Globally, over 537 million adults are living with diabetes mellitus. Treatment of diabetes poses a large burden on patients, since it relies predominantly on the patient’s daily self-management.... Show moreGlobally, over 537 million adults are living with diabetes mellitus. Treatment of diabetes poses a large burden on patients, since it relies predominantly on the patient’s daily self-management. Therefore, providing the patient with a care plan that fits seamlessly in one’s daily routines, is in line with their values and preferences and does not overburden their capacities, is of major importance. In order to make diabetes care fit, clinicians and patients need to collaborate and share their knowledge and experience. One possible approach to this collaboration is shared decision making (SDM). In SDM, patients and clinicians partner up and work together to decide on the best available healthcare strategy for the individual patient, taking into account both the best available evidence, and the patient’s preferences, needs and context. This thesis aimed to explore patient and clinician efforts towards making diabetes care fit. In this exploration we aimed to provide insight in the factors driving the decision making process, discuss various strategies to tailor SDM to the patient’s situation, needs and preferences, and explore ways to support the patient and the patient-clinician partnership in diabetes care. Show less
Résumé de la thèse Cette thèse porte sur le rapport entre communication, pouvoir et violence au Tchad depuis la pénétration coloniale jusqu’à la période postindépendance. Les régions du Moyen... Show moreRésumé de la thèse Cette thèse porte sur le rapport entre communication, pouvoir et violence au Tchad depuis la pénétration coloniale jusqu’à la période postindépendance. Les régions du Moyen-Chari et du Guéra illustrent cette problématique structurant l’interaction communication, pouvoir et violence au Tchad. Ce territoire connut des violences multiformes liées à la mise en place et à l’usage des systèmes de communication. Pendant la colonisation, l’instauration de l’autorité coloniale sur ce vaste territoire avait nécessité la création des voies de communication dont les réalisations ont été dramatiques pour les populations paysannes. Celles-ci étaient astreintes aux corvées de portage des matériels militaires et des travaux forcés. Pendant, les guerres civiles postindépendances, les systèmes de communication ont été intégrés dans les stratégies de violences. Les routes et les divers moyens de l’information et de transport constituent des enjeux stratégiques pour lesquels les forces militaires en guerre projettent la violence sur les populations rurales. Les nouvelles technologies de l’information et de communication révolutionnent l’organisation des forces rebelles et les stratégies de guerre au Tchad sans exclure les violences sur les populations. Cependant, les guerres civiles successives ont gravement impacté sur la conduite de l’appareil étatique tchadien. Show less
Kunneman- van Unnik, Helena Josefina Antonia Maria 2016
In this thesis, we aimed to gain insight in the process of shared decision making in the setting of adjuvant cancer treatments. We observed clinician-patient consultations in daily clinical... Show moreIn this thesis, we aimed to gain insight in the process of shared decision making in the setting of adjuvant cancer treatments. We observed clinician-patient consultations in daily clinical practice, and developed a core list of information that should be provided in the pre-treatment consultation. We showed that the three key steps of shared decision making are followed to a limited extent. Choice awareness is rarely created in pre-treatment consultations on (neo-)adjuvant cancer treatment, and the option of foregoing these treatments is omitted consistently (Step 1). There is large variation in information provision on possible treatment strategies. Patients tend to overestimate the beneficial effect of treatment, and to underestimate the probability of harms (Step 2). Finally, patients' values and treatment preferences are elicited in only a minority of consultations. If patients voice their values or treatment preferences, or if the oncologist indicates to consider these, patients perceive a significant more active role in the decision making process (Step 3). Our results show that opportunities are missed to engage patients in a process of shared decision making. Small changes in doctor-patient communication can facilitate patients' involvement in deciding about treatment. Show less
The corpus of art from the Pleistocene has grown substantially in recent decades, and with it, the earliest evidence of visual art has become much older than previously anticipated, going back over... Show moreThe corpus of art from the Pleistocene has grown substantially in recent decades, and with it, the earliest evidence of visual art has become much older than previously anticipated, going back over 100,000 years. This new information has rendered some traditional ideas about the recent origins of visual art obsolete. Existing archaeological and evolutionary models that aim to explain the emergence of visual art should now be reassessed in light of current data. That is the aim of this book. First, it reviews the earliest examples of different forms of visual art in two important archaeological periods of human artistic innovation, the height of the African Middle Stone Age, and the European Early Upper Palaeolithic. It then takes a critical view at three influential origins-of-art models, namely, the sexual selection model, the social cohesion model, and the cognitive evolution model. Finally, it offers an alternative proposal that redefines visual art as a communication signal and, using the archaeological evidence, relates its emergence and development to the evolution of human cooperation strategies. This book will appeal to anyone interested in the debate of the origins of art and the evolution of modern human cognition, behaviour, and culture. Show less
The safety of an organization can be improved by investigating and correcting the many processes that shape performance at the __sharp end__. Errors do not occur of themselves, but arise within the... Show moreThe safety of an organization can be improved by investigating and correcting the many processes that shape performance at the __sharp end__. Errors do not occur of themselves, but arise within the context of the work environment. Where the environment is one that makes errors by individuals more likely, we can identify the underlying problems that will have been present in the system, often recognized but long tolerated. The factors that make errors more likely, can be characterized as Latent Risk Factors (LRFs). The prospective identification of LRFs can lead to removal of error-inducing conditions before they can contribute to patient injury. Identifying LRFs will improve patient safety by improving the conditions that set the working environment for the occurrence of errors. Interventions aimed at unfavorable LRFs may contribute to patient safety in the Operating Theatre. Staff from Operating Theatre and Intensive Care Unit is able to detect these shortcomings but differ in their scope of the present risks. Unfavorable LRFs can act as stressful triggers at the workplace. If staff cannot control such stress this may negatively affect their well-being. The key to a healthy workplace is to control the deficiencies in the structure of the working environment. Show less
Children with autism and intellectual disability form a particularly vulnerable group, as both disorders have a significant impact on the way and level of information processing and communication.... Show moreChildren with autism and intellectual disability form a particularly vulnerable group, as both disorders have a significant impact on the way and level of information processing and communication. However, children with autism and co-occurring intellectual disability are often excluded from research. Therefore, this study focused on problems in functions, forms, and content of communication by comparing children with autism and intellectual disability with children with intellectual disability only and typically developing children. The results showed that low-functioning children with autism, especially nonverbal children, have severe problems in the use of communicative functions (Chapter 3). In children with autism and intellectual disability receptive language is generally more impaired than expressive language. Joint attention and symbolic skills are strongly related to concurrent language skills (Chapter 4). Because of the limited symbol understanding in low-functioning children with autism, level of sense-making has to be taken into account before starting interventions (Chapter 5). Relative strengths in visual perception can be used to offer the best suitable intervention (Chapter 6). The results of our study emphasize that communicative interventions should have improvement and support of language comprehension as a key target, but also should target the motivation to communicate. Show less
This thesis describes an example of optimization of the traditional multidisciplinary team care model and evolving arthritis care models with emphasis on the question how theoretical models of the... Show moreThis thesis describes an example of optimization of the traditional multidisciplinary team care model and evolving arthritis care models with emphasis on the question how theoretical models of the system theory and communication can be used to analyse, evaluate, and optimize care delivery. With respect to the team care model we used a rehabilitation tool, for which we developed an accompanying computer application. This thesis contributes to the use of theoretical models, measurement instruments, and information technology applications to rationalize the attempts to innovate patient-centred team care in rheumatology. Show less
