Patients diagnosed with esophageal cancer have to deal with the consequences, such as major impact on their physical status and quality of life. A digital self-management tool could be a solution to support these patients in their self-management during the peri-operative period. This dissertation resulted in a better understanding of patients' needs and desires for (digital) self-management support during pre- (and post-operative) care. In addition, a core set consisting of the most relevant topics for self-management was developed. Differences were found between esophageal cancer patients in their expectations and needs regarding self-management and eHealth for self-management support. It is important to apply a diversity of forms of support given the increased desire to provide person-centered care and the fact that no single approach will meet the needs of all patients at all times. The development of a new (digital) self-management intervention to support these patients can be based on the results of the various studies in this dissertation.
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Summary Purpose The purpose of this study was to investigate the adoption and actual use of a digital dietary monitoring system (DDMS) and its impact on patient satisfaction with the provided hospital care, body weight changes and health-related quality of life (HRQoL) in patients with potentially curable esophageal cancer planned for surgery. The DDMS enables patients and dietitians to monitor patients' nutritional intake and body weight during the preoperative period. Methods In this prospective observational study, the first 47 included patients received usual nutritional care, and were followed from diagnosis until surgery. After implementation of the DDMS 37 patients were followed, again from diagnosis until surgery. Main outcomes were actual use of the DDMS, by means of adoption and usage measures, overall patient satisfaction (EORTC-INPATSAT32), weight change and HRQoL (EORTC QLQ-C30 and EORTC-OG25). Outcomes were assessed immediately after diagnosis, and 6 and 12 weeks later. Results The system had an adoption rate of 64% and a usage rate of 78%. No significant effects on patient satisfaction were found at 12 weeks after diagnosis between the intervention and the usual care group. The implementation of the DDMS also had no significant effect on body weight and HRQoL over time. Conclusions Patients with potentially curable esophageal cancer planned for surgery were able to use the DDMS. However, no significant effects on patient satisfaction, body weight changes and HRQoL were observed. Further research should focus on the specific needs of patients regarding information and support to preoperatively optimize nutritional intake and nutritional status.
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Background: Post-term pregnancy, a pregnancy exceeding 294 days or 42 completed weeks, is associated with increased perinatal morbidity and mortality and is considered a high-risk condition which requires specialist surveillance and induction of labour. However, there is uncertainty on the policy concerning the timing of induction for post-term pregnancy or impending post-term pregnancy, leading to practice variation between caregivers. Previous studies on induction at or beyond 41 weeks versus expectant management showed different results on perinatal outcome though conclusions in meta-analyses show a preference for induction at 41 weeks. However, interpretation of the results is hampered by the limited sample size of most trials and the heterogeneity in design. Most control groups had a policy of awaiting spontaneous onset of labour that went far beyond 42 weeks, which does not reflect usual care in The Netherlands where induction of labour at 42 weeks is the regular policy. Thus leaving the question unanswered if induction at 41 weeks results in better perinatal outcomes than expectant management until 42 weeks. Methods/design: In this study we compare a policy of labour induction at 41 + 0/+1 weeks with a policy of expectant management until 42 weeks in obstetrical low risk women without contra-indications for expectant management until 42 weeks and a singleton pregnancy in cephalic position. We will perform a multicenter randomised controlled clinical trial. Our primary outcome will be a composite outcome of perinatal mortality and neonatal morbidity. Secondary outcomes will be maternal outcomes as mode of delivery (operative vaginal delivery and Caesarean section), need for analgesia and postpartum haemorrhage (≥1000 ml). Maternal preferences, satisfaction, wellbeing, pain and anxiety will be assessed alongside the trial. Discussion: his study will provide evidence for the management of pregnant women reaching a gestational age of 41 weeks.
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Surgery aims to improve a patient’s medical condition. However, surgery is a major life event with the risk of negative consequences, like peri- and postoperative complications, prolonged hospitalization and delayed recovery of physical functioning. One of the major common side effects, functional decline, before (in the “waiting” period), during and after hospitalization is impressive, especially in frail people. Preoperative screening aims to identify frail, highrisk patients at an early stage, and advice these high-risk patients to start supervised preoperative home-based exercise training (prehabilitation) as soon as possible. Depending on the health status of the patient and his/her outcomes during the screening and the type of surgery, prehabilitation should focus on respiratory, cardiovascular and/or musculoskeletal parameters to prepare the patient for surgery. By improving preoperative physical fitness, a patient is able to better with stand the impact of major surgery and this will lead to a both reduced risk of negative side effects and better short term outcomes as a result. Besides prehabilitation hospital culture and infrastructure should be inherently activating so that patients stay as active as can be, socially, mentally and physically. In the first part of this chapter the concept of prehabilitation and different parameters that should be trained will be described. The second part focuses on the “Better in, Better out” (BiBo™) strategy, which aims to optimize patient’s pre-, peri- and postoperative physical fitness. Prehabilitation should comprise “shared decisions” between patient and physical therapist regarding experience and evidence based best options for rehabilitation goals, needs, and potential of the individual patient and his/her (in) formal support-system. Next, a case will describe the preoperative care pathway. This chapter will close with conclusions about how moving people before and after surgery will improve their outcomes.
