The aim of this study was to describe patients' experiences of, and preferences for, surgical wound care discharge education and how these experiences predicted their ability to self-manage their surgical wounds. A telephone survey of 270 surgical patients was conducted across two hospitals two weeks after discharge. Patients preferred verbal (n = 255, 94.8%) and written surgical wound education (n = 178, 66.2%) from medical (n = 229, 85.4%) and nursing staff (n = 211, 78.7%) at discharge. The most frequent education content that patients received was information about follow-up appointments (n = 242, 89.6%) and who to contact in the community with wound care concerns (n = 233, 86.6%). Using logistic regression, patients who perceived that they participated in surgical wound care decisions were 6.5 times more likely to state that they were able to manage their wounds at home. Also, patients who agreed that medical and/or nursing staff discussed wound pain management were 3.1 times more likely to report being able to manage their surgical wounds at home. Only 40% (107/270) of patients actively participated in wound-related decision-making during discharge education. These results uncovered patient preferences, which could be used to optimise discharge education practices. Embedding patient participation into clinical workflows may enhance patients' self-management practices once home.
BACKGROUND: An early return to normal intake and early mobilization enhances postoperative recovery. However, one out of six surgical patients is undernourished during hospitalization and approximately half of the patients eat 50% or less of the food provided to them. We assessed the use of newly introduced breakfast buffets in two wards for gastrointestinal and oncological surgery and determined the impact on postoperative protein and energy intake.METHODS: A prospective pilot cohort study was conducted to assess the impact of the introduction of breakfast buffets in two surgical wards. Adult patients had the opportunity to choose between an attractive breakfast buffet and regular bedside breakfast service. Primary outcomes were protein and energy intake during breakfast. We asked patients to report the type of breakfast service and breakfast intake in a diary over a seven-day period. Prognostic factors were used during multivariable regression analysis.RESULTS: A total of 77 patients were included. The median percentage of buffet use per patient during the seven-day study period was 50% (IQR 0-83). Mean protein intake was 14.7 g (SD 8.4) and mean energy intake 332.3 kcal (SD 156.9). Predictors for higher protein intake included the use of the breakfast buffet (β = 0.06, p = 0.01) and patient weight (β = 0.13, p = 0.01). Both use of the breakfast buffet (β = 1.00, p = 0.02) and Delirium Observation Scale scores (β = -246.29, p = 0.02) were related to higher energy intake.CONCLUSION: Introduction of a breakfast buffet on a surgical ward was associated with higher protein and energy intake and it could be a promising approach to optimizing such intake in surgical patients. Large, prospective and preferably randomized studies should confirm these findings.
Abstract Purpose Knowledge of clinical pharmacotherapy is essential for all who prescribe medication. The aims of this study were to investigate differences in the pharmacotherapy and polypharmacy knowledge of medical and surgical residents and consultants and whether this knowledge can be improved by following an online course. Methods Design: A before-and-after-measurement. Setting: An online course available for Dutch residents and consultants working in hospitals. Study population: Dutch residents and consultants from different disciplines who voluntarily followed an online course on geriatric care. Intervention An online 6-week course on geriatric care, with 1 week dedicated to clinical pharmacotherapy and polypharmacy. Variables, such as medical vs surgical specialty, consultant vs resident, age, and sex, that could predict the level of knowledge. The effects of the online course were studied using repeated measures ANOVA. The study was approved by the National Ethics Review Board of Medical Education (NERB dossier number 996). Results A total of 394 residents and 270 consultants, 220 from surgical and 444 from medical specialties, completed the online course in 2016 and 2017. Residents had higher test scores than consultants for pharmacotherapy (73% vs 70%, p<0.02) and polypharmacy (75% vs 72%, p<0.02). The learning effect did not differ. Medical residents/consultants had a better knowledge of pharmacotherapy (74% vs 68%, p<0.001) and polypharmacy (77% vs 66%, p<0.001) than surgical residents/consultants, but the learning effect was the same. Conclusions Residents and consultants had a similar learning curve for acquiring knowledge, but residents outperformed consultants on all measures. In addition, surgical and medical residents/consultants had similar learning curves, but medical residents/consultants had higher test scores on all measures.
