OBJECTIVE: 'Better By Moving' is a multifaceted intervention developed and implemented in collaboration with patients and healthcare professionals to improve physical activity in hospitalized adults. This study aimed to understand if, how and why 'Better By Moving' resulted in higher levels of physical activity by evaluating both outcomes and implementation process.DESIGN: Mixed-methods study informed by the Medical Research Council guidance.SETTING: Tertiary hospital.PARTICIPANTS: Adult patients admitted to surgery, haematology, infectious diseases and cardiology wards, and healthcare professionals.MEASURES: Physical activity was evaluated before and after implementation using the Physical Activity Monitor AM400 on one random day during hospital stay between 8 am and 8 pm. Furthermore, the time spent lying on bed, length of stay and discharge destination was investigated. The implementation process was evaluated using an audit trail, surveys and interviews.RESULTS: There was no significant difference observed in physical activity (median [IQR] 23 [12-51] vs 27 [17-55] minutes, P = 0.107) and secondary outcomes before-after implementation. The intervention components' reach was moderate and adoption was low among patients and healthcare professionals. Patients indicated they perceived more encouragement from the environment and performed exercises more frequently, and healthcare professionals signalled increased awareness and confidence among colleagues. Support (priority, resources and involvement) was perceived a key contextual factor influencing the implementation and outcomes.CONCLUSION: Although implementing 'Better By Moving' did not result in significant improvements in outcomes at our centre, the process evaluation yielded important insights that may improve the effectiveness of implementing multifaceted interventions aiming to improve physical activity during hospital stay.
From Narcis.nl :" Patients with substance use disorder (SUD) are frequently suffering from co-occurring somatic disorders, increasing the risk of mortality. Somatic health care utilization (sHCU) often remains unknown to the physician during SUD treatment. This paper analyses sHCU and associated costs among patients in SUD treatment compared to matched, non-substance dependent controls. METHODS: Health care utilization data on 4972 SUD patients were matched to 19,846 controls by gender, birth year and ethnic origin. Subcategories of patients were formed based on SUD and on co-morbid psychiatric disorder. Data on sHCU during the year prior to the last treatment contact (the 'index date') for both patients and their matched controls were extracted from a health insurance database. RESULTS: Patients had a higher sHCU (with increased associated costs) than controls, especially when alcohol dependence was involved. In particular, sHCU for cardiovascular, respiratory, infectious diseases, injuries and accidents was increased among patients. However, the use of preventive medication, such as lipid-lowering drugs, is lower among SUD patients. Co-morbidity of psychiatric disorders led to further increase of sHCU, whereas patients with comorbid non-affective psychotic disorder (NAPD) showed lower sHCU and costs. CONCLUSION: Patients with SUD overall have a high sHCU, associated with high costs. There are indications that SUD patients have less access to preventive medication. Patients with comorbid NAPD are at risk of possible underutilization of somatic health care. Furthermore, we conclude that these larger administrative databases allow for comparisons between various diagnostic categories."
MULTIFILE
Routine neuropathology diagnostic methods are limited to histological staining techniques or directed PCR for pathogen detection and microbial cultures of brain abscesses are negative in one-third of the cases. Fortunately, due to improvements in technology, metagenomic sequencing of a conserved bacterial gene could provide an alternative diagnostic method. For histopathological work up, formalin-fixed paraffin-embedded (FFPE) tissue with highly degraded nucleic acids is the only material being available. Innovative amplicon-specific next-generation sequencing (NGS) technology has the capability to identify pathogens based on the degraded DNA within a few hours. This approach significantly accelerates diagnostics and is particularly valuable to identify challenging pathogens. This ensures optimal treatment for the patient, minimizing unnecessary health damage. Within this project, highly conserved primers in a universal PCR will be used, followed by determining the nucleotide sequence. Based on the obtained data, it is then precisely determined which microorganism(s) is/are responsible for the infection, even in cases of co-infection with multiple pathogens. This project will focus to answer the following research question; how can a new form of rapid molecular diagnostics contribute to the identification of microbial pathogens in CNS infections? The SME partner Molecular Biology Systems B.V. (MBS) develops and sells equipment for extremely rapid execution of the commonly used PCR. In this project, the lectorate Analysis Techniques in the Life Sciences (Avans) will, in collaboration with MBS, Westerdijk Institute (WI-KNAW) and the Institute of Neuropathology (Münster, DE) establish a new molecular approach for fast diagnosis within CNS infections using this MBS technology. This enables the monitoring of infectious diseases in a fast and user-friendly manner, resulting in an improved treatment plan.
Since the COVID-19-pandemic, the enormous societal, medical and financial impact associated with the transfer of infectious pathogens from wild animals to humans and other animals urged for further follow-up in early signalling management of zoonotic diseases. Consequently, the Raad-voor-Dierenaangelegenheden and the Dutch government currently recommend to set up a surveillance system and cooperation with (applied-)scientists to detect zoonotic diseases using data and samples from animals entering wildlife rehabilitation centres. Each year approximately 100,000 wild animals are submitted to ±78 Dutch wildlife rehabilitation centres. This would potentially generate an enormous amount of currently unutilized information, which could reduce disease incidence and avoid the problems of scaling-up disease control if early detection can be improved. The current wild animal health surveillance system could be much enhanced if wild animals taken into care by wildlife rehabilitation centres would be consistently registered, processed and shared. However the processes, technology and biological knowhow to do this are currently not up to standards. Besides for this to work, wildlife rehabilitation centres need to be more strongly aligned and strongly embedded in the current health networks. Therefore, our objective is to develop a sustainable participatory collaboration system in the current health networks, on which first the focus is on valid and reliable data bundling of animals and their diseases from wildlife rehabilitation centres. These data can be made applicable to scientific research and the professional field to be able to signal the risks of (inter)national zoonotic diseases. We will focus our methodology on the societal, technical and biological elements involved. Van Hall Larenstein Hogeschool, Wageningen University, the Dutch Wildlife Health Centre, the National-Institute-for-Public-Health-and-the-Environment, Falcon together with Dutch wildlife rehabilitation centres will develop the fundaments of the surveillance system. The Foundation DierenLot, the Ministry-of-Agriculture-Nature-and-Food-quality, Flemish wildlife rehabilitation centres, vets, and governmental organisations are partners, among others.
