Background and aims: Malnutrition screening is a first step in the nutrition care process for hospitalized patients, to identify those at risk of malnutrition and associated worse outcome, preceding further assessment and intervention. Frequently used malnutrition screening tools including the Malnutrition Universal Screening Tool (MUST) mainly screen for characteristics of malnutrition, while the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) additionally includes risk factors for development of malnutrition, yielding a higher percentage of patients at risk. To investigate whether this translates into higher risk of worse outcome, we aimed to determine the predictive validity of MUST and PG-SGA SF for prolonged hospitalization >8 days, readmission, and mortality <6 months after hospital discharge.Methods: In this observational study, MUST was performed according to university hospital protocol. Additional screening using PG-SGA SF was performed within 24 h of hospital admission (high risk: MUST ≥ 2, PG_SGA SF ≥ 9). Associations of MUST and PG-SGA SF with outcomes were analyzed by logistic- and Cox PH-regression.Results: Of 430 patients analyzed (age 58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m2), MUST and PG-SGA SF identified 32 and 80 at high risk, respectively. One-hundred-eight patients had prolonged hospitalization, 109 were readmitted and 20 died. High risk by MUST was associated with mortality (HR = 3.9; 95% CI 1.3–12.2, P = 0.02), but not with other endpoints. High risk by PG-SGA SF was associated with prolonged hospitalization (OR = 2.5; 95% CI 1.3–5.0, P = 0.009), readmission (HR = 1.9; 95% CI 1.1–3.2, P = 0.03), and mortality (HR = 34.8; 95% CI 4.2–289.3, P = 0.001), independent of age, sex, hospital ward and previous hospitalization <6 months. In the 363/430 patients classified as low risk by MUST, high risk by PG-SGA SF was independently associated with higher risk of readmission (HR = 1.9; 95% CI 1.0–3.5, P = 0.04) and mortality (HR = 19.5; 95% CI 2.0–189.4, P = 0.01).Conclusions: Whereas high malnutrition risk by MUST was only associated with mortality, PG-SGA SF was associated with higher risk of prolonged hospitalization, readmission, and mortality. In patients considered as low risk by MUST, high malnutrition risk by PG-SGA SF was also predictive of worse outcome. Our findings support the use of PG-SGA SF in routine care to identify patients at risk of malnutrition and worse outcome, and enable proactive interventions.
Background: Dysphagia is potentially life‐threatening and highly prevalent in people with severe/profound intellectual and multiple disabilities (SPIMD). The “Signaleringslijst Verslikken” (SV) is a frequently used Dutch screening tool to detect dysphagia. The aim was to examine the convergent validity of the SV for people with SPIMD. Method: Direct support staff completed the SV, with speech and language therapists scoring a validated tool, the Dysphagia Disorders Survey (DDS), for 41 persons with SPIMD, aged ≥50 years. The results were compared for agreement using the McNemar's Test. Results: The proportion of agreement was 0.59 (95% CI 0.43–0.72). The SV did not detect dysphagia in 17 participants (44%) who were assessed as having dysphagia according to the DDS. The difference in proportion of detection of dysphagia between the two methods was significant (p < 0.0001). Conclusions: The results suggest that the convergent validity of the SV is insufficient: the SV is not sensitive for detecting dysphagia in people with SPIMD.
In a class or group of twenty children, - statistically - one child has a developmental language disorder (DLD). For children with DLD it is very difficult to keep up at school. The problems in the language also easily lead to miscommunication, which can cause behavioral problems. The timely recognition of a DLD is of great importance for early treatment. This way you can prevent or reduce problems at school, at home and in the children's leisure time. At the moment, children with DLD are not always identified early.Problems in language development can be identified early, for example at the age of two by child health workers. Parents, kindergarten teachers and elementary school teachers can also identify problems in children's language development. This requires a language screening instrument that can easily determine whether a child's language is 'at risk' or 'not at risk'. Early identification of language problems is important, but until today children are still missed. In this dissertation I present a new instrument for the identification of problems in the language development of children from one to six years old, the Early Language Scale (ELS). I also describe the development of the milestones in the language development of children, how good the current screening at the age of two at the health care office is and what parents think of this language screening. The ELS appears to detect DLD in young children well and can therefore make an important contribution to the detection of these problems at the primary health care.
