Forest, people, government : a policy-oriented analysis of the social dynamics of tropical deforestation

Wetensch. publicatieInstitute of Environmental Science

The development of a nursing subset of patient problems to support interoperability

Since the emergence of electronic health records, nursing information is increasingly being recorded and stored digitally. Several studies have shown that a wide range of nursing information is not interoperable and cannot be re-used in different health contexts. Difficulties arise when nurses share information with others involved in the delivery of nursing care. The aim of this study is to develop a nursing subset of patient problems that are prevalent in nursing practice, based on the SNOMED CT terminology to assist in the exchange and comparability of nursing information. Explorative qualitative focus groups were used to collect data. Mixed focus groups were defined. Additionally, a nursing researcher and a nursing expert with knowledge of terminologies and a terminologist participated in each focus group. The participants, who work in a range of practical contexts, discussed and reviewed patient problems from various perspectives. Sixty-seven participants divided over seven focus groups selected and defined 119 patient problems. Each patient problem could be documented and coded with a current status or an at-risk status. Sixty-six percent of the patient problems included are covered by the definitions established by the International Classification of Nursing Practice, the reference terminology for nursing practice. For the remainder, definitions from either an official national guideline or a classification were used. Each of the 119 patient problems has a unique SNOMED CT identifier. To support the interoperability of nursing information, a national nursing subset of patient problems based on a terminology (SNOMED CT) has been developed. Using unambiguously defined patient problems is beneficial for clinical nursing practice, because nurses can then compare and exchange information from different settings. A key strength of this study is that nurses were extensively involved in the development process. Further research is required to link or associate nursing patient problems to concepts from a nursing classification with the same meaning

Associations of 25-hydroxyvitamin D with fasting glucose, fasting insulin, dementia and depression in European elderly: the SENECA study

Purpose The classical consequence of vitamin D deficiency is osteomalacia, but recent insights into the function of vitamin D suggest that it may play a role in other body systems as well. The objective of this study was to examine the association between 25-hydroxyvitamin D (25(OH)D) and markers of glucose metabolism (n = 593), global cognitive functioning (n = 116) and depression (n = 118) in European elderly participating in the SENECA study. Moreover, we wanted to explore whether the observed associations of 25(OH)D with depression and global cognitive performance were mediated by fasting plasma glucose (FPG) levels. Methods Cross-sectional associations between 25(OH)D and FPG, fasting plasma insulin (FPI) and homeostatic model assessment-insulin resistance (HOMA-IR), a marker of insulin resistance, were estimated from multiple regression analyses. Associations of 25(OH)D with global cognitive functioning (Mini Mental State Examination) and depression (Geriatric Depression Scale) were examined using Poisson regression. Results An inverse association was observed between 25(OH)D and FPG (ß-0.001), indicating a 1 % decrease in FPG per 10 nmol/L increase in 25(OH)D, but after full adjustment for demographic factors, lifestyle factors and calcium intake, this association was not statistically significant (P = 0.07). Although participants with intermediate and high serum 25(OH)D levels showed a tendency towards a lower depression score after adjustment for demographic and lifestyle factors, RR and 95 % CI: 0.73 (0.51–1.04) and 0.76 (0.52–1.11), respectively, these findings were not statistically significant. Conclusion An inverse association of 25(OH)D with depression and FPG was observed, but this association was not statistically significant. There was no association between 25(OH)D with FPI and HOMA-IR or with global cognitive functioning. More studies are needed to further explore the possible role of vitamin D in the various body system

Opslibbing en vegetatie kwelder ameland-Oost; Jaarrapportage 2014

In 2014 zijn op de kwelder van Ameland-Oost de opslibbing en vegetatieontwikkeling gemeten, als onderdeel van de lopende monitoring van de effecten van de bodemdaling door gaswinning. De meting vindt plaats op twee raaien, in totaal bestaande uit 38 permanente kwadraten (pq’s). De observaties over 2014 passen binnen de tot nu toe gemeten trends in maaiveldhoogte en vegetatieontwikkeling als gevolg van de bodemdaling op Ameland en de natuurlijke variatie in opslibbing en vegetatieontwikkeling. De opslibbing was binnen de range van normale waarden. De vegetatieontwikkeling heeft op een aantal plaatsen regressie of veranderingen binnen een zone laten zien. Het grootste deel daarvan is gerelateerd aan pq’s die fluctueren tussen verschillende vegetatiezones of aan fluctuaties in beweidingsdruk en -type. Dat past binnen de natuurlijke jaar-op-jaar variatie van kweldervegetatie

An evaluation of the use of a Website and Telephonic Information Service as public education about forgetfulness

There is increasing interest in telehealth as a potential new approach for healthcare delivery. To investigate whether telehealth is suitable to inform the older population about forgetfulness, we designed and compared two types of telehealth: Memory Website and the Memory Phone. The aim of this study was to analyze characteristics of the individuals who are interested in the Memory Phone and the Memory Website, to investigate the nature of the information in which the users were interested, and to evaluate the usefulness of the services. Participants were asked to answer several questions before and after visiting the main information menu of the telehealth facilities. Characteristics are given for all participants who used the facilities. In the evaluation period of 3 months, more individuals used the Memory Website (n = 2,631) than the Memory Phone (n = 228). The two services were used by different populations. Phone users were significantly older, more often female, and perceived themselves more often as forgetful. In the specific group of nonprofessional older individuals, general information about memory was more requested by Phone users compared with Website users (67% vs. 41%). Website users more often requested strategies and tips than Phone users (66% vs. 34%). The Phone and the Website were both considered useful. Overall, the Memory Website and the Memory Phone are two different types of evidence-based telehealth interventions, which are relevant for different populations, and are useful in informing the older population about forgetfulness and aging

