Background: Post-term pregnancy, a pregnancy exceeding 294 days or 42 completed weeks, is associated with increased perinatal morbidity and mortality and is considered a high-risk condition which requires specialist surveillance and induction of labour. However, there is uncertainty on the policy concerning the timing of induction for post-term pregnancy or impending post-term pregnancy, leading to practice variation between caregivers. Previous studies on induction at or beyond 41 weeks versus expectant management showed different results on perinatal outcome though conclusions in meta-analyses show a preference for induction at 41 weeks. However, interpretation of the results is hampered by the limited sample size of most trials and the heterogeneity in design. Most control groups had a policy of awaiting spontaneous onset of labour that went far beyond 42 weeks, which does not reflect usual care in The Netherlands where induction of labour at 42 weeks is the regular policy. Thus leaving the question unanswered if induction at 41 weeks results in better perinatal outcomes than expectant management until 42 weeks. Methods/design: In this study we compare a policy of labour induction at 41 + 0/+1 weeks with a policy of expectant management until 42 weeks in obstetrical low risk women without contra-indications for expectant management until 42 weeks and a singleton pregnancy in cephalic position. We will perform a multicenter randomised controlled clinical trial. Our primary outcome will be a composite outcome of perinatal mortality and neonatal morbidity. Secondary outcomes will be maternal outcomes as mode of delivery (operative vaginal delivery and Caesarean section), need for analgesia and postpartum haemorrhage (≥1000 ml). Maternal preferences, satisfaction, wellbeing, pain and anxiety will be assessed alongside the trial. Discussion: his study will provide evidence for the management of pregnant women reaching a gestational age of 41 weeks.
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The main question in this PhD thesis is: How can Business Rules Management be configured and valued in organizations? A BRM problem space framework is proposed, existing of service systems, as a solution to the BRM problems. In total 94 vendor documents and approximately 32 hours of semi-structured interviews were analyzed. This analysis revealed nine individual service systems, in casu elicitation, design, verification, validation, deployment, execution, monitor, audit, and version. In the second part of this dissertation, BRM is positioned in relation to BPM (Business Process Management) by means of a literature study. An extension study was conducted: a qualitative study on a list of business rules formulated by a consulting organization based on the Committee of Sponsoring Organizations of the Treadway Commission risk framework. (from the summary of the Thesis p. 165)
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Background and aim ʹ Many countries signed the Paris Agreement to mitigate global average temperature rise. In this context, Dutch government decided to realize a reduction of 50% using resources and raw materials in 2030. This paper explores how practice-based research into facility operations can contribute to this aim. Methods / Methodology ʹ Practice-based research which includes direct observations, desk research, and participatory action research. Results ʹ This explorative research presents principles and suggestions for facility managers and procurement managers on how they can embed sustainable materials management in the organisation and how to take control of waste. The proposed suggestions are derived from practice-based research and presented as topics of attention for facility professionals. Originality ʹ Within education of Dutch universities of applied sciences and daily professional facility practices, the phenomenon of materials management is underexposed. To contribute to the national and international climate objectives, (future) facility professionals need better support to reduce waste. Bachelor students were involved throughout this research. This approach gave refreshing insights into waste at the end of the supply chain (control separation units) that can improve informed decisionmaking at the beginning of the supply chain. Practical or social implications ʹ Facility management professionals have an important role to play in the mitigation of global average temperature rise, because of their leading role in procurement, service operations, and materials management. However, they struggle to find sustainable solutions. This paper seeks to inspire professionals with interventions that have proven effectiveness on the reduction of waste. Type of paper ʹ Short research paper.
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