BACKGROUND: In the Netherlands, the scope of dental hygiene practice was expanded in 2006. The objective of this study was to explore reasons among dentists and dental hygienists for supporting or opposing an extended scope of practice and to find explanatory factors.METHODS: A questionnaire containing pre-defined reasons and an open-ended question was distributed among 1,674 randomly selected members of two Dutch professional associations (874 dentists, 800 dental hygienists). Data were analyzed with binary logistic regression with Bayesian information criterion (BIC) model selection.RESULTS: Response were obtained from 541 practitioners (32.3%): i.e., 233 dentists (43.1%) and 308 dental hygienists (56.9%). Non-response analysis revealed no differences, and representativeness analysis showed similarities between samples and target populations. Most often, dentists reported flexible collaboration (50.2%) and dental hygienists indicated task variation (71.1%) as supportive reasons. As opposing reasons, dentists generally reported quality of care (41.2%) and dental hygienists' self-competence (22.7%). Reasons were explained by profession, gender, and new-style practitioners.CONCLUSION: Dentists and dental hygienists conveyed different reasons for supporting or opposing an extended scope of dental hygiene practice. Outcomes can be categorized as reasons related to economic, professional status, quality, job satisfaction, and flexible collaboration and are not only explained by profession.
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Background: Rising healthcare costs, an increasing general practitioner shortage and an aging population have made healthcare organization transformation a priority. To meet these challenges, traditional roles of non-medical members have been reconsidered. Within the domain of physiotherapy, there has been significant interest in Extended Scope Physiotherapy (ESP). Although studies have focused on the perceptions of different stakeholders in relation to ESP, there is a large variety in the interpretation of ESP. Aim: To identify a paradigm of ESP incorporating goals, roles and tasks, to provide a consistent approach for the implementation of ESP in primary care. Methods: An exploratory, qualitative multi-step design was used containing a scoping review, focus groups and semi-structured interviews. The study population consisted of patients, physiotherapists, general practitioners and indirect stakeholders such as lecturers, health insurers and policymakers related to primary care physiotherapy. The main topics discussed in the focus groups and semi-structured interviews were the goals, skills and roles affiliated with ESP. The ‘framework’ method, developed by Ritchie & Spencer, was used as analytical approach to refine the framework. Results: Two focus groups and twelve semi-structured interviews were conducted to explore stakeholder perspectives on ESP in Dutch primary care. A total of 11 physiotherapists, six general practitioners, five patients and four indirect stakeholders participated in the study. There was a lot of support for ‘decreasing healthcare costs’, ‘tackling increased health demand’ and ‘improving healthcare effectiveness’ as main goals of ESP. The most agreement was reached on ‘triaging’, ‘referring to specialists’ and ‘ordering diagnostic imaging’ as tasks fitting for ESP. Most stakeholders also supported ‘working in a multidisciplinary team’, ‘working as a consultant’ and ‘an ESP role separated from a physiotherapist role’ as roles of ESP. Conclusions: Based on the scoping review, focus groups and interviews with direct and indirect stakeholders, it appears that there is sufficient support for ESP in the Netherlands. This study provides a clear presentation of how ESP can be conceptualized in primary care. A pilot focused on determining the feasibility of ESP in Dutch primary care will be the next step.
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AIMS: Attitudes of dentists and dental hygienists towards extended scope and independent dental hygiene practice are described in several studies, but the results are heterogenous. The purpose of this systematic review was to compare the attitudes of dentists and dental hygienists towards extended scope and independent dental hygiene practice.METHODS: PubMed, AMED and CINAHL were screened by two independent assessors to identify relevant studies. Only quantitative studies that reported the percentages of dentists' and dental hygienists' attitude towards extended scope and independent dental hygiene practice were included. The random-effects model was used to synthesise possible heterogenous influences.RESULTS: Meta proportions with regard to a positive attitude towards extended scope of practice are 0.54 for dentists and 0.81 for dental hygienists. Meta proportions of a positive attitude towards independent practice are 0.14 for dentists and 0.59 for dental hygienists. A meta analysis with regard to negative attitudes could only be performed on extended scope of practice and did not reveal a difference between the two professions. We obtained homogeneous outcomes of the studies included regarding negative attitudes of dentists . A minority of dentists hold negative attitudes towards extended scope of dental hygiene practice. Study outcomes regarding negative attitudes of dental hygienists were heterogeneous.CONCLUSIONS: Positive attitudes are present among a majority of dentists and dental hygienists with regard to extended scope of dental hygiene practice, while for independent dental hygiene practice this holds for a minority of dentists and a majority of dental hygienists.
