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Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma

Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894

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Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma

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Emerging business models in horticulture value chains

High-tech horticulture production methods (such as vertical farming, hydroponics and other related technology possibilities), combined with evolving market side possibilities (consumer’s willingness to pay for variety, food safety and security), are opening new ways to create and deliver value. In this paper we present four emerging business models and attempt to understand the conditions under which each business model is able to create positive market value and sustained business advantage. The first of these four models is the case of a vertically integrated production to retail operation. The second model is the case of a production model with assured retail/distribution side commitment. The third model deals with a marketing/branding driven production model with differentiated market positioning. Finally, the forth is a production model with direct delivery to the end-consumer based upon the leveraging of wide spread digital technology in the consumer market. To demonstrate these four business models, we analyze practical case studies and analyze their market approach and impact. Using this analysis, we create a framework that enables entrepreneurs and businesses to adopt a business model that matches their capabilities with market opportunities.

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Emerging business models in horticulture value chains

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The Cardiac Care Bridge randomized trial in high-risk older cardiac patients

Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.

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The Cardiac Care Bridge randomized trial in high-risk older cardiac patients

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Ready for goal setting?

Background: Patient participation and goal setting appear to be difficult in daily physiotherapy practice, and practical methods are lacking. An existing patient-specific instrument, Patient-Specific Complaints (PSC), was therefore optimized into a new Patient Specific Goal-setting method (PSG). The aims of this study were to examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method. Methods: We conducted a process evaluation within a non-controlled intervention study. Community-based physiotherapists were instructed on how to work with the PSG in three group training sessions. The PSG is a six-step method embedded across the physiotherapy process, in which patients are stimulated to participate in the goal-setting process by: identifying problematic activities, prioritizing them, scoring their abilities, setting goals, planning and evaluating. Quantitative and qualitative data were collected among patients and physiotherapists by recording consultations and assessing patient files, questionnaires and written reflection reports. Results: Data were collected from 51 physiotherapists and 218 patients, and 38 recordings and 219 patient files were analysed. The PSG steps were performed as intended, but the ‘setting goals’ and ‘planning treatment’ steps were not performed in detail. The patients and physiotherapists were positive about the method, and the physiotherapists perceived increased patient participation. They became aware of the importance of engaging patients in a dialogue, instead of focusing on gathering information. The lack of integration in the electronic patient system was a major barrier for optimal use in practice. Although the self-reported actual use of the PSG, i.e. informing and involving patients, and client-centred competences had improved, this was not completely confirmed by the objectively observed behaviour. Conclusion: The PSG is a feasible method and tends to have impact on increasing patient participation in the goal-setting process. However, its full potential for shared goal setting has not been utilized yet. More implementation effort is needed to achieve the required behaviour change and a truly client-centred attitude, to make physiotherapists totally ready for shared goal setting.

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The impact of research by TLT

The research group Teaching, Learning & Technology investigates the didactic use of technology in learning processes. In doing so, it looks at themes such as flexibilisation, personalised learning, activating didactics and the effects of the use of technology in educational practice, particularly in higher vocational education. What had not been investigated so far was whether previously conducted research had a demonstrable impact on educational practice. This study is the first phase in providing insight into the impact of research carried out by the Teaching, Learning & Technology (TLT) research group of Inholland University of Applied Sciences. It looks at research carried out between 2010 and 2021. The objective is to describe how impact factors that can be influenced in previous research have been shaped. On the basis of this description, it may be possible to make recommendations to the research group with which the impact of the research it conducts in relation to these factors can be increased. The research question is: How do stakeholders describe the impact of research carried out by the research group Teaching, Learning & Technology in relation to the impact factors that can be influenced with regard to the research, the dissemination and the user value (experienced)? In order to answer this research question, we used a convergent mixed methods design, in which a new conceptual model served as the basis for the analysis of data from the field research. Three types of data were collected, namely a qualitative document analysis (N=31), a survey (N=6) and semi-structured interviews with survey participants (N=4). The study revealed that stakeholders mainly point to the researcher as the primary source of impact. Impact begins and ends with the researcher, especially in the extent to which he or she makes an effort to make the research relevant and in line with questions from the educational practice. We have listed a number of recommendations with regard to the way in which impact can be achieved in future research. These recommendations are mainly aimed at the way in which researchers of the research group can pay attention in a structured way to the design of the collaboration and to the concrete visualisation of expectations and intended impact at an early stage.

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Personen 4

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Jeroen Knol

Senior Research Policy Advisor

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Magali Goncalves

Environmental and GIS Specialist

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Bernardina Borra

Lecturer/researcher

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Gerard Schepers

Professor

Projecten 193

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100% recycled denim

The production of denim makes a significant contribution to the environmental impact of the textile industry. The use of mechanically recycled fibers is proven to lower this environmental impact. MUD jeans produce denim using a mixture of virgin and mechanically recycled fibers and has the goal to produce denim with 100% post-consumer textile by 2020. However, denim fabric with 100% mechanically recycled fibers has insufficient mechanical properties. The goal of this project is to investigate the possibilities to increase the content of recycled post-consumer textile fibers in denim products using innovative recycling process technologies.

