Prostate cancer follow-up care in secondary and primary healthcare

After primary treatment for prostate cancer, patient enter the survivorship phase. Prostate cancer survivorship care includes the surveillance for cancer recurrence and the management of long-term and late effects. The sequel of prostate cancer and its treatment can influence men’s quality of life. A central question in this thesis is what prostate cancer survivors find important in their follow-up care and what their perspectives are on current follow-up practices. During follow-up care, some patients may encounter physical or psychosocial problems. For example, in one study they found that at 1-year follow-up, prostate cancer patients perceived erectile problems (56%), problems with the recovery period (29%), urinary problems (28%), fatigue (24%), and bowel problems (17%) to be worse than expected. It is important that clinicians working in follow-up care provide supportive care and address information needs of these patients. To guide clinicians, (tailored) supportive care interventions can help to meet the informational, emotional, social and physical needs of prostate cancer patients. Another central question in this thesis is whether primary care should play a more prominent role in the follow-up of prostate cancer survivors. As many (prostate) cancer patients also deal with other chronic conditions, primary care seems to be a suitable place to take a holistic approach to cancer follow-up. Currently, Wollersheim coordinates a randomized controlled trial that investigates the (cost-)effectiveness of primary care-based versus hospital-based prostate cancer follow-up care, called the PROstate cancer follow-up care in Secondary and Primary hEalth Care (PROSPEC) study. The results of the 2-year follow-up of this trial are expected in 2023. During the trial, a process evaluation was conducted to help interpret the study results. The reach of the trial showed that 67% of the patients and their general practitioners were willing to receive/provide primary care-based follow-up care. Nevertheless, several challenges and requirement were identified in this study: guidelines should be developed and implemented, communication and collaboration between primary and secondary care should be improved, quality indicators should be collected, and general practitioners should be compensated. If the trial shows that primary care- is equally effective and safe as specialist-based follow-up, this process evaluation can be used to enable a smooth transition of prostate cancer follow-up to primary care. Barbara Wollersheim will defend her thesis with the title ‘’prostate cancer follow-up care in secondary and primary healthcare’’ at Tilburg University on Tuesday July 5, 2022

Retrograde Returns of the American Housewife: Reimagining an Old Character in a New Millennium

This dissertation explores the immensely popular return of the housewife character in the twenty-first century. From films like The Stepford Wives (2004), to television dramas like Desperate Housewives (2004-2012) and The Good Wife (2009- ), to reality shows like Wife Swap (2004- ), Bravo’s The Real Housewives franchise (2006- ), Basketball Wives (2010- ), Mob Wives (2011- ), and most recently on the blogosphere with personalities like The Pioneer Woman, Ree Drummond, the housewife character has reentered our imaginations on a mass scale. This anachronistic character trend is in stark contrast to the urban, working superwoman ideal of the 1980s and 1990s portrayed in characters like Ally McBeal and Carrie Bradshaw. Arguably, reimagining the housewife in the new millennium is both a part of a larger project to nostalgically return to earlier periods of US history while trying to redefine womanhood and motherhood today, post 9/11. Chapter one links the rise of the housewife as an American stock character to American nationalism in anywhere from early advice books in the nineteenth century, such Lydia M. Child’s The American Frugal Housewife (1829), into cinematic narratives such as Cecil B. DeMille’s sex comedies like Old Wives For New (1918) and, later, to the classic 1950s June Cleaver television character in Leave it to Beaver. Chapter two analyzes the 2004 film remake of The Stepford Wives and its relationship to second-wave feminism and the 1970s popular horror novel by Ira Levin and film directed by Bryan Forbes. Chapter three describes how the television show Desperate Housewives (2004-2012) was the first to bring the character of the suffering housewife imagined by Betty Friedan in The Feminine Mystique back to life. Chapter four examines the pervasiveness of the housewife character on reality television, as it explores the relationship between so-called real housewives and real feminists within neoliberal constructions of postfeminist and post-racial identities. Chapter five concludes with a brief discussion of new trends in hip domesticity that are popular on the blogosphere, ultimately revealing how the housewife character has been historically aligned with articulating American feminist identities and concerns