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In dit boek vindt u een beknopte weergave van de ideeën en plannen behorende bij de eerste twee lectoraten van het Kenniscentrum voor Procesinnovatie. In het eerste deel behandelt lector Extended Enterprise Studies Johan Versendaal het concept van de extended enterprise en belangrijke aandachtsgebieden daarbij zoals inkoopvolwassenheid, procesdenken, en e-business ontwikkelingen. Het succes van een extended enterprise is voor een groot deel afhankelijk van de kwaliteit van de architectuur en architecten die de bedrijfsvoering ondersteunen. Dit is dan ook het thema van het tweede deel van dit boek. Hierin neemt lector Architectuur voor Digitale Informatiesystemen Wiebe Wiersema u mee op een tocht die gaat van de opkomst van architectuur tot de knelpunten die zich voordoen binnen het hedendaagse informaticaonderwijs
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Entrepreneurs are likely to be victims of ransomware. Previous studies have found that entrepreneurs tend to adopt few preventive measures, thereby increasing their chances of victimization. Due to a lack of research, however, not much is known about why entrepreneurs lack self-protective behaviors and how they can be encouraged to change said behaviors. Therefore, the purpose of this study is to explain, by means of an extended model of the Protection Motivation Theory (PMT), the motivation for entrepreneurs using protective measures against ransomware in the future. The data for our study were collected thanks to a questionnaire that was answered by 1,020 Dutch entrepreneurs with up to 250 employees. Our Structural Equation Modelling (SEM) analysis revealed that entrepreneurs are more likely to take preventive measures against ransomware if they perceive the risk of ransomware as severe (perceived severity), if they perceive their company as being vulnerable (perceived vulnerability), if they are concerned about the risks (affective response), and if they think that the people and companies around them expect them to apply preventive measures (subjective norms). However, if entrepreneurs think that they are capable of handling the risk (self-efficacy) and are convinced that their adopted preventive measures are effective (response efficacy), they are less likely to take preventive measures. Furthermore, for entrepreneurs that outsource IT security, the significant effect of perceived vulnerability and subjective norms disappears. The likelihood of entrepreneurs protecting their business against ransomware is thus influenced by a complex interplay of various motivational factors and is partly dependent on the business’ characteristics. Based on these findings, we will discuss security professionals’ prospects for increasing the cyber resilience of entrepreneurs, thus preventing cybercrime victimization.
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This paper examines the network governance approach of the Dutch Urban Envoy in the context of multilevel governance in the European Union. This paper aims to answer the research question on how the scope of network governance can explore the performance of the Dutch Urban Envoy. By analyzing network characteristics, such as legitimacy, actor-level properties, and network-level properties, this paper seeks to provide a nuanced understanding of the performance of the Dutch Urban Envoy. Drawing on previous research, this paper identifies the applicability and limitations of assessing network characteristics in understanding advocacy processes. The paper successfully visualizes the networks of the Dutch Urban Envoy and explores their roles and mandates, contributing to determining the added value of their position. However, the network governance approach has limitations in explaining the tangible successes and challenges of the Dutch Urban Envoy that cannot be directly attributed to their overall performance.
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Reading and writing is modelled in CSP using actions containing the symbols ? and !. These reading actions and writing actions are synchronous, and there is a one-to-one relationship between occurrences of pairs of these actions. In the CPA conference 2017, we introduced the extended half-synchronous al- phabetised parallel operator X ⇕ Y , which disconnects the writing to and reading from a channel in time; the reading processes are divided into sets which are set-wise asynchronous, but intra-set-wise synchronous, giving full flexibility to the reads. In this paper, we allow multiple writers to write to the same channel set-wise asynchronously, but intra-set-wise synchronously and we study the impact on our (Extended) Vertex Removing Synchronised Product. The advantages we accomplish are that the extension of X ⇕ Y gives more flexibility by indexing the writing actions and the reading actions, leading to a straightforward majority vote design. Furthermore, the extension of X ⇕ Y preserves the advantages of the X ⇕ Y operator.
