Food, nutrition & behaviour : research for healthy eating, healthy living

This brochure illustrates this range of research activities in the domain of food and nutrition, lifestyle and health. It does so by providing examples of collaboration of Wageningen UR with partners in the public and private sector

International variation in survival after out-of-hospital cardiac arrest : A validation study of the Utstein template

Introduction: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. Methods: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n = 232). Results: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8%(range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. Conclusions: The Utstein factors explained 51%. of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.Peer reviewe

Resultaatgericht onderhoud voor installaties in verpleeghuizen

Resultaatgericht onderhoud aan installaties en gebouwen is voor verpleeghuizen en verzorgingshuizen nog geen gemeengoed. Daarom staken vijf installatiebedrijven en twee organisaties voor ouderenzorg onder leiding van TN0 de koppen bij elkaar tijdens een aañtal workshops met als centrale vraag: hoe slechten we de drempels op de weg naar resultaatgericht onderhoud? Want zowel installateurs als zorgorganisaties onderkennen de voordelen van meerjarige resultaatafspraken

Cognitive function and quality of life after successful resuscitation from cardiac arrest

Studies on out-of-hospital cardiac arrest (OHCA) use overall performance category (OPC)/cerebral performance category (CPC) as outcome. We studied quality of life, neuro-cognitive functioning and independency in daily life of patients and strain of caregivers 6-12 months after cardiac arrest. Two hundred and twenty patients (>18 year) who survived 6-12 months after OHCA and relatives were interviewed by telephone with validated questionnaires (Short-form Health Survey) (SF-12), Modified Rankin Scale (MRS), telephonic interview cognitive status (TICS) and Caregiver Strain Index (CSI) and compared with OPC and CPC at discharge. SF-12 of elderly (≥80 years) was compared to an open Dutch population of ≥80 years. Of all patients, 45% had normal physical and 90% had normal mental SF-12. Eighty-one percent had a normal MRS (MRS≤2). Eighty-four percent had normal TICS. Compared to the reference population, elderly scored 40.5 on the mental physical [corrected] and 53.2 on the physical mental [corrected] SF-12, while the reference population scored 38.1 (θ=0.20) and 54.4 (θ=-0.15), respectively, (n.s.) Of the patients with OPC≤2 and CPC≤2 at discharge 15% scored MRS 3-5 and 15% abnormal TICS at follow-up, respectively. Ninety-two percent of all patients gave their quality of life a value of ≥6 (maximum 10). Patients treated with hypothermia scored on most health outcomes similar to those who did not need such treatment. Sixteen percent of caregivers experienced strain, correlating significantly with TICS of patients. The great majority of survivors have normal functioning and cognition 6-12 months after OHCA. Functional and neuro-cognitive telephonic tests 6-12 months after OHCA are simple and better reflect patients functioning at home than OPC/CPC at discharg

Food, nutrition & behaviour : research for healthy eating, healthy living

This brochure illustrates this range of research activities in the domain of food and nutrition, lifestyle and health. It does so by providing examples of collaboration of Wageningen UR with partners in the public and private sector

To transport or to terminate resuscitation on-site. What factors influence EMS decisions in patients without ROSC? A mixed-methods study

Background: If a patient in out-of-hospital cardiac arrest (OHCA) does not achieve return of spontaneous circulation (ROSC) despite advanced life support, emergency medical services can decide to either transport the patient with ongoing CPR or terminate resuscitation on scene. Purpose: To determine differences between patients without ROSC to be transported vs. terminated on scene and explore medical and nonmedical factors that contribute to the decision-making of paramedics on scene. Methods: Mixed-methods approach combining quantitative and qualitative data. Quantitative data on all-cause OHCA patients without ROSC on scene, between January 1, 2012, and December 31, 2016, in the Amsterdam Resuscitation Study database, were analyzed to find factors associated with decision to transport. Qualitative data was collected by performing 16 semi-structured interviews with paramedics from the study region, transcribed and coded to identify themes regarding OHCA decision-making on the scene. Results: In the quantitative Utstein dataset, of 5870 OHCA patients, 3190 (54%) patients did not achieve ROSC on scene. In a multivariable model, age (OR 0.98), public location (OR 2.70), bystander witnessed (OR 1.65), EMS witnessed (OR 9.03), and first rhythm VF/VT (OR 11.22) or PEA (OR 2.34), were independently associated with transport with ongoing CPR. The proportion of variance explained by the model was only 0.36. With the qualitative method, four main themes were identified: patient-related factors, local circumstances, paramedic-related factors, and the structure of the organization. Conclusion: In patients without ROSC on scene, besides known resuscitation characteristics, the decision to transport a patient is largely determined by non-protocollized factors

Psychological impact on dispatched local lay rescuers performing bystander cardiopulmonary resuscitation

We studied the short-term psychological impact and post-traumatic stress disorder (PTSD)-related symptoms in lay rescuers performing cardiopulmonary resuscitation (CPR) after a text message (TM)-alert for out-of-hospital-cardiac arrest, and assessed which factors contribute to a higher level of PTSD-related symptoms. The lay rescuers received a TM-alert and simultaneously an email with a link to an online questionnaire. We analyzed all questionnaires from February 2013 until October 2014 measuring the short-term psychological impact. We interviewed by telephone all first arriving lay rescuers performing bystander CPR and assessed PTSD-related symptoms with the Impact of Event Scale (IES) 4-6 weeks after the resuscitation. IES-scores 0-8 reflected no stress, 9-25 mild, 26-43 moderate, and 44-75 severe stress. A score ≥ 26 indicated PTSD symptomatology. Of all alerted lay rescuers, 6572 completed the online questionnaire. Of these, 1955 responded to the alert and 507 assisted in the resuscitation. We interviewed 203 first arriving rescuers of whom 189 completed the IES. Of these, 41% perceived no/mild short-term impact, 46% bearable impact and 13% severe impact. On the IES, 81% scored no stress and 19% scored mild stress. None scored moderate or severe stress. Using a multivariable logistic regression model we identified three factors with an independent impact on mild stress level: no automated external defibrillator connected by the lay rescuer, severe short-term impact, and no (very) positive experience. Lay rescuers alerted by text messages, do not show PTSD-related symptoms 4-6 weeks after performing bystander CPR, even if they perceive severe short-term psychological impac