Deze handreiking ‘Triage, Advance Care Planning en symptomatische behandeling bij een ernstig verloop van corona binnen de GGZ-instelling of thuis’ hoort bij de Richtlijn GGZ en corona. Bji het maken van de afweging om een patiënt wel/niet in het ziekenhuis te laten opnemen, dan wel of de patiënt wel/niet naar IC kan gaan gelden deze overwegingen: zie bestand.
DOCUMENT
Background: Transmural palliative care interventions aim to identify older persons with palliative care needs and timely provide advance care planning, symptom management, and coordination of care. Nurses can have an important role in these interventions; however, their expertise is currently underused. A new transmural care pathway with a central role for the community care registered nurse in advance care planning aims to contribute to the quality of palliative care for older persons. Objective: To examine the perspectives of community nurses on the feasibility of a new transmural care pathway for advance care planning for older persons. Design: A qualitative study design using semi-structured interviews. Setting(s): Interviews were performed with community nurses of three participating homecare organizations in the Netherlands between March and May 2023. Participants: 19 community nurses. Methods: A topic guide was based on (1) challenges in advance care planning identified from the literature and (2) concepts that are important in assessing the feasibility of complex healthcare interventions provided by the Normalisation Process Theory framework. A combined inductive and deductive thematic analysis was performed. Results: Four themes were identified: views on the transmural care pathway, community nurses’ needs to fulfil their role, key points regarding implementation, and evaluation of the new practice. In general, community nurses were positive about the feasibility of the new practice as it provided a more structured work process that could facilitate interprofessional collaboration and improve the quality of palliative care. Overall, the feasibility of the new practice, from community nurses perspective, was determined by (1) clear roles and responsibilities in the transmural care pathway, (2) standardized registration of advance care planning, and (3) close involvement of community nurses in the whole implementation process. Conclusions: We highlighted important factors, from the perspectives of community nurses, that need to be considered in the implementation of a new transmural care pathway for advance care planning. A clear division of roles and responsibilities, standardized registration of advance care planning, and involvement of community nurses during the whole implementation process were mentioned as important enabling factors. This knowledge might contribute to successful implementation of a transmural care pathway that aims to enhance the quality of palliative care for older persons. Tweetable abstract: Community nurses’ perspectives on the feasibility of a transmural care pathway for advance care planning for older persons.
DOCUMENT
BackgroundSpecialist palliative care teams are consulted during hospital admission for advice on complex palliative care. These consultations need to be timely to prevent symptom burden and maintain quality of life. Insight into specialist palliative care teams may help improve the outcomes of palliative care.MethodsIn this retrospective observational study, we analyzed qualitative and quantitative data of palliative care consultations in a six-month period (2017 or 2018) in four general hospitals in the northwestern part of the Netherlands. Data were obtained from electronic medical records.ResultsWe extracted data from 336 consultations. The most common diagnoses were cancer (54.8%) and organ failure (26.8%). The estimated life expectancy was less than three months for 52.3% of all patients. Within two weeks after consultation, 53.2% of the patients died, and the median time until death was 11 days (range 191) after consultation. Most patients died in hospital (49.4%) but only 7.5% preferred to die in hospital. Consultations were mostly requested for advance care planning (31.6%). End-of-life preferences focused on last wishes and maintaining quality of life.ConclusionThis study provides detailed insight into consultations of palliative care teams and shows that even though most palliative care consultations were requested for advance care planning, consultations focus on end-of-life care and are more crisis-oriented than prevention-oriented. Death often occurs too quickly after consultation for end-of-life preferences to be met and these preferences tend to focus on dying. Educating healthcare professionals on when to initiate advance care planning would promote a more prevention-oriented approach. Defining factors that indicate the need for timely palliative care team consultation and advance care planning could help timely identification and consultation.
