Abstract Background: 30 to 60% of the acute hospitalized older adults experience functional decline after hospitalization. The first signs of functional decline after discharge can often be observed in the inability to perform mobility tasks, such as raising from a chair or walking. Information how mobility develops over time is scarce. Insight in the course of mobility is needed to prevent and decrease mobility limitations. Objectives: The objectives of this study were to determine (i) the course of mobility of acute hospitalized older adults and (ii) the association between muscle strength and the course of mobility over time controlled for influencing factors. Methods: In a multicenter, prospective, observational cohort study, measurements were taken at admission, discharge, one- and three months post-discharge. Mobility was assessed by the De Morton Mobility Index (DEMMI) and muscle strength by the JAMAR. The longitudinal association between muscle strength and mobility was analysed with a Linear Mixed Model and controlled for potential confounders. Results: 391 older adults were included in the analytic sample with a mean (SD) age of 79.6 (6.7) years. Mobility improved significantly from admission up to three months post-discharge but did not reach normative levels. Muscle strength was associated with the course of mobility (beta=0.64; p<0.01), even after controlling for factors as age, cognitive impairment, fear of falling and depressive symptoms (beta=0.35; p<0.01). Conclusion: Muscle strength is longitudinally associated with mobility. Interventions to improve mobility including muscle strength are warranted, in acute hospitalized older adults.
BACKGROUND: A significant number of older patients planned for transcatheter aortic valve implantation (TAVI) experience a decline in physical functioning and death, despite a successful procedure.OBJECTIVE: To systematically review the literature on the association of preprocedural muscle strength and physical performance with functional decline or long-term mortality after TAVI.METHODS: We followed the PRISMA guidelines and pre-registered this review at PROSPERO (CRD42020208032). A systematic search was conducted in MEDLINE and EMBASE from inception to 10 December 2021. Studies reporting on the association of preprocedural muscle strength or physical performance with functional decline or long-term (>6 months) mortality after the TAVI procedure were included. For outcomes reported by three or more studies, a meta-analysis was performed.RESULTS: In total, two studies reporting on functional decline and 29 studies reporting on mortality were included. The association with functional decline was inconclusive. For mortality, meta-analysis showed that low handgrip strength (hazard ratio (HR) 1.80 [95% confidence interval (CI): 1.22-2.63]), lower distance on the 6-minute walk test (HR 1.15 [95% CI: 1.09-1.21] per 50 m decrease), low performance on the timed up and go test (>20 s) (HR 2.77 [95% CI: 1.79-4.30]) and slow gait speed (<0.83 m/s) (HR 2.24 [95% CI: 1.32-3.81]) were associated with higher long-term mortality.CONCLUSIONS: Low muscle strength and physical performance are associated with higher mortality after TAVI, while the association with functional decline stays inconclusive. Future research should focus on interventions to increase muscle strength and physical performance in older cardiac patients.
Purpose. This cross-sectional study investigates deficits and associations in muscle strength, 6-minute walking distance (6MWD), aerobic capacity (VO2peak), and physical activity (PA) in independent ambulatory children with lumbosacral spina bifida. Method. Twenty-tree children participated (13 boys, 10 girls). Mean age (SD): 10.4 (±3.1) years. Muscle strength (manual muscle testing and hand-held dynamometry), 6MWD, VO2peak (maximal exercise test on a treadmill), and PA (quantity and energy expenditure [EE]), were measured and compared with aged-matched reference values. Results. Strength of upper and lower extremity muscles, and VO2peak were significantly lower compared to reference values. Mean Z-scores ranged from -1.2 to -2.9 for muscle strength, and from -1.7 to -4.1 for VO2peak. EE ranged from 73 - 84% of predicted EE. 6MWD was significantly associated with muscle strength of hip abductors and foot dorsal flexors. VO2peak was significantly associated with strength of hip flexors, hip abductors, knee extensors, foot dorsal flexors, and calf muscles. Conclusions. These children have significantly reduced muscle strength, 6MWD, VO2peak and lower levels of PA, compared to reference values. VO2peak and 6MWD were significantly associated with muscle strength, especially with hip abductor and ankle muscles. Therefore, even in independent ambulating children training on endurance and muscle strength seems indicated.
