Anxiety and depression in nursing home patients : Prevalence, risk indicators and consequences

Beekman, A.T.F. [Promotor]Eefsting, J.A. [Promotor]Pot, A.M. [Copromotor

Systematic review on barriers and facilitators of complex interventions for residents with dementia in long-term care

Objectives:Psychotropic drugs are frequently and sometimes inappropriately used for the treatment of neuropsychiatric symptoms of people with dementia, despite their limited efficacy and side effects. Interventions to address neuropsychiatric symptoms and psychotropic drug use are multifactorial and often multidisciplinary. Suboptimal implementation of these complex interventions often limits their effectiveness. This systematic review provides an overview of barriers and facilitators influencing the implementation of complex interventions targeting neuropsychiatric symptoms and psychotropic drug use in long-term care.Design:To identify relevant studies, the following electronic databases were searched between 28 May and 4 June: PubMed, Web of Science, PsycINFO, Cochrane, and CINAHL. Two reviewers systematically reviewed the literature, and the quality of the included studies was assessed using the Critical Appraisal Skills Programme qualitative checklist. The frequency of barriers and facilitators was addressed, followed by deductive thematic analysis describing their positive of negative influence. The Consolidated Framework for Implementation Research guided data synthesis.Results:Fifteen studies were included, using mostly a combination of intervention types and care programs, as well as different implementation strategies. Key factors to successful implementation included strong leadership and support of champions. Also, communication and coordination between disciplines, management support, sufficient resources, and culture (e.g. openness to change) influenced implementation positively. Barriers related mostly to unstable organizations, such as renovations to facility, changes toward self-directed teams, high staff turnover, and perceived work and time pressures.Conclusions:Implementation is complex and needs to be tailored to the specific needs and characteristics of the organization in question. Champions should be carefully chosen, and the application of learned actions and knowledge into practice is expected to further improve implementation

The performance of organic electronic ratchets

Organic electronic ratchets rectify time-correlated external driving forces, giving output powers that can drive electronic circuitry. In this work their performance characteristics are investigated using numerical modeling and measurements. It is shown how the characteristic parameters of the time–varying asymmetric potential like length scales and amplitude, as well as the density and mobility of the charge carriers in the device influence the performance characteristics. Various ratchet efficiencies and their relations are discussed. With all settings close to optimum, a ratchet with charge displacement and power efficiencies close to 50% and 7% respectively is obtained

Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia

BACKGROUND: Research suggests that collaborative and tailored approaches with external expertise are important to process implementations. We therefore performed a process evaluation of an intervention using participatory action research, tailored information provision, and external coaching to reduce inappropriate psychotropic drug use among nursing home residents with dementia. The process evaluation was conducted alongside a randomized controlled trial assessing the utility of this approach. METHODS: We used Leontjevas’ model of process evaluation to guide data collection and analysis, focusing on the relevance and feasibility, extent of performance, and barriers and facilitators to implementation. Data on the relevance and feasibility and on the extent of performance were collected using a questionnaire targeting internal project leaders at nursing homes and our external coaches. Implementation barriers and facilitators were identified by individual semi-structured interviews. The Consolidated Framework for Implementation Research was used to structure and describe the identified barriers and facilitators. RESULTS: The intervention was viewed positively, but it was also considered time consuming due to the involvement of many people and designing a tailored action and implementation plan was viewed as complex. The extent of performance differed between nursing homes. Delays in implementation and suboptimal execution of actions may have reduced effectiveness of the RID intervention in some nursing homes. Barriers to implementation were reorganizations, staff turnover, communication issues, unclear expectations, and perceived time pressures. Implementation also depended on the involvement and skills of key stakeholders, and organizations’ readiness to change. Although external coaches stimulated implementation, their additional value was rated variably across organizations. CONCLUSIONS: Barriers to implementation occurred on several levels and some barriers appear to be inherent to the nursing home environment and could be points of leverage of future implementation trajectories. This underlines the importance of assessing and supporting organizations in their readiness to change. Sensitivity analyses, taking into account the week in which nursing homes started with implementation and the degree to which actions were implemented as intended, will be appropriate in the effect analyses of the trial. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-021-02357-w

High-performance InP-based photodetector in an amplifier layer stack on semi-insulating substrate

A waveguide photodetector (PD) based on semi-insulating (SI) indium phosphide (InP) was simulated, designed, and fabricated. The layer stack for this PD was optimized for use as an optical amplifier or laser and it can be combined with the passive components. By using an SI substrate and deep etching, a small, efficient, and high-speed PD was made, which allows for easy integration of source, detector, and passive optical components on a single chip. A 3-dB bandwidth of 35 GHz and 0.25 A/W external radio-frequency reponsivity is measured at 1.55-mum wavelength for a 1.5-mum-wide and 30-mum-long waveguide PD at -4-V bias voltage. The polarization dependence in the responsivity is less than 0.27 d

Psychotropic drug treatment for agitated behaviour in dementia:what if the guideline prescribing recommendations are not sufficient? A qualitative study

BACKGROUND: Agitation is a common challenging behaviour in dementia with a negative influence on patient's quality of life and a high caregiver burden. Treatment is often difficult. Current guidelines recommend restrictive use of psychotropic drug treatment, but guideline recommendations do not always suffice. OBJECTIVE: To explore how physicians decide on psychotropic drug treatment for agitated behaviour in dementia when the guideline prescribing recommendations are not sufficient. METHODS: We conducted five online focus groups with a total of 22 elderly care physicians, five geriatricians and four old-age psychiatrists, in The Netherlands. The focus groups were thematically analysed. RESULTS: We identified five main themes. Transcending these themes, in each of the focus groups physicians stated that there is 'not one size that fits all'. The five themes reflect physicians' considerations when deciding on psychotropic drug treatment outside the guideline prescribing recommendations for agitated behaviour in dementia: (1) 'reanalysis of problem and cause', (2) 'hypothesis of underlying cause and treatment goal', (3) 'considerations regarding drug choice', (4) 'trial and error' and (5) 'last resort: sedation'. CONCLUSION: When guideline prescribing recommendations do not suffice, physicians start with reanalysing potential underlying causes. They try to substantiate and justify medication choices as best as they can with a hypothesis of underlying causes or treatment goal, using other guidelines, and applying personalised psychotropic drug treatment

Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia

Item does not contain fulltex

Low-loss, low-confinement GaAs-AlGaAs DQW laser diode with optical trap layer for high-power operation

A low-confinement asymmetric GaAs-AlGaAs double-quantum-well molecular-beam-epitaxy grown laser diode structure with optical trap layer is characterized, The value of the internal absorption coefficient is as low as 1.4 cm-1, while keeping the series resistance at values comparable cm with symmetrical quantum-well gradient index structures in the same material system. Uncoated devices show COD values of 35 mW/µm. If coated, this should scale to about 90 mW/µm. The threshold current density is about 1000 A/cm2 for 2-mm-long devices and a considerable part of it is probably due to recombination in the optical trap layer. Fundamental mode operation is limited to 120-180 mW for 6.5-µm-wide ridge waveguide uncoated devices and to 200-300 mW for 13.5-µm-wide ones, because of thermal waveguiding effects. These values are measured under pulsed conditions, 10 µs/l m