Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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High-tech horticulture production methods (such as vertical farming, hydroponics and other related technology possibilities), combined with evolving market side possibilities (consumer’s willingness to pay for variety, food safety and security), are opening new ways to create and deliver value. In this paper we present four emerging business models and attempt to understand the conditions under which each business model is able to create positive market value and sustained business advantage. The first of these four models is the case of a vertically integrated production to retail operation. The second model is the case of a production model with assured retail/distribution side commitment. The third model deals with a marketing/branding driven production model with differentiated market positioning. Finally, the forth is a production model with direct delivery to the end-consumer based upon the leveraging of wide spread digital technology in the consumer market. To demonstrate these four business models, we analyze practical case studies and analyze their market approach and impact. Using this analysis, we create a framework that enables entrepreneurs and businesses to adopt a business model that matches their capabilities with market opportunities.
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Abstract Business Process Management (BPM) is an important discipline for organizations to manage their business processes. Research shows that higher BPM-maturity leads to better process performance. However, contextual factors such as culture seem to influence this relationship. The purpose of this paper is to investigate the role of national culture on the relationship between BPM-maturity and process performance. A multiple linear regression analysis is performed based on data from six different countries within Europe. Although the results show a significant relationship between BPM-maturity and process performance, no significant moderation effect of national culture has been found. The cultural dimension long term orientation shows a weak negative correlation with both BPM-maturity and process performance. Through a post-hoc moderation analysis on each dimension of BPM-maturity, we further find that long term orientation negatively moderates the relationship between process improvement and process performance. Three other moderation effects are also discovered. The results of this study contribute to insights into the role of culture in the field of BPM.
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Longitudinal Business Process Management (BPM) studies are rare. BPM maturity and process performance can be used to quantify an organization's BPM evolution. This research aims to examine the growth of BPM maturity over time and its impact on process performance inside an organization in continuous transformation. Over a seven-year period, BPM maturity and process performance were measured annually at a Dutch university. During this time, the organization has undergone an organizational restructuring with a focus on process management and has temporarily switched completely to digital education propelled by the Covid-19 crisis. Based on a repeated cross-sectional study (N = 921), the results present key BPM maturity features that are critical during disruptive organizational transformations. Furthermore, we found that BPM maturity is positively related to process performance throughout organizational changes during the period of our research
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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.
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The research group Teaching, Learning & Technology investigates the didactic use of technology in learning processes. In doing so, it looks at themes such as flexibilisation, personalised learning, activating didactics and the effects of the use of technology in educational practice, particularly in higher vocational education. What had not been investigated so far was whether previously conducted research had a demonstrable impact on educational practice. This study is the first phase in providing insight into the impact of research carried out by the Teaching, Learning & Technology (TLT) research group of Inholland University of Applied Sciences. It looks at research carried out between 2010 and 2021. The objective is to describe how impact factors that can be influenced in previous research have been shaped. On the basis of this description, it may be possible to make recommendations to the research group with which the impact of the research it conducts in relation to these factors can be increased. The research question is: How do stakeholders describe the impact of research carried out by the research group Teaching, Learning & Technology in relation to the impact factors that can be influenced with regard to the research, the dissemination and the user value (experienced)? In order to answer this research question, we used a convergent mixed methods design, in which a new conceptual model served as the basis for the analysis of data from the field research. Three types of data were collected, namely a qualitative document analysis (N=31), a survey (N=6) and semi-structured interviews with survey participants (N=4). The study revealed that stakeholders mainly point to the researcher as the primary source of impact. Impact begins and ends with the researcher, especially in the extent to which he or she makes an effort to make the research relevant and in line with questions from the educational practice. We have listed a number of recommendations with regard to the way in which impact can be achieved in future research. These recommendations are mainly aimed at the way in which researchers of the research group can pay attention in a structured way to the design of the collaboration and to the concrete visualisation of expectations and intended impact at an early stage.
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This research aims to contribute to a better understanding of strategic collaborations between work-integration social enterprises (WISEs) and for-profit enterprises (FPEs) with the joint objective to improve labour market opportunities for vulnerable groups. We find that most collaborations strive towards integration or transformation in order to make more social impact.
