Background: A highly promoted opportunity for optimizing healthcare services is to expand the role of nonphysician care providers by care reallocation. Reallocating care from physicians to non-physicians can play an important role in solving systemic healthcare problems such as care delays, hospital overcrowding, long waiting lists, high work pressure and expanding healthcare costs. Dermatological healthcare services, such as the acne care provision, are well suited for exploring the opportunities for care reallocation as many different types of care professionals are involved in the care process. In the Netherlands, acne care is mainly delivered by general practitioners and dermatologists. The Dutch healthcare system also recognizes non-physician care providers, among which dermal therapists and beauticians are the most common professions. However, the role and added value of non-physicians is still unclear. The present study aimed to explore the possibilities for reallocating care to nonphysicians and identify drivers for and barriers to reallocation. Methods: A mixed-method design was used collecting quantitative and qualitative data from representatives of the main 4 Dutch professions providing acne care: dermatologists, GP’s, Dermal therapists and beauticians. Results: A total of 560 questionnaires were completed and 24 semi-structured interviews were conducted. A broad spectrum of non-physician tasks and responsibilities were delineated. Interviewed physicians considered acne as a low-complexity skin condition which made them willing to explore the possibilities for reallocating. A majority of all interviewees saw a key role for non-physicians in counselling and supporting patients during treatment, which they considered an important role for increasing patients’ adherence to proposed treatment regimes, contributing to successful clinical outcome. Also, the amount of time non-physicians spend on patients was experienced as driver for reallocation. Legislation and regulations, uncertainties about the extent of scientific evidence and proper protocols use within the non-physician clinical practice were experienced as barriers influencing the possibilities for reallocation. Conclusions: Delineated roles and drivers demonstrate there is room and potential for reallocation between physicians and non-physicians within acne healthcare, when barriers are adequately addressed.
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This contribution concerns the province of Drenthe in the Netherlands, focusing on four municipalities in the southeast of Drenthe where real estate vacancy is a top priority of ministers and interested parties. This study introduces questions, ideas and solutions. The municipalities are developing and are responsible for the developments in the field of economic developments, community real estate, vacancy and reallocation. But what is the uniting force? The skill in managing community real estate lies in asking questions and having patience with answers. Answers may develop by asking questions and entering into the dialogue with the community. Municipalities are continually attempting to establish a balance between the opportunities of interested parties and those of themselves. A balance between public values, legitimacy and organization (capacity). Einstein discovered surprising answers because of the many questions he asked. Always asking questions stimulates personal knowledge, expertise and skills. Just like sailors running a tight ship who are always on the lookout for wind and currents. The study in economic developments, community real estate, vacancy and reallocation was carried out by the readership for Community Real Estate with 77 professionals in four municipalities with a total population of 195,000 and a surface area of approximately 1,200 square kilometers, comparable to the province of Utrecht
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Protein kinases function as pivotal regulators in biological events, governing essential cellular processes through the transfer of phosphate groups from ATP molecules to substrates. Dysregulation of kinase activity is frequently associated with cancer, ocasionally arising from chromosomal translocation events that relocate genes encoding kinases. Fusion proteins resulting from such events, particularly those involving the proto-oncogene tyrosine-protein kinase ROS (ROS1), manifest as constitutively active kinases, emphasizing their role in oncogenesis. Notably, the chromosomal reallocation of the ros1 gene leads to fusion of proteins with the ROS1 kinase domain, implicated in various cancer types. Despite their prevalence, targeted inhibition of these fusion proteins relies on repurposed kinase inhibitors. This review comprehensively surveys experimentally determined ROS1 structures, emphasizing the pivotal role of X-ray crystallography in providing high-quality insights. We delve into the intricate interactions between ROS1 and kinase inhibitors, shedding light on the structural basis for inhibition. Additionally, we explore point mutations identified in patients, employing molecular modeling to elucidate their structural impact on the ROS1 kinase domain. By integrating structural insights with in vitro and in silico data, this review advances our understanding of ROS1 kinase in cancer, offering potential avenues for targeted therapeutic strategies.
