Zoekresultaten

Exploring the Feasibility of Relapse Prevention Strategies in Interdisciplinary Multimodal Pain Therapy Programs: Qualitative Study

Background: Although interdisciplinary multimodal pain treatment (IMPT) programs are widely regarded as treatment of choice for patients with chronic pain, there are signs that many patients are unable to maintain their treatment gains in the long term. To facilitate the maintenance of positive treatment outcomes over time, we developed two relapse prevention strategies. Objective: The main objective of this study was to explore the feasibility of these strategies within the context of IMPT programs. Methods: We performed a feasibility study using 3 workbook prototypes containing either one or both strategies. For a period of 6 months, the workbooks were made available in two IMPT facilities. Qualitative data were collected through a focus group and semistructured interviews. We performed a thematic analysis using a deductive approach with (1) applicability to the treatment program, (2) acceptability of the workbook content, and (3) form, as predefined themes. Results: The final dataset consisted of transcripts from a focus group with health care providers and 11 telephone interviews and 2 additional in-depth interviews with patients. In general, the intervention was perceived as useful, easy to use, and in line with the treatment program. The data also include suggestions to further improve the use of both strategies, including more specific implementation guidelines, revised goal-setting procedure, and development of a mobile health version. However, several factors, including a high dropout rate and small sample size, impact the external validity of our findings. Conclusions: This study should be regarded as a first step in the process of transforming the prototype workbook into an effective intervention for clinical practice. Although these initial results indicate a favorable evaluation of both behavior regulation strategies within the workbook, this study encountered multiple barriers regarding implementation and data collection that limit the generalizability of these results. Future research efforts should specifically address the fidelity of HCPs and patients and should include clear procedures regarding recruitment and use of both relapse prevention strategies during treatment.

Feasibility of a microlearning intervention about nutritional care for older adults provided by hospital and home care nurses and nursing assistants: A mixed-methods study

Background and objective: Hospital and home care nurses and nursing assistants do not provide optimal nutritional care to older adults, which is due to several factors that influence their current behaviour. To successfully target these factors, we developed a microlearning intervention. The next step is to assess its feasibility to achieve the best fit with nursing practice. The aim of this study was to test the feasibility of the microlearning intervention about nutritional care for older adults provided by hospital and home care nurses and nursing assistants. Methods: In a multicentre study, we used a mixed-methods design. Feasibility was determined by assessing 1) recruitment and retention of the participants and 2) the acceptability, compliance and delivery of the intervention. Data about the use of the intervention (consisting of 30 statements), and data from a standardised questionnaire and two focus group interviews were used to measure the feasibility outcomes. Results: Fourteen teams with a total of 306 participants (response rate: 89.7%) completed the intervention and the median (Q1, Q3) score for completed statements per participant was 23 (12, 28). The mean proportion of correct answers was 72.2%. Participants were both positive and constructive about the intervention. They confirmed that they mostly learned from the intervention. Overall, the intervention was acceptable to the participants and compliance and delivery was adequate. Conclusions: The microlearning intervention is mostly feasible for hospital and home care nurses and nursing assistants. Based on participants’ constructive feedback, we consider that the intervention needs refinement to improve its feasibility.

Feasibility Study to Assess Canagliflozin Distribution and Sodium-Glucose Co-Transporter 2 Occupancy Using [18F]Canagliflozin in Patients with Type 2 Diabetes

