HU Annual Report 2013 Centre for Innovations in healthcare

ANNUAL REPORT 2013 RESEARCH CENTRE FOR INNOVATIONS IN HEALTHCARE HU UNIVERSITY OF APPLIED SCIENCES UTRECHT

/ COLUMN Continuous improvement and innovation are essential in the healthcare sector. Currently, the focus is primarily on the renewal of healthcare products and processes as a means of ensuring that healthcare can remain accessible, affordable and of good quality as volumes increase and the demand for care changes. The Research Centre for Innovations in Healthcare focuses its own research on this area, with a special emphasis on the problems faced by people with chronic conditions who would like to remain independent and maintain control over their own lives for as long as possible. In view of the changing age distribution in the population, multi-morbidity and the increased possibilities offered by medicine and technology, this is a large group of people.

Our Research Centre has significant research capacity and impact, both in terms of professional practice and the healthcare sector and our own Bachelor’s and Master’s programmes. The first external audit of the Research Centre, conducted in 2007, clearly acknowledged this. As you will discover later in this annual report, the second external audit that was held last year was even more appreciative of our work. But we are not achieving all of this on our own.

We work with ever greater numbers of alliance partners: healthcare institutions, SMEs, other research centres and professionals. Together with them, we investigate what works in practice.

The Faculty of Healthcare at HU University of Applied Sciences Utrecht (HU) successfully fulfils its mission in higher professional education and, more specifically, higher professional healthcare education. In their recent publication, the Fact-finding Committee in the field (Verkenningscommissie HGZO) described this mission as pioneering change. In its recommendations issued under the same name (Voortrekkers in Verandering), this committee highlights how essential practice-oriented research is for improving the quality of healthcare. The Faculty of Healthcare aims to play this pioneering role: through its Bachelor’s and Master’s programmes, the Research Centre for Innovations in Healthcare and in consultation with local external parties.

Harm Drost Director of the Faculty of Healthcare, HU University of Applied Sciences Utrecht 3

TABLE OF CONTENTS

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Column

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Facts and figures 2013

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External audit

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Marieke Schuurmans appointed as Chief Nursing Officer

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Prizes and nominations

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New research

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• In the spotlight / Esther du Pon’s PhD research

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• HAYS / Health in Adapted Youth Sports

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• Fit for the Future / Making fitness achievable for disabled children

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• How do you promote oral hygiene among the elderly?

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• Godiva / Can film be used to measure motor development?

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• In the spotlight / Gerda Bruinsma’s PhD research

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Research completed

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• TUK! / Language screening for Utrecht children

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• PETZ / Use of e-health by the elderly and professionals

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• Outstanding Nursing Care

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• HALYNED / Exercise intervention for children in wheelchairs

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• SUSTAIN / Exercise intervention for elderly people after a stroke

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• PREDOS

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• Acceptance of Assisted Living Technologies in Europe

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• In the spotlight / Carolien Sino’s PhD research

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Symposium in Pharmaceutical Business Administration

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Healthcare and Technology Challenge

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In the spotlight / Hans Heneweer, research in education

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Internationalization

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• HU member of Healthcare Innovation Transfer

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• Summer School Utrecht

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• International working visits

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Meander Medical Centre opens

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2013 STATISTICS

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• 5 RESEARCH GROUPS • 7 PROFESSORS • 50 RESEARCH GROUPS MEMBERS • 19 PHD STUDENTS AT VARIOUS UNIVERSITIES • 73 SCIENTIFIC PUBLICATIONS • 34 ABSTRACTS • 35 PUBLICATIONS FOR PROFESSIONALS • 84 PRESENTATIONS FOR PROFESSIONALS • 60 PRESENTATIONS AT SCIENTIFIC CONFERENCES • 406 BACHELOR’S AND MASTER’S STUDENTS INVOLVED IN RESEARCH • 15 MASTERCLASSES ATTENDED BY OVER 1,450 STUDENTS

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/ ‘HU RESEARCH CENTRE DELIVERS OUTSTANDING PERFORMANCE’ According to a committee of external experts in research, healthcare and governance, the HU Research Centre for Innovations in Healthcare is delivering an outstanding performance. The intrinsic quality and impact of the Research Centre on practice is also deemed to be excellent.

“The committee saw a high-quality research centre that is still regarded as a pioneer in higher professional education in the Netherlands after ten years.”

Every five years, HU Utrecht asks a group of people with a proven track record in research, healthcare and governance to investigate the performance of the Research Centre. In its report, the committee, chaired by former Dutch State Secretary Guusje ter Horst, described the location of the Research Centre as ‘ideal’. The Research Centre is located in the University’s Faculty of Healthcare and on a campus that is also home to the Utrecht University and Utrecht University Medical Centre. According to the report, this location has been a contributory factor in the Research Centre’s great success in collaborating with the academic world. PhD students at HU confirmed this impression during the committee’s visit: “This is what you might call a Care Valley. You can collaborate on a course with clinical health scientists, which is not possible at any other University of Applied Sciences.”

Outstanding impact on professional practice The committee considers the Research Centre’s impact on professional practice to be outstanding, especially in terms of the implementation of innovative healthcare programmes. Practising professionals regularly make use of the centre’s research results. For example, the Research Centre played an instrumental role in formulating the professional profile for Nurses and Healthcare Assistants (V&V 2020).

More multidisciplinary collaboration The committee recommended that the Research Centre opt in the future for research groups that forge links between the different degree programmes.

If they act as standard bearers for themes that straddle several degree programmes, they can serve as a platform for multidisciplinary collaboration between teaching staff and students, enabling students to learn how to work

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2 together with other subject areas during their programme. This will enable all of them to join forces to tackle the complex healthcare problems of modern professional practice. Obvious themes for the Research Centre include oncology and e-health, the use of information and communication technology to support or improve healthcare. The latter theme is already the subject of a great deal of research within the Research Centre.

