Numerous laboratory-based studies recorded eye movements in participants with varying expertise when watching video projections in the lab. Although research in the lab offers the advantage of internal validity, reliability and ethical considerations, ecological validity is often questionable. Therefore the current study compared visual search in 13 adult cyclists, when cycling a real bicycle path and while watching a film clip of the same road. Dwell time towards five Areas of Interest (AOIs) is analysed. Dwell time (%) in the lab and real-life was comparable only for the low quality bicycle path. Both in real-life and the lab, gaze is predominantly driven towards the road. Since gaze behaviour in the lab and real-life tends to be comparable with increasing task-complexity (road quality), it is concluded that under certain task constraints laboratory experiments making use of video clips might provide valuable information regarding gaze behaviour in real-life.
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Daily wheelchair ambulation is seen as a risk factor for shoulder problems, which are prevalent in manual wheelchair users. To examine the long-term effect of shoulder load from daily wheelchair ambulation on shoulder problems, quantification is required in real-life settings. In this study, we describe and validate a comprehensive and unobtrusive methodology to derive clinically relevant wheelchair mobility metrics (WCMMs) from inertial measurement systems (IMUs) placed on the wheelchair frame and wheel in real-life settings. The set of WCMMs includes distance covered by the wheelchair, linear velocity of the wheelchair, number and duration of pushes, number and magnitude of turns and inclination of the wheelchair when on a slope. Data are collected from ten able-bodied participants, trained in wheelchair-related activities, who followed a 40 min course over the campus. The IMU-derived WCMMs are validated against accepted reference methods such as Smartwheel and video analysis. Intraclass correlation (ICC) is applied to test the reliability of the IMU method. IMU-derived push duration appeared to be less comparable with Smartwheel estimates, as it measures the effect of all energy applied to the wheelchair (including thorax and upper extremity movements), whereas the Smartwheel only measures forces and torques applied by the hand at the rim. All other WCMMs can be reliably estimated from real-life IMU data, with small errors and high ICCs, which opens the way to further examine real-life behavior in wheelchair ambulation with respect to shoulder loading. Moreover, WCMMs can be applied to other applications, including health tracking for individual interest or in therapy settings.
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Abstract Specialist oncology nurses (SONs) have the potential to play a major role in monitoring and reporting adverse drug reactions (ADRs); and reduce the level of underreporting by current healthcare professionals. The aim of this study was to investigate the long term clinical and educational efects of real-life pharmacovigilance education intervention for SONs on ADR reporting. This prospective cohort study, with a 2-year follow-up, was carried out in the three postgraduate schools in the Netherlands. In one of the schools, the prescribing qualifcation course was expanded to include a lecture on pharmacovigilance, an ADR reporting assignment, and group discussion of self-reported ADRs (intervention). The clinical value of the intervention was assessed by analyzing the quantity and quality of ADR-reports sent to the Netherlands Pharmacovigilance Center Lareb, up to 2 years after the course and by evaluating the competences regarding pharmacovigilance of SONs annually. Eighty-eight SONs (78% of all SONs with a prescribing qualifcation in the Netherlands) were included. During the study, 82 ADRs were reported by the intervention group and 0 by the control group. This made the intervention group 105 times more likely to report an ADR after the course than an average nurse in the Netherlands. This is the frst study to show a signifcant and relevant increase in the number of well-documented ADR reports after a single educational intervention. The real-life pharmacovigilance educational intervention also resulted in a long-term increase in pharmacovigilance competence. We recommend implementing real-life, context- and problem-based pharmacovigilance learning assignments in all healthcare curricula.