Afgerond

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Additive Manufacturing of smart biobased sandwich panels

Currently, many novel innovative materials and manufacturing methods are developed in order to help businesses for improving their performance, developing new products, and also implement more sustainability into their current processes. For this purpose, additive manufacturing (AM) technology has been very successful in the fabrication of complex shape products, that cannot be manufactured by conventional approaches, and also using novel high-performance materials with more sustainable aspects. The application of bioplastics and biopolymers is growing fast in the 3D printing industry. Since they are good alternatives to petrochemical products that have negative impacts on environments, therefore, many research studies have been exploring and developing new biopolymers and 3D printing techniques for the fabrication of fully biobased products. In particular, 3D printing of smart biopolymers has attracted much attention due to the specific functionalities of the fabricated products. They have a unique ability to recover their original shape from a significant plastic deformation when a particular stimulus, like temperature, is applied. Therefore, the application of smart biopolymers in the 3D printing process gives an additional dimension (time) to this technology, called four-dimensional (4D) printing, and it highlights the promise for further development of 4D printing in the design and fabrication of smart structures and products. This performance in combination with specific complex designs, such as sandwich structures, allows the production of for example impact-resistant, stress-absorber panels, lightweight products for sporting goods, automotive, or many other applications. In this study, an experimental approach will be applied to fabricate a suitable biopolymer with a shape memory behavior and also investigate the impact of design and operational parameters on the functionality of 4D printed sandwich structures, especially, stress absorption rate and shape recovery behavior.

Afgerond

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AI in the Creative Industry/Understanding the Impact and Driving Process Innovation (AICI)

Lopend

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An exploratory case study: In search of key enabling factors for effective participatory design for socio-technical innovation

The pace of technology advancements continues to accelerate, and impacts the nature of systems solutions along with significant effects on involved stakeholders and society. Design and engineering practices with tools and perspectives, need therefore to evolve in accordance to the developments that complex, sociotechnical innovation challenges pose. There is a need for engineers and designers that can utilize fitting methods and tools to fulfill the role of a changemaker. Recognized successful practices include interdisciplinary methods that allow for effective and better contextualized participatory design approaches. However, preliminary research identified challenges in understanding what makes a specific method effective and successfully contextualized in practice, and what key competences are needed for involved designers and engineers to understand and adopt these interdisciplinary methods. In this proposal, case study research is proposed with practitioners to gain insight into what are the key enabling factors for effective interdisciplinary participatory design methods and tools in the specific context of sociotechnical innovation. The involved companies are operating at the intersection between design, technology and societal impact, employing experts who can be considered changemakers, since they are in the lead of creative processes that bring together diverse groups of stakeholders in the process of sociotechnical innovation. A methodology will be developed to capture best practices and understand what makes the deployed methods effective. This methodology and a set of design guidelines for effective interdisciplinary participatory design will be delivered. In turn this will serve as a starting point for a larger design science research project, in which an educational toolkit for effective participatory design for socio-technical innovation will be designed.

Lopend

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Anthocyanins as novel sustainable antimicrobial preservatives

Chemical preservation is an important process that prevents foods, personal care products, woods and household products, such as paints and coatings, from undesirable change or decomposition by microbial growth. To date, many different chemical preservatives are commercially available, but they are also associated with health threats and severe negative environmental impact. The demand for novel, safe, and green chemical preservatives is growing, and this process is further accelerated by the European Green Deal. It is expected that by the year of 2050 (or even as soon as 2035), all preservatives that do not meet the ‘safe-by-design’ and ‘biodegradability’ criteria are banned from production and use. To meet these European goals, there is a large need for the development of green, circular, and bio-degradable antimicrobial compounds that can serve as alternatives for the currently available biocidals/ preservatives. Anthocyanins, derived from fruits and flowers, meet these sustainability goals. Furthermore, preliminary research at the Hanze University of Applied Science has confirmed the antimicrobial efficacy of rose and tulip anthocyanin extracts against an array of microbial species. Therefore, these molecules have the potential to serve as novel, sustainable chemical preservatives. In the current project we develop a strategy consisting of fractionation and state-of-the-art characterization methods of individual anthocyanins and subsequent in vitro screening to identify anthocyanin-molecules with potent antimicrobial efficacy for application in paints, coatings and other products. To our knowledge this is the first attempt that combines in-depth chemical characterization of individual anthocyanins in relation to their antimicrobial efficacy. Once developed, this strategy will allow us to single out anthocyanin molecules with antimicrobial properties and give us insight in structure-activity relations of individual anthocyanins. Our approach is the first step towards the development of anthocyanin molecules as novel, circular and biodegradable non-toxic plant-based preservatives.