Committee The external committee that assessed the Research Centre included the following members: Dr Guusje ter Horst, member of the Dutch Senate and former chair of the Council of the Netherlands Association of Universities of Applied Sciences (HBO-raad), the Netherlands Organization for Health Research and Development (ZonMW) and the National Prevention Platform (Nationaal Preventieplatform); Prof. Vanessa Evers, Professor of Human Media Interaction at Twente University; Mr John Taks, member of the Executive Board at the Albert Schweitzer Hospital and former director and later member of the Supervisory Board at the Zuwe Hofpoort hospital; Mr Chiel Bos, independent healthcare consultant, former director of the Association of Dutch Healthcare Insurance Companies (Zorgverzekeraars Nederland), vice-chairman of the Regional Council for Healthcare Quality, member of the Executive Board at VUmc Cancer Center Amsterdam and chairman of the quality committee in the Netherlands Federation of Cancer Patient Associations (Nederlandse Federatie van Kankerpatiëntenverenigingen); Dr Gertjan Schuiling, organizational development consultant at Thierry & Schuiling and Emeritus Professor at HAN University of Applied Sciences.

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“AN APP THAT HELPS IMPROVE PHYSIOTHERAPISTS’ UNDERSTANDING OF THE PROBLEMS OF PATIENTS WITH READING DIFFICULTIES.”

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/ PRIZES AND NOMINATIONS

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TRANSFYSA PROJECT WINS THIRD PRIZE IN RAAK AWARDS

The TransFysA project run by the Lifestyle and Health and Product Development and Engineering research groups at HU won at the third RAAK Award 2013 on 21 November, the third prize for the best ­ practice-oriented research. The winners were announced at the annual conference of the Innovation Alliance Foundation (Stichting Innovatie Alliantie, SIA), held in The Hague.

The TransFysA project developed the Talking Touchscreen (TTS) app that enables physiotherapists to gain a better understanding of the problems faced by their patients with reading difficulties. Physiotherapists often use questionnaires during new patient intake. However, only 5.6% of those officially defined as less well-educated (laaggeschoolden) are able to fully complete this type of questionnaire. With the TTS, that figure increases to 68.8%. TransFysA received the third prize because of the major social significance for those with reading difficulties and the forged sustainable cooperative relationships.

The project is being coordinated by Harriët Wittink (Professor of Lifestyle and Health) and Marlies Welbie (PhD student in Lifestyle and Health, diversity lecturer on the Physiotherapy and Cesar Kinetics and Therapy programmes and diversity policy officer).

The first prize also went to another HU research project: the NAT test developed by the Innovative Testing in Life Sciences & Chemistry research group.

The RAAK programme is a special scheme designed to promote collaborative projects between universities of applied sciences and the professional field, implemented by SIA and funded by the Ministry of Education, Culture and Science (OCW).

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/ PRIZES AND NOMINATIONS

BART BARTELS WINS TALMA-EIJKMAN PRIZE Bart Bartels has won the Talma-Eijkman prize. He was awarded the prize on Thursday 4 April for his study of the safety and validity of a cardiopulmonary exercise test (CPET) for children with Duchenne and Becker muscular dystrophy. The study was part of the HALYNeD research being conducted by the Lifestyle and Health research group.

The Talma-Eijkman prize for outstanding students is awarded annually by the UMC Utrecht. Bart was nominated by the Child Development & Exercise Center (Kinderbewegingscentrum) and the UMC divisional management. He conducted his Master’s research as part of the alliance between Lifestyle and Health, the UMCU Child Development & Exercise Centre and the Muscles for Muscles Children’s Centre (Spieren voor Spieren Kindercentrum). Dr Janke de Groot, a research fellow in the research group was his supervisor. Bart: ‘I am delighted to have received this prize. Our study was an investigation of the safety and validity of a cardiopulmonary exercise test for children with Duchenne and Becker muscular dystrophy. These conditions involve a lack of dystrophin that plays a role in stabilizing the muscular cell wall. The course of these diseases is characterized by progressive muscular weakness, respiratory insufficiency and cardiomyopathy. The study revealed that the CPET can be conducted safely and is more effective in detecting disease progression at an early stage than current methods. Potentially interesting follow-up research could involve the question of whether the CPET can help in the early detection of cardiac involvement.’ Bartels is a researcherat the Research Centre for Innovation in Healthcare and lectures in the Master’s programme on paediatric physiotherapy.

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“POTENTIALLY INTERESTING FOLLOW-UP RESEARCH COULD INVOLVE THE QUESTION OF WHETHER THE CPET CAN HELP IN THE EARLY DETECTION OF CARDIAC INVOLVEMENT.”

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Karlijn Damen, physiotherapist

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/ PRIZES AND NOMINATIONS

FORMER STUDENT NOMINATED FOR STUDENT RESEARCH AWARD Karlijn Damen, who completed her Bachelor’s degree programme in June of this year, has been nominated for the Student Research Award 2013 presented by the VSNU, the Association of Universities in the Netherlands.

Karlijn’s thesis explored the reproducibility of two wheelchair skills tests used for wheelchair-bound children and adolescents with Spina Bifida. Her research was part of the Let’s Ride study, itself part of the SIA RAAK project Healthy Active Living for Youth with Neuromotor Disability (HALYNeD). In this project, Lifestyle and Health is researching how wheelchair-dependent children with neuromotor disabilities can improve their levels of fitness by becoming more physically active.

In her research, Karlijn was supervised by lecturer/researchers Manon Bloemen MSc, Dr Janke de Groot and Huib van Moorsel.

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/ PRIZES AND NOMINATIONS

MARIEKE SCHUURMANS APPOINTED AS CHIEF NURSING OFFICER Professor Marieke Schuurmans has been appointed as Chief Nursing Officer (CNO) by Minister Edith Schippers of Health, Welfare and Sport (VWS) effective as of 1 October 2013. The CNO is the most important independent adviser to the Minister on the subject of nursing.

The Chief Nursing Officer plays an important role at the Ministry of VWS. She has direct access to the Minister, enabling nurses as a professional group to have an influence on policy. The Chief Nursing Officer is the foremost independent ministerial adviser on nursing care. Across the various different European countries, the Chief Nursing Officers form a network for sharing knowledge.

Prof. Marieke Schuurmans is Professor in Geriatric Care in the Care for the Chronically Ill research group. She has also ultimate responsibility for research into optimal care for elderly people with multiple chronic conditions, which aims to encourage patients to remain independent for as long as possible.

