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European Setting (european + setting)

Distribution by Scientific Domains

Medical Sciences	50%

Selected Abstracts

Reliability of the Clinical Teaching Effectiveness Instrument

MEDICAL EDUCATION, Issue 9 2005
H H Van Der Hem-Stokroos
Introduction, The Clinical Teaching Effectiveness Instrument (CTEI) was developed to evaluate the quality of the clinical teaching of educators. Its authors reported evidence supporting content and criterion validity and found favourable reliability findings. We tested the validity and reliability of this instrument in a European context and investigated its reliability as an instrument to evaluate the quality of clinical teaching at group level rather than at the level of the individual teacher. Methods, Students participating in a surgical clerkship were asked to fill in a questionnaire reflecting a student,teacher encounter with a staff member or a resident. We calculated variance components using the urgenova program. For individual score interpretation of the quality of clinical teaching the standard error of estimate was calculated. For group interpretation we calculated the root mean square error. Results, The results did not differ statistically between staff and residents. The average score was 3.42. The largest variance component was associated with rater variance. For individual score interpretation a reliability of >,0.80 was reached with 7 ratings or more. To reach reliable outcomes at group level, 15 educators or more were needed with a single rater per educator. Discussion, The required sample size for appraisal of individual teaching is easily achievable. Reliable findings can also be obtained at group level with a feasible sample size. The results provide additional evidence of the reliability of the CTEI in undergraduate medical education in a European setting. The results also showed that the instrument can be used to measure the quality of teaching at group level. [source]

Prepayment Behavior of Dutch Mortgagors: An Empirical Analysis

REAL ESTATE ECONOMICS, Issue 2 2003
Erwin Charlier
The suboptimal exercise of the prepayment option in a mortgage is relevant for mortgage pricing and the management of a mortgage portfolio. Construction of an accurate prepayment model requires quantification of driving factors such as seasoning, seasonality, refinance incentive and burnout. We focus on Dutch mortgages but also discuss the Dutch market in a European setting. Within the euro-denominated MBS market, the Dutch market is often referred to as the benchmark market. In our application we include typical Dutch market and contract characteristics such as the annual penalty-free prepayment of 10 to 20% of the original loan amount. We use loan-level historical data on mortgages originated between January 1989 and June 1999 to estimate separate models for two popular redemption types: savings mortgages and interest-only mortgages. In both models we allow for suboptimal prepayment behavior. The results clearly indicate that prepayment rates depend on interest rates and the age of the mortgage contract. Moreover, we find that burnout is an important element in describing the prepayment behavior of Dutch mortgagors. [source]

Patient-centred and professional-directed implementation strategies for diabetes guidelines: a cluster-randomized trial-based cost-effectiveness analysis

DIABETIC MEDICINE, Issue 2 2006
R. F. Dijkstra
Abstract Aims Economic evaluations of diabetes interventions do not usually include analyses on effects and cost of implementation strategies. This leads to optimistic cost-effectiveness estimates. This study reports empirical findings on the cost-effectiveness of two implementation strategies compared with usual hospital outpatient care. It includes both patient-related and intervention-related cost. Patients and methods In a clustered-randomized controlled trial design, 13 Dutch general hospitals were randomly assigned to a control group, a professional-directed or a patient-centred implementation programme. Professionals received feedback on baseline data, education and reminders. Patients in the patient-centred group received education and diabetes passports. A validated probabilistic Dutch diabetes model and the UKPDS risk engine are used to compute lifetime disease outcomes and cost in the three groups, including uncertainties. Results Glycated haemoglobin (HbA1c) at 1 year (the measure used to predict diabetes outcome changes over a lifetime) decreased by 0.2% in the professional-change group and by 0.3% in the patient-centred group, while it increased by 0.2% in the control group. Costs of primary implementation were < 5 Euro per head in both groups, but average lifetime costs of improved care and longer life expectancy rose by 9389 Euro and 9620 Euro, respectively. Life expectancy improved by 0.34 and 0.63 years, and quality-adjusted life years (QALY) by 0.29 and 0.59. Accordingly, the incremental cost per QALY was 32 218 Euro for professional-change care and 16 353 for patient-centred care compared with control, and 881 Euro for patient-centred vs. professional-change care. Uncertainties are presented in acceptability curves: above 65 Euro per annum the patient-directed strategy is most likely the optimum choice. Conclusion Both guideline implementation strategies in secondary care are cost-effective compared with current care, by Dutch standards, for these patients. Additional annual costs per patient using patient passports are low. This analysis supports patient involvement in diabetes in the Netherlands, and probably also in other Western European settings. [source]

Rates and social patterning of household smoking and breastfeeding in contrasting European settings

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2005
G. Papadimitriou
Abstract Objective To compare rates and social patterning of household smoking and breastfeeding in families with newborn infants in birth cohorts in Coventry, UK and Veria, North Greece. Methods Infants born in 1996 in Coventry, 1999 in Veria were recruited into birth cohort studies using similar methodologies. In Coventry recruitment was by family health visitor at the primary visit; in Veria, hospital-based paediatricians enrolled infants at the neonatal examination. Data were collected at the initial contact on household smoking, type of feeding, and household socio-demographic characteristics. Rates of initial breastfeeding and household smoking with 95% confidence intervals were estimated and breastfeeding and household smoking regressed on parental education and housing tenure in logistic regression models. Results Data were available on 2612 Coventry infants and 773 Veria infants. Rates of household smoking and breastfeeding were higher in Veria compared to Coventry. In Coventry, living in rented accommodation and lower maternal and paternal education were associated with household smoking and bottle feeding. Logistic regression models fitted on initiation of breastfeeding failed to show social patterning in Veria but more educated mothers showed a longer duration of breastfeeding. Only low paternal education was associated with household smoking after adjustment for maternal education and housing tenure. Conclusions Smoking and breastfeeding are more prevalent among households with young infants in Veria compared with Coventry. The social patterning of health-related behaviours noted in Coventry is less marked in Veria. The relevance of these findings for public health interventions in the contrasting settings is discussed. [source]