Het meten van de lichaamstemperatuur van patiënten is een basisvaardigheid van verpleegkundigen. Zij doen dit veelvuldig. Nauwkeurige meting van de lichaamstemperatuur is belangrijk voor de tijdige detectie van koorts of onderkoeling bij patiënten. Waar lange tijd rectale lichaamstemperatuur- meting de norm was, worden tegenwoordig vaker niet-invasieve instrumenten gebruikt. Het Universitair Medisch Centrum Groningen (UMCG) maakt sinds eind 2018 op alle verpleegafdelingen gebruik van de voorhoofdthermometer om de lichaamstemperatuur te meten. Dit instrument wordt ook wel Temporal Artery Thermometer (TAT) genoemd (zie figuur 1). Sinds de invoering van de TAT hebben verpleegkundigen en artsen twijfels over de nauwkeurigheid van de metingen, maar zij hadden niet de mogelijkheid deze zorgen voldoende te onderbouwen. Dit was voor de intensive care volwassenen (ICV) van het UMCG, in samenwerking met het lectoraat verpleegkundige diagnostiek van de Hanzehogeschool Groningen, aanleiding om een exploratief, vergelijkend cohortonderzoek uit te voeren. 1
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When firefighting, the combination of exposition to high temperatures, high physical demands and wearing (heavy and insulated) personal protective equipment lead to increased risk of heat stress and exhaustion in firefighters. Heat stress can easily evolve into a life-threatening heat stroke. Once heat stress occurred, the chance of getting another heat stroke during deployment gets higher. Moreover, intermittent exposure to heat stress over several years, is a risk factor for heart diseases. Similarly, exhausted during a deployment, a firefighter needs more time to rehabilitate before he can safely be deployed again. Heat stress and exhaustion can lead to line-of-duty cardiovascular events. Therefore preventing heat stress and exhaustion during deployment is beneficial for health, functioning and employability of firefighters. Since currently available measurement of the core temperature, such as thermometer pill or neck patch thermometer, are not reliable or practical for firefighters, an alternative approach may be used, namely, estimation of the core temperature based on non-invasive observation of the heart rate. Exhaustion is estimated using the training impulse model based on the heart rate reserve. Our achievement is a MoSeS health monitor system (as a smartphone application) that can real time analyze the health status of a firefighter and predict exhaustion and heat stress during deployment. The system is cheap (only a heart rate sensor and a smartphone application is needed), easy to use (intuitive “traffic light” signal), and objective (the health status is determined based on measurements of the heart rate). The only restriction is that the developed model is strongly dependent on personal maximum and minimum heart rate which need to be established behforehand. Moses Health Monitoring system for Firefighters CC BY-NC-ND Conference Proceedings 17th international e-SOCIETY 2019 IADIS
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Hematological malignancies and treatment with hematopoietic SCT are known to affect patients’ quality of life. The problem profile and care needs of this patient group need clarification, however. This study aimed to assess distress, problems and care needs after allo- or auto-SCT, and to identify risk factors for distress, problems or care needs. In this cross-sectional study, patients treated with allo-SCT or auto-SCT for hematological malignancies completed the Distress Thermometer and Problem List. Three patient groups were created: 0–1, 1–2.5 and 2.5–5.5 years after transplantation. After allo-SCT, distress and the number of problems tended to be lower with longer follow-up. After auto-SCT, distress was highest at 1–2.5 year(s). Patients mainly reported physical problems, followed by cognitive-emotional and practical problems. A minority reported care needs. Risk factors for distress as well as problems after allo-SCT included younger age, shorter time after transplantation and GVHD. A risk factor for distress as well as problems after auto-SCT was the presence of comorbid diseases. Up to 5 years after auto-SCT or allo-SCT, patients continue to experience distress and problems. Judged by prevalence, physical problems are first priority in supportive care, followed by cognitive-emotional and practical problems.
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A growing interest in person-centered care from a biopsychosocial perspective has led to increased attention to structural screening. The aim of this study was to develop an easy-to-comprehend screening instrument using single items to identify a broad range of health-related problems in adult burn survivors. This study builds on earlier work regarding content generation. Focus groups and expert meetings with healthcare providers informed content refinement, resulting in the Aftercare Problem List (APL). The instrument consists of 43 items divided into nine health domains: scars, daily life functioning, scars treatment, body perceptions, stigmatization, intimacy, mental health, relationships, financial concerns, and a positive coping domain. The APL also includes a Distress Thermometer and a question inquiring about preference to discuss the results with a healthcare provider. Subsequently, the APL was completed by 102 outpatients. To test face validity, a linear regression analysis showed that problems in three health domains, i.e., scars, mental health, and body perceptions, were significantly related to higher distress. Qualitative results revealed that a minority found the items difficult which led to further adjustment of the wording and the addition of illustrations. In summation, this study subscribes to the validity of using single items to screen for burn-related problems.