Schuurmans is also Professor of Nursing Science at Utrecht University.

“THE CHIEF NURSING OFFICER IS THE FOREMOST INDEPENDENT MINISTERIAL ADVISER ON NURSING CARE.” 14

Marieke Schuurmans, Professor in Geriatric Care

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/ NEW RESEARCH IN THE SPOTLIGHT PHD RESEARCH

BY ESTHER DE PON

“I WANT TO MAKE A DIFFERENCE FOR SOCIETY.” The desire to work as an investigative journalist, a qualification in pharmaceutical business administration, a part-time job in home care and a Master’s degree in Communication Studies. All of these proved to be the perfect ingredients for Esther du Pon’s PhD research.

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4 Esther du Pon, PhD student

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/ ESTHER DE PON’S PHD RESEARCH “I used to dream of becoming an investigative journalist. Stella Braam - who went undercover as a tramp in Amsterdam to explore the drugs world, wrote several books and never let anything deter her - was always my heroine. I want to make a difference for society. In the summer of 2009, when I had just graduated in Pharmaceutical Business Administration, I was not quite ready to start my professional career. I was eager to continue studying in order to pursue my interest in communication and journalism. Pharmaceuticals and communications seemed to me to be an interesting combination which could, for example, secure me a position on the editorial team at a medical journal. The Master’s degree in Communication Studies at Utrecht University seemed the obvious choice. During the course, I did indeed learn a lot about a range of communication theories (do linguistic errors have an influence on the attractiveness and persuasiveness of a piece of text?), but my interest soon started to falter. The level of detail was too focused. I was much more fascinated by the scientific method in general: conducting research. While writing my Master’s thesis in the faculty of Social Sciences, my first ever relatively large piece of independent research, I learned a great deal. Although I didn’t realize it at the time, the only thing that was missing was creativity, the practical application.

In 2011, I completed my Master. Immediately after that, I came into contact again with Ad van Dooren, one of my lecturers on the Pharmaceutical Business Administration programme. He had just been appointed as Professor in Dissemination of Pharmaceutical Innovations. One of the lines of research, ‘Communication with the patient’, was absolutely perfect for me, he explained.

I was enthusiastic from the outset! I had never before considered doing a PhD, but I am naturally very inquisitive and always up for a challenge. With the adventures of Stella Braam at the back of my mind, I seized the opportunity with vigour. I have never regretted that decision. At HU, I am able to express my creativity: the research I am working on is practice-oriented. And rather than working as an editor on a medical journal, I soon hope to be submitting my own publications to medical journals. Who would have thought it?

In my PhD research, I plan to test an intervention (a new or existing one).

The intervention (which has the working title ConsultHulp) is intended to enable patients with Type II Diabetes to gain more from a medical consultation.

My expectation is that it will enable such patients to respond more effectively to treatment advice on medication and lifestyle. Patient compliance in this group is low, despite the fact that it is so important for such chronic conditions.

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An interesting development in recent years is that patients have been asking their healthcare providers fewer biomedical questions. They have also been expressing fewer concerns. In the consulting room, the issues of the use of medication and patient compliance are hardly ever raised, according to the literature. This is problematic since it means that patients’ questions can remain unanswered and they may be left to their own devices to struggle with the use of medication and lifestyle issues at home. This can undermine compliance.

I would like to change that.

Originally, I wanted to work as an investigative journalist and make people think by confronting them with problems in society. My PhD research actually goes a step further than that: I am not only targeting the problem but also devising a solution! I am looking for a solution that is cheap, proven to be effective and easy to understand for the patient. Simplicity and remaining as close as possible to day-to-day care are my two key aims.

“AN INTERESTING DEVELOPMENT IN RECENT YEARS IS THAT PATIENTS HAVE BEEN ASKING THEIR HEALTHCARE PROVIDERS FEWER BIOMEDICAL QUESTIONS.” 19

/ NEW RESEARCH HAYS / HEALTH EFFECTS OF SPORT ON CHRONIC ILLNESSES The Research Centre has launched a study to examine the effect sport has on young people with a chronic illness or condition. The study, entitled Health in Adapted Youth Sports Study (HAYS study), compares young people with a disability who engage in sport with those who do not. It includes young people who use wheelchairs and young people who do not. What effect does sport have on physical fitness, physical activity, health and injuries? And what are the repercussions in terms of school performance, absenteeism and psychosocial welfare? This study is being conducted in the Lifestyle and Health research group.

FIT FOR THE FUTURE / MAKING FITNESS ACHIEVABLE FOR CHILDREN WITH PHYSICAL DISABILITIES Being physically active is important for a child’s health and for their motor, cognitive, social and emotional development. This also applies for children with a physical disability. However, in practice it is not only difficult encouraging children with a physical disability to become active, but even more so to keep them active over the longer term. The aim of the research is to develop a knowledge transfer system to be called ‘Fit for the Future’, in which knowledge about fitness and activity in young people with a physical disability is translated into knowledge that can be applied by paediatric physiotherapists.

The research group is also developing new knowledge on how to measure and improve fitness and participation in physical activity among children with a physical disability. At HU, the research groups of Lifestyle and Health (Professor Harriet Wittink) and Digital Architecture (Professor Raymond Slot) are involved in the research.

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HOW DO YOU PROMOTE ORAL HYGIENE AMONG THE ELDERLY

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Many elderly people do not visit the dentist or oral hygienist for a check-up of their teeth or dentures often enough. This may be because they assume that minor oral health issues are just a part of becoming older. Because they have fewer check-ups, they have less up-to-date knowledge about effective oral hygiene, which in any case becomes more difficult with advancing age. The Research Centre is therefore investigating the most effective way of promoting oral hygiene among the elderly and the effects that various interventions have. One of these interventions is information: in October and November, students of Oral Hygiene visited various care homes to provide information about the subject.

