56 research outputs found
Defining quality in outbreak management: a perspective from the first responders
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191620.pdf (Publisher’s version ) (Open Access)Radboud University, 04 juli 2018Promotor : Hulscher, M.E.J.L. Co-promotores : Timen, A., Huis, A.M.P., Steenbergen, J.E. va
Patient centered and disease activity based management of Rheumatoid Arthritis
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231208.pdf (Publisher’s version ) (Open Access)Radboud University, 23 april 2021Promotores : Riel, P.L.C.M. van, Hulscher, M.E.J.L., Laar, M.A.F.J. van de Co-promotor : Huis, A.M.P.195 p
Helping hands: a cluster randomised trial to evaluate the effectiveness of two different strategies for promoting hand hygiene in hospital nurses
No full textBackground: hand hygiene prescriptions are the most important measure in the prevention of hospital-acquired infections. Yet, compliance rates are generally below 50% of all opportunities for hand hygiene. This study aims at evaluating the short- and long-term effects of two different strategies for promoting hand hygiene in hospital nurses.Methods/design: this study is a cluster randomised controlled trial with inpatient wards as the unit of randomisation. Guidelines for hand hygiene will be implemented in this study. Two strategies will be used to improve the adherence to guidelines for hand hygiene. The state-of-the-art strategy is derived from the literature and includes education, reminders, feedback, and targeting adequate products and facilities. The extended strategy also contains activities aimed at influencing social influence in groups and enhancing leadership. The unique contribution of the extended strategy is built upon relevant behavioural science theories. The extended strategy includes all elements of the state-of-the-art strategy supplemented with gaining active commitment and initiative of ward management, modelling by informal leaders at the ward, and setting norms and targets within the team. Data will be collected at four points in time, with six-month intervals. An average of 3,000 opportunities for hand hygiene in approximately 900 nurses will be observed at each time point.Discussion: performing and evaluating an implementation strategy that also targets the social context of teams may considerably add to the general body of knowledge in this field. Results from our study will allow us to draw conclusions on the effects of different strategies for the implementation of hand hygiene guidelines, and based on these results we will be able to define a preferred implementation strategy for hospital based nursing.Trial registration: the study is registered as a Clinical Trial in ClinicalTrials.gov, dossier number: NCT0054801
Helping hands. Strategies to improve hand hygiene compliance in hospital care
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106933.pdf (Publisher’s version ) (Open Access)Radboud Universiteit Nijmegen, 27 maart 2013Promotores : Achterberg, T. van, Grol, R.P.T.M., Hulscher, M.E.J.L. Co-promotor : Schoonhoven, L
Pain management: a review of organisation models with integrated processes for the management of pain in adult cancer patients
No full textAims and objectives:?This paper reports a review of the literature conducted to identify organisation models in cancer pain management that contain integrated care processes and describe their effectiveness.Background:?Pain is experienced by 30–50% of cancer patients receiving treatment and by 70–90% of those with advanced disease. Efforts to improve pain management have been made through the development and dissemination of clinical guidelines. Early improvements in pain management were focussed on just one or two single processes such as pain assessment and patient education. Little is known about organisational models with multiple integrated processes throughout the course of the disease trajectory and concerning all stages of the care process.Design:?Systematic review.Method:?The review involved a systematic search of the literature, published between 1986–2006. Subject-specific keywords used to describe patients, disease, pain management interventions and integrated care processes, relevant for this review were selected using the thesaurus of the databases.Conclusion:?Institutional models, clinical pathways and consultation services are three alternative models for the integration of care processes in cancer pain management. A clinical pathway is a comprehensive institutionalisation model, whereas a pain consultation service is a ‘stand-alone’ model that can be integrated in a clinical pathway. Positive patient and process outcomes have been described for all three models, although the level of evidence is generally low. Evaluation of the quality of pain management must involve standardised measurements of both patient and process outcomes.Relevance to clinical practice:?We recommend the development of policies for referrals to a pain consultation service. These policies can be integrated within a clinical pathway. To evaluate the effectiveness of pain management models standardised outcome measures are needed.<br/
Explaining the effects of two different strategies for promoting hand hygiene in hospital nurses: a process evaluation alongside a cluster randomised controlled trial
