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Rationale, aims and objectives Structuring the diagnostic section of the medical record ( MR) improves diagnosis and communication between doctors. However, little is known about the therapeutic section of the MR. The aim of this study was to gain insight into the extent to which MRs are structured for therapeutic information, to determine which therapeutic data registrars and clinical consultants consider should be recorded in the MR and to what extent registrars record this information themselves. Methods A multicentre observational study was carried out in the internal medicine outpatient clinics of five teaching hospitals in the Netherlands. Preformatted structure, importance and actual recording of therapeutic information was compared with a reference list of 35 therapeutic items based on the WHO Guide to Good Prescribing (e.g. drug name, indication for drug). Results The preformatted structure of four paper MRs and one electronic MR was assessed. Eight of the 35 therapeutic items were listed in the paper MRs and 18 items in the electronic MR. Registrars and consultants agreed on the importance of recording most of the therapeutic items in the MR, 25 and 27 out of the 35 items, respectively; however, registrars recorded only 11 of the 35 items in the paper MR and 20 of the 35 items in the electronic MR. Conclusions The structure and content of paper and electronic MRs are not adequate. While both registrars and consultants agree on the importance of recording therapeutic items in the MR, registrars fail to record most of this information in practice. The results of this study can be used as starting point for the discussion regarding the necessity of structured recording of therapeutic information in the MR and its possible benefits with regard to medication safety and training of the new generation of prescribers. [ABSTRACT FROM AUTHOR]

Background: Reading comprehension is an interactive process. Yet, instructional needs are usually identified with isolated componential tests. This study examined whether a dynamic approach, in which componential abilities are measured within the same text and global text comprehension is facilitated via feedback, can help in understanding variation in children's reading comprehension. Objectives: With a pretest‐posttest control group design, componential abilities before and after feedback were related to growth in global text comprehension within the same text. Methods: At pretest, third to fifth graders read 30 short texts, each followed by one global text comprehension question. This was repeated at posttest, but additional questions were asked with feedback prior to each global text comprehension question. The vocabulary group received two vocabulary questions with feedback (n = 97). The vocabulary plus integration group received two vocabulary questions and one sentence‐integration question with feedback (n = 98). The control group (n = 98) only answered the global text comprehension questions. Results and Conclusion: Participants in the experimental conditions who needed feedback (i.e., lower‐skilled) experienced a decrease in global text comprehension, whereas this was not found for the control group and participants in the experimental groups who did not need feedback (i.e., higher‐skilled). There was also less decrease among those lower‐skilled participants who had profited from the feedback. Implications: It is concluded from explorative analyses that not feedback but the overall design caused the decrease. Conceptually, the dynamic approach is worth further research. Lay Description: What is already known about this topic: Reading comprehension is a complex interaction of several componential abilities at word level, sentence level, and text level (e.g., vocabulary and sentence‐integration).Instruction should adapt to the profile of strengths and weaknesses in componential abilities.Assessing componential abilities with isolated tests does not align with the interactive processes in reading comprehension.Measuring learning ability can help to identify children with low responsiveness to instruction. What this paper adds: Reading comprehension is profiled by asking questions on vocabulary, sentence‐integration, and global text comprehension for the same text in third to fifth graders (8–11 years olds).Feedback is provided after a mistake in a vocabulary and sentence‐integration question, and the feedback effect on global text comprehension is measured with a pretest‐posttest design.Children who receive feedback decrease in global text comprehension but children with higher skills in componential abilities decrease less.Explorative analyses and previous research indicate that the assessment design had a negative impact on performance, for example, via cognitive load, attention, self‐esteem, and motivation. Implications for practice and/or policy: Global text comprehension cannot always be facilitated by providing feedback on vocabulary and sentence‐integration within the same text.The design of the assessment and its influence on performance should be carefully considered by instructional designers, educators, and researchers, especially in case of young learners.It remains unclear from this study if facilitating global text comprehension via feedback with a dynamic approach is useful to understand variation in children's reading comprehension.The dynamic approach with a proper design may potentially still provide a useful insight in individual differences. [ABSTRACT FROM AUTHOR]

Adolescents in secure residential care mostly suffer from serious behavioural problems, often accompanied by trauma and adverse family circumstances. This paper presents findings of a comparison of behavioural problems and risk factors of 255 boys and girls (aged 12 to 18 years) in secure residential care in the Netherlands and their association with behavioural problems. A cross‐sectional design and standardized questionnaires were used to measure behavioural problems and individual and familial risk factors. By using independent‐sample t tests, the severity of these factors in boys and girls was compared, and by using structural equation modelling (SEM), associations between these factors and behavioural problems were investigated. The findings of the study show that post‐traumatic stress disorder (PTSD) symptoms, maladaptive emotion regulation, impaired perceived competence and internalizing behavioural problems were more severe in girls than in boys. Boys experienced more severe externalizing behavioural problems and more family problems than girls. Maladaptive emotion regulation, PTSD symptoms, perceived competence and parenting problems were related to behavioural problems. The results indicate that treatment for girls should address PTSD symptoms, perceived competence and maladaptive emotion regulation and that extra attention for family problems in the treatment of boys is warranted. [ABSTRACT FROM AUTHOR]

The circumplex version of the Impact Message Inventory (IMI-C) is one of the few existing diagnostic devices for the assessment of 'objective' (inter-subjective) countertransference. The IMI-C purports to assess eight categories of countertransference reactions along the circumference of the interpersonal circle, conceptualized as blends of the two basic dimensions of affiliation (AFF) and control (CON): dominant (D), hostile-dominant (HD), hostile (H), hostile-submissive (HS), submissive (H), friendly-submissive (FS), friendly (F) and friendly-dominant (FD). As a measure of objective (or 'inter-subjective') countertransference, a crucial test for the IMI-C is its ability to produce scores that are generalizable across different therapists involved with the same patients. In four previous psychometric studies, the 'objectivity' of countertransference reactions was examined with a Dutch paper-and-pencil IMI-C version. In the present study, the generalizability of countertransference reactions across therapists was tested with a computer-delivered IMI-C. Results obtained with the electronic IMI-C format were compared with the findings of the paper-and-pencil version. Similar to the four prior studies, D and HD were the comparatively most generalizable classes of countertransference reactions among the eight categories. Both the AFF and CON main dimensions scores were substantially generalizable across therapists. From different perspectives of analysis, more favorable results were obtained with the computer-delivered IMI-C in comparison to the paper-and-pencil-version for (a) five of the eight countertransference classes (D, HD, F, FS, FD) and also for (b) the AFF main dimension. The computer-based IMI-C appears to be a promising tool for assessing objective countertransference reactions. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • Your countertransference reactions are likely to be partly patient-induced ('objective'). • Countertransference reactions can conveniently be classified in terms of the interpersonal circle. • The computer-based IMI-C is a user-friendly clinical instrument for the assessment of patient-induced countertransference reactions. [ABSTRACT FROM AUTHOR]

Noticing and interpreting classroom events (professional vision) is an important element of preservice teachers' (PSTs) interpersonal competence. This paper presents a mixed‐method study about a classroom simulation using 360‐degree videos combined with theoretical lectures in teacher education, intended to improve PSTs' interpretations of noticed events. Furthermore, this study examined how PSTs evaluate technological and educational affordances of 360‐degree videos. Results indicate that participating PSTs improved in noticing classroom events and in applying a more theory‐based terminology to describe these events. PSTs perceived observing other teachers teach as an educational affordance for mastering theory and for developing insights about interpersonal teacher behaviour. Concerning technological affordances, mainly physical discomforts and technical hindrances, was reported by PSTs. The results of this study imply that 360‐degree videos can be useful for teacher education to improve PSTs' interpretation of noticed events. Practitioner Notes: What is already known: Professional interpersonal vision is considered an important element of preservice teachers' (PSTs) interpersonal competence.Interpersonal competence can be practiced using computer‐based classroom simulations.One type of content in simulations is video, which can provide PSTs authentic cases.Recent technological developments enable enrichment of video simulations using 360‐degree cameras. What this paper adds: Findings indicate that classroom simulations using 360‐degree videos added with theoretical lectures can improve PSTs' level of interpretations of noticed classroom events as part of their professional interpersonal vision.Technological and educational affordances of classroom simulation using 360‐degree videos evaluated by PSTs. Implications for practitioners: Classroom simulations using 360‐degree are a useful method to prepare PSTs for educational practice.Classroom simulations using 360‐degree videos help PSTs learn theory about interpersonal teacher behaviour.Classroom simulations using 360‐degree videos help PSTs develop insights about teaching styles that influence teacher–student relationships.This study advises good quality VR‐environments to improve the immersive experience. [ABSTRACT FROM AUTHOR]

