Psychology, Health and Technology

Methods: Data were used from baseline, 6 and 18 months of follow-up during a prospective cohort study of 120 CWP patients who completed multidisciplinary rehabilitation treatment. Cross-sectional and longitudinal relationships were analyzed between fatigue, clinical (i.e. pain, interference of pain and depression) and pain related cognitive factors (i.e. negative emotional cognitions, active cognitive coping, and control and chronicity beliefs). Results: Higher levels of pain, interference of pain, depression, negative emotional cognitions, and negative control and chronicity beliefs were associated with a higher level of fatigue. Improvement in depression was related to improvement in fatigue. Conclusions: In CWP patients, worse clinical status, and dysfunctional pain related cognitions are associated with a higher level of fatigue. Our results suggest that improvement in depression might be a mechanism of improvement in fatigue. Furthermore, improvement in fatigue seems to be independent of improvement in pain related cognitions. Targeting fatigue in multidisciplinary pain treatment may need specific strategies.

Background: A health promotion intervention was developed for inflammatory arthritis patients, based on goal management. Elevated levels of depression and anxiety symptoms, which indicate maladjustment, are found in such patients. Other indicators of adaptation to chronic disease are positive affect, purpose in life and social participation. The new intervention focuses on to improving adaptation by increasing psychological and social well-being and decreasing symptoms of affective disorders. Content includes how patients can cope with activities and life goals that are threatened or have become impossible to attain due to arthritis. The four goal management strategies used are: goal maintenance, goal adjustment, goal disengagement and reengagement. Ability to use various goal management strategies, coping versatility and self-efficacy are hypothesized to mediate the intervention's effect on primary and secondary outcomes. The primary outcome is depressive symptoms. Secondary outcomes are anxiety symptoms, positive affect, purpose in life, social participation, pain, fatigue and physical functioning. A cost-effectiveness analysis and stakeholders' analysis are planned. Methods/design: The protocol-based psycho-educational program consists of six group-based meetings and homework assignments, led by a trained nurse. Participants are introduced to goal management strategies and learn to use these strategies to cope with threatened personal goals. Four general hospitals participate in a randomized controlled trial with one intervention group and a waiting list control condition. Discussion: The purpose of this study is to evaluate the effectiveness of a goal management intervention. The study has a holistic focus as both the absence of psychological distress and presence of well-being are assessed. In the intervention, applicable goal management competencies are learned that assist people in their choice of behaviors to sustain and enhance their quality of life.

Usually priorities in goal management-intended to minimize discrepancies between a given and desired situation-are studied as person characteristics, neglecting possible domain-specific aspects. However, people may make different decisions in different situations depending on the importance of the personal issues at stake. Aim of the present study therefore was to develop arthritis-related vignettes to examine domain-specific goal management and to explore patients' preferences. Based on interviews and literature, situation-specific hypothetical stories were developed in which the main character encounters a problem with a valued goal due to arthritis. Thirty-one patients (61 % female, mean age 60 years) evaluated the face validity of the newly developed vignettes. Secondly, 262 patients (60 % female, mean age 63 years) were asked to come up with possible solutions for the problems with attaining a goal described in a subset of the vignettes. Goal management strategies within th...

Process evaluations of newly developed interventions are necessary to identify effective and less effective intervention components. First aim of this study was to identify key components of a psychosocial goal management intervention from the perspective of participants, and second aim was to evaluate the intervention's fidelity. A mixed-methods approach was applied to 24 interviews with participants post-intervention and 16 audio recordings of random training sessions. Participants experienced three key components: (1) the content, in which specific exercises helped to raise awareness and (intention to) change goal management behaviour, (2) person-focused approach, specifically, the nurse as trainer and personal fit of the approach, and (3) social mechanisms, including facilitating group processes and interpersonal processes. Adherence to the protocol by the trainers was high, while differences were found in the degree to which they were able to apply the intended collaborativ...

