Promoting physical activity and a healthy active lifestyle in community-dwelling older adults: a design thinking approach for the development of a mobile health application

BackgroundPhysical activity (PA) has wide-ranging, and well documented benefits for older adults, encompassing physical, cognitive, and mental well-being. The World Health Organization advocates for a minimum of 150–300 min of moderate intensity PA per week, supplemented by muscle-strengthening exercises. However, the rates of PA among older adults remain a concern. While portable technologies hold promises in promoting PA, sustaining long-term engagement continues to be a challenge.ObjectiveThe aims of this study are to identify barriers and facilitators to PA in older adults, to develop an mHealth app promoting PA and an active healthy lifestyle in collaboration with community-dwelling older adults guided by the design thinking process, and to test it.MethodsA co-creative process was used, employing design thinking. Interviews were conducted to understand the needs of the target population and identify the problem of insufficient PA. Two cocreation sessions involving older adults and experts were conducted to generate innovative ideas. Participants were selected based on age (≥65 years), no severe illness, Dutch language proficiency, and active participation ability. Results were qualitatively analyzed and coded. Finally a prototype was developed and tested.ResultsInterviews with older adults highlighted diverse perceptions of PA but unanimous agreement on its importance. They recognized health benefits such as improved mobility, balance, and reduced fall risk, while emphasizing the social and mental aspects. Barriers included poor health, time constraints, weather conditions and fear of falling. Cocreation sessions identified key topics: perception of a healthy lifestyle, coping strategies, mHealth App features, screen visualization, and tailored notifications, which led to the development of a mobile app promoting PA and an active lifestyle. The app was stepwise prototyped.ConclusionThis study emphasizes the importance of promoting PA among older adults through a collaborative design thinking approach. However, the implementation of mHealth apps faces obstacles due to the digital divide, necessitating personalized solutions to bridge the gap. Moreover, it calls for further research to investigate the long-term impact of such interventions and explore behavior change patterns in this population

Knowing what to expect, forecasting monthly emergency department visits: A time-series analysis

OBJECTIVE: To evaluate an automatic forecasting algorithm in order to predict the number of monthly emergency department (ED) visits one year ahead. METHODS: We collected retrospective data of the number of monthly visiting patients for a 6-year period (2005-2011) from 4 Belgian Hospitals. We used an automated exponential smoothing approach to predict monthly visits during the year 2011 based on the first 5 years of the dataset. Several in- and post-sample forecasting accuracy measures were calculated. RESULTS: The automatic forecasting algorithm was able to predict monthly visits with a mean absolute percentage error ranging from 2.64% to 4.8%, indicating an accurate prediction. The mean absolute scaled error ranged from 0.53 to 0.68 indicating that, on average, the forecast was better compared with in-sample one-step forecast from the naïve method. CONCLUSION: The applied automated exponential smoothing approach provided useful predictions of the number of monthly visits a year in advance.publisher: Elsevier articletitle: Knowing what to expect, forecasting monthly emergency department visits: A time-series analysis journaltitle: International Emergency Nursing articlelink: http://dx.doi.org/10.1016/j.ienj.2013.08.001 content_type: article copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.status: publishe

Prehospital stroke scales in a Belgian prehospital setting: A pilot study

OBJECTIVE: To compare the diagnostic value of the Cincinnati Prehospital Stroke Scale, the Face Arm Speech Test, the Los Angeles Prehospital Stroke Screen and the Melbourne Ambulance Stroke Screen for identifying patients with an acute stroke in a prehospital setting in Belgium. METHODS: A prospective study was performed, using a questionnaire for every primarily transported patient within emergency medial service with relevant neurological complaints. Exclusion criteria were: patients below 18 years, trauma victims, Glasgow Coma Scale of less than 8 or transported to another hospital. The questionnaire is a comprehension of different stroke scales. RESULTS: The Face Arm Speech Test and Cincinnati Prehospital Stroke Scale demonstrate a high sensitivity (95%) but a lower specificity (33%). The sensitivity of the Los Angeles Prehospital Stroke Screen and Melbourne Ambulance Stroke Screen was lower (74%), but the specificity increased (83 and 67%). Items investigating unilateral facial paralysis and unilateral loss/absence of motor response in upper extremities seemed to be most discriminating between the stroke group (68-78%) and the nonstroke group (17%), suggesting that items related to clinical assessment are more important in stroke recognition than history items. Combination of all clinical parameters of the different scores resulted in a sensitivity and specificity of 95 and 83%, respectively. CONCLUSION: The results obtained in this study are comparable with earlier investigations. Given the limitations of the study, we could not identify the most adequate stroke scale. History items seem to be less relevant compared with clinical assessment. Further research is needed to determine the most adequate stroke scale.status: publishe

Patiëntveiligheid in de ziekenhuissector: wat kunnen we leren van de luchtvaartsector?

