Background:Many patients show deterioration in functioning and increased care needs in the last year of life. End-of-life care needs and health care utilization might differ between groups of acutely hospitalized older patients.Aim:To investigate differences in geriatric conditions, advance care planning, and health care utilization in patients with cancer, organ failure, or frailty, who died within 1 year after acute hospitalization.Design:Prospective cohort study conducted between 2002 and 2008, with 1-year follow-up.Setting:University teaching hospital in the Netherlands.Participants:Aged ⩾65 years, acutely hospitalized for ⩾48 h, and died within 1 year after hospitalization. At admission, all patients received a systematic comprehensive geriatric assessment. Hospital records were searched for advance care planning information and health care utilization. Differences between patient groups were calculated.Results:In total, 306 patients died within 1 year after acute admission (35%) and were included; 151 with cancer, 98 with end-stage organ failure, and 57 frail older persons. At hospital admission, 72% of the frail group had delirium and/or severe pre-existing cognitive impairment. The frail and organ failure group had many pre-existing disabilities. Three months post-discharge, 75% of the frail and organ failure group had died, 45% of these patients had an advance care plan in their hospital records.Conclusion:Patients with frailty and organ failure had highest rates of geriatric conditions at hospital admission and often had missing information on advance care planning in the hospital records. There is a need to better identify end-of-life needs for these groups.
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Rationale To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. Guideline development A systematic literature search was performed to formulate conclusions on the efficacy of exercise-based intervention during all CR phases in patients with CHF. Evidence was graded (1–4) according the Dutch evidence-based guideline development criteria. Clinical and research recommendations Recommendations for exercise-based CR were formulated covering the following topics: mobilisation and treatment of pulmonary symptoms (if necessary) during the clinical phase, aerobic exercise, strength training (inspiratory muscle training and peripheral muscle training) and relaxation therapy during the outpatient CR phase, and adoption and monitoring training after outpatient CR. Applicability and implementation issues This guideline provides the physiotherapist with an evidence-based instrument to assist in clinical decision-making regarding patients with CHF. The implementation of the guideline in clinical practice needs further evaluation. Conclusion This guideline outlines best practice standards for physiotherapists concerning exercise-based CR in CHF patients. Research is needed on strategies to improve monitoring and follow-up of the maintenance of a physical active lifestyle after supervised CR.
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For almost fifteen years, the availability and regulatory acceptance of new approach methodologies (NAMs) to assess the absorption, distribution, metabolism and excretion (ADME/biokinetics) in chemical risk evaluations are a bottleneck. To enhance the field, a team of 24 experts from science, industry, and regulatory bodies, including new generation toxicologists, met at the Lorentz Centre in Leiden, The Netherlands. A range of possibilities for the use of NAMs for biokinetics in risk evaluations were formulated (for example to define species differences and human variation or to perform quantitative in vitro-in vivo extrapolations). To increase the regulatory use and acceptance of NAMs for biokinetics for these ADME considerations within risk evaluations, the development of test guidelines (protocols) and of overarching guidance documents is considered a critical step. To this end, a need for an expert group on biokinetics within the Organisation of Economic Cooperation and Development (OECD) to supervise this process was formulated. The workshop discussions revealed that method development is still required, particularly to adequately capture transporter mediated processes as well as to obtain cell models that reflect the physiology and kinetic characteristics of relevant organs. Developments in the fields of stem cells, organoids and organ-on-a-chip models provide promising tools to meet these research needs in the future.
