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Objective: Family caregivers are often intensively involved in palliative and end-of-life cancer care. A variety of interventions to support family caregivers have been developed, differing in target population, modality, and components. We aimed to systematically examine characteristics and the effectiveness of interventions to support family caregivers of patients with advanced cancer. Methods: A systematic review was conducted using Embase, Medline Ovid, Web of Science, Cochrane, Google Scholar, and Cinahl. This review included quantitative studies published from January 2004 until January 2020 reporting on interventions to support family caregivers of patients with advanced cancer in all care settings. Results: Out of 7957 titles, 32 studies were included. Twenty-two studies were randomized controlled trials. Interventions were delivered to four target populations: individual family caregivers (n = 15), family caregiver-patient dyads (n = 11), families (n = 2) and peer groups (n = 4). Most interventions (n = 26) were delivered face-to-face or by phone, two were delivered online. Most interventions included multiple components and were primarily aimed at supporting family caregivers' self-care. Twenty-nine interventions were shown to have beneficial effects on family caregiver outcomes, mostly in the psycho-emotional (n = 24), daily functioning (n = 13) and social dimension (n = 6). Individual interventions were mainly effective in the psycho-emotional dimension, dyad and family interventions in the psycho-emotional and social domain, and group interventions mainly had an effect on daily functioning. Conclusions: Interventions to support family caregivers in advanced cancer care vary widely. Most intervention studies reported beneficial effects for the wellbeing of family caregivers. There is evidence that the target group is associated with beneficial effects on different outcome dimensions.

Objective: Assess improvable care factors in late preterm mortality, defined as death of a child during labour or in the first 28 days thereafter between 32 + 0 and 36 + 6 weeks gestation, in the Netherlands. Design: Perinatal audit has been coordinated and supported at the national level, with selection of nationwide audit themes, and audit sessions are performed at the local level across the country as multidisciplinary meetings with primary and secondary level health care professionals, organised in local perinatal cooperation units. In 2017–2019, late preterm mortality was such a theme. We compiled and systematically categorised all improvable care factors formulated during local audit meetings in a national perinatal audit database. Results: In total, 27 cases were discussed in local perinatal audits and analysed locally and at the national level. Altogether, 52 improvable care factors were identified. Most identified improvable care factors concerned inadequate foetal monitoring by cardiotocography during labour, factors related to care organisation, particularly unclarity around local assigning of responsibilities and work procedures, and poor communication between involved health care professionals especially in transfer of care. Conclusion: Several critical improvable care factors were identified through nationwide perinatal audit of late preterm deaths in the Netherlands.

This review aims to identify self-report instruments examining aspects of transition to parenthood for use in practice and research. After performing a literature search in Embase, Medline, Web of Science, Cochrane, PsycINFO and Google Scholar, the Patient Reported Outcome Measures (PROMs) measuring (aspects of) transition to parenthood during pregnancy or up to 1-year postpartum were identified. Following COSMIN guidelines for systematic reviews on PROMs, the quality of the PROM development and PROM content validity was evaluated. From the 129 included studies, 39 PROMs assessed aspects of transition to parenthood. A total of 32 PROMs were included in the evaluation. The development quality of 30/32 PROMS was mostly rated as inadequate and the quality of 15 content validity studies was mostly rated as doubtful. All PROMs received inadequate or doubtful ratings on content validity. Most of the PROMs measuring aspects of the transition to parenthood didn’t include parents’ points of view when developing them. Many PROMs are being used for a long time without reassessing relevance, comprehensiveness, and comprehensibility among parents and/or practitioners. It is recommended that researchers and healthcare professionals assess content validity of the PROM before use with the target population.

In some countries, personal assistants may facilitate sexual engagement of people with disabilities. A specific form of facilitating sexuality are services that offer paid sex with sex care workers. In the Netherlands, there is no training available for sex care workers. To provide input for such training, this study examined sex care workers’ (perceived importance of) knowledge about sexuality and relevant aspects of sex care, their educational needs, motives for becoming a sex care worker, and experiences. An online survey was completed by 29 sex care workers (response rate 52%). The sex care workers expressed high importance of knowledge and generally reported good, but slightly lower current knowledge levels on these aspects. Educational needs included both general and disability-related sexuality and sexual problems and how to deal with problem behaviors and/or emotional disinhibition. Some participants indicated that learning how to prevent physical strain was important. The importance of setting boundaries was reported. Overall, participants experienced little stigma, although few reported negative experiences. Important motives for sex care work included the lack of attention to sexuality support for clients with disabilities and wanting to contribute to clients’ sexual citizenship. The formulated educational needs may be helpful in the development of such training. In addition to knowledge and practical skills, the training should pay attention to discovering and setting boundaries, providing a safe space for reflection on one’s own body experience and ethics, as well as considering the clients’ perspectives.

Social, contextual, and technological changes affected the educational context for students who are deaf or hard of hearing (D/HH) in higher education in many countries. Although, several barriers to academic success already have been identified, the perspectives of D/HH-students on inclusion, educational facilities, and support are important to overcome them. This interview-based qualitative study describes the perspectives of 32 D/HH-students in mainstream higher education in The Netherlands. Within the dichotomy of environmental factors and personal factors, data have been analysed. Students experienced social acceptance by others with typical hearing, although participating in social events sometimes caused feelings of loneliness or separation. Access arrangements and adjustments in educational programs were necessary to cope with the experienced fatigue, participate during lectures or increase speech intelligibility of the lecturer. Especially poor classroom acoustics and limited intelligibility of speech hampered students during lectures. Students expressed their dissatisfaction about the way access arrangements and adjustments were arranged, yet at the same time, they do not know what the requested help should look like. A co-created policy in which D/HH-students, student support officers, and institutional policy makers are involved, would support D/HH-students in mainstream higher education in The Netherlands and abroad in their needs.

Despite the current terminology debate, little is known about the terminology experiences of people with disabilities and their relatives. Therefore, their interviews and letters to editors about disability terminology experiences published in Dutch newspapers between 1950 and 2020 were examined using inductive qualitative analysis. Three themes were derived. Contributors (1) objected to the use of particular terms and explained why a change in disability terminology was required; (2) argued that a change in disability terminology was viable; and (3) opposed proposed terminological changes. Contributors stated that derogatory and outmoded terms did not accurately depict the abilities of people with disabilities, resulting in stigmatisation and exclusion. Few contributors addressed a cross-disability perspective, and there was no mention of disability policy in the terminology debate. Meaningful associations between disability terminology experiences and the visibility and onset of the disability could be established. The newspaper contributions reflected the growing self-awareness of people with disabilities and their relatives.

Background Psychiatric comorbidity is high in adults with posttraumatic stress disorder (PTSD), with up to 90% having at least one additional condition, and two-thirds having two or more other diagnoses. With an increasing aging population in industrialized counties, knowing which psychiatric disorders frequently co-occur in older adults with PTSD can have implications to improve diagnosis and treatment. This systematic literature review explores the current empirical literature on psychiatric comorbidity in older adults with PTSD. Method Literature databases PubMed, Embase, PsycINFO, and CINAHL were searched. The following inclusion criteria were applied: research done since 2013, PTSD diagnosis based on diagnostic criteria according to Diagnostic and Statistics Manual-Fifth Edition, International Classification of Diseases—10th Revision (ICD-10), or ICD-11, and studies include individuals aged 60 years or older. Results Of 2068 potentially relevant papers identified, 246 articles were examined based on titles and abstracts. Five papers met the inclusion criteria and were included. Major depressive disorder and alcohol use disorder were the most frequently studied and diagnosed psychiatric comorbidities in older adults with PTSD. Conclusions and implications Screening for depression and substance use in older adults should include an assessment of trauma and PTSD. Additional studies in the general older adult population with PTSD and a broader range of comorbid psychiatric disorders are needed.

