Background: Early identification of older cardiac patients at high risk of readmission or mortality facilitates targeted deployment of preventive interventions. In the Netherlands, the frailty tool of the Dutch Safety Management System (DSMS-tool) consists of (the risk of) delirium, falling, functional impairment, and malnutrition and is currently used in all older hospitalised patients. However, its predictive performance in older cardiac patients is unknown. Aim: To estimate the performance of the DSMS-tool alone and combined with other predictors in predicting hospital readmission or mortality within 6 months in acutely hospitalised older cardiac patients. Methods: An individual patient data meta-analysis was performed on 529 acutely hospitalised cardiac patients ≥70 years from four prospective cohorts. Missing values for predictor and outcome variables were multiply imputed. We explored discrimination and calibration of: (1) the DSMS-tool alone; (2) the four components of the DSMS-tool and adding easily obtainable clinical predictors; (3) the four components of the DSMS-tool and more difficult to obtain predictors. Predictors in model 2 and 3 were selected using backward selection using a threshold of p = 0.157. We used shrunk c-statistics, calibration plots, regression slopes and Hosmer-Lemeshow p-values (PHL) to describe predictive performance in terms of discrimination and calibration. Results: The population mean age was 82 years, 52% were males and 51% were admitted for heart failure. DSMS-tool was positive in 45% for delirium, 41% for falling, 37% for functional impairments and 29% for malnutrition. The incidence of hospital readmission or mortality gradually increased from 37 to 60% with increasing DSMS scores. Overall, the DSMS-tool discriminated limited (c-statistic 0.61, 95% 0.56-0.66). The final model included the DSMS-tool, diagnosis at admission and Charlson Comorbidity Index and had a c-statistic of 0.69 (95% 0.63-0.73; PHL was 0.658). Discussion: The DSMS-tool alone has limited capacity to accurately estimate the risk of readmission or mortality in hospitalised older cardiac patients. Adding disease-specific risk factor information to the DSMS-tool resulted in a moderately performing model. To optimise the early identification of older hospitalised cardiac patients at high risk, the combination of geriatric and disease-specific predictors should be further explored.
Background: Patient involvement in interprofessional education (IPE) is a new approach in fostering person-centeredness and collaborative competencies in undergraduate students. We developed the Patient As a Person (PAP-)module to facilitate students in learning from experts by experience (EBEs) living with chronic conditions, in an interprofessional setting. This study aimed to explore the experiences of undergraduate students, EBEs and facilitators with the PAP-module and formulate recommendations on the design and organization of patient involvement in IPE. Methods: We collected data from students, EBEs and facilitators, through eight semi-structured focus group interviews and two individual interviews (N = 51). The interviews took place at Maastricht University, Zuyd University of Applied Sciences and Regional Training Center Leeuwenborgh. Conventional content analysis revealed key themes. Results: Students reported that learning from EBEs in an interprofessional setting yielded a more comprehensive approach and made them empathize with EBEs. Facilitators found it challenging to address multiple demands from students from different backgrounds and diverse EBEs. EBEs were motivated to improve the personcentredness of health care and welcomed a renewed sense of purpose. Conclusions: This study yielded six recommendations: (a) students from various disciplines visit an EBE to foster a comprehensive approach, (b) groups of at least two students visit EBEs, (c) students may need aftercare for which facilitators should be receptive, (d) EBEs need clear instruction on their roles, (e) multiple EBEs in one session create diversity in perspectives and (f) training programmes and peer-to-peer sessions for facilitators help them to interact with diverse students and EBEs.
