Background: Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increase. Objective: To assess the effects of OGR on the primary outcome functional performance (FP) and secondary outcomes: length of in-patient stay, re-admission rate, patients’ and caregivers’ quality of life, mortality and cost-effectiveness. We also aim to describe the organisation and content of OGR. Methods: Systematic review and meta-analysis. Five databases were queried from inception to July 2022. We selected randomised controlled trials written in English, focusing on multidisciplinary interventions related to OGR, included participants aged ≥65 and reported one of the main outcomes. A meta-analysis was performed on FP, patients’ quality of life, length of stay and re-admissions. The structural, procedural and environmental aspects of OGR were systematically mapped. Results: We selected 24 studies involving 3,405 participants. The meta-analysis showed no significant effect on the primary outcome FP (activity). It demonstrated a significant effect of OGR on shortening length of in-patient stay (P = 0.03, MD = −2.41 days, 95%CI: [−4.61—0.22]). Frequently used elements of OGR are: inpatient start of OGR with an interdisciplinary rehabilitation team, close cooperation with primary care, an OGR coordinator, individual goal setting and education for both patient and caregiver. Conclusion: This review showed that OGR is as effective as usual care on FP activity. It shows low certainty of evidence for OGR being effective in reducing the length of inpatient stay. Further research is needed on the various frequently used elements of OGR
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BACKGROUND: Early accurate assessment of burn depth is important to determine the optimal treatment of burns. The method most used to determine burn depth is clinical assessment, which is the least expensive, but not the most accurate.Laser Doppler imaging (LDI) is a technique with which a more accurate (>95%) estimate of burn depth can be made by measuring the dermal perfusion. The actual effect on therapeutic decisions, clinical outcomes and the costs of the introduction of this device, however, are unknown. Before we decide to implement LDI in Dutch burn care, a study on the effectiveness and cost-effectiveness of LDI is necessary.METHODS/DESIGN: A multicenter randomised controlled trial will be conducted in the Dutch burn centres: Beverwijk, Groningen and Rotterdam. All patients treated as outpatient or admitted to a burn centre within 5 days post burn, with burns of indeterminate depth (burns not obviously superficial or full thickness) and a total body surface area burned of ≤ 20% are eligible. A total of 200 patients will be included. Burn depth will be diagnosed by both clinical assessment and laser Doppler imaging between 2-5 days post burn in all patients. Subsequently, patients are randomly divided in two groups: 'new diagnostic strategy' versus 'current diagnostic strategy'. The results of the LDI-scan will only be provided to the treating clinician in the 'new diagnostic strategy' group. The main endpoint is the effect of LDI on wound healing time.In addition we measure: a) the effect of LDI on other patient outcomes (quality of life, scar quality), b) the effect of LDI on diagnostic and therapeutic decisions, and c) the effect of LDI on total (medical and non-medical) costs and cost-effectiveness.DISCUSSION: This trial will contribute to our current knowledge on the use of LDI in burn care and will provide evidence on its cost-effectiveness.TRIAL REGISTRATION: NCT01489540.
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In this article, we examine the relationship between important types of policies for asylum permit holders in the Netherlands and the improvement in their command of Dutch. As far as asylum policy is concerned, we find that participation in activities in the asylum seekers reception centre – and in particular, following Dutch language classes – contribute to an improvement in Syrian asylum permit holders’ command of Dutch. On the other hand, a prolonged period of stay and frequent relocations between reception centres are not favourable. Asylum permit holders who have successfully completed the civic integration programme have a better command of the language than asylum permit holders who are still undergoing the programme. An important finding is that there seems to be a sort of double deficit in the area of civic integration: not only do the elderly and lower educated make less progress in learning Dutch, but they are also the ones more likely to receive a dispensation from the civic integration requirement, which places them at a further disadvantage. Third, we find that early participation in the labour market or as a volunteer is also beneficial for language proficiency.
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Objectives: In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI. Setting: ICUs in 16 European countries. Participants: In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems. Primary and secondary outcomes measures: We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies. Results: In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95%CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95%CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95%CI 1.42 to 3.58) and low HDI (aOR 1.22, 95%CI 1.64 to 2.20) settings. Conclusions: The 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations.
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This study examines completion rate for a self-assessment survey designed to assess employees' digital skills levels in the workplace. The aim is to improve data quality by investigating completion of the survey. The study reviews the theoretical background related to self-assessment surveys and completion rate, and explores the influence of survey length and format in survey design on completion rate. The research design and data analysis are described in detail, with a focus on identifying factors that may influence completion rate. Results suggest that survey designers should consider using Likert scales to optimize completion rate and completion time. However, this study did not find a significant increase in completion rate as a result of motivation, which was claimed from the literature. The study concludes with implications for the design and implementation of self-assessment surveys in the workplace, including the importance of reducing length and complexity of survey items and questions.
