Het is de week van de internationale student. Centraal staat het opdoen van een internationale ervaring. Wist je dat dit breder is dan enkel naar het buitenland gaan? Internationale competenties opdoen kan ook met internationalisaton at home (IaH). In deze aflevering van de podcastserie "Nuffic Actueel" gaan we in op een veelbesproken onderwerp: internationalisation at home. Wat is dat nu eigenlijk? En hoe ziet dit er uit in de praktijk? We gaan in gesprek met expert Eveke de Louw van het lectoraat Global Learning van de Haagse hogeschool. Ook studenten Thijs (Windesheim), Jan (HAN) en Alex (Hogeschool Leiden) sluiten aan en delen hun ervaring.
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Background Reduced aerobic capacity predicts poor postoperative outcomes in liver transplant candidates. While exercise is safe and effective, adherence remains a challenge. Home-based prehabilitation may improve participation, especially when tailored to the patient's fitness level. Objective To evaluate the effectiveness and feasibility of a home-based, bimodal (exercise + nutrition) prehabilitation program in frail patients with liver cirrhosis awaiting transplantation. Methods This prospective study started in October 2024 and includes patients with reduced aerobic capacity. The intervention combines high-intensity interval training and endurance training based on Steep Ramp Test results, resistance exercises, inspiratory muscle training, and protein supplementation. Primary outcome: VO₂ at ventilatory threshold and VO₂peak. Secondary outcomes: muscle mass (ultrasound, SARC-F, Liver Frailty Index), functional mobility, fatigue, quality of life, hepatic encephalopathy, microbiome, blood biomarkers, and postoperative outcomes. Feasibility is assessed through participation, adherence and safety. Results Of 41 screened patients, 8 were eligible and included; others were mostly too fit or ineligible. Three underwent transplantation before retesting. Among the remaining, adherence varied due to disease-related instability, yet several showed measurable improvement in aerobic capacity and muscle function. Home training combined with remote support proved acceptable and motivating for both patients and care teams. Technical monitoring allowed timely feedback and support, potentially enhancing adherence. Conclusion Home-based prehabilitation appears feasible and beneficial in selected, vulnerable liver transplant candidates. Inclusion continues toward a target of 24 patients.
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The transition from home to a nursing home can be stressful and traumatic for both older persons and informal caregivers and is often associated with negative outcomes. Additionally, transitional care interventions often lack a comprehensive approach, possibly leading to fragmented care. To avoid this fragmentation and to optimize transitional care, a comprehensive and theory-based model is fundamental. It should include the needs of both older persons and informal caregivers. Therefore, this study, conducted within the European TRANS-SENIOR research consortium, proposes a model to optimize the transition from home to a nursing home, based on the experiences of older persons and informal caregivers. These experiences were captured by conducting a literature review with relevant literature retrieved from the databases CINAHL and PubMed. Studies were included if older persons and/or informal caregivers identified the experiences, needs, barriers, or facilitators during the transition from home to a nursing home. Subsequently, the data extracted from the included studies were mapped to the different stages of transition (pre-transition, mid-transition, and post-transition), creating the TRANSCITmodel. Finally, results were discussed with an expert panel, leading to a final proposed TRANSCIT model. The TRANSCIT model identified that older people and informal caregivers expressed an overall need for partnership during the transition from home to a nursing home. Moreover, it identified 4 key components throughout the transition trajectory (ie, pre-, mid-, and post-transition): (1) support, (2) communication, (3) information, and (4) time. The TRANSCIT model could advise policy makers, practitioners, and researchers on the development and evaluation of (future) transitional care interventions. It can be a guideline reckoning the needs of older people and their informal caregivers, emphasizing the need for a partnership, consequently reducing fragmentation in transitional care and optimizing the transition from home to a nursing home.
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Purpose: To describe nurses' support interventions for medication adherence, and patients' experiences and desired improvements with this care. Patients and methods: A two-phase study was performed, including an analysis of questionnaire data and conducted interviews with members of the care panel of the Netherlands Patients Federation. The questionnaire assessed 14 types of interventions, satisfaction (score 0-10) with received interventions, needs, experiences, and desired improvements in nurses' support. Interviews further explored experiences and improvements. Data were analyzed using descriptive statistics and a thematic analysis approach. Results: Fifty-nine participants completed the questionnaire, and 14 of the 59 participants were interviewed. The satisfaction score for interventions was 7.9 (IQR 7-9). The most common interventions were: "noticing when I don't take medication as prescribed" (n = 35), "helping me to find solutions to overcome problems with using medications" (n = 32), "helping me with taking medication" (n = 32), and "explaining the importance of taking medication at the right moment" (n = 32). Fifteen participants missed ≥1 of the 14 interventions. Most mentioned the following: "regularly asking about potential problems with medication use" (33%), "regularly discussing whether using medication is going well" (29%), and "explaining the importance of taking medication at the right moment" (27%). Twenty-two participants experienced the following as positive: improved self-management of adequate medication taking, a professional patient-nurse relationship to discuss adherence problems, and nurses' proactive attitude to arrange practical support for medication use. Thirteen patients experienced the following as negative: insufficient timing of home visits, rushed appearance of nurses, and insufficient expertise about side effects and taking medication. Suggested improvements included performing home visits on time, more time for providing support in medication use, and more expertise about side effects and administering medication. Conclusion: Overall, participants were satisfied, and few participants wanted more interventions. Nurses' support improved participants' self-management of medication taking and enabled patients to discuss their adherence problems. Adequately timed home visits, more time for support, and accurate medication-related knowledge are desired.