Background: To use advanced medical technologies (AMTs) correctly and safely requires both specialist knowledgeand skills, and an awareness of risks and how those can be minimized. Reporting safety concerns aboutAMTs in home care can contribute to an improved quality of care. The extent to which a health care organizationhas integrated the reporting, evaluation and learning from incidents is a key element of that organization’spatient safety culture.Objectives: To explore nurses’ experiences regarding the education followed in the use of AMTs in the homesetting, and their organizations’ systems of reporting.Design: Descriptive cross-sectional design.Methods: 209 home care nurses from across the Netherlands who worked with infusion therapy, parenteralnutrition and/or morphine pumps responded to the online questionnaire between July 2018 and February 2019.The analysis of the data was mainly descriptive.Results: Educational interventions that are most often used to learn how to use AMTs were, as an average over thethree AMTs, instruction by a nurse (71%), practical training in the required skills (71%) and acquiring informationto increase theoretical knowledge (69%). Considerable attention is paid to patient safety (88%) and thehome setting (89%). However, a substantial proportion of the nurses (up to 29%) use AMTs even though they hadnot been tested on their skills. 95% of the respondents were well acquainted with the incident reporting protocolof their organization, but only 49% received structural or regular feedback on any actions taken as a result ofevent reporting.Conclusions: This study revealed aspects of nurses’ education that imply risk factors for patient safety. Practicaltraining is not always given, additional or retraining is often voluntary, and the required skills are not alwaystested. However, the results show that nurses do have a good awareness of patient safety. Incidents are mainlydiscussed within the team, but less at the organizational level.
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The project aims to improve palliative care in China through the competence development of Chinese teachers, professionals, and students focusing on the horizontal priority of digital transformation.Palliative care (PC) has been recognised as a public health priority, and during recent years, has seen advances in several aspects. However, severe inequities in the access and availability of PC worldwide remain. Annually, approximately 56.8 million people need palliative care, where 25.7% of the care focuses on the last year of person’s life (Connor, 2020).China has set aims for reaching the health care standards of the developed countries by 2030 through the Healthy China Strategy 2030, where one of the improvement areas in health care includes palliative care, thus continuing the previous efforts.The project provides a constructive, holistic, and innovative set of actions aimed at resulting in lasting outcomes and continued development of palliative care education and services. Raising the awareness of all stakeholders on palliative care, including the public, is highly relevant and needed. Evidence based practice guidelines and education are urgently required for both general and specialised palliative care levels, to increase the competencies for health educators, professionals, and students. This is to improve the availability and quality of person-centered palliative care in China. Considering the aging population, increase in various chronic illnesses, the challenging care environment, and the moderate health care resources, competence development and the utilisation of digitalisation in palliative care are paramount in supporting the transition of experts into the palliative care practice environment.General objective of the project is to enhance the competences in palliative care in China through education and training to improve the quality of life for citizens. Project develops the competences of current and future health care professionals in China to transform the palliative care theory and practice to impact the target groups and the society in the long-term. As recognised by the European Association for Palliative Care (EAPC), palliative care competences need to be developed in collaboration. This includes shared willingness to learn from each other to improve the sought outcomes in palliative care (EAPC 2019). Since all individuals have a right to health care, project develops person-centered and culturally sensitive practices taking into consideration ethics and social norms. As concepts around palliative care can focus on physical, psychological, social, or spiritual related illnesses (WHO 2020), project develops innovative pedagogy focusing on evidence-based practice, communication, and competence development utilising digital methods and tools. Concepts of reflection, values and views are in the forefront to improve palliative care for the future. Important aspects in project development include health promotion, digital competences and digital health literacy skills of professionals, patients, and their caregivers. Project objective is tied to the principles of the European Commission’s (EU) Digital Decade that stresses the importance of placing people and their rights in the forefront of the digital transformation, while enhancing solidarity, inclusion, freedom of choice and participation. In addition, concepts of safety, security, empowerment, and the promotion of sustainable actions are valued. (European Commission: Digital targets for 2030).Through the existing collaboration, strategic focus areas of the partners, and the principles of the call, the PalcNet project consortium was formed by the following partners: JAMK University of Applied Sciences (JAMK ), Ramon Llull University (URL), Hanze University of Applied Sciences (HUAS), Beijing Union Medical College Hospital (PUMCH), Guangzhou Health Science College (GHSC), Beihua University (BHU), and Harbin Medical University (HMU). As project develops new knowledge, innovations and practice through capacity building, finalisation of the consortium considered partners development strategy regarding health care, (especially palliative care), ability to create long-term impact, including the focus on enhancing higher education according to the horizontal priority. In addition, partners’ expertise and geographical location was also considered important to facilitate long-term impact of the results.Primary target groups of the project include partner country’s (China) staff members, teachers, researchers, health care professionals and bachelor level students engaging in project implementation. Secondary target groups include those groups who will use the outputs and results and continue in further development in palliative care upon the lifetime of the project.