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Background: Implementation of an eRehabilitation intervention named Fit After Stroke @Home (Fast@home) – including cognitive/physical exercise applications, activity-tracking, psycho-education – after stroke resulted in health-related improvements. This study investigated what worked and why in the implementation. Methods: Implementation activities (information provision, integration of Fast@home, instruction and motivation) were performed for 14 months and evaluated, using the Medical Research Council framework for process evaluations which consists of three evaluation domains (implementation, mechanisms of impact and contextual factors). Implementation activities were evaluated by field notes/surveys/user data, it’s mechanisms of impact by surveys and contextual factors by field notes/interviews among 11 professionals. Surveys were conducted among 51 professionals and 73 patients. User data (n=165 patients) were extracted from the eRehabilitation applications. Results: Implementation activities were executed as planned. Of the professionals trained to deliver the intervention (33 of 51), 25 (75.8%) delivered it. Of the 165 patients, 82 (49.7%) were registered for Fast@home, with 54 patient (65.8%) using it. Mechanisms of impact showed that professionals and patients were equally satisfied with implementation activities (median score 7.0 [IQR 6.0–7.75] versus 7.0 [6.0–7.5]), but patients were more satisfied with the intervention (8.0 [IQR 7.0–8.0] versus 5.5 [4.0–7.0]). Guidance by professionals was seen as most impactful for implementation by patients and support of clinical champions and time given for training by professionals. Professionals rated the integration of Fast@home as insufficient. Contextual factors (financial cutbacks and technical setbacks) hampered the implementation. Conclusion: Main improvements of the implementation of eRehabilitation are related to professionals’ perceptions of the intervention, integration of eRehabilitation and contextual factors.
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Active participation of stakeholders in health research practice is important to generate societal impact of outcomes, as innovations will more likely be implemented and disseminated in clinical practice. To foster a co-creative process, numerous frameworks and tools are available. As they originate from different professions, it is not evident that health researchers are aware of these tools, or able to select and use them in a meaningful way. This article describes the bottom-up development process of a compass and presents the final outcome. This Co-creation Impact Compass combines a well-known business model with tools from design thinking that promote active participation by all relevant stakeholders. It aims to support healthcare researchers to select helpful and valid co-creation tools for the right purpose and at the right moment. Using the Co-creation Impact Compass might increase the researchers’ understanding of the value of co-creation, and it provides help to engage stakeholders in all phases of a research project.
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The impact communities of practice (CoPs) make can be understood in several different ways, depending on which theoretical perspective is used. For example, CoPs have been studied from a learning-theory perspective, from organizational development theory, and from a small-group theory. To understand the effects of participating in a CoP on individuals, groups or the organization in which they function, we could use traditional learning theory, organizational learning theory, information-processing theory or small-group process theory, etc. Or we could look at the internal processes of CoPs; the output they generate, or employ a synthesized view. CoPs can also be seen as impacting different actors in the organization in which they operate; individuals, groups or the whole organization. This means, for example, that we could look at CoPs from an organizational learning perspective to see how CoPs impact strategy development or renewal. At the level of the group, we could look at how CoPs lead to increased group performance and how that in turn leads to a higher output of knowledge products. And as learning is one of the key processes in a CoP, an important aspect of we need to study is how the individual learns, as well as what the individual learns. The complexity of impact a CoP can have on the diverse actors requires a pluralistic and multiperspective approach. However, a review of the literature showed no comprehensive model that neither integrates these different levels of impact nor employs multiple theoretical perspectives. Furthermore, most models of measurement or assessment use traditional types of output measurement, such as ROI, or anecdotal evidence that the CoP has improved organizational capability. Much like any human resource development initiative – which is the perspective of CoPs we take in this paper – there has been no real attempt to develop measures for assessing impact. We try to fill this gap by presenting a comprehensive, multidisciplinary, conceptual model that approaches measuring certain aspects a CoP has on individuals, groups and organizations.
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