STUDY OBJECTIVE: Endotracheal suctioning in intubated patients is routinely applied in most ICUs but may have negative side effects. We hypothesised that on-demand minimally invasive suctioning would have fewer side effects than routine deep endotracheal suctioning, and would be comparable in duration of intubation, length of stay in the ICU, and ICU mortality.DESIGN: Randomised prospective clinical trial.SETTING: In two ICUs at University Hospital Groningen, the Netherlands.PATIENTS: Three hundred and eighty-three patients requiring endotracheal intubation for more than 24 h.INTERVENTIONS: Routine endotracheal suctioning (n=197) using a 49-cm suction catheter was compared with on-demand minimally invasive airway suctioning (n=186) using a suction catheter only 29 cm long.MEASUREMENTS AND RESULTS: No differences were found between the routine endotracheal suctioning group and the minimally invasive airway suctioning group in duration of intubation [median (range) 4 (1-75) versus 5 (1-101) days], ICU-stay [median (range) 8 (1-133) versus 7 (1-221) days], ICU mortality (15% versus 17%), and incidence of pulmonary infections (14% versus 13%). Suction-related adverse events occurred more frequently with RES interventions than with MIAS interventions; decreased saturation: 2.7% versus 2.0% (P=0.010); increased systolic blood pressure 24.5% versus 16.8% (P<0.001); increased pulse pressure rate 1.4% versus 0.9% (P=0.007); blood in mucus 3.3% versus 0.9% (P<0.001).CONCLUSIONS: This study demonstrated that minimally invasive airway suctioning in intubated ICU-patients had fewer side effects than routine deep endotracheal suctioning, without being inferior in terms of duration on intubation, length of stay, and mortality.
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Citizens regularly search the Web to make informed decisions on daily life questions, like online purchases, but how they reason with the results is unknown. This reasoning involves engaging with data in ways that require statistical literacy, which is crucial for navigating contemporary data. However, many adults struggle to critically evaluate and interpret such data and make data-informed decisions. Existing literature provides limited insight into how citizens engage with web-sourced information. We investigated: How do adults reason statistically with web-search results to answer daily life questions? In this case study, we observed and interviewed three vocationally educated adults searching for products or mortgages. Unlike data producers, consumers handle pre-existing, often ambiguous data with unclear populations and no single dataset. Participants encountered unstructured (web links) and structured data (prices). We analysed their reasoning and the process of preparing data, which is part of data-ing. Key data-ing actions included judging relevance and trustworthiness of the data and using proxy variables when relevant data were missing (e.g., price for product quality). Participants’ statistical reasoning was mainly informal. For example, they reasoned about association but did not calculate a measure of it, nor assess underlying distributions. This study theoretically contributes to understanding data-ing and why contemporary data may necessitate updating the investigative cycle. As current education focuses mainly on producers’ tasks, we advocate including consumers’ tasks by using authentic contexts (e.g., music, environment, deferred payment) to promote data exploration, informal statistical reasoning, and critical web-search skills—including selecting and filtering information, identifying bias, and evaluating sources.
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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.
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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 systenaticaly. 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.
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Lichamelijke zwakte is een belangrijk onderdeel van kwetsbaarheid en komt veel voor bij oudere volwassenen. Terwijl vrouwen een hogere prevalentie en een eerder begin van kwetsbaarheid kennen zijn sekseverschillen in de ontwikkeling van lichamelijke zwakte nauwelijks bestudeerd. Daarom hebben we in spieren de veranderingen onderzocht die onderscheid maken tussen fitte en zwakke ouderen voor elk geslacht afzonderlijk. Mannen (n = 28) en vrouwen (n = 26) van 75 jaar en ouder werden gegroepeerd op basis van hun fysieke prestatiecriteria. Er werd gebruik gemaakt van spierbiopten genomen uit de vastus lateralis-spier voor genexpressie- en histologisch onderzoek. Er werden paarsgewijze vergelijkingen gemaakt tussen de sterkste en de zwakste groepen voor elk geslacht afzonderlijk, en potentiële geslachts-specifieke effecten werden beoordeeld. Zwakke vrouwen toonden een hogere expressie van ontstekingsroutes, infiltratie van NOX2-immuuncellen, samen met een hogere VCAM1-expressie. Zwakke mannen werden gekenmerkt door een kleinere diameter van type 2 (snelle) spiervezels en lagere expressie van PRKN. Zwakte-geassocieerde genexpressie-veranderingen in de spieren waren verschillend van veroudering-geassocieerde genexpressie-veranderingen, wat erop wijst dat de pathofysiologie van fysieke zwakte niet noodzakelijkerwijs afhankelijk is van veroudering. We concluderen dat zwakte-geassocieerde veranderingen in de spieren sekse-specifiek zijn. Aanbevolen wordt om bij onderzoek naar kwetsbaarheid rekening te houden met sekseverschillen, omdat deze verschillen een grote impact kunnen hebben over de ontwikkeling van (farmaceutische) interventies tegen kwetsbaarheid.
