Background: A quality improvement collaborative is an intensive project involving a combination of implementation strategies applied in a limited “breakthrough” time window. After an implementation project, it is generally difficult to sustain its success. In the current study, sustainability was described as maintaining an implemented innovation and its benefits over a longer period of time after the implementation project has ended. The aim of the study was to explore potentially promising strategies for sustaining the Enhanced Recovery After Surgery (ERAS) programme in colonic surgery as perceived by professionals, three to six years after the hospital had successfully finished a quality improvement collaborative. Methods: A qualitative case study was performed to identify promising strategies to sustain key outcome variables related to the ERAS programme in terms of adherence, time needed for functional recovery and hospital length of stay (LOS), as achieved immediately after implementation. Ten hospitals were selected which had successfully implemented the ERAS programme in colonic surgery (2006–2009), with success defined as a median LOS of 6 days or less and protocol adherence rates above 70%. Fourteen semi-structured interviews were held with eighteen key participants of the care process three to six years after implementation, starting with the project leader in every hospital. The interviews started by confronting them with the level of sustained implementation results. A direct content analysis with an inductive coding approach was used to identify promising strategies. The mean duration of the interviews was 37 minutes (min 26 minutes – max 51 minutes). Results: The current study revealed strategies targeting professionals and the organisation. They comprised internal audit and feedback on outcomes, small-scale educational booster meetings, reminders, changing the physical structure of the organisation, changing the care process, making work agreements and delegating responsibility, and involving a coordinator. A multifaceted self-driven promising strategy was applied in most hospitals, and in most hospitals promising strategies were suggested to sustain the ERAS programme. Conclusions: Joining a quality improvement collaborative may not be enough to achieve long-term normalisation of transformed care, and additional investments may be needed. The findings suggest that certain post-implementation strategies are valuable in sustaining implementation successes achieved after joining a quality improvement collaborative.
Knowledge of the time of deposition is pivotal in forensic investigations. Recent studies show that changes in intrinsic fluorescence over time can be used to estimate the age of body fluids. These changes have been attributed to oxidative modifications caused by protein–lipid interactions. This pilot study aims to explore the impact of these modifications on body fluid fluorescence, enhancing the protein–lipid model system for age estimation. Lipid and protein oxidation markers, including protein carbonyls, dityrosine, advanced glycation end-products (AGEs), malondialdehyde (MDA), and 4-hydroxynonenal (HNE), were studied in aging semen, urine, and saliva over 21 days. Surface plasmon resonance imaging (SPRi), enzyme-linked immunosorbent assay (ELISA), and fluorescence spectroscopy were applied. Successful detection of AGE, dityrosine, MDA, and HNE occurred in semen and saliva via SPRi, while only dityrosine was detected in urine. Protein carbonyls were measured in all body fluids, but only in saliva was a significant increase observed over time. Additionally, protein fluorescence loss and fluorescent oxidation product formation were assessed, showing significant decreases in semen and saliva, but not in urine. Although optimization is needed for accurate quantification, this study reveals detectable markers for protein and lipid oxidation in aging body fluids, warranting further investigation.
MULTIFILE
This paper explores the intersection of Human-Comput- er Integration (HInt) and Critical Disability Studies (CDS) to explore how a posthumanistic epistemology in design can produce knowledge and know-how for the application do- mains of Health and Well-being. To use disability as a catalyst for innovation, a rethinking in the philosophy of sciences is necessary to establish knowledge production that emerges from new fluid politics that operate in ‘composition’ instead of ‘organization’. By placing an emphasis on nomadic practic- es that move beyond fixed borders, the encounters between Disability Studies or Human-Computer Integration can pro- duce situated, embodied and contingent design knowledge that study deviant and complex embodiment, and the kinds of alterations of human characteristics and abilities through technology. The first section of this paper explores the re- thinking in the philosophy of sciences. The second section ar- gues for a posthumanistic epistemology in design, which can be seen as the perfect way to produce situated, embodied and contingent design knowledge on the intersection of HInt and CDS. The final section of this paper highlights the poten- tial for the disciplines of Somatechnics and Soma Design to engage in each other’s body of knowledge to produce trans- formative knowledge through a shared focus on deviant em- bodiment and disability. The takeaway message of this paper is that the intersection of HInt and CDS potentially leads to new – otherwise overlooked - insights on the human-technol- ogy relationship, and therefore can take part in the historical strive for man-machine symbiosis. The posthumanist episte- mology allows for alternative ways of thinking that move be- yond the current Humanist perspective, and builds on a plu- ral, relational and expansive foundation for the development of design practices that catalyze innovation in the application domains of Health and Well-being.
