The central goal of this study is to clarify to what degree former education and students' personal characteristics (the 'Big Five personality characteristics', personal orientations on learning and students' study approach) may predict study outcome (required credits and study continuance). Analysis of the data gathered through questionnaires of 1,471 Universities of Applied Sciences students make clear that former Education did not come forth as a powerful predictor for Credits or Study Continuance. Significant predictors are Conscientiousness and Ambivalence and Lack of Regulation. The higher the scores on Conscientiousness the more credits students are bound to obtain and the more likely they will continue their education. On the other hand students with high scores on Ambivalence and Lack of Regulation will most likely obtain fewer Credits or drop out more easily. The question arises what these results mean for the present knowledge economy which demands an increase of inhabitants with an advanced level of education. Finally, implications and recommendations for future research are suggested.
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Studies evaluating the effects of power training in older adults use a variety of measurement tools and outcome parameters, limiting comparability of results and calling the validity of conclusions into question. This study aimed to identify a core outcome set (COS) to measure the effects of power training in older adults, encompassing the function, activities, and participation domain of the International Classification of Functioning, Disease, and Health (ICF). Twenty-one tests were evaluated based on their ability to measure muscle power and the effects of power training. Our methodology consisted of two Delphi survey rounds and an expert panel meeting using modified Nominal Group Technique. The COS consisted of tests considered most feasible for clinical practice and least burdensome for older adults. The COS included the Squat Jump Test (paired with accelerometery-based instrumentation) and the Timed Up-and-Go Test for the function and function and activities domain, respectively. No test was identified for the participation domain, however, experts proposed using daily-life accelerometery until more suitable outcome measures are defined and validated. This study addresses a critical research gap in standardised assessment protocols, and contributes to a multifaceted approach to measuring the impact of power training in older adults.
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Aim and method: To examine in obese people the potential effectiveness of a six-week, two times weekly aquajogging program on body composition, fitness, health-related quality of life and exercise beliefs. Fifteen otherwise healthy obese persons participated in a pilot study. Results: Total fat mass and waist circumference decreased 1.4 kg (p = .03) and 3.1 cm (p = .005) respectively. The distance in the Six-Minute Walk Test increased 41 meters (p = .001). Three scales of the Impact of Weight on Quality of Life-Lite questionnaire improved: physical function (p = .008), self-esteem (p = .004), and public distress (p = .04). Increased perceived exercise benefits (p = .02) and decreased embarrassment (p = .03) were observed. Conclusions: Aquajogging was associated with reduced body fat and waist circumference, and improved aerobic fitness and quality of life. These findings suggest the usefulness of conducting a randomized controlled trial with long-term outcome assessments.
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Interdisciplinary multimodal pain therapy (IMPT) is a biopsychosocial treatment approach for patients with chronic pain that comprises at least psychological and physiotherapeutic interventions. Core outcome sets (COSs) are currently developed in different medical fields to standardize and improve the selection of outcome domains, and measurement instruments in clinical trials, to make trial results meaningful, to pool trial results, and to allow indirect comparison between interventions. The objective of this study was to develop a COS of patient-relevant outcome domains for chronic pain in IMPT clinical trials. An international, multiprofessional panel (patient representatives [n = 5], physicians specialized in pain medicine [n = 5], physiotherapists [n = 5], clinical psychologists [n = 5], and methodological researchers [n = 5]) was recruited for a 3-stage consensus study, which consisted of a mixed-method approach comprising an exploratory systematic review, a preparing online survey to identify important outcome domains, a face-to-face consensus meeting to agree on COS domains, and a second online survey (Delphi) establishing agreement on definitions for the domains included. The panel agreed on the following 8 domains to be included into the COS for IMPT: pain intensity, pain frequency, physical activity, emotional wellbeing, satisfaction with social roles and activities, productivity (paid and unpaid, at home and at work, inclusive presentism and absenteeism), health-related quality of life, and patient's perception of treatment goal achievement. The complexity of chronic pain in a biopsychosocial context is reflected in the current recommendation and includes physical, mental, and social outcomes. In a subsequent step, measurement instruments will be identified via systematic reviews.