In this paper, we revisit this well‐established linear relationship of person‐organisation, demands‐abilities, and needs‐supply fit with job satisfaction, commitment, and OCBs, and propose that this relationship may be linear for affective work outcomes but curvilinear for behavioural ones. We test this idea in a two‐wave sample of 212 employees, with measures taken 4 weeks apart. The results support the idea that the relationship between fit and behavioural outcomes can, indeed, be curvilinear. Overall, this study contributes to a better understanding of the nature of the relationship between fit and work outcomes by challenging the long‐held 'more fit is better' logic that pervades much of the PE fit research to date. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Computer Assisted Learning is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Computer Assisted Learning is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study investigated the effect of a touch‐typing course on the spelling and narrative‐writing skills on the computer of elementary school students. Data of 207 students in Grades 4, 5, and 6 were analysed using a pretest–posttest design. Students in the experimental group (n = 154) followed a touch‐typing course, and those in the control group (n = 53) did not. The experimental group showed more progress in typing, spelling, and narrative‐writing skills on the computer than the control group. It can be concluded that the touch‐typing course had a positive effect, not only on typing skills but also on spelling and narrative‐writing skills on the computer. Lay Description: What is known Typing skills are important for the quality of the typewritten text output.In touch‐typing with automaticity of transcription, workting‐memory load is decreased.Studies on the effect of a touch‐typing course are rare. What this paper adds This study investigated the effect of a touch‐typing course on spelling and narrative writing.We used a design with an experimental (with typing‐course) and a control group (no course)The experimental group showed more improvement in typing, spelling and narrative writing. Implications for practitioners It is important for the quality of student's text output to learn how to touch‐typeTouch‐typing can be learned in a teacher-directed course, containing 15 training sessions of 1.5 hours eachPractice of 20 minutes a day is necessary [ABSTRACT FROM AUTHOR]

Task solving processes and changes in these processes have long been expected to provide valuable information about children's performance in school. This article used electronic tangibles (concrete materials that can be physically manipulated) and a dynamic testing format (pretest, training, and posttest) to investigate children's task solving processes and changes in these processes as a result of training. We also evaluated the value of process information for the prediction of school results. Participants were N = 253 children with a mean age of 7.8 years. Half of them received a graduated prompts training; the other half received repeated practice only. Three process measures were used: grouping behaviour, verbalized strategies, and completion time. Different measures showed different effects of training, with verbalized strategies showing the largest difference on the posttest between trained and untrained children. Although process measures were related to performance on our dynamic task and to math and reading performance in school, the amount of help provided during training provided the most predictive value to school results. We concluded that children's task solving processes provide valuable information, but the interpretation requires more research. Lay Description: What is already known about this topic: Dynamic testing provides information on a child's ability to learn.Solving process information provides indications for intervention.Computerized testing can be of great help in recording process information. What this paper adds: Process‐oriented dynamic testing provides explanatory information beyond traditional tests.The use of a tangible user interface (TUI) console uncovers valuable information on solving processes.Process measures are related to series completion performance, math, and reading.Need for instruction is the best predictor of math and reading ability.Implications for practice and/or policy: A framework for interpreting process information is necessary in dynamic testing.Process‐oriented dynamic testing may be more suitable to inform education.TUIs provide a more natural testing environment. [ABSTRACT FROM AUTHOR]

Aim To explore the debate on the development of the nurse practitioner profession in the Netherlands. Background In the Netherlands, the positives and negatives of nurse practitioners working in the medical domain have been debated since the role was introduced in 1997. The outcome of the debate is crucial for nurse practitioners' professional development and society's justification of their tasks. Method Review of 14 policy documents, 35 opinion papers from nurses, 363 opinion articles from physicians and 24 Dutch research papers concerning nurse practitioners from 1995 to 2012. Results Two discourses were revealed: one related to efficiency and one to the development of the profession. In both, the nurse practitioner role was presented as a solution for healthcare and workforce problems, while arguments differed. The efficiency discourse seemed most influential. Opinions of nurse practitioners were underrepresented; taking up new responsibilities was driven by the wish to improve patient care. While most physicians were willing to delegate tasks to nurse practitioners, they wished to retain final responsibility for medical care. Limitations All available publications were extensively studied, which could not include unpublished policy documents from the government or influential parties. This may have led to some selectivity. Conclusion The case of the Netherlands shows that nurses in developing their advanced role are facing barriers, similar to those in other countries. The dominance of efficiency arguments combined with protection of medical autonomy undermines the development towards nursing care that really benefits patients. Implications for nursing and health policy Nurse practitioners should strive to obtain positions in which they are allowed to make their own decisions and wise use of healthcare resources for the good of patients and society. Nurse practitioners should aim to become members of influential healthcare Boards in their countries, in which they can raise their voices and be involved in policy making. [ABSTRACT FROM AUTHOR]

Abstract: Increasingly, experts as deemed by personal experience or mental health service use, are involved in the education of nurses; however, accompanying research is limited and focuses primarily on opinions of nurse educators and students. The aim of this study was to develop an understanding of the potential contribution to mental health nursing education by those with experience of mental health service use. The research was part of the international COMMUNE (Co‐production of Mental Health Nursing Education) project, established to develop and evaluate co‐produced mental health content for undergraduate nursing students. A qualitative descriptive design was adopted with data collected through focus group interviews in seven sites across Europe and Australia. Experts by experience (people with experience of distress, service use, and recovery) co‐produced the project in partnership with nursing academics. Co‐production enriched the process of data collection and facilitated the analysis of data from multiple perspectives. Two themes are presented in this paper. The first focuses on how experts by experience can enhance students’ understanding of recovery by seeing the strengths inherent in the ‘human’ behind the diagnostic label. The second highlights the importance of communication and self‐reflection on personal values, where students can explore their own thoughts and feelings about mental distress alongside those with lived experience. Interacting with experts by experience in the classroom can assist in challenging stigmatizing attitudes prior to nursing placements. These findings can be used to inform international nursing curricula by increasing the focus on nursing skills valued by those who use the services. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Fifty to eighty percent of patients suffering from chronic kidney disease (CKD) experience a form of sexual dysfunction (SD), even after renal transplantation. Despite this, inquiring about SD is often not included in the daily practice of renal care providers. Objectives: This paper explores the perspectives of renal social workers regarding sexual care for patients and evaluates their practice, attitude towards responsibility and knowledge of SD. Design: A cross‐sectional study was conducted using a 41‐item online survey. Participants: Seventy‐nine members of the Dutch Federation of Social Workers Nephrology. Results: It was revealed that 60% of respondents discussed SD with a fifth of their patients. Frequency of discussion was associated with experience (p = 0.049), knowledge (p = 0.001), supplementary education (p = 0.006), and the availability of protocols on sexual care (p = 0.007). Main barriers towards discussing SD consisted of ‘culture and religion’ (51.9%), ‘language and ethnicity’ (49.4%), and ‘presence of a third person’ (45.6%). Sufficient knowledge of SD was present in 28% of respondents. The responsibility for discussion was 96% nephrologists and 81% social workers. Conclusion: This study provides evidence that a part of Dutch nephrology social workers do not provide sexual care regularly, due to insufficient experience and sexual knowledge, absence of privacy and protocols and barriers based on cultural diversity. According to the respondents the responsibility for this aspect of care should be multidisciplinary. Recommendations include a need for further education on the topic, private opportunities to discuss SD and multidisciplinary guidelines on sexual care. [ABSTRACT FROM AUTHOR]

