How do practically trained (student) caregivers in nursing homes learn?:A scoping review

Background and objective: Practically trained (student) caregivers (further: caregivers) make up the majority of care staff in nursing homes (NHs). To keep up with the fast-changing healthcare environment and ensure a high quality of care, it is important to know how to stimulate continuous work-based learning (WBL) among this group. The purpose of the study was to systematically study the scientific literature published to date on (1) how caregivers learn in NHs and (2) what facilitates or impedes their learning. Methods: A scoping review was carried out, systematically searching six scientific databases. A total of 35 studies published from January 2009 to February 2021 were included. Study characteristics, learning mechanisms, facilitators, and barriers to learning were extracted and synthesized. Results: None of the studies specifically focused on how caregivers learn. Yet, we identified various learning mechanisms, and found that learning by theory or supervision was most frequently engaged in. Most learning mechanisms used among the groups in the included studies were planned and formal and developed and initiated by others out of the context. Three main themes were identified among the facilitators and barriers of WBL: individual learning, collective learning, and resources for learning. An interdependency between (sub)themes was found. Conclusions: The way caregivers in NHs learn is understudied. Moreover, both their informal learning and the support they receive to be(come) active learners has been overlooked. As WBL provides caregivers with opportunities to learn within a real-life setting, we suggest more research on informal learning mechanisms

Actieonderzoek als vehicle voor werken, leren en ontwikkelen in de verpleeghuissector

Veel medewerkers geven de voorkeur aan informele vormen van leren en ontwikkelen op de werkplek, terwijl formele leeractiviteiten gangbaarder zijn in organisaties. Deze activiteiten lijken vaak geïnitieerd door managers en HR-functionarissen en vinden veelal buiten de werkplek plaats. Dit terwijl arbeidsmarkttekorten noodzaken om leren en ontwikkelen in het dagelijkse werk vorm te geven. Dit artikel gaat in op het potentieel van participatief actieonderzoek om te leren en te ontwikkelen op de werkplek. Er wordt verslag gedaan van een actieonderzoeksproject binnen de verpleeghuiscontext. Onderzocht is hoe leren en ontwikkelen plaatsvonden en welke werkzame elementen binnen het actieonderzoeksproject hieraan bijdroegen. Resultaten laten zien dat leren en ontwikkelen in en van werk plaatsvinden op het moment dat authentieke situaties, direct beleefd worden. Ook helpt het als de authentieke situaties verkend worden vanuit verschillende perspectieven en als er mogelijkheden gezien worden voor nieuw of anders handelen. Regels en routines kunnen de integratie van leren en ontwikkelen in het werk beperken. Op basis van opgedane ervaringen en geleerde lessen worden aanbevelingen gegeven

Long-Term Serial Follow-Up of Pulmonary Artery Size and Wall Shear Stress in Fontan Patients

Pulmonary arterial (PA) flow is abnormal after the Fontan operation and is marked by a lack of pulsatility. We assessed the effects of this abnormal flow on the size and function of the PA’s in Fontan patients in long-term serial follow-up. Twenty-three Fontan patients with serial follow-up were included. Median age was 11.1 (9.5–16.0) years at baseline and 15.5 (12.5–22.7) years at follow-up. Median follow-up duration was 4.4 (4.0–5.8) years. Flow and size of the left pulmonary artery were determined using phase-contrast MRI. From this wall shear stress (WSS), distensibility and pulsatility were determined. A group of healthy peers was included for reference. Flow and pulsatility were significantly lower in patients than in controls (p < 0.001). Mean area was comparable in patients and controls, but distensibility was significantly higher in controls (p < 0.001). Mean and peak WSS were significantly lowe

The role of 18F-FDG PET in the differentiation between lung metastases and synchronous second primary lung tumours

