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This thesis has received funding by General Electrics Healthcare. The funding has been used to cover the costs of the adenosine perfusion CMR, the contrast medium and adenosine of all included patients. Funding for the statistical analysis was received by Limburg Clinical Research Program (LRCP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Hospital Oost-Limburg and Jessa Hospital.

info:eu-repo/semantics/published

Knowledge of the normal and pathological three-dimensional (3D) gleno-humeral relationship is imperative when planning and performing a total shoulder arthroplasty. Currently, two-dimensional (2D) parameters are used to describe this anatomy and despite the fact that these 2D measurements have a wide distribution in the normal population, they are commonly accepted. This broad distribution can be explained on one hand by anatomical factors and on the other hand, by positional errors. A 3D CT-scan reconstruction and evaluation can overcome this shortcoming and can be used to determine more accurately the surgical planes on the normal and pathological shoulder joint. There is, however, no consensus on which references should be used when studying this 3D relationship. This thesis describes the normal 3D gleno-humeral relationship and the best glenoid plane to use in surgery, based on 3D CT-scan. Furthermore, a glenoid aiming device that can be of surgical help in the reconstruction of the normal glenoid anatomy was developed based on these measurements.

Review article based on a dissertation submitted to fulfill the academic grade of doctor in medical sciences (....), entitled: Imaging the mechanisms involved in abdominal aortic aneurysms rupture; a step towards patient-specific risk assessment.

The main objective of this paper is to provide an overview of the impact of information technology on radiology services during the past 15 years and to promote awareness of the digital revolution that is taking place in health care, including radiology. The combination of two major innovations is playing a central role in this revolution, namely, the Internet and the digitisation of medical information. The various stages of the Internet development and their relationship with the almost simultaneously ongoing digitisation of the radiology department are described. The onset of teleradiology services and the more recent trend toward the usage of cloud-based networks and services are explained. The recent changes in digital communication and electronic transmission of medical information are discussed, hereby paying attention to the value of social media in medicine and radiology in particular. Finally, the future prospects of health care and medical imaging are outlined in the spotlight of today’s major trends, and the role of the radiologist in this quickly changing environment is redefined.

More than a century ago, the menisci were considered to be the functionless remains of a leg muscle. Gradually the usefulness and function of the meniscus was investigated and proven, and the link between total meniscectomy, radiographic osteoarthritis and reduced knee function was made. Subsequently, partial meniscectomy was introduced in the clinical practice. However, the frequency of symptomatic knee osteoarthritis was not substantially lowered. Therefore, meniscal repair was introduced for younger individuals with traumatic meniscus lesions with a good healing potential. Later on in the development process, the quest for meniscal replacement strategies arose. The introduction of allogenic, xenogenic and artificial materials followed in research and clinical settings. Nowadays, a lot of research is conducted on meniscal substitutes, because meniscal injuries are a very common problem in the general population. The imaging of the meniscus is running parallel to this evolution. With the development of magnetic resonance imaging (MRI), the meniscus could be perfectly visualized. A lot of studies were published on imaging of the normal meniscus, and subsequently meniscal pathology on MRI was investigated. In the current literature, a growing number of papers describe the MRI findings in artificial meniscus replacements.

Multiparametric Magnetic Resonance Imaging (mp-MRI) is the current standard of reference for the local staging of prostate cancer (PCa). On the other hand, despite the low sensitivity and specificity of Technetium Bone Scanning (BS) for the detection of bone metastases (BM) and of Body Computed Tomography CT for the detection of lymph node metastases (LNM), these techniques are routinely used, in the current clinical practice. Nevertheless, whole Body MRI (WB-MRI) and Positron Emission Tomography Computed Tomography (PET-CT) are emerging as robust tools for the staging of oncologic patients, including those with (PCa). The available techniques (BS, WB-MRI, PET, CT) for the detection of BM in oncologic patients were compared and showed striking center differences in terms of anatomic sequences and planes used. This heterogeneity and the long acquisition time of WB-MRI protocols – due to the addition of multiple anatomic sequences in different planes – questioned whether a single three dimensional (3D) sequence could replace the multiple anatomic sequences used for node and bone staging of PCa. We demonstrated that WB-MRI is a credible tool for the detection of bone and node metastasis. The second question addressed the possibility to obtain a complete TNM staging of PCa in a single MRI session. A WB-MRI protocol was developed to enable complete, T (local), N (regional) and M (distant) staging of PCa in a single session, in less than an hour. This ‘all-in-one’ protocol proved to be as efficient as the sum of exams currently in use for the staging of PCa (ie: mp-MRI of the prostate for ‘T’ staging, Thoraco-abdominal CT for ‘N’ staging and bone scintigraphy for ‘M’ staging).