Abstract: Background and Purpose: Physiotherapy (PT) and occupational therapy (OT) are key professions providing treatment for the arm after stroke; however, knowledge about the content of these treatments is scant. Detailed data are needed to replicate interventions, evaluate their effective components, and evaluate PT and OT practice. This paper describes PT and OT treatment for the severely affected arm in terms of duration, content according to components and categories of the International Classification of Human Functioning, Disability and Health, and to analyze differences between professions. Methods: Design: This is a retrospective analysis of randomized trial data. Participants: 46 patients after stroke with poor arm motor control recruited from inpatient neurological units from three rehabilitation centers in the Netherlands. Procedure: PTs and OTs recorded duration and content of arm treatment interventions for 8 weeks using a bespoke treatment schedule with 15 International Classification of Human Functioning, Disability and Health categories. Results: PTs and OTs spent on average 4–7 min per treatment session (30 min) on arm treatment. OTs spent significantly more time providing arm treatment and treatment at the activities level than PTs. PTs spent 79% of their arm treatment time on body functions, OTs 41%. OTs spent significantly more time on “moving around using transportation,” “self care,” and “household tasks” categories. Conclusions: Patients after stroke with a severely affected arm and an unfavorable prognosis for arm motor recovery receive little arm‐oriented PT and OT. Therapists spent most arm treatment time on body functions. There was a considerable overlap in the content of PT and OT in 12 of the 15 categories. Results can be generalized only to patients with poor arm motor control and may not represent practice in other countries. [ABSTRACT FROM AUTHOR]

Nurse middle managers are in an ideal position to facilitate patient-centred care. However, their contribution is underexposed in literature due to difficulties to articulate this in practice. This paper explores how nurse middle managers contribute to patient-centred care in hospitals. A combination of time-use analysis and ethnographic work was used to disclose their contribution to patient-centred care at a micro level. Sixteen nurse managers were shadowed for over 560 hours in four hospitals. Some nurse middle managers seldom contribute to patient-centred care. Others are involved in direct patient care, but this does not result in patient-centred practices. At one hospital, the nurse middle managers did contribute to patient-centred care. Here balancing between 'organizing work' and 'caring work' is seen as a precondition for their patient-centeredness. Other important themes are feedback mechanisms; place matters; with whom to talk and how to frame the issues at stake; and behavioral style. Both 'hands-on' and 'heads-on' caring work of nurse middle managers enhances their patient-centeredness. This study is the first of its kind to obtain insight in the often difficult to articulate 'doings' of nurse middle managers with regard to patient-centred care through combining time-use analysis with ethnographic work. [ABSTRACT FROM AUTHOR]

SUMMARY Background The aim of this paper is to describe the quality of exit site care by evaluating the use of the Dutch exit site guideline over a period of 15 years. Method The special interest group (SIG) for peritoneal dialysis (PD) analysed results of three surveys concerning general exit site care among members of the Dutch Association for nurses and carers (V&VN), the dialysis and nephrology section. Results In 2002 (when no guidelines were available) the survey showed huge diversity in practice, with no definition of the post-operative period after catheter placement and no uniform monitoring of the exit site. There was a difference in use of dressings and exit site care. In 2009, the survey showed that most dialysis centres worked with the first guideline of the V&VN (2006) and exit site classification (2006). However, at this time, there was still diversity in the way exit site care was undertaken. In 2016, there was widespread use of guidelines and classification alongside a more individual approach to practice. Differences occured in use of disinfectant, antimicrobial ointment, swimming and going to the sauna. Conclusion The exit site guideline has been widely used in the Netherlands, improving quality in care and utilising a more individual patient approach in care. However, there are still differences identified in practice for which the evidence-base and evaluation will be undertaken to supplement the guideline and attribute to exit site care practice. [ABSTRACT FROM AUTHOR]

Introduction: Shared decision making (SDM) requires an active role of both clinicians and patients. We aimed to conceptualise patient readiness for SDM about treatment, and to develop a patient questionnaire to assess readiness. Methods: We used the results of a scoping review and a qualitative study to inform the patient readiness construct. We conducted five additional rounds of data collection to finalise the construct definition and develop the Patient Readiness for SDM Questionnaire (ReadySDM) in an oncological setting: (1) longitudinal interviews with patients with cancer during and after a treatment decision‐making process; (2) a pilot study among experts, clinicians, and patients for feedback on the concept and items; (3) a field test among (former) patients with cancer to test item format and content validity, and to reduce the number of items; (4) cognitive interviews with people with low literacy to test the comprehensibility of the questionnaire; and (5) a field test among (former) patients who faced a cancer treatment decision in the last year, to test the content validity of the final version of the questionnaire. Results: A total of 251 people participated in the various rounds of data collection. We identified eight elements of patient readiness for SDM about treatment: (1) understanding of and attitude towards SDM; (2) information skills; (3) skills in communicating and claiming space; (4) self‐awareness; (5) consideration skills; (6) self‐efficacy; (7) emotional distress; and (8) experienced time. We developed the 20‐item ReadySDM to retrospectively measure these elements in an oncological setting. Conclusion: We conducted a thorough procedure to conceptualise patient readiness and to develop the ReadySDM. The questionnaire aims to provide novel insights into ways to enhance SDM in daily practice. Patient or Public Contribution: Multiple people with lived experience were involved in various phases of the study. They were asked for input on the study design, the conceptualisation of readiness, and the development of the questionnaire. [ABSTRACT FROM AUTHOR]

Specific phobia of vomiting (also known as emetophobia) is a relatively understudied phobia with respect to its aetiology, clinical features and treatment. In this stage, research is mostly based on people with self-reported fear of vomiting. This paper presents a survey on the clinical features of fear of vomiting of individuals. Self-reported vomit-fearful subjects from the Dutch community and from an Internet support group are included. Both vomit-fearful groups were characterized by high reports of fear, the presence of panic symptoms, and by extensive avoidance and safety behaviours. They also reported other psychiatric complaints, which were measured with a structured screening instrument. Vomiting complaints started mostly in late puberty. A significant proportion of the vomit-fearful participants had a treatment history. The prevalence rate of fear of vomiting in the community sample was established at 8.8% (female : male ratio = 4:1). Overall, results show that fear of vomiting is a common phenomenon, which can seriously impair daily functioning. Finally, clinical questions to be addressed in future research are formulated. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message Specific phobia of vomiting (also known as emetophobia) is among the least studied phobias., Most clinical data come from research with self-described fear of vomiting., This paper presents data on the clinical features, prevalence and additional psychiatric complaints of fear of vomiting in two vomit-fearful samples and one control sample with no fear of vomiting., Estimates of prevalence of fear of vomiting in a Dutch community sample were established at 1.8% for men and 7% for women., Evidence suggests that fear of vomiting is a chronic and disabling condition that may cause significant impairment in daily functioning. [ABSTRACT FROM AUTHOR]

Context The handover represents a high-risk event in which errors are common and lead to patient harm. A better understanding of the cognitive mechanisms of handover errors is essential to improving handover education and practice. Objectives This paper reports on an experiment conducted to study the effects of learner knowledge, case complexity (i.e. cases with or without a clear diagnosis) and their interaction on handover accuracy and cognitive load. Methods Participants were 52 Dutch medical students in Years 2 and 6. The experiment employed a repeated-measures design with two explanatory variables: case complexity (simple or complex) as the within-subject variable, and learner knowledge (as indicated by illness script maturity) as the between-subject covariate. The dependent variables were handover accuracy and cognitive load. Each participant performed a total of four simulated handovers involving two simple cases and two complex cases. Results Higher illness script maturity predicted increased handover accuracy (p < 0.001) and lower cognitive load (p = 0.007). Case complexity did not independently affect either outcome. For handover accuracy, there was no interaction between case complexity and illness script maturity. For cognitive load, there was an interaction effect between illness script maturity and case complexity, indicating that more mature illness scripts reduced cognitive load less in complex cases than in simple cases. Conclusions Students with more mature illness scripts performed more accurate handovers and experienced lower cognitive load. For cognitive load, these effects were more pronounced in simple than complex cases. If replicated, these findings suggest that handover curricula and protocols should provide support that varies according to the knowledge of the trainee. [ABSTRACT FROM AUTHOR]

