Background: A transitional care pathway (TCP) could improve care for older patients in the last months of life. However, barriers exist such as unidentified palliative care needs and suboptimal collaboration between care settings. The aim of this study was to determine the feasibility of a TCP, named PalliSupport, for older patients at the end of life, prior to a stepped-wedge randomized controlled trial. Methods: A mixed-method feasibility study was conducted at one hospital with affiliated primary care. Patients were ≥ 60 years and acutely hospitalized. The intervention consisted of (1) training on early identification of the palliative phase and end of life conversations, (2) involvement of a transitional palliative care team during admission and post-discharge and (3) intensified collaboration between care settings. Outcomes were feasibility of recruitment, data collection, patient burden and protocol adherence. Experiences of 14 professionals were assessed through qualitative interviews. Results: Only 16% of anticipated participants were included which resulted in difficulty assessing other feasibility criteria. The qualitative analysis identified misunderstandings about palliative care, uncertainty about professionals' roles and difficulties in initiating end of life conversations as barriers. The training program was well received and professionals found the intensified collaboration beneficial for patient care. The patients that participated experienced low burden and data collection on primary outcomes and protocol adherence seems feasible. Discussion: This study highlights the importance of performing a feasibility study prior to embarking on effectiveness studies. Moving forward, the PalliSupport care pathway will be adjusted to incorporate a more active recruitment approach, additional training on identification and palliative care, and further improvement on data collection.
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BackgroundThere is a shift from inpatient to home-based geriatric rehabilitation (HBGR), and potential benefits are demonstrated. Previously, a theoretical HBGR model, version 1.0, has been developed, outlining its essential components. However, clear guidance on the practical design and organisation of HBGR in everyday practice is still lacking. Therefore, determining the optimal design for this complex intervention is essential for its successful implementation in daily practice. The objective of this study is to redesign the theoretical HBGR trajectory and assess its feasibility, acceptability, and usability from both patient and professional perspectives.MethodsA redesign and feasibility study based on the MRC framework was conducted in a Dutch skilled nursing facility using the MRC framework in co-creation with eleven healthcare professionals and four patient representatives. The HBGR trajectory 1.0, comprises four building blocks (structure, process, environment, and outcomes) based on the Post-Acute-Care rehabilitation quality framework. Version 1.0 was redesigned during the development phase and subsequently pilot-tested in daily practice during the feasibility phase. Adjustments were made based on semi-structured interviews with ten patients and (interim) evaluations.ResultsThe HBGR trajectory 1.0 has been redesigned into version 2.0. It contains eleven elements: individualised goal setting, providing HBGR is the default unless otherwise indicated, an information letter, blended eHealth, mapping the patient’s living environment, stimulation support from informal caregivers, collaboration with community care nursing, rehabilitation coordination, central planning, therapy at home, and online multidisciplinary evaluation. Version 2.0 was enthusiastically endorsed by patients, patient representatives, and professionals, who found it feasible, acceptable, and usable in daily practice.ConclusionThe HBGR trajectory 1.0 was adapted, tested, and finally redesigned into version 2.0. The study revealed that involving patients, their representatives, and healthcare professionals was critical to garnering support and facilitating implementation. Key developments align with global trends and include the successful integration of eHealth with traditional treatment methods, enhanced collaboration and knowledge sharing among community care nurses, and increased involvement of informal caregivers in rehabilitation. This redesigned HBGR trajectory is ready for evaluation and implementation in follow-up effectiveness research.
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Background: Transmural palliative care interventions aim to identify older persons with palliative care needs and timely provide advance care planning, symptom management, and coordination of care. Nurses can have an important role in these interventions; however, their expertise is currently underused. A new transmural care pathway with a central role for the community care registered nurse in advance care planning aims to contribute to the quality of palliative care for older persons. Objective: To examine the perspectives of community nurses on the feasibility of a new transmural care pathway for advance care planning for older persons. Design: A qualitative study design using semi-structured interviews. Setting(s): Interviews were performed with community nurses of three participating homecare organizations in the Netherlands between March and May 2023. Participants: 19 community nurses. Methods: A topic guide was based on (1) challenges in advance care planning identified from the literature and (2) concepts that are important in assessing the feasibility of complex healthcare interventions provided by the Normalisation Process Theory framework. A combined inductive and deductive thematic analysis was performed. Results: Four themes were identified: views on the transmural care pathway, community nurses’ needs to fulfil their role, key points regarding implementation, and evaluation of the new practice. In general, community nurses were positive about the feasibility of the new practice as it provided a more structured work process that could facilitate interprofessional collaboration and improve the quality of palliative care. Overall, the feasibility of the new practice, from community nurses perspective, was determined by (1) clear roles and responsibilities in the transmural care pathway, (2) standardized registration of advance care planning, and (3) close involvement of community nurses in the whole implementation process. Conclusions: We highlighted important factors, from the perspectives of community nurses, that need to be considered in the implementation of a new transmural care pathway for advance care planning. A clear division of roles and responsibilities, standardized registration of advance care planning, and involvement of community nurses during the whole implementation process were mentioned as important enabling factors. This knowledge might contribute to successful implementation of a transmural care pathway that aims to enhance the quality of palliative care for older persons. Tweetable abstract: Community nurses’ perspectives on the feasibility of a transmural care pathway for advance care planning for older persons.