Objective To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP. Design A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS). Setting Nationwide, the Netherlands. Population All pregnant women between April 2016 and April 2018. Methods This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP. Main outcome measures Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP. Results In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention. Conclusions SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.

Objective To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP. Design A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS). Setting Nationwide, the Netherlands. Population All pregnant women between April 2016 and April 2018. Methods This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP. Main outcome measures Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP. Results In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention. Conclusions SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.

De COM-interventie helpt naasten en verpleegkundigen inzichtelijk te krijgen welke ondersteuning naasten nodig hebben om palliatieve zorg thuis zo lang mogelijk vol te houden.

Contains fulltext : 292505.pdf (Publisher’s version ) (Open Access) Post-traumatic stress disorder (PTSD) is associated with cognitive dysfunctions and is an independent risk factor for dementia. A recent study has found the prevalence of PTSD in people with dementia is 4.7%-7.8%. However, little is known about the effectiveness of PTSD treatment for people with dementia. The primary aim of the current study is to review previous studies on the treatment of PTSD in people with dementia. A structured literature review was performed using a 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' analysis in PubMed, Embase, PsycINFO and CINAHL. Two independent researchers screened titles and abstracts. The inclusion criteria were: PTSD symptoms present, diagnosis of dementia, PTSD treatment form described and effects of the treatment mentioned. Articles that matched these criteria were included and content and quality were analyzed. We included nine articles, all case reports, with a total of 11 cases. The discussed treatment options are eye movement desensitisation and reprocessing (EMDR) (n = 3), prolonged exposure (n = 1), cognitive behavioural therapy (n = 1) and pharmacological treatment (n = 4). All articles reported a positive effect of the intervention on several monitored symptoms. Evidence for positive effects and feasibility of EMDR were most reliable, and it was applied in two articles of sufficient quality published in 2018 and 2019. EMDR 'on-the-spot' was described with positive effect in one article in which three cases were discussed. The quality of included papers ranged from insufficient to sufficient. This review shows that people with PTSD and dementia can benefit from PTSD treatment. EMDR, prolonged exposure, acceptance and commitment therapy and pharmacological treatment are applicable in this population. EMDR treatment is most described in this population (n = 5) and shows positive results, and the studies are of sufficient quality (n = 3). Further research in the form of a randomised controlled trial is required to study the effectivity of different treatment interventions in this population.

Meer dan 90% van mensen met dementie vertoont symptomen van psychisch lijden zoals depressie, angst of apathie. Onderzoek liet zien dat er vaak onvolledig of onjuist wordt omgegaan met probleemgedrag, zelfs na invoering van de richtlijn ‘Probleemgedrag bij mensen met dementie’ in 2018. In de STIP-Methode zijn de drie effectieve aanpakken uit deze richtlijn gecombineerd voor betere preventie en behandeling van probleemgedrag.

Meer dan 90% van mensen met dementie vertoont symptomen van psychisch lijden zoals depressie, angst of apathie. Onderzoek liet zien dat er vaak onvolledig of onjuist wordt omgegaan met probleemgedrag, zelfs na invoering van de richtlijn ‘Probleemgedrag bij mensen met dementie’ in 2018. In de STIP-Methode zijn de drie effectieve aanpakken uit deze richtlijn gecombineerd voor betere preventie en behandeling van probleemgedrag.

ObjectivesThe objective of this study is to better understand how the COVID-19 outbreak impacted the different domains of the palliative care approach to end-of-life care from the perspective of healthcare professionals (HCPs) from different professions, working in different settings during the first months of the COVID-19 outbreak in the Netherlands.MethodsAn in-depth qualitative interview study among 16 HCPs of patients who died between March and July 2020 in different healthcare settings in the Netherlands. The HCPs were recruited through an online survey about end-of-life care. Maximum variation sampling was used. Data were analysed following the principles of thematic analysis.ResultsSeveral aspects impacted the quality of the palliative care approach to care at the end of life. First, COVID-19 was a new disease and this led to challenges in the physical domain of end-of-life care, for example, a lack of knowledge on how to manage symptoms and an unreliable clinical view. Second, the high workload HCPs experienced impacted the quality of end-of-life care, especially in the emotional, social and spiritual domains, since they only had time for urgent, physical care. Third, COVID-19 is a contagious disease and measures taken to prevent the spread of the virus hampered care for both patients and relatives. For example, because of the visiting restrictions, HCPs were not able to provide emotional support to relatives. Finally, the COVID-19 outbreak also had a potentially positive impact in the longer term, for example, more awareness of advance care planning and the importance of end-of-life care that includes all the domains.ConclusionThe palliative care approach, which is key to good end-of-life care, was often negatively influenced by the COVID-19 pandemic, predominantly in the emotional, social and spiritual domains. This was related to a focus on essential physical care and prevention of the spread of COVID-19.

Posttraumatic stress disorder (PTSD) is a prevalent disorder worldwide and often co-occurs in dementia. Both have a major impact on disease burden and quality of life. PTSD may be difficult to recognize in dementia and a structured diagnostic method is lacking. In order to get insight into the clinical diagnostics of PTSD in dementia, this systematic literature review evaluates the clinical presentation of PTSD and other relevant symptoms in people with dementia. PubMed, PsycINFO, Embase, and CINAHL were searched for all publications through 30 December 2021. Articles were included which met the following criteria: (i) description of at least one case with a current diagnosis of dementia and co-morbid PTSD; (ii) clinical presentation of symptoms being adequately described; (iii) no difference being made between chronic PTSD, PTSD with re-activation, and delayed onset PTSD. Of the 947 identified abstracts, 13 papers met the inclusion criteria and were included (describing 30 cases). Based on our rating, only one case completely fulfilled the DSM-5 criteria of PTSD. Avoidance was only described in three cases. Most commonly described symptoms were irritability and anger (E1, 9%), persistent negative emotional state (D4, 9%), and sleep disturbances (E6, 8%). In 93% of the case reports, other symptoms were also described, i.e. memory problems (58%), screaming (33.3%), and wandering (22.2%). People with dementia who have experienced a traumatic event seem to present, based on our rating method, with insufficient symptoms to meet all criteria for a PTSD DSM-5 diagnosis. The DSM-5 core symptom of avoidance was absent in most of the cases. Clinical presentation consists mainly of symptoms of irritability, anger, persistent negative emotional state, and sleep disturbances, often accompanied by other symptoms. These findings suggest that older people with dementia may have other symptom presentations than people without dementia.

Inclusion is an important topic in today’s society, yet it is surrounded by confusion and is difficult to attain in reality. This paper aims to critically appraise the concept of inclusion, to reflect on the essence of what inclusion in society is about, and to translate this essence into user involvement in small-scale, long-term care practices for people with disabilities. Most professionals in care services find user involvement important, and user involvement has shifted expectations and broadened the roles of clients in health care, but real partnerships remain difficult to achieve. In this paper, we try to understand why this is the case and what can be done about it. To this end, we reflect on the mechanisms underlying the difficulties in realising partnerships in everyday care practices and portray two long-term care practices in which the professionals and care users work in partnership. Finally, we draw conclusions about the factors underlying these practices in the context of inclusion.