Resistance exercise training is effective to counteract the adverse effects of androgen deprivation therapy (ADT) on body composition, muscle mass and leg strength in prostate cancer patients (PCa). However, it is unknown whether these effects can be autonomously maintained after cessation of the supervised program. Sixty‐eight PCa patients on ADT were included. The exercise intervention group (EX, n = 37) performed 20 weeks of supervised resistance exercise training. Thereafter, patients were advised to autonomously continue exercise training. The control group (CON, n = 31) only received usual care. Outcome measures were compared between baseline and after 1 year. Changes during the intervention (baseline vs. 20 weeks) and follow‐up period (20 weeks vs. 1 year) were descriptively explored. In EX, 83% reported to have continued exercise training themselves. After 1 year, fat mass gains were attenuated in EX compared to CON (1.2 ± 2.6 and 2.8 ± 1.9 kg, respectively; time × treatment effect p = 0.032). The fat percentage increased, and lean mass and quadriceps muscle cross‐sectional area decreased over time, with no differences between groups (overall 1.6 ± 2.1%, −0.7 ± 2.3 kg and −2.2 ± 2.9 cm2, respectively; time effects, all p < 0.05). For muscle strength, an increase of ∼5% in EX was observed, significantly different from the ∼10% decrease in CON (p < 0.001). Subsequent analyses showed that the initial exercise training‐obtained gains in lean mass, muscle mass and strength in EX compared to CON, declined during the follow‐up period. In conclusion, PCa patients on ADT are not capable to autonomously maintain the exercise‐obtained gains of a 20‐week supervised training program over a subsequent 1‐year period. Highlights: ADT for prostate cancer results in many side effects, including muscle mass lossA supervised resistance exercise training program can counteract many side effectsAfter cessation of the supervised program, exercise benefits are not effectively preservedMore focus on sustainability of exercise programs during ADT is required [ABSTRACT FROM AUTHOR]

This paper starts from a care ethical perspective on care and reports on a phenomenological study into older patients' experiences of hospitalisation. Although hospital care for older patients is at the centre of attention, questions what is at stake and what defines quality of care are rarely discussed with a view to the perspective of older patients themselves. The qualitative observational method of shadowing was used. Ten patients of 75 years old or older were shadowed from admission until discharge. The reflective lifeworld approach, based on phenomenological philosophy, was used to analyse the collected data. For the older patients included in the study, the essential meaning of hospitalisation can be described as feeling an outsider left in uncertainty. The word 'left' reveals how hospitalisation is experienced as a solitary struggle with various uncertainties that are related both to the hospital environment and to the patient's personal situation. The essential meaning is composed of the following three constituents: (i) staying in an inhospitable place, (ii) feeling constrained and (iii) experiencing disruption. The busy walking back and forth of care professionals and the functional character of involvement, restrain older patients from participating and make them feel abandoned. Feeling constrained reveals the feelings brought on by the ageing body which are emphasised by hospitalisation but often neglected by hospital staff. The failure of healthcare professionals to recognise and respond to who older patients are aside from their illness exacerbate the experience of disruptions. To improve care, hospital staff must be more sensitive to older patients' uncertainties. Also, hospital staff should provide older patients with understandable information and explanation which besides offering patients the possibility to feel involved, meets their need for recognition. [ABSTRACT FROM AUTHOR]

The aim was to determine predictors for the development of complaints of temporomandibular disorders ( TMD) in a large sample of Dutch scuba divers who were free of any TMD complaints before they started diving actively. Five-hundred and thirty-six scuba divers (mean ± SD age = 40·4 ± 11·9 years; 34·1% women) completed a specifically developed questionnaire, either online or on paper. Stepwise forward logistic regression analysis was performed to predict the presence of TMD pain, with several potential risk factors as predictors. Four hundred and eighty-five of the 536 respondents were free of any TMD pain before they started diving actively. In this sample, TMD pain was present in 214 persons (44·1%). Four predictors contributed significantly to the presence of TMD pain, viz., clenching ( OR = 2·466), warm water ( OR = 1·685), biting on the mouthpiece ( OR = 1·598), and the quality rating of the mouthpiece ( OR = 0·887, that is, a higher rating means a smaller odds of having TMD pain). TMD pain is a common complaint among scuba divers who were free of such complaints before they started diving actively. Clenching, biting on the mouthpiece, and a low rating of the mouthpiece are predictors for the presence of TMD pain in scuba divers, while diving in cold water serves as a protective factor for TMD pain. [ABSTRACT FROM AUTHOR]

Background and Aims A strong correlation exists between smoking and the use of alcohol and cannabis. This paper uses polygenic risk scores to explore the possibility of overlapping genetic factors. Those scores reflect a combined effect of selected risk alleles for smoking. Methods Summary-level P-values were available for smoking initiation, age at onset of smoking, cigarettes per day and smoking cessation from the Tobacco and Genetics Consortium ( n between 22 000 and 70 000 subjects). Using different P-value thresholds (0.1, 0.2 and 0.5) from the meta-analysis, sets of 'risk alleles' were defined and used to generate a polygenic risk score (weighted sum of the alleles) for each subject in an independent target sample from the Netherlands Twin Register ( n = 1583). The association between polygenic smoking scores and alcohol/cannabis use was investigated with regression analysis. Results The polygenic scores for 'cigarettes per day' were associated significantly with the number of glasses alcohol per week ( P = 0.005, R2 = 0.4-0.5%) and cannabis initiation ( P = 0.004, R2 = 0.6-0.9%). The polygenic scores for 'age at onset of smoking' were associated significantly with 'age at regular drinking' ( P = 0.001, R2 = 1.1-1.5%), while the scores for 'smoking initiation' and 'smoking cessation' did not significantly predict alcohol or cannabis use. Conclusions Smoking, alcohol and cannabis use are influenced by aggregated genetic risk factors shared between these substances. The many common genetic variants each have a very small individual effect size. [ABSTRACT FROM AUTHOR]

This paper identifies autochthony-the belief that a place belongs to its original inhabitants and that they are therefore more entitled-as a relevant new determinant of out-group prejudice. We hypothesized that autochthony uniquely predicts prejudice towards migrant groups and that it mediates the relationship between national identification and prejudice. The mediation process was anticipated to be especially strong for people who perceive out-group encroachment, that is, those who feel that immigrants are 'getting out of place'. These hypotheses were tested in two studies using nationally representative samples of native Dutch participants. In Study 1 (N = 793), we showed that autochthony is an empirically distinct construct and that it is a unique predictor of prejudice. Furthermore, higher national identifiers expressed stronger claims of autochthony, and these claims were in turn associated with more negative feelings towards migrant groups. Study 2 (N = 466) showed support for a moderated mediation model: Beliefs in autochthony were only related to prejudice for participants who perceived out-group encroachment. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Several studies have investigated preferences and experiences of adolescents with different chronic conditions and their parents. Some have included the provider's perspective. Studies comparing the three perspectives on satisfaction with (transitional) care for different chronic conditions, however, are lacking. The main aim of this paper was to explore differences and similarities in perspectives between adolescents with chronic conditions, their parents and providers on transitional care. A secondary aim was to explore the extent to which such perspectives are disease-specific. Methods This quantitative study included 127 adolescents with juvenile rheumatoid arthritis (JRA), neuromuscular disorder with chronic ventilation (NMD), or diabetes Type I; 166 parents; and 19 care providers. To assess the experiences and perceptions of adolescents and parents on transitional care, we used the 'Mind the Gap' instrument. The survey for providers included a checklist of shortcomings in transitional care. Results Adolescents rate current care significantly worse than parents on opportunities to make their own decisions and be seen without parents present. Adolescents also rated providers' current social skills lower than parents. Adolescents are more satisfied than their parents about transitional care process aspects such as co-ordination and communication between providers, but both groups indicated that the care process offers most room for improvement. Providers reported other aspects such as adolescents' lack of responsibility with regard to self-care and parents' difficulties with ceding control to their children. When looking at the three disease groups - JRA, NMD, diabetes, we found only small differences. According to providers, shortcomings in the care process with respect to guidelines, protocols and co-ordination are most prevalent. Conclusion Adolescents, parents and providers all report that there is room for improvement with regard to aspects of the care delivery process in transitional care. With respect to disease-specific issues we only found small differences. [ABSTRACT FROM AUTHOR]

