Staffing practices in long-term care lack a clear evidence base and often seem to be guided by opinions instead of evidence. While stakeholders believe intuitively that there is a positive relationship between staffing levels and quality in nursing homes, the research literature is contradictory (1). In this editorial we consider the evidence found in a literature study that we conducted for the Dutch Ministry of Health, Welfare and Sports (VWS). The aim of this study was to summarize all available evidence on the relationship between staffing and quality in nursing homes. Specifically, we focused on the quantity and the educational background of staff and quality in nursing homes. The literature study has contributed to the recent Dutch quality framework for nursing homes (Kwaliteitskader verpleeghuiszorg in Dutch) of the National Health Care Institute. This quality framework was published in January 2017 and provides norms – among other quality aspects – for nursing home staffing. As well as a description of the main findings of the literature study, we present implications for different stakeholders charged with staffing issues in nursing homes.
The definition of ‘Assistive Technology’ (AT) includes both assistive products and the services or actions necessary for safe and effective provision of the assistive products to people who need them. International standards and product specifications exist for assistive products. Despite huge unmet need for effective AT provision, a variety of service delivery models across different countries, and a shortage of personnel trained in this field, nowidely useable and accepted AT service provision guidelines currently exist. Aligned with contemporary global initiatives to improve access to AT, a scoping review was commissioned to inform the development of globally useable provision guidance. The aim was to deliver a rapid scoping review of the literature regarding quality guidelines for AT service provision. Method: The rapid scoping review utilised a two-tiered approach to identifying relevant publications: 1) systematic search of academic databases; 2) consultation with assistive technology organisations. The review was conducted in March 2023 across four databases (Medline, CINAHL, SCOPUS and Google Scholar) with no date limitations. Systematic outreach to international and global AT networks was used to access expert informants. Non-English publications were included utilizing Google Translate and support from expert informants to verify content. Analysis was guided by the body of work on quality AT provision and service delivery processes in Europe, as well as the World Health Organization-GATE 5P framework for strengthening access to AT. Results: The search strategies yielded 41 publications from diverse countries, and directed at differing assistive products, personnel and provision contexts. Results are reported from the charted data through to the data extraction framework, including type of publication, study design, audience and reach. We report on the type of AT and the AT provision ecosystem elements discussed, and service delivery process or steps and quality criteria service delivery. Conclusion: This review did not find established guidelines or standards for service provision, but it did identify key service delivery steps which may form part of such guidelines, and many of the 3 publications included mentioned the need for practice guidelines. Despite different contexts such as type of assistive product, recipient of the guidance, language, location and authorship, core elements of AT provision including service delivery steps can be identified. Consideration regarding the nuances of vocabulary, of process, and of enabling flexible foci, is recommended in systematizing globally applicable guidance. This review offers a strong starting point for developing guidance for assistive technology provision to meet global need.
Rationale, aims and objective: Primary Care Plus (PC+) focuses on the substitution of hospital-based medical care to the primary care setting without moving hospital facilities. The aim of this study was to examine whether population health and experience of care in PC+ could be maintained. Therefore, health-related quality of life (HRQoL) and experienced quality of care from a patient perspective were compared between patients referred to PC+ and to hospital-based outpatient care (HBOC). Methods: This cohort study included patients from a Dutch region, visiting PC+ or HBOC between December 2014 and April 2018. With patient questionnaires (T0, T1 and T2), the HRQoL and experience of care were measured. One-to-two nearest neighbour calliper propensity score matching (PSM) was used to control for potential selection bias. Outcomes were compared using marginal linear models and Pearson chi-square tests. Results: One thousand one hundred thirteen PC+ patients were matched to 606 HBOC patients with well-balanced baseline characteristics (SMDs <0.1). Regarding HRQoL outcomes, no significant interaction terms between time and group were found (P > .05), indicating no difference in HRQoL development between the groups over time. Regarding experienced quality of care, no differences were found between PC+ and HBOC patients. Only travel time was significantly shorter in the HBOC group (P ≤ .001). Conclusion: Results show equal effects on HRQoL outcomes over time between the groups. Regarding experienced quality of care, only differences in travel time were found. Taken as a whole, population health and quality of care were maintained with PC+ and future research should focus more on cost-related outcomes.
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.
With the help of sensors that made data collection and processing possible, many products around us have become “smarter”. The situation that our car, refrigerator, or umbrella communicating with us and each other is no longer a future scenario; it is increasingly a shared reality. There are good examples of such connectedness such as lifestyle monitoring of elderly persons or waste management in a smart city. Yet, many other smart products are designed just for the sake of embedding a chip in something without thinking through what kind of value they add everyday life. In other words, the design of these systems have mainly been driven by technology until now and little studies have been carried out on how the design of such systems helps citizens to improve or maintain the quality of their individual and collective lives. The CREATE-IT research center creates new solutions and methodologies in “digital design” that contribute to the quality of life of citizens. Correspondingly, this proposal focuses on one type of digital design—smart products—and investigate the concept of empowerment in relation to the design of smart products. In particular, the proposal aims to develop a model with its supplementary tools and methods for designing such products better. By following a research-through-design methodology, the proposal intends to offer a critical understanding on designing smart products. Along with its theoretical contribution, the proposal will also aid the students of ICT and design, and professionals such as designers and engineers to create smart products that will empower people and the industry to develop products grounded in a clear user experience and business model.
The natural environment is dependent on water to provide society with many essential benefits or “ecosystemservices” (e.g. drinking water, biodiversity, food production, recreation, carbon sequestration). A number of EUdirectives aim to protect and improve the delivery of these services. However, successful implementation andintegration of the different directives at a local level is a major shared challenge in the North Sea Region.Understanding how this can be achieved is fundamental to delivering long-term sustainable ecosystem-basedmanagement strategies for the North Sea Region and the focus for the WaterCoG project.The project will demonstrate through the adoption of new participatory, ecosystem service based approachesthat implementation and integration of different water management frameworks can be achieved at the sametime as providing additional social, economic and environmental benefits not currently being realised.A strong transnational component will identify and incorporate common, transferable elements of differentapproaches into an up-scaling toolbox that will extend the impact of the project and build capacity for deliveringimproved sustainable management strategies for North Sea Region ecosystems.The projects’ output aims for a change in working practice that will improve the integration between top-downimplementation of European and national directives and bottom-up, participatory developed solutions forimproving the quality and sustainable management strategies of North Sea Region ecosystems.