This paper aims to shed light on what becomes of discrete torsion within heterotic orbifolds when they are resolved to smooth geometries. Gauged Linear Sigma Models (GLSMs) possessing (0,2) worldsheet supersymmetry are employed as interpolations between them.

This paper aims to shed light on what becomes of discrete torsion within heterotic orbifolds when they are resolved to smooth geometries. Gauged Linear Sigma Models (GLSMs) possessing (0,2) worldsheet supersymmetry are employed as interpolations between them.

Cerebral palsy is a lifelong neurodevelopmental condition arising from non-progressive disorders occurring in the fetal or infant brain. Cerebral palsy has long been categorised into discrete motor types based on the predominance of spasticity, dyskinesia, or ataxia. However, these motor disorders, muscle weakness, hypotonia, and impaired selective movements should also be discriminated across the range of presentations and along the lifespan. Although cerebral palsy is permanent, function changes across the lifespan, indicating the importance of interventions to improve outcomes in motor disorders associated with the condition. Mounting evidence exists for the inclusion of several interventions, including active surveillance, adapted physical activity, and nutrition, to prevent secondary and tertiary complications. Avenues for future research include the development of evidence-based recommendations, low-cost and high-quality alternatives to existing therapies to ensure universal access, standardised cerebral palsy registers to harmonise epidemiological and clinical information, improved adult screening and check-up programmes to facilitate positive lived experiences, and phase 3 trials for new interventions.

Objectives: Posttraumatic stress disorder is frequently present in people with dementia, but the symptoms are difficult to recognize and suitable treatments are lacking. The aim of the present study was to investigate which trauma-focused treatments are applicable to these patients. Methods: The Delphi method is a process which is used to reach consensus from a panel of experts. The study was conducted online and consisted of three rounds with statements about support for treatment, treatment, and implementation. Results: There are several treatment options available, but it depends on the symptoms, and the severity of PTSD and dementia which treatment is most suitable Conclusions: The outcomes offer some practical tips for health care workers, and they provide a fundamental base for future research. Clinical Implications: Clinicians should pay attention to the treatment of PTSD symptoms in people with dementia and it is necessary to examine the type and severity of both PTSD symptoms and dementia. Taking these factors into account, clinicians are able to focus on the best treatment option in order to improve the quality of life of these specific type of patients.

Background: Previous studies in somatic health care revealed that patients find nurse practitioners reliable, helpful, and empathic and feel empowered, at peace, and in control when cared for by nurse practitioners (NPs). Only one study so far considered what value people with severe mental illness (SMI) attached to treatment by a psychiatric mental health nurse practitioner (PMHNP). Purpose: To explore what meaning people with SMI associate with the care provided by a PMHNP. Methodology: A qualitative study from a phenomenological perspective was conducted, in which 32 people with SMI were interviewed. Data were analyzed using Colaizzi's seven-step method and the metaphor identification procedure (MIP). Results: Eight fundamental themes emerged: (1) impact of the PMHNP on well-being, (2) feeling connected with, and (3) acknowledged by the PMHNP; (4) the PMHNP's care (not) needed; (5) perception of the PMHNP as a person; (6) shared decision-making; (7) PMHNP's expertise; and (8) flexibility of contact with the PMHNP. MIP analysis revealed six metaphors: PMHNP is a travel aid, means trust, is a combat unit, means hope, is an exhaust valve, and a helpdesk/encyclopedia. Conclusions: The interviewees highly appreciated the treatment and support by the PMHNP for the impact on their well-being. Thanks to the connection with and recognition by the PMHNP, they felt empowered, human, and understood. Challenged by the PMHNP, they focused on possibilities to strengthen self-confidence and self-acceptance. Implications: For further positioning of and education for PMHNPs, it is recommended to consider the meaning people with SMI associate with treatment and support by a PMHNP.

Intermitterende toediening van epidurale analgesie is even effectief als continue toediening, maar zorgt voor lagere pijnscores tijdens de laatste twee uur van epidurale analgesie, voor afname van de hoeveelheid lokaal anestheticum en leidt tot minder motorische blokkade.

Intermitterende toediening van epidurale analgesie is even effectief als continue toediening, maar zorgt voor lagere pijnscores tijdens de laatste twee uur van epidurale analgesie, voor afname van de hoeveelheid lokaal anestheticum en leidt tot minder motorische blokkade.

Objective Medical Crew Resource Management (CRM) training courses are designed to increase patient safety by reducing the effects of human errors. These training courses are most popular in surgery and a wide range of medical CRM training courses for surgical teams is now available. However, the effects of these CRM training courses on patient outcomes are inconclusive. Although surgical teams feel the need to be trained in team collaboration skills, they are often puzzled about what criteria to apply when choosing a medical CRM training course. This study aimed to compare CRM training courses on didactic components and simulation-exercises to explore if these courses are interchangeable. Methods In this qualitative study, semi-structured interviews were conducted among 10 main CRM training providers of surgical teams in the Netherlands. Results Although a large variety was found in the content of CRM training courses, the most substantial differences were found in the simulation-exercises. Nine out of 10 trainers stated that standard simulation-exercises would be a step forward to ensure quality in CRM trainings. According to the trainers, the implementation of medical CRM can reduce human errors and as a result, preventable patient complications. They suggested a quality standard for CRM trainers in the medical field to ensure the quality of medical team training as a way to reach this. Conclusions Medical CRM training courses are diverse and noninterchangeable. Trainers expect that if CRM becomes part of surgical training and is embedded in operating theatre culture, it could be of great value for patients and professionals.

ObjectiveThis cross-sectional questionnaire study investigates if there a difference in the extent to which health care providers in prenatal Shared Medical Appointments (CenteringPregnancy©) and in prenatal individual appointments support self-management in patient education. It also investigates if there is a difference in the extent to which health care providers in CenteringPregnancy@ and in individual appointments pay attention to the factors of the Integrated Model for Behavioral Change (I-Change) in supporting self-management.MethodsDutch health care providers in prenatal care were invited to fill out a questionnaire. Respondents who provided care in CenteringPregnancy© formed the CenteringPregnancy© group, the others were categorized in the individual appointments’ group. After a definition of self-management and an introduction of the I-Change model, respondents were asked if they supported self-management and if they paid attention to the I-Change model for each of 17 themes of prenatal patient education. Pearson’s chi-squared tests and Fisher’s Exact tests were performed to compare both groups.ResultsWe included 133 respondents. Health care providers in the CenteringPregnancy@ group supported self-management to a higher extent compared to the individual appointments group. This difference was statistically significant for eight themes (body position and exercises, oral health, domestic violence, birth mechanism and premature birth, postnatal period, transition from pregnancy to parenthood, taking care of the baby and newborn’s safety). In both groups, health care providers paid most attention to information or to awareness factors instead of motivation factors.ConclusionWe found a first prove that health care providers in CenteringPregnancy@ support self-management to a higher extent than health care providers in individual appointments. This could be explained by factors as time, feelings of safety and bonding, continuity of care and emphasis on future health behaviour changes. For effective self-management support, attention to motivation factors is important. However, we found that health care providers in both groups paid more attention to information or to awareness factors than to motivation.Practice implicationsHealth care providers in prenatal individual appointments should be aware of the fact that they possibly support self-management less than health care providers in CenteringPregnancy@ . Health care providers in both types of prenatal care should be aware of the fact that they pay little attention to motivation factors. They might need some skills to change their role from teaching professional to supportive leader.

