Background: The number of medical technologies used in home settings has increased substantially over the last 10-15 years. In order to manage their use and to guarantee quality and safety, data on usage trends and practical experiences are important. This paper presents a literature review on types, trends and experiences with the use of advanced medical technologies at home. Methods: The study focused on advanced medical technologies that are part of the technical nursing process and 'hands on' processes by nurses, excluding information technology such as domotica. The systematic review of literature was performed by searching the databases MEDLINE, Scopus and Cinahl. We included papers from 2000 to 2015 and selected articles containing empirical material. Results: The review identified 87 relevant articles, 62% was published in the period 2011-2015. Of the included studies, 45% considered devices for respiratory support, 39% devices for dialysis and 29% devices for oxygen therapy. Most research has been conducted on the topic 'user experiences' (36%), mainly regarding patients or informal caregivers. Results show that nurses have a key role in supporting patients and family caregivers in the process of homecare with advanced medical technologies and in providing information for, and as a member of multi-disciplinary teams. However, relatively low numbers of articles were found studying nurses perspective. Conclusions: Research on medical technologies used at home has increased considerably until 2015. Much is already known on topics, such as user experiences; safety, risks, incidents and complications; and design and technological development. We also identified a lack of research exploring the views of nurses with regard to medical technologies for homecare, such as user experiences of nurses with different technologies, training, instruction and education of nurses and human factors by nurses in risk management and patient safety.
BACKGROUND: After hospitalization for cardiac disease, older patients are at high risk of readmission and death. Although geriatric conditions increase this risk, treatment of older cardiac patients is limited to the management of cardiac diseases. The aim of this study is to investigate if unplanned hospital readmission and mortality can be reduced by the Cardiac Care Bridge transitional care program (CCB program) that integrates case management, disease management and home-based cardiac rehabilitation.METHODS: In a randomized trial on patient level, 500 eligible patients ≥ 70 years and at high risk of readmission and mortality will be enrolled in six hospitals in the Netherlands. Included patients will receive a Comprehensive Geriatric Assessment (CGA) at admission. Randomization with stratified blocks will be used with pre-stratification by study site and cognitive status based on the Mini-Mental State Examination (15-23 vs ≥ 24). Patients enrolled in the intervention group will receive a CGA-based integrated care plan, a face-to-face handover with the community care registered nurse (CCRN) before discharge and four home visits post-discharge. The CCRNs collaborate with physical therapists, who will perform home-based cardiac rehabilitation and with a pharmacist who advices the CCRNs in medication management The control group will receive care as usual. The primary outcome is the incidence of first all-cause unplanned readmission or mortality within 6 months post-randomization. Secondary outcomes at three, six and 12 months after randomization are physical functioning, functional capacity, depression, anxiety, medication adherence, health-related quality of life, healthcare utilization and care giver burden.DISCUSSION: This study will provide new knowledge on the effectiveness of the integration of geriatric and cardiac care.TRIAL REGISTRATION: NTR6316 . Date of registration: April 6, 2017.
Background: Team-based palliative care interventions have shown positive results for patients at the end of life in both hospital and community settings. However, evidence on the effectiveness of transmural, that is, spanning hospital and home, team-based palliative care collaborations is limited. Aim: To systematically review whether transmural team-based palliative care interventions can prevent hospital admissions and increase death at home. Design: Systematic review and meta-analysis. Data sources: MEDLINE (Ovid), Embase (Ovid), CINAHL (Ebsco), PsychINFO (Ovid), and Cochrane Library (Wiley) were systematically searched until January 2021. Studies incorporating teams in which hospital and community professionals co-managed patients, hospital-based teams with community follow-up, and case-management interventions led by palliative care teams were included. Data was extracted by two researchers independently. Results: About 19 studies were included involving 6614 patients, of whom 2202 received an intervention. The overall pooled odds ratio of at least one hospital (re)admissions was 0.46 (95% confidence interval (CI) 0.34–0.68) in favor of the intervention group. The highest reduction in admission was in the hospital-based teams with community follow-up: OR 0.21 (95% CI 0.07–0.66). The pooled effect on home deaths was 2.19 (95% CI 1.26–3.79), favoring the intervention, with also the highest in the hospital-based teams: OR 4.77 (95% CI 1.23–18.47). However, studies had high heterogeneity regarding intervention, study population, and follow-up time. Conclusion: Transmural team-based palliative care interventions, especially hospital-based teams that follow-up patients at home, show an overall effect on lowering hospital admissions and increasing the number of patients dying at home. However, broad clinical and statistical heterogeneity of included studies results in uncertainty about the effect size.
