Gastrostomy fed head or neck cancer patients frequently have impaired speech capacities. Enteral ... more Gastrostomy fed head or neck cancer patients frequently have impaired speech capacities. Enteral feeding teams frequently depend on laboratorial or anthropometrical parameters for nutritional assessment. In these patients, this study aimed to evaluate: (1) the practicability of Scored - Patient-Generated Subjective Global Assessment (PG-SGA); (2) their nutritional status using the Scored-PG-SGA; (3) association of serum albumin and transferrin values to the nutritional status rating using PG-SGA. On adult outpatients with head or neck cancer under prolonged (> 1 month) gastrostomy feeding, Scored-PGSGA, albumin and transferrin were evaluated during the same appointment. Scored-PG-SGA was easily feasible in 42 patients, even in patients with speech difficulties. Twenty-five patients were moderately/severely undernourished (PG-SGA/B+C). Scored-PG-SGA rated 41 patients as ≥ 2, thus needing nutritional/ pharmacologic intervention. Albumin was low in 13 patients. Transferrin was low i...
Background The Fas Associated Death Domain (FADD) gene is often overexpressed in squamous cell ca... more Background The Fas Associated Death Domain (FADD) gene is often overexpressed in squamous cell carcinoma of the head and neck (HNSCC) and is considered to be a driver gene in DNA amplification of the chromosomal 11q13.3 region. Amplification of 11q13.3 is associated with increased metastasis in HNSCC and breast cancer. The aim of this study was to correlate FADD expression in advanced stage HNSCC with clinico-pathological features and clinical outcome. Patients and Methods Tumor tissues of 177 HNSCC patients uniformly treated with primary surgery and postoperative radiotherapy were collected. FADD expression was assessed on pre-treatment tumor biopsies using immunohistochemistry. Results High FADD expression was detected in 44% of the HNSCC patients. High expression was associated with an increased rate of lymph node metastases (p=0.001) and with shorter distant metastasis free interval (DMFI) (HR:3.3, 95%CI: 1.3-8.1, p=0.008) independent of lymph node status at the time of diagnosis. Conclusion Our data show that an increase in FADD expression is associated with a higher incidence of lymph node metastasis at presentation and with shorter DMFI when lymph node metastases are present. High FADD expression in the primary tumor could be a useful marker to select patients for systemic treatment strategies that reduce the risk for distant metastases.
Een slechte voedingstoestand, oftewel ondervoeding, is een voedingstoestand waarbij een combinati... more Een slechte voedingstoestand, oftewel ondervoeding, is een voedingstoestand waarbij een combinatie van onvoldoende voedselinname en ontsteking heeft geleid tot een afname van de vet- en spiermassa in combinatie met een afname van de spierfunctie, cognitieve functie en/of immuunfunctie (Soeters et al., 2008). Bij ziektegerelateerde ondervoeding worden lichaamseiwitten afgebroken (katabolie). Katabolie resulteert onder andere in afname van de skeletspiermassa. Glutamine, een eiwit dat is opgeslagen in de skeletspieren, is betrokken bij de afweer. Tijdens een katabole toestand ontstaat een tekort aan glutamine, waardoor de immuunfunctie vermindert. Complicaties, zoals vertraagde wondgenezing en mucositis, duren hierdoor langer en verlopen heftiger (Van Bokhorst-de van der Schueren et al., 1997). Ook is de opnameduur van ondervoede patienten langer dan van niet-ondervoede patienten (Kyle et al., 2005; Pichard et al., 2004) en is de kwaliteit van leven van de ondervoede patient vaak slechter (Jager-Wittenaar et al., 2010).
Photodiagnosis and Photodynamic Therapy, Jun 1, 2011
of cases. Malignant neoplastic lesions appeared as hypoechoic focal lesions. SCCs are usually vis... more of cases. Malignant neoplastic lesions appeared as hypoechoic focal lesions. SCCs are usually visualized as hypoechoic structures within the hyperechoic dermis. Basal cell carcinomas are usually visualized as hypoechoic structures but also can show a mixed echogenicity. Conclusion: Optical coherence tomography has been identified as a successful tool in distinguishing normal from abnormal skin in vivo; as well as accurately identifying different skin pathologies.
