Background: Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods: We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n=4). Results: The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions: The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment.
In this work, in situ measurements of the radio frequency electromagnetic field exposure have been conducted for an indoor massive MIMO 5G base station operating at 26–28 GHz. Measurements were performed at six different positions (at distances between 9.94 and 14.32 m from the base station), of which four were in line-of-sight and two were in non-line-of-sight. A comparison was performed between the measurements conducted with an omnidirectional probe and with a horn antenna, for scenarios with and without a user equipment used to actively create an antenna traffic beam from the base station towards the measurement location. A maximum exposure of 171.9 mW/m2 was measured at a distance of 9.94 m from the base station. This is below 2% of the ICNIRP reference level. Moreover, the feasibility to measure the power per resource element of the Synchronization Signal Block - which can be used to extrapolate the maximum exposure level - with a conventional spectrum analyzer was shown by comparison with a network decoder.
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ObjectiveHospital-to-home (H2H) transitions challenge families of children with medical complexity (CMC) and healthcare professionals (HCP). This study aimed to gain deeper insights into the H2H transition process and to work towards eHealth interventions for its improvement, by applying an iterative methodology involving both CMC families and HCP as end-users.MethodsFor 20-weeks, the Dutch Transitional Care Unit consortium collaborated with the Amsterdam University of Applied Sciences, HCP, and CMC families. The agile SCREAM approach was used, merging Design Thinking methods into five iterative sprints to stimulate creativity, ideation, and design. Continuous communication allowed rapid adaptation to new information and the refinement of solutions for subsequent sprints.ResultsThis iterative process revealed three domains of care – care coordination, social wellbeing, and emotional support – that were important to all stakeholders. These domains informed the development of our final prototype, ‘Our Care Team’, an application tailored to meet the H2H transition needs for CMC families and HCP.ConclusionComplex processes like the H2H transition for CMC families require adaptive interventions that empower all stakeholders in their respective roles, to promote transitional care that is anticipatory, rather than reactive.InnovationA collaborative methodology is needed, that optimizes existing resources and knowledge, fosters innovation through collaboration while using creative digital design principles. This way, we might be able to design eHealth solutions with end-users, not just for them.
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Binnen het MKB wordt in meer of mindere mate gebruik gemaakt van product configuratoren, informatietools waarmee producten klantgericht geconfigureerd kunnen worden uit aanwezige bouwstenen. Product configuratoren structureren het overleg met de klant. De verkregen informatie wordt, na orderacceptatie, gebruikt in het informatiesysteem van het bedrijf waarmee inkoop, productie en aflevering bestuurd wordt. Dankzij product configuratoren kunnen bedrijven beter en sneller producten aanbieden aan klanten, inclusief haalbare levertijden. Diverse bedrijven die een product configurator hebben aangeschaft, merken dat het niet eenvoudig is om de configurator goed in te zetten. Specifieke klanteisen kunnen het gebruik van de configurator frustreren. Ook is het moeilijk om de consequenties van productinnovaties eenvoudig te verwerken in de product configurator. Een kleine verandering vraagt vaak om veel veranderingen in de het systeem. Een beter gebruik van de product configurator lijkt te vragen om een meer modulaire productarchitectuur waar variaties in modules opgevangen kunnen worden. Dit wordt zowel in de literatuur als door de deelnemende bedrijven in dit KIEM project genoemd. In dit KIEM project onderzoeken we hoe informatie die opgeslagen wordt in de product configurator, en informatie over het gebruik van de product configurator gebruikt kan worden als input voor het productinnovatieproces. Deze vraag is afkomstig van de bedrijven die meedoen met dit onderzoek. De vraag sluit ook aan bij eerder onderzoek vanuit het Lectoraat Lean/World Class Performance waarin de ontwikkeling van productarchitectuur centraal stond. Met de opgedane kennis wordt de basis gelegd voor relevant vervolgonderzoek naar de link tussen procesintegratie (i.c. het gebruik van een product configurator) en productinnovatie.