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Background: Clinicians are currently challenged to support older adults to maintain a certain level of Functional Independence (FI). FI is defined as "functioning physically safely and independent from another person, within one's own context". A Core Outcome Set was developed to measure FI. The purpose of this study was to assess discriminative validity of the Core Outcome Set FI (COSFI) in a population of Dutch older adults (≥ 65 years) with different levels of FI. Secondary objective was to assess to what extent the underlying domains 'coping', 'empowerment' and 'health literacy' contribute to the COSFI in addition to the domain 'physical capacity'. Methods: A population of 200 community-dwelling older adults and older adults living in residential care facilities were evaluated by the COSFI. The COSFI contains measurements on the four domains of FI: physical capacity, coping, empowerment and health literacy. In line with the COSMIN Study Design checklist for Patient-reported outcome measurement instruments, predefined hypotheses regarding prediction accuracy and differences between three subgroups of FI were tested. Testing included ordinal logistic regression analysis, with main outcome prediction accuracy of the COSFI on a proxy indicator for FI. Results: Overall, the prediction accuracy of the COSFI was 68%. For older adults living at home and depending on help in (i)ADL, prediction accuracy was 58%. 60% of the preset hypotheses were confirmed. Only physical capacity measured with Short Physical Performance Battery was significantly associated with group membership. Adding health literacy with coping or empowerment to a model with physical capacity improved the model significantly (p < 0.01). Conclusions: The current composition of the COSFI, did not yet meet the COSMIN criteria for discriminative validity. However, with some adjustments, the COSFI potentially becomes a valuable instrument for clinical practice. Context-related factors, like the presence of a spouse, also may be a determining factor in this population. It is recommended to include context-related factors in further research on determining FI in subgroups of older people.
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Self-efficacy and outcome expectations regarding client activation determine professionals’ level of actively engaging clients during daily activities. The Client Activation Self-Efficacy and Outcome Expectation Scales for nurses and domestic support workers (DSWs) were developed to measure these concepts. This study aimed to assess their psychometric properties. Cross-sectional data from a sample of Dutch nurses (n=150) and DSWs (n=155) were analysed. Descriptive statistics were used to examine floor and ceiling effects. Construct validity was assessed by testing research-based hypotheses. Internal consistency was determined with Cronbach’s alpha. The scales for nurses showed a ceiling effect. There were no floor or ceiling effects in the scales for domestic support workers. Three out of five hypotheses could be confirmed (construct validity). For all scales, Cronbach’s alpha coefficients exceeded 0.70. In conclusion, all scales had moderate construct validity and high internal consistency. Further research is needed concerning their construct validity, testretest reliability and sensitivity to change.
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When planning a study measuring the effects of a neurodevelopmental treatment (NDT), we were confronted with the methodological problem that while measuring the effects of NDT, a rival hypothesis is that the decision to implement the NDT might be related to the quality of nursing care. Therefore, we measured the quality of nursing care as a possible confounding variable in relation to this outcome study. The quality of nursing care was measured on 12 wards participating in the experimental and control groups of the outcome study. Data were collected from 125 patients and 71 nurses and patients' records. The findings showed no significant differences in the quality of nursing care between the 2 groups of wards (P = .49). This method may be useful to other researchers conducting outcome research and who are confronted with a similar methodological problem.
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Background: Multimodal prehabilitation programs are effective at reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital.Methods: In this observational cohort study with multiple case analyses, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting the criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise modalities and three nutrition modalities. Implementation fidelity was investigated by evaluating: (1) coverage (participation rate), (2) duration (number of days between the start of prehabilitation and surgery), (3) content (delivery of prescribed intervention modalities), and (4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence.Results: Fifty-eight patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33-84 days). Adherence was high (84-100%) in five and moderate (72-73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled to execute the prehabilitation program due to multiple physical and cognitive impairments.Conclusion: Implementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness.
