Zoekresultaten

Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people

Effects of Nurse-Led Multifactorial Care to Prevent Disability in Community-Living Older People: Cluster Randomized Trial

BACKGROUND: To evaluate the effects of nurse-led multifactorial care to prevent disability in community-living older people.METHODS: In a cluster randomized trail, 11 practices (n = 1,209 participants) were randomized to the intervention group, and 13 practices (n = 1,074 participants) were randomized to the control group. Participants aged ≥ 70 years were at increased risk of functional decline based on a score ≥ 2 points on the Identification of Seniors at Risk- Primary Care, ISAR-PC. Participants in the intervention group received a systematic comprehensive geriatric assessment, and individually tailored multifactorial interventions coordinated by a trained community-care registered nurse (CCRN) with multiple follow-up home visits. The primary outcome was the participant's disability as measured by the modified Katz activities of daily living (ADL) index score (range 0-15) at one year follow-up. Secondary outcomes were health-related quality of life, hospitalization, and mortality.RESULTS: At baseline, the median age was 82.7 years (IQR 77.0-87.1), the median modified Katz-ADL index score was 2 (IQR 1-5) points in the intervention group and 3 (IQR 1-5) points in the control group. The follow-up rate was 76.8% (n = 1753) after one year and was similar in both trial groups. The adjusted intervention effect on disability was -0.07 (95% confidence interval -0.22 to 0.07; p = 0.33). No intervention effects were found for the secondary outcomes.CONCLUSIONS: We found no evidence that a one-year individualized multifactorial intervention program with nurse-led care coordination was better than the current primary care in community-living older people at increased risk of functional decline in The Netherlands.TRIAL REGISTRATION: Netherlands Trial Register NTR2653.

Increasing value and reducing waste by optimizing the development of complex interventions

In recent years there has been much emphasis on 'research waste' caused by poor question selection, insufficient attention to previous research results, and avoidable weakness in research design, conduct and analysis. Little attention has been paid to the effect of inadequate development of interventions before proceeding to a full clinical trial. We therefore propose to enrich the development phase of the MRC Framework by adding crucial elements to improve the likelihood of success and enhance the fit with clinical practice METHODS: Based on existing intervention development guidance and synthesis, a comprehensive iterative intervention development approach is proposed. Examples from published reports are presented to illustrate the methodology that can be applied within each element to enhance the intervention design.

Responsive curriculum development for professional education

Due to fast and unpredictable developments, professional education is challenged with being responsive, which demands a rethinking of conventional curriculum development approaches. Yet, literature on curriculum development falls short in terms of recognising how to react rapidly and adequately to these new developments. This study focuses on curriculum development initiatives at the school level in a Dutch university of applied sciences. Open interviews were held with 29 curriculum developers to explore how they define and give substance to developing curricula for new, changing or unpredictable professions. These 29 participants were involved in seven curriculum development trajectories. Four themes were detected: (1) curriculum developers are in favour of open, flexible and authentic curricula; (2) the context in which the curriculum development takes place and the different roles and responsibilities of curriculum developers are challenging; (3) curriculum developers feel insufficiently equipped to carry out their tasks; and (4) involving stakeholders is necessary but results in a “viscous” social–political process. Responsive curriculum development requires a great deal of flexibility and adaptability from curriculum developers. Yet, in our study, “institutional concrete” is found to severely hinder responsive curriculum development processes. To be responsive, such processes need to be supported and institutional barriers need to be removed.

Views of older people on environmental sustainability: The development of the SustainABLE-16 Questionnaire

There are over 1400 age-friendly cities and communities worldwide, and the efforts to create a better quality of life for older people progressively intersect with sustainability goals. The intentions and behaviours concerning sustainability among older are, however, not yet well understood. Therefore, there is a need for assessing these intentions and behaviours through the use of a transparently constructed and validated instrument which can be used to measures the construct of environmental sustainability among older people. The aim of this study is to develop a questionnaire measuring how older people view the theme of environmental sustainability in their daily lives, with a focus on the built environment, providing full transparency and reproducibility. The process of development and validation of the SustainABLE-16 Questionnaire followed the COSMIN protocol, and has been conducted in five phases. This rigorous process has resulted in a valid, psychometrically sound, comprehensive 16-item questionnaire. This instrument can be applied to assess older people's beliefs, behaviours and financial aspects regarding environmental sustainability in their lives. The SustainABLE-16 Questionnaire was created in Dutch and in British English.

Learning and developing teaching competencies in a Professional Learning Community

Context When the pandemic hit the world, teachers were forced to change their education from onsite to virtual overnight Understandably, teaching quality decreased in the beginning, as there was little experience in how to adapt the educational design Zuyd University of Applied Sciences ( recognized the problem that teachers were on different didactic and pedagogical levels when it comes to online education Unfortunately, the pandemic made it hard for teachers to connect with each other In the Domain of Health and Welfare, this led to the idea of establishing a professional learning community A professional learning community ( can be seen as an informal group of people who share knowledge and experiences among each other on a common topic they are all highly interested in Zuyd’s vision “passion for development” sets a good basis for the start of such a community. Steps we took In order to find out how a professional learning community can look like in Zuyd, the following steps were taken Firstly, we collected and evaluated literature and best practices around the topic Based on our findings we developed an interview guideline and conducted interviews with eight teachers from the Domain of Health and Welfare Throughout the whole report a SWOT analysis was performed with the literature and best practices filling opportunities and threats and the interviews providing content for strengths and weaknesses Main findings From these sources, we derived enablers for a successful learning community, which led to recommendations for Zuyd on how to strategically position, implement and organize a PLC One of our major recommendations is to make didactic and pedagogical skills an important topic within Zuyd in order to strategically implement the learning community into Zuyd’s strategy Furthermore, we recommend giving the lead in organizing and facilitating the PLC to the blended learning task force To collect a diverse set of interested employees to the core group, the educational managers should personally approach teachers that might be interested The sense of urgency around the topic needs to be addressed regularly through the directors of the Domain, the task force of blended learning, as well as the PLC itself In this way, interest in the topic of didactic and pedagogical skills and blended learning can be enhanced In the report we go into greater detail on how to organize and apply these recommendations. We are convinced that implementing these steps will pay off in the future and will successfully enhance competencies on blended learning and didactic and pedagogical skills through knowledge exchange.