BackgroundCritically ill patients are subject to severe skeletal muscle wasting during intensive care unit (ICU) stay, resulting in impaired short- and long-term functional outcomes and health-related quality of life. Increased protein provision may improve functional outcomes in ICU patients by attenuating skeletal muscle breakdown. Supporting evidence is limited however and results in great variety in recommended protein targets.MethodsThe PRECISe trial is an investigator-initiated, bi-national, multi-center, quadruple-blinded randomized controlled trial with a parallel group design. In 935 patients, we will compare provision of isocaloric enteral nutrition with either a standard or high protein content, providing 1.3 or 2.0 g of protein/kg/day, respectively, when fed on target. All unplanned ICU admissions with initiation of invasive mechanical ventilation within 24 h of admission and an expected stay on ventilator support of at least 3 days are eligible. The study is designed to assess the effect of the intervention on functional recovery at 1, 3, and 6 months following ICU admission, including health-related quality of life, measures of muscle strength, physical function, and mental health. The primary endpoint of the trial is health-related quality of life as measured by the Euro-QoL-5D-5-level questionnaire Health Utility Score. Overall between-group differences will be assessed over the three time points using linear mixed-effects models.DiscussionThe PRECISe trial will evaluate the effect of protein on functional recovery including both patient-centered and muscle-related outcomes.Trial registrationClinicalTrials.gov Identifier: NCT04633421. Registered on November 18, 2020. First patient in (FPI) on November 19, 2020. Expected last patient last visit (LPLV) in October 2023.
MULTIFILE
Assistive technology supports maintenance or improvement of an individual’s functioning and independence, though for people in need the access to assistive products is not always guaranteed. This paper presents a generic quality framework for assistive technology service delivery that can be used independent of the setting, context, legislative framework, or type of technology. Based on available literature and a series of discussions among the authors, a framework was developed. It consists of 7 general quality criteria and four indicators for each of these criteria. The criteria are: accessibility; competence; coordination; efficiency; flexibility; user centeredness, and infrastructure. This framework can be used at a micro level (processes around individual users), meso level (the service delivery scheme or programme) or at a macro level (the whole country). It aims to help identify in an easy way the main strengths and weaknesses of a system or process, and thus guide possible improvements. As a next step in the development of this quality framework the authors propose to organise a global consultancy process to obtain responses from stakeholders across the world and to plan a number of case studies in which the framework is applied to different service delivery systems and processes in different countries.
Digitalization enables public organizations to personalize their services, tuning them to the specific situation, abilities, and preferences of the citizens. At the same time, digital services can be experienced as being less personal than face-to-face contact by citizens. The large existing volume of academic literature on personalization mainly represents the service provider perspective. In contrast, in this paper we investigate what makes citizens experience a service as personal. The result are eight dimensions that capture the full range of individual experiences and expectations that citizens expressed in focus groups. These dimensions can serve as a framework for public sector organizations to explore the expectations of citizens of their own services and identify the areas in which they can improve the personal experiences they offer.