In this paper, we examined how identification with urban districts as a common ingroup identity and perceived ingroup prototypicality influence the attitudes of residents toward other ethnic groups in their neighborhood. The overall conclusion of two field studies (N = 214 and N = 98) is that for majority-group members, there may be a positive relation between identification with an overarching identity and outgroup attitudes but only when they perceive their ingroup as low in prototypicality for the overarching group (Study 1 and 2). Conversely, for minority-group members, there may be a positive relation between identification and outgroup attitudes but only when they perceive their ingroup as high in prototypicality for the overarching group (Study 2). Outgroup prototypicality did not moderate the relation between identification and outgroup attitudes. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Diagnostics and care for people with intellectual disabilities (ID) and psychiatric disorders need to be improved. This can be done by using assessment instruments to routinely measure the nature and severity of psychiatric symptoms. Up until now, in the Netherlands, assessment measures are seldom used in the psychiatric care for this population. The objective of the present paper is to evaluate the use of the Brief Symptom Inventory (BSI), a widely used standardised questionnaire in general psychiatry, in a well-defined sample of people with borderline intellectual functioning or mild ID diagnosed with one or more psychiatric disorders. Methods A total of 224 psychiatric outpatients with either borderline intellectual functioning or mild ID participated in this study. All participants were new patients of Kristal, Centre for Psychiatry and Intellectual Disability in the Netherlands, in the period between 1 April 2008 and 1 October 2009. All participants were assessed by a multidisciplinary team, including a certified psychiatrist. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria were applied. The mean total intelligence quotient was measured with the Wechsler Adult Intelligence Scale (WAIS-III). The BSI was administered in an assisted fashion. Utility and psychometric properties of the BSI were investigated. Internal consistency coefficients (Cronbach's alphas) were computed. Bivariate correlations between the sub-scales were computed to assess differentiation between the scales. Mean sub-scale scores were compared between different DSM-IV-TR subgroups to investigate the discriminant abilities of the scales. A confirmatory factor analysis was conducted. Results The results suggest that the BSI is practically useful. Internal consistencies ranged from 0.70 to 0.96 and thus are considered good to adequate. Sub-scale inter-correlations showed there is a degree of differentiation between the sub-scales. Discriminant validity was shown for the sub-scales depression, anxiety and phobic anxiety. Confirmatory factor analysis showed that the underlying structure of the BSI could be described by the same nine-factor model as reported in previous studies. Conclusions As a result of the psychometric properties illustrated, this study supports the use of the BSI as a screener for psychopathology and a general outcome measure in people with ID. [ABSTRACT FROM AUTHOR]

Objective This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2012; 26; 133-143 The professional nursing practice environment and nurse-reported job outcomes in two European countries: a survey of nurses in Finland and the Netherlands The working environment of nurses is receiving international interest, because there is a growing consensus that identifying opportunities for improving working conditions in hospitals is essential to maintain adequate staffing, high-quality care, nurses' job satisfaction and hence their retention. Thus, the aim of this study was to investigate the relationship between nurse work environment characteristics and nurse-reported job outcomes in hospital settings in Finland and the Netherlands and to compare these results. A comparative cross-sectional nurse survey was conducted. Data were collected from the two countries randomly sampling the countries' National Nurses Association' membership databases. In this paper, the results from Registered Nurses working in hospital settings are used. In total, 869 hospital nurses participated: 535 from Finland and 334 from the Netherlands with the response rate of 44.9 and 33.4%, respectively. Fifty-five items from the Nursing Work Index-Revised were used as a main tool for the practice environment. Exploratory factor analysis was used to identify a set of internally consistent subscales. Further, logistic regression analysis and T-tests were used. Three practice environment characteristics were identified: adequacy of resources, supportiveness of management and assurance of care quality via collaborative relationships. Favourable evaluations of the adequacy of resources and supportiveness of management were positively correlated with nurse-assessed quality of care and job-related positive feelings and negatively correlated with intentions to leave a unit, organization or the entire profession. In neither of the participating countries were adverse incidents affecting nurses related to nurses' evaluations of their current professional practice environment. Compared with Finland, in the Netherlands, RN appears to evaluate the majority of work environment characteristics more positively; nevertheless, to some extent, the results were uniform as adequacy of resources and supportiveness of management were main predictors for nurse-reported job outcomes considered. [ABSTRACT FROM AUTHOR]

Background: Studies revealed unidirectional associations between frailty and medication‐related problems (MRPs) among older adults. Less is known about the association between frailty and the risk of MRPs. We aimed to assess the bi‐directional association between frailty and the risk of MRPs in community‐dwelling older adults in five European countries. Methods: Participants were 1785 older adults in the population‐based Urban Health Centres Europe project. Repeated assessments were collected at baseline and one‐year follow‐up, including frailty, the risk of MRPs, and covariates. Linear regression analyses were conducted to examine the unidirectional associations. A cross‐lagged panel modeling was used to assess bi‐directional associations. Results: The unidirectional association between frailty at baseline and the risk of MRPs at follow‐up remained statistically significant after adjusting for covariates (β = 0.10, 95%CI:0.08, 0.13). The association between the risk of MRPs at baseline and frailty at follow‐up shows similar trends. The bi‐directional association was comparable with reported unidirectional associations, with a stronger effect from frailty at baseline to the risk of MRPs at follow‐up than reversed path (Wald test for comparing lagged effects: p < 0.05). Conclusion: This longitudinal study suggests that a cycle may exist where older adults with higher frailty levels are more likely to have a higher risk of MRPs, which in turn contributes to developing a higher level of frailty. Further research is needed to validate our findings and explore underlying pathways. [ABSTRACT FROM AUTHOR]

Background: We aimed to gain more insight into autonomy of older people with intellectual disabilities in a residential care facility in making choices. Methods: We performed a descriptive ethnographic study in a residential facility in the Netherlands for 22 persons, aged 54–89 years, with mild to moderate intellectual disabilities (IQ <70) and low social–emotional development levels. We combined participant observations and qualitative interviews. Results: Based on the observations, the main themes for the interviews were established. Residents indicated to be free to make independent choices, and experienced less autonomy with regard to health issues and finances. Support staff stated that residents' level of autonomy depends on residents' characteristics, needs, preferences, the attitude of support staff and the rules of the care institution. Conclusion: Residents had a clear view on their autonomy in making independent choices. Support staff is mindful of preserving residents' autonomy, which in practice is limited. [ABSTRACT FROM AUTHOR]

Background: Early mobilisation of critically ill adults has been proven effective and is safe and feasible for critically ill children. However, barriers and perceived benefits of paediatric intensive care unit (PICU) staff involvement in mobilising critically ill children are largely unknown. Aim: To explore the barriers and perceived benefits regarding early mobilisation of critically ill children as perceived by PICU staff. Study design: A cross‐sectional survey study among staff from seven PICUs in the Netherlands has been carried out. Results: Two hundred and fifteen of the 641 health care professionals (33.5%) who were invited to complete a questionnaire responded, of whom 159 (75%) were nurses, 40 (19%) physicians, and 14 (6%) physical therapists. Respondents considered early mobilisation potentially beneficial to shorten the duration of mechanical ventilation (86%), improve wake/sleep rhythm (86%) and shorten the length of stay in the PICU (85%). However, staff were reluctant to mobilise patients on extracorporeal membrane oxygenation (ECMO) (63%), and patients with traumatic brain injury (49%). Perceived barriers to early mobilisation were hemodynamic instability (78%), risk of dislocation of lines/tubes (74%), and level of sedation (62%). In total, 40.3% of PICU nurses stated that physical therapists provided enough support in their PICU, but 84.6% of the physical therapists believed support was sufficient. Conclusion: Participating PICU staff considered early mobilisation as potentially beneficial in improving patient outcomes, although barriers were noted in certain patient groups. Relevance to clinical practice: We identified barriers to early mobilisation which should be addressed in implementation research projects in order to make early mobilisation in critically ill children work. [ABSTRACT FROM AUTHOR]

