BACKGROUND: Despite the evidence of the adverse consequences of immobility during hospitalization, patients spend most of the time in bed. Although physical activity is a modifiable factor that can prevent in-hospital functional decline, bed rest is deeply rooted in the hospital culture. To attack this, a multidimensional approach is needed. Therefore, Hospital in Motion, a multidimensional implementation project, was designed to improve physical behavior during hospitalization. OBJECTIVE: The primary objective of this study is to investigate the effectiveness of Hospital in Motion on inpatient physical behavior. Secondary objectives are to investigate the effectiveness on length of hospital stay and immobility-related complications of patients during hospitalization and to monitor the implementation process. METHODS: For this study, Hospital in Motion will be implemented within 4 wards (cardiology, cardiothoracic surgery, medical oncology, and hematology) in a Dutch University Medical Center. Per ward, multidisciplinary teams will be composed who follow a step-by-step multidimensional implementation approach including the development and implementation of tailored action plans with multiple interventions to stimulate physical activity in daily care. A prepost observational study design will be used to evaluate the difference in physical behavior before and 1 year after the start of the project, including 40 patients per time point per ward (160 patients in total). The primary outcome measure is the percentage of time spent lying, measured with the behavioral mapping method. In addition, a process evaluation will be performed per ward using caregivers' and patient surveys and semistructured interviews with patients and caregivers. RESULTS: This study is ongoing. The first participant was enrolled in October 2017 for the premeasurement. The postmeasurements are planned for the end of 2018. The first results are expected to be submitted for publication in autumn 2019. CONCLUSIONS: This study will provide information about the effectiveness of the Hospital in Motion project on physical behavior and about the procedures of the followed implementation process aimed to incorporate physical activity in usual care. These insights will be useful for others interested in changing physical behavior during hospitalization.
Evidence concerning psychosocial interventions for children and young people with externalizing behavior problems has amassed at an impressive pace in recent years. Interventions that have been proven effective are now considered vehicles through which the knowledge of “what works” can be applied in practice. Outcomes for children, young people, and their families, however, have not improved in line with these advances in knowledge. This difference between the knowledge of “what works” and the application of this knowledge in real-life practice has become known as the “implementation gap”. This dissertation explores questions considering the implementation gap, with a focus on whether professionals are delivering the interventions as intended (treatment integrity).The results of the research underlying this dissertation show that 1) although measuring treatment integrity is important, it is often missing or not examined under adequate circumstances in studies, 2) applying interventions with a high level of treatment integrity makes a real difference to the end-users of the services and 3) targeted and continued support to professionals with a focus on providing feedback on levels of treatment integrity is necessary to enable them to deliver interventions as intended. Organizing support around common factors of interventions can be a first step in integrating and providing feasible support for professionals that provide more than one intervention.
MULTIFILE
Background: A new selective preventive spinal immobilization (PSI) protocol was introduced in the Netherlands. This may have led to an increase in non-immobilized spinal fractures (NISFs) and consequently adverse patient outcomes. Aim: A pilot study was conducted to describe the adverse patient outcomes in NISF of the PSI protocol change and assess the feasibility of a larger effect study. Methods: Retrospective comparative cohort pilot study including records of trauma patients with a presumed spinal injury who were presented at the emergency department of a level 2 trauma center by the emergency medical service (EMS). The pre-period 2013-2014 (strict PSI protocol), was compared to the post-period 2017-2018 (selective PSI protocol). Primary outcomes were the percentage of records with a NISF who had an adverse patient outcome such as neurological injuries and mortality before and after the protocol change. Secondary outcomes were the sample size calculation for a larger study and the feasibility of data collection. Results: 1,147 records were included; 442 pre-period, and 705 post-period. The NISF-prevalence was 10% (95% CI 7-16, n = 19) and 8% (95% CI 6-11, n = 33), respectively. In both periods, no neurological injuries or mortality due to NISF were found, by which calculating a sample size is impossible. Data collection showed to be feasible. Conclusions: No neurological injuries or mortality due to NISF were found in a strict and a selective PSI protocol. Therefore, a larger study is discouraged. Future studies should focus on which patients really profit from PSI and which patients do not.
Hipper to Implementation is een vervolg op het RAAK-publiek project Hipper. Het eindproduct daarvan (een toolkit voor het begeleiden van revaliderende patienten na een heupoperatie) is positief ontvangen. De toolkit vereist echter een zorgvuldige doorontwikkeling voordat sprake kan zijn van implementatie op grotere schaal. De doorontwikkeling is nodig op twee onderdelen: het inpassen van de aanpak binnen de reguliere revalidatiebehandeling door de zorgprofessionals en het robuurster maken van het systeem. In Hipper to Implementation ligt de focus op het inpassen van de aanpak binnen de reguliere behandeling. Hierbij worden zorgprofessionals begeleid bij het werken volgens het Hipper behandelprotocol zodat dit deel uit gaat maken van reguliere zorg. De inhoud van de ondersteuning zal bestaan uit het aanbieden van scholing en begeleiding. Het robuuster maken van het systeem vindt plaats in een parallel lopend project.
Aerogel fibers consist of up to 99.9% of air which leads to outstanding insulation proper-ties for e.g. house construction. The simple use of aerogel fibers as wallpaper could lead to 25% energy savings. According to calculations of Advanced Manufacturing Office, energy savings of 1% saves 7500 million gallons of gasoline every year in the USA which equals, depending on the oil price, more than 18 billon USD. In this KIEM project, the cellulose purity needed to be able to spin cellulose into a fila-ment for aerogel production will be determined. Cellulose is the most abundant polymer on the planet. In principle, cellulose-based aerogels could replace petroleum-based and partly toxic polystyrene which is currently used for insulation purposes and which leads to toxic waste. The cellulosic starting material is generated via the “Beta process” as developed by a company called DSD. The “Beta process” offers an efficient way of generating ethanol from sugar beets. The by-product of that process contains cellulose, pectines and hemi-cellulose. To be able to use this mixture for wet spinning, this mixture needs to be puri-fied. Researchers and students from Zuyd University of Applied Sciences will, in collabora-tion with DSD, pursue the purification of the waste stream material in the labs of the Centre of Expertise CHILL. Next, the obtained cellulose grades will be processed as spinning dope in a wet spinning process on lab scale with up to 60 ml per batch at AMI-BM. The results will be used as feedback for the purification process. Several possible partners such as DSD, ACRRES (Application Center for Renewable Resources), Technoforce (extraction), Greenfields (fermentation) and VAM (washing in-stallations) show high interest for the up-scaling of the process and for the validation and implementation in the built environment, showing the feasibility a follow-up project.