GODIVA / CAN FILM BE USED TO MEASURE MOTOR DEVELOPMENT? Is it possible to measure children’s development of motor skills by using videos made by their parents? Professor Harriet Wittink’s Lifestyle and Health research group has received a grant to research this. “In physiotherapy, no previous research has been conducted on the development of children’s motor skills based on videos made by their parents”, says senior research fellow Jacqueline Nuysink, “In this research – the GODIVA study – we intend to explore whether the use of videos offers advantages for young patients, parents and physiotherapists. For example, it can be easier for parents to make videos rather than regularly visiting the physiotherapist. In addition, it can save time for physiotherapists to simply analyse a video rather than scheduling a consultation.

It can also be a less invasive way of examining the children.

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/ IN THE SPOTLIGHT GERDA BRUINSMA’S PHD RESEARCH

“I AM DELIGHTED TO BE ABLE TO CONDUCT RESEARCH THAT WILL FURTHER IMPROVE THE CARE PROVIDED TO CHILDREN WITH LANGUAGE DEVELOPMENT DISORDERS.” Gerda Bruinsma, a lecturer in Speech and Language Therapy has been awarded funding to conduct her PhD studies by the Netherlands Organization for Scientific Research (NWO). She is to conduct research into the effect of speech and language therapy on infants with serious language development disorders.

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6 Gerda Bruinsma, PhD student

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/ GERDA BRUINSMA’S PHD RESEARCH “In speech and language therapy, scientific research into the effects of treatment methods is still in its very early stages. For example, there is as yet no scientific evidence confirming which is the best treatment for infants with serious language development disorders. I will be recording the progress that children make in their language skills during one year and will investigate the factors that play a role in that progress. These factors could include the intensity and content of the treatment, the seriousness of the child’s language development disorder, the parents’ involvement in the therapy and the additional support the child receives in education.

I will also be investigating how effective Communicative Language Therapy is compared to regular speech and language therapy. Communicative Language Therapy was developed by Leen van den Dungen, who was a lecturer at HU for many years. The therapy has a good theoretical basis, but its effectiveness has not yet been fully assessed. I plan to keep records on a number of children on how they perform with their regular therapy. I will then provide intensive training to the speech and language therapists to enable them to apply Van den Dungen’s Communicative Language Therapy in accordance with a protocol that I will compile for them. I will then monitor the children again. This will enable me not only to compare the children with a control group but also with themselves.

I will be able to conduct my research at the Royal Auris Group, a major institution for care and education for children with serious language development disorders.

Personally, I have worked twenty years as a speech and language therapist, including with infants at special schools and at a medical daycare centre.

What I missed in my work was evidence to back up the treatment I was giving.

I am therefore delighted to be able to conduct research that will further improve the care provided to children with language development disorders.

“PERSONALLY, I HAVE WORKED TWENTY YEARS AS A SPEECH AND LANGUAGE THERAPIST, INCLUDING WITH INFANTS AT SPECIAL SCHOOLS AND AT A MEDICAL DAYCARE CENTRE.” 24

I was overjoyed when I received a letter confirming I had received the PhD grant. These grants are not easy to come by: of the 166 research applications submitted, 37 were ultimately honoured. NWO applies a strict selection procedure involving several different rounds: my application was first assessed by a multidisciplinary scientific committee and then I gave a presentation and had a selection interview. The PhD grant was initiated in order to offer teachers from various sectors of education an opportunity to take a PhD. As a PhD student, I continue to do a lot for education: alongside my research, I am still teaching about language development disorders. I also hope, as a lecturer who also conducts research, to be able to serve as a role model.

My project is also highly suited forinvolving students in the speech and language therapy programme. It gives them the opportunity to gain research experience in practice and develop knowledge about the effectiveness of treatments.

This will boost evidence-based practice in the future.�

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/ RESEARCH COMPLETED TUK! / LANGUAGE SCREENING FOR UTRECHT CHILDREN Moniek Schaars, researcher in Speech and Language Therapy was commissioned by the municipal medical and healthcare service (GG&GD) in the municipality of Utrecht to conduct research into the most suitable language screening tools for health centres in Utrecht. With this project, referred to as ‘TUK!’, the GG&GD aims to be able to identify poor language skills at an early age and especially during the consultation at the age of two when 5,000 young infants are examined. As part of the ‘TUK!’ project, two language screening tools were compared in a feasibility study among paediatricians and paediatric nurses.

Schaars also developed a tool to chart the children’s linguistic environment.

Parents were asked how many languages are spoken at home and how often they play with and read aloud to their child. The professionals found this tool to be a valuable addition and it is now being developed further. The Speech and Language research group conducted the research together with the Faculty of Social Sciences at Utrecht University.

PETZ / PREDICTORS OF THE USE OF E-HEALTH

BY THE ELDERLY AND PROFESSIONALS In the Netherlands, demand for healthcare is increasing by 2% per year on average and the growth in the number of healthcare professionals is nowhere near that figure. It is also known that the number of voluntary carers is set to fall by half in the future. Elderly (and vulnerable) clients will need to organize alternative support strategies and assistance. The government foresees a role for e-health technology in this area. However, both (elderly) clients and healthcare professionals are not sufficiently competent in dealing with e-health.

How do you develop e-health technologies that healthcare professionals and older people are able and willing to work with? Knowledge in this area is being developed in the PETZ study, which stands for Predictors for the use of e-health by the elderly and professionals in healthcare. www.research.hu.nl/Projecten/Predictors-voor-gebruik-van-e-Health-doorouderen-en-professionals%20in%20de%20zorg.aspx 26

7 OUTSTANDING NURSING CARE Over 60% of healthcare institutions have difficulty attracting staff. This is why the Research Centre conducted research into how hospitals can strengthen and retain nursing talent with a managerial role. Consortium partners indicated that there were major benefits to be had by correctly positioning nursing managers.

For this reason, nurses, researchers, lecturers and students joined forces to devise a model of specialist nursing leadership, to form the basis for in-company training courses, the Bachelor’s programme in Nursing and the summer school course on Strategic and Clinical Nursing Leadership.

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HALYNED / EXERCISE INTERVENTION FOR CHILDREN IN WHEELCHAIRS During the HALYNeD (Healthy Active Living for Youth with Neuromotor Disability) research project, a specially-designed exercise intervention was developed to promote long-term behavioural change among children with neuromotor disabilities who use wheelchairs. It makes it easier for children to participate in sport and games activities as part of their everyday life.

