Zoekresultaten

Measuring compound flood potential from river discharge and storm surge extremes at the global scale

The interaction between physical drivers from oceanographic, hydrological, and meteorological processes in coastal areas can result in compound flooding. Compound flood events, like Cyclone Idai and Hurricane Harvey, have revealed the devastating consequences of the co-occurrence of coastal and river floods. A number of studies have recently investigated the likelihood of compound flooding at the continental scale based on simulated variables of flood drivers, such as storm surge, precipitation, and river discharges. At the global scale, this has only been performed based on observations, thereby excluding a large extent of the global coastline. The purpose of this study is to fill this gap and identify regions with a high compound flooding potential from river discharge and storm surge extremes in river mouths globally. To do so, we use daily time series of river discharge and storm surge from state-of-the-art global models driven with consistent meteorological forcing from reanalysis datasets. We measure the compound flood potential by analysing both variables with respect to their timing, joint statistical dependence, and joint return period. Our analysis indicates many regions that deviate from statistical independence and could not be identified in previous global studies based on observations alone, such as Madagascar, northern Morocco, Vietnam, and Taiwan. We report possible causal mechanisms for the observed spatial patterns based on existing literature. Finally, we provide preliminary insights on the implications of the bivariate dependence behaviour on the flood hazard characterisation using Madagascar as a case study. Our global and local analyses show that the dependence structure between flood drivers can be complex and can significantly impact the joint probability of discharge and storm surge extremes. These emphasise the need to refine global flood risk assessments and emergency planning to account for these potential interactions.

Educational intervention for patients with head and neck cancer in the discharge phase

The consequences of head and neck cancer (HNC) treatment have great impact on patients' lives. Despite the importance of preparing patients for the period after discharge, patients frequently experience a lack of information. Aims of the study were to develop a nurse-led educational intervention to provide information during a discharge interview and to investigate the effects of the intervention on informational needs and satisfaction with information in HNC patients.

Fundamentally shifting discharge planning and post-hospital care

Survivors of critical illness and their relatives

Rationale: In order to target rehabilitation needs of survivors of critical illness and their relatives timely and adequately, a thorough needs assessment is recommended when hospital discharge planning is initiated. In light of existing evidence on physical and psychological consequences of critical illness for both patient and family, it is as yet unclear if current hospital discharge procedures suffice to meet the needs of this group. Objectives: To explore hospital discharge experience and to identify perceived barriers and enablers for a positive transition experience from hospital to home or rehabilitation facility as perceived by survivors of critical illness and their families. Methods: We performed a grounded theory study with semi-structured interviews among a group of survivors of critical illness and their relatives (N=35) discharged from 16 hospitals across the Netherlands. Interviews were audio recorded and transcribed verbatim. Using constant comparative methods, initial and focused coding was applied to the data, which were further labeled into major and subcategories, ultimately leading to the identification of key concepts. Triangulation was applied through several reflexivity meetings at different stages of the study. Results: Twenty-two former ICU patients and 13 relatives were interviewed. The mean age was 53 (SD ± 11.2) and 60% were female. Median ICU and hospital length of stay were 14 days (IQR 9.75-24.5) and 35 days (IQR 21.75-57.25) respectively. Thematic analyses led to identification of seven key concepts, representing barriers and enablers to a positive transition experience. 'Existing in a fragmented reality', 'being overlooked' and 'feeling disqualified', were identified barriers and 'feeling empowered', 'encountering empathic and expert professionals', 'managing recovery expectations' and 'family engagement' were identified as enablers for a positive perceived transition experience. Conclusions: Findings of this study suggest that current hospital discharge practice for survivors of critical illness is driven by speed and efficiency, rather than by individual needs assessments, despite advocacies for patient- and family centered care. Discharge strategies should be customized to facilitate adequate and comprehensive assessment of aftercare needs, conducted at the right time and within the right context, encouraging empowerment and a positive perceived transition from hospital to home.