compared with hierarchical architectures (mean 2.86, SD 0.60; P=.002). Furthermore, increased perceptions of personal relevance in the tunnel IA (β=.18) were found to improve satisfaction (β=.17) indirectly. Increased perceptions of active control in the matrix IA (β=.11) also improved satisfaction (β=.27) indirectly., Applied Ergonomics and Design, Human Information Communication Design

Contains fulltext : 220540.pdf (Publisher’s version ) (Open Access), OBJECTIVE: Prediction models have been developed to predict either unilateral or bilateral primary aldosteronism, and these have not been validated externally. We aimed to develop a simplified score to predict both subtypes and validate this externally. METHODS: Our development cohort was taken from 165 patients who underwent adrenal vein sampling (AVS) in two Asian tertiary centres. Unilateral disease was determined using both AVS and postoperative outcome. Multivariable analysis was used to construct prediction models. We validated our tool in a European cohort of 97 patients enrolled in the SPARTACUS trial who underwent AVS. Previously published prediction models were also tested in our cohorts. RESULTS: Backward stepwise logistic regression analysis yielded a final tool using baseline aldosterone-to-lowest-potassium ratio (APR, ng/dl/mmol/l), with an area under receiver-operating characteristic curve of 0.80 (95% CI 0.70-0.89). In the Asian development cohort, probability of bilateral disease was 90.0% (with APR <5) and probability of unilateral disease was 91.4% (with APR >15). Similar results were seen in the European validation cohort. Combining both cohorts, probability of bilateral disease was 76.7% (with APR <5), and probability for unilateral was 91.7% (with APR >15). Other models had similar predictive ability but required more variables, and were less sensitive for identifying bilateral PA. CONCLUSION: The novel aldosterone-to-lowest-potassium ratio is a convenient score to guide clinicians and patients of various ethnicities on the probability of primary aldosteronism subtype. Using APR to identify patients more likely to benefit from AVS may be a cost-effective strategy to manage this common condition.

BACKGROUND: Improving communication and information services for people receiving a total joint (knee or hip) arthroplasty (TJA) depends on the differences in patient communication needs and personal characteristics. PURPOSE: The purpose of this study was to further examine individual differences in TJA patient preferences regarding communication and information provision. METHODS: Nineteen patients participated in generative research, which meant they actively reflected on their TJA experiences and communication preferences through creative exercises (e.g., collage making). Audio transcripts of their shared reflections were qualitatively analyzed through an inductive approach. RESULTS: Some participants wanted detailed health education, others did not. Participants also reported different support needs (e.g., at hospital discharge or during rehabilitation). Moreover, participant preferences for social connections with care providers differed. CONCLUSIONS: An individual patient's mindset, his or her social support needs, physical condition, and medical history should guide the provision of tailored services., Applied Ergonomics and Design, Human-Centered Design

In order to provide patients with the highest possible quality of care, healthcare institutions often standardize the way they provide healthcare. Yet, there are also more and more calls for tailored healthcare services that are intended for one specific person and based on characteristics that are unique to that person. This dissertation investigates tailored healthcare services and does so specifically in the orthopaedic context. Orthopaedic patients, in particular patients who have undergone joint replacement surgery of the hip or knee joint, are relatively dissatisfied with the current healthcare service provided to them. Specifically, the communication with total joint replacement patients (including the way in which patients are informed about the surgery, its risks and the treatment plan, but also the emotional support they receive from healthcare providers) often leaves something to be desired. In examining tailored healthcare as a potential solution to dissatisfaction with patient-provider communication, this dissertation focuses on the definition, validation and implementation of so-called patient profiles. Patient profiles represent the common characteristics of a specific subgroup of patients that are unique compared to the overall patient population. The patient profiling approach is derived from the principles of mass customization and assumes that representations of the common and unique preferences, needs, and competences of different groups of patients can be used to design tailored healthcare services. These tailored healthcare services can then be offered to individual patients based on their profile. It is expected that tailored healthcare services will lead to improvements in patient experience. This dissertation examines patient profiles and the effect of the patient profiling approach on patient experience following four questions: (1) what are relevant patient characteristics for patient profiling?, (2) which data driven patient profiles can, Applied Ergonomics and Design

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Radboud University, 26 november 2019, Promotores : Lenders, J.W.M., Wilt, G.J. van der, Schultze Kool, L.J. Co-promotor : Deinum, J., Contains fulltext : 209717.pdf (publisher's version ) (Open Access)

