BACKGROUND: Urinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25-50%, and to evaluate the affecting factors of our de-implementation strategy.METHODS: In a multicenter, prospective interrupted time series analysis, several interventions to avoid inappropriate use of catheters will be conducted in seven hospitals in the Netherlands. Firstly, we will define a list of appropriate indications for urinary and (peripheral and central) intravenous catheters, which will restrict the use of catheters and urge catheter removal when the indication is no longer appropriate. Secondly, after the baseline measurements, the intervention will take place, which consists of a kick-off meeting, including a competitive feedback report of the baseline measurements, and education of healthcare workers and patients. Additional strategies based on the baseline data and local conditions are optional. The primary endpoint is the percentage of catheters with an inappropriate indication on the day of data collection before and after the de-implementation strategy. Secondary endpoints are catheter-related infections or other complications, catheter re-insertion rate, length of hospital (and ICU) stay and mortality. In addition, the cost-effectiveness of the de-implementation strategy will be calculated.DISCUSSION: This study aims to reduce the use of urinary and intravenous catheters with an inappropriate indication, and as a result reduce the catheter-related complications. If (cost-) effective it provides a tool for a nationwide approach to reduce catheter-related infections and other complications.TRIAL REGISTRATION: Dutch trial registry: NTR6015 . Registered 9 August 2016.
http://dx.doi.org/10.14261/postit/E878E1FB-39D2-4B34-AC3ABBEDA3DC35EFIn 2015 and 2016, Saxion University of Applied Sciences organized the 2nd and 3rd edition of the Regional Innovation and Entrepreneurship Conference (RIEC).Relatively peripheral border regions are often seen as less attractive for high qualified temporary migrant workers (expats). Usually these region offer less possibilities for highly skilled migrants to find suitable work, because of the clustering of these types of jobs in core regions. Companies in more peripheral regions are thought to be less open for international experience and international cooperation. To test this assumption, several interviews with expats about their personal experiences and future improvement suggestions were held in order to get an overview of how expats feel working and living in Twente, a region which is located in the Eastern part of The Netherlands
Background/Aims: This study examines the feasibility of a preoperative exercise program to improve the physical fitness of a patient before gastrointestinal surgery. Methods: An outpatient exercise program was developed to increase preoperative aerobic capacity, peripheral muscle endurance and respiratory muscle function in patients with pancreatic, liver, intestinal, gastric or esophageal cancer. During a consult at the outpatient clinic, patients were invited to participate in the exercise program when their surgery was not scheduled within 2 weeks. Results: The 115 participants followed on average 5.7 (3.5) training sessions. Adherence to the exercise program was high: 82% of the planned training sessions were attended, and no adverse events occurred. Mixed model analyses showed a significant increase of maximal inspiratory muscle strength (84.1-104.7 cm H2O; p = 0.00) and inspiratory muscle endurance (35.0-39.5 cm H2O; p = 0.00). No significant changes were found in aerobic capacity and peripheral muscle strength. Conclusion: This exercise program in patients awaiting oncological surgery is feasible in terms of participation and adherence. Inspiratory muscle function improved significantly as a result of inspiratory muscle training. The exercise program however failed to result in improved aerobic capacity and peripheral muscle strength, probably due to the limited number of training sessions as a result of the restricted time interval between screening and surgery.
Supermarkets are essential urban household amenities, providing daily products, and for their social role in communities. Contrary to many other countries, including nearby ones, the Netherlands have a balanced distribution of supermarkets across villages and urban neighbourhoods. However, spatial supermarket patterns, are subject to influential developments. First, due to economies of scale, there is a tendency for supermarkets to increase their catchment areas and to disappear from peripheral villages. Second, supermarkets are now mainly located in residential areas, although the urban periphery appears to be attractive for the retail sector, perhaps including the rise of hypermarkets. Third, today, online grocery shopping is still lagging far behind on other online shopping products, but a breaks through will dilute population support for in-store supermarkets and can lead to dramatic ‘game changer’ shifts with major spatial and social effects. These three important trends will reinforce each other. Consequences are of natural community meeting places at the expense of social cohesion; reduced accessibility for daily products, leading to more travel, often by car; increasing delivery flows; real estate vacancies, and increasing suburban demand increase for retail and logistics. Expected changes in supermarket patterns require understanding, but academic literature on OGS is still scarce, and does hardly address household behaviour in changing spatial constellations. We develop likely spatial supermarket patterns, and model the consequences for travel demand, social cohesion and real estate demand, as well as the distribution between online and in-store grocery shopping, by developing a stated preference experiment, among Dutch households.
