Dit proefschrift beschrijft de effectiviteit en veiligheid van monoclonale antilichamen gericht tegen CGRP (fremanezumab) en de CGRP receptor (erenumab) als preventieve behandeling van... Show moreDit proefschrift beschrijft de effectiviteit en veiligheid van monoclonale antilichamen gericht tegen CGRP (fremanezumab) en de CGRP receptor (erenumab) als preventieve behandeling van migrainepatiënten in een ‘real world’ setting. Daarnaast bespreekt het factoren die voorspellend zijn voor de mate van de klinische response op deze medicatie. Show less
Tallberg, J.; Bäckstrand, K.; Scholte, J.A.; Sommerer, T. 2023
This report from the SNS Democracy Council provides a thorough assessment of whether the current system of global governance is fit for purpose. Do current international organizations hold the... Show moreThis report from the SNS Democracy Council provides a thorough assessment of whether the current system of global governance is fit for purpose. Do current international organizations hold the power required to develop, implement, and enforce global policies? Do these institutions wield this power with sufficient effectiveness to reduce transboundary problems? And do they possess legitimacy as governing bodies in the eyes of citizens and elites? This report explores these themes in a comparative perspective, mapping and analyzing patterns across a broad range of international organizations in areas such as development, finance, health, human rights, security, and trade. As an illustration, the report also offers an in-depth analysis of power, effectiveness, and legitimacy in respect of global climate governance. Show less
In this article, the authors discuss the implications of their study on the effectiveness of the Multilateral Instrument (MLI). Their analysis finds that there are 79 parties to the MLI and that... Show moreIn this article, the authors discuss the implications of their study on the effectiveness of the Multilateral Instrument (MLI). Their analysis finds that there are 79 parties to the MLI and that the MLI covers 1,231 tax treaties and that the OECD currently overreports the effectiveness of the MLI. Show less
This historical study deals with the deployment and the effectiveness of observers in the former Yugoslavia. The intervention started small, but the number of observers from the European Community... Show moreThis historical study deals with the deployment and the effectiveness of observers in the former Yugoslavia. The intervention started small, but the number of observers from the European Community Monitoring Mission (ECMM) and particularly the number of United Nations Military Observers (UNMOs) grew substantially during the war. The variety of their tasks and the growing number of observers seem to indicate that they played an important role. However, there was initially little clarity about how they were deployed, how this deployment evolved and how effective the observers really were. In this study, effectiveness is a key concept, which involves not only taking a closer look at the results achieved by this category of military personnel, but also comparing those results with the investments their efforts required. This makes it possible to analyse and weigh the 'costs' and 'benefits' of their deployment. Based on the results achieved by observers in the former Yugoslavia and the investment this required, conclusions can be drawn about their effectiveness. In short, the observer operations on the Balkans could be described as complex, multi-faceted and high-risk. How justifiable was it to deploy observers in a conflict at the high end of the spectrum of force? Show less
Solis, E.C.; Carlier, I.V.E.; Wee, N.J.A. van der; Hemert, A.M. van 2021
Background: After regular treatment, patients with persistent depressive disorder (PDD) may remain in specialized psychiatric outpatient care without achieving remission. Lacking other options,... Show moreBackground: After regular treatment, patients with persistent depressive disorder (PDD) may remain in specialized psychiatric outpatient care without achieving remission. Lacking other options, these patients often receive long-term, non-protocolized care as usual (CAU) that does not involve the partner/caregiver of the patient. Although the revised depression treatment guidelines suggest focusing on psychiatric rehabilitation and self-management as the next treatment step for PDD, an evidence-based cost-effective self-management protocol for PDD is lacking. This study investigates the "Patient and Partner Education Program for All Chronic Illnesses" (PPEP4All) as a brief self-management protocol that could lead to lower costs, higher quality of life, and less disease burden in PDD patients and their partners/caregivers.Methods: Presented is the rationale and methods of a multicenter pragmatic randomized controlled trial to evaluate the clinical efficacy and cost-effectiveness of PPEP4All for patients with PDD and their partners/caregivers. In accordance with current recommendations, a mixed methods research approach is used with both quantitative and qualitative data. A total of 178 eligible outpatients with PDD and their partners/caregivers are recruited and randomized to either PPEP4All or CAU. Those assigned to PPEP4All receive nine weekly self-management sessions with a trained PPEP4All therapist. Primary and secondary outcome measurements are at 0, 3, 6, and 12 months.Discussion: This project will result in the implementation of a self-management intervention for patients with PDD, meeting an urgent need in mental healthcare. Using PPEP4All can optimize the quality and efficiency of care for both patients with PDD and their partners/caregivers. Show less