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Background Interprofessional education is promoted as a means of enhancing future collaborative practice in healthcare. We developed a learning activity in which undergraduate medical, nursing and allied healthcare students practice interprofessional collaboration during a student-led interprofessional team meeting. Design and delivery During their clinical rotation at a family physician’s practice, each medical student visits a frail elderly patient and prepares a care plan for the patient. At a student-led interprofessional team meeting, medical, nursing and allied healthcare students jointly review these care plans. Subsequently, participating students reflect on their interprofessional collaboration during the team meeting, both collectively and individually. Every 4 weeks, six interprofessional team meetings take place. Each team comprises 9–10 students from various healthcare professions, and meets once. To date an average of 360 medical and 360 nursing and allied healthcare students have participated in this course annually. Evaluation Students mostly reported positive experiences, including the opportunity to learn with, from and about other healthcare professions in the course of jointly reviewing care plans, and feeling collectively responsible for the care of the patients involved. Additionally, students reported a better understanding of the contextual factors at hand. The variety of patient cases, diversity of participating health professions, and the course material need improvement. Conclusion Students from participating institutions confirmed that attending a student-led interprofessional team meeting had enabled them to learn with, from and about other health professions in an active role. The use of real-life cases and the educational design contributed to the positive outcome of this interprofessional learning activity.
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Background: Multimodal prehabilitation programs are effective at reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital.Methods: In this observational cohort study with multiple case analyses, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting the criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise modalities and three nutrition modalities. Implementation fidelity was investigated by evaluating: (1) coverage (participation rate), (2) duration (number of days between the start of prehabilitation and surgery), (3) content (delivery of prescribed intervention modalities), and (4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence.Results: Fifty-eight patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33-84 days). Adherence was high (84-100%) in five and moderate (72-73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled to execute the prehabilitation program due to multiple physical and cognitive impairments.Conclusion: Implementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness.
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Population ageing has become a domain of international discussions and research throughout the spectrum of disciplines including housing, urban planning, and real estate. Older people are encouraged to continue living in their homes in their familiar environment, and this is referred to as “ageing-in-place”. Enabling one to age-in-place requires new housing arrangements that facilitate and enable older adults to live comfortably into old age, preferably with others. Innovative examples are provided from a Dutch social housing association, illustrating a new approach to environmental design that focuses more on building new communities in conjunction with the building itself, as opposed to the occupational therapeutic approaches and environmental support. Transformation projects, referred to as “Second Youth Experiments”, are conducted using the Røring method, which is based on the principles of co-creation. De Benring in Voorst, The Netherlands, is provided as a case study of an innovative transformation project. This project shows how social and technological innovations can be integrated in the retrofitting of existing real estate for older people. It leads to a flexible use of the real estate, which makes the building system- and customer preference proof. Original article at: https://doi.org/10.3390/buildings8070089 © 2018 by the authors. Licensee MDPI.
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BACKGROUND: Combining increased dietary protein intake and resistance exercise training for elderly people is a promising strategy to prevent or counteract the loss of muscle mass and decrease the risk of disabilities. Using findings from controlled interventions in a real-life setting requires adaptations to the intervention and working procedures of healthcare professionals (HCPs). The aim of this study is to adapt an efficacious intervention for elderly people to a real-life setting (phase one) and test the feasibility and potential impact of this prototype intervention in practice in a pilot study (phase two).METHODS: The Intervention Mapping approach was used to guide the adaptation in phase one. Qualitative data were collected from the original researchers, target group, and HCPs, and information was used to decide whether and how specified intervention elements needed to be adapted. In phase two, a one-group pre-test post-test pilot study was conducted (n = 25 community-dwelling elderly), to elicit further improvements to the prototype intervention. The evaluation included participant questionnaires and measurements at baseline (T0) and follow-up (T1), registration forms, interviews, and focus group discussions (T1). Qualitative data for both phases were analysed using an inductive approach. Outcome measures included physical functioning, strength, body composition, and dietary intake. Change in outcomes was assessed using Wilcoxon signed-rank tests.RESULTS: The most important adaptations to the original intervention were the design of HCP training and extending the original protein supplementation with a broader nutrition programme aimed at increasing protein intake, facilitated by a dietician. Although the prototype intervention was appreciated by participants and professionals, and perceived applicable for implementation, the pilot study process evaluation resulted in further adaptations, mostly concerning recruitment, training session guidance, and the nutrition programme. Pilot study outcome measures showed significant improvements in muscle strength and functioning, but no change in lean body mass.CONCLUSION: The combined nutrition and exercise intervention was successfully adapted to the real-life setting and seems to have included the most important effective intervention elements. After adaptation of the intervention using insights from the pilot study, a larger, controlled trial should be conducted to assess cost-effectiveness.TRIAL REGISTRATION: Trial registration number: ClinicalTrials.gov NL51834.081.14 (April 22, 2015).