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Background: Increasing attention to palliative care for the general population has led to the development of various evidence-based or consensus-based tools and interventions. However, specific tools and interventions are needed for people with severe mental illness (SMI) who have a life-threatening illness. The aim of this systematic review is to summarize the scientific evidence on tools and interventions in palliative care for this group. Methods: Systematic searches were done in the PubMed, Cochrane Library, CINAHL, PsycINFO and Embase databases, supplemented by reference tracking, searches on the internet with free text terms, and consultations with experts to identify relevant literature. Empirical studies with qualitative, quantitative or mixed-methods designs concerning tools and interventions for use in palliative care for people with SMI were included. Methodological quality was assessed using a critical appraisal instrument for heterogeneous study designs. Stepwise study selection and the assessment of methodological quality were done independently by two review authors. Results: Four studies were included, reporting on a total of two tools and one multi-component intervention. One study concerned a tool to identify the palliative phase in patients with SMI. This tool appeared to be usable only in people with SMI with a cancer diagnosis. Furthermore, two related studies focused on a tool to involve people with SMI in discussions about medical decisions at the end of life. This tool was assessed as feasible and usable in the target group. One other study concerned the Dutch national Care Standard for palliative care, including a multicomponent intervention. The Palliative Care Standard also appeared to be feasible and usable in a mental healthcare setting, but required further tailoring to suit this specific setting. None of the included studies investigated the effects of the tools and interventions on quality of life or quality of care. Conclusions: Studies of palliative care tools and interventions for people with SMI are scarce. The existent tools and intervention need further development and should be tailored to the care needs and settings of these people. Further research is needed on the feasibility, usability and effects of tools and interventions for palliative care for people with SMI.
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The effectiveness of smart home technology in home care situations depends on the acceptance and use of the technology by both users and end-users. In the Netherlands many projects have started to introduce smart home technology and telecare in the homes of elderly people, but only some have been successful. In this paper, features for success and failure in the deployment of new (ICT) technology in home care are used to revise the technology acceptance model (TAM) into a model that explains the use of smart home and telecare technology by older adults. In the revised model we make the variable 'usefulness' more specific, by describing the benefits of the technology that are expected to positively affect technology usage. Additionally, we state that several moderator variables - that are expected to influence this effect - should be added to the model in order to explain why people eventually do (not) use smart home technology, despite the benefits and the intention to use. We categorize these variables, that represent the problems found in previous studies, in 'accessibility', 'facilitating conditions' and 'personal variables'.
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Purpose: The aims of this study were to investigate how a variety of research methods is commonly employed to study technology and practitioner cognition. User-interface issues with infusion pumps were selected as a case because of its relevance to patient safety. Methods: Starting from a Cognitive Systems Engineering perspective, we developed an Impact Flow Diagram showing the relationship of computer technology, cognition, practitioner behavior, and system failure in the area of medical infusion devices. We subsequently conducted a systematic literature review on user-interface issues with infusion pumps, categorized the studies in terms of methods employed, and noted the usability problems found with particular methods. Next, we assigned usability problems and related methods to the levels in the Impact Flow Diagram. Results: Most study methods used to find user interface issues with infusion pumps focused on observable behavior rather than on how artifacts shape cognition and collaboration. A concerted and theorydriven application of these methods when testing infusion pumps is lacking in the literature. Detailed analysis of one case study provided an illustration of how to apply the Impact Flow Diagram, as well as how the scope of analysis may be broadened to include organizational and regulatory factors. Conclusion: Research methods to uncover use problems with technology may be used in many ways, with many different foci. We advocate the adoption of an Impact Flow Diagram perspective rather than merely focusing on usability issues in isolation. Truly advancing patient safety requires the systematic adoption of a systems perspective viewing people and technology as an ensemble, also in the design of medical device technology.
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The aim of this research was to study the clinical characteristics and mortality and disability outcomes of patients who present distinct risk profiles for functional decline at admission. A multicenter, prospective cohort study was conducted between 2006 and 2009 in three hospitals in the Netherlands in consecutive patients of 65 years and over, acutely admitted and hospitalized for at least 48 hours. Nineteen geriatric conditions were assessed at hospital admission, and mortality and functional decline were assessed until twelve months after admission. Patients were divided into risk categories for functional decline (low, intermediate or high risk) according to the Identification of Seniors at Risk-Hospitalized Patients.
