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The introduction of the surgical robot resulted in increasing technical difficulty of these robot assisted surgeries (RAS). The qualification and certification of RAS skills are still in a preliminary phase within all surgical specialties, also in urology. New methods of training for novice surgeons (residents and fellows) in these highly specialised techniques should be implemented to guarantee patient safety. The challenge for novice surgeons is how to learn new surgical procedures and once the procedure is learned and they become experts how to analyse past performances and subsequently use this as a lesson for the future in order to improve postoperative outcome. In the first part of this these we explored the best methods to educate surgeons in robotic surgery. By using different modalities of training, (i.e., hands-on training combined with theoretical information of learning) we discovered (chapter 2) novice robot surgeons were too positive in the self-assessment of their own surgical skills after a training in RAS. To prevent overconfidence biases the novice surgeons should be provided with feedback (proctoring) to inform them about their results to enhance learning and inform them of their competence levels. Although results (chapter 3) show there is no significant difference in the acquisition of surgical skills between different types of proctoring provided to novice surgeons the participant satisfaction seems to be higher in the “human proctoring” group. Which could result in additional motivation for the participant to continue training in RAS. Additional research (chapter 4) shows residents in urology are allowed to perform RAS during their residency, but criteria for starting RAS differ significantly among the teaching hospitals. This shows there is a need for the implementation of a (multi-step) training and certification program in the Dutch urology residency curriculum. The long-term effects of the structured fellowship in RAS were investigated in chapter 5. The results of the survey showed that most respondents still perform RAS after the fellowship, which matches results from other research into the impact of RAS fellowships.34,35 A remarkable finding of this study is that a large proportion of respondents is unaware of the oncological (33%) and functional outcomes (66%) of their patients. Thus, participants of RAS fellowships should be coached to review their own results to learn from their past performance and reduce their learning curve. The second part of the thesis focuses the assessment of a robotic surgeon’s surgical performance. Different methods were used to identify which factors should be assed in surgical video analysis in order to ascertain a surgeon’s surgical skills. In robot assisted surgery. (Chapter 6 and 8). In addition, a research protocol is provided by which the non-technical skills can be assed in both laparotomic surgery and robot assisted surgery in order to discover the difference in non-technical skills between the two surgical modalities. The third part of the thesis focusses on the relation between a surgeon’s performance and postoperative outcome of patients. In this part multiple methods of surgical video analysis were used to identify factors which could influence the postoperative outcome of patients (Chapters 9, 10, 11, and 12). Results show the length of the urethral stump after dissection of the prostate could be a significant factor in the recovery of continence after prostatectomy.

