The Methodological Development of an Interprofessional Educational Program to Provide Proactive Integrated Care for Elders

Background: Interprofessional collaboration in practice (IPCP) between professionals from the medical and social domain within primary care is desirable; however, it is also challenging due to fragmented healthcare. Little is known about the development of IPCP in primary care to fit the implementation context. This article describes the methodological development and the final content of an IPCP program.Methods and findings: The development process started with the identification of IPCP competencies in a literature review and a qualitative needs analysis with semi-structured interviews among eight elders and four health care professionals. The results were discussed during a first consultation with an expert team, which consisted of ten health care professionals. Consensus was reached on the themes role identity, communication, and shared vision development to form the basis of the program. A second consultation with the experts discussed the first version of the program. Then, consensus was reached on the final version of the program, which included a blended learning approach consisting of two face-to-face meetings, online learning, and on-the-job learning with a sixteen-hour time investment over a six-week period.Conclusions: The IPCP program was developed based on educational strategies and evidence, and with the support and knowledge of practice experts to fit the implementation context.

Perspective for the 20th Anniversary of the Faculty of Human Development, Kobe University

textabstractBackground. Few data are available on the course of and predictors for disability in patients with chronic nonspecific low back pain (CNSLBP). Objective. The purpose of this study was to describe the course of disability and identify clinically important prognostic factors of low-back-pain-specific disability in patients with CNSLBP receiving multidisciplinary therapy. Design. A prospective cohort study was conducted. Methods. A total of 1,760 patients with CNSLBP who received multidisciplinary therapy were evaluated for their course of disability and prognostic factors at baseline and at 2-, 5-, and 12-month follow-ups. Recovery was defined as 30% reduction in low back pain-specific disability at follow-up compared with baseline and as absolute recovery if the score on the Quebec Back Pain Disability Scale (QBPDS) was ≤20 points at follow-up. Potential prognostic factors were identified using multivariable logistic regression analysis. Results. Mean patient-reported disability scores on the QBPDS ranged from 51.7 (SD 15.6) at baseline to 31.7 (SD 15.2), 31.1 (SD 18.2), and 29.1 (SD 20.0) at 2, 5, and 12 months, respectively. The prognostic factors identified for recovery at 5 and 12 months were younger age and high scores on disability and on the 36-Item Short-Form Health Survey (SF-36) (Physical and Mental Component Summaries) at baseline. In addition, at 5-month follow-up, a shorter duration of complaints was a positive predictor, and having no comorbidity and less pain at baseline were additional predictors at 12-month follow-up. Limitations. Missing values at 5and 12-month follow-ups were 11.1% and 45.2%, respectively. Conclusion. After multidisciplinary treatment, the course of disability in patients with CNSLBP continued to decline over a 12-month period. At 5-and 12-month follow-ups, prognostic factors were identified for a clinically relevant decrease in disability scores on the QBPDS

Course and prognosis of recovery for chronic non-specific low back pain: design, therapy program and baseline data of a prospective cohort study

Background: There has been increasing focus on factors predicting the development of chronic musculoskeletal disorders. For patients already experiencing chronic non-specific low back pain it is also relevant to investigate which prognostic factors predict recovery. We present the design of a cohort study that aims to determine the course and prognostic factors for recovery in patients with chronic non-specific low back pain. Methods/Design. All participating patients were recruited (Jan 2003-Dec 2008) from the same rehabilitation centre and were evaluated by means of (postal) questionnaires and physical examinations at baseline, during the 2-month therapy program, and at 5 and 12 months after start of therapy. The therapy protocol at the rehabilitation centre used a bio-psychosocial approach to stimulate patients to adopt adequate (movement) behaviour aimed at physical and functional recovery. The program is part of regular care and consists of 16 sessions of 3 hours each, over an 8-week period (in total 48 hours), followed by a 3-month self-management program. The primary outcomes are low back pain intensity, disability, quality of life, patient's global perceived effect of recovery, and participation in work. Baseline characteristics include information on socio-demographics, low back pain, employment status, and additional clinical items status such as fatigue, duration of activities, and fear of kinesiophobia. Prognostic variables are determined for recovery at short-term (5 months) and long-term (12 months) follow-up after start of therapy. Discussion. In a routine clinical setting it is important to provide patients suffering from chronic non-specific low back pain with adequate information about the prognosis of their complaint

