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#2: Culturele verschillen in de klas:Leerpracht de Podcast
No full textIn de tweede aflevering van Leerpracht de Podcast gaan we in op de vragen: Hoe geef je cultuursensitief les in een superdiverse klas? Hoe ga je om met verschillen in normen, waarden en gedragingen, zonder je eigenheid te verliezen? Hoe voorkom je dat je verschillen negeert of wegpoetst. Hoe zorg je ervoor dat je verschillen erkent én benut als kracht en inspiratie? Host Karim Amghar gaat in gesprek met Lotte Henrichs (Universitair docent Universiteit Utrecht), Dorine Petri (Onderzoeker cultureel responsief lesgeven bij de Hanze) en Emma Snijders (leraar in Overvecht). We sluiten af met een wetenschappelijke reflectie van Zehra Çolak (onderzoeker belonging bij jongeren uit minderheidsgroepen bij de Universiteit Utrecht): “Als docent kun je het verschil maken door de geschiedenis en het verhaal van leerlingen te herkennen. Daarmee laat je zien, jij doet ertoe.
Home-based prehabilitation for frail patients awaiting liver transplant:Preliminary results of the Fit4Cirrhotics@home study
No full textIntroductionReduced aerobic capacity and frailty are highly prevalent in liver transplant candidates and are associated with increased morbidity and mortality. Although exercise-based prehabilitation is safe and effective, adherence remains a challenge. Home-based prehabilitation may improve participation, especially when tailored to the patient’s fitness level and remotely monitored. This type of prehabilitation has shown promising results in other surgical groups1,2. However, their feasibility and effect in frail liver transplant candidates remain largely unknown. This study addresses this knowledge gap and contributes to the broader question of how best to prehabilitate highly frail patients. The aim of this study is to evaluate the effectiveness and feasibility of a remotely monitored bimodal (exercise + nutrition) prehabilitation program in frail patients with liver cirrhosis awaiting transplantation.MethodsThis ongoing investigator-initiated, single-center, single-arm, prospective clinical trial started in October 2024 at the University Medical Center Groningen, the Netherlands. Eligible patients with reduced aerobic capacity (i.e., VO₂ at the ventilatory anaerobic threshold ≤13 ml/kg/min and/or VO₂peak ≤18 ml/kg/min) participate in the bimodal lifestyle program. The program includes high-intensity interval training and endurance training based on Steep Ramp Test (SRT) results, resistance training, inspiratory muscle training, and protein supplementation. The SRT is regularly performed at home to monitor progress and adjust training intensity. Training includes two six-week home-based periods (12 weeks total, or until transplantation), followed by a final assessment at 18 weeks to evaluate the durability of the program’s effects.Primary outcome: Change in VO₂ at the ventilatory threshold and VO₂peak after six weeks of training.Secondary outcomes: Changes in sarcopenia (ultrasound, Liver Frailty Index), functional mobility, perceived fatigue, quality of life, number of hospital admissions, incidence of hepatic encephalopathy, microbiome composition, blood biomarkers, and postoperative outcomes. Feasibility is assessed through participation rate, adherence to prescribed training sessions and protein intake, and safety. ResultsAt the time of submission, 41 patients were screened and 9 were included. The majority of exclusions were due to either adequate fitness or underlying liver disease without cirrhosis (e.g., ADPKD). The participation rate was 82%. Among those included, three have completed the first training period with available primary outcome data, three are currently in training, and three underwent liver transplantation before the first reassessment. While the primary outcomes showed variable patterns, consistent improvements in SRT performance were observed (figure 1). Adherence varied due to disease-related instability and intercurrent hospital admissions. It appears safe, since there have been no intervention-related adverse events until now. The other secondary outcomes are not available to present yet.ConclusionThis early-phase study demonstrates that home-based, remotely monitored prehabilitation is feasible and acceptable in frail liver transplant candidates. Although consistent improvements in CPET outcomes could not be demonstrated because of variable results and incomplete data, measurable improvements in functional capacity were seen when assessed with the Steep Ramp Test. Conducting structured research in this vulnerable population was challenging, as clinical instability and hospital admissions often disrupted the intervention and assessments. However, these difficulties reflect the real-world fragility of liver transplant candidates. These interim findings underscore the need for flexible, patient-centered prehabilitation and support the potential of home-based approaches not only in liver transplant candidates but also in other highly vulnerable surgical populations. Recruitment is ongoing toward a target of 24 patients.IntroductionReduced aerobic capacity and frailty are highly prevalent in liver transplant candidates