Roken, overgewicht en alcoholgebruik zijn veruit de grootste veroorzaker van ziektelast in Nederland met 35.000 doden en 9 miljard euro aan zorguitgaven per jaar. Om dit probleem aan te pakken heeft de Rijksoverheid in 2018 het Nationaal Preventieakkoord opgezet. Met het Nationaal Preventieakkoord (NPA) streeft de Rijksoverheid samen met maatschappelijke organisaties om Nederlanders gezonder te maken. Binnen dit akkoord staan de thema’s roken, overgewicht en alcoholgebruik centraal. Intussen zijn deze thema’s uitgebreid met mentale gezondheid en het terugdringen van gezondheidsachterstanden. Vanuit het NPA kunnen gemeentes met een lokaal preventieakkoord (LPA) voortborduren op het nationale programma. Lokale preventieakkoorden geven ruimte om de thema’s in het NPA te verbinden met specifieke problematiek waarmee inwoners binnen een gemeente kampen. Daarbij valt te denken aan schulden, armoede en eenzaamheid. De gemeente of regio bepaalt zelf welke problematiek centraal staat in een lokaal preventieakkoord: de lokale behoefte is leidend. De gemeente Goes heeft in 2021 een LPA opgesteld voor 2021-2023. De gemeente heeft ervoor gekozen om in te zetten op het verhogen van welbevinden en (positieve) gezondheid van inwoners. Anderzijds streeft het akkoord de ziektelast, het zorggebruik en de zorgkosten te verlagen. Om deze doelstellingen te behalen heeft de gemeente Goes geïnvesteerd in het landelijke programma Welzijn op Recept (WoR) en is aan de slag gegaan deze interventie op te schalen in alle wijken van Goes. WoR is een alternatief voor mensen met psychosociale klachten. In plaats van het ‘traditionele pilletje’ voor te schrijven, verwijst de huisarts deze patiënten door naar een welzijnscoach. In 2023 was WoR al in meer dan negentig Nederlandse gemeenten geïmplementeerd. Sinds juli 2019 is WoR een van de aandachtspunten binnen het preventieve gezondheidsbeleid van VWS. De gemeente Goes heeft in samenwerking met stakeholders eerste stappen gezet, voornamelijk gericht op het creëren van een goede relatie tussen de eerstelijns zorg en welzijnscoaches. Na de aftrap ligt de focus op de volgende stap, namelijk het inzichtelijk maken van het passend welzijns- en gezondheidsaanbod en de huidige implementatie. Het inzichtelijk maken van passende welzijns- en gezondheidsprogramma’s voor relevante stakeholders is een cruciale stap in succesvolle implementatie van WoR. Om ervoor te zorgen dat de welzijnscoach de doelgroep zo gericht mogelijk kan doorverwijzen naar een welzijnsarrangement is het noodzakelijk dat dit aanbod goed in beeld is binnen een gemeente. Tevens kan er op die manier worden geëvalueerd of nieuw aanbod nodig is of dat het huidige aanbod voldoet aan de eisen. Het inzichtelijk maken van het aanbod kan op diverse manieren aangepakt worden aan de hand van verschillende thema’s. Binnen de uitvoering van de interventie in de praktijk is er geen uniformiteit. Het is daarom lastig om inzicht te krijgen hoe het aanbod het beste vormgegeven kan worden. De doelstelling van dit onderzoek is er daarom op gericht om inzicht, advies en handvatten te bieden voor de gemeente Goes bij het vormgeven van een toegankelijke passend welzijns- en gezondheidsaanbod. Om de vormgeving handen en voeten te geven en de volgende stappen te kunnen zetten is het aansluitend belangrijk inzicht en input te vergaren van de belangrijkste WoR stakeholders binnen de gemeente Goes over de huidige implementatie. Het eerstvolgende hoofdstuk bestaat uit een literatuurstudie met achtergrondinformatie van WoR en een analyse van de beschikbare informatie rondom het maken van een toegankelijk, begrijpelijk en passend welzijns- en gezondheid aanbod. Vervolgens zijn de resultaten beschreven van de inzichten en input van de stakeholders binnen de gemeente Goes. Het rapport sluit af met enkele aanbevelingen over het vormgeven van de welzijnsarrangementen en verdere voortgang van WoR binnen de gemeente Goes.