MULTIFILE
Since 2015, the research group Lifelong Learning in Music of Hanze University of Applied Sciences Groningen, together with the University Medical Center Groningen (UMCG), has developed and researched the MiMiC practice for patients and nurses on surgical wards. The musicians make tailor-made music in the patients' rooms in collaboration with patients and nurses. They do this on the basis of verbal and non-verbal contact with patients and nurses. Person-centred music-making turns out to be easy to realise in a medical setting and to be meaningful for all involved. People who have just had surgery experience less pain. Nurses feel more deeply involved with their patients. Musicians show sensitivity for the social context in which they carry out their artistic practice.In this project the research group is developing an innovative artistic practice with a focus on elderly patients. Musicians work with patients and the care staff that are taking care of these patients during their stay in hospital. The research should lead to insights in the effects of this practice and to a new training for master students and professional musicians who want wish to specialise themselves in this field. Pilots on six different wards of the UMCG with professional musicians and master students are part of the research which will last two years in its entirety. The project has been granted funding from the 'Banning de Jong Fonds' of the national 'Prins Bernhard Cultuurfonds' and the 'Fonds Sluyterman van Loo'.
In Nederland worden jaarlijks meer dan 2 miljoen operaties uitgevoerd waarbij 75% van de patiënten acute pijn krijgen. Bij één op de tien mensen ontwikkelt de acute pijn zich tot chronische pijn en bij één op de zeven mensen leidt dat tot langdurig opioïdengebruik. Mensen met beperkte gezondheidsvaardigheden hebben hierop een verhoogd risico. Deze problemen leiden niet alleen tot een traag herstel, de ontwikkeling van nieuwe ziekten of vermindering van de levenskwaliteit, maar maatschappelijk gezien neemt het werkvermogen af en de medische zorgconsumptie toe. Het is belangrijk dat zorgprofessionals deze potentiële problemen vroegtijdig herkennen en passende interventies uitvoeren, voor en na een operatie om ernstige gevolgen van pijn en langdurig gebruik van opioïden te verminderen. Een antwoord op deze problemen is de begeleiding van patiënten door zorgprofessionals, die werkzaam zijn in een zogenaamde Transitionele Pijn Service. Zij kunnen de multidisciplinaire pijnzorg coördineren, de patiënt (met beperkte gezondheidsvaardigheden) en naaste coachen en begeleiden in de pijnbehandeling, en opioïde pijnmedicatie tijdig helpen afbouwen, ook in de thuissituatie. Zorgprofessionals voelen zich echter handelingsverlegen ten aanzien van welke interventies en hulpmiddelen ze hierbij in kunnen zetten, en hoe ze daarbij patiënten met beperkte gezondheidsvaardigheden adequaat kunnen ondersteunen. Doel van dit project is om voor en door zorgprofessionals en samen met ervaringsdeskundigen een tool set van preventieve gepersonaliseerde interventies en hulpmiddelen te ontwikkelen om kwetsbare chirurgische patiënten met beperkte gezondheidsvaardigheden te ondersteunen. Hiermee kunnen patiënten vanaf de voorbereiding tot in de thuissituatie begeleiding ontvangen, gestimuleerd worden in zelfmanagement, en zal acute en chronische pijn en langdurig en ongewenst opioïdengebruik verminderen. Deze tool set, die ontwikkeld wordt via ontwerpgericht onderzoek, zal in een pilot getest worden op bruikbaarheid, acceptatie en toepasbaarheid. Tevens ontwikkelen we een onderwijsmodule voor zorgprofessionals in het initiële zorgonderwijs en voor bij-en nascholingstrajecten, zodat zorgprofessionals in het hele land hiermee gaan werken.
The clubfoot deformity is one of the most common congenital orthopaedic “conditions”. Worldwide approximately 100,000 children are born with unilateral or bilateral clubfoot every year. In the Netherlands the incidence is approximately 175 every year. This three dimensional deformity of the foot involves, equinus, varus, adductus, and cavus . Left untreated the clubfoot leads to deformity, functional disability and pain. Physical impairments of children with clubfoot might lead to limitations in activities and therefore impede a child’s participation. In clinical practice, the orthopaedic surgeon and physiotherapists are regularly consulted by (parents of) clubfoot patients for functional problems such as impaired walking and other daily activities. This does not only affect long-term and physical health of a child, it will also affect the development of social relationships and skills as well. Since walking is a main activity in children to be able to participate in daily life, our previous study (financially supported by SIA Raak Publiek) focussed on gait differences between children with clubfoot and controls. However, differences in gait characteristics do not necessarily lead to functional limitations and restricted participation. Therefore, providing insight in participation and a child’s performance in other activities than walking is necessary. Insight in a child’s participation will also indicate the functional outcome of the treatment, which on its turn could provide essential information concerning a possible relapse.. Early identification of a relapse is important since it could prevent the need for major surgical interventions. The occurrence of a relapse clubfoot will probably also lead to functional differences in the foot as well as problems during activity and participation. Therefore, the main focus of this study is the functional outcomes of physical activities and the characterisation of participation of children with clubfeet in daily activities of childhood.