Introduction: Understanding participants' concerns and information needs regarding broadened consent is crucial to ensure transparency and participant autonomy. Our study qualitatively examined these issues in women participating in the Personalized RISk‐based MAmmascreening study (PRISMA). The original PRISMA informed consent was project‐specific (i.e., breast cancer research), limiting the scope of secondary research. We explored participants' needs for broadened consent to preserve informed decision‐making while maximising the potential re‐use of data. Methods: Focus groups (FGs) were performed following a semistructured discussion guide. Two independent researchers analysed the data thematically using an inductive approach. Findings: Twenty‐three asymptomatic women and 13 women diagnosed with breast cancer were randomly divided into six FGs. Four superordinate themes were identified: (1) Normalization, (2) Attitude towards the pharmaceutical industry, (3) Privacy and (4) Knowledge. Our participants viewed data sharing as an important conduit for advancing medical science. Perceived integrity was more often attributed to noncommercial than commercial parties, with a marked mistrust towards the pharmaceutical industry. Most requested information needs related to data protection. Participants' ideal consent process would confer a range of options; for example, they would be able to choose with whom data can be shared, whether data will be de‐identified or anonymous, the expiration date of their consent and how, if requested, general and personal study results would be disclosed. Conclusion: Our participants expressed clear information needs and a strong desire to be actively engaged in future data sharing decisions. Given that many researchers collaborate with commercial parties, building public confidence in these institutions would be beneficial. Illustrative examples addressing privacy concerns and clarifying difficult terms would aid consent decision‐making. Although our participants displayed great altruism in sharing their data and accepted that broad consent would ultimately facilitate future research, broad consent did not reflect their ideal situation. Dynamic consent may be an option but warrants further feasibility research. Patient and Public Contribution: Women were recruited from the general breast cancer screening population. Their perceptions and information needs, as reported in this study, will not only inform broadened consent for PRISMA but ideally guide other consent templates and decisions regarding consent processes. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity has risen in recent decades and reached epidemic proportions worldwide. The proportion of those living with obesity is also increasing in nursing homes. This could impact the nursing care required, equipment and facilities provided, and morbidity in these settings. Limited evidence exists on clinical consequences of obesity in nursing home residents and their care. Objective: Therefore, the aim was to examine the rate and associated factors of obesity (BMI ≥30; class I (BMI 30.0–34.9 kg/m2), class II (BMI 35.0–39.9 kg/m2), and class III (BMI >40.0 kg/m2)) amongst older nursing home residents in European countries. Methods: We analysed data from 21,836 people who reside in nursing homes in Austria, the Netherlands, and the United Kingdom. They participated in the "International Prevalence Measurement of Care Quality", a cross sectional study between 2016 and 2019, where trained nurses interviewed the residents, reviewed care records, and conducted clinical examinations. A tested and standardised questionnaire comprised questions on demographic data, measured BMI, medical diagnosis according to ICD‐10, and care dependency. Descriptive and logistic regression analyses were performed. Results: Obesity rates were highest in Austria (17.1%) and lowest in the UK (13.0%) (p =.006). Residents with obesity were younger and less likely to be care dependent or living with dementia and had more often diabetes mellitus, endocrine, metabolic, and skin diseases compared to residents without obesity (p <.05). Most obese residents had obesity class I. Therefore, two subgroups were built (class I vs. class II + III). Residents with obesity class II + III were more frequently care dependent for mobility, getting dressed and undressed, and personal hygiene compared to residents with class I (p <.05). Conclusions: This study identified several factors that are associated with obesity amongst older nursing home residents in selected European countries. Implications for practice: The division into obesity classes is important for planning targeted care according to the individual needs of nursing home residents. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care can create several advantages, such as better quality of care and better outcomes. These advantages apply especially to clients with multiple problems (CWMPs) who have multiple, interconnected needs that span health and social issues and require different health care (e.g., mental health care or addiction care), social care (e.g., social benefits) and welfare services at the same time. Integrated care is most often studied as a phenomenon taking place at the system, organizational, professional and clinical levels. Therefore, in many studies, clients seem to be implicitly conceptualized as passive recipients of care. Less research has been conducted on how clients and (in)formal caretakers coproduce integrated care. Methods: We performed a longitudinal study to investigate how CWPMs and (in)formal caretakers coproduce integrated care. Data were collected among CWMPs and their (in)formal caretakers in Rotterdam, the Netherlands. CWMPs' care trajectories were followed for 1–1.5 years. CWMPs were interviewed three times at an interval of 6 months (T0, T1, T2). Informal caretakers were interviewed three times (T0, T1, T2), and formal caretakers of 16 clients were interviewed twice (T1, T2). Data in the municipal record systems about participating CWMPs were also included. Results: Our study shows that the CWMPs' multidimensional needs, which should function as the organizing principle of integrated care, are rarely completely assessed at the start (first 6 weeks) of CWMPs' care trajectories. Important drivers behind this shortcoming are the urgent problems CWMPs enter the support trajectory with, their lack of trust in 'the government' and the complexity of their situations. We subsequently found two distinct types of cases. The highest level of integrated care is achieved when formal caretakers initiate an iterative process in which the CWMP's multidimensional needs are constantly further mapped out and interventions are attuned to this new information. Conclusions: Our study indicates that integrated care is the joint product of formal caretakers and CWMPs. Integrated care however does not come naturally when CWMPs are 'put at the center'. Professionals need to play a leading role in engaging CWMPs to coproduce integrated care. Patient Contribution: CWMPs and their (in)formal caretakers participated in this study via interviews and contributed with their experiences of the process. [ABSTRACT FROM AUTHOR]

Background: Patient‐centred care has been recognised as vital for today's healthcare quality. This type of care puts patients at the centre, contributing to positive patient outcomes such as patient autonomy. Empirical research comparing nurses' and patients' perceptions of the support and provision of patient‐centred care is limited and focuses solely on nurses and patients working and staying on surgical wards. Aims and objectives: Comparing patients' and nurses' perceptions of patient‐centred care on different types of hospital wards, and exploring if patient empowerment, health literacy, and certain sociodemographic and context‐related variables are associated with these perceptions. Design: Cross‐sectional design. Methods: Data were collected in ten Flemish (February–June 2016) and two Dutch (December 2014–May 2015) hospitals using the Individualised Care Scale (ICS). A linear mixed model was fitted. Data from 845 patients and 569 nurses were analysed. As the ICS was used to measure the concept of patient‐centred care, it is described using the term 'individualised care.' Results: Nurses perceived that they supported and provided individualised care more compared with patients as they scored significantly higher on the ICS compared with patients. Patients with higher empowerment scores, higher health literacy, a degree lower than bachelor, a longer hospital stay, and patients who were employed and who were admitted to Dutch hospitals scored significantly higher on some of the ICS subscales/subsections. Nurses who were older and more experienced and those working in Dutch hospitals, regional hospitals and maternity wards scored significantly higher on some of the ICS subscales/subsections. Conclusion: Nurses perceived that they supported and provided individualised care more compared with patients. Relevance to clinical practice: Creating a shared understanding towards the support and provision of individualised care should be a priority as this could generate more effective nursing care that takes into account the individuality of the patient. [ABSTRACT FROM AUTHOR]

The purpose of this study was threefold, namely (1) to differentiate between multiproblem families and control families on characteristics and processes within the family based on a theoretical framework, (2) to identify multiproblem families by establishing cut-off scores on various questionnaires, and (3) to categorize multiproblem families into subtypes by cluster analyses. Various questionnaires were administered to multiproblem families (n = 85) and control families (n = 150). Results showed that what we propose to refer to as multiproblem families present a broad range of problems on seven domains: (1) child factors, (2) parental factors, (3) childrearing problems (inadequate or inconsistent parenting), (4) family functioning problems, (5) contextual problems, (6) social network problems, and (7) mental health care problems. Further, reliable cut-off scores were established for various questionnaires. Finally, three types of families were found: (1) community-problem families, (2) multiproblem families, and (3) child-focused mild-problem families. This paper looks to advance an evidence-based definition and assessment of 'multiproblem families' suggesting the possible value of defining and assessing multiproblem families in relation to these seven dimensions. Moreover, the classification of multiproblem families stresses the importance of providing tailored treatments. [ABSTRACT FROM AUTHOR]

