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Search Results: 1 - 10 of 33927 matches for " Theo van Achterberg "
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A systematic review of hand hygiene improvement strategies: a behavioural approach
Huis Anita,van Achterberg Theo,de Bruin Marijn,Grol Richard
Implementation Science , 2012, DOI: 10.1186/1748-5908-7-92
Abstract: Background Many strategies have been designed and evaluated to address the problem of low hand hygiene (HH) compliance. Which of these strategies are most effective and how they work is still unclear. Here we describe frequently used improvement strategies and related determinants of behaviour change that prompt good HH behaviour to provide a better overview of the choice and content of such strategies. Methods Systematic searches of experimental and quasi-experimental research on HH improvement strategies were conducted in Medline, Embase, CINAHL, and Cochrane databases from January 2000 to November 2009. First, we extracted the study characteristics using the EPOC Data Collection Checklist, including study objectives, setting, study design, target population, outcome measures, description of the intervention, analysis, and results. Second, we used the Taxonomy of Behavioural Change Techniques to identify targeted determinants. Results We reviewed 41 studies. The most frequently addressed determinants were knowledge, awareness, action control, and facilitation of behaviour. Fewer studies addressed social influence, attitude, self-efficacy, and intention. Thirteen studies used a controlled design to measure the effects of HH improvement strategies on HH behaviour. The effectiveness of the strategies varied substantially, but most controlled studies showed positive results. The median effect size of these strategies increased from 17.6 (relative difference) addressing one determinant to 49.5 for the studies that addressed five determinants. Conclusions By focussing on determinants of behaviour change, we found hidden and valuable components in HH improvement strategies. Addressing only determinants such as knowledge, awareness, action control, and facilitation is not enough to change HH behaviour. Addressing combinations of different determinants showed better results. This indicates that we should be more creative in the application of alternative improvement activities addressing determinants such as social influence, attitude, self-efficacy, or intention.
Haloperidol prophylaxis in critically ill patients with a high risk for delirium
Mark van den Boogaard, Lisette Schoonhoven, Theo van Achterberg, Johannes G van der Hoeven, Peter Pickkers
Critical Care , 2013, DOI: 10.1186/cc11933
Abstract: This study was a before/after evaluation of a delirium prevention project using prophylactic treatment with haloperidol. Patients with a predicted risk for delirium of ≥ 50%, or with a history of alcohol abuse or dementia, were identified. According to the prevention protocol these patients received haloperidol 1 mg/8 h. Evaluation was primarily focused on delirium incidence, delirium free days without coma and 28-day mortality. Results of prophylactic treatment were compared with a historical control group and a contemporary group that did not receive haloperidol prophylaxis mainly due to non-compliance to the protocol mostly during the implementation phase.In 12 months, 177 patients received haloperidol prophylaxis. Except for sepsis, patient characteristics were comparable between the prevention and the historical (n = 299) groups. Predicted chance to develop delirium was 75 ± 19% and 73 ± 22%, respectively. Haloperidol prophylaxis resulted in a lower delirium incidence (65% vs. 75%, P = 0.01), and more delirium-free-days (median 20 days (IQR 8 to 27) vs. median 13 days (3 to 27), P = 0.003) in the intervention group compared to the control group. Cox-regression analysis adjusted for sepsis showed a hazard rate of 0.80 (95% confidence interval 0.66 to 0.98) for 28-day mortality. Beneficial effects of haloperidol appeared most pronounced in the patients with the highest risk for delirium. Furthermore, haloperidol prophylaxis resulted in less ICU re-admissions (11% vs. 18%, P = 0.03) and unplanned removal of tubes/lines (12% vs. 19%, P = 0.02). Haloperidol was stopped in 12 patients because of QTc-time prolongation (n = 9), renal failure (n = 1) or suspected neurological side-effects (n = 2). No other side-effects were reported. Patients who were not treated during the intervention period (n = 59) showed similar results compared to the untreated historical control group.Our evaluation study suggests that prophylactic treatment with low dose haloperidol in criticall
Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study
Geense Wytske W,van de Glind Irene M,Visscher Tommy LS,van Achterberg Theo
BMC Family Practice , 2013, DOI: 10.1186/1471-2296-14-20
Abstract: Background The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study. Method This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews. Results All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients’ motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from ‘ignorer’ to ‘nurturer’. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive. Conclusion GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate implementation are identified, including those that relate to attitudes of GPs and PNs.
