Innovatie in de revalidatie - Een kwalitatieve evaluatie van het innovatieprogramma Revalidatie

Abstract ZonMw en Revalidatie Nederland hebben het iBMG opdracht gegeven onderzoek te doen naar het innovatievermogen van Nederlandse revalidatiesector. Dit rapport beschrijft de resultaten van een kwalitatieve evaluatie (eind 2011 – begin 2013) van het Innovatieprogramma Revalidatie. Het onderzoek is opgezet om inzichten op te doen over hoe de innovatiekracht in de revalidatie duurzaam kan worden gestimuleerd. De hoofdvraag voor dit onderzoek was: “Welke betekenis heeft het Innovatieprogramma Revalidatie voor innovatie in de revalidatiesector en welke lering kan hieruit worden getrokken voor de duurzame bestendiging van de innovatiekracht in deze sector? Het Innovatieprogramma Revalidatie was erop gericht om de ontwikkeling van kleinschalige innovaties, de implementatie van bestaande innovaties en op het opzetten van een infrastructuur voor innovatie, in de vorm van een kennisnet, mogelijk te maken. In het onderzoek zijn de ontwikkeling, de opzet en het verloop van het programma geanalyseerd en zijn verschillende projecten als casestudie bestudeerd. Het onderzoek had een kwalitatieve onderzoeksopzet zodat de praktijk van innovatie centraal heeft kunnen staan. Het onderzoek bestond uit vier afzonderlijke onderzoeksfasen: (1) een analyse van de opzet en het verloop van het Innovatieprogramma Revalidatie, (2) casestudies van vier innovatieen/ of implementatieprojecten, (3) onderzoek naar de ontwikkeling van Revalidatie Kennisnet en (4) reflecterende interviews als controle op de analyse. Dit heeft geleid tot een grote hoeveelheid materiaal, bestaande uit interviewverslagen, veldnotities, observatieaantekeningen en velddocumenten, dat voor verslaglegging is geanalyseerd. In dit onderzoek is hiertoe eerst een visie op innovatie ontwikkeld op basis van theoretische inzichten. Deze visie op innovatie gaat ervanuit dat innovatie en implementatie onlosmakelijk aan elkaar verbonden zijn en dat voor innovatie het proces van translatie/vertalen van belang is. Het onderzoek heeft laten zien hoe dit in de praktijk van de revalidatie vorm krijgt

Novel insights in pathophysiology of postoperative atrial fibrillation

OBJECTIVES: Atrial extrasystoles are usually benign; however, they can also trigger atrial fibrillation. It is most likely that if atrial extrasystoles provoke a larger amount of conduction disorders and a greater degree of endo-epicardial asynchrony, the risk of postoperative atrial fibrillation increases. To test this hypothesis, we investigated the effect of programmed atrial extrasystoles on endo-epicardial conduction and postoperative atrial fibrillation. METHODS: Twelve patients (58% male, age 68 ± 7 years) underwent simultaneous endo-epicardial mapping (256 electrodes) of the right atrium during sinus rhythm and programmed atrial extrasystoles provoked from the right atrial free wall. Areas of conduction block were defined as conduction delays of ≥12 milliseconds and endo-epicardial asynchrony as activation time differences of exact opposite electrodes of ≥15 milliseconds. RESULTS: Endo-epicardial mapping data of all programmed atrial extrasystoles were analyzed and compared with sinus rhythm (median preceding cycle length = 531 milliseconds [345-787] and median sinus rhythm cycle length = 843 milliseconds [701-992]). All programmed atrial extrasystoles were aberrant (severe, moderate, and mildly aberrant, respectively, n = 6, 3, and 3) and had a mean prematurity index of 50.1 ± 11.9%. The amount of endo-epicardial asynchrony (1% [1-2] vs 6.7 [2.7-16.9], P = .006) and conduction block (1.4% [0.6-2.6] vs 8.5% [4.2-10.4], P = .005) both increased during programmed atrial extrasystoles. Interestingly, conduction block during programmed atrial extrasystoles was more severe in patients (n = 4, 33.3%) who developed postoperative atrial fibrillation (5.1% [2.9-8.8] vs 11.3% [10.1-12.1], P = .004). CONCLUSIONS: Atrial conduction disorders and endo-epicardial asynchrony, which play an important role in arrhythmogenesis, are enhanced during programmed atrial extrasystoles compared with sinus rhythm. The findings of this pilot study provide a possible explanation for enhanced vulnerability for postoperative atrial extrasystoles to induce postoperative atrial fibrillation in patients after cardiac surgery