Teachers have a crucial role in bringing about the extensive social changes that are needed in the building of a sustainable future. In the EduSTA project, we focus on sustainability competences of teachers. We strengthen the European dimension of teacher education via Digital Open Badges as means of performing, acknowledging, documenting, and transferring the competencies as micro-credentials. EduSTA starts by mapping the contextual possibilities and restrictions for transformative learning on sustainability and by operationalising skills. The development of competence-based learning modules and open digital badge-driven pathways will proceed hand in hand and will be realised as learning modules in the partnering Higher Education Institutes and badge applications open for all teachers in Europe.Societal Issue: Teachers’ capabilities to act as active facilitators of change in the ecological transition and to educate citizens and workforce to meet the future challenges is key to a profound transformation in the green transition.Teachers’ sustainability competences have been researched widely, but a gap remains between research and the teachers’ practise. There is a need to operationalise sustainability competences: to describe direct links with everyday tasks, such as curriculum development, pedagogical design, and assessment. This need calls for an urgent operationalisation of educators’ sustainability competences – to support the goals with sustainability actions and to transfer this understanding to their students.Benefit to society: EduSTA builds a community, “Academy of Educators for Sustainable Future”, and creates open digital badge-driven learning pathways for teachers’ sustainability competences supported by multimodal learning modules. The aim is to achieve close cooperation with training schools to actively engage in-service teachers.Our consortium is a catalyst for leading and empowering profound change in the present and for the future to educate teachers ready to meet the challenges and act as active change agents for sustainable future. Emphasizing teachers’ essential role as a part of the green transition also adds to the attractiveness of teachers’ work.
Dit project richt zich op de ontwikkeling van de biotechnologische en chemische procesvoering om op basis van mycelium een alternatief voor leer te produceren. In vergelijking met leer is het voordeel van mycelium dat geen runderen nodig zijn, de productie kan plaatsvinden onder industriële condities en met gebruik van reststromen, de CO2 uitstoot alsook hoeveelheid afval verlaagd wordt, en het gebruik van toxische stoffen zoals chroom wordt vervangen door biobased alternatieven. In het project zullen de procescondities worden bepaald die leiden tot de vorming van optimaal mycelium. Daartoe zullen twee verschillende schimmels worden gekweekt in bioreactoren bij de Hogeschool Arnhem Nijmegen (HAN), waarbij specifiek de effecten van de procescondities (temperatuur, pH, shear, beluchting) en de samenstelling van het kweekmedium op groei van het mycelium en materiaal eigenschappen zullen worden onderzocht. De meest optimale condities zullen vervolgens worden opgeschaald. Op het op deze wijze verkregen materiaal zal Mylium BV een aantal nabehandelingsstappen uitvoeren om de sterkte, elasticiteit, en duurzaamheid van het product te vergroten. Daartoe worden biobased plasticizers, cross-linkers en/of flexibility agents gebruikt. Het resulterende eindproduct zal middels specifiek fysieke testen vergeleken worden met leer alsook worden voorgelegd aan mogelijke klanten. Indien beide resultaten positief zijn kan het betreffende proces na het project verder worden opgeschaald voor toepassing naar de markt.