Helping hands: A cluster randomised trial to evaluate the effectiveness of two different strategies for promoting hand hygiene in hospital nurses
Anita Huis, Lisette Schoonhoven, Richard Grol, George Borm, Eddy Adang, Marlies Hulscher, Theo van Achterberg
Implementation Science , 2011, DOI: 10.1186/1748-5908-6-101
Abstract: This study is a cluster randomised controlled trial with inpatient wards as the unit of randomisation. Guidelines for hand hygiene will be implemented in this study. Two strategies will be used to improve the adherence to guidelines for hand hygiene. The state-of-the-art strategy is derived from the literature and includes education, reminders, feedback, and targeting adequate products and facilities. The extended strategy also contains activities aimed at influencing social influence in groups and enhancing leadership. The unique contribution of the extended strategy is built upon relevant behavioural science theories. The extended strategy includes all elements of the state-of-the-art strategy supplemented with gaining active commitment and initiative of ward management, modelling by informal leaders at the ward, and setting norms and targets within the team. Data will be collected at four points in time, with six-month intervals. An average of 3,000 opportunities for hand hygiene in approximately 900 nurses will be observed at each time point.Performing and evaluating an implementation strategy that also targets the social context of teams may considerably add to the general body of knowledge in this field. Results from our study will allow us to draw conclusions on the effects of different strategies for the implementation of hand hygiene guidelines, and based on these results we will be able to define a preferred implementation strategy for hospital based nursing.The study is registered as a Clinical Trial in ClinicalTrials.gov, dossier number: NCT00548015.Hospital-acquired infections (HAIs) are a serious and persistent problem throughout the world. They are burdensome to patients, complicate treatment, prolong hospital stay, increase costs, and can be life threatening [1,2].Micro-organisms on the hands of healthcare workers contribute to the incidence of infections in patients [3,4]. Therefore, hand hygiene prescriptions are widely accepted as the most importa
Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness
Maria W. Mauritz,Peter J. J. Goossens,Nel Draijer,Theo van Achterberg
European Journal of Psychotraumatology , 2013, DOI: 10.3402/ejpt.v4i0.19985
Abstract: Background: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. Objective: To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. Methods: We conducted a systematic review of four databases (1980–2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. Results: Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25–72%), sexual abuse 37% (range 24–49%), and posttraumatic stress disorder (PTSD) 30% (range 20–47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. Conclusions: Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI.
Implementation of a delirium assessment tool in the ICU can influence haloperidol use
Mark van den Boogaard, Peter Pickkers, Hans van der Hoeven, Gabriel Roodbol, Theo van Achterberg, Lisette Schoonhoven
Critical Care , 2009, DOI: 10.1186/cc7991
Abstract: We used a tailored implementation strategy focused on potential barriers. We measured CAM-ICU compliance, interrater reliability, and delirium knowledge, and compared the haloperidol use, as a proxy for delirium incidence, before and after the implementation of the CAM-ICU.Compliance and delirium knowledge increased from 77% to 92% and from 6.2 to 7.4, respectively (both, P < 0.0001). The interrater reliability increased from 0.78 to 0.89. More patients were treated with haloperidol (9.9% to 14.8%, P < 0.001), however with a lower dose (18 to 6 mg, P = 0.01) and for a shorter time period (5 [IQR:2–9] to 3 [IQR:1–5] days, P = 0.02).With a tailored implementation strategy, a delirium assessment tool was successfully introduced in the ICU with the main goals achieved within four months. Early detection of delirium in critically ill patients increases the number of patients that receive treatment with haloperidol, however with a lower dose and for a shorter time period.Delirium is a common psychiatric disorder in critically ill patients. It has an acute onset and combines cognitive and attention defects with a fluctuating consciousness [1]. It is associated with a prolonged intensive care and hospital stay and an increased morbidity and mortality [2-4].Although there has been increasing interest in delirium in the past five years, standard screening of patients in daily practice is still not common, resulting in an underestimation of the problem. Previous studies showed that, without the use of a screening instrument, more than 60% of patients with delirium are missed by ICU nurses and more than 70% by physicians [5,6]. It can therefore be assumed that delirious patients are not sufficiently treated if they are not recognized. The incidence rate in critically ill patients varies between 11% and 87%, depending on the study design, methods for assessment, and differences in population [2,4,7-9].Although there is no evidence that the use of a delirium assessment tool resul
