BACKGROUND: Conflicting evidence exists on the effectiveness of routinely measured vital signs on the early detection of increased probability of adverse events.PURPOSE: To assess the clinical relevance of routinely measured vital signs in medically and surgically hospitalized patients through a systematic review.DATA SOURCES: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature, and Meta-analysen van diagnostisch onderzoek (in Dutch; MEDION) were searched to January 2013.STUDY SELECTION: Prospective studies evaluating routine vital sign measurements of hospitalized patients, in relation to mortality, septic or circulatory shock, intensive care unit admission, bleeding, reoperation, or infection.DATA EXTRACTION: Two reviewers independently assessed potential bias and extracted data to calculate likelihood ratios (LRs) and predictive values.DATA SYNTHESIS: Fifteen studies were performed in medical (n = 7), surgical (n = 4), or combined patient populations (n = 4; totaling 42,565 participants). Only three studies were relatively free from potential bias. For temperature, the positive LR (LR+) ranged from 0 to 9.88 (median 1.78; n = 9 studies); heart rate 0.82 to 6.79 (median 1.51; n = 5 studies); blood pressure 0.72 to 4.7 (median 2.97; n = 4 studies); oxygen saturation 0.65 to 6.35 (median 1.74; n = 2 studies); and respiratory rate 1.27 to 1.89 (n = 3 studies). Overall, three studies reported area under the Receiver Operator Characteristic (ROC) curve (AUC) data, ranging from 0.59 to 0.76. Two studies reported on combined vital signs, in which one study found an LR+ of 47.0, but in the other the AUC was not influenced.CONCLUSIONS: Some discriminative LR+ were found, suggesting the clinical relevance of routine vital sign measurements. However, the subject is poorly studied, and many studies have methodological flaws. Further rigorous research is needed specifically intended to investigate the clinical relevance of routinely measured vital signs.CLINICAL RELEVANCE: The results of this research are important for clinical nurses to underpin daily routine practices and clinical decision making.
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Background: This study investigates patients’ use of eHealth services, their awareness of the availability of these services, and their intention to use them in primary care. It also examines patient characteristics and factors that influence the use of these services. Methods: A cross-sectional design using questionnaires was conducted. Based on the unified theory of acceptance and use of technology (UTAUT), the participants rated the two most common services. Descriptive analyses and linear correlation analyses were performed. A simple linear regression was conducted to identify factors influencing the participants’ intention to use eHealth services. Results: In total, 1203 participants with an average age of 43.7 years were surveyed. The participants’ usage rates varied, with the lowest at 2.4%, for measuring vital signs, and the highest at 47.4%, for booking appointments. The intentions to use the services ranged from 22.5%, for video consultations, to 46.6%, for prescription refill requests. Approximately 20% of the respondents were unaware of each service’s availability. Positive associations were found between all the constructs and the intention to use online services, with a younger age being the most significant factor. Conclusions: The use of and intention to use eHealth services varied greatly. The participants were often unaware of the availability of these services. Promoting the availability and benefits of eHealth services could enhance patient engagement in primary care settings.
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Aim: The aim of this study is to explore patients' and (in)formal caregivers' perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. Design: This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. Methods: Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi-structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients' medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six-step analysis of Strauss & Corbin have been used. Results: Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients' health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers' perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). Conclusion: Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients' care needs and expectations should be prioritized to stimulate participation. Impact: (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients' care needs and expectations.
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Almere is a green city where the greenery extends into the centre through a framework of nature, forests, parks and canals. With this green environment, Almere fulfils an important condition for a liveable city, where it is pleasant to live and work. An important goal for the municipality is to challenge its residents to develop a healthy lifestyle by using that green framework.But what really motivates Almeerders to go outside to exercise, enjoy the surroundings and meet each other? Are there sufficient green meeting or sports facilities nearby? Could the routes that connect the living and working environment with the larger parks or forests be better designed? And can those routes simultaneously contribute to climate adaptation?With the Green Escape Challenge, we invited students and young professionals to work on these assignments together.
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Economische impact World Rowing Championships 2014 Van 24 tot 31 augustus 2014 vond op de Bosbaan in Amsterdam de World Rowing Championships (WRC) plaats. Met het oog op de verdere ontwikkeling van het evenement wil de World Rowing Federation (FISA inzicht krijgen in de economische impact van dit evenement. Zij heeft de Hogeschool van Amsterdam in samenwerking met Hogeschool Inholland en Sport2B gevraagd hier onderzoek naar te doen. Daarnaast heeft de FISA enkele aanvullende vragen geformuleerd over de tevredenheid van bezoekers en vrijwilligers. Bezoekers Het bezoekersaantal wordt geschat op 40.000, waarvan 30.000 unieke bezoekers. Buitenlandse bezoekers besteedden gemiddeld 77 euro per dag, Nederlandse bezoekers 27 euro en Amsterdamse bezoekers 20 euro. De bezoekers waren goed voor 28.500 overnachtingen in de dagen rondom het evenement. De totale bestedingsimpuls gerealiseerd door bezoekers bedroeg 3,1 miljoen. Deelnemers In totaal namen 1.800 atleten en begeleiders deel aan het evenement. Conservatief geschat gaven de deelnemers gemiddeld 25 euro per dag uit. De totale additionele uitgaven van atleten en begeleiders komen daarmee op 534.000 euro. In totaal waren de atleten goed voor 19.500 overnachtingen. De totale uitgaven voor de accommodatie komen daarmee op meer dan 2 miljoen euro. Zes nationale teams hebben als voorbereiding op WRC in juni deelgenomen aan de International Rowing Regatta Amsterdam (IRRA), dit genereerde een lokale economische impact van 149.000 euro. De totale bestedingsimpuls gerealiseerd door deelnemers bedroeg 2,7 miljoen euro. Organisatie en media Het saldo van in- en uitgaande geldstromen veroorzaakt door de organisatie en de media bedroeg 0,8 miljoen euro. De totale directe en indirecte economische impact: 9,2 miljoen euro.