Introduction Various forms of videoconferenced collaborations exist in oncology care. In regional... more Introduction Various forms of videoconferenced collaborations exist in oncology care. In regional oncology networks, multidisciplinary teams (MDTs) are essential in coordinating care in their region. There is no recent overview of the benefits and drawbacks of videoconferenced collaborations in oncology care networks. This scoping review presents an overview of videoconferencing (VC) in oncology care and summarises its benefits and drawbacks regarding decisionmaking and care coordination. Design We searched MEDLINE, Embase, CINAHL (nursing and allied health) and the Cochrane Library from inception to October 2020 for studies that included VC use in discussing treatment plans and coordinating care in oncology networks between teams at different sites. Two reviewers performed data extraction and thematic analyses. Results Fifty studies were included. Six types of collaboration between teams using VC in oncology care were distinguished, ranging from MDTs collaborating with similar teams or with national or international experts to interactions between palliative care nurses and experts in that field. Patient benefits were less travel for diagnosis, better coordination of care, better access to scarce facilities and treatment in their own community. Benefits for healthcare professionals were optimised treatment plans through multidisciplinary discussion of complex cases, an ability to inform all healthcare professionals simultaneously, enhanced care coordination, less travel and continued medical education. VC added to the regular workload in preparing for discussions and increased administrative preparation. Discussion Benefits and drawbacks for collaborating teams were tied to general VC use. VC enabled better use of staff time and reduced the time spent travelling. VC equipment costs and lack of reimbursement were implementation barriers. Conclusion VC is highly useful for various types of collaboration in oncology networks and improves decisionmaking over treatment plans and care coordination, with substantial benefits for patients and specialists. Drawbacks are additional time related to administrative preparation.
Annually 650,000 new patients are diagnosed with Head and Neck cancer, making it the sixth most c... more Annually 650,000 new patients are diagnosed with Head and Neck cancer, making it the sixth most common cancer worldwide. The 5-year survival is only 60% due to inaccurate detection of nodal metastases in the cervical or submandibular region (N-status). Our goal is to find new DNA methylation markers in the primary tumor that predict nodal metastases to improve diagnostics and treatment. For biomarker discovery we used a new approach combining global methylation assessment, next generation sequencing, quantitative methylation and microarray expression profiling. Here we report the success of this new approach and the further validation of novel biomarkers. We performed MethylCap-Seq on DNA from 6 oral squamous cell carcinomas (OSCC) with nodal metastases (N+) and 6 OSCC without nodal metastases (N0) to measure global methylation levels. After comparison of the sequenced reads a list was composed of the 5000 most differentially methylated genes between the two groups. The most significantly differentially methylated genes were validated using Quantitative Methylation Specific PCR (QMSP) and Pyrosequencing on a independent series of 20 N+ and 20 N0 OSCC. In addition, the MethylCap-Seq methylation data was combined with microarray expression data of 696 genes for a N-status validation cohort containing 222 OSCC (Hoof et al.; J Clin Oncol. 2012 Oct 8). Based upon the assumption that hypermethylation is associated with downregulation of gene expression, we selected hypermethylated and downregulated genes distinguishing between the two groups. The effect of DNA methylation on gene expression will be measured by (Q)RT-PCR and immunohistochemistry on a N-status validation panel. The most promising methylation markers will be further validated by Pyrosequencing and QMSP on DNA of a N-status validation cohort containing 463 cases for which complete clinicopathological and follow-up data are available. These markers might contribute to better diagnosis, improved quality of life and may be associated with increased survival. This research was supported by the Center for Translational Molecular Medicine (project AIRFORCE). Citation Format: Martijn Clausen, Lieuwe J. Melchers, Leonie Bruine de Bruin, Mirjam F. Mastik, Lorian Slagter-Menkema, Harry J. Groen, Bert van der Vegt, Bernard F. Van der Laan, Tim De Meyer, Wim Van Criekinge, G Bea Wisman, Jan L. Roodenburg, Ed Schuuring. DNA methylation marker discovery for the prediction of nodal metastases in head and neck cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 645. doi:10.1158/1538-7445.AM2013-645