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Background: Adverse outcome pathway (AOP) networks are versatile tools in toxicology and risk assessment that capture and visualize mechanisms driving toxicity originating from various data sources. They share a common structure consisting of a set of molecular initiating events and key events, connected by key event relationships, leading to the actual adverse outcome. AOP networks are to be considered living documents that should be frequently updated by feeding in new data. Such iterative optimization exercises are typically done manually, which not only is a time-consuming effort, but also bears the risk of overlooking critical data. The present study introduces a novel approach for AOP network optimization of a previously published AOP network on chemical-induced cholestasis using artificial intelligence to facilitate automated data collection followed by subsequent quantitative confidence assessment of molecular initiating events, key events, and key event relationships. Methods: Artificial intelligence-assisted data collection was performed by means of the free web platform Sysrev. Confidence levels of the tailored Bradford-Hill criteria were quantified for the purpose of weight-of-evidence assessment of the optimized AOP network. Scores were calculated for biological plausibility, empirical evidence, and essentiality, and were integrated into a total key event relationship confidence value. The optimized AOP network was visualized using Cytoscape with the node size representing the incidence of the key event and the edge size indicating the total confidence in the key event relationship. Results: This resulted in the identification of 38 and 135 unique key events and key event relationships, respectively. Transporter changes was the key event with the highest incidence, and formed the most confident key event relationship with the adverse outcome, cholestasis. Other important key events present in the AOP network include: nuclear receptor changes, intracellular bile acid accumulation, bile acid synthesis changes, oxidative stress, inflammation and apoptosis. Conclusions: This process led to the creation of an extensively informative AOP network focused on chemical-induced cholestasis. This optimized AOP network may serve as a mechanistic compass for the development of a battery of in vitro assays to reliably predict chemical-induced cholestatic injury.
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Students' educational careers in Higher Education: a search into key factors regarding study outcome One of the political goals of the EU is to develop 'the most competitive knowledge-based economy in the world by 2010'. The Dutch knowledge economy faces an increased demand for highly-educated inhabitants, and more graduates from Higher Education are needed. Dutch Universities of Applied Sciences have experienced a considerable growth in enrolment, resulting into a mixed variety of students. Former education of the students forms one of the sources of this heterogeneity. More students enter HE and the number of dropouts has increased proportionally. The increasing amount of dropouts counteracts the desire and the potential of HE to increase the volume of graduates. This study describes a search into students' key factors regarding study outcome in the first year of a study in Higher Education in the Netherlands. The aim of the study is to gain deeper insight into the relations between students' personal characteristics and study outcome. It is deeper insight in these relations which is a necessary condition to enhance study outcome, in order to support students at risk and prevent dropout more successfully. This is considered to be important because dropout has considerably economic and psychological consequences for the individual student, as well as on the institutional level and societal level. In general, we define dropout as 'ending the study before obtaining a degree'. In this study dropouts are defined as 'all students who start a study within a University of Applied Sciences and end the study within the first 14 months after enrolment'. In order to determine key factors predicting study outcome, the present study started from a working model. This model is based on a learning psychological point of view with regard to the individual learner. Three concepts were taken as central variables: (1) biographical aspects, being former education: i.e. students with a Senior General Secondary Education-background (SGSE) or a Senior Secondary Vocational Education-background (SVSE), and gender, (2) personality characteristics, and (3) learning patterns, being personal orientations on learning and study approaches. Furthermore, students' personal reasons to continue or drop out were investigated as well as how these reasons were related to the students' study approach. The main research questions in this study are: 1. What is the influence of personality characteristics on personal orientations on learning which, in turn, influence study approaches and are there any differences between students when entering Higher Education with regard to former education (Senior General Secondary Education and Senior Secondary Vocational Education)? 2. To what degree do former education and students' personal characteristics (the 'Big Five personality characteristics', personal orientations on learning and students' study approach) predict study outcome? 