Modelling Clock Synchronization in the Chess gMAC WSN Protocol

We present a detailled timed automata model of the clock synchronization algorithm that is currently being used in a wireless sensor network (WSN) that has been developed by the Dutch company Chess. Using the Uppaal model checker, we establish that in certain cases a static, fully synchronized network may eventually become unsynchronized if the current algorithm is used, even in a setting with infinitesimal clock drifts

Characterization of pre-existing arrhythmogenic substrate associated with de novo early and late postoperative atrial fibrillation

Background: PoAF is the most common complication after cardiac surgery and may occur in patients with pre-existing arrhythmogenic substrate. Characterization of this substrate could aid in identifying patients at risk for PoAF. We therefore compared intra-atrial conduction parameters and electrogram morphology between patients without and with early- (≤5 days after surgery) and late- (up to 5 years) postoperative atrial fibrillation (PoAF). Methods and results: Epicardial mapping of the right and left atrium and Bachmann's Bundle (BB) was performed during sinus rhythm (SR) in 263 patients (207male, 67 ± 11 years). Unipolar potentials were classified as single, short or long double and fractionated potentials. Unipolar voltage, fractionation delay (time difference between the first and last deflection), conduction velocity (CV) and conduction block (CB) prevalence were measured. Comparing patients without (N = 166) and with PoAF (N = 97), PoAF was associated with lower CV and more CB at BB. Unipolar voltages were lower and more low-voltage areas were found at the left and right atrium and BB in PoAF patients. These differences were more pronounced in patients with late-PoAF (6%), which could even occur up to 5 years after surgery. Although several electrophysiological parameters were related to PoAF, age was the only independent predictor. Conclusions: Patients with de novo PoAF have more extensive arrhythmogenic substrate prior to cardiac surgery compared to those who remained in SR, which is even more pronounced in late-PoAF patients. Future studies should evaluate whether intra-operative electrophysiological examination enables identification of patients at risk for developing PoAF and hence (preventive) therapy.</p

The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use

A standardised methodology for a combined point prevalence survey (PPS) on healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals developed by the European Centre for Disease Prevention and Control was piloted across Europe. Variables were collected at national, hospital and patient level in 66 hospitals from 23 countries. A patient-based and a unit-based protocol were available. Feasibility was assessed via national and hospital questionnaires. Of 19,888 surveyed patients, 7.1% had an HAI and 34.6% were receiving at least one antimicrobial agent. Prevalence results were highest in intensive care units, with 28.1% patients with HAI, and 61.4% patients with antimicrobial use. Pneumonia and other lower respiratory tract infections (2.0% of patients; 95% confidence interval (CI): 1.8-2.2%) represented the most common type (25.7%) of HAI. Surgical prophylaxis was the indication for 17.3% of used antimicrobials and exceeded one day in 60.7% of cases. Risk factors in the patient-based protocol were provided for 98% or more of the included patients and all were independently associated with both presence of HAI and receiving an antimicrobial agent. The patient-based protocol required more work than the unit-based protocol, but allowed collecting detailed data and analysis of risk factors for HAI and antimicrobial use.peer-reviewe

Framework for assessing sustainability levels in Belgium agricultural systems - SAFE

