93 research outputs found
Eigen regie en waardigheid in de zorg: een kwestie van persoonsgerichte praktijkvoering
Eigen regie en waardigheid in de zorg: een kwestie van persoonsgerichte praktijkvoeringDe gezondheidszorg is aan sterke veranderingen onderhevig. Pregnant is de ontwikkeling naar ondersteuning van eigen regievoering van cliĂŤnten. In deze bijdrage plaatsen we twee kanttekeningen bij de invulling van dit begrip. Vanuit een neoliberaal marktdenken ligt de focus op de controleerbaarheid van leven en gezondheid. Dit doet echter geen recht aan de kwetsbaarheid die mensen ook ervaren en hun behoefte aan respect, erkenning en als mens geacht te worden. Vanuit een bureaucratisch organisatie denken staat de beheersbaarheid van organisaties in termen van doelen en kosten centraal. Dit leidt tot fragmentatie van zorg en dreigt professionals tot uitvoerders van regels en procedures te maken. Persoonsgerichte praktijkvoering kan deze knelpunten ondervangen. Het is het voortdurend samen vormgeven van relaties en structuren binnen zorg-, leer- en werkomgevingen zodanig dat eigen regie en waardigheid van alle betrokkenen worden gerealiseerd.  Eigen regie is dus geen individuele aangelegenheid, maar een kwestie van âgrensoverschrijdend samenwerkenâ en verbinden vanuit verschillen in waarden, kennis en betekenisgeving. Persoonsgerichte praktijkvoering biedt daarbij een alternatief model voor het expertmodel, dat is aangeduid als het samenwerkingsmodel. Autonomy and dignity in healthcare: a matter of person-centred practice Healthcare in the Netherlands is subject to major changes. Due to rising living standards and new technologies in healthcare, people are living longer and this is related to an increase in multimorbidity. The demand for and cost of healthcare are rising as a result. In the process of trying to transform healthcare and reduce costs, the government is trying to increase the amount of self-care and self-sufficiency. Significant herein, is the development towards support for clients' self-management. This is not a new concept: patient empowerment and patient autonomy have been on the agenda since the 1970s. In order to explain the difficulties that healthcare is encountering in supporting patient autonomy, we use the theory of the American sociologist Eliot Freidson (2001), who makes a distinction between the logic of the market (consumerism), the logic of the organization (managerialism) and the logic of the profession (professionalism). Based on his theory, we would expect that although consumers do now have a stronger voice in their own healthcare, neither patients nor professionals experience autonomy in current healthcare practices. First of all, from a neo-liberal market perspective, the focus of self-management is on the controllability of life and health. However, this does not take account of the vulnerability that people experience and their need for respect, recognition and treatment as human beings. Consequently, patients often do not feel they are seen as people in their own right and do not feel supported in dealing with difficult life questions and issues. Secondly, from an organizational and bureaucratic perspective, the controllability of organizations in terms of goals and costs is central. This leads to the fragmentation of care, leaving patients to manage not only themselves but also their care. Organizational bureaucracy also conflicts with professional autonomy, turning professionals into the enforcers of rules and procedures. Person-centred practice can provide a solution to help overcome these issues and is the subject of increasing attention worldwide. It is part of a humanization movement in healthcare which sees the personal and interpersonal dimensions as essential to good care (McCormack & McCance, 2010; Hummelvoll, Karlsson & Borg, 2015; Jacobs, 2015). Our vision of person-centred practice is inspired by the ethics of care, relational psychology and relational constructionism. These currents are critical of individualism and the focus is on control and manageability in contemporary healthcare. Person-centred care is defined as the continuous co-creation of relationships and structures within care, learning and work environments in such a way that the patientâs own direction and dignity are realized. Self-management is therefore not an individual matter, but a question of âworking together across the boundariesâ of differences in values, knowledge and meanings. Person-centred practice provides an alternative model for the expert model, which is referred to as the cooperation model. In this model, collaboration involves not only professionals from various disciplines and sectors, but also clients and their stakeholders in healthcare. The expertise required for this by participants is known as dialogical or relational expertise. The intention of cross-border cooperation is to contribute to sustainable change by developing relationships and structures that promote autonomy and dignity.The current transformation of healthcare to provide more support for self-management will benefit from a critical reflection on market forces, and in particular its implicit assumptions of the controllability of individual lives and organizations. People are vulnerable and have a deep-seated need for respect and recognition, even if they are no longer able to manage and organize their own lives. Professionals and organizations benefit from working on the basis of core values to support their own self-management. Self-management is therefore not an individual matter, but a matter of âworking together across boundariesâ and connecting amidst differences in values, knowledge and meanings. Person-centred practice provides important insights in how to approach this