The results described in this thesis support the strong empirical evidence for the effectiveness of CBT-Ef for patients with an eating disorder and a BMI>17.5. When compared to TAU, we found... Show moreThe results described in this thesis support the strong empirical evidence for the effectiveness of CBT-Ef for patients with an eating disorder and a BMI>17.5. When compared to TAU, we found comparable effects on eating disorder psychopathology, however CBT-Ef is superior in enhancing self-esteem with significantly fewer sessions and within a shorter time. We found no support for the hypothesis that more severe self-esteem problems, higher levels of perfectionism, or more interpersonal problems would obstruct long-term improvement and would therefore need extra attention in an extended protocol. A broader use of CBT-Ef in clinical practice could result in more efficient and accessible treatment for patients with an eating disorder. In another study we found COMET to be effective in enhancing self-esteem in patients with an eating disorder. Since we did not find the predictive value of low self-esteem in CBT-E treatment outcome, we suggest to integrate COMET in an eating disorder treatment only when low self-esteem is pronounced and interferes with making progress. Show less
Stroke is a relatively common condition with a large impact on patients’ lives. Rehabilitation treatment aims to support patients in coping with the physical, mental, cognitive and social... Show moreStroke is a relatively common condition with a large impact on patients’ lives. Rehabilitation treatment aims to support patients in coping with the physical, mental, cognitive and social consequences of stroke. Recently, there is an increasing interest in the application of digital technologies (eRehabilitation) in healthcare in general, including in stroke rehabilitation. ERehabilitation may include physical and cognitive exercise programs, patient information and education, e-consultations, physical activity tracking and serious gaming, preferably all together in one digital environment.Although there is evidence on the effectiveness and feasibility of eRehabilitation, the uptake of eRehabilitation in specialized stroke rehabilitation facilities has been slow, warranting the need for implementation research. The aim of this thesis was to provide insight in the complex interplay between the effectiveness, the implementation strategy and the context of eRehabilitation after stroke, as delivered in a specialized rehabilitation facility, in order to improve future use of eRehabilitation in specialized stroke rehabilitation facilities. Show less
Aims Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. Recent randomized clinical trials have demonstrated that... Show moreAims Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. Recent randomized clinical trials have demonstrated that novel antithrombotic therapies improve in-hospital outcomes in STEMI patients. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in clinical practice in patients with STEMI based on data from contemporary European ACS registries.Methods and results Five registries from the PIRAEUS initiative (AAPCI/ADPAT, ALKK-PIC, AMIS Plus, Belgium STEMI, and EYESHOT) provided data for the assessment of P2Y12 receptor inhibitor-based dual antiplatelet therapy. Registries were heterogeneous in terms of setting, patient characteristics, and treatment selection. Matched pair analysis and propensity score matching were used to assess all-cause in-hospital death rates based on data from 25 250 patients (8577 patients on prasugrel, 5995 on ticagrelor, and 10 678 on clopidogrel). The odds ratio (OR) for the death of any cause when compared with clopidogrel was 0.72 [95% confidence interval (CI) 0.62-0.84, P < 0.001] in favour of the new P2Y12 receptor inhibitors (prasugrel and ticagrelor combined). In the comparison between prasugrel and ticagrelor, there were no relevant differences (OR 0.97, 95% CI 0.77-1.23; P= 0.81). Event rates of cardiovascular death and stroke were also substantially lower for the new P2Y12 receptor inhibitors. The differences between clopidogrel and prasugrel or ticagrelor on major bleeding were numerically in the same order as for death of any cause but were not statistically significant. No differences in ischaemic and bleeding outcomes were observed between prasugrel and ticagrelor.Conclusion This analysis suggests that the prasugrel or ticagrelor compared with clopidogrel have favourable outcomes in clinical practice while not being inferior in terms of safety. Show less
Walterbos, N.R.; Fiocco, M.; Neelis, K.J.; Linden, Y.M. van der; Langers, A.M.J.; Slingerland, M.; ... ; Lips, I.M. 2019
Background Thermal coagulation is gaining popularity for treating cervical intraepithelial neoplasia (CIN) in screening programs in low- and middle-income countries (LMICs) due to unavailability of... Show moreBackground Thermal coagulation is gaining popularity for treating cervical intraepithelial neoplasia (CIN) in screening programs in low- and middle-income countries (LMICs) due to unavailability of cryotherapy. Objectives Assess the effectiveness of thermal coagulation for treatment of CIN lesions compared with cryotherapy, with a focus on LMICs. Search strategy Papers were identified from previous reviews and electronic literature search in February 2018 with publication date after 2010. Selection criteria Publications with original data evaluating cryotherapy or thermal coagulation with proportion of cure as outcome, assessed by colposcopy, biopsy, cytology, and/or visual inspection with acetic acid (VIA), and minimum 6 months follow-up. Data collection and analysis Pooled proportions of cure are presented stratified per treatment modality, type of lesion, and region. Main results Pooled cure proportions for cryotherapy and thermal coagulation, respectively, were 93.8% (95% CI, 88.5-97.7) and 91.4% (95% CI, 84.9-96.4) for CIN 1; 82.6% (95% CI, 77.4-87.3) and 91.6% (95% CI, 88.2-94.5) for CIN 2-3; and 92.8% (95% CI, 85.6-97.7) and 90.1% (95% CI, 87.0-92.8) for VIA-positive lesions. For thermal coagulation of CIN 2-3 lesions in LMICs 82.4% (95% CI, 75.4-88.6). Conclusions Both cryotherapy and thermal coagulation are effective treatment modalities for CIN lesions in LMICs. Show less
