BACKGROUND: Acute kidney injury (AKI) often occurs in critically ill patients. AKI is associated with mortality and morbidity. Interventions focusing on the reduction of AKI are suggested by the Kidney Disease: Improving Global Outcomes guideline. We hypothesized that these educational interventions would improve outcome in patients admitted to the Intensive Care Unit (ICU).METHODS: This was a pragmatic single-centre prospective observational before-after study design in an ICU in a tertiary referral hospital. All consecutive patients admitted to the ICU irrespective their illness were included. A 'Save the Kidney' (STK) bundle was encouraged via an educational intervention targeting health care providers. The educational STK bundle consisted of optimizing the fluid balance (based on urine output, serum lactate levels and/or central venous oxygen saturation), discontinuation of diuretics, maintaining a mean arterial pressure of at least 65 mmHg with the potential use of vasopressors and critical evaluation of the indication and dose of nephrotoxic drugs. The primary outcome was the composite of mortality, renal replacement therapy (RRT), and progression of AKI. Secondary outcomes were the components of the composite outcome the severity of AKI, ICU length of stay and in-hospital mortality.MAIN RESULTS: The primary outcome occurred in 451 patients (33%) in the STK group versus 375 patients (29%) in the usual care group, relative risk (RR) 1.16, 95% confidence interval (CI) 1.03-1.3, p < 0.001. Secondary outcomes were, ICU mortality in 6.8% versus 5.6%, (RR 1.22, 95% CI 0.90-1.64, p = 0.068), RRT in 1.6% versus 3.6% (RR 0.46, 95% CI 0.28-0.76, p = 0.002), and AKI progression in 28% versus 24% (RR 1.18, 95% CI 1.04-1.35, p = 0.001).CONCLUSIONS: Providing education to uniformly apply an AKI care bundle, without measurement of the implementation in a non-selected ICU population, targeted at prevention of AKI progression was not beneficial.
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BACKGROUND: There is uncertainty about how much positive end-expiratory pressure (PEEP) should be used in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19).OBJECTIVE: To investigate whether a higher PEEP strategy is superior to a lower PEEP strategy regarding the number of ventilator-free days (VFDs).DESIGN: Multicentre observational study conducted from 1 March to 1 June 2020.SETTING AND PATIENTS: Twenty-two ICUs in The Netherlands and 933 invasively ventilated COVID-19 ARDS patients.INTERVENTIONS: Patients were categorised retrospectively as having received invasive ventilation with higher (n=259) or lower PEEP (n=674), based on the high and low PEEP/FIO2 tables of the ARDS Network, and using ventilator settings and parameters in the first hour of invasive ventilation, and every 8 h thereafter at fixed time points during the first four calendar days. We also used propensity score matching to control for observed confounding factors that might influence outcomes.MAIN OUTCOMES AND MEASURES: The primary outcome was the number of VFDs. Secondary outcomes included distant organ failures including acute kidney injury (AKI) and use of renal replacement therapy (RRT), and mortality.RESULTS: In the unmatched cohort, the higher PEEP strategy had no association with the median [IQR] number of VFDs (2.0 [0.0 to 15.0] vs. 0.0 [0.0 to 16.0] days). The median (95% confidence interval) difference was 0.21 (-3.34 to 3.78) days, P = 0.905. In the matched cohort, the higher PEEP group had an association with a lower median number of VFDs (0.0 [0.0 to 14.0] vs. 6.0 [0.0 to 17.0] days) a median difference of -4.65 (-8.92 to -0.39) days, P = 0.032. The higher PEEP strategy had associations with higher incidence of AKI (in the matched cohort) and more use of RRT (in the unmatched and matched cohorts). The higher PEEP strategy had no association with mortality.CONCLUSION: In COVID-19 ARDS, use of higher PEEP may be associated with a lower number of VFDs, and may increase the incidence of AKI and need for RRT.TRIAL REGISTRATION: Practice of VENTilation in COVID-19 is registered at ClinicalTrials.gov, NCT04346342.
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Conference organized by the Faculty of Social Sciences of Eötvös Loránd University, Hilscher Rezső Social Policy Association, Gyere Association and CARe Europe 3 Foreword 5 Section 1. Transition from institutional to recovery-oriented community care: challenges throughout Europe 5 Zsolt Bugarszki: Introduction 7 Jan Pfeiff er: Developments in Central and Eastern Europe with regard to transition from Institutional to Community Care 13 Robert van Voren: Reform of the mental health system in Eastern Europe and in the former Soviet Republics 17 Jean-Pierre Wilken: Developments in Western Europe with regard to transition from traditional to recovery oriented care 21 Dirk den Hollander: Recognition of power and the power of recognition
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"Despite many efforts, people with a refugee background still have great difficulties to find a job on the Dutch labour market. This has adverse consequences for the economic independence of people with a refugee background, their social connections, personal development, health and general well-being, but also for employers as well as society in general. There are many sectors in the Dutch labour market with large, structural labor shortages, while at the same time much talent remains untapped. Meanwhile, more and more social enterprises in the Netherlands are stepping into this void, with the explicit goal to facilitate access to the labour market for people with a vulnerable position, including people with a refugee background. Consequently, these so-called work integration social enterprises (WISEs) are — by far — the dominant type of social enterprises in the Netherlands. Although the diversity between WISEs in terms of economic sectors, specific target groups and business models is large, the way in which they organize their key activities can serve as an example for regular employers, who still tend to think in problems rather than opportunities when it comes to employing people with a refugee background. At the same time, the impact of these social enterprises still remains relatively limited in comparison to the scale of the societal challenge. The aim of this study therefore is twofold: 1) to obtain a better understanding of the role of WISEs with regard to the sustainable labor participation of refugees, and 2) to assess the ways in which WISEs can scale their societal impact with respect to labour participation of refugees. These conference proceedings focus in particular on (new) forms of collaboration between WISEs and regular employers that aim to become more inclusive employers."
