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Background: Value-based healthcare (VBHC) is increasingly implemented in healthcare worldwide. Transparent measurement of the outcomes most important and relevant to patients is essential in VBHC, which is supported by a core set of most important quality indicators and outcomes. Therefore, the aim of this study was to develop a VBHC-burns core set for adult burn patients. Methods: A three-round modified national Delphi study, including 44 outcomes and 24 quality indicators, was conducted to reach consensus among Dutch patients, burn care professionals and researchers. Items were rated on a nine-point Likert scale and selected if ≥ 70% in each group considered an item ‘important’. Subsequently, instruments quantifying selected outcomes were identified based on a literature review and were chosen in a consensus meeting using recommendations from the Dutch consensus-based standard set and the Dutch Centre of Expertise on Health Disparities. Time assessment points were chosen to reflect the burn care and patient recovery process. Finally, the initial core set was evaluated in practice, leading to the adapted VBHC-burns core set. Results: Twenty-seven patients, 63 burn care professionals and 23 researchers participated. Ten outcomes and four quality indicators were selected in the Delphi study, including the outcomes pain, wound healing, physical activity, self-care, independence, return to work, depression, itching, scar flexibility and return to school. Quality indicators included shared decision-making (SDM), the number of patients receiving aftercare, determination of burn depth, and assessment of active range of motion. After evaluation of its use in clinical practice, the core set included all items except SDM, which are assessed by 9 patient-reported outcome instruments or measured in clinical care. Assessment time points included are at discharge, 2 weeks, 3 months, 12 months after discharge and annually afterwards. Conclusion: A VBHC-burns core set was devel

Background: The use of patient-reported outcomes to improve burn care increases. Little is known on burn patients’ views on what outcomes are most important, and about preferences regarding online Patient Reported Outcome Measures (PROMs). Therefore, this study assessed what outcomes matter most to patients, and gained insights into patient preferences towards the use of online PROMs. Methods: Adult patients (≥18 years old), 3–36 months after injury completed a survey measuring importance of outcomes, separately for three time periods: during admission, short-term (<6 months) and long-term (6–24 months) after burn injury. Both open and closed-ended questions were used. Furthermore, preferences regarding the use of patient-reported outcome measures in burn care were queried. Results: A total of 140 patients were included (response rate: 27%). ‘Not having pain’ and ‘good wound healing’ were identified as very important outcomes. Also, ‘physical functioning at pre-injury level’, ‘being independent’ and ‘taking care of yourself’ were considered very important outcomes. The top-ten of most important outcomes largely overlapped in all three time periods. Most patients (84%) had no problems with online questionnaires, and many (67%) indicated that it should take up to 15 minutes. Patients’ opinions differed widely on the preferred frequency of follow-up. Conclusions: Not having pain and good wound healing were considered very important during the whole recovery of burns; in addition, physical functioning at pre-injury level, being independent, and taking care of yourself were deemed very important in the short and long-term. These outcomes are recommended to be used in burn care and research, although careful selection of outcomes remains crucial as patients prefer online questionnaires up to 15 minutes.

De deelnemers van het project Natuurinclusief Betuws Boeren hebben de afgelopen jaren ervaring opgedaan met de diverse toepassingen van natuurinclusieve landbouw in de boomteelt (incl. de spillenteelt). Deze kennis, resultaten en ervaringen uit de praktijk zijn gebundeld in deze leaflet.

De deelnemers van het project Natuurinclusief Betuws Boeren hebben de afgelopen jaren ervaring opgedaan met het toepassen van natuurinclusieve maatregelen. Deze kennis, resultaten en ervaringen uit de praktijk zijn gebundeld in deze leaflet.

De deelnemers van N de afgelopen jaren ervaring opgedaan met het toepassen van natuurinclusieve maatregelen. Deze kennis, resultaten en ervaringen uit de praktijk zijn gebundeld in deze leaflet.

De deelnemers van het natuurinclusief Betuws Boeren hebben de afgelopen jaren op verschillende vlakken ervaring opgedaan met het toepassen van natuurinclusieve maatregelen in de fruiteelt. Deze kennis, resultaten en ervaringen uit praktijk zijn gebundeld in deze leaflet.

The demand for wood in Europe is expected to increase in the coming decades. However, any theoretical maximum supply will be affected by sustainability constraints, the motivations of forest owners and regional factors, such as incentives, species and assortments. However, the influence of these factors on supply is changeable. In this study, we quantify what might be realistically available as additional wood supply from currently existing European forests, based on a combination of results of the forest resource model EFISCEN-Space and a literature review of national supply projections. Wood mobilization scenarios for 10 representative Model Regions in Europe that assume forest owners and managers in the simulated regions will adapt their behaviour to alternative behaviour as recorded from other regions were projected with the EFISCEN-Space model. The realistic additional potential based on the literature review is 90 million m3 yr−1. This potential should be attainable within 10–20 years. However, the simulations in the Model Regions found potentials to be lower in 7 out of 10 cases as compared with the country they are located in. On average, the model regions reached less than half of the potential as compared with the literature review. This suggests that the realistic additional potential at the European scale may well be lower if all mobilization barriers are taken into account in more detail, but also highlights the uncertainty surrounding these estimates. We conclude from the analyses that although there are large differences in potential between regions and the analysis method employed, there are no ‘hotspots’ where a large pool of accessible wood can be quickly mobilized using existing infrastructure for nearby industries. An increase in harvest would therefore only be possible with a large effort that spans the whole chain, from forest owners’ behaviour to capacity building, financial incentives and matching resources to harvesting capacity. The additio