Roken, overgewicht en alcoholgebruik zijn veruit de grootste veroorzaker van ziektelast in Nederland met 35.000 doden en 9 miljard euro aan zorguitgaven per jaar. Om dit probleem aan te pakken heeft de Rijksoverheid in 2018 het Nationaal Preventieakkoord opgezet. Met het Nationaal Preventieakkoord (NPA) streeft de Rijksoverheid samen met maatschappelijke organisaties om Nederlanders gezonder te maken. Binnen dit akkoord staan de thema’s roken, overgewicht en alcoholgebruik centraal. Intussen zijn deze thema’s uitgebreid met mentale gezondheid en het terugdringen van gezondheidsachterstanden. Vanuit het NPA kunnen gemeentes met een lokaal preventieakkoord (LPA) voortborduren op het nationale programma. Lokale preventieakkoorden geven ruimte om de thema’s in het NPA te verbinden met specifieke problematiek waarmee inwoners binnen een gemeente kampen. Daarbij valt te denken aan schulden, armoede en eenzaamheid. De gemeente of regio bepaalt zelf welke problematiek centraal staat in een lokaal preventieakkoord: de lokale behoefte is leidend. De gemeente Goes heeft in 2021 een LPA opgesteld voor 2021-2023. De gemeente heeft ervoor gekozen om in te zetten op het verhogen van welbevinden en (positieve) gezondheid van inwoners. Anderzijds streeft het akkoord de ziektelast, het zorggebruik en de zorgkosten te verlagen. Om deze doelstellingen te behalen heeft de gemeente Goes geïnvesteerd in het landelijke programma Welzijn op Recept (WoR) en is aan de slag gegaan deze interventie op te schalen in alle wijken van Goes. WoR is een alternatief voor mensen met psychosociale klachten. In plaats van het ‘traditionele pilletje’ voor te schrijven, verwijst de huisarts deze patiënten door naar een welzijnscoach. In 2023 was WoR al in meer dan negentig Nederlandse gemeenten geïmplementeerd. Sinds juli 2019 is WoR een van de aandachtspunten binnen het preventieve gezondheidsbeleid van VWS. De gemeente Goes heeft in samenwerking met stakeholders eerste stappen gezet, voornamelijk gericht op het creëren van een goede relatie tussen de eerstelijns zorg en welzijnscoaches. Na de aftrap ligt de focus op de volgende stap, namelijk het inzichtelijk maken van het passend welzijns- en gezondheidsaanbod en de huidige implementatie. Het inzichtelijk maken van passende welzijns- en gezondheidsprogramma’s voor relevante stakeholders is een cruciale stap in succesvolle implementatie van WoR. Om ervoor te zorgen dat de welzijnscoach de doelgroep zo gericht mogelijk kan doorverwijzen naar een welzijnsarrangement is het noodzakelijk dat dit aanbod goed in beeld is binnen een gemeente. Tevens kan er op die manier worden geëvalueerd of nieuw aanbod nodig is of dat het huidige aanbod voldoet aan de eisen. Het inzichtelijk maken van het aanbod kan op diverse manieren aangepakt worden aan de hand van verschillende thema’s. Binnen de uitvoering van de interventie in de praktijk is er geen uniformiteit. Het is daarom lastig om inzicht te krijgen hoe het aanbod het beste vormgegeven kan worden. De doelstelling van dit onderzoek is er daarom op gericht om inzicht, advies en handvatten te bieden voor de gemeente Goes bij het vormgeven van een toegankelijke passend welzijns- en gezondheidsaanbod. Om de vormgeving handen en voeten te geven en de volgende stappen te kunnen zetten is het aansluitend belangrijk inzicht en input te vergaren van de belangrijkste WoR stakeholders binnen de gemeente Goes over de huidige implementatie. Het eerstvolgende hoofdstuk bestaat uit een literatuurstudie met achtergrondinformatie van WoR en een analyse van de beschikbare informatie rondom het maken van een toegankelijk, begrijpelijk en passend welzijns- en gezondheid aanbod. Vervolgens zijn de resultaten beschreven van de inzichten en input van de stakeholders binnen de gemeente Goes. Het rapport sluit af met enkele aanbevelingen over het vormgeven van de welzijnsarrangementen en verdere voortgang van WoR binnen de gemeente Goes.

This dissertation centers on the concept of “urgency for change” in narratives—how, in processes of change, several urgency narratives develop and interact dynamically, influencing the process and outcome of organizational change. Classically, urgency for change is the domain of organizational change scholars like Kotter, who adopted a “clock time” perspective on organizational change. Such scholars pay considerable attention to the role of management and the idea that a good change story facilitates change. These assumptions are challenged in this thesis, which has a temporal narrative focus and appreciates the multiplicity of stories. Martijn van Ooijen asks himself: How do multiple urgency narratives dynamically interact in organizational change processes with societal implications? While in this first chapter a framework for temporal narratives is developed, the next three chapters investigate the dynamic interaction of urgency narratives on several levels in two societal cases. The first case deals with implementation of a new health care law in the Netherlands (Wet Langdurige Zorg in Dutch). The new law that was passed to improve the system, had a big societal impact. First, this chapter adresses the urgency narratives and stakeholders that authored them in the public debate. Second, it investigates the impact of these public narratives on local processes of change in health care organizations. The second case was a change project in the Dutch earthquake region where the researcher was part of a change team. The project’s aim was to improve the safety culture of construction companies involved in the recovery of damaged houses. This case deals with the problematic societal acceptance of construction as a high-risk field with frequent injuries, sickness, absences, and disability retirement. The chapter provides an in-depth view of the development of various urgency narratives of several groups of stakeholders involved. Moreover, it pays attention to the thought processes and intervention strategies of the change consultants of the change platform. The results of the dissertation point to the value of combining temporality and narrative in the tempo-narrative framework. The framework supports researchers through the practical application of time and narrative in processes of change by highlighting various temporal narrative concepts and the necessity and ways to work with a multitude of stories. By focusing on temporality in the two cases, it became possible to explain the tensions in several narrative struggles. The dissertation also points to the importance of dialog on the often hidden and taken-for-granted ideas and beliefs as intervention strategy, and ways to do that. For instance, a good setting where people feel free to share their stories with others is important. Certain questions can help and in one of the chapters a multistory movie was used as an opener for dialog. Future researchers could benefit from the tempo-narrative research approach that was adopted and the various temporal narrative approaches it incorporates. Future research should further explore and integrate the way different intervention strategies are adopted and unfold in change processes characterized by a multitude of urgency narratives. Moreover, there is value in the researcher–practitioner combination but it also requires reflexivity, which is still an underexposed theme in this type of research.

