Most studies described in this thesis were part of a consortium-inspired research program ‘Transmural collaboration in palliative care’ in the southwest region of the Netherlands.
The first aim was to gain insight into the perspectives and experiences of nurses and physicians working in different care settings on transmural collaboration in palliative care and into their underlying attitudes towards transmural collaboration. We found that most healthcare professionals attach much importance to transmural collaboration and continuity of palliative care for patients and their relatives. However, in clinical practice transmural collaboration and information exchange are often perceived as sub-optimal. Our findings indicate that healthcare professionals need more shared professional attitudes towards transmural collaboration in palliative care.
The second aim was to gain insight into how transmural collaboration in palliative care can be efficiently organized. We found that nurses and physicians need more guidance in defining shared views on goals, activities and working procedures and on organizational issues.
Livestream link: https://youtu.be/QXSnbPzqUZE
Traumatic Brain Injury (TBI) and stroke are major public health concerns and these patients are often admitted to neurocritical care for intensive monitoring and treatments. Comparative Effectiveness Research has been proposed to study the effect treatments and management strategies for patients admitted to neurocritical care. The objective of this thesis was to describe the contemporary landscape of neurocritical care in Europe and Australia and to assess the effectiveness and quality of neurocritical care. This research was part of the CENTER-TBI study and the OzENTER-TBI study, prospective observational cohort studies of patients with TBI in Europe, Israel and Australia and the MR CLEAN study, a Dutch collaboration of patients with ischemic stroke that are treat with Endovascular Thrombectomy. Results from this thesis demonstrated that compared to previous studies, patients with TBI in neurocritical care are older, more often have mild TBI and a substantial part stays in the ICU for less than 72 hours. We observed large variation between centres, regions, and countries regarding to case-mix, specific interventions, and management aspects in neurocritical care, but variation in outcome between centres and countries were smaller. In critically ill patients with TBI, more positive fluid balances were associated with worse outcomes.
In this thesis we studied the perception of leprosy, interventions to change these perceptions, and interventions to reduce the impact of leprosy at individual and family level. We showed that interventions that focus on the entire family and that aim to strengthen resilience or social support and social connection, have the potential to reduce the impact of leprosy at individual and family level. While these interventions can the reduce the impact of leprosy at individual and family level, they do not target the sources of stigma (public perceptions). We also developed two interventions to change public perceptions of leprosy, based on knowledge gaps, misconceptions, beliefs and fears we identified. These two interventions (contextualised posters and community meetings) were effective in increasing knowledge and changing personal and perceived community attitudes. We identified three main drivers of negative attitudes: (1) poor knowledge and misconceptions about leprosy, (2) local beliefs about leprosy, and (3) fear of contagion. Interventions to change the perception of leprosy should target these drivers taking care to adapt these carefully to the local context.
Patient-reported outcome measures (PROMs) can be defined as instruments that measure aspects of a patient’s health condition and/ or treatment that come directly from the patient, thus without external interpretation. PROMs have been implemented in clinical care with wide-ranging intentions: from screening of health problems, monitoring patients’ response to treatment, facilitating patient-provider communication, enhancing shared decision-making, to benchmarking healthcare institutions for quality-of-care improvement.
The overall aim of this dissertation has been to study methodological aspects of the analysis of PROMs such as case-mix adjustment, and to explore the implementation and application of PROMs in clinical care including facilitators and barriers. Our findings suggest that PROMs are outcomes that are influenced by a wider variety of case-mix factors than traditional (clinical) outcomes. We also determined that the collection of PROMs can be challenging due to IT-infrastructure issues, care providers’ lack of experience, and the clinical workflow. The uptake of PROMs in clinical care is more likely to succeed with a multi-disciplinary approach, and by informing patients about the objectives of PROM collection.
