Inspanning en training bij patiënten met ICD
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Several studies have reported improved survival rates thanks to the use of an implantable cardioverter defibrillator (ICD) in the treatment of patients with life-threatening arrhythmia. However, the effects of the ICD on health-related quality of life (HR-QoL) of these patients are not clear. The aim of this study is to describe HR-QoL and fear of exercise in ICD patients. Eighty-nine ICD patients from the University Hospital in Groningen, the Netherlands, participated in this study. HR-QoL was measured using the Rand-36 and the Quality of Life After Myocardial Infarction Dutch language version questionnaires. Fear of exercise was measured using the Tampa Scale for Kinesiophobia, Dutch version and the Fear Avoidance Beliefs Questionnaire, Dutch version. Association between outcome variables was analysed by linear regression analyses. Study results show that the HR-QoL of patients with ICDs in our study population is significantly worse than that of normal healthy people. Furthermore, fear of exercise is negatively associated with HR-QoL corrected for sex, age and number of years living with an ICD. After implantation of the ICD, patients with a clear fear of exercise should be identified and interventions should be considered in order to increase their HR-QoL.
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Cervical spinal manipulations (CSM) are frequently employed techniques to alleviate neck pain and headache. Minor and major complications following CSM have been described, though clear consensus on definition and the classification of the complications had not yet been achieved. As a result, incidence rates may be underestimated. The aim of this study was to develop a consensus-based classification of adverse events following cervical spinal manipulations which has good feasibility in clinical practice and research. Design: A three round Delphi-study. Medical specialists, manual therapists, and patients (n=30) participated in an online survey. In Round 1, participants were invited to select a classification system of adverse events. Potential complications were inventoried and detailed in accordance with the ICF and the ICD-10. In Round 2, panel members categorized the potential complications in their selected classification. During the third round, it was inquired of the participants whether they concurred with the answer of the majority of participants. Results: Thirty four complications were defined. Consensus was achieved for 29 complications for all durations [hours, days, weeks]. For the remaining five complications, consensus was reached for two of the three durations [hours, days, weeks]. Conclusions: A consensus-based classification system of adverse events after cervical spinal manipulation was developed which comprises patients’ and clinicians’ perspectives and has only a small number of categories. The classification system includes a precise description of potential adverse events and is based on international accepted classifications (ICD-10 and ICF). This classification system may be useful for utilization in both clinical practice and research.
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Background: It is thought that physical health conditions start at a young age in people with profound intellectual and multiple disabilities (PIMD). Knowledge regarding the prevalence, associations and development of these physical health conditions could be used for purposes of prevention as well as appropriate care and support but is currently lacking. Objective: The aim of this study is to gain insight into the prevalence of physical health conditions and associations between these conditions in young children with PIMD. Methods: The study used cross-sectional data related to the physical health conditions of children with PIMD (n = 51, aged between 12 and 61 months). Data were collected in Belgium and in the Netherlands through a checklist filled in by primary caregiver(s). Physical health conditions were classified into categories by the 10th revision of the International Classification of Diseases and Related Health Problems (ICD-10) system. The number of physical health conditions and associations between them were analysed. The analysis focused on prevalence rates and associations represented by odds ratios (p < 0.05). A graphical model was estimated to represent dependencies and conditional dependencies between physical health conditions. Results: We found a mean of 3.8 (range 1–8, SD 1.9) physical health conditions per child. Most of the physical health conditions were found in the ICD-10 chapter ‘Nervous System’, with hypotonia as the most frequent at 70.6%. Five significant large associations were found between spasticity–contractures (OR 9.54); circulatory system–contractures (OR 7.50); scoliosis–contractures (OR 10.25); hearing impairments–skin problems (OR 58.20) and obstipation–hypotonia (OR 19.98). Conclusion: This study shows that at a young age, multiple physical health conditions are present in children with PIMD. In addition, we found five associations between physical health conditions.
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Full text via link. Recensie boek Verstandelijke Beperking. Definitie en Context In de sector gebruiken we het woord vrijwel dagelijks: mensen met een verstandelijke beperking. Maar wat een verstandelijke beperking precies is, is niet op voorhand duidelijk
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Introduction This study aims to explore maternal and perinatal outcomes of migrant women in Iceland. Material and methods This prospective population-based cohort study included women who gave birth to a singleton in Iceland between 1997 and 2018, comprising a total of 92 403 births. Migrant women were defined as women with citizenship other than Icelandic, including refugees and asylum seekers, and categorized into three groups, based on their country of citizenship Human Development Index score. The effect of country of citizenship was estimated. The main outcome measures were onset of labor, augmentation, epidural, perineum support, episiotomy, mode of birth, obstetric anal sphincter injury, postpartum hemorrhage, preterm birth, a 5-minute Apgar <7, neonatal intensive care unit admission and perinatal mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) for maternal and perinatal outcomes were calculated using logistic regression models. Results A total of 8158 migrant women gave birth during the study period: 4401 primiparous and 3757 multiparous. Overall, migrant women had higher adjusted ORs (aORs) for episiotomy (primiparas: aOR 1.43, 95% CI 1.26–1.61; multiparas: 1.39, 95% CI 1.21–1.60) and instrumental births (primiparas: 1.14, 95% CI 1.02–1.27, multiparas: 1.41, 95% CI 1.16–1.72) and lower aORs of induction of labor (primiparas: 0.88, 95% CI 0.79–0.98; multiparas: 0.74, 95% CI 0.66–0.83), compared with Icelandic women. Migrant women from countries with a high Human Development Index score (≥0.900) had similar or better outcomes compared with Icelandic women, whereas migrant women from countries with a lower Human Development Index score than that of Iceland (<0.900) had additionally increased odds of maternal and perinatal complications and interventions, such as emergency cesarean and postpartum hemorrhage. Conclusions Women’s citizenship and country of citizenship Human Development Index scores are significantly associated with a range of maternal and perinatal complications and interventions, such as episiotomy and instrumental birth. The results indicate the need for further exploration of whether Icelandic perinatal healthcare services meet the care needs of migrant women.