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Aim To provide insight into the basic characteristics of decision making in the treatment of symptomatic severe aortic stenosis (SSAS) in Dutch heart centres with specific emphasis on the evaluation of frailty, cognition, nutritional status and physical functioning/functionality in (instrumental) activities of daily living [(I)ADL]. Methods A questionnaire was used that is based on the European and American guidelines for SSAS treatment. The survey was administered to physicians and non-physicians in Dutch heart centres involved in the decision-making pathway for SSAS treatment. Results All 16 Dutch heart centres participated. Before a patient case is discussed by the heart team, heart centres rarely request data from the referring hospital regarding patients’ functionality (n = 5), frailty scores (n = 0) and geriatric consultation (n = 1) as a standard procedure. Most heart centres ‘often to always’ do their own screening for frailty (n = 10), cognition/mood (n = 9), nutritional status (n = 10) and physical functioning/functionality in (I)ADL (n = 10). During heart team meetings data are ‘sometimes to regularly’ available regarding frailty (n = 5), cognition/mood (n = 11), nutritional status (n = 8) and physical functioning/functionality in (I)ADL (n = 10). After assessment in the outpatient clinic patient cases are re-discussed ‘sometimes to regularly’ in heart team meetings (n = 10). Conclusions Dutch heart centres make an effort to evaluate frailty, cognition, nutritional status and physical functioning/functionality in (I)ADL for decision making regarding SSAS treatment. However, these patient data are not routinely requested from the referring hospital and are not always available for heart team meetings. Incorporation of these important data in a structured manner early in the decision-making process may provide additional useful information for decision making in the heart team meeting.
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Early mobilisation after abdominal surgery is necessary to avoid complications and increase recovery. However, due to a variety of factors, failure of early mobilisation is seen in clinical practice. The aim of this study is to investigate the perspectives of nurses and patients of the Haaglanden Medical Center (HMC) how to increase mobilisation frequency after colorectal surgery in the oncological surgery ward. This explorative study employed qualitative data collection and analysis by means of semi-structured interviews with patients and nurses. Patients were included when they had a colorectal resection, were older than 18 years and spoke Dutch. The interviews were audiotaped and verbatum transcribed. A thematic content analysis was performed. It was concluded that mobilisation can be increased when it is incorporated in daily care activities and family support during visiting hours. Appropriate information about mobilisation and physical activity is needed for nurses, patients and family and the hospital environment should stimulate mobilisation.
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Introduction: This study evaluates the course of physical fitness and nutritional status during curative therapy for esophageal cancer, after implementation of a prehabilitation program. Additionally, the impact of baseline physical fitness level and severe postoperative complications on the course of individual patients were explored. Materials and methods: This multicenter, observational cohort study included patients with esophageal cancer following curative treatment. Prehabilitation, consisting of supervised exercise training and nutritional counseling was offered as standard care to patients after neoadjuvant therapy, prior to surgery. Primary outcome measures included change of exercise capacity, hand grip strength, self-reported physical functioning, Body Mass Index, and malnutrition risk from diagnosis to 2–6 months postoperatively. Analyses over time were performed using linear mixed models, and linear mixed regression models to investigate the impact of baseline level and severe postoperative complications. Results: Hundred sixty-eight patients were included (mean age 65.9 ± 8.6 years; 78.0 % male). All parameters (except for malnutrition risk) showed a decline during neoadjuvant therapy (p < .05), an improvement during prehabilitation (p < .005) and a decline postoperatively (p < .001), with a high heterogeneity between patients. Change in the outcomes from baseline to postoperatively was not different for patients with or without a severe complication. Better baseline physical fitness and nutritional status were significantly associated with a greater decline postoperatively (p < .001). Conclusion: This study demonstrates a notable decline during neoadjuvant therapy, that fully recovers during prehabilitation, and a subsequent long lasting decline postoperatively. The heterogeneity in the course of physical fitness and nutritional status underlines the importance of individualized monitoring.