Background: The number of type 2 diabetes mellitus (T2DM) patients and related treatment costs are rapidly increasing. Consequentially, more cost-effective and efficient strategies for the treatment of T2DM are needed. One such strategy is improving patients' self-management. As patients are more and more expected to self-manage their disease, it is important to provide them with suitable self-management support. This way, success of self-management will increase and complications and related costs of T2DM can be reduced. Currently, self-management support is developed mainly from the perspective of health professionals and caregivers, rather than patients. This research focused on gaining a better understanding of patients' perspectives on self-management and support. Methods: Semi-structured interviews, preceded by preparatory assignments, were conducted with ten patients with T2DM treated in Dutch primary care. Results: We found that patients experience 'active' self-management when recently diagnosed. As time progresses and no problems occur, patients do not experience their disease-related behaviour as self-management. Diabetes has 'just' become part of their daily life, now including new routines taking diabetes into account. Conclusions: With this knowledge, support solutions can be designed and implemented that better fit the needs, preferences and abilities of patients with T2DM., Applied Ergonomics and Design

Theories of behaviour change and health behaviour change interventions are most often evaluated in between-person designs. However, behaviour change theories apply to individuals not groups and behavioural interventions ultimately aim to achieve within-person rather than between-group change. Within-person methodology, such as N-of-1 (also known as single case design), can circumvent this issue, though has multiple design-specific challenges. This paper provides a conceptual review of the challenges and potential solutions for undertaking N-of-1 studies in health psychology. Key challenges identified include participant adherence to within-person protocols, carry-over and slow onset effects, suitability of behaviour change techniques for evaluation in N-of-1 experimental studies, optimal allocation sequencing and blinding, calculating power/sample size, and choosing the most suitable analysis approach. Key solutions include involving users in study design, employing recent technologies for unobtrusive data collection and problem solving by design. Within-person designs share common methodological requirements with conventional between-person designs but require specific methodological considerations. N-of-1 evaluation designs are appropriate for many though not all types of interventions. A greater understanding of patterns of behaviours and factors influencing behaviour change at the within-person level is required to progress health psychology into a precision science. Video abstract: Supplementary Material 1., Accepted author manuscript, Applied Ergonomics and Design

Objective: Tailored communication and information provision is expected to contribute to patient-centred care (PCC) in total hip arthroplasty (THA). In previous research, three subgroups of THA patients were identified that are similar in their clinical, psychological and communication characteristics. Preliminary subgroup-specific design guidelines were also formulated. Using these insights as a starting point, a theoretical framework was developed for tailored information provision and communication using digital applications. This study aims to refine the framework as well as subgroup-specific design guidelines for digital applications. Methods: This study uses a Research through Design (RtD) approach, generating insights both from the development and evaluation of prototypes in the early design stage. Paper-based prototypes will be made for each subgroup and evaluated with patients and care providers. Semi-structured interviews are held with participants exploring their experiences with the prototype. A quasi-experiment with a non-random control cohort is used to validate the qualitative findings. Post-surgery consultations with and without prototype are videotaped and scored using a structured instrument. Results: A design diary will be used to summarize design decisions and considerations. Feedback from participants is analysed inductively. Adaptations in subgroup-specific guidelines will be based on comparison of verbal feedback and descriptive statistics from consultations with and without prototype. Conclusions: Although mixed-method feasibility studies of digital health interventions are common, this protocol also considers the utility of the early design process and the designer’s perspective for realizing PCC and tailored care., Applied Ergonomics and Design, Industrial Design

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Theories of behaviour change and health behaviour change interventions are most often evaluated in between-person designs. However, behaviour change theories apply to individuals not groups and behavioural interventions ultimately aim to achieve within-person rather than between-group change. Within-person methodology, such as N-of-1 (also known as single case design), can circumvent this issue, though has multiple design-specific challenges. This paper provides a conceptual review of the challenges and potential solutions for undertaking N-of-1 studies in health psychology. Key challenges identified include participant adherence to within-person protocols, carry-over and slow onset effects, suitability of behaviour change techniques for evaluation in N-of-1 experimental studies, optimal allocation sequencing and blinding, calculating power/sample size, and choosing the most suitable analysis approach. Key solutions include involving users in study design, employing recent technologies for unobtrusive data collection and problem solving by design. Within-person designs share common methodological requirements with conventional between-person designs but require specific methodological considerations. N-of-1 evaluation designs are appropriate for many though not all types of interventions. A greater understanding of patterns of behaviours and factors influencing behaviour change at the within-person level is required to progress health psychology into a precision science. Video abstract: Supplementary Material 1.