Background: Thirst is one of the most intense and distressing symptoms experienced by patients in the intensive care unit (ICU), and no validated measurement tools exist. Validating a thirst measurement tool for the ICU population could be a first step in gaining a better understanding of thirst in ICU patients and aid the development and implementation of strategies regarding the prevention and control of thirst. Aim: The objective of this study was to determine the validity and reliability of the "Thirst distress scale for patients with heart failure (TDS‐HF)" in measuring thirst distress in adult ICU patients. Methods: Content validity was established by an expert panel consisting of ICU nurses, intensivists and five ICU patients. Concurrent validity, known‐groups validity and internal consistency were determined in a consecutive sample of 56 awake and oriented ICU patients with a median age of 70 years (IQR: 57‐74). Results: Content validity of the TDS‐HF in the ICU population was low, with item‐content validity indexes between 0.25 and 0.75. Concurrent validity was high as Spearman's correlation between TDS‐HF and the numeric rating score (0‐10) for thirst distress was 0.71. Internal consistency was high (Cronbach's alpha 0.78). When comparing groups, only higher blood urea nitrogen was significantly related to higher scores on the TDS‐HF (P =.003). Conclusion: The TDS‐HF has high concurrent validity and reliability in measuring thirst distress in ICU patients. Nevertheless, questions remain regarding the applicability and content validity of the scale, which should be further explored before the TDS‐HF can be used in the ICU. Relevance for clinical practice: The TDS‐HF can be used to explore thirst distress and to evaluate interventions. Individual items of the scale can be used to explore the nature of thirst distress in individual patients. [ABSTRACT FROM AUTHOR]

Context Ethnic minority students find that their ethnicity negatively affects the evaluation of their capacities and their feelings in medical school. This study tests whether ethnic minority and majority students differ in their 'self‐regulatory focus' in clinical training, that is, their ways to approach goals, due to differences in social learning experiences. Self‐regulatory focus consists of a promotion and prevention focus. People who are prone to stereotypes and unfair treatments are more likely to have a prevention focus and conceal certain identity aspects. The objectives of the study are to test whether ethnic minority students, as compared with ethnic majority students, are equally likely to have a promotion focus, but more likely to have a prevention focus in clinical training due to more negative social learning experiences (Hypothesis 1), and whether the relationship between student ethnicity and clinical evaluations can be explained by students' gender, social learning experiences, self‐regulatory focus and impression management (Hypothesis 2). Methods: Survey and clinical evaluation data of 312 (71.2% female) clerks were collected and grouped into 215 ethnic majority (69.4%) and 95 ethnic minority students (30.6%). Students' social learning experiences were measured as perceptions of unfair treatment, trust in supervisors and social academic fit. Self‐regulatory focus (general and work specific) and impression management were also measured. A parallel mediation model (Hypothesis 1) and hierarchical multiple regression analyses were used (Hypothesis 2). Results: Ethnic minority students had higher perceptions of unfair treatment and lower trust in their supervisors in clinical training. They were more prevention focused in clinical training, but this was not mediated by having more negative social learning experiences. Lower clinical evaluations for ethnic minority students were unexplained. Promotion focus in clinical training and trust in supervisors positively relate to clinical grades. Conclusion: Student ethnicity predicts social learning experiences, self‐regulatory focus and grades in clinical training. The hidden curriculum plausibly plays a role here. van Andel et al. demonstrate that systematic differences between ethnic minority and majority students can be predicted based on social learning experiences, self‐regulatory focus and clinical grades. [ABSTRACT FROM AUTHOR]

Background: At the start of the COVID‐19 pandemic, some parents in the Netherlands decided to bring their offspring with intellectual disabilities, who normally live in residential care, home. The present study explored why the mothers decided to bring their offspring home. Method: Interviews were carried out with seven mothers of adults with intellectual disabilities. An interpretative phenomenological approach was used to establish in‐depth accounts of the mothers' experiences. Results: The analysis yielded three overarching themes: (a) Families are indispensable; (b) the complex role of being a mother of a child with intellectual disabilities; and (c) Who is looking out for our offspring during COVID‐19? Conclusions: The mothers experienced a strong sense of wanting to do what was best for their offspring with intellectual disabilities during COVID‐19. The study provides insight into why mothers remain involved in the care for their offspring and the complexity of navigating lifelong care responsibilities. [ABSTRACT FROM AUTHOR]

This randomized controlled trial evaluated the effect of a 5‐week daily skin‐to‐skin contact (SSC) intervention between mothers and their full‐term infants, compared with care‐as‐usual, on exclusive and continued breastfeeding duration during the first post‐natal year. Healthy pregnant women (n = 116) from a community sample were enrolled and randomly allocated to the SSC or care‐as‐usual condition. SSC mothers were requested to provide one daily hour of SSC for the first five post‐natal weeks. Twelve months post‐partum, mothers indicated the number of exclusive and continued breastfeeding months. Multiple regression analyses were conducted using intention‐to‐treat, per‐protocol and exploratory dose–response frameworks. In intention‐to‐treat analyses, exclusive and continued breastfeeding duration was not different between groups (exclusive: 3.61 ± 1.99 vs. 3.16 ± 1.77 months; adjusted mean difference 0.28, 95% confidence interval [CI] −0.33 to 0.89; p = 0.36; continued: 7.98 ± 4.20 vs. 6.75 ± 4.06 months; adjusted mean difference 0.81, 95% CI −0.46 to 2.08; p = 0.21). In per‐protocol analyses, exclusive and continued breastfeeding duration was longer for SSC than care‐as‐usual dyads (exclusive: 4.89 ± 1.26 vs. 3.25 ± 1.80 months; adjusted mean difference 1.28, 95% CI 0.31–2.24; p = 0.01; continued: 10.81 ± 1.97 vs. 6.98 ± 4.08 months; adjusted mean difference 2.33, 95% CI 0.13–4.54; p = 0.04). Exploratory dose–response effects indicated that more SSC hours predicted longer exclusive and continued breastfeeding duration. This study demonstrates that for the total group, the 5‐week daily SSC intervention did not extend exclusive and continued breastfeeding duration. However, for mothers performing a regular daily hour of SSC, this simple and accessible intervention may extend exclusive and continued breastfeeding duration by months. Future studies are required to confirm these promising findings. Trial registration: Netherlands Trial Register (NTR5697). [ABSTRACT FROM AUTHOR]

Those using intermittent catheterization (IC) have many catheter types and styles to select from; including what manufacturers refer to as discreet catheters. Discreet catheters are often manufactured to be smaller in length, coiled in design, or foldable, thus allowing for easier concealment or discretion when carried in public and offering a degree of personal privacy. This study explores discreet catheter use and its alignment with the lifestyle experience of those who use such catheters. This study assesses the user and user experience with discreet catheters. User experience is defined as catheter choice, associated activities, and urinary tract health. A cross‐sectional survey investigated life and health status of individuals in the Netherlands requiring IC. The study enrolled 1892 individuals of which 784 use a discreet catheter as their primary catheter. Catheter choice: 82% of study respondents state they have the ability to choose the type of catheter they use. Of those indicating not having the ability to choose their catheter, they state their health care professional did not inform them of different catheters, brands, or options. Catheter associated activities: Those employed full or part time are satisfied with their discreet catheter (95.1%) claiming it is discreet, and gives them confidence to live their life the way they choose; that the catheter did not interference with social activities (72.6%), and had little to no interference with work outside of the home (76.1%). Urinary tract infections (UTI): 39.4% report a clinician diagnosed UTI within 6 months prior to the survey. The data indicates that 18.3% of the sample are deficient in UTI knowledge stating they do not know what a UTI is, or what associated symptoms are; 41% followed a clinician suggested regimen for catheterizing; 25.5% altered catheterization schedules to fit daily activities; 33.3% stated they did not follow a regimen, but catheterized when convenient The data supports positive experiences for individuals who use discreet catheters as their primary method of bladder voiding, particularly socially active individuals requiring an element of personal privacy in their life. However, UTI's are a matter of concern due to a reported deficit in knowledgeable about UTI's and symptomology. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore cross‐level mechanisms stimulating employees' innovative behavior in small firms, specifically emotional contagion between small business owners and their employees. Using data from three European countries and applying a multilevel approach, we tested how small business owners' work‐related affect—enthusiasm and comfort—relate to their employees' work‐related affect and innovative work behavior. The sample consisted of 85 small business owners and 711 employees from firms operating in the Netherlands, Poland, and Spain. Controlling for country, the results of multilevel modeling showed that small business owners' work‐related affect was positively related to their employees' work‐related affect. The hypothesized contagion of work‐related affect in small firms was, thus, supported. Employees' work‐related affect, in turn, was positively associated with their innovative behavior. Employees' work‐related affect mediated the relationship between small business owners' work‐related affect and employees' innovative behavior. The results also showed cross‐country differences in the strength of some of the relationships. The study is a step forward in understanding innovation in small firms, extending the insights gained from single‐level investigations. [ABSTRACT FROM AUTHOR]

