Transitie van een psychogeriatrische dagbehandeling in het verpleeghuis naar een laagdrempelige dagbehandeling in de wijk: een pilotonderzoek

Achtergrond In deze studie wordt de transitie van een reguliere psychogeriatrische dagbehandeling in het verpleeghuis naar laagdrempelige psychogeriatrische dagbehandeling met mantelzorgondersteuning (LPD-plus MO) in de wijk op de voet gevolgd. Het bewezen effectieve Model Ontmoetingscentra vormde het uitgangspunt bij de transitie. Methode Door middel van kwalitatieve analyse van documenten en interviews met sleutelfiguren (n = 11) worden factoren opgespoord die de overgang van de oude naar de nieuwe vorm van dagbehandeling bevorderen of belemmeren. Bij deelnemers en mantelzorgers die langer dan 6 maanden gebruik maken van het ondersteuningsaanbod wordt de tevredenheid over het nieuwe aanbod gepeild. Resultaten Verschillende kenmerken van LPD-plus MO blijken de samenwerking met andere zorg- en welzijnsaanbieders in de regio te bevorderen, zoals: de laagdrempelige locatie, de sociale integratie in de buurt en de focus op gecombineerde ondersteuning van zowel de persoon met dementie als de mantelzorger. Een goede samenwerking met andere zorg- en welzijnsorganisaties, en een geschikte locatie vergemakkelijken de implementatie. De aanwezigheid van concurrerend aanbod in de regio, zoals ontmoetingscentra voor mensen met dementie en hun mantelzorgers, belemmeren de werving van deelnemers voor de LPDplus MO. Deelnemers en mantelzorgers zijn over het algemeen tevreden over het ondersteuningsprogramma. Conclusie en discussie De transitie is succesvol verlopen en levert andere reguliere dagbehandelingen tips op voor de transitie naar LPD-plus MO

Variatie in aanmelding van vrije plaatsen door neonatale intensive-careafdelingen en consequenties voor doelmatigheid, rechtvaardigheid en kwaliteit en zorg

Objective. To determine whether the national information system on available beds in neonatal intensive care units (NICUs) leads to fair distribution and good efficiency and quality of care. Setting. Two out of the ten NICUs in the Netherlands. Design. Descriptive. Methods. Data were gathered through observations and 18 interviews with among others neonatologists, gynaecologists and paediatricians. Another 19 doctors were interviewed by phone after a patient they had referred was refused. Interviews were analysed by means of Kwalitan, a computer programme for analysis of qualitative research. Results. When a patient could not be admitted in his own region, the information system was often used to find out which NICUs had a bed available. Sometimes a NICU was called that, according to the information system, did not have a place available. Reasons were: the information was not up to date and not all available beds were reported. This last reason had to do with the wish to keep a bed free for patients from the NICU's own region. Because most doctors were aware of this, they sometimes negotiated about beds, which was time-consuming. Conclusion. The information system was used often, but was working below optimal level, resulting in diminished efficiency. This was primarily caused by the priority given to patients of the own region, which had to do with quality of care considerations. The existing variation in use of the priority policy deserves attention from the viewpoint of procedural justice

Psychiatric consultations in medical outpatients with abdominal pain: Patient and physician effects

Objective: The purpose of the study was to assess the effect of a psychiatric consultation intervention in terms of changes in 1) the patients' psychological symptoms, and 2) satisfaction of general practitioners (GPs) concerning their cooperation with the internists. Method: In a randomized controlled design, the effect of a psychiatric consultation intervention in medical outpatients with abdominal pain (n = 106) has been assessed. The goal of the intervention was 1) a holistic approach toward the patients' symptoms, and 2) the improvement of the cooperation between primary and secondary medical health services. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. The 106 patients were subdivided in an index group (N = 49) and a control group (N = 57). The major outcome measures were the psychological status of the patient and degree of satisfaction of the GPs about the cooperation with the medical specialists. Results: At six months follow-up, there was a significantly greater decline in depressive symptoms assessed by SCL-90 in the patient index group compared with the control group. The GPs of the index group were significantly more satisfied with the cooperation and communication with the internists compared with the control group. Conclusions: An experimental psychiatric consultation intervention did effect the patients' well-being to a certain degree, and especially the GPs were affected in terms of satisfaction. The relevance of improving the communication between health care providers in the management of somatizing patients is discussed

Effect of the Meeting Centres Support Program on informal carers of people with dementia: Results from a multi-centre study

Because of the complex nature of the problems that carers of persons with dementia encounter, several comprehensive support programs for carers were developed in the past decade. One such program is the Meeting Centres Support Program (MCSP) that integrates different types of support for persons with dementia and their carers, which have proved to be effective in practice and/or research. Within the framework of a study into the national implementation of the MCSP, it was investigated whether the positive effects found in carers that participated in the first Amsterdam Meeting Centres, were also achieved in other regions of The Netherlands. A pre-test-post-test control group design with matched groups was applied. In total, 94 carers in the MCSP in eight meeting centres and 34 carers of dementia patients who frequented regular psychogeriatric day care (PDC) in three nursing homes were included in the study. During the study period 23 carers of the MCSP group and 21 carers of the PDC group dropped out. At baseline and after seven months indicators of burden (psychological and psychosomatic symptoms, feelings of burden and time between start of support and institutionalization of the persons with dementia) were measured, as well as potential determinants of burden (sense of competence, coping strategies, experienced support, loneliness and the emotional impact of behaviour problems). Though on a group level no effect was found, either in psychological and psychosomatic symptoms or in the determinants of burden, a subgroup of carers who felt lonely ( n=22) at baseline benefited significantly more from the MCSP than from PDC in terms of psychological and psychosomatic symptoms. A majority of MCSP carers (82.1%) experienced less burden and more professional support. After seven months significantly fewer persons with dementia in the MCSP (4%) were institutionalized as compared to the patients in PDC (29%). Patients in the MCSP participated for a longer period of time before institutionalization. Although the effect on sense of competence of carers that was found in the Amsterdam study was not found in this multi-centre study, the effect on burden and delayed institutionalization of the person with dementia were confirmed. The integrated MCSP also proved more effective than PDC in decreasing psychological and psychosomatic symptoms in lonely carers. Further dissemination of the MCSP is therefore recommended