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Older people are often over-represented in morbidity and mortality statistics associated with hot and cold weather, despite remaining mostly indoors. The study “Improving thermal environment of housing for older Australians” focused on assessing the relationships between the indoor environment, building characteristics, thermal comfort and perceived health/wellbeing of older South Australians over a study period that included the warmest summer on record. Our findings showed that indoor temperatures in some of the houses reached above 35 °C. With concerns about energy costs, occupants often use adaptive behaviours to achieve thermal comfort instead of using cooling (or heating), although feeling less satisfied with the thermal environment and perceiving health/wellbeing to worsen at above 28 °C (and below 15 °C). Symptoms experienced during hot weather included tiredness, shortness of breath, sleeplessness and dizziness, with coughs and colds, painful joints, shortness of breath and influenza experienced during cold weather. To express the influence of temperature and humidity on perceived health/wellbeing, a Temperature Humidity Health Index (THHI) was developed for this cohort. A health/wellbeing perception of “very good” is achieved between an 18.4 °C and 24.3 °C indoor operative temperature and a 55% relative humidity. The evidence from this research is used to inform guidelines about maintaining home environments to be conducive to the health/wellbeing of older people. Original publication at MDPI: https://doi.org/10.3390/atmos13010096 © 2022 by the authors. Licensee MDPI.
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Background: Major surgery is associated with negative postoperative outcomes such as complications and delayed or poor recovery. Multimodal prehabilitation can help to reduce the negative effects of major surgery. Offering prehabilitation by means of mobile health (mHealth) could be an effective new approach. Objective: The objectives of this pilot study were to (1) evaluate the usability of the Be Prepared mHealth app prototype for people undergoing major surgery, (2) explore whether the app was capable of bringing about a change in risk behaviors, and (3) estimate a preliminary effect of the app on functional recovery after major surgery. Methods: A mixed-methods pilot randomized controlled trial was conducted in two Dutch academic hospitals. In total, 86 people undergoing major surgery participated. Participants in the intervention group received access to the Be Prepared app, a smartphone app using behavior change techniques to address risk behavior prior to surgery. Both groups received care as usual. Usability (System Usability Scale), change in risk behaviors 3 days prior to surgery, and functional recovery 30 days after discharge from hospital (Patient-Reported Outcomes Measurement Information System physical functioning 8-item short form) were assessed using online questionnaires. Quantitative data were analyzed using descriptive statistics, chi-square tests, and multivariable linear regression. Semistructured interviews about the usability of the app were conducted with 12 participants in the intervention group. Thematic analysis was used to analyze qualitative data. Results: Seventy-nine people—40 in the intervention group and 39 in the control group—were available for further analysis. Participants had a median age of 61 (interquartile range 51.0-68.0) years. The System Usability Scale showed that patients considered the Be Prepared app to have acceptable usability (mean 68.2 [SD 18.4]). Interviews supported the usability of the app. The major point of improvement identified was further personalization of the app. Compared with the control group, the intervention group showed an increase in self-reported physical activity and muscle strengthening activities prior to surgery. Also, 2 of 2 frequent alcohol users in the intervention group versus 1 of 9 in the control group drank less alcohol in the run-up to surgery. No difference was found in change of smoking cessation. Between-group analysis showed no meaningful differences in functional recovery after correction for baseline values (β=–2.4 [95% CI –5.9 to 1.1]). Conclusions: The Be Prepared app prototype shows potential in terms of usability and changing risk behavior prior to major surgery. No preliminary effect of the app on functional recovery was found. Points of improvement have been identified with which the app and future research can be optimized.
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Abstract Aims: To lower the threshold for applying ultrasound (US) guidance during peripheral intravenous cannulation, nurses need to be trained and gain experience in using this technique. The primary outcome was to quantify the number of procedures novices require to perform before competency in US-guided peripheral intravenous cannulation was achieved. Materials and methods: A multicenter prospective observational study, divided into two phases after a theoretical training session: a handson training session and a supervised life-case training session. The number of US-guided peripheral intravenous cannulations a participant needed to perform in the life-case setting to become competent was the outcome of interest. Cusum analysis was used to determine the learning curve of each individual participant. Results: Forty-nine practitioners participated and performed 1855 procedures. First attempt cannulation success was 73% during the first procedure, but increased to 98% on the fortieth attempt (p<0.001). The overall first attempt success rate during this study was 93%. The cusum learning curve for each practitioner showed that a mean number of 34 procedures was required to achieve competency. Time needed to perform a procedure successfully decreased when more experience was achieved by the practitioner, from 14±3 minutes on first procedure to 3±1 minutes during the fortieth procedure (p<0.001). Conclusions: Competency in US-guided peripheral intravenous cannulation can be gained after following a fixed educational curriculum, resulting in an increased first attempt cannulation success as the number of performed procedures increased.
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