Afgerond

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Automatische nieuwsredactie

Aanleiding Nieuwsuitgeverijen bevinden zich in zwaar weer. Economische malaise en toegenomen concurrentie in het pluriforme medialandschap dwingen uitgeverijen om enerzijds kosten te besparen en tegelijkertijd te investeren in innovatie. De verdere automatisering van de nieuwsredactie vormt hierbij een uitdaging. Buiten de branche ontstaan technieken die uitgeverijen hierbij zouden kunnen gebruiken. Deze zijn nog niet 'vertaald' naar gebruiksvriendelijke systemen voor redactieprocessen. De deelnemers aan het project formuleren voor dit braakliggend terrein een praktijkgericht onderzoek. Doelstelling Dit onderzoek wil antwoord geven op de vraag: Hoe kunnen bewezen en nieuw te ontwikkelen technieken uit het domein van 'natural language processing' een bijdrage leveren aan de automatisering van een nieuwsredactie en het journalistieke product? 'Natural language processing' - het automatisch genereren van taal - is het onderwerp van het onderzoek. In het werkveld staat deze ontwikkeling bekend als 'automated journalism' of 'robotjournalistiek'. Het onderzoek richt zich enerzijds op ontwikkeling van algoritmes ('robots') en anderzijds op de impact van deze technologische ontwikkelingen op het nieuwsveld. De impact wordt onderzocht uit zowel het perspectief van de journalist als de nieuwsconsument. De projectdeelnemers ontwikkelen binnen dit onderzoek twee prototypes die samen het automated-journalismsysteem vormen. Dit systeem gaat tijdens en na het project gebruikt worden door onderzoekers, journalisten, docenten en studenten. Beoogde resultaten Het concrete resultaat van het project is een prototype van een geautomatiseerd redactiesysteem. Verder levert het project inzicht op in de verankering van dit soort systemen binnen een nieuwsredactie. Het onderzoek biedt een nieuw perspectief op de manier waarop de nieuwsconsument de ontwikkeling van 'automated journalism' in Nederland waardeert. Het projectteam deelt de onderzoekresultaten door middel van presentaties voor de uitgeverijbranche, presentaties op wetenschappelijke conferenties, publicaties in (vak)tijdschriften, reflectiebijeenkomsten met collega-opleidingen en een samenvattende white paper.

Afgerond

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Beauti-Fully Biobased Fibers

The textile and clothing sector belongs to the world’s biggest economic activities. Producing textiles is highly energy-, water- and chemical-intensive and consequently the textile industry has a strong impact on environment and is regarded as the second greatest polluter of clean water. The European textile industry has taken significant steps taken in developing sustainable manufacturing processes and materials for example in water treatment and the development of biobased and recycled fibres. However, the large amount of harmful and toxic chemicals necessary, especially the synthetic colourants, i.e. the pigments and dyes used to colour the textile fibres and fabrics remains a serious concern. The limited range of alternative natural colourants that is available often fail the desired intensity and light stability and also are not provided at the affordable cost . The industrial partners and the branch organisations Modint and Contactgroep Textiel are actively searching for sustainable alternatives and have approached Avans to assist in the development of the colourants which led to the project Beauti-Fully Biobased Fibres project proposal. The objective of the Beauti-Fully Biobased Fibres project is to develop sustainable, renewable colourants with improved light fastness and colour intensity for colouration of (biobased) man-made textile fibres Avans University of Applied Science, Zuyd University of Applied Sciences, Wageningen University & Research, Maastricht University and representatives from the textile industry will actively collaborate in the project. Specific approaches have been identified which build on knowledge developed by the knowledge partners in earlier projects. These will now be used for designing sustainable, renewable colourants with the improved quality aspects of light fastness and intensity as required in the textile industry. The selected approaches include refining natural extracts, encapsulation and novel chemical modification of nano-particle surfaces with chromophores.

Afgerond

Partijen 3

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Lectoraat Circular Plastics

Lectoraat, onderdeel van NHL Stenden Hogeschool

partij

Lectoraat Open Innovatie

Lectoraat, onderdeel van NHL Stenden Hogeschool

partij

Lectoraat Zorg & Innovatie in de Psychiatrie

Lectoraat, onderdeel van NHL Stenden Hogeschool

Redactie-artikelen 2

redactie

Circular Wood 4.0: een tweede leven voor resthout

redactie

Zet zoekmachines gericht in en til je onderzoek naar een hoger niveau

Producten 2.790

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Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma

DOCUMENT

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Emerging business models in horticulture value chains

DOCUMENT

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