Skewed X-inactivation is common in the general female population

X-inactivation is a well-established dosage compensation mechanism ensuring that X-chromosomal genes are expressed at comparable levels in males and females. Skewed X-inactivation is often explained by negative selection of one of the alleles. We demonstrate that imbalanced expression of the paternal and maternal X-chromosomes is common in the general population and that the random nature of the X-inactivation mechanism can be sufficient to explain the imbalance. To this end, we analyzed blood-derived RNA and whole-genome sequencing data from 79 female children and their parents from the Genome of the Netherlands project. We calculated the median ratio of the paternal over total counts at all X-chromosomal heterozygous single-nucleotide variants with coverage ≥10. We identified two individuals where the same X-chromosome was inactivated in all cells. Imbalanced expression of the two X-chromosomes (ratios ≤0.35 or ≥0.65) was observed in nearly 50% of the population. The empirically observed skewing is explained by a theoretical model where X-inactivation takes place in an embryonic stage in which eight cells give rise to the hematopoietic compartment. Genes escaping X-inactivation are expressed from both alleles and therefore demonstrate less skewing than inactivated genes. Using this characteristic, we identified three novel escapee genes (SSR4, REPS2, and SEPT6), but did not find support for many previously reported escapee genes in blood. Our collective data suggest that skewed X-inactivation is common in the general population. This may contribute to manifestation of symptoms in carriers of recessive X-linked disorders. We recommend that X-inactivation results should not be used lightly in the interpretation of X-linked variants

Expertiseontwikkeling en professionalisering van de assessor: ontwikkeling van een rubriek voor assessorenkwaliteit criteriumgericht beoordelen

Toetsen is een vak apart en niet elke goede opleider is direct ook een goede beoordelaar. Toetsen en leren zijn onlosmakelijk met elkaar verbonden en voor het verkrijgen van beter onderwijs zullen onderwijs en toetsing steeds beter geïntegreerd en op elkaar afgestemd dienen te worden. Professionalisering van de beoordelaars is daarvoor noodzakelijk. Het onderzoek dat in dit rapport beschreven wordt, wil antwoord geven op de vraag of er inderdaad verschil in interventies waar te nemen is tijdens het criteriumgericht interview (CGI) tussen de verschillende groepen van assessoren (ongetraind, getraind en expert), en op de vraag of er verschillende professionele niveaus van criteriumgericht beoordelen zijn te beschrijven in de vorm van een kwaliteitsrubriek (rubric) criteriumgericht beoordelen? Dit leidt tot de onderstaande onderzoeksvragen: 1. Is er verschil te observeren bij de 3 onderzoeksgroepen (ongetraind, getraind en expert) in het gebruik van de interventies die de assessoren bij het criteriumgericht beoordelen hanteren tijdens de afname van het CGI? Het onderzoek richt zich vooral op de eerste vijf onderdelen van het assessorenprofiel. 2. Als blijkt dat er verschil is in de hantering van de onderdelen van het assessorenprofiel, zijn er dan patronen waar te nemen in de interventies die de assessoren gebruiken? 3. Is er een kwaliteitsrubriek criteriumgericht beoordelen te beschrijven waarin de drie verschillende professionele niveaus (ongetraind, getraind en gecertificeerd) qua interventies met betrekking tot criteriumgericht beoordelen zichtbaar zijn. Om de onderzoekvragen te kunnen beantwoorden is het noodzakelijk om de assessoren te observeren bij het afnemen van assessments. De onderzoeker heeft daarom gekozen voor observaties van ongetrainde, getrainde en expert assessoren. Dit was mogelijk doordat de onderzoeker vanuit haar assessorentrainingspraktijk direct toegang heeft tot het observeren van alle drie de onderzoeksgroepen ongetraind – ervaren - expert. De observaties waren deels ‘live’ en deels observaties van op DVD opgenomen assessments. De methode van onderzoek is kwalitatief. Gekozen is voor de observatie als waarnemingstechniek om via de directe waarneming (zien en horen) de gedragsinterventies die de assessor pleegt tijdens het criteriumgericht interview (CGI) te observeren en te analyseren. Dit gebeurt in de natuurlijke context van de assessmentafname. De onderzoeker gebruikt het assessorenprofiel als kijkkader om de CGI-gesprekken en DVD’s te analyseren. Op basis van de observaties die in het kader van dit onderzoek zijn uitgevoerd, kunnen drie prototypische assessorenprofielen beschreven worden, die onderling verschillen in de mate waarin ze systematisch gebruik maken van gesprekstechnieken, in staat zijn om tot objectieve en transparante oordelen te komen, zich bewust zijn van de kwaliteit van hun handelen en gericht zijn op het verbeteren daarvan. Het gaat hier om prototypische beschrijvingen: individuele assessoren kunnen ook zonder formele training tot de categorie expert assessor horen, en assessoren kunnen kenmerken uit verschillende prototypen hebbe

Certificeren van assessoren in het hbo. Waarom en hoe?