Bernice Engeltjes,1,2 Ageeth Rosman,2 Loes CM Bertens,3 Eveline Wouters,4 Doug Cronie,2 Fedde Scheele1,5 1Athena Institute for Transdisciplinary Research, Faculty of Science, VU University, Amsterdam, the Netherlands; 2Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands; 3Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; 4Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; 5Department of Healthcare Education, OLVG Teaching Hospital, Amsterdam, the NetherlandsCorrespondence: Bernice EngeltjesDepartment of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the NetherlandsTel +31 6 41804881Email engeltjesbernice@gmail.comBackground: Safety and efficiency of emergency care can be optimized with a triage system which uses urgency to prioritize care. The Dutch Obstetric Telephone Triage System (DOTTS) was developed to provide a basis for assessing urgency of unplanned obstetric care requests by telephone. Reliability and validity are important components in evaluating such (obstetric) triage systems.Objective: To determine the reliability of Dutch Obstetric Telephone Triage, by calculating the inter-rater and intra-rater reliability.Methods: To evaluate the urgency levels of DOTTS by testing inter-rater and intra-rater reliability, 90 vignettes of possible requests were developed. Nineteen participants, from hospitals where DOTTS had been implemented, rated in two rounds a set of ten vignettes. The five urgency levels and five presenting symptoms had an equal spread and had to be entered in accordance with DOTTS per vignette. Urgency levels were dichotomized into high urgency and intermediate urgency. Inter-rater reliability was rated as degree of agreement between two different participants with the same vignette. Intra-rater reliability was rated as agreement by the same participants at different moments in time. The degree of inter-rater and intra-rater reliability was tested using weighted Cohen’s Kappa and ICC.Results: The agreement of urgency level between participants in accordance with predefined urgency level per vignette was 90.5% (95% CI 87.5– 93.6) [335 of 370]. Agreement of urgency level between participants was 88.5% (95% CI 84.9– 93.0) [177 of 200] and 84.9% (95% CI 78.3– 91.4) after re-rating [101 of 119]. Inter-rater reliability of DOTTS expressed as Cohen’s Kappa was 0.77 and as ICC 0.87; intra-rater reliability of DOTTS expressed as Cohen’s Kappa was 0.70 and as ICC 0.82.Conclusion: Inter-rater and intra-rater reliability of DOTTS showed substantial correlation, and is comparable to other studies. Therefore, DOTTS is considered reliable.Keywords: obstetrics, triage system, inter-observer agreement, intra-observer agreement, undertriage and overtriage

ObjectivesTo describe characteristics of neonates with severe neonatal hyperbilirubinaemia (SNH) and to gain more insight in improvable factors that may have contributed to the development of SNH.Design and settingDescriptive study, based on national Dutch perinatal audit data on SNH from 2017 to 2019.PatientsNeonates, born ≥35 weeks of gestation and without antenatally known severe blood group incompatibility, who developed hyperbilirubinaemia above the exchange transfusion threshold.Main outcome measuresCharacteristics of neonates having SNH and corresponding improvable factors.ResultsDuring the 3-year period, 109 neonates met the eligibility criteria. ABO antagonism was the most frequent cause (43%). All neonates received intensive phototherapy and 30 neonates (28%) received an exchange transfusion. Improvable factors were mainly related to lack of knowledge, poor adherence to the national hyperbilirubinaemia guideline, and to incomplete documentation and insufficient communication of the a priori hyperbilirubinaemia risk assessment among healthcare providers. A priori risk assessment, a key recommendation in the national hyperbilirubinaemia guideline, was documented in only six neonates (6%).ConclusionsSNH remains a serious threat to neonatal health in the Netherlands. ABO antagonism frequently underlies SNH. Lack of compliance to the national guideline including insufficient a priori hyperbilirubinaemia risk assessment, and communication among healthcare providers are important improvable factors. Implementation of universal bilirubin screening and better documentation of the risk of hyperbilirubinaemia may enhance early recognition of potentially dangerous neonatal jaundice.

Community housing services adopt care models such as rehabilitation, recovery-oriented care and person-centered planning to improve the quality of life of service users with an intellectual or psychiatric disability. However, the way these care models are implemented and practiced can negatively impact service users’ experience with the service as their complex needs go unmet. In this paper, we conceptualize these experiences through developing the counternarrative of burdens of support. For this we draw on burden of treatment theory. We conducted ethnographic fieldwork in a community service organization in the Netherlands. This included participant observation (84 h), interviews with service users (n = 20), experts-by-experience (n = 8), family members (n = 10) and photovoice workshops. Our analysis identifies four burdens of support: burden of self-determination; re-identification; responsibilisation and re-placement. The results show that burden of support is very much a relational concept: through their support, professionals can aggravate or alleviate burden. Points of interest People with intellectual or psychiatric disabilities often receive support with living in the community. Good support fits people’s needs (e.g. person-centered planning), builds on people’s strengths and contributes to recovery and community participation. Even when support is practiced or organized with such aims, service users can have negative experiences. In this research we call this: ‘burden of support’. Examples of burden of support identified include: Clients’ needs and wishes are sometimes not sufficiently attended too when working with a personal care plan. Too much responsibility is sometimes shifted to clients, which results in feelings of failing or abandonment. The focus on strengths and recovery sometimes leaves too little room for clients to voice support needs. Having to move to a different home or neighborhood as part of becoming more independent can result in many difficulties including loneliness. The research recommended that those who improve services should also alleviate these burdens.

Cognitive and behavioral aspects may mask posttraumatic stress disorder (PTSD) in people with dementia. PTSD severely lowers quality of life in people with dementia. Proper recognition of PTSD is essential to ensure adequate treatment. However, a valid diagnostic tool for PTSD in dementia is lacking. A Delphi study was conducted among 20 Dutch and 6 international experts in the field of PTSD and dementia care or research. The aim was to reach consensus in 3 rounds on the added value, form, content, and application for developing such an instrument. The first round confirmed the need for a new diagnostic tool for research and clinical practice. Consensus was reached on 23 statements regarding the support base and 19 related to content of the instrument. In the third round, opinions on several conceptual problems were gathered. Based on the experts' opinions, a draft version of an instrument, the TRAuma and DEmentia-interview (TRADE-interview), was developed. Clinical and research implications of this new measure are discussed.

Background There are distinct differences in the implementation of physiotherapeutic care in nursing homes. Both nationally and internationally staffing levels of physiotherapy differ significantly between and within nursing homes. Since legislation or guidelines that specify the parameters of physiotherapy required in nursing homes are lacking, it is unknown how physiotherapists currently estimate the usefulness and necessity of physiotherapy in individual situations in long-term care. The purpose of this study was to describe how physiotherapists actually work, and how they want to work, in daily practice in Dutch nursing homes. Methods We performed a qualitative study with an online questionnaire. We asked 72 physiotherapists working in Dutch nursing homes to describe as accurately as possible usual care in nine different cases in long-term care. Furthermore we asked them to describe their role in the prevention and treatment of a number of indicators that measure the quality of care in nursing homes. Two reviewers thematically analysed the answers to the questionnaires. Results Forty-six physiotherapists returned the questionnaire. Physiotherapy services include active exercise therapy aimed to improve mobility and movement dysfunctions, advising on prevention and management of falls, pressure ulcers, incontinence, malnutrition and sarcopenia, overweight, physical restraints, intertrigo, chronic wounds, behavioural and psychological symptoms in dementia, and physical inactivity, and ergonomic and behavioural training. The way and extent in which physiotherapists are involved in the various care- and functional problems differs and depends on organisational and personal factors such as, organisation’s policy, type of ward, time pressure, staffing level, collaboration with other members of the multidisciplinary team, or lack of knowledge. Conclusion Physiotherapists in nursing homes are involved in the prevention and management of different care situations and functional problems. The way in which they are involved differs between physiotherapist. Aiming for more uniformity seems necessary. A shared vision can help physiotherapists to work more consistently and will strengthen their position in nursing homes.

