Melt electrowriting (MEW) enables precise scaffold fabrication for biomedical applications. With a limited number of processable materials with short and tunable degradation times, polyhydroxyalkanoates (PHAs) present an interesting option. Here, poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) and a blend of PHBV and poly(3-hydroxybutyrate-co-4-hydroxybutyrate) (PHBV+P34HB) are successfully melt electrowritten into scaffolds with various architectures. PHBV+P34HB exhibits greater thermal stability, making it a superior printing material compared to PHBV in MEW. The PHBV+P34HB scaffolds subjected to enzymatic degradation show tunable degradation times, governed by enzyme dilution, incubation time, and scaffold surface area. PHBV+P34HB scaffolds seeded with human dermal fibroblasts (HDFs), demonstrate enhanced cell adherence, proliferation, and spreading. The HDFs, when exposed to the enzyme solutions and enzymatic degradation residues, show good viability and proliferation rates. Additionally, HDFs grown on enzymatically pre-incubated scaffolds do not show any difference in behavior compared those grown on control scaffolds. It is concluded that PHAs, as biobased materials with enzymatically tunable degradability rates, are an important addition to the already limited set of materials available for MEW technology.
LINK
Polyhydroxyalkanoates (PHAs) are biodegradable biopolymers (polyesters), produced by a wide range of bacterial strains. They are gaining increasing interest in different research fields, due to their sustainability and environmental-friendly properties. Additionally, PHAs are also biocompatible, which makes them interesting for tissue engineering and regenerative medicine. At the same time, they are characterized by properties ideal for 3D printing processing, such as high tensile strength, easy processability and thermoplasticity. To date, the techniques employed in PHAs printing mostly include fused deposition modeling (FDM), selective laser sintering (SLS), electrospinning (ES), and melt electrospinning (MES). In this review, we provide a comprehensive summary of the versatile and sustainably sourced bacterial PHAs, also modified by blending with natural and synthetic polymers (e.g., PLA, PGA) or combining them with inorganic fillers (e.g., nanoparticles, glass), used for 3D printing in biomedical applications. We specify focus on the printing conditions and the properties of the obtained scaffolds with a focus on the print resolution and scaffolds mechanical and biological properties. New perspectives in the emerging field of PHAs biofabrication process, characterized by sustainability and efficiency of the scaffold production, are demonstrated. The use of alternative printing techniques, i.e. melt electrowriting (MEW), and producing smart and functional materials degrading on demand under in vitro and in vivo conditions is proposed.
LINK
Kwaliteit vraagt om vertrouwen en vakvolwassenheid van de professional.
DOCUMENT
Treatment guidelines difer signifcantly, not only between Europe and North America but also among European countries [1–4]. Reasons for these diferences include antimicrobial resistance patterns, accessibility to and reimbursement policies for medicines, and culturally and historically determined prescribing attitudes. The European Association of Clinical Pharmacology and Therapeutics’ Education Working Group has launched several initiatives to improve and harmonize European pharmacotherapy education, but international diferences have proven to be a major barrier to these eforts [5–7]. While we have taken steps to chart these diferences [6, 8], it will probably not be possible to fully resolve them. Rather than viewing these diferences as a barrier, we should perhaps see them as an opportunity for intercultural learning by providing students and teachers a valuable lesson in the context-dependent nature of prescribing medication and the diferent interpretations of evidence-based medicine. Here, we extend our experience with interprofessional student-run clinics [9, 10], to report on our first experiences with the “International and Interprofessional Student-run Clinic.” We organized three successful video meetings with medical and pharmacy students of the Amsterdam UMC, location VU University (the Netherlands), and the University of Bologna (Italy). During these meetings, one of the students presented a real-life case of a patient on polypharmacy. Then, in a 45-min session, the students split into smaller groups (break-out rooms) to review the patient’s medication, using the prescribing optimization method and STOPP/ START criteria [11, 12]. The teachers rotated between the diferent rooms and assisted the students when necessary. Teachers and students reconvened for 60 min for debriefng, with students presenting their fndings and suggestions to revise the medication list and teachers stimulating discussion and indicating how they would alter the medication list. Participation was voluntary, and the meetings were held in the evenings to accommodate students in clinical rotations. Third-to-fnal-year medical and pharmacy students participated in the three meetings (n=17, n=20, n=12, respectively). They reported learning a lot from each other, gaining an international and interprofessional perspective. Moreover, they learned to always consider the patient’s perspective, that evidence-based medicine is context-dependent, and that guidelines should be adapted to the patient’s situation.
MULTIFILE
Een kunstenaar moet hedendaags zijn, wil hij serieus genomen worden. Maar waar komt die verheerlijking van het hedendaagse vandaan? Hoe relevant is hedendaagsheid in de kunst en het kunstonderwijs eigenlijk? Dit boek gaat vanuit diverse perspectieven dieper in op het thema hedendaagsheid. Wat maakt het hedendaagse nu zo belangrijk dat haar schijn een haast mythologiserend karakter krijgt?
