Educational programs teaching entrepreneurial behaviour and knowledge are crucial to a vital and healthy economy. The concept of building a Communities of Practice (CoP) could be very promising. CoP’s are formed by people who engage in a process of collective learning in a shared domain of human endeavour (Wenger, McDermott and Snyder, 2002). They consist of a group of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly. Normally CoP’s are rather homogeneous. Saxion institute Small Business & Retail Management (SB&RM) started a CoP with entrepreneurs September 2007. Typical in the this community, are the differences between the partners. The Community consists of students, entrepreneurs and members of an institution for higher education. They have different characteristics and they don’t share the same knowledge. Thus, building long-lasting relations can be complicated. Solid relations for longer periods are nevertheless inevitable in using CoP as a mean in an educational concept that takes approximately 4 years. After one year an evaluation took place on the main aspects of a lasting partnership. The central problem SB&RM in Deventer faces is to design the CoP in a way possible members will join and stay for a longer period and in a way it ensures entrepreneurial learning. This means important design characteristics have to be identified, and the CoP in Deventer has to be evaluated to assess whether it meets those design characteristics in an effective and efficient way. The main target of the evaluation is to determine which key factors are important to make sure continuity in partnership is assured and entrepreneurial learning is best supported. To solve the problem, an investigation on how a CoP works, what group dynamics take place, and how this can be measured has to be conducted. Furthermoreusing the CoP as a tool for entrepreneurship means key aspects of entrepreneurial learning have to be identified. After that the CoP in Deventer has to be examined on both aspects. According to literature CoP’s define themselves along three dimensions: domain (indicating what is it about), community (defining how it functions), and practice (indicating what capabilities it has produced) (Wenger, 1998). This leads to meaningful, shared and coordinated activities (Akkerman et al, 2007): Key aspects of a successful CoP lie in both hard and soft sides of creating a partnership. It means on one hand a CoP has to deal with defining their own overall vision, formulating long term goals and targets on the short term. They have to formulate how to achieve those targets and create meaningful activities (reification). On the other hand a CoP has to deal with relations, trust, norms and values (participation). Reification and participation as design characteristic can provide indicators on which the CoP in Deventer can be evaluated. A lasting partnership means joining the CoP and staying. Weick provides us with a suitable model that enables us to do research and evaluate whether the CoP in Deventer is successful or not, Weick’s model of means convergence. To effectively ensure entrepreneurial learning the process in the CoP has to provide or enable actionoriented forms through Project-based activity, accompanied by reflection, with high emotional exposure (or cognitive affection) preferably caused by discontinuities to be suitable as a tool in entrepreneurial learning. Furthermore it should be accompanied by the right preconditions to work effectively and efficiently. The evaluation of the present CoP in Deventer is done by interviewing all participants at the end of the first year of the partnership. In a structured interview, based on literature studies, all participants were separately questioned
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BACKGROUND: Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increase.OBJECTIVE: To assess the effects of OGR on the primary outcome functional performance (FP) and secondary outcomes: length of in-patient stay, re-admission rate, patients' and caregivers' quality of life, mortality and cost-effectiveness. We also aim to describe the organisation and content of OGR.METHODS: Systematic review and meta-analysis. Five databases were queried from inception to July 2022. We selected randomised controlled trials written in English, focusing on multidisciplinary interventions related to OGR, included participants aged ≥65 and reported one of the main outcomes. A meta-analysis was performed on FP, patients' quality of life, length of stay and re-admissions. The structural, procedural and environmental aspects of OGR were systematically mapped.RESULTS: We selected 24 studies involving 3,405 participants. The meta-analysis showed no significant effect on the primary outcome FP (activity). It demonstrated a significant effect of OGR on shortening length of in-patient stay (P = 0.03, MD = -2.41 days, 95%CI: [-4.61-0.22]). Frequently used elements of OGR are: inpatient start of OGR with an interdisciplinary rehabilitation team, close cooperation with primary care, an OGR coordinator, individual goal setting and education for both patient and caregiver.CONCLUSION: This review showed that OGR is as effective as usual care on FP activity. It shows low certainty of evidence for OGR being effective in reducing the length of inpatient stay. Further research is needed on the various frequently used elements of OGR.
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Background: Multimodal prehabilitation programs are effective at reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital.Methods: In this observational cohort study with multiple case analyses, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting the criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise modalities and three nutrition modalities. Implementation fidelity was investigated by evaluating: (1) coverage (participation rate), (2) duration (number of days between the start of prehabilitation and surgery), (3) content (delivery of prescribed intervention modalities), and (4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence.Results: Fifty-eight patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33-84 days). Adherence was high (84-100%) in five and moderate (72-73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled to execute the prehabilitation program due to multiple physical and cognitive impairments.Conclusion: Implementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness.
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