Increased patient involvement has been show to result in better clinical outcomes and increased autonomy and to offer a way to control volume and costs of chronic healthcare. The main research... Show moreIncreased patient involvement has been show to result in better clinical outcomes and increased autonomy and to offer a way to control volume and costs of chronic healthcare. The main research question of this thesis was whether part of the kidney transplant aftercare can be delegated to patients without loss of quality of care. The results of the studies described show that self-monitoring kidney function after transplantation is an attractive option to kidney transplant patients and can lead to a significant decrease in number of outpatient visits without compromising on quality of care. Further, self-monitoring could offer a relatively cheap way to increase monitoring frequency, which could lead to earlier detection and treatment of complications and, consequently, improved clinical outcomes. To unravel the full potential of self-monitoring kidney function after transplantation, it is recommended to use accurate measurement devices that both patients and healthcare professionals have confidence in, design a protocol with the involvement of a multidisciplinary group that is truly representative of all stakeholders (including patients and physicians that are more critical of self-monitoring) and choose a study design that includes formative evaluations instead of summative evaluations alone. Show less
Molen, L. van der; Rossum, M.A. van; Burkhead, L.M.; Smeele, L.E.; Rasch, C.R.N.; Hilgers, F.J.M. 2011
The aim of this study was to assess the effect of (preventive) rehabilitation on swallowing and mouth opening after concomitant chemoradiotherapy (CCRT). Forty-nine patients with advanced oral... Show moreThe aim of this study was to assess the effect of (preventive) rehabilitation on swallowing and mouth opening after concomitant chemoradiotherapy (CCRT). Forty-nine patients with advanced oral cavity, oropharynx, hypopharynx and larynx, or nasopharynx cancer treated with CCRT were randomized into a standard (S) or an experimental (E) preventive rehabilitation arm. Structured multidimensional assessment (i.e., videofluoroscopy, mouth-opening measurement, structured questionnaires) was performed before and 10 weeks after CCRT. In both S and E arms, feasibility was good (all patients could execute the exercises within a week) and compliance was satisfactory (mean days practiced per week was 4). Nevertheless, mouth opening, oral intake, and weight decreased significantly. Compared to similar CCRT studies at our institute, however, fewer patients were still tube-dependent after CCRT. Furthermore, some functional outcomes seemed less affected than those of studies in the literature that did not incorporate rehabilitation exercises. Patients in the E arm practiced significantly fewer days in total and per week, but they obtained results comparable to the S arm patients. Preventive rehabilitation (regardless of the approach, i.e., experimental or standard) in head and neck cancer patients, despite advanced stage and burdensome treatment, is feasible, and compared with historical controls, it seems helpful in reducing the extent and/or severity of various functional short-term effects of CCRT. Show less
