Publications by authors named "Paul Robben"

Hypothermia in combination with infection presents a complex challenge in clinical and battlefield medicine. Multifaceted physiological and immunological consequences of hypothermia drastically change the risk, progression, and treatment of a concomitant infection. Managing hypothermia and infection in extreme cold settings is particularly relevant in an era with increased risk of military operations in Polar climates.

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The global burden of malaria remains substantial. Circumsporozoite protein (CSP) has been demonstrated to be an effective target antigen, however, improvements that offer more efficacious and more durable protection are still needed. In support of research and development of next-generation malaria vaccines, Walter Reed Army Institute of Research (WRAIR) has developed a CSP-based antigen (FMP013) and a novel adjuvant ALFQ (Army Liposome Formulation containing QS-21).

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Lyme disease is a vector-borne infection that can affect multiple different organ systems. Lyme carditis represents one of these sequelae and is defined by acute onset of high-grade atrioventricular block in the presence of laboratory-confirmed infection. Current guidelines recommend patients with Lyme carditis be admitted for close cardiac monitoring and intravenous antibiotics therapy.

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We report a case of febrile Plasmodium falciparum malaria in a 36-year-old male patient occurring 14 years after immigration from and more than 12 months since a return visit to the endemic area. The critical need for awareness regarding late presentations of P. falciparum is discussed.

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Background: Multidrug-resistant infections complicating combat-related trauma necessitate the use of broad-spectrum antimicrobials. Recent literature posits an association between vancomycin (VANC) and piperacillin-tazobactam (VPT) combination therapy and acute kidney injury (AKI). We examined whether therapy with VPT was associated with an increased risk of AKI compared to VANC and other broad-spectrum β-lactam antibiotics (VBL) following combat-related injuries.

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Article Synopsis
  • Infection is a leading complication and cause of death in burn patients, who are at high risk for infections from multi-drug-resistant organisms (MDROs) due to prolonged hospital stays and repeated antibiotic use.
  • Effective management strategies in burn units include stringent infection prevention, antimicrobial stewardship, and embracing new therapeutic options to combat MDROs while reducing the reliance on antibiotics.
  • Continuous sensitivity testing is crucial for identifying MDROs and informing effective treatment plans for burn patients.
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Many working hours of healthcare professionals are spent on administrative tasks. Administrative burden is caused by political choices, legislation, the requirements of health insurers and supervisors. Coordination between the parties involved, is lacking.

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Background: Responsive regulation assumes that the parties being regulated are trustworthy and motivated by social responsibility. This assumes that regulation based upon trust will improve the regulated organization more effectively than other regulation models. The purpose of our qualitative study was to unravel the most important elements of trust in the inspectee which can support the inspector's work and to develop a model and a framework of trust that can be used by the inspectors to legitimize their trust in the inspectee.

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Coloring concentrates of carotenoid-rich plant materials are currently used in the food industry to meet the consumer's demand for natural substitutes for food colorants. The production of shelf-stable powders of such concentrates comes with particular challenges linked to the sensitivity of the active component towards oxidation and the complexity of the composition and microstructure of such concentrates. In this study, different strategies for the stabilization of crystalline carotenoids as part of a natural carrot concentrate matrix during drying and storage were investigated.

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Review the application of telemedicine support for managing a patient with possible sepsis, suspected malaria, and unusual musculoskeletal symptoms. Clinical Context: Regionally Aligned Forces (RAF) supporting US Army Africa/Southern European Task Force (USARAF/ SETAF) in the Africa Command area of responsibility. Care provided by a small Role I facility on the compound.

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The exercise of leadership demands leaders draw upon multiple capabilities in order to simultaneously enforce standards and achieve mission success while successfully nurturing candor and engagement within the organization. The following case highlights one officer's challenge related to balancing mission requirements with the aspirations of personnel.

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Background: Although healthcare regulation is commonplace, there is limited evidence of its impact. Making sure that healthcare professionals comply with the regulatory requirements is a prerequisite to achieving effective regulation. Therefore, investigating factors that influence compliance may provide better insights into how regulators can be more effective.