Ethiek tussen kunst en zorg - Sessie over ethische aspecten in transdisciplinaire co-creatie op het snijvlak van kunst en zorg

Descriptions of course modules and workshops for nurses and musicians (Deliverable WP4)

Descriptions of course modules and workshops for nurses and musicians (Deliverable WP4)

Aphasia is a language disorder as a consequence of stroke. People with aphasia experience difficulties with understanding and communicating with others, such as healthcare professionals. As result, people with aphasia have higher risks of receiving inadequate care, show worse rehabilitation outcomes, lower satisfaction rates, higher risks for adverse events and higher medical costs. International studies have shown positive effects on communication between people with aphasia and healthcare professionals (HCPs) after providing HCPs with Communication Partner Training (CPT). CPT is an umbrella term for interventions that are aimed at improving communication between people with aphasia and their conversation partners. CPT interventions often include training modules where HCPs learn to use supportive conversation techniques. Positive effects include an increase in the use of conversation techniques, increased satisfaction and participation of the person with aphasia and improved quality of life scores. However, although the implementation of CPT intervention was included in best-practice statements and evidence-based guidelines, there were no CPT interventions available that were developed for the Dutch or Flemish context. Also, due to underreporting of CPT interventions, lack of outcome measures and lack of implementation research, there was little understanding of how different intervention elements in CPT interventions produce different outcomes. In this PhD thesis, we aimed to develop and evaluate a CPT intervention that is applicable for the Dutch and Flemish context. The CPT intervention was named CommuniCare and was developed based on the needs and wishes of the users (HCPs) and end-users (people with aphasia and their relatives) (Chapter 1-4). Chapter 5 describes the CommuniCare intervention in detail. From 2018-2020, almost 300 HCPs were provided the intervention. The evaluation of CommuniCare was conducted by analyzing the mechanisms of change from HCPs' perspectives (Chapter 6). Different intervention elements in CommuniCare improved HCPs skills, capacities and confidence to use supportive conversation techniques during conversations. The main barriers included time constraints, remaining lack of confidence and lack of positive beliefs. Using implementation theory, participating healthcare centers developed implementation strategies to address these barriers. This PhD thesis provides recommendations for implementing CPT interventions in healthcare centers, in order to improve communication between HCPs and people with aphasia. Implementation strategies include leadership, the development of supportive tools, financial and organizational facilitation by management and a change in role of Speech-and Language Therapists (SLTs). We also provide recommendations on how to lay the foundations of good communication skills in early-career healthcare students. Examples include teaching SLTs to coach and support their colleagues, and providing student courses for becoming Implementation Support Practitioners.

De alarmbellen luiden al een tijd voor de zorg. Het CBS telde onlangs 68 duizend vacatures. Ook vindt de helft van het zorgpersoneel de werkdruk te hoog. De piek van de vergrijzing moet dan nog komen, die wordt in 2040 verwacht.