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Background. This study assessed whether malnourished patients score lower on quality of life afte... more Background. This study assessed whether malnourished patients score lower on quality of life after treatment for oral/oropharyngeal cancer. Methods. Malnutrition (weight loss !10% in 6 months/!5% in 1 month) and quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 questionnaire) were assessed cross-sectionally in patients treated for oral/oropharyngeal cancer. The interval after treatment varied from 1 day to 3 years. The relationship between malnutrition and quality of life was analyzed univariately (Mann-Whitney U test) and multivariately (linear regression analyses). Statistical significance was set at p < .05. Results. Prevalence of posttreatment malnutrition was 16% (18/115, 95% confidence interval [CI]: 9% to 23%). Analyzed univariately, malnourished patients scored significantly worse on physical functioning (p ¼ .007) and fatigue (p ¼ .034) than well-nourished patients. Multivariate analysis revealed that malnutrition was significantly related to physical functioning (p ¼ .015). Conclusions. Malnourished patients treated for oral/oropharyngeal cancer score lower on quality of life scales related to physical fitness. V
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
With a total incidence of ca. 800 per year, oral cavity or oropharyngeal carcinoma represents onl... more With a total incidence of ca. 800 per year, oral cavity or oropharyngeal carcinoma represents only a small fraction of the total number of cases of cancer in The Netherlands. In order to achieve as much nationwide uniformity as possible in its diagnosis, treatment, after-care and follow-up, a practice guideline has now been developed. The diagnosis of the primary tumour and the neck, careful clinical examination is complemented by echography, often combined with a biopsy, MRI and CT, while technetium scintigraphy in combination with an orthopantomogram is used to detect invasion of the mandible. The smaller oropharyngeal carcinomas (T1 and T2), surgery and radiotherapy (external therapy or brachytherapy) are equally useful, but for the larger carcinomas (T3 and T4) in patients in good general condition, surgery in combination with radiotherapy is preferred. When radiotherapy is chosen, then brachytherapy is preferred for the smaller tumours of the tongue and the floor of the mouth. In patients without demonstrable metastases to the lymph nodes, just as in the case oforopharyngeal carcinomas, the decision whether or not to treat the neck depends on the chances that cervical lymph node metastases are present: when the risk is smaller than 20% (as with smaller tumours), then a wait-and-see policy is justified, but if the risk is greater than 20% (as with larger tumours or very thick rumours), then the neck should be treated, either surgically or by radiotherapy. The practice guideline also contains information regarding decision making, information and communication, palliative therapy and symptomatic treatment, psychosocial assistance, prosthetic reconstruction, physiotherapy, oral hygiene, nutrition and dietetics, swallowing and speech rehabilitation, and the policy with regard to smoking and alcohol consumption.
In health care, optimal collaboration between nurses and physicians is crucial in the quality of ... more In health care, optimal collaboration between nurses and physicians is crucial in the quality of the care process-but not self-generating. Little is known about how health-care professionals cope with conflicts within their collaboration. This qualitative study investigates the way nurses and physicians cope with conflict, and clarifies the determinants of conflict management styles. All respondents formulate clear expectations which in their opinion are essential to collaboration. When collaboration leads to disagreement, physicians and nurses choose between ignoring the conflict or engaging in it. Choice is determined by five factors: the influence of oneself , the influence of the other, the nature of the conflict, the context of conflict, and personal motives.
For more than two decades, the International Summer School Oncology for Medical Students (ISOMS) ... more For more than two decades, the International Summer School Oncology for Medical Students (ISOMS) has organized a biennial 2-week international summer school program in Groningen, the Netherlands. The summer school aims to increase knowledge about general cancer care, reduce fear of talking to cancer patients, and expose students to cancer-related problems. After 22 years, there was a need to improve the summer school format, the application procedure, and the intensity of the course. Here, we describe and evaluate these and additional changes that were made to the program. Several changes were made to the summer school format. The course was shortened from 10 days to a more intensive 7 days. The scientific program was integrated with the clinical program and students were taught scientific writing and presentation skills. The application process involved a personal video pitch. Importantly, the new summer school format was organized by a committee in which medical students had the lead. To evaluate the changes to the summer school, we conducted knowledge tests and regularly obtained feedback. There was a high overall student satisfaction, with a median score of a 9 out of 10. Students appreciated the interactive sessions and practicals and the scientific program, and were satisfied with the course level. All students had improved test scores. Improvement points highlighted the need for a less packed schedule and more lectures on basic oncology principles, or were related to specific lectures. The student-led innovation and adaptation of the ISOMS has been successful.
