Zoekresultaten

Tailoring of exercise and dietary interventions to adverse effects and existing comorbidities in patients with ovarian cancer receiving chemotherapy

Purpose: This study aims to capture the complex clinical reasoning process during tailoring of exercise and dietary interventions to adverse effects and comorbidities of patients with ovarian cancer receiving chemotherapy. Methods: Clinical vignettes were presented to expert physical therapists (n = 4) and dietitians (n = 3). Using the think aloud method, these experts were asked to verbalize their clinical reasoning on how they would tailor the intervention to adverse effects of ovarian cancer and its treatment and comorbidities. Clinical reasoning steps were categorized in questions raised to obtain additional information; anticipated answers; and actions to be taken. Questions and actions were labeled according to the evidence-based practice model. Results: Questions to obtain additional information were frequently related to the patients’ capacities, safety or the etiology of health issues. Various hypothetical answers were proposed which led to different actions. Suggested actions by the experts included extensive monitoring of symptoms and parameters, specific adaptations to the exercise protocol and dietary-related patient education. Conclusions: Our study obtained insight into the complex process of clinical reasoning, in which a variety of patient-related variables are used to tailor interventions. This insight can be useful for description and fidelity assessment of interventions and training of healthcare professionals.

Inclusive education towards more sensitive leisure managers : developing new skills through cooperation with experience experts

Risicomanagement, interne controle en de kredietschandalen.

Als gevolg van nieuwe wetgeving zoals Sarbanes-Oxley en gedragscodes als die van de commissie Tabaksblat is het de expliciete verantwoordelijkheid van de directie om te zorgen voor een adequaat en effectief risicomanagement en intern beheersingssysteem. Het is opvallend dat deze nieuwe interne-controlevereisten de kredietcrisis niet hebben kunnen voorkomen in een zo streng gereguleerde bedrijfstak als die van de financiële dienstverlening. De grote vraag is dan ook hoe dit allemaal heeft kunnen gebeuren en welke mogelijke lessen er te trekken zijn.

Toward advising SME's on stacked funding

This paper addresses new funding issues faced by SMEs. Over a period of nine months, the authors conducted a preliminary study into the problems surrounding stacked funding faced by SMEs and their financial advisers. The study includes a short literature review, the outcomes of three round table discussions and the identification of problems and possible solutions.

Movement for Ethical Game Production (MEG-P)

Shifting back in the Dutch social housing sector

Since the financial and administrative liberalisation from the government in the late 1980s and the 1990s, the Dutch housing associations have been very dynamic, regarding the considerable extension of both commercial and social activities, the increased reliance and dependence on market circumstances, and the large number of amalgamations, creating bigger organisations. In recent years the Dutch social housing sector is under increased pressure as a consequence of the credit crunch, increased tax levies and the national implementation in the sector of EU regulations on ‘Services of General Economic Interest’. Factors like these are likely to have an effect on the organisational strategies of housing associations, the main providers of social housing in the Netherlands. The direction and the size of these effects, however, are not well known. A recent inquiry among housing associations sheds more light on this. In this paper, we make use of a classification including a socialcommercial dimension and a dimension between so-called ‘prospectors’ and ‘defenders’. This classification proves to be an adequate tool to describe the recent developments in the sector. It is concluded that, in general, housing associations are focussing more on traditional social housing tasks and ‘defending’ strategies, implying a shift back compared to the trend in recent decades.