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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In this paper we explore the extent to which privacy enhancing technologies (PETs) could be effective in providing privacy to citizens. Rapid development of ubiquitous computing and ‘the internet of things’ are leading to Big Data and the application of Predictive Analytics, effectively merging the real world with cyberspace. The power of information technology is increasingly used to provide personalised services to citizens, leading to the availability of huge amounts of sensitive data about individuals, with potential and actual privacy-eroding effects. To protect the private sphere, deemed essential in a state of law, information and communication systems (ICTs) should meet the requirements laid down in numerous privacy regulations. Sensitive personal information may be captured by organizations, provided that the person providing the information consents to the information being gathered, and may only be used for the express purpose the information was gathered for. Any other use of information about persons without their consent is prohibited by law; notwithstanding legal exceptions. If regulations are properly translated into written code, they will be part of the outcomes of an ICT, and that ICT will therefore be privacy compliant. We conclude that privacy compliance in the ‘technological’ sense cannot meet citizens’ concerns completely, and should therefore be augmented by a conceptual model to make privacy impact assessments at the level of citizens’ lives possible.
One of the core elements of the Programme for the International Assessment of Adult Competencies (PIAAC) is a survey of adult skills. The survey measures adults’ proficiency in literacy, numeracy, and problem solving in technology-rich environments. Furthermore, the survey gathers data on how adults use their skills at home, at work and in the wider community. The second cycle of PIAAC will take place in 2021 and 2022. Preparations have started by the Numeracy Expert Group in reviewing the numeracy framework used in the first cycle and designing items which will be used to measure the numerate capabilities and numerate behavior of adults.
