BACKGROUND: Delirium is a frequent form of psychopathology in elderly hospitalized patients; it is a symptom of acute somatic illness. The consequences of delirium include high morbidity and mortality, lengthened hospital stay, and nursing home placement. Early recognition of delirium symptoms enables the underlying cause to be diagnosed and treated and can prevent negative outcomes. The aim of this study was to determine which of the two delirium observation screening scales, the NEECHAM Confusion Scale or the Delirium Observation Screening (DOS) scale, has the best discriminative capacity for diagnosing delirium and which is more practical for daily use by nurses. METHODS: The project was conducted on four wards of a university hospital; 87 patients were included. During 3 shifts, these patients were observed for symptoms of delirium, which were rated on both scales. A DSM-IV diagnosis of delirium was made or rejected by a geriatrician. Nurses were asked to rate the practical value of both scales using a structured questionnaire. RESULTS: The sensitivity (0.89-1.00) and specificity (0.86-0.88) of the DOS and the NEECHAM were high for both scales. Nurses rated the practical use of the DOS scale as significantly easier than the NEECHAM. CONCLUSION: Successful implementation of standardized observation depends largely on the consent of professionals and their acceptance of a scale. In our hospital, we therefore chose to involve nurses in the choice between two instruments. During the study they were able to experience both scales and give their opinion on ease of use. In the final decision on the instrument we found that both scales were very acceptable in terms of sensitivity and specificity, so the opinion of the nurses was decisive. They were positive about both instruments; however, they rated the DOS scale as significantly easier to use and relevant to their practice. Our findings were obtained from a single site study with a small sample, so a large comparative trial to study the value of both scales further is recommended. On the basis of our experience during this study and findings from the literature with regard to the implementation of delirium guidelines, we will monitor the further implementation of the DOS Scale in our hospital with intensive consultation.
A burden scale is described that is conceptually specific by concentrating on an assessment of different aspects of distress of care-giving burden and conceptually sensitive by distinguishing two dimensions: the relationship of the carer and the care-receiver and the limitations in the personal life of the carer. To develop a burden scale an analysis was carried out on a database of an intervention study in which 89 informal caregivers of psychogeriatric patients were interviewed twice. A principal components analysis was carried out showing two main factors that could be interpreted as the two dimensions mentioned above. Reliability analysis showed a Cronbach's alpha of 0.84 for the total care-giving burden scale (13 items) and 0.77 for both subscales (7 and 6 items), confirmed in an independent sample. An analysis of the hierarchy of items (Mokken Scale Analysis) showed a strong and moderate hierarchy for the subscales and the total scale, respectively. Finally, an analysis of construct validity showed strong correlations of care-giving burden with depression of the carer and deviant behaviour of the patient.
Description: The Neck Pain and Disability Scale (NPDS or NPAD) is a questionnaire aiming to quantify neck pain and disability.1 It is a patient-reported outcome measure for patients with any type of neck pain, of any duration, with or without injury.1,2 It consists of 20 items: three related to pain intensity, four related to emotion and cognition, four related to mobility of the neck, eight related to activity limitations and participation restrictions and one on medication.1,3 Patients respond to each item on a 0 to 5 visual analogue scale of 10 cm. There is also a nine-item short version.4 Feasibility: The NPDS is published and available online (https://mountainphysiotherapy.com.au/wp-content/uploads/2016/08/Neck-Pain-and-Disability-Scale.pdf).1 