Sustainability is now regarded as a crucial property of agricultural systems and its evaluation has become a main challenge for scientists, policy makers and farmers. In the last decade, different sets of indicators have been designed both at national and international levels. Meanwhile, more practical environmental impact assessment (EIA) tools have been developed at the farm level . However, none of these indicator sets can be used at both levels. Further, most of these initiatives focus only on environmental aspects of sustainability and do not take socio-economic aspects into consideration. Indicator selection does not always fit in a consistent and comprehensive framework, although there is a strong need to integrate sustainability indicators in order to facilitate comparison and assessment. Finally, few of these works relate to Belgian agriculture, which up til now lacked a tool for assessing the sustainability of its farms. This project aims at providing a framework for assessing sustainability levels in Belgian agricultural systems (SAFE) that overcomes the deficiencies mentioned above. This is achieved by: 1. Considering the concept of agricultural sustainability in a holistic manner – SAFE accounts for all three pillars of sustainability (environmental, economic & social). 2. Developing (a) a consistent approach for defining sustainability principles and criteria and (b) a core list of sustainability indicators identified through a standardized selection procedure. The ‘SAFE selection procedure’ is a flexible scientific process that builts on knowledge and experience of numerous experts. 3. Ensuring that the tool remains as easy as possible to interpret and thus to use, thanks to the integration procedure of sustainability indicators and the graphic expression of the results. 4. Building on a generic methodology. Though the set of selected indicators presented in this report is specific to the Belgian agricultural context, the method developed for the construction of the SAFE tool can be transferred for assessing sustainability levels in other geographical (Europe, world, …) and sectorial contexts. In particular, principles and criteria defined in SAFE have a universal value. 5. Taking action at three spatial levels, depending on the scale of application: (1) parcel (2) farm or (3) watershed for surface water-related issues, landscape/ecosystem for some soil and biodiversity related issues, and administrative units (region, state) for some environmental as well as for some socio-economic issues

Framework for assessing sustainability levels in Belgium agricultural systems - SAFE

Sustainability is now regarded as a crucial property of agricultural systems and its evaluation has become a main challenge for scientists, policy makers and farmers. In the last decade, different sets of indicators have been designed both at national and international levels. Meanwhile, more practical environmental impact assessment (EIA) tools have been developed at the farm level . However, none of these indicator sets can be used at both levels. Further, most of these initiatives focus only on environmental aspects of sustainability and do not take socio-economic aspects into consideration. Indicator selection does not always fit in a consistent and comprehensive framework, although there is a strong need to integrate sustainability indicators in order to facilitate comparison and assessment. Finally, few of these works relate to Belgian agriculture, which up til now lacked a tool for assessing the sustainability of its farms. This project aims at providing a framework for assessing sustainability levels in Belgian agricultural systems (SAFE) that overcomes the deficiencies mentioned above. This is achieved by: 1. Considering the concept of agricultural sustainability in a holistic manner – SAFE accounts for all three pillars of sustainability (environmental, economic & social). 2. Developing (a) a consistent approach for defining sustainability principles and criteria and (b) a core list of sustainability indicators identified through a standardized selection procedure. The ‘SAFE selection procedure’ is a flexible scientific process that builts on knowledge and experience of numerous experts. 3. Ensuring that the tool remains as easy as possible to interpret and thus to use, thanks to the integration procedure of sustainability indicators and the graphic expression of the results. 4. Building on a generic methodology. Though the set of selected indicators presented in this report is specific to the Belgian agricultural context, the method developed for the construction of the SAFE tool can be transferred for assessing sustainability levels in other geographical (Europe, world, …) and sectorial contexts. In particular, principles and criteria defined in SAFE have a universal value. 5. Taking action at three spatial levels, depending on the scale of application: (1) parcel (2) farm or (3) watershed for surface water-related issues, landscape/ecosystem for some soil and biodiversity related issues, and administrative units (region, state) for some environmental as well as for some socio-economic issues