Zicht op Evenwicht. Evaluatie van een landelijk geïmplementeerde cursus gericht op het verminderen van bezorgdheid om te vallen bij zelfstandig wonende ouderen

Inleiding In een gerandomiseerd onderzoek liet een cognitief gedragsmatige cursus, Zicht op Evenwicht, positieve effecten zien op bezorgdheid om te vallen en gerelateerd vermijdingsgedrag bij zelfstandig wonende ouderen. Het huidige onderzoek richt zich op de effecten en uitvoerbaarheid van deze cursus na (landelijke) implementatie in thuiszorgorganisaties. Methode In een pre-experimenteel onderzoek met een voormeting en nametingen na twee en vier maanden is Zicht op Evenwicht geëvalueerd bij 125 zelfstandig wonende ouderen. De effectmaten betroffen bezorgdheid om te vallen, gerelateerd vermijdingsgedrag, valincidenten, medische hulp na een valincident, gevoelens van angst, symptomen van depressie en eenzaamheid. Resultaten Met de Wilcoxon signed-rank test en de gepaarde t-test is een significante verbetering waargenomen tussen de voormeting en de laatste nameting voor bezorgdheid om te vallen, gerelateerd vermijdingsgedrag, aantal valincidenten, gevoelens van angst en symptomen van depressie. De andere uitkomsten verschilden in deze analyses niet significant. Discussie Ook na implementatie in de thuiszorgorganisaties lijkt de cursus Zicht op Evenwicht een positief effect te hebben bij zelfstandig wonende ouderen, op onder andere bezorgdheid om te vallen, gerelateerd vermijdingsgedrag en valincidenten. Gezien de overeenkomsten met de resultaten uit het gerandomiseerde onderzoek kan worden gesteld dat de cursus succesvol te implementeren is in thuiszorgorganisaties

Zicht op Evenwicht Landelijke implementatie van een cursus gericht op het verminderen van angst om te vallen bij zelfstandig wonende ouderen

Achtergrond: Zicht op Evenwicht is een effectieve cognitief gedragsmatige groepscursus om bezorgdheid om te vallen en gerelateerd vermijdingsgedrag bij zelfstandig wonende ouderen te verminderen. Dit artikel beschrijft de landelijke implementatiestrategie van deze cursus en de resultaten daarvan. De implementatiestrategie had als doel de cursus in 2009 en 2010 bij minimaal 50 % van 64 thuiszorgorganisaties die zijn aangesloten bij het Landelijk Steunpunt Preventie - Thuiszorg (LSP-T) te implementeren. Methoden: De implementatiestrategie is gebaseerd op de vier fasen van het ‘Replicating Effective Interventions’ (REP)model: randvoorwaarden, preimplementatie, implementatie, en borging en doorontwikkeling. Resultaten: Na voorbereidende implementatieactiviteiten zoals identificeren van belemmerende factoren, consulteren van stakeholders, gereedmaken van cursusmaterialen en training van cursusbegeleiders (n053), is Zicht op Evenwicht in de periode 2009–2010 geïmplementeerd bij 16 van thuiszorgorganisaties van het LSP-T (25 %). Nog eens vijf thuiszorgorganisaties hadden plannen om de cursus aan te bieden. De cursus is in deze periode landelijk 26 keer aangeboden, 19 keer uitgevoerd en heeft 178 cursisten bereikt. Het verschil tussen aanbod en uitvoering is een gevolg van moeizame werving van cursisten. Na de implementatiefase zijn nog eens 16 cursusbegeleiders getraind en verloopt de verspreiding van cursusmaterialen voorspoedig. Conclusie: Het implementatietraject is overeenkomstig de opzet van het REP-model verlopen. Het beoogde implementatiedoel is niet volledig bereikt in de periode van twee jaar,maar de cursus geniet zichtbaar de interesse van ouderen, cursusbegeleiders en thuiszorgorganisaties. De continuering van aandacht voor verspreiding en borging van de cursus in de eerstelijnszorg wordt daarom aanbevolen

Patients' experiences of the quality of long-term care among the elderly: comparing scores over time

Contains fulltext : 108999.pdf (publisher's version ) (Open Access)BACKGROUND: Every two years, long-term care organizations for the elderly are obliged to evaluate and publish the experiences of residents, representatives of psychogeriatric patients, and/or assisted-living clients with regard to quality of care. Our hypotheses are that publication of this quality information leads to improved performance, and that organizations with substandard performance will improve more than those whose performance is relatively good. METHODS: The analyses included organizational units that measured experiences twice between 2007 (t(0)) and 2009 (t(1)). Experiences with quality of care were measured with Consumer Quality Index (CQI) questionnaires. Besides descriptive analyses (i.e. mean, 5(th) and 95(th) percentile, and 90% central range) of the 19 CQI indicators and change scores of these indicators were calculated. Differences across five performance groups (ranging from 'worst' to 'best') were tested using an ANOVA test and effect sizes were measured with omega squared (omega(2)). RESULTS: At t0 experiences of residents, representatives, and assisted-living clients were positive on all indicators. Nevertheless, most CQI indicators had improved scores (up to 0.37 change score) at t(1). Only three indicators showed a minor decline (up to -0.08 change score). Change scores varied between indicators and questionnaires, e.g. they were more profound for the face-to-face interview questionnaire for residents in nursing homes than for the other two mail questionnaires (0.15 vs. 0.05 and 0.04, respectively), possibly due to more variation between nursing homes on the first measurement, perhaps indicating more potential for improvement. A negative relationship was found between prior performance and change, particularly with respect to the experiences of residents (omega(2) = 0.16) and assisted-living clients (omega(2) = 0.15). However, the relation between prior performance and improvement could also be demonstrated with respect to the experiences reported by representatives of psychogeriatric patients and by assisted-living clients. For representatives of psychogeriatric patients, the performance groups 1 and 2 ([much] below average) improved significantly more than the other three groups (omega(2) = 0.05). CONCLUSIONS: Both hypotheses were confirmed: almost all indicator scores improved over time and long-term care organizations for the elderly with substandard performance improved more than those with a performance which was already relatively good

