The way that innovation is currently done requires a new research methodology that enables co-creation and frequent, iterative evaluation in realworld settings. This paper describes the employment of the living lab methodology that corresponds to this need. Particularly, this paper presents the way that the Amsterdam University of Applies Sciences (HvA) incorporates living labs in its educational program with a particular focus on ambient intelligence. A number of examples are given to illustrate its place in the university’s curriculum. Drawing on from this, problems and solutions are highlighted in a ‘lessons learned’ section.
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Background: An estimated 18 million people in the world have to cope with a decline in intellectual functioning that is not a normal part of the ageing process, called dementia. By 2025, this number is expected to reach 34 million. Alzheimer's disease accounts for 50-70 % of all cases of dementia. In the Netherlands, about two thirds of those affected live at home, with or without a partner. The increasing group of older adults with dementia presents great challenges in terms of creating suitable living environments and appropriate housing. Extramural housing needs further development, as opposed to intramural housing, such as nursery homes. The new extramural housing forms account for and compensate decreasing vitality and overall health status through the use of ICT and other technologies to serve human well-being. This should facilitate both residents and alleviate the intensity of care given by voluntary and professional care givers. In order to create these optimal dwellings at cost effective prices, evidence-based introduction of architectural measures and technological applications is essential. Existing knowledge is best viewed as an effort to expand and stimulate thinking on the relationships between dementia and design; thus, knowledge is largely a collection of hypotheses amenable to, and requiring, implementation and validation.This PhD-project will research some of the design aspects and needs, relevant to the technological home environment for older adults with dementia. This PhD project is shared with Hogeschool Utrecht, Lectureship of Demand Driven Care. Aim of research: Assessing thermal, lighting, and acoustic requirements, feasible home modifications and teleservices to sustain independence and well-being, both being the end product of all services rendered. Results so far indicate that requirements of older adults with dementia differ largely from the requirements of healthy older adults.
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Patients living at home who suffer from Korsakoff's syndrome (KS) need highly specialistic care from competent healthcare professionals who can bridge the gap between specialistic and generalistic care. Patients suffering from KS lack insight into their illness and often do not have any care demands for themselves. A voluntary admission is not at issue.However, they need professional care due to physical and mental deterioration and without help they will literally drink themselves to death. An involuntary admission is only possible when the criteria mentioned in the Dutch Compulsory Admission Act (BOPZ) are met. Generally, the presence of KS is insufficient to consider a mental disorder, which means that an involuntary admission will not be possible. The only possibility for this group will be extramural healthcare.In 2020 two new acts will replace the BOPZ. The Compulsory Mental Health Care Act (WvGGZ) and the Care and Compulsion Act (WZD). The WZD can be applied on patients suffering from Korsakoff's syndrome. Both acts offer the possibility to apply coercive home healthcare.Healthcare professionals working with patients suffering from KS note that they are missing experience, skills and information about working in an extramural setting. What competencies do they need to provide good care for people with KS? New challenges are created when the new legislation has to be applied. This research project investigates, firstly, what good extramural care is for patients suffering from KS. Secondly, what competencies extramural healthcare professionals need in order to provide care that increases the quality of life of people with KS, meet the needs of people with KS and their informal caregivers, and takes into account the human rights of these patients.
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Achtergrond: De Two-Minute Step Test (TMST) is een meetinstrument gericht op het beoordelen van uithoudingsvermogen. Verscheidene psychometrische eigenschappen van de TMST-NL (Nederlands vertaalde versie) zijn onderzocht bij intramuraal wonende ouderen. De gevoeligheid voor verandering en de responsiviteit is bij deze patiëntenpopulatie nog niet vastgesteld. Doel: Het vaststellen van de gevoeligheid voor verandering en de responsiviteit (Minimal Clinical Important Difference) van de TMST-NL bij intramuraal wonende ouderen. Design: Prospectief responsiviteitsonderzoek.Methode: De onderzoekspopulatie bestond uit intramuraal wonende ouderen. Deelnemers hebben twee meetmomenten (T0 en T1) ondergaan waartussen ze drie maanden fysiotherapie gericht op uithoudingsvermogen ontvingen. Om de gevoeligheid van verandering te meten werd de distributie methode gebruikt waarbij de correlatie met de 6-minuten wandeltest (6MWT) werd getoetst. Via de anker methode met de Receiver Operating Characteristic (ROC) curve werd de MCID bepaald.Metingen voor het aerobe uithoudingsvermogen werden verricht met de TMST-NL en de 6-minuten wandeltest (6MWT). De Global Rating of Change (GRC) en de Borg Category-Ratio10 (BORG-CR10) werden gebruikt als subjectieve vragenlijsten om verandering van de gezondheidssituatie en vermoeidheid te meten.Resultaten: Intramurale ouderen (N=50) met een gemiddelde (SD) leeftijd van 83,96 jaar (6,96) zijn geïncludeerd. De correlatie tussen de verschilscores van de TMST-NL en de 6MWT over de deelnemerspopulatie die T1 ook hebben afgerond (N= 36) kwam uit op r=0.51 (P <0.05). Vanuit de ROC curve werd een MCID van 8,50 stappen berekend. De AUC-waarde was 0,74 (95% CI 0,54-0,94; P =0.02). Conclusie: De TMST-NL is gevoelig voor verandering en responsief bij intramuraal wonende ouderen. Echter doordat de MCID binnen de minimale meetfout (MDC) valt moeten de resultaten voor individuele evaluatie bij deze doelgroep met voorzichtigheid worden geïnterpreteerd.