and are associated with increased morbidity and mortality. Although exercise-based prehabilitation is safe and effective, adherence remains a challenge. Home-based prehabilitation may improve participation, especially when tailored to the patient’s fitness level and remotely monitored. This type of prehabilitation has shown promising results in other surgical groups1,2. However, their feasibility and effect in frail liver transplant candidates remain largely unknown. This study addresses this knowledge gap and contributes to the broader question of how best to prehabilitate highly frail patients. The aim of this study is to evaluate the effectiveness and feasibility of a remotely monitored bimodal (exercise + nutrition) prehabilitation program in frail patients with liver cirrhosis awaiting transplantation.MethodsThis ongoing investigator-initiated, single-center, single-arm, prospective clinical trial started in October 2024 at the University Medical Center Groningen, the Netherlands. Eligible patients with reduced aerobic capacity (i.e., VO₂ at the ventilatory anaerobic threshold ≤13 ml/kg/min and/or VO₂peak ≤18 ml/kg/min) participate in the bimodal lifestyle program. The program includes high-intensity interval training and endurance training based on Steep Ramp Test (SRT) results, resistance training, inspiratory muscle training, and protein supplementation. The SRT is regularly performed at home to monitor progress and adjust training intensity. Training includes two six-week home-based periods (12 weeks total, or until transplantation), followed by a final assessment at 18 weeks to evaluate the durability of the program’s effects.Primary outcome: Change in VO₂ at the ventilatory threshold and VO₂peak after six weeks of training.Secondary outcomes: Changes in sarcopenia (ultrasound, Liver Frailty Index), functional mobility, perceived fatigue, quality of life, number of hospital admissions, incidence of hepatic encephalopathy, microbiome composition, blood biomarkers, and postoperative outcomes. Feasibility is assessed through participation rate, adherence to prescribed training sessions and protein intake, and safety. ResultsAt the time of submission, 41 patients were screened and 9 were included. The majority of exclusions were due to either adequate fitness or underlying liver disease without cirrhosis (e.g., ADPKD). The participation rate was 82%. Among those included, three have completed the first training period with available primary outcome data, three are currently in training, and three underwent liver transplantation before the first reassessment. While the primary outcomes showed variable patterns, consistent improvements in SRT performance were observed (figure 1). Adherence varied due to disease-related instability and intercurrent hospital admissions. It appears safe, since there have been no intervention-related adverse events until now. The other secondary outcomes are not available to present yet.ConclusionThis early-phase study demonstrates that home-based, remotely monitored prehabilitation is feasible and acceptable in frail liver transplant candidates. Although consistent improvements in CPET outcomes could not be demonstrated because of variable results and incomplete data, measurable improvements in functional capacity were seen when assessed with the Steep Ramp Test. Conducting structured research in this vulnerable population was challenging, as clinical instability and hospital admissions often disrupted the intervention and assessments. However, these difficulties reflect the real-world fragility of liver transplant candidates. These interim findings underscore the need for flexible, patient-centered prehabilitation and support the potential of home-based approaches not only in liver transplant candidates but also in other highly vulnerable surgical populations. Recruitment is ongoing toward a target of 24 patients
Music-Enhanced Emotion (Re)construction (MEER!):An innovative training enriched with participatory live music
No full textBackground and need for innovation: In healthcare, emotions are traditionally avoided as they might cloud clinical judgement. However, ignoring emotions may lead to emotional exhaustion and burnout, jeopardising quality of care. More attention to emotions is needed to support healthcare professionals’ wellbeing and vitality, especially given the high rates of emotional exhaustion and burnout among them and factors like workforce shortages, an ageing population and increasing workload demands. Goal of innovation: The training aims to support healthcare professionals’ wellbeing and vitality and help prevent emotional exhaustion and burnout. Steps taken for development and implementation of innovation: The training is grounded in the theory of constructed emotion, incorporates an evidence-informed pedagogical approach, and uses participatory live music to teach healthy emotion construction. Based on the theory, we refer to this process as ‘emotion construction' rather than ‘emotion regulation'. The training includes theoretical background, six exercises following a gradual build-up towards (re)constructing emotions, and homework assignments.Evaluation of innovation: Preliminary findings