Business models for sustained ehealth implementation: lessons from two continents

There is general consensus that Computers and Information Technology have the potential to enhance health systems applications, and many good examples of such applications exist all over the world. Unfortunately, with respect to eHealth and telemedicine, there is much disillusionment and scepticism. This paper describes two models that were developed separately, but had the same purpose, namely to facilitate a holistic approach to the development and implementation of eHealth solutions. The roadmap of the Centre for eHealth Research (CeHRes roadmap) was developed in the Netherlands, and the Telemedicine Maturity Model (TMMM) was developed in South Africa. The purpose of this paper is to analyse the commonalities and differences of these approaches, and to explore how they can be used to complement each other. The first part of this paper comprises of a comparison of these models in terms of origin, research domain and design principles. Case comparisons are then presented to illustrate how these models complement one another

Investeren in competenties; een onderzoek in de Greenports

Inventarisatie van de huidige en toekomstige vraag/behoeftes aan competenties bij ondernemers, managers en werknemers in het tuinbouwcluste

Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

Background Antibiotic resistance is a global threat to patient safety and care. In response, hospitals start antibiotic stewardship programs to optimise antibiotic use. Expert-based guidelines recommend strategies to implement such programs, but local implementations may differ per hospital. Earlier published assessments determine maturity of antibiotic stewardship programs based on expert-based structure indicators, but they disregard that there may be valid deviations from these expert-based programs. Aim To analyse the progress and barriers of local implementations of antibiotic stewardship programs with stakeholders in nine Dutch hospitals and to develop a toolkit that guides implementing local antibiotic stewardship programs. Methods An online questionnaire based on published guidelines and recommendations, conducted with seven clinical microbiologists, seven infectious disease physicians and five clinical pharmacists at nine Dutch hospitals. Results Results show local differences in antibiotic stewardship programs and the uptake of interventions in hospitals. Antibiotic guidelines and antibiotic teams are the most extensively implemented interventions. Education, decision support and audit-feedback are deemed important interventions and they are either piloted in implementations at academic hospitals or in preparation for application in non-academic hospitals. Other interventions that are recommended in guidelines - benchmarking, restriction and antibiotic formulary - appear to have a lower priority. Automatic stop-order, pre-authorization, automatic substitution, antibiotic cycling are not deemed to be worthwhile according to respondents. Conclusion There are extensive local differences in the implementation of antibiotic stewardship interventions. These differences suggest a need to further explore the rationale behind the choice of interventions in antibiotic stewardship programs. Rather than reporting this rationale, this study reports where rationale can play a key role in the implementation of antibiotic stewardship programs. A one-size-fits-all solution is unfeasible as there may be barriers or valid reasons for local experts to deviate from expert-based guidelines. Local experts can be supported with a toolkit containing advice based on possible barriers and considerations. These parameters can be used to customise an implementation of antibiotic stewardship programs to local needs (while retaining its expert-based foundation)

Optimizing gamma-ray spectrometers for UAV-borne surveys with geophysical applications

Heavy duty unmanned aerial vehicles (UAVs) have made it possible to fly with large gamma-ray spectrometers that weigh several kilograms. Moreover, they can be purchased at an affordable price. These large UAV-borne gamma-ray detection systems are used to map the naturally occurring radionuclides 40K, 238U, 232Th. Such platforms have the advantage that they can be deployed over terrain that is difficult to access, while still maintaining a high spatial resolution. In contrast to UAV-borne radioactive pollution studies, the naturally occurring radionuclides have a much lower activity and therefore require longer integration time, slower flying speed or a larger detector, in order to effectively determine the spatial radionuclide distribution. Therefore, the question arises: what is the minimum practical detector size required to successfully map 40K, 238U and 232Th concentrations from UAV platforms. In this study an agricultural field has been mapped with three different scintillator-based gamma-ray spec-trometers: a 2000 ml, 1000 ml, and 350 ml detector. They were mounted together on the same UAV. At a flying height of 20 m and a speed of 5.6 m

Tetrahedral zinc in tetrakis(1-methyl-1H-imidazole-kappa N-3)zinc bis(tetrafluoridoborate)

Peer reviewe

Participatory eHealth development to support nurses in antimicrobial stewardship

Background Antimicrobial resistance poses a threat to patient safety worldwide. To stop antimicrobial resistance, Antimicrobial Stewardship Programs (ASPs; programs for optimizing antimicrobial use), need to be implemented. Within these programs, nurses are important actors, as they put antimicrobial treatment into effect. To optimally support nurses in ASPs, they should have access to information that supports them in their preparation, administration and monitoring tasks. In addition, it should help them to detect possible risks or adverse events associated with antimicrobial therapy. In this formative study, we investigate how nurses’ can be supported in ASPs by means of an eHealth intervention that targets their information needs. Methods We applied a participatory development approach that involves iterative cycles in which health care workers, mostly nurses, participate. Focus groups, observations, prototype evaluations (via a card sort task and a scenario-based information searching task) and interviews are done with stakeholders (nurses, managers, pharmacist, and microbiologist) on two pulmonary wards of a 1000-bed teaching hospital. Results To perform the complex antimicrobial-related tasks well, nurses need to consult various information sources on a myriad of occasions. In addition, the current information infrastructure is unsupportive of ASP-related tasks, mainly because information is not structured to match nurse tasks, is hard to find, out of date, and insufficiently supportive of awareness. Based our findings, we created a concept for a nurse information application. We attuned the application’s functionality, content, and structure to nurse work practice and tasks. Conclusions By applying a participatory development approach, we showed that task support is a basic need for nurses. Participatory development proved useful regarding several aspects. First, it allows for combining bottom-up needs (nurses’) and top-down legislations (medical protocols). Second, it enabled us to fragmentise and analyse tasks and to reduce and translate extensive information into task-oriented content. Third, this facilitated a tailored application to support awareness and enhance patient safety. Finally, the involvement of stakeholders created commitment and ownership, and helped to weigh needs from multiple perspective