Background: There is an increase in the number of frail elderly patients presenting to the emergency department. Diagnosis and treatment for this patient group is challenging due to multimorbidity, a-typical presentation and polypharmacy and requires specialised knowledge and competencies from healthcare professionals. We aim to explore the needs and preferences regarding emergency care in frail older patients based on their experiences with received care during Emergency Department admission. Method: A qualitative study design was used, and semi-structured interviews were conducted after discharge with twelve frail older patients admitted to emergency departments in the Netherlands. Data collection and analysis were performed iteratively, and data were thematically analysed. Results: The analysis enfolded the following themes; feeling disrupted, expecting to be cared for, suppressing their needs and wanting to be seen. These themes indicated a need for situational awareness by healthcare professionals when taking care of the participants and were influenced by the participants' life experiences. Conclusion: Frail older patients feel disrupted when admitted to the emergency department. Because of this, they expect to be cared for, lessen their own needs and want to be seen as human beings. The impact of the admission is influenced by the extent to which healthcare professionals show situational awareness.
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Introduction: Retrospective studies suggest that a rapid initiation of treatment results in a better prognosis for patients in the emergency department. There could be a difference between the actual medication administration time and the documented time in the electronic health record. In this study, the difference between the observed medication administration time and documentation time was investigated. Patient and nurse characteristics were also tested for associations with observed time differences. Methods: In this prospective study, emergency nurses were followed by observers for a total of 3 months. Patient inclusion was divided over 2 time periods. The difference in the observed medication administration time and the corresponding electronic health record documentation time was measured. The association between patient/nurse characteristics and the difference in medication administration and documentation time was tested with a Spearman correlation or biserial correlation test. Results: In 34 observed patients, the median difference in administration and documentation time was 6.0 minutes (interquartile range 2.0-16.0). In 9 (26.5%) patients, the actual time of medication administration differed more than 15 minutes with the electronic health record documentation time. High temperature, lower saturation, oxygen-dependency, and high Modified Early Warning Score were all correlated with an increasing difference between administration and documentation times. Discussion: A difference between administration and documentation times of medication in the emergency department may be common, especially for more acute patients. This could bias, in part, previously reported time-to-treatment measurements from retrospective research designs, which should be kept in mind when outcomes of retrospective time-to-treatment studies are evaluated.
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Introduction: Worldwide, there is an increase in the extent and severity of mental illness. Exacerbation of somatic complaints in this group of people can result in recurring ambulance and emergency department care. The care of patients with a mental dysregulation (ie, experiencing a mental health problem and disproportionate feelings like fear, anger, sadness or confusion, possibly with associated behaviours) can be complex and challenging in the emergency care context, possibly evoking a wide variety of feelings, ranging from worry or pity to annoyance and frustration in emergency care staff members. This in return may lead to stigma towards patients with a mental dysregulation seeking emergency care. Interventions have been developed impacting attitude and behaviour and minimising stigma held by healthcare professionals. However, these interventions are not explicitly aimed at the emergency care context nor do these represent perspectives of healthcare professionals working within this context. Therefore, the aim of the proposed review is to gain insight into interventions targeting healthcare professionals, which minimise stigma including beliefs, attitudes and behaviour towards patients with a mental dysregulation within the emergency care context. Methods and analysis: The protocol for a systematic integrative review is presented, using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A systematic search was performed on 13 July 2023. Study selection and data extraction will be performed by two independent reviewers. In each step, an expert with lived experience will comment on process and results. Software applications RefWorks-ProQuest, Rayyan and ATLAS.ti will be used to enhance the quality of the review and transparency of process and results. Ethics and dissemination: No ethical approval or safety considerations are required for this review. The proposed review will be submitted to a relevant international journal. Results will be presented at relevant medical scientific conferences.
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OBJECTIVE: To determine the value of training for the Emergency Management of Severe Burns (EMSB) for medical and nursing staff working in emergency care as measured by their performance in a simulated burn incident online program.METHODS: An Internet-based questionnaire, which included a simulated burn incident, was developed. All of the medical and nursing staff in hospital emergency departments and ambulance services in the Netherlands were invited to complete this questionnaire. The effect of EMSB training on the individual's knowledge of and performance in the emergency management of a burn victim was evaluated because some of the respondents had participated in EMSB training, whereas others had not.RESULTS: Of the 280 responses received, 198 questionnaires were included in the analysis. The analyzed questionnaires were submitted by nurses (43%), ambulance workers (33%), and physicians (23%). Only 14% of the people in the study had participated in EMSB training, whereas 78% had received other or additional life support training and 22% of respondents had no additional life support training. Medical and nursing staff who had participated in EMSB training performed better in the following subjects: mentioning hypothermia as a focus of attention (70% versus 53%, p=0.085), correct use of hand size (70% versus 36%, p=0.001) and use of the correct hand percentage in the estimation of total body surface area (TBSA, 82% versus 57%, p=0.015), suspicion of no airway obstruction in an outdoor trauma (93% versus 63%, p = 0.002) and referral of functional area burns to a burn center (22% versus 8%, p = 0.04). However, both groups overestimated the TBSA (34% of the total group overestimated ≥ 20%) and did not know the correct formula for fluid resuscitation (87% of the total group).CONCLUSION: There is some evidence that medical staff members who have participated in EMSB training have a better knowledge of emergency management and are more effective in the management of a simulated burn case. However, both individuals who had participated in EMSB as well as those who had not participated in EMSB needed additional training in EMSB.
