Product-service Systems as a Promising Approach to Sustainability: Exploring the Sustainable Aspects of a PSS in Brazil

AbstractProduct-Service Systems (PSS) represent a business proposition with potential to provide a wide range of economic, environmental, and social benefits, allowing achievingthe sustainability. However, PSS does not necessarily lead to sustainable solutions and this potential must be assessed in each case. In this sense, the aim of this paper is to investigate sustainable aspects of a ‘result oriented PSS’(a reverse osmosis water filter system) available in Brazil and compares it with the conventional product, the bottled water. Some aspects from the literature, mentioned as important in each sustainability dimension, were selected to analyze the PSS under study. A qualitative analysis was performed and demonstrates that in comparison with bottled water, the water filter PSS is competitive, satisfy customer needs, and has a relatively lower environmental impact. However, besides conceiving sustainable solutions, is necessary to identify which factors drive the implementation and diffusion of PSS. Some findings of this study suggest that the effects caused by unexpected consumer behavior and incorrect PSS application may compromise PSS sustainable performance during operational phase. An analysis of these effects during transition process is essential to successful sustainable strategies. The study aimed to contribute to the PSS empirical knowledge and to assist building a theoretical basis regarding PSS and sustainability

Measuring quality of care for colorectal cancer care : comprehensive feedback driving quality improvement

Data from clinical audits such as the Dutch Surgical Colorectal Audit, can be used for valid and meaningful feedback information, which may support improvement of quality of care. First, we showed that the continuous feedback cycle of clinical auditing has an autonomous, positive effect on the quality of surgical care. Second, we describe how data from clinical audits can be used to monitor and improve national practice and performance in colorectal cancer care, especially for high-risk patients. Third, we describe how clinical auditing can be used for the evaluation and monitoring of the implementation of new techniques, such as laparoscopic surgery, on a national level. We demonstrate that, although there is a large hospital variation in the use of laparoscopic surgery, this does not explain the variation in outcome. Last, we investigate how data can be used to evaluate quality of care and give transparency to all stakeholders. As the various aspects of quality of care can be strongly interrelated, quality of care may best be represented using composite-measures. These composite measures can be used by all stakeholders to evaluate quality of care as a whole. The methodologies described in this thesis may be used in many other clinical audits

Measuring quality of care for colorectal cancer care : comprehensive feedback driving quality improvement

Data from clinical audits such as the Dutch Surgical Colorectal Audit, can be used for valid and meaningful feedback information, which may support improvement of quality of care. First, we showed that the continuous feedback cycle of clinical auditing has an autonomous, positive effect on the quality of surgical care. Second, we describe how data from clinical audits can be used to monitor and improve national practice and performance in colorectal cancer care, especially for high-risk patients. Third, we describe how clinical auditing can be used for the evaluation and monitoring of the implementation of new techniques, such as laparoscopic surgery, on a national level. We demonstrate that, although there is a large hospital variation in the use of laparoscopic surgery, this does not explain the variation in outcome. Last, we investigate how data can be used to evaluate quality of care and give transparency to all stakeholders. As the various aspects of quality of care can be strongly interrelated, quality of care may best be represented using composite-measures. These composite measures can be used by all stakeholders to evaluate quality of care as a whole. The methodologies described in this thesis may be used in many other clinical audits.UBL - phd migration 201

Behandeling van bevriezingsletsels

• In Nederland zijn bevriezingsletsels in de gezonde populatie zeldzaam. Door een groeiend aantal winter- en buitensporters en reizigers naar hooggelegen gebieden, neemt het risico op bevriezingsletsel wel toe. • Bevriezing is een koudegeïnduceerd letsel veroorzaakt door 2 processen: bevriezing en microvasculaire occlusie. • Een goede eerste opvang, bestaande uit voorkoming van opnieuw bevriezen en van mechanisch letsel in combinatie met snel opwarmen en ibuprofen, is de belangrijkste factor die de uiteindelijke weefselschade kan beperken. • Als een patiënt zich presenteert binnen 24 uur nadat het bevroren lichaamsdeel is ontdooid en de ernst van het letsel van dien aard is dat ernstige morbiditeit verwacht kan worden, is behandeling met iloprost en eventueel recombinant weefselplasminogeenactivator geïndiceerd. • Als een patiënt zich later presenteert, is hyperbare-zuurstofbehandeling te overwegen; het bewijs hiervoor is echter beperkt

Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality

Surgical oncolog

Analysis of Variation Between Diagnosis at Admission vs Discharge and Clinical Outcomes Among Adults With Possible Bacteremia

Importance  Misdiagnosis of infection is among the most commonly made diagnostic errors and is associated with increased morbidity and mortality. Little is known about how often misdiagnosed site of infection occurs and its association with clinical outcomes.Objectives  To evaluate the discrepancy between admission and discharge site of infection diagnoses among patients with suspected bacteremia, to explore factors associated with discrepant diagnoses, and to evaluate the association with clinical outcomes.Design, Setting, and Participants  This cohort study used electronic records of 1477 adult patients who were admitted to the hospital for suspected bacteremia from April 1, 2019, to May 31, 2020, and who had blood cultures taken at the emergency department at Haga Teaching Hospital, The Hague, the Netherlands. Suspected infection sites were classified into 8 categories at admission and discharge. Misdiagnosed site was defined as a discrepancy between the suspected site of infection at admission and at discharge.Main Outcomes and Measures  Clinical outcomes were 30-day mortality, intensive care unit admission, length of hospital stay, and antibiotic use, analyzed with logistic and linear regression. Risk factors for misdiagnosed site were determined using regression analysis.Results  A total of 1477 patients (820 [55.5%] male; median [IQR] age, 68 [56-78] years) were analyzed. The rate of misdiagnosed site of infection was 11.6% (171 of 1477); 3.1% of all patients (46 of 1477) ultimately had no infection. No association was found between misdiagnosis and 30-day mortality (adjusted odds ratio [aOR], 0.8; 95% CI, 0.3-1.9; P = .60), intensive care unit admission (aOR, 1.3; 95% CI, 0.6-3.0; P = .54), and hospital length of stay (adjusted increase of stay, 15.5%; 95% CI, −3.1% to 37.7%; P = .11). Misdiagnosed site was associated with receiving broad-spectrum antibiotics (aOR, 4.0; 95% CI, 1.8-8.8; P Conclusions and Relevance  In this cohort study, misdiagnosed site of infection occurred in 1 of 9 patients and was not associated with worse short-term clinical outcomes. Clinicians should be aware of risk factors associated with misdiagnosed site of infection and potential inappropriate antibiotic use.</p

The Dutch surgical colorectal audit

Surgical oncolog

Use of different comorbidity scores for risk-adjustment in the evaluation of quality of colorectal cancer surgery: Does it matter?

Clinical Oncolog

Differences in circumferential resection margin involvement after abdominoperineal excision and low anterior resection no longer significant

Surgical oncolog

Multicenter Stratified Comparison of Hospital Costs Between Laparoscopic and Open Colorectal Cancer Resections Influence of Tumor Location and Operative Risk

Surgical oncolog