Onderzoeksrapport Kennisagenda Geestelijke Verzorging Thuis:Behorend bij âKennisagenda GV Thuisâ (november 2023)
Onderzoeksrapport Kennisagenda Geestelijke Verzorging Thuis:Behorend bij âKennisagenda GV Thuisâ (november 2023)
Multicenter Evaluation of the Course of Coagulopathy in Patients with Isolated Traumatic Brain Injury:Relation to CT Characteristics and Outcome
This prospective multicenter study investigated the association of the course of coagulation abnormalities with initial computed tomography (CT) characteristics and outcome in patients with isolated traumatic brain injury (TBI). Patient demographics, coagulation parameters, CT characteristics, and outcome data of moderate and severe TBI patients without major extracranial injuries were prospectively collected. Coagulopathy was defined as absent, early but temporary, delayed, or early and sustained. Delayed/sustained coagulopathy was associated with a higher incidence of disturbed pupillary responses (40% versus 27%; p<0.001) and higher Traumatic Coma Data Bank (TCDB) CT classification (5 (2-5) versus 2 (1-5); p=0.003) than in patients without or with early, but short-lasting coagulopathy. The initial CT of patients with delayed/sustained coagulopathy more frequently showed intracranial hemorrhage and signs of raised intracranial pressure (ICP) compared to patients with early coagulopathy only. This was paralleled by higher in-hospital mortality rates (51% versus 33%; p<0.05), and poorer 6-month functional outcome in patients with delayed/sustained coagulopathy. The relative risk for in-hospital mortality was particularly related to disturbed pupillary responses (OR 8.19; 95% CI 3.15,21.32; p<0.001), early, short-lasting coagulopathy (OR 6.70; 95% CI 1.74,25.78; p=0.006), or delayed/sustained coagulopathy (OR 5.25; 95% CI 2.06,13.40; p=0.001). Delayed/sustained coagulopathy is more frequently associated with CT abnormalities and unfavorable outcome at 6 months after TBI than early, short-lasting coagulopathy. Our finding that not only the mere presence but also the time course of coagulopathy holds predictive value for patient outcome underlines the importance of systematic hemostatic monitoring over time in TBI
Person-centredness - The âstateâ of the art
Background: Person-centred practice is now firmly embedded in the nursing and healthcare discourse. While there is a growing body of development and research activity in the field, there is increased recognition of the need for further advances in the body of existing knowledge. This is reflected in the different approaches to person-centredness being adopted by healthcare systems internationally.
Aims: To provide an overview of person-centredness and ways in which person-centred practice has been adopted in healthcare systems internationally.
Methods: A summary review of the evidence underpinning the concepts and theory of person-centredness, incorporating an overview of national strategic frameworks that influence the development of person-centred practice in different countries.
Findings: While there have been considerable advances in the development of person-centredness, there is a lot of work to be done in the adoption of more consistent approaches to its development and evaluation. In particular, a shared discourse and measurement tools are needed. Internationally, person-centredness is gaining momentum and many countries have strategic frameworks in place to direct its development and implementation
Anti-Arthritic Effects of Magnolol in Human Interleukin 1β-Stimulated Fibroblast-Like Synoviocytes and in a Rat Arthritis Model
Fibroblast-like synoviocytes (FLS) play an important role in the pathologic processes of destructive arthritis by producing a number of catabolic cytokines and metalloproteinases (MMPs). The expression of these mediators is controlled at the transcriptional level. The purposes of this study were to evaluate the anti-arthritic effects of magnolol (5,5â˛-Diallyl-biphenyl-2,2â˛-diol), the major bioactive component of the bark of Magnolia officinalis, by examining its inhibitory effects on inflammatory mediator secretion and the NF-ÎşB and AP-1 activation pathways and to investigate its therapeutic effects on the development of arthritis in a rat model. The in vitro anti-arthritic activity of magnolol was tested on interleukin (IL)-1β-stimulated FLS by measuring levels of IL-6, cyclooxygenase-2, prostaglandin E2, and matrix metalloproteinases (MMPs) by ELISA and RT-PCR. Further studies on how magnolol inhibits IL-1β-stimulated cytokine expression were performed using Western blots, reporter gene assay, electrophoretic mobility shift assay, and confocal microscope analysis. The in vivo anti-arthritic effects of magnolol were evaluated in a Mycobacterium butyricum-induced arthritis model in rats. Magnolol markedly inhibited IL-1β (10 ng/mL)-induced cytokine expression in a concentration-dependent manner (2.5â25 Âľg/mL). In clarifying the mechanisms involved, magnolol was found to inhibit the IL-1β-induced activation of the IKK/IÎşB/NF-ÎşB and MAPKs pathways by suppressing the nuclear translocation and DNA binding activity of both transcription factors. In the animal model, magnolol (100 mg/kg) significantly inhibited paw swelling and reduced serum cytokine levels. Our results demonstrate that magnolol inhibits the development of arthritis, suggesting that it might provide a new therapeutic approach to inflammatory arthritis diseases
Ruis op de lijn met de professionele zorg: Een onderzoek onder coĂśrdinatoren vrijwillige palliatieve terminale zorg
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