Ontwikkelingen in het kwaliteitsdenken in het hbo laten zien dat er steeds meer eisen worden gesteld aan de deskundigheid van docenten. Door het invoeren van competentiegericht onderwijs komt daarbij dat nieuwe competenties moeten worden ontwikkeld voor verschillende docentrollen. De rol van assessor staat in dit artikel centraal. Hogeschool van Amsterdam en Fontys Hogescholen hebben ervaring opgedaan met certificeringsprogramma's voor assessoren, die, hoewel verschillend qua invulling en vormgeving, haalbaar blijken in de (praktische) uitvoering

Ontwikkeling van een interprofessionele training in de wijk

De zorg voor ouderen verandert en wordt steeds meer in de wijk georganiseerd. Mensen worden niet alleen ouder, ook de complexiteit van hun zorgbehoefte neemt toe. Dit geldt met name voor ouderen die meerdere chronische ziekten en aandoeningen hebben. Vaak zijn diverse disciplines tegelijkertijd betrokken bij deze doelgroep. Voor goede zorg en ondersteuning is interprofessionele samenwerking tussen professionals uit het medisch en sociaal domein in de wijk noodzakelijk. Om de samenwerking in de wijk te versterken, hebben de Hogeschool Utrecht, Universitair Medisch Centrum Utrecht en Stichting Volte, in cocreatie met het veld en de doelgroep (professionals in de wijk) een interprofessionele training ontwikkeld voor professionals in de wijk. De training wordt op wijkniveau aangeboden en omvat een mix tussen online, face-to-face en on the job leren. In dit artikel beschrijven we hoe de training in nauwe samenwerking met de praktijk en experts uit de verschillende domeinen is ontwikkeld

EVC in de lerarenopleidingen

Oudkerk Pool, I., Reinink, M., Scholte, W., Van der Klink, M., & Haan, J. (2008). EVC in de lerarenopleidingen. Velon Tijdschrift. Tijdschrift voor Lerarenopleiders, 29(2), 14-21.This article describes the outcomes of a project, funded by the HBO-raad, that aimed at the description of guidelines for APL in Dutch teacher education. The project included an investigation of current APL practices in teacher educationHBO-raa

Bekwaam als leraar: begeleiding startende leraren

Deze app biedt leraren en coaches in het po, vo en mbo een handvat bij de ontwikkeling van hun bekwaamheid als leraar. Het beschrijft bekwaamheden van leraren op verschillende niveau's als handvat voor reflectie en biedt een aantal reeflectieve vragen als startpunt voor een professionele dialoog tussen (startende) leraar en coach of binnen lerarenteams. De app komt voort uit het project Junior Leraar en is uitgebreid met een mbo variant

Strategies for continuing professional development among younger, middle-aged, and older nurses : A biographical approach

Background: A nursing career can last for more than 40 years, during which continuing professional development is essential. Nurses participate in a variety of learning activities that correspond with their developmental motives. Lifespan psychology shows that work-related motives change with age, leading to the expectation that motives for continuing professional development also change. Nevertheless, little is known about nurses' continuing professional development strategies in different age groups. Objectives: To explore continuing professional development strategies among younger, middle-aged, and older nurses. Methods: A qualitative study using semi-structured interviews, from a biographical perspective. Data were analysed using a vertical process aimed at creating individual learning biographies, and a horizontal process directed at discovering differences and similarities between age groups. Participants: Twenty-one nurses in three age groups from general and academic hospitals in the Netherlands. Results: In all age groups, daily work was an important trigger for professional development on the ward. Performing extra or new tasks appeared to be an additional trigger for undertaking learning activities external to the ward. Learning experiences in nurses' private lives also contributed to their continuing professional development. Besides these similarities, the data revealed differences in career stages and private lives, which appeared to be related to differences in continuing professional development strategy; 'gaining experience and building a career' held particularly true among younger nurses, 'work-life balance' and 'keeping work interesting and varied' to middle-aged nurses, and 'consistency at work' to older nurses. Conclusions: Professional development strategies can aim at performing daily patient care, extra tasks and other roles. Age differences in these strategies appear to relate to tenure, perspectives on the future, and situations at home. These insights could help hospitals to orientate continuing professional development approaches toward the needs of all age groups. This should be particularly relevant in the face of present demographic changes in the nursing workforce. (C) 2015 Elsevier Ltd. All rights reserved