Summary Purpose The purpose of this study was to investigate the adoption and actual use of a digital dietary monitoring system (DDMS) and its impact on patient satisfaction with the provided hospital care, body weight changes and health-related quality of life (HRQoL) in patients with potentially curable esophageal cancer planned for surgery. The DDMS enables patients and dietitians to monitor patients' nutritional intake and body weight during the preoperative period. Methods In this prospective observational study, the first 47 included patients received usual nutritional care, and were followed from diagnosis until surgery. After implementation of the DDMS 37 patients were followed, again from diagnosis until surgery. Main outcomes were actual use of the DDMS, by means of adoption and usage measures, overall patient satisfaction (EORTC-INPATSAT32), weight change and HRQoL (EORTC QLQ-C30 and EORTC-OG25). Outcomes were assessed immediately after diagnosis, and 6 and 12 weeks later. Results The system had an adoption rate of 64% and a usage rate of 78%. No significant effects on patient satisfaction were found at 12 weeks after diagnosis between the intervention and the usual care group. The implementation of the DDMS also had no significant effect on body weight and HRQoL over time. Conclusions Patients with potentially curable esophageal cancer planned for surgery were able to use the DDMS. However, no significant effects on patient satisfaction, body weight changes and HRQoL were observed. Further research should focus on the specific needs of patients regarding information and support to preoperatively optimize nutritional intake and nutritional status.
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Tom van Weert argues that economic, societal and cultural developments in indus-trialized countries push for educational innovation. He sees Information and Communication Technology (ICT) as enabling factor of this innovation. His line of reasoning is the following. Knowledge intensive economies have a need for modern professionals with new qualifications. These professionals have to be able to produce concrete business results, but need also to contribute to essential business knowledge, needed to survive in a highly competitive and changing environment. Knowledge creation is becoming part of working and is therefore not anymore the exclusive right of research institutions. In this light, universities as breeding place of modern professionals, need to redefine their role in much more fundamental ways than simply continuing old practices by modern ICT means. A new educational paradigm is needed, integrating learning, working and knowledge creation. Situation based learning environments may be the materialization of this new paradigm.
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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