When something goes wrong in healthcare, it is important that patients are informed in an open and honest manner. This dissertation focuses on the question: what is the role of law when something goes wrong in health care? To answer this question, research was conducted in three domains: action research with Dutch hospitals that want to become more open and practice being open in a better way; quantitative questionnaire research into the impact of medical disciplinary procedures on doctors who received a disciplinary measure, and traditional legal research into openness and the settlement of complaints and claims under the Quality, Complaints and Disputes in Health Care Act (Wkkgz). This study shows that openness requires policy, such as assistance for patients and support for care providers. At the institutional level, it is important to strive for a just culture, in which open discussion and learning from mistakes is the norm. The law appears to have adverse side effects in all three domains. The organisation of openness in hospitals is compartmentalised in procedures that make it difficult to pay attention to the full range of needs of the people involved; medical disciplinary law has a negative impact on the professional practice of defendants and rarely leads to learning; in principle, the Wkkgz has the potential to improve the settlement of both complaints and claims. Restorative justice, as a legal perspective on the principles of a just culture, has been explored as a way of realising that potential. Reflecting on these findings in a broader sense, it appears that the problems described here are not an isolated phenomenon. What can be learned from this dissertation is that when solving problems, it is important to strive for participation of those who are affected; in this dissertation patients and caregivers. In line with the principles of a just culture, restorative justice has been studied as a legal perspective for the settlement of incidents. The challenge this dissertation poses is how a restorative response after a medical incident can be organized concretely. Three methods were used in this thesis: action research, quantitative questionnaire research, traditional legal literature and case law research. As such, this dissertation is in line with the development towards a more empirical approach to law. Action research in particular offers potential for (legal) scholars who want to contribute to the improvement of an undesirable situation. The legal method does not lose its added value in this approach; on the contrary, it is one of the methods that action researchers will need in order to understand and change a problem in its entirety.

When something goes wrong in healthcare, it is important that patients are informed in an open and honest manner. This dissertation focuses on the question: what is the role of law when something goes wrong in health care? To answer this question, research was conducted in three domains: action research with Dutch hospitals that want to become more open and practice being open in a better way; quantitative questionnaire research into the impact of medical disciplinary procedures on doctors who received a disciplinary measure, and traditional legal research into openness and the settlement of complaints and claims under the Quality, Complaints and Disputes in Health Care Act (Wkkgz). This study shows that openness requires policy, such as assistance for patients and support for care providers. At the institutional level, it is important to strive for a just culture, in which open discussion and learning from mistakes is the norm. The law appears to have adverse side effects in all three domains. The organisation of openness in hospitals is compartmentalised in procedures that make it difficult to pay attention to the full range of needs of the people involved; medical disciplinary law has a negative impact on the professional practice of defendants and rarely leads to learning; in principle, the Wkkgz has the potential to improve the settlement of both complaints and claims. Restorative justice, as a legal perspective on the principles of a just culture, has been explored as a way of realising that potential. Reflecting on these findings in a broader sense, it appears that the problems described here are not an isolated phenomenon. What can be learned from this dissertation is that when solving problems, it is important to strive for participation of those who are affected; in this dissertation patients and caregivers. In line with the principles of a just culture, restorative justice has been studied as a legal perspective for the settlement of incidents. The challenge this dissertation poses is how a restorative response after a medical incident can be organized concretely. Three methods were used in this thesis: action research, quantitative questionnaire research, traditional legal literature and case law research. As such, this dissertation is in line with the development towards a more empirical approach to law. Action research in particular offers potential for (legal) scholars who want to contribute to the improvement of an undesirable situation. The legal method does not lose its added value in this approach; on the contrary, it is one of the methods that action researchers will need in order to understand and change a problem in its entirety.

The aim of this review was to explore which factors influence nurses' adoption of information and communication technology. A systematic review was conducted using qualitative and quantitative studies. The authors performed the search strategy in the databases of PubMed, CINAHL, and IEEE and included articles published between January 2011 and July 2021. This review explores the following factors: collaboration, leadership, and individual and team factors - that, according to qualitative and quantitative research, seem to influence nurses' adoption of information and communication technology. A gradual implementation process of the information and communication technology, involvement from care professionals in the implementation process, and team functioning are important factors to consider when adopting information and communication technology. In addition to these, individual factors such as age, experience, attitude, and knowledge are also influencing factors. The review suggests that collaboration is important within the implementation of information and communication technology in care and that it positively influences nurses' adoption of it. Individual factors are researched more extensively than collaboration, leadership, and team factors. Although they also appear to influence the adoption of information and communication technology, there is insufficient evidence to convincingly substantiate this.

Workshop in het aan elkaar beschrijven en tekenen van afbeeldingen van planten, op basis van werk van Karl Blossfelft. Locatie: Groninger Museum.

Pres for potential students for the MScIBP. Our research project Food for Care: local food for hospitals.