Short interventions have shown that there are benefits to be gained in terms of physical function and fitness in the short term, but interventions that ensure that children with a disability remain active in the longer term are much more important for health. The Research Centre developed evidence-based recommendations for paediatric physiotherapists involving measurement instruments for wheelchair-using children with Spina Bifida.

SUSTAIN / EXERCISE INTERVENTION FOR ELDERLY PEOPLE AFTER A STROKE For people who have suffered a stroke, there is often no structured care following rehabilitation. As a result, many people find it difficult to learn to deal with the disabilities following the stroke and there is little support for their informal carers. In order to improve the physical activity of these people and reduce the numbers dependent on physiotherapy and other care, physiotherapists from Aveant and the Regional Consultative Group of Hospital Physiotherapists asked the Research Centre to develop an effective and lowcost instrument based on scientific research that encourages patients suffering a stroke to stay physically active. The Research Centre responded in the form of the research project entitled InveStigating and Stimulating long Term walking Activity IN stroke (SUSTAIN). The research culminated in a symposium where interested parties were able to gain new knowledge on the treatment of patients who need to become active again in the wake of a stroke.

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PREDOS A simple programme can enable nurses to prevent post-operative complications in elderly patients. Currently, more than one third of patients who have undergone open-heart surgery go on to develop delirium, depression, bedsores or an infection. This often leads to an extended stay in hospital and reduced quality-of-life after that: patients who would originally have returned home can end up in a care home. This does not need to happen. Roelof Ettema, research fellow at HU and UMC Utrecht, developed the PREDOS programme. Before the patient is admitted to hospital, a nurse checks whether the patient has an enhanced risk of complications and takes appropriate measures. This can prevent people having an extended stay in hospital and a great deal of unnecessary suffering.

ACCEPTANCE OF ASSISTED LIVING TECHNOLOGIES IN EUROPE Why is it that elderly people in the United Kingdom are reasonably likely to use e-health (15%), whereas the rest of Europe uses it much less? For example, only 3% of elderly people in the Netherlands make use of e-health. This issue was investigated by the Demand-driven Care research group, together with Coventry University in the UK, Spanish Universidad Politécnica and the Beuth Hochschule für Technik in Germany. The project was commissioned by the SME Verklizan, a company active in the field of e-health. The four research centres conducted exploratory research into the influence of psychological factors on the part of the user, the role played by the design of the e-health application, the training of healthcare professionals and e-health business models.

Thijs van Houwelingen, PhD student in the group: “In the UK, healthcare professionals regularly initiate the use of e-health, whereas it is often only the people themselves or their families who consider this kind of solution in the Netherlands. It may have something to do with the different healthcare systems in the two countries.”

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/ IN THE SPOTLIGHT CAROLIEN SINO’S PHD RESEARCH

“HALF OF ALL HOME-CARE PATIENTS CANNOT MANAGE THEIR OWN MEDICATION.” Carolien Sino, Director of the Institute for Nursing Studies was awarded her PhD on 12 December for her thesis entitled ‘Medication Management in Home-care Patients’. It reveals that elderly home-care patients do not have sufficient awareness of their risk of problems relating to medication.

Home-care workers play an important role in identifying problems at an early stage.

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8 Carolien Sino, Director of the Institute for Nursing Studies

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“The elderly are more likely to have problems with medication than other groups of people. There are various causes: first of all, older people tend to take more medication, but they also often take several different drugs at the same time. People over 65 use three times as much medication as the average Dutch person and those over 75 take five times as much. These drugs can have side-effects and may also interact. But there are other influences too: there are natural changes going on in old people’s metabolism, they develop cognitive issues and may suffer several different conditions – often including reduced kidney function – and can take longer to recover.

Problems with medication can seriously affect people and the associated costs can be high. I therefore conducted research into medication problems among elderly people who were not receiving support in their use of medication: elderly people living at home. My research reveals that elderly people living at home are fully aware of the need to take their drugs, but they have no concerns about side-effects. This means that they will be compliant in taking the medication, but there is a chance that they may fail to recognize any side-effects or only at a later stage. It also emerged that half of the home-care patients cannot manage their own medication. This constitutes a risk since the doctors and GPs (general practitioners), pharmacists and nurses responsible cannot provide these elderly people with daily support in taking the medication.

Home-care staff, however, do have regular contact with these elderly people.

I therefore investigated whether they can help the professionals responsible for treatment to identify the signals of a medication-related problem at an early stage. This proved to be the case. Home-care staff can do this using a standardized questionnaire that I developed specially for this purpose.

The results of the questionnaire are fed back to the person ultimately responsible for treatment. The research also showed that the home-care staff feel that they require training in order to be able to deal more effectively with elderly people’s medication.”

“PROBLEMS WITH MEDICATION CAN SERIOUSLY AFFECT PEOPLE AND THE ASSOCIATED COSTS CAN BE HIGH.” 32

“PEOPLE OVER 65 USE THREE TIMES AS MUCH MEDICATION AS THE AVERAGE DUTCH PERSON AND THOSE OVER 75 TAKE FIVE TIMES AS MUCH” 33

/ SYMPOSIUM IN PHARMACEUTICAL BUSINESS ADMINISTRATION Experts in pharmaceutical business administration can make an important contribution in ensuring healthcare remains affordable whilst also helping to improve it. This was the message delivered by Jaap Maljers at a symposium on the subject held on 29 November. Organized by the Dissemination of Pharmaceutical Innovations research group and NEFEVA, the Netherlands Association of Pharmaceutical Managers, the symposium attracted as many as 150 delegates.

Jaap Maljers, healthcare entrepreneur and director of the Bergman clinics and Visionclinics, looked ahead to the future of pharmaceutical management.

Pharmaceutical managers are qualified to higher professional level (Dutch: HBO) and have knowledge about medicines, communication, ICT and management.