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Future work processes are going to change in several aspects. The working population (at least in Western European countries) is decreasing, while average age of employees increases. Their productivity is key to continuity in sectors like healthcare and manufacturing. Health and safety monitoring, combined with prevention measures must contribute to longer, more healthy and more productive working careers. The ‘tech-optimist’ approach to increase productivity is by means of automation and robotization, supported by IT, AI and heavy capital investments. Unfortunately, that kind of automation has not yet fulfilled its full promise as productivity enhancer as the pace of automation is significantly slower than anticipated and what productivity is gained -for instance in smart industry and healthcare- is considered to be ‘zero-sum’ as flexibility is equally lost (Armstrong et al., 2023). Simply ‘automating’ tasks too often leads to ‘brittle technology’ that is useless in unforeseen operational conditions or a changing reality. As such, it is unlikely to unlock high added-value. In healthcare industry we see “hardly any focus on research into innovations that save time to treat more patients.” (Gupta Strategists, 2021). Timesaving, more than classic productivity, should be the leading argument in rethinking the possibilities of human-technology collaboration, as it allows us to reallocate our human resources towards ‘care’, ’craft’ and ’creativity’.
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Purpose To empirically define the concept of burden of neck pain. The lack of a clear understanding of this construct from the perspective of persons with neck pain and care providers hampers adequate measurement of this burden. An additional aim was to compare the conceptual model obtained with the frequently used Neck Disability Index (NDI). Methods Concept mapping, combining qualitative (nominal group technique and group consensus) and quantitative research methods (cluster analysis and multidimensional scaling), was applied to groups of persons with neck pain (n = 3) and professionals treating persons with neck pain (n = 2). Group members generated statements, which were organized into concept maps. Group members achieved consensus about the number and description of domains and the researchers then generated an overall mind map covering the full breadth of the burden of neck pain. Results Concept mapping revealed 12 domains of burden of neck pain: impaired mobility neck, neck pain, fatigue/concentration, physical complaints, psychological aspects/consequences, activities of daily living, social participation, financial consequences, difficult to treat/difficult to diagnose, difference of opinion with care providers, incomprehension by social environment, and how person with neck pain deal with complaints. All ten items of the NDI could be linked to the mind map, but the NDI measures only part of the burden of neck pain. Conclusion This study revealed the relevant domains for the burden of neck pain from the viewpoints of persons with neck pain and their care providers. These results can guide the identification of existing measurements instruments for each domain or the development of new ones to measure the burden of neck pain.
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Depicting news graphically is considered an apt way to deal with two challenges of modern journalism: to disclose big data, and present the news attractively, visually, and fast to grasp. Newsrooms try their hand at it and are figuring out how to organize production of information visualizations effectively. This study delves into reported obstacles and challenges for the production of news visualizations and suggests that enhancing the quality of information visualization in news media, asks for a clear view on what information visualization means for the production of news, rather than only stimulating journalist to acquire new skills
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Background: Neurodevelopmental treatment (NDT) is a rehabilitation approach increasingly used in the care of stroke patients, although no evidence has been provided for its efficacy. Objective: To investigate the effects of NDT on the functional status and quality of life (QoL) of patients with stroke during one year after stroke onset. Methods: 324 consecutive patients with stroke from 12 Dutch hospitals were included in a prospective, non-randomised, parallel group study. In the experimental group (n = 223), nurses and physiotherapists from six neurological wards used the NDT approach, while conventional treatment was used in six control wards (n = 101). Functional status was assessed by the Barthel index. Primary outcome was poor outcome, defined as Barthel index ,12 or death after one year. QoL was assessed with the 30 item version of the sickness impact profile (SA-SIP30) and the visual analogue scale. Results: At 12 months, 59 patients (27%) in the NDT group and 24 (24%) in the non-NDT group had poor outcome (corresponding adjusted odds ratio = 1.7 (95% confidence interval, 0.8 to 3.5)). At discharge the adjusted odds ratio was 0.8 (0.4 to 1.5) and after six months it was 1.6 (0.8 to 3.2). Adjusted mean differences in the two QoL measures showed no significant differences between the study groups at six or 12 months after stroke onset. Conclusions: The NDT approach was not found effective in the care of stroke patients in the hospital setting. Health care professionals need to reconsider the use of this approach.