MULTIFILE
The projectThe overarching goal of DIGNITY, DIGital traNsport In and for socieTY, is to foster a sustainable, integrated and user-friendly digital travel eco-system that improves accessibility and social inclusion, along with the travel experience and daily life of all citizens. The project delves into the digital transport eco-system to grasp the full range of factors that might lead to disparities in the uptake of digitalised mobility solutions by different user groups in Europe. Analysing the digital transition from both a user and provider’s perspective, DIGNITY looks at the challenges brought about by digitalisation, to then design, test and validate the DIGNITY approach, a novel concept that seeks to become the ‘ABCs for a digital inclusive travel system’. The approach combines proven inclusive design methodologies with the principles of foresight analysis to examine how a structured involvement of all actors – local institutions, market players, interest groups and end users – can help bridge the digital gap by co-creating more inclusive mobility solutions and by formulating user-centred policy frameworks.The objectivesThe idea is to support public and private mobility providers in conceiving mainstream digital products or services that are accessible to and usable by as many people as possible, regardless of their income, social situation or age; and to help policy makers formulate long-term strategies that promote innovation in transport while responding to global social, demographic and economic changes, including the challenges of poverty and migration.The missionBy focusing on and involving end-users throughout the process of designing policies, products, or services, it is possible to reduce social exclusion while boosting new business models and social innovation. The end result that DIGNITY is aiming for is an innovative decision support tool that can help local and regional decision-makers formulate digitally inclusive policies and strategies, and digital providers design more inclusive products and services.The approachThe DIGNITY approach combines analysis with concrete actions to make digital mobility services inclusive over the long term. The approach connects users’ needs and requirements with the provision of mobility services, and at the same time connects those services to the institutional framework. It is a multi-phase process that first seeks to understand and bridge the digital gap, and then to test, evaluate and fine-tune the approach, so that it can be applied in other contexts even after the project’s end.Partners: ISINNOVA (Italy), Mobiel 21 (Belgium), Universitat Politechnica deCatalunya Spain), IZT (Germany), University of Cambridge (UK), Factualconsulting (Spain), Barcelona Regional Agencia (Spain), City of Tilburg(Netherlands), Nextbike (Germany), City of Ancona (Italy), MyCicero (Italy),Conerobus (Italy), Vlaams Gewest (Belgium)
In het PRIMa mond CARE project wordt onderzocht in hoeverre de mondgezondheid bijdraagt aan de voorspelling van kwetsbaarheid bij thuiswondende ouderen.Doel Het doel van het PRIMa mond CARE project is te onderzoeken in hoeverre mondgezondheid bijdraagt aan de voorspelling van kwetsbaarheid bij thuiswonende ouderen. Resultaten Voor het onderzoek zijn 1202 ouderen geïncludeerd, waarvan 45% mannen. De gemiddelde leeftijd van de participanten was 73 jaar. De eerste resultaten laten verbanden zien tussen kwetsbaarheid en onderstaande gezondheidsfactoren: • het bezoeken van de tandarts voor een spoedconsult; • het ervaren van ongemakken in de mond; • het aanpassen van de voeding als gevolg van ongemakken in de mond en • het dragen van een gebitsprothese. De volgende artikelen over dit onderzoek zijn inmiddels gepubliceerd: 'Probing problems and priorities in oral health among community dwelling elderly in the Netherlands' in het International Journal of Health Sciences and Research. In het International Journal of Health Services is het artikel 'Needs in Sevice Provision for Older People: An comparison Between Greater Manchester (United Kingdom) and Utrecht (the Netherlands)' gepubliceerd. Recentelijk verscheen ‘’Measurement properties of oral health assessments for non-dental professionals in older people: a systematic review’’ in het BMC Geriatrics. Looptijd 01 november 2016 - 01 juli 2020 Aanpak De huisarts brengt met een softwareprogramma genaamd ‘’U-PRIM’’ de groep potentieel kwetsbare ouderen in kaart. De mensen uit deze screening komen in fase twee: U-CARE. Zij ontvangen een vragenlijst: de Groningen Frailty Indicator. Met de uitkomsten van de vragenlijsten worden de domeinen van kwetsbaarheid gedefinieerd. Deze mensen krijgen huisbezoek van een praktijkverpleegkundige die een zorgplan op maat maakt. De verpleegkundige screent tijdens dit bezoek de oudere ook op mondgezondheidsproblemen, naast de algemene gezondheidscontrole. Daarnaast zijn de gegevens uit het tandartsenbestand gekoppeld aan de gegevens van de huisarts. Ook zijn twee vragen over mondgezondheid toegevoegd aan de Groningen Frailty Indicator. Aan de deelnemers van het onderzoek is toestemming gevraagd om de tandartsgegevens op te vragen bij de tandarts en deze te koppelen aan de huisartsgegevens. Daarnaast zijn alle gegevens anoniem verwerkt.