They work in pharmacies, the pharmaceutical industry, healthcare insurance companies or as developers of ICT products for use in healthcare. Maljer’s research has revealed that pharmacists spend much of their time doing work for which they are not fully qualified. He called for pharmacists to focus primarily on the work for which they are qualified and which they can do well. “Let them play to their strengths.” This will make it possible for other activities, including HR management, logistics, protocolized healthcare and patient information and education to be done by pharmaceutical managers. “In our clinic, the surgeons each head up a healthcare team. These kinds of surgeons should standardize the care in such a way that it can be left to the pharmaceutical managers who will call the surgeons in if a customized approach is required. In order to achieve such a scenario with pharmacists and pharmaceutical managers, the Pharmaceutical Business Administration programmes and the Pharmacy programme should be better coordinated with each other”, said Maljers.

Future of the pharmaceutical industry During the symposium, Professor Ad van Dooren talked about the future of drug development. The pharmaceutical industry is facing difficult times. Most of the bestselling drugs will soon be off-patent and will make virtually no money. Developing a new medicine costs more than an Airbus, and new medicines that can earn some serious money, the so-called blockbusters, are not easy to develop. What should the pharmaceutical industry be working on now? Nichebusters, extremely expensive medicines for small groups of patients, are one option. Personalized

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medicine is another, involving methods for determining in advance whether a drug will suit the patient. The industry will also focus more on improved ways of administering medication. Complicated diseases such as Alzheimer’s also need effective methods of treatment. Research into these kinds of diseases takes so long that it is not financially viable for pharmaceutical companies to invest independently in this. “This is why alliances are so important: collaboration with patient organizations, healthcare insurance companies, research institutes, such as the Pharmaceutical Business Administration research group, and other companies in the pharmaceutical industry.”

Future of public pharmacy Speaker Rik van der Meer, Chairman of the KNMP (the professional and sector organization of pharmacists) talked about the latest developments within public pharmacy (chemists). Many pharmacists in the Netherlands currently face financial problems partly as a result of the preferential policy according to which healthcare insurance companies only reimburse the most favourably-priced medicine and because of the contracts imposed by healthcare insurance companies. Van der Meer is committed to achieving a better relationship between the delivery and payment of care. “Currently, the pharmacists that do the least gain the most financially, which sends out the wrong message. The method of funding should be more like the one that currently applies to general practitioners.” GPs are actually paid for the consultations they have with patients.

The organizational structure of the KNMP itself is under review: Van der Meer does not rule out allowing others such as pharmaceutical managers to become members of the KNMP. At the moment, only pharmacists are eligible to join the association. He believes that pharmacists face only two options: go with the flow of new developments or be left behind: “Fly or die!”

“PHARMACEUTICAL MANAGEMENT MAKES HEALTHCARE MORE AFFORDABLE AND BETTER.” 35

/ HEALTHCARE AND TECHNOLOGYÂ CHALLENGE

The Healthcare and Technology Challenge (Speerpunt Zorg en Technologie) focuses on research that responds to two different trends. The rapidly ageing population and the speed of developments in technology.

In healthcare and technology it is generally thought that technical applications will have a positive influence on the everyday lives of people in need of care. On the other hand, technology, such as ICT applications, can actually have an inhibitive effect on people in need of care. How can technology be designed and used in order to prevent this? This is the focus of the Health and Technology Challenge.

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Meet-ups and publication series HU has a great deal of knowledge at its disposal about healthcare and technology and we are eager to share it. The Challenge therefore organizes regular Meet-ups, where we present the latest knowledge about healthcare and technology, and we also issue a series of publications.

This year, there were three publications.

The Social Business Case: added value for technological innovations in healthcare In recent years, the issue of whether interventions are financially viable has begun to play an ever greater role. But healthcare cannot solely be seen from a financial perspective: earning money is not its main purpose. Professor Hans Duits therefore investigated how benefits for society can be incorporated as part of the business case.

Promoting screen-to-screen care: a question of gaining experience.

Screen-to-screen care involves providing care remotely, using a video screen.

The technology has only so far been applied piecemeal in the Netherlands.

One of the main reasons for this is resistance among professionals. The Demanddriven Care research group investigated the origin of this resistance and how it can be combatted.

Taste: the secret of the success of self-management Self-management in healthcare is in vogue. Many e-health applications are being developed to teach patients to deal effectively with chronic conditions, increasing their independence and making healthcare cheaper. However, this self-management does not work equally well for every patient. This is why the development of e-health should in principle be patient-centred.

View all publications Want to receive regular updates?

To make sure you are informed of any upcoming Meet-ups, simply send an e-mail to SpeerpuntZenT@hu.nl.

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/ HANS HENEWEER RESEARCH IN EDUCATION

“WE AIM TO STRENGTHEN BACHELOR STUDENTS.”

The Innovations in Healthcare Research Centre not only develops knowledge to improve professional practice. This knowledge is also implemented in education, enabling students to share in the latest insights and learn how to conduct proper research. Hans Heneweer is responsible for the form and content of scientific principles in the teaching of students in the Healthcare Faculty.

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11 Hans Heneweer, research fellow

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“In the 1970s and 1980s, higher professional education in the Netherlands focused on reproducible knowledge and primarily practical skills, whereas now it is focusing on delivering the best care based on the best available evidence, preferably itself based on scientific research.

Although you may not realize it every day, this has been a real shift in thinking.

If today’s professional needs to be capable of adopting an investigative, research-based attitude to improve the way his or her profession is practised, it is obvious that the study programme will also need to focus on that aspect.

It is ultimately about intertwining education and research.

With LOEP (research and practice learning path), we aim to strengthen Bachelor students’ research-based attittude. They learn to find scientific evidence, to reflect critically on their own professional performance and develop best practices. This is no mean ambition and we work hard to achieve it.

The study programmes have completely embraced LOEP and have adopted a dynamic approach in doing so. That is something I find especially inspiring.

At the start of this learning path in 2005, everything was organized centrally: every student had the same teaching and a fixed schedule of activities.

Now, most of it is incorporated into the study programmes themselves.

The programmes have quickly developed content and are fully able to manage the teaching themselves. They are able to design the research teaching in such a way that is in line with the type of healthcare professional they are training.

But we have not quite achieved our targets yet. Most teaching staff and, of course, scientific researchers at the Research Centre have a good scientific grounding. However, the students still need to develop this. It is not necessarily something that automatically develops over time: best practices do not develop themselves and available evidence does not necessarily jump out at you.