Purpose: Goal was to establish whether an intervention that aims to increase goal management competencies is effective in decreasing elevated levels of depressive symptoms and increasing well-being in patients with polyarthritis. Materials and methods: Eighty-five persons with polyarthritis and elevated levels of depressive symptoms participated in the goal management intervention consisting of six group-based meetings. A quasiexperimental design with baseline measurement, follow-up at 6 months and a reference group of 151 patients from an observational study was applied. Primary outcome was depression; secondary outcomes were anxiety, purpose in life, positive affect, satisfaction with participation, goal management strategies, and arthritis self-efficacy. A linear mixed model procedure was applied to evaluate changes in outcomes. Results: No improvement was found for depressive symptoms and no changes were found for the secondary outcomes, except for positive affect that improved in the intervention group. This increase was mediated by an increase in goal adjustment. Furthermore, goal maintenance decreased and self-efficacy for other symptoms increased in the intervention group. Conclusion: This study indicates that interventions designed to aid patients with arthritis with goal management skills are potentially helpful for increasing positive affect, although further studies are needed. ä IMPLICATIONS FOR REHABILITATION People with polyarthritis have to manage their disease in combination with possibly conflicting roles and personal goals, resulting in an ongoing process of finding equilibrium in a constantly changing situation. Based on a person-focused view, the program Right on Target focused on coping with threatened activities and life goals due to arthritis. The program consisted of six group-based meetings led by a trained nurse and a personal trajectory wherein participants were stimulated to try out various behavioral options related to an own threatened activity in concordance with their personal goals. The program seemed effective in increasing flexible goal adjustment and self-efficacy and participants experienced more positive affect directly after the program and at 6-month follow-up.

Background: The lack of association between fatigue and objective disease activity markers in patients with rheumatoid arthritis (RA) is counterintuitive since patients and doctors consider fatigue an indicator of underlying disease activity. We hypothesized that there is hardly any association between rather stable between-subject differences in levels of fatigue and disease activity, but that within-subject changes in fatigue are associated with fluctuations in disease activity. To examine this hypothesis we used a method-latent growth curve model analyses-that is able to disentangle between-subject differences and within-subject changes. Objectives: To examine if, in contrast to between-subject differences, withinsubject changes in fatigue are associated with changes in objective markers of disease activity, i.e. erythrocyte sedimentation rate and swollen joint count. Methods: Consecutive patients with RA (n=248, mean age 53 years, 76% female, 56% rheumatoid factor positive) starting with biological treatment were monitored at treatment start and 3 and 6 months later. Fatigue was assessed with a visual analogue scale (0-10) and disease activity with the erythrocyte sedimentation rate and swollen joint count (28 joints). The intraclass correlation coefficient (ICC) was calculated to examine the extent to which fatigue reflected stable differences between patients. Latent growth curve model analyses examined the level and change of fatigue and disease activity, their association, and the prediction by patient characteristics. Results: Two-third of the variance in fatigue reflected stable individual differences (ICC =0.67); the remaining one-third reflected patients' fatigue fluctuations across time and error variance. Across six months, the mean improvements of fatigue (small effect size, d =-0.43) and disease activity (moderate effect size, d =-0.68) were significant. Latent growth curve model analyses showed that neither stable between-subject differences in fatigue and disease activity were associated nor within-subject changes of fatigue and disease activity. Female gender, younger age, rheumatoid factor negative, and previous use of biologicals predicted a higher fatigue level, but these variables were not correlated with within-subject change of fatigue. Conclusions: Current knowledge suggests that it is most fruitful to target chronic fatigue by means of rehabilitation including lifestyle adjustment, physical exercise training, and cognitive-behavioral and sleep hygiene education. This fits with our observation and previous observations that RA fatigue is a rather stable individual characteristic that does not give a reflection of steady levels of disease activity. However, contrary to expectation, transient changes in fatigue are also not associated with transient changes in disease activity, which indicates that treatment directed at disease remission is hardly a means to treat fatigue.

prescribe the appropriate drug regime for the next NLBI clinic. During NLBI clinic visit, patient's clinical conditions, including their disease activity, laboratory results and vital signs were assessed according to standardized protocol to ensure treatment safety. After the infusion therapy, rheumatology nurse will make proper discharge record to ensure continuity of care. For patients with unstable conditions or infusion reactions, rheumatologists are readily available for timely management. Results: The NLBI clinic was set up in April 2012, totally 23 patients were recruited in the clinic and currently 21 patients (91.3% of total biologic infusion case) were still under the programme. Two patients dropped out due to switching to other biologics which are administrated by subcutaneous injection. Three episodes required ad hoc referral to rheumatologist for medical problems including hyperglycaemia, hypertension and skin rash. From April 2012 to December 2013, the total NLBI clinic attendances were 90. All cases were given biologic infusion safely and successfully without any adverse effects. Patients saved 45minutes in each visit since there is no need to wait for drug prescription and collection. The alternating follow-up arrangement also reduced doctor's workload by 50%. A questionnaire survey was administered to all recruited patients with 20 questionnaires collected (response rate 95.3%). 18 out of 20 (90%) patients either agreed or strongly agreed that adequate pre-treatment assessment was provided. Majority (19/20, 95%) of the patients reported that they have saved time in each attendance and 70% of them saved more than 30 minutes and 35% of them saved more than 1 hour. All participating patients (20/20, 100%) either agreed or strongly agreed that the overall Nurse-led Biologic Infusion Service was satisfactory. All of the patients agreed or strongly agreed that they would like to continue the service from rheumatology nurse. Conclusions: Nurse-led biologic infusion is smooth and safe. It saves patient's time in terms of the total duration of the treatment session. Furthermore, it spares the time of rheumatologists spent on routine visits and enables them to concentrate on the management of more complex cases.

