Article: Oral health care in older people in long term care facilities: A systematic review of implementation strategies.[show abstract] [hide abstract]
ABSTRACT: OBJECTIVES: Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the importance of a clear evidence-based implementation strategy to improve oral health care. The aim of this study is to review implementation strategies used to promote or improve oral health care for older people in long term care facilities from the perspective of behaviour change, to code strategy content at the level of determinants, and to explore their effectiveness. DESIGN: Systematic review of literature. DATA SOURCES: The digital databases of the Cochrane Library, PubMed and Cinahl have been searched up to September 2011 for relevant articles. REVIEW METHODS: After a systematic selection process, included studies were quality assessed by three researchers. We extracted the study characteristics using the EPOC Data Collection Checklist and Data Abstraction Form. Strategy content was extracted and coded by using the Coding Manual for Behavioural Change Techniques. This manual groups the behaviour change techniques under relevant behavioural determinants. RESULTS: Twenty studies were included in this review. Implementation strategies were delivered by dental hygienists or dentists. Oral health care was performed by nurses and nurse assistants in all studies. All studies addressed knowledge, mostly operationalized as one educational session. Knowledge was most often combined with interventions addressing self efficacy. Implementation strategies aimed at knowledge (providing general information), self-efficacy (modelling) or facilitation of behaviour (providing materials to facilitate behaviour) were most often identified as successful in improving oral health. CONCLUSIONS: Knowledge, self-efficacy and facilitation of behaviour are determinants that are often addressed in implementation strategies for successful improvement of oral health care in older patients. Strategies addressing increasing memory, feedback of clinical outcomes, and mobilizing social norm are promising and should be studied in the future. However, as the quality and heterogeneity of studies is a reason for concern, it is not possible to unequivocally recommend strategies or combinations of strategies for improving oral health care in the older population. When choosing strategies to improve oral health care, care professionals should thoroughly examine the setting and target group, identify barriers to change and tailor their implementation strategies to these barriers for oral health care.International journal of nursing studies 01/2013; · 1.91 Impact Factor
Article: Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study.M van den Boogaard, P Pickkers, A J C Slooter, M A Kuiper, P E Spronk, P H J van der Voort, J G van der Hoeven, R Donders, T van Achterberg, L Schoonhoven[show abstract] [hide abstract]
ABSTRACT: To develop and validate a delirium prediction model for adult intensive care patients and determine its additional value compared with prediction by caregivers. Observational multicentre study. Five intensive care units in the Netherlands (two university hospitals and three university affiliated teaching hospitals). 3056 intensive care patients aged 18 years or over. Development of delirium (defined as at least one positive delirium screening) during patients' stay in intensive care. The model was developed using 1613 consecutive intensive care patients in one hospital and temporally validated using 549 patients from the same hospital. For external validation, data were collected from 894 patients in four other hospitals. The prediction (PRE-DELIRIC) model contains 10 risk factors-age, APACHE-II score, admission group, coma, infection, metabolic acidosis, use of sedatives and morphine, urea concentration, and urgent admission. The model had an area under the receiver operating characteristics curve of 0.87 (95% confidence interval 0.85 to 0.89) and 0.86 after bootstrapping. Temporal validation and external validation resulted in areas under the curve of 0.89 (0.86 to 0.92) and 0.84 (0.82 to 0.87). The pooled area under the receiver operating characteristics curve (n=3056) was 0.85 (0.84 to 0.87). The area under the curve for nurses' and physicians' predictions (n=124) was significantly lower at 0.59 (0.49 to 0.70) for both. The PRE-DELIRIC model for intensive care patients consists of 10 risk factors that are readily available within 24 hours after intensive care admission and has a high predictive value. Clinical prediction by nurses and physicians performed significantly worse. The model allows for early prediction of delirium and initiation of preventive measures. Trial registration Clinical trials NCT00604773 (development study) and NCT00961389 (validation study).BMJ (Clinical research ed.). 01/2012; 344:e420.
Sivera A A Berben, Hennie H L M Kemps, Pierre M van Grunsven, Joke A J Mintjes-de Groot, Robert T M van Dongen, Lisette Schoonhoven[show abstract] [hide abstract]
ABSTRACT: Pain management for trauma patients is a neglected aspect in the chain of emergency care in general practices, ambulance services, mobile trauma teams and in hospital emergency departments. The aim of the guideline 'Pain management for trauma patients in the chain of emergency care' is to provide pain management recommendations for trauma patients in the chain of emergency care and thereby improve the assistance that patients receive. Paracetamol is the treatment of choice, if necessary with additional use of NSAIDs or opioids; NSAIDs can be administered in the absence of contra-indications, but should be avoided in cases where the patient history is unknown; fentanyl and morphine can be given for severe pain during emergency care, esketamine can be considered in patients with severe pain and hypovolemia. The guideline contains 3 algorithms for measuring pain and for its pharmacological treatment in the chain of emergency care. Implementation of the algorithms requires an alternative working procedure; pain scores must be documented, and general practitioners and nursing staff may administer opioids intravenously.Nederlands tijdschrift voor geneeskunde 01/2011; 155(18):A3100.
Chapter: Preventie van decubitus1L. Schoonhoven, T. Defloor[show abstract] [hide abstract]
ABSTRACT: Effectieve decubituspreventie richt zich op het beïnvloeden van de oorzaak van decubitus: druk en schuifkrachten.02/2009: pages 83-115;
Article: Mitochondrial disease: needs and problems of children, their parents and family. A systematic review and pilot study into the need for information of parents during the diagnostic phase.[show abstract] [hide abstract]
ABSTRACT: Firstly, this paper aims to systematically review the mitochondrial disease literature to identify studies assessing the needs and problems in the daily life of children with a mitochondrial disease and of their parents and family. The second aim is to provide more insight into the need for information by the parents of these children during the diagnostic process while in hospital. A systematic review and a pilot study, using a qualitative (focus group interviews; n = 7) and a quantitative (questionnaire; n = 37) design. Mothers reported great socioeconomic and psychoaffective strain and showed psychopathological symptoms in the two studies published with respect to this topic. The pilot study showed that parents considered an honest and interested attitude of the person who is giving the information as most important. Furthermore they wanted oral and written information and a central point where they could go with their questions at any time they felt the need. The need for information increased during the four phases of the diagnostic process and was highest in the fourth phase. The few studies found in the review, combined with expectations that having a mitochondrial disease must have a great impact on these children and their parents and family, call for more research in their needs and problems. Furthermore, there are gaps in the current information provision to parents of these children. A better understanding of the needs and problems of these children and their family is essential for effective care planning and might result in an improved quality of life.Journal of Inherited Metabolic Disease 07/2007; 30(3):333-40. · 3.58 Impact Factor