An innovative hand hygiene study (RCT) was conducted in 80 nursing homes across the Netherlands. We developed an intervention to improve the compliance of health care workers to hand hygiene rules, including a novel explanation of the WHO’s hand hygiene rules. The intervention included 3 live lessons about hand hygiene, access to an e-learning, posters for the nursing home wards and a hand hygiene photo competition. Policy regarding personal hygiene and hand hygiene materials was also addressed. A randomized study subsequently showed that compliance improved significantly more in the intervention nursing homes (from 12% to 36%) than in the control nursing homes (from 13% to 21%). The intervention was also successful in a Train the Trainer model. The intervention did not lead to a decrease in infectious diseases among the residents of the nursing homes. Materials to carry out the intervention are available at: https://www.zorgvoorbeter.nl/hygiene/handhygiene-verbeteren-verpleeghuis
Lifestyle determinants, together with the aging population leads to a high prevalence of CVD and fall incidents. Prevention programs exist, but implementation of prevention programs remains difficult. The main focus of this thesis is to study conditions for successful implementation of prevention programs. Programs on cardiovascular disease prevention in the hospital and programs for fall prevention in the hospital and community setting were selected as illustrative examples. This thesis showed that the use of familiar healthcare settings or familiar healthcare providers is crucial for the success of recruiting individuals for prevention. To keep both involved, programs with room for adjustments to needs and preferences of participants and participant health status has proved important. Furthermore, this thesis described that simple and short programs can be a first step towards behavioral change. However for adherence to advice and actual behavioral change, more intensive interventions and collaboration among healthcare providers is necessary.
Changes in the environment cannot be studied like a drug. This thesis uses so-called “natural experiments”, sudden changes in the environment, to evaluate the effects of these changes in real-world settings. We found that play facilities near home makes it easier for children to play outside. The current fast food paradises where children grow up could be a barrier for healthy dietary behaviours. The hosting of international sport events may contribute to increasing sport participation levels in the population, and largest effects were found following the Grand Départ of the Tour de France. We also reviewed international evidence on smoke-free car policies, and found that these initiatives can considerably reduce the harmful effects of tobacco smoke exposure in children.
A healthy population starts by creating a healthy environment. We should shift our priorities from interventions primarily targeting behaviour of individuals, towards interventions targeting the environment to which individuals are exposed. We need to intervene in the environment to ensure that the healthy choice becomes the easy choice.
Colorectal cancer is an important global public health issue. With over 1.8 million new diagnoses in 2018, colorectal cancer was the third leading cause of cancer incidence. Each year, almost half of all colorectal cancer patients die from the disease, making it the second leading cause of cancer-related deaths.
Encouragingly, the burden of colorectal cancer can be reduced with screening. However, although screening has been widely implemented, programs differ markedly throughout the world. While some variation is not entirely unexpected given that risk of colorectal cancer varies significantly, the extent of variety suggests there may be room to improve screening programs.
In this thesis we investigate pathways to improve colorectal cancer screening programs. In the first instance, we explore pathways to optimise uniform screening programs to ensure they are designed and implemented to achieve the best possible outcomes for the average risk population. Subsequently, as it is increasingly recognised that individuals may not benefit equally from the same screening protocol, we investigate personalisation as a pathway to improve colorectal cancer screening programs.
Een jaar geleden zijn we overvallen door het coronavirus, een pandemie die de wereld nog steeds op zijn kop zet. Niets was meer zoals het was en alles moest anders. De opgaven waren enorm en de kennislacune was groot en breed. In Rotterdam kon door de bestaande kennisinfrastructuur zeer snel gewerkt worden aan nieuwe kennis, kennis worden uitgewisseld én ingezet bij beleid.
In deze gezamenlijke bijeenkomst ‘Kennis en Corona’ maken we nu, na één jaar corona, de tussenbalans op. Wat weten we nu, wat weten we nog niet en waar moeten we in de toekomst aan werken?
Met een afwisselend programma van discussies en presentaties willen we met elkaar nadenken welke grote opgaven én kennisleemtes er zijn. En hoe de Rotterdamse kennisinfrastructuur daarbij kan helpen.
We voeren de discussie zowel plenair in Studio Kennis als in parallelsessie op thema’s als: Veerkracht, Gedrag, Economie, Jongeren, Kwetsbaarheid, Welbevinden en meer … .
Bent u beleidsmedewerker, directeur of onderzoeker – gaat handelen o.b.v. kennis u aan het hart – zet dan de datum in uw agenda en meldt u aan!
Inschrijving is geopend, zie aanmeldlink.
Organisatie:
dr. ir. Beitske Boonstra, Kenniswerkplaats Leefbare wijken
dr. Mariëlle Beenackers, Academische werkplaats Cephir
Marjolein Kooistra, Academische Zaken EUR | ESSB (e-mail voor meer informatie)
drs. Marco Bik, Kenniscoördinator gemeente Rotterdam