support music's ability to evoke distinct memories, bodily sensations, feelings, and emotions, corroborating its intended function. Eliciting personal memories with specific emotions through music supports the theory of constructed emotion and justifies its use in the training. First training evaluations included descriptions like enlightening, inspiring and empowering.Critical reflection: The training programme shows a clear build-up and alignment with the theory, while incorporating evidence-informed pedagogical steps seamlessly. Implementation challenges include obtaining funding and, due to time constraints of the target groups, implementing the full training, which we mitigated by developing variations.Background and need for innovation: In healthcare, emotions are traditionally avoided as they might cloud clinical judgement. However, ignoring emotions may lead to emotional exhaustion and burnout, jeopardising quality of care. More attention to emotions is needed to support healthcare professionals’ wellbeing and vitality, especially given the high rates of emotional exhaustion and burnout among them and factors like workforce shortages, an ageing population and increasing workload demands. Goal of innovation: The training aims to support healthcare professionals’ wellbeing and vitality and help prevent emotional exhaustion and burnout. Steps taken for development and implementation of innovation: The training is grounded in the theory of constructed emotion, incorporates an evidence-informed pedagogical approach, and uses participatory live music to teach healthy emotion construction. Based on the theory, we refer to this process as ‘emotion construction' rather than ‘emotion regulation'. The training includes theoretical background, six exercises following a gradual build-up towards (re)constructing emotions, and homework assignments.Evaluation of innovation: Preliminary findings support music's ability to evoke distinct memories, bodily sensations, feelings, and emotions, corroborating its intended function. Eliciting personal memories with specific emotions through music supports the theory of constructed emotion and justifies its use in the training. First training evaluations included descriptions like enlightening, inspiring and empowering.Critical reflection: The training programme shows a clear build-up and alignment with the theory, while incorporating evidence-informed pedagogical steps seamlessly. Implementation challenges include obtaining funding and, due to time constraints of the target groups, implementing the full training, which we mitigated by developing variations
Goochelen met klimaatemissies
No full textMartien Visser schetst de volgende situatie in Nederland: Het is bijna windstil en het regent. Nederlandse kolen- en gascentrales zijn volop in touw. Naast het nationale verbruik exporteert Nederland veel elektriciteit naar Denemarken, België en Duitsland. Bij de Oosterburen verdringt Nederlandse export de kolencentrales. Dat geldt indirect ook voor België en Denemarken, want de Duitse kolencentrales vormen in Noordwest-Europa, met de Nederlandse gascentrales, de marginale opwekeenheden. De stroomexport leidt in Nederland tot extra CO2-emissie; in Duitsland is de CO2-uitstoot dankzij import uit Nederland juist lager
Biodegradable bioplastics in healthcare:opportunities, challenges and sustainable recycling
No full textThe healthcare sector ranks among the largest consumers of single-use plastics, generating substantialamounts of waste, an issue strikingly captured in Maria Koijck's breast surgery photography. To reducethe environmental impact, biobased and biodegradable polymers are promising alternatives toconventional plastic medical disposables, offering sustainability while maintaining functionality. Thisreview evaluates the suitability, circularity and benefits of various biobased and biodegradable plastics forhealthcare applications and the critical role of effective waste management in enhancing sustainability inthe medical sector. Implementing biobased medical plastics requires rethinking recycling strategies andwaste management. Unlike fossil-based plastics, which reduce in quality while recycling, enzymatic andwhole-cell biocatalytic recycling processes can preserve the quality of biobased and biodegradablematerials, allowing them to be re-used for new products and offering a sustainable end-of-life solution.Integrating these materials into existing waste management requires overcoming social, economic,logistical, and technological challenges that must be addressed. Standardised regulations, awareness ofthe circular economy, and collaboration between academia and industry are crucial for developingmedical-grade, sustainable solutions for a circular and environmentally responsible healthcare system.The healthcare sector ranks among the largest consumers of single-use plastics, generating substantial amounts of waste, an issue strikingly captured in Maria Koijck’s breast surgery photography. To reduce the environmental...The healthcare sector ranks among the largest consumers of single-use plastics, generating substantial amounts of waste, an issue strikingly captured in Maria Koijck’s breast surgery photography. To