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Calls for a more tailored approach to the management of cardiometabolic and musculoskeletal diseases have been increasing. Although tailored care is a centuries-old concept, it is still unclear how it should be best practised. The current paper introduces two phenotype-based Dutch approaches to support tailored care. One approach focuses on patients with type 2 diabetes, the other on patients undergoing total joint replacement. Using the patient profiling approach, both projects propose that care can be tailored by the assessment of biopsychosocial patient characteristics, stratification of patients into subgroups of patients with similar care needs, abilities, and preferences (so-called patient profiles) and tailoring of care in concordance with the common care preferences of these profiles. In this article, the advantages and disadvantages of the method are discussed to enable researchers or clinicians who want to extend the patient profiling approach to other patient populations to carefully evaluate these in relation to their project’s focus and available resources. Funding: Novo Nordisk B.V., the Netherlands Organisation for Scientific Research (NWO) (Grant 314-99-118) and Zimmer Biomet Inc., Applied Ergonomics and Design

Design research in healthcare can be demanding. We report on eight challenges that designers and design researchers face when working on healthcare projects. We conducted four workshops with design researchers active in healthcare: six PhD candidates, a mixed group of thirteen design researchers, twelve design students, and eight design practitioners. Participants shared critical events from recent projects and reflected collaboratively to identify common challenges across different design approaches or disciplines. An analysis of the workshop materials resulted in eight themes of challenges, divided into three clusters. The first cluster, challenges in practice, includes (1) conducting fieldwork, (2) involving end users, and (3) dealing with sensitive situations. The second cluster, managerial challenges, includes (4) managing relations, (5) building understanding, and (6) communicating value. Finally, in the third cluster, generic challenges, includes (7) attuning to time and financial restrictions and (8) establishing rapport. This overview can contribute to design education and practice by helping both novice and experienced designers recognize and anticipate potential hurdles when engaging with the complexities of the healthcare environment., Applied Ergonomics and Design, Human Information Communication Design

Patient-centred care is becoming more important in healthcare. The success of patient-centred care can be assessed by exploring the patient experience through a patient journey map. As the number of outpatient surgeries is increasing, it is important to reveal the specific characteristics of this type of surgery. The perioperative patient experience is considered very important for outpatient surgery, because all perioperative activities are condensed in one day. To investigate this experience, we performed a case study of hand and wrist surgery. Six teams of two industrial design engineering students interviewed 40 patients in total in two private and two public hospitals in the Netherlands. All teams created a patient journey map, describing the patient experience. These maps were analysed by the authors to identify common themes among the six journeys. Four time-independent themes and four time-dependent themes were identified. Insecurity, reassurance by staff, loneliness, and lack of information were associated with the whole patient experience. Before surgery, lack of control was the most prominent experience. During surgery, acceptance and curiosity were present. After surgery, relief was the dominant experience. No significant differences between the public and private hospitals were discovered. Several suggestions are given on how to facilitate positive experiences and how to resolve negative experiences in outpatient surgery. These include suggestions for hospital policy and design interventions., Applied Ergonomics and Design

Background: Patients with orthopedic conditions frequently use the internet to find health information. Patient education that is distributed online may form an easily accessible, time- and cost-effective alternative to education delivered through traditional channels such as one-on-one consultations or booklets. However, no systematic evidence for the comparative effectiveness of Web-based educational interventions exists. Objective: The objective of this systematic review was to examine the effects of Web-based patient education interventions for adult orthopedic patients and to compare its effectiveness with generic health information websites and traditional forms of patient education. Methods: CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, PUBMED, ScienceDirect, Scopus, and Web of Science were searched covering the period from 1995 to 2016. Peer-reviewed English and Dutch studies were included if they delivered patient education via the internet to the adult orthopedic population and assessed its effects in a controlled or observational trial. Results: A total of 10 trials reported in 14 studies involving 4172 patients were identified. Nine trials provided evidence for increased patients' knowledge after Web-based patient education. Seven trials reported increased satisfaction and good evaluations of Web-based patient education. No compelling evidence exists for an effect of Web-based patient education on anxiety, health attitudes and behavior, or clinical outcomes. Conclusions: Web-based patient education may be offered as a time- and cost-effective alternative to current educational interventions when the objective is to improve patients' knowledge and satisfaction. However, these findings may not be representative for the whole orthopedic patient population as most trials included considerably younger, higher-educated, and internet-savvy participants only., Applied Ergonomics and Design, Human Information Communication Design