Contains fulltext : 285850.pdf (Publisher’s version ) (Open Access) Aim To identify predictors of late academic or early career dropout, and derive a simple model for identifying nursing students and novice nurses with significant increased dropout risk. Background Dropout from nursing school and the nursing profession is of great concern for students, educators, as well as graduated nurses. Nurse shortages are a major problem in healthcare worldwide (Drennan & Ross, 2019). Retention of nursing students and novice nurses can contribute to reducing the deficits (Smith-Wacholz et al., 2019). Little is known about the predictors of dropout among nursing students in the later years of their degree programme (late dropout) and early nurse dropout from the profession. Design Prospective cohort study with three years of follow-up, among 406 third-year nursing students of the Bachelor of Nursing programme of Rotterdam University of Applied Sciences. Methods Data were collected between May 2016 and February 2019 using a self-administered questionnaire. Backward binary multiple logistic regression analyses were used to build a prediction model for dropout. Results Dropout from nursing education and at the start of the nursing career totalled 12%. Twelve factors, including male sex (OR 3.76, 95% CI 1.41-10.04), age (OR 1.06, 95% CI 1.00-1.12), migration background (OR 2.42, 95% CI 1.10-5.32), clinical placement setting (including mental healthcare; OR 0.18, 95% CI 0.04-0.83), musculoskeletal symptoms (OR 1.20, 95% CI 1.02-1.42) and psychosocial work characteristics (including exposure to violence; OR 3.13, 95% CI 1.25-7.81) were statistically significant predictors in our dropout model. The explained variance of the final model was 26%. Conclusion The study highlights the importance of taking musculoskeletal and mental health symptoms, psychosocial work characteristics, as well as sex, age and migration background into consideration as predictors for dropout among nursing students and novice nurses. This study is a first step towards a predictive model that helps identifying high-risk groups. 5 p.

Bernice Engeltjes,1,2 Corlijn Van Dijk,3 Ageeth Rosman,2 Rudy Rijke,2 Fedde Scheele,1,4 Eveline Wouters5 1Athena Institute for Transdisciplinary Research, Faculty of Science, VU University, Amsterdam, the Netherlands; 2Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands; 3Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands; 4Department of Healthcare Education, OLVG Teaching Hospital, Amsterdam, the Netherlands; 5Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the NetherlandsCorrespondence: Bernice EngeltjesDepartment of Health Care Studies, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam, 3015 EK, the NetherlandsTel +31 6 41804881Email engeltjesbernice@gmail.comObjective and Purpose: A triage system that prioritizes care according to medical urgency has a favorable effect on safety and efficiency of emergency care. The Dutch obstetric telephone triage system is comparable to physical triage systems. It consists of five urgency levels: resuscitation and life threatening (U1), emergency (U2), urgent (U3), non-urgent (U4) and self-care advice (U5). The purpose of this study was to determine the diagnostic and external validity of the Dutch obstetric telephone triage system in obstetric emergency care.Patients and Methods: The validity of the Dutch obstetric telephone triage system was studied in a prospective observational study in four hospitals. Diagnostic validity of usual care was determined by comparing the assigned urgency level of the Dutch obstetric telephone triage system with a reference standard. This reference standard was obtained by face-to-face clinical assessment in hospital following telephone triage. Clinical follow-up after assessment was also recorded. For statistical analyses, urgency levels were dichotomized into high urgency (U1, U2) and intermediate urgency (U3, U4). Self-care advice (U5) could not be studied because these patients were not referred to hospital.Results: In total, 983 cases (U1-U4) across the four hospitals were included, 625 (64%) cases were categorized as high urgency and 358 (36%) as intermediate urgency. The Dutch obstetric telephone triage system’s urgency level agreed with the reference standard in 53% (n=525; 95% CI 50– 57%). According to the reference standard the Dutch obstetric telephone triage system had undertriage in 16% (n=160) and overtriage in 30% (n=298) of the cases. Sensitivity for high urgency was 76% (95% CI 72– 80), specificity 49% (95% CI 44– 53). Positive predictive value and negative predictive value were 60% (95% CI 56– 63) and 67% (95% CI 62– 72), respectively. After clinical assessment, urgent care was needed in 8.7% (n=31) of the intermediate-urgency cases, none of these cases were life threatening situations.Conclusion: DOTTS shows an acceptable diagnostic validity with room for improvement.Keywords: telephone triage, diagnostic validity, external validity, under-triage, sensitivity, obstetric emergency care

Inleiding. Richtlijnen ondersteunen ergotherapeuten bij het nemen van beslissingen over diagnostiek en behandeling en dragen bij aan goede kwaliteit van zorg. Dit onderzoek evalueert het gebruik van richtlijnen door ergotherapeuten in Nederland, en hun behoefte aan richtlijnen. Methode. Met behulp van een vragenlijst is een cross-sectioneel inventariserend onderzoek uitgevoerd onder 246 ergotherapeuten in Nederland. De gegevens zijn geanalyseerd met SPSS versie 27. Resultaten. Bijna alle deelnemende ergotherapeuten zijn bekend met richtlijnen en ruim 90% van de respondenten raadpleegt richtlijnen. De belangrijkste reden om richtlijnen te raadplegen is als steun bij het nemen van beslissingen over zorg en om cliënten te informeren. De ergotherapierichtlijnen CVA en valpreventie worden het meest gebruikt. Van de respondenten heeft 29% de afgelopen 6 maanden een ergotherapeutische of multidisciplinaire richtlijn gemist. Een meerderheid van de respondenten is geïnteresseerd in een ander type richtlijnen, zoals persoonsgerichte of uitkomstgerichte richtlijnen. Conclusie. Richtlijnen zijn goed bekend bij ergotherapeuten en een grote meerderheid gebruikt richtlijnen, met name om beslissingen te ondersteunen en cliënten te informeren. Meer diversiteit en flexibiliteit in richtlijnen kan bijdragen aan het blijven gebruiken van richtlijnen en het blijven bieden van kwalitatief goede zorg.

Inleiding. Richtlijnen ondersteunen ergotherapeuten bij het nemen van beslissingen over diagnostiek en behandeling en dragen bij aan goede kwaliteit van zorg. Dit onderzoek evalueert het gebruik van richtlijnen door ergotherapeuten in Nederland, en hun behoefte aan richtlijnen. Methode. Met behulp van een vragenlijst is een cross-sectioneel inventariserend onderzoek uitgevoerd onder 246 ergotherapeuten in Nederland. De gegevens zijn geanalyseerd met SPSS versie 27. Resultaten. Bijna alle deelnemende ergotherapeuten zijn bekend met richtlijnen en ruim 90% van de respondenten raadpleegt richtlijnen. De belangrijkste reden om richtlijnen te raadplegen is als steun bij het nemen van beslissingen over zorg en om cliënten te informeren. De ergotherapierichtlijnen CVA en valpreventie worden het meest gebruikt. Van de respondenten heeft 29% de afgelopen 6 maanden een ergotherapeutische of multidisciplinaire richtlijn gemist. Een meerderheid van de respondenten is geïnteresseerd in een ander type richtlijnen, zoals persoonsgerichte of uitkomstgerichte richtlijnen. Conclusie. Richtlijnen zijn goed bekend bij ergotherapeuten en een grote meerderheid gebruikt richtlijnen, met name om beslissingen te ondersteunen en cliënten te informeren. Meer diversiteit en flexibiliteit in richtlijnen kan bijdragen aan het blijven gebruiken van richtlijnen en het blijven bieden van kwalitatief goede zorg.