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This paper presents work aimed at improved organization and performance of production in housing renovation projects. The purpose is to explore and demonstrate the potential of lean work organization and industrialized product technology to improve workflow and productive time. The research included selected case studies that have been found to implement lean work organization and industrialized product technology in an experimental setting. Adjustments to the work organization and construction technology have been implemented on site. The effects of the adjustments have been measured and were reviewed with operatives and managers. The data have been collected and analyzed, in comparison to traditional settings. Two projects were studied. The first case implied am application of lean work organization in which labor was reorganized redistributing and balancing operations among operatives of different trades. In the second case industrialized solution for prefabricated installation of prefabricated roofs. In both cases the labor productivity increased substantially compared to traditional situations. Although the limited number of cases, both situations appeared to be representative for other housing projects. This has led to conclusions extrapolated from both cases applicable to other projects, and contribution to the knowledge to improve production in construction. Vrijhoef, R. (2016). “Effects of Lean Work Organization and Industrialization on Workflow and Productive Time in Housing Renovation Projects.” In: Proc. 24 th Ann. Conf. of the Int’l. Group for Lean Construction, Boston, MA, USA, sect.2 pp. 63–72. Available at: .
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This article outlines the expected benefits of ERASMUS+ Teaching/Training Exchanges for individuals, the institution as a whole and the degree programmes of The Hague University of Applied Sciences (THUAS), the Netherlands. The method employed was a series of semi-structured interviews, following initial email contact of 32 (approx. 1.5% of staff) who had been on exchange, or were scheduled to be, during the academic year. Interviews were agreed with 7 staff. Leask (2015) identified a lack of research in this area, and it is hoped this research will help to stimulate thinking on this issue. Despite the small sample size, general preliminary conclusions can be drawn and further research is encouraged. The article examines processes and procedures in place for monitoring such exchanges, and it also explores control and monitoring prior to the exchange taking place, as well as post-exchange outcomes and evaluations. It describes the context and theoretical frameworks and discusses the major findings, including accounts of the participants’ experiences and the benefits for them as individuals, their perceptions, their line manager’s responses and institutional policies and processes. The conclusion has recommendations for improvement based upon the participants’ comments. The main message of this article is the need to set goals for the individual and the institution and to evaluate them upon return.
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In the past decades many psychosocial interventions for elderly people with dementia have been developed and implemented. Relatively little research has been done on the extent to which these interventions were implemented in the daily care. The aim of this study was to obtain insight into strategies for successful implementation of psychosocial interventions in the daily residential dementia care. Using a modified RE-AIM framework, the indicators that are considered important for effective and sustainable implementation were defined. Methods: A systematic literature search was undertaken in PubMed, PsycINFO, and Cinahl, followed by a hand search for key papers. The included publications were mapped based on the dimensions of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Results: Fifty-four papers met the inclusion criteria and described various psychosocial interventions. A distinction was made between studies that used one and studies that used multiple implementation strategies. This review shows that to improve their knowledge, caregivers needed at least multiple implementation strategies, only education is not enough. For increasing a more person-centered attitude, different types of knowledge transfer can be effective. Little consideration is given to the adoption of the method by caregivers and to the long-term sustainability (maintenance). Conclusions: This review shows that in order to successfully implement a psychosocial method the use of multiple implementation strategies is recommended. To ensure sustainability of a psychosocial care method in daily nursing home care, innovators as well as researchers should specifically pay attention to the dimensions Adoption, Implementation, and Maintenance of the RE-AIM implementation framework.
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