Reinforcement learning has shown great potential in many applications in recent years. However, many of these applications rely on simulators such as games to obtain a significant amount of interactions at a relatively low cost. Especially in the health domain data suitable for sequential decision-making is hard to obtain, while simulators are complicated to build. In this thesis, we investigate how we can use reinforcement learning for personalization in e-Health. We explored the state-of-the-art applications of reinforcement learning for personalization through a systematic literature review. Looking at the related work in the health domain, we found that reinforcement learning is an appropriate learning paradigm for personalization in general. Furthermore, we observed a lack of simulator environments and standardized datasets for the health domain. To mitigate this limitation, we developed an open-source simulation environment for e-Health problems. Using this simulator as a testbed, we proposed a cluster-based reinforcement learning approach to personalize e-Health interventions. Our approach finds similarities in behaviors and learns personalized policies optimized for long-term health behaviors. To bridge the gap towards real-life applications, we employed generative models, such as generative adversarial models, to synthesize low-level sensor data we can obtain from mobile devices in real-life. To evaluate the generated data's representativity for sequential decision-making problems, we proposed a framework consisting of two properties, structural and functional representativity. Using our realistic simulator, we used deep reinforcement learning to demonstrate that end-to-end learning on raw sensor data can improve performance. Finally, we utilized reinforcement learning for personalization for several real-world problems. We applied deep reinforcement learning for the hemodynamic optimization of patients with sepsis at the Intensive Care Unit. Finally, we applied our proposed cluster-based reinforcement learning approach for personalization to improve adherence to internet-based interventions tested in a real-life experiment using a mobile application.

Reinforcement learning has shown great potential in many applications in recent years. However, many of these applications rely on simulators such as games to obtain a significant amount of interactions at a relatively low cost. Especially in the health domain data suitable for sequential decision-making is hard to obtain, while simulators are complicated to build. In this thesis, we investigate how we can use reinforcement learning for personalization in e-Health. We explored the state-of-the-art applications of reinforcement learning for personalization through a systematic literature review. Looking at the related work in the health domain, we found that reinforcement learning is an appropriate learning paradigm for personalization in general. Furthermore, we observed a lack of simulator environments and standardized datasets for the health domain. To mitigate this limitation, we developed an open-source simulation environment for e-Health problems. Using this simulator as a testbed, we proposed a cluster-based reinforcement learning approach to personalize e-Health interventions. Our approach finds similarities in behaviors and learns personalized policies optimized for long-term health behaviors. To bridge the gap towards real-life applications, we employed generative models, such as generative adversarial models, to synthesize low-level sensor data we can obtain from mobile devices in real-life. To evaluate the generated data's representativity for sequential decision-making problems, we proposed a framework consisting of two properties, structural and functional representativity. Using our realistic simulator, we used deep reinforcement learning to demonstrate that end-to-end learning on raw sensor data can improve performance. Finally, we utilized reinforcement learning for personalization for several real-world problems. We applied deep reinforcement learning for the hemodynamic optimization of patients with sepsis at the Intensive Care Unit. Finally, we applied our proposed cluster-based reinforcement learning approach for personalization to improve adherence to internet-based interventions tested in a real-life experiment using a mobile application.

Reinforcement learning has shown great potential in many applications in recent years. However, many of these applications rely on simulators such as games to obtain a significant amount of interactions at a relatively low cost. Especially in the health domain data suitable for sequential decision-making is hard to obtain, while simulators are complicated to build. In this thesis, we investigate how we can use reinforcement learning for personalization in e-Health. We explored the state-of-the-art applications of reinforcement learning for personalization through a systematic literature review. Looking at the related work in the health domain, we found that reinforcement learning is an appropriate learning paradigm for personalization in general. Furthermore, we observed a lack of simulator environments and standardized datasets for the health domain. To mitigate this limitation, we developed an open-source simulation environment for e-Health problems. Using this simulator as a testbed, we proposed a cluster-based reinforcement learning approach to personalize e-Health interventions. Our approach finds similarities in behaviors and learns personalized policies optimized for long-term health behaviors. To bridge the gap towards real-life applications, we employed generative models, such as generative adversarial models, to synthesize low-level sensor data we can obtain from mobile devices in real-life. To evaluate the generated data's representativity for sequential decision-making problems, we proposed a framework consisting of two properties, structural and functional representativity. Using our realistic simulator, we used deep reinforcement learning to demonstrate that end-to-end learning on raw sensor data can improve performance. Finally, we utilized reinforcement learning for personalization for several real-world problems. We applied deep reinforcement learning for the hemodynamic optimization of patients with sepsis at the Intensive Care Unit. Finally, we applied our proposed cluster-based reinforcement learning approach for personalization to improve adherence to internet-based interventions tested in a real-life experiment using a mobile application.

