Numerous laboratory-based studies recorded eye movements in participants with varying expertise when watching video projections in the lab. Although research in the lab offers the advantage of internal validity, reliability and ethical considerations, ecological validity is often questionable. Therefore the current study compared visual search in 13 adult cyclists, when cycling a real bicycle path and while watching a film clip of the same road. Dwell time towards five Areas of Interest (AOIs) is analysed. Dwell time (%) in the lab and real-life was comparable only for the low quality bicycle path. Both in real-life and the lab, gaze is predominantly driven towards the road. Since gaze behaviour in the lab and real-life tends to be comparable with increasing task-complexity (road quality), it is concluded that under certain task constraints laboratory experiments making use of video clips might provide valuable information regarding gaze behaviour in real-life.
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Daily wheelchair ambulation is seen as a risk factor for shoulder problems, which are prevalent in manual wheelchair users. To examine the long-term effect of shoulder load from daily wheelchair ambulation on shoulder problems, quantification is required in real-life settings. In this study, we describe and validate a comprehensive and unobtrusive methodology to derive clinically relevant wheelchair mobility metrics (WCMMs) from inertial measurement systems (IMUs) placed on the wheelchair frame and wheel in real-life settings. The set of WCMMs includes distance covered by the wheelchair, linear velocity of the wheelchair, number and duration of pushes, number and magnitude of turns and inclination of the wheelchair when on a slope. Data are collected from ten able-bodied participants, trained in wheelchair-related activities, who followed a 40 min course over the campus. The IMU-derived WCMMs are validated against accepted reference methods such as Smartwheel and video analysis. Intraclass correlation (ICC) is applied to test the reliability of the IMU method. IMU-derived push duration appeared to be less comparable with Smartwheel estimates, as it measures the effect of all energy applied to the wheelchair (including thorax and upper extremity movements), whereas the Smartwheel only measures forces and torques applied by the hand at the rim. All other WCMMs can be reliably estimated from real-life IMU data, with small errors and high ICCs, which opens the way to further examine real-life behavior in wheelchair ambulation with respect to shoulder loading. Moreover, WCMMs can be applied to other applications, including health tracking for individual interest or in therapy settings.
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Abstract Specialist oncology nurses (SONs) have the potential to play a major role in monitoring and reporting adverse drug reactions (ADRs); and reduce the level of underreporting by current healthcare professionals. The aim of this study was to investigate the long term clinical and educational efects of real-life pharmacovigilance education intervention for SONs on ADR reporting. This prospective cohort study, with a 2-year follow-up, was carried out in the three postgraduate schools in the Netherlands. In one of the schools, the prescribing qualifcation course was expanded to include a lecture on pharmacovigilance, an ADR reporting assignment, and group discussion of self-reported ADRs (intervention). The clinical value of the intervention was assessed by analyzing the quantity and quality of ADR-reports sent to the Netherlands Pharmacovigilance Center Lareb, up to 2 years after the course and by evaluating the competences regarding pharmacovigilance of SONs annually. Eighty-eight SONs (78% of all SONs with a prescribing qualifcation in the Netherlands) were included. During the study, 82 ADRs were reported by the intervention group and 0 by the control group. This made the intervention group 105 times more likely to report an ADR after the course than an average nurse in the Netherlands. This is the frst study to show a signifcant and relevant increase in the number of well-documented ADR reports after a single educational intervention. The real-life pharmacovigilance educational intervention also resulted in a long-term increase in pharmacovigilance competence. We recommend implementing real-life, context- and problem-based pharmacovigilance learning assignments in all healthcare curricula.
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Background Interprofessional education is promoted as a means of enhancing future collaborative practice in healthcare. We developed a learning activity in which undergraduate medical, nursing and allied healthcare students practice interprofessional collaboration during a student-led interprofessional team meeting. Design and delivery During their clinical rotation at a family physician’s practice, each medical student visits a frail elderly patient and prepares a care plan for the patient. At a student-led interprofessional team meeting, medical, nursing and allied healthcare students jointly review these care plans. Subsequently, participating students reflect on their interprofessional collaboration during the team meeting, both collectively and individually. Every 4 weeks, six interprofessional team meetings take place. Each team comprises 9–10 students from various healthcare professions, and meets once. To date an average of 360 medical and 360 nursing and allied healthcare students have participated in this course annually. Evaluation Students mostly reported positive experiences, including the opportunity to learn with, from and about other healthcare professions in the course of jointly reviewing care plans, and feeling collectively responsible for the care of the patients involved. Additionally, students reported a better understanding of the contextual factors at hand. The variety of patient cases, diversity of participating health professions, and the course material need improvement. Conclusion Students from participating institutions confirmed that attending a student-led interprofessional team meeting had enabled them to learn with, from and about other health professions in an active role. The use of real-life cases and the educational design contributed to the positive outcome of this interprofessional learning activity.
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Background: Multimodal prehabilitation programs are effective at reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital.Methods: In this observational cohort study with multiple case analyses, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting the criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise modalities and three nutrition modalities. Implementation fidelity was investigated by evaluating: (1) coverage (participation rate), (2) duration (number of days between the start of prehabilitation and surgery), (3) content (delivery of prescribed intervention modalities), and (4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence.Results: Fifty-eight patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33-84 days). Adherence was high (84-100%) in five and moderate (72-73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled to execute the prehabilitation program due to multiple physical and cognitive impairments.Conclusion: Implementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness.
