Potkleibossen in Noord- en Oost-Drenthe:Ondergrond, cultuurgeschiedenis en vegetatie

Two specific regions in the north and east of the province of Drenthe (northern Netherlands) contain shallow heavy clay soils that date from the Elsterien Ice Age (475,000—410,000 years BP). As these soils are unsuittable for human settlement or arable farming these regions include a relatively high numberof ancient woodlands. The paper describes the geological, cultural-historical and ecological characteristics of three of these woodlands. Glacial clay soils dating from this second—tolast ice age occur exclusively in places where all younger sediments have been eroded. This is only the case at the edge of the DrentsPlateau. The blackish grey clay layers are extremely stagnant, making them suitable for nothing but grassland. But in the Middle Ages the clay was found to be very well suited for the production of bricks and tiles.This is why the largest monastery in the Netherlands — the Cistercian Abbey of Aduard — founded several brick and tile factories in these glacial clay areas in the 13th and 14th centuries. In the 16th and 17th centuries local noblemen and industrial entrepreneurs took over this brick industry, which remained active until the mid-20th century. The best preserved brick-production landscape is in the ancient woodland of De Kleibosch (Foxwolde), where numerous clay pits, field oven relics and heaps of misfired bricks are the silent witnesses of this historical brick industry. Most ancient woodlands on glacial clay soilshave been used as commons by local farmers since medieval times. Written sources like village by-laws tell us that these woodlands produced vast amounts of oak timber, coppice wood and faggots, and were also extensively used for herding cattle and pigs. Because of their rich clay soil and long history of humanexploitation, the last five remnants of this particular type of ancient woodlands contain a unique flora including more than 25 native tree and shrub species and many rare ancient woodland plants. Even though the original woodland was reclaimed in the 19th and 20th centuries, the hedges and woodbanks appearto contain many relics of this ancient woodland vegetation. They therefore deserve speccial attention from researchers, nature managers and politicians to guarantee a sustainable future for these very rare historical-ecological landscapes

Facilitators and barriers in pain management for trauma patients in the chain of emergency care

The aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands. A qualitative approach was adopted with the use of the implementation Model of Change of Clinical Practice. The chain of emergency care concerned prehospital Emergency Medical Services (EMS) and Emergency Departments (EDs). We included two EMS ambulance services and three EDs and conducted five focus groups and 10 individual interviews. Stakeholders and managers of organisations were interviewed individually. Focus group participants were selected based on availability and general characteristics. Transcripts of the audio recordings and field notes were analysed in consecutive steps, based on thematic content analysis. Each step was independently performed by the researchers, and was discussed afterwards. We analysed differences and similarities supported by software for qualitative analysis MaxQDA

Facilitators and barriers in pain management for trauma patients in the chain of emergency care

INTRODUCTION: The aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands. PATIENTS AND METHODS: A qualitative approach was adopted with the use of the implementation Model of Change of Clinical Practice. The chain of emergency care concerned prehospital Emergency Medical Services (EMS) and Emergency Departments (EDs). We included two EMS ambulance services and three EDs and conducted five focus groups and 10 individual interviews. Stakeholders and managers of organisations were interviewed individually. Focus group participants were selected based on availability and general characteristics. Transcripts of the audio recordings and field notes were analysed in consecutive steps, based on thematic content analysis. Each step was independently performed by the researchers, and was discussed afterwards. We analysed differences and similarities supported by software for qualitative analysis MaxQDA. RESULTS: This study identified five concepts as facilitators and barriers in pain management for trauma patients in the chain of emergency care. We described the concepts of knowledge, attitude, professional communication, organisational aspects and patient input, illustrated with quotes from the interviews and focus group sessions. Furthermore, we identified whether the themes occurred in the chain of care. Knowledge deficits, attitude problems and patient input were similar for the EMS and ED settings, despite the different positions, backgrounds and educational levels of respondents. In the chain of care a lack of professional communication and organisational feedback occurred as new themes, and were specifically related to the organisational structure of the prehospital EMS and EDs. CONCLUSION: Identified organisational aspects stressed the importance of organisational embedding of improvement of pain management. However, change of clinical practice requires a comprehensive approach focused at all five concepts. We think a shift in attitudes is needed, together with constant surveillance and feedback to emergency care providers. Implementation efforts need to be aimed at the identified barriers and facilitators, tailored to the chain of emergency care and the multi-professional group of emergency care providers.status: publishe

Facilitators and barriers in pain management for trauma patients in the chain of emergency care

Introduction: the aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands.Patients and methods: a qualitative approach was adopted with the use of the implementation Model of Change of Clinical Practice. The chain of emergency care concerned prehospital Emergency Medical Services (EMS) and Emergency Departments (EDs). We included two EMS ambulance services and three EDs and conducted five focus groups and 10 individual interviews. Stakeholders and managers of organisations were interviewed individually. Focus group participants were selected based on availability and general characteristics. Transcripts of the audio recordings and field notes were analysed in consecutive steps, based on thematic content analysis. Each step was independently performed by the researchers, and was discussed afterwards. We analysed differences and similarities supported by software for qualitative analysis MaxQDA.Results: this study identified five concepts as facilitators and barriers in pain management for trauma patients in the chain of emergency care. We described the concepts of knowledge, attitude, professional communication, organisational aspects and patient input, illustrated with quotes from the interviews and focus group sessions. Furthermore, we identified whether the themes occurred in the chain of care. Knowledge deficits, attitude problems and patient input were similar for the EMS and ED settings, despite the different positions, backgrounds and educational levels of respondents. In the chain of care a lack of professional communication and organisational feedback occurred as new themes, and were specifically related to the organisational structure of the prehospital EMS and EDs.Conclusion: identified organisational aspects stressed the importance of organisational embedding of improvement of pain management. However, change of clinical practice requires a comprehensive approach focused at all five concepts. We think a shift in attitudes is needed, together with constant surveillance and feedback to emergency care providers. Implementation efforts need to be aimed at the identified barriers and facilitators, tailored to the chain of emergency care and the multi-professional group of emergency care provider