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According to the critics of conventional sustainability models, particularly within the business context, it is questionable whether the objective of balancing the social, economic and environmental triad is feasible, and whether human equality and prosperity (as well as population growth) can be achieved with the present rate of natural degradation (Rees 2009). The current scale of human economic activity on Earth is already excessive; finding itself in a state of unsustainable ‘overshoot’ where consumption and dissipation of energy and material resources exceed the regenerative and assimilative capacity of supportive ecosystems (Rees 2012). Conceptualizing the current ‘politics of unsustainability’, reflected in mainstream sustainability debates, Blühdorn (2011) explores the paradox of wanting to ‘sustain the unsustainable, noting that the socio-cultural norms underpinning unsustainability support denial of the gravity of our planetary crises. This denial concerns anything from the imminence of mass extinctions to climate change. As Foster (2014) has phrased it: ‘There was a brief window of opportunity when the sustainability agenda might, at least in principle, have averted it’. That agenda, however, has failed. Not might fail, nor even is likely to fail – but has already failed. Yet, instead of acknowledging this failure and moving on from the realization of the catastrophe to the required radical measures, the optimists of sustainable development and ecological modernization continue to celebrate the purported ‘balance' between people, profit and planet. This is an Accepted Manuscript of a book chapter published by Routledge/CRC Press in "A Future Beyond Growth: Towards a Steady State Economy" on 4/14/16 ,available online: https://doi.org/10.4324/9781315667515 LinkedIn: https://www.linkedin.com/in/helenkopnina/
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Justice for nature remains a confused term. In recent decades justice has predominantly been limited to humanity, with a strong focus on social justice, and its spin-off – environmental justice for people. We first examine the formal rationale for ecocentrism and ecological ethics, as this underpins attitudes towards justice for nature, and show how justice for nature has been affected by concerns about dualisms and by strong anthro-pocentric bias. We next consider the traditional meaning of social justice, alongside the recent move by some scholars to push justice for nature into social justice, effectively weakening any move to place ecojustice centre-stage. This, we argue, is both unethical and doomed to failure as a strategy to protect life on Earth. The dominant meaning of ‘environmental justice’ – in essence, justice for humans in regard to environmental issues – is also explored. We next discuss what ecological justice (ecojustice) is, and how academia has ignored it for many decades. The charge of ecojustice being ‘antihuman’ is refuted. We argue that distributive justice can also apply to nature, including an ethic of bio-proportionality, and also consider how to reconcile social justice and eco-justice, arguing that ecojustice must now be foregrounded to ensure effective conservation. After suggesting a ‘Framework for implementing ecojustice’ for conservation practitioners, we conclude by urging academia to foreground ecojustice. https://doi.org/10.1016/j.biocon.2018.09.011 LinkedIn: https://www.linkedin.com/in/helenkopnina/
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Kennis uit onderzoek is van cruciaal belang om het onderwijs te verbeteren en te innoveren. Dit vraagt om een nauwe verbinding tussen onderwijsonderzoek en de dagelijkse onderwijspraktijk. De roep om een meer lerende cultuur in het onderwijs en de ambitie om onderwijsonderzoek meer te benutten voor het verbeteren van de onderwijspraktijk is niet nieuw: in het onderwijswerkveld zijn steeds meer scholen bezig met kennisbenutting, en het vraagstuk staat al langere tijd op de politieke agenda. Tegelijkertijd blijkt uit verschillende studies dat dit nog geen vanzelfsprekendheid is en dat het versterken van een kennisinfrastructuur een bijzonder complexe opgave is. In opdracht van de onderwijsraad heeft het lectoraat Public Governance een internationale vergelijking uitgevoerd naar de kennisinfrastructuur in andere – met Nederland vergelijkbare – landen. Deze ‘best practices’ zijn beschreven vanuit de vraag: wat kan Nederland van deze andere landen leren?
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