The students need a challenging learning environment to achieve this, at all levels. From the research centre itself to the individual lecturer who can serve as a role model, from study guide to assessment and from ICT to the HU Library.

At the end of their studies, the students complete a practice-oriented research report. In this case too, the study programmes have chosen subjects that best suit the professional context for which they are preparing students. Many students conduct research with support from the Research Centre. They help to extend knowledge about healthcare and improve its quality. A fantastic prospect! This means that we are training healthcare professionals who, together with the Research Centre, professional practice and the study programmes, are working to achieve ongoing innovation in their professional practice.

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“THE PROGRAMMES HAVE QUICKLY DEVELOPED CONTENT AND ARE FULLY ABLE TO MANAGE THE TEACHING THEMSELVES”

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/ INTERNATIONALIZATION

ALLIANCE PARTNERS In 2013, HU became one of the research partners of Healthcare Innovation Transfer (HIT), an organization that promotes the sharing of knowledge in healthcare between the Netherlands and the United States.

Because of the ageing population, both the United States and the Netherlands face the challenge of improving the results of healthcare whilst reducing costs at the same time. Healthcare needs to change because of the increasing numbers of elderly people, increased life expectancy and the desire of many baby boomers to live independently for longer.

Healthcare innovations are seen as a solution for making healthcare cheaper, without undermining its quality. HIT supports international collaboration in the area of innovation. The Netherlands and the United States make interesting partners because the Netherlands has one of the most efficient healthcare systems and the United States leads the way in applied innovation and technological advances. The HIT network is based on three key cornerstones: cost reduction and process optimization, vitality and innovative geriatric care and personalized medical care. www.healthcareinnovationtransfer.org

“BECAUSE OF THE AGEING POPULATION, BOTH THE UNITED STATES AND THE NETHERLANDS FACE THE CHALLENGE OF IMPROVING THE RESULTS OF HEALTHCARE WHILST REDUCING COSTS AT THE SAME TIME.” 42

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“DURING THE COURSE, WE HAD A LOT OF DISCUSSION ABOUT WHEN YOU ARE HEALTHY AND WHEN YOU ARE ILL AND HOW THE TWO CAN INFLUENCE EACH OTHER.” 44

/ INTERNATIONALIZATION

SUMMER SCHOOL Every year, HU, Utrecht University and HKU University of the Arts Utrecht organize the Summer School of Europe: Utrecht Summer School. Some 3,000 students from 98 countries come to Utrecht during the summer recess to take part in one of the 170 courses. Four of them are organized

by Research Centre professors or their researchers: Clinical Research; Monitoring, Nurses Work, Nursing Management and Clinical Leadership; Health & Engineering and Healthy Ageing.

Jeroen Dikken, PhD student in the Chronic Diseases research group organized the course in Healthy Ageing and taught it from 8 to 19 July 2013. “Healthcare is often about being ill, but this course actually focuses on health: how long will you stay healthy? We look at what we can learn from research about the biological aspects, for example, how you can ensure that you will be able to continue to function, and the psychological, social and spiritual aspects of growing older healthily. There are certain elements of the course that students particularly enjoy: some elderly people join us and the students can ask questions and we have field trips to a care home and a hospice.

During the course, we have a lot of discussion about when you are healthy and when you are ill and how the two can influence each other. For example, it is normal for your network to shrink as you grow older: you are no longer working and have no colleagues and your mobility becomes reduced making it more difficult to cover long distances. This means that you will not see family who live a long way away so often. Although this is normal, it is a problem: who will look after you if you need care because you are ill?� www.utrechtsummerschool.nl

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/ INTERNATIONALIZATION

INTERNATIONAL WORKING VISITS VISIT TO PARTNER UNIVERSITY IN BALTIMORE From 18-25 March, Jacqueline Outermans and Michiel Punt, PhD students in the Lifestyle and Health research group, visited our research partner in Baltimore (USA), together with Professor Harriet Wittink and consortium partner Dr Ingrid van de Port. The University of Maryland, Geriatric Research Education and Clinical Centers (GRECC) is collaborating with the research group on the SUSTAIN project.

The GRECC is also conducting research into physical activity and physical fitness among people who have suffered a stroke. One of the researchers, Dr Kathleen Michael, gave a keynote speech on the theme of stroke and fatigue during the symposium about SUSTAIN in Utrecht.

During the visit to Baltimore, the Utrecht research fellows presented the results so far achieved in SUSTAIN and two sets of measurements were taken from nine American test subjects. In view of the fact that it is difficult to mobilize elderly people who have suffered a stroke to participate in research, it is important for research groups to join forces and achieve as large a sample as possible in order to gain optimum results from the research. Although it is still in its very early stages, it is clear that this alliance is proving so fruitful that it is certain to continue, possibly also encompassing new projects.

Within SUSTAIN, a technological tool has been developed to enable patients who have suffered a stroke to measure how much exercise they have done.

The device also feeds this information back to the physiotherapist responsible for treatment. Once it is validated, colleagues in Baltimore will use the system in their tests on these patients.

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2 “WITHIN SUSTAIN, A TECHNOLOGICAL TOOL HAS BEEN DEVELOPED TO ENABLE PATIENTS WHO HAVE SUFFERED A STROKE TO MEASURE HOW MUCH EXERCISE THEY HAVE DONE.” 47

/ INTERNATIONALIZATION

PHARMACEUTICAL BUSINESS ADMINISTRATION RESEARCH GROUP SHOWCASES ITS RESEARCH AT INTERNATIONAL CONGRESS

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Professor Ad van Dooren and research fellow Esther du Pon presented their research during the International Conference on Communication in Healthcare (ICCH). The congress was held in Montreal, Canada from 29 September until 2 October.

