Kennisarrangementen tussen onderwijs en onderzoek Een verkenning van kennisarrangementen tussen PPO en ASG en het agrarisch onderwijs

Wageningen UR besteedt veel aandacht aan samenwerking met het agrarisch onderwijs en ondernemers om de kenniscirculatie vanuit het onderzoek beter vorm en inhoud te geven. In Leren met Toekomst (Potters, 2006) wordt sinds 2005 gewerkt aan het bevorderen van structurele samenwerking tussen onderzoek en groen onderwijs, in eerste instantie is gericht op het ontwikkelen van samenwerking in ondernemersnetwerken. Er is gezamenlijk met het onderwijs een concept ontwikkeld en getest, dit concept of kennisarrangement is vervolgens binnen de sectoren plant en dier benut. Naast deze samenwerking in ondernemersnetwerken biedt Leren met Toekomst de mogelijkheid om andere vormen van samenwerking tussen Onderwijs, Ondernemers en Onderzoek te stimuleren en verder ontwikkelen. In 2007 is een aantal projecten uitgevoerd die zich richtten op de versterking van de samenwerking tussen Onderwijs, Ondernemers en Onderzoek. De centrale vraag van Leren met Toekomst is sinds 2006: Hoe kunnen onderwijs en onderzoek elkaar effectief en structureel versterken in hun inspanningen voor de duurzame Nederlandse landbouwsector en vitaal platteland? Daarvoor werkt het project volgens vier pijlers met elk hun eigen doelstellingen en activiteiten: Ondernemersnetwerken als leeromgeving; Kenniscirculatie tussen onderzoek en onderwijs; Beroepspraktijkvorming op netwerkbedrijven; Bruggen bouwen tussen onderzoek en onderwijs. Centrale vraag bij deze verkennende studie is: Welke kennisarrangementen waar ervaring mee is binnen WUR hebben (naast het beproefde Leren met Toekomst concept) hebben de potentie om bij te dragen aan de centrale doelstelling van Leren met Toekomst, te weten een structurele samenwerking tussen onderzoek en onderwijs? Het gaat in deze verkenning met nadruk niet om een diepte studie, maar om een globale verkenning van mogelijkheden en potenties. Met aandacht voor praktische handvatten voor hen die de relatie tussen onderwijs en onderzoek willen versterken. Doelgroep van de verkennende studie zijn de onderzoekers binnen PPO en ASG3

Quality requirements for cross-border care in Europe: a qualitative study of patients’, professionals’ and healthcare financiers’ views

In the past decade the issue of patient mobility has emerged on the European health policy agenda. Although the volume of patients crossing borders to obtain healthcare is low, it is increasing continuously and, due to its legal, financial and medical implications, has generated considerable interest among health policy and other decision makers. However, there is little information available on the safety and patient-centredness of cross-border care and neither governments nor citizens have an explicit basis for comparing healthcare delivery in Europe. This study investigated the viewpoints of patients, professionals and healthcare financiers on the safety and patient-centredness of cross-border care. Qualitative interviews were carried out during 2005 and early 2006 with 40 patients, 30 professionals (doctors, nurses and managers) and 3 healthcare-financing bodies. Although cross-border care has become a common issue in many European countries, there remain uncertainties on the side of each of the parties addressed-patients, professionals and financiers-with regard to the provision of cross-border care. One of the most striking results of this project is the current lack of research on systematic knowledge on the quality of cross-border care. Many of the issues identified through this research may have a potential impact on the quality and safety of cross-border care and will support further investigation and help shape the health policy agenda on patients crossing borders in European Union countries

Experience with a Wearable Cardioverter-defibrillator in 436 Patients

The aim of the present study was to review the safety and efficiency of wearable cardioverter-defibrillators (WCDs) under current guideline-directed medical therapy (GDMT). We retrospectively analyzed 436 consecutive WCD patients seen in the years 2014-2020. Detected automatic arrhythmia alarm (AA) episodes were validated and classified as correct or incorrect. The positive predictive value (PPV) was calculated. GDMT was optimized in our outpatient clinic to maximal tolerated doses. During a total wear time (WT) of 23,527 days, 3,135 AAs were transmitted from 206 of 436 (47.2%) patients. Visual analysis revealed correct diagnoses of non-sustained ventricular tachycardia (VT) in 38 AAs from 6 patients (total PPV, 1.21%; PPV in VT patients, 41%); the remaining AAs were artifacts. No appropriate or inappropriate shocks and fatalities were recorded. LVEF significantly improved (P < .001) during the WT from 25% (range, 20%-30%) to 40% (range, 34%-46%). Defibrillators were implanted in 109 patients (27%). The PPV for VT of the WCD was very low. There were fewer instances of true VT than previously reported, and no shocks (appropriate or inappropriate) were delivered. The majority of patients greatly improved with GDMT, and device implantation rates were lower than previously reported. Improvements in arrhythmia detection algorithms are warranted. Based on our results, WCDs are rarely needed for lifesaving shocks under optimal GDMT. Keywords: Heart failure; sudden cardiac arrest; sudden cardiac death; ventricular tachycardia; wearable cardioverter-defibrillator

Evaluating the Impact of an Accountable Care Organization on Population Health: The Quasi-Experimental Design of the German Gesundes Kinzigtal.

