Jaarlijks worden ongeveer 80.000 patiënten behandeld op de ruim 80 intensive care-afdelingen in Nederland.Op een intensive careafdeling worden vitale functies bewaakt en meestal zelfs overgenomen. Bij de meeste patiënten is voor kortere of langere tijd kunstmatige beademing noodzakelijk. Kunstmatige beademing is effectief en soms zelfs levens reddend maar is in het geheel niet zonder risico’s. Lector Critical Care Frederique Paulus gaat in haar rede in op de uitdagingen die de interprofessionele teams op de Intensive Care hebben ten aanzien van de luchtweg- en beademingszorg. Zij zal proberen te schetsen wat ‘Wij gaan goed voor u zorgen’ op een Intensive Care betekent. Het bijzonder lectoraat CriticalCare is ingesteld in samenwerking methet Amsterdam UMC locatie AMC.
Objectives: In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI. Setting: ICUs in 16 European countries. Participants: In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems. Primary and secondary outcomes measures: We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies. Results: In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95%CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95%CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95%CI 1.42 to 3.58) and low HDI (aOR 1.22, 95%CI 1.64 to 2.20) settings. Conclusions: The 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations.
BACKGROUND: The quality standards of the Dutch Society of Intensive Care require monitoring of the satisfaction of patient's relatives with respect to care. Currently, no suitable instrument is available in the Netherlands to measure this. This study describes the development and psychometric evaluation of the questionnaire-based Consumer Quality Index 'Relatives in Intensive Care Unit' (CQI 'R-ICU'). The CQI 'R-ICU' measures the perceived quality of care from the perspective of patients' relatives, and identifies aspects of care that need improvement.METHODS: The CQI 'R-ICU' was developed using a mixed method design. Items were based on quality of care aspects from earlier studies and from focus group interviews with patients' relatives. The time period for the data collection of the psychometric evaluation was from October 2011 until July 2012. Relatives of adult intensive care patients in one university hospital and five general hospitals in the Netherlands were approached to participate. Psychometric evaluation included item analysis, inter-item analysis, and factor analysis.RESULTS: Twelve aspects were noted as being indicators of quality of care, and were subsequently selected for the questionnaire's vocabulary. The response rate of patients' relatives was 81% (n = 455). Quality of care was represented by two clusters, each showing a high reliability: 'Communication' (α = .80) and 'Participation' (α = .84). Relatives ranked the following aspects for quality of care as most important: no conflicting information, information from doctors and nurses is comprehensive, and health professionals take patients' relatives seriously. The least important care aspects were: need for contact with peers, nuisance, and contact with a spiritual counsellor. Aspects that needed the most urgent improvement (highest quality improvement scores) were: information about how relatives can contribute to the care of the patient, information about the use of meal-facilities in the hospital, and involvement in decision-making on the medical treatment of the patient.CONCLUSIONS: The CQI 'R-ICU' evaluates quality of care from the perspective of relatives of intensive care patients and provides practical information for quality assurance and improvement programs. The development and psychometric evaluation of the CQI 'R-ICU' led to a draft questionnaire, sufficient to justify further research into the reliability, validity, and the discriminative power of the questionnaire.
MULTIFILE
Developing a framework that integrates Advanced Language Models into the qualitative research process.Qualitative research, vital for understanding complex phenomena, is often limited by labour-intensive data collection, transcription, and analysis processes. This hinders scalability, accessibility, and efficiency in both academic and industry contexts. As a result, insights are often delayed or incomplete, impacting decision-making, policy development, and innovation. The lack of tools to enhance accuracy and reduce human error exacerbates these challenges, particularly for projects requiring large datasets or quick iterations. Addressing these inefficiencies through AI-driven solutions like AIDA can empower researchers, enhance outcomes, and make qualitative research more inclusive, impactful, and efficient.The AIDA project enhances qualitative research by integrating AI technologies to streamline transcription, coding, and analysis processes. This innovation enables researchers to analyse larger datasets with greater efficiency and accuracy, providing faster and more comprehensive insights. By reducing manual effort and human error, AIDA empowers organisations to make informed decisions and implement evidence-based policies more effectively. Its scalability supports diverse societal and industry applications, from healthcare to market research, fostering innovation and addressing complex challenges. Ultimately, AIDA contributes to improving research quality, accessibility, and societal relevance, driving advancements across multiple sectors.
