Verzoek nietigverklaring besluit Europese Toezichthouder voor gegevensbescherming (EDPS). In deze casus is de Verordening (EU) nr. 2018/1725 van toepassing en niet de Algemene Verordening Gegevensbescherming (AVG). Toch is deze zaak op een groot aantal punten interessant voor de AVG, aangezien de beginselen en rechten uit de Verordening die ter discussie staan in deze zaak grotendeels vergelijkbaar zijn met de beginselen en rechten uit de AVG. Daarnaast is het belang van het duidelijk formuleren van een klacht bij de Europese Toezichthouder Gegevensbescherming, de European Data Protection Supervisor (EDPS), voor iedereen die dit overweegt relevant.
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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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In case of a major cyber incident, organizations usually rely on external providers of Cyber Incident Response (CIR) services. CIR consultants operate in a dynamic and constantly changing environment in which they must actively engage in information management and problem solving while adapting to complex circumstances. In this challenging environment CIR consultants need to make critical decisions about what to advise clients that are impacted by a major cyber incident. Despite its relevance, CIR decision making is an understudied topic. The objective of this preliminary investigation is therefore to understand what decision-making strategies experienced CIR consultants use during challenging incidents and to offer suggestions for training and decision-aiding. A general understanding of operational decision making under pressure, uncertainty, and high stakes was established by reviewing the body of knowledge known as Naturalistic Decision Making (NDM). The general conclusion of NDM research is that experts usually make adequate decisions based on (fast) recognition of the situation and applying the most obvious (default) response pattern that has worked in similar situations in the past. In exceptional situations, however, this way of recognition-primed decision-making results in suboptimal decisions as experts are likely to miss conflicting cues once the situation is quickly recognized under pressure. Understanding the default response pattern and the rare occasions in which this response pattern could be ineffective is therefore key for improving and aiding cyber incident response decision making. Therefore, we interviewed six experienced CIR consultants and used the critical decision method (CDM) to learn how they made decisions under challenging conditions. The main conclusion is that the default response pattern for CIR consultants during cyber breaches is to reduce uncertainty as much as possible by gathering and investigating data and thus delay decision making about eradication until the investigation is completed. According to the respondents, this strategy usually works well and provides the most assurance that the threat actor can be completely removed from the network. However, the majority of respondents could recall at least one case in which this strategy (in hindsight) resulted in unnecessary theft of data or damage. Interestingly, this finding is strikingly different from other operational decision-making domains such as the military, police and fire service in which there is a general tendency to act rapidly instead of searching for more information. The main advice is that training and decision aiding of (novice) cyber incident responders should be aimed at the following: (a) make cyber incident responders aware of how recognition-primed decision making works; (b) discuss the default response strategy that typically works well in several scenarios; (c) explain the exception and how the exception can be recognized; (d) provide alternative response strategies that work better in exceptional situations.
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Project objectives Radicalisation research leads to ethical and legal questions and issues. These issues need to be addressed in way that helps the project progress in ethically and legally acceptable manner. Description of Work The legal analysis in SAFIRE addressed questions such as which behavior associated with radicalisation is criminal behaviour. The ethical issues were addressed throughout the project in close cooperation between the ethicists and the researchers using a method called ethical parallel research. Results A legal analysis was made about criminal law and radicalisation. During the project lively discussions were held in the research team about ethical issues. An ethical justification for interventions in radicalisation processes has been written. With regard to research ethics: An indirect informed consent procedure for interviews with (former) radicals has been designed. Practical guidelines to prevent obtaining information that could lead to indirect identification of respondents were developed.
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Abstract Review Article: Introduction: Registered nurses and students of the Bachelor of Nursing are improving the quality of healthcare by working together in a Learning and Innovation Network (LIN). A LIN is a powerful learning environment, where employees and students work together towards a common goal. Methods: In the Netherlands, Amsterdam UMC, location VUmc and Inholland University of Applied Sciences have set up a LIN on the internal medicine traumatology, oncology, cardiology and urology departments. On the LIN departments, the number of students has increased significantly. Because the students are supernumerary, space and time are created to optimize the learning process of the RNs without compromising the care to be provided. Within the LIN, students learn from the practical experience of RNs, which gives them tools to apply knowledge practically. On the other hand, students can contribute to the adaptation of long established practices, based on recently acquired knowledge. A bridge is built between acting according to recent scientific insights and experiences from practice. It is also important to take the patient’s wishes into account. This guarantees nursing action based on evidence based practice and best practice. Several projects aimed at increasing the quality of care have already been carried out within the LIN such as projects focused on removing a catheter and bandaging. Conclusion: The LIN is taking more and more shape within the VUmc. There is a broad support base between educational and healthcare institutions, both on management and executive level. In order to make the LIN activities even more attuned to the authentic development needs of the department, interprofessional learning and working should be encouraged by also enthusing other care disciplines and researchers to participate in the LIN. An EBP working group consisting of permanent team members can contribute to the safeguarding of the outcomes of the LIN projects.