The goal of this thesis was to elucidate the details of cerebellovascular diseases with advanced magnetic resonance (MR) imaging (MRI) and to translate the findings to routine clinical MRI. The first aim was to image cerebellar arterial perfusion territories, which was achieved by applying super-selective arterial spin labelling (ASL) MRI with labelling of both vertebral arteries in addition to the carotid arteries. The second aim was to unravel the imaging patterns of cerebellar infarctions with 7T post-mortem MRI in addition to volume (3D) clinical MRI. This research led to the description of “cerebellar cortical infarct cavities”, an incidental imaging finding that proved to be the most frequent manifestation of cerebellar ischemia as well as a marker of atherosclerotic and thromboembolic cerebrovascular disease. Finally, we found that almost all patients with such cavities lack a clinical history of vertebrobasilar transient ischemic attack (TIA) or stroke, disclosing the still very high incidence of clinically occult ischemia in the posterior fossa.

The present manuscript discusses the development of a quantitative, and ultimately a visual approach as well, for detecting, diagnosing, staging, and following-up chest diseases. At the moment, computer tomography (CT) and positron emission tomography (PET) are the modalities of choice, and despite repeated attempts to integrate magnetic resonance imaging (MRI) in thoracic imaging diagnosis protocols, the classic sequences have – outside radiation reduction – usually no additional benefit in diagnosis. During this thesis, the attempt was made to show that by means of functional imaging sequences a better characterization of pleural, mediastinal and lung lesions was feasible. We even evaluated early treatment response by using diffusion-weighted imaging (DWI) as biomarker. Where possible, the correlation was made between radiological and histopathological images.

This thesis aimed to contribute to a better understanding of what integrated primary care is, and how it can be achieved by focussing on the collaboration processes that underlie the development of integrated primary care. The first part of this thesis operationalized the concept of integrated care from a primary care perspective. The second part of this thesis described the collaboration mechanisms among integrated care projects that were part of a national integrated primary care study in The Netherlands.

Bu çalışmada 2001-20016 yılları arasında fen bilgisi eğitimi alanında yazılan doktora tezlerinin yıllara göre ve üniversitelere göre dağılımını, çalışma konularını, kullanılan yöntemleri, örneklem sayısı ve düzeyini, veri toplama araçlarını, veri analiz yöntemlerini ve anahtar kelimeleri belirlemek amaçlanmıştır. Araştırma nitel bir çalışmadır. Tez özetleri, içerik analizi ve betimsel analiz yöntemleri kullanılarak analiz edilmiştir. Yıllara göre tez sayıları ve doktora programından mezun veren üniversite sayısı artmıştır. En fazla çalışma öğretim yaklaşımları alanında yapılmış ve genellikle tezlerde karma yöntem tercih edilmiştir. Örneklem olarak çoğunlukla ortaokul öğrencileri ve aday öğretmenlerle çalışılmıştır. Deneysel çalışmalar ve durum çalışmaları en çok kullanılan desenlerdir. Veri analizlerinde çıkarımsal analiz ve içerik analizi en fazla kullanılan yöntemlerdir, In this study, it is aimed to identify the distribution of theses by years and universities, the subject fields, methods used, sample sizes and levels, data collection instruments, data analyses and keywords in the science education doctoral theses written between 2001-2016. This research is a qualitative study. The study's sample consists of 199 doctoral theses written in the field of science education. Dissertation abstracts were analyzed using content analysis and descriptive analysis. Over time, the number of thesis has increased.The doctoral theses were conducted in 15 universities. Most studies were carried out in the field of teaching approaches and usually mixed method was preferred in the theses. The samples of the theses were mostly middle school students and prospective science teachers. Experimental studies and case studies were the most common used designs. The tests and scales were often used as data collection tools. As qualitative data collection tools, the interviews and observations were mostly used. In data analysis, inferential analysis and content analysis were the most widely used methods. Keywords remained at the global level to describe researches