Contains fulltext : 87717.pdf (publisher's version ) (Closed access)PURPOSE: In lung cancer patients with multiple lesions, the differentiation between metastases and second primary tumours has significant therapeutic and prognostic implications. The aim of this retrospective study was to investigate the potential of (18)F-FDG PET to discriminate metastatic disease from second primary lung tumours. METHODS: Of 1,396 patients evaluated by the thoracic oncology group between January 2004 and April 2009 at the Radboud University Nijmegen Medical Centre, patients with a synchronous second primary lung cancer were selected. Patients with metastatic disease involving the lungs served as the control group. Maximum standardized uptake values (SUVs) measured with (18)F-FDG PET were determined for two tumours in each patient. The relative difference between the SUVs of these tumours (SUV) was determined and compared between the second primary group and metastatic disease group. Receiver-operating characteristic (ROC) curve analysis was performed to determine the sensitivity and specificity of the SUV for an optimal cut-off value. RESULTS: A total of 37 patients (21 metastatic disease, 16 second primary cancer) were included for analysis. The SUV was significantly higher in patients with second primary cancer than in those with metastatic disease (58 vs 28%, respectively, p < 0.001). The area under the ROC curve was 0.81 and the odds ratio for the optimal cut-off was 18.4. CONCLUSION: SUVs from (18)F-FDG PET images can be helpful in differentiating metastatic disease from second primary tumours in patients with synchronous pulmonary lesions. Further studies are warranted to confirm the consistency of these results.1 november 201

Increase in perceived case suspiciousness due to local contrast optimisation in digital screening mammography

Item does not contain fulltextOBJECTIVES: To determine the influence of local contrast optimisation on diagnostic accuracy and perceived suspiciousness of digital screening mammograms. METHODS: Data were collected from a screening region in the Netherlands and consisted of 263 digital screening cases (153 recalled,110 normal). Each case was available twice, once processed with a tissue equalisation (TE) algorithm and once with local contrast optimisation (PV). All cases had digitised previous mammograms. For both algorithms, the probability of malignancy of each finding was scored independently by six screening radiologists. Perceived case suspiciousness was defined as the highest probability of malignancy of all findings of a radiologist within a case. Differences in diagnostic accuracy of the processing algorithms were analysed by comparing the areas under the receiver operating characteristic curves (A(z)). Differences in perceived case suspiciousness were analysed using sign tests. RESULTS: There was no significant difference in A(z) (TE: 0.909, PV 0.917, P = 0.46). For all radiologists, perceived case suspiciousness using PV was higher than using TE more often than vice versa (ratio: 1.14-2.12). This was significant (P <0.0083) for four radiologists. CONCLUSIONS: Optimisation of local contrast by image processing may increase perceived case suspiciousness, while diagnostic accuracy may remain similar. KEY POINTS: Variations among different image processing algorithms for digital screening mammography are large. Current algorithms still aim for optimal local contrast with a low dynamic range. Although optimisation of contrast may increase sensitivity, diagnostic accuracy is probably unchanged. Increased local contrast may render both normal and abnormal structures more conspicuous.1 april 201

Bone suppression increases the visibility of invasive pulmonary aspergillosis in chest radiographs

Objective: Chest radiographs (CXR) are an important diagnostic tool for the detection of invasive pulmonary aspergillosis (IPA) in critically ill patients, but their diagnostic value is limited by a poor sensitivity. By using advanced image processing, the aim of this study was to increase the value of chest radiographs in the diagnostic work up of neutropenic patients who are suspected of IPA. Methods: The frontal CXRs of 105 suspected cases of IPA were collected from four institutions. Radiographs could contain single or multiple sites of infection. CT was used as reference standard. Five radiologists and two residents participated in an observer study for the detection of IPA on CXRs with and without bone suppressed images (ClearRead BSI 3.2; Riverain Technologies). The evaluation was performed separately for the right and left lung, resulting in 78 diseased cases (or lungs) and 132 normal cases (or lungs). For each image, observers scored the likelihood of focal infectious lesions being present on a continuous scale (0-100). The area under the receiver operating characteristics curve (AUC) served as the performance measure. Sensitivity and specificity were calculated by considering only the lungs with a suspiciousness score of greater than 50 to be positive. Results: The average AUC for only CXRs was 0.815. Performance significantly increased, to 0.853, when evaluation was aided with BSI (p = 0.01). Sensitivity increased from 49% to 66% with BSI, while specificity decreased from 95% to 90%. Conclusion: The detection of IPA in CXRs can be improved when their evaluation is aided by bone suppressed images. BSI improved the sensitivity of the CXR examination, outweighing a small loss in specificity

