BACKGROUND: The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe.METHODS: This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265).RESULTS: In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%).CONCLUSION: An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients.TRIAL REGISTRATION NUMBER: NCT04321265 , registered March 19th, 2020.
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The focus of the thesis is an exploration into students’ vocational knowledge in the context of Dutch vocational education and training (VET). The reason students’ vocational knowledge requires exploration is because there is no consensus among scholars in the field of VET about how to theorise the nature of students’ vocational knowledge; most (not all) scholars rely on dichotomous conceptualisations, such as theory versus practice, general versus specific or explicit versus implicit. However, such commonly used dichotomies are not very helpful to understand the complex nature of vocational knowledge. Vocational knowledge is more than putting bits of theoretical and practical knowledge together, it is characterised by sometimes-intimate relationships between knowledge and actions. As a result of the above-mentioned gap in the VET literature, there is little empirical research on how VET students develop vocational knowledge and the extent to which this is occupation-specific knowledge. To understand students’ vocational knowledge, four different aims are formulated and carried out in four studies. The aim of the first study is to identify powerful vocational learning environments to enable the selection of a case that represents high quality vocational learning and teaching. With an eye on analysing students’ vocational knowledge, the second study aims to conceptualise the nature of vocational knowledge that avoids dichotomies. Therefore, two conceptual frameworks are integrated; the idea of contextualising is introduced which is based on cultural-historical theory to highlight the crucial role activity plays in knowledge development and to understand the relationships between the mind (i.e., what people think (and feel)), and action (i.e., what people do). Secondly, the theory is supplemented with ideas from inferentialism, a philosophical semantic theory of meaning to provide a useful way to focus on students’ processes of knowing and to reveal students’ vocational knowledge in terms of ongoing reasoning processes. The third study uses the conceptualisation of vocational knowledge to explore how students develop vocational knowledge in occupational practice, and to illustrate the process of contextualising. The forth study aims to describe what characterises students’ vocational knowledge using an analytic framework that distinguishes between occupation-specific knowledge components and qualities. This thesis contributes to research scholarship in the field of VET and an understanding of students’ vocational knowledge in practice. The theoretical framework of contextualising supplemented with inferentialism provides an alternative way to focus on students’ processes of knowing and helps to reveal students’ vocational knowledge in terms of reasoning processes. The empirical explorations and illustrations of students’ vocational knowledge contribute to the scholarly literature and practice on understanding the nature of vocational knowledge, how students develop vocational knowledge and what characterises their vocational knowledge. The intention to introduce the idea of contextualising is not about reinventing the wheel but rather an attempt to understand how it turns and how it functions. The intention of this thesis is to encourage dialogue and move the debate about the nature of vocational knowledge further, and hence, to provide some “food for thought”.
Background Eating behaviour of older adults is influenced by a complex interaction of determinants. Understanding the determinants of a specific target group is important when developing targeted health-promoting strategies. The aim of this study was to explore interpersonal determinants of eating behaviours in older adults living independently in a specific neighbourhood in the Netherlands. Methods In the neighbourhood of interest, populated by relatively many older adults, fifteen semi-structured interviews were conducted with independently living older adults (aged 76.9 ± 6.4y). Interviews were complemented with observations among the target group: three occasions of grocery shopping and three collective eating occasions in the neighbourhood. A thematic approach was used to analyse the qualitative data. Results When we asked the older adults unprompted why they eat what they eat, the influence of interpersonal determinants did not appear directly; respondents rather mentioned individual (e.g. habits) and environmental factors (e.g. food accessibility). Key findings regarding interpersonal factors were: 1) Behaviours are shaped by someone’s context; 2) Living alone influences (determinants of) eating behaviour via multiple ways; 3) There is a salient norm that people do not interfere with others’ eating behaviour; 4) Older adults make limited use of social support (both formal and informal) for grocery shopping and cooking, except for organised eating activities in the neighbourhood. In this particular neighbourhood, many facilities (e.g. shops at walking distance) are present, and events (e.g. dinners) are organised with and for the target group, which likely impact (determinants of) their behaviours. Conclusions The study showed that older adults do not directly think of interpersonal factors influencing their eating behaviour, but rather of individual or environmental factors. However, multiple interpersonal factors did appear in the interviews and observations. Moreover, neighbourhood-specific factors seem to play a role, which underlines the need to understand the specific (social) setting when developing and implementing intervention programmes. Insights from this study can assist in developing health-promoting strategies for older adults, taking into account the context of the specific neighbourhood.
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