Item does not contain fulltext, Phaeochromocytoma localisation is generally reliably achieved with modern imaging techniques, particularly in sporadic cases. On occasion, however, there can be diagnostic doubt due to the presence of bilateral adrenal abnormalities, particularly in patients with mutations in genes predisposing them to the development of multiple phaeochromocytomas. In such cases, surgical intervention is ideally limited to large or functional lesions due to the long-term consequences associated with hypoadrenalism. Adrenal venous sampling (AVS) for catecholamines has been used in this situation to guide surgery, although there are few data available to support diagnostic thresholds. Retrospective analyses of AVS results from 2 centres were carried out. A total of 172 patients (88 men, 84 women) underwent AVS under cosyntropin stimulation for the diagnosis of established primary aldosteronism (PA) with measurement of adrenal and peripheral venous cortisol, aldosterone and catecholamines. Six patients (3 men, 3 women) with phaeochromocytoma underwent AVS for diagnostic purposes with subsequent histological confirmation. Reference intervals for the adrenal venous norepinephrine to epinephrine ratio were created from the PA group. Using the 97.5th centile (1.21 on the left, 1.04 on the right), the false negative rate in the phaeochromocytoma group was 0%. In conclusion, this study describes the largest dataset of adrenal venous catecholamine measurements and provides reference intervals in patients without phaeochromocytoma. This strengthens the certainty with which conclusions related to adrenal venous sampling for catecholamines can be drawn, acknowledging the procedure is not part of the routine diagnostic workup and is an adjunct for use only in difficult clinical cases.

Contains fulltext : 168006.pdf (publisher's version ) (Closed access)

Item does not contain fulltext, BACKGROUND: The distinction between unilateral aldosterone-producing adenoma or bilateral adrenal hyperplasia as causes of primary aldosteronism is usually made by adrenal CT or by adrenal vein sampling (AVS). Whether CT or AVS represents the best test for diagnosis remains unknown. We aimed to compare the outcome of CT-based management with AVS-based management for patients with primary aldosteronism. METHODS: In a randomised controlled trial, we randomly assigned patients with aldosteronism to undergo either adrenal CT or AVS to determine the presence of aldosterone-producing adenoma (with subsequent treatment consisting of adrenalectomy) or bilateral adrenal hyperplasia (subsequent treatment with mineralocorticoid receptor antagonists). The primary endpoint was the intensity of drug treatment for obtaining target blood pressure after 1 year of follow-up, in the intention-to-diagnose population. Intensity of drug treatment was expressed as daily defined doses. Key secondary endpoints included biochemical outcome in patients who received adrenalectomy, health-related quality of life, cost-effectiveness, and adverse events. This trial is registered with ClinicalTrials.gov, number NCT01096654. FINDINGS: We recruited 200 patients between July 6, 2010, and May 30, 2013. Of the 184 patients that completed follow-up, 92 received CT-based treatment (46 adrenalectomy and 46 mineralocorticoid receptor antagonist) and 92 received AVS-based treatment (46 adrenalectomy and 46 mineralocorticoid receptor antagonist). We found no differences in the intensity of antihypertensive medication required to control blood pressure between patients with CT-based treatment and those with AVS-based treatment (median daily defined doses 3.0 [IQR 1.0-5.0] vs 3.0 [1.1-5.9], p=0.52; median number of drugs 2 [IQR 1-3] vs 2 [1-3], p=0.87). Target blood pressure was reached in 39 (42%) patients and 41 (45%) patients, respectively (p=0.82). On secondary endpoints we found no differences in health-r

Contains fulltext : 168159.pdf (publisher's version ) (Closed access), CONTEXT: For health care planning and allocation of resources, realistic estimation of the prevalence of primary aldosteronism is necessary. Reported prevalences of primary aldosteronism are highly variable, possibly due to study heterogeneity. OBJECTIVE: Our objective was to identify and explain heterogeneity in studies that aimed to establish the prevalence of primary aldosteronism in hypertensive patients. DATA SOURCES: PubMed, EMBASE, Web of Science, Cochrane Library, and reference lists from January 1, 1990, to January 31, 2015, were used as data sources. STUDY SELECTION: Description of an adult hypertensive patient population with confirmed diagnosis of primary aldosteronism was included in this study. DATA EXTRACTION: Dual extraction and quality assessment were the forms of data extraction. DATA SYNTHESIS: Thirty-nine studies provided data on 42 510 patients (nine studies, 5896 patients from primary care). Prevalence estimates varied from 3.2% to 12.7% in primary care and from 1% to 29.8% in referral centers. Heterogeneity was too high to establish point estimates (I(2) = 57.6% in primary care; 97.1% in referral centers). Meta-regression analysis showed higher prevalences in studies 1) published after 2000, 2) from Australia, 3) aimed at assessing prevalence of secondary hypertension, 4) that were retrospective, 5) that selected consecutive patients, and 6) not using a screening test. All studies had minor or major flaws. CONCLUSIONS: This study demonstrates that it is pointless to claim low or high prevalence of primary aldosteronism based on published reports. Because of the significant impact of a diagnosis of primary aldosteronism on health care resources and the necessary facilities, our findings urge for a prevalence study whose design takes into account the factors identified in the meta-regression analysis.

