New in old: Evaluation of a multidisciplinary integrated care model and studies in residential care homes

Nijpels, M.G.A.A.M. [Promotor]Hout, H.P.J. van [Copromotor]Frijters, D.H.M. [Copromotor

Renal Compression in Heart Failure The Renal Tamponade Hypothesis

Renal dysfunction is one of the strongest predictors of outcome in heart failure. Several studies have revealed that both reduced perfusion and increased congestion (and central venous pressure) contribute to worsening renal function in heart failure. This paper proposes a novel factor in the link between cardiac and renal dysfunction: "renal tamponade" or compression of renal structures caused by the limited space for expansion. This space can be limited either by the rigid renal capsule that encloses the renal interstitial tissue or by the layer of fat around the kidneys or by the peritoneal space exerting pressure on the retroperitoneal kidneys. Renal decapsulation in animal models of heart failure and acute renal ischemia has been shown effective in alleviating pressure-related injury within the kidney itself, thus supporting this concept and making it a potentially interesting novel treatment in heart failure. (J Am Coll Cardiol HF 2022;10:175-183) (c) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Unknown makes unloved:A case study on improving integrated health and social care in the Netherlands using a participatory approach

Many initiatives integrating health and social care have been implemented in order to provide adequate care and support to older people living at home. Further development of existing initiatives requires iterative processes of developing, implementing and evaluating improvements to current practice. This case study provides insight into the process of improving an existing integrated care initiative in the Netherlands. Using a participatory approach, researchers and local stakeholders collaborated to develop and implement activities to further improve collaboration between health and social care professionals. Improvement activities included interprofessional meetings focussing on reflection and mutual learning and workplace visits. Researchers evaluated the improvement process, using data triangulation of multiple qualitative and quantitative data sources. According to participating professionals, the improvement activities improved their communication and collaboration by establishing mutual understanding and trust. Enabling factors included the safe and informal setting in which the meetings took place and the personal relationships they developed during the project. Different organisational cultures and interests and a lack of ownership and accountability among managers hindered the improvement process, whereas issues such as staff shortages, time constraints and privacy regulations made it difficult to implement improvements on a larger scale. Still, the participatory approach encouraged the development of partnerships and shared goals on the level of both managers and professionals. This case study highlights that improving communication between professionals is an important first step in improving integrated care. In addition, it shows that a participatory approach, in which improvements are co-created and tailored to local priorities and needs, can help in the development of shared goals and trust between stakeholders with different perspectives. However, stakeholders' willingness and ability to participate in such an improvement process is challenged by many factors

UNAFLOW project: UNsteady Aerodynamics of FLOating Wind turbines

UNAFLOW (UNsteady Aerodynamics for Floating Wind) is a joint EU-IRPWIND founded experiment on wind turbine rotor unsteady aerodynamics. It brings together four different academic contributors: Energy research Centre of the Netherlands (ECN), DTU Wind Energy, University of Stuttgart (USTUTT) and Politecnico di Milano (PoliMi) sharing knowledge both in numerical modelling and in experimental tests design, allowing direct numerical and experimental comparison. The experimental tests carried out for UNAFLOW are of the same type of the ones carried out during the ongoing EU H2020 project LIFES50+ [1], regarding both the unsteady behaviour of the 2d blade section and the entire turbine rotor, although with improved setup and wider test matrix. The project partners are already currently jointly collaborating in the AVATAR project [2], developing and validating numerical models of different accuracy level. The numerical models used in the UNALFOW project range from engineering tool (eg. BEM) to high fidelity CFD methods. Numerical simulations are used both in the design of experiment phase and in the results analysis allowing for an in depth understanding of the experimental findings through advanced modelling approach. The UNAFLOW project, together with a new understanding of the unsteady behaviour of the turbine rotor aerodynamics, will provide also an open database to be shared among the scientific community for future analysis and new models validation

Is It Time for a Change? A Cost-Effectiveness Analysis Comparing a Multidisciplinary Integrated Care Model for Residential Homes to Usual Care

OBJECTIVE: The objective of this study was to evaluate the cost-effectiveness of a Multidisciplinary Integrated Care (MIC) model compared to Usual Care (UC) in Dutch residential homes. METHODS: The economic evaluation was conducted from a societal perspective alongside a 6 month, clustered, randomized controlled trial involving 10 Dutch residential homes. Outcome measures included a quality of care weighted sum score, functional health (COOP WONCA) and Quality Adjusted Life-Years (QALY). Missing cost and effect data were imputed using multiple imputation. Bootstrapping was used to analyze differences in costs and cost-effectiveness. RESULTS: The quality of care sum score in MIC was significantly higher than in UC. The other primary outcomes showed no significant differences between the MIC and UC. The costs of providing MIC were approximately €225 per patient. Total costs were €2,061 in the MIC group and €1,656 for the UC group (mean difference €405, 95% -13; 826). The probability that the MIC was cost-effective in comparison with UC was 0.95 or more for ceiling ratios larger than €129 regarding patient related quality of care. Cost-effectiveness planes showed that the MIC model was not cost-effective compared to UC for the other outcomes. INTERPRETATION: Clinical effect differences between the groups were small but quality of care was significantly improved in the MIC group. Short term costs for MIC were higher. Future studies should focus on longer term economic and clinical effects. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN11076857