The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomised controlled trial.

Background: The additional benefit of lifestyle interventions in patients receiving cardioprotective drug treatment to improve cardiovascular risk profile is not fully established.The objective was to evaluate the effectiveness of a target-driven multidisciplinary structured lifestyle intervention programme of 6 months duration aimed at maximum reduction of cardiovascular risk factors in patients with cardiovascular disease (CVD) compared with usual care.

Methods: A single centre, two arm, parallel group randomised controlled trial was performed.

Revision of the Dutch clinical algorithm for assessing patient needs in cardiac rehabilitation based on identified implementation problems.

Background: Despite all available evidence of its effectiveness, cardiac rehabilitation and secondary prevention (CRSP) is still insufficiently implemented in current clinical practice. Based on an analysis of implementation problems, recently the Dutch clinical algorithm for the assessment of patient's CRSP needs was revised. The purpose of this paper is to describe the revision process and its results to improve CRSP guideline implementation.

Design of a continuous multifaceted guideline-implementation strategy based on computerized decision support.

Implementation of clinical practice guidelines into daily care is hindered by a variety of barriers related to professional knowledge, collaboration in teams and organizations, and practicability of the guidelines. Clinical computerized decision support (CCDS) has been shown to be one of the most effective instruments to improve compliance to practice guidelines by tackling barriers related to professional knowledge. To address other barriers, however, additional interventions are needed.

The effect of computerized decision support on barriers to guideline implementation: a qualitative study in outpatient cardiac rehabilitation.

Context: Computerized decision support systems (CDSSs) can be used to improve the implementation of clinical practice guidelines by changing the behaviour of care professionals. While the influence of system characteristics on the effectiveness of CDSSs is studied, little is known about the relation between cognitive, organizational and environmental factors, and CDSSs' effectiveness.

Objective: To assess the effect of CDSSs on cognitive, organizational, and environmental factors that hamper guideline implementation.

Effect of guideline based computerised decision support on decision making of multidisciplinary teams: cluster randomised trial in cardiac rehabilitation.

Objective: To determine the extent to which computerised decision support can improve concordance of multidisciplinary teams with therapeutic decisions recommended by guidelines.

Design: Multicentre cluster randomised trial.

Participants: Multidisciplinary cardiac rehabilitation teams in Dutch centres and their cardiac rehabilitation patients.

Is the MacNew quality of life questionnaire a useful diagnostic and evaluation instrument for cardiac rehabilitation?

Purpose: The MacNew health-related quality of life questionnaire is internationally used as a standard for psychosocial assessment in many cardiac rehabilitation centres. This study investigates its discriminating capacity between diagnostic disease categories, sex and age at entry (T1) and at the end (T2) of cardiac rehabilitation as well as the responsiveness of the MacNew during this period.

Method: Data were used from 6,749 cardiac rehabilitation patients at T1 and 1,654 at T2.

Motives for (not) participating in a lifestyle intervention trial.

Background: Non-participants can have a considerable influence on the external validity of a study. Therefore, we assessed the socio-demographic, health-related, and lifestyle behavioral differences between participants and non-participants in a comprehensive CVD lifestyle intervention trial, and explored the motives and barriers underlying the decision to participate or not.

Methods: We collected data on participants (n = 50) and non-participants (n = 50) who were eligible for inclusion in a comprehensive CVD lifestyle interventional trial.