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Verpleeghuizen bieden zoveel mogelijk mensgerichte zorg om de kwaliteit van leven van bewoners te verbeteren. Ouderen die alcohol drinken of roken willen dit vaak voortzetten in het verpleeghuis. Zowel roken als alcohol drinken hebben schadelijke gezondheidsgevolgen en ouderen zijn hier gevoeliger voor. Daarom kan de wens van bewoners om dit voort te zetten leiden tot dilemma’s en conflicten. In dit kwalitatieve onderzoek is het bewonersperspectief over roken en alcohol drinken in het verpleeghuis onderzocht. Er zijn interviews gedaan met bewoners die wonen op psychogeriatrische en somatische afdelingen. De resultaten zijn geanalyseerd middels thematische analyse. De uitkomsten van dit onderzoek beschrijven we hieronder.

Person-centred care (PCC) in residential care facilities (RCFs) is valuable but creates challenges for care professionals balancing involvement and a partnership approach for residents while considering the health and safety outcomes of all residents. This review evaluates what is known about the substance use and misuse of residents living in RCFs and what is important to study in future research to enhance PCC, especially in cases in which residents wish to choose unhealthy behaviours. A scoping review was conducted and exclusion criteria were set. The included papers were assessed on methodological quality using the Mixed Methods Appraisal Tool and the results were qualitatively analysed. The included papers consisted of studies regarding alcohol, tobacco and illicit drugs. The results showed that care professionals are involved in facilitating and regulating alcohol and tobacco. The focus of the included papers is on alcohol and tobacco. Five of the 16 papers assessed the residents’ perspective. This review highlights the importance of incorporating the perspectives of residents, care professionals and the organisation to enhance PCC and enable residents to make shared and well-informed decisions in dialogue with care professionals. Future research should also assess the distinction between substance use and misuse, and how this affects implementing PCC in RCFs.

Background: The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited. Objective: Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization. Methods: Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors. Results: Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted odds ratio [OR] = 1.59 per 10 years; 95% CI = 1.19-2.13), male sex (OR = 2.51; 95% CI = 1.23-5.12), nonwhite ethnicity (OR = 3.15; 95% CI = 1.24-8.03), and comorbid chronic lung disease (OR = 3.87; 95% CI = 1.52-9.83). Hospitalization was more frequent in patients using nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94). Conclusion: In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19–related hospitalization than with

Deformation of skeletal muscle in the proximity of bony structures may lead to deep tissue injury category of pressure ulcers. Changes in mechanical properties have been proposed as a risk factor in the development of deep tissue injury and may be useful as a diagnostic tool for early detection. MRE allows for the estimation of mechanical properties of soft tissue through analysis of shear wave data. The shear waves originate from vibrations induced by an external actuator placed on the tissue surface. In this study a combined Magnetic Resonance (MR) compatible indentation and MR Elastography (MRE) setup is presented to study mechanical properties associated with deep tissue injury in rats. The proposed setup allows for MRE investigations combined with damage-inducing large strain indentation of the Tibialis Anterior muscle in the rat hind leg inside a small animal MR scanner. An alginate cast allowed proper fixation of the animal leg with anatomical perfect fit, provided boundary condition information for FEA and provided good susceptibility matching. MR Elastography data could be recorded for the Tibialis Anterior muscle prior to, during, and after indentation. A decaying shear wave with an average amplitude of approximately 2 μm propagated in the whole muscle. MRE elastograms representing local tissue shear storage modulus Gd showed significant increased mean values due to damage-inducing indentation (from 4.2 ± 0.1 kPa before to 5.1 ± 0.6 kPa after, p

BACKGROUND: Myocardial fibrosis is a common hallmark of many diseases of the heart. Late gadolinium enhanced MRI is a powerful tool to image replacement fibrosis after myocardial infarction (MI). Interstitial fibrosis can be assessed indirectly from an extracellular volume fraction measurement using contrast-enhanced T1 mapping. Detection of short T2* species resulting from fibrotic tissue may provide an attractive non-contrast-enhanced alternative to directly visualize the presence of both replacement and interstitial fibrosis.OBJECTIVE: To goal of this paper was to explore the use of a T2*-weighted radial sequence for the visualization of fibrosis in mouse heart.METHODS: C57BL/6 mice were studied with MI (n = 20, replacement fibrosis), transverse aortic constriction (TAC) (n = 18, diffuse fibrosis), and as control (n = 10). 3D center-out radial T2*-weighted images with varying TE were acquired in vivo and ex vivo (TE = 21 μs-4 ms). Ex vivo T2*-weighted signal decay with TE was analyzed using a 3-component model. Subtraction of short- and long-TE images was used to highlight fibrotic tissue with short T2*. The presence of fibrosis was validated using histology and correlated to MRI findings.RESULTS: Detailed ex vivo T2*-weighted signal analysis revealed a fast (T2*fast), slow (T2*slow) and lipid (T2*lipid) pool. T2*fast remained essentially constant. Infarct T2*slow decreased significantly, while a moderate decrease was observed in remote tissue in post-MI hearts and in TAC hearts. T2*slow correlated with the presence of diffuse fibrosis in TAC hearts (r = 0.82, P = 0.01). Ex vivo and in vivo subtraction images depicted a positive contrast in the infarct co-localizing with the scar. Infarct volumes from histology and subtraction images linearly correlated (r = 0.94, P<0.001). Region-of-interest analysis in the in vivo post-MI and TAC hearts revealed significant T2* shortening due to fibrosis, in agreement with the ex vivo results. However

After extensive flooding in 1953, Deltaworks were constructed to protect the Southwest delta in the Netherlands. In the Eastern Scheldt the connection to the North Sea was regulated by an open storm surge barrier and two compartment dams. These decreased the tidal volume and consequently tidal flats are eroding and disappear under water. The intertidal flats and shoals have two important functions in the basin. Firstly, they are valuable habitat and foraging grounds for wading bird species. A second function of intertidal foreshores is to reduce the wave attack on surrounding water barriers. In front of the Oesterdam Rijkswaterstaat has started a pilot project called “the Oesterdam safety buffer? to find a solution to the erosion problems. This report investigates several solutions for this foreshore nourishment. In total seven different designs have been evaluated in this report. Four different design strategies have been found in a workshop namely, a high dune, a buffer, an equally spread flat nourishment and finally a wave breaking ridge. For all these strategies different profiles have been dimensioned. To model the morphological development of the profiles a 1D morphological model called XBeach has been used. A safety check for the design conditions (1/4000yr) has been done both for the initial profiles, as designed, and for the final profiles at the end of their 50years lifetime. To calculate the overtopping over the Oesterdam the program PC-Overslag has been used. Results showed that all nourishment designs give a smaller overtopping volume of the dam and thus create safety. Final evaluation of the designs showed that a Flat foreshore nourishment combines a solution for nature and safety., Hydraulic Engineering and Water Resources Managment, Hydraulic Engineering, Civil Engineering and Geosciences