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Introduction: From the patient and staff perspective, care delivery for patients experiencing a mental health problem in ambulance and emergency department (ED) settings is challenging. There is no uniform and internationally accepted concept to reflect people with a mental health problem who require emergency care, be it for, or as a result of, a mental health or physical health problem. On initial presentation to the emergency service provider (ambulance or ED), the cause of their healthcare condition/s (mental health and/or physical health) is often initially unknown. Due to this (1) the prevalence and range of underlying causes (mental and/or physical) of the patients presenting condition is unknown; (2) misattribution of physical symptoms to a mental health problem can occur and (3) diagnosis and treatment of the initial somatic complaint and cause(s) of the mental/physical health problem may be hindered.This study will name and define a new concept: 'mental dysregulation' in the context of ambulance and ED settings. Methods and analysis: A Delphi study, informed by a rapid literature review, will be undertaken. For the literature review, a steering group (ie, persons with lived experience, ED and mental health clinicians, academics) will systematically search the literature to provide a working definition of the concept: mental dysregulation. Based on this review, statements will be generated regarding (1) the definition of the concept; (2) possible causes of mental dysregulation and (3) observable behaviours associated with mental dysregulation. These statements will be rated in three Delphi rounds to achieve consensus by an international expert panel (comprising persons with lived experience, clinicians and academics). Ethics and dissemination: This study has been approved by the Medical Ethical Committee of the University of Applied Sciences Utrecht (reference number: 258-000-2023_Geurt van der Glind). Results will be disseminated via peer-reviewed journal publication(s), scientific conference(s) and to key stakeholders.
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This paper presents the design and the results of a comparative study of multidisciplinary on-scene command teams at work in virtual emergency training exercises. The principal goals of the study were to understand how "on-scene command teams" coordinate on multidisciplinary objectives and tasks, and how the manner in which this is done affects their performance. The study involved 20 on-scene command teams consisting of various individuals, such as police, fire and medical services personnel, municipal officers and infrastructure operators, drawn from a Safety Region in The Netherlands. Integrated video recordings by five synchronized cameras captured the coordination processes during the virtual exercises. The integrated and synchronized video recordings were then transformed into numerical data for analysis. Performance was operationalized by scoring the progress and completion of emergency management tasks for which individual members and/or teams as a whole were responsible. Team coordination was operationalized using network centrality and density measures. The significant findings are the following: (i) emergency management performance and coordination patterns within and among on-scene command teams have considerable variation; and (ii) teams that use less coordination during the intermediate phases of emergency management perform significantly better than teams that do not, moreover, actors who have central positions in a network are better able to achieve their performance goals.
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The COVID-19 pandemic has forced higher education (HE) to shift to emergency remote teaching (ERT), subsequently influencing academic belonging and social integration, as well as challenging students' engagement with their studies. This study investigated influences on student engagement during ERT, based on student resilience. Serial mediation analyses were used to test the predictive effects between resilience, academic belonging, social integration, and engagement.
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A considerable amount of the required information in risk and emergency management is geographical, but this information does not always reach the right actors at the right time, so how can geographical information be organised in such a way that it supports risk and emergency management more effectively? The answer requires a conceptualisation of risk and emergency management practices resulting in the network-centric concept, which implies that those involved in risk and emergency management are connected and that they have the capability to share and access information. The concept was made operational through the development of an information system and the exchange of geographical information within the system was facilitated by the use of peer-to-peer networking in combination with a client server network. On the application level, the information was presented in both map and text forms to support the exchange of information between actors. This way of organising geographical information and technology leads to improved information and communication, better situational awareness and faster decisionmaking.
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The main question in this PhD thesis is: How can Business Rules Management be configured and valued in organizations? A BRM problem space framework is proposed, existing of service systems, as a solution to the BRM problems. In total 94 vendor documents and approximately 32 hours of semi-structured interviews were analyzed. This analysis revealed nine individual service systems, in casu elicitation, design, verification, validation, deployment, execution, monitor, audit, and version. In the second part of this dissertation, BRM is positioned in relation to BPM (Business Process Management) by means of a literature study. An extension study was conducted: a qualitative study on a list of business rules formulated by a consulting organization based on the Committee of Sponsoring Organizations of the Treadway Commission risk framework. (from the summary of the Thesis p. 165)
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Background and aim ʹ Many countries signed the Paris Agreement to mitigate global average temperature rise. In this context, Dutch government decided to realize a reduction of 50% using resources and raw materials in 2030. This paper explores how practice-based research into facility operations can contribute to this aim. Methods / Methodology ʹ Practice-based research which includes direct observations, desk research, and participatory action research. Results ʹ This explorative research presents principles and suggestions for facility managers and procurement managers on how they can embed sustainable materials management in the organisation and how to take control of waste. The proposed suggestions are derived from practice-based research and presented as topics of attention for facility professionals. Originality ʹ Within education of Dutch universities of applied sciences and daily professional facility practices, the phenomenon of materials management is underexposed. To contribute to the national and international climate objectives, (future) facility professionals need better support to reduce waste. Bachelor students were involved throughout this research. This approach gave refreshing insights into waste at the end of the supply chain (control separation units) that can improve informed decisionmaking at the beginning of the supply chain. Practical or social implications ʹ Facility management professionals have an important role to play in the mitigation of global average temperature rise, because of their leading role in procurement, service operations, and materials management. However, they struggle to find sustainable solutions. This paper seeks to inspire professionals with interventions that have proven effectiveness on the reduction of waste. Type of paper ʹ Short research paper.
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