For English see below In dit project werkt het Lectoraat ICT-innovaties in de Zorg van hogeschool Windesheim samen met zorganisaties de ZorgZaak, De Stouwe, en IJsselheem en daarnaast Zorgcampus Noorderboog, Zorgtrainingscentrum Regio Zwolle, Patiëntenfederatie NPCF, VitaalThuis, ActiZ, Vilans, V&VN, Universiteit Twente en het Lectoraat Innoveren in de Ouderenzorg van Windesheim aan het in staat stellen van wijkverpleegkundigen om autonoom en doelmatig, op basis van klinisch redeneren, eHealth te indiceren en in te zetten bij cliënten. De aanleiding voor dit project wordt gevormd door de wijzigingen per 1 januari 2015 in de Zorgverzekeringswet. Wijkverpleegkundigen zijn sindsdien zelf verantwoordelijk voor de indicatiestelling en zorgtoewijzing voor verzorging en verpleging thuis: zij moeten bepalen welke zorg hun cliënten nodig hebben gezien hun individuele situaties, en hoe die zorg het best geleverd kan worden. Zorgverzekeraars leggen hierbij minimumeisen op, o.a. met betrekking tot de inzet van eHealth. Wijkverpleegkundigen hebben op dit moment echter niet of nauwelijks ervaring met het inzetten en toepassen van technologische toepassingen zoals eHealth. Vraagarticulatie leidde tot de volgende praktijkvraagstelling: 1. Hoe kunnen wijkverpleegkundigen worden voorzien in hun informatiebehoefte over eHealth? 2. Hoe kunnen wijkverpleegkundigen worden ondersteund in hun klinisch redeneren over het inzetten van eHealth bij hun cliënten? 3. Hoe kunnen wijkverpleegkundigen worden ondersteund bij het inzetten van eHealth in hun zorgproces? Het project levert hiertoe drie bijdragen: - De eerste bijdrage is een duurzaam geborgde keuzehulp (een app voor tablet of smartphone) waarmee wijkverpleegkundigen toegang hebben tot de benodigde informatie over eHealth-toepassingen en die aansluit bij de manier waarop wijkverpleegkundigen zorg indiceren (bijvoorbeeld door relaties te leggen tussen NIC-interventies en bijpassende eHealth-toepassingen). - Informatievoorziening is niet een afdoende antwoord op de handelingsverlegenheid van de wijkverpleegkundige omdat eHealth sterk in ontwikkeling is en blijft waardoor er altijd een discrepantie zal bestaan tussen de beschikbare en de benodigde informatie. . De tweede bijdrage van dit project is daarom kennis over (en inzicht in) het klinisch redeneren over de inzet van eHealth. Deze kennis wordt in het project doorvertaald naar een trainingsmodule die erop is gericht om het klinisch redeneren van wijkverpleegkundigen over het inzetten van eHealth en andere thuiszorgtechnologie bij hun cliënten te versterken. - De derde bijdrage van dit project omhelst inbedding van bovengenoemde resultaten in het verpleegkunde-onderwijs van onder meer Windesheim en in nascholingstrajecten voor wijkverpleegkundigen. Voor duurzame, bredere inbedding in het onderwijs wordt samengewerkt met regionale zorgonderwijsnetwerken. In this project the research group IT-innovations in Health Care of Windesheim University of Applied Sciences cooperates with care organisations de ZorgZaak, De Stouwe, and IJsselheem, and stakeholders Zorgcampus Noorderboog, Zorgtrainingscentrum Regio Zwolle, Patiëntenfederatie NPCF, VitaalThuis, ActiZ, Vilans, V&VN, University of Twente, and research group Innovation of Care of Older Adults of Windesheim to enable home care nurses to autonomously and adequately, based on clinical reasoning, allocate eHealth and implement it in patient care. The motivation behind this project lies in the alterations in the care insurance legislation per January 2015. Since then, home care nurses are responsible for the care allocation of all care at home: they determine which care their clients require, taking into account the individual situations, and how this care can best be delivered. Care insurance companies impose minimum requirements for this allocation of home care, among others concerning the implementation of eHealth. Home care nurses, however, have no or limited information about and experience with technical applications like eHealth. Articulation of the demands of home care nurses resulted in the following questions: 1. How can home care nurses be provided with information concerning eHealth? 2. How can home care nurses be supported in their clinical reasoning about the deployment of eHealth by their patients? 3. How can home care nurses be supported when deploying eHealth in their care process? This project contributes in three ways: " The first contribution is a sustainable selection tool (an app for tablet or smartphone) to be used by home care nurses to provide them with the required information about eHealth applications. This selection tool will work in accordance with how home care nurses allocate care, e.g. by relating NIC-interventions to matching eHealth applications. " Providing information is an insufficient, although necessary, answer to the demands of home care nurses because of continuously developing eHealth applications. Hence, the second contribution of this project is knowledge about (and insight in) the clinical reasoning about the deployment of eHealth. This knowledge will be converted into a training module aimed at strengthening the clinical reasoning about the deployment of eHealth by their patients. " The third contribution of this project concerns embedding the selection tool and the training module in regular education (among others at Windesheim) and in refresher courses for home care nurses. Cooperation with regional care education networks will ensure sustainable and broad embedding of both the selection tool and the training module.
