Een holistisch perspectief op binnenstedelijke herontwikkeling Spatial Planning http://www.uu.nl/agenda/promotie-een-holistisch-perspectief-op-binnenstedelijke-herontwikkeling Promovendus Rien van Stigt onderzoekt waarom het moeilijk is om milieukwaliteit een prominente plaats te geven in de besluitvorming over ruimtelijke plannen. In zijn proefschrift ontwikkelt hij een holistisch perspectief op het complexe proces van compacte binnenstedelijke herontwikkeling. De kwaliteit van de stedelijke leefomgeving is essentieel in duurzame stedelijke ontwikkeling. Die kwaliteit staat met name bij compacte binnenstedelijke herontwikkeling onder druk, en daarom is milieukwaliteit een belangrijke factor in het plannen van zulke ontwikkelingen. Uit de literatuur over de integratie van milieubeleid blijkt dat dit, vooral op lagere bestuurlijke niveaus, niet altijd goed lukt. Er is nog geen overtuigende verklaring waarom dit zo is. Promotor(es): Prof.dr. P.P.J. Driessen en Prof.dr. T.J.M. Spit
Background: Advanced medical technologies (AMTs), such as respiratory support or suction devices, are increasingly used in home settings and incidents may well result in patient harm. Information about risks and incidents can contribute to improved patient safety, provided that those are reported and analysed systematically. Objectives: To identify the frequency of incidents when using AMTs in home settings, the effects on patient outcomes and the actions taken by nurses following identification of incidents. Methods: A cross-sectional study of 209 home care nurses in the Netherlands working with infusion therapy, parenteral nutrition or morphine pumps, combining data from a questionnaire and registration forms covering more than 13 000 patient contacts. Descriptive statistics were used. Results: We identified 140 incidents (57 adverse events; 83 near misses). The frequencies in relation to the number of patient contacts were 2.7% for infusion therapy, 1.3% for parenteral nutrition and 2.6% for morphine pumps. The main causes were identified as related to the product (43.6%), the organisation of care (27.9%), the nurse as a user (15.7%) and the environment (12.9%). 40% of all adverse events resulted in mild to severe harm to the patient. Incidents had been discussed in the team (70.7%), with the patient/informal caregiver(s) (50%), or other actions had been taken (40.5%). 15.5% of incidents had been formally reported according to the organisation's protocol. Conclusions: Most incidents are attributed to product failures. Although such events predominantly cause no harm, a significant proportion of patients do suffer some degree of harm. There is considerable underreporting of incidents with AMTs in home care. This study has identified a discrepancy in quality circles: learning takes place at the team level rather than at the organisational level.
Reporting of research findings is often selective. This threatens the validity of the published body of knowledge if the decision to report depends on the nature of the results. The evidence derived from studies on causes and mechanisms underlying selective reporting may help to avoid or reduce reporting bias. Such research should be guided by a theoretical framework of possible causal pathways that lead to reporting bias. We build upon a classification of determinants of selective reporting that we recently developed in a systematic review of the topic. The resulting theoretical framework features four clusters of causes. There are two clusters of necessary causes: (A) motivations (e.g. a preference for particular findings) and (B) means (e.g. a flexible study design). These two combined represent a sufficient cause for reporting bias to occur. The framework also features two clusters of component causes: (C) conflicts and balancing of interests referring to the individual or the team, and (D) pressures from science and society. The component causes may modify the effect of the necessary causes or may lead to reporting bias mediated through the necessary causes. Our theoretical framework is meant to inspire further research and to create awareness among researchers and end-users of research about reporting bias and its causes.
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