In the healthcare domain, human collaboration processes (HCPs), which consist of interactions bet... more In the healthcare domain, human collaboration processes (HCPs), which consist of interactions between healthcare workers from different (para)medical disciplines and departments, are of growing importance as healthcare delivery becomes increasingly integrated. Existing workflow-based process modelling tools for healthcare process management, which are the most commonly applied, are not suited for healthcare HCPs mainly due to their focus on the definition of task sequences instead of the graphical description of human interactions. This paper uses a case study of a healthcare HCP at a Dutch academic hospital to evaluate a novel interaction-centric process modelling method. The HCP under study is the care pathway performed by the head and neck oncology team. The evaluation results show that the method brings innovative, effective, and useful features. First, it collects and formalizes the tacit domain knowledge of the interviewed healthcare workers in individual interaction diagrams. Second, the method automatically integrates these local diagrams into a single global interaction diagram that reflects the consolidated domain knowledge. Third, the case study illustrates how the method utilizes a graphical modelling language for effective tree-based description of interactions, their composition and routing relations, and their roles. A process analysis of the global interaction diagram is shown to identify HCP improvement opportunities. The proposed interaction-centric method has wider applicability since interactions are the core of most multidisciplinary patient-care processes. A discussion argues that, although (multidisciplinary) collaboration is in many cases not optimal in the healthcare domain, it is increasingly considered a necessity to improve integration, continuity, and quality of care. The proposed method is helpful to describe, analyze, and improve the functioning of healthcare collaboration.
Gastrostomy fed head or neck cancer patients frequently have impaired speech capacities. Enteral ... more Gastrostomy fed head or neck cancer patients frequently have impaired speech capacities. Enteral feeding teams frequently depend on laboratorial or anthropometrical parameters for nutritional assessment. In these patients, this study aimed to evaluate: (1) the practicability of Scored - Patient-Generated Subjective Global Assessment (PG-SGA); (2) their nutritional status using the Scored-PG-SGA; (3) association of serum albumin and transferrin values to the nutritional status rating using PG-SGA. On adult outpatients with head or neck cancer under prolonged (> 1 month) gastrostomy feeding, Scored-PGSGA, albumin and transferrin were evaluated during the same appointment. Scored-PG-SGA was easily feasible in 42 patients, even in patients with speech difficulties. Twenty-five patients were moderately/severely undernourished (PG-SGA/B+C). Scored-PG-SGA rated 41 patients as ≥ 2, thus needing nutritional/ pharmacologic intervention. Albumin was low in 13 patients. Transferrin was low i...
Background The Fas Associated Death Domain (FADD) gene is often overexpressed in squamous cell ca... more Background The Fas Associated Death Domain (FADD) gene is often overexpressed in squamous cell carcinoma of the head and neck (HNSCC) and is considered to be a driver gene in DNA amplification of the chromosomal 11q13.3 region. Amplification of 11q13.3 is associated with increased metastasis in HNSCC and breast cancer. The aim of this study was to correlate FADD expression in advanced stage HNSCC with clinico-pathological features and clinical outcome. Patients and Methods Tumor tissues of 177 HNSCC patients uniformly treated with primary surgery and postoperative radiotherapy were collected. FADD expression was assessed on pre-treatment tumor biopsies using immunohistochemistry. Results High FADD expression was detected in 44% of the HNSCC patients. High expression was associated with an increased rate of lymph node metastases (p=0.001) and with shorter distant metastasis free interval (DMFI) (HR:3.3, 95%CI: 1.3-8.1, p=0.008) independent of lymph node status at the time of diagnosis. Conclusion Our data show that an increase in FADD expression is associated with a higher incidence of lymph node metastasis at presentation and with shorter DMFI when lymph node metastases are present. High FADD expression in the primary tumor could be a useful marker to select patients for systemic treatment strategies that reduce the risk for distant metastases.
