BACKGROUND: Medication-related problems are common after hospitalization, for example when changes in patients' medication regimens are accompanied by insufficient patient education, poor information transfer between healthcare providers, and inadequate follow-up post-discharge. We investigated the effect of a pharmacy-led transitional care program on the occurrence of medication-related problems four weeks post-discharge.METHODS: A prospective multi-center before-after study was conducted in six departments in total of two hospitals and 50 community pharmacies in the Netherlands. We tested a pharmacy-led program incorporating (i) usual care (medication reconciliation at hospital admission and discharge) combined with, (ii) teach-back at hospital discharge, (iii) improved transfer of medication information to primary healthcare providers and (iv) post-discharge home visit by the patient's own community pharmacist, compared with usual care alone. The difference in medication-related problems four weeks post-discharge, measured by means of a validated telephone-interview protocol, was the primary outcome. Multiple logistic regression analysis was used, adjusting for potential confounders after multiple imputation to deal with missing data.RESULTS: We included 234 (January-April 2016) and 222 (July-November 2016) patients in the usual care and intervention group, respectively. Complete data on the primary outcome was available for 400 patients. The proportion of patients with any medication-related problem was 65.9% (211/400) in the usual care group compared to 52.4% (189/400) in the intervention group (p = 0.01). After multiple imputation, the proportion of patients with any medication-related problem remained lower in the intervention group (unadjusted odds ratio 0.57; 95% CI 0.38-0.86, adjusted odds ratio 0.50; 95% CI 0.31-0.79).CONCLUSIONS: A pharmacy-led transitional care program reduced medication-related problems after discharge. Implementation research is needed to determine how best to embed these interventions in existing processes.
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We review the current body of academic literature concerning gamification of production and logistics. The findings indicate that production execution and control has been addressed most often in the current body of literature, which consists mostly of design research. Objectives and goals, points, achievements, multimedial feedback, metaphorical/fictional representations, and levels and progress are currently most often employed gamification affordances on this field. The research has focused on examining or considering motivation, enjoyment and flow as the main psychological outcomes of gamification in the given context, while individual performance and efficiency are the most commonly examined or suggested behavioral/organizational impacts. Future studies should employ more rigorous study designs and firmly ground the discussions in organization theory.
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Background Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. Methods In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks’ gestation in 2010–2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman’s rank correlations. Findings Intrapartum referral rates varied between 55–68% (nulliparous) and 20–32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6–16% (nulliparous) and 16–31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14–42% (nulliparous) and 3–13% (multiparous) and in obstetrician-led births from 46–67% and 14–28% respectively. Rates of postpartum oxytocin varied between 59–88% (nulliparous) and 50–85% (multiparous) and artificial rupture of membranes between 43–52% and 54–61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. Conclusions Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.
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Aanleiding Nieuwsuitgeverijen bevinden zich in zwaar weer. Economische malaise en toegenomen concurrentie in het pluriforme medialandschap dwingen uitgeverijen om enerzijds kosten te besparen en tegelijkertijd te investeren in innovatie. De verdere automatisering van de nieuwsredactie vormt hierbij een uitdaging. Buiten de branche ontstaan technieken die uitgeverijen hierbij zouden kunnen gebruiken. Deze zijn nog niet 'vertaald' naar gebruiksvriendelijke systemen voor redactieprocessen. De deelnemers aan het project formuleren voor dit braakliggend terrein een praktijkgericht onderzoek. Doelstelling Dit onderzoek wil antwoord geven op de vraag: Hoe kunnen bewezen en nieuw te ontwikkelen technieken uit het domein van 'natural language processing' een bijdrage leveren aan de automatisering van een nieuwsredactie en het journalistieke product? 'Natural language processing' - het automatisch genereren van taal - is het onderwerp van het onderzoek. In het werkveld staat deze ontwikkeling bekend als 'automated journalism' of 'robotjournalistiek'. Het onderzoek richt zich enerzijds op ontwikkeling van algoritmes ('robots') en anderzijds op de impact van deze technologische ontwikkelingen op het nieuwsveld. De impact wordt onderzocht uit zowel het perspectief van de journalist als de nieuwsconsument. De projectdeelnemers ontwikkelen binnen dit onderzoek twee prototypes die samen het automated-journalismsysteem vormen. Dit systeem gaat tijdens en na het project gebruikt worden door onderzoekers, journalisten, docenten en studenten. Beoogde resultaten Het concrete resultaat van het project is een prototype van een geautomatiseerd redactiesysteem. Verder levert het project inzicht op in de verankering van dit soort systemen binnen een nieuwsredactie. Het onderzoek biedt een nieuw perspectief op de manier waarop de nieuwsconsument de ontwikkeling van 'automated journalism' in Nederland waardeert. Het projectteam deelt de onderzoekresultaten door middel van presentaties voor de uitgeverijbranche, presentaties op wetenschappelijke conferenties, publicaties in (vak)tijdschriften, reflectiebijeenkomsten met collega-opleidingen en een samenvattende white paper.
