Objectives. Many aspects of palliative care, such as managing (complicated) symptoms, conductinggoals-of-care conversations, and repeated exposure to loss, can be stressful to clinicians.Previous... Show moreObjectives. Many aspects of palliative care, such as managing (complicated) symptoms, conductinggoals-of-care conversations, and repeated exposure to loss, can be stressful to clinicians.Previous research on the emotional impact of providing palliative care was mainlydone in specialist settings. However, the majority of palliative care is provided by clinicianswho are not specialized in palliative care, and can be supported by palliative care specialistsonly when needed. Therefore, this study aimed to gain insight into the emotional impactof providing palliative care on clinicians, both palliative care generalists and specialists.Methods. A qualitative interview study among 21 clinicians (11 doctors and 10 nurses) workingin hospitals, home care, or nursing homes in the Netherlands was conducted. BetweenFebruary and June 2019, 13 palliative care generalists and 8 specialists were interviewed.Interviews were thematically analyzed by two researchers.Results. All clinicians considered the emotional impact of providing palliative care to be substantialand experienced both positive and negative aspects of providing palliative care. Severalaspects of providing palliative care can support or undermine emotional stability. These socalledfacilitators and barriers, such as practicing self-care and complexity of palliative care,were found at three different levels: individual, team, and organization.Significance of results. Although clinicians experience providing palliative care as meaningfuland valuable, the emotional impact is considerable. Negative and positive aspects often coexist.Further insight into the dynamics and magnitude of the emotional impact of providingpalliative care is needed in order to create a healthy working environment and develop adequateinterventions. Show less
Objective: To examine the relationship between risk factors for low patient activation and change in patient activation, well-being, and health outcomes in people with type 2 diabetes mellitus ... Show moreObjective: To examine the relationship between risk factors for low patient activation and change in patient activation, well-being, and health outcomes in people with type 2 diabetes mellitus (T2DM). Method: A longitudinal prospective study was conducted with measurements at baseline and 20-week follow-up among 603 people with T2DM participating in a group-based walking intervention. Patient activation and risk factors were assessed using online questionnaires. Health outcomes were assessed in participants' general practices. Results: No association was found between risk factors for activation and change in patient activation. Patient activation significantly increased (t(602) = 2.53, p = 0.012) and was associated with an increase in emotional well-being (beta = 0.22), exercise behavior (beta = 0.17), general diet behavior (beta = 0.20), and a reduction in BMI (beta = -0.28), weight (beta = -0.29), and HbA1c (beta = -0.27). Conclusion: Favorable changes in patient activation, self-management, well-being, and health outcomes occurred during a walking intervention, despite highly prevalent risk factors for low activation and less engagement in self-management. Practice implications: Group-based walking interventions might empower people with T2DM to begin taking a larger role in their self-care and improve (mental) health outcomes. Vulnerable groups of patients (with multiple risk factors for low activation) can change and presumably need this kind of interventions to be able to change. Show less
Vitamin D is a hormone produced in the skin via a non-enzymatic process involving ultraviolet light.It is well known that the physiology of aging makes older people particularly susceptible to... Show moreVitamin D is a hormone produced in the skin via a non-enzymatic process involving ultraviolet light.It is well known that the physiology of aging makes older people particularly susceptible to vitamin D deficiency and that, if untreated, it can have serious health consequences. This thesis deliberates on the topics of vitamin D supplementation in older people in light of the current guidelines and on the possible additional effects of ultraviolet light beyond vitamin D synthesis on nursing home residents. We present a cross-sectional study in nursing home residents aged 70 years and over designed to evaluate the efficacy of vitamin D supplementation in achieving vitamin D sufficiency. We also discuss the different supplementation strategies for nursing home residents and community dwelling persons aged 70 years and over based on a survey administered to general practitioners and elderly care physicians in the Netherlands.In the second part we concentrate on additional effects of ultraviolet light beyond vitamin D synthesis. We describe our systematic review of literature on the effect of ultraviolet light, when applied to the skin or eyes, on mood, depression and well-being. We present also our randomized controlled trial on the effect of ultraviolet radiation compared with oral vitamin D supplementation on the well-being of nursing home residents with dementia. Further we use the data of the RCT to carry out a post-hoc analysis to compare the effect of vitamin D alone compared with ultraviolet radiation on the blood pressure of old people with dementia. Show less
Patients treated for DTC represent a unique clinical population to investigate aspects of thyroid hormone metabolism, thyroid function and related clinical endpoints. Thyroidectomized patients... Show morePatients treated for DTC represent a unique clinical population to investigate aspects of thyroid hormone metabolism, thyroid function and related clinical endpoints. Thyroidectomized patients have no intrinsic T3 production and are completely dependent on peripheral deiodination of exogenous T4. Furthermore, during long-term follow-up thyroid hormone serum levels are frequently measured and the majority of patients have a normal life-span related to high cure rates. Mostly, no autoimmune origin of hypothyroidism is present to take account of, which may have effects on thyroid hormone metabolism itself. It is therefore favorable to investigate the influence of e.g. genetic factors and certain drugs on thyroid metabolism and other endpoints in an athyreotic population.In this thesis several aspects being encountered in the diagnostic process, therapeutic process and follow-up of a thyroid carcinoma are addressed: - Bone morphogenetic protein 7 (BMP7) and downstream proteins as a tool to differentiate between different thyroid pathologies - Thyroid function following hemithyroidectomy - Thyroid dysfunction following treatment with tyrosine kinase inhibitors - Clinical effects of genetic variation in deiodinases - Factors affecting quality of life in patients treated for DTC Show less