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In May 2007, our Centre for Research in Intellectual Capital hosted the International Congress on Intellectual Capital: The future of business navigation. The Congress – which took place in Haarlem, The Netherlands – was attended by more than 140 participants from 23 countries. Based on almost 70 papers, we designed a conference program that consisted of more than 90 sessions. This special issue is based on a selection of the best papers of our conference.
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With an increasingly ageing population there will be a rising demand for palliative care, including from older migrants and ethnic minorities. While many (future) physicians are unfamiliar with specific needs of older migrants and ethnic minorities regarding care and communication in palliative care, this may be challenging for them to deal with. Moreover, even many medical teachers also feel unprepared to teach palliative care and culturally sensitive communication to students. In order to support medical teachers, we suggest twelve tips to teach culturally sensitive palliative care to guide the development and implementation of teaching this topic to medical students. Drawn from literature and our own experiences as teachers, these twelve tips provide practical guidance to both teachers and curriculum designers when designing and implementing education about culturally sensitive palliative care.
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There has been limited adoption of Immersive Journalism (IJ) by the audience; simultaneously, the audience’s perspective is rarely considered in the production and research of IJ. At this point, however, it is crucial to incorporate an audience perspective to identify potentially unintended effects of IJ and improve on the innovation of IJ. This study investigates the audience’s experience and evaluation of IJ by qualitatively analyzing their thoughts after viewing two IJ cases. Our results indicate that the audience may pick up on intended effects, such as a sense of presence and an intense emotional experience, but some also express unease towards these effects. Furthermore, the audience struggles to comprehend this study’s two immersive journalistic cases as part of the journalistic genre. These findings provide insight into the gap between the initial hype and the current reality of IJ and provide the basis for propositions for future IJ productions.
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Deze publicatie beschrijft het actieonderzoek van het Project ‘De Haagse Verbindt Jong en Oud in de Wijk’, dat binnen de Werkplaats Sociaal Domein heeft plaatsgevonden in het studiejaar 2023-2024. Opdrachtgevers en samenwerkingspartners zijn Wijkz, de Gemeente Den Haag en het lectoraat Urban Ageing van De Haagse Hogeschool. Het project genaamd ‘De Haagse Verbindt Jong en Oud in de wijk’ (DHVJO) onderzoekt de ervaringen en behoeften van ouderen en hun mantelzorgers bij de Haags Ontmoeten locaties van Wijkz en de WoonZorgcentra Haaglanden. Deze organisaties verzorgen ontmoetingsactiviteiten voor zelfstandig wonende senioren onder de noemer Haags Ontmoeten. Bij de locaties van Haags Ontmoeten kunnen ouderen in de wijk terecht zonder een Wet maatschappelijke ondersteuning indicatie (Rijksoverheid, 2015). Het eerste deel van het project vond plaats in 2022-2023 (Kroon, 2023). Uit dit project blijkt dat Haags Ontmoeten een waardevolle wijze van elkaar treffen is tussen ouderen en jongeren. Ook komen de ouderen graag in de Haags Ontmoeten locaties en voelen zij zich erbij betrokken. Voor de eerstejaars studenten Social Work is het project een goede leerervaring in het ouderenwerk en voor de locaties van Haags Ontmoeten een bijdrage aan hun activiteitenaanbod voor de ouderen in de wijk. Het vervolg in studiejaar 2023-2024 gaf de mogelijkheid nog meer ouderen te spreken, portretteren en activiteiten voor hen te bedenken en te organiseren. Bij alle interviews is gekozen meer de focus te leggen op de levensgebieden zoals die door het Kennisplatform zijn benoemd. In samenwerking met de programmacoördinatoren van Haags Ontmoeten zijn er zo’n 25 Haags Ontmoeten locaties benaderd en beschikbaar gesteld en er is met zo’n 186 ouderen gesproken. De activiteiten zijn in subgroepjes uitgevoerd op één middag per locatie. De projectleider heeft de 20 betrokken professionals van de Haags Ontmoeten organisaties benaderd (in studiejaar 2023-2024) en zo mogelijk geïnterviewd om ook hun visie, kennis en ervaringen bij het antwoord op de onderzoeksvragen te betrekken.
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Rapport heeft de volgende onderdelen: Gemeenten: extra middelen Gemeenten: gerealiseerde effecten UWV: inzet extra middelen Motie Ortega- Martijn c.s. Amendement Spekman c.s.
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Een van de instrumenten voor de bepaling van de kwaliteit en van de aanwezigheid van opgetreden schade vormt het niet-destructief onderzoek (NDO), waarvan vele uitvoeringsvormen zijn ontwikkeld en waaraan binnen de kaders van de wetgeving en de in gebruik zijnde Codes zowel aan de apparatuur als aan de bediening eisen worden gesteld. Zo moeten ook de uitvoerders van NDO in de praktijk gecertificeerd zijn.
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