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Ready for goal setting?

Background: Patient participation and goal setting appear to be difficult in daily physiotherapy practice, and practical methods are lacking. An existing patient-specific instrument, Patient-Specific Complaints (PSC), was therefore optimized into a new Patient Specific Goal-setting method (PSG). The aims of this study were to examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method. Methods: We conducted a process evaluation within a non-controlled intervention study. Community-based physiotherapists were instructed on how to work with the PSG in three group training sessions. The PSG is a six-step method embedded across the physiotherapy process, in which patients are stimulated to participate in the goal-setting process by: identifying problematic activities, prioritizing them, scoring their abilities, setting goals, planning and evaluating. Quantitative and qualitative data were collected among patients and physiotherapists by recording consultations and assessing patient files, questionnaires and written reflection reports. Results: Data were collected from 51 physiotherapists and 218 patients, and 38 recordings and 219 patient files were analysed. The PSG steps were performed as intended, but the ‘setting goals’ and ‘planning treatment’ steps were not performed in detail. The patients and physiotherapists were positive about the method, and the physiotherapists perceived increased patient participation. They became aware of the importance of engaging patients in a dialogue, instead of focusing on gathering information. The lack of integration in the electronic patient system was a major barrier for optimal use in practice. Although the self-reported actual use of the PSG, i.e. informing and involving patients, and client-centred competences had improved, this was not completely confirmed by the objectively observed behaviour. Conclusion: The PSG is a feasible method and tends to have impact on increasing patient participation in the goal-setting process. However, its full potential for shared goal setting has not been utilized yet. More implementation effort is needed to achieve the required behaviour change and a truly client-centred attitude, to make physiotherapists totally ready for shared goal setting.

The Cardiac Care Bridge randomized trial in high-risk older cardiac patients

Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.

Process Mining (As Part of e-book Transforming Logistics with Analytics)

Process Mining can roughly be defined as a data-driven approach to process management. The basic idea of process mining is to automatically distill and to visualize business processes using event logs from company IT-systems (e.g. ERP, WMS, CRM etc.) to identify specific areas for improvement at an operational level. An event log can be described as a database entry that signifies a specific action in a software application at a specific time. Simple examples of these actions are customer order entries, scanning an item in a warehouse, and registration of a patient for a hospital check-up.Process mining has gained popularity in the logistics domain in recent years because of three main reasons. Firstly, the logistics IT-systems' large and exponentially growing amounts of event data are being stored and provide detailed information on the history of logistics processes. Secondly, to outperform competitors, most organizations are searching for (new) ways to improve their logistics processes such as reducing costs and lead time. Thirdly, since the 1970s, the power of computers has grown at an astonishing rate. As such, the use of advance algorithms for business purposes, which requires a certain amount of computational power, have become more accessible.Before diving into Process Mining, this course will first discuss some basic concepts, theories, and methods regarding the visualization and improvement of business processes.

Imagining energy potential

Significant factors in the success or failure of energy transition arise from the spatial potential of places and their communities. Scenario planning appears to be an appropriate design instrument to enable architects to unveil, conceptualise, imagine, test and communicate this potential to stakeholders. This paper critically refelcts on the scenario as an architectural design instrument. Inscribed with political intentions, scenario planning may be a far from neutral design instrument. Instead of triggering communities to explore local energy potential, a scenario may have a normative effect on a community's imagination. The paper aims to define guidelines for the deployment of scenarios in an open, participatory planning process. To mediate in a local participatory planning process, we argue, scenarios should be situational, dynamic and open-ended, allowing or even triggering communities to (re)define the issues relevant to a place during the ongoing process of energy-transition. How, when and where should scenarios be deployed in order to enable communities to understand and develop their local energy potential?

Playful Identity in game design and open ended play

Gamers are, like Yamauchi, described as nonconformist, creative, and self-confident persons, who seem unafraid to make mistakes (Beck and Wade 2004). Is it true that games present us with an opportunity to develop a particular identity, or are specific people attracted to games that create these opportunities? In the last decade, research has been conducted into the (playful) organizational style of gamers, and into the leadership qualities that may be developed in a game (DeMarco, Lesser, and O’Driscoll 2007; Reeves and Malone 2007). The search for an answer to the above question is the aim of this chapter. To be more specific, we would like to better understand identity construction and representation. For this reason we would like to further elaborate on the notion of playful identity as discussed in the introductory chapter of this volume. In contrast to other identity constructs, a playful identity characterizes someone’s ludic activities without immediately discussing the valuing and moralizing practices arising from these activities

Playful identity in game design and open-ended play