Dutch guideline to prevent perioperative pulmonal complications: how is the adherence?

INTRODUCTION: Patients with a history of chronic obstructive pulmonary disease (COPD) or asthma undergoing surgery are at risk for developing postoperative pulmonary complications, associated with morbidity and mortality. A national guideline was composed on preventive strategies in non-thoracic surgery, in which perioperative administration of corticosteroids are a cornerstone. We investigated the implementation in our hospital. METHOD: Patients with a history of asthma and/or COPD who underwent non-thoracic surgery between January 2017 and July 2018 in our hospital, were included. Primary outcome was perioperative administration of intravenous prednisolone or oral prednisone as preventative treatment. The reasons for (non)adherence were investigated as secondary outcome. RESULTS: 1,623 patients qualified for a preventative treatment. Overall, 653 patients (40%) received treatment according to protocol. The other 970 patients received no treatment (79%), another corticosteroid (12%) or received the other strategy (9%). Based on interviews and surveys, several barriers were found: fear of side effects of corticosteroids, indications for other types of corticosteroids, and lack of confidence in the literature. CONCLUSION: The current guideline for prevention of postoperative pulmonary complications has not been implemented thoroughly at our hospital. The lack of adherence appears to be caused by lack in clarity in clinical practice, lack of confidence in the evidence on which the protocol is based, and fear of side effects of corticosteroids. There are also notable differences between the vision of pulmonologists and the anesthesiologists. Further research is needed to solidify the guideline, anticipating aforementioned compliance barriers to achieve better implementation

Boundary spanning in social and cultural geography

This is an Accepted Manuscript of an article published by Taylor & Francis in Social and Cultural Geography on 6 February 2016, available online: http://www.tandfonline.com/10.1080/14649365.2015.1126628.This article situates interactions between German- and English-language social and cultural geographies since the mid-20th century within their wider intellectual, political and socioeconomic contexts. Based on case study examples, we outline main challenges of international knowledge transfer due to nationally and linguistically structured publication cultures, differing academic paradigms and varying promotion criteria. We argue that such transfer requires formal and informal platforms for academic debate, the commitment of boundary spanners and supportive peer groups. In German-language social and cultural geography, these three aspects induced a shift from a prevalent applied research tradition in the context of the modern welfare state towards a deeper engagement with Anglophone debates about poststructuralist approaches that have helped to critique the increase of neoliberal governance since the 1990s. Anglophone and especially British social and cultural geography, firmly grounded in poststructuralist and critical approaches since the 1980s, are increasingly pressurized through the neoliberal corporatization of the university to develop more applied features such as research impact and students’ employability

Entwicklungslinien der Border Studies und Zugänge zu Geographien der Grenzen

Die Border Studies haben seit den 1990er Jahren einen tiefgreifenden Wandel durchlaufen, der die Beschäftigung mit Grenz(ziehung)en als unhinterfragte Gegebenheiten relativiert hat. Die Neuorientierung stützt sich auf konstruktivistische Zugänge und fragt nach den Prozessen der Einsetzung, Relativierung, Verschiebung oder Überwindung von Grenzen. Diesem Verständnis von Grenzen als politische, soziale, kulturelle, mentale Produktionen folgt dieser Sammelband und diskutiert den Zusammenhang von Räumen, Ordnungen und Verflechtungen. Die Herausgeber*innen führen in diesem Beitrag grundlegend in das Themenfeld ein und geben einen Überblick über die Beiträge des Bandes. Die Autor*innen aus den Raum-, Sozial- und Kulturwissenschaften wählen unterschiedliche Zugänge zu Grenzen und analysieren ihre (Re-)Produktionsprozesse als ‚Geographien der Grenzen‘. Dabei rücken sie auch andere als nationalstaatliche Grenzen in den Blick, wie zum Beispiel stadtlandhybride Differenzierungen. So wird in diesem Band aus verschiedenen theoretischen und thematischen Blickwinkeln der Frage nachgegangen, wie und welche ,Geographien der Grenzen‘ sich im Zusammenspiel von unterschiedlichen Destabilisierungen und (Re-)Stabilisierungen von Grenzen (re)konstruieren lassen