The ‘What Being the Parent of a New Baby is Like-Revised’ (WPL-R) is an instrument designed to measure adaptation to parenthood. In the process of pilot testing and validating the WPL-R in a postpartum Dutch population, we became aware of the potentially sensitive nature of the measure. Despite the ethics committee waiving the invasive nature of the measure, we conducted a survey to explore its possible effect on women’s thoughts and emotions by using the Positive And Negative Affect Schedule (PANAS) to measure changes associated with completion of the WPL-R. Two hundred and fifteen questionnaires were returned. Our findings indicated a change in PANAS scores, implying an intervening effect when using the WPL-R, in research. This raises the question of whether it is acceptable to use a questionnaire with postpartum women without any knowledge of the possible effect it may have, even though the ethics committee has approved the study and considers the measure to be non-invasive.

ObjectivesTo identify implicit and more profound barriers and facilitators and involving context elements to accomplish sustained physical activity (PA) in patients with a chronic disease. Understanding these barriers and facilitators may help develop future strategies to be used by healthcare professionals in primary care to support patients with a chronic disease to reach sustained PA.Design and methodsThe qualitative, narrative research method storytelling was applied. Perspectives of both patients with a chronic disease (n=12) and involved healthcare professionals (n=11) were collected. Stories were audiotaped and retrieved from the transcriptions. Analysis involved a cyclic process of constant comparison. Main themes were arranged in the theoretical framework of the Capability, Opportunity, Motivation and Behaviour (COM-B) model.ParticipantsPatients were adults with a chronic disease or at high risk of developing a chronic disease who participated in a PA promoting programme. Eligible healthcare professionals were those involved in these PA promoting programmes in primary care, such as physiotherapists, nurse practitioners or sports consultants.ResultsFrom 176 stories, 62 relevant and unique stories were selected for further analysis. Eleven main themes were identified and afterwards linked to the COM-B model. Trust in one’s own capabilities and in the healthcare professional were relevant themes. Also, health literacy and coping with temporary interruption were important capabilities. Important motivators were customised PA, increasing awareness, meaningful activities, exercising in a group and success experiences. Aversion to sports was seen as a barrier. Interprofessional collaboration and prerequisites can be a facilitator or a barrier.ConclusionsThis study provides insight into deeper motivations, barriers and facilitators of sustained PA from both the patients’ and healthcare professionals’ perspective. Comparing these perspectives revealed different views and beliefs on some themes. Attention for temporary interruptions, aversion to sports and health literacy were identified to be important for sustained PA.

Background Preconception care (PCC) is care prior to conception to optimize parental health, and health of the future child, through biomedical and behavioral changes. Providing PCC to all women with a wish to conceive will improve perinatal health. PCC is especially important for women with a chronic disease, such as inflammatory bowel disease (IBD) and rheumatic diseases (RD). At present PCC is not part of routine care for these women. The aim of this study is to identify facilitators and barriers on a patient and professional level regarding the provision of PCC in women with IBD and RD. Methods An explorative survey study among women with IBD and RD, their treating physicians and obstetric professionals was performed. Patients with a wish to conceive, pregnant women or those with a recent pregnancy ( Results A total of 71% of the IBD patients (n = 22/31) and 35% of the RD patients (n = 20/58) received a PCC consultation. PCC consultation was considered easy to enter, short in time and patients felt comfortable. Patients (71% IBD; 62% RD) preferred a personal PCC consultation with their disease specific specialist together with an obstetrician. Patients specifically wanted to receive information about the safety of medication use and disease activity following delivery. Of the included healthcare professionals 67% (n = 31) agreed PCC was applicable to their patients. Main barrier to providing PCC was lack of time and unavailability of professionals. In total 41% (n = 16) of obstetric professionals felt they had the knowledge and skills to provide PCC compared to 33% (n = 1) and 75% (n = 3) of gastroenterologists and rheumatologists, respectively. Conclusion Lack of awareness and urgency for the effectuation can be seen as important barriers for implementation of PCC. Due to the explorative nature generalisation of the results is not allowed. In the future, adaptation of the curricula of healthcare professionals by implementing interventions for pregnancy planning and preparation will generate awareness. Modelling of the impact of PCC might prove useful in resolving the lack of urgency for PCC realization.

Purpose There has been increasing awareness of perinatal health and organisation of maternal and child health care in the Netherlands as a result of poor perinatal outcomes. Vulnerable women have a higher risk of these poor perinatal outcomes and also have a higher chance of receiving less adequate care. Therefore, within a consortium, embracing 100 organisations among professionals, educators, researchers, and policymakers, a joint aim was defined to support maternal and child health care professionals and social care professionals in providing adequate, integrated care for vulnerable pregnant women. Description Within the consortium, vulnerability is defined as the presence of psychopathology, psychosocial problems, and/or substance use, combined with a lack of individual and/or social resources. Three studies focussing on population characteristics, organisation of care and knowledge, skills, and attitudes of professionals regarding vulnerable pregnant women, were carried out. Outcomes were discussed in three field consultations. Assessment The outcomes of the studies, followed by the field consultations, resulted in a blueprint that was subsequently adapted to local operational care pathways in seven obstetric collaborations (organisational structures that consist of obstetricians of a single hospital and collaborating midwifery practices) and their collaborative partners. We conducted 12 interviews to evaluate the adaptation of the blueprint to local operational care pathways and its’ embedding into the obstetric collaborations. Conclusion Practice-based research resulted in a blueprint tailored to the needs of maternal and child health care professionals and social care professionals and providing structure and uniformity to integrated care provision for vulnerable pregnant women.

Background The Pictorial Fear of Activity Scale-Cervical (PFActS-C) is a reliable and valid instrument to assess fear of movement in people with whiplash associated disorders. It is not available in Dutch and has not been evaluated in other neck pain populations. This study aimed to systematically translate the PFActS-C into Dutch and evaluate the psychometric properties of this Dutch Language Version (DLV) in people with non-specific neck pain. Methods The PFActS-C was translated according to international guidelines. Internal consistency, test-retest reliability, floor and ceiling effects, face validity and construct validity (convergent and discriminant validity by hypotheses testing and structural validity by confirmatory and exploratory factor-analyses) of the PFActS-C-DLV were tested in 125 people with non-specific neck pain. Results The PFActS-C-DLV showed good to excellent internal consistency (Cronbach’s alpha: 0.98) and stability over time (ICC: 0.90 [95%CI: 0.82–0.93). Four out of five a priori formulated hypotheses regarding related (convergent validity) and unrelated (discriminant validity) constructs were confirmed. However, the confirmatory factor analysis could not confirm the expected 1-factor solution. Furthermore, the exploratory factor analyses revealed that also a higher factor solution would not lead to a good fit of the model. Conclusions The PFActS-C-DLV is a reliable region-specific instrument for people with non-specific neck pain. The construct validity was supported, based on hypotheses testing. However, factor analyses could not confirm a 1-factor solution, so the underlying construct of the PFActS-C-DLV remains unclear. Given the PFActS-C’s photographic format, we believe these findings also have relevance for the original English version.

