The Journal of Ambulatory Care Management, Jul 1, 2012
The Dutch primary care system has drawn international attention, because of its high performance ... more The Dutch primary care system has drawn international attention, because of its high performance at low cost. Primary care practices are easily accessible during office hours and collaborate in a unique out-of-hours system. After the reforms in 2006, there are no copayments for patients receiving care in the primary care practice in which they are registered. Financial incentives support the transfer of care from hospital specialists to primary care physicians, and task delegation from primary care physicians to practice nurses. Regional collaborative care groups of primary care practices offer disease management programs. The quality assessment system and the electronic medical record system are predominantly driven by health care professionals. Bottom-up and top-down activities contributed to a successful Dutch primary care system.
A national, evidence-based guideline on the staging and treatment of patients with non-small cell... more A national, evidence-based guideline on the staging and treatment of patients with non-small cell lung carcinoma (NSCLC) has been compiled by the various disciplines involved. The initial diagnostic measures in patients with suspected lung cancer include history taking, physical examination and chest x-ray. Additional examinations include CT scan of the chest and upper abdomen, bronchoscopy, and 18F-fluorodeoxyglucose-positron-emission-tomography(FDG-PET)-scintigraphy, if curative therapy
Na herinrichting van enkele uiterwaarden langs de Waal werden natuurwaarden en ecologische ontwik... more Na herinrichting van enkele uiterwaarden langs de Waal werden natuurwaarden en ecologische ontwikkeling in beeld gebracht door monitoring van ongewervelde dieren. Het onderzoek was gericht op het vaststellen van ontwikkelingen in de soortenrijkdom na ontkleiing. Ook werd het belang van evertebraten voor foeragerende vogels en zoogdieren bestudeerd. In de eerste jaren na ontkleiing werden nieuwe biotopen ingenomen door een groeiend
Daar komt ze voor op allerlei sierplanten en ze behoort zelfs tot de schadelijkste snuitkevers va... more Daar komt ze voor op allerlei sierplanten en ze behoort zelfs tot de schadelijkste snuitkevers van Italië. In 1994 en 2001 werd deze soort ook in Nederland aangetroffen, in respectievelijk Hoofddorp, Rijswijk en Heemstede. In Heemstede werd voornamelijk schade veroorzaakt ...
Background: International interest in clinical practice guidelines has never been greater but man... more Background: International interest in clinical practice guidelines has never been greater but many published guidelines do not meet the basic quality requirements. There have been renewed calls for validated criteria to assess the quality of guidelines. Objective: To develop and validate an international instrument for assessing the quality of the process and reporting of clinical practice guideline development. Methods: The instrument was developed through a multi-staged process of item generation, selection and scaling, field testing, and refinement procedures. 100 guidelines selected from 11 participating countries were evaluated independently by 194 appraisers with the instrument. Following refinement the instrument was further field tested on three guidelines per country by a new set of 70 appraisers. Results: The final version of the instrument contained 23 items grouped into six quality domains with a 4 point Likert scale to score each item (scope and purpose, stakeholder inv...
Developing and updating high-quality guidelines requires substantial time and resources. To reduc... more Developing and updating high-quality guidelines requires substantial time and resources. To reduce duplication of effort and enhance efficiency, we developed a process for guideline adaptation and assessed initial perceptions of its feasibility and usefulness. Based on preliminary developments and empirical studies, a series of meetings with guideline experts were organised to define a process for guideline adaptation (ADAPTE) and to develop a manual and a toolkit made available on a website (http://www.adapte.org). Potential users, guideline developers and implementers, were invited to register and to complete a questionnaire evaluating their perception about the proposed process. The ADAPTE process consists of three phases (set-up, adaptation, finalisation), 9 modules and 24 steps. The adaptation phase involves identifying specific clinical questions, searching for, retrieving and assessing available guidelines, and preparing the draft adapted guideline. Among 330 registered indiv...