Mede ingegeven door de bijwijlen schrijnende incidenten die zich voordoen in ziekenhuizen, komt patiëntveiligheid steeds vaker onder de aandacht. Veertig jaar geleden kampte de luchtvaartsector met een gelijkaardig veiligheidsprobleem, tot in de jaren zeventig besloten werd dit niet langer te dulden en proactief het hoofd te bieden aan dit probleem. Doorheen de jaren leverde de sector enorme inspanningen om de luchtvaartveiligheid structureel en duurzaam te verbeteren. En met succes. Intussen is de luchtvaartsector, ondanks enkele recente incidenten, uitgegroeid tot één van de veiligste sectoren. De ervaringen van deze sector met betrekking tot veiligheidsverbeterinitiatieven verschaffen ziekenhuizen belangrijke inzichten wat betreft de aanpak van het patiëntveiligheidsprobleem. Na een algemene duiding van het begrippenkader worden een aantal concrete aanknopingspunten voor meer veiligheid in de zorg aangereikt

Healthcare professionals' perspectives on the prevalence, barriers and management of psychosocial issues in cancer care: A mixed methods study

This cross-sectional mixed methods survey explores healthcare professionals' perspective on their management of cancer patients' psychosocial concerns, and barriers to integrate the psychosocial approach in their work. An invitation for participation was sent to 4,965 inpatient and outpatient working professionals, of which 583 responded (12% response rate), and 368 fully completed the survey. The majority of respondents does not use a systematic approach to discuss patients' psychosocial concerns, 37.5% use the general question "How are you?," and 65.0% spontaneously addresses various psychosocial aspects. Most psychosocial topics are "sometimes" or "regularly" discussed. Sexuality and return to work are rarely mentioned. About half of the respondents are convinced that they pay enough attention to the psychosocial well-being of cancer patients: by listening, engaging in a deeper conversation, providing advice and through referral. Mostly, patients are referred to a psychologist, a general practitioner, a social worker, a specialised nurse or a centre for well-being and mental health. The barriers experienced, when providing psychosocial support, can be attributed to the patients, to themselves or other healthcare professionals, and to policy restrictions. These barriers should be addressed in order to enable healthcare professionals to improve the integration of the psychosocial approach in cancer care.status: publishe

Has lean improved organizational decision making?

Purpose – Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization’s decision-making context). Lean management can improve implementation results because it decreases ambiguity and uncertainties. But does it succeed? Many quality improvement (QI) initiatives are appropriate improvement strategies in organizational contexts characterized by low ambiguity and uncertainty. However, most care settings do not fit this context. The purpose of this paper is to investigate whether a Lean-inspired change program changed the organization’s decision-making context, making it more amenable for QI initiatives. Design/methodology/approach – In 2014, 12 professionals from a Dutch radiotherapy institute were interviewed regarding their perceptions of a Lean program in their organization and the perceived ambiguous objectives and uncertain cause-effect relations in their clinical processes. A survey (25 questions), addressing the same concepts, was conducted among the interviewees in 2011 and 2014. The structured interviews were analyzed using a deductive approach. Quantitative data were analyzed using appropriate statistics. Findings – Interviewees experienced improved shared visions and the number of uncertain cause-effect relations decreased. Overall, more positive (99) than negative Lean effects (18) were expressed. The surveys revealed enhanced process predictability and standardization, and improved shared visions. Practical implications – Lean implementation has shown to lead to greater transparency and increased shared visions. Originality/value – Lean management decreased ambiguous objectives and reduced uncertainties in clinical process cause-effect relations. Therefore, decision making benefitted from Lean increasing QI’s sustainability.status: publishe

Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection : a systematic review and meta-analysis