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BACKGROUND: Combining increased dietary protein intake and resistance exercise training for elderly people is a promising strategy to prevent or counteract the loss of muscle mass and decrease the risk of disabilities. Using findings from controlled interventions in a real-life setting requires adaptations to the intervention and working procedures of healthcare professionals (HCPs). The aim of this study is to adapt an efficacious intervention for elderly people to a real-life setting (phase one) and test the feasibility and potential impact of this prototype intervention in practice in a pilot study (phase two).METHODS: The Intervention Mapping approach was used to guide the adaptation in phase one. Qualitative data were collected from the original researchers, target group, and HCPs, and information was used to decide whether and how specified intervention elements needed to be adapted. In phase two, a one-group pre-test post-test pilot study was conducted (n = 25 community-dwelling elderly), to elicit further improvements to the prototype intervention. The evaluation included participant questionnaires and measurements at baseline (T0) and follow-up (T1), registration forms, interviews, and focus group discussions (T1). Qualitative data for both phases were analysed using an inductive approach. Outcome measures included physical functioning, strength, body composition, and dietary intake. Change in outcomes was assessed using Wilcoxon signed-rank tests.RESULTS: The most important adaptations to the original intervention were the design of HCP training and extending the original protein supplementation with a broader nutrition programme aimed at increasing protein intake, facilitated by a dietician. Although the prototype intervention was appreciated by participants and professionals, and perceived applicable for implementation, the pilot study process evaluation resulted in further adaptations, mostly concerning recruitment, training session guidance, and the nutrition programme. Pilot study outcome measures showed significant improvements in muscle strength and functioning, but no change in lean body mass.CONCLUSION: The combined nutrition and exercise intervention was successfully adapted to the real-life setting and seems to have included the most important effective intervention elements. After adaptation of the intervention using insights from the pilot study, a larger, controlled trial should be conducted to assess cost-effectiveness.TRIAL REGISTRATION: Trial registration number: ClinicalTrials.gov NL51834.081.14 (April 22, 2015).
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In policing, Virtual Reality scenario-based training (VR SBT) is being explored to complement real-life scenario-based training (RL SBT). We investigated whether relevant training responses in VR SBT, namely heart rate (HR), level of physical activity, mental effort, and perceived stress, resemble those in RL SBT. Utilizing a within-subject study design, we investigated the training responses of 237 police officers of the Dutch National Police. We found that the maximum HR and average level of physical activity were significantly higher in RL SBT, whereas invested mental effort was significantly higher in VR SBT. No significant differences were found in average HR and perceived stress. We also found that perceived stress in VR was predicted by participants’ VR experiences such as engagement with VR and experience of negative effects, but not by participant characteristics. Participants’ mental effort in VR was predicted by their VR experiences and participant characteristics, particularly gaming frequency. In conclusion, VR SBT can elicit perceived stress, mental effort, and average HR that resemble or exceed responses in RL SBT, providing a promising tool to complement police training.
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This experimental study with a pre-post and follow-up design evaluates the financial education program “SaveWise” for ninth grade students in the Netherlands (n = 713). SaveWise adopts a holistic approach, emphasizing action rather than mere cognition. Benefitting from explicit instruction embedded in real-life contexts, students in the program set a personal savings goal and are coached on how to achieve it. The short-term treatment results indicated that SaveWise expanded the students’ level of financial knowledge; encouraged their intentions to save more, spend less and earn an income; and broadly improved their financial and savings behavior. The program demonstrated that it could serve as an effective and low-cost method to enhance the financial literacy of pre-vocational students, a financially vulnerable group. Although long-term effects were expressed only through financial socialization, this study offers evidence linking curricula to increased knowledge and improved behavior for a specific sample of students.
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Intelligent environments can offer support to people with early-stage dementia, who often experience problems with maintaining their circadian rhythm. The focus of this work is developing a prototype of an Intelligent Environment for assisting these people with their daily rhythm while living independently at home. Following the four phases of the Empathic Design Framework (Explore, Translate, Process, and Validate), the needs of people with dementia and their caregivers were incorporated into the design. In the exploration phase, a need assessment took place using focus groups (N=12), observations (N=10), and expert interviews (N=27). Then, to determine the requirements for a prototype of an intelligent environment, the second phase, Translate, used three co-creation sessions with different stakeholder groups. In these sessions, Mind Maps (N=55) and Idea Generation Cards (N=35) were used. These resulted in a set of 10 requirements on the following topics: context-awareness, pattern recognition, adaptation, support, personalization, autonomy, modularity, dementia proof interaction, costs, data, and privacy. Finally, in the third phase, the requirements were applied to a real-life prototype by a multidisciplinary design team of researchers, (E-Health) tech companies, designers, software engineers with representatives of eight organizations. The prototype serves as a basis for further development of Intelligent Environments to enable people with dementia to live longer independently at home.
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Abstract The purpose of the Business Model Template (BMT) is to help you turn your idea into a viable project or organization. To illustrate this, two real-life case studies are offered in this chapter. Firstly, the KipCaravan project, which is a mobile home—a caravan—for chickens. It involves low-scale egg production in several locations. Secondly, the Sun at School NSV2 project in the city of Nijmegen. For both projects you will find a step-by-step description of the different routes followed. As you will see, the interpretation of the building blocks is different for every project and there is no best order in which to stack the building blocks. Bear in mind that both projects are still up and running successfully at the time of writing. These examples are shown in simplified versions and with the benefit of hindsight, of course. Perhaps the essence of doing business is having the courage to start without a ready-made recipe.
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