Export flux succession of dinoflagellate cysts and planktonic foraminifera in an active upwelling cell off Cape Blanc (NW Africa)

To extend information about dinoflagellate cysts (dinocysts) and planktonic foraminifera production, succession, excystment and transport in the upper water column, we investigated their fluxes during a 7-day survey in the active upwelling off Cape Blanc (NW Africa) in November 2018 with drifting traps at 100 m, 200 m, and 400 m water depth. The 7-day survey covered a successive change from active upwelling toward stratified conditions. Highest production of organic dinocysts and planktonic foraminifera were observed under active upwelling conditions and decreased drastically towards the end of the survey. Calcareous dinocysts appeared later during upwelling relaxation. Collected cytoplasm bearing (full) dinocysts and foraminifera were produced in the water column above the traps (<100 m depth). Part of the organic-walled empty dinocysts were resuspended implying that sediments below the survey site are likely to contain both local and allochthonous cyst assemblages. We are the first to show that excystment in the upper water column is species-specific. Brigantedinium excysted in the upper water column before reaching deeper depths whereas no upper water column excystment was observed for the other dinoflagellate species. Dinoflagellate and planktonic foraminifera associations showed a clear succession. Echinidinium zonneveldiae, Brigantedinium spp., other peridinioids, Echinidinium spp., cysts of Pentapharsodinium dalei and other photosynthetic organic-walled dinocysts” as well as Neogloboquadrina incompta and Globigerinella calida were collected during active upwelling. Lingulodinium machaerophorum was produced during upwelling relaxation and Gymnodiniaceae cysts (G. microreticulatum, G. catenatum) as well as the foraminifera Globigerina bulloides and Orbulina universa were collected during stratified conditions. Apart from enhancing the biological knowledge of these species, our observations will allow more detailed reconstructions of upwelling history in the Cape Blanc region based on sedimentary archives using fossilised dinoflagellate and planktonic foraminifera assemblages

The use of the waiting list in a fair selection of patients for nursing home care

When health care resources are scarce, waiting lists may be used as a distribution measure in order to enhance the fair allocation of resources through selection of patients. In this study, the structure and use of a waiting list for a fair selection of patients for nursing home admission was studied. Qualitative research took place in two regions in the Netherlands, where scarcity exists in nursing home care. Selection meetings were attended and 39 health care workers were interviewed. Not only did waiting list criteria like urgency and chronology determine the final selection decision, but also efficiency and quality of care considerations (patients' preferences for particular nursing homes and nursing homes' considerations of matching the unit and work load). These considerations, their relative importance, and the resulting need for enforcement of the decision-making procedures, should be part of the discussion of patient selection. This acknowledges the complexity of the selection of patient

Development of a theoretical model for tracing facilitators and barriers in adaptive implementation of innovative practices in dementia care

The implementation of innovations in the care sector that have been proven effective is not always easy. The implementation of innovative care programs frequently requires adaptive implementation, modified to suit local and regional circumstances. So far there has been very little research into the strategies and factors that facilitate or impede adaptive implementation processes. In the context of a study of the conditions for successful nationwide implementation of meeting centers for people with dementia and their carers, we developed a theoretical model to trace facilitators and barriers in adaptive implementation. We proceeded on the basis of a literature study, previous experiences with setting up meeting centers, and consulting with experts. The theoretical model we constructed distinguishes different phases of implementation, and describes activities and factors that can influence implementation on the micro-, meso- and macro-level for each phase. In addition, the model distinguishes characteristics of the innovation and other preconditions that may facilitate or impede implementation during the entire process. If the model is satisfactory for the study of the implementation of meeting centers, perhaps it can also be used to study other types of care innovations that would benefit from adaptive implementation

Urgency coding as a dynamic tool in management of waiting lists for psychogeriatric nursing home care in The Netherlands

Criteria are used to prioritise patients on waiting lists for health care services. This is also true for waiting lists for admission to psychogeriatric nursing homes. A patient's position on these latter waiting lists is determined by (changes in) urgency and waiting time. The present article focuses on the process and outcome of an urgency coding system in a fair selection of patients, It discusses the use of urgency codes in the daily practice of waiting list management and the related waiting times. Patients and their informal caregivers were followed from entry on the waiting list to admission to a nursing home. Caregivers were interviewed during the waiting period and after their relative's admission to a nursing home. and the formal urgency codes on the waiting list were monitored. Seventy-eight of the initial 93 patients were admitted to a nursing home. High urgency codes were commonly assigned and the waiting times were shorter for patients with higher urgency codes. Negative consequences of an urgency coding system, e.g. patients with less urgency not being admitted at all and patients not being admitted to the nursing home of their choice, could not be demonstrated. Patients without higher urgency codes were admitted after a mean waiting time of 28 weeks. It may be questioned whether this long waiting time is problematic. because satisfaction of the caregivers with regard to waiting times was not influenced by the actual waiting times. An urgency coding system enables health care professionals to react to changes in the situation of both patients and caregivers by adjusting urgency codes to influence the length of time until nursing home admission. (C) 2002 Elsevier Science Ireland Ltd. All rights reserve