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118412.pdf (Publisher’s version ) (Open Access)BACKGROUND: There is only limited understanding of why hand hygiene improvement strategies are successful or fail. It is therefore important to look inside the 'black box' of such strategies, to ascertain which components of a strategy work well or less well. This study examined which components of two hand hygiene improvement strategies were associated with increased nurses' hand hygiene compliance. METHODS: A process evaluation of a cluster randomised controlled trial was conducted in which part of the nursing wards of three hospitals in the Netherlands received a state-of-the-art strategy, including education, reminders, feedback, and optimising materials and facilities; another part received a team and leaders-directed strategy that included all elements of the state-of-the-art strategy, supplemented with activities aimed at the social and enhancing leadership. This process evaluation used four sets of measures: effects on nurses' hand hygiene compliance, adherence to the improvement strategies, contextual factors, and nurses' experiences with strategy components. Analyses of variance and multiple regression analyses were used to explore changes in nurses' hand hygiene compliance and thereby better understand trial effects. RESULTS: Both strategies were performed with good adherence to protocol. Two contextual factors were associated with changes in hand hygiene compliance: a hospital effect in long term (p < 0.05), and high hand hygiene baseline scores were associated with smaller effects (p < 0.01). In short term, changes in nurses' hand hygiene compliance were positively correlated with experienced feedback about their hand hygiene performance (p < 0.05). In the long run, several items of the components 'social influence' (i.e., addressing each other on undesirable hand hygiene behaviour p < 0.01), and 'leadership' (i.e., ward manager holds team members accountable for hand hygiene performance p < 0.01) correlated positively with changes in nurses' hand hygiene compliance. CONCLUSION: This study illustrates the use of a process evaluation to uncover mechanisms underlying change in hand hygiene improvement strategies. Our study results demonstrate the added value of specific aspects of social influence and leadership in hand hygiene improvement strategies, thus offering an interpretation of the trial effects. TRIAL REGISTRATION: The study is registered in ClinicalTrials.gov, dossier number: NCT00548015
Impact of a team and leaders-directed strategy to improve nurses' adherence to hand hygiene guidelines: A cluster randomised trial
No full textItem does not contain fulltextBACKGROUND: Improving hand hygiene compliance is still a major challenge for most hospitals. Innovative approaches are needed. OBJECTIVE: We tested whether an innovative, theory based, team and leaders-directed strategy would be more effective in increasing hand hygiene compliance rates in nurses than a literature based state-of-the-art strategy. DESIGN AND SETTING: A cluster randomised controlled trial called HELPING HANDS was conducted in 67 nursing wards of three hospitals in the Netherlands. PARTICIPANTS: All affiliated nurses of the nursing wards. Wards were randomly assigned to either the team and leaders-directed strategy (30 wards) or the state-of-the-art strategy (37 wards). METHODS: The control arm received a state-of-the-art strategy including education, reminders, feedback and targeting adequate products and facilities. The experimental group received all elements of the state-of-the-art strategy supplemented with interventions based on social influence and leadership, comprising specific team and leaders-directed activities. Strategies were delivered during a period of six months. We monitored nurses' HH compliance during routine patient care before and directly after strategy delivery, as well as six months later. Secondary outcomes were compliance with each type of hand hygiene opportunity, the presence of jewellery and whether the nurses wore long-sleeved clothes. The effects were evaluated on an intention-to-treat basis by comparing the post-strategy hand hygiene compliance rates with the baseline rates. Multilevel analysis was applied to compensate for the clustered nature of the data using mixed linear modelling techniques. RESULTS: During the study, we observed 10,785 opportunities for appropriate hand hygiene in 2733 nurses. The compliance in the state-of-the-art group increased from 23% to 42% in the short term and to 46% in the long run. The hand hygiene compliance in the team and leaders-directed group improved from 20% to 53% in the short term and remained 53% in the long run. The difference between both strategies showed an Odds Ratio of 1.64 (95% CI 1.33-2.02) in favour of the team and leaders-directed strategy. CONCLUSIONS: Our results support the added value of social influence and enhanced leadership in hand hygiene improvement strategies. The methodology of the latter also seems promising for improving team performance with other patient safety issues. TRIAL REGISTRATION: ClinicalTrials.gov [NCT00548015]
Bulking sludge control. Kinetics, substrate storage, and process design aspects