MULTIFILE
Background: Successful implementation of multifactorial fall prevention interventions (FPIs) is essential to reduce increasing fall rates in communitydwelling older adults. However, implementation often fails due to the complex context of the community involving multiple stakeholders within and across settings, sectors, and organizations. As there is a need for a better understanding of the occurring context-related challenges, the current scoping review purposes to identify what contextual determinants (i.e., barriers and facilitators) influence the implementation of FPIs in the community. Methods: A scoping reviewwas performed using the Arksey andO’Malley framework. First, electronic databases (Pubmed, CINAHL, SPORTDiscus, PsycINFO) were searched. Studies that identified contextual determinants that influence the implementation of FPIs in the community were included. Second, to both validate the findings from the literature and identify complementary determinants, health and social care professionals were consulted during consensus meetings (CMs) in four districts in the region of Utrecht, the Netherlands. Data were analyzed following a directed qualitative content analysis approach, according to the 39 constructs of the Consolidated Framework for Implementation Research. Results: Fourteen relevant studies were included and 35 health and social care professionals (such as general practitioners, practice nurses, and physical therapists) were consulted during four CMs. Directed qualitative content analysis of the included studies yielded determinants within 35 unique constructs operating as barriers and/or facilitators. The majority of the constructs (n = 21) were identified in both the studies and CMs, such as “networks and communications”, “formally appointed internal implementation leaders”, “available resources” and “patient needs and resources”. The other constructs (n = 14) were identified only in the . Discussion: Findings in this review show that awide array of contextual determinants are essential in achieving successful implementation of FPIs in the community. However, some determinants are considered important to address, regardless of the context where the implementation occurs. Such as accounting for time constraints and financial limitations, and considering the needs of older adults. Also, broad cross-sector collaboration and coordination are required in multifactorial FPIs. Additional context analysis is always an essential part of implementation efforts, as contexts may differ greatly, requiring a locally tailored approach.
DOCUMENT
Introduction: Retrospective studies suggest that a rapid initiation of treatment results in a better prognosis for patients in the emergency department. There could be a difference between the actual medication administration time and the documented time in the electronic health record. In this study, the difference between the observed medication administration time and documentation time was investigated. Patient and nurse characteristics were also tested for associations with observed time differences. Methods: In this prospective study, emergency nurses were followed by observers for a total of 3 months. Patient inclusion was divided over 2 time periods. The difference in the observed medication administration time and the corresponding electronic health record documentation time was measured. The association between patient/nurse characteristics and the difference in medication administration and documentation time was tested with a Spearman correlation or biserial correlation test. Results: In 34 observed patients, the median difference in administration and documentation time was 6.0 minutes (interquartile range 2.0-16.0). In 9 (26.5%) patients, the actual time of medication administration differed more than 15 minutes with the electronic health record documentation time. High temperature, lower saturation, oxygen-dependency, and high Modified Early Warning Score were all correlated with an increasing difference between administration and documentation times. Discussion: A difference between administration and documentation times of medication in the emergency department may be common, especially for more acute patients. This could bias, in part, previously reported time-to-treatment measurements from retrospective research designs, which should be kept in mind when outcomes of retrospective time-to-treatment studies are evaluated.
DOCUMENT
"Probation is a fast-developing field that plays an important role in the response to crime and the prevention of reoffending. Probation covers various sanctions and community-based measures, including supervision and community service, designed to promote community safety and the social inclusion of offenders. This brochure is intended for justice ministers, other politicians and senior civil servants interested in setting up or upgrading a probation service. The ‘key message’ highlights the main topics and messages in this brochure. Readers who want to learn more about the benefits of probation and about how to bring these into practice should read the full text."
DOCUMENT
Dit hoofdstuk behandelt tal van onderwerpen uit de dagelijkse praktijk op de intensive care. Allereerst belichten we het assessment en de eerste opvang van de vitaal bedreigde patiënt volgens de ABCDE-systematiek. Vervolgens de aandachtspunten en wettelijke eisen die gesteld worden aan rapportage en verpleegkundige verslaglegging. We belichten scoringssystemen om zaken als de ernst van aandoeningen, sterftekans, diepte van sedatie, pijn, werklast en overlevingskans te kunnen classificeren: APACHE, SOFA, SAPS, CAM ICU en RASS, (TISS), frailty-index, MEWS en SF-36/RAND-36. Na een uiteenzetting over debriefing is er aandacht voor lichamelijke en persoonlijke verzorging en mobilisatie van de IC-patiënt, en voor de gevolgen van immobiliteit. Comorbiditeit en multimorbiditeit blijven evenmin onbelicht, evenals thermoregulatie met aandacht voor hyperthermie en hypothermie. Het fenomeen pijn, en daaraan gekoppeld pijnbestrijding/analgesie, wordt besproken. Ook slaapproblemen, Family-Centered Care (PFCC), ofwel familiegerichte zorg, en crisismanagement worden besproken. Ten slotte is er aandacht voor klinische ethiek. Hierbij spelen onder andere hersendood en orgaandonatie een belangrijke rol.
LINK
"A proportion of those with eating disorders have also experienced traumatic events and ongoing symptoms of PTSD such as re-experiencing of the trauma and nightmares. We implemented an innovative trauma intervention called Imagery Rescripting (ImRs) to explore whether for those undergoing inpatient treatment for an eating disorder (in an underweight phase), it would be possible to treat the various trauma-related symptoms as well as the eating problems. Since this has not been investigated before, we asked the participants in this study to recount their experiences. Twelve participants who were underweight, reported a past history of trauma and were in an inpatient eating disordertreatment program participated in ImRs therapy intervention. One of these participant did not engage in the ImRs therapy because she discontinued the inpatient ED treatment. Analysis of interviews with these participants found that -although they were reluctant before the start of the treatment- the ImRs treatment during their inpatient admission had given them hope again. They added that it was important to have support from group members, sociotherapists and therapists. They shared a number of ways that the ImRs treatment could be adapted to people with eating disorders. Their experiences indicated that given these factors it was possible to treat PTSD during an underweight phase. This is important: until now, treatment for eating disorders has not specifically been trauma-focused and these tips have scope to improve the ImRs intervention and eating disorder treatment more broadly in the future."
MULTIFILE