Objective: To describe the epidemiology of health status, impairments, activities and participation in adults with cerebral palsy (CP). Data Sources: Embase, MEDLINE, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane, and Google Scholar were searched for 3 themes (“cerebral palsy,” “adult,” and “outcome assessment”) in literature published between January 2000 and December 2018. Study Selection: Full-article peer-reviewed English journal articles on descriptive, observational, or experimental studies describing the most studied outcomes in adults with CP (n≥25, age≥18y) were included. Studies were included in the analyses if frequently studied outcomes were described in at least 3 studies using similar methods of assessment. Data Extraction: Data were extracted independently by 2 authors from 65 articles (total N=28,429) using a standardized score sheet. Data Synthesis: Meta-analyses revealed that overall, on average 65.1% (95% confidence interval [CI], 55.1-74.5) of adults with CP experienced pain, 57.9% (95% CI, 51.1-64.6) were ambulant, 65.5% (95% CI, 61.2-69.7) had little or no limitation in manual ability, 18.2% (95% CI, 10.6-27.2) had tertiary education, 39.2% (95% CI, 31.5;47.1) were employed, and 29.3% (95% CI, 9.0-55.3) lived independently. In adults without intellectual disability, proportions of individuals who were ambulant (72.6% [95% CI, 58.8-84.5]) and lived independently (90.0% [95% CI, 83.8-94.9]) were higher (P=.014 and P

Background Exercise, a cornerstone in current treatments for people with musculoskeletal pain, elicits a phenomenon called exercise‐induced hypoalgesia (EIH), which may result in reduced pain intensity and/or increased pain thresholds. However, EIH can be impaired in patients with musculoskeletal pain, and psychosocial factors may play a mediating role in EIH. Objective The aim of this study was to systematically review the scientific literature regarding the association between psychosocial factors and EIH in healthy people and people with musculoskeletal pain. Methods An extensive search in databases including Medline Ovid, Embase, Web of Science, PsycINFO Ovid, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCOhost was carried out. Two reviewers independently carried out study selection, data extraction, and critical appraisal. Included studies analyzed the association or effect of psychosocial factors on EIH in adults with or without musculoskeletal pain. Results Nine cross‐sectional studies were included, 6 involving healthy people and 4 involving people with musculoskeletal pain; 1 study included both. Overall risk of bias was high. Different types of exercise bouts, psychosocial factors, and/or outcome measures were used across studies. In healthy people and people with musculoskeletal pain, most studies did not find an association between psychosocial factors and EIH. However, 1 study involving musculoskeletal pain and 2 studies with healthy people did find a significant association. Conclusion Due to poor quality and heterogeneity between studies, no conclusions can be drawn regarding whether psychosocial factors are associated with EIH or not. This review includes recommendations and directions for further research to investigate the role of psychosocial factors on EIH.

To provide: (a) an overview of interventions aimed at improving mental health of student or novice nurses; and (b) an evaluation of their effectiveness on dropout-related outcomes.Systematic review.Research papers published between January 1971-February 2019 were identified from the following databases: Embase, Medline, PsycInfo, CINAHL, ERIC, the Cochrane Library, Web of Science, and Google Scholar.We followed the procedures recommended by the Editorial Board of the Cochrane Collaboration Back Review Group. We included peer-reviewed articles with a quantitative research design, examining interventions aimed at improving mental health of student and novice nurses and their effect on dropout-related outcomes. The large variation in studies prohibited statistical pooling and a synthesis without meta-analysis of studies was performed.We identified 21 studies with three areas of focus: managing stress or stressors (N = 4); facilitating the transition to nursing practice (N = 14); and a combined approach (N = 3). Five studies showed a statistically significant effect on dropout-related outcomes. The overall risk of bias was high.A wide range of interventions are available, but the evidence for their effectiveness is limited. There is a need for high-quality studies in this field, preferably with a randomized controlled design.目的: 提供：（a）旨在改善学生或新手护士心理健康的干预措施概述；（b）评估其对辍学相关结果的有效性。 设计: 系统评估。 数据源: 1971年1月至2019年2月之间发表的研究论文来自以下数据库：Embase、Medline、PsycInfo、CINAHL、ERIC、科克伦图书馆（Cochrane Library），科学网（Web of Science）和谷歌学术（Google Scholar）。 评估方法: 我们遵循了科克伦协作回顾评述小组（Cochrane Collaboration Back Review Group）编辑委员会推荐的程序。我们纳入了具有定量研究设计的同行评审文章，研究了旨在改善学生和新手护士心理健康及其对辍学相关结果影响的干预措施。研究中的巨大差异无法进行统计汇总，采用了无荟萃分析研究的综合。 结果: 我们确定了21个研究，重点关注三个领域：管理压力或压力源（N = 4）；促进向护理实践的过渡（N = 14）；以及组合方法（N = 3）。五项研究表明，与辍学相关的结果在统计上具有显著影响。总体偏倚风险很高。 结论: 干预措施的种类很多，但其有效性的证据有限。这一领域需要高质量的研究，最好采用随机对照设计。.

textabstractIntroduction: For adequate pain treatment in patients with cancer, it is important to monitor and evaluate pain regularly. Although the numeric rating scale (NRS) is implemented in hospitals in the Netherlands, pain is still not systematically registered during outpatient consultations. The aim of this study was to assess whether home telemonitoring increases pain registration in medical records of outpatients with cancer. Methods: Patients with cancer were included in the intervention group (IG) when they visited the outpatient clinic. They received a short message service and an interactive voice response on their mobile phones 3 times a week, asking them to provide their pain score (NRS). When the reported NRS pain score was ≥5, a specialized oncology nurse adapted the pain treatment when necessary. Outcomes were compared to a control group (CG) without home telemonitoring. In both groups, medical records were analyzed and data on pain and analgesics were collected. Results: In each group, the medical records of 54 patients were analyzed on 3 consecutive outpatient visits. In the CG, pain registration or its absence was described in 60 visits (37.0%). In the IG, pain registration or its absence was reported in 83 visits (51.2%). Patients in the IG received a prescription for analgesics significantly more often (36/54 patients [66.6%]) than did patients in the CG (18/54 patients [33.3%]), P < 0.01). Conclusion: Home telemonitoring for patients with cancer significantly increases registration of pain and prescriptions of analgesics in outpatient medical records. Home telemonitoring helps to increase the awareness of pain and its management

PURPOSE: Youth with disabilities face challenges regarding achieving autonomy. The ?Skills for Growing Up? tool was adapted for use in Dutch pediatric rehabilitation (SGU-D) to support development of autonomy. This study presents the experiences with the SGU-D tool.METHODS: The SGU-D was implemented in 18 settings, of which 4 participated in the evaluation. Rehabilitation professionals were trained in the use of the SGU-D. In a qualitative study, participants were interviewed for their opinions regarding the tool.RESULTS: Experience with the SGU-D was evaluated in 11 youth with disabilities, 11 parents and 8 rehabilitation professionals. They perceived the SGU-D as a helpful tool: i) to support development of autonomy, ii) to focus on future perspectives, and iii) to facilitate communication with family and rehabilitation professionals. Additional support from rehabilitation professionals on using the SGU-D was appreciated.CONCLUSION: Youth with disabilities, their parents and rehabilitation professionals value the SGU-D as a practical tool for working on autonomy, and to identify important areas of development.