Towards Learning Business Process Management Thinking

Business process management is indisputable an approach many organizations are aiming to adopt. While much emphasis is put on modeling business processes and designing information systems, the employees working in a process-oriented organization often struggle with these changes. Here, it is of major importance for organizations to take their employees with this change of mind towards process orientation to be successful. However, the question how an organization can support its employees in learning process-oriented thinking, remains open so far in the literature. Thus, this research-in-progress paper presents first results in trying to explore how employees can be supported. A rather new empirical method in this research field, namely a questionnaire experiment, is used. Based on a sample of 114 participants, we find empirical support for our hypotheses that learning in general matters with regard to process-oriented thinking. Organizations are better off when their employees learn process-oriented thinking by doing in comparison to provide documentations in order to actively promote learning

Kulturunterschiede bei Mergers & Acquisitions: Entwicklung eines Konzeptes zur Durchführung einer Cultural Due Diligence

Several investigations came to the conclusion that, considering in retrospect, most Mergers & Acquisitions were not successful. Differences in the corporate cultures are often quoted as being responsible for the failures. So, the question arises how such failures can be prevented in future. Conducting a Cultural Due Diligence is a possibility to examine differences in corporate cultures, even before a merger takes place. That is why, after a description of general culture concepts, we discuss various attempts at Cultural Due Diligence of consultancy firms. Referring to these attempts at Cultural Due Diligence as well as to the general culture concepts, we draft a further developed concept at the end of this working paper

Dynamic capabilities and their characteristic qualities : insights from a lab experiment

Despite the prominence of dynamic capabilities in the strategy and organization literatures, we still lack an empirically grounded understanding of the construct. Featuring an extended version of an established card game, our study uses an experiment to induce dynamic capabilities in the laboratory. Our findings reveal that (a) more efficient use of resources, (b) increasing efficiency of coordination, (c) reliance on more appropriate action sequences, and (d) greater deliberation in action are characteristic qualities of dynamic capabilities. Beyond empirically identifying dynamic capabilities, we offer implications for dynamic capabilities and transfer theory

Kulturunterschiede bei Mergers & Acquisitions: Entwicklung eines Konzeptes zur Durchführung einer Cultural Due Diligence

Several investigations came to the conclusion that, considering in retrospect, most Mergers & Acquisitions were not successful. Differences in the corporate cultures are often quoted as being responsible for the failures. So, the question arises how such failures can be prevented in future. Conducting a Cultural Due Diligence is a possibility to examine differences in corporate cultures, even before a merger takes place. That is why, after a description of general culture concepts, we discuss various attempts at Cultural Due Diligence of consultancy firms. Referring to these attempts at Cultural Due Diligence as well as to the general culture concepts, we draft a further developed concept at the end of this working paper. --Culture,cultural due diligence,mergers & acquisitions

The Business Perspective on Cloud Computing - A Literature Review of Research on Cloud Computing

This literature review synthesized the existing research on cloud computing from a business perspective by investigating 60 sources. It integrates their results in order to offer an overview about the existing body of knowledge. Using an established framework our results are structured according to the four dimensions following: cloud computing characteristics, adoption determinants, governance mechanisms, and business impact. This work reveals a shifting focus from technological aspects to a broader understanding of cloud computing as a new IT delivery model. There is a growing consensus about its characteristics and design principles. Unfortunately, research on factors driving or inhibiting the adoption of cloud services, as well as research investigating its business impact empirically, is still limited. This may be attributed to cloud computing being a rather recent research topic. Research on structures, processes and employee qualification to govern cloud services is at an early stage as well

Differential contractile response of critically ill patients to neuromuscular electrical stimulation