Background: Early mobilization (EM) of intensive care (IC) patients is important but complex with facilitators and barriers. Compared to general IC patients, burn IC patients are more hyper-metabolic. They have extensive wounds, lengthy wound dressing changes, and repeated surgeries that may affect possibilities of EM. This study aimed to identify facilitators and barriers of EM in burn IC patients among all disciplines involved. Additionally, we assessed EM practices, i.e. when are which patients considered suitable for EM. Methods: A survey was sent to 139 professionals involved in EM of burn IC patients (discipline groups: Intensivists, medical doctors, registered nurses, therapists). Results: Response rate was 57 %. The majority found EM very important, yet different definitions were chosen. Perceived barriers mainly concerned patient-level factors, most frequently hemodynamic instability and excessive sedation followed by skin graft surgery, fatigue, and pain management. Most frequent barriers at the provider-level were limited staffing, safety concerns, and conflicting perceptions about the suitability of EM. At the institutional-level, we found no high barriers. Interdisciplinary variation on perceived barriers, when to initiate it, and permitted maximal activity were ascertained. Conclusion: Skin grafts and pain management were barriers of EM specific for burn care. Opinions on frequency, dosage and duration of EM varied widely. Improving interdisciplinary communication is key.

BACKGROUND: Burden of disease estimates are an important resource in public health. Currently, robust estimates are not available for the burn population. Our objectives are to adapt a refined methodology (INTEGRIS method) to burns and to apply this new INTEGRIS-burns method to estimate, and compare, the burden of disease of burn injuries in Australia, New Zealand and the Netherlands.METHODS: Existing European and Western-Australian health-related quality of life (HRQL) datasets were combined to derive disability weights for three homogenous burn injury groups based on percentage total body surface area (%TBSA) burned. Subsequently, incidence data from Australia, New Zealand, and the Netherlands from 2010 to 2017 were used to compute annual non-fatal burden of disease estimates for each of these three countries. Non-fatal burden of disease was measured by years lived with disability (YLD).RESULTS: The combined dataset included 7159 HRQL (EQ-5D-3 L) outcomes from 3401 patients. Disability weights ranged from 0.046 (subgroup < 5% TBSA burned > 24 months post-burn) to 0.497 (subgroup > 20% TBSA burned 0-1 months post-burn). In 2017 the non-fatal burden of disease of burns for the three countries (YLDs/100,000 inhabitants) was 281 for Australia, 279 for New Zealand and 133 for the Netherlands.CONCLUSIONS: This project established a method for more precise estimates of the YLDs of burns, as it is the only method adapted to the nature of burn injuries and their recovery. Compared to previous used methods, the INTEGRIS-burns method includes improved disability weights based on severity categorization of burn patients; a better substantiated proportion of patients with lifelong disability based; and, the application of burn specific recovery timeframes. Information derived from the adapted method can be used as input for health decision making at both the national and international level. Future studies should investigate whether the applica

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Background: Burden of disease estimates are an important resource in public health. Currently, robust estimates are not available for the burn population. Our objectives are to adapt a refined methodology (INTEGRIS method) to burns and to apply this new INTEGRIS-burns method to estimate, and compare, the burden of disease of burn injuries in Australia, New Zealand and the Netherlands. Methods: Existing European and Western-Australian health-related quality of life (HRQL) datasets were combined to derive disability weights for three homogenous burn injury groups based on percentage total body surface area (%TBSA) burned. Subsequently, incidence data from Australia, New Zealand, and the Netherlands from 2010 to 2017 were used to compute annual non-fatal burden of disease estimates for each of these three countries. Non-fatal burden of disease was measured by years lived wi