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OBJECTIVES: This study compares the scope of practice of Dutch dental hygienists (DHs) educated through a 2- or 3-year curriculum ('old-style DHs') with that of hygienists educated through a new extended 4-year curriculum leading to a bachelor's degree ('new-style DHs'), with the aim to investigate whether an extended scope of practice positively affects perceived skill variety, autonomy and job satisfaction.METHODS: The questionnaires were obtained from old- and new-style DHs (n = 413, response 38%; n = 219, response 59%, respectively), in which respondents had recorded their dental tasks, perceived skill variety, autonomy and job satisfaction. T -tests were used to analyse differences between old- and new-style DHs, and regression analyses were performed to assess the relation between scope of practice and skill variety, autonomy and job satisfaction.RESULTS: New-style DHs have a more extended scope of practice compared with old-style DHs. Despite their more complex jobs, which are theoretically related to higher job satisfaction, new-style DHs perceive lower autonomy and job satisfaction (P < 0.05). Skill variety is the strongest predictor for DHs' job satisfaction (β = 0.462), followed by autonomy (β = 0.202) and caries decisive tasks, the last affecting job satisfaction negatively (β = -0.149). Self-employment is the strongest significant predictor for autonomy (β = 0.272).CONCLUSIONS: The core business of DHs remains the prevention and periodontology services. New-style DHs combine these tasks with extended tasks in the caries field, which can lead to comparatively less job satisfaction, because of a lower experienced autonomy in performing these extended tasks.
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New consumer awareness is shifting industry towards more sustainable practices, creating a virtuous cycle between producers and consumers enabled by eco-labelling. Eco-labelling informs consumers of specific characteristics of products and has been used to market greener products. Eco-labelling in the food industry has yet been mostly focused on promoting organic farming, limiting the scope to the agricultural stage of the supply chain, while carbon labelling informs on the carbon footprint throughout the life cycle of the product. These labelling strategies help value products in the eyes of the consumer. Because of this, decision makers are motivated to adopt more sustainable models. In the food industry, this has led to important environmental impact improvements at the agricultural stage, while most other stages in the Food Supply Chain (FSC) have continued to be designed inefficiently. The objective of this work is to define a framework showing how carbon labelling can be integrated into the design process of the FSC. For this purpose, the concept of Green Supply Chain Network Design (GSCND) focusing on the strategic decision making for location and allocation of resources and production capacity is developed considering operational, financial and environmental (CO2 emissions) issues along key stages in the product life cycle. A multi-objective optimization strategy implemented by use of a genetic algorithm is applied to a case study on orange juice production. The results show that the consideration of CO2 emission minimization as an objective function during the GSCND process together with techno-economic criteria produces improved FSC environmental performance compared to both organic and conventional orange juice production. Typical results thus highlight the importance that carbon emissions optimization and labelling may have to improve FSC beyond organic labelling. Finally, CO2 emission-oriented labelling could be an important tool to improve the effects eco-labelling has on food product environmental impact going forward.
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Objective: To explore predictors of dropout of patients with chronic musculoskeletal pain from an interdisciplinary chronic pain management programme, and to develop and validate a multivariable prediction model, based on the Extended Common- Sense Model of Self-Regulation (E-CSM). Methods: In this prospective cohort study consecutive patients with chronic pain were recruited and followed up (July 2013 to May 2015). Possible associations between predictors and dropout were explored by univariate logistic regression analyses. Subsequently, multiple logistic regression analyses were executed to determine the model that best predicted dropout. Results: Of 188 patients who initiated treatment, 35 (19%) were classified as dropouts. The mean age of the dropout group was 47.9 years (standard deviation 9.9). Based on the univariate logistic regression analyses 7 predictors of the 18 potential predictors for dropout were eligible for entry into the multiple logistic regression analyses. Finally, only pain catastrophizing was identified as a significant predictor. Conclusion: Patients with chronic pain who catastrophize were more prone to dropout from this chronic pain management programme. However, due to the exploratory nature of this study no firm conclusions can be drawn about the predictive value of the E-CSM of Self-Regulation for dropout.
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