3. Are there any differences between students who continue and students who drop out from the educational system within one year with regard to their study approaches, their personal reasons and the relations between these two? These research questions were answered with three different studies, each addressing one of the main questions. In chapter 2, the first research question is answered by a survey study using two questionnaires. The first questionnaire was Vermunt's learning style inventory for Higher Education. This questionnaire investigates learning conceptions, motivational orientations, regulation strategies and cognitive processing activities. For the assessment of personality characteristics the Dutch version of the Five-Factor Personality Inventory was used. This questionnaire measures five aspects of personality: extraversion, agreeableness, conscientiousness, emotional stability and autonomy. Participants were 2.284 full-time first-year students entering a Dutch university of applied sciences. The questionnaires were administered in the fifth study week. Cohen's effect size d, principal component analyses and structural equation analyses with backward elimination procedures were used to obtain results. The main findings of the study were that at the level of personality characteristics, SSVE-students were found to be significantly more autonomous and conscientious than SGSE-students. In general, all five personality characteristics (extraversion, agreeableness, conscientiousness, emotional stability and autonomy) influenced students' personal orientations on learning. Personality characteristics also influenced study approach directly. This happened for all participating students, regardless their former education. The study revealed three personal orientations on learning: 1) constructive self-regulation, (2) reproductive external regulation and (3) ambivalence and lack of regulation. SGSE-students showed significantly lower preferences on all three personal orientations on learning than SSVE-students did. Furthermore, two types of study approaches were revealed: (1) meaningful integrative approach and (2) superficial approach. SGSE-students tended to report a more superficial approach than SSVE-students did. No difference between both groups of students was found regarding the meaningful integrative approach. Personal orientations on learning were strong predictors for study approach with the exception of ambivalence and lack of regulation, which had no predictive value for a superficial approach. Finally, the causal relations between the concepts of the working model appeared to be identical for SGSE-students and SSVE-students with regard to the strength as well as to the direction of the relations. The concepts appeared to be 'general', regardless of students' former education. To answer the second research question, we report in chapter three on a study that investigated the possible predictive value of former education and students' personality characteristics, personal orientations on learning and students' study approach regarding study outcome (system of credits and study continuance). The two questionnaires of the first study were used and the data were extended with the students' amount of obtained credits and their status. Logistic regression analyses of the gathered data of 1.471 students are performed in order to answer the research questions. The main findings of the study showed that differences in former education (i.e. students originating from SSGE or SSVE) did not seem to be a predictor for study outcome. Gender, however, seemed to be of influence: female students obtained more credits and continued their studies more often than their male counterparts did. This applied to female students both from SSGE and from SSVE. With regard to personality characteristics, conscientiousness turned out to be a significant predictor for study outcome: being more conscientious was beneficial with regard to study outcome. With regard to students' personal orientations on learning, ambivalence and lack of regulation seemed to matter: students with high scores on this orientation obtained fewer credits and dropped out more often. Finally, the two different types of study approaches, meaningful integrative approach and superficial approach, showed no significant influence on study outcome. In chapter four we report on a study that answers the third research question. The central goal of this study was to gain insight into students' study approach, their personal reasons and the relations between these two for students who continue or drop out from the educational system within one year. Vermunts' questionnaire of the first study was used and the data was extended with the students' status. In order to gain insight into students' personal reasons, two retrospective questionnaires with items considering reasons to drop out and reasons to continue, were constructed. A Principal Component Analysis was carried out to investigate the construct validity of the factors. Cronbach's alpha (α) was used considering the reliability of the factors. The main findings of the study were that significant differences existed between students who dropped out and those who continued with regard to their study approach. Students who continued, scored significantly higher on the meaningful integrative approaches when entering UAS. Students' personal reasons to drop out or to continue their study were threefold. Principal Component Analysis revealed three reliable main factors, as reasons for leaving education or staying in the educational program. The three main reasons were identical for dropouts and for students who continued, but these reasons corresponded in the opposite direction. These reasons were: (1) students' views on their future occupations, (2) pragmatic and personal matters, and (3) students' perceptions and experiences with issues related to education, organization and the learning environment. Regarding the relation between study approach and these three reasons, differences between students who dropped out and continuing students existed. Furthermore, relations between the reasons differed with regard to both groups studied. Chapter five presents the conclusion and discussion of this dissertation. Regarding the first main research question the main conclusions are that the findings reported in this dissertation confirm that personality characteristics influence personal orientations on learning which, in turn, influence study approach. Furthermore, personality characteristics influence study approach directly. This conclusion is valid for SGSE-students as well as for SSVE-students: the fit of the working model applied to both SGSE-students and SSVE-students for strength and direction of the relations. Next, there are differences between students with regard to former education with respect to personality characteristics and learning patterns, personal orientations on learning and study approach when entering UAS. Regarding the second