BACKGROUND: Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response, our aim was to characterise the response of critically ill patients to NMES and investigate potential outcome benefits of an adequate contractile response. METHODS: This is a sub-analysis of a randomised controlled trial investigating early muscle activating measures together with protocol-based physiotherapy in patients with a SOFA score ≥ 9 within the first 72 h after admission. Included patients received protocol-based physiotherapy twice daily for 20 min and NMES once daily for 20 min, bilaterally on eight muscle groups. Electrical current was increased up to 70 mA or until a contraction was detected visually or on palpation. Muscle strength was measured by a blinded assessor at the first adequate awakening and ICU discharge. RESULTS: One thousand eight hundred twenty-four neuromuscular electrical stimulations in 21 patients starting on day 3.0 (2.0/6.0) after ICU admission were included in this sub-analysis. Contractile response decreased from 64.4% on day 1 to 25.0% on day 7 with a significantly lower response rate in the lower extremities and proximal muscle groups. The electrical current required to elicit a contraction did not change over time (day 1, 50.2 [31.3/58.8] mA; day 7, 45.3 [38.0/57.5] mA). The electrical current necessary for a contractile response was higher in the lower extremities. At the first awakening, patients presented with significant weakness (3.2 [2.5/3.8] MRC score). When dividing the cohort into responders and non-responders (> 50% vs. ≤ 50% contractile response), we observed a significantly higher SOFA score in non-responders. The electrical current necessary for a muscle contraction in responders was significantly lower (38.0 [32.8/42.9] vs. 54.7 [51.3/56.0] mA, p < 0.001). Muscle strength showed higher values in the upper extremities of responders at ICU discharge (4.4 [4.1/4.6] vs. 3.3 [2.8/3.8] MRC score, p = 0.036). CONCLUSION: Patients show a differential contractile response to NMES, which appears to be dependent on the severity of illness and also relevant for potential outcome benefits. TRIAL REGISTRATION: ISRCTN ISRCTN19392591 , registered 17 February 201

Risk Factors of Intraoperative Dysglycemia in Elderly Surgical Patients

BACKGROUNDː Dysglycemia is associated with adverse outcome including increased morbidity and mortality in surgical patients. Acute insulin resistance due to the surgical stress response is seen as a major cause of so-called stress hyperglycemia. However, understanding of factors determining blood glucose (BG) during surgery is limited. Therefore, we investigated risk factors contributing to intraoperative dysglycemia. METHODSː In this subgroup investigation of the BIOCOG study, we analyzed 87 patients of ≥ 65 years with tight intraoperative BG measurement every 20 min during elective surgery. Dysglycemia was defined as at least one intraoperative BG measurement outside the recommended target range of 80-150 mg/dL. Additionally, all postoperative BG measurements in the ICU were obtained. Multivariable logistic regression analysis adjusted for age, sex, American Society of Anesthesiologists (ASA) status, diabetes, type and duration of surgery, minimum Hemoglobin (Hb) and mean intraoperative norepinephrine use was performed to identify risk factors of intraoperative dysglycemia. RESULTSː 46 (52.9%) out of 87 patients developed intraoperative dysglycemia. 31.8% of all intraoperative BG measurements were detected outside the target range. Diabetes [OR 9.263 (95% CI 2.492, 34.433); p=0.001] and duration of surgery [OR 1.005 (1.000, 1.010); p=0.036] were independently associated with the development of intraoperative dysglycemia. Patients who experienced intraoperative dysglycemia had significantly elevated postoperative mean (p<0.001) and maximum BG levels (p=0.001). Length of ICU (p=0.007) as well as hospital stay (p=0.012) were longer in patients with dysglycemia. CONCLUSIONSː Diabetes and duration of surgery were confirmed as independent risk factors for intraoperative dysglycemia, which was associated with adverse outcome. These patients, therefore, might require intensified glycemic control. Increased awareness and management of intraoperative dysglycemia is warranted