Early diagnosis of spondyloarthritis (SpA) is becoming more important as new medical treatment options have become available to treat inflammation and delay progression of the disease. Increasingly, magnetic resonance imaging (MRI) of the sacroiliac joints is obtained for early detection of inflammatory changes, as it shows active inflammatory and structural lesions of sacroiliitis long before radiographic changes become evident. MRI of the sacroiliac joints in children is a useful tool for suspected juvenile spondyloarthritis (JSpA), even though it is not yet included in the current pediatric classification systems. Recognizing MRI features of pediatric sacroiliitis is a challenge. As most radiologists are not familiar with the normal MRI appearance of the pediatric sacroiliac joint, clear definitions are mandatory. Actually, the adult Assessment of Spondyloarthritis International Society (ASAS) definition for sacroiliitis needs some adaptations for children. A proposal for a possible pediatric-specific definition for active sacroiliitis on MRI is presented in this review. Furthermore, MRI without contrast administration is sufficient to identify bone marrow edema (BME), capsulitis, and retroarticular enthesitis as features of active sacroiliitis in JSpA. In selected cases, when high short tau inversion recovery (STIR) signal in the joint is the only finding, gadolinium-enhanced images may help to confirm the presence of synovitis. Lastly, we found a high correlation between pelvic enthesitis and sacroiliitis on MRI of the sacroiliac joints in children. As pelvic enthesitis indicates active inflammation, it may play a role in assessment of the inflammatory status. Therefore, it should be carefully sought and noted when examining MRI of the sacroiliac joints in children.

Summary Figure 1 summarizes the conceptual thinking thatemerged from the three studies. The construct of“Integration Mindsets” is at the heart of Figure 1 andis defined as an individual’s way of thinking about inte-gration that is based on knowledge and beliefs regard-ing the strategy for achieving integration (i.e., StrategyMental Model) and the roles and relationships of thoseinvolved in the integration process (i.e., RelationshipsMental Model) [5]. The similarity of Integration Mindsetsis shaped by contextual factors at multiple levels [4].The similarity of Integration Mindsets, in turn, influ-ences strategic processes and proximal outcomes.The relationships among Integration Mindset similarity,strategic processes, and proximal outcomes are mod-erated by mental model type (strategy and/or relation-ships) and mental model content (knowledge and/orbeliefs). Both formal and informal feedback from inte-grative processes and performance continually shapeintegration strategy content (i.e., what is decided) andthe similarity of Integration Mindsets. Thus, sharedIntegration Mindsets are not a static “state”, but rathera dynamic process in which knowledge and beliefsare continuously modified and negotiated.

Introduced by the UK Department of Health in 1990, the Care Programme Approach (CPA) was intended to be a framework through which health and social services could provide integrated care for people with mental health problems. Its purpose was to ensure that services had systematic arrangements to provide psychiatric, health and social care with arrangements in place for the ongoing provision and review of that care. Care coordinators, spanning service boundaries, were expected to oversee that process. In order to ensure that services could work together, the Health Act (1999) enabled local services to pool budgets, lead commissioning and integrate provision.

textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated care. Based on a systematic approach in which a literature study, a delphi study, a concept mapping study and questionnaire research are combined, a development model for integrated care is created. The model exists of 89 elements of integrated care, which are clustered in nine themes. Also the model describes four phases of development which integrated care services can experience. The model is succesfully empirically validated in 84 integrated care services for stroke, acute myocardial infarct or dementia patients. The model has the potential to serve as a generic quality management model for integrated care services and can be used for monitoring, self evaluation or benchmarking of integrated care services. Also insurers or policy makers could use the model to stimulate integrated care services to further improve and develop their integrated care.