Een slechte voedingstoestand, oftewel ondervoeding, is een voedingstoestand waarbij een combinati... more Een slechte voedingstoestand, oftewel ondervoeding, is een voedingstoestand waarbij een combinatie van onvoldoende voedselinname en ontsteking heeft geleid tot een afname van de vet- en spiermassa in combinatie met een afname van de spierfunctie, cognitieve functie en/of immuunfunctie (Soeters et al., 2008). Bij ziektegerelateerde ondervoeding worden lichaamseiwitten afgebroken (katabolie). Katabolie resulteert onder andere in afname van de skeletspiermassa. Glutamine, een eiwit dat is opgeslagen in de skeletspieren, is betrokken bij de afweer. Tijdens een katabole toestand ontstaat een tekort aan glutamine, waardoor de immuunfunctie vermindert. Complicaties, zoals vertraagde wondgenezing en mucositis, duren hierdoor langer en verlopen heftiger (Van Bokhorst-de van der Schueren et al., 1997). Ook is de opnameduur van ondervoede patienten langer dan van niet-ondervoede patienten (Kyle et al., 2005; Pichard et al., 2004) en is de kwaliteit van leven van de ondervoede patient vaak slechter (Jager-Wittenaar et al., 2010).
Photodiagnosis and Photodynamic Therapy, Jun 1, 2011
of cases. Malignant neoplastic lesions appeared as hypoechoic focal lesions. SCCs are usually vis... more of cases. Malignant neoplastic lesions appeared as hypoechoic focal lesions. SCCs are usually visualized as hypoechoic structures within the hyperechoic dermis. Basal cell carcinomas are usually visualized as hypoechoic structures but also can show a mixed echogenicity. Conclusion: Optical coherence tomography has been identified as a successful tool in distinguishing normal from abnormal skin in vivo; as well as accurately identifying different skin pathologies.
Introduction Various forms of videoconferenced collaborations exist in oncology care. In regional... more Introduction Various forms of videoconferenced collaborations exist in oncology care. In regional oncology networks, multidisciplinary teams (MDTs) are essential in coordinating care in their region. There is no recent overview of the benefits and drawbacks of videoconferenced collaborations in oncology care networks. This scoping review presents an overview of videoconferencing (VC) in oncology care and summarises its benefits and drawbacks regarding decisionmaking and care coordination. Design We searched MEDLINE, Embase, CINAHL (nursing and allied health) and the Cochrane Library from inception to October 2020 for studies that included VC use in discussing treatment plans and coordinating care in oncology networks between teams at different sites. Two reviewers performed data extraction and thematic analyses. Results Fifty studies were included. Six types of collaboration between teams using VC in oncology care were distinguished, ranging from MDTs collaborating with similar teams or with national or international experts to interactions between palliative care nurses and experts in that field. Patient benefits were less travel for diagnosis, better coordination of care, better access to scarce facilities and treatment in their own community. Benefits for healthcare professionals were optimised treatment plans through multidisciplinary discussion of complex cases, an ability to inform all healthcare professionals simultaneously, enhanced care coordination, less travel and continued medical education. VC added to the regular workload in preparing for discussions and increased administrative preparation. Discussion Benefits and drawbacks for collaborating teams were tied to general VC use. VC enabled better use of staff time and reduced the time spent travelling. VC equipment costs and lack of reimbursement were implementation barriers. Conclusion VC is highly useful for various types of collaboration in oncology networks and improves decisionmaking over treatment plans and care coordination, with substantial benefits for patients and specialists. Drawbacks are additional time related to administrative preparation.