A central goal of accountable care organizations (ACOs) is to improve the health of their accountable population. No evidence currently links ACO development to improved population health. A major challenge to establishing the evidence base for the impact of ACOs on population health is the absence of a theoretically grounded, robust, operationally feasible, and meaningful research design. The authors present an evaluation study design, provide an empirical example, and discuss considerations for generating the evidence base for ACO implementation. A quasi-experimental study design using propensity score matching in combination with small-scale exact matching is implemented. Outcome indicators based on claims data were constructed and analyzed. Population health is measured by using a range of mortality indicators: mortality ratio, age at time of death, years of potential life lost/gained, and survival time. The application is assessed using longitudinal data from Gesundes Kinzigtal, one of the leading population-based ACOs in Germany. The proposed matching approach resulted in a balanced control of observable differences between the intervention (ACO) and control groups. The mortality indicators used indicate positive results. For example, 635.6 fewer years of potential life lost (2005.8 vs. 2641.4; t-test: sig. P < 0.05*) in the ACO intervention group (n = 5411) attributable to the ACO, also after controlling for a potential (indirect) immortal time bias by excluding the first half year after enrollment from the outcome measurement. This empirical example of the impact of a German ACO on population health can be extended to the evaluation of ACOs and other integrated delivery models of care

An evaluation of a model for the systematic documentation of hospital based health promotion activities: results from a multicentre study

BACKGROUND: The first step of handling health promotion (HP) in Diagnosis Related Groups (DRGs) is a systematic documentation and registration of the activities in the medical records. So far the possibility and tradition for systematic registration of clinical HP activities in the medical records and in patient administrative systems have been sparse. Therefore, the activities are mostly invisible in the registers of hospital services as well as in budgets and balances.A simple model has been described to structure the registration of the HP procedures performed by the clinical staff. The model consists of two parts; first part includes motivational counselling (7 codes) and the second part comprehends intervention, rehabilitation and after treatment (8 codes).The objective was to evaluate in an international study the usefulness, applicability and sufficiency of a simple model for the systematic registration of clinical HP procedures in day life. METHODS: The multi centre project was carried out in 19 departments/hospitals in 6 countries in a clinical setup. The study consisted of three parts in accordance with the objectives.A: Individual test. 20 consecutive medical records from each participating department/hospital were coded by the (coding) specialists at local department/hospital, exclusively (n = 5,529 of 5,700 possible tests in total).B: Common test. 14 standardized medical records were coded by all the specialists from 17 departments/hospitals, who returned 3,046 of 3,570 tests.C: Specialist evaluation. The specialists from the 19 departments/hospitals evaluated if the codes were useful, applicable and sufficient for the registration in their own department/hospital (239 of 285). RESULTS: A: In 97 to 100% of the local patient pathways the specialists were able to evaluate if there was documentation of HP activities in the medical record to be coded.B: Inter rater reliability on the use of the codes were 93% (57 to 100%) and 71% (31 to 100%), respectively.C: The majority of the study participants found the codes to be useful (71%), applicable (92%) and sufficient (92%). CONCLUSION: Systematic registration of HP activities is relevant in clinical day life and the suggested codes proved to be applicable for international use. HP is an essential part of the clinical pathway or the value chain. This model promises to improve the documentation and thereby facilitate analysis of records for evidence based medicine as well as cost and policy analyses

Involvement of patients or their representatives in quality management functions in EU hospitals:implementation and impact on patient-centred care strategies

OBJECTIVE: The objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies. DESIGN: A cross-sectional, multilevel STUDY DESIGN: that surveyed quality managers and department heads and data from an organizational audit. SETTING: Randomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). PARTICIPANTS: Hospital quality managers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012. MAIN OUTCOME MEASURES: Four items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level. RESULTS: Current levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies. CONCLUSIONS: There is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect

Steeds preciezer met de sensor

Maurits Bax uit Luyksgestel werkt met de Yara N-sensor. Zo spuit hij minder dan een derde van de voorgeschreven dosering voor loofdodingsmiddel in aardappelen. Andere toepassingen zijn minder praktijkrijp, zoals aardappelen bijmesten. Daarvoor lijkt een app, ontwikkeld door het PPO, uitkomst te gaan bieden. PPO Lelystad begeleidt het project waar Bax aan mee doet. De teler kreeg de afgelopen twee teeltseizoenen voor zijn aardappelen een adviesgift van PPO op basis van twee systemen: de BemestingsNavigator aardappel van Altic en een systeem dat PPO ontwikkelt. De volgende toepassing was voor het spuiten van halmverstevigers in zomergerst

A possible influence of the Great White Spot on Saturn kilometric radiation periodicity

The periodicity of Saturn kilometric radiation (SKR) varies with time, and its two periods during the first 5 years of the Cassini mission have been attributed to SKR from the northern and southern hemisphere. After Saturn equinox in August 2009, there were long intervals of time (March 2010 to February 2011 and September 2011 to June 2012) with similar northern and southern SKR periods and locked SKR phases. However, from March to August 2011 the SKR periods were split up again, and the phases were unlocked. In this time interval, the southern SKR period slowed down by ~ 0.5% on average, and there was a large jump back to a faster period in August 2011. The northern SKR period speeded up and coalesced again with the southern period in September 2011. We argue that this unusual behavior could be related to the so-called Great White Spot (GWS), a giant thunderstorm that raged in Saturn's atmosphere around that time. For several months in 2011, the visible head of the GWS had the same period of ~ 10.69 h as the main southern SKR modulation signal. The GWS was most likely a source of intense gravity waves that may have caused a global change in Saturn's thermospheric winds via energy and momentum deposition. This would support the theory that Saturn's magnetospheric periodicities are driven by the upper atmosphere. Since the GWS with simultaneous SKR periodicity measurements have only been made once, it is difficult to prove a physical connection between these two phenomena, but we provide plausible mechanisms by which the GWS might modify the SKR periods

Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety?

UNLABELLED: ABSTRACT: BACKGROUND: Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. METHODS: The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. RESULTS: Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. CONCLUSIONS: We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes