This two-year longitudinal study explores how an earlier international teaching experience influences the way six newly qualified teachers perceive their current teaching practice and professional self-understanding during personally significant experiences. The concept of an experiential continuum, a key concept in these findings, suggests that every experience reflects back on previous experiences and modifies later experiences. We identified 12 individual examples of personally significant experiences in which newly graduated teachers described how their previous international teaching experience informed their present teaching practice. Our study shows that experiential continuity identified during significant personal experiences in newly qualified teachers’ teaching practice influences them when interpreting: (1) professional beliefs regarding teaching knowledge; (2) moral questions regarding the teacher they want to be or become; and (3) their international teaching experience as a tool for placing new experiences in perspective. The study describes practical cases of how experiential continuity can help newly qualified teachers to understand why they make certain personal or moral interpretations in their teaching induction phase and what this means for the teacher they want to become.
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Purpose – Continuity of forensic mental health care is important in building protective structures around a patient and has been shown to decrease risks of relapse. Realising continuity can be complicated due to restrictions from finances or legislation and difficulties in collaboration between settings. In the Netherlands, several programs have been developed to improve continuity of forensic care. It is unknown whether professionals and clients are sufficiently aware of these programs. The paper aims to discuss this issue. Design/methodology/approach – The experienced difficulties and needs of professionals and patients regarding continuity of forensic care were explored by means of an online survey and focus groups. The survey was completed by 318 professionals. Two focus groups with professionals (15 participants), one focus group and one interview with patients (six participants) were conducted. Findings – The overall majority (85.6 percent) reported to experience problems in continuity on a frequent basis. The three main problems are: first, limited capacity for discharge from inpatient to outpatient or sheltered living; second, collaboration between forensic and regular mental health care; and, third, limited capacity for long-term inpatient care. Only a quarter of the participants knew the existing programs. Actual implementation of these programs was even lower (3.9 percent). The top three of professionals’ needs are: better collaboration; higher capacity; more knowledge about rules and regulation. Participants of the focus groups emphasized the importance of transparent communication, timely discharge planning and education. Practical implications – Gathering best practices about regional collaboration networks and developing a blue print based on the best practices could be helpful in improving collaboration between setting in the forensic field. In addition, more use of systematic discharge planning is needed to improve continuity in forensic mental healthcare. It is important to communicate in an honest, transparent way to clients about their forensic mental health trajectories,even if there are Setbacks or delays. More emphasis needs to be placed on communicating and implementing policy programs in daily practice and more education about legislation is needed Structured evaluations of programs aiming to improve continuity of forensic mental health care are highly needed. Originality/value – Policy programs hardly reach professionals. Professionals see improvements in collaboration as top priority. Patients emphasize the human approach and transparent communication.
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Background: The COVID-19 pandemic taught us how to rethink care delivery. It catalyzed creative solutions to amplify the potential of personnel and facilities. This paper presents and evaluates a promptly introduced triaging solution that evolved into a tool to tackle the ever-growing waiting lists at an academic ophthalmology department, the TeleTriageTeam (TTT). A team of undergraduate optometry students, tutor optometrists, and ophthalmologists collaborate to maintain continuity of eye care. In this ongoing project, we combine innovative interprofessional task allocation, teaching, and remote care delivery. Objective: In this paper, we described a novel approach, the TTT; reported its clinical effectiveness and impact on waiting lists; and discussed its transformation to a sustainable method for delivering remote eye care. Methods: Real-world clinical data of all patients assessed by the TTT between April 16, 2020, and December 31, 2021, are covered in this paper. Business data on waiting lists and patient portal access were collected from the capacity management team and IT department of our hospital. Interim analyses were performed at different time points during the project, and this study presents a synthesis of these analyses. Results: A total of 3658 cases were assessed by the TTT. For approximately half (1789/3658, 48.91%) of the assessed cases, an alternative to a conventional face-to-face consultation was found. The waiting lists that had built up during the first months of the pandemic diminished and have been stable since the end of 2020, even during periods of imposed lockdown restrictions and reduced capacity. Patient portal access decreased with age, and patients who were invited to perform a remote, web-based eye test at home were on average younger than patients who were not invited. Conclusions: Our promptly introduced approach to remotely review cases and prioritize urgency has been successful in maintaining continuity of care and education throughout the pandemic and has evolved into a telemedicine service that is of great interest for future purposes, especially in the routine follow-up of patients with chronic diseases. TTT appears to be a potentially preferred practice in other clinics and medical specialties. The paradox is that judicious clinical decision-making based on remotely collected data is possible, only if we as caregivers are willing to change our routines and cognitions regarding face-to-face care delivery.
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Business continuity management (BCM) is allang niet meer alleen 'disaster recovery planning '. In dit artikel een schets van de ontwikkelingen van BCM in de afgelopen decennia tot wat het nu is: een holistisch managementproces. Maar inmiddels is er ook sprake van verwevenheid van de onderneming met de omgeving. Een artikel in de Security Management.