Development of the Nurses' Observation Scale for Cognitive Abilities (NOSCA)
Anke Persoon,Liesbeth Joosten-Weyn Banningh,Wim van de Vrie,Marcel G. M. Olde Rikkert,Theo van Achterberg
ISRN Nursing , 2011, DOI: 10.5402/2011/895082
Abstract: Background. To assess a patient's cognitive functioning is an important issue because nurses tailor their nursing interventions to the patient's cognitive abilities. Although some observation scales exist concerning one or more cognitive domains, so far, no scale has been available which assesses cognitive functioning in a comprehensive way. Objectives. To develop an observation scale with an accepted level of content validity and which assesses elderly patients' cognitive functioning in a comprehensive way. Methods. Delphi technique, a multidisciplinary panel developed the scale by consensus through four Delphi rounds (>70% agreement). The International Classification of Functioning/ICF was used as theoretical framework. Results. After the first two Delphi rounds, the panel reached consensus about 8 cognitive domains and 17 sub domains. After two other rounds, 39 items were selected, divided over 8 domains and 17 sub domains. Discussion. The Nurses' Observation Scale Cognitive Abilities (NOSCA) was successfully designed. The content validity of the scale is high because the scale sufficiently represents the concept of cognitive functioning: the experts reached a consensus of 70% or higher on all domains and items included; and no domains or items were lacking. As a next step, the psychometric qualities of the NOSCA will have to be tested. 1. Background The vulnerability of elderly hospital patients is characterised by simultaneously occurring somatic, psychological, and social problems, which may result in problems in cognitive functioning, mood, behaviour, activities of daily life, and, consequently, in declining quality of life. Determination of an individual’s specific cognitive status is important for two reasons. First, the choices of nursing interventions are substantially influenced by the patient’s cognitive abilities. The patient’s cognitive abilities determine the provision of nursing care to a large extent as they influence communication, the support to be given in daily life activities, the recognition and treatment of other nursing problems (e.g., pain, behavioural problems), and discharge policy [1–3]. The nurse’s approach to individual patients is also largely influenced by the type of cognitive problem. In case of memory problems, for example, information is repeated or written down; in case of problems in sustaining attention, a quiet environment is offered; and in case of executive problems, information is kept simple. Second, facilitation of medical diagnosis is another reason for determining cognitive status. Neuropsychiatric
Biomarkers associated with delirium in critically ill patients and their relation with long-term subjective cognitive dysfunction; indications for different pathways governing delirium in inflamed and noninflamed patients
Mark van den Boogaard, Matthijs Kox, Kieran L Quinn, Theo van Achterberg, Johannes G van der Hoeven, Lisette Schoonhoven, Peter Pickkers
Critical Care , 2011, DOI: 10.1186/cc10598
Abstract: In an exploratory observational study, we included 100 ICU patients with or without delirium and with ("inflamed") and without ("noninflamed") infection/systemic inflammatory response syndrome (SIRS). Delirium was diagnosed by using the confusion-assessment method-ICU (CAM-ICU). Within 24 hours after the onset of delirium, blood was obtained for biomarker analysis. No differences in patient characteristics were found between delirious and nondelirious patients. To determine associations between biomarkers and delirium, univariate and multivariate logistic regression analyses were performed. Eighteen months after ICU discharge, a cognitive-failure questionnaire was distributed to the ICU survivors.In total, 50 delirious and 50 nondelirious patients were included. We found that IL-8, MCP-1, procalcitonin (PCT), cortisol, and S100-β were significantly associated with delirium in inflamed patients (n = 46). In the noninflamed group of patients (n = 54), IL-8, IL-1ra, IL-10 ratio Aβ1-42/40, and ratio AβN-42/40 were significantly associated with delirium. In multivariate regression analysis, IL-8 was independently associated (odds ratio, 9.0; 95% confidence interval (CI), 1.8 to 44.0) with delirium in inflamed patients and IL-10 (OR 2.6; 95% CI 1.1 to 5.9), and Aβ1-42/40 (OR, 0.03; 95% CI, 0.002 to 0.50) with delirium in noninflamed patients. Furthermore, levels of several amyloid-β forms, but not human Tau or S100-β, were significantly correlated with self-reported cognitive impairment 18 months after ICU discharge, whereas inflammatory markers were not correlated to impaired long-term cognitive function.In inflamed patients, the proinflammatory cytokine IL-8 was associated with delirium, whereas in noninflamed patients, antiinflammatory cytokine IL-10 and Aβ1-42/40 were associated with delirium. This suggests that the underlying mechanism governing the development of delirium in inflamed patients differs from that in noninflamed patients. Finally, elevated levels of amy