Europe's forests provide vital habitat for biodiversity and essential ecosystem services whose provision must be sustained or enhanced over the coming century. However, the potential to secure or increase forest ecosystem services, while securing the habitat requirements of taxa remains unclear, especially within the context of uncertain climate and socio-economic developments. To tease out the associated trade-offs and synergies, we used 10 case study landscapes within nine countries throughout Europe. Starting with the current status of the forests in the case study landscapes, we simulated forest development 100 years into the future. Simulations were embedded in three combined climate and socio-economic frame scenarios based on global and European policies which varied in their climate change mitigation efficiency. Scenarios were translated into country specific projections of climate variables, and resultant demands for wood products. Forest management regimes were projected to vary in response to these scenarios at local scales. The specific combinations of alternative forest management practices were based on parallel research and input from local forest stakeholders. For each case study, a specific forest growth simulator was used. In general, the climate scenarios applied did not cause fundamentally different ecosystem service outputs at the case study level. Our results revealed almost no reduction in outcomes for biodiversity indicators with an increase in wood production, and in some cases synergistic results occurred when diversity was actively promoted as part of the management concept. Net carbon uptake was not strongly correlated with biodiversity, indicating that biodiversity-friendly forest management doesn't need to curtail carbon sequestration. Notably, we obtained heterogeneous results for the relation between sustainable wood production and net carbon uptake. Most scenarios resulted in a more or less reduced net carbon uptake over the long term

WMA Meekes,1 CJ Leemrijse,2 JC Korevaar,2 JMAE Henquet,3 M Nieuwenhuis,4 LAM van de Goor1 1Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, Netherlands; 2NIVEL, Utrecht, Netherlands; 3Huisartsenpraktijk de Ypelaer, Hilvarenbeek, Noord-Brabant, Netherlands; 4Fysiotherapie Nieuwenhuis, Best, Noord-Brabant, NetherlandsCorrespondence: WMA MeekesTranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, Postbus 90153, NetherlandsTel +31 13 466 4451Email w.m.a.meekes@tilburguniversity.eduBackground: Falls are an increasing problem among older people. There are several evidence-based interventions available to prevent falls. However, these are not always well implemented in the primary care setting. General practitioners (GPs) are often the first point of contact for health issues, making them the designated professionals for providing falls prevention. Because GPs are often unaware which patients have a high fall risk and patients themselves do not always know they have a high fall risk, this study aims to evaluate the implementation of a targeted fall risk screening strategy among independently living, frail older people in the primary care setting.Materials and Methods: The targeted fall risk screening strategy used in this study consists of tools for screening high fall risk and for identifying the underlying cause(s) of the high fall risk, an accredited training course in falls prevention for professionals, and service provision by certified physio- and exercise therapists who are able to offer evidence-based falls prevention interventions. This targeted fall risk screening strategy will be implemented in the primary care setting and evaluated at the level of the GP practice and at the level of the patient by using the RE-AIM model of Glasgow et al. In a pre-posttest design, data will be collected of the total number of frail older people who are screened, referred and enrolled fo

Background: Falls are an increasing problem among older people. There are several evidence-based interventions available to prevent falls. However, these are not always well implemented in the primary care setting. General practitioners (GPs) are often the first point of contact for health issues, making them the designated professionals for providing falls prevention. Because GPs are often unaware which patients have a high fall risk and patients themselves do not always know they have a high fall risk, this study aims to evaluate the implementation of a targeted fall risk screening strategy among independently living, frail older people in the primary care setting. Materials and methods: The targeted fall risk screening strategy used in this study consists of tools for screening high fall risk and for identifying the underlying cause(s) of the high fall risk, an accredited training course in falls prevention for professionals, and service provision by certified physio- and exercise therapists who are able to offer evidence-based falls prevention interventions. This targeted fall risk screening strategy will be implemented in the primary care setting and evaluated at the level of the GP practice and at the level of the patient by using the RE-AIM model of Glasgow et al. In a pre-posttest design, data will be collected of the total number of frail older people who are screened, referred and enrolled for fall-preventive care. Furthermore, barriers and facilitators of the implementation of the fall risk screening strategy will be identified by conducting focus groups and interviews with the care providers and frail older patients. Additionally, the influence of the falls prevention interventions on frail older patients will be evaluated by using a pre-posttest design with a 12-month follow-up period during which data are collected regarding patients' stability, mobility, strength, balance, self-efficacy, health status, and daily activities.

Sustainable forest management is driving the development of forest decision support systems (DSSs) to include models and methods concerned with climate change, biodiversity and various ecosystem services (ESs). The future development of forest landscapes is very much dependent on how forest owners act and what goes on in the wider world; thus, models are needed that incorporate these aspects. The objective of this study is to assess how nine European state-of-the-art forest DSSs cope with these issues. The assessment focuses on the ability of these DSSs to generate landscape-level scenarios to explore the output of current and alternative forest management models (FMMs) in terms of a range of ESs and the robustness of these FMMs in the face of increased risks and uncertainty. Results show that all DSSs assessed in this study can be used to quantify the impacts of both stand- and landscape-level FMMs on the provision of a range of ESs over a typical planning horizon. DSSs can be used to assess how timber price trends may impact that provision over time. The inclusion of forest owner behavior as reflected by the adoption of specific FMMs seems to be also in the reach of all DSSs. Nevertheless, some DSSs need more data and development of models to estimate the impacts of climate change on biomass production and other ESs. Spatial analysis functionality needs to be further developed for a more accurate assessment of the landscape-level output of ESs from both current and alternative FMMs.