INTRODUCTION: The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibiotic use in patients with severe infection and to identify its relationship with patient outcomes. METHODS: Medline (from 2004 to 2014) was systematically searched by using predefined inclusion criteria. Reference lists of retrieved articles were screened for additional relevant studies. The systematic review included original articles reporting a quantitative measure of the association between the use of (in)appropriate empiric antibiotics in patients with severe in-hospital infections and their outcomes. A meta-analysis, using a random-effects model, was conducted to quantify the effect on mortality by using risk ratios. RESULTS: In total, 27 individual articles fulfilled the inclusion criteria. The percentage of inappropriate empiric antibiotic use ranged from 14.1% to 78.9% (Q1-Q3: 28.1% to 57.8%); 13 of 27 studies (48.1%) described an incidence of 50% or more. A meta-analysis for 30-day mortality and in-hospital mortality showed risk ratios of 0.71 (95% confidence interval 0.62 to 0.82) and 0.67 (95% confidence interval 0.56 to 0.80), respectively. Studies with outcome parameter 28-day and 60-day mortality reported significantly (P ≤0.02) higher mortality rates in patients receiving inappropriate antibiotics. Two studies assessed the total costs, which were significantly higher in both studies (P ≤0.01). CONCLUSIONS: This systematic review with meta-analysis provides evidence that inappropriate use of empiric antibiotics increases 30-day and in-hospital mortality in patients with a severe infection. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0795-y) contains supplementary material, which is available to authorized users

Short-term unscheduled return visits of adult patients to the emergency department

BACKGROUND: Emergency department (ED) crowding is a major international concern that affects patients and providers. STUDY OBJECTIVE: We describe the characteristics of patients who had an unscheduled related return visit to the ED and investigate its relation to ED crowding. METHODS: Retrospective medical record review of all unscheduled related ED return visits by patients older than 16 years of age over a 1-year period. The top quartile of ED occupancy rates was defined as ED crowding. RESULTS: Eight hundred thirty-seven patients (1.9%) made an unscheduled related return visit. Length of stay (LOS) at the ED for the index visit and the LOS for the return visit (5 h, 54 min vs. 6 h, 51 min) were significantly different, as were the percent admitted (11.6% vs. 46.1%). Of these patients, 85.1% and 12.0% returned due to persistence or a wrong initial diagnosis, of their initial illness, respectively, and 2.9% returned due to an adverse event related to the treatment initially received. Patients presented the least frequently with an alcohol-related complaint during the index visit (480 patients), but they had the highest number of unscheduled return visits (45 patients; 9.4%). Unscheduled related return visits were not associated with ED crowding. CONCLUSION: Return visits impose additional pressure on the ED, because return patients have a significantly longer LOS at the ED. However, the rate of unscheduled return visits and ED crowding was not related. Because this parameter serves as an essential quality assurance tool, we can assume that the studied hospital scores well on this particular parameter.publisher: Elsevier articletitle: Short-term Unscheduled Return Visits of Adult Patients to the Emergency Department journaltitle: The Journal of Emergency Medicine articlelink: http://dx.doi.org/10.1016/j.jemermed.2014.01.016 content_type: article copyright: Copyright © 2014 Elsevier Inc. All rights reserved.status: publishe

Mantelzorg : een literatuurstudie en simulatiemodel betreffende de economische waarde en de financiële impact op de ziekteverzekering

De vraag naar mantelzorg zal ongetwijfeld verder stijgen door de toenemende vergrijzing en de hiermee gepaard gaande chronische (multi)morbiditeit. Socio-economische veranderingen kunnen echter de beschikbaarheid van mantelzorg in de toekomst beperken. Het eerste deel van dit artikel bestaat uit een literatuuronderzoek over de karakteristieken van de mantelzorger, zijn gezondheid en welbevinden, zijn specifieke taken inzake informele hulpverlening en de economische waarde van mantelzorg. Het tweede deel bevat een simulatiemodel waarin de economische waarde van mantelzorg en de financiële impact ervan op de ziekteverzekering worden berekend. Volgens het simulatiemodel bedraagt de economische waarde van mantelzorg in België en in Vlaanderen op jaarbasis respectievelijk € 22,27 miljard en € 11,38 miljard. De financiële impact van mantelzorg op de ziekteverzekering in België en in Vlaanderen wordt geraamd op respectievelijk € 1,2 miljoen en € 0,6 miljoen per dag. Idealiter kan het bedrag van deze kosten beter geïnvesteerd worden in ondersteunende maatregelen teneinde mantelzorgers beter te erkennen en te begeleiden