Elderly patients more outspoken during GP consultations Esther du Pon: “We now expect today’s patients to act as if they are outspoken healthcare consumers. However, research shows that in recent years patients have been asking fewer questions during consultations with their GPs. When the issue of medication is raised, subjects such as appropriate medication and patient compliance are rarely addressed.” Elderly patients (65+) in particular run the risk of not having been fully informed when they leave the consultation room because they are less assertive than younger patients. This means that healthcare needs to be tailored to the elderly patient to encourage him or her to be more active during the consultation. In order to achieve this, the research group is developing an application that provides support to elderly patients with Type II Diabetes to actively to pose questions during the consultation. If this is successful, the research group will investigate whether it can be adapted for use by pharmacies.”

How satisfied are pharmacy assistants with medication information?

The information leaflets that accompany medications can often be too complicated for patients. For this reason, many patients put their questions to the pharmacy assistants. Ad van Dooren investigated what was confusing about the information leaflets for pharmacy assistants and patients. Patients’ questions are usually about side-effects, using the medicine during pregnancy and use by children. Pharmacy assistants appear to receive more questions about medicines when patients are given a different medicine with the same active ingredient or if a drug product runs a nationwide campaign. Not all of the necessary information is included on the information leaflet. Pharmacy assistants often wonder what they should do if the patient has difficulty swallowing tablets.

For example, are they permitted to crush the tablet into a powder? This is often not on the information leaflet. Ad van Dooren: “it makes sense to investigate what patients’ expectations are and how satisfied they are with the answers they receive from pharmacy staff.”

At the congress, hundreds of communication professionals came together from healthcare companies and institutions in North America and Europe.

This interdisciplinary event raised a wide range of issues in the healthcare field including reading difficulties, behavioural change, social media, communicating risk, ethical questions and patient participation.

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/ INTERNATIONALIZATION

VISIT TO FLORIDA STATE UNIVERSITY Researchers in the Demand-driven Care research group went to Tallahassee in March with two lecturers from the Nursing programme to determine the framework for two courses: a course to encourage healthcare professionals to apply screen-to-screen care and a course for patients.

The researchers from HU and Florida State University had been working together for two years on the PETZ (Predictors for the use of e-Health by older adults and care professionals) research project. They investigated what is needed in order to encourage professionals and elderly patients to start using screen-to-screen care. PhD student Thijs van Houwelingen: “For nurses, it is important to know what the advantages of screen-to-screen care are for the patient. Patients also need to have confidence that e-health is easy to use. We therefore incorporated a practical part to enable them to practice with screen-to-screen care”. Anne Moerman, lecturer in Nursing and expert in developing course material: “My involvement in the PETZ project opened my eyes to new developments in the field and how they can be used in professional education.”

“MY INVOLVEMENT IN THE PETZ PROJECT OPENED MY EYES TO NEW DEVELOPMENTS IN THE FIELD AND HOW THEY CAN BE USED IN PROFESSIONAL EDUCATION.”

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“STUDENTS OF MEDIA TECHNOLOGY, NURSING, PHYSIOTHERAPY AND FACILITY MANAGEMENT WORKED TOGETHER IN MULTIDISCIPLINARY GROUPS TO INVESTIGATE HOW BEST TO ENCOURAGE PERSONAL WELL-BEING.” 52

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/ MEANDER MEDICAL CENTRE OPENS

On 23 December, the new Meander Medical Centre opened its doors.

The hospital has been built and fitted out according to the principles of the Healing Environment, one of the Research Centre’s specializations.

In recent years, the Research Centre has conducted research on and advised the hospital on how to apply the Healing Environment concept.

People recover more quickly if you design the environment in order to enable them to be active and independent and if you make appropriate use of natural and artificial light, natural colours, plants and art. That is the idea behind Healing Environments.

New Meander Medical Centre building Albert Trip, project director for the new Meander Medical Centre building, is enthusiastic about the idea and has applied it across the board: “We have built a kind of village, because the hospital, covering 10,000 m2, has an atmosphere that does not feel like a hospital. Patients and visitors can easily find their way around and logistics are well organized.” The hospital can be restocked and supplied 24 hours per day without patients or visitors even noticing it: goods never have to be moved through the department. The transport of patients to the operating department has also been carefully considered. The route to use for this purpose is separate from that used by visitors.

The research Students from all HU faculties worked on the research, including students of Media Technology, Nursing, Physiotherapy and Facility Management.

The students worked in multidisciplinary groups to investigate how best to encourage personal well-being in patients. They investigated what effect it has if patients have their own personal room. Single rooms have a positive impact: patients have the rest they need in order to recover. But it also emerged that attention is needed to ensure that the patient does not feel lonely. It is important to meet other people. For this reason, the Meander Medical Centre has special beds that enable family members to stay overnight in the patient’s room.

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Because the patient’s room has such an impact on patient welfare, the room design was replicated in full-size cardboard in order to enable students and researchers to test it. They were able to see things from the perspective of patients and nursing staff, examine their movements, angles of rotation and whether the surface area of the room was actually sufficient.

Students also designed a type of iPad that patients can use to engage in social contact on the internet and to control the climate within their own environment.

For example, they can use it to adjust the temperature and open and close a window. It also enables patients to call the nurse, order meals, view a film and read books. It was designed by the students in 2006 before the first iPad ever even appeared. Professor Helianthe Kort: “Did Steve Jobs know about this?

No,” she laughs, “We obviously missed a trick there!”

Knowledge brought back to the classroom The results of the research, and specifically its theoretical framework, has been brought back to the classroom. A summer course has been launched entitled: ‘Health & Engineering’ along with a minor in Public Health Engineering. In these, students learn the influence of the environment on people’s health and what can be done to promote health within this environment.

In the study entitled BEZO (Bezielende Zorgomgeving or Inspiring Care Environment), the Research Centre is examining how the results from this research can be applied in the construction and outfitting of hospitals. www.researchinhealingenvironments.eu

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“THE RESEARCH CENTRE CONDUCTS RESEARCH FOR AND IN COLLABORATION WITH THE WORLD OF PRACTICE” Photography: Harold van de Kamp Dirk Verwoerd / Atelier PRO HU Image Database, Jurjen Drenth By: Stijntje Vogelaar Design: RAAK Grafisch Ontwerp

HU University of Applied Sciences Utrecht Bolognalaan 101 3584 CJ Utrecht, the Netherlands www.ivz.onderzoek.hu.nl secretariaatlectoraat.fg@hu.nl