In her inaugural lecture, Sabine Niederer presents visual methodologies that take into account the contemporary state of digital images and demonstrates how visualizations may be put to use for collaborative research.
BackgroundEarly 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.AimTo 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.MethodsAn 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.ResultsThe 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).DiscussionThe 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.
MULTIFILE
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.
The project Decolonising Education: from Teachers to Leading Learners (DETeLL) aims to develop a multi-site approach for interventions towards inclusion and decolonisation in order to change the hierarchical nature of higher education in the Netherlands. DETeLL identifies the model of the ‘traditional teacher’ as embodying the structural exclusions and discriminations built into the classroom and proposes the figure of a ‘Leading Learner’ as a first step towards a radical change in the educational system. In collaboration with the education departments in the Theatre and Dance Academy at ArtEZ, the post-doc will build up a research and teaching programme that engages with students and teachers in the faculty to create a prototype of an inclusive and diverse educational practice. RELEVANCE: Education should be the critical space in which changes occur in order to shape best possible futures. In DETeLL’s acceptation, decolonisation refers to a complete change in the way of thinking and behaving. It does not refer only to the urgency of dealing with historical colonial legacies embedded in society, but also to the subversion of the deeply oppressive colonial culture that (also unconsciously) regulates public and private living, whether this is related to gender, race, class or sexuality issues. RESULTS: 1) Create a theory and practice-based scientific base-line of decolonisation and art education; 2) Provide a definition of ‘Artist educator as Leading Learner’ following a practice- based methodology of intervention; 3) Design and Pilot a new teaching programme for theatre education at ArtEZ to be then upscaled to all educational departments in a follow-up project); 4) Produce a strong interdisciplinary and international output plan: 3 academic publications, 2 conferences, 4 expert group workshops. NETWORK: ArtEZ; University of Amsterdam (UvA); Ghent University; UCHRI; Hildesheim University; Cape Town University. The partners will serve as steering committee through planned expert group meetings.
Nxus is a Software as a Service startup that provides higher educational institutions with one integrated community and bias-free career platform. With this platform, Nxus connects employers, students and alumni in a unique and innovative way. The Nxus platform is already deployed university-wide by the launching partner, Radboud University. The Take-Off HBO feasibility grant allows Nxus to research the feasibility of further developing the existing platform to meet the needs of Secondary Vocational Institutions (MBO-instellingen). Nxus hereby aims to address 2 present-day societal issues, the shortage of internships for MBO students and internship discrimination in the recruitment and selection process.