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The 'implementation' and use of smart home technology to lengthen independent living of non-instutionalized elderly have not always been flawless. The purpose of this study is to show that problems with smart home technology can be partially ascribed to differences in perception of the stakeholders involved. The perceptual worlds of caregivers, care receivers, and designers vary due to differences in background and experiences. To decrease the perceptual differences between the stakeholders, we propose an analysis of the expected and experienced effects of smart home technology for each group. For designers the effects will involve effective goals, caregivers are mainly interested in effects on workload and quality of care, while care receivers are influenced by usability effects. Making each stakeholder aware of the experienced and expected effects of the other stakeholders may broaden their perspectives and may lead to more successful implementations of smart home technology, and technology in general.
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This chapter revisits the concept of internationalisation at home in light of the COVID pandemic and also of experiences and ongoing discourses on internationalisation. These include how internationalisation at home relates to diversity, inclusion and decolonisation of curricula. It discusses how the COVID pandemic has led to increased attention to internationalisation at home but also that confusion about terminology and the desire for physical mobility to be available to students may lead us to return to pre-COVID practices, in which internationalisation is mainly understood as mobility for a small minority of students and internationalisation of the home curriculum is a poor second best. A component of this chapter is how Virtual Exchange and Collaborative Online International Learning (COIL) have moved into the spotlight during the pandemic but were already in focus areas well before. This will be illustrated by some recent developments in internationalisation at home, mainly from non-Anglophone, European and particularly Dutch perspectives.
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The quality of the built environment can impact the quality of life and the sense of home of nursing home residents. This study investigated (1) which factors in the physical and social environment correlate with the sense of home of the residents and (2) which environmental factors are most meaningful. Twelve participants engaged in a qualitative study, in which photography was as a supportive tool for subsequent interviews. The data were analysed based on the six phases by Braun and Clarke. The four themes identified are (1) the physical view; (2) mobility and accessibility; (3) space, place, and personal belongings; and (4) the social environment and activities. A holistic understanding of which features of the built environment are appreciated by the residents can lead to the design and retrofitting of nursing homes that are more in line with personal wishes.
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BackgroundThe increasing demands of an aging population, healthcare workforce shortages, financial constraints, and a shift in care perspectives call for rethinking geriatric rehabilitation (GR). To ensure GR remains sustainable, a transition towards home-based GR is proposed, reducing the need for prolonged inpatient GR. This study assesses the outcomes, costs and feasibility of the “Better@Home” program, in which home-based GR replaces part of inpatient GR.MethodsThis multicenter cohort study is conducted in eight GR facilities in the Netherlands, implementing the Better@Home program. Core elements of this program include replacing part of inpatient GR with home-based GR, focusing on participation goals, using eHealth, promoting self-management, and fostering close collaboration among all care partners. Data is gathered through semi-structured interviews, questionnaires, group interviews, registration forms, and electronic patient files.The Better@Home study is designed as a cohort study accompanied by a mixed-methods feasibility study. The study includes an outcome-and cost assessment. Within the cohort study, two evaluations can be distinguished. The first is a comparative evaluation, comparing the multicentre prospective Better@Home cohort with a historical control group on the primary outcome measure, as well as patient, family, and healthcare-related costs, from admission to completion of GR. The primary outcome measure of the comparative evaluation is independence in activities of daily living, assessed by the Barthel Index. The second is a follow-up evaluation, to assess the course of the outcomes and costs from GR admission to three months of follow-up after GR completion, solely in the Better@Home cohort. The primary outcome measure of the follow-up evaluation is participation, assessed by the Canadian Occupational Performance Measure. The mixed-methods feasibility study incorporates both quantitative and qualitative methods. It evaluates the program’s reach, performance according to plan, active engagement of patients and informal caregivers, barriers and facilitators affecting implementation, and the opinions of patients, informal caregivers, and professionals on the program.DiscussionThis study offers insights into the potential of home-based GR. The multicentre and multilayered design enables a comprehensive evaluation of the Better@Home program’s outcomes, costs and feasibility, providing a basis for further optimization and upscaling of home-based GR.
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Background Neonatal hyperbilirubinemia is a leading cause of hospitalization during the first week of life. Recent research suggest that phototherapy, the standard treatment, can be safely and effectively administered at home. Some Dutch hospitals have already adopted home-based phototherapy. The TREAT Jaundice@home study aims to contribute to its broader implementation across the Netherlands. Understanding the perspectives, perceptions, and needs of healthcare professionals is essential for facilitating this implementation. Methods This cross-sectional survey targeted pediatricians, midwives, and maternity care assistants with and without prior experience with phototherapy at home. The 82-item questionnaire covered respondent background, experience, interests, motivation, responsibilities, logistics, collaboration, knowledge, indications and contraindications, financial aspects, and implementation readiness. Results The study included responses from 16 pediatricians, 90 community midwives, and 514 maternity care assistants. Findings indicate a positive reception of phototherapy at home, regardless of prior experience. The majority expressed satisfaction, recognized potential benefits, and/or demonstrated a willingness to adopt this innovation. Key challenges identified include the need for information, the lack of guidelines, coordination and collaboration issues, and concerns about financial compensation. Discussion Phototherapy at home is well-received by healthcare professionals. Addressing the identified challenges is imperative for successful implementation, ultimately benefiting neonates, their families, and healthcare systems. Impact Phototherapy at home is well-received and perceived as beneficial by healthcare professionals with and without prior experience Key challenges include the need for better knowledge and guidelines, coordination and collaboration issues among healthcare professionals, and concerns about financial compensation Addressing these challenges through comprehensive information, standardized protocols, improved collaboration, and adequate financial compensation is essential to successfully implement phototherapy at home on a larger scale
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