The design of the Dutch EASYcare study: a randomised controlled trial on the effectiveness of a problem-based community intervention model for frail elderly people [NCT00105378]
René JF Melis, Monique IJ van Eijken, George F Borm, Michel Wensing, Eddy Adang, Eloy H van de Lisdonk, Theo van Achterberg, Marcel GM Olde Rikkert
BMC Health Services Research , 2005, DOI: 10.1186/1472-6963-5-65
Abstract: DGIP is a community intervention model for frail elderly persons where the GP refers elderly patients with a problem in cognition, mood, behaviour, mobility, and nutrition. A geriatric specialist nurse applies a guideline-based intervention with a limited number of follow up visits. The intervention starts with the application of the EASYcare instrument for geriatric screening. The EASYcare instrument assesses (instrumental) activities of daily life, cognition, mood, and includes a goal setting item. During the intervention the nurse regularly consults the referring GP and a geriatrician. Effects on functional performance (Groningen Activity Restriction Scale), health related quality of life (MOS-20), and carer burden (Zarit Burden Interview) are studied in an observer blinded randomised controlled trial. 151 participants were randomised over two treatment arms – DGIP and regular care – using pseudo cluster randomisation. We are currently performing the follow up visits. These visits are planned three and six months after inclusion. Process measures and cost measures will be recorded. Intention to treat analyses will focus on post intervention differences between treatment groups.The design of a trial evaluating the effects of a community intervention model for frail elderly people was presented. The problem-based participant selection procedure satisfied; few patients that the GP referred did not meet our eligibility criteria. The use of standard terminology makes detailed insight into the contents of our intervention possible using terminology others can understand well.In frail elderly persons chronic conditions and loss of function challenge their autonomy. This harms their well-being, and often leads to institutionalisation and high health care costs.There is much heterogeneity in the degree to which frailty affects older people. While some have many problems, others age successfully [1]. The introduction of the concept of successful aging voiced a change in ou
The design of the SAFE or SORRY? study: a cluster randomised trial on the development and testing of an evidence based inpatient safety program for the prevention of adverse events
Betsie GI van Gaal, Lisette Schoonhoven, Marlies EJL Hulscher, Joke AJ Mintjes, George F Borm, Raymond TCM Koopmans, Theo van Achterberg
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-58
Abstract: The aim of this study is to develop and test such an integral patient safety program that addresses several AEs simultaneously in hospitals and nursing homes. This paper reports the design of this study.The patient safety program addresses three AEs: pressure ulcers, falls and urinary tract infections. It consists of bundles and outcome and process indicators based on the existing evidence based guidelines. In addition it includes a multifaceted tailored implementation strategy: education, patient involvement, and a computerized registration and feedback system. The patient safety program was tested in a cluster randomised trial on ten hospital wards and ten nursing home wards. The baseline period was three months followed by the implementation of the patient safety program for fourteen months. Subsequently the follow-up period was nine months. Primary outcome measure was the incidence of AEs on every ward. Secondary outcome measures were the utilization of preventive interventions and the knowledge of nurses regarding the three topics. Randomisation took place on ward level. The results will be analysed separately for hospitals and nursing homes.Major challenges were the development of the patient safety program including a digital registration and feedback system and the implementation of the patient safety program.Trial registration: ClinicalTrials.gov ID [NCT00365430]Over the past seventeen years several studies showed that patients are at risk of injuries or even death as a result of care delivered in hospitals [1-11]. These studies show that 2.9 to 16.6% of patients in acute care hospitals experienced at least one adverse event (AE) (Table 1) [1,2,9-11]. In 5 to 13% of these events the patients died [1-3,7,9-11]. Half of all events are considered preventable [1,3,6,9-11]. While these studies did not include nursing homes, other studies show that AEs, such as urinary tract infection, pneumonia, falls, pressure ulcers and medication errors, also occur frequently
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