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from Narcis: "What is known and objective Medication discrepancies are common at hospital discharge, and medication reconciliation is widely endorsed as a preventive strategy. However, implementation is difficult for instance due to the unreliability of patients medication histories. In the Netherlands, community pharmacies are well-informed about their patients’ pre-admission medication status which enables thorough post-discharge reconciliation. Our aim was to study the frequency and nature of medication discrepancies, missing patient's knowledge and administrative problems at admission to primary care. Methods A cross-sectional study was conducted in pharmacies belonging to the Utrecht Pharmacy Practice network for Education and Research in the Netherlands. Structured checklists were used to evaluate all discharge prescriptions presented by adult patients discharged from the hospital to their own home during the study period. The primary outcome was all possible problems with continuity of care, defined as (i) the number and type of medication discrepancies, (ii) administrative problems and (iii) the necessity for patient education. Results and discussion In forty-four pharmacies, checklists were completed for 403 patients. Most discharge prescriptions (92%) led to one or more problems with continuity of care (n = 1154, mean 2·9 ± 2·0), divided into medication discrepancies (31%), administrative problems (34%) and necessity for further education (35%). Medication discrepancies (n = 356) resulted mainly from missing pre-admission medication (n = 106) and dose regimen changes (n = 55) on the discharge prescription. Administrative problems (n = 392) originated mainly from administrative incompleteness (n = 177), for example missing reimbursement authorization forms, or supply issues (n = 150), for example insufficient pharmacy stock. The patients’ lack of medication knowledge post-discharge was illustrated by the high need for patient education (n = 406). What is new and conclusion Community pharmacists are still confronted with problems due to inadequate documentation at discharge which can inflict harm to patients if not properly addressed. To reduce these problems, a rigorous implementation of the medication reconciliation process at all transition points, standardized electronic transfer of all medication-related information and interdisciplinary collaboration are crucial."
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Against the backdrop of depopulation and Big Society, citizen initiatives in rural areas are believed to be able to mitigate service-provision inequalities between urban and peripheral regions. Factors influencing the success and failure of such citizen initiatives and their potential in providing solutions to perceived problems have thus far hardly been explored. Our previous work on potential aspects of success and failure indicates that the durability of an initiative does not necessarily define the success of the initiative. Studies have neglected the question of continuity and what will happen when the initiators put down their efforts. In what way do initiators transfer their responsibility and is there a sense of problem ownership?This paper aims to conceptualize factors influencing the continuity of citizen initiatives and provide insight in the processes that take place when initiators stop their activities. Further, the study aims to identify who claims ownership of the issue the initiative focuses on. An inventory of citizen initiatives was made in the three northern provinces of the Netherlands, where rural areas experience depopulation. Questionnaires focusing on how initiatives think about their future, especially when the initiators stop, were sent to around 600 initiatives. The results will add to future research on success and failure of citizen initiatives, but also provide insights for citizen initiatives and ways local governments try to facilitate them.
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Background: The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care – one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care. Methods: We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes. Results: In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups. Conclusions: We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care – both antenatally and in the intrapartum period – and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.
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Hoofdstuk 9 in 'Lessen uit crises en mini-crises 2012' van Duin, van M., Wijkhuijs, V. en Jong, W. (red.) (p. 139-149). In de nacht van dinsdag op woensdag 18 juli 2012 brandt het gemeentehuis van Waalre (gelegen in de buurt van Eindhoven) volledig uit na een opzettelijke brandstichting. Rond drie uur ’s nachts rijden twee personenauto’s in op het gebouw en vliegen vervolgens in brand. De vlammen slaan in korte tijd uit het dak. De brandweer, die snel ter plaatse is, schaalt op naar zeer grote brand. Rond negen uur ’s ochtends kan het sein brand meester worden gegeven. Het tachtig jaar oude, architectuurhistorische monument gaat echter geheel in vlammen op. Een grote rookwolk drijft over Waalre en omgeving. Vrijwel onmiddellijk is duidelijk dat opzet in het spel is. Er wordt een groot onderzoek gestart en 40 rechercheurs worden op de zaak gezet. Wat betreft de motieven en achtergronden van de brandstichting worden alle opties opengelaten. Het huis van de burgemeester wordt uit voorzorg bewaakt.
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The challenge of sustainable development requires cities to aim for drastic improvements in the systems that support its vital functions. Innovating these systems can be extremely hard, and might take lots of time. A transparent and democratic strategy is important to guarantee support for change. Such a process should aim at developing consensus regarding a basic vision to guide the process of systems change. This paper sketches future options for the development of sanitation- and urban drainage systems in industrialized economies. It will provide an analysis of relevant trends for sewage system innovation. In history, sewage systems have emerged from urban sewage and precipitation removal systems, to urban sewage and precipitation removal and cleaning systems. The challenge for the future is recovering energy and resources from sewage systems while maintaining/improving its sanitary service and lowering its emissions. https://doi.org/10.3390/su11051383 LinkedIn: https://www.linkedin.com/in/karel-mulder-163aa96/
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