Sodium-glucose co-transporter 2 (SGLT2) inhibitors, including canagliflozin, reduce the risk of cardiovascular and kidney outcomes in patients with and without type 2 diabetes, albeit with a large interindividual variation. The underlying mechanisms for this variation in response might be attributed to differences in SGLT2 occupancy, resulting from individual variation in plasma and tissue drug exposure and receptor availability. We performed a feasibility study for the use of [18F]canagliflozin positron emission tomography (PET) imaging to determine the association between clinical canagliflozin doses and SGLT2 occupancy in patients with type 2 diabetes. We obtained two 90-minute dynamic PET scans with diagnostic intravenous [18F]canagliflozin administration and a full kinetic analysis in 7 patients with type 2 diabetes. Patients received 50, 100, or 300 mg oral canagliflozin (n = 2:4:1) 2.5 hours before the second scan. Canagliflozin pharmacokinetics and urinary glucose excretion were measured. The apparent SGLT2 occupancy was derived from the difference between the apparent volume of distribution of [18F]canagliflozin in the baseline and post-drug PET scans. Individual canagliflozin area under the curve from oral dosing until 24-hours (AUCP0-24h) varied largely (range 1,715–25,747 μg/L*hour, mean 10,580 μg/L*hour) and increased dose dependently with mean values of 4,543, 6,525, and 20,012 μg/L*hour for 50, 100, and 300 mg, respectively (P = 0.046). SGLT2 occupancy ranged between 65% and 87%, but did not correlate with canagliflozin dose, plasma exposure, or urinary glucose excretion. We report the feasibility of [18F]canagliflozin PET imaging to determine canagliflozin kidney disposition and SGLT2 occupancy. This suggests the potential of [18F]canagliflozin as a tool to visualize and quantify clinically SGLT2 tissue binding.

Effectieve werkwijzen in reclasseringstoezicht

In dit systematische literatuuronderzoek is kennis uit empirisch onderzoek in kaart gebracht over de werkzaamheid van werkwijzen voor reclasseringstoezicht. Werkzaamheid is daarbij gedefinieerd als: bijdragen aan recidivevermindering, beter functioneren van cliënten op verschillende gebieden of voorkomen van overtreding van voorwaarden en uitval. Op grond van een systematische verkenning van de (inter)nationale literatuur zijn 141 artikelen en rapporten geselecteerd en geanalyseerd. Van de volgende werkwijzen is voldoende empirische onderbouwing om te stellen dat deze werkzaam zijn in reclasseringstoezicht: • Hybride werken: combinatie van monitoring en begeleiding. • Inzetten van de zogenoemde RNR-principes als basis voor reclasseringstoezicht: ➢ Intensiviteit van de aanpak sluit aan bij het recidiverisico; ➢ Focus op dynamische criminogene factoren; ➢ Een cognitief-gedragsmatige aanpak, die is afgestemd op de krachten, motivatie, mogelijkheden, beperkingen en situatie van de cliënt. • Continuïteit in de relatie tussen reclasseringswerker en cliënt. • Een goede relatie / werkalliantie tussen reclasseringswerker en cliënt. • Prosociaal modelleren: voorbeeldgedrag laten zien, positief waarderen van prosociale uitingen en gedragingen door de cliënt, en afkeuren van procriminele uitingen en gedragingen. • Inzetten van cognitief gedragsmatige technieken. • Cliënten ondersteunen bij het versterken van hun vermogen om problemen op te lossen. • Ondersteunen bij het aangaan en onderhouden van prosociale bindingen en het doorbreken van sociale contacten die delictgedrag bevorderen.

Traumabehandeling bij kinderen met een licht verstandelijke beperking : Naar een methodiek voor de behandeling van getraumatiseerde kinderen en jongeren met een licht verstandelijke beperking.

Power-to-ammonia: rethinking the role of ammonia – from a value product to a flexible energy carrier (FlexNH3)

This report focuses on the feasibility of the power-to-ammonia concept. Power-to-ammonia uses produced excess renewable electricity to electrolyze water, and then to react the obtained hydrogen with nitrogen, which is obtained through air separation, to produce ammonia. This process may be used as a “balancing load” to consume excess electricity on the grid and maintain grid stability. The product, ammonia, plays the role of a chemical storage option for excess renewable energy. This excess energy in the form of ammonia can be stored for long periods of time using mature technologies and an existing global infrastructure, and can further be used either as a fuel or a chemical commodity. Ammonia has a higher energy density than hydrogen; it is easier to store and transport than hydrogen, and it is much easier to liquefy than methane, and offers an energy chain with low carbon emissions.The objective of this study is to analyze technical, institutional and economic aspects of power-to-ammonia and the usage of ammonia as a flexible energy carrier.