Due to societal developments, like the introduction of the ‘civil society’, policy stimulating longer living at home and the separation of housing and care, the housing situation of older citizens is a relevant and pressing issue for housing-, governance- and care organizations. The current situation of living with care already benefits from technological advancement. The wide application of technology especially in care homes brings the emergence of a new source of information that becomes invaluable in order to understand how the smart urban environment affects the health of older people. The goal of this proposal is to develop an approach for designing smart neighborhoods, in order to assist and engage older adults living there. This approach will be applied to a neighborhood in Aalst-Waalre which will be developed into a living lab. The research will involve: (1) Insight into social-spatial factors underlying a smart neighborhood; (2) Identifying governance and organizational context; (3) Identifying needs and preferences of the (future) inhabitant; (4) Matching needs & preferences to potential socio-techno-spatial solutions. A mixed methods approach fusing quantitative and qualitative methods towards understanding the impacts of smart environment will be investigated. After 12 months, employing several concepts of urban computing, such as pattern recognition and predictive modelling , using the focus groups from the different organizations as well as primary end-users, and exploring how physiological data can be embedded in data-driven strategies for the enhancement of active ageing in this neighborhood will result in design solutions and strategies for a more care-friendly neighborhood.
In de faculteit ‘Science en Engineering’ van de Rijksuniversiteit Groningen is kennis ontwikkeld op het gebied van verduurzaming en vergroening in de chemie. De ambitie is om toe te werken naar de transitie van synthetische chemische processen naar biobased chemische processen. Een expertisegebied betreft de inzet van biotechnologische enzymconversies als alternatief voor klassieke (fossiele) chemische omzettingen. De vakgroep ‘Product and Processes for Biotechnology’ heeft expertise op het gebied van de opschaling van enzymatische conversies. Het MKB-bedrijf CarbExplore Research B.V. werkt aan procesontwikkeling van enzymatische glucosylering. De methode kan worden toegepast bij de (duurzame) productie van ingrediënten (w.o. zoetstoffen en surfactanten) die nodig zijn voor zogenaamde Home & Personal care producten van de toekomst. Bij de opschaling van de technologie, ontstaan innovatievragen. Inzet van het praktijkgerichte onderzoek tussen de RUG en CarbExplore is het vinden van een efficiënte enzymatische opschalingsroute voor deze groene grondstoffen. In de relatie met CarbExplore wordt gewerkt aan de conversie van een Stevia zoetstof. In het vervolg kan de universiteit deze enzymatische opschalingsmethode toepassen in andere bioconversies, andere producten, en bij andere bedrijven. Zowel voor de universiteit, als voor het bedrijf CarbExplore, wordt een economisch potentieel gecreëerd. De uiteindelijke visie en einddoel is het toewerken naar een vergroening van de chemie door middel van enzymatische conversies.
