Aim To provide insight into the basic characteristics of decision making in the treatment of symptomatic severe aortic stenosis (SSAS) in Dutch heart centres with specific emphasis on the evaluation of frailty, cognition, nutritional status and physical functioning/functionality in (instrumental) activities of daily living [(I)ADL]. Methods A questionnaire was used that is based on the European and American guidelines for SSAS treatment. The survey was administered to physicians and non-physicians in Dutch heart centres involved in the decision-making pathway for SSAS treatment. Results All 16 Dutch heart centres participated. Before a patient case is discussed by the heart team, heart centres rarely request data from the referring hospital regarding patients’ functionality (n = 5), frailty scores (n = 0) and geriatric consultation (n = 1) as a standard procedure. Most heart centres ‘often to always’ do their own screening for frailty (n = 10), cognition/mood (n = 9), nutritional status (n = 10) and physical functioning/functionality in (I)ADL (n = 10). During heart team meetings data are ‘sometimes to regularly’ available regarding frailty (n = 5), cognition/mood (n = 11), nutritional status (n = 8) and physical functioning/functionality in (I)ADL (n = 10). After assessment in the outpatient clinic patient cases are re-discussed ‘sometimes to regularly’ in heart team meetings (n = 10). Conclusions Dutch heart centres make an effort to evaluate frailty, cognition, nutritional status and physical functioning/functionality in (I)ADL for decision making regarding SSAS treatment. However, these patient data are not routinely requested from the referring hospital and are not always available for heart team meetings. Incorporation of these important data in a structured manner early in the decision-making process may provide additional useful information for decision making in the heart team meeting.
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Detecting practical problems of persons with dementia (PwD) experience at home, and advising them on solutions to facilitate aging in place are complex and challenging tasks for nurses and case managers. In this two group randomized, controlled laboratory experiment, the efficacy of a decision support application aiming to increase nurses' and case managers' confidence in clinical judgment and decision-making was tested. The participants (N = 67) assessed a case of a PwD within the problem domains: self-reliance, safety and informal care, and provided suggestions for possible solutions. Participants used either their regular procedure with (intervention group) or without the App (control group) to conduct these tasks. No statistically significant difference was found on the primary outcome measure, the overall level of confidence. However, nurses and case managers highly recommended use of the App in practice. To explain these results, more research on the potential added value of the App is needed.
Aims and objectives To gain insight into the perceived added value of a decision support App for district nurses and case managers intended to support a problem assessment and the provision of advices on possible solutions to facilitate ageing in place of people with dementia, and to investigate how they would implement the App in daily practice. Background District nurses and case managers play an important role in facilitating ageing in place of people with dementia (PwD). Detecting practical problems preventing PwD from living at home and advising on possible solutions is complex and challenging tasks for nurses and case managers. To support them with these tasks, a decision support App was developed. Methods A qualitative study using semi‐structured interviews was conducted. A photo‐elicitation method and an interview guide were used to structure the interviews. The data were analysed according to the principles of content analysis. Results In five interviews with seven district nurses and case managers, the added value was described in terms of five themes: (a) providing a broader/better overview of possible solutions; (b) providing a guideline/checklist for problem assessment and advice on solutions; (c) supporting an in‐depth problem assessment; (d) being a support tool for unexperienced case managers/district nurses; and (e) providing up‐to‐date information. The participants regarded the App as complementary to their current work procedure, which they would use in a flexible manner at different stages in the care continuum. Conclusions The participants valued both parts, the problem assessment and the overview of possible solutions. An important requisite for the usage would be that the content is continuously updated. Before implementation of the App can be recommended, an evaluation of its effectiveness regarding decision‐making should be conducted. Relevance to clinical practice This study underpins the need of nurses and case managers for decision support with regard to problem assessment and providing advices on possible solutions to facilitate ageing in place of PwD. There results also show the importance of listening to users experience and their perceived added value of decision support tools as this helps to explain the lack of statistically significant effects on quantitative outcome measure in contrast to a high willingness to use the App in a previous study.
Urban open space has a huge impact on human health, well-being and urban ecosystems. One of the open spaces where the environmental and ecological challenges of cities manifest the most is the urban riverfront, often characterised by fragmented land use, lack of accessibility, heavy riverside vehicular traffic, and extreme degradation of river hydrology and ecology. More often than not, the current spatial design of the riverfront hinders rather than supports the delivery of ecosystem services and, in consequence, its potential to improve the health and well-being of urban inhabitants is diminished. Hence, the design of riverside open spaces is crucial. Urban and landscape design in those spaces requires instruments that can aid designers, planners, decision-makers and stakeholders in devising spatial interventions that integrate complex environmental and ecological goals in high quality public space design. By recognising the multiple environmental and ecological benefits of green space and water in the city, the project “I surf” applies a set of four design instruments, namely the Connector, the Sponge, the Integrator, and the Scaler. I surf is a three-phased project that tests, validates and updates these instruments through a design-driven research methodology involving two design workshops and expert meetings addressing three different riverside urban spaces in Amsterdam: in the Ij waterfront, along River Amstel, and on a site located on the canal network. The project concludes with an updated and transferrable instrument set available for urban and landscape design applications in Amsterdam and in other Dutch cities crossed by rivers.