Purpose: Goal was to establish whether an intervention that aims to increase goal management competencies is effective in decreasing elevated levels of depressive symptoms and increasing well-being in patients with polyarthritis. Materials and methods: Eighty-five persons with polyarthritis and elevated levels of depressive symptoms participated in the goal management intervention consisting of six group-based meetings. A quasiexperimental design with baseline measurement, follow-up at 6 months and a reference group of 151 patients from an observational study was applied. Primary outcome was depression; secondary outcomes were anxiety, purpose in life, positive affect, satisfaction with participation, goal management strategies, and arthritis self-efficacy. A linear mixed model procedure was applied to evaluate changes in outcomes. Results: No improvement was found for depressive symptoms and no changes were found for the secondary outcomes, except for positive affect that improved in the intervention group. This increase was mediated by an increase in goal adjustment. Furthermore, goal maintenance decreased and self-efficacy for other symptoms increased in the intervention group. Conclusion: This study indicates that interventions designed to aid patients with arthritis with goal management skills are potentially helpful for increasing positive affect, although further studies are needed. ä IMPLICATIONS FOR REHABILITATION People with polyarthritis have to manage their disease in combination with possibly conflicting roles and personal goals, resulting in an ongoing process of finding equilibrium in a constantly changing situation. Based on a person-focused view, the program Right on Target focused on coping with threatened activities and life goals due to arthritis. The program consisted of six group-based meetings led by a trained nurse and a personal trajectory wherein participants were stimulated to try out various behavioral options related to an own threatened activity in concordance with their personal goals. The program seemed effective in increasing flexible goal adjustment and self-efficacy and participants experienced more positive affect directly after the program and at 6-month follow-up.

Background Collaborative partnerships are considered an essential strategy for integrating local disjointed health and social services. Currently, little evidence is available on how integrated care arrangements between professionals and organisations are achieved through the evolution of collaboration processes over time. The first aim was to develop a typology of integrated care projects (ICPs) based on the final degree of integration as perceived by multiple stakeholders. The second aim was to study how types of integration differ in changes of collaboration processes over time and final perceived effectiveness. Methods A longitudinal mixed-methods study design based on two data sources (surveys and interviews) was used to identify the perceived degree of integration and patterns in collaboration among 42 ICPs in primary care in The Netherlands. We used cluster analysis to identify distinct subgroups of ICPs based on the final perceived degree of integration from a professional, organisational and system perspective. With the use of ANOVAs, the subgroups were contrasted based on: 1) changes in collaboration processes over time (shared ambition, interests and mutual gains, relationship dynamics, organisational dynamics and process management) and 2) final perceived effectiveness (i.e. rated success) at the professional, organisational and system levels. Results The ICPs were classified into three subgroups with: 'United Integration Perspectives (UIP)', 'Disunited Integration Perspectives (DIP)' and 'Professional-oriented Integration Perspectives (PIP)'. ICPs within the UIP subgroup made the strongest increase in trust-based (mutual gains and relationship dynamics) as well as control-4-based (organisational dynamics and process management) collaboration processes and had the highest overall effectiveness rates. On the other hand, ICPs with the DIP subgroup decreased on collaboration processes and had the lowest overall effectiveness rates. ICPs within the PIP subgroup increased in control-based collaboration processes (organisational dynamics and process management) and had the highest effectiveness rates at the professional level. Conclusions The differences across the three subgroups in terms of the development of collaboration processes and the final perceived effectiveness provide evidence that united stakeholders' perspectives are achieved through a constructive collaboration process over time. Disunited perspectives at the professional, organisation and system levels can be aligned by both trust-based and control-based collaboration processes.

