Objective: To evaluate the preliminary effectiveness of a goal-directed movement intervention using a movement sensor on physical activity of hospitalized patients. Design: Prospective, pre-post study. Setting: A university medical center. Participants: Patients admitted to the pulmonology and nephrology/gastro-enterology wards. Intervention: The movement intervention consisted of (1) self-monitoring of patients' physical activity, (2) setting daily movement goals and (3) posters with exercises and walking routes. Physical activity was measured with a movement sensor (PAM AM400) which measures active minutes per day. Main measures: Primary outcome was the mean difference in active minutes per day pre- and post-implementation. Secondary outcomes were length of stay, discharge destination, immobility-related complications, physical functioning, perceived difficulty to move, 30-day readmission, 30-day mortality and the adoption of the intervention. Results: A total of 61 patients was included pre-implementation, and a total of 56 patients was included post-implementation. Pre-implementation, patients were active 38 ± 21 minutes (mean ± SD) per day, and post-implementation 50 ± 31 minutes per day (Δ12, P = 0.031). Perceived difficulty to move decreased from 3.4 to 1.7 (0-10) (Δ1.7, P = 0.008). No significant differences were found in other secondary outcomes. Conclusions: The goal-directed movement intervention seems to increase physical activity levels during hospitalization. Therefore, this intervention might be useful for other hospitals to stimulate inpatient physical activity.
Objective: To describe the development of a goal-directed movement intervention in two medical wards, including recommendations for implementation and evaluation. Design: Implementation Research. Setting: Pulmonology and nephrology/gastroenterology wards of the University Medical Centre Utrecht, The Netherlands. Participants: Seven focus groups were executed including 28 nurses, 7 physical therapists and 15 medical specialists. Patients' perceptions were repeatedly assessed during the iterative steps of the intervention development. Intervention: Interventions were targeted to each ward's specific character, following an Intervention Mapping approach using literature and research meetings. Main measures: Intervention components were linked to Behavior Change Techniques and implementation strategies will be selected using the Expert Recommendation Implementing Change tool. Evaluation outcomes like number of patients using the movement intervention will be measured, based on the taxonomy of Proctor. Results: The developed intervention consists of: insight in patients movement behavior (monitoring & feedback), goal setting (goals & planning) and adjustments to the environment (associations & antecedents). The following implementation strategies are recommended: to conduct educational meetings, prepare & identify champions and audit & provide feedback. To measure service and client outcomes, the mean level of physical activity per ward can be evaluated and the Net Promoter Score can be used. Conclusion(s): This study shows the development of a goal-directed movement intervention aligned with the needs of healthcare professionals. This resulted in an intervention consisting of feedback & monitoring of movement behavior, goal setting and adjustments in the environment. Using a step-by-step iterative implementation model to guide development and implementation is recommended.
Background: Patient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goal-setting process because patients can identify and rate their own problems. The aim of this study is to explore patients’ experiences with the feasibility of the PSC, in the physiotherapy goal setting. Method: We performed a qualitative study. Data were collected by observations of physiotherapy sessions (n=23) and through interviews with patients (n=23) with chronic conditions in physiotherapy practices. Data were analyzed using directed content analysis. Results: The PSC was used at different moments and in different ways. Two feasibility themes were analyzed. First was the perceived ambiguity with the process of administration: patients perceived a broad range of experiences, such as emotional and supportive, as well as feeling a type of uncomfortableness. The second was the perceived usefulness: patients found the PSC useful for themselves – to increase awareness and motivation and to inform the physiotherapist – as well as being useful for the physiotherapist – to determine appropriate treatment for their personal needs. Some patients did not perceive any usefulness and were not aware of any relation with their treatment. Patients with a more positive attitude toward questionnaires, patients with an active role, and health-literate patients appreciated the PSC and felt facilitated by it. Patients who lacked these attributes did not fully understand the PSC’s process or purpose and let the physiotherapist take the lead. Conclusion: The PSC is a feasible tool to support patient participation in the physiotherapy goal setting. However, in the daily use of the PSC, patients are not always fully involved and informed. Patients reported varied experiences related to their personal attributes and modes of administration. This means that the PSC cannot be used in the same way in every patient. It is perfectly suited to use in a dialogue manner, which makes it very suitable to improve goal setting within client-centered care.
