This thesis shows that quality of care in surgical oncology varies by provider and is partly based on differences in procedural volume and other attributes of hospitals. Especially for low-volume... Show moreThis thesis shows that quality of care in surgical oncology varies by provider and is partly based on differences in procedural volume and other attributes of hospitals. Especially for low-volume high-risk surgical procedures concentration of services in hospitals with better outcomes (outcome-based referral) can lead to dramatic improvement in short- as well as long-term outcomes. Casemix- and reliability adjustments are essential in the evaluation of quality of care. In addition, an integrated approach, in which several determinants of outcome are combined, might provide a more valid instrument to assess the quality of complex clinical processes. Clinical audit combines several ways to improve quality of care. It stimulates guideline adherence and provides clinicians with continuous and timely feedback on their performance, in relation to a national benchmark. Feedback itself has proven to be very effective, though the most important benefits of clinical audit can be found in the identification and appreciation of clinical processes that lead to better outcomes. This knowledge can be transferred to all practices treating such patient groups, improving outcome on a population-level. In addition, transparency of reliable, meaningful, hospital-specific outcome information, can catalyst the continuous process of quality improvement, steer patients to the right hospitals and reduce the costs of healthcare. Show less
This book is entitled ‘The Dutch Law on Higher Education’. It concerns the law relating to higher education, which includes both academic education and higher professional education. It also... Show moreThis book is entitled ‘The Dutch Law on Higher Education’. It concerns the law relating to higher education, which includes both academic education and higher professional education. It also relates to the institutions that are responsible for providing education: the universities, the universities of professional education, the Open University and other higher education institutions, as well as those organisations that are closely connected to them. These comprise the teaching hospitals, the Netherlands Organisation for Scientific Research (NWO), the Royal Netherlands Academy of Arts and Sciences (KNAW) and the National Library of the Netherlands (KB).The law on higher education is largely set out in legislation, both government legislation and regulations established by the institutions. The jurisprudence of the different courts is also important. This dissertation does not address the internal regulations of the institutions ad these differ from institution to institution and therefore have a limited local significance. The most relevant form of legislation for this dissertation is the Higher Education and Research Act (WHW), which regulates not only the relations between the institutions and the government, but also those of the institutions and their staff and students. This Act stipulates prescriptions – at times very detailed – on the internal business of these institutions, such as how their management boards are structured and the arrangements for co-participation by staff and students. The WHW to a large extent determines the relationship between government and the institutions. The assumptions about the question of what form this relationship should take and what the responsibilities of government and the institutions should be in the area of higher education have undergone considerable change in the course of time. This can be seen in the regular amendments to the legislation on higher education that have been introduced over the years. The question is whether the division of responsibilities of government and higher education institutions as set out at a particular point in time are still adequate and whether it is possible to increase the independence of the institutions in relation to that of the government, naturally without prejudicing the responsibility of the government. The primary aim of this work is to provide an answer to this key question. To facilitate this aim, this dissertation will describe and analyse thematically current higher education law based on the WHW. The subjects that will be addressed include: institutions, the open education system and regulation, quality assurance and accreditation, funding, teaching, examinations and the awarding of diplomas, staff, students, the management structure of the institutions, co-participation, legal protection for staff and students and the relationship between the universities and the teaching hospitals. Show less
Roelofs, E.; Persoon, L.; Qamhiyeh, S.; Verhaegen, F.; Ruysscher, D. de; Scholz, M.; ... ; Lambin, P. 2010
This report introduces a framework for comparing radiotherapy treatment planning in multicentric in silico clinical trials. Quality assurance, data incompatibility, transfer and storage issues, and... Show moreThis report introduces a framework for comparing radiotherapy treatment planning in multicentric in silico clinical trials. Quality assurance, data incompatibility, transfer and storage issues, and uniform analysis of results are discussed. The solutions that are given provide a useful guide for the set-up of future multicentric planning studies or public repositories of high quality data. (C) 2010 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 97 (2010) 567-571 Show less
The past decade has provided many technological advances in radiotherapy. The European Institute of Radiotherapy (EIR) was established by the European Society of Therapeutic Radiology and Oncology ... Show moreThe past decade has provided many technological advances in radiotherapy. The European Institute of Radiotherapy (EIR) was established by the European Society of Therapeutic Radiology and Oncology (ESTRO) to provide current consensus statement with evidence-based and pragmatic guidelines on topics of practical relevance for radiation oncology. This report focuses primarily on 3D CT-based in-room image guidance (3DCT-IGRT) systems. It will provide an overview and current standing of 3DCT-IGRT systems addressing the rationale, objectives, principles, applications, and process pathways, both clinical and technical for treatment delivery and quality assurance. These are reviewed for four categories of solutions; kV CT and kV CBCT (cone-beam CT) as well as MV CT and MV CBCT. It will also provide a framework and checklist to consider the capability and functionality of these systems as well as the resources needed for implementation. Two different but typical clinical cases (tonsillar and prostate cancer) using 3DCT-IGRT are illustrated with workflow processes via feedback questionnaires from several large clinical centres currently utilizing these systems. The feedback from these clinical centres demonstrates a wide variability based on local practices. This report whilst comprehensive is not exhaustive as this area of development remains a very active field for research and development. However, it should serve as a practical guide and framework for all professional groups within the field, focussed on clinicians, physicists and radiation therapy technologists interested in IGRT. (C) 2010 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 94 (2010) 129-144 Show less
This thesis focuses on quality assurance of rectal cancer treatment, in particular of the surgical treatment. Both oncological short-term and long-term outcome parameters are studied, but also... Show moreThis thesis focuses on quality assurance of rectal cancer treatment, in particular of the surgical treatment. Both oncological short-term and long-term outcome parameters are studied, but also other end-points which are important for quality assurance are investigated, such as anastomotic leakage and stoma reversal. The introduction of total mesorectal excision (TME) surgery resulted in an improved survival of patients with rectal cancer. However, survival of the elderly patients and patients treated with an abdominoperineal resection improved less. For frail elderly patients, postoperative mortality is an important competitive risk factor and other treatment schedules might be more appropriate. The abdominoperineal resection itself was associated with a nonradical resection, decreased local control and decreased survival compared to patients treated with a low anterior resection. To improve these results, in selected cases preoperative treatment should consist of chemoradiotherapy and/or a widened resection. Anastomotic leakage is a feared complication after colorectal surgery. After surviving this complication, the overall survival rate in the long-term is still reduced. However, oncological outcome was not significantly affected. The presence of a stoma resulted in a lower symptomatic leakage rate. 20% of stomas was never reversed. Standardised postoperative surveillance resulted in an earlier confirmation of the diagnosis anastomotic leakage. Show less
