Het ontwerp van een onderzoek naar de effectiviteit van twee interventiemethodes (U-PRIM en U-CARE) voor een proactieve zorg voor kwetsbare ouderen. Uitdagingen en methodologische kwesties worden uitgelicht.
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Aim. To report the expectations and experiences of general practitioners and practice nurses regarding the U-CARE programme, to gain a better understanding of the barriers and facilitators in providing proactive, structured care to frail older people and to determine whether implementation is feasible. Background. Care for older patients with complex care needs in primary care is fragmented, reactive and time consuming. A structured, proactive care programme was developed to improve physical functioning and quality of life in frail older patients. Design. An explanatory mixed-methods study nested in a cluster-randomized trial. Methods. The barriers to and needs for the provision of structured, proactive care, and expectations regarding the U-CARE programme were assessed with prequestionnaires sent to all participating general practitioners (n = 32) and practice nurses (n = 21) in October 2010. Postquestionnaires measured experiences with the programme after 5 months. Twelve months later, focus group meetings were conducted. Results. Practice nurses and general practitioners reported that it was difficult to provide proactive and structured care to older patients with multi-morbidity, different cultural backgrounds and low socioeconomic status. Barriers were a lack of time and financial compensation. Most general practitioners and practice nurses indicated that the programme added value for the coordination of care and allowed them to provide structured care. Conclusion. This explanatory mixed-methods study showed that general practitioners and practice nurses perceived the U-CARE programme as feasible in general practice. A transition was made from reactive, ad hoc care towards a proactive and preventive care approach
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Artificially intelligent agents increasingly collaborate with humans in human-agent teams. Timely proactive sharing of relevant information within the team contributes to the overall team performance. This paper presents a machine learning approach to proactive communication in AI-agents using contextual factors. Proactive communication was learned in two consecutive experimental steps: (a) multi-agent team simulations to learn effective communicative behaviors, and (b) human-agent team experiments to refine communication suitable for a human team member. Results consist of proactive communication policies for communicating both beliefs and goals within human-agent teams. Agents learned to use minimal communication to improve team performance in simulation, while they learned more specific socially desirable behaviors in the human-agent team experiment
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OBJECTIVES: To determine the effectiveness of a proactive primary care program on the daily functioning of older people in primary care. DESIGN: Single-blind, three-arm, cluster-randomized controlled trial with 1-year follow-up. SETTING: Primary care setting, 39 general practices in the Netherlands. PARTICIPANTS: Community-dwelling people aged 60 and older (N = 3,092). INTERVENTIONS: A frailty screening intervention using routine electronic medical record data to identify older people at risk of adverse events followed by usual care from a general practitioner; after the screening intervention, a nurse-led care program consisting of a comprehensive geriatric assessment, evidence-based care planning, care coordination, and follow-up; usual care. MEASUREMENTS: Primary outcome was daily functioning measured using the Katz-15 (6 activities of daily living (ADLs), 8 instrumental activities of daily living (IADLs), one mobility item (range 0–15)); higher scores indicat greater dependence. Secondary outcomes included quality of life, primary care consultations, hospital admissions, emergency department visits, nursing home admissions, and mortality. RESULTS: The participants in both intervention arms had less decline in daily functioning than those in the usual care arm at 12 months (mean Katz-15 score: screening arm, 1.87, 95% confidence interval (CI) = 1.77–1.97; screening and nurse-led care arm, 1.88, 95% CI = 1.80–1.96; control group, 2.03, 95% CI = 1.9 –2.13; P = .03). No differences in quality of life were observed. CONCLUSION: Participants in both intervention groups had less decline than those in the control group at 1-year follow-up. Despite the statistically significant effect, the clinical relevance is uncertain at this point because of the small differences. Greater customizing of the intervention combined with prolonged follow-up may lead to more robust results.
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Complex interventions are criticized for being a “black box”, which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary-care programs aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare, and synthesize the development and evaluation of nine primary-care programs within a controlled trial to further improve the development and evaluation of complex interventions. A systematic overview of all written data on the nine proactive primary-care programs was conducted using a validated item list.