Microbiological profiles of sputum and gastric juice aspirates in Cystic Fibrosis patients.

Gastro-Oesophageal Reflux (GOR) is a key problem in Cystic Fibrosis (CF), but the relationship between lung and gastric microbiomes is not well understood. We hypothesised that CF gastric and lung microbiomes are related. Gastric and sputum cultures were obtained from fifteen CF patients receiving percutaneous endoscopic gastrostomy feeding. Non-CF gastric juice data was obtained through endoscopy from 14 patients without lung disease. Bacterial and fungal isolates were identified by culture. Molecular bacterial profiling used next generation sequencing (NGS) of the 16S rRNA gene. Cultures grew bacteria and/or fungi in all CF gastric juice and sputa and in 9/14 non-CF gastric juices. Pseudomonas aeruginosa(Pa) was present in CF sputum in 11 patients, 4 had identical Pa strains in the stomach. NGS data from non-CF gastric juice samples were significantly more diverse compared to CF samples. NGS showed CF gastric juice had markedly lower abundance of normal gut bacteria; Bacteroides and Faecalibacterium, but increased Pseudomonas compared with non-CF. Multivariate partial least squares discriminant analysis demonstrated similar bacterial profiles of CF sputum and gastric juice samples, which were distinct from non-CF gastric juice. We provide novel evidence suggesting the existence of an aerodigestive microbiome in CF, which may have clinical relevance

Detection of extended TeV emission around the Geminga pulsar with H.E.S.S.

Highly extended gamma-ray emission around the Geminga pulsar was discovered by Milagro and verified by HAWC. Despite many observations with Imaging Atmospheric Cherenkov Telescopes (IACTs), detection of gamma-ray emission on angular scales exceeding the IACT field-of-view has proven challenging. Recent developments in analysis techniques have enabled the detection of significant emission around Geminga in archival data with H.E.S.S.. In 2019, further data on the Geminga region were obtained with an adapted observation strategy. Following the announcement of the detection of significant TeV emission around Geminga in archival data, in this contribution we present the detection in an independent dataset. New analysis results will be presented, and emphasis given to the technical challenges involved in observations of highly extended gamma-ray emission with IACTs

Astronomy outreach in Namibia : H.E.S.S. and beyond

Astronomy plays a major role in the scientific landscape of Namibia. Because of its excellent sky conditions, Namibia is home to ground-based observatories like the High Energy Spectroscopic System (H.E.S.S.), in operation since 2002. Located near the Gamsberg mountain, H.E.S.S. performs groundbreaking science by detecting very-high-energy gamma rays from astronomical objects. The fascinating stories behind many of them are featured regularly in the "Source of the Month", a blog-like format intended for the general public with more than 170 features to date. In addition to other online communication via social media, H.E.S.S. outreach activities have been covered locally, e.g. through 'open days' and guided tours on the site itself. An overview of the H.E.S.S. outreach activities are presented in this contribution, along with discussions relating to the current landscape of astronomy outreach and education in Namibia. There has also been significant activity in the country in recent months, whereby astronomy is being used to further sustainable development via human capacity-building. Finally, as we take into account the future prospects of radio astronomy in the country, momentum for a wider range of astrophysics research is clearly building — this presents a great opportunity for the astronomy community to come together to capitalise on this movement and support astronomy outreach, with the overarching aim to advance sustainable development in Namibia

Detection of new Extreme BL Lac objects with H.E.S.S. and Swift XRT

Extreme high synchrotron peaked blazars (EHBLs) are amongst the most powerful accelerators found in nature. Usually the synchrotron peak frequency of an EHBL is above 10$^{17}$ Hz, i.e., lies in the range of medium to hard X-rays making them ideal sources to study particle acceleration and radiative processes. EHBL objects are commonly observed at energies beyond several TeV, making them powerful probes of gamma-ray absorption in the intergalactic medium. During the last decade, several attempts have been made to increase the number of EHBL detected at TeV energies and probe their spectral characteristics. Here we report new detections of EHBLs in the TeV energy regime, each at a redshift of less than 0.2, by the High Energy Stereoscopic System (H.E.S.S.). Also, we report on X-ray observations of these EHBLs candidates with Swift-XRT. In conjunction with the very high energy observations, this allows us to probe the radiation mechanisms and the underlying particle acceleration processes