The NPDS is an easy to use questionnaire that can be completed within 5 to 8 minutes.1,5 There is no training needed to administer the instrument but its validity is compromised if the questionnaire must be read to the patient.2 Higher scores indicate higher severity (0 for normal functioning to 5 for the worst possible situation ‘your’ pain problem has caused you).2 The total score is the sum of scores on the 20 items (0 to 100).1 The maximum acceptable number of missing answers is three (15%).4 Two studies found a minimum important change of 10 points (sensitivity 0.93; specificity 0.83) and 11.5 points (sensibility 0.74; specificity 0.70), respectively.6,7 The NPDS is available in English, Dutch, Finnish, French, German, Italian, Hindi, Iranian, Korean, Turkish, Japanese and Thai. Reliability and validity: Two systematic reviews have evaluated the clinimetric properties of 11 of the translated versions.5,8 The Finnish, German and Italian translations were particularly recommended for use in clinical practice. Face validity was established and content validity was confirmed by an adequate reflection of all aspects of neck pain and disability.1,8 Regarding structural validity, the NPDS is a multidimensional scale, with moderate evidence that the NPDS has a three-factor structure (with explained variance ranging from 63 to 78%): neck dysfunction related to general activities; neck pain and neck-specific function; and cognitive-emotional-behavioural functioning. 4,5,9 A recent overview of four systematic reviews found moderate-quality evidence of high internal consistency (Cronbach’s alphas ranging from 0.86 to 0.93 for the various factors).10 Excellent test-retest reliability was found (ICC of 0.97); however, the studies were considered to be of low quality.3,10 Construct validity (hypotheses-testing) seems adequate when the NPDS is compared with the Neck Disability Index and the Global Assessment of Change with moderate to strong correlations (r = 0.52 to 0.86), based on limited moderate-quality studies.3,11,12 One systematic review reported good responsiveness to change in patients (r = 0.59).12
Beweegrichtlijnen geven aan hoeveel beweging nodig is voor een goede gezondheid van jong tot oud. Voor een gezonde leefstijl van kinderen zijn bewegen, samen spelen, samen leren en samen werken van groot belang, maar dat geldt ook voor ouderen. Picoo brengt het belang van bewegen en samenzijn bij elkaar. Dat zorgt voor een goede ontwikkeling van het kind, het welzijn van ouderen en het verstevigen van het bewegen en samenzijn in de maatschappij. Project: Actief Plezier met Picoo: Jong en Oud in Beweging! Vraag: Draagt Picoo bij aan meer beweging en verbinding tussen kinderen en ouderen door samen te bewegen? Doel: Het inzetten van Picoo leidt tot meer samen beweging, waardoor welzijn van ouderen en ontwikkeling van het kind en meer beweging wordt vergroot. Methode: Mixed method observatieonderzoek /survey/kort gesprek Kinderen tot 18 jaar en senioren 65 plus met een zorgvraag T0: kinderen en ouderen krijgen uitleg over het gebruik van Picoo Interventie: Picoo is een controller en spelcomputer ineen, ontwikkeld om kinderen (maar ook volwassen) interactief buiten te laten spelen.6 Tijdens de actieve games heeft elke deelnemer een eigen controller. De controllers staan met elkaar in verbinding. T1 Tijdens het spel wordt d.m.v. een observatielijst gekeken hoe jong en oud reageren op het samen spelen met Picoo. T2 Na het spel geven kinderen en ouderen door middel van Visual Analogue Scale (smileys) wat hun ervaringen zijn. T3 Na het spel gaan kinderen en ouderen kort met elkaar in gesprek over hun ervaringen Uitvoering: Interdisciplinaire mix van studenten Verpleegkunde, Fysiotherapie, Mens en Techniek en Social Work Eindproduct: Nieuwe testcase en input voor doorontwikkeling Picoo richting verbinding jong en oud. Kennis over mogelijkheden/ervaringen over verbinding door beweging wordt gedissemineerd naar de praktijk en onderwijs. Resultaten worden gerapporteerd en gepubliceerd op relevante sites zoals bijvoorbeeld kenniscentrum sport en bewegen, zorginstellingen en scholen.