MULTIFILE
Every year the police are confronted with an ever increasing number of complex cases involving missing persons. About 100 people are reported missing every year in the Netherlands, of which, an unknown number become victims of crime, and presumed buried in clandestine graves. Similarly, according to NWVA, several dead animals are also often buried illegally in clandestine graves in farm lands, which may result in the spread of diseases that have significant consequences to other animals and humans in general. Forensic investigators from both the national police (NP) and NWVA are often confronted with a dilemma: speed versus carefulness and precision. However, the current forensic investigation process of identifying and localizing clandestine graves are often labor intensive, time consuming and employ classical techniques, such as walking sticks and dogs (Police), which are not effective. Therefore, there is an urgent request from the forensic investigators to develop a new method to detect and localize clandestine graves quickly, efficiently and effectively. In this project, together with practitioners, knowledge institutes, SMEs and Field labs, practical research will be carried out to devise a new forensic investigation process to identify clandestine graves using an autonomous Crime Scene Investigative (CSI) drone. The new work process will exploit the newly adopted EU-wide drone regulation that relaxes a number of previously imposed flight restrictions. Moreover, it will effectively optimize the available drone and perception technologies in order to achieve the desired functionality, performance and operational safety in detecting/localizing clandestine graves autonomously. The proposed method will be demonstrated and validated in practical operational environments. This project will also make a demonstrable contribution to the renewal of higher professional education. The police and NVWA will be equipped with operating procedures, legislative knowledge, skills and technological expertise needed to effectively and efficiently performed their forensic investigations.
Hoewel cariës (gaatjes in het gebit) eenvoudig te voorkomen is heeft bijna de helft van alle vijfjarige kinderen cariës. Hiervan leidt naar schatting 10% aan ernstige cariës. Ernstige cariës op jonge leeftijd beperkt de algemene gezondheid, de kwaliteit van leven en belemmert de algemene ontwikkeling. Hoewel het een wettelijke basistaak van jeugdgezondheidszorg is, ontbreekt bij het consultatiebureau (CB) de focus op mondzorg. Adviezen op het CB over mondzorg en bezoek aan een mondzorgprofessional vanaf twee jaar blijken niet effectief. Slechts 33% van de kinderen in de leeftijd van 0-4 jaar heeft eenmaal een tandarts bezocht. Preventie in mondgezondheid bij peuters komt te laat en dit raakt met name kinderen uit de lagere sociale klassen. De schade is dan vaak al aanzienlijk en bij ernstige cariës is behandeling onder algehele anesthesie vaak vereist. Naast het feit dat kinderen te laat een mondzorgprofessional bezoeken, zijn er in Nederland geen interventies ter bevordering van mondgezondheid van peuters die voldoende onderbouwd, transparant en (kosten)effectief zijn. In dit gerandomiseerde praktijkonderzoek wordt het effect geëvalueerd van een preventief mondzorgprogramma gericht op het verbeteren van de mondgezondheid bij peuters in vergelijking met usual care. Daarmee wordt tegemoet gekomen aan de urgentie van de evaluatie van preventieve en zelfzorg bevorderende interventies gericht op jonge kinderen en het reduceren van ongelijkheden binnen de mondzorg. Gebaseerd op het succesvolle Schotse Childsmile zal er vanuit de eerstelijns mondzorg een mondzorgcoach (MZC) bij het consultatiebureau gedetacheerd worden om deze JGZ basistaak te ondersteunen. De MZC zal tijdens reguliere CB-bezoeken geïndividualiseerd preventief mondzorgadvies geven aan ouders op basis van het effectief gebleken non–operative caries treatment and prevention (NOCTP) principe. Bij succes van de MZC wordt een forse stijging verwacht van het aantal cariësvrije peuters (30%), een aanmerkelijke cariësreductie per kind (30%, ofwel circa 1,5 gaatje) en een significante kostenreductie.
English: This living lab aims to support the creation, development and implementation of next generation concepts for sustainable healthcare logistics, with special attention for last mile solutions. Dutch healthcare providers are on the verge of a transition towards (more) sustainable business models, spurred by e.g., increasing healthcare costs, ongoing budget cuts, tight labor market conditions and increasing ecological awareness. Consequently, healthcare providers need to improve and innovate their business model and underlying logistics concept(s). Simultaneously, many cities are struggling with congestion in traffic, air quality and liveability in general. This calls for Last Mile Logistics (LML) concepts that can address challenges like effective and efficient resource planning, scheduling and utilization and, particularly, sustainability goals. LML can reduce environmental and social impact by decreasing emissions, congestion and pollution through effectively consolidating in-flows of goods and providing innovative solutions for care, wellbeing and related services. The research and initiatives in the living lab will address the following challenges: reducing the ecological footprint, reducing (healthcare-related) costs, improving service quality, decreasing loneliness of frail citizens and improving the livability of urban areas (reducing congestion and emissions). Given the scarcity and fragmentation of knowledge on healthcare logistics in organizations the living lab will also act as a learning community for (future) healthcare- and logistics professionals, thereby supporting the development of human capital. By working closely with related stakeholders and using a transdisciplinary research approach it is ensured that the developed knowledge and solutions deliver a contribution to societal challenges and have sound business potential.