research question the main conclusions are that gender, conscientiousness and the personal orientation on learning ambivalence and lack of regulation are the three key factors predicting study outcome. Contrary to the expectations, former education turns out to be not a key factor predicting study outcome. Regarding the third research question the main conclusions are that differences exist between dropouts and continuing students with regard to their study approach when entering UAS: continuing students score higher on the meaningful integrative approach. Secondly, both groups of students, i.e. the dropouts and the students who continue their education, show the same three reasons to drop out or to continue their studies in the opposite direction. Finally, there are statistical differences between students who drop out and students who continue with regard to the correlations between their study approach and these reasons. Although meaningful differences between SGSE and SSVE-students were found, and the expected relations between aspects within the working model were significant, much of the variance was left unexplained. Therefore, the working model might need further adaptation in order to increase its predictive value. Three main suggestions for an adapted model are made. Firstly, other learning psychological aspects should be added, in order to increase the predictive value of the model and in order to gain more insight in student-related characteristics predicting study outcome. Possible examples are goal orientations and motivation in terms of expectancy. Secondly, to the suggested addition of these two psychological, student-related aspects, we suggest integrating students' reasons to continue or drop out into the adapted model once more. Thirdly, the dominant psychological point of view in this study might be broadened in order to gain more insight into characteristics explaining and predicting study outcome. Approximately 20% of the variance of declaring study outcome occur at the level of the learning environment. Aspects such as teacher quality, the curriculum and forms of assessment have shown to have an effect on study outcome. An adapted model could consist of: (1) biographical aspects: former education and gender, (2) psychological aspects: personality characteristics, learning patterns, goal orientations and expectancy motivation, (3) learning environmental aspects: teacher quality, assessment and curriculum, (4) students' reasons to continue or drop out, and (5) study outcome. The limitations of the study were that it was limited to enrolling students at one study year (cohort) of one particular UAS. After all, a longitudinal design is believed to be a better option in the future. Furthermore, besides a longitudinal design, also different types of research methods could be used to gain more insight into the predictors of study outcome. A so-called mixed method approach (a combination of quantitative and qualitative research) might be useful, because a mixed method design is a good way to shed light upon the complex relationships between personal aspects, environmental aspects and study outcome. Finally, the representative of the setting of the present study is something that needs attention. From a social economic perspective, the Fontys UAS participants are mainly Dutch speaking indigenous students. It is possible that in some other specific parts of the Netherlands, with more ethnic diverse inhabitants, some differences in results might be found. Three suggestions for future research were made. Firstly, to replicate this study longitudinally: participants need to be followed for a period of at least two years or, preferably, during the completion of their entire study. Secondly, it was suggested to design a quasi-experimental study in order to assess the effects of intervention programs, which have the aim to support students during their study career. Thirdly, the need for designing case studies and studies with mixed method approaches in addition to the dominant survey research approach was underlined, because these approaches deepen insights into complex relations between the students, their learning environment and study outcome. Small-scale research regarding in-depth aspects of dropout and continuation, like the effect of interventions on a students' personal orientation on learning, might shed specific light upon predictive aspects of individual students, the underlying processes and the earlier mentioned reasons to drop out or continue. Finally, several implications for practice are presented in chapter five. When a potential student meets all the formal requirements, enrolment in UAS is possible. However, this does not guarantee a positive study outcome. Detecting and signalling students at risk at an early stage is a powerful way to reduce dropout. Although the development of intake assessments, specific interventions and obtaining separate profiles of students who are at risk on the one hand and successful students on the other hand has not been the focus of this study, our results may be a starting point for UAS for the design of an intake assessment program. These kind of implications can be implemented by student coaches in dialogue with lecturers and become embedded within an integral study career guidance program during at least the first year of study and should be 'student-centred'. This study clearly shows that study outcome cannot be described adequately as a problem caused by the students' individual characteristics alone (external attribution phenomenon), but it also comes to life by a complex interaction between students' psychological and environmental characteristics (for instance the third reason found: students' 'perception and experiences with issues related to education, organization and the learning environment'). Study outcome should be of interest and of concern, to all parties involved, students, lecturers and study career coaches, including the management of institutes and society. The results of our study underline the necessity to gain more insights into the causes of the phenomenon of dropout in order to reduce dropout and enhance study outcome of UAS-students.
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