This research focuses on data subject rights – a set of data protection provisions that directly linked to the concept of individual control. In 2018, the European Parliament adopted the... Show moreThis research focuses on data subject rights – a set of data protection provisions that directly linked to the concept of individual control. In 2018, the European Parliament adopted the Regulation on the protection of natural persons with regard to the processing of personal data and on the free movement of such data (GDPR). The new law also introduced some substantial improvements in the section on data subject rights. However, in the light of the fast-changing economic and technological environment, it is possible to notice a gap between data subject rights when understood as law in the books and when applied in practice. By using the analysis of legal sources and academic literature, this thesis explored whether the data subject rights under the GDPR are effective in the data-driven economy, and if not, what are possible solutions to overcome the shortcomings. Show less
Background: Effective interventions for young adults with severe, multiple problems - such as psychosocial and psychiatric problems, delinquency, unemployment and substance use - are scarce but... Show moreBackground: Effective interventions for young adults with severe, multiple problems - such as psychosocial and psychiatric problems, delinquency, unemployment and substance use - are scarce but urgently needed in order to support an adequate transition to adulthood. A multimodal day treatment program called "New Opportunities" (in Dutch: "De Nieuwe Kans"; DNK) was specifically developed to target multi-problem young adults in The Netherlands. The aim of this study protocol is to describe the design of a randomized controlled trial (RCT) in clinical practice to examine the effectiveness of DNK in comparison with care as usual (CAU). Methods/design: Multi-problem young adults in Rotterdam, The Netherlands, will be assigned randomly to DNK (expected N = 150) and CAU (expected N = 150). Primary outcome measures are recidivism and self-sufficiency. Secondary outcome measures include quality of life, attending school/work, psychological functioning, cognitive distortions and substance use. Participant and program characteristics will be examined as potential moderators of effectiveness. Additionally, cost-effectiveness will be measured. During 14 months, data from multiple resources will be collected at four time points. Discussion: This study is one of the first RCTs on the effectiveness of interventions developed for multi-problem young adults. The results will contribute to the currently scant knowledge about what works for various multi-problem young adults in their transition to adulthood. In addition, the study protocol will provide insight into implementing an RCT in a dynamic setting of clinical practice. Trial registration: Dutch Trial Register, identifier: NTR5163. Registered on 17 April 2015; retrospectively registered during the recruitment phase. Show less
This dissertation aimed to study the functioning and effectiveness of the Prevention of Recidivism Program, a prison-based rehabilitation program aimed to reduce the re-offending rates of... Show moreThis dissertation aimed to study the functioning and effectiveness of the Prevention of Recidivism Program, a prison-based rehabilitation program aimed to reduce the re-offending rates of program participants, by conducting a plan-, process and product evaluation. The results indicated that the Prevention of Recidivism program could be considered promising, since it applied methods that were considered effective based on theoretical and empirical knowledge. In practice however, it was shown that program-execution was severely hampered by a number of issues; the program had rather strict inclusion criteria; faced considerable non-participation and non-completion rates; and often allocated offenders to inappropriate treatment. In the end, the program reached a limited group of offenders, most of whom completed a standard program, with no specific treatment aimed to target the factors that initially caused their criminal behavior. Consequently, the program was only shown effective for a small group of offenders that completed a standard treatment program. The most vital program-component, criminogenic need-specific treatment modules, was not shown effective. It was therefore concluded that the Prevention of Recidivism Program had for the most part not been effective in reaching its goals. Show less
Beugen, S. van; Ferwerda, M.; Spillekom-van Koulil, S.; Smit, J.V.; Zeeuwen-Franssen, M.E.J.; Kroft, E.B.M.; ... ; Evers, A.W.M. 2016
Is public procurement of research and development (‘R&D’) services the key to European Union (‘EU’)’s sustainable welfare? Is it being regulated in accordance with economic prescripts for... Show moreIs public procurement of research and development (‘R&D’) services the key to European Union (‘EU’)’s sustainable welfare? Is it being regulated in accordance with economic prescripts for effectiveness? Is the regulatory and policy setting clear and comprehensive in order to stimulate a widespread use of this instrument by EU public authorities? In 2007, the EU released an Interpretative Communication, explaining how to purchase R&D services in compliance with the EU public procurement and State aid rules. The prescribed procedure was named ‘pre-commercial procurement’ (‘PCP’). The motivation advanced for adopting this Communication was the need to clarify the applicable law, in order to encourage public authorities throughout the EU to engage in R&D services procurement. The EU policy makers aimed to help the public sector become a sophisticated customer, capable of steering the development of cutting-edge technologies towards the resolution of public needs. This would yield solutions to serious problems such as climate change, pressure on the health system due to an ageing population, security threats etc. In addition, it would strengthen the competitive advantages of European private innovators on global markets. Eventually this would strengthen EU’s economy and would increase the welfare of its citizens Show less