Annually 650,000 new patients are diagnosed with Head and Neck cancer, making it the sixth most c... more Annually 650,000 new patients are diagnosed with Head and Neck cancer, making it the sixth most common cancer worldwide. The 5-year survival is only 60% due to inaccurate detection of nodal metastases in the cervical or submandibular region (N-status). Our goal is to find new DNA methylation markers in the primary tumor that predict nodal metastases to improve diagnostics and treatment. For biomarker discovery we used a new approach combining global methylation assessment, next generation sequencing, quantitative methylation and microarray expression profiling. Here we report the success of this new approach and the further validation of novel biomarkers. We performed MethylCap-Seq on DNA from 6 oral squamous cell carcinomas (OSCC) with nodal metastases (N+) and 6 OSCC without nodal metastases (N0) to measure global methylation levels. After comparison of the sequenced reads a list was composed of the 5000 most differentially methylated genes between the two groups. The most significantly differentially methylated genes were validated using Quantitative Methylation Specific PCR (QMSP) and Pyrosequencing on a independent series of 20 N+ and 20 N0 OSCC. In addition, the MethylCap-Seq methylation data was combined with microarray expression data of 696 genes for a N-status validation cohort containing 222 OSCC (Hoof et al.; J Clin Oncol. 2012 Oct 8). Based upon the assumption that hypermethylation is associated with downregulation of gene expression, we selected hypermethylated and downregulated genes distinguishing between the two groups. The effect of DNA methylation on gene expression will be measured by (Q)RT-PCR and immunohistochemistry on a N-status validation panel. The most promising methylation markers will be further validated by Pyrosequencing and QMSP on DNA of a N-status validation cohort containing 463 cases for which complete clinicopathological and follow-up data are available. These markers might contribute to better diagnosis, improved quality of life and may be associated with increased survival. This research was supported by the Center for Translational Molecular Medicine (project AIRFORCE). Citation Format: Martijn Clausen, Lieuwe J. Melchers, Leonie Bruine de Bruin, Mirjam F. Mastik, Lorian Slagter-Menkema, Harry J. Groen, Bert van der Vegt, Bernard F. Van der Laan, Tim De Meyer, Wim Van Criekinge, G Bea Wisman, Jan L. Roodenburg, Ed Schuuring. DNA methylation marker discovery for the prediction of nodal metastases in head and neck cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 645. doi:10.1158/1538-7445.AM2013-645
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Background. This study assessed whether malnourished patients score lower on quality of life afte... more Background. This study assessed whether malnourished patients score lower on quality of life after treatment for oral/oropharyngeal cancer. Methods. Malnutrition (weight loss !10% in 6 months/!5% in 1 month) and quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 questionnaire) were assessed cross-sectionally in patients treated for oral/oropharyngeal cancer. The interval after treatment varied from 1 day to 3 years. The relationship between malnutrition and quality of life was analyzed univariately (Mann-Whitney U test) and multivariately (linear regression analyses). Statistical significance was set at p < .05. Results. Prevalence of posttreatment malnutrition was 16% (18/115, 95% confidence interval [CI]: 9% to 23%). Analyzed univariately, malnourished patients scored significantly worse on physical functioning (p ¼ .007) and fatigue (p ¼ .034) than well-nourished patients. Multivariate analysis revealed that malnutrition was significantly related to physical functioning (p ¼ .015). Conclusions. Malnourished patients treated for oral/oropharyngeal cancer score lower on quality of life scales related to physical fitness. V
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
With a total incidence of ca. 800 per year, oral cavity or oropharyngeal carcinoma represents onl... more With a total incidence of ca. 800 per year, oral cavity or oropharyngeal carcinoma represents only a small fraction of the total number of cases of cancer in The Netherlands. In order to achieve as much nationwide uniformity as possible in its diagnosis, treatment, after-care and follow-up, a practice guideline has now been developed. The diagnosis of the primary tumour and the neck, careful clinical examination is complemented by echography, often combined with a biopsy, MRI and CT, while technetium scintigraphy in combination with an orthopantomogram is used to detect invasion of the mandible. The smaller oropharyngeal carcinomas (T1 and T2), surgery and radiotherapy (external therapy or brachytherapy) are equally useful, but for the larger carcinomas (T3 and T4) in patients in good general condition, surgery in combination with radiotherapy is preferred. When radiotherapy is chosen, then brachytherapy is preferred for the smaller tumours of the tongue and the floor of the mouth. In patients without demonstrable metastases to the lymph nodes, just as in the case oforopharyngeal carcinomas, the decision whether or not to treat the neck depends on the chances that cervical lymph node metastases are present: when the risk is smaller than 20% (as with smaller tumours), then a wait-and-see policy is justified, but if the risk is greater than 20% (as with larger tumours or very thick rumours), then the neck should be treated, either surgically or by radiotherapy. The practice guideline also contains information regarding decision making, information and communication, palliative therapy and symptomatic treatment, psychosocial assistance, prosthetic reconstruction, physiotherapy, oral hygiene, nutrition and dietetics, swallowing and speech rehabilitation, and the policy with regard to smoking and alcohol consumption.