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Background In a large randomized trial, Utrecht PROactive Frailty Intervention Trial (U‐PROFIT), we evaluated the effectiveness of an integrated program on the preservation of daily functioning in older people in primary care that consisted of a frailty identification tool and a multicomponent nurse‐led care program. Examination of treatment fidelity is critical to successful translation of evidence‐based interventions into practice. Aims To assess treatment delivery, dose and content of nursing care delivered within the nurse‐led care program, and to explore if the delivery may have influenced the trial results. Methods A mixed‐methods study was conducted. Type and dose of nursing care were collected during the trial. Shortly after the trial, a focus group with nurses was conducted to explore reasons for the observed differences between the type and dose of nursing care delivered. Results A total of 835 older persons were included in the nurse‐led care program. The mean age was 75 years, 64% were female and 53.5% were living alone. The most frequent self‐reported conditions were loneliness (60.8%) and cognitive problems (59.4%). One‐third of the patients with a geriatric condition received an additional assessment (e.g., Mini‐Mental State Examination), and the majority of these patients received at least one nurse intervention (>85%). Most nursing care was delivered to patients at risk of falling and to those with urinary incontinence. Patients with nutrition problems seldom received nursing interventions. The nurses explained that differences in type and dose were influenced by the preference of the patient, the type of geriatric problem, and the time required to apply a nurse intervention. Linking Evidence to Action All intervention components were delivered; however, differences were observed in the type and dose of nursing care delivered across geriatric conditions. The findings better explain the treatment fidelity and suggest that there is room for improvement that may result in more beneficial patient outcomes.
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Background: Interprofessional collaboration in practice (IPCP) between professionals from the medical and social domain within primary care is desirable; however, it is also challenging due to fragmented healthcare. Little is known about the development of IPCP in primary care to fit the implementation context. is article describes the methodological development and the final content of an IPCP program. Methods and findings:e development process started with the identification of IPCP competencies in a literature review and a qualitative needs analysis with semi-structured interviews among eight elders and four healthcare professionals. e results were discussed during a first consultation with an expert team, which consisted of ten healthcare professionals. Consensus was reached on the themes role identity, communication, and shared vision development to form the basis of the program. A second consultation with the experts discussed the first version of the program. en, consensus was reached on the final version of the program, which included a blended learning approach consisting of two face-to-face meetings, online learning, and on-the-job learning with a sixteen-hour time investment over a six-week period. Conclusions: e IPCP program was developed based on educational strategies and evidence, and with the support and knowledge of practice experts to fit the implementation context.
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Bookreviews of Anders Ericsson & Robert Pool. Peak: How All of Us Can Achieve Extraordinary Things and of Cal Newport. Deep Work: Rules for Focused Success in a Distracted World. Human beings are unique among all living organisms in that their primary adaptive specialization does not require some particular physical form or skill or fit in an ecological niche, but rather in identification with the process of adaptation itself – in the process of learning. We are thus the learning species, and our survival depends on our ability to adapt not only in the reactive sense of fitting into the physical and social worlds, but in the proactive sense of creating and shaping those worlds. (Kolb, 1984, Experiential Learning: Experience as The Source of Learning and Development, p. 1)
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This article focuses on which aspects of the learning environment, aimed at fostering career learning, correspond with the development of career competencies among students (aged 12-19 years) enrolled in prevocational and secondary vocational education in The Netherlands. Aspects of the learning environment that are taken into account here are the following: career orientation and guidance methods used, instruments implemented, and the degree to which the curriculum is practice-based and dialogical. In the study, three career competencies are identified: career reflection (reflective behaviour), career forming (proactive behaviour), and networking (interactive behaviour). To research the relationship between the learning environment and the presence of career competencies, a study was done among 3499 students and 166 teachers in 226 classes in 34 schools. The results show that career guidance in school, in which a dialogue takes place with the student about concrete experiences and which is focused on the future, contributes most to the presence of career competencies among students. Without this dialogue, career guidance methods and instruments barely contribute to the acquisition of career competencies.
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