Follow-up in oncology: focused on the patient and the disease

Follow-up in oncology primarily encompasses medical technical examinations of patients following treatment for cancer. The term "aftercare" more accurately represents which approach should be taken after completion of cancer treatment: not only medical technical care, but fulfilment of care needs that result from the disease and its treatment. For each patient an individual aftercare plan should be put in place, which fulfils the 3 goals of aftercare: psycho-social and medical care, early diagnosis of recurrent disease or new primary disease activity if such early diagnosis bears clinical relevance, and medical audit. Involving patients in this decision-making process is generally limited in daily practice. The way in which the individual patient's aftercare is carried out, is still a scientific challenge. It is clear, however, that nothing about this is "standard".     

Optimising eHealth tools for older patients: Collaborative redesign of a hospital website

Most hospital websites have not been developed in collaboration with patients and, therefore, rarely take into account the preferences and abilities of older patients. This study describes the systematic redesign of an existing hospital website in a co‐design process with patients and professional stakeholders (e.g. researchers, physicians, nurses, department heads, policymakers, website designers), with the aim to make it more user‐friendly for older patients with colorectal cancer (CRC). The redesign process consisted of three phases, where (I) both existing content and design were evaluated among CRC patients; (II) a prototype website was developed based on these insights; which (III) was evaluated again before making final adjustments. Mixed research methods were used for the redesign process. Specifically, insights from existing literature, outcomes from qualitative and quantitative empirical studies conducted by our team, and expert knowledge from relevant stakeholders, were collected and discussed in multidisciplinary consensus meetings, and served as input for the redesigned website. While the existing website was evaluated poorly, the qualitative evaluation of the prototype website in phase 3 showed that the newly redesigned website was usable for older CRC patients. A practical roadmap on how to collaboratively redesign and optimise existing eHealth tools to make them suitable for and operational in clinical settings is provided.     

Evaluation of adding item‐response theory analysis for evaluation of the European Board of Ophthalmology Diploma examination

Purpose: To investigate whether introduction of item‐response theory (IRT) analysis, in parallel to the ‘traditional’ statistical analysis methods available for performance evaluation of multiple T/F items as used in the European Board of Ophthalmology Diploma (EBOD) examination, has proved beneficial, and secondly, to study whether the overall assessment performance of the current written part of EBOD is sufficiently high (KR‐20 ≥ 0.90) to be kept as examination format in future EBOD editions. Methods: ‘Traditional’ analysis methods for individual MCQ item performance comprise P‐statistics, Rit‐statistics and item discrimination, while overall reliability is evaluated through KR‐20 for multiple T/F items. The additional set of statistical analysis methods for the evaluation of EBOD comprises mainly IRT analysis. These analysis techniques are used to monitor whether the introduction of negative marking for incorrect answers (since EBOD 2010) has a positive influence on the statistical performance of EBOD as a whole and its individual test items in particular. Results: Item‐response theory analysis demonstrated that item performance parameters should not be evaluated individually, but should be related to one another. Before the introduction of negative marking, the overall EBOD reliability (KR‐20) was good though with room for improvement (EBOD 2008: 0.81; EBOD 2009: 0.78). After the introduction of negative marking, the overall reliability of EBOD improved significantly (EBOD 2010: 0.92; EBOD 2011:0.91; EBOD 2012: 0.91). Conclusion: Although many statistical performance parameters are available to evaluate individual items, our study demonstrates that the overall reliability assessment remains the only crucial parameter to be evaluated allowing comparison. While individual item performance analysis is worthwhile to undertake as secondary analysis, drawing final conclusions seems to be more difficult. Performance parameters need to be related, as shown by IRT analysis. Therefore, IRT analysis has proved beneficial for the statistical analysis of EBOD. Introduction of negative marking has led to a significant increase in the reliability (KR‐20 > 0.90), indicating that the current examination format can be kept for future EBOD examinations.     

History and future of the European Board of Ophthalmology Diploma examination

Purpose: The European Board of Ophthalmology Diploma (EBOD) examination has evolved over the last few years, especially with the introduction of negative marking (?0.5 points) for incorrect or blank answers (0 points for don’t know option), which aimed to improve the quality and reliability of the examination. Methods: In 2010, negative marking at the written part of the EBOD examination has been introduced in an attempt to improve not only the reliability of the examination as entity but also the statistical performance parameters of the individual questions. As lower pass rates and discrimination of female candidates are feared by the general public when negative marking is concerned, these parameters have been explicitly investigated. Results: Introduction of negative marking has not only lead to improved reliability of the EBOD examination (increased Cronbach’s alpha value: ≤0.80 without and ≥0.90 with negative marking), but also to improved statistical performance parameters of the individual questions. The pass rate of the EBOD examination has proven to remain at the same high level as without negative marking (around 90%). Furthermore, although female candidates do seem to have different answering strategies (p < 0.01, use of don’t know option), no statistically significant difference has been found between total scores of male and female candidates (p > 0.05). Conclusion: Introduction of negative marking at the written EBOD examination has proven to be beneficial, not only for the organizers (improvement of the statistical performance of the examination and its questions), but also for candidates (better discrimination with borderline candidates). These results have been obtained without evidence of lower pass rates or discrimination of female candidates.     

Barriers and facilitators for physical activity in rheumatic and musculoskeletal disease: a European-based survey

Clinical Rheumatology - Physical activity (PA) is a key strategy for improving symptoms in people with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to investigate and...