Background: Digital health solutions can provide populations with musculoskeletal pain with high-reach, low-cost, easily accessible, and scalable patient education and self-management interventions that meet the time and resource restrictions. Objective: The main objective of this study was to determine the effectiveness of digital health interventions for people with musculoskeletal pain conditions (ie, low back pain, neck pain, shoulder pain, knee pain, elbow pain, ankle pain, and whiplash). Methods: A systematic review and meta-analysis was conducted. We searched PubMed and Cochrane Central Register of Controlled Trials (from 1974 to August 2021) and selected randomized controlled trials of digital health interventions in the target population of patients with musculoskeletal pain with a minimum follow-up of 1 month. A total of 2 researchers independently screened and extracted the data. Results: A total of 56 eligible studies were included covering 9359 participants, with a mean follow-up of 25 (SD 15.48) weeks. In moderate-quality evidence, digital health interventions had a small effect on pain (standardized mean difference [SMD] 0.19, 95% CI 0.06-0.32), disability (SMD 0.14, 95% CI 0.03-0.25), quality of life (SMD 0.22, 95% CI 0.07-0.36), emotional functioning (SMD 0.24, 95% CI 0.12-0.35), and self-management (SMD 0.14, 95% CI 0.05-0.24). Conclusions: Moderate-quality evidence supports the conclusion that digital health interventions are effective in reducing pain and improving functioning and self-management of musculoskeletal pain conditions. Low-quality evidence indicates that digital health interventions can improve the quality of life and global treatment. Little research has been conducted on the influence of digital health on expenses, knowledge, overall improvement, range of motion, muscle strength, and implementation fidelity.

In 90 % of the responses, goal management strategies were identified (31 % goal maintenance, 29 % goal adjustment, 21 % goal disengagement, and 10 % goal re-engagement). Strategy preference was related to domains. Solutions containing goal disengagement were the least preferred. Using vignettes for measuring domainspecific goal management appears as valuable addition to the existing questionnaires. The vignettes can be used to study how patients with arthritis cope with threatened goals in specific domains from a patient's perspective. Domainspecific strategy preference emphasizes the importance of a situation-specific instrument.

Background: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic systemic illnesses that demand lifelong treatment. Adhesion to therapy is fundamental to achieve adequate disease control. Objectives: We aimed to assess adherence to chronic therapy in RA and PsA patients and to identify reasons of non-adherence. Methods: An anonymous written self-reported questionnaire was applied to consecutive RA and PsA patients followed-up in our Day Care Rheumatology Unit. Demographic and clinical characteristics were evaluated as well as chronic medication prescribed. Medication adherence was assessed using a qualitative 4-point scale. Patients were deemed adherent when stated that drug was always taken as prescribed. Reasons for non-adherence were collected. Presence and intensity of side effects was also investigated. Patients were asked to indicate one drug that they would like to stop and to specify the reasons for their choice. Variables independently associated with non-adherence where assessed by logistic regression analyses. Results: One hundred and five participants were included: 83 females, 85 RA patients, with a mean age of 55±13 years and mean disease duration of 13±8 years. Drugs with lowest self-reported adherence were calcium supplements (58.3%, n=60) followed by hydroxychloroquine (62.5%, n=16) and the drugs with highest level of adherence were subcutaneous biologics (90.9% of patients, n=44) and leflunomide (85.7%, n=7). Forgetfulness was most often the perceived reason for non-adherence (67.8% of patients, n=59), followed by fear/presence of side effects (11.9% each). The drugs most frequently appointed for discontinuation were methotrexate (50% of patients, n=64) and glucocorticoids (23.4%), mainly due to fear of (69.4%, n=62) or presence of adverse events (27.4%). Methotrexate side effects most often indicated were nausea (25.3% of patients, n=87) and hair loss (18.4%). Younger age was associated with non-adherence to methotrexate and calcium supplement use (table 1).