In dit project verricht het lectoraat Familiebedrijven van Hogeschool Windesheim samen met CAH Vilentum in Dronten, LTO Noord, NAJK en agrarische MKB familiebedrijven praktijkgericht onderzoek naar de familiale en bedrijfsmatige aspecten rond opvolging bij agrarische MKB familiebedrijven. Met dit project wordt nieuwe kennis ontwikkeld, die aansluit bij kennis over opvolging in familiebedrijven en die specifiek wordt toegepast binnen de agrarische sector. Bijna de helft van alle agrarische bedrijven in Nederland heeft een bedrijfshoofd van 55 jaar of ouder. Het merendeel van deze bedrijven is een familiebedrijf en heeft te maken met het onderwerp bedrijfsopvolging. Voor een geslaagd opvolgingsproces is het belangrijk dat familiebelangen en bedrijfsbelangen adequaat worden gebalanceerd. In de praktijk blijkt het lastig deze belangen rond overdracht van leiding en eigendom bespreekbaar te maken en goed af te wegen. Vanuit agrarische families is daarom de vraag hoe het opvolgingsproces het beste kan worden vormgegeven en welke instrumenten daarbij kunnen worden ingezet. De belangrijkste doelstelling van dit project is om nieuwe kennis op te doen over het opvolgingsproces bij agrarische familiebedrijven en het opvolgingsproces met instrumenten in positieve zin te veranderen. Door kwalitatief onderzoek worden belemmerende factoren rond opvolging in de agrarische context onderzocht. Op basis van deze nieuwe inzichten worden instrumenten ontwikkeld die het opvolgingsproces faciliteren. Door interventies zal worden vastgesteld of de instrumenten in de praktijk werken. De kennis die uit dit project voortkomt, beoogt daarmee het handelingsvermogen van agrarische families rond bedrijfsopvolging te ondersteunen. Het project levert een bijdrage aan bestaande kennis door gebruik te maken van multi-level onderzoek (perspectief van de opvolger, overdrager, familieleden, familie en bedrijf) en het observeren van gesprekken over het opvolgingsproces, de familie en het bedrijf. Het meest concrete resultaat is een beschrijving van een model opvolgingsproces met bijbehorende instrumenten om belangrijke onderwerpen rond opvolging bespreekbaar te maken, zoals een zelfanalyse instrument, een stappenplan, hulpmiddelen om gesprekken te faciliteren en een model familiestatuut afgestemd op agrarische familiebedrijven.
Denim Democracy from the Alliance for Responsible Denim (ARD) is an interactive exhibition that celebrates the journey and learning of ARD members, educates visitors about sustainable denim and highlights how companies collaborate together to achieve results. Through sight, sound and tactile sensations, the visitor experiences and fully engages sustainable denim production. The exhibition launches in October 2018 in Amsterdam and travels to key venues and locations in the Netherlands until April 2019. As consumers, we love denim but the denim industry, like other sub-sectors in the textile, apparel and footwear industries, faces many complex sustainability challenges and has been criticized for its polluting and hazardous production practices. The Alliance for Responsible Denim project brought leading denim brands, suppliers and stakeholders together to collectively address these issues and take initial steps towards improving the ecological sustainability impact of denim production. Sustainability challenges are considered very complex and economically undesirable for individual companies to address alone. In denim, small and medium sized denim firms face specific challenges, such as lower economies of scale and lower buying power to affect change in practices. There is great benefit in combining denim companies' resources and knowledge so that collective experimentation and learning can lift the sustainability standards of the industry and lead to the development of common standards and benchmarks on a scale that matters. If meaningful, transformative industrial change is to be made, then it calls for collaboration between denim industry stakeholders that goes beyond supplier-buyer relations and includes horizontal value chain collaboration of competing large and small denim brands. However collaboration between organizations, and especially between competitors, is highly complex and prone to failure. The research behind the Alliance for Responsible Denim project asked a central research question: how do competitors effectively collaborate together to create common, industry standards on resource use and benchmarks for improved ecological sustainability? To answer this question, we used a mixed-method, action research approach. The Alliance for Responsible Denim project mobilized and facilitated denim brands to collectively identify ways to reduce the use of water and chemicals in denim production and then aided them to implement these practices individually in their respective firms.