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The 'implementation' and use of smart home technology to lengthen independent living of non-instutionalized elderly have not always been flawless. The purpose of this study is to show that problems with smart home technology can be partially ascribed to differences in perception of the stakeholders involved. The perceptual worlds of caregivers, care receivers, and designers vary due to differences in background and experiences. To decrease the perceptual differences between the stakeholders, we propose an analysis of the expected and experienced effects of smart home technology for each group. For designers the effects will involve effective goals, caregivers are mainly interested in effects on workload and quality of care, while care receivers are influenced by usability effects. Making each stakeholder aware of the experienced and expected effects of the other stakeholders may broaden their perspectives and may lead to more successful implementations of smart home technology, and technology in general.
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Multiple organizations around the world have issued evidence-based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health-related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them.
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This study assesses the evolutionary leadership theory and the natural leadership instrument of Van Vugt and Ahuja (2011) in the context of youth elite football. The Evolutionary Leadership Theory is a comprehensive new way of looking at leadership that suggests environmental pressures influence the choice of who becomes the leader. The results revealed that the concept of natural leadership, as measured using the six natural leaders questionnaire, cannot be applied to the context of youth football. The preliminary data showed that natural leadership in youth sport requires a more basic framework of leadership consisting of communication, resources and focus on competition.
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Individuals with mild intellectual disabilities or borderline intellectual functioning are at increased risk to develop a substance use disorder—however, effective treatment programs adapted to this target group are scarce. This study evaluated the effectiveness of Take it Personal!+ in individuals with mild intellectual disabilities or borderline intellectual functioning and substance use disorder. Take it Personal!+ is a personalized treatment based on motivational interviewing and cognitive-behavioral therapy supported by an mHealth application. Data were collected in a nonconcurrent multiple baseline single-case experimental design across individuals with four phases (i.e., baseline, treatment, posttreatment, and follow-up). Twelve participants were randomly allocated to baseline lengths varying between 7 and 11 days. Substance use quantity was assessed during baseline, treatment, and posttreatment with a daily survey using a mobile application. Visual analysis was supported with statistical analysis of the daily surveys by calculating three effect size measures in 10 participants (two participants were excluded from this analysis due to a compliance rate below 50%). Secondary, substance use severity was assessed with standardized questionnaires at baseline, posttreatment, and follow-up and analyzed by calculating the Reliable Change Index. Based on visual analysis of the daily surveys, 10 out of 12 participants showed a decrease in mean substance use quantity from baseline to treatment and, if posttreatment data were available, to posttreatment. Statistical analysis showed an effect of Take it Personal!+ in terms of a decrease in daily substance use in 8 of 10 participants from baseline to treatment and if posttreatment data were available, also to posttreatment. In addition, data of the standardized questionnaires showed a decrease in substance use severity in 8 of 12 participants. These results support the effectiveness of Take it Personal!+ in decreasing substance use in individuals with mild intellectual disabilities or borderline intellectual functioning.
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Dit jaar presenteert het lectoraat Maatschappelijk Vastgoed voor het eerst de Barometer Zorgvastgoed met als thema (inter)nationale context. Deze internationale context is van belang omdat de trackrecord voor het investeren in zorgvastgoed in Nederland nog erg beperkt is. Door te reflecteren aan de hand van de internationale context kunnen we wellicht in Nederland leren van ervaringen van anderen. In de Barometer Maatschappelijk Vastgoed 2014 was al te zien dat er veel aandacht is voor zorgvastgoed (Veuger et al., 2014: 129-235). De Barometer Zorgvastgoed is hier dan ook een gevolg van en heeft een drietal relevante en actuele invalshoeken: ontwikkelingen in zorgvastgoed, waardering en financiering van zorgvastgoed en assetmanagement zorgvastgoed. Het belang van de internationalisering van de zorgvastgoed wordt onderschreven door de bijdragen in internationale context en bijdrage van internationale auteurs. Hoewel de ervaringen voor het investeren in zorgvastgoed in Nederland nu nog erg beperkt zijn, gebeurd er in de internationale context veel. Sinds 2012 zijn Nederlandse zorgorganisaties zelf verantwoordelijk voor hun eigen vastgoed. Daarom staat het investeren in zorglocaties in Nederland nog in de kinderschoenen. Maar in de ons omringende landen als het Verenigd Koninkrijk (UK), België en Duitsland is zorgvastgoed anders georganiseerd. Buitenlandse investeerders zien veel pluspunten als ze naar de Nederlandse zorgvastgoedmarkt kijken. Pluspunten zijn dat de Nederlandse instellingen tegen de economische trend in de solvabiliteit en het eigen vermogen groeien. Voor financiering van zorgvastgoed heeft de zorgsector maar een beperkte keuze van een aantal Nederlandse banken die ook met enige regelmaat consortia vormen bij forse investeringen. Private investeerders en institutionele beleggers hebben wel meer belangstelling voor zorgvastgoed maar zijn relatief nog onbekend met investeringen in zorgvastgoed in Nederland. Zorginstellingen nemen steeds vaker het initiatief om een creditrating aan te vragen, op zoek naar vreemd vermogen.
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Our study shows a steady increase in dementia- and DHT-related publications, particularly in areas such as mobile health, virtual reality, artificial intelligence, and sensor-based technologies interventions. This increase underscores the importance of systematic approaches and interdisciplinary collaborations, while identifying knowledge gaps, especially in lower-income regions. It is crucial that researchers worldwide adhere to evidence-based medicine principles to avoid duplication of efforts. This analysis offers a valuable foundation for policy makers and academics, emphasizing the need for an international collaborative task force to address knowledge gaps and advance dementia care globally.
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