Background: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic systemic illnesses that demand lifelong treatment. Adhesion to therapy is fundamental to achieve adequate disease control. Objectives: We aimed to assess adherence to chronic therapy in RA and PsA patients and to identify reasons of non-adherence. Methods: An anonymous written self-reported questionnaire was applied to consecutive RA and PsA patients followed-up in our Day Care Rheumatology Unit. Demographic and clinical characteristics were evaluated as well as chronic medication prescribed. Medication adherence was assessed using a qualitative 4-point scale. Patients were deemed adherent when stated that drug was always taken as prescribed. Reasons for non-adherence were collected. Presence and intensity of side effects was also investigated. Patients were asked to indicate one drug that they would like to stop and to specify the reasons for their choice. Variables independently associated with non-adherence where assessed by logistic regression analyses. Results: One hundred and five participants were included: 83 females, 85 RA patients, with a mean age of 55±13 years and mean disease duration of 13±8 years. Drugs with lowest self-reported adherence were calcium supplements (58.3%, n=60) followed by hydroxychloroquine (62.5%, n=16) and the drugs with highest level of adherence were subcutaneous biologics (90.9% of patients, n=44) and leflunomide (85.7%, n=7). Forgetfulness was most often the perceived reason for non-adherence (67.8% of patients, n=59), followed by fear/presence of side effects (11.9% each). The drugs most frequently appointed for discontinuation were methotrexate (50% of patients, n=64) and glucocorticoids (23.4%), mainly due to fear of (69.4%, n=62) or presence of adverse events (27.4%). Methotrexate side effects most often indicated were nausea (25.3% of patients, n=87) and hair loss (18.4%). Younger age was associated with non-adherence to methotrexate and calcium supplement use (table 1).

Purpose: Goal was to establish whether an intervention that aims to increase goal management competencies is effective in decreasing elevated levels of depressive symptoms and increasing well-being in patients with polyarthritis. Materials and methods: Eighty-five persons with polyarthritis and elevated levels of depressive symptoms participated in the goal management intervention consisting of six group-based meetings. A quasiexperimental design with baseline measurement, follow-up at 6 months and a reference group of 151 patients from an observational study was applied. Primary outcome was depression; secondary outcomes were anxiety, purpose in life, positive affect, satisfaction with participation, goal management strategies, and arthritis self-efficacy. A linear mixed model procedure was applied to evaluate changes in outcomes. Results: No improvement was found for depressive symptoms and no changes were found for the secondary outcomes, except for positive affect that improved in the intervention group. This increase was mediated by an increase in goal adjustment. Furthermore, goal maintenance decreased and self-efficacy for other symptoms increased in the intervention group. Conclusion: This study indicates that interventions designed to aid patients with arthritis with goal management skills are potentially helpful for increasing positive affect, although further studies are needed. ä IMPLICATIONS FOR REHABILITATION People with polyarthritis have to manage their disease in combination with possibly conflicting roles and personal goals, resulting in an ongoing process of finding equilibrium in a constantly changing situation. Based on a person-focused view, the program Right on Target focused on coping with threatened activities and life goals due to arthritis. The program consisted of six group-based meetings led by a trained nurse and a personal trajectory wherein participants were stimulated to try out various behavioral options related to an own threatened activity in concordance with their personal goals. The program seemed effective in increasing flexible goal adjustment and self-efficacy and participants experienced more positive affect directly after the program and at 6-month follow-up.

Background: A health promotion intervention was developed for inflammatory arthritis patients, based on goal management. Elevated levels of depression and anxiety symptoms, which indicate maladjustment, are found in such patients. Other indicators of adaptation to chronic disease are positive affect, purpose in life and social participation. The new intervention focuses on to improving adaptation by increasing psychological and social well-being and decreasing symptoms of affective disorders. Content includes how patients can cope with activities and life goals that are threatened or have become impossible to attain due to arthritis. The four goal management strategies used are: goal maintenance, goal adjustment, goal disengagement and reengagement. Ability to use various goal management strategies, coping versatility and self-efficacy are hypothesized to mediate the intervention's effect on primary and secondary outcomes. The primary outcome is depressive symptoms. Secondary outcomes are anxiety symptoms, positive affect, purpose in life, social participation, pain, fatigue and physical functioning. A cost-effectiveness analysis and stakeholders' analysis are planned. Methods/design: The protocol-based psycho-educational program consists of six group-based meetings and homework assignments, led by a trained nurse. Participants are introduced to goal management strategies and learn to use these strategies to cope with threatened personal goals. Four general hospitals participate in a randomized controlled trial with one intervention group and a waiting list control condition. Discussion: The purpose of this study is to evaluate the effectiveness of a goal management intervention. The study has a holistic focus as both the absence of psychological distress and presence of well-being are assessed. In the intervention, applicable goal management competencies are learned that assist people in their choice of behaviors to sustain and enhance their quality of life.