A transition to a circular economy is needed to revolutionize the construction sector and make it more sustainable for present and future generations. While the construction industry and the production of construction materials contribute to environmental pollution, they also offer great potential for addressing many environmental problems. Sheet materials are engineered wood boards that are produced from recycled or solid wood where an adhesive is used to bind the particles together, predominantly used in: Furniture manufacturing, Flooring application, Roofing, Wall sheathing. The most common binder for boards is urea-formaldehyde. Other binders may be used depending on the grade of board and its intended end-use. For example, melamine urea-formaldehyde, phenolic resins and polymeric diphenylmethane diisocyanate (PMDI) are generally used in boards that require improved moisture resistance. Formaldehyde is classified in the in the European Union as a carcinogen and it carries the hazard statement 'suspected of causing cancer'. In this project mycelium composites are developed as a formaldehyde-free, fully natural and biodegradable material with high potential to substitute these hazardous materials. The heat-press process, the feasibility of which was evaluated in a previous Kiem HBO project, is to be further developed towards a process where mycelium sheets with different thicknesses will be obtained. This is considered as a fundamental step to increase the material approachability to the market. Different Material manufacturing techniques are also considered to enable the increase of sample thicknesses and volume. Moreover, a business study will be incorporated to allow further understanding of the material market potential. The consortium composition of V8 Architects, QbiQ, Fairm, Verbruggen Paddestoelen BV, and CoEBBE merges different expertise and guarantees the consideration of the whole material production chain. The research will contribute to bring mycelium composites a step closer to the market, giving them visibility and increasing the possibility to a commercial breakthrough.
NO-REGRETS examines the ecological and economic trade-offs of upscaling Offshore Wind Farms (OWFs) in the context of climate change and the ongoing food and nature transitions in the North Sea. NO-REGRETS advances knowledge on potential impacts of OWFs on ocean currents, suspended sediments, microscopic plankton, various life stages of fishes, seabed composition, seafloor organisms, marine mammals, and sea birds. Economic analyses explore changes in the value of marine fisheries and other ocean assets. Co-developed with stakeholders, NO-REGRETS will create tools allowing policymakers, industries and other stakeholders to gauge and optimise the ecological and bioeconomic consequences of North Sea OWF expansion.Collaborative partnersArcadis Nederland B.V., Blauwwind, Boskalis, Breda University of Applied Sciences, Centraal Bureau voor de Statistiek, Clusius C.V., Cooperatie Kottervisserij Nederland, Deltares, EcoShape, Eneco Windmolens Offshore B.V., Heerema Marine Contractors, Jaczon B.V., Nederlandse Vissersbond, Noordelijke Visserij Alliantie, NIOZ, NWO-institutenorganisatie, Ørsted Wind Power Netherlands Holding B.V., Pelagic Freezer Trawler Association, Rijksuniversiteit Groningen, Rijkswaterstaat, RWE Offshore Wind Netherlands B.V., Stichting Naturalis Biodiversity Center, Stichting Wageningen Research, Technische Universiteit Delft, Technische Universiteit Eindhoven, TNO Utrecht, Universiteit Leiden, Universiteit Twente, Universiteit van Amsterdam, Wageningen University & Research.
