Zoekresultaten

Quality of care in the intensive care unit from the perspective of patient's relatives

BACKGROUND: The quality standards of the Dutch Society of Intensive Care require monitoring of the satisfaction of patient's relatives with respect to care. Currently, no suitable instrument is available in the Netherlands to measure this. This study describes the development and psychometric evaluation of the questionnaire-based Consumer Quality Index 'Relatives in Intensive Care Unit' (CQI 'R-ICU'). The CQI 'R-ICU' measures the perceived quality of care from the perspective of patients' relatives, and identifies aspects of care that need improvement.METHODS: The CQI 'R-ICU' was developed using a mixed method design. Items were based on quality of care aspects from earlier studies and from focus group interviews with patients' relatives. The time period for the data collection of the psychometric evaluation was from October 2011 until July 2012. Relatives of adult intensive care patients in one university hospital and five general hospitals in the Netherlands were approached to participate. Psychometric evaluation included item analysis, inter-item analysis, and factor analysis.RESULTS: Twelve aspects were noted as being indicators of quality of care, and were subsequently selected for the questionnaire's vocabulary. The response rate of patients' relatives was 81% (n = 455). Quality of care was represented by two clusters, each showing a high reliability: 'Communication' (α = .80) and 'Participation' (α = .84). Relatives ranked the following aspects for quality of care as most important: no conflicting information, information from doctors and nurses is comprehensive, and health professionals take patients' relatives seriously. The least important care aspects were: need for contact with peers, nuisance, and contact with a spiritual counsellor. Aspects that needed the most urgent improvement (highest quality improvement scores) were: information about how relatives can contribute to the care of the patient, information about the use of meal-facilities in the hospital, and involvement in decision-making on the medical treatment of the patient.CONCLUSIONS: The CQI 'R-ICU' evaluates quality of care from the perspective of relatives of intensive care patients and provides practical information for quality assurance and improvement programs. The development and psychometric evaluation of the CQI 'R-ICU' led to a draft questionnaire, sufficient to justify further research into the reliability, validity, and the discriminative power of the questionnaire.

How to build a webscraper in R to retrieve restaurant data from Iens?

tech-report

In vitro–in silico-based prediction of inter-individual and inter-ethnic variations in the dose-dependent cardiotoxicity of R- and S-methadone in humans

New approach methodologies predicting human cardiotoxicity are of interest to support or even replace in vivo-based drug safety testing. The present study presents an in vitro–in silico approach to predict the effect of inter-individual and inter-ethnic kinetic variations in the cardiotoxicity of R- and S-methadone in the Caucasian and the Chinese population. In vitro cardiotoxicity data, and metabolic data obtained from two approaches, using either individual human liver microsomes or recombinant cytochrome P450 enzymes (rCYPs), were integrated with physiologically based kinetic (PBK) models and Monte Carlo simulations to predict inter-individual and inter-ethnic variations in methadone-induced cardiotoxicity. Chemical specific adjustment factors were defined and used to derive dose–response curves for the sensitive individuals. Our simulations indicated that Chinese are more sensitive towards methadone-induced cardiotoxicity with Margin of Safety values being generally two-fold lower than those for Caucasians for both methadone enantiomers. Individual PBK models using microsomes and PBK models using rCYPs combined with Monte Carlo simulations predicted similar inter-individual and inter-ethnic variations in methadone-induced cardiotoxicity. The present study illustrates how inter-individual and inter-ethnic variations in cardiotoxicity can be predicted by combining in vitro toxicity and metabolic data, PBK modelling and Monte Carlo simulations. The novel methodology can be used to enhance cardiac safety evaluations and risk assessment of chemicals.

Polandball is of Reddit

Predicted Ellipse Area

Calculation of the 95% predicted ellipse area in R from center of pressure measurements by means of posturography, following the code as published by Dr. P Schubert and Dr. M. Kirschner

Keeping trouble at a safe distance

‘The fear of crime’ is “upon everybody’s tongue” nowadays (Farrall & Gadd 2004:1). The concept is widely accepted as social problem across the globe (Gray, Jackson & Farrall 2008, Garland 2001) as it is held to impinge ‘(…) upon the well-being of a large proportion of the population’ (Farralll et al. 1997:658). But do we actually have a valid picture of a genuine ‘social problem of striking dimensions’ (Ditton 1999:83)? Critical voices say we don’t. ‘The fear of crime’ - as we generally know it - is seen by them as ‘(…) a product of the way it has been researched rather than the way it is’ (Farrall et al. 1997:658). And still, 45 years after the start of research, ‘surprisingly little can be said conclusively about the fear of crime‘ (Ditton & Farrall 2000:xxi). This research contributes to a growing body of knowledge - from especially the last fifteen years - that treats ‘the fear of crime’ as ‘(…) a complex allocation of interacting feelings, perceptions, emotions, values and judgments on the personal as well as the societal level’ (Pleysier 2010:43). One often replicated and paradoxical observation catches the eye: citizens perceive a growing threat of crime to their society, but consequently perceive a low risk that they themselves will fall victim of crime. Taking a social psychological approach (e.g. see Farrall et al. 2000; Jackson 2008), we will search for suitable explanations for this paradoxical observation in the fear of crime’s research tradition. The aim of this research is ‘to integrate social psychological concepts related to the individual’s identity and evaluation of his position in an increasingly complex society, to enhance our understanding of the fear of crime concept’ (Pleysier & Cops 2016:3).