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Een beroerte is de belangrijkste oorzaak van invaliditeit in Nederland. Revalidatie van mensen die een beroerte hebben gehad, is erop gericht hen zo zelfstandig mogelijk in hun eigen omgeving te laten functioneren. Vaak zijn er na de revalidatie nog altijd gevolgen van een beroerte, die het zelfstandig functioneren bemoeilijken. Mensen die een beroerte overleven houden er vaak chronische gevolgen aan over, zoals loop- en balansproblemen, verhoogd valrisico, vermoeidheid en depressie. Deze problemen bij thuiswonende mensen met een beroerte resulteren vaak in een inactieve leefstijl. Dit leidt tot een neerwaartse spiraal waarin de fysieke activiteit steeds verder afneemt, patiënten steeds verder deconditioneren, de verzorgingsbehoefte toe- en de mate van zelfstandigheid afneemt en het risico op een volgende beroerte toeneemt. Studies laten zien dat fysieke activiteit een positief effect op gezondheid heeft van patiënten na beroerte. De technologie om fysieke activiteit betrouwbaar en valide te meten is aanwezig en er is inzicht in belemmerende en faciliterende factoren voor fysieke activiteit. Er is echter nog geen bewezen effectieve interventie voor het aanleren en behouden van een fysiek actieve leefstijl voor patiënten na beroerte. Omdat alle richtlijnen voor beroerte aangeven dat het belangrijk is dat patiënten na beroerte fysiek actief zijn, vragen fysiotherapeuten zich af hoe krijgen en houden wij patiënten na een beroerte actief, dus hoe krijgen wij een actieve leefstijl bij een patiënt? Deze praktijkvraag is “vertaald” naar de volgende onderzoeksvraag: Wat is het effect van een beweegstimuleringsinterventie bij thuiswonende patiënten na beroerte op fysieke activiteit en aerobe capaciteit? Deze onderzoeksvraag wordt in drie stappen uitgewerkt: 1. Het ontwikkelen van een veldtest om aerobe capaciteit te meten in de praktijk, 2 Het ontwikkelen van een interventie gericht op het (langdurig) bevorderen van een fysiek actieve leefstijl; 3. Het testen van de feasibility van de interventie in een pilot studie.
The SPRONG-collaboration “Collective process development for an innovative chemical industry” (CONNECT) aims to accelerate the chemical industry’s climate/sustainability transition by process development of innovative chemical processes. The CONNECT SPRONG-group integrates the expertise of the research groups “Material Sciences” (Zuyd Hogeschool), “Making Industry Sustainable” (Hogeschool Rotterdam), “Innovative Testing in Life Sciences & Chemistry” and “Circular Water” (both Hogeschool Utrecht) and affiliated knowledge centres (Centres of Expertise CHILL [affiliated to Zuyd] and HRTech, and Utrecht Science Park InnovationLab). The combined CONNECT-expertise generates critical mass to facilitate process development of necessary energy-/material-efficient processes for the 2050 goals of the Knowledge and Innovation Agenda (KIA) Climate and Energy (mission C) using Chemical Key Technologies. CONNECT focuses on process development/chemical engineering. We will collaborate with SPRONG-groups centred on chemistry and other non-SPRONG initiatives. The CONNECT-consortium will generate a Learning Community of the core group (universities of applied science and knowledge centres), companies (high-tech equipment, engineering and chemical end-users), secondary vocational training, universities, sustainability institutes and regional network organizations that will facilitate research, demand articulation and professionalization of students and professionals. In the CONNECT-trajectory, four field labs will be integrated and strengthened with necessary coordination, organisation, expertise and equipment to facilitate chemical innovations to bridge the innovation valley-of-death between feasibility studies and high technology-readiness-level pilot plant infrastructure. The CONNECT-field labs will combine experimental and theoretical approaches to generate high-quality data that can be used for modelling and predict the impact of flow chemical technologies. The CONNECT-trajectory will optimize research quality systems (e.g. PDCA, data management, impact). At the end of the CONNECT-trajectory, the SPRONG-group will have become the process development/chemical engineering SPRONG-group in the Netherlands. We can then meaningfully contribute to further integrate the (inter)national research ecosystem to valorise innovative chemical processes for the KIA Climate and Energy.
Unwanted tomatoes represent ~20% of the European market, meaning that ~3 million metric tons of tomatoes are wasted every year. On a national scale, this translates to 7000 tons of tomato waste every year. Considering the challenge that food spillage represents worldwide and that the Netherlands wants to be circular by 2050, it is important to find a way to circularize these tomatoes back into the food chain. Moreover, tomatoes are the largest greenhouse crop in the Netherlands, which means that reducing the waste of this crop will positively and significantly affect the circularity and sustainability of the Dutch food system. A way to bring these tomatoes back into the food chain is through fermentation with lactic acid bacteria (LAB), which are already used in many food applications. In this project, we will assemble a unique new mix (co-culture) of LAB bacteria, which will lead to a stable fermented product with low sugar, low pH and a fresh taste, without compromising its nutritional value. This fermentation will prevent the contamination of the product with other microorganisms, providing the product with a prolonged shelf life, and will have a positive impact on the health of the consumers. Up until now, only non-fermented products have been produced from rejected tomatoes. This solution allows for an in-between product that can be used towards many different applications. This process will be upscaled to pilot scale with our consortium partners HAN BioCentre, Keep Food Simple, LLTB and Kramer B.V. The aim is to optimize the process and taste the end result of the different fermentations, so the end product is an attractive, circular, and tasty fermented tomato paste. These results will help to advance the circularity and sustainability of our food system, both at a national and European level.