Burgers kunnen met hun juridische vragen aankloppen bij Het Juridisch Loket. Maar wat als er achter hun vraag meerdere problemen schuilgaan, zoals schulden of psychische nood? Daar is de dienstverlening niet op ingericht. Dit onderzoek kijkt hoe mensen met multiproblematiek beter kunnen worden geholpen.Doel Het doel van dit onderzoeksproject is de dienstverlening van Het Juridisch Loket (HJL) aan hulpvragers met multiproblematiek te verbeteren door een multidisciplinaire aanpak. Deze nieuwe klantgerichte aanpak helpt om multiproblematiek op tijd te signaleren en waar nodig de klant door te verwijzen. Hulpvragers met multiproblematiek ervaren niet alleen problemen op het juridische vlak, maar ook psychische, financiële en/of fysieke problemen. De combinatie van problemen op verschillende vlakken maakt de hulpvraag van deze doelgroep complex. Resultaten De resultaten van het onderzoek worden gedeeld in publicaties, workshops en een slotconferentie. Ook worden ze opgenomen in de juridische opleidingen van Hogeschool Utrecht, zodat huidige én toekomstige juridische professionals ervan kunnen profiteren. Highlights Eerstelijns rechtshulp aan mensen met multiproblematiek – Publieksversie eindrapport Samenvatting project t.b.v. eindcongres. Veel aan hun hoofd: mensen met multiproblematiek in de eerstelijns rechtshulp Whiteboard animatie over multiproblematiek in de eerstelijns rechtshulp Blog 'Eerstelijns (rechts)hulp voor cliënten met multiproblematiek. Een wereld te winnen' Rechtshulp moet niet alleen juridisch zijn Artikel op socialevraagstukken.nl Voorkomen van multiproblematiek Factsheet voorkomen multiproblematiek in de eerstelijns rechtshulpverlening Screeningsinstrument Multiproblematiek herkennen Opname college multiproblematiek in de eerstelijns (rechts)hulpverlening Presentatie multiproblematiek in de eerstelijns (rechts)hulpverlening Ontwikkelwerkplaatsen In de werkplaatsen Arnhem en Dordrecht hebben professionals in de eerstelijns (rechts)hulp afspraken gemaakt over de warme doorverwijzing van klanten met multiproblematiek. Afspraken over de warme doorverwijzing Dordrecht Afspraken over de warme doorverwijzing Arnhem Wetenschappelijke publicaties Focus op cliënt behoeften – Een studie over eerstelijns rechtshulp in Nederland Artikel in de European Journal of Social Work Aanbevelingen uit de literatuur Aanbevelingen voor (rechts)hulp bij multiproblematiek Een overzicht van aanbevelingen uit de praktijkliteratuur. Prezi ‘Recht doen’ aan de cliënt met multiproblematiek - Adviezen uit de praktijkliteratuur. Een dynamisch online presentatietool gebaseerd op mindmappen (Prezi) waarin aanbevelingen uit de praktijkliteratuur worden toegelicht. ‘Recht doen’ aan de client met multiproblematiek – Workshop voor professionals Werkvormen waarmee de aanbevelingen uit de praktijkliteratuur kunnen worden overgebracht naar professionals op de werkvloer. Animatie ‘Recht doen’ aan de client met multiproblematiek - Adviezen uit de praktijkliteratuur. In onderstaande animatie wordt uitgelegd hoe op basis van adviezen uit de praktijkliteratuur recht kan worden gedaan aan cliënten met multiproblematiek. Looptijd 01 januari 2019 - 30 juni 2021 Aanpak Mixed-methods opzet: kwantitatieve (enquête onder cliënten) en kwalitatieve (diepte interviews met professionals en cliënten) data-analyse en actieonderzoek in twee lokale settings. Financiering Het onderzoek heeft een subsidie gekregen van SIA-RAAK.
CRISPR/Cas genome engineering unleashed a scientific revolution, but entails socio-ethical dilemmas as genetic changes might affect evolution and objections exist against genetically modified organisms. CRISPR-mediated epigenetic editing offers an alternative to reprogram gene functioning long-term, without changing the genetic sequence. Although preclinical studies indicate effective gene expression modulation, long-term effects are unpredictable. This limited understanding of epigenetics and transcription dynamics hampers straightforward applications and prevents full exploitation of epigenetic editing in biotechnological and health/medical applications.Epi-Guide-Edit will analyse existing and newly-generated screening data to predict long-term responsiveness to epigenetic editing (cancer cells, plant protoplasts). Robust rules to achieve long-term epigenetic reprogramming will be distilled based on i) responsiveness to various epigenetic effector domains targeting selected genes, ii) (epi)genetic/chromatin composition before/after editing, and iii) transcription dynamics. Sustained reprogramming will be examined in complex systems (2/3D fibroblast/immune/cancer co-cultures; tomato plants), providing insights for improving tumor/immune responses, skin care or crop breeding. The iterative optimisations of Epi-Guide-Edit rules to non-genetically reprogram eventually any gene of interest will enable exploitation of gene regulation in diverse biological models addressing major societal challenges.The optimally balanced consortium of (applied) universities, ethical and industrial experts facilitates timely socioeconomic impact. Specifically, the developed knowledge/tools will be shared with a wide-spectrum of students/teachers ensuring training of next-generation professionals. Epi-Guide-Edit will thus result in widely applicable effective epigenetic editing tools, whilst training next-generation scientists, and guiding public acceptance.
In the context of sustainability, the use of biocatalysis in organic synthesis is increasingly observed as an essential tool towards a modern and ‘green’ chemical industry. However, the lack of a diverse set of commercially available enzymes with a broad selectivity toward industrially-relevant substrates keeps hampering the widespread implementation of biocatalysis. Aminoverse B.V. aims to contribute to this challenge by developing enzymatic screening kits and identifying novel enzyme families with significant potential for biocatalysis. One of the most important, yet notoriously challenging reaction in organic synthesis is site-selective functionalization (e.g. hydroxylation) of inert C-H bonds. Interestingly, Fe(II)/α-ketoglutarate-dependent oxygenases (KGOs) have been found to perform C-H hydroxylation, as well as other oxyfunctionalization, spontaneously in nature. However, as KGOs are not commercially available, or even extensively studied in this context, their potential is not readily accessible to the chemical industry. This project aims to demonstrate the potential of KGOs in biocatalysis. In order to achieve this, the following challenges will be addressed: i) establishing an enzymatic screening methodology to study the activity and selectivity of recombinant KGOs towards industrially relevant substrates, ii) establishing analytical methods to characterize KGO-catalyzed substrate conversion and product formation. Eventually, the proof-of-principle demonstrated during this project will allow Aminoverse B.V. to develop a commercial biocatalysis kit comprised of KGO enzymes with a diverse activity profile, allowing their application in the sustainable production of either commodity, fine or speciality chemicals. The project consortium is composed of: i) Aminoverse B.V, a start-up company dedicated to facilitate chemical partners towards implementing biocatalysis in their chemical processes, and ii) Zuyd University, which will link Aminoverse B.V. with students and (bio)chemical professionals in creating a novel collaboration which will not only stimulate the development of (bio)chemical students, but also the translation of academic knowledge on KGOs towards a feasible biocatalytic application.