Kansen voor circulaire beademingszorg De gezondheidszorg is verantwoordelijk voor 7% van de totale Nederlandse CO2-uitstoot. Eén van de meest materiaal intensieve afdelingen in een ziekenhuis is de intensive care. Patiënten op een intensive care worden beademd en ontvangen daarbij zogenaamde beademingszorg. Tijdens beademingszorg wordt gemaakt van hulpmiddelen zoals beademingsslangen, uitzuigslangen, filters en materialen ter infectiepreventie. De meeste hulpmiddelen worden na gebruik weggegooid. Om de zorg te verduurzamen zijn in de Green Deal doelstellingen geformuleerd om grondstoffenverbruik te verminderen in 2030 en uiteindelijk toe te werken naar circulaire zorg 2050. Er is op dit moment echter weinig kennis over de milieubelasting van gebruikte hulpmiddelen tijdens beademingszorg en de mogelijkheden om circulaire strategieën toe te passen. Dit project heeft als doel om een inventarisatie te maken van de milieubelasting en de afvalstromen van hulpmiddelen rondom beademingszorg. Daarbij is het project ook gericht op een inventarisatie van de mate waarin milieubelasting een overweging is bij de besluitvorming door betrokken stakeholders. Vervolgens zal in kaart worden gebracht welke mogelijkheden er zijn om via circulaire strategieën een bijdrage te leveren om de milieubelasting van hulpmiddelen rondom beademingszorg te verminderen. Voor de uitvoering van dit project zijn unieke deskundigheidsgebieden samengebracht in een consortium. De praktijkpartners hebben expertise in zorgverlening op de intensive care afdeling (AmsterdamUMC) en afvalstromen in ziekenhuizen (adviesbureau Innomax). De betrokken kennisinstellingen hebben expertise in onderwijs- en onderzoek rondom duurzaamheid (de Hogeschool van Amsterdam, Technische Universiteit Delft en Radboudumc). Dit consortium is een unieke samenwerking waarbij om kennis van zorgprocessen, afvalstromen en de milieubelasting van de zorgverlening op de intensive care worden gebundeld om de kansen voor duurzame beademingszorg te inventariseren. De resultaten van dit project zullen een praktijkverandering in gang zetten op intensive care afdelingen van AmsterdamUMC en Radboudumc en vervolgens ook verspreid worden via de landelijke en internationale netwerken.
Every year the police are confronted with an ever increasing number of complex cases involving missing persons. About 100 people are reported missing every year in the Netherlands, of which, an unknown number become victims of crime, and presumed buried in clandestine graves. Similarly, according to NWVA, several dead animals are also often buried illegally in clandestine graves in farm lands, which may result in the spread of diseases that have significant consequences to other animals and humans in general. Forensic investigators from both the national police (NP) and NWVA are often confronted with a dilemma: speed versus carefulness and precision. However, the current forensic investigation process of identifying and localizing clandestine graves are often labor intensive, time consuming and employ classical techniques, such as walking sticks and dogs (Police), which are not effective. Therefore, there is an urgent request from the forensic investigators to develop a new method to detect and localize clandestine graves quickly, efficiently and effectively. In this project, together with practitioners, knowledge institutes, SMEs and Field labs, practical research will be carried out to devise a new forensic investigation process to identify clandestine graves using an autonomous Crime Scene Investigative (CSI) drone. The new work process will exploit the newly adopted EU-wide drone regulation that relaxes a number of previously imposed flight restrictions. Moreover, it will effectively optimize the available drone and perception technologies in order to achieve the desired functionality, performance and operational safety in detecting/localizing clandestine graves autonomously. The proposed method will be demonstrated and validated in practical operational environments. This project will also make a demonstrable contribution to the renewal of higher professional education. The police and NVWA will be equipped with operating procedures, legislative knowledge, skills and technological expertise needed to effectively and efficiently performed their forensic investigations.