In the Netherlands, children with cerebral palsy are the largest diagnostic group treated in paediatric rehabilitation, requiring specialized health-, education- and social services of multiple professionals from diverse organizations. To provide ‘integrated care’ in these settings, effective care coordination is essential, though in practice this is challenged by inadequate communication across the child’s care network. In order to improve communication across the integrated care setting of cerebral palsy, the present study aimed to (i) identify experienced gaps in parent-professional and inter-professional communication in three Dutch cerebral palsy care regions; and (ii) obtain insight in the feasibility and usability of an ‘eHealth’-application as a potential improvement strategy for the identified gaps in communication in each care region. To identify experienced gaps in communication a mixed method approach attuned to integrated care settings was developed and applied in each care region. Parents primarily experienced gaps in inter-professional communication, ranging from lack of cooperation and patient-centeredness to insufficient information-exchange and consistency of information. Consequently, parents had to take up the role of messenger of information and/ or care coordinator. Involved professionals recognized these gaps and primarily attributed them to capacity problems, lack of interdisciplinary guidelines and a clear definition of roles, tasks and responsibilities. Based on these gaps an asynchronous secure web-based system for parent-professional and inter-professional communication was developed, aimed to increase patient centeredness, facilitate inter-professional contact and enhance network transparency. A 6-month pilot evaluation in each care region showed broad variation in frequency of system use and its experienced added value, which was related to users’ actual consultation needs and the complexity of the child’s care network. The system’s technical feasibility and added value, although more pronounced for parents than professionals, merit further research into its effective implementation for those patients who require frequent consultation across various organizations and settings. In addition, further development of the technology should focus on incorporating advanced consultation options, next to increasing the system’s ease of use and its integration into daily care practice. This requires an interactive process of co-creation with relevant stakeholders, in order to realize a ‘fit-for-all’ service tailored to specific user needs.

The need for health and social care agencies and their professionals to work in partnership is a central component of contemporary English health and social care policy. Partnership is predicated on the notion that this way of working improves services and outcomes for service users. However, as there is little evidence that partnerships improve service user outcomes, some commentators suggest that this indicates either a failure of the policy or a deficit in terms of implementation. This thesis investigates the link between health and social care partnerships and service user outcomes. Rather than adopting the types of rationalist and instrumental approach which the majority of studies in this field have done, the thesis develops a new conceptual framework for partnership which is interpretive and performative. This framework is developed and tested in four exploratory case study sites and concludes that partnership is not necessarily simply an instrument of improvement in a traditional sense. The power of partnership lies in its cultural and symbolic value. This takes partnership beyond traditional discussions of partnership and governance; rather than representing a particular mode of governance, instead arguing that partnership is an active tool of governance.

In the light of an ageing society with shrinking economic resources, deinstitutionalization of elderly care is a general trend. As a result, homecare is increasing, and increasingly shared between ...

The project was one of several structural efforts that were launched in Sweden in the 1990s to increase integration between different organisations regarding vocational rehabilitation. The goal was to obtain advantages for both clients and society through coordination of joint resources. To understand the development of interorganisational integration four studies were performed based on data collection from four years. The specific objectives were to analyse: (i) variation in views on long-term goals, (ii) different views on clients, (iii) the perceived barriers to the progress of the project and (iv) to describe and analyse the organising of the project over time. Each of the four objectives was undertaken as a separate study during the research.

The transition to adult care �or adolescents �ith dia�e� tes is a complex issue, and several studies have sho�n that one o� the important �arriers to success�ul transi� tions is the health care system itsel�. Adolescence is also a vulnera�le time in li�e as many o� the patterns o� sel��care �ehaviour are set �hich coincides �ith a struggle �or independence �rom adults. The overall aim o� this thesis �as to illuminate main concerns related to the transition o� adolescents/ emerging adults �ith type 1 dia�etes to adult li�e and adult dia�etes care and to gain a deeper understanding o� ho� care pro� viders, patients and their parents handle this situation.

Disease management is defined as ‘a systematic approach to identify persons at risk, intervene with specific programs of care, and measure clinical and other outcomes’. It is believed to have a high potential to improve outcomes of patients with type 2 diabetes above the classical healthcare system that lacks coordination of chronic care. This thesis reports on an observational study to evaluate the changes in patients’ clinical characteristics after their entry into a structured diabetes management model.