Item does not contain fulltext, BACKGROUND: Differentiating patients with primary aldosteronism caused by aldosterone-producing adenomas (APAs) from those with bilateral adrenal hyperplasia (BAH), which is essential for choice of therapeutic intervention, relies on adrenal venous sampling (AVS)-based measurements of aldosterone and cortisol. We assessed the utility of LC-MS/MS-based steroid profiling to stratify patients with primary aldosteronism. METHODS: Fifteen adrenal steroids were measured by LC-MS/MS in peripheral and adrenal venous plasma from AVS studies for 216 patients with primary aldosteronism at 3 tertiary referral centers. Ninety patients were diagnosed with BAH and 126 with APAs on the basis of immunoassay-derived adrenal venous aldosterone lateralization ratios. RESULTS: Among 119 patients confirmed to have APAs at follow-up, LC-MS/MS-derived lateralization ratios of aldosterone normalized to cortisol, dehydroepiandrosterone, and androstenedione were all higher (P < 0.0001) than immunoassay-derived ratios. The hybrid steroids, 18-oxocortisol and 18-hydroxycortisol, also showed lateralized secretion in 76% and 35% of patients with APAs. Adrenal venous concentrations of glucocorticoids and androgens were bilaterally higher in patients with BAH than in those with APAs. Consequently, peripheral plasma concentrations of 18-oxocortisol were 8.5-fold higher, whereas concentrations of cortisol, corticosterone, and dehydroepiandrosterone were lower in patients with APAs than in those with BAH. Correct classification of 80% of cases of APAs vs BAH was thereby possible by use of a combination of steroids in peripheral plasma. CONCLUSIONS: LC-MS/MS-based steroid profiling during AVS achieves higher aldosterone lateralization ratios in patients with APAs than immunoassay. LC-MS/MS also enables multiple measures for discriminating unilateral from bilateral aldosterone excess, with potential use of peripheral plasma for subtype classification.

Item does not contain fulltext, Primary aldosteronism comprises 2 main subtypes: unilateral aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia. Somatic KCNJ5 mutations are found in APA at a prevalence of around 40% that drive and sustain aldosterone excess. Somatic APA mutations have been described in other genes (CACNA1D, ATP1A1, and ATP2B3) albeit at a lower frequency. Our objective was to identify genotype-specific steroid profiles in adrenal venous (AV) and peripheral venous (PV) plasma in patients with APAs. We measured the concentrations of 15 steroids in AV and PV plasma samples by liquid chromatography-tandem mass spectrometry from 79 patients with confirmed unilateral primary aldosteronism. AV sampling lateralization ratios of steroids normalized either to cortisol or to DHEA+androstenedione were also calculated. The hybrid steroid 18-oxocortisol exhibited 18- and 16-fold higher concentrations in lateralized AV and PV plasma, respectively, from APA with KCNJ5 mutations compared with all other APA combined together (P<0.001). Lateralization ratios for the KCNJ5 group were also generally higher. Strikingly, we demonstrate that a distinct steroid signature can differentiate APA genotype in AV and PV plasma. Notably, a 7-steroid fingerprint in PV plasma correctly classified 92% of the APA according to genotype. Prospective studies are necessary to translate these findings into clinical practice and determine if steroid fingerprinting could be of value to select patients with primary aldosteronism who are particularly suitable candidates for adrenal venous sampling because of a high probability of having an APA.

Item does not contain fulltext, BACKGROUND: Steroid profiling for diagnosis of endocrine disorders featuring disordered production of steroid hormones is now possible from advances in liquid chromatography with tandem mass spectrometry (LC-MS/MS). Adrenal venous (AV) measurements of aldosterone and cortisol are a standard practice in the clinical work-up of primary aldosteronism, but do not yet take advantage of steroid profiling. METHODS: A novel LC-MS/MS based method was developed for simultaneous measurement of 15 adrenal steroids: aldosterone, corticosterone, 11-deoxycorticosterone, progesterone, pregnenolone, cortisone, cortisol, 11-deoxycortisol, 17-hydroxyprogesterone, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone-sulfate, 21-deoxycortisol, 18-oxocortisol and 18-hydroxycortisol. These were compared in peripheral venous (pV) and AV plasma from 70 patients undergoing AV sampling with and without cosyntropin stimulation. Aldosterone and cortisol levels measured by LC-MS/MS were compared with those measured by immunoassay. RESULTS: Reproducibility of measurements with coefficients of variation