Aims and objectives: To examine the predictive properties of the brief Dutch National Safety Management Program for the screening of frail hospitalised older patients (VMS) and to compare these with the more extensive Maastricht Frailty Screening Tool for Hospitalised Patients (MFST-HP). Background: Screening of older patients during admission may help to detect frailty and underlying geriatric conditions. The VMS screening assesses patients on four domains (i.e. functional decline, delirium risk, fall risk and nutrition). The 15-item MFST-HP assesses patients on three domains of frailty (physical, social and psychological). Design: Retrospective cohort study. Methods: Data of 2,573 hospitalised patients (70+) admitted in 2013 were included, and relative risks, sensitivity and specificity and area under the receiver operating characteristic (AUC) curve of the two tools were calculated for discharge destination, readmissions and mortality. The data were derived from the patients nursing files. A STARD checklist was completed. Results: Different proportions of frail patients were identified by means of both tools: 1,369 (53.2%) based on the VMS and 414 (16.1%) based on the MFST-HP. The specificity was low for the VMS, and the sensitivity was low for the MFST-HP. The overall AUC for the VMS varied from 0.50 to 0.76 and from 0.49 to 0.69 for the MFST-HP. Conclusion: The predictive properties of the VMS and the more extended MFST-HP on the screening of frailty among older hospitalised patients are poor to moderate and not very promising. Relevance to clinical practice: The VMS labels a high proportion of older patients as potentially frail, while the MFST-HP labels over 80% as nonfrail. An extended tool did not increase the predictive ability of the VMS. However, information derived from the individual items of the screening tools may help nurses in daily practice to intervene on potential geriatric risks such as delirium risk or fall risk.
Electrification of transportation, communication, working and living continues worldwide. Televisions, telephones, servers are an important part of everyday life. These loads and most sustainable sources as well, have one thing in common: Direct Current. The Dutch research and educational programme ‘DC – road to its full potential’ studies the impact of feeding these appliances from a DC grid. An improvement in energy efficiency is expected, other benefits are unknown and practical considerations are needed to come to a proper comparison with an AC grid. This paper starts with a brief introduction of the programme and its first stages. These stages encompass firstly the commissioning, selection and implementation of a safe and user friendly testing facility, to compare performance of domestic appliances when powered with AC and DC. Secondly, the relationship between the DC-testing facility and existing modeling and simulation assignments is explained. Thirdly, first results are discussed in a broad sense. An improved energy efficiency of 3% to 5% is already demonstrated for domestic appliances. That opens up questions for the performance of a domestic DC system as a whole. The paper then ends with proposed minor changes in the programme and guidelines for future projects. These changes encompass further studying of domestic appliances for product-development purposes, leaving less means for new and costly high-power testing facilities. Possible gains are 1) material and component savings 2) simpler and cheaper exteriors 3) stable and safe in-house infrastructure 4) whilst combined with local sustainable generation. That is the road ahead. 10.1109/DUE.2014.6827758