In line with European sustainability goals, small and medium sized enterprises (SMEs) in the Dutch automotive aftermarket face the challenge of maintaining competitiveness while transitioning to circular business models. These models, supported by EU policies such as the Circular Economy Action Plan and the European Green Deal, drive innovation in product lifecycle management, recycling, and sustainability. However, as SMEs adapt to these changes, they must also navigate the growing competition from imported Chinese electric vehicles (EVs), which bring both opportunities and risks. Logistics plays a critical role in this transition, as optimizing supply chains, enhancing resource efficiency, and minimizing waste are essential for achieving circularity. Will the Chinese car manufacturers move their value chain to Europe? Or will they further localize in aftersales businesses? Either scenario would affect a chain of SMEs in automotive aftermarket. Focusing on the auto parts SMEs in the Brainport region, this research examines how SMEs can stay competitive by leveraging logistics strategies to support circular practices, and navigate the challenges posed by the influx of Chinese EVs while remaining resilient and adaptable in the automotive aftermarket value chain. Together with our consortium partners, we help the regional SMEs in the automotive aftermarket with: 1. Mapping out logistical challenges and objectives, 2. Risk mitigation and demand planning, 3. Strategic supply chain development. Involving Fontys International Business graduation projects on data analysis, this project combines quantitative and qualitative insights to examine the transition of automotive aftermarket to an EV-dominated future. The SMEs in our consortium network are drive to adapt to the evolving landscape by investing in new measures. Through scenario assessment, we help them with scenario strategies in circular transition. For a broader impact, this project brings SMEs, branch and public organizations together and presents shared responsibilities in creating a resilient supply chain.
In the Glasgow declaration (2021), the tourism sector promised to reduce its CO2 emissions by 50% and reduce them to zero by 2050. The urgency is felt in the sector, and small steps are made at company level, but there is a lack of insight and overview of effective measures at global level.This study focuses on the development of a necessary mix of actions and interventions that the tourism sector can undertake to achieve the goal of a 50% reduction in greenhouse gases by 2030 towards zero emissions by 2050. The study contributes to a better understanding of the paths that the tourism sector can take to achieve this and their implications for the sector. The aim of the report is to spark discussion, ideas and, above all, action.The study provides a tool that positively engages the sector in the near and more distant future, inspires discussion, generates ideas, and drives action. In addition, there will be a guide that shows the big picture and where the responsibilities lie for the reduction targets. Finally, the researchers come up with recommendations for policymakers, companies, and lobbyists at an international and European level.In part 1 of the study, desk research is used to lay the foundation for the study. Here, the contribution of tourism to global greenhouse gas emissions is mapped out, as well as the image and reputation of the sector on climate change. In addition, this section describes which initiatives in terms of, among other things, coalitions and declarations have already been taken on a global scale to form a united front against climate change.In part 2, 40 policies and measures to reduce greenhouse gas emissions in the sector are evaluated in a simulation. For this simulation, the GTTMdyn simulation model, developed by Paul Peeters from BUAS, is used which works on a global scale and shows the effect of measures on emissions, tourism, transport, economy, and behaviour. In this simulation, the researchers can 'test' measures and learn from mistakes. In the end one or more scenarios will; be developed that reach the goals of 50% reduction in 2030 and zero emissions in 2050. In part 3, the various actions that should lead to the reduction targets are tested against the impacts on the consequences for the global tourism economy, its role in providing leisure and business opportunities and the consequences for certain destinations and groups of industry stakeholders. This part will be concluded with two workshops with industry experts to reflect on the results of the simulation.Part 4 reports the results of the study including an outline of the consequences of possibly not achieving the goal. With this, the researchers want to send a warning signal to stakeholders who may be resistant to participating in the transition.
In Gelderland at industriepark Kleefsewaard, a prominent knowledge hub for hydrogen technology has been developed, featuring key industry players and research groups contributing to innovative and cost-effective hydrogen technologies. However, the region faces a challenge in the lack of available test equipment for hydrogen innovations. In Anion Exchange Membrane (AEM) technology, a route to follow is to create hydrogen more efficiently with stacks that can operate under high pressure (50 bar – 200 bar). This results in compact hydrogen storage. Research must be done to understand crossover effects which become more apparent at these high pressure conditions. The overall goal is to design a Balanced of Plant (BOP) system, incorporating Process Flow Diagram (PFD) and Piping & Instrumentation Diagram (P&ID) elements, alongside hydrogen purification systems and gas-liquid separators, for a test setup operating AEM stacks at 200 bar. De Nooij Stainless contributes by designing and fabricating a gas liquid separator, addressing challenges such as compatibility, elevated temperatures, and hydrogen safety. ON2Quest collaborates in supporting the design of a hydrogen purification system and the Balance of Plant (BoP), ensuring flexibility for testing future stacks and hydrogen purification components. HyET E-Trol specializes in high pressure (up to 200 bar) AEM electrolyser stacks and is responsible for providing problem statements and engineering challenges related to the (Balanced of Plant) BoP of AEM systems, and contributes in solving them. Subsequent projects will feature test sequences centered on other stacks, allowing for testing stacks from other companies. The resulting framework will provide a foundation for ongoing advancements, with contributions from each partner playing a crucial role in achieving the project's goals.