For English see below In dit project werkt het Lectoraat ICT-innovaties in de Zorg van hogeschool Windesheim samen met zorganisaties de ZorgZaak, De Stouwe, en IJsselheem en daarnaast Zorgcampus Noorderboog, Zorgtrainingscentrum Regio Zwolle, Patiëntenfederatie NPCF, VitaalThuis, ActiZ, Vilans, V&VN, Universiteit Twente en het Lectoraat Innoveren in de Ouderenzorg van Windesheim aan het in staat stellen van wijkverpleegkundigen om autonoom en doelmatig, op basis van klinisch redeneren, eHealth te indiceren en in te zetten bij cliënten. De aanleiding voor dit project wordt gevormd door de wijzigingen per 1 januari 2015 in de Zorgverzekeringswet. Wijkverpleegkundigen zijn sindsdien zelf verantwoordelijk voor de indicatiestelling en zorgtoewijzing voor verzorging en verpleging thuis: zij moeten bepalen welke zorg hun cliënten nodig hebben gezien hun individuele situaties, en hoe die zorg het best geleverd kan worden. Zorgverzekeraars leggen hierbij minimumeisen op, o.a. met betrekking tot de inzet van eHealth. Wijkverpleegkundigen hebben op dit moment echter niet of nauwelijks ervaring met het inzetten en toepassen van technologische toepassingen zoals eHealth. Vraagarticulatie leidde tot de volgende praktijkvraagstelling: 1. Hoe kunnen wijkverpleegkundigen worden voorzien in hun informatiebehoefte over eHealth? 2. Hoe kunnen wijkverpleegkundigen worden ondersteund in hun klinisch redeneren over het inzetten van eHealth bij hun cliënten? 3. Hoe kunnen wijkverpleegkundigen worden ondersteund bij het inzetten van eHealth in hun zorgproces? Het project levert hiertoe drie bijdragen: - De eerste bijdrage is een duurzaam geborgde keuzehulp (een app voor tablet of smartphone) waarmee wijkverpleegkundigen toegang hebben tot de benodigde informatie over eHealth-toepassingen en die aansluit bij de manier waarop wijkverpleegkundigen zorg indiceren (bijvoorbeeld door relaties te leggen tussen NIC-interventies en bijpassende eHealth-toepassingen). - Informatievoorziening is niet een afdoende antwoord op de handelingsverlegenheid van de wijkverpleegkundige omdat eHealth sterk in ontwikkeling is en blijft waardoor er altijd een discrepantie zal bestaan tussen de beschikbare en de benodigde informatie. . De tweede bijdrage van dit project is daarom kennis over (en inzicht in) het klinisch redeneren over de inzet van eHealth. Deze kennis wordt in het project doorvertaald naar een trainingsmodule die erop is gericht om het klinisch redeneren van wijkverpleegkundigen over het inzetten van eHealth en andere thuiszorgtechnologie bij hun cliënten te versterken. - De derde bijdrage van dit project omhelst inbedding van bovengenoemde resultaten in het verpleegkunde-onderwijs van onder meer Windesheim en in nascholingstrajecten voor wijkverpleegkundigen. Voor duurzame, bredere inbedding in het onderwijs wordt samengewerkt met regionale zorgonderwijsnetwerken. In this project the research group IT-innovations in Health Care of Windesheim University of Applied Sciences cooperates with care organisations de ZorgZaak, De Stouwe, and IJsselheem, and stakeholders Zorgcampus Noorderboog, Zorgtrainingscentrum Regio Zwolle, Patiëntenfederatie NPCF, VitaalThuis, ActiZ, Vilans, V&VN, University of Twente, and research group Innovation of Care of Older Adults of Windesheim to enable home care nurses to autonomously and adequately, based on clinical reasoning, allocate eHealth and implement it in patient care. The motivation behind this project lies in the alterations in the care insurance legislation per January 2015. Since then, home care nurses are responsible for the care allocation of all care at home: they determine which care their clients require, taking into account the individual situations, and how this care can best be delivered. Care insurance companies impose minimum requirements for this allocation of home care, among others concerning the implementation of eHealth. Home care nurses, however, have no or limited information about and experience with technical applications like eHealth. Articulation of the demands of home care nurses resulted in the following questions: 1. How can home care nurses be provided with information concerning eHealth? 2. How can home care nurses be supported in their clinical reasoning about the deployment of eHealth by their patients? 3. How can home care nurses be supported when deploying eHealth in their care process? This project contributes in three ways: " The first contribution is a sustainable selection tool (an app for tablet or smartphone) to be used by home care nurses to provide them with the required information about eHealth applications. This selection tool will work in accordance with how home care nurses allocate care, e.g. by relating NIC-interventions to matching eHealth applications. " Providing information is an insufficient, although necessary, answer to the demands of home care nurses because of continuously developing eHealth applications. Hence, the second contribution of this project is knowledge about (and insight in) the clinical reasoning about the deployment of eHealth. This knowledge will be converted into a training module aimed at strengthening the clinical reasoning about the deployment of eHealth by their patients. " The third contribution of this project concerns embedding the selection tool and the training module in regular education (among others at Windesheim) and in refresher courses for home care nurses. Cooperation with regional care education networks will ensure sustainable and broad embedding of both the selection tool and the training module.
