OBJECTIVES: To improve transmural palliative care for acutely admitted older patients, the PalliSupport transmural care pathway was developed. Implementation of this care pathway was challenging. The aim of this study was to improve understanding why the implementation partly failed.DESIGN: A qualitative process evaluation study.SETTING/PARTICIPANTS: 17 professionals who were involved in the PalliSupport program were interviewed.METHODS: Online semi-structured interviews. Thematic analysis to create themes according to the implementation framework of Grol & Wensing.RESULTS: From this study, themes within four levels of implementation emerged: 1) The innovation: challenges in current palliative care, the setting of the pathway and boost for improvement; 2) Individual professional: feeling (un)involved and motivation; 3) Organizational level: project management; 4) Political and economic level: project plan and evaluation.CONCLUSION AND IMPLICATIONS: We learned that the challenges involved in implementing a transmural care pathway in palliative care should not be underestimated. For successful implementation, we emphasize the importance of creating a program that fits the complexity of transmural palliative care. We suggest starting on a small scale and invest in project management. This could help to involve all stakeholders and anticipate current challenges in palliative care. To increase acceptance, create one care pathway that can start and be used in all care settings. Make sure that there is sufficient flexibility in time and room to adjust the project plan, so that a second pilot study can possibly be performed, and choose a scientific evaluation with both rigor and practical usefulness to evaluate effectiveness.
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Standard SARS-CoV-2 testing protocols using nasopharyngeal/throat (NP/T) swabs are invasive and require trained medical staff for reliable sampling. In addition, it has been shown that PCR is more sensitive as compared to antigen-based tests. Here we describe the analytical and clinical evaluation of our in-house RNA extraction-free saliva-based molecular assay for the detection of SARS-CoV-2. Analytical sensitivity of the test was equal to the sensitivity obtained in other Dutch diagnostic laboratories that process NP/T swabs. In this study, 955 individuals participated and provided NP/T swabs for routine molecular analysis (with RNA extraction) and saliva for comparison. Our RT-qPCR resulted in a sensitivity of 82,86% and a specificity of 98,94% compared to the gold standard. A false-negative ratio of 1,9% was found. The SARS-CoV-2 detection workflow described here enables easy, economical, and reliable saliva processing, useful for repeated testing of individuals.
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Objective: In myocardial perfusion single-photon emission computed tomography (SPECT), abdominal activity often interferes with the evaluation of perfusion in the inferior wall, especially after pharmacological stress. In this randomized study, we examined the effect of carbonated water intake versus still water intake on the quality of images obtained during myocardial perfusion images (MPI) studies. Methods: A total of 467 MIBI studies were randomized into a carbonated water group and a water group. The presence of intestinal activity adjacent to the inferior wall was evaluated by two observers. Furthermore, a semiquantitative analysis was performed in the adenosine subgroup,using a count ratio of the inferior myocardial wall and adjacent abdominal activity. Results: The need for repeated SPECT in the adenosine studies was 5.3 % in the carbonated water group versus 19.4 % in the still water group (p = 0.019). The inferior wall-to-abdomen count ratio was significantly higher in the carbonated water group compared to the still water group (2.11 ± 1.00 vs. 1.72 ± 0.73, p\0.001). The effect of carbonated water during rest and after exercise was not significant. Conclusions: This randomized study showed that carbonated water significantly reduced the interference of extra-cardiac activity in adenosine SPECT MPI. Keywords: Extra-cardiac radioactivity, Myocardial SPECT, Image quality enhancement, Carbonated water
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Objectives: Promoting unstructured outside play is a promising vehicle to increase children’s physical activity (PA). This study investigates if factors of the social environment moderate the relationship between the perceived physical environment and outside play. Study design: 1875 parents from the KOALA Birth Cohort Study reported on their child’s outside play around age five years, and 1516 parents around age seven years. Linear mixed model analyses were performed to evaluate (moderating) relationships among factors of the social environment (parenting influences and social capital), the perceived physical environment, and outside play at age five and seven. Season was entered as a random factor in these analyses. Results: Accessibility of PA facilities, positive parental attitude towards PA and social capital were associated with more outside play, while parental concern and restriction of screen time were related with less outside play. We found two significant interactions; both involving parent perceived responsibility towards child PA participation. Conclusion: Although we found a limited number of interactions, this study demonstrated that the impact of the perceived physical environment may differ across levels of parent responsibility.