No full textThe activated sludge process is the preferred technology for biological wastewater treatment. Despite decades of progress and operation serious operating problems still occur with this process. One major problem is the regular occurrence of excessive growth of filamentous bacteria, phenomena known as filamentous bulking sludge. Poor solid-liquid separation can occur as result of this problem, leading to effluent quality deterioration and to process failure due to uncontrollable loss of biomass with the effluent. The goal of this thesis was to achieve a better understanding of bulking sludge and the relevant factors involved. To accomplish these objectives, well-controlled laboratory scale sequencing batch reactors with mixed microbial cultures and defined substrates, were operated under different conditions. Traditionally pure culture microbiology or full scale reactor observations have been the basis for the research. The choosen process engineering approach proved to be a success to study bulking sludge. Not only filamentous bacteria grew very well under specific conditions but also the results were reproducible and trends relating sludge settleability and operational conditions were identified. Design guidelines and operation aspects were proposed to control bulking sludge, leading to more robust, reliable, predictive, and sustainable activated sludge systems. Together with a literature review, the experimental results were the basis to develop a unifying hypothesis about bulking sludge - diffusion based selection. This theory can replace the existing theory based on kinetic selection. Both bacterial morphology and substrate micro-gradients inside microbial aggregates are hypothesized as playing a dominant role in selection for bulking sludge. An individual-based model, originally developed to a biofilm system, is adapted for the first time to model the competition between different bacterial morphotypes in activated sludge flocs. The first modelling results support qualitatively the hypothesis. Several chapters in this PhD thesis have been published by commercial publishers. These chapters can only be found in publications of these publishers. Bibliographical information of these publications can be found in the different chapters.Applied Science
A systematic review of hand hygiene improvement strategies: a behavioural approach
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108114.pdf (Publisher’s version ) (Open Access)ABSTRACT: BACKGROUND: Many strategies have been designed and evaluated to address the problem of low hand hygiene (HH) compliance. Which of these strategies are most effective and how they work is still unclear. Here we describe frequently used improvement strategies and related determinants of behaviour change that prompt good HH behaviour to provide a better overview of the choice and content of such strategies. METHODS: Systematic searches of experimental and quasi-experimental research on HH improvement strategies were conducted in Medline, Embase, CINAHL, and Cochrane databases from January 2000 to November 2009. First, we extracted the study characteristics using the EPOC Data Collection Checklist, including study objectives, setting, study design, target population, outcome measures, description of the intervention, analysis, and results. Second, we used the Taxonomy of Behavioural Change Techniques to identify targeted determinants. RESULTS: We reviewed 41 studies. The most frequently addressed determinants were knowledge, awareness, action control, and facilitation of behaviour. Fewer studies addressed social influence, attitude, self-efficacy, and intention. Thirteen studies used a controlled design to measure the effects of HH improvement strategies on HH behaviour. The effectiveness of the strategies varied substantially, but most controlled studies showed positive results. The median effect size of these strategies increased from 17.6 (relative difference) addressing one determinant to 49.5 for the studies that addressed five determinants. CONCLUSIONS: By focussing on determinants of behaviour change, we found hidden and valuable components in HH improvement strategies. Addressing only determinants such as knowledge, awareness, action control, and facilitation is not enough to change HH behaviour. Addressing combinations of different determinants showed better results. This indicates that we should be more creative in the application of alternative improvement activities addressing determinants such as social influence, attitude, self-efficacy, or intention
Enabling Continuous Descent Operations in High-Density Traffic
No full textThe Air Traffic Management (ATM) community strives to reduce the environmental impact per flight. Continuous Descent Operation (CDO) has been identified by the ATM community as one of the operational improvements that could reduce aviation’s environmental impact, both in terms of aircraft noise and gaseous emissions. In the current ATM system, CDOs are only feasible in low-density traffic. The ultimate goal is an ATM system that facilitates CDOs in high-density traffic. This research described in this thesis focused on two features of such an ATM system: decision support that enables the air traffic controller to accurately set up traffic for CDO, and delegation of the spacing task to the flight crew during the CDO. Two enablers are real-time availability of meteorological data, and accurate trajectory prediction. In this thesis new methods were developed and validated to infer wind, air pressure, and air temperature profiles from aircraft surveillance data. Trajectory prediction was defined as a machine learning problem, enabling predictions based on historic aircraft trajectory and meteorological data without the need for explicit modeling of the aircraft performance and procedures. A decision support tool was developed further and tested using a human-in-the-loop experiment. The tool enabled the subjects to set up traffic for CDO in high-density traffic at an acceptable work load level and high level of situation awareness. Monte-Carlo simulations were carried out to assess the runway capacity that can be achieved when delegating the spacing task to the flight crew. These simulations showed the feasibility of CDOs in high-density traffic.Control and SimulationAerospace Engineerin
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