Purpose. We aimed to evaluate the potential for implementing exercise interventions for patients with breast cancer in the Netherlands, based on findings of the Dutch randomized controlled trials in this population. Methods. We evaluated the implementation of four Dutch exercise trials retrospectively, using the five dimensions of the RE-AIM framework: Reach (exercise participation rate), Effectiveness for physical fitness, fatigue, quality of life, and physical function, Adoption (e.g., satisfaction of physical therapists guiding the exercise intervention), Implementation (cost-effectiveness and exercise adherence correlates thereof), and Maintenance (maintenance of exercise levels by individual patients and sustainability of exercise delivery at organization level). Thereby, we reflect on these results using (international) literature to gain better insight in overall barriers, facilitators, and opportunities for further implementation of exercise interventions. Results. Participation rates of 44-52% not only indicated acceptable Reach in the context of a trial but also indicated room for improvement. Effectiveness of exercise during and after treatment was demonstrated in most trials showing benefits for aerobic fitness, physical fatigue, quality of life and physical function, and high patient satisfaction. Adoption of the exercise interventions by physical therapists was adequate (satisfaction score: 7.5 out of 10). Evaluation of Implementation indicated adequate adherence to supervised exercise, inconsistent findings on potential correlates of adherence, and promising results on cost-effectiveness. Currently, reimbursement for exercise programs is lacking. Maintenance of intervention effects at the patient level was limited and inconsistent. Maintenance of intervention availability at the organizational level was facilitated by an extensive network of specially trained physical therapists, but better communication and collaboration between different healthcare professionals are desired. Conclusions. Improved implementation could particularly be achieved by increasing reach and improved focus on exercise maintenance on both the patient and organizational level.
Conflict lies at the core of urban sustainability transitions and the indispensable structural changes that accompany them. In this chapter we examine the RESILIO project, a multi-actor collaboration in Amsterdam aiming to transition towards a 'climate proof' city through smart water retention systems on urban roofs. The focus is on the conflict that emerged during discussions about controlling the smart valves on the rooftops which are designed to prevent urban flooding. Using a discourse analytical framework, the study analyses participant interactions, conflicting positions, and discursive strategies employed by the partners involved in the initiative. Participants utilised several discursive strategies, including identity, stake, and accountability management, to manage their positions in the conflict and influence the discourse. The study highlights the challenges of addressing conflict that involves redefining accountability and responsibility between public and private actors in the collaborative setting of transition initiatives. By doing so the findings contribute to a deeper understanding of how conflict can shape learning processes and foster sustainable urban transitions.
Grote maatschappelijke opgaven vragen om strategische samenwerking tussen organisaties (overheid, bedrijven, non-profit organisaties), die elk een eigen belang of verantwoordelijkheid hebben in het realiseren van oplossingsrichtingen. In strategische samenwerkingen zit veel strijd, maar het is lastig die strijd productief te laten zijn. Als partijen te snel tot compromissen komen, of conflicten in het midden laten, leidt dit uiteindelijk niet tot duurzame oplossingen. Als conflicten wél op tafel komen, wordt meestal geprobeerd deze snel op te lossen, compromissen te sluiten, omdat wordt aangenomen dat onenigheid een succesvolle samenwerking in de weg staat. Er is daardoor relatief weinig aandacht voor het feit dat strijd ook productief – en dus positief – kan zijn, en innovatie en gezamenlijk leren juist kan bevorderen. Wij baseren ons pleidooi voor een ketenaanpak als een manier om productieve strijd te faciliteren op bevindingen uit een project in de internationale thee handelsketen en ervaringen met de ketenaanpak in een samenwerkingsverband op de arbeidsmarkt, House of Skills.
LINK