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This thesis provides an examination of judgement autonomy of Dutch commercial real estate valuers in relation to client orientation. The valuation of commercial real estate such as offices or retail properties requires in-depth analysis due to its uniqueness by location, building type and usage details. Essentially, a register-valuer is qualified and instructed to assess a property value to one’s best cognitive effort and inform others of this outcome by means of a valuation report. In the Netherlands, concerns over independence risks and client-related judgement risks of valuers have been raised by regulative authorities as the Dutch Central Bank (DNB) and the Dutch Authority for the Financial Markets (AFM). A significant part of these concerns followed the 2008 financial crisis, which appeared to be at least partially driven by unreliable and incomparable valuations of Dutch commercial real estate (AFM, 2014; DNB, 2012; 2015). Among other things, these concerns led to the instigation of the Nederlands Register Vastgoed Taxateurs (NRVT) in 2015. NRVT is a new Dutch central register of valuation practitioners set up in order to improve self-regulation, quality control and compliance of valuation practitioners. Currently, the chamber for commercial real estate valuation holds about 2,000 commercial valuation registrations (NRVT, 2020). The introduction of NRVT, and other measures taken, reflect an instrumental view towards enhancing professionalism of Dutch valuers. This view is based on a systematic orientation to professional conduct in which good practice is primarily objectively determined (Van Ewijk, 2019). However, Wassink and Bakker (2016) point out that individuals make personal choices in order to deal with work complexity. Insight into and reflection on individual choices is part of what is referred to as normative aspects of professionalisation: what norms prevail in individual judgement and decision-making and why (Van Ewijk, 2019). In this regard, insight into judgement reasoning of valuation practitioners may contribute to normative levels of professional development of valuers. The need for such is expressed through community concerns over how individual judgement autonomy may become subdued due to instrumental-driven developments taking place in the sector. The combination of authoritative concerns over professional quality in the Netherlands and lack of (scientific) insight on how client influence affects judgement in valuation practice poses a problem: How may practitioners address client-related judgement bias risks and improve valuation accuracy from this viewpoint, if little is known on how such risks may occur in daily practice? The seemingly scarce scientific insights available in this regard in the Netherlands may also prevent educational programs to adequately address valuer independence and objectivity risks in relevant training programs. In order to address this knowledge gap, the present PhD research examines the following research problem: 169 Summary “How does client orientation affect professional judgement autonomy of commercial real estate valuers in the Netherlands?” The term ‘client orientation’ should be broadly interpreted and may refer to valuers’ perception, understanding and meaning given to alleged, actual or anticipated client-related aspects. Information on such client aspects is not required for the performance of valuation instructions. It should also be noted that this research examines the context of how client orientation may affect valuer judgement reasoning patterns during work practice, yet not its effect in terms of decision on final value opinion.
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Purpose: Board members and real estate managers (decision makers) play an important role in the decision-making process in nursing home organisations. This study aims to provide an understanding of underlying attributes and benefits sought by decision makers when making nursing home real estate decisions. Design/methodology/approach: Decision makers from seven different nursing home organisations in The Netherlands were interviewed using the laddering technique to determine the individual requirements, the considerations of the decision alternatives, the relevant attributes and benefits and their mutual relationships. Findings: This study details the motivations behind real estate management decisions in nursing home organisations. The findings show that apart from financial considerations, decision makers strive to enhance the quality of life and satisfaction of users with their real estate decisions and seek to include residents and employees in the process. These benefits are connected to the goals of well-being and innovation in health care. Furthermore, functionality, physical and functional flexibility and technology are key considerations when undertaking corporate real estate (CRE) decisions, to ensure that real estate management aligns with the strategic goals of the nursing home organisation. Practical implications: The insights of this study can support decision makers in healthcare facilities to create strategic value with their real estate. Understanding how to obtain certain benefits from nursing home real estate may result in a better realisation of organisational objectives and user needs. Originality/value: This study reveals the decision-making process in a nursing home context. Moreover, the laddering technique is used as a new method to explore and gain a deep understanding of CRE decision-making processes.
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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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