reduce the environmental impact, biobased and biodegradable polymers are promising alternatives to conventional plastic medical disposables, offering sustainability while maintaining functionality. This review evaluates the suitability, circularity and benefits of various biobased and biodegradable plastics for healthcare applications, and the critical role of effective waste management in enhancing sustainability in the medical sector. Implementing biobased medical plastics requires rethinking recycling strategies and waste management. Unlike fossil-based plastics, which reduce in quality while recycling, enzymatic and whole-cell biocatalytic recycling processes can preserve the quality of biobased and biodegradable materials, allowing them to be re-used for new products and offering a sustainable end-of-life solution. Integrating these materials into existing waste management requires overcoming social, economic, logistical, and technological challenges that must be addressed. Standardised regulations, awareness of the circular economy, and collaboration between academia and industry are crucial for developing medical-grade, sustainable solutions for a circular and environmentally responsible healthcare system
TriSO:Triadisch samenwerken rondom situaties met onbegrepen gedrag
Get PDFDoel: Bijdragen aan kennis over betere samenwerking tussen persoon, hulpverlening en naastenMethode: Kwalitatief onderzoek door middel van diepte-interviews met persoon, naaste en hulpverlener en hierop volgend een dialoogsessie waarin persoon, naaste en hulpverlener met elkaar uitwisselen rondom de onderlinge verwachtingen, rollen en verantwoordelijkheden.Resultaten: Voorlopige resultaten laten zien dat goede samenwerking ten eerst afhangt van contact, bejegening en laagdrempeligheid bij de hulpverlener. Wanneer mensen niet worden begrepen door de omgeving of hulpverlener veroorzaakt de frustratie om het onbegrip gedrag dat het onderlinge contact verder verstoort. Hiermee ontstaat een vicieuze cirkel. Effectieve houdingsaspecten om samenwerking vorm te geven blijken: gelijkwaardigheid, echt luisteren, open en nieuwsgierig, aansluiten bij wat de persoon belangrijk vindt (zingeving en normen). Hiernaast blijkt dat de rol van naasten in de situatie groot is; naasten bieden op vele manieren steun (praktisch, emotioneel, financieel, informatie) maar hebben daarnaast een signalerende en zorgtoeleidende rol. Binnen de zorg wordt de kennis en rol van de naaste nog nauwelijks erkend, herkend en benut.Conclusies: Om tot betere samenwerking binnen de triade ‘persoon, hulpverlening en naasten’ te komen, is nodig dat wordt geïnvesteerd in systemisch en netwerkgericht werken, met specifieke aandacht voor de visie, attitude en houding die bij deze werkwijze vereist zijn.<br/
Perceptions, barriers and facilitators regarding nutritional care for patients with chronic limb threatening ischemia:a focus group study among healthcare professionals
No full textBackground: Nutrition and nutritional care are essential for optimal outcomes, and, therefore of importance for patients with chronic limb threatening ischemia (CLTI) given their high risk of complications. However, insight is lacking in how healthcare professionals directly involved in the care of patients with CLTI perceive nutritional care, as well as in the perceived barriers and facilitators regarding optimal nutritional care. Methods: In this qualitative study with a phenomenological approach, 3 online focus groups were conducted with various healthcare professionals directly involved in the care of patients with CLTI. Sample size was guided by information power. Focus group recordings were transcribed verbatim, and reflexive thematic analysis was performed. Results: Seventeen healthcare professionals participated, including vascular surgeons, fellows in vascular surgery, a medical doctor and researcher, nurse specialized in wound care, general nurse, physical therapists, dietitians, and nutrition assistants. Four themes were generated: (1) nutritional care is crucial for optimal clinical outcomes and a healthy life, (2) insufficient attention to undernutrition and nutritional care by healthcare professionals, (3) patient-related factors challenge healthcare professionals in providing nutritional care, and (4) need for optimizing the organizational process related to nutritional care. Perceived barriers regarding nutritional care included knowledge deficits, nutritional care not being part of the healthcare professionals’ routine, missing tools to identify undernutrition, patient-related factors, and time constraints. Facilitators regarding nutritional care included more scientific evidence regarding the effect of nutritional care on clinical outcomes and optimization of organizational processes related to nutritional care. Conclusions: Healthcare professionals perceive nutritional care as important for optimal outcomes, but nutritional care is not routinely implemented in the care of patients with CLTI. This lack of implementation of nutritional care may be due to the barriers perceived in various domains. The findings of this study stress the need to optimize nutritional care, with the aim of improving outcomes in the CLTI population