The decentralization of social care in the Netherlands has had a major impact on the professionals working in this field. This dissertation examines this impact by specifically focusing on the... Show moreThe decentralization of social care in the Netherlands has had a major impact on the professionals working in this field. This dissertation examines this impact by specifically focusing on the cognitive uncertainty experiences of social care professionals. It shows that cognitive uncertainty is a multi-faceted concept that covers different domains of the work and can have multiple sources. Contrary to the frequently expressed view in the literature on bureaucracy, this dissertation shows that rules do not reduce cognitive uncertainty. Leadership of team leaders, in contrast, can reduce cognitive uncertainty experiences of professionals.Moreover, leadership plays a key role in managing cognitive uncertainty. When properly managed, cognitive uncertainty can prove highly valuable as it can spur innovation and thus contribute to achieving the goals set in the decentralization of social care in the Netherlands. Show less
WHO ARE WE? OR A PROFILE OF THE ARCHAEOLOGICAL PROFESSIONAL COMMUNITY IN BRAZIL: FIRST APPROACHESIn the last twenty years, archeological academic-scientific training has grown exponen-tially in... Show moreWHO ARE WE? OR A PROFILE OF THE ARCHAEOLOGICAL PROFESSIONAL COMMUNITY IN BRAZIL: FIRST APPROACHESIn the last twenty years, archeological academic-scientific training has grown exponen-tially in Brazil, culminating in the recognition of the profession in 2018. However, little is known about the demographic profiles of people working in the area, as well as of students in the process of training, in undergraduate and graduate levels. By updating some data from previous studies, in this manuscript we present the results of an initial survey on the professional profile in Brazilian archeology, which includes information on the trajectory of education, gender, nationality and re-search themes. This initiative allows us to outline the challenges of inclusion and representativeness in the exercise of the profession, whose reflections will assist us in the conceiving of practical measures for a change in this situation in the future. Show less
Background To meet the needs of high-vulnerable families with severe and enduring problems across several life domains, professionals must improve their ability to provide integrated care timely... Show moreBackground To meet the needs of high-vulnerable families with severe and enduring problems across several life domains, professionals must improve their ability to provide integrated care timely and adequately. The aim of this study was to identify facilitators and barriers professionals encounter when providing integrated care. Methods Experiences and perspectives of 24 professionals from integrated care teams in the Netherlands were gathered by conducting semi-structured interviews. A theory-driven framework method was applied to systematically code the transcripts both deductively and inductively. Results There was a consensus among professionals regarding facilitators and barriers influencing their daily practice, leading to an in depth, thematic report of what facilitates and hinders integrated care. Themes covering the facilitators and barriers were related to early identification and broad assessment, multidisciplinary expertise, continuous pathways, care provision, autonomy of professionals, and evaluation of care processes. Conclusions Professionals emphasized the need for flexible support across several life domains to meet the needs of high-vulnerable families. Also, there should be a balance between the use of guidelines and a professional's autonomy to tailor support to families' needs. Other recommendations include the need to improve professionals' ability in timely stepping up to more intensive care and scaling down to less restrictive support, and to further our insight in risk factors and needs of these families. Show less
In this thesis the feasibility of tailored follow-up for early-stage breast cancer patients is evaluated. In order to do so, we first determined the risk of locoregional recurrence (LRR) dependent... Show moreIn this thesis the feasibility of tailored follow-up for early-stage breast cancer patients is evaluated. In order to do so, we first determined the risk of locoregional recurrence (LRR) dependent on local treatment in a large cohort of low-risk breast cancer patients, treated with adequate modern systemic therapy. In the second part we evaluated both patients__ and professionals__ needs and preferences for breast cancer follow-up and we reviewed the literature on cost effectiveness of known follow-up schedules. Finally we prospectively examined whether the implementation of a tailored follow-up programme, based on a prognostic index for LRR, is feasible and acceptable to patients and professionals. The results show that in general, implementation of minimised tailored follow-up seems feasible, but professionals tend to more frequent follow-up. Patients accept less intensive follow-up schedules and follow-up by a nurse practitioner. Given the low risk of LRR, tailoring should not only be done based on this risk, but individually, based on the presence of treatment related side effects, either physical or psychosocial. If patients do not experience side effects, annual planned mammography and telephone contact coordinated by a single professional, preferably a specialised nurse, suffice in case of easily accessible information and on demand visits. Show less
Despite the promising findings related to the efficacy of primary health care-based physical activity interventions and recommendations for primary health care professionals to promote physical... Show moreDespite the promising findings related to the efficacy of primary health care-based physical activity interventions and recommendations for primary health care professionals to promote physical activity, the introduction of physical activity interventions in routine daily primary health care practice does not always happen as desired. Specifically, rates of physical activity promotion by primary health care professionals are far from optimal and physical activity interventions are not delivered as intended by the intervention developers. Knowledge of the factors that determine the success or failure of the introduction of innovations in health care is important for the development of strategies to improve the introduction process. As a first step towards the effective introduction of physical activity interventions in primary health care practice, the main aim of this thesis is to investigate what factors influence the introduction of physical activity interventions in primary health care. Show less
Hofstede, S.N.; Marang-van de Mheen, P.J.; Wentink, M.M.; Stiggelbout, A.M.; Vleggeert-Lankamp, C.L.A.; Vlieland, T.P.M.V.; ... ; DISC Study Grp 2013