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Nationwide and across the globe, the quality, affordability, and accessibility of home-based healthcare are under pressure. This issue stems from two main factors: the rapidly growing ageing population and the concurrent scarcity of healthcare professionals. Older people aspire to live independently in their homes for as long as possible. Additionally, governments worldwide have embraced policies promoting “ageing in place,” reallocating resources from institutions to homes and prioritising home-based services to honour the desire of older people to continue living at home while simultaneously addressing the rising costs associated with traditional institutional care.Considering the vital role of district nursing care and the fact that the population of older people in need of assistance at home is growing, it becomes clear that district nursing care plays a crucial role in primary care. The aim of this thesis is twofold: 1) to strengthen the evidence base for district nursing care; and 2) to explore the use of outcomes for learning and improving in district nursing care. The first part of this thesis examines the current delivery of district nursing care and explores its challenges during the COVID-19 pandemic to strengthen the evidence base and get a better understanding of district nursing care. Alongside the goal of strengthening the evidence for district nursing care, the second part of this thesis explores the use of patient outcomes for learning and improving district nursing care. It focuses on nurse-sensitive patient outcomes relevant to district nursing care, their current measurement in practice, and what is needed to use outcomes for learning and improving district nursing practice.
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Om inzicht te krijgen in spierveroudering is genexpressie gemeten in vastus lateralis biopten van jonge en oude mannen en vrouwen. We vonden dat tijdens het ouder worden bij beide geslachten dezelfde categorieën genen in spieren worden aan- en uitgeschakeld (“gereguleerd”); de mate van deze zogenaamde differentiële expressie was echter geslachtsspecifiek. Bij mannen was oxidatieve fosforylering het meest in het oog springende proces, en bij vrouwen was dit celgroei gemedieerd door AKT-signalering. De conclusie is dat dezelfde processen zijn geassocieerd met skeletspierveroudering bij mannen en vrouwen, maar dat de differentiële expressie van die processen geslachtsspecifiek is.
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Immunofluorescence microscopy in this study shows that GLUT-4 protein expression is fibre-type specific within a muscle. It is postulated that both fibre-type-dependent and fibre-type-independent factors affect GLUT-4 expression.
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This paper describes some explorations on the concept of disassemblability as an important circularity indicator for products because of its severe impact on reuse value. Although usefulness of the concept for determining disassembly strategies and for improving circular product design clearly shows in earlier studies, the link with Industry 4.0 (I4.0)-related process innovation is still underexposed. For further technical development of the field of remanufacturing, research is needed on tools & training for operators, diagnostics, disassembly/repair instructions and forms of operator support. This includes the use of IoT and cobots in remanufacturing lines for automatic disassembly, sorting and recognition methods; providing guidance for operators and reduction of change-over times. A prototype for a disassembly work cell for a mobile phone has been developed together with researchers and students. This includes the removal of screws by means of a cobot using both vision & the available info in the product’s Bill-Of-Materials, the removal of covers, opening of snap fits and replacement of modules. This prototyping demonstrates that it is relatively easy to automate disassembly operations for an undamaged product, that has been designed with repairability in mind and for which product data and models are available. Process innovations like robotisation influence the disassemblability in a positive way, but current indicators like a Disassembly Index (DI) can’t reflect this properly. This study therefore concludes with suggestions for an evaluation of disassemblability by looking at the interaction between product, process and resources in a coherent way.
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It is of utmost importance to collect organic waste from households as a separate waste stream. If collected separately, it could be used optimally to produce compost and biogas, it would not pollute fractions of materials that can be recovered from residual waste streams and it would not deteriorate the quality of some materials in residual waste (e.g. paper). In rural areas with separate organic waste collection systems, large quantities of organic waste are recovered. However, in the larger cities, only a small fraction of organic waste is recovered. In general, citizens dot not have space to store organic waste without nuisances of smell and/or flies. As this has been the cause of low organic waste collection rates, collection schemes have been cut, which created a further negative impact. Hence, additional efforts are required. There are some options to improve the organic waste recovery within the current system. Collection schemes might be improved, waste containers might be adapted to better suit the needs, and additional underground organic waste containers might be installed in residential neighbourhoods. There are persistent stories that separate organic waste collection makes no sense as the collectors just mix all municipal solid waste after collection, and incinerate it. Such stories might be fuelled by the practice that batches of contaminated organic waste are indeed incinerated. Trust in the system is important. Food waste is often regarded as unrein. Users might hate to store food waste in their kitchen that could attract insects, or the household pets. Hence, there is a challenge for socio-psychological research. This might also be supported by technology, e.g. organic waste storage devices and measures to improve waste separation in apartment buildings, such as separate chutes for waste fractions. Several cities have experimented with systems that collect organic wastes by the sewage system. By using a grinder, kitchen waste can be flushed into the sewage system, which in general produces biogas by the fermentation of sewage sludge. This is only a good option if the sewage is separated from the city drainage system, otherwise it might create water pollution. Another option might be to use grinders, that store the organic waste in a tank. This tank could be emptied regularly by a collection truck. Clearly, the preferred option depends on local conditions and culture. Besides, the density of the area, the type of sewage system and its biogas production, and the facilities that are already in place for organic waste collection are important parameters. In the paper, we will discuss the costs and benefits of future organic waste options and by discussing The Hague as an example.
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