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Population ageing has been a focus of research since the 1960s (Michael et al. 2006), and it has become a domain of international discussions, debates and research throughout a myriad of disciplines including housing, urban planning and real estate (Buffel and Phillipson 2016, van Bronswijk 2015, Kort 2017). Kazak et al. (2017) described how the ageing population has a profound impact on the real estate market, which is transforming in terms of availability of retirement accommodation for older people including accessibility, adaptability, and the availability of single-floor dwellings. Older people usually have a strong connection with the environment they understand and know well (van Hoof et al. 2016), enabling them to spend the latter years of their life in a familiar setting, which, in turn, influences their self-confidence, independence and the potential to successfully age in place. Older people are encouraged to continue living in their homes a familiar environment to them, instead of moving to an institutional care facility, and this is referred to as “ageing-in-place” (van Hoof 2010). This can be supported by creating a functional and spatial structure of cities that are friendly to older people (van Hoof et al. 2018, van Hoof and Kazak 2018). In the domain of environmental design, a series of home modifications can be identified. The most frequently encountered measures in and around the home are adaptations to improve the accessibility of the home (i.e., removal of barriers such as thresholds, installation of stair lifts in multi-storey homes, and the replacement of bath tubs by walk-in showers,). Separately from these expensive measures and adaptations, simple handgrips can improve the accessibility, safety and mobility of older people (van Hoof et al. 2010, van Hoof et al. 2013). A further concern that should be considered within the living environment is the lack of storage space for wheeled walkers and mobility scooters (including a place to charge batteries) whilst living in an apartment block with limited space to manoeuvre on corridors (Kazak et al. 2017). However, with increasing demands for care, it is not always possible to remain living in one’s own home and moving into a residential or nursing facility is the only remaining option; whereby, specialist and/or nursing care can be accessed and provided in these living environments (van Hoof et al. 2009). Policy principles within long-term care aim to provide a home from home environment for their residents (Moise et al. 2004). Several specialised housing models have been developed in order to facilitate this person-centred care approach, as more traditional institutional settings often do not match with the new holistic and therapeutic goals (Verbeek 2017). Radical alterations have been made in comparison with traditional nursing homes, implementing changes in the organisational, physical and social environment of settings (Verbeek et al. 2009, van Hoof et al. 2009). For example, smaller groups of older people (six to seven persons) form a household, with nursing staff having integrated tasks, including assistance with activities of daily living, preparing meals, organising activities and doing household chores together with residents. Daily life is mainly determined by residents and nursing staff, and the physical environment resembles an archetypal house. With this distinct increase and popular notion of the role real estate plays in ageing-in-place and living well in old age, there is also a shifting focus regarding participation, activation, and helping each other. Home modifications and the home environment itself have a profound influence on the care provided and received at home. In short, the fewer barriers there are at home, the easier and less onerous responsibilities placed on the family carer(s) (Duijnstee 1992). Family carers themselves need such environmental interventions that support care, and a sense of community and belonging. Enabling one to age-in-place and to successfully age requires more than a simple occupational therapeutic approach of environmental interventions. It requires innovative new housing encompassing suitable technology arrangements that can facilitate and enable older adults to live comfortably into old age, preferably with others and offer family members (i.e., children, grandchildren and spouse). Furthermore, interconnecting technology into such environments can offer family members the option and opportunity to monitor their loved one remotely whilst all actors know there are additional safety barriers in place. This chapter discusses and provides innovative examples from a Dutch social housing association and their practices, which illustrates 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. First, we take a closer look at why we care for each other, which is the basis of the participation society, in which we must look after people who are near to us. This should ideally be at the basis of new housing arrangements -in which people are stimulated to meet, engage, survey and care- that social housing associations are developing, retrofitting and developing.