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Introduction: In March 2014, the New South Wales (NSW) Government (Australia) announced the NSW Integrated Care Strategy. In response, a family-centred, population-based, integrated care initiative for vulnerable families and their children in Sydney, Australia was developed. The initiative was called Healthy Homes and Neighbourhoods. A realist translational social epidemiology programme of research and collaborative design is at the foundation of its evaluation. Theory and Method: The UK Medical Research Council (MRC) Framework for evaluating complex health interventions was adapted. This has four components, namely 1) development, 2) feasibility/piloting, 3) evaluation and 4) implementation. We adapted the Framework to include: critical realist, theory driven, and continuous improvement approaches. The modified Framework underpins this research and evaluation protocol for Healthy Homes and Neighbourhoods. Discussion: The NSW Health Monitoring and Evaluation Framework did not make provisions for assessment of the programme layers of context, or the effect of programme mechanism at each level. We therefore developed a multilevel approach that uses mixed-method research to examine not only outcomes, but also what is working for whom and why.
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While traditional crime rates are decreasing, cybercrime is on the rise. As a result, the criminal justice system is increasingly dealing with criminals committing cyber-dependent crimes. However, to date there are no effective interventions to prevent recidivism in this type of offenders. Dutch authorities have developed an intervention program, called Hack_Right. Hack_Right is an alternative criminal justice program for young first-offenders of cyber-dependent crimes. In order to prevent recidivism, this program places participants in organizations where they are taught about ethical hacking, complete (technical) assignments and reflect on their offense. In this study, we have evaluated the Hack_Right program and the pilot interventions carried out thus far. By examining the program theory (program evaluation) and implementation of the intervention (process evaluation), the study adds to the scarce literature about cybercrime interventions. During the study, two qualitative research methods have been applied: 1) document analysis and 2) interviews with intervention developers, imposers, implementers and participants. In addition to the observation that the scientific basis for linking specific criminogenic factors to cybercriminals is still fragile, the article concludes that the theoretical base and program integrity of Hack_Right need to be further developed in order to adhere to principles of effective interventions.
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Background: Quality Improvement (QI) is the key for every healthcare organization. QI programs may help healthcare professionals to develop the needed skills for interprofessional collaboration through interprofessional education. Furthermore, the role of diversity in QI teams is not yet fully understood. This evaluation study aimed to obtain in-depth insights into the expectations and experiences of different stakeholders of a hospital-wide interprofessional QI program. Methods: This qualitative study builds upon 20 semi-structured interviews with participants and two focus groups with the coaches and program advisory board members of this QI program. Data were coded and analyzed using thematic analysis. Results: Three themes emerged from the analysis: “interprofessional education”, “networking” and “motivation: presence with pitfalls”. Working within interprofessional project groups was valuable, because participants with different experiences and skills helped to move the QI project forward. It was simultaneously challenging because IPE was new and revealed problems with hierarchy, communication and planning. Networking was also deemed valuable, but a shared space to keep in contact after finalizing the program was missing. The participants were highly motivated to finish their QI project, but they underestimated the challenges. Conclusions: A hospital-wide QI program must explicitly pay attention to interprofessional collaboration and networking. Leaders of the QI program must cherish the motivation of the participants and make sure that the QI projects are realistic.