Validation, comparison, and combination of algorithms for automatic detection of pulmonary nodules in computed tomography images: The LUNA16 challenge

Automatic detection of pulmonary nodules in thoracic computed tomography (CT) scans has been an active area of research for the last two decades. However, there have only been few studies that provide a comparative performance evaluation of different systems on a common database. We have therefore set up the LUNA16 challenge, an objective evaluation framework for automatic nodule detection algorithms using the largest publicly available reference database of chest CT scans, the LIDC-IDRI data set. In LUNA16, participants develop their algorithm and upload their predictions on 888 CT scans in one of the two tracks: 1) the complete nodule detection track where a complete CAD system should be developed, or 2) the false positive reduction track where a provided set of nodule candidates should be classified. This paper describes the setup of LUNA16 and presents the results of the challenge so far. Moreover, the impact of combining individual systems on the detection performance was also investigated. It was observed that the leading solutions employed convolutional networks and used the provided set of nodule candidates. The combination of these solutions achieved an excellent sensitivity of over 95% at fewer than 1.0 false positives per scan. This highlights the potential of combining algorithms to improve the detection performance. Our observer study with four expert readers has shown that the best system detects nodules that were missed by expert readers who originally annotated the LIDC-IDRI data. We released this set of additional nodules for further development of CAD systems

Professionele werkplaatsen als lerende ecosystemen: de complexiteit van meervoudige samenwerkingen: de complexiteit van meervoudige samenwerkingen

Het zorg- en sociale domein kenmerkt zich door snelle ontwikkelingen en grote veranderingen. Deze komen voort uit technologische vernieuwingen, de vergrijzing, stijgende kosten en personele tekorten. Het is belangrijk aandacht te hebben voor preventie en het is noodzakelijk om slimme oplossingen te vinden om de zorg- en dienstverlening hoogwaardig en betaalbaar te houden. Dit vraagt om samenwerking tussen beroepspraktijk, onderwijs, (lokale) overheid en burgers. Het lectoraat Professionele Werkplaatsen: samenwerken met impact doet onderzoek naar deze meervoudige samenwerkingen. Hierbij richt het lectoraat zich op Professionele Werkplaatsen: samenwerkingsverbanden die gesitueerd zijn in het zorg en sociaal-maatschappelijke domein waarbinnen actoren lerend en onderzoekend samenwerken en gezamenlijk innoveren

Working = learning: a complexity approach to workplace learning within residential care for older people

To adequately deal with the challenges faced within residential care for older people, such as the increasing complexity of care and a call for more person-centred practices, it is important that health care providers learn from their work. This study investigates both the nature of learning, among staff and students working within care for older people, and how workplace learning can be promoted and researched. During a longitudinal study within a nursing home, participatory and democratic research methods were used to collaborate with stakeholders to improve the quality of care and to promote learning in the workplace. The rich descriptions of these processes show that workplace learning is a complex phenomenon. It arises continuously in reciprocal relationship with all those present through which both individuals and environment change and co-evolve enabling enlargement of the space for possible action. This complexity perspective on learning refines and expands conventional beliefs about workplace learning and has implications for advancing and researching learning. It explains that research on workplace learning is itself a form of learning that is aimed at promoting and accelerating learning. Such research requires dialogic and creative methods. This study illustrates that workplace learning has the potential to develop new shared values and ways of working, but that such processes and outcomes are difficult to control. It offers inspiration for educators, supervisors, managers and researchers as to promoting conditions that embrace complexity and provides insight into the role and position of self in such processes

Het ontwikkelen en integreren van diverse vormen van kennis: de rol van de lecturer practitioner

Binnen twee zorginnovatiecentra in de ouderenzorg wordt op bijzondere wijze theoretische en praktische kennis geïntegreerd. Lecturer practitioners ondersteunen deze integratie van meerdere kennisbronnen. In dit artikel wordt ingegaan op de context en inhoud van de rol van de Lecturer Practitioner en wordt aan de hand van enkele praktijkvoorbeelden geïllustreerd hoe kennisbronnen geïntegreerd worden