Recognizing the importance for companies of having high-quality employment relationships with employees, previous studies have sought to explain the variability in employees' perceptions of HRM service value. However, most of these studies view employees as inactive in employment relationships and, therefore, do not consider whether employees' own attributes affect their perceptions of HRM service value. In accepting the alternative notion that consumers create value 'in use,' the current study regards employees as active consumers of HRM practices, and so examines the extent and way in which employees' HRM competences (i.e., knowledge, skills, and abilities) explain the variability in HRM service value. Based on data collected from 2,002 employees in 19 companies in the Netherlands, a positive relationship has been found between employees' HRM competences and their perception of HRM service value, albeit one that is mediated by the perceived quality and nonmonetary costs of HRM services. The main implication of our findings is that employees should be seen as active agents in employment relationships who, through coproducing and consuming HRM services as well as leveraging their knowledge and skills, influence the value of HRM services and have the potential to increase or undermine the outcomes of the employment relationship. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

In an experimental study and a field study, we studied whether high-commitment human resource management (HC-HRM) is more effective when employees can make sense of HRM (attribute HRM to management). In the experimental study (n = 354), employees' HC-HRM perceptions were evoked by a management case, and their attributions were manipulated with an information pattern based on the three dimensions of the covariation principle of the attribution theory: distinctiveness, consistency, and consensus. As expected, the results showed that the effect of HC-HRM on affective organizational commitment was stronger when employees understood HRM as was intended by management. This experimental finding was confirmed in a cross-level field study (n = 639 employees within 42 organizations): the relationship between HC-HRM, on one hand, and affective organizational commitment and innovative behavior, on the other hand, was stronger under the condition that employees could make sense of HRM. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Sustainable success calls for contextually ambidextrous organizing. According to theory, this entails enabling simultaneous high levels of exploration and exploitation within a subsystem. The practices involved in enabling contextual ambidexterity form a major and relatively unexplored leadership challenge. Our main aim is to draw on a combination of ambidexterity and complexity theory insights to understand how contextual ambidexterity emerges in dynamic contexts. We contribute to the literature on the role of leadership in enabling contextual ambidexterity by exploring the daily practices leaders enact to stimulate exploration and exploitation as well as to shift dynamically between them to (re)gain contextual ambidexterity. We present the results of two qualitative studies exploring leadership in project-based organizations where the pressure for contextual ambidexterity is relevant. We show that in responding adaptively to environmental stimuli, leaders shift between practices to emphasize exploitation or exploration to (re)gain the needed high levels of both, and their enactments are bounded by the conditions of keeping exploration and exploitation simultaneously high. We discuss the implications of these findings for understanding contextual ambidexterity as a dynamic accomplishment that emerges in everyday interactions, the role of leaders in enabling contextual ambidexterity, and the need for HR managers to support leaders in enacting this dynamic form of leadership. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This study is based on Philippe van der Voorn's master's dissertation at the Utrecht University, Department of Science, Information and Computing Sciences. The problem identified was a lack of an integrated information chain and clear governance structure for information flow in the Netherlands' health care sector. The method of Design Science was followed to construct an overview model of the chain, and towards a business process model that is intuitive for both technical and business users. An initial declaration chain was identified in the literature and presented, to be confirmed and elaborated on via eight interviews at seven different organisations in the medical specialist health care sector. Based on these interviews, the draft overview was adjusted and a Business Process Model and Notation model created that indicates the shared understanding of the data elements and activities between the organisations. The contribution of the overview of the declaration chain, in particular, can help medical specialist staff obtain an understanding of the administrative side of their work, and with a clear information infrastructure lead to better working processes and information quality. F.J. [ABSTRACT FROM AUTHOR]

Aim: The aim of this prospective cohort study was to assess the effect of a pocket irrigator/evacuator device (IED) in the non‐surgical treatment of peri‐implantitis. Material and Methods: In total 24 patients having 38 implants diagnosed with peri‐implantitis were included in this study. Peri‐implant pockets were irrigated six times in three consecutive weeks. The primary outcome was bleeding on probing (BoP). Secondary outcome parameters included plaque index (Pl), suppuration on probing (SoP), probing pocket depth (PPD), marginal bone loss (MBL), presence and numbers of periodontal pathogens. Parameters were assessed at baseline and 3 months after the last treatment. Treatment pain perception was scored using the visual analog scale (VAS) after the first and last treatment. Results: At 3 months, IED treatment revealed significant reduction of peri‐implant BoP (71% [±20] vs 57% [±28] [P =.014]) and peri‐implant plaque scores (10 [±14] to 5 [±9] [P =.039] [T0 vs T3 respectively]). Significant reduction in mean peri‐implant PPD from 4.92 mm (SD ± 1.28) to 4.66 mm (SD ± 1.35) (P =.041) was observed. In addition, a reduction in VAS pain score between the first and the last (6th) treatment was found (P =.039). No reduction in SoP (P =.088) was found. No changes in mean periodontal full mouth plaque, BOP, SOP and PPD levels, MBL and microbiological outcomes were found. Conclusion: Beneficial clinical effects in terms of BoP, PPD and PI were found at 3 months after IED treatment. However, the IED does not seem to effectively treat peri‐implantitis in terms of disease resolution. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence of burnout among Dutch young and more experienced dental hygienists and the work experience of young professional dental hygienists. Material and methods: Two studies were carried out using the Dutch version of the Maslach Burnout Inventory; the Utrecht Burnout Scale (UBOS) and the Utrecht Work Engagement Scale (UWES). In Study I, 400 participants completed an online questionnaire, including the UBOS‐general version. In Study II, a questionnaire was distributed via social media to young professionals, including the UBOS‐health care version and the UWES‐9. Results: 2.5% of 157 dental hygienists (Study I) satisfied the norm of burnout. Dental hygienists' average work experience was 16.6 years, and one‐thirds worked 25‐32 hours per week. In Study II, 73 young professionals (M = 26.5 years) reported 32.9 weekly working hours. Three‐quarters were employed and worked in a dental clinical team practice. UWES‐mean scores indicated a moderate to high level of work engagement. Mostly, all aspects of burnout were low compared with the test Manual norms. Conclusions: Exploratory findings show that generally burnout appears no threat for Dutch dental hygienists, and moderate to high level of work engagement coincides with a low level of burnout‐related symptoms. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is a risk factor for impaired functionality and independence. For optimal treatment of malnourished older adults (OA), close collaboration and communication between all stakeholders involved (OA, their caregivers and health‐care and welfare professionals) is important. This qualitative study assesses current collaboration and communication in nutritional care over the continuum of health‐care settings and provides recommendations for improvement. Methods: Eleven structured focus group interviews and five individual interviews took place in three regions across the Netherlands from November 2017 until February 2018, including OA, caregivers and health‐care and welfare professionals. Various aspects of collaboration and communication between all stakeholders were discussed. Interviews were transcribed and analysed using a thematic approach. Results: Six main themes emerged: causes of malnutrition, knowledge and awareness, recognition and diagnosis of malnutrition, communication, accountability and food preparation and supply. Physical and social aspects were recognized as important risk factors for malnutrition. Knowledge and awareness regarding malnutrition were acknowledged as being insufficient among all involved. This may impair timely recognition and diagnosis. Responsibility for nutritional care and its communication to other disciplines are low. Food preparation and supply in hospitals, rehabilitation centres and home care are below expected standards. Conclusion: Many stakeholders are involved in nutritional care of OA, and lack of communication and collaboration hinders continuity of nutritional care over health‐care settings. Lack of knowledge is an important risk factor. Establishing one coordinator of nutritional care is suggested to improve collaboration and communication across health‐care settings. [ABSTRACT FROM AUTHOR]