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Article Synopsis
  • Changes in Dutch long-term care policy have led to a regulatory framework focusing on care networks for independent elderly individuals, involving both care providers and the older adults themselves.
  • Semi-structured interviews and focus groups revealed the value of involving older adults and fostering open discussions, but highlighted significant time investments and concerns about providers' roles in care networks.
  • While the framework aims to enhance cooperation among care providers, challenges such as financial and privacy issues suggest that careful planning is needed for effective regulation of care networks.
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  • The study explores the factors that affect effective auditing for patient safety governance in hospitals.
  • A questionnaire was sent to various hospital executives and staff in the Netherlands, identifying 30 key factors that influence audit effectiveness.
  • The findings culminated in eight recommendations to enhance auditing processes, helping hospital boards better manage patient safety.
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  • Altruistic behavior among strangers remains an evolutionary mystery, with one theory suggesting that our evolved psychology promotes kindness even in situations where reciprocity isn't possible.
  • Laboratory studies show that cues like images of watching eyes can enhance altruistic actions, but this may be due to participants wanting to appear good rather than true altruism.
  • A field experiment demonstrated that when participants were unaware of being observed, surveillance cues did not influence their hand hygiene, indicating that such cues only matter when people believe they are being monitored.
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Article Synopsis
  • The study explores how internal audit results from hospitals can be shared with external supervisors, emphasizing the necessary conditions for such sharing.
  • The qualitative research involved interviews with 36 individuals from various hospital roles and identified a lack of coordination between internal and external supervision.
  • Participants supported sharing internal audit results to ease supervisory pressures, highlighting that these audits reveal valuable insights into hospital quality improvement and governance.
  • Preconditions for sharing include ensuring that the information collected is reliable and risk-based, and that the Inspectorate uses this information carefully to foster transparency with healthcare providers.
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Background: Users of care services are increasingly participating in inspections of the quality of care. In practice, incorporating service users' views is difficult, as users may have other views on good care than inspectors and thus give information that does not fit the inspectors' assessment criteria. This study compared the views on good care of young care users (adolescents) and inspectors, seeking to understand what the differences and similarities mean to incorporating the users' views in inspections.

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The growth in the numbers of older adults needing long-term care has resulted in rising costs which have forced the Dutch government to change its long-term care system. Now, the local authorities have greater responsibility for supporting older adults and in prolonging independent living with increased support provided by the social network. However, it is unclear whether these older adults have such a network to rely upon.

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Background: The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent and success of these reforms has not recently been comprehensively reviewed.

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Objectives: Internationally, healthcare quality regulators are criticized for failing to respond to patients' complaints. Patient involvement is, therefore, an important item on the policy agenda. However, it can be argued that there is a discrepancy between the patients' perspective and current regulatory approaches.

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Objectives: Hospital boards are legally responsible for safe healthcare. They need tools to assist them in their task of governing patient safety. Almost every Dutch hospital performs internal audits, but the effectiveness of these audits for hospital governance has never been evaluated.

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Article Synopsis
  • Understanding the risks faced by older adults living independently is crucial for improving their quality of life, as seen from both their own viewpoint and that of their caregivers.
  • Common concerns in the Netherlands include loneliness, the risk of falls, budget cuts in long-term care, and difficulty in calling for help.
  • The study highlights the need for preventive measures that address not only medical issues but also the broader social and emotional challenges that older adults prioritize to maintain their independence.
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Background: The Dutch Healthcare Inspectorate supervises care providers in order to improve quality of care. Recently the inspectorate assessed and promoted the use of a guideline on smoking-cessation counselling in midwifery practices. The supervision programme consisted of an announcement of the enforcement deadline for the guideline and site visits.

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Objectives: It is assumed that classifying and aggregated reporting of patients' complaints by regulators helps to identify problem areas, to respond better to patients and increase public accountability. This pilot study addresses what a classification of complaints in a regulatory setting contributes to the various goals.

Methods: A taxonomy with a clinical, management, and relationship domain was used to systematically analyze 364 patients' complaints received by the Dutch regulator.

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Background: Moral case deliberation (MCD) as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of regulatory bodies are regularly confronted with moral challenges. This pilot study describes and evaluates the use of MCD at the Dutch Health Care Inspectorate (IGZ).

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