Search

Community care is becoming increasingly important. In the Netherlands, the percentage of people over the age of 65 is expected to increase to 22% by 2025, leading to more elderly patients, often with long-term and complex health problems (multimorbidity). Because many of these patients continue to live at home until a very old age, nurses are increasingly working outside of institutions. The 17 Dutch Bachelor nursing programmes responded to this development with a new national education profile 'Bachelor Nursing 2020 (BN2020)’ with more elements of community care. However, despite the increase in extramural care, the Dutch labour market has a shortage of community nurses with higher professional education qualifications, partly because most nursing students focus on the general hospital setting as the environment for their future career. Whether this is based on a perception of community care that deters making this choice has never been systematically investigated. It is also unclear whether a more community-oriented curriculum will better equip students for working in community care. In response to these issues, the nursing programme at the Amsterdam University of Applied Sciences (AUAS) redesigned its curriculum to include more elements of community care. Three perspectives were chosen for the redesign: (1) the influence of lecturers as role models, (2) positive placement experiences, and (3) five new ‘community-based’ themes in education. These new themes are as follows: patient self-management, shared decision-making, collaboration with the patients’ social system, healthcare technology, and allocation of care. The redesign also includes a ‘paved way’ into community care in the form of a coherent and attractive programme for interested students. This thesis describes whether and how the curriculum-redesign within higher professional education in nursing can be effective in terms of (1) stimulating a positive perception of community care and (2) realising a form of community care in line with the new themes in BN2020. In other words, that students will base choices in their actions/nursing interventions on these new themes in the education profile.

Doel. Beoordelen van werkzaamheid en bijwerkingen van antipsychotica voor neuropsychiatrische symptomen bij dementie. Nagaan van bewijs voor de waarschuwing voor cerebrovasculaire bijwerkingen van atypische antipsychotica. Opzet. Systematische review. Methode. Selectie in Medline, Cinahl, PsycINFO, Embase en het Cochrane central register of controlled trials (1980-2005) van gerandomiseerde dubbelblinde studies met ‘intention-to-treat’-analyse naar werkzaamheid en bijwerkingen van antipsychotica voor neuropsychiatrische symptomen bij dementie. Deze studies werden gestandaardiseerd beoordeeld op kwaliteit. Resultaten. Van de 950 gevonden artikelen werden 14 studies geselecteerd over het effect van haloperidol, risperidon, olanzapine, quetiapine, tiapride, loxapine en perfenazine. Haloperidol, risperidon en olanzapine bleken in 7 van de 10 onderzoeken werkzamer voor de behandeling van agressie en psychose dan placebo. Bij onderlinge vergelijking van klassieke en atypische antipsychotica was er geen statistisch significant verschil. De meest voorkomende bijwerkingen waren extrapiramidale symptomen en sufheid. Risperidon had deze bijwerkingen in lagere doseringen minder dan haloperidol en olanzapine, maar risperidon en olanzapine lieten in twee studies een verhoogde kans op beroerte zien. Conclusie. Klassieke en atypische antipsychotica vertonen een vergelijkbare werkzaamheid en alleen risperidon lijkt vooral in lagere doseringen minder (extrapiramidale) bijwerkingen te geven. Het bijwerkingenprofiel is matig omschreven in het gepubliceerde onderzoek en de waarschuwingen voor een verhoogde sterfte kunnen op basis hiervan niet worden bevestigd.

Een 69-jarige man werd geopereerd aan een subduraal hematoom, ontstaan tijdens acenocoumarolgebruik. Direct na de operatie kreeg de patiënt sondevoeding; de toediening van acenocoumarol werd later herstart. De benodigde dosering acenocoumarol voor een goede instelling van de INR was tijdens toediening van de sondevoeding 2 maal zo hoog als daarvóór. Dit was niet toe te schrijven aan interacties met geneesmiddelen. Na de overgang van sondevoeding naar orale voeding was de oude dosis acenocoumarol weer voldoende. De hogere benodigde dosering was waarschijnlijk veroorzaakt door een verhoogde binding aan eiwitten in de sondevoeding. Patiënt werd opgenomen in het verpleeghuis. De combinatie acenocoumarol en sondevoeding komt vaak voor bij revaliderende patiënten. Het is belangrijk de INR te controleren bij het starten, het afbouwen en het beëindigen van sondevoeding.

Production of alcohol-free beer is performed with immobilized cells of Saccharomyces cerevisiae var. uvarum . In the reactor, combined stress factors such as low temperature (0-4°C) and anaerobic conditions limit cell metabolism.Cells of S. cerevisiae are able to grow as low as -2°C. Although sugar metabolism is instantaneously and similar in cells grown at high or low temperature, respiration differs significantly. Latter cells do not show substrate-induced respiration in spite of the presence of active mitochondria and biomass yield was substantially reduced.We noticed an increase in reductive capacity of yeasts grown under anaerobic conditions and we subsequently purified and characterized a novel NADP-dependent branched-chain ADH. Based on the high reductive activity with 3-methylbutanal at physiological pH and higher ionic strength, the enzyme will have an important function in reduction of Strecker aldehydes during alcoholic fermentation.The activity of the bcADH and the influence of immobilization on cell physiology were further monitored during alcohol-free beer production. Higher activities of glycolytic enzymes, and the bcADH were observed compared to those in batch grown cells. In addition, glucose flux was increased. The shifts in enzyme activities and glucose flux correlate with a higher in vivo reduction capacity of the immobilized cells.Formation of ester and diacetyl by immobilized yeast cells were investigated. Due to the anaerobic conditions, acetate ester production and in vitro enzyme activity increase simultaneous with the decrease in unsaturated fatty acids. Sterol metabolism is blocked; consequently, squalene accumulates. Despite the presence of active acetohydroxy acid synthase, no diacetyl-precursor is formed at low temperatures.S. cerevisiae W34 flocculates at the end of the exponential growth phase. Grown at low temperatures, cells have a higher flocculation capacity and a higher cell wall hydrophobicity. The immobilization of cells to DEAE-cellulose is influenced by both charge differences between cell wall and carrier and flocculation characteristics.In conclusion, immobilized cells show some unique physiological features at low temperatures. These contribute positively to the limited fermentation of wort to alcohol-free beer.

The optothermal window (OW) described here is a practical and easy to use sensor that enables one to calculate the optical absorption coefficient of fluid and semi fluid samples from the measured optothermal signal. The potential of this new and universal device is demonstrated in studies on liquids and gels of agricultural interest.