Healthcare is undergoing a profound technological and digital transformation and has become increasingly complex. It is important for burns professionals and researchers to adapt to these developments which may require new ways of thinking and subsequent new strategies. As Einstein has put it: 'We must learn to see the world anew'. The relatively new scientific discipline "Complexity science" can give more direction to this and is the metaphorical open door that should not go unnoticed in view of the burn care of the future. Complexity sciences studies 'why the whole is more than the sum of the parts'. It studies how multiple separate components interact with each other and their environment and how these interactions lead to 'behavior of the system'. Biological systems are always part of smaller and larger systems and exhibit the behavior of adaptivity, hence the name complex adaptive systems. From the perspective of complexity science, a severe burn injury is an extreme disruption of the 'human body system'. But this disruption also applies to the systems at the organ and cellular level. All these systems follow principles of complex systems. Awareness of the scaling process at multilevel helps to understand and manage the complex situation when dealing with severe burn cases. The aim of this paper is to create awareness of the concept of complexity and to demonstrate the value and possibilities of complexity science methods and tools for the future of burn care through examples from preclinical, clinical, and organizational perspective in burn care. The authors sincerely acknowledge the contribution of Jeroen G.N. van de Pauw Kraan, Titus R. Radstake, Ariette van Reekum, M.D. Ph.D., Prof. Marcel G.M. Olde Rikkert, M.D. Ph.D., Prof. Marinus de Kleuver, M.D. Ph.D., Lieke C. van Zuijlen, and Rosalyn Rus during the realization of this manuscript

Many discussions, studies, and policy reports regarding ageing and digital technology (DT) begin by addressing the following logic: the population is rapidly ageing, leading to an increase in chronic diseases and increasing costs and burden on the healthcare system (Neven, 2010). DT is often presented as an answer or a solution to this ‘problem’ in what Peine and Neven (2019) described as ‘interventionist logic’. However, older adults are often categorised and discoursed as a homogeneous group of ‘non-users’ in the context of designing DTs (Quan-Haase et al., 2018), associated with illness, frailty, cognitive decline, and dependency (Neven, 2010). These conceptions, together with the notion that as people age they consume’ as much as three times more healthcare resources than others (Alemayehu and Warner, 2004), leads to a fixation on DTs developed primarily for care and healthcare for older adults (Schulz et al., 2015). This is often policy-driven due to the idea that DT has the potential to reduce healthcare costs. This fixation has led to a rapidly growing age-tech market of healthcare DT, as can be seen in a visualised mapping of age-tech companies currently operating in the market (see Etkin, 2021). Consequently, healthcare professionals and caregivers are positioned at the forefront of using DT with older adults. For the purpose of this chapter, we describe DT as technological devices, ser vices, or platforms that use, collect, and often process data, and are connected to the Internet, other devices, or apps. Examples of such DTs are eHealth apps, smart watches, sensors and systems that can detect and predict falls, and social robots, among others.

Many discussions, studies, and policy reports regarding ageing and digital technology (DT) begin by addressing the following logic: the population is rapidly ageing, leading to an increase in chronic diseases and increasing costs and burden on the healthcare system (Neven, 2010). DT is often presented as an answer or a solution to this ‘problem’ in what Peine and Neven (2019) described as ‘interventionist logic’. However, older adults are often categorised and discoursed as a homogeneous group of ‘non-users’ in the context of designing DTs (Quan-Haase et al., 2018), associated with illness, frailty, cognitive decline, and dependency (Neven, 2010). These conceptions, together with the notion that as people age they consume’ as much as three times more healthcare resources than others (Alemayehu and Warner, 2004), leads to a fixation on DTs developed primarily for care and healthcare for older adults (Schulz et al., 2015). This is often policy-driven due to the idea that DT has the potential to reduce healthcare costs. This fixation has led to a rapidly growing age-tech market of healthcare DT, as can be seen in a visualised mapping of age-tech companies currently operating in the market (see Etkin, 2021). Consequently, healthcare professionals and caregivers are positioned at the forefront of using DT with older adults. For the purpose of this chapter, we describe DT as technological devices, ser vices, or platforms that use, collect, and often process data, and are connected to the Internet, other devices, or apps. Examples of such DTs are eHealth apps, smart watches, sensors and systems that can detect and predict falls, and social robots, among others.