Rationale, design and methodology of APPROACH-IS II : International study of patient-reported outcomes and frailty phenotyping in adults with congenital heart disease

Background: In recent years, patient-reported outcomes (PROs) have received increasing prominence in cardiovascular research and clinical care. An understanding of the variability and global experience of PROs in adults with congenital heart disease (CHD), however, is still lacking. Moreover, information on epidemiological characteristics and the frailty phenotype of older adults with CHD is minimal. The APPROACH-IS II study was established to address these knowledge gaps. This paper presents the design and methodology of APPROACH-IS II. Methods/design: APPROACH-IS II is a cross-sectional global multicentric study that includes Part 1 (assessing PROs) and Part 2 (investigating the frailty phenotype of older adults). With 53 participating centers, located in 32 countries across six continents, the aim is to enroll 8000 patients with CHD. In Part 1, self-report surveys are used to collect data on PROs (e.g., quality of life, perceived health, depressive symptoms, autonomy support), and explanatory variables (e.g., social support, stigma, illness identity, empowerment). In Part 2, the cognitive functioning and frailty phenotype of older adults are measured using validated assessments. Discussion: APPROACH-IS II will generate a rich dataset representing the international experience of individuals in adult CHD care. The results of this project will provide a global view of PROs and the frailty phenotype of adults with CHD and will thereby address important knowledge gaps. Undoubtedly, the project will contribute to the overarching aim of improving optimal living and care provision for adults with CHD

The risks of nation branding as crisis response:A case study of how the Danish government turned the Cartoon Crisis into a struggle with Globalization

In this article, we investigate the limitations of organization-centric models for crisis communication in handling place crises. Two distinct types of place crisis are identified as what we respectively term the ‘sudden’ and the ‘ongoing’ type. We point out that place branding traditionally has been used to handle the latter type. We then demonstrate how the inspiration from corporate communication in place branding has led to a fixation on reputation, which becomes salient when place branding is used as crisis communication in sudden crisis. Here the corporate inspiration tends to rule out alternative strategies for handling crises based on ‘societal models’. Through a case study of Denmark’s so-called Cartoon Crisis we demonstrate how crisis communication falls short of coping aptly with the complexity of the crisis due to the branding-inspired translation from ‘sudden’ to ‘ongoing’ crisis. We thus argue that the Danish government’s solution in nation branding aimed at the reputational implications failed to address the immediate consequences of the crisis vis-à-vis national security and exports. And that this solution in turn created the reputation as additional risk. We conclude that a broader societal perspective on crises therefore is needed in the emerging academic literature on place crisis communication