Clinical practice guidelines are often evidence-based. However, it is inevitable that there are v... more Clinical practice guidelines are often evidence-based. However, it is inevitable that there are value judgements in the practical recommendations contained in the guidelines. In order to see if patients are ultimately being supplied with sufficient information to help them make treatment decision, we determined 1) which value judgements influence the process of developing guidelines for palliative chemotherapy, and 2) whether these value judgements were made explicit in the final guideline report. We studied the development process of six Dutch oncology guidelines in which palliative chemotherapy plays a substantial role. We observed the guideline development groups (GDGs), conducted semi-structured interviews with individual GDG members (including the chairs), and analysed the minutes of GDG meetings and subsequent versions of the guidelines. A value judgement was defined as a statement about the value of a patient outcome with regard to palliative chemotherapy. We identified the f...
Dementia is a clinical diagnosis which a general practitioner can either make him/herself or by s... more Dementia is a clinical diagnosis which a general practitioner can either make him/herself or by specific referral. If no abnormalities are found on further clinical investigations by the GP, the risk of missing a treatable cause of dementia is very small; therefore routine imaging examinations are not necessary. GPs are not recommended to prescribe cholinesterase inhibitors or memantine. The implementation of various psycho-social interventions has a positive effect on patients and their home carers and can postpone admission to a nursing home. Dementia care requires working agreements and collaboration amongst local care providers.
We evaluated seven years of light cattle grazing of dune valleys (Frisian island of Vlieland) as ... more We evaluated seven years of light cattle grazing of dune valleys (Frisian island of Vlieland) as to management objectives and effects on vegetation, flora and fauna. We compared vegetation, flora and fauna from 1993 and 2000 in a BACI-design of 14 grazed and 14 ungrazed plots, of which 20 were randomly selected from the stratum `grass overgrown moist dune valleys',
We evaluated seven years of light cattle grazing of dune valleys (Frisian Island of Vlieland) as ... more We evaluated seven years of light cattle grazing of dune valleys (Frisian Island of Vlieland) as to management objectives and effects on vegetation, flora and fauna. We compared data from 1993 and 2000 in a Before-After/Control-Impact design of 14 grazed and 14 ungrazed plots which were randomly selected from the vegetation strata `grass-encroached moist dune valleys' and `intact Empetrum vegetation'.
The Journal of Ambulatory Care Management, Jul 1, 2012
The Dutch primary care system has drawn international attention, because of its high performance ... more The Dutch primary care system has drawn international attention, because of its high performance at low cost. Primary care practices are easily accessible during office hours and collaborate in a unique out-of-hours system. After the reforms in 2006, there are no copayments for patients receiving care in the primary care practice in which they are registered. Financial incentives support the transfer of care from hospital specialists to primary care physicians, and task delegation from primary care physicians to practice nurses. Regional collaborative care groups of primary care practices offer disease management programs. The quality assessment system and the electronic medical record system are predominantly driven by health care professionals. Bottom-up and top-down activities contributed to a successful Dutch primary care system.
A national, evidence-based guideline on the staging and treatment of patients with non-small cell... more A national, evidence-based guideline on the staging and treatment of patients with non-small cell lung carcinoma (NSCLC) has been compiled by the various disciplines involved. The initial diagnostic measures in patients with suspected lung cancer include history taking, physical examination and chest x-ray. Additional examinations include CT scan of the chest and upper abdomen, bronchoscopy, and 18F-fluorodeoxyglucose-positron-emission-tomography(FDG-PET)-scintigraphy, if curative therapy
Na herinrichting van enkele uiterwaarden langs de Waal werden natuurwaarden en ecologische ontwik... more Na herinrichting van enkele uiterwaarden langs de Waal werden natuurwaarden en ecologische ontwikkeling in beeld gebracht door monitoring van ongewervelde dieren. Het onderzoek was gericht op het vaststellen van ontwikkelingen in de soortenrijkdom na ontkleiing. Ook werd het belang van evertebraten voor foeragerende vogels en zoogdieren bestudeerd. In de eerste jaren na ontkleiing werden nieuwe biotopen ingenomen door een groeiend
Daar komt ze voor op allerlei sierplanten en ze behoort zelfs tot de schadelijkste snuitkevers va... more Daar komt ze voor op allerlei sierplanten en ze behoort zelfs tot de schadelijkste snuitkevers van Italië. In 1994 en 2001 werd deze soort ook in Nederland aangetroffen, in respectievelijk Hoofddorp, Rijswijk en Heemstede. In Heemstede werd voornamelijk schade veroorzaakt ...
