Development of the Surgical Patient safety Observation Tool (SPOT)

Background: A Surgical Patient safety Observation Tool (SPOT) was developed and tested in a multicentre observational pilot study. The tool enables monitoring and benchmarking perioperative safety performance across departments and hospitals, covering international patient safety goals. Methods: Nineteen perioperative patient safety observation topics were selected from Dutch perioperative patient safety guidelines, which also cover international patient safety goals. All items that measured these selected topics were then extracted from available local observation checklists of the participating hospitals. Experts individually prioritized the best measurement items per topic in an initial written Delphi round. The second (face to face) Delphi round resulted in consensus on the content of SPOT, after which the measurable elements (MEs) per topic were defined. Finally, the tool was piloted in eight hospitals for measurability, applicability, improvement potential, discriminatory capacity and feasibility. Results: The pilot test showed good measurability for all 19 patient safety topics (range of 8-291 MEs among topics), with good applicability (median 97 (range 11.8-100) per cent). The overall improvement potential appeared to be good (median 89 (range 72.5-100) per cent), and at topic level the tool showed good discriminatory capacity (variation 27.5 per cent, range in compliance 72.5-100 per cent). Overall scores showed relatively little variation between the participating hospitals (variation 13 per cent, range in compliance 83-96 per cent). All eight auditors considered SPOT a straightforward and easy-to-use tracer tool. Conclusion: A comprehensive tool to measure safety of care was developed and validated using a systematic, stepwise method, enabling hospitals to monitor, benchmark and improve perioperative safety performance

Verdiepen in warmer water: een modelstudie naar watertemperaturen en het effect van diepte

‘s Zomers zullen steeds vaker langere periodes van hitte gaan optreden. Wat heeft dit voor effect op de lokale watertemperatuur? En heeft het zin om waterpartijen te verdiepen? Met de Cool Water Tool is geprobeerd modelmatig greep te krijgen op deze vragen. De resultaten laten zien dat de watertemperaturen met klimaatverandering toenemen. Lokaal verdiepen heeft weinig effect op de gemiddelde watertemperatuur. Daarentegen neemt de lengte van de maximale aaneengesloten periode met watertemperaturen hoger dan 20 graden fors toe

Verdienmodellen Natuurinclusieve landbouw

Voor de sectoren akkerbouw en veehouderij zijn voorbeelden uitgewerkt hoe rekening gehouden kan worden met natuur. Bij natuurinclusieve landbouw zijn de negatieve effecten van de agrarische bedrijfsvoering op de natuur minimaal en de positieve effecten van de natuur op de bedrijfsvoering maximaal. Dit nieuwe perspectief op de relatie tussen economie en natuur biedt, zeker in de landbouw met zijn specifieke relatie tot natuur en omgeving, een andere kijk op bedrijfsvoering

Symptom Dimensions of Anxiety Following Myocardial Infarction:Associations With Depressive Symptoms and Prognosis

Objective: Differential associations of symptom dimensions with prognosis in myocardial infarction (MI) patients have been shown for depression, but no studies have focused on anxiety dimensions. The aim of this study was to assess the association between somatic and psychological symptoms of anxiety following acute MI with adverse prognosis and to assess the overlap between anxiety and depression dimensions. Method: Patients (n = 418) were assessed on demographic and clinical variables. The Hamilton Anxiety and Depression Rating Scales were used to measure anxiety and depression 2 months post-MI. Mean follow-up period was 3.8 years and the endpoint consisted of all-cause mortality and recurrent MI. Results: After adjustment for demographic and clinical variables, somatic anxiety was significantly associated with recurrent MI and mortality (HR: 1.32; 95% CI [1.03, 1.69]; p = .03), and a trend was shown for an association between psychological anxiety and outcome (HR: 1.29; 95% CI [0.99, 1.67]; p = .06). The total anxiety score of the HARS was the strongest predictor of recurrent MI and mortality (HR: 1.38; 95% CI [1.07, 1.78]; p = .02). The HARS and the HDRS were highly correlated (r = .86; p < .01). Dimensions consisting of psychological distress (HR: 1.29; 95% CI [1.02, 1.63]; p = .03) and cardiopulmonary/autonomic symptoms (HR: 1.36; 95% CI [1.06, 1.75]; p = .02) also predicted outcome in adjusted analyses. Conclusions: Anxiety was associated with adverse prognosis in MI patients with significant associations for somatic anxiety and total anxiety. When combining anxiety and depression items, psychological distress and cardiopulmonary/autonomic symptoms predicted recurrent MI and mortality. Future research might better focus on dimensions of anxiety and depression simultaneously in MI patients

Logistiek in een Circulaire Economie

De Nederlandse overheid heeft de ambitie uitgesproken om Nederland in 2050 volledig circulair te laten zijn. Daarnaast is er een grote uitdaging om de doelen van het Klimaatakkoord in 2030 en 2050 te behalen. Een circulaire economie kan hieraan een belangrijke bijdrage leveren. De logistieke sector zal in deze transitie mee moeten gaan. Tegelijkertijd heeft de sector zelf ook veel kennis en oplossingen te bieden in deze transitie

Glucocorticoids induce differentiation of monocytes towards macrophages that share functional and phenotypical aspects with erythroblastic island macrophages

The classical central macrophage found in erythroblastic islands plays an important role in erythroblast differentiation, proliferation and enucleation in the bone marrow. Convenient human in vitro models to facilitate the study of erythroid-macrophage interactions are desired. Recently, we demonstrated that cultured monocytes/macrophages enhance in vitro erythropoiesis by supporting hematopoietic stem and progenitor cell survival. Herein, we describe that these specific macrophages also support erythropoiesis. Human monocytes cultured in serum-free media supplemented with stem cell factor, erythropoietin, lipids and dexamethasone differentiate towards macrophages expressing CD16, CD163, CD169, CD206, CXCR4 and the phagocytic TAM-receptor family. Phenotypically, they resemble both human bone marrow and fetal liver resident macrophages. This differentiation is dependent on glucocorticoid receptor activation. Proteomic studies confirm that glucocorticoid receptor activation differentiates monocytes to anti-inflammatory tissue macrophages with a M2 phenotype, termed GC-macrophages. Proteins involved in migration, tissue residence and signal transduction/receptor activity are upregulated whilst lysosome and hydrolase activity GO-categories are downregulated. Functionally, we demonstrate that GC-macrophages are highly mobile and can interact to form clusters with erythroid cells of all differentiation stages and phagocytose the expelled nuclei, recapitulating aspects of erythroblastic islands. In conclusion, glucocorticoid-directed monocyte differentiation to macrophages represents a convenient model system to study erythroid-macrophage interactions