In health care, optimal collaboration between nurses and physicians is crucial in the quality of ... more In health care, optimal collaboration between nurses and physicians is crucial in the quality of the care process-but not self-generating. Little is known about how health-care professionals cope with conflicts within their collaboration. This qualitative study investigates the way nurses and physicians cope with conflict, and clarifies the determinants of conflict management styles. All respondents formulate clear expectations which in their opinion are essential to collaboration. When collaboration leads to disagreement, physicians and nurses choose between ignoring the conflict or engaging in it. Choice is determined by five factors: the influence of oneself , the influence of the other, the nature of the conflict, the context of conflict, and personal motives.
For more than two decades, the International Summer School Oncology for Medical Students (ISOMS) ... more For more than two decades, the International Summer School Oncology for Medical Students (ISOMS) has organized a biennial 2-week international summer school program in Groningen, the Netherlands. The summer school aims to increase knowledge about general cancer care, reduce fear of talking to cancer patients, and expose students to cancer-related problems. After 22 years, there was a need to improve the summer school format, the application procedure, and the intensity of the course. Here, we describe and evaluate these and additional changes that were made to the program. Several changes were made to the summer school format. The course was shortened from 10 days to a more intensive 7 days. The scientific program was integrated with the clinical program and students were taught scientific writing and presentation skills. The application process involved a personal video pitch. Importantly, the new summer school format was organized by a committee in which medical students had the lead. To evaluate the changes to the summer school, we conducted knowledge tests and regularly obtained feedback. There was a high overall student satisfaction, with a median score of a 9 out of 10. Students appreciated the interactive sessions and practicals and the scientific program, and were satisfied with the course level. All students had improved test scores. Improvement points highlighted the need for a less packed schedule and more lectures on basic oncology principles, or were related to specific lectures. The student-led innovation and adaptation of the ISOMS has been successful.
In the healthcare domain, human collaboration processes (HCPs), which consist of interactions bet... more In the healthcare domain, human collaboration processes (HCPs), which consist of interactions between healthcare workers from different (para)medical disciplines and departments, are of growing importance as healthcare delivery becomes increasingly integrated. Existing workflow-based process modelling tools for healthcare process management, which are the most commonly applied, are not suited for healthcare HCPs mainly due to their focus on the definition of task sequences instead of the graphical description of human interactions. This paper uses a case study of a healthcare HCP at a Dutch academic hospital to evaluate a novel interaction-centric process modelling method. The HCP under study is the care pathway performed by the head and neck oncology team. The evaluation results show that the method brings innovative, effective, and useful features. First, it collects and formalizes the tacit domain knowledge of the interviewed healthcare workers in individual interaction diagrams. Second, the method automatically integrates these local diagrams into a single global interaction diagram that reflects the consolidated domain knowledge. Third, the case study illustrates how the method utilizes a graphical modelling language for effective tree-based description of interactions, their composition and routing relations, and their roles. A process analysis of the global interaction diagram is shown to identify HCP improvement opportunities. The proposed interaction-centric method has wider applicability since interactions are the core of most multidisciplinary patient-care processes. A discussion argues that, although (multidisciplinary) collaboration is in many cases not optimal in the healthcare domain, it is increasingly considered a necessity to improve integration, continuity, and quality of care. The proposed method is helpful to describe, analyze, and improve the functioning of healthcare collaboration.
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