Organ-on-a-chip technology holds great promise to revolutionize pharmaceutical drug discovery and development which nowadays is a tremendously expensive and inefficient process. It will enable faster, cheaper, physiologically relevant, and more reliable (standardized) assays for biomedical science and drug testing. In particular, it is anticipated that organ-on-a-chip technology can substantially replace animal drug testing with using the by far better models of true human cells. Despite this great potential and progress in the field, the technology still lacks standardized protocols and robust chip devices, which are absolutely needed for this technology to bring the abovementioned potential to fruition. Of particular interest is heart-on-a-chip for drug and cardiotoxicity screening. There is presently no preclinical test system predicting the most important features of cardiac safety accurately and cost-effectively. The main goal of this project is to fabricate standardized, robust generic heart-on-a-chip demonstrator devices that will be validated and further optimized to generate new physiologically relevant models to study cardiotoxicity in vitro. To achieve this goal various aspects will be considered, including (i) the search for alternative chip materials to replace PDMS, (ii) inner chip surface modification and treatment (chemistry and topology), (iii) achieving 2D/3D cardiomyocyte (long term) cell culture and cellular alignment within the chip device, (iv) the possibility of integrating in-line sensors in the devices and, finally, (v) the overall chip design. The achieved standardized heart-on-a-chip technology will be adopted by pharmaceutical industry. This proposed project offers a unique opportunity for the Netherlands, and Twente in particular, which has relevant expertise, potential, and future perspective in this field as it hosts world-leading companies pioneering various core aspects of the technology that are relevant for organs-on-chips, combined with two world-leading research institutes within the University of Twente.
De toename van spoedeisende ambulancevragen legt een enorme druk op hbo-professionals in de ambulancezorg en de spoedzorgketen. Een op de vier ambulancezorgritten, die de meldkamer met spoedurgentie uitgeeft, resulteert in behandeling ter plaatse zonder vervoer naar de spoedeisende hulp (SEH). Behandeling ter plaatse kan plaats vinden op straat, in huis of overal waar de patiënt zich bevindt. Dit wordt in vaktermen ook wel ‘Eerste Hulp Geen Vervoer’ (EHGV) genoemd. EHGV-zorg leidt echter ook tot het hoogste percentage incidentmeldingen en calamiteiten, omdat patiënten met spoedeisende ingangsklachten achteraf soms toch een SEH-verwijzing en behandeling nodig hadden. In een aantal gevallen leidt EHGV-zorg zelfs tot ernstige schade of de dood. Ambulanceprofessionals voelen handelingsverlegenheid bij de risicotaxatie en besluitvorming ter plaatse zonder het vervoeren van de patiënt naar de SEH. Ze willen namelijk graag het juiste doen voor de patiënt, maar missen voor EHGV-zorg aanvullende competenties en handvatten. Niet voor niets staat EHGV op nummer één van de Landelijke Onderzoeksagenda Ambulancezorg 2014-2018. Ambulancezorgprofessionals hebben het lectoraat AIZ gevraagd hen te helpen om de risicotaxatie en besluitvorming bij patiënten met onwelwording en tijdelijk bewustzijnsverlies ter plaatse te verbeteren. Daarmee willen ze de patiëntveiligheid verhogen door onnodige verwijzing (en drukte) of vertraging in verwijzing naar de SEH te voorkomen. In dit project wordt ontwerpgericht onderzoek toegepast, waarbij we in vier fases toewerken naar de ontwikkeling van bruikbare evidence based criteria en passende innovatieve tools voor verbeterde risicotaxatie en besluitvorming voor EHGV-zorg. Het gaat daarbij bij om patiënten met klachten van onwelwording en tijdelijk bewustzijnsverlies. De HAN werkt samen met twee regionale ambulancevoorzieningen in Gelderland, V&VN Ambulancezorg en Ambulancezorg Nederland als consortiumpartners. Via het netwerk van Acute Zorgregio Oost en Zorgbelang Gelderland-Utrecht sluiten andere ketenpartners en patiëntvertegenwoordigers aan. Alle partners verspreiden ontwikkelde kennis en producten via hun netwerk.