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Purpose – In the domain of healthcare, both process efficiency and the quality of care can be improved through the use of dedicated pervasive technologies. Among these applications are so-called real-time location systems (RTLS). Such systems are designed to determine and monitor the location of assets and people in real time through the use of wireless sensor networks. Numerous commercially available RTLS are used in hospital settings. The nursing home is a relatively unexplored context for the application of RTLS and offers opportunities and challenges for future applications. The paper aims to discuss these issues. Design/methodology/approach – This paper sets out to provide an overview of general applications and technologies of RTLS. Thereafter, it describes the specific healthcare applications of RTLS, including asset tracking, patient tracking and personnel tracking. These overviews are followed by a forecast of the implementation of RTLS in nursing homes in terms of opportunities and challenges. Findings – By comparing the nursing home to the hospital, the RTLS applications for the nursing home context that are most promising are asset tracking of expensive goods owned by the nursing home in orderto facilitate workflow and maximise financial resources, and asset tracking of personal belongings that may get lost due to dementia. Originality/value – This paper is the first to provide an overview of potential application of RTLS technologies for nursing homes. The paper described a number of potential problem areas that can be addressed by RTLS. Published by Emerald Publishing Limited Original article: https://doi.org/10.1108/JET-11-2017-0046 For this paper Joost van Hoof received the Highly Recommended Award from Emerald Publishing Ltd. in October 2019: https://www.emeraldgrouppublishing.com/authors/literati/awards.htm?year=2019
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Even though mango productivity in Ethiopia is low due to moisture stress, there is no report on how such constraint could alleviate using Cocoon water-saving technology. Cocoon is small water reservoir technology which uses for plant growth in dry season. The objectives of this study were to introduce and evaluate effectiveness of water-saving techniques on mango seedlings survival and growth in Mihitsab-Azmati watershed, northern Ethiopia. In this experiment, five treatments of water-saving techniques with mango seedlings were evaluated. These were: Cocoon sprayed by tricel (T1), Cocoon painted by used engine oil (T2), Cocoon without tricel and oil (T3), manually irrigated seedlings (T4) and mango seedlings planted during rainy season (T5). The survival and growth performance of mango seedlings were recorded at six months and one-year after transplanting. Data on plant survival, height, number of leaves per plant, shoot length, stem diameter and crown width were subjected to analysis of variance and t-test. There were significant differences in the treatment effects on mango seedlings transplanted survival, plant height, number of leaves per plant, shoot length, stem diameter and crown width measured at six months and one-year after transplanting. The lowest survival rate (20 %) was found during both data collection time in T5. Six months after transplanting, the highest growth parameters were measured from T1 whereas the lowest was from T5. However, one-year after transplanting, the highest growth parameters were measured from T3. Plant heights increments between the two measurement periods for T3, T2, T1, T4 and T5 were 45.1, 38.5, 24.8, 9.8 and 7.0 cm, respectively; indicating that T3 performed better than the other treatments. The t-test on mean differences between the same growth parameter measured at 12 and six months after transplanting also showed significant differences. The Cocoon water-saving technology was superior in improving mango seedlings survival and growth in the study area. This study generalized that Cocoon seems promising, sustainable and highly scalable with mango seedlings at large-scale in the study area conditions. However, this technology should not be assumed to perform uniformly well in all environmental conditions and with all tree species before demonstrated on a pilot study.
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Regenerative forms of higher education are emerging, and required, to connect with some of the grand transition challenges of our times. This paper explores the lived experience of 21 students learning to navigate a regenerative form of higher education in the Mission Impact course at The Hague University of Applied Sciences. This semester-length course ran for two iterations with the intention of connecting the students with local transitions towards a more circular society, one where products are lasting and have multiple lives when they are shared, refurbished, or become a source for a new product. At the end of each iteration, the students reflected on their experience using the Living Spiral Framework, which served as basis for an interpretative phenomenological analysis of their journey navigating this transformative course. The results of this study include four themes; (1) Opting in—Choosing RHE, (2) Learning in Regenerative Ways, (3) Navigating Resistance(s), and (4) Transformative Impacts of RHE. These themes can be used by practitioners to design and engage with regenerative forms of higher education, and by scholars to guide further inquiry. van den Berg B, Poldner KA, Sjoer E, Wals AEJ. ‘Sweet Acid’ An Interpretative Phenomenological Analysis of Students’ Navigating Regenerative Higher Education. Education Sciences. 2022; 12(8):533. https://doi.org/10.3390/educsci12080533
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This paper analyzes connectivity and efficiency of a SME network across two industries. These characteristics are likely to be different for networks of various industries. The concept of 'small worlds' is used to judge overall network efficiency. The actual network can be classified as one in which a small world is present. Visualization of the results shows a single core group in the network. It was found that non-profit as well as science actors were overrepresented in the core of the field.
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The professional growth of midwives, essential for optimizing midwifery leadership globally, can be enhanced through twinning collaborations. How twinning promotes growth is unclear. This case study explores how professional growth is affected by cultural differences between twins. We used a longitudinal qualitative design including data from open-ended questionnaires and focus groups. These data were analyzed using a content analysis. Our findings show that cultural differences were capable of both hindering and facilitating professional growth. Within the complex dynamics of twinning, professional growth was facilitated by twins’ preparedness to bridge cultural differences. Common goals positively influenced this process. Friction was more likely, and professional growth was hindered, when midwives were unprepared to bridge cultural differences. To optimize professional growth through twinning, we recommend a clear focus on common goals and consideration of the interaction between the length of a project and the extent of the cultural differences between twins.
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