Background Neuropsychiatric symptoms occur frequently in many nursing home residents with dementia. Despite the availability of multidisciplinary guidelines, neuropsychiatric symptoms are often inadequately managed. Three proven effective methods for managing neuropsychiatric symptoms were integrated into a single intervention method: the STIP-Method, a personalized integrated stepped-care method to prevent and treat neuropsychiatric symptoms. The STIP-Method comprises 5 phases of clinical reasoning to neuropsychiatric symptoms and 4 stepped-care interventions and is supported with a web application. Objective This study aims to identify the facilitators and barriers in the implementation of the STIP-Method in nursing homes. Methods A mixed methods design within a participatory action research was used to implement the STIP-Method in 4 facilities of 2 Dutch nursing home organizations. In total, we aimed at participation of 160-200 persons with dementia and expected an intervention fidelity of 50% or more, based on earlier studies regarding implementation of effective psychosocial interventions to manage neuropsychiatric symptoms. All involved managers and professionals were trained in the principles of the STIP-Method and in using the web application. An advisory board of professionals, managers, and informal caregivers in each facility supported the implementation during 21 months, including an intermission of 6 months due to the COVID-19 pandemic. In these 6-weekly advisory board meetings, 2 researchers stimulated the members to reflect on progress of the implementation by making use of available data from patient records and the web application. Additionally, the 2 researchers invited the members to suggest how to improve the implementation. Data analysis will involve (1) analysis of facilitators and barriers to the implementation derived from verbatim text reports of advisory board meetings to better understand the implementation process; (2) analysis of patient records in accordance with multidisciplinary guidelines to neuropsychiatric symptoms: personalized, interdisciplinary, and proactive management of neuropsychiatric symptoms; (3) evaluation of the web application in terms of usability scores; (4) pre- and postimplementation analysis of patient records and the web application to evaluate the impact of the STIP-Method, such as changes in neuropsychiatric symptoms and informal caregiver burden. Results We enrolled 328 persons with dementia. Data collection started in July 2019 and ended in December 2021. The first version of this manuscript was submitted in October 2021. The first results of data analysis are expected to be published in December 2022 and final results in June 2023. Conclusions Our study may increase understanding of facilitators and barriers to the prevention and treatment of neuropsychiatric symptoms in nursing home residents with dementia by implementing the integrated STIP-Method. The need for well-designed implementation studies is of importance to provide nursing homes with optimal tools to prevent and treat neuropsychiatric symptoms. International Registered Report Identifier (IRRID) DERR1-10.2196/34550

Problem Within maternity care policies and practice, pregnant migrant women are regarded as a vulnerable population. Background Women’s experiential knowledge is a key element of woman-centred care but is insufficiently addressed in midwifery practice and research that involves migrant women. Aim To examine if pregnant migrant women’s experiential knowledge of vulnerability corresponds with sets of criteria of vulnerability, and to explore how migrant women make sense of vulnerability during pregnancy. Methods A sequential two-phased mixed-methods study, conducted in the Netherlands, integrating survey data of 89 pregnant migrant women and focus group data obtained from 25 migrant mothers - living in deprived areas according to the Dutch socio-economic index. Results Criteria associated with vulnerability were reported by 65.2% of the participants and 62.9% of the participants reported adverse childhood experiences. On a Visual Analogue Scale, ranging from 0 (not vulnerable) to 10 (very vulnerable), participants self-reported sense of vulnerability withshowed a mean score of 4.2 (±2.56). Women’s experiential knowledge of vulnerability significantly correlated with the mean sum score of clinical criteria of vulnerability (r .46;, p .002) and with the mean sum score of adverse childhood experiences (r .48, p < .001). Five themes emerged from the focus group discussions: “Look beyond who you think I am and see and treat me for who I really am”, “Ownership of truth and knowledge”, “Don’t punish me for being honest”, “Projection of fear” and “Coping with labelling”. Conclusion Pregnant migrant women’s experiential knowledge of vulnerability is congruent with the criteria. Calling upon experiential knowledge is an attribute of the humane woman-midwife relationship.

Background: Little is known, whether physical workload and musculoskeletal complaints (MSCs) have an impact on the intended or actual dropout of nursing students in the later years of their degree program.Purpose: Studying the determinants of intention to leave and actual dropout from nursing education. We hypothesized that physical workload and MSCs are positively associated with these outcomes.Methods: A prospective cohort study among 711 third-year students at a Dutch Bachelor of Nursing degree program. Multivariable backward binary logistic regression was used to examine the association between physical work factors and MSCs, and intention to leave or actual dropout.Results: Intention to leave was 39.9% and actual dropout 3.4%. Of the nursing students, 79% had regular MSCs. The multivariable model for intention to leave showed a significant association with male sex, working at a screen, physical activity, decision latitude, co-worker support, distress and need for recovery. The multivariable model for dropout showed a significant association with living situation (not living with parents), male sex, sick leave during academic year and decision latitude.Conclusions: Our research shows that the prevalence of MSCs among nursing students is surprisingly high, but is not associated with intention to leave nor with actual dropout.

Vanaf 2019 kunnen thuiswonende burgers vanaf 50 jaar gratis consulten krijgen van een geestelijk verzorger. De overheid veronderstelt een behoefte van ouderen aan ondersteuning bij zingeving, maar of en hoe ouderen deze behoefte aan ondersteuning zelf ervaren is onbekend. Actieonderzoekers van Linking-Zin stelden ouderen deze vraag.

Vanaf 2019 kunnen thuiswonende burgers vanaf 50 jaar gratis consulten krijgen van een geestelijk verzorger. De overheid veronderstelt een behoefte van ouderen aan ondersteuning bij zingeving, maar of en hoe ouderen deze behoefte aan ondersteuning zelf ervaren is onbekend. Actieonderzoekers van Linking-Zin stelden ouderen deze vraag.

Contains fulltext : 287756.pdf (Publisher’s version ) (Open Access) BACKGROUND: Non-traumatic complaints of the arm, neck and/or shoulder (CANS) are difficult-to-treat musculoskeletal conditions. CANS treatment has varying degrees of success, particularly in the working population. OBJECTIVES: To evaluate the experiences and needs of physiotherapists (PTs) and exercise therapists (ETs) regarding the treatment of working patients with CANS. DESIGN: An exploratory qualitative focus group study was conducted. METHOD: Qualitative data were collected from 27 therapists who were purposefully recruited for their broad range of experience and qualifications. The data was analysed using thematic analysis. RESULTS: Both PTs and ETs assess CANS extensively by exploring their patients' psychosocial factors, work-related factors, illness beliefs, and working conditions. Therapists apply hands-off treatment interventions, such as coaching the patient to make behavioural changes and providing self-management support. However, therapists experience many difficulties in these areas, resulting in a need to learn more about coaching techniques for behavioural change, engaging in meaningful conversations about the patient's perspective, supporting patients in building a strong social network in the workplace, and creating a professional network for collaboration. CONCLUSIONS: The treatment of working people with CANS is difficult for PTs and ETs. Therapists express a need to learn more about supporting self-management, applying coaching techniques and engaging in meaningful conversations. Moreover, therapists indicate a need to establish a professional multidisciplinary network to support collaborations with other disciplines to treat working patients with CANS.