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As most Universities around the world the Amsterdam University of Applied Sciences conduct surveys (student evaluation monitor: STEM) among their students to evaluate the different courses and their teachers. At the Department of Media, Information and Communication the response by students tend to decline in the course of the year. In 2011-2012 with a limited enrolment of 900 first year students, 70% responded to the first survey conducted after the first exams in October and dropped to 26% in the last survey at the end of the first year (July 2012). In 2012-2013 (with the same amount of students) the response was respectively 75% and 30%. This might be due to several factors, such as the length of the questionnaire, the way the survey is spread (via e-mail to the students University account), the time of spreading the surveys (after the courses and exams) or simple due to lack of interest. Another problem of the surveys is found in the quest to limit the length of the questionnaires. Hereby, some relevant aspects to apprehend the success of students (or the return of the department) and the quality of the courses and teachers aren’t measured, such as: coherence between the courses, the students opinion about the form of education and exams, the connection between the evaluation and the exam results or other influential factors of student’s success. Given these difficulties and the fact that insight in all of the above mentioned aspects are crucial for both students and teachers and not in the least for the management, a new approach for evaluating is needed. An evaluating system that can uncover crucial information, for example to pinpoint the characteristics of dropout or long-term students in order to limit these, and/or improve the education/course. This paper will describe a pilot study wherein a first step towards a new way of evaluating is taken by separating the course- and teacher evaluation from the rest of the surveys by using an app/QR or website. Furthermore, the literature about in- or outside class surveys and student success will serve as a theoretical base for the discussion this pilot and is part of a broader PhD research.
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Explainable Artificial Intelligence (XAI) aims to provide insights into the inner workings and the outputs of AI systems. Recently, there’s been growing recognition that explainability is inherently human-centric, tied to how people perceive explanations. Despite this, there is no consensus in the research community on whether user evaluation is crucial in XAI, and if so, what exactly needs to be evaluated and how. This systematic literature review addresses this gap by providing a detailed overview of the current state of affairs in human-centered XAI evaluation. We reviewed 73 papers across various domains where XAI was evaluated with users. These studies assessed what makes an explanation “good” from a user’s perspective, i.e., what makes an explanation meaningful to a user of an AI system. We identified 30 components of meaningful explanations that were evaluated in the reviewed papers and categorized them into a taxonomy of human-centered XAI evaluation, based on: (a) the contextualized quality of the explanation, (b) the contribution of the explanation to human-AI interaction, and (c) the contribution of the explanation to human- AI performance. Our analysis also revealed a lack of standardization in the methodologies applied in XAI user studies, with only 19 of the 73 papers applying an evaluation framework used by at least one other study in the sample. These inconsistencies hinder cross-study comparisons and broader insights. Our findings contribute to understanding what makes explanations meaningful to users and how to measure this, guiding the XAI community toward a more unified approach in human-centered explainability.
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Background: The environment affects children’s energy balance-related behaviors to a considerable extent. A context-based physical activity and nutrition school- and family-based intervention, named KEIGAAF, is being implemented in low socio-economic neighborhoods in Eindhoven, The Netherlands. The aim of this study was to investigate: 1) the effectiveness of the KEIGAAF intervention on BMI z-score, waist circumference, physical activity, sedentary behavior, nutrition behavior, and physical fitness of primary school children, and 2) the process related to the implementation of the intervention. Methods: A quasi-experimental, controlled study with eight intervention schools and three control schools was conducted. The KEIGAAF intervention consists of a combined top-down and bottom-up school intervention: a steering committee developed the general KEIGAAF principles (top-down), and in accordance with these principles, KEIGAAF working groups subsequently develop and implement the intervention in their local context (bottom-up). Parents are also invited to participate in a family-based parenting program, i.e., Triple P Lifestyle. Children aged 7 to 10 years old (grades 4 to 6 in the Netherlands) are included in the study. Effect evaluation data is collected at baseline, after one year, and after two years by using a child questionnaire, accelerometers, anthropometry, a physical fitness test, and a parent questionnaire. A mixed methods approach is applied for the process evaluation: quantitative (checklists, questionnaires) and qualitative methods (observations, interviews) are used. To analyze intervention effectiveness, multilevel regression analyses will be conducted. Content analyses will be conducted on the qualitative process data. Discussion: Two important environmental settings, the school environment and the family environment, are simultaneously targeted in the KEIGAAF intervention. The combined top-down and bottom-up approach is expected to make the intervention an effective and sustainable version of the Health Promoting Schools framework. An elaborate process evaluation will be conducted alongside an effect evaluation in which multiple data collection sources (both qualitative and quantitative) are used.
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