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In BMC Oral Health verscheen het volgende artikel van Inholland-docente en promovenda Janneke Scheerman (en collega’s). Background: Adolescents with fixed orthodontic appliances are at high risk of developing dental caries. To date, new smartphone technologies have seldom been used to support them in the preventive behavior that can help prevent dental caries. After an intervention-mapping process, we developed a smartphone application (the WhiteTeeth app) for preventing dental caries through improved oral-health behavior and oral hygiene. The app, which is intended to be used at home, will help adolescents with fixed orthodontic appliances perform their oral self-care behavior. The app is based on the Health Action Process Approach (HAPA) theory, and incorporates several behavior-change techniques that target the psychosocial factors of oral-health behavior. This article describes the protocol of a randomized controlled trial (RCT) to evaluate the effects of the WhiteTeeth app on oral-health behavior and oral-hygiene outcomes (presence of dental plaque and gingival bleeding) compared with those of care as usual, in patients aged 12–16 with fixed orthodontic appliances.
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Background: In 2009, the Steering Committee for Pregnancy and Childbirth in the Netherlands recommended the implementation of continuous care during labor in order to improve perinatal outcomes. However, in current care, routine maternity caregivers are unable to provide this type of care, resulting in an implementation rate of less than 30%. Maternity care assistants (MCAs), who already play a nursing role in low risk births in the second stage of labor and in homecare during the postnatal period, might be able to fill this gap. In this study, we aim to explore the (cost) effectiveness of adding MCAs to routine first- and second-line maternity care, with the idea that these MCAs would offer continuous care to women during labor. Methods: A randomized controlled trial (RCT) will be performed comparing continuous care (CC) with care-as-usual (CAU). All women intending to have a vaginal birth, who have an understanding of the Dutch language and are > 18 years of age, will be eligible for inclusion. The intervention consists of the provision of continuous care by a trained MCA from the moment the supervising maternity caregiver establishes that labor has started. The primary outcome will be use of epidural analgesia (EA). Our secondary outcomes will be referrals from primary care to secondary care, caesarean delivery, instrumental delivery, adverse outcomes associated with epidural (fever, augmentation of labor, prolonged labor, postpartum hemorrhage, duration of postpartum stay in hospital for mother and/or newborn), women’s satisfaction with the birth experience, cost-effectiveness, and a budget impact analysis. Cost effectiveness will be calculated by QALY per prevented EA based on the utility index from the EQ-5D and the usage of healthcare services. A standardized sensitivity analysis will be carried out to quantify the outcome in addition to a budget impact analysis. In order to show a reduction from 25 to 17% in the primary outcome (alpha 0.05 and bèta 0.20), taking into account an extra 10% sample size for multi-level analysis and an attrition rate of 10%, 2 × 496 women will be needed (n = 992). Discussion: We expect that adding MCAs to the routine maternity care team will result in a decrease in the use of epidural analgesia and subsequent costs without a reduction in patient satisfaction. It will therefore be a costeffective intervention. Trial registration: Trial Registration: Netherlands Trial Register, NL8065. Registered 3 October 2019 - Retrospectively registered.
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How come Open Science is a well-shared vision among research communities, while the prerequisite practice of research data management (RDM) is lagging? This research sheds light on RDM adoption in the Dutch context of universities of applied sciences, by studying influencing technological, organizational, and environmental factors using the TOE-framework. A survey was sent out to researchers of universities of applied sciences in the Netherlands. The analyses thereof showed no significant relation between the influencing factors and the intention to comply with the RDM guidelines (p-value of ≤ .10 and a 90% confidence level). Results did show a significant influence of the factor Management Support towards compliance with a p-value of 0.078. This research contributes towards the knowledge on RDM adoption with the new insight that the factors used in this research do not seem to significantly influence RDM adoption in the Dutch context of universities of applied sciences. The research does show that the respondents have a positive attitude in their intention to change, increase or invest time and effort towards RDM compliance. More research is advised to uncover factors that do significantly influence RDM adoption among universities of applied sciences in the Netherland for stakeholders in Open Science and RDM to enhance their strategies.
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Author supplied: A manufacturing process can be described by a sequence or combination of production steps. Based on this approach a manufacturing system has been developed that is capable to produce several different products in parallel. A batch size of one unit is possible and the production is pull-driven. The manufacturing system is based on agent technology and a special so-called product agent collects information about the assembly process. This agent will be connected to the actual product and can guide the disassembly process at the end of the products life. The agent will show the inverse steps to be taken to take a product apart. This approach can be used in the agent based manufacturing process described in this paper but the concept can also be used for other manufacturing systems. The paper discusses the possibilities as well as the restrictions of the method proposed here.
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