The aim of this study was to assess the association between prescription changes frequency (PCF) and hospital admissions and to compare the PCF to the Chronic Disease Score (CDS). The CDS measures comorbidity on the basis of the 1-year pharmacy dispensing data. In contrast, the PCF is based on prescriptionchanges over a 3-month period. A retrospective matched case–control design was conducted. 10.000 patients were selected randomly from the Dutch PHARMO database, who had been hospitalized (index date) between July 1, 1998 and June 30, 2000. The primary study outcome was the number of prescription changes during several three-month time periods starting 18, 12, 9, 6, and 3 months before the index date. For each hospitalized patient, one nonhospitalized patient was matched for age, sex, and geographic area, and was assigned the same index date as the corresponding hospitalized patient.We classified four mutually exclusive types of prescription changes: change in dosage, switch, stop and start.
Hop tests are frequently used to determine return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). Given that bilateral deficits are present after ACLR, this may result in a falsely high limb symmetry index (LSI), since LSI is calculated as a ratio between the values of the limbs.HypothesisAthletes after ACLR would achieve LSI > 90% for the hop test. Secondly, athletes after ACLR demonstrate decreased jump distance on the single hop for distance (SLH) and triple leg hop for distance (TLH) and decreased number of hops for the side hop (SH) for both involved and uninvolved limbs compared to normative data of sex, age and type of sports matched healthy athletes.Materials and MethodsFifty-two patients (38 males mean age 23.9 ±3.5 yrs; 14 females mean age 21.7±3.5 years) who had undergone an ACLR participated in this study. Patients performed the 3 hop tests at a mean time of 7.0 months after ACLR. Hop distance, number of side hops and LSI were compared with normative data of 188 healthy athletes.ResultsThe differences between the involved limb and the uninvolved limb were significant in all hop tests (SLH p=0.003, TLH p=0.003 , SH p=0.018). For females, only significant between limb differences were found in the SLH (p=0.049). For both the SLH and the TLH, significant differences were found between the involved limb and the normative data (males; SLH p<0.001, TLH p<0.001; females; SLH p<0.001, TLH p=0.006) and between the uninvolved limb and the normative data for both males and females (males; SLH p<0.001, TLH p<0.001; females; SLH p=0.003, TLH p=0.038). For the SH, only significant differences were found between the involved limb and the normative values in males (p=0.033).ConclusionAthletes who have undergone an ACLR demonstrate bilateral deficits on hop tests in comparison to age and sex matched normative data of healthy controls. Using the LSI may underestimate performance deficits and should therefore be analyzed with caution when used as a criterion for RTS after ACLR.
Summary Project objectives This study fits into a larger research project on logistics collaboration and outsourcing decisions. The final objective of this larger project is to analyze the logistics collaboration decision in more detail to identify thresholds in these decisions. To reach the overall objectives, the first step is to get a clearer picture on the chemical and logistics service providers industry, sectors of our study, and on logistics collaboration in these sectors. The results of this first phase are presented in this report. Project Approach The study consists of two parts: literature review and five case studies within the chemical industry. The literature covers three topics: logistics collaboration, logistics outsourcing and purchasing of logistics services. The five case studies are used to refine the theoretical findings of the literature review. Conclusions Main observations during the case studies can be summarized as follows: Most analyzed collaborative relationships between shippers and logistics service providers in the chemical industry are still focused on operational execution of logistics activities with a short term horizon. Supply management design and control are often retained by the shippers. Despite the time and cost intensive character of a logistics service buying process, shippers tendering on a very regular basis. The decision to start a new tender project should more often be based on an integral approach that includes all tender related costs. A lower frequency of tendering could create more stability in supply chains. Beside, it will give both, shippers and LSPs, the possibility to improve the quality of the remaining projects. Price is still a dominating decision criterion in selecting a LSP. This is not an issue as long as the comparison of costs is based on an integral approach, and when shippers balance the cost criterion within their total set of criteria for sourcing logistics services. At the shippers' side there is an increased awareness of the need of more solid collaboration with logistics service providers. Nevertheless, in many cases this increased awareness does not actually result in the required actions to establish more intensive collaboration. Over the last years the logistics service providers industry was characterized by low profit margins, strong fragmentation and price competition. Nowadays, the market for LSPs is changing, because of an increasing demand for logistics services. To benefit from this situation a more pro-active role of the service providers is required in building stronger relationships with their customers. They should pay more attention on mid and long term possibilities in a collaborative relation, in stead of only be focused on running the daily operation.