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This overview can be regarded as an atlas or travel guide with which the reader can follow a route along the various professorships. Chapter 2 centres on the professorships that are active in the field of Service Economy. Chapter 3 is dedicated to the professorships that are focussed on the field of Vital Region. Chapter 4 describes the professorships operating in the field of Smart Sustainable Industries. Chapter 5 deals with the professorships that are active in the field of the institution-wide themes of Design Based Education and Design Based Research. Lastly, in Chapter 6 we make an attempt to discover one or more connecting themes or procedures in the approach of the various professorships. This publication is not intended to give a definitive answer to the question as to what exactly NHL Stenden means by the concept of Design Based Research. The aim of this publication is to get an idea of everything that is happening in the NHL Stenden professorships and to pique one’s curiosity to find out more.
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The international classroom is presumably a far more effective learning environment for the acquisition of intercultural competence when students receive adequate training to make the most of their intercultural encounters. This paper provides a summary of the intercultural training taught to first-year students of an international programme in The Hague University of Applied Sciences. The purpose of the paper is to investigate how the students respond to this intercultural training as well as what signs of intercultural awareness they show after completing the course. The findings were obtained via qualitative methods such as semi-structured interviews, observations and student homework assignments. Overall, students evaluate the training positively. Furthermore, students show some awareness of the necessary ingredients for effective intercultural communication in the international classroom as well as of the challenging nature of this communication due to cultural diversity. Finally, this paper provides recommendations from the facilitators on stimulating intercultural learning in the international classroom.
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In L1 grammar teaching, teachers often struggle with the students’ conceptual understanding of the subject matter. Frequently, students do not acquire an in-depth understanding of grammar, and they seem generally incapable of reasoning about grammatical problems. Some scholars have argued that an in-depth understanding of grammar requires making connections between concepts from traditional grammar and underlying metaconcepts from linguistic theory. In the current study, we evaluate an intervention aiming to do this, following up on a previous study that found a significant effect for such an approach in university students of Dutch Language and Literature (d = 0.62). In the current study, 119 Dutch secondary school students’ grammatical reasonings (N=684) were evaluated by language teachers, teacher educators and linguists pre and post intervention using comparative judgement. Results indicate that the intervention significantly boosted the students’ ability to reason grammatically (d = 0.46), and that many students can reason based on linguistic metaconcepts. The study also shows that reasoning based on explicit underlying linguistic metaconcepts and on explicit concepts from traditional grammar is more favored by teachers and (educational) linguists than reasoning without explicit (meta)concepts. However, some students show signs of incomplete acquisition of the metaconcepts. The paper discusses explanations for this incomplete acquisition.
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AimThe aim of this study is to explore patients’ and (in)formal caregivers’ perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program.DesignThis study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles.MethodsFive cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi-structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients’ medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six-step analysis of Strauss & Corbin have been used.ResultsThree main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients’ health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers’ perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3).ConclusionEarly detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients’ care needs and expectations should be prioritized to stimulate participation.Impact(In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients’ care needs and expectations.
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Abstract Background: COVID-19 was first identified in December 2019 in the city of Wuhan, China. The virus quickly spread and was declared a pandemic on March 11, 2020. After infection, symptoms such as fever, a (dry) cough, nasal congestion, and fatigue can develop. In some cases, the virus causes severe complications such as pneumonia and dyspnea and could result in death. The virus also spread rapidly in the Netherlands, a small and densely populated country with an aging population. Health care in the Netherlands is of a high standard, but there were nevertheless problems with hospital capacity, such as the number of available beds and staff. There were also regions and municipalities that were hit harder than others. In the Netherlands, there are important data sources available for daily COVID-19 numbers and information about municipalities. Objective: We aimed to predict the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands, using a data set with the properties of 355 municipalities in the Netherlands and advanced modeling techniques. Methods: We collected relevant static data per municipality from data sources that were available in the Dutch public domain and merged these data with the dynamic daily number of infections from January 1, 2020, to May 9, 2021, resulting in a data set with 355 municipalities in the Netherlands and variables grouped into 20 topics. The modeling techniques random forest and multiple fractional polynomials were used to construct a prediction model for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands. Results: The final prediction model had an R2 of 0.63. Important properties for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality in the Netherlands were exposure to particulate matter with diameters <10 μm (PM10) in the air, the percentage of Labour party voters, and the number of children in a household. Conclusions: Data about municipality properties in relation to the cumulative number of confirmed infections in a municipality in the Netherlands can give insight into the most important properties of a municipality for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality. This insight can provide policy makers with tools to cope with COVID-19 and may also be of value in the event of a future pandemic, so that municipalities are better prepared.
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