Development of a practical guideline for person centred goal setting in geriatric rehabilitation:A participatory action research

PurposeTo improve goal setting in Geriatric Rehabilitation (GR), by developing an evidence-based practical guideline for patient-centred goal setting.MethodsParticipatory action research (PAR) in a cyclical process, with GR professionals as co-researchers. Each cycle consisted of five phases: problem analysis, literature review, development, practical experience, feedback & evaluation. The evaluation was based on video recordings of goal setting conversations, and on oral and written feedback of the GR professionals who tested the guideline.ResultsIn two PAR-cycles the guideline was developed, consisting of eight recommendations for setting and using goals, and of practical advices elaborating three of the recommendations, concerning conversational skills specific for goal setting conversations. After the second cycle the research team concluded that the guideline was feasible in daily practice and effective when used consciously.ConclusionIn this study, a practical guideline for setting and using goals in GR was developed. GR teams can improve their patient centred working with goals by discussing the recommendations in their team and choosing the recommendations to work on. This can be supported by the development of an interdisciplinary training. The effect on quality of care should be subject to further investigation

Real-world cost-effectiveness of cetuximab in the third-line treatment of metastatic colorectal cancer based on patient chart review in the Netherlands

Objective: To assess the cost effectiveness of cetuximab in third-line treatment of patients with KRAS wild-type (wt) metastatic colorectal cancer (mCRC) in routine clinical practice compared with best supportive care (BSC). Methods: Patients (n = 287) with KRAS wt mCRC treated with cetuximab or BSC in eight hospitals in the Netherlands between 2009 and 2012 were included in our real-world study. Outcome measures were costs per life-year (LY) and costs per quality-adjusted LY (QALY) gained. A Markov model was developed, and a time horizon of four years was applied. Outcomes were calculated from Kaplan-Meier survival curves from patient-level data and literature. Direct medical costs were estimated in all centers (2013 values), and incremental cost-effectiveness ratios (ICERs) were calculated. Results were discounted, and a probabilistic sensitivity analysis was performed. Results: Administration of cetuximab in third-line treatment of mCRC resulted in a gain of 0.29 LYs and 0.25 QALYs compared with BSC. In the four-year study period, average discounted healthcare costs were €36,637 in the cetuximab group vs. €3648 in the BSC group. The discounted ICERs of cetuximab vs. BSC in the real-world setting were €114,907and €133,527 per LY and QALY gained, respectively. Conclusions: Results of this cost-effectiveness analysis showed that third-line treatment with cetuximab for patients with KRAS (exon 2) wt mCRC offered clinical benefits at additional cost. The real-world ICERs were in line with those of previously published cetuximab and panitumumab cost-utility models

Intragraft interleukin 2 mRNA expression during acute cellular rejection and left ventricular total wall thickness after heart transplantation

OBJECTIVE: To assess whether diastolic graft function is influenced by intragraft interleukin 2 (IL-2) messenger RNA (mRNA) expression in rejecting cardiac allografts. DESIGN: 16 recipients of cardiac allografts were monitored during the first three months after transplantation. The presence of IL-2 mRNA in endomyocardial biopsies (n = 123) was measured by reverse transcriptase polymerase chain reaction. To determine heart function, concurrent M mode and two dimensional Doppler echocardiograms were analysed. RESULTS: Histological signs of acute rejection (International Society for Heart and Lung Transplantation (ISHLT) rejection grade > 2) were strongly associated with IL-2 mRNA expression (IL-2 mRNA was present in 12 of 20 endomyocardial biopsies (60%) with acute rejection and in 24 of 103 endomyocardial biopsies (23%) without acute rejection, p = 0.002). No significant relation was found between either histology or IL-2 mRNA expression alone and the studied echocardiographic parameters. However, stratification of the echocardiographic data into those of patients with and those without acute rejection showed that during acute rejection IL-2 mR

Can Mobile Phone Data Improve Emergency Response to Natural Disasters?

Peter Gething and Andrew Tatem discuss the potential impact of mobile phone positioning data on disaster response and highlight challenges that must be addressed if use of this technology is to develop

Biobouwers als onderdeel van een kansrijke waterveiligheidsstrategie voor Deltaprogramma Waddengebied

Binnen het Deltaprogramma Waddengebied wordt gezocht naar nieuwe veiligheidsstrategieën in verband met klimaatverandering en zeespiegelstijging. Deze strategieën moeten worden ingepast in het bijzondere ecosysteem van de Wadden. Er bestaan op dit moment veel ideeën over de inzet van biobouwers (ook wel ‘ecosystem engineers’ genoemd) in de waterveiligheid. Deze organismen beïnvloeden hun omgeving en kunnen mogelijk via deze natuurlijke processen bijdragen aan de waterveiligheid. Dit rapport geeft een overzicht van de biobouwers die mogelijk een bijdrage kunnen leveren aan de lange-termijn veiligheidsopgave en het meegroeivermogen van de Waddenzee met zeespiegelstijging, de orde van grootte van hun effecten en de mate van hun inzetbaarheid. De volgende biobouwers zijn onderzocht: mosselen, oesters, Ensis (schelpdierbanken), kweldervormende vegetatie, duinvormende vegetatie, diatomeeën en zeegras