Methods: Data were used from baseline, 6 and 18 months of follow-up during a prospective cohort study of 120 CWP patients who completed multidisciplinary rehabilitation treatment. Cross-sectional and longitudinal relationships were analyzed between fatigue, clinical (i.e. pain, interference of pain and depression) and pain related cognitive factors (i.e. negative emotional cognitions, active cognitive coping, and control and chronicity beliefs). Results: Higher levels of pain, interference of pain, depression, negative emotional cognitions, and negative control and chronicity beliefs were associated with a higher level of fatigue. Improvement in depression was related to improvement in fatigue. Conclusions: In CWP patients, worse clinical status, and dysfunctional pain related cognitions are associated with a higher level of fatigue. Our results suggest that improvement in depression might be a mechanism of improvement in fatigue. Furthermore, improvement in fatigue seems to be independent of improvement in pain related cognitions. Targeting fatigue in multidisciplinary pain treatment may need specific strategies.

Background: A health promotion intervention was developed for inflammatory arthritis patients, based on goal management. Elevated levels of depression and anxiety symptoms, which indicate maladjustment, are found in such patients. Other indicators of adaptation to chronic disease are positive affect, purpose in life and social participation. The new intervention focuses on to improving adaptation by increasing psychological and social well-being and decreasing symptoms of affective disorders. Content includes how patients can cope with activities and life goals that are threatened or have become impossible to attain due to arthritis. The four goal management strategies used are: goal maintenance, goal adjustment, goal disengagement and reengagement. Ability to use various goal management strategies, coping versatility and self-efficacy are hypothesized to mediate the intervention's effect on primary and secondary outcomes. The primary outcome is depressive symptoms. Secondary outcomes are anxiety symptoms, positive affect, purpose in life, social participation, pain, fatigue and physical functioning. A cost-effectiveness analysis and stakeholders' analysis are planned. Methods/design: The protocol-based psycho-educational program consists of six group-based meetings and homework assignments, led by a trained nurse. Participants are introduced to goal management strategies and learn to use these strategies to cope with threatened personal goals. Four general hospitals participate in a randomized controlled trial with one intervention group and a waiting list control condition. Discussion: The purpose of this study is to evaluate the effectiveness of a goal management intervention. The study has a holistic focus as both the absence of psychological distress and presence of well-being are assessed. In the intervention, applicable goal management competencies are learned that assist people in their choice of behaviors to sustain and enhance their quality of life.

prescribe the appropriate drug regime for the next NLBI clinic. During NLBI clinic visit, patient's clinical conditions, including their disease activity, laboratory results and vital signs were assessed according to standardized protocol to ensure treatment safety. After the infusion therapy, rheumatology nurse will make proper discharge record to ensure continuity of care. For patients with unstable conditions or infusion reactions, rheumatologists are readily available for timely management. Results: The NLBI clinic was set up in April 2012, totally 23 patients were recruited in the clinic and currently 21 patients (91.3% of total biologic infusion case) were still under the programme. Two patients dropped out due to switching to other biologics which are administrated by subcutaneous injection. Three episodes required ad hoc referral to rheumatologist for medical problems including hyperglycaemia, hypertension and skin rash. From April 2012 to December 2013, the total NLBI clinic attendances were 90. All cases were given biologic infusion safely and successfully without any adverse effects. Patients saved 45minutes in each visit since there is no need to wait for drug prescription and collection. The alternating follow-up arrangement also reduced doctor's workload by 50%. A questionnaire survey was administered to all recruited patients with 20 questionnaires collected (response rate 95.3%). 18 out of 20 (90%) patients either agreed or strongly agreed that adequate pre-treatment assessment was provided. Majority (19/20, 95%) of the patients reported that they have saved time in each attendance and 70% of them saved more than 30 minutes and 35% of them saved more than 1 hour. All participating patients (20/20, 100%) either agreed or strongly agreed that the overall Nurse-led Biologic Infusion Service was satisfactory. All of the patients agreed or strongly agreed that they would like to continue the service from rheumatology nurse. Conclusions: Nurse-led biologic infusion is smooth and safe. It saves patient's time in terms of the total duration of the treatment session. Furthermore, it spares the time of rheumatologists spent on routine visits and enables them to concentrate on the management of more complex cases.

Gezondheid van mensen wordt beinvloed door een veelheid van factoren. Gezondheids—bevorderende factoren kunnen uiteenlopen van materiéle welvaait tot een goedo hygiéne, maar ook eon good huwelijk. Bcdreigendo factoren varit-iron van bijvoorbeeld virussen tot onveiligo arbcidsomstandighedon. Hot menselijk gcdrag speclt in dit geheel can belang» rijke rol. Gezondhoid, ziekte en welzijn hebben gevolgen voor hot gedrag van mensen. Andersom doet ook menselijk gedrag zijn invloed gelden op gezondheid, direct en ...