Dealing with care disruption in High and Intensive Care wards:From difficult patients to difficult situations

High and Intensive Care is a relatively new care model in Dutch mental health care for clinical admissions. One of the goals is to keep the admission short. For some patients, this goal is not realized, which results in a long-term admission. Often, this is experienced as a disruption. Disruptions in care processes are frequently defined in terms of patient characteristics. Yet, it may be that other factors play a role. The aim of this study is to gain better insight into the perceptions of care professionals of what is characteristic for disruptions at High and Intensive Care wards and how professionals can deal with these. Qualitative research was performed by means of semi-structured interviews and a focus group with professionals. Results show that a focus on patient characteristics is too narrow and that other factors also play an important role. These factors include challenges in the relation between professionals and the patient, a divided team, and a lack of collaboration with ambulatory care. In order to deal with these factors, professionals should invest in the relationship with the patient, identify destructive team processes early, and improve communication with ambulatory care. It is recommended to develop a monitoring tool that includes all these factors. Another recommendation is to organize structured reflection on dilemmas experienced in care. In conclusion, this study shows the importance of going beyond patient characteristics in order to better understand, identify, and deal with disruption at High and Intensive Care wards

Necrotiserende encefalitis bij de yorkshire terriër: a retrospective study (1990-2008)

In this retrospective study thirteen Yorkshire terriers with histopathologically confirmed necrotizing encephalitis were studied All the dogs had progressive neurologic symptoms compatible with a cerebral or a brainstem disease The blood work revealed increased creatinine kinase (CK) levels in most cases The cerebrospinal fluid analysis was characterized by elevated protein concentrations and mononuclear pleocytosis Computed tomography (CT) scans revealed hypodense areas, ventriculomegaly and contrast enhancement All thirteen Yorkshire terriers were euthanized due to the progressive course of this brain disease and the lack of an effective treatment

Topography-driven alterations in endothelial cell phenotype and contact guidance

Bioengineering; Biophysics; Cell biology; Biomedical engineering; Regenerative medicine; Directional topography; Endothelial cells; Vascular-like networks; Contact guidance; Vascularizatio