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Purpose:The International Commission on Illumination (CIE) recommends researchers to investigate a widevariety of behavioural and health outcomes. However, researchers often investigate only a part of occupationalhealth (OH) in relation to light. A literature study (2002–2017) regarding the relationship between office lightingconditions and OH was performed to identify gaps and methodological issues.Method:The OH outcomes investigated in this paper were grouped according to the International Classificationof Diseases and analysed per category: physical and physiological health, mental health, eye health, sleep param-eters and visual comfort.Results:Findings from the literature study (20 eligible papers) showed that all OH aspects were mostly but notexclusively measured subjectively. Furthermore, most studies investigated only a fraction of office lighting par-ameters and OH aspects.Conclusions:It seems that Correlated Colour Temperature (CCT) and illuminance mainly correlate with OH.However, this may also be explained by gaps and methodological issues in studies described in eligible papers.Based on the literature study, an overview was composed elucidating gaps and methodological issues of officelighting and OH studies. It can be used to design and target the purpose of light and health research.
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Het document beschrijft allereerst reeds uitgevoerd onderzoek naar het gebruik van vaktherapieën bij agressieregulatie in de forensische psychiatrie.
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ABSTRACT Purpose: Polypharmacy is a known risk factor for potentially inappropriate prescribing. Recently there is an increasing interest in clinical decision support systems (CDSS) to improve prescribing. The objective of this study was to evaluate the impact of a CDSS, with the START-STOPP criteria as main content in the setting of a geriatric ward. Endpoints were 1) appropriateness of prescribing and 2) acceptance rate of recommendations. Methods: This prospective study comparing the use of a CDSS with usual care involved patients admitted to geriatric wards in two teaching hospitals in the Netherlands. Patients were included from January to May 2017. The medications of 64 patients in the first six weeks was assessed according to the current standard, whereas the medications of 61 patients in the second six weeks were also assessed by using a CDSS. Medication appropriateness was assessed with the Medication Appropriateness Index (MAI). Results: The medications of 125 patients (median age 83 years) were reviewed. In both the usual care group and the intervention group MAI scores decreased significantly from admission to discharge (within group analyses, p<0.001). This effect was significantly larger in the intervention group (p<0.05). MAI scores at discharge in the usual care group and the intervention group were respectively 9.95±6.70 and 7.26±5.07. The CDSS generated 193 recommendations, of which 71 concerned START criteria, 45 STOPP criteria, and 77 potential interactions. Overall, 31.6% of the recommendations were accepted. Conclusion: This study shows that a CDSS to improve prescribing has additional value in the setting of a geriatric ward. Almost one third of the software-generated recommendations were interpreted as clinically relevant and accepted, on average one per patient.
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Hogeschool Utrecht, Kenniscentrum Sociale Innovatie Gemeenten zijn vanaf 2015 voor een nog grotere groep kwetsbare burgers de toegangspoort tot ondersteuning bij het meedoen in de samenleving. Door de decentralisatie van de AWBZ begeleiding zal de vraag waarmee burgers naar de gemeente komen complexer worden. Gemeenten pakken deze complexe vraagstukken steeds meer op vanuit een brede blik, dat wil zeggen over levensterreinen heen en op het hele sociale domein (werk, inkomen, opvoeding, zorg en ondersteuning) Dit vraagt behoorlijk wat van de gespreksvoerder die het Gesprek voert met de burger. In deze Train-de-trainer bieden de Hanzehogeschool Groningen, Academie voor Sociale Studies – lectoraat Rehabilitatie; Hogeschool Utrecht, kenniscentrum sociale innovatie – lectoraat participatie, zorg en ondersteuning; en Movisie trainingsmateriaal voor de gespreksvoerder, zodat deze in staat is het gesprek op een goede manier te voeren. In deze training besteden we aandacht aan: 1. De context en het kader waarin het gesprek plaatsvindt. 2. Het Gesprek met verschillende doelgroepen. 3. Gesprekstechnieken en contactvaardigheden. 4. Integraal werken en netwerkversterking.
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