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Marfan syndrome (MFS) is a multisystemic, autosomal dominant connective tissue disorder that occurs de novo in 25%. In many families, parent and child(ren) are affected, which may increase distress in parents. To assess distress, 42 mothers (29% MFS) and 25 fathers (60% MFS) of 43 affected children, completed the validated screening‐questionnaire Distress thermometer for parents of a chronically ill child, including questions on overall distress (score 0–10; ≥4 denoting “clinical distress”) and everyday problems (score 0–36). Data were compared to 1,134 control‐group‐parents of healthy children. Mothers reported significantly less overall distress (2, 1–4 vs. 3, 1–6; p = .049; r = −.07) and total everyday problems (3, 0–6 vs. 4, 1–8; p = .03; r = −.08) compared to control‐group‐mothers. Mothers without MFS reported significantly less overall distress compared to mothers with MFS, both of a child with MFS (1, 0–4 vs. 3.5, 2–5; p = .039; r = −.17). No significant differences were found between the father‐groups, nor between the group of healthy parents of an affected child living together with an affected partner compared to control‐group‐parents. No differences in percentages of clinical distress were reported between mothers and control‐group‐mothers (33 vs. 42%); fathers and control‐group‐fathers (28 vs. 32%); nor between the other groups. Distress was not associated with the children's MFS characteristics. Concluding, parents of a child with MFS did not show more clinical distress compared to parents of healthy children. However, clinical distress was reported in approximately one‐third and may increase in case of acute medical complications. We advise monitoring distress in parents of a child with MFS to provide targeted support.
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Thermal comfort is determined by the combined effect of the six thermal comfort parameters: temperature, air moisture content, thermal radiation, air relative velocity, personal activity and clothing level as formulated by Fanger through his double heat balance equations. In conventional air conditioning systems, air temperature is the parameter that is normally controlled whilst others are assumed to have values within the specified ranges at the design stage. In Fanger’s double heat balance equation, thermal radiation factor appears as the mean radiant temperature (MRT), however, its impact on thermal comfort is often ignored. This paper discusses the impacts of the thermal radiation field which takes the forms of mean radiant temperature and radiation asymmetry on thermal comfort, building energy consumption and air-conditioning control. Several conditions and applications in which the effects of mean radiant temperature and radiation asymmetry cannot be ignored are discussed. Several misinterpretations that arise from the formula relating mean radiant temperature and the operative temperature are highlighted, coupled with a discussion on the lack of reliable and affordable devices that measure this parameter. The usefulness of the concept of the operative temperature as a measure of combined effect of mean radiant and air temperatures on occupant’s thermal comfort is critically questioned, especially in relation to the control strategy based on this derived parameter. Examples of systems which deliver comfort using thermal radiation are presented. Finally, the paper presents various options that need to be considered in the efforts to mitigate the impacts of the thermal radiant field on the occupants’ thermal comfort and building energy consumption.
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Purpose: Accurate measurement of body temperature is important for the timely detection of fever or hypothermia in critically ill patients. In this prospective study, we evaluated whether the agreement between temperature measurements obtained with TAT (test method) and bladder catheter-derived temperature measurements (BT; reference method) is sufficient for clinical practice in critically ill patients. Methods: Patients acutely admitted to the Intensive Care Unit were included. After BT was recorded TAT measurements were performed by two independent researchers (TAT1; TAT2). The agreement between TAT and BT was assessed using Bland-Altman plots. Clinical acceptable limits of agreement (LOA) were defined a priori (<0.5°C). Subgroup analysis was performed in patients receiving norepinephrine. Results: In total, 90 critically ill patients (64 males; mean age 62 years) were included. The observed mean difference (TAT-BT; ±SD, 95% LOA) between TAT and BT was 0.12°C (-1.08°C to +1.32°C) for TAT1 and 0.14°C (-1.05°C to +1.33°C) for TAT2. 36% (TAT1) and 42% (TAT2) of all paired measurements failed to meet the acceptable LOA of 0.5°C. Subgroup analysis showed that when patients were receiving intravenous norepinephrine, the measurements of the test method deviated more from the reference method (p = NS). Conclusion: The TAT is not sufficient for clinical practice in critically ill adults
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Purpose: Head and neck cancer (HNC) treatment often leads to physical and psychosocial impairments. Rehabilitation can overcome these limitations and improve quality of life. The aim of this study is to obtain an overview of rehabilitation care for HNC, and to investigate factors influencing rehabilitation provision, in Dutch HNC centers, and to some extent compare it to other countries. Methods: An online survey, covering five themes: organizational structure; rehabilitation interventions; financing; barriers and facilitators; satisfaction and future improvements, among HNC healthcare- and financial professionals of Dutch HNC centers. Results: Most centers (86%) applied some type of rehabilitation care, with variations in organizational structure. A speech language therapist, physiotherapist and dietitian were available in all centers, but other rehabilitation healthcare professionals in less than 60%. Facilitators for providing rehabilitation services included availability of a contact person, and positive attitude, motivation, and expertise of healthcare professionals. Barriers were lack of reimbursement, and patient related barriers including comorbidity, travel (time), low health literacy, limited financial capacity, and poor motivation. Conclusion: Although all HNC centers included offer rehabilitation services, there is substantial practice variation, both nationally and internationally. Factors influencing rehabilitation are related to the motivation and expertise of the treatment team, but also to reimbursement aspects and patient related factors. More research is needed to investigate the extent to which practice variation impacts individual patient outcomes and how to integrate HNC rehabilitation into routine clinical pathways.
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Met het aantrekken van de arbeidsmarkt richt HRM zich weer meer op werven, binden en boeien van medewerkers: wat maakt de werkgever aantrekkelijk? Daarmee komt de voice van medewerkers weer nadrukkelijker in beeld. In dit artikel voorbeelden van twee onderzoeken waarin die voice naar voren komt
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Een lespakket waarin kinderen tussen de 10 en 12 uitleg krijgen over klimaatverandering en -adaptatie en hier een aantal weken lang via opdrachten mee aan de slag gaan
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