Background: International interest in clinical practice guidelines has never been greater but man... more Background: International interest in clinical practice guidelines has never been greater but many published guidelines do not meet the basic quality requirements. There have been renewed calls for validated criteria to assess the quality of guidelines. Objective: To develop and validate an international instrument for assessing the quality of the process and reporting of clinical practice guideline development. Methods: The instrument was developed through a multi-staged process of item generation, selection and scaling, field testing, and refinement procedures. 100 guidelines selected from 11 participating countries were evaluated independently by 194 appraisers with the instrument. Following refinement the instrument was further field tested on three guidelines per country by a new set of 70 appraisers. Results: The final version of the instrument contained 23 items grouped into six quality domains with a 4 point Likert scale to score each item (scope and purpose, stakeholder inv...
Developing and updating high-quality guidelines requires substantial time and resources. To reduc... more Developing and updating high-quality guidelines requires substantial time and resources. To reduce duplication of effort and enhance efficiency, we developed a process for guideline adaptation and assessed initial perceptions of its feasibility and usefulness. Based on preliminary developments and empirical studies, a series of meetings with guideline experts were organised to define a process for guideline adaptation (ADAPTE) and to develop a manual and a toolkit made available on a website (http://www.adapte.org). Potential users, guideline developers and implementers, were invited to register and to complete a questionnaire evaluating their perception about the proposed process. The ADAPTE process consists of three phases (set-up, adaptation, finalisation), 9 modules and 24 steps. The adaptation phase involves identifying specific clinical questions, searching for, retrieving and assessing available guidelines, and preparing the draft adapted guideline. Among 330 registered indiv...
Clinical practice guidelines are often evidence-based. However, it is inevitable that there are v... more Clinical practice guidelines are often evidence-based. However, it is inevitable that there are value judgements in the practical recommendations contained in the guidelines. In order to see if patients are ultimately being supplied with sufficient information to help them make treatment decision, we determined 1) which value judgements influence the process of developing guidelines for palliative chemotherapy, and 2) whether these value judgements were made explicit in the final guideline report. We studied the development process of six Dutch oncology guidelines in which palliative chemotherapy plays a substantial role. We observed the guideline development groups (GDGs), conducted semi-structured interviews with individual GDG members (including the chairs), and analysed the minutes of GDG meetings and subsequent versions of the guidelines. A value judgement was defined as a statement about the value of a patient outcome with regard to palliative chemotherapy. We identified the f...
Dementia is a clinical diagnosis which a general practitioner can either make him/herself or by s... more Dementia is a clinical diagnosis which a general practitioner can either make him/herself or by specific referral. If no abnormalities are found on further clinical investigations by the GP, the risk of missing a treatable cause of dementia is very small; therefore routine imaging examinations are not necessary. GPs are not recommended to prescribe cholinesterase inhibitors or memantine. The implementation of various psycho-social interventions has a positive effect on patients and their home carers and can postpone admission to a nursing home. Dementia care requires working agreements and collaboration amongst local care providers.
We evaluated seven years of light cattle grazing of dune valleys (Frisian island of Vlieland) as ... more We evaluated seven years of light cattle grazing of dune valleys (Frisian island of Vlieland) as to management objectives and effects on vegetation, flora and fauna. We compared vegetation, flora and fauna from 1993 and 2000 in a BACI-design of 14 grazed and 14 ungrazed plots, of which 20 were randomly selected from the stratum `grass overgrown moist dune valleys',
We evaluated seven years of light cattle grazing of dune valleys (Frisian Island of Vlieland) as ... more We evaluated seven years of light cattle grazing of dune valleys (Frisian Island of Vlieland) as to management objectives and effects on vegetation, flora and fauna. We compared data from 1993 and 2000 in a Before-After/Control-Impact design of 14 grazed and 14 ungrazed plots which were randomly selected from the vegetation strata `grass-encroached moist dune valleys' and `intact Empetrum vegetation'.
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Papers by Jako Burgers