Objective To identify implementation determinants of blended periconception lifestyle care, and to evaluate patient satisfaction. Design Cross-sectional study. Setting The outpatient clinic of the... Show moreObjective To identify implementation determinants of blended periconception lifestyle care, and to evaluate patient satisfaction. Design Cross-sectional study. Setting The outpatient clinic of the department of Obstetrics and Gynaecology of the Erasmus MC. Participants Implementation part: counsellors providing blended periconception lifestyle care. Patient satisfaction part: women who received blended periconception lifestyle care. Methods Blended periconception lifestyle care, including face-to-face counselling and 26 weeks of lifestyle coaching via the online platform ‘Smarter Pregnancy’, was implemented between June–December 2018. The Measurement Instrument for Determinants of Innovations questionnaire was used as input for the consolidated framework for implementation research to assess determinants of implementation. To evaluate patient satisfaction, patients receiving lifestyle care filled out an evaluation questionnaire, including questions on the needs for lifestyle counselling, information provision during counselling, and motivation and lifestyle change after counselling. Primary and secondary outcome measures Identification of implementation determinants and the level of patient satisfaction. Results Facilitators were reported in the implementation domains ‘characteristics of the intervention’ and ‘characteristics of the individuals’. Barriers were in the implementation domains ‘inner setting’ and ‘implementation process’. Regarding patient satisfaction on nutrition counselling, 31% of the respondents wanted information prior to the counselling session, 22% received new information after consultation, 51% got motivated to change and 40% changed their nutritional behaviour. Conclusions A considerable number of patients improved lifestyle after counselling, although, a relatively small number wanted lifestyle counselling prior to consultation. This study underlines the importance of implementation science and the information it provides for improving the implementation process. Show less
Have, P. ten; Hal, P. van; Wichers, I.; Kooistra, J.; Hagedoorn, P.; Brakema, E.A.; ... ; Ossebaard, H.C. 2022
Objectives Dry powder inhalers (DPIs) and soft mist inhalers have a substantially lower global warming potential than pressurised metered-dose inhalers (pMDIs). To help mitigate climate change, we... Show moreObjectives Dry powder inhalers (DPIs) and soft mist inhalers have a substantially lower global warming potential than pressurised metered-dose inhalers (pMDIs). To help mitigate climate change, we assessed the potential emission reduction in CO2 equivalents when replacing pMDIs by non-propellant inhalers (NPIs) in Dutch respiratory healthcare and estimated the associated cost. Design We performed a descriptive analysis of prescription data from two national databases of two independent governmental bodies. First, we calculated the number of patients with chronic obstructive pulmonary disease (COPD) and asthma that were using inhalation medication (2020). Second, we calculated the number and total of daily defined doses of pMDIs and NPIs including DPIs and soft mist inhalers, as well as the number of dispensed spacers per patient (2020). Third, we estimated the potential emission reduction in CO2 equivalents if 70% of patients would switch from using pMDIs to using NPIs. Fourth, we performed a budget impact analysis. Setting Dutch respiratory healthcare. Primary and secondary outcome measures The carbon footprint of current inhalation medication and the environmental and financial impact of replacing pMDIs with NPIs. Results In 2020, 1.4 million patients used inhalers for COPD or asthma treatment. A total of 364 million defined daily doses from inhalers were dispensed of which 49.6% were dispensed through pMDIs. We estimated that this could be reduced by 70% which would lead to an annual reduction in greenhouse gas emission of 63 million kg.CO2 equivalents saving at best EUR 49.1 million per year. Conclusions In the Netherlands, substitution of pMDIs to NPIs for eligible patients is theoretically safe and in accordance with medical guidelines, while reducing greenhouse gas emission by 63 million kg.CO2 equivalents on average and saving at best EUR 49.1 million per year. This study confirms the potential climate and economic benefit of delivering a more eco-friendly respiratory care. Show less
Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR)... Show moreAllergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional. Show less
After four decades of M&A experience most M&A still fail to deliver on their promise. The reasons often lie in the social, psychological and cultural challenges of the post merger process.... Show moreAfter four decades of M&A experience most M&A still fail to deliver on their promise. The reasons often lie in the social, psychological and cultural challenges of the post merger process. Why is it that corporations so often do not seem to get the grasp of this important and popular company strategy? And what is the part of the Chief Executive (CEO) in such projects? In a seven-year empirical research project in Germany and Switzerland on CEOs in international post-merger situations, this thesis uncovered some of the powerful learning inhibitors these executives face in their complex and challenging global integration endeavours. The author identifies three generic types of executive behavioural patterns – the Cartel, the Aesthetic and the Videogame Executive – and proposes a taxonomy of leadership behaviours that seem particularly propitious to post-merger performance. Seven impressionist tales of typical post-merger situations – a bank, an airline company, a car manufacturer, an IT company, an industrial conglomerate, a life sciences group and a large public event – are described and discussed in a first ethnographic research loop. In the second part of the study the actors themselves, 20 CEOs and top executives of global companies speak up and candidly share with the reader how they go about solving problems, how they struggle between art and science in